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.

Human rights activist threatens German govt with lawsuit over its opposition of access to Covid vaccines in low income countries

Moses Mulumba from Uganda threatens the German federal government with a lawsuit if it does not advocate the suspension of the coronavirus patents. medico and ECCHR support him.

With vaccine shortages, millions of people are currently exposed to permanent, preventable health threats. In Uganda, for example, only just under 10 percent of the population are vaccinated, not even 2 per cent of them completely. This shortage could be overcome if vaccine patents were released and production capacities increased more quickly due to their free availability.

This is what the Ugandan human rights activist Moses Mulumba says and has therefore called on the German government to support the demand for the patents to be released – and otherwise threatened with legal action . So far, the federal government has blocked the application to suspend patents from the World Trade Organization. This is possibly unconstitutional and contrary to international law.

Moses Mulumba, Executive Director of Center for Health, Human Rights and Development (CEHURD). COURTESY PHOTO


With a so-called letter of claim, Moses Mulumba, who heads a health and human rights organization in Uganda, calls on the federal government to approve the release of the patents on COVID vaccines and drugs in the upcoming WTO negotiations. If the federal government does not comply with Moses Mulumba’s request, it will face legal proceedings, because “According to international human rights treaties and the UN Charter, Germany is obliged to cooperate internationally as best as possible and to take the most effective, joint measures to combat a global pandemic participate. If Germany continues to fail to vote for a derogation from the TRIPS agreement at the World Trade Organization, The federal government must live up to Moses’ claims and thus its human rights obligations. Intellectual property rights must not take precedence over the human right to health and life, ”says Miriam Saage-Maaß from ECCHR. 

“The corona management of the federal government still in office is often and rightly under criticism. However, it is often forgotten that German government action does not only have national consequences. The federal government has been in charge of blocking the TRIPS waiver for months. And to be clear: It is blocking the central instrument for faster and more cost-effective global production of corona vaccines, which costs human lives and destroys livelihoods, ”says Anne Jung from medico international.

The letter from Moses’ lawyer was served on the Chancellor, the Minister of Health and the Minister of Economic Affairs.

The aid and human rights organization medico international and the ECCHR (European Center for Constitutional and Human Rights) support Mulumba Moses legally and financially in his approach, which is part of an internationally coordinated action.

This article was first published on www.medico.de on November 25th, 2021.

Pfizer says to appeal over India drug patent refusal

US drug giant Pfizer said Friday it will appeal against an Indian ruling overturning a patent for a cancer drug, saying the decision raises questions about intellectual property protection in India.

 

Indian generics heavyweight Cipla opposed the granting of the domestic patent for Prizer’s Sutent, which is used to combat liver and kidney cancer.

The patent office’s decision went to the heart of India’s patent act, which says a patent cannot be granted for a drug unless changes make it significantly more effective and innovative.

“The patentee (Pfizer) has miserably failed to demonstrate any improved activity” warranting a patent, the patent office said in its decision.

“The invention that is claimed in the patent does not involve any inventive step… and hence (is) not patentable,” Nilanjana Mukherjee, senior patent officer, said.

A spokesman for Cipla, which revolutionized AIDS treatment by supplying cut-price drugs to the world’s poor and which has been campaigning to be able offer other low-cost generic medicines, had no immediate comment.

But Pfizer managing director Jazz Tobaccowalla said the company believes the ruling “undermines intellectual property rights in India”.

“We will vigorously defend our basic Sutent patent,” the Pfizer executive said in a statement, adding the company would appeal against the ruling to India’s Intellectual Property Appellate Board.

The patent decision marked another win by Cipla against a global pharmaceutical company.

In September, a court threw out a patent infringement case launched against Cipla by Swiss drug maker F. Hoffmann-La Roche over the Mumbai firm’s version of a lung-cancer drug, ruling it had a different molecular makeup.

The cases have been watched worldwide as they involve interpretation of stricter drug patent protection rules introduced by India in 2005 to comply with World Trade Organization regulations.

India has some of the toughest criteria for drug companies to obtain patents, said D.G. Shah, secretary general of the Indian Pharmaceutical Alliance, an industry body.

“These rulings show (foreign) companies need to take into account that India will not permit tweaking of formulations for getting a patent. If they had those expectations, they were unrealistic,” Shah told AFP.

Medical charities have expressed concern compliance with WTO rules could reduce the country’s role as a supplier of low-cost medicines. India is the world’s leading exporter and manufacturer of non-branded medicines.

But Western firms — looking to countries such as India for sales growth — have voiced criticism of brand protection in India.

Earlier this year, an Indian ruling allowed a local firm to produce a vastly cheaper copy of German pharmaceutical giant Bayer’s patented drug Nexavar for liver and kidney cancer.

India’s patents chief ruled the price Bayer charged was “exorbitant” and told the firm to give a “compulsory license” — permitted under WTO rules for public health reasons — to Indian firm Natco Pharma to make a less costly version.

Experts say that ruling could pave the way for a rush of other “compulsory license” applications in India and other poor nations, allowing access to patented life-saving drugs at a fraction of the cost.

Read more: http://india.nydailynews.com/business/678d561f1bf06eab53965176d7bfd4cf/pfizer-to-appeal-over-india-drug-patent-refusal#ixzz28ZbSjQ00

Sisters in Death – Women in Kenya profiting from ARVs

In the video below NTV Kenya investigates a story of HIV+ women in various slums in Kenya who profit from ARVs given to them.

[youtube_video id=”xeiie4nusqA” width=”560″ height=”315″]

 

They are the people for whom free anti retroviral treatment was designed; HIV+ women do not have the money to access the medicine they need.  Yet for a group of HIV+ women in various informal settlements in Nairobi, the ARVs they receive do not profit their health, but they do profit from them.  Many unsuspecting Kenyans may be settling down to a drink that they’ve made, using the very same drugs that could save their lives. Here now is NTV’s Jane Ngoiri with a brand new NTV Investigates documentary, on women driven by poverty into a game of chance with their own lives, those of many others. These are the Sisters of Death.

Technology opens the doors of Africa’s health sector

By Fiona Graham
Technology of business reporter, Nairobi and Kampala

WATCH: In Kenya, only the very richest are guaranteed quality healthcare. The BBC’s Fiona Graham looks at the technology that could change that
“I had just attended too many funerals, people dying from completely preventable causes and treatable diseases.

“Standing at the sides of the graves and holding the babies of parents who had died from basic infections that are treatable in other parts of the world.” Stephanie Koczela is one of the founders of Penda Health, and she’s explaining what motivated her and her colleagues to open their first clinic in the town of Kitengela.

It’s a huge, sprawling, dusty conurbation that’s growing explosively, absorbing the overflow of people from nearby Nairobi.

A trip to the doctor’s in much of East Africa can be something of a game of Russian roulette.

As co-founder Beatrice Ongoce puts it: “In Kenya, healthcare quality is associated with being rich, being able to pay more, and bad options are related to being poor.”

Stephanie Koczela and Beatrice Ongoce at the Penda Health Clinic
The start-up aims to provide quality, affordable healthcare for the middle and lower income segments of Kenyan society. And to do this technology plays a big part.

“The surprising thing is that middle 70%, they spend about $1bn a year on outpatient healthcare alone in Kenya,” according to the third part of the team, Nicholas Sowden.

Lock, stock
This means there’s plenty of incentive to find ways to cut costs while keeping standards high.

“I think that most of the health care providers that we’re competing with don’t use technology at all to supplement their systems,” says Ms Koczela.

“They’re all paper records, their drugs are often out of stock.

Kitengela lies next to the Nairobi National Park, and is growing fast, as its neighbour Nairobi continues to expand
“We have a system that gives us a warning if any of our drugs are expired, and it forces our providers to dispose of those drugs immediately.”

Penda Health’s system is bespoke, tracking stock and expiry dates through a simple interface accessible from a PC. When supplies run low, this triggers a warning to make sure more is ordered.

“It raises our medical quality. One of the most common problems with healthcare providers in Kenya is that they don’t have the equipment that’s necessary to provide medical care.

The start-up had originally focused on women’s healthcare, including family planning and reproductive health, but soon realised that to attract women you need to treat the whole family
“This system ensures that we will always have what’s necessary for our patients.”

The clinic uses mobile broadband, meaning the system is completely portable – and mobile technology is useful in other ways.

Staff text patients to make sure they’re taking their drugs at the right times and in the right way, or to tell groups of patients that a specialist is visiting. Investing in an internet connection means accessing online resources to build up-to-date treatment protocols is fairly straightforward.

The start-up is now working on developing their own electronic medical records system – that ultimately will allow them to share those records if need be with specialists both within Kenya and internationally.

“We want to be the most friendly and highest quality provider for the low and middle-income Kenyan, and in order to do that we need to have tech systems that are backing our chain,” says Ms Koczela.

Right of way
For some Kenyans even the most basic clinic can seem out of reach. For many people living in rural areas, the nearest hospital could be many days’ journey away. Living in a rural area can mean that a trip to a doctor could take days. If you need to see a specialist, this means a referral, another long journey and probably a lengthy wait.

So to tackle this Amref – the African Medical and Research Foundation – is using computers and the internet to let local healthcare professionals consult urban experts.

The next step is to build an online knowledge base, says Amref’s Frank Odhiambo
“This technology is important because it helps cover the great distance that the poor have to cover while seeking healthcare,” says Frank Odhiambo, Amref’s telemedicine project officer.

The telemedicine equipment – computers, printers, scanners, and digital cameras – is provided by Computer Aid International.

The technology has been installed in around 50 hospitals in Kenya, as well as in Ethiopia, Tanzania, and Uganda, with more planned.

Operating in rural areas means connectivity is one of the project’s biggest challenges.

Although fibre-optic cable is gradually being rolled out through the region, large areas are still reliant on 2G mobile broadband, and even satellite broadband, which is pricey.

The telemedicine technology lets rural doctors share pictures and x-rays with specialists to find the right diagnosis. A reliable electricity supply is the other conundrum in rural areas. So Computer Aid is supplying Amref with solar-powered Zuba boxes – shipping containers fitted out as cyber cafes.

For Mr Odhiambo, the rewards of the project are clear.

“What I find most rewarding is availing a solution to someone in the most remote location, who does not have hope. IT just does it like magic.”

Beat of your heart
The mobile phone in your pocket can also prove an effective way to give people in isolated areas access to healthcare technology.

“Africa has a high mobile penetration rate,” says Aaron Tsushabe, an app developer with Uganda start-up ThinVoid.

The team behind WinSenga got the idea for the app after watching a nurse using a pinard horn . “They actually say that in about three years’ time there will be more phones in Africa than in the US.”

Mr Tsushabe and his team – all students at Makere University in Kampala – have developed an app that matches smartphone technology with the pinard horn, which has been in use for over 100 years to monitor the heart rate of unborn babies.

Joseph Kaizzi and Aaron Tsushabe have renamed the adapted pinard horn the senga horn
It resembles an old-fashioned ear horn, and is used by placing the wide end of the cone on the abdomen of a pregnant woman, and listening.

You then count the beats to calculate the fetal heartrate – one of the primary indicators of the health of the child.

This simple piece of technology is still widely used in developing countries.

The students took the pinard horn, and fitted it with a microphone, which plugs into the phone. The app monitors the sound of the baby’s heart, and can then indicate if there is any cause for concern.

The team recently took part in Microsoft’s Imagine Cup, the student technology competition, placing in the top 20 globally.

WinSenga is still in the prototype stage, although ThinVoid’s Joseph Kaizzi says they hope that it will be available generally very soon.

WinSenga takes smartphone technology and matches it with a pinard horn, a device invented in the 19th century by a French obstetrician, Dr Adolphe Pinard
“We’re working hard with the consultant from Unicef trying to make this as adaptable as possible, and we’re trying to localise it.

“It’s currently in English, we’re trying to get it in some of our local dialects.”

Dr Felix Olale is executive chairman at investment banking firm Excelsior Firm, based in Nairobi. He is also an adviser to the Kenyan government.

He says the future for healthcare in the regions depends heavily on investment in technology innovation.

“Ultimately it’s about patients and outcomes.

“It’s about increasing access to care for these folks who may not have access to facilities. It’s about increasing the socio-economic growth of these communities. Technology allows you to do all these things, right?

Dr Felix Olale: The future for healthcare in rural areas depends on investment in technology
“If we can take technology and build off of the infrastructure that’s already in place, what that does, it allows us to push these at a low investment for the amount of return that you actually get.”

In Kitengela, Penda Health has taken its reliance on technology one step further, issuing what they call “social shares” to fund their first clinic.

They used social media platform Facebook to find investors prepared to lend them the money to pay for the bricks, mortar and equipment needed.

They have big ambitions – and those ambitions rely heavily on technology to push growth.

“Technology allows us to have quality healthcare at scale,” says Penda Health’s Stephanie Koczela.

“With one clinic you could imagine we could monitor our drug supplies and do chart review with paper and all those things.

“But with a hundred clinics that’s just not possible. The only way to do that is to leverage amazing systems.”

Source: http://www.bbc.co.uk/news/business-18969646