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Justice Kabiito breaches new frontier in Human Rights Litigation

Until 16th July 2014, it was unheard of in Uganda’s human rights jurisprudence for a judicial officer in Uganda to visit to location of an alleged human rights violation to contextualize for himself what the circumstances in which the violation is alleged to have occurred. Such was the occasion at Nakaseke District hospital at 10.00am when Hon. Benjamin Kabiito visited the Hospital to ascertain the circumstances under which Nanteza Irene died after failing to access emergency obstetric care she needed to give birth to her baby.

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Magistrates’ Forum on Human Rights in the Criminal Justice System in Uganda – Update

On 8th August 2014, the Center for Health Human Rights and Development hosted judicial officers at Protea Hotel in Kampala to discuss a Human right approach to the criminal justice system in Uganda.

Read More Magistrates’ Forum on Human Rights in the Criminal Justice System in Uganda – Update

Call for concepts from University Students

The Center for Health, Human Rights and Development (CEHURD) in Collaboration with the Leaning Network based at the School of Public Health and Family Medicine, University of Cape Town (UCT) and with support from IDRC invites students in Universities in Uganda to submit concept notes for their research to be conducted within the project “Health System Governance: Community Participation as a key strategy for realising the right to health”.

Center for Health Human Rights and Development (CEHURD) in Collaboration with the Leaning Network based at the School of Public Health and Family Medicine, University of Cape Town (UCT) are undertaking an IDRC supported project which entails research on “Health System Governance: Community Participation as a key strategy for realising the Right to Health”. The overall aim of the project is to develop models for community participation in health that advance health equity and strengthen governance systems for health.

The main objective of the project is to explore the hypothesis that building civil society capacity to participate in health care and in services that provide the social determinants of health using a rights-based approach, in the context of interventions to enhance service responsiveness will help to address inequities in health and promote stronger and more sustainable governance systems for health that give voice to the poorest and most marginalized in developing countries.

We welcome approaches from students to conduct research within the broader aims of the project, and invite you to submit a concept note for a study you would like to conduct under the auspices of the project.

Objectives of the call
This project aims to identify, in two sites, one in South Africa and one in Uganda, opportunities for best practice in utilizing community participation as a vehicle for realizing the health rights. As part of the project, we will be developing and testing training materials targeting primary health committees and structures that act as the voice for communities in relation to the health services. In addition, students will play a key role in documenting, describing and evaluating the processes and effectiveness of different strategies of the project.

Research Topics
The research topics should focus on the challenges regarding the sustainability of community participation strategies; effective participation strategies for the right to health ; enhanced responsiveness and better governance of the health system at local level up to the higher levels and how to build stronger conceptual and advocacy links between human rights approaches to health and health equity.

CEHURD and will collaborate with the Universities to select the students that will qualify to undertake research under the project. These students will typically be doing studies in the areas of Public Health, Human Rights, Social Sciences, Law and related areas. The students should be undertaking their research projects within academic year 2012/2013

Students whose projects are approved under this collaboration will receive a student bursary to support their field costs and field work, as long as the project meets a research objective under the broader project aims.

For any inquiries concerning this call, please send an email to

Uganda: The Deadly Hours for Women to Give Birth


Woe unto a mother who goes to deliver in Mulago hospital at night or early morning. Chances are she could die.

A new report shows that the highest number of maternal deaths (14.2%) occurs between 9 am- 10am. Other “deadly” hours to be admitted are 7-8pm, 1-2am and 9-10pm.

In other regional referral hospitals combined, the highest number of deaths (13.2%) occurred between 7-10pm, followed by the 5-6am and 1-2pm.

The revelations are contained in a report titled “maternal mortality reviews in three referral hospitals in Uganda” 2009-2011. About 300 deaths of mothers were reviewed in Fort portal, Masaka and Mulago referral Hospitals.

According to the report, these time periods, in which mothers died relate to health worker fatigue and the periods of changeover of the medical staff.

Although 42% mothers died within 24 hours of admission, 20% died in the first six hours of admission. These were considered as the “walk in” dead, which suggested that they came to hospital when it was a little too late and nothing little could be done for them.

The report is the first of its kind and was carried out by the Association of Gynecologist and Obstetrics in Uganda, to explore why women continue to die in labour. An estimated 6,000 women die every year due to birth related problems.

Months of death

Overall, many mothers admitted at Mulago Hospital died in January and in July. These two months a number of changes on the calendar- the university examinations and holidays for the lecturers and some medical students, as well as recruitment of new interns.

“These personnel changes, impacted on the quality of services, provided at these hospitals,” the report states.

Furthermore, June and July was cited as the end of the financial year, and the hospitals were generally faced with challenges in procurement of essential supplies.

Causes of death

Presenting the findings at a conference on Thursday, Dr. Jolly Beyeza, a senior gynecologist and obstetrician said heavy bleeding ranked the highest cause of mortality at these hospitals, which often resulted from complications in labor, and delivery.

Other top complications, according to Beyeza were abortion, infections, and hypertentive disease in pregnancy. “Among mothers who died from abortion and ectopic related conditions had never had any antenatal care,” said Dr. Beyeza. Among the mothers whose mode of delivery was recorded, 11% died undelivered. Seven mothers were brought in hospitals when they were already dead, while the majority of mothers who came in with abortion or after delivery were critically ill.

Should abortion be legalized?

During the conference, participants debated on whether to legalise abortion or not.

Joy Asasira, a lawyer with the Center for Women’s Rights and Development said a lot of women are unnecessarily dying from crude methods of abortion.

“If a woman wants to have an abortion, it does not matter what the law says. She’ll have it anyway,” Asasira said.

“Many people don’t want to talk about it, but it happens. If you don’t talk about abortion, yet we want to achieve the Millennium Development Goal of improving maternal health, we are deceiving ourselves,” she added.

Asasira argued that the government was spending sh7.5billion every year to treat complications resulting from unsafe abortions. The World Health Organization estimates that in Uganda, about 300,000 abortions are carried out every year.

Statistics show that the use of contraceptives is still low in Uganda. About 26% of women in Uganda are using modern contraception methods, while about 16 women die every day due to maternal health problems, including abortion.

Asasira stressed that nearly all unsafe abortions are because of unwanted pregnancies.

She also acknowledged that while the law in Uganda does not criminalize abortion, terminating a pregnancy had to be done within constraints of the law.

Quoting Section 224 of the Penal Code Act, Asasira said: “The law doesn’t prohibit abortion absolutely. It has a provision that acknowledges that to save the life of a mother, in case of a severe illness, that is threatening the life of a mother; a safe abortion should be carried out. But most people are not aware of this fact.”

However, doctors were skeptic, arguing that if safe abortion is readily available, women might choose to use it as a form of family planning, rather than an emergency solution to an unwanted pregnancy.

“The best thing is preventing pregnancy itself. You cannot start solving a problem from the bottom of it. Even if you made removal of pregnancy available, women will decide to use abortion as a family planning method,” argued Prof Donald Amoko, a Ugandan gynecologist based in South Africa.

Dr, James Batwala, a senior consultant obstetrician and gynecology was also pessimistic. “I am sure as we talk now; abortion is going on either legally or illegally. When you think about it, a woman has a right [to abort]. But what about the child? Don’t they have a right to life? We need to draw a line. What is more important right now is that abortion is a killer,” Batwala said.

Reacting to the concerns, Asasira, argued: “As a lawyer, rights begin at birth. I am a woman, I love babies, but there are some issues beyond the woman.”

What mothers say

The median age at death was 25 years. According to the study, only 57% of women in Uganda deliver in a health facility. “We are wondering. Where do the rest go?” asked Beyeza.

Many mothers cite lack of transport from home to the health facilities in time, staff lacking expertise and shortage of doctors among others. But doctors also complained that patients came to hospital when it was way too late. They also lacked essential facilities in health centers to carry out emergencies.

Way forward

Participants noted that most the complications were treatable. Dr. Florence Mirembe, a gynecologist said involving men in the maternal health fight would make a difference. “The men need to walk with us,” she said.

The ministry of health permanent sectary Dr. Asuman Lukwago said the government was committed to give more resources to the sector. He also announced that a women’s hospital at Mulago Hospital would be ready within two years, and called for the need for training of more gynecologists and obstetricians to work at the center.

Frank Tumwebaze, the incoming minister of presidency said the government would look into recruitment of midwives. He also called on parliament to advocate aggressively for the increase of doctors and nurses salaries, saying it would make them motivated.


Living positively behind bars

By Petride Mudoola: Robert Sebunya, who is serving a 45-year jail term for murder in Luzira Maximum Prison, is HIV-positive. His life in jail has been one hell of a nightmare. “Its double tragedy living positively behind bars,” he says.

Sebunya is in bad shape and is required to use Antiretroviral (ARVS) drugs which he is able to get but finds it difficult to take.

“I cannot swallow them on an empty stomach. I end up throwing them away,” he says.

For a man whose state of health requires constant and proper feeding, Sebunya is in danger of experiencing more serious complications.
He says that even though inmates receive the required medication, there is need for authorities to consider supplementary diet for HIVpositive inmates.

The prisons lack the necessary nutrition to cater for HIV-positive inmates, yet those on ARVs are meant to take a balanced diet. Gabriel Mugaga, another inmate living with HIV, says many of his colleagues fear to take ARVs due to the bad feeding in the prison.

“We throw away the ARVs because we cannot swallow them on empty stomachs.” Mugaga wishes to have healthy meals from his family in Kibaale, but they are far away and cannot bring food for him.

Poor feeding is one of the major challenges that HIVpositive prisoners in Uganda face. This has made the already appalling conditions of HIVpositive prisoners even worse.

Frank Baine, the prison’s publicist, observes that while the prison is supposed to cater for HIV-positive inmates, its budget is too small to do.

“We have no specific budget for feeding inmates on ARVs,” he said. He adds that those on treatment are sometimes provided with vegetables and eggs from prison farms.”

Baine says as a prerequisite, prisoners are subjected to an HIV test upon being imprisoned.

Those found to be positive are referred to the inmate’s health facility for treatment and restricted from engaging in hard labour. But there is little support in curbing the spread of the virus among the inmates, he adds.

The HIV prevalence among inmates has also been heightened by the increased sharing of sharp objects among prisoners.

HIV challenges in Ugandan Prisons

According to the prisons department, Uganda’s prisons has over 2,000 HIV-positive prisoners. Three hundred and fifty inmates living with HIV are in Luzira Maximum Security Prison. Only 178 of them have access to ARVs on a regular basis.

During celebrations to mark World AIDS Day at Luzira Prison, Dr. Joseph Andama, the medical superintendent Murchison Bay Hospital, said HIV prevalence among inmates was higher than the national average. He urged the Government to invest in the management of HIV/AIDS and Tuberculosis (TB) in prisons to reduce more infections.

“This investment should consider timely diagnosis, early treatment, observing the dosage strategy, ensuring that HIV inmates are screened for TB and those with latent TB receive isoniazid treatment so that they don’t develop fullblown TB,”Andama explained.

Andama said prisoners’ misuse of sharp objects has worsened the situation. And due to shortage of counsellors, many inmates find it hard to cope with their condition.

Johnson Wavamuno, an inmate in charge of prisoners living with HIV in Luzira Upper Prison, says the limited number of counsellors due to understaffing leaves inmates unable to deal with the consequences of HIV.

He says more trained counsellors should be attached to the detention facility.

HIV at a glance

According to AVERT-An international HIV/AIDS charity, the number of people living with HIV globally rose from around eight million in 1990 to 34 million by 2010.

The World Health Organisation (WHO) statistics for 2010 corroborate this figure. WHO adds that 17% of people living with HIV by 2010 were women.

The overall spread of the epidemic, according to AVERT, has stabilised in recent years. The number of AIDS-related deaths has also declined “due to the significant increase in people receiving antiretroviral therapy.”

Since the beginning of the epidemic, nearly 30 million people have died from AIDS-related causes.

In 2010 there were an estimated 23 million people living with HIV in Sub- Saharan Africa.

This has increased since 2009, when an estimated 23 million people were living with HIV, including 2.3 million children.

In Uganda, incidence rates have stalled at 6.4%. According to the Uganda AIDS Commission (UAC), close to 128,980 people acquired HIV/AIDS last year up from 124,261 in 2009.
UAC estimates that 64,016 people die in Uganda from HIV/AIDS per year.