By Peter Eceru – Programme Coordinator, Advocacy – CEHURD

Currently, the East African Legislative Assembly is undertaking regional consultations on the Sexual and Reproductive Health Bill, 2021 in the all-members states. The Bill is premised on Article 118 of the treaty for the establishment of the East African Community which provides for cooperation in health and promotes the management of health delivery systems and better planning mechanisms to enhance the efficiency of health care services. The East African Community treaty also seeks to harmonise national health policies and regulations in order to achieve quality health care in partner states. The treaty also looks at cooperation in the development of specialised health training, health research, reproductive health, pharmaceutical products and preventive medicines.

The Bill further seeks to strengthen the mechanism that facilitates attainment by the Community of the goal to ensure universal access to sexual and reproductive health care services by 2030. These services include family planning, information and education, and the integration of reproductive health into national strategies and programmes. This goal is enshrined in the EAC Integrated Reproductive Maternal, New-born Child and Adolescent Health Policy Guidelines 2016-2030, and the EAC Sexual and Reproductive Health Rights Strategic Plan.

The Bill recognises the obligation of Partner States under several international, continental and Community frameworks, to respect, protect and fulfil the right to health. They do this by facilitating, providing, and promoting the highest attainable standard of health and providing measures toward the full realisation of the right to health. Bill will strengthen the mechanism to facilitate the attainment of the Community goal of ensuring universal access to sexual and reproductive health care services, including family planning, information and education.

The Reproductive, Maternal, Newborn, Child and Adolescent Health indicators in the East African Community member states are worse than the average in the rest of Africa. High maternal and mortality rates for children under five, high unmet need for contraceptives and adolescent fertility rates demonstrate a need for collective action across the community to respond to the sexual and reproductive health challenges. In 2020, 39,000 children in East Africa were born with HIV infections that could have been easily prevented. During the same period, 62,000 mothers died from childbirth complications that could have been easily addressed. Two hundred million girls and women are estimated to have undergone genital mutilation. Additionally, cervical cancer remains a leading cause of cancer-related deaths in African women, where the estimated rate of deaths is 94 women per 100,000. Currently, 19 million women in East Africa cannot access modern contraception and a further 2.5 million are at risk of death due to complications from unsafe abortions. The Covid-19 pandemic led to a very big increase in violence against women and girls all over the East African Community putting the future of millions of women and children in jeopardy.

Indicators across the different countries in the region vary in terms of severity. For example, South Sudan has the highest maternal mortality rate within the Community with 1,150 deaths per 100,000 women who give birth, while Rwanda has the lowest at 248 deaths per 100,000 women giving birth. These variations demonstrate the need for collaborative health systems planning and how this would benefit the region in dealing with high mortality rates within the East African Community Member states. Various countries have over time developed best practices that can be shared across the Community. In Uganda, a weekly maternal death surveillance enables the ministry to follow up on maternal deaths and investigate the causes. This enables timely response.

To strengthen regional Health Information Management Systems, it is critical to have a regional framework to guide this. The collection of data on for example contraceptive use, sexual and reproductive health and the wider reproductive, adolescent maternal newborn remains uncoordinated across the Community. In Uganda, this information is collected through the Uganda Demographic Health Survey and the Health Information Management Systems. In the case of partner states, different information is collected among partner states and this information is collected along different time periods. This makes it difficult to utilise the information for the purpose of regional planning and collective decision-making. Sound and reliable data is the foundation for decision-making across all health system building blocks and is essential for health system policy formulation and implementation, governance and regulation, health research, human resource development, service delivery and financing.

The consultations on this Bill are therefore a very important process in strengthening regional integration and specific emphasis on the promotion of sexual and reproductive health in the EAC partner states.

A version of this article was first published in the Daily Monitor Newspaper on 6th July 2022.

A total of 63 Health Centre (HC) IVs conducted cesarean sections without blood transfusion services and 38 HC IVs did not provide any emergency obstetric care services in FY 2019/20 because of the inability to access blood or absence of requisite staff.

By Grace Awilli

It is likely that the National Budget Speech will be read today. Incidentally, today also happens to be World Blood Donor Day. The day was first commemorated in 2005 by a joint initiative of the World Health Organization (WHO) and the International Federation of Red Cross and Red Cross societies to raise awareness of the need for safe blood and blood products as well as thank the donors for their voluntary, life-saving gift of blood. It is one of the eleven global public health campaigns marked by WHO as well as the civil society organisations around the world. 

Usually, blood and blood products are essential for the management of injuries, medical illnesses, and childbirth.  However, chronic shortages in blood supply in the country perpetuate the high levels of morbidity and mortality from injuries, maternal loss of blood and treatable diseases. Therefore, a safe and adequate blood supply is crucial in ensuring patients in both emergency and non-emergency situations get access to safe blood to save their lives. According to WHO’s global database on blood safety, a country should be able to collect blood equivalent to one per cent of its population and Uganda with an estimated population of about 48 million collects far below the required amount which in turn leads to a wide shortage of blood in the country and thus loss of lives. In 2021, Uganda Red Cross Society mobilised 152,891 units of blood which were still insufficient in relation to the population of the country.

In Uganda, haemorrhage continues to be the leading cause of maternal death, contributing 42 per cent of all deaths reviewed, with postpartum haemorrhage contributing up to 90 per cent of all haemorrhage cases reported. Thirty-six per cent of maternal deaths occurred among young mothers under 24 years who should have been in school, contributing up to 10 percent of all maternal deaths. It should be noted that a total of 63 Health Centre (HC) IVs conducted Cesarean sections without blood transfusion services and 38 HC IVs did not provide any emergency obstetric care services in FY 2019/20 because of the inability to access blood or absence of requisite staff. It is estimated that 8,400 mothers are being unnecessarily referred to regional referral hospitals because the HC IVs lack the capacity to perform obstetric care due to the lack of blood supplies. Installation of blood fridges at HC IVs would allow these patients to receive on-site care and reduce unnecessary referrals, saving time and effort of the specialised medical staff at the regional hospitals, and reducing transportation costs. The Budget Committee of parliament noted that UBTS collects about 300,000 Units of blood annually yet the actual estimated need stands at about 420,000 Units. This leaves a blood deficit of 120,000 Units annually. In order to meet this gap, UBTS needs to expand its capacity to mobilise, collect and screen enough blood requirements.

It should be noted that low-and middle-income countries frequently have insufficient blood supplies necessary to meet the demand and as a result, patients in low and middle-income countries are frequently unable to access blood units necessary for the transfusion in a timely manner. At times, shortages of blood at hospitals in Uganda, especially in rural areas last for several days and according to statistics from various hospitals, so many people die due to these shortages. Much as Uganda has a national blood transfusion service, there has been a noticeable lack of a steady blood supply available for patients at the different health facilities. The reluctance by the community members to donate blood is attributed to a number of factors including superstition, fear of knowing their HIV status and interruptions in the supply of donor kits and testing reagents. 

Therefore, the WHO recommends voluntary, non-remunerated blood donation and has set a standard of 10 blood donations/ 1000 population as a baseline value for all countries to meet. While on average, high-income counties have 32.1 donations/1,000 population, low-Income countries have only 4.6 donations/1000 population which is really low to meet the high demand for the blood needed by patients. It is estimated that blood donation by only one per cent of a country’s population is needed to meet the basic demand for blood and to achieve this, there is a lot that should be done by Ugandans in order to meet the blood donation standards by WHO and this can only be done by mobilising and encouraging the public to voluntarily donate blood so as to fill the national blood demand. Uganda also needs to improve existing structures for blood collection and enhance allocation to Uganda Blood Transfusion to cater for blood collection and processing.

It is therefore our hope that today’s budget speech will indicate increased funding for blood collection and management in order to save lives. 

The writer is a Lawyer and volunteer in the Campaigns, Partnerships and Networks programme at the Center for Health, Human Rights and Development (CEHURD).

Does it make business sense, if your product killed 8 million people especially when it is addictive?

Tobacco use has remained a significant public health challenge in Uganda and a leading cause of non-communicable diseases including heart diseases and premature deaths. Tobacco is also the only legally available consumer product that kills people when it is used entirely as intended.

Even when the law is in place, tobacco is still used in various forms including smoked and smokeless tobacco. The government needs to strengthen existing schemes to make tobacco producers more responsible for the environmental and economic costs of dealing with tobacco waste products.

~ By Esther Dhafa | Lawyer | Programme Officer – Strategic Litigation programme.

Background:
The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than 8 million people a year, including around 1.2 million deaths from exposure to second-hand smoke (Global Burden of Disease database) Washington DC: Institute of Health Metrics 2009 IHME accessed 17th July 2021.) Tobacco is also the only legally available consumer product that kills people when it is used entirely as intended. It is the single greatest preventable cause of death in the world today, killing up to half of the people who use it.

Tobacco seriously threatens sustainable development in the world’s poorest nations through its impact on human health, high economic costs, and environmental damage due to massive land clearing and extensive felling of trees. In Uganda, tobacco-growing areas are among the poorest regions in the country. Scientific evidence has proved that tobacco farmers suffer from green leaf disease caused by the penetration of tobacco compounds into the skin of farmers while handling the tobacco leaves.

Tobacco use has remained a significant public health challenge in Uganda and a leading cause of non-communicable diseases including heart diseases and premature deaths. Tobacco use is regulated by the Tobacco Control Act, 2015. Section 16 of the law prohibits the sale of tobacco products in specific public places and within 50 meters of those places, bans electronic cigarettes, waterpipe tobacco delivery systems, smokeless tobacco, and flavored tobacco products, prohibits the sale of single cigarette sticks and bans prominent display of tobacco products at the point of sale. Section 17 of the law prohibits the sale of tobacco products to and by persons below 21 years. Even when the law is in place, tobacco is still used in various forms including smoked and smokeless tobacco.

Commemoration of the World No Tobacco Day (WNTD) 2022:
The World Health Organization (WHO) member states created the World No Tobacco Day (WNTD) to draw global attention to the tobacco epidemic and the preventable death and disease it causes. In 1987, the World Health Assembly (WHA) passed Resolution WHA40.38, calling for 7 April 1988 to be “a world no-smoking day.” In 1988, Resolution WHA42.19 was passed, calling for the celebration of World No Tobacco Day, every year on 31 May.

The Center for Health Human Rights and Development (CEHURD) joins Uganda and the world to celebrate World No Tobacco Day and to mark 35 years since its inception in 1987. We are committed to informing the public about the dangers of using tobacco, the business practices of tobacco companies, what the World Health Organization (WHO) is doing to fight the tobacco epidemic, and what people around the world can do to claim their right to health and healthy living and to protect future generations.
Given that this 2022 year’s theme is “Tobacco: Threat to our environment”, we need to be more environmentally conscious as a country, choose more sustainable products, and step up our legislation including implementing and strengthening existing schemes to make tobacco producers more responsible for the environmental and economic costs of dealing with tobacco waste products.

The fact that the cost of tobacco use in Uganda exceeds the benefits, justifies government intervention to control and combat tobacco use in the country and protect youth from industry manipulation. We call upon the Government to further prevent the future generation from tobacco and nicotine use and enforce Uganda’s Tobacco Control Act 2015’s stringent measures that need enforcement.

Call to action:
“Does it make business sense, if your product killed 8 million people especially when it is addictive??? Wouldn’t you be targeting a new generation each year to face the consequences of using the harmful product???”
As advocates for tobacco control in Uganda, we implore the government this World No Tobacco Day in its non-delegable duty- that cannot be outsourced to a third party to:
• Continue to support the implementation of the Tobacco Control Act 2015, the Tobacco Control Regulations, and the WHO Framework Convention on Tobacco Control (FCTC).

•Support activities that promote healthy lifestyle choices and encourage the public to avoid the use of tobacco and related products.
• Educating members of the public themselves to support the Tobacco Control cause through complying with the tobacco control and public health measures in place.
• Create within the National budget a vote to finance the implementation of nationwide tobacco control programming.
• Establish a Tobacco Control Fund that sources funds from development partners and taxes from the Tobacco industry.

The parents were overwhelmed by their child’s condition, they resorted to tying him to a tree as a way of monitoring and protecting him

Background:

In 2016 during one of the community outreaches conducted by the Center for Health Human Rights and Developed (CEHURD), the team came across a minor aged 12 years who hadn’t been growing normally since the age of 4 and whose condition hadn’t been established despite visiting several health facilities. It was later discovered that the child had a severe form of a neurodevelopmental disorder called autism spectrum disorder (ASD).

Prior to this, the parents were overwhelmed by the child’s condition, he would run to other villages and be beaten by community members who didn’t understand his condition. With no other option left to protect their child, they resorted to tieing him to a tree at home whenever they went to the garden, as a way of monitoring him. When CEHURD officials met with the mother, she informed them that she wasn’t proud about tying her son but it was the only way of restraining him from destroying property for the family and community.

Perez’ Medical Condition:

From our conversations with the child’s mother, it was established that when Perez was about four years old, he used to cry a lot in the night and fail to sleep. He was taken to Kidera Hospital where he was first diagnosed with malaria and given treatment which did not work. He was further taken to Buyende Hospital where he was diagnosed with malaria as well. He was later referred to Kamuli-Rubaga Hospital, where they failed to diagnose him and to Nalufenya Hospital for children. CEHURD contacted a medical expert Dr Catherine Abbo of Makerere University who carried out a mental state examination on Perez and developed a psychiatric report.

Filing a case in Court

In 2017 CEHURD together with Perez’ mother, Perez’ sister and Perez filed a case against Buyende District Local Government and the Attorney General in the High Court of Uganda at Jinja vide HCCS 135 of 2017 (CEHURD and Ors Vs Buyende District Local Government and Anor HCCS 135/2017). The case was based on the Government’s failure through Buyende District Local Government, to provide outreach services and early detection services to Perez hence denying him access to health services for early detection of his condition at an early stage of his life. The case also challenged the State’s failure to provide medical expertise, rehabilitation and rehabilitation centers which are easily accessible by persons with disabilities which is in violation of the right to Health, equality and freedom from discrimination.

On Tuesday 15^th March 2022, CEHURD and its co-petitioners received a positive judgment in the case delivered by Justice Dr. Winifred Nabisinde who made orders that;

• Failure of the defendants to provide medical expertise, rehabilitation and rehabilitation centers which are easily accessible by persons with disability is a violation of his right to health, right to equality and freedom from discrimination. The judgement emphasizes that it is high time the State of Uganda through the responsible duty bearers provides early detection and management services for persons with neurological disorders at the primary health care level.

• Failure of the defendants to provide access to early detection and management services for autism to the 4^th plaintiff at the primary health care level is a violation of his right to human dignity and to realize his full mental and physical potential contrary to the law.

This victory is a key step towards advancing the health rights of people with disabilities. We hope the orders and recommendations from court will be implemented.

Perez’ current condition:

Currently, the boy is aged 17 years and stays at Grace Center, an organization focusing at addressing the plight of young adults with intellectual conditions such as autism and dawn syndrome. He joined the organisation in 2020. He currently uses his hands to eat, he can sit and interact with people normally which wasn’t the case before.

The family is grateful to CEHURD for following up the case, and it is their prayer that no mother and child go through the same situation that they did.

Compiled by CEHURD’s Strategic Litigation Team (Esther Dhafa & Jane Namaganda) and the Communications Team (Grace Kenganzi & Jacqueline Twemanye).

By

Decent Kamukama

On March 1^st, the international community observes Zero Discrimination Day in honour and celebration of every person’s right to enjoy their rights and live a fulfilled life. In commemoration of this day, we seek to raise awareness of everyone’s right to be treated equally and with dignity with specific attention to ensuring that countries, “remove laws that harm, create laws that empower” as this year’s theme.

“Discrimination is a violation of human rights and must not go unchallenged,” United Nations Secretary-General Ban Ki-moon declared, “Everyone has the right to live with respect and dignity.” It is against this basis that discrimination against women and girls should be challenged in all ways to attain an equal world where all groups of people have equal access to services. As we commemorate the International Zero Discrimination Day, let us all be cognizant of the fact that more than 70 percent of the world’s population have been victims of discrimination in various ways on grounds of being young people, female, of different sexual orientation, persons living with HIV/AIDS, refugees, and persons with disabilities, among other people. More particularly 3.97 billion of 7.9 billion population are women, and nearly 90 percent of the world’s population of every gender holds some prejudice against women, according to a UN study published in 2020.

At Center for Health, Human Rights and Development (CEHURD), today is an opportunity to call for urgent action to end the differences related to income, gender, age overall health, profession, impairment, sexual preference, substance use, gender identification, racial group, class, ethnic group, and religion. While it is unfortunate we still need a day to remind us of this basic right, discrimination, intolerance, and inequality remain unresolved issues that lead to the unjust treatment of individuals due to their particular social identities. That is why we need laws that empower people to defend their rights. Without laws to provide guidance, societal practices and norms can be manipulated to foster discrimination.

Celebrating the right of everyone to live a full and productive life and live it with dignity is what we recognize today with an ardent focus on highlighting how women and girls can become informed and promote inclusion. You and I can unite and work together in our battle against prejudice by standing up for what is rightfully ours.

That is why it is important to ponder on the cultural practices that have been promoted over the years and yet are discriminatory. In the Elgon/Sebei region, young women and girls are at risk of forced Female Genital Mutilation/Cutting (FGM/C), which is a cultural rite of passage into adulthood. This is a risk to their health and wellbeing, and not only exposes them to negative consequences such as difficult labour, male domination and gender stereotyping but also reduced sexual expression. In looking forward to a zero-discrimination world, both state and non-state actors need to work together and ensure coordination towards the achievement of gender equality by 2030.

Stigma and discrimination of girls and women based on gender, sexual orientation and gender identity and expression (SOGIE), HIV status, or other lived realities such as trade, disability, geography greatly impact their access to SRHR information and services. Most interventions are often mainstream and do not reach these categories of young people or if they do, they reach them with messages that are inconsistent with their needs and lived realities. The National Sexuality Education Framework was a key milestone in the implementation of sexuality education in schools. However, despite the passing of the National Sexuality Education Framework (NSEF) in 2016, there has been little progress towards its full implementation on account of opposition to key content areas by religious groups and institutions. In a bid to end discrimination against girls and women, the stakeholders should look forward to implementing the decision from the Comprehensive Sexuality Education (CSE) case ruling of 2021 to enable the dissemination of Sexual Reproductive Health and Rights information.

Celebrating the right of everyone to live a full and productive life and live it with dignity is what we recognize today with an ardent focus on highlighting how women and girls can become informed and promote inclusion. You and I can unite and work together in our battle against prejudice by standing up for what is rightfully ours.

The writer is an intern at Center for Health, Human Rights and Development (CEHURD).