Center for Health, Human Rights and Development (CEHURD) is seeking for the services of a competent and experienced large events organiser to coordinated the upcoming Uganda National Conference on Health, Human Rights and Development for a duration of Five (5) months (June – October 2023).
Deadline for submission of applications is Friday 26th May 2023.
Parliament is currently scrutinising Ministerial Policy Statements for the 2023/2024 Financial Year. The statements are the equivalent to the draft Budgets for the subsequent financial year. For most people, discussions on the budget does not make sense because it is perceived not to add value to their lives. Unfortunately, for millions of Uganda, whose lives depend on access to health care, is dependent on the public health delivery system these conversations are a question of life and death.
Adequate allocation to the health sector is critical to promoting equity in health service delivery. In the next financial year, the health budget allocation is projected to drop to about 6.5 percent of total budget from 7.7 percent as provided in the current budget. The drop is worrying development and must be arrested by Parliament during the current budget scrutiny. To put this into perspective, it is important to look at some macro-economic factors that have a direct impact on the health budget. In Uganda, the annual population growth rate is about 3 percent per year. The increasing population calls for increased investment in public health. Also, the Uganda shilling is projected to lose value against the dollar. This implies the cost of importing a unit of drugs and other health equipment will become more expensive in the coming year than it is this year. Prudent budget allocation will, therefore, demand that the allocation of resources to health should take into consideration these macro-economic considerations.
The Ministry of Health has made significant strides in improving access to health services with 91 percent of Ugandans now leaving with 5km of the health facility. Reduction of budget allocation to health will roll back the achievement made this far. Investment must now be directed at functionalising these health facilities. In Uganda, 71.6 percent of the Out-patient Department attendance is at health centres II and III. Similarly, 56 percent of deliveries take place there. To foster health equity, public health financing must ensure that the quality of service at these lower health facilities is improved because they help decongest the higher health facilities. Improving the quality of health service delivery means investing in essential medicines and health supplies, strengthening human resources for health, investing resources in primary health care, ensuring that there are medical equipment and that they are functional, among others.
The draft budget does not respond to the above needs and in some cases, financing has been reduced. National Medical Stores is projected to receive about Shs537.6 billion in the next financial year with a funding shortfall at Shs245 billion. The biggest funding gap for essential medicines is in health centre IIs accounting for about Shs17 billion. At the height of the drug stockouts earlier this year, we argued that funding was one of the driving factors for drug stockouts in the public health facilities. This budget making process gives Parliament an opportunity to conclusively address stock out challenges.
Last year, Parliament allocated Shs23 billion for Uganda Blood Transfusion Service and made a proposal for progressive increase in the budget for blood collection, processing and distribution. Unfortunately, government has instead proposed a reduction in the budget for blood from Shs23 billion to Shs21 billion. The reduction will mean that Uganda Blood Transfusion Service will be incapable of closing the gap of 150,000 units of blood needed by patients in Uganda with the possible result being that more Ugandans will die. Financing for service delivery, including health is usually dependent on availability of resources and we have consistently argued that we need to tap into all available opportunities including health insurance. We also need to aggressively ensure that every one pays their fair share of the tax that is due to them. Uganda currently loses more than Shs7 trillion annually to tax exemptions that would be channelled to service delivery. These have a direct impact on the country’s ability to provide quality health service delivery for its citizens. Government needs to urgently review its policy on tax exemptions.
The writer is the Program Coordinator- Advocacy at Center for Health Human Rights and Development (CEHURD)
A version of this article was published in the Daily Monitor on April 24th 2023.
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).
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.