Reflecting on CEHURD’s Achievements and Stories of Success in Uganda’s Health Care System

CEHURD launched a national campaign to raise awareness of and advocate for safety in health-care facilities, recognizing that safety is a prerequisite for a strong health-care system.

Israel iya jeep

Post-World Patient Safety Day 2022 by Israel Iya Jeep                                    

The world patient safety day is observed annually on 17th September with the objective of increasing public awareness and engagement, enhance global understanding, and work towards global solidarity and action by member states to promote patient safety.[1] Across the world, unsafe medication practices and medication errors are a leading cause of avoidable harm in health care [l1]  and this year’s theme for the World Patient Safety Day embraces this fact. The theme builds on the ongoing efforts by the World Health Organization to ensure medication without harm. The theme provides the necessary motivation to take urgent action towards reducing medication-related harm through strengthening systems and practices of medication use.[2]  The world patient safety day is thus a global campaign calling on stakeholders to prioritize and take early action in key areas associated with significant patient harm that may occur due to unsafe medication practices. Furthermore, the world patient day offers great potential to raise awareness and understanding of health issues and mobilize support for action, from local communities to the international stage to further the fundamental principle of medicine “do no harm”.[3]

CEHURD with support from the Joint Advocacy for Sexual and Reproductive Health and Rights (JAS) Programme in commemoration of world patient safety day, kick-started a national campaign to amplify and advocate for safety in health facilities, recognizing that safety is a prerequisite for a strong health system. CEHURD is contributing – towards ensuring safety issues in health facilities are addressed and to this end, CEHURD has challenged the actions and inactions of hospitals that put patients safety at stake for instance, it challenged Mulago hospital on new born care and management, challenged the actions and omissions of the government of Uganda for failure to provide minimum maternal health services in petition 16 – What the constitutional court decision on access to basic maternal healthcare means, CEHURD with the Uganda Medical Association advocated for Prioritization of safety of health workers to protect patients during covid-19-and-beyond, an increase of salaries for health workers, documented facts on the state of health facilities and amplified the voice to renovate, build and ensure adequate health infrastructure. All these efforts are aimed at ensuring that patients’ safety is guaranteed and no patient suffers injury or dies because of unsafe and poor health care.

CEHURD’s efforts have recorded stories of success and progress in the health sector; he first success was achieved in constitutional appeal 01 of 2013, In this case, CEHURD contended that the non-provision of basic indispensable health maternal commodities in government health facilities and the imprudent and unethical behaviours of health workers towards expectant mothers contravened the constitution.  The supreme court, in rejecting the political-question-doctrine defence raised by the Attorney General, held that the executive cannot escape scrutiny where its actions or inactions violate constitutional provisions and that Article 20 of the constitution does not exclude any institution from respecting, upholding and promoting human rights. 

In addition to the above, the supreme court opened gates for public interest litigation especially in the area of health rights and patient safety when Justice lady Esther Kisaakye held that it’s not a requirement under the constitution for a petitioner who seeks redress to show that they suffered a personal legal grievance. CEHURD has leveraged on this order to bring legal action to advance health rights and cause structural reforms in the health sector as demonstrated in civil case No. 212 of 2013 in the High Court of Uganda between Center for health, human rights and development and others v Executive Director Mulago Hospital and others. In this case, court issued orders in form of structural interdicts in the health sector for instance orders requiring that Mulago hospital as a mandatory obligation takes steps to ensure and or enhance the respect, movement and safety of babies, dead or alive in hospitals and orders relating to the Executive Director of Mulago hospital to submit as a mandatory duty a written report every after 4 months regarding the steps taken to enhance the respect, movement and safety of babies to CEHURD.

Still in the jurisprudential circles, the dismissal and the decision in Uganda v Kato Frederick criminal case 56 of 2020 builds confidence among medical practitioners to continue providing safe-post-abortion care to different people that enter the doors for help which in turn may   reduce the severe effects of unsafe abortion that contribute to high maternal mortality rates[l2] . The case demonstrates that medical practitioners can provide safe post abortion care without fear of getting prosecuted.

CEHURD has conducted policy and legal framework mapping aimed at identifying laws, bills, policies, strategies and guidelines affecting self-care to identify opportunities and gaps that  inform advocacy for institutionalization of self-care in Uganda. [l3] 

CEHURD has also conducted research and facilitated investigations on the state of health facilities in Uganda for example the “No safety guarantees in moribund health system | PANORAMA” documentary which identified issues relating to poor quality health care, health expert shortage, unskilled man power, inadequate documentation of statistics relating to patient safety, inadequate man power, lack of infrastructure, ageing infrastructure among others. All these efforts have culminated into structural reforms in the health sector such as provision of safety gears to health workers, mitigating health expert shortage, building homes for cancer patients at the Mulago cancer institute, renovation of Busolwe Hospital, and influencing budgetary innovations in the health sector.

CEHURD has condemned detention of persons with mental illnesses and patients in health facilities, emphasising that Hospitals are not gazetted detention facilities according to the law of Uganda, and that there are special places where we have to detain people “No health facility is allowed to detain patients for any reason despite the business background. If people owe you, hand them to institutions who have that mandate.” ~ Dr Katumba | Uganda Medical & Dental practitioners’ Council.

We talk about these successes, achievements, progress to inform, influence, and inspire movements, the government, and all stakeholders to join the campaign aimed at causing positive structural changes in our heath sector and ensuring patient safety because a flourishing health sector is key in achieving our national goals. We call everyone to engage in advocacy efforts with key stakeholders including developing national campaigns, organizing policy forums, advocacy and technical events, capacity-building initiatives, lighting up iconic monuments with the goal of pursuing the objectives of the world patient safety day and the year’s theme of raising global awareness on the high burden of medication-related harm due to medication error and unsafe practices. We must not tire to advocate for urgent action to improve medication safety through engaging with health workers and other partners in the health sector in the efforts to prevent medication errors and reduce medical-related harm. We must empower patients and families to be actively involved in the safe use of medication, and scaling up implementation of the global patients’ safety challenge which is medication without harm.

In conclusion therefore, we all have a role to play in ensuring patient safety and the call for all persons to fully embrace and actively take part in activities aimed at promoting awareness and mobilize support for safety in health facilities at large.

The writer is an intern at the Center for Health, Human rights and Development.


[1] World patient safety day 2022 accessible at https://www.who.int/news-room/events/details/2022/09/17/default-calendar/world-patient-safety-day-2022

[2] Supra

[3] World patient safety day accessible ta https://nationaltoday.com/world-patient-safety-day


 [l1]This is repeated in the same sentence so lets keep the one at the beginning of the sentence

 [l2]I don’t know if this is a fact because we don’t have evidence that the numbers have reduced

 [l3]This is not very accurate so just leave it out.

Empowering Adolescents and Youths will yield long-term benefits

Adolescents have the highest rate of unintended pregnancies and their unmet need for contraception is much higher. In developing countries, roughly half of the pregnancies among adolescents aged 15-19 are unintended, and half of these result in abortions, the majority of which are unsafe.

BY RODNEY KITANDWE

Sustainable development requires ensuring healthy lives and promoting well-being at all ages. To achieve the Sustainable Development Goals of excellent health and well-being, the world must harness the full potential of all generations.

As a young person, I constantly come across contradictory and perplexing messages about gender and sexuality. With the help of a comprehensive and high-quality curriculum-based sexuality education program, I believe that all children and young people can navigate these messages and develop healthy norms about themselves and relationships that can help them become responsible citizens from an informed point of view. Although most governments have some sort of sexuality education program in place, these programs are frequently ineffective or poorly implemented. The emergence of new resources for putting these approaches into practice, as well as newly emerging research findings about effective approaches to sexual and reproductive health and rights, make this a very advantageous time to advance this fundamental human right.

As we commemorate the international youth day 2022 under the theme Inter-Generational Solidarity: In Preventing Teenage Pregnancies and Child marriages, we must promote access to comprehensive contraceptive care and contraceptive methods as an essential component of women’s health care by enacting policies and taking actions that ensure the availability of affordable and accessible services. There is a need to underpin all advocacy and programming work that ensures sexual and reproductive health and rights for all without discrimination. Fulfilling these rights and empowering adolescents and youths to make timely, informed decisions about their own bodies and their place in the world will yield long-term benefits.

Efforts should be made to increase access to emergency contraception, including the removal of the age restriction for contraception products, and to create over-the-counter access to oral contraceptives with full insurance coverage or cost assistance. Adolescents have the highest rate of unintended pregnancies and their unmet need for contraception is much higher. In developing countries, roughly half of the pregnancies among adolescents aged 15-19 are unintended, and half of these result in abortions, the majority of which are unsafe.

When designing programs for young people, it is critical to consider their reasons for not using contraception despite the fact that they do not want a pregnancy. Infrequent sex, concerns about contraceptive side effects, breastfeeding, or opposition to contraception, believing that its use conflicts with their traditions and religious directives are examples of such reasons. In this context, contraception information and education are required, as are efforts to understand and address myths and misconceptions. The revised International Technical Guidance on Sexuality Education establishes key concepts and learning objectives for use in school and community-based sexuality education that are scientifically accurate, comprehensive, age and developmentally appropriate, and based on human rights and gender equality.

The writer is an intern in the Strategic Litigation programme at the Center for Health, Human Rights and Development (CEHURD.

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.

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