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MultiDrug Resistant Tuberculosis: The Challenge of Adherence among Women in Uganda

In 2018, there were over 484,000 cases of MultiDrug Resistant Tuberculosis recorded around the world, which contributed to 44.21% of deaths caused by tuberculosis. Women diagnosed with MDR-TB are more vulnerable to low mental and social well-being than men, it is imperative that immediate action be taken to address the difficulties experienced by female patients as well as their support networks. This can be accomplished by putting emphasis on ’patient-centered care’, and a strong Primary Health Care system that is adequately facilitated would go a long way in ensuring efficient prevention and response to MDR-TB especially among women. 

By Christopher Ogwang

Christopher Ogwang

Multi-drug-resistant tuberculosis (MDR-TB) is a major public health hazard on a global scale. It is a kind of tuberculosis (TB) infection caused by bacteria that are resistant to treatment with at least two of the most powerful first-line anti-tuberculosis (anti-TB) medications. This is caused by non-adherence to the treatment regimen or poor prescription. In 2018, there were over 484,000 cases of MDR-TB recorded around the world, which contributed to 44.21% of deaths caused by tuberculosis. Over 62% of these instances were not treated, which is more than half. Noteworthy, the treatment of MDR-TB is much more expensive than the treatment of susceptible TB. In Uganda, various health challenges impede the scale-up of Drug-Resistant Tuberculosis treatment and care, treatment is either inadequate or lacking and in some cases, diagnosed patients delay on the treatment waiting list. Having one or more drug stock outs in health facilities treating susceptible TB was significantly associated with the risk of developing MDR-TB which has been noted as one of the factors contributing to poor outcomes and risk of developing drug-resistant TB, especially in rural communities. 

Women diagnosed with MDR-TB are more vulnerable to low mental and social well-being than men. Married women and women of childbearing age are most vulnerable to MDR-TB’s socio-economic, and mental health consequences, such as isolation, financial difficulties, and despair. Besides the intricacies and length of treatment, psychosocial difficulties frequently aggravate MDR-TB. It is essential to broaden patients’ access to psychotherapy and other forms of mental healthcare while they are undergoing treatment for MDR-TB.

The reproductive and parental roles of women and mothers compound the difficulties they already face in coping with, remaining adherent to, and ultimately benefiting from MDR-TB treatment. In most cases, a female patient is also a wife or mother who provides essential care for other members of her family, including those who also suffer from MDR-TB. Women have the social obligation to care for their sick children and spouses, but they may be denied even the most fundamental needs when they are ill themselves.

It is imperative that immediate action be taken to address the difficulties experienced by female patients as well as their support networks. This can be accomplished by putting emphasis on the requirement for ’patient-centered care’” and enhancing the services offered at local health facilities that are closer to the patients. This would cut indirect related costs associated with treatment that female patients may not be able to afford. This is critical because most women are incapable of maintaining adherence to the treatment regimen, yet worse when it comes to women in rural areas that mainly engage in unpaid care work and have no room to create and focus on income streams.

Along the therapy continuum, we need to emphasise  the significance of psychosocial stresses and social support as intermediary predictors for successful treatment results. To be able to ensure that female patients have a supportive environment to sustain adherence, families, patients and their family members should each receive the appropriate health information relevant to the condition and treatment plan in order to establish a support system that is both enabling and supportive. This is critical in sustaining adherence to treatment and care for Tuberculosis.

In addition, in order to improve the overall level of care provided, the screening for and treatment of mental health disorders should be incorporated in the national recommendations for the management of MDR-TB cases.

There is need to develop and implement a comprehensive mechanism for contact tracing of new tuberculosis cases and defaulters, implement an all-inclusive surveillance system such as the community awareness, screening, testing, prevention and treatment to combat TB. As evidenced from the work by the Center for Health, Human Rights and Development (CEHURD) contact tracing in northern Uganda, continuous tracing and reintegration into treatment saves lives not just of those who had dropped out of treatment but also the ones in their communities. A strong Primary Health Care system that is adequately facilitated would go a long way in ensuring efficient prevention and response to MDR-TB especially among women. 

The writer is a Senior Programme Officer at the Center for Health, Human Rights and Development (CEHURD).

My Experience Litigating Sexual and Reproductive Health and Rights Related Cases

“Where, after all, do universal human rights begin? In small places, close to home – so close and so small that they cannot be seen on any maps of the world. Such are the places where every man, woman and child seeks equal justice, equal opportunity, and equal dignity without discrimination. Unless these rights have meaning there, they have little meaning anywhere.”

Eleanor Roosevelt

By Ruth Ajalo | Lawyer

Before joining the Center for Health, Human Rights and Development (CEHURD), I had basic information
about the right to health. This basic information was gained while pursuing the health and the law course
unit in my fourth year at Makerere University Law School. Learning the right to health was exciting and it
set a spark within me that I desired to carry forward in my career. This did not materialise immediately after Law School but when I eventually joined CEHURD, I was excited and looked forward to learning more about the right to health and this unique area of legal practice.


At CEHURD, I have learnt, unlearnt and I continue to learn each day about the right to health and the
intersectionality of health and human rights. I can confirm that there is a lot of knowledge and exposure that the right to health brings to light. CEHURD, among other things, provides legal support to victims and survivors of sexual violence and health rights violations. It also litigates strategic cases aimed at addressing systemic gaps and bottlenecks within the provision of health services in the country. 


CEHURD prepares, nurtures, and gives you a platform to shine and build your career. As a legal
practitioner, last year, I had the unique opportunity of litigating a landmark Sexual and Reproductive Health Rights case before a bench of five justices of the Constitutional Court. This is a dream come true for any young lawyer.


My experience in handling and litigating SRHR cases has been an emotional rollercoaster; it has been easy, hard, tasking, draining both physically and emotionally at times but above all, fulfilling. It is exciting to secure a win for a client and a win for the transformation in the provision of health services in the country.
Litigating SRHR cases is unique because this is not something you do without learning, unlearning,
understanding and preparing. Your mind is trained to creatively pick out the rights issues in the case and
articulate them sufficiently in a manner that reflects preparation and in-depth knowledge of the issues at
hand. Furthermore, the external lawyers we work with on some of our cases have to be oriented on the
unique aspects of the right to health and why it matters before they delve into the gist of the cases. This
calls for thorough research, preparation which continuously builds one’s mastery in the area of Health and Sexual and Reproductive health.


When a person calls the CEHURD toll-free line or walks into the office seeking help, that person is either
seeking information or is seeking for support. They are usually hurting or have suffered some form of loss
and need redress and or some form of support. Regardless of the circumstances and the facts of the case,
as lawyers we are expected to be non-judgmental, good listeners and provide the most appropriate
professional support. During the client-advocate meeting, when the client breaks down and starts to cry, the counsel must wear another hat of a counsellor and have to exercise empathy towards them. This requires that the lawyer for a moment, abandons the legal path and the knowledge acquired in Law School to concentrate on helping a client recompose through provision of Psychological first aid. This requires that for a moment, you abandon the legal package and knowledge you walked into the meeting with, and take on a new mantle of a counsellor.

We walk the journey with our clients, we counsel them, we exercise empathy, we hand-hold, we manage expectations and above all, we keep an open mind as we handle these cases. It is important to note this process also takes on an emotional toll on the lawyer and calls for selfcare. The emotional toll is largely because lawyers by training are not counsellors but in country with limited professional counsellors, any lawyer will by default provide; counselling to their clients especially when engaged in SRHR.


This type of work is not void of challenges such as the heart-breaking experiences of the clients, and being misunderstood by the public because of the nature of the work done, among others. Sexual and
Reproductive Health is a largely contested arena. Listening to clients’ experiences can get emotionally
draining because their experiences are in most cases very painful and nobody deserves to go through such grueling experiences. Furthermore, the clients are not conversant with the litigation progress and despite an effort to explain to them and manage expectations, they get burnt out and experience litigation fatigue.


Litigating human rights will certainly be difficult for any client especially if they are facing stigma,
discrimination, abuse, and isolation among others because of the delay in the disposal of their cases. 
To respond to these challenges, CEHURD has invested in the provision of psychosocial support to the
legal team that handles these cases, general staff wellness and welfare to enhance the continuity of
litigation. We also share and learn amongst ourselves in the Strategic Litigation Programme with the view
of bettering ourselves. We also hold annual clients’ meetings where clients are invited for interactions and
update meetings about their cases, clients share amongst themselves and learn from each other and we
also receive feedback which we find useful for improving our service delivery.


As mentioned, we are sometimes misunderstood by the public but choose top stick to our calling trudge on nonetheless, undeterred and ever so ready to defend and stand for our clients’ rights and for system
change. 
Justice for our clients comes in many forms; arrest of an accused person, sentencing (imprisonment) of an
accused person, an apology from the health worker, an explanation offered for what went wrong, an
admission of wrongdoing from the health facility or health worker among others. It is these small wins and seeing systemic changes in the provision of Health that is the power below my wings and that keeps me waking up every day to provide legal support.


Despite all the hurdles and challenges encountered, the work is fulfilling. Fulfilment is in the fact that you
helped a person and they didn’t pay you for that service; that you utilised your legal knowledge to address a human rights violation and get justice for your client. Fulfilment is the phone call from a grateful client highlighting his or her gratitude “mwebale nyo, tusimye byona bye mwakola” –” thank you very much, we appreciate everything you do for us”. Some clients call us to update us on the progress of their daughters who suffered violence to indicate that our interventions built the girl’s confidence, she returned to school and she passed her Primary Leaving Examinations (PLE). 


To all human rights defenders, your work is not in vain; a step-by-step effort, a multi-sectoral approach, and perseverance will go a long way in realising a just society; a society in which people are free from sexual violence, free from health rights violations and all other violations around us. Let us persevere and keep the flame burning because society and the world at large still need us. 


Helping one person might not change the world, but it could change the world for one person” – Anonymous.

The writer is a Programme Officer in the Strategic Litigation Programme at the Center for Health, Human Rights and Development (CEHURD).

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.

Employment Opportunity

1. Job Title: Legal Officer

Department/Group: Strategic Litigation

Reports to: Programmes Coordinator

Direct Reportees: All Programme Staff

Job Purpose: The Legal Officer will work with a group of experience lawyers to provide a cross section of legal services to health service providers.

Key Responsibilities: a) Legal Advisory and Representation

• Meet and interview clients for the purpose of identifying their grievances and planning appropriate legal solutions

• Gather evidence to inform any possible litigation cases or policy review and development process

• Represent clients in all legal proceedings including but not limited to arbitrations, negotiation, settlement meetings, court proceedings and other legal proceedings,

• Draw up legal documents for the purposes of protecting the rights and interests of the clients and/or presenting their cases before any judicial or quasi-judicial body

• Advise clients on all legal issues especially issues relating to the protection and realisation of their sexual reproductive health and rights

• Interpret laws, rulings and regulations for the purposes of explaining the law to clients

• Identify and challenge obstacles to the realisation of the right to health especially sexual and reproductive health rights

• Work with Programme managers in CEHURD to engage those in charge of setting health policies to implement the solutions reached via research. This will include but not limited to preparing Policy or Research briefs, reports, testimonies for public hearings, presentations and petitions on health policies.

• Contribute towards ensuring timely, quality and accurate programme quarterly and annual reporting

• To develop and expand CEHURD’s strategic relations and partnerships in litigation of the right to health especially sexual reproductive health rights Details of the Job Description and qualifications can be accessed here>>>

The Closing date for the receipt of applications is March 20th 2015, by 5:00pm

Minister asked to issue directive on water disconnections in public health facilities.

20th February, 2015

Press release

For immediate release

Kampala –Uganda – The Center for Health, Human Rights and Development (CEHURD) has petitioned the Uganda Human rights Commission to initiate an investigation of human rights violations that occur as result of disconnection of water supply to public health facilities by National Water and Sewerage Corporation (NWSC).

CEHURD in addition has appealed to the minister of water and Environment to invoke his powers as provided for under the Water Act to ISSUE an URGENT directive to prohibit water disconnection in public health institutions.

In the recent past, there have been frequent news reports of Mulago National referral Hospital being disconnected from water supply, Kiboga Hospital, Kawolo District hospital and most recently Bududa Hospital (See Newvision, Thursday 19th February, 2015 at Page 35 – Water Crisis Hits Bududa Hospital). The Lack of water in these health facilities has led to sanitation disease outbreaks including diarrhoea, dysentery to mention but a few.
“The right to water like other human rights creates a number of obligations on government and its agent’s m including obligations to protect respect and fulfill this human right.” Mr. Mulumba says. “The disconnection of water supply in public health institutions demonstrates the government’s failure to restrain third parties like NWSC from violating rights of its citizens of Uganda and thereby violating human rights such as rights to access water, right to health enshrined in Articles 8A, 45 and objectives XIV (b) and XX of the Constitution”, Moses Mulumba the Executive Director of CEHURD notes.

Relatedly Nyamiringa Health Centre II in Kiboga District is in dire state. “The maternity ward at this health facility cannot operate because of lack of water. Women keep trekking long distances in search for proper delivery services. Extra costs are incurred to transport expectant mothers to Hoima regional referral Hospital for the service” , Steven Maisho, HUMC Member, Nyamiringa.

In November 2002, the Committee on Economic, Social and Cultural Rights adopted General Comment No. 15 on the right to water. In its Article I.1, the committee notes that the human right to water is indispensable for leading a life in human dignity and a prerequisite for the realization of other human rights.

For more information contact info@cehurd.org, or call 0414 532283, 0702977730, 0702245536