JUDGEMENT: Supreme Court orders the Constitutional Court to hear Maternal Health Cases

The judgment struck down a 2012 ruling by the Constitutional Court that it had no mandate to hear a case regarding the alleged violation of health rights and the rights of women.

The case had been filed by families of two pregnant women who died in childbirth and the Center for Health Human Rights and Development (CEHURD) against the Attorney General in 2011 (Constitutional Petition No. 16 of 2011), arguing that non-provision of maternal health services in Uganda violated the Constitution.

The Attorney General argued on preliminary objection that issues relating to health rights were “political questions”—matter that the Judiciary had no authority to address. Constitutional Court agreed with the State’s objection and dismissed the case.

The Supreme Court’s ruling struck down the Constitutional Court’s judgment, and means the original case can now be heard on its merits.

“With great respect to the Constitutional Court, I think they misunderstood what was required of the court. I do not think the court was required to determine, formulate or implement the health policies of government. In my view, the court is required to determine whether the government has provided or taken all practical measures to ensure the basic medical services to the population. In this case it is maternal services in issue” Bart M Katureebe, Chief Justice

 

 

Supreme Court to deliver Judgment on Maternal Health Rights in Uganda

The Supreme Court of the Republic of Uganda is on Friday 30th October, 2015 at 9.30a.m expected to deliver Judgment on whether maternal health rights are justifiable in Uganda.

In a case filed by the Center for health, Human Rights and Development (CEHURD), Mr. Inziku Valenti, and Ms. Rhoda Kukiriza against the government of Uganda, the petitioners sought remedies for non-provision of basic maternal health commodities in public health facilities in Uganda that led to death of their loved ones.

CEHURD and its co-petitioners argued that the public are affected by the non-provision of basic maternal health commodities in government health facilities, and that the imprudent and unethical behavior of health workers towards expectant mothers was unconstitutional and an abuse of poor women’s rights to access health services.

The petitioners relied on evidence that;

  1. The death of a one Sylvia Nalubowa (daughter of Ms. Rhoda Kukiriza) in Mityana hospital due to non-availability of the basic maternal health kits in the district hospital and the unethical behavior of the health workers towards her violated her constitutional right to life and health.
  2. The death of Anguko Jennifer (wife to Mr. Inziku Valente) in a regional referral hospital in Arua also due to non-provision of the basic maternal health commodities and the reluctance of the health workers towards this expectant mother leading to her death was an infringement of her rights to life and health guaranteed under the constitution of Uganda.
  3. Non provision of the basic maternal health commodities to expectant mothers (evidence gathered from community health facilities) and the failure on the part of health workers to exercise the requisite health care leads to death of children hence an infringement of their rights guaranteed under the Articles 22, 33 and 34 of the constitution.

The constitutional Court absconded from hearing the merits of the case on a preliminary objection raised by the attorney General’s Lawyer that the Court did not have the authority to handle matters of that gravity. The court was of the opinion that the issues the petitioners had put to court were of a political nature that necessitated the intervention of the Executive to allocate resources to the health sector and none of courts business to intervene.

As a matter of fact and law, CEHURD, Ms. Rhoda Kukiriza and Mr. Izinku proceeded to appeal that decision to the Supreme Court on the basis that the Constitutional Court erred in law in refusing to listen to the merits of the case. It is this decision that Court will be making Judgment on Friday 30th October, 2015 at the Supreme Court of Uganda.

The Judgment is particularly important because the Ugandan Constitution does not provide for a right to health and in addition makes no commitments or priorities for health financing for primary health care for Ugandans from a legal perspective.

High-Court

Utilizing social media to realize maternal health rights – the #selfie4her campaign

Social media has tremendously grown to sensitize people on their rights. A number of communities have engaged on different social media platforms including but not limited to Twitter, Facebook, Whatsapp, and Instagram, and in one way or another there have been massive campaigns geared towards realization of rights.

With text, photos and info graphics, users of the different social media platforms have developed techniques to target not only the rights holders but also the duty bearers. This they do either by tagging the duty bearers themselves onto the different posts or ensuring that the initiated campaigns are popularized with clear explanations on how to get involved.

Once a campaign takes shape, there is community attraction and support for the same and this on many occasions leads to the much desired change. A number of publicly known successful campaigns have started in social media; take for example the case of a maid that mistreated a child in Uganda, whose video clip went viral on social media. What started as a simple post in social media turned out to be the centre of debate across the country for some good time. To-date, a mere mention of the “maid from hell” – like she was tagged – anyone can give you the whole chronology of the case.

Center for Health Human Rights and Development has for a long time focused efforts towards the realization, protection and preservation of human rights, key among which are maternal health related rights. In a bid to realize these, and given its experience in advocacy, CEHURD initiated a new media campaign, the #selfie4her campaign, to amplify citizen voices in the fight to end preventable maternal mortality. This campaign was launched in March 2015 during an east African media fellowship organized by CEHURD, that brought together journalists from the East African region to discuss sexual reproductive health rights issues.

This social media campaign set out to advocate for maternal health rights with reflection that it would in the end lead to an influence of the national budget to at least have 15% of it diverted to the health sector given that it greatly contributes to maternal deaths in the country.

The campaign has since gone viral with different people posting selfies for a woman’s cause. It is one of the simplest campaigns you could think of and it is very easy to follow;

  1. Take a picture of yourself and post it on any social media platform
  2. Or, take a picture of yourself and a mother
  3. Or post a picture of a health facility that could be bad or ideal

With either of the above, one posts a picture with a message aimed at improving lives of women.

CEHURD has not stopped at posting and inviting people to post but its methodology is quite distinctive. We have gone ahead to speak about the same on different TV and radio stations. This has created more attention to and recognition of the same. We have also linked the campaign to other key heath related issues like the planned exportation of health workers to Trinidad and Tobago and health budget advocacy. We hope that you can also join the campaign, and remember the #selfie4her is your hash tag.

By Nakibuuka Noor Musisi and Vivian Nakaliika

Why health literacy is important in improving maternal health

There is a common belief that pregnancy and child birth is a test of endurance and maternal deaths are just a sad occurrence that in one way or another could not have been avoided; and any woman who evades the traditional birthing practices and delivers by caesarian, is weak and cannot endure pain and suffering that women were born to endure by virtue of them being women. This mentality has resulted into very dangerous practices in which women delay seeking assistance during labor and by the time they realize they are obstructed, it’s too late and they cannot access emergency obstetric care in the nearby health facilities thus end up losing their lives. This coupled with other delays such as distance from the home to the nearby health facility, the health facility’s capacity to manage obstetric complications and the failure to utilize health facilities because mothers do not understand the relevance of the treatments or do not ever seek such services because of ignorance of their existence; all contribute to the high maternal mortality rate in Uganda.

Although maternal mortality in Uganda has declined from 527 deaths per 100,000 live births in 1995, to 438 deaths per 100,000 live births in 2011, this still falls way below the MDG target of 131 deaths per 100,000 live births by 2015. This translates into an annual decline rate of 5.1% and an average of 18 women dying every day. It remains evident that many mothers are still dying as a result of pregnancy related complications and as shown in the Reproductive maternal, Newborn and child health Sharpened plan for Uganda; November 2013 which highlighted the highest maternal mortality to be in Eastern, Western, North and the Karamoja regions and lowest in Central the central region.

Although there has been strong commitment from the Ministry of health and government at large to address preventable causes of maternal morbidity and mortality, there is still generally low turn up for health services in rural areas as expectant mothers prefer receiving care from traditional birth attendants other than health facilities and often mix conventional medicine with local herbs.

Many women choose not to go to health facilities because they do not understand why they are being subjected to tests or why certain medication is important in saving their lives and that of the baby. This is so because most women in rural areas are illiterate and therefore rely on ancient family practices, rumors, myths and misconceptions associated to pregnancy and child birth. Even where women endeavor to visit health facilities for antenatal care, health providers ignore communicating certain information that is important in advising them accordingly on the dangers of prolonged labor and what signs to look out for in order to identify complications that may in one way or another cause obstruction in delivery of the baby which may endanger the mother’s life.

We as Ugandans must keep our mothers, wives, sisters and daughters alive by doing what we can to reduce preventable maternal deaths from happening. Many of us think about saving the child’s life and not the mother’s, but there is a link between child mortality and maternal mortality and it’s indelible. Research and practice have shown that infants whose mothers die within the first 6 weeks of their lives are most likely to die before reaching the age of 2 than infants whose mothers survive child birth. This shows that a child’s survival is dependent on the survival of the mother.

We can therefore only improve access to and delivery of maternal health services in rural areas through Health literacy amongst health providers, women and girls of reproductive age, men, cultural and religious heads etc. There is need for appropriate interventions to address the existing barriers between rural mothers and the formal health care system, this should include health literacy for both men and women in rural communities and health providers on a human rights based approach to service delivery such that we reduce mother’s seeking care in more traditional or homeopathic environments.

In this century, with drugs and commodities to save lives, no woman should have to die due to lack of reproductive health choices or worse still, have to give her life to give life. We can all make it happen for all the women in our lives.

By Florence Nabweteme.

Luuka District Hospital finally gets Maternity Ward

Giving birth, though painful, is supposed to be a joyful process, a process of pride that reflects the dignity of a woman and puts her aside as the mother of all humanity. But this is not always the case as mothers have across the country been forced into giving birth under terrible and inhumane conditions that degrade all the dignity that women are naturally entitled to given their life giving role in society. Such has been the plight of women in Luuka District who have been subjected to giving birth under trees and in dingy squalid and dirty rooms when it rains because there has been no semblance a premise in the form of a maternity ward where women can be taken to give birth.

It all started in 2012 when fire gutted the maternity ward at Kiyunga Health Center leaving the health facility without a maternity ward. This left the facility bereft of options of how to handle the cases of pregnant mothers that came to the hospital and what followed is a harrowing tale of just how far the challenges of the decentralized system of health system management in Uganda can become synonymous with decentralisation of health rights violations. Luuka District it should be noted is one of the newer districts in Uganda and its facilities haven’t been upgraded to reflect its District status so Kiyunga Health Center is operationally a District hospital for Luuka District without the capacity to serve as a district Hospital. Therefore when the maternity ward was burnt down leaving the district without a maternity ward it became a case of stealing from the church mouse.

Concerned by the on-going human rights violations at the health facility, CEHURD took special interest in the matter and led a fact finding mission to establish the state of affairs at the facility which confirmed the worst of our fears that indeed mothers were giving birth under trees, on verandas and in dingy rooms because the maternity ward had been burnt. Unfortunately the Luuka District Local Government which is mandated with administration of health facilities and provision of medical services at that level did nothing to rectify this situation because apparently protecting the dignity of mothers giving birth in the district is not one of the financial priorities of the District.

CEHURD begun a process of engagement of the district authorities to prioritise the renovation and restoration of the maternity ward at the hospital to the extent of issuing a notice of intention against the district authorities to sue for the continuing violations of the rights of women in the district. Despite the slow reaction to the needs of the women in Luuka District, CEHURD is pleased to confirm that our efforts have paid off and following a resolution by the District Local Council Meeting held in December 2014, funds have been specifically committed to the reconstruction of the maternity ward at Kiyunga Health Center in Luuka District.

In a recent meeting with the Chief Administrative Officer Luuka District, the Chairman LC3 Kiyunga, the District Secretary for Health and CEHURD representatives, the CAO confirmed that the District has committed funds for the reconstruction of the Maternity Ward and showed CEHURD representatives a copy of a Memorandum of Understanding entered between the district and the UPDF Engineering Brigade for the reconstruction of the ward. We appreciate the Luuka District Local government for finally seeing sense in the situation and avoiding litigation to prioritise the rights of mothers in the district. CEHURD will continue to monitor the developments for the expeditious reconstruction of the ward to immediately rectify the on-going violations of the maternal health rights at the health facility.

By James Zeere

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