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Unpacking prospects and challenges of litigating the right to health in Uganda

By Nakibuuka Noor Musisi
Since time in memorial, maternal Mortality has continued to be a daunting concern in the health sector of Uganda. Today, the country faces over 438 maternal deaths per 100,000 live births (UDHS 2011). This statistics has been rounded off to 16 women loosing life on a daily basis, and indeed this can be summarized into one mini bus crashing every day. This number is way high and with the 500 days left to end of Millennium development goals, Uganda is most likely not going to achieve MDG 5.

Regardless of all efforts that have been made to ensure that such rates are curbed, there has been one missing link, which is the use of the judiciary. It was not until 2011 that Uganda saw a move towards litigating the right to health. This came with CEHURD’s intervention of filing a case against the government for non provision of basic maternal health commodities in public health facilities leading to death of expectant mothers.

The filing of the case has since seen a number of civil society organizations working in the area of health come together under the umbrella of coalition to stop maternal mortality to advocate for the right. For the first time in Uganda, a communication platform was formed. Today, the coalition has over 60 organizations ranging from different walks of life including health, human rights, women’s organizations, HIV/AIDS and community-based organizations and it fights to end the crisis of preventable maternal mortality in Uganda through policy, advocacy and grassroots mobilization. It has been very instrumental in not only supporting the case but also ensuring that the right is realized.

The formation of the coalition has always seen a big turn at each court hearing. Despite the court’s ruling that they do not have the mandate to hear and determine the case (political question doctrine), the spirit of the organizations and communities in turning up to court has not dwindled. This is evident enough to show the sanguinity communities still hold in courts.

A lot of advocacy has evolved both at the national and community levels. This resulted into filing of yet another case, Civil suit No. 111 of 2012, CEHURD Vs. Nakaseke District local government seeking for declarations on violation of the right to health, rights of the child, family and freedom from cruel, inhuman and degrading treatment.

The case relates to the death of Nanteza Irene, a mother that stayed in the health facility for hours without according her a caesarean operation until she died. The filing of the case has seen vibrant changes in provision of services at the health centre.

Increased media coverage, increment in health budget, passing of a resolution by the Honorable members of parliament on maternal health, formation of a legal advisory experts group, among others has been some of the achievements prompted with litigating the right to health.

Other cases that have been filed out of the outreaches and advocacy include civil suit No. 212 of 2013, a case of the lost baby at Mulago national referral hospital and access to patient information, civil suit No. 172 of 2014 a case on right to health and right to a clean and healthy environment, Complaint lodged against Dr. Bingi Christopher for his un ethical behavior towards an expectant mother, and complaint lodged with Uganda Human rights Commission for Violating right to health as a result of UMEME’s load shedding of public health facilities.

The prospects have not gone without challenges. Delayed court response when cases are filed is one challenge that has and is still delaying the realization of the right to health. The Attorney General and other defendants also play a role in delaying justice. One can actually conclude that they many times do not take the cases seriously.

This is not to mention the challenges met with media sensitization and ensuring that they understand the argot on justiciability of right to health. Communities expect a lot from us yet helping them understand the importance of asking and keeping information as well as appearing as witnesses in court is a problem.

Therefore despite the many prospects associated with litigating right to health, especially in ensuring that provisions of the constitution like article 45 and 8A are tested where there is no express provisions on rights like health in the Constitution,  litigation has been faced with many challenges.

The delays and continued adjournments of cases due to a number of factors have contributed to low progress in realizing the right to health. The voice added by the court of public opinion has however been important in ensuring that these challenges are surmount. The coalition to stop maternal mortality, legal expert’s advisory group among other stakeholders is thus applauded for its continued efforts, advocacy, and time towards realizing the right to health

Mukono residents want quarry company closed

By Anthony Wesaka

Residents of BA group of Mukono residents has sued a stone quarrying firm – China Communications Construction Company for allegedly violating and depriving them of their rights to a “clean” and “health” environment.

The residents from the villages of Bumutakkude and Kiryamuli, are represented by a civil society group, Centre for Health, Human Rights and Development (CEHURD).

Also sued are, National Environment Management Authority and the Mukono District Local Government.

Nema and Mukono District Local Government have been sued for alleged failure to protect the environment.
In the complaint filed yesterday, residents claim that in 2012, the firm was licensed by Nema to commence stone quarrying in their villages.

The quarry blasts rocks and grades land, which processes, resident say puts them in harm’s way since they emit dust into space
Through their lawyers, Kabanda and Co Advocates, residents want a declaratory judgment that omits the acts of the firm.
They also want court to issue an injunction restraining the firm from carrying out any activities alienating in any way the natural water stream serving the two villages.

Court is yet to summon any of the defendants.
The suit further read: “The third defendant (Chinese firm) has started grading the landscape surrounding the natural water stream which has led to the contamination of the natural stream with mud and rendered the stream inaccessible especially during rainy season.”

Residents also say as a result of stone quarrying, they are suffering health complications resulting from inhaling dust and drinking the contaminated water.

http://www.monitor.co.ug/News/National/Mukono-residents-want-quarry-company-closed/-/688334/2334940/-/4d0pkoz/-/index.html

Prevalence of risk factors for Non-Communicable Diseases among University Students in and around Kampala

It is evident that Non Communicable Diseases (NCDs) are rapidly becoming a major cause of preventable and premature death and illness in Uganda. According to the study, the four NCD-related diseases share common risk factors that include tobacco use, unhealthy diets, physical inactivity, and harmful use of alcohol, as well as high blood pressure and cholesterol.

Today Shisha is the most commonly used tobacco product among youths other than cigarettes and it is more prevalent among females than males. This therefore calls for universities and other tertiary institutions to set up effective mechanisms to help students wishing to stop smoking to do so, and also to expand smoke-free environments. READ FULL STUDY REPORT

Press Statement of the Tobacco Control Forum on World No Tobacco Day 2014

Uganda ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2007. The Convention was negotiated as a Global Intervention to protect present and future generations from the devastating health, environmental and socio-economic effects of tobacco. As a party to this convention Uganda was expected to have domesticated the treaty including enacting a comprehensive law by 2012. READ FULL STATEMENT

“Raise Tobacco Taxes to Reduce and Curb Tobacco Consumption among Youths in Uganda”

TFUToday Uganda joins the rest of the world in recognizing the devastating effects of Tobacco use and exposure to tobacco smoke on human lives. This year’s world no Tobacco Day (WNTD) is being commemorated at a time when the Tobacco Control Bill has been tabled before parliament for debate.

It also coincides with a health awareness campaign facilitated by the Center for Health, Human Rights and Development (CEHURD) in four Universities of Makerere University, Uganda Christian University, Kampala Internal University and Nkumba University Funded by the United Nations Development Program (UNDP) Uganda Country office.

The campaign is based on findings from a survey done in the four Universities in 2013. The survey discovered that at least 50% of university students had no information as to what causes Non Communicable diseases.

It should be noted that Tobacco is the leading cause of NCDs. And that majority of smokers in the world today begin smoking long before they are 18 years of age. The World Health Organization (WHO) estimates that 70 percent of premature deaths in adults are the result of behaviors begun during adolescence and youth.

Behavioral researchers on Non Communicable Diseases (NCDs) have also established that behaviors associated with two of the key risk factors for NCDs—tobacco and alcohol use—are likely to start or become established during adolescence.

In 2006, the Uganda demographic Health Survey established that 22% and 4% of Uganda’s adult males and females between the ages of 15-49 respectively are habitual smokers, while the Global Youth Tobacco Survey (GYTS) of 2010 stated that 15% of boys and 13% of girls in secondary schools start smoking annually.

In 2011, WHO Country NCD profile estimated Uganda’s mortality due to NCDs at 64/1000 for males and 42/1000 for females and reported a daily tobacco smoking rate of 12.3% among males and 1.5% among females.

Today youths especially in urban areas are reported to be smoking Shisha – a glass-bottomed water pipe in which fruit-flavored tobacco is covered in foil and roasted over charcoal. WHO studies report that smoking a pot of shisha is equated to one who has smoked 200 cigarettes, which factually means that shisha is a more dangerous option.

Despite the growing popularity of shisha smoking among urban youths, university students and young professionals and the presence of National Environment (Control of Smoking in Public Places) Regulations of 2004 mandating a smoke-free environment, and prohibiting smoking in public places, the practice remains largely unregulated.

Tobacco use and exposure are a leading public health problem in our country. They are a detriment to development and worsen poverty. Studies conducted in tobacco growing areas have reported that a tobacco farmer earns only 33% of the basic household expenditure of an average Ugandan; the farmer suffers cases of green tobacco sickness caused by poisoning from exposure to nicotine absorbed during cultivation and harvesting tobacco; the community is exposed to food insecurity as most of the land is devoted to tobacco farming; and four (4) in every ten (10) boys and six (6) of every ten (10) girls of school-going age are unable to join schools in tobacco-growing areas because they are working in Tobacco Fields.

As a party to the WHO Framework work Convention on Tobacco Control (FCTC), Uganda is obliged to put in place and implement tax and price policies on tobacco products as a way to reduce tobacco consumption.

Research has proven that increasing taxes on tobacco products effectively reduces consumption of tobacco products among poor people and acts as a deterrent to young people who would otherwise start smoking. WHO reports that a tax increase that increases tobacco prices by 10% decreases tobacco consumption by up to 8% in low- and middle-income countries.

Furthermore, focusing on cessation measures for youths and adolescents presents Uganda with an opportunity to reinforce the benefits of positive behaviors that could cut the projected burden of NCDs by half or more if we paid attention to health promotion and disease prevention.

Civil Society Organizations therefore urge the Government to;
• Increase taxes on tobacco products to levels that reduce tobacco consumption by youths in the financial year 2014/15. Uganda’s taxation policy on Tobacco products is still lagging at a paltry 42%, far below the industry’s international threshold of 70 per cent of retail price.
• Ban smoking in public places, advertising, promotion and sponsorship of tobacco related events that are aimed at encouraging youths to start smoking.
• Increase the resources for smoking cessation services in community health centers
• Offer smoke-free education and promotion in schools.
• Pass the Tobacco Control Bill of 2014:

Enforcement measures in this bill will protect Ugandans from the devastating health, social, economic and environmental consequences of tobacco use and exposure to tobacco smoke by, imposing bans on smoking in public places and tobacco advertising, increasing taxes on tobacco products and restricting government alliances with the Tobacco Industry.