JUDGEMENT: Supreme Court orders the Constitutional Court to hear Maternal Health Cases

The judgment struck down a 2012 ruling by the Constitutional Court that it had no mandate to hear a case regarding the alleged violation of health rights and the rights of women.

The case had been filed by families of two pregnant women who died in childbirth and the Center for Health Human Rights and Development (CEHURD) against the Attorney General in 2011 (Constitutional Petition No. 16 of 2011), arguing that non-provision of maternal health services in Uganda violated the Constitution.

The Attorney General argued on preliminary objection that issues relating to health rights were “political questions”—matter that the Judiciary had no authority to address. Constitutional Court agreed with the State’s objection and dismissed the case.

The Supreme Court’s ruling struck down the Constitutional Court’s judgment, and means the original case can now be heard on its merits.

“With great respect to the Constitutional Court, I think they misunderstood what was required of the court. I do not think the court was required to determine, formulate or implement the health policies of government. In my view, the court is required to determine whether the government has provided or taken all practical measures to ensure the basic medical services to the population. In this case it is maternal services in issue” Bart M Katureebe, Chief Justice

 

 

Supreme Court to deliver Judgment on Maternal Health Rights in Uganda

The Supreme Court of the Republic of Uganda is on Friday 30th October, 2015 at 9.30a.m expected to deliver Judgment on whether maternal health rights are justifiable in Uganda.

In a case filed by the Center for health, Human Rights and Development (CEHURD), Mr. Inziku Valenti, and Ms. Rhoda Kukiriza against the government of Uganda, the petitioners sought remedies for non-provision of basic maternal health commodities in public health facilities in Uganda that led to death of their loved ones.

CEHURD and its co-petitioners argued that the public are affected by the non-provision of basic maternal health commodities in government health facilities, and that the imprudent and unethical behavior of health workers towards expectant mothers was unconstitutional and an abuse of poor women’s rights to access health services.

The petitioners relied on evidence that;

  1. The death of a one Sylvia Nalubowa (daughter of Ms. Rhoda Kukiriza) in Mityana hospital due to non-availability of the basic maternal health kits in the district hospital and the unethical behavior of the health workers towards her violated her constitutional right to life and health.
  2. The death of Anguko Jennifer (wife to Mr. Inziku Valente) in a regional referral hospital in Arua also due to non-provision of the basic maternal health commodities and the reluctance of the health workers towards this expectant mother leading to her death was an infringement of her rights to life and health guaranteed under the constitution of Uganda.
  3. Non provision of the basic maternal health commodities to expectant mothers (evidence gathered from community health facilities) and the failure on the part of health workers to exercise the requisite health care leads to death of children hence an infringement of their rights guaranteed under the Articles 22, 33 and 34 of the constitution.

The constitutional Court absconded from hearing the merits of the case on a preliminary objection raised by the attorney General’s Lawyer that the Court did not have the authority to handle matters of that gravity. The court was of the opinion that the issues the petitioners had put to court were of a political nature that necessitated the intervention of the Executive to allocate resources to the health sector and none of courts business to intervene.

As a matter of fact and law, CEHURD, Ms. Rhoda Kukiriza and Mr. Izinku proceeded to appeal that decision to the Supreme Court on the basis that the Constitutional Court erred in law in refusing to listen to the merits of the case. It is this decision that Court will be making Judgment on Friday 30th October, 2015 at the Supreme Court of Uganda.

The Judgment is particularly important because the Ugandan Constitution does not provide for a right to health and in addition makes no commitments or priorities for health financing for primary health care for Ugandans from a legal perspective.

High-Court

Launching the standards and guidelines on unsafe abortions to confront the public health crisis in Uganda

The Ministry of health launched the “Standards and Guidelines for the Reduction of Maternal Mortality and Morbidity Due to Unsafe abortion in Uganda on 4th April 2015.” According to the Uganda Demographic and Health Survey (UDHS) 2011, Uganda has a maternal mortality ration of 438 per 100,000 live births, 26 percent of these deaths are attributed to unsafe abortions.

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As an intervention, in 2013 the Ministry of Health in collaboration with Development partners, implementing partners, and stakeholders including; the Center for health human rights and development (CEHURD), IPAS Reproductive health Uganda (RHU), Association of Obstetricians and Gynecologist of Uganda (AOGU), Makerere University department of Psychiatry, Ministry of Justice and Constitutional Affairs, Makerere University School of Laws PACE, Health GAP, Marie Stopes Uganda, and the Coalition to Stop Maternal Mortality Due to Unsafe abortion (CSMMUA) started a consultative process for the development of Standards and Guidelines to address the mortality and morbidity as caused by unsafe abortions in the country.

These guidelines will be implemented in all health facilities nationwide and will also be used by health professionals as well as policy makers to take steps in the area of service delivery, advocacy and capacity building all aimed at reducing maternal mortality and morbidity caused by unsafe abortion in Uganda.

The launch of the Standards and guidelines which has marked the end of the two years multi-stakeholder consultative journey has been officiated by the Director of Health services at the ministry of Health Professor Anthony Mbonye on behalf of the State Minister of Health (in charge of primary health care) Honourable Sarah Opendi. In his statement during the launch, the Professor noted that Uganda like any other country pledged to meet the obligation under the Maputo plan of Action, MDG 5 on reduction of maternal mortality as well as other Global initiatives in order to ensure that lives are not lost as a result of unsafe abortions. “This has therefore remained a key Government concern,” he added.

The chief executive officer of CEHURD, Mr. Mulumba Moses said that the standards and guidelines document is a step towards stopping women from turning to backstreet alleys. Mr. Mulumba added that it is encouraging to hear that the ministry is ready to tackle the problem head on by developing a policy structure that aims to deal with an issue that has been ignored for far too long.

In Uganda, termination of pregnancy is restricted and only permitted to preserve the life, mental and physical health of pregnant mothers. There have been challenges due to limited understanding of the legal environment by health providers, policy makers and patients hence formulating these guidelines which will help in solving this issue.

Dr. Charles Kigundu, president of the Association of Gynecologist and Obstetricians of Uganda noted that as health workers dealing with maternal health issues still find a lot of women coming to them with complications such as infections and punctured uteri. The guidelines will help solve the situation greatly since many health professionals believe that abortion is totally legal yet the guidelines provide a better picture on how, when, and in what circumstances a safe abortion can be performed.

The role of civil society organisations in promoting community participation

Among the tenets of the Human Rights based Approach to participation is empowerment. Empowerment involves equipping communities with skills to voice their concerns in seeking better services for their well being. Health Unit management committees as established by the ministry of Health are structures utilized to promote community participation in health at the community level.

In an initiative to promote the decentralizing of the health system, the government of Uganda through Ministry of Health called for an establishment of HUMCs at each government health facility as a way of empowering community members to participate in influencing health system for better service delivery.

This is also due to the fact that Community participation has been identified among the key elements which must be utilized in advancing for the right to health. These committees were established with a responsibility of oversight role at the facility through inspection and supervision of work at the facilities all aimed at improving the quality of health care in these facilities.

As part of an action research process, the Center for Health Human Rights and Development (CEHURD) carried out a case study on two HUMCs in Kikoolimbo health center III in Kyankwanzi district and Nyamiringa health center II Kiboga district. The purpose of this case study was to provide an understanding of the experiences of HUMCs in performing their roles and what role Civil Society can play to support them perform their roles and responsibilities as well as advancing health rights and addressing health inequities using the human rights based approach.

Astonishingly, our findings revealed that these two health unit management committees had limited knowledge of the HUMCs guidelines established by the Ministry of Health which clearly elaborates the roles and responsibilities of these health structures.  This therefore steered the training of these committee members in order to equip them with knowledge on what is expected of them hence improved performance. After the trainings, community dialogues were also held to inform community members about the existence of these committees as well as their roles and responsibilities. We thought this would foster HUMCs performance since majority of the community members within the district were also not aware of existence of the HUMCs but also there guidelines,

This intervention by CEHURD has seen the growth of these HUMCs and transition in leadership. It is worth reporting that after the training, one of the HUMCS team realized that it had over leaved its usefulness and opted to hand over power to a newly trained team that they thought was still energetic to carry on the work. On the 25th March 2015 we witnessed the handing over of office by the old members of the HUMC of Kikoolimbo health center III to the newly selected members. As a means of appreciation, old members were awarded with certificates of service appreciating them for their dedicated efforts in promoting improved health service delivery at the facility. This gives us a lesson that when communities are empowered, they can take it upon them to differentiate between performing and non-performing committees or structures hence seeking for change.

5 die daily as Jinja hospital runs out of blood

blood-transfusionWritten by TREVOR S BALEKE, An acute shortage of blood has hit Jinja Regional referral hospital. There is no single blood unit available to give patients in critical condition, hospital managers say.

The Observer has established that on average, 12 patients are referred to Mulago hospital daily for blood transfusions. Dr Micheal Osinde, the hospital director, said in an interview last Thursday that at least five children die every day in the children’s ward due to the blood shortage. The casualty ward and pregnant mothers are also affected.

“This is the worst the blood shortage there has ever been. And because this is a regional referral hospital, we receive patients from about 10 districts,” he said.

According to him, it costs $80 to process one unit of blood. Jinja regional referral hospital needs at least 70 units of blood in a crisis-free week.

“We do not just get blood from a donor and transfuse it into the body of a recipient. It has to be processed first,” he said.

“We don’t have a single pint of blood for all the groups in the laboratory,” he said.

Asked what could have caused the shortage, Dr Osinde pinned it on funding gaps in the ministry. He said the Uganda Blood Transfusion Service had run short of money to collect, process and store blood by last December.
Source: http://www.observer.ug/index.php?option=com_content&view=article&id=25522:5-die-daily-as-jinja-hospital-runs-out-of-blood&catid=34:news&Itemid=114