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Health ministry needs sh3b to fight Ebola

By Anne Mugisa & Norah Mutesi

The health ministry says sh3b is needed to fight the deadly Ebola haemorrhagic fever. This includes the money needed to run the operations centre at the health ministry and to trace and care for all the reported cases and for local governments, the health ministry has said.

Five ebola cases have been confirmed to date, three of whom are dead, the ministry said. However, 13 other people connected with these in Kibaale died and were buried before their samples could be collected.

Health minister Christine Ondoa told journalists Friday that 32 cases were being investigated, while 312 others, who had contacts with the suspects were being monitored.

She said an inter-ministerial task force, as well as the national task force on Ebola, had been formed, the latter headed by the health ministry.

Health Minister needs 3 billion to fight Ebola

Ondoa said the ministry was also working with the World Health Organisation (WHO), the Centre for Diseases Control, Medicine San Frontiers, Uganda Red Cross and others, to contain the outbreak.

She said those suspected were in isolation centres, including health workers.

The ministry, she added, had sent an ambulance to Kibaale to collect the sick and an equipped vehicle to help bury the dead.

WHO representative Dr. Joaquim Saweka, ministers Ephraim Kamuntu, Mary Karooro Okurut and Asuman Kiyingi also addressed the press.

They expressed dismay that some people were exaggerating the Ebola issue to scare others away, yet the WHO says there is no need for travel restrictions.

The Mbarara and Makerere suspected cases were false, Ondoa said.

Activists to Pursue Maternal Health Case Against Government

By Andrew Green

Kampala — A petition backed by over 50 NGOs and charging Uganda’s government with failing to prevent the deaths of expectant mothers was thrown out by the constitutional court on 5 June, but the petition’s supporters plan to appeal.

The constitutional court argued that upholding the petition, which urges the government to boost health services, would have forced judges to wade into a political issue that was outside their jurisdiction.

However, the petitioners said the court relied on outdated international law in making its decision and overlooked its constitutional obligation to protect Uganda’s mothers.

Principal State Attorney Patricia Mutesi, who argued the case for the government, said the petition “was asking the court to do the work of the parliament in reviewing the efficiency of the health sector”.

The petition, which centred around the deaths of two mothers (Sylvia Nalubowa in central Uganda and Jennifer Anguko in the north), got nationwide media coverage when it was filed in March 2011. It said the women’s deaths could have been prevented if the health centres where they died had had “basic indispensable health maternal commodities” and if health workers at the facilities had not neglected the two women.

In throwing out the case, the justices suggested the petitioners seek an order from the high court compelling a public officer, such as a government health worker, to carry out his or her duties, or to request compensation for individual deaths from the government.

On 14 June the petitioners filed a notice informing the Supreme Court and the Attorney General’s office of their plan to appeal against the constitutional court decision; they have 50 days to finalize and file the appeal.

Rights denied?

Moses Mulumba is the executive director of the Centre for Health, Human Rights & Development (CEHURD) – the group that originally pushed the petition forward. He said the court’s decision not to wade into a “political question” was based on antiquated law and failed to address the fact that women were being denied rights guaranteed under Uganda’s constitution.

“I think it was very wrong for the judiciary to rely on very old United States jurisprudence to inform their decisions on clear violations of human rights,” he said. The courts should focus on upholding the constitution, he said, instead of “hiding under old political doctrines.”

In a country where statistics show that 16 women die every day from childbirth complications, the activists generally charged the government with perpetuating a maternal death rate that is “unacceptably high”. Ultimately, they are looking for the government to invest more in the country’s health system, to improve care and make sure critical resources are always available.

Valente Inziku, Anguko’s husband and one of the petitioners, said he watched his wife bleed to death as he tried to get nurses at the hospital to attend to her. “When she started bleeding seriously, the only the thing [the staff] did was they came and they told me… to clean the blood,” he said.

“People are disappointed, but we are not stopping there,” said Sylveria Alwoch, of the Uganda National Health Consumers Organization, one of the groups that supported the petition. “We are encouraging people to always report those cases. They shouldn’t be demotivated… They should still have that courage, that vigilance to speak out and bring out those issues.”

Win or lose, CEHURD’s Mulumba said;

the petition had raised awareness of the country’s ongoing maternal deaths and helped rally people around the cause.


UGANDA : Creating A Healthier Future for our Youth

By; Ikirimat Grace Odeke (Program officer , Sexual Health improvement Project

It was the day before we broke off for the Christmas holiday. I was wrapping up at the office when a phone call came from 400 kilometers away. On the other end of the line was John, a student nurse and sexual health educator, and my colleague at the Sexual Health Improvement Project (SHIP). He urgently wanted advice on how best to handle the ordeal of an 11-year-old girl who was raped by a man two years ago.

The girl reported the abuse to her mother, who concealed the matter after receiving a bribe from the perpetrator. The mother warned the little girl never to tell anyone what had happened. “Sarah has just revealed this to me after she tested HIV+ during our outreach visit today,” John said in a poignant tone. “She is emaciated, weak, and malnourished. I need advice on how best to handle this delicate issue.” As I listened, I found myself baffled both by the details of Sarah’s story and by the fact that her situation is all too common in Uganda: This is the reality girls are grappling with in my community.

As coordinator of SHIP, it is my job to help young people like Sarah who confide in our sexual health educators. We are now connecting Sarah to the local health facility for treatment and are getting in touch with the District Probation Officer who is in charge of children’s affairs to take up the issue. Setting the wheels in motion to get Sarah out of her predicament reminds me of my own path to this work, and of all the reasons we urgently need sexual health education. Rape, incest, teen pregnancy, and transmission of AIDS are all serious problems in Uganda. I believe the only way to combat these situations is to address the cultural and social issues that cause them. I know that education is our most powerful tool to create a safer and healthier future for Uganda’s youth. SHIP’s vision is a society of healthy young people empowered to make informed and responsible decisions regarding their sexuality. And with more than 70 percent of Ugandans under 24 years, we’ve got no time to lose.

Navigating Adolescence Alone

A girl is considered a woman in my community when she develops breasts. Adolescents who have never been prepared for this stage of life are surprised and frightened. How can we blame them when things go wrong?

My own adolescence was challenging, yet punctuated with excitement, exploration, discovery, and vulnerability. My parents never talked to me about growing up. Friends told me about maturation, menstruation, and relationships with boys. Of course these were mixed messages. I grew up in a remote area, without TV; the small radio was only tuned in by my father for the news broadcast or his favorite music channel. I vividly remember the day my mother found me stealthily reading Drum, a fashion, music, and relationships magazine. She scolded and beat me. “So you have started reading this kind of magazine, do you want to get spoiled!” she shouted.

My mother’s rage is a typical scenario in Uganda, where parents talking about sex with their children is simply taboo. Because of these cultural realities, it was up to me to make decisions on sensitive matters that none of my parents wanted to discuss. I have no sister, so I was confronted with big issues for which I had no solutions.

When I was 15 years old, one of the big boys in my class used to tease and abuse me with inappropriate touches. I did not know how to deal with this situation. I began hating school and my self esteem was affected. Fortunately he left our school, but I continued to be confronted by all sorts of unfair situations. I thought the world just hated me. Inside I suffered alone while my society was busy threatening me instead of educating me.

Making decisions as a young person can be a daunting challenge without advice, information, and experience. Young people in Uganda are told that having sex before marriage is an abomination and immoral. But these kinds of threats do not protect youth from unsafe behaviors. They only attract the desire among young people to test the facts, discover, and experiment.

Studies show that by 18 years of age, 72 percent of girls in Uganda have had sexual intercourse. The reality is that adolescents are engaging in sex and we need to give them the right information beforehand. Peer pressure motivates many adolescents to initiate sexual activity early, and financial transactions are a major component of adolescent sexual relationships. In fact, 31 percent of young women in Uganda report receiving money for sex. Being educated about the likely dangers and consequences of such acts can help them decide. For 20 percent of girls, their initial sexual encounter is coerced or conducted under considerable pressure. Having the support of health professionals in the community can empower them to seek help in such situations.

As an adult and mother of teens, I never understood the dilemma today’s adolescents go through until I began working with them through SHIP. Going into schools and communicating with young people in informal, participatory ways has given me new insight into their worlds. I realize today that having experienced the transition into adulthood is not adequate to make parents understand what young people are struggling with to become responsible adults.

My work with SHIP has brought me face to face with horrors that are difficult to comprehend, and has made me aware of stories like Sarah’s that are common in Uganda. Cases of girls who are abused, defiled, and raped by relatives in their homes are reported daily. Daphne, a young nursing officer and sexual health educator, was horrified by the story of Rose, a 17-year-old who came to her at a health facility last year seeking a five-year contraceptive injection. Rose, a poor student under the care of her uncle in Kampala, divulged that her uncle was sexually abusing her. When Daphne met her, Rose had already conducted two crude abortions; the last one left her critically ill, so she wanted to avoid getting pregnant again. Daphne advised Rose to tell her mother about what was going on. “I told my parents, but they say I should endure the situation for the sake of completing my examinations,” Rose lamented in tears. Rose only feared pregnancy, which is reprimanded by Ugandan society. She did not think about sexually transmitted diseases, like HIV/AIDS.

No Way Out

Abortion is illegal in Uganda. In 2011, Rhoda, 17-years-old, was clandestinely brought to the rural health unit by her friends and abandoned there in critical condition. Rhoda had conducted a crude abortion that went septic. This was an emergency, but post-abortion care services are not developed in Uganda. Rhoda had to be transferred urgently to a different health facility. She was rushed to the hospital about ten kilometers away; however her life could not be saved. I lost many of my own adolescent friends to abortions that went bad. Others dropped out of school due to pregnancy.

The adolescents I work with identify poverty and negligence as common reasons for engaging in sex. Parents are preoccupied meeting their own personal needs and have forgotten about the needs of their children. Many parents think school fees are the most important thing in their children’s lives and they overlook nurturing them and providing sex education. Hope’s story is not uncommon: She was sent away from school to collect a book and pencil that her parents refused to provide. The Universal Primary Education program requires that parents provide children scholastic materials, food, and uniforms. Disappointed, Hope went home weeping, knowing her future was doomed without an education. A businessman eventually lured Hope into sex with the promise of keeping her in school. Hope is now 12-years-old and has just tested HIV positive.

Hope’s terrible dilemma reflects the fact that parents still believe that children are the sole responsibility of government. Universal Primary Education is now compulsory, but the law is not yet in place to deal with parents who do not meet their obligations of keeping children in school.

Phina, now a nursing student and a sexual health educator for SHIP, has vowed to complete her education against all odds. She says her father promised never to educate a girl because her elder sister got pregnant while at school. He arranged a husband for Phina, a proposal she rejected outright. But how many girls can find the inner strength to take such a defiant stance?

Where Do We Go From Here?

I am certain sexual health education needs to begin as early as 11 years. Children, especially in rural areas, tend to complete primary education at 17. Waiting until later ages to begin sex education is a missed opportunity. Last year, over 63 girls in 30 primary schools in Ngora district who registered for Primary Leaving Examinations either got pregnant or married.

Coordinating SHIP has opened my eyes about adolescents’ sexual health. It is clear that young people do not have adequate information about what to expect as they grow up. Adolescents have no one to listen to them. To combat this situation, we go into the schools to complement the formal efforts of the public education sector in sexual health education. We recognize the vital role played by parents, teachers, and community leaders in the lives of young people. It is my dream that one day every adolescent will be able to have the information they require to make appropriate decisions about their sexuality. We are working out an expansion program with some of the local members of Parliament to reach youths with these skills and information.

The current generation has been unfair to the next generation. We are leaving the youth to their own fate. It’s critical that we educate young people about sexual health, about the dangers and consequences of unsafe behaviors. We must give girls the tools and empowerment they need to stay in school, seek help when they need it, and fight back against sexual abuse — and we need to do it now.

Uganda needs 3,000 surgeons

By Francis Kagolo

The high rate of brain drain is continuing to wound Uganda’s health sector with fresh revelations indicating the country is short of over 3,300 surgeons.

An expert said many people who would have survived treatable surgical conditions like cataract blindness, hernia, clubfoot and injuries end up dying due to inadequacy of surgeons in the country.

“Every year, Makerere University, other institutions and hospitals pass out surgeons. But due to low pay, many quit the country for greener pastures abroad,” said Dr. Edward Naddumba, the secretary general of the College of Surgeons of East, Central and Southern Africa (COSECSA).

“Currently we are less than 100 specialist surgeons for 34 million people. This means one surgeon for every 340,000 people.”

Other potentially productive people become disabled and destitute because of treatable surgical conditions, he said.

Naddumba made the remarks while briefing New Vision online on COSECSA’s efforts to improve the numbers and working conditions of surgeons in sub-Saharan Africa.

The efforts include offering specialized postgraduate surgical training at major hospitals like Mulago, Nsambya and Masaka.

The college passed out four graduates at its first graduation ceremony in 2004. About 113 trainee surgeons are to sit the COSECSA exams this year, 51 of whom are in their final year.

The college charges $1700 (about sh4.2m) as entry, examinations and graduation fees.

His revelations come amidst a public outcry over the underfunding of the health sector.

A report by Makerere University Medical School two years ago revealed that health spending in Uganda covers about a third of what the country needs to meet its minimum healthcare package.

It said Uganda spends only $14 per-capita on health. Of this, $9 is out-of-pocket and $5 from public sector (government and donor funding).

Today, less than 100 specialist surgeons available for 34 million Ugandans.

Yet, as the country’s health system remains in a coma, the Government still spends at least $150m (about sh368b) annually treating top government officials abroad.

This amount is nearly half of the combined budgets of health and education ministries.

Makerere’s development expert Prof. Augustus Nuwagaba recently argued that Uganda’s problem is not lack of medical practitioners but poor remuneration.

“Almost half of the 40,000 Ugandan professionals in North America are health personnel, which means our problem is not the human resource,” he said.

We shall block budget if health funding is not increased – MPs


Next financial year’s budget framework indicates that funding to the health sector might shrink, a move MPs threaten to oppose.

MPs on the Social Services committee have asked the government to increase funding to the health sector in next year’s expenditure estimates and warned that a failure to accept their recommendation could provoke them into blocking the ministry’s budget.

According to the 2012/13 National Budget framework paper, the health ministry is expected to absorb a reduction of Shs52.7 billion from the Shs814 billion which was allocated to it this financial year with the government proposing to spend Shs761.6 billion for the next financial year.

The Minister for Health, Ms Christine Ondoa, while appearing before the committee yesterday, brought the matter to the attention of the legislators where she attributed the reduction of the budget to a decrease in the donor-funded project component.
The reduction, however, means that the sector’s allocation will account for 8 per cent of the overall national budget which is way below the 15 per cent target set in the Abuja Declaration which Uganda ratified.

“The strengthening of reproductive and mental health programme under Butabika Hospital has ended and the donor budget will therefore reduce from Shs19.5 billion to Shs5.4 billion. Also, the project of rehabilitating and equipping health facilities in the central region is coming to an end and its donor budget will reduce from Shs53.7 billion to Shs15 billion,” Ms Ondoa said.

The legislators in a meeting chaired by Dr Sam Lyomoki (Workers MP), however, indicated that the budget cut would have a significant impact on the already sick health sector.

Ngora District Woman MP Jacqueline Amongin said the committee will not pass the budget if government does not increase the funding.

“It is surprising that the government is cutting money for the Ministry of Health and yet the same government committed itself and ratified the Abuja Declaration which talks of at least 15 per cent for the ministry,” Ms Amongin said.
“We still have so many challenges of health as women are still dying either because there is no transport or the health centre is very far. It’s unbelievable that in Ngora we have no doctor in the hospitals,” she added.

Ms Sylvia Namabidde, the Mityana Woman MP, said Uganda will not meet its Millennium Development Goal targets on health if government does not prioritise the health sector given the increasing population.

Poor services
While the government has endeavoured to set up health facilities across the country, the Uganda Local Government Councils Score Card 2009/2010 report by Advocates Coalition for Development and Environment, shows that improvements are only in infrastructure, especially in construction of health centres.

The report said problems such as shortage of drugs, understaffing, shortage of equipment, absenteeism of health workers, and weak accountability mechanisms still exist.

The minister had also noted that despite a government proposal to recruit about 1,020 health workers, there is no money for the exercise. But the MPs said unless the issue of human resource is handled, the public health sector will continue to fail to deliver services.

Ms Angelina Osege, the Soroti Woman MP, wondered why the government had not allocated money for the treatment of tuberculosis yet it is one of the leading killer diseases in the country.

Meanwhile, government has announced a Shs33 billion enhancement for health workers’ salaries. The 21 per cent increment is expected to benefit all public health workers although they have always demanded for a 100 per cent increment.

Dr Asuman Lukwago, the acting permanent secretary in the ministry, however, said Shs214 billion would be required to effect the 100 per cent increment but they are constrained by resources.