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Uganda Through the Lens of MDGs on Health

By Juliana Nantaba

Participants during the MDG community consultation in Gulu District Northern Uganda
Participants during the MDG community consultation in Gulu District Northern Uganda

As the Millennium Development Goals (MDGs) target date of 2015 approaches, it is essential to take stock of Uganda’s progress.  Even though in the past years, Uganda’s infant mortality rate and maternal mortality have declined, an inexcusable amount of children and pregnant women still die every year from preventable causes. Health is a human right and a matter of social justice. Better and more equitable health outcomes increase productivity and resilience, reduce poverty and promote social stability.

The 2013 Report Of The Commission On The Post 2015 Development Agenda: Towards An African Common Position And Modalities For Establishment Of A Committee Of Heads Of State And Government On The Post 2015 Development Agenda reveals that some of the factors contributing to inadequate achievement of the child health MDGs include weak health systems (physical and financial barriers to essential health services, shortage of medicine, poor human resources) and poor conditions as determinants of health (household education, income, insufficient and inappropriate nutritional practices, poor sanitation facilities).

The causes of maternal mortality and morbidity are well known and mainly result from the inability of a health system to deal effectively with complications, especially during or shortly after childbirth. The availability of skilled health providers is critical in ensuring high-quality antenatal, delivery, emergency obstetric and post-natal services.

Health as a right is an important driver and key indicator of what sustainable development seeks to achieve.  One of the reasons why the MDGs have been widely affirmed as a good tool for development is that they were globally agreed; however, there is need to ensure that they are locally relevant and mutually owned.

The post-MDG framework must promote and facilitate genuine and representative country ownership that gives attention to accountability including downward accountability to beneficiaries.

In light of the above, CEHURD is currently undertaking a GO4HEALTH project  to identify, engage and involve stakeholders in the formulation of global health goals to follow-on the United Nations Millennium Development Goals (MDGs) beyond 2015.

The purpose of the project is to inform European Commission on how new goal to right to health should be and advise on how new ideas should be set through community consultations. The project is being done across the globe including Africa, Asia and South America. The African region has selected three countries i.e. Zimbabwe, south Africa and Uganda. Each of these countries has unique characteristics and will provide unique insights for the consultations.

With the end of the current MDGs less than 1000 days away, there is still much work to be done to achieve the health goals. The feedback from various CSOs consultations on health priorities for post 2015 state that the Post-2015 framework presents a massive opportunity to improve global health and should build on and improve the current health MDGs.

Each child should be able to live up to their full potential, intellectually and physically. Each young adult should be taught and empowered to live a healthy lifestyle, including reproductive and sexual health. And, through demographic and ageing transitions, each adult should be able to age gracefully with minimal morbidity and maximum functionality.

Effect of Intellectual Property Rights on access to medicines

By Prima Kwagala

Media, CSOs and Community members during a Press Conference at CEHURD
Media, CSOs and Community members during a Press Conference at CEHURD offices in Kamwokya

A visit to a drug shop will shock you if you ask for a certain drug and the pharmacist in turn asks, “do you want the cheap duplicates from India or the original from Switzerland.”   Question remains, who sets the price of medicines in Uganda? Why are there different kinds of medicines to cure one illness?

According to the medicines index in Uganda (National Drug Authority), 80% of medicines in Uganda are imported from countries like India, China, Germany and Switzerland with only 20% produced by local industries for the local population

Who should we hold accountable for drug prices? Why should a particular drug have two or several prices? The answer is simple. When someone or an industry invests in research of a particular disease and discovers a drug to cure it, a government gives them monopoly rights (Patents) to market the drug. These rights are meant to last 20 years according to international trade rules. This gives the product owner mandate to determine the price of the drug so as to recover the expenses they incurred in researching on the drug.

These rights are under what is termed as ‘intellectual property rights’. If not regulated, these rights are selfishly abused by the owners through setting very high prices at the expense of the poor populations who fail to raise funds for such essential medicines.

International trade rules have however been put in place by the World Trade Organization (WTO) to ensure that poor nations can benefit from the innovations of rich countries which have the resources to invest in research and development of drugs. An example of these rules came in 1994 as the World Trade Organization’s Trade Related Aspects of Intellectual Property (TRIPS) Agreement.’

This agreement was interpreted by a council of ministers meeting at DOHA in November 2001 [Doha Declaration (2001)] to the effect that the TRIPS Agreement ‘can and should be interpreted
and implemented in a manner supportive of WTO members’ right to protect public health and, in particular, to promote access to medicines for all.

As a result of this agreement and subsequent declaration at Doha, countries party to the World trade Organisation have put in place laws and policies to ensure access to medicines for all. This is because the agreement allowed developing countries to manipulate or make use of intellectual property rights of drug companies to build their capacity to produce drugs for their populations until 2004.

These flexibilities in the WTO -TRIPS Agreement have been beneficial because in 2000, the price of a first line drug of HIV/AIDS cost $12000 (at least UGX 30,000,000) per person per year. Due to our poor situation, people in Uganda considered HIV/AIDS a death sentence.

When the International trade rules came into place as interpreted by the council of ministers at DOHA in 2001, India put in place industries to reverse engineer these drugs and produced them at a much cheaper price. Today the price of first line drugs for HIV/AIDS is less than $67 (UGX. 167,500) per person per year!

The beauty of making proper use of the flexibility to copy versions of ‘brand name’ or ‘originator’ drugs to make ‘generic’ versions of the very same kinds of medicines is what is causing the differences in pricing of medicines. The ‘brand name’ or ‘originator’ drug is expensive because it is inclusive of research costs and the ‘generic’ or copy version from India is not fake but does not include research costs of the first innovator! Thus the difference in pricing

The government of Uganda needs to understand the dynamics of drug pricing by utilising all the flexibilities and to put in place a legal and policy frame work that promotes access to medicines. This is because progressive realization of the right to health entails that governments not only put in place structures for service provision, but also ensure that there is affordable, reliable and accessible services for the populace.

It is everyone’s right to claim access to medicines in Uganda.

Saving the Youth: Sexual Reproductive Health Literacy Training Training on SRH

By Serunjogi Francis, Communications Officer

Participants in the Sexual Reproductive Health training during the life cycle mapping
Participants in the Sexual Reproductive Health training during the life cycle mapping

According to the Uganda demographic survey, 26.4% of the girls between the ages of 15 and 19 are sexually active and can readily give birth. On the other hand, 16 million girls under the age of 16 years give birth each year worldwide (United Nations Populations fund). A community intervention recommended that if the girl child is to be protected, early sexual reproductive health literacy training should be done.

This should be complemented with creation of awareness on contraception use, accessibility and availability of reproduction health services. This will save these young people from getting “unwanted” pregnancies, and will also avail them with basic knowledge about HIV AIDS and other STIs. Creating awareness through sensitization programs is highly recommendable.

Interventions can include, making out reaches to education institutions by different stake holders to talk to students about sexual reproductive health and can create more impact if parents and teachers are involved. On the other hand, having students in closed sessions with health practitioners make it easier for them to open.

On 6th June 2013 the Center for Health Human Rights and Development (CEHURD) organized a Health Literacy Program in the Districts of Kiboga and Kyankwanzi. The aim of the training was to facilitate community participation in improving sexual reproductive health (SRH) for the youth of Mulagi, Wattuba and Gayaza sub-counties using the Participatory Reflection Action (PRA) processes.

The programme was carried out in Buyimbaazi Senior secondary school and aimed at improving youth knowledge in SRH and to strengthen relations with health workers and the health system in general by engineering discussions on youth friendly services.

The training included technical and vocational schools which enabled to reach out to youth that are not in secondary schools for reasons such as dropping out of school due to early teenage pregnancy.

According to Nantaba Juliana, the programme Officer, Community Empowerment Programme at CEHURD, “Health literacy refers to people’s ability to obtain, interpret and understand basic health information and health services and to use such information and services in ways that promote their health.”

The Health Literacy program gives an all-inclusive approach to SRH with the perspective that the boy child too has a role to play. This draws away from the common Health Literacy on SRH that is only focused to the girl child.

Generally it is important to mobilize the wider communities to join efforts to meet the sexual reproductive health needs of the youth. Emphasis should be put on both girls and boys.

CEHURD drags Executive Director of Mulago National Referral Hospital and Attorney General to Court for Violating health human rights

By Serunjogi Francis and Nsereko Ibrahim

Mr. Mubangizi Micheal and Musimenta Jennifer (holding baby) during a press conference
Mr. Mubangizi Micheal and Musimenta Jennifer (holding baby) during a press conference

Today 25th July 2013 the Center for health Human rights and Development (CEHURD) together with other CSOs working on health and human rights issues have held a press conference at CEHURD offices in Kamwokya to strongly condemn the continuous violation of fundamental human rights in health facilities.

During the press conference, members have called upon the Judiciary to pronounce itself on violations of the right to health, access to health information, right to a family and rights of the child.

This follows a case filed by the Center for Health, Human rights and Development (CEHURD) together with Mubangizi Micheal and Musimenta Jennifer in the High Court of Uganda (Civil Suit No. 212 of 2013) against the office of the Executive Director of Mulago National Referral Hospital and the Attorney General for Violation of fundamental human rights guaranteed in the Constitution of the Republic of Uganda of 1995.

In that case the plaintiffs state that by denying the couple access to their medical records, opportunity to nurture and bring up their child, taking away their child without permission coupled with the daily mental anguish and agony they go through because of denial to access their child or its body which is a violation of their Constitutional rights and the defendants are answerable.

“I gave birth to two babies, but I was only given one. I was denied my child or its body and they even denied me my medical records. I am traumatized and psychologically tortured every day of my life every time I look at my other child. I know my child isn’t dead, she is alive. I am afraid of giving birth in hospitals”, says Musimenta Jennifer, the mother to the missing child.

With the uncertainty as to the whereabouts of their Child or its body, the Couple tirelessly searched for their child but only to be given a fresh body after three days. They resorted to undertaking a DNA test which revealed that the child was not related to any of them.

“I searched for my child in the entire Mulago hospital and I had faith that my baby would be located.  My hope was shuttered as I failed to discover my child or her body for three days. I was only called after the three days and given a fresh body of the child. I looked at the body but I was sure that this was not my child since the body was fresh. I decided to report the matter to police which advised me to undertake a DNA test. This test revealed that the components were negative. I approached CEHURD to file a Human rights case for the human rights violations my family suffered and we are still going through” Says Mubangizi Michael, father to the lost child.

“A number of women are facing human rights violations in health facilities all over the Country when they go to give birth. Most of these cases go unnoticed since the perpetrators of such violations are not made answerable for such injustices. These vulnerable women are not aware of their rights guaranteed under the Constitution and Regional and International Human Rights Instruments,” says Ms. Nakibuuka Noor the Program Manager Strategic Litigation.

The above reflects the suffering mothers and their families go through when their rights are violated in the health facilities. It is time for everyone to act to stop these injustices.

For more information, contact: Nakibuuka Noor Musisi, CEHURD, +256782496681

Soaring maternal deaths: MPs seek Museveni’s attention

By Umaru Kashaka

The Uganda Parliamentary Women’s Association (UWOPA) has written to Speaker Rebecca Kadaga to help fix an appointment with President Yoweri Museveni over the alarming maternal mortality rate in Uganda and the appalling state of private health services.

MPs and the civil society organizations observed that their efforts in lobbying and advocating for women rights in Uganda are producing diminishing returns due to lack of political will from the Government.

“We want the government to sit up and take notes because we are tired of lamenting about maternal deaths in this country.

We have requested the Speaker to fix an appointment for us to meet the President over the stagnation and non-progress in maternal issues despite our continued efforts in complaining about it. We want the President to provide the stewardship that is now lacking,” Mityana Woman MP, Sylvia Namabidde told a news conference at Parliament.

UWOPA chairperson, Betty Amongi, stressed that the meeting with the President would also solve the continued non-supervision of private health facilities by the government which has resulted into unprofessionalism of health workers in handling expectant mothers.

“We want to share with the President on the issue of inadequate human resource in both private and public facilities in terms of qualified and experienced doctors and mid-wives, and yet we allocated a large sum of money to recruit more health workers,” Amongi added.

They appealed to private health facilities to provide the necessary cooperation to an ad-hoc committee that was set up by Parliament on Wednesday to probe them, following the sudden death of the 36-year-old coordinator of the Uganda Parliamentary Forum for Children, Remmie Wamala, at IHK where she had gone to deliver last Friday.

According to Namutumba Woman MP, Florence Mutyabule, the post-mortem report indicated that Wamala died of excessive bleeding and a ruptured uterus. She said her child (a son) survived, but was on oxygen.

FIDA-Uganda board member, Berna Bakkidde said in spite of Article 33(3) of the constitution which clearly requires the government to protect women and their rights taking into account their unique status and natural maternal functions in society, the rate of maternal deaths per 100,000 live births has increased from 435 from 2005 to 438 in 2011, according to the Uganda Demographic Health Survey 2011/2012.

“We are concerned about the rising number of maternal deaths in Uganda as a result of the high level of negligence by health workers in private and public health facilities which pose a danger to the lives of women in Uganda,” Bakkidde said.

She added: “Remmie’s death is representative of so many women who have died in child birth, as a result of preventable medical complications.”

Bakkidde called upon the ministry of health to borrow a leaf from Parliament and also institute an investigation into the high rate of maternal deaths in private health facilities, saying they have failed to provide timely and appropriate medical care which has escalated the number of maternal deaths.

“I still believe that the passing on of Remmie and many other women who have died under these circumstances could have been avoided in private facilities. Our colleague by going to the International Hospital Kampala (IHK) knew what she was doing but was unfortunately let down by the system,” she noted sadly.

The Uganda Women’s Network communication officer, Sandra Kamuhimbo, urged government to increase resource allocation to the health sector and honor its commitment to invest 15% of its national budget on health as per the Abuja Declaration.

“We feel no woman should die while bringing a life into the world. However, in Uganda today pregnant women look at death in the face every time they go into labour. The health ministry should take up their role in regularizing and supervising these private health facilities to ensure efficient service delivery of our mothers and sisters,” she implored.

Source: http://www.newvision.co.ug/news/644729-soaring-maternal-deaths-mp-seek-museveni-s-attention.html