By Matthias Heilke (Intern CEHURD, 2014)

A Chinese quarrying company, China Communications Construction Company (C.C.C.C), has deprived two villages in Mukono District, Bamutakudde and Kiryamuli of their right to health and right to a clean and healthy environment. The company, which operates a large quarry in Bamutakudde and Kiryamuli villages, has been uprooting trees and tearing apart earth, polluting the stream from which the two villages collect all their water. The company practices “dry quarrying”, which throws up stone dust that throttles the villagers’ plants and gets into their lungs. The explosions used for quarrying damage villagers’ homes and give them terrible stress.

The right to health means more than just getting care if you are sick. It also means living in an environment that is safe for your health and having access to safe water. CEHURD recognizes this fact, and we have brought a case to the High Court of Uganda to enforce those rights.

CEHURD visited Bamutakudde and Kiryamuli earlier in May to inspect the condition of the villages. By the time we became involved, the residents had petitioned Mukono District Local Government and held peaceful protests, to no avail. The district authorities in Mukono had rebuffed to intervene, and C.C.C.C. had promised better practices, only to break its word. Now, the torn-up earth nearly reached the stream. Much longer, and the stream would be permanently buried underneath a few tons of rock and dirt. We quickly filed a case against C.C.C.C. and the two government agencies that had ignored their duty to supervise them (Civil suit No. 172 of 2014).

The environmental focus of the claim makes it especially strong. The Constitution of Uganda only mentions the right to health in its National Objectives, which Ugandan courts often decline to enforce them. The Constitution is more blunt about environmental rights: “Every Ugandan has a right to a clean and healthy environment” (Article 39). There are more detailed articles that detail the government’s duties, as well. Anyone who sees the conditions in Bamutakudde and Kiryamuli would realize that the quarry is making their environment unclean and unhealthy, so the villagers have a strong case that their rights have been violated.

We also filed for an interlocutory injunction (Misc application No. 290 of 2014 (arising out of civil suit No. 172 of 2014), and an interim injunction (Misc Appln. No. 291 of 2014, arising out of Misc Application No. 290 of 2014). An interim injunction means that the registrar orders the defendant to stop doing whatever it is doing while the court considers the actual case. That way, the court’s final ruling doesn’t come too late to matter. For instance, if C.C.C.C. were to bulldoze the stream while the High Court was hearing the actual case, it might be impossible for anyone to restore the stream — so we want an injunction to make sure the stream is protected until the final ruling is made. The registrar plans to release her ruling on the interim injunction on 14th July.

Even though the court has not yet ruled on the interim injunction, much less the main case, we are starting to see practical results. C.C.C.C. has been digging a trench around the stream in hopes that dirty water will stop flowing into it. There is talk of repairing houses that have been damaged. We still need a court order, of course, to make sure that C.C.C.C. doesn’t revert to its damaging practices and to get the government to start supervising properly. Still, the practical results in the case show how litigation can advance human rights.

Today July 4, 2014, the High court of Uganda will give its ruling in the miscellaneous application filed by the Center for Health Human Rights and Development (CEHURD) against C.C.C.C, NEMA and Mukono District Local Government for violation of rights to health and right to clean and healthy environment. PRESS STATEMENT

By Joan Kabayambi:

A global report released this month (May 2014) reveals that maternal deaths have declined by 45% since 1990. There were 523,000 deaths that occurred from complications in pregnancy or childbirth in 1990; in 2013, that number was 289,000. This new data  published in “Trends in maternal mortality estimates 1990 to 2013” is under the collective authorship led by World Health Organization (WHO) and includes UNFPA, the United Nations Children’s Fund (UNICEF), the United Nations Population Division (UNPD) and the World Bank Group.

The figures were produced through an academic collaboration with the National University of Singapore and the University of California, Berkeley. The data, which come from dozens of studies and improved methods of estimating births and deaths, are considered more reliable than previous assessments.

Despite this global progress, most countries are not on track to meet the fifth Millennium Development Goal (MDG 5) target on maternal mortality, which is cutting maternal mortality ratio by 75 % by 2015. The report reveals that just 10 countries account for around 60 per cent of all maternal deaths: India (50,000), Nigeria (40,000), the Democratic Republic of the Congo (21,000), Ethiopia (13,000), Indonesia (8,800), Pakistan (7,900), the United Republic of Tanzania (7,900), Kenya (6,300), China (5,900) and Uganda (5,900).

According to 2011 Uganda Demographic Health Survey, Uganda’s maternal mortality rate was found to be 438 per 100,000 live births. However, this was within 95% confidence within the confidence interval of 368 – 507 per 100,000. Considering that in 1995 MMR was 505 per 100,000 and today it is said to be 438 per 100,000, this change is not statistically significant.

With a few months to the MDG year of 2015, it also shows that sub-Saharan Africa is still the riskiest region in the world for a woman to give birth. Although Chad and Somalia have the highest lifetime risk of maternal death, Uganda accounts for 2% of annual maternal deaths globally.

This translates into 492 maternal death per month and 16 deaths per day. This is a very high figure and yet we also know that most of the deaths are not captured by the health information management system which was the source of the maternal mortality estimates. One wonders how the mothers that died at home or on the way or never made it to a health facility are counted or estimated.

Although the new data reports Uganda as “making progress” on MDG 5, it is clear that Uganda will not be on track in the next 7 months to meet its MDG 5 target unless a miracle happens.  There is still a lot to be done to improve the national healthcare delivery systems and maternal health services in particular which continues to face serious challenges.

What is killing the women? New data says the worst place to be pregnant is sub- Saharan Africa where one (1) woman out of 40 die of maternal death compared to 1 out of 3300 women in Europe. The pattern of causes of maternal death has changed and now topped by pre-existing medical conditions accelerated by pregnancy like diabetes, malaria, HIV, and Obesity (28%), bleeding (27%), Eclampsia (14%), sepsis (11%), obstructed labour (9%), unsafe abortion (8%) and blood clots (3%) as opposed to the conventional known highest cause of death which has been bleeding.  Like it is today with general population, the disease burden profile in pregnancy is changing from communicable to non-communicable diseases.

What more can be done for Uganda?

Health systems must be strengthened, with quality facilities, personnel, equipment and medicine made accessible to all women. Comprehensive sexuality education and services for young people must also be made available. Supervised deliveries, improved antenatal services and increased use of contraception, access to emergency obstetric care, ensuring skilled medical attendance to mothers at birth, universal access to family planning and antenatal care.

Many efforts to improve maternal health care are currently underway. Ministry of Health and its partners are working on the ground to train health workers – particularly midwives – and to distribute life-saving supplies such as clean delivery kits (Mama kits) also supports voluntary family planning services, comprehensive sexuality education and emergency obstetric care.

But healthcare solutions are not enough. The human rights of women and girls must also be prioritized.
Improving roads to facilitate access to health units, provision of standby ambulance for referral, car and bicycle ambulances, telephone communication to health units and carrying out public sensitization campaigns.

As a country, we should purpose that for “every mother that is pregnant to term there must be a baby to go back with, and for each baby there must be a mother to go home with” But there is also a challenge of mothers not going to health facilities for delivery in preference for traditional birth attendants. The government and community should also purpose that each pregnant mother in the community should go to a health facility to deliver.

Most importantly, more accurate data is needed; it is believed that only one third of all deaths around the world are recorded. We need to document every one of these tragic events, determine their cause and initiate corrective actions urgently. When more is known about how many women are dying, and more is also known about the reasons behind their deaths. This will help policymakers and public health officials design better interventions.

Joan is MakSPH – CDC Fellow attached CEHURD

By James Zeere:

As a consequence of an on-going advocacy process to regulate tobacco consumption and to ratify the provisions of the World Health Organisation’s (WHO) Framework Convention for Tobacco Control (FCTC), the Tobacco Control Bill has been presented before parliament of Uganda.

The WHO FCTC sets the minimum global standards for all its signatories to implement in the control, production and distribution of tobacco and its products. Introduced by Hon Chris Baryomunsi as a private members Bill, the Tobacco Control Bill prescribes standards to be adopted by the Government of Uganda to regulate the production, supply and consumption of tobacco products in Uganda.

The key objects of the Bill are built around controlling consumption, demand and supply of tobacco products by the public, protecting the environment from effects of tobacco and promoting the health of persons by reducing tobacco related illness among others. It is not only the duty of every citizen of the republic of Uganda to create a clean and healthy environment under Article 17 (j) of the constitution but it is also the right of every citizen to enjoy a clean and healthy environment under Article 39.

The personal right to consume tobacco products cannot be completely ruled out but the constitution permits the limitation of the enjoyment of any right in public interest under Article 43. It is on this basis that Tobacco Control Bill proposes among others that a person should not be allowed to smoke in an outdoor space within 100 meters of any public place or transport, or any window or air intake mechanism of a public place, or any place for service of food or drink or any designated non-smoking area.

The Bill confronts the tobacco control fight by going after the public demand for consumption of tobacco products. It has always been alleged that most consumers of tobacco products have no idea what they are consuming and barely understand the addictive nature of tobacco products.

To deal with this, the Bill places restrictions on advertisement, promotion, packaging and labeling of tobacco products so as to eliminate any aesthetic appeal the tobacco industry may attach to tobacco products through either advertisement or packaging. Tobacco control advocates insist that the public should be empowered with information about the effects of tobacco consumption which the tobacco industry has conveniently omitted to provide so that when a person consumes a tobacco product they do so knowingly; a form of informed decision making.

By eliminating the demand for tobacco products, it is envisaged that tobacco consumption will drop and without a sustainable market, production will make no business sense for the tobacco industry. It is not in contention however that the tobacco industry is a major player in Uganda’s economy and not only gives the government a significant amount of revenue but also provides jobs for a lot of people in the country.

Should the Tobacco Control Bill achieve its objectives, the tobacco industry could be pushed out of the country and so will all that revenue and employment. This is not something the government will take lightly when assessing the relevance of the Bill.

From a public health perspective however, it is in the interest of the government to control how tobacco is consumed in Uganda because despite all the revenue that may reaped from tobacco production, the cost of treating the diseases burden created by tobacco far outweighs all the revenue that tobacco contributes to the government.

The World Health Organisation (WHO) has reported that for every dollar tobacco contributes in revenue three dollars are spent on treating related illnesses. Tobacco farming has however has been documented to have a negative effect on not only farming but also forestry because being highly labour intensive farmers cannot engage in other income generating activities yet a lot of firewood is needed for curing the tobacco respectively.

Kyankanzi district and Arua district which rank among the poorest districts in the country have paid the heaviest prices nationally for concentrating on tobacco farming which has reaped very low yields and thus income for them compared to other farmers who have abandoned tobacco for other food stuffs.

Cumulatively speaking there is no benefit either the government or the public derives from production or consumption of tobacco. The tobacco industry has repeatedly masked this fact behind the smoke screen of revenue and employment opportunities but the bigger picture reveals that more harm than good is being done. From increasing the incidence of non-communicable diseases to deforestation to soil degradation to perpetuating poverty among rural households, the tobacco industry is damaging several lives and households across Uganda.

The Tobacco Control Bill is as such a timely intervention and it is only imperative as it is its duty that the government gets behind the Tobacco Bill to protect the public from the negative effects of tobacco production and consumption.

Zeere James Samuel is a Human Rights Lawyer working with Human Rights Documentation and Advocacy at the Center for Health, Human Rights and Development (CEHURD)
Email: james.zeere@gmail.com Twitter: @james_zeere

By Juliana Nantaba:
The Institute of Tropical Medicine in Antwerp, Belgium (ITM) is one of the leading institutes for training, research and assistance in tropical medicine and health care in developing countries. Through my work as a project officer on CEHURD’s GO4HEALTH research project collaborated by ITM, I was informed about the 7 week specialization short course on Health Policy for health professionals and researchers involved in health systems.

After undertaking this short course, it is a hard task to write about the experience in only age, so I will only give you a glimpse. The course kicked off in March 2014 with a class of about 20 participants with various backgrounds including political science, psychology and sociology, economics and medicine.

Even though I was the only lawyer among the participants, their diverse backgrounds and work experience from different low and middle income countries in Africa, Asia and Latin coupled with that of faculty professors gave me a memorable, productive and invaluable understanding on various public health issues.
Through out the course period, we progressively navigated through different health policy issues in public health. These were covered under three modules titled; 1) health policy analysis, 2) right to health and 3) Health System Reform.

These were covered through lectures, group work, and use of case studies and innovative methods like “fish bowls” with the support of resource persons. Within each module we analyzed various aspects in health systems, their challenges and also drew examples from various country contexts on strategies to address the problems as well as possible solutions.

Interestingly and also very relevant for me, was the fact that all the discussions were also done in-light of current global health and global issues like the move towards Universal Health Coverage, realizing the right to health, access to medicines issues, post 2015 MDGs Agenda and Sustainable Development Goals(SDGs) and roles of various stake holders.

As such, the course did not only tackle issues theoretically but gave me an opportunity to apply available theories to practical situations and health system challenges from all over the world and most importantly to my research as a lawyer working in the public health environment in Uganda. Another valuable element of this course entailed attending various seminars and public defenses for PhD students.

At this point you are wondering, “was it all work and no play?” of course not! The ITM student service organized various activities to enable the students visit various places including the city of Antwerp, Brugge, Amsterdam and my personal adventure with friends to Gent and Paris.

Special thanks to the various GO4HEALTH partners especially in work package 2 for your effort and interest in building capacity of young researchers who are part of the project, to the office of the Director  General for Development cooperation, Belgium for the study scholarship and to the CEHURD staff for their support through out the course.

After my ITM experience, I feel very energized, equipped and ready to take on health system research and advocacy and contribute to litigation for realizing the right to health in Uganda. All this I am ready as a lawyer with a perspective appreciates various public health issues.