By Nakibuuka Noor Musisi

Dr. Kiggundu was and still remains an irreplaceable maternal health champion that the Sexual and reproductive fraternity has ever had. For over 30 years of his professional career, Dr Kiggundu worked to advance sexual and reproductive rights in Uganda. With him, the gap between advocacy and service provision was bridged. He brought on board the insight of the lived realities of service providers with the legal fraternity. 

 “How do we get an ambulance to collect a gravida 10 9 previous scar at 28 weeks with preterm labour from Ndejje Bombo?” Kiggundu Charles’ last message sent on 25^th December 2020.

While the world went to sleep on Christmas day, at about 8:48pm on 25th December Dr Kiggundu was thinking about a mother in labour. 

I first met Dr Kiggundu at a meeting organized by the Center for Health, Human Rights and Development (CEHURD) to analyse the laws on sexual and reproductive health and rights in 2012. CEHURD had initiated a campaign on maternal health in Uganda and had sued the government of Uganda for its failure to protect women and their lives despite the natural maternal functional role they played in society. This later came to be known as the famous land mark maternal Health case, Constitutional petition No. 16 of 2011. 

Being a health service provider, Kiggundu together with a team of lawyers played a critical role in addressing questions around maternal health legislation. He made things look easy as he spoke from a humanistic and an informed point of view, citing lived realities of what women go through while accessing reproductive health services. He was the only health service provider who was part of the CEHURD’s Legal support network (LSN), a network of lawyers that provide legal advice and representation to health service providers caught up in the criminal justice system while providing essential sexual and reproductive health services. The advocates under the Network have continued to support efforts towards strategic litigation, legal and policy reform and empowerment of health workers qualified to SRH services in accordance with the laws and policies in Uganda). He later came to refer to himself as a “learned friend” and to others he called himself a “midwife”

What a way to commemorate the international day of the Midwife without Kiggundu! What a life to reckon!  

Tuesday, December 29^th 2020 is the day God tested our patience and courage and took away our own Charles Kiggundu. The news of his demise threw us off balance!

“Noor, I have information that is not yet confirmed. I have read on Dr Sabrina Kitaka’s social media page that Dr Kiggundu has passed on. Can I share the screen shot? Do you think we should tell people?” One of the workmates reckoned.

I froze for a moment and failed to respond. I realised that for the past ten (10) years of my engagement with Dr Kiggundu, he had never missed my phone call. I was quick to tell a friend to wait to share the news so that I call him. As the phone rang with no response, I could not feel my legs anymore. My eyes got filled with tears. I knew the information could be true. Before I could hang up, a colleague from the Association of Obstetricians and Gynaecologists in Uganda, Dr Kiggundu former workplace rang me. 

“Noor, I am sorry but your friend Kiggundu has gone to be with the Lord. It is unbelievable that we have lost Kiggundu to COVID-19. It is sad that we could not save the life of a brave man.” He noted. 

The demise of Dr Kiggundu leaves a lot to think about. Early last week, CEHURD filed a case challenging the Attorney General for failing to act on orders of Court given in Constitutional petition No. 16. As we reached out to people to attend to a press conference, I realised we missed an important person, one who would tell a story from his own humanistic experience of delivering women. That person who had mastered the art and intersectionality between the law and health. 

We continue to miss a kind, approachable and welcoming person. He mentored many of us into advocacy and spoke about women’s rights with passion and he always had a story to tell prior to a training. Dr Kiggundu occupied policy development places and his advocacy influenced cases before courts of law.  

He will be remembered for being an extraordinary health service provider, a down to earth person who worked with passion to advance women’s rights. It has been five difficult months of advocating for sexual and reproductive health and rights without this great champion. To anybody that has engaged in advocacy for women’s rights, I am certain you did not miss his presence and input. 

Dr Charles Kiggundu was born in 1965 at Kasana, Luweero District to the late Wilson Kabaale and Nsangi Esther Ruth. He was married to Mrs Ndagire Harriet Kiggundu, left behind 9 children and was laid to rest on 31^st December 2020. 

At the time of his demise, Dr Kiggundu was heading the Department of Obstetrics and Gynaecology at Makerere University. He served as a treasurer of the Association of Gynaecologists and Obstetricians (AOGU) between 2004 and 2009. He also served as the Vice President (2008-2013) and President of the Association between 2013 – 2015. 

Your life reigns Charles. Rest in peace, you will be deeply missed by the SRHR fraternity, gynaecologist association and Midwifery Association. 

The writer is the Director of programs at the Center for Health, Human Rights and Development.

Providing affordable healthcare to the population of low- and middle-income countries is a persistent development issue.

In 2016, the government of Uganda developed a health financing strategy to facilitate the attainment of sustainable development goal three (SDG3) of ensuring Universal Health Coverage.

This can be achieved by making the required resources for delivery of essential health services for Ugandans available, in an efficient and equitable manner. Revenue collection and risk pooling mechanisms such as insurance are one way of doing this.

The dream is that no one should face the risk of impoverishment when accessing healthcare, nor should anyone forgo medical services because of the financial cost of accessing health services.
Currently, the principal mechanism for funding health services in Uganda is through government revenue tax financing.

Out of pocket payments and contributions by health development partners constitute a substantial amount of health financing. Due to the poor quality of health service delivery, many households are compelled to seek services from private medical facilities, which are very expensive.

The cost of access to health services in private places is a huge burden on most families in Uganda, leading to financial hardships for many patients and their caretakers, and often to long-term indebtedness.

It is currently estimated that the total annual health expenditure is 7.5 trillion. Of this, 15 per cent is from government funding, with 42 per cent from donors and 41 per cent from individuals (out of pocket).

These statistics should be worrying because the government has abandoned its responsibility of providing healthcare in this country to donors and families.

The World Health Organisation (WHO) recommends that out of pocket expenditure on health should not exceed 20 per cent of a country’s total health expenditure, otherwise citizens will stand the risk of impoverishment in case a family member falls ill.

In terms of per capita health expenditure on health, Uganda stands at $53, which is less than the standard $84 dollars recommended by the WHO. In comparison with other East African states, this is the lowest.
 
It is evident that public financing available for the health sector remains the single most important constraint to Universal Health Coverage and overall enjoyment of the right to health. Over the last five years, the budget for the health sector has dwindled from 8.9 per cent of the national budget in 2016/2017 to the projected 6.2 per cent in 2021/22 financial year.

In 2019/2020, the needs analysis by the National Medical Stores (NMS) showed that there was a medicines funding gap of 6 per cent in Health Centre IIs, 56 per cent in Health Centre IVs, and 32 per cent in general hospitals. This means that Health Centre IIs are running with only 39 per cent of the drugs they need while Health Centre IVs are operating with only 44 per cent of the drugs they need.
 
The passing of the National Health Insurance Scheme Bill,  2019, by Parliament provides a glimmer of hope in enhancing access to health services. As can be demonstrated by the Rwandan experience, health insurance is instrumental in increasing access to health. By 2015/16, the health insurance cover in Rwanda had a coverage of 86.1 per cent compared to Uganda’s 2 per cent.

The Bill as passed by Parliament may not be perfect, but provides the best opportunity for beginning conversations on increasing funding to the health sector and catering for the poor and vulnerable groups.

By contributing to the health scheme, their dependants will benefit from the insurance and so will the poor  who are incapable of contributing. These shall be entitled to a defined package of healthcare benefits from government contribution  based on Uganda National Minimum Health Care package.

The Health Insurance Scheme will be an addition to the government contribution to the health sector. Government will continue to invest in health promotion and education; disease surveillance and response; immunisation and any other specialised services outside the National Health Insurance Scheme benefits package and health systems investment.

Government will also continue to finance major health sector infrastructural development, specialised medicines, technology and human resources.

Peter Eceru is a Programme Specialist, Health and Human Rights Advocacy at Center for Health, Human Rights and Development (CEHURD)
A version of this article was published in the Daily Monitor Newspaper on Friday 30th 2021.

These rains can lead to flooding, which contaminates water sources and increases vegetation around homes, creating a conducive atmosphere for mosquitoes to breed.

– Katia Olaro, Strategic Litigation program, CEHURD

World Malaria Day | 25th April 2021

With all the work that has gone into fighting it, malaria still kills tons of people despite the fact that it is preventable. In an article on news.trust.org a 74 year old Rose Acayo of Gulu District narrates how she had been sleeping under a worn out inherited mosquito net which consequently exposed her to malaria infection. Just as she was recovering, her two-year-old grandchild in her care also fell ill which left her with medical bills she could not meet. How can we draw the line for zero malaria infections as this year’s World Malaria Day theme states?

According to the World Health Organisation 2019 report, Uganda was the third highest contributor to global malaria cases, at 13.7 million cases. Globally, we were the eighth highest contributor to malaria deaths at 5,610 deaths. Malaria therefore remains a high cause of death and financial constraints, considering its non-discriminatory nature in terms of age, gender, race, economic or social status. Transmission lines are very thin and so is the severity, failure to stop its spread will continue causing high levels of poverty among the poor as treatment is a financial burden which they cannot afford.

What we can do

As the world puts the spotlight on the fight against malaria, CEHURD joins the rest of the world to ensure acceptable, accessible, affordable and good quality health for all. As a country, Uganda is making efforts to reduce malaria infections and morbidity in a sustainable way through mass media awareness campaigns, and distribution of free mosquito nets, among other interventions.

In a recent press statement, Dr Joyce Kaducu, Minister of State for Health- Primary Health Care revealed that there are currently no malaria outbreaks in the country. She, however, warned that there is a risk of outbreaks due to the ongoing heavy rains in various parts of the country. These rains can lead to flooding, which contaminates water sources and increases vegetation around homes, creating a conducive atmosphere for mosquitoes to breed.  In order to prevent these outbreaks, the Ministry of Health  urges everyone to step up the implementation of preventive measures. This includes sleeping under treated mosquito nets, getting rid of stagnant water, and seeking medical assistance where symptoms present.

Call to action

It is important to improve overall health care. The government should therefore provide quality assured services for malaria prevention and treatment to all the people in Uganda. This will lead to a good standard of health, which contributes to national development. It is also important to ensure that there is sufficient stock of essential supplies and medicines to minimise possible capacity constraints, and reduce the burden on health facilities in providing services to diagnose and treat malaria.

Change also begins with each of us. Let us do our part in preventing malaria, and if diagnosed, seek medical treatment. While preventing COVID-19 is the current issue, let us not forget that “mosquitoes are not in lockdown, they are still free”, as Mr Jimmy Opigo, a programme manager of the National Malaria Control Programme said.