Kampala – Uganda. Center for Health, Human Rights and Development (CEHURD) with joy welcomes the long-awaited ruling from the High Court of Uganda at Kampala in the case of CEHURD vs. Attorney General & Family Life Network [Miscellaneous Cause No. 309 of 2016], commonly referred to as the Comprehensive Sexuality Education case. The High Court agreed with our submissions and the trial judge, Hon. Justice Lydia Mugambe, directed the Ministry of Education and Sports to develop a comprehensive sexuality education policy within two years, among other orders.
Another point of contention in the case was the use of the term, “comprehensive” sexuality education. To this, Hon. Justice Mugambe stated that, “The inclusion or exclusion of the term ‘comprehensive’ is a simple matter of form that should never derail the substance of this process.”
Through this judgement, Hon. Justice Mugambe upheld the fundamental human rights of all Ugandans to access health information on their sexuality.
Background
On the 18th day of November 2016, The Center for Health, Human Rights and Development (CEHURD) filed a case against the Attorney General, challenging the Ministry of Education and Sports’ ban on Comprehensive Sexuality Education (CSE), and their omission and delay to pass a policy on sexuality education as a violation of the right to access information contrary to Article 41 and the right to education contrary to article 30 and 34(2) of the Constitution of the Republic of Uganda, 1995.
This case was premised on a resolution issued by the Parliament of the Republic of Uganda on 17th August 2016 directing the Ministry of Education and Sports to ban the teaching and training of CSE in Uganda. On 28th November 2016 the Ministry of Gender, Labour and Social Development issued a press statement emphasizing to the public that the ban of CSE in Uganda was applicable in both school and non-school environments. This in effect halted the dissemination of all sexuality education in Uganda, leaving the population prey to unwanted pregnancies, STDs and STIs due to lack of information.
In May 2018, the Ministry of Education and Sports finalized and passed the National Sexuality Education Framework (NSEF) which has never been implemented and actualised, three years since its development.
Uganda, however, committed herself to formulating policies on comprehensive sexuality education in December 2013 under the Ministerial Commitment on Comprehensive Sexuality on sexual and reproductive health services for adolescents and young people in Eastern and Southern Africa (ESA).
Court ruling
The High Court of Uganda through Lady Justice Lydia Mugambe upheld the rights of adolescents and ordered that;
The Government’s inordinate delay and/or omission of over ten years to develop a comprehensive sexuality education policy in Uganda is a violation of Uganda’s obligations under international law and Articles 30,41 and 34(2) of the Constitution; Sections 4 (1) (c), (g) and (i) of the Children (Amendment) Act 2016; and Section 4(1) & (2) of the Education (pre-primary, primary and post primary) Act.
The Government of Uganda through the Ministry of Education and Sports should within two years develop a Comprehensive Sexuality Education Policy
The Government of Uganda through the Ministry of Education and Sports should identify and work with a breadth of relevant stakeholders and address all issues competently
The Attorney General should compile and submit a report to this Court every six months showing progress and implementation of the orders.
National Forum of People Living with HIV/AIDS Networks Uganda (NAFOPHANU) in consortium with Center for Health Human Rights and Development (CEHURD) and Uganda Harm Reduction Network (UHRN) are implementing a Global fund project titled: Supporting Uganda’s Response to HIV/AIDS and Tuberculosis Reduction Strategy (UGA-C-TASO) in three regions of West Nile, Acholi and Karomoja. The project has the job opportunities below for immediate deployment:
Government Must Prioritise Safety of Health Workers to Protect Patients During Covid-19 and Beyond
Kampala-Uganda. Center for Health, Human Rights and Development (CEHURD) and partners join the world to mark World Patient Safety Day. At a time when the healthcare system is receiving more patients, the day, which is marked every September 17th (tomorrow), is an opportunity to pause and evaluate their safety. The day has come at a time when CEHURD is running on online campaign, calling for safety in health facilities, under the hashtag, #SafetyInHealthFacilities.
This year’s theme, “safe maternal and newborn care”, is a reminder to deal with the issues mothers face in health facilities, when their safety is not taken care of.
It is estimated that on average, Uganda loses more than 300 mothers per 100,000 live births every year. Furthermore, about 200,000 children under the age of five, due to preventable causes. Considering the significant burden of risks and harm women and newborns are exposed to due to unsafe care, compounded by the disruption of essential health services caused by the COVID-19 pandemic, the campaign on safety is even more important this year.
It is imperative to note that the majority of stillbirths and maternal and new-born deaths are avoidable through the provision of safe and quality care by skilled health professionals working in supportive environments. This can only be achieved through the engagement of all stakeholders and the adoption of comprehensive health systems and community-based approaches.
The safety of patients is closely related to the safety of health workers. This has been magnified by the COVID pandemic. The COVID-19 pandemic has reminded all of us of the vital role health workers play to relieve suffering and save lives. In addition to physical risks, the pandemic has placed extraordinary levels of psychological stress on health workers exposed to high-demand settings for long hours, living in constant fear of disease exposure while separated from family and facing social stigmatisation. The World Health Organisation recently highlighted an alarming rise in reports of verbal harassment, discrimination, and physical violence against health workers in the wake of COVID-19. No country, hospital or clinic can keep its mothers and children safe without keeping its workers safe.
We therefore call on government and health care leaders to address persistent threats to health safety of health workers to ensure safe maternal and newborn care.
On this World Patient Safety Day, we remind the government that it has a legal and moral obligation to ensure the health, safety and wellbeing of health facility workers, health facility users and make child bearing a dignified process. To promote safety in health facilities, we specifically call on government to;
Develop and implement national programmes for occupational health and safety of health workers. This will include appointment of officers specifically responsible for health and safety in health facilities, and reporting and analysing serious safety related incidents.
Protect health workers and health users from violence in health facilities, and promote the culture of zero tolerance to violence in health facilities. This should also provide for implementation mechanisms through which survivors can easily report cases of abuse to responsible officers.
Improve mental health psychological wellbeing of health workers. This includes maintaining appropriate safe staffing levels within health facilities, providing health related insurance to ensure coverage for work related risk, especially for those working in high-risk areas.
Protect health workers and patients from physical and biological hazards.Ensure availability of personal protective equipment (PPE) at all times, as relevant to the roles and tasks performed, in adequate quantity and appropriate fit and of acceptable quality. Ensure an adequate, locally held, buffer stock of PPE. Ensure adequate training on the appropriate use of PPE and safety precautions.
Uganda is committed to scaling up the use of modern contraceptive methods to ensure that every Ugandan woman can be able to make a decision of when to have children. On this day it’s imperative that we popularize the various contraceptive methods that are safe and appropriate for both young people and adolescents’ use.
BY MARIANNA KAYAGA –Programme Officer at CEHURD and the President for the Youth Advisory Committee SRHR Alliance.
As a young person who was then fresh from campus, I had friends who were sexually active. I really didn’t know much about the need for contraception or the various types on the market. As time went by, I noticed that a number of girls I had studied with showed up pregnant. I simply wondered to myself “why didn’t she ask her boyfriend to put on a condom or even withdraw?” I thought this since these were the only forms of contraception I knew at the time.
I inadvertently became the judge and jury to all these girls who ended up pregnant while we were still in school and under the care of our parents and guardians. This kind of judgment came about because I didn’t have access to information on contraception and neither did I understand or know the circumstances in which these girls got pregnant. One of these girls gave birth to twins and I recall how during classes, her lactating breasts gave off a strange smell let alone the fact that her garments often had patches around the breasts area.
One of my very close friends also got pregnant at the age of nineteen years and the first thing I remember telling her was to get an abortion because it really didn’t make much sense to me for a young girl to be pregnant without having any financial security. She then went through the nine months of the pregnancy but indicated that whole process was really devastating to the fact that she ended up getting a Caesarean section. The midwives said she was too weak to have a natural child birth.
Due to the overwhelming on-going experiences around me I became curious about learning of the different contraceptives and I must say I was privileged to have access to SRHR information through various media platforms, my friends who have unlimited access to information and various easy to read materials.
According to the Oxford dictionary Contraception is the deliberate use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse. On September 26th ‘’World contraception day’’ as we usually prefer to call it, it is our mission as young people to spread the word and raise awareness about different contraceptive methods and safe sex. This is to enable both young men and women to make informed choices on their sexual and reproductive health. As a country we are all going through a crisis and uncertainty from the COVID-19 pandemic, reliable sexual health services that provide a range of options and information are more important now than ever.
Uganda’s total fertility, maternal mortality and teenage pregnancy rates remain among the highest globally. Uganda is committed to scaling up the use of modern contraceptive methods to ensure that every Ugandan woman can be able to make a decision of when to have children. In 2017, Uganda revised its commitment made in 2012 of reducing unmet needs of adolescents from 30.4% in 2016 to 25% in 2021. By improving the number of health facilities or structures in hard-to-reach areas, the government of Uganda strives to expand its reach and provision of services including permanent, reversible and long-acting methods. These commitments will contribute to the nation’s ambitious goal to reduce the unmet need for family planning to 10% and increase the use of modern contraception by 50%.
In Uganda, with national lockdowns and restrictions in movement which meant no transportation by both public and private means, young people could not access their usual services. This has been acute in rural areas which make up 85% of the country’s population and as a result, the numbers of unplanned and teenage pregnancies have immensely risen especially with the closure of schools.
The enormous rise in unplanned pregnancies amongst young people is because there is a huge gap in access to information about the available services, the supply chain of distribution and the overwhelmed health systems diverting resources to the COVID – 19 responses, access to SRHR services for young people including contraception, has been restricted and barriers have increased.
Considering the significant burden of risks and harm women and new-borns are exposed to due to unsafe care, compounded by the disruption of essential health services caused by the COVID-19 pandemic, the campaign is even more important this year. For the world safety day 17th September, 2021, we call on government and other stakeholders to act now for safe and respectful child birth under the theme “Safe Maternal and new born care.”
By peter eceru
The media has in the recent past reported cases of abuse of patients, health workers and other health users in health facilities. These included cases of sexual abuse of health workers, patients and care givers with in the health facilities. Relatedly, there have been cases of health workers and non-health workers administering medication with disastrous consequences to the patients. It is against this background that the WHO declared September 17th a world patient safety day to raise global awareness about patient safety and call for solidarity and united action by all to reduce harm. Safety plays an important role in the daily operation of any health care facility. Safety means that there is absence of preventable harm to a patient during the process of receiving health care. Effective safety management not only assures employees that they have a safe working environment, but also allows patients to enjoy an atmosphere that is free from unnecessary risks and hazards. Having an effective safety program that addresses pertinent safety issues within the facility, as well as within the community will give the administration confidence that the facility is delivering the highest quality of patient care.
While Uganda committed to achieving Universal Health Coverage, safety which is one of the key pillars continues to be hugely ignored. Patients and other service users will be more comfortable when they are assured of safety when they go to a health facility be it private or public. Safety encompasses the need, use and quality of interventions provided by the health system.
Out of the realization and concern for the safety of patients, the Ministry of Health put in place a Patient Rights and Responsibilities Charter 2009 – an official document that offers guidance on various patient rights and responsibilities in the national health care system. Prominent in the document is the notion of human dignity and the provision of moral ground towards improving standard health services in the country. While the country has an elaborate legislation in relation to safety of patients, the challenge for the country relates largely to the implementation and how health facility administrators construe safety. In most health facilities, Health Facility safety committees have not been established. The law requires that each health facility should have in place a safety committee which is supposed to oversee safety issues and make recommendations on how to better safety in health facilities. Most health facilities have confused this with the Infectious Disease Control committee which have been active because COVID.
The COVID pandemic has demonstrated that the safety of patients is closely related to the safety of health workers. It has also reminded all of us of the vital role health workers play to relieve suffering and save lives. In addition to physical risks, the pandemic has placed extraordinary levels of psychological stress on health workers exposed to high-demand settings for long hours, living in constant fear of disease exposure while separated from family and facing social stigmatisation. The World Health Organisation recently highlighted an alarming rise in reports of verbal harassment, discrimination, and physical violence against health workers in the wake of COVID-19. No country, hospital or clinic can keep its mothers and children safe without keeping its workers safe.
It is important to remind the government that it has a legal and moral obligation to ensure the health, safety and wellbeing of health facility workers, health facility users and make seeking health services a dignified process. To do this government needs to take deliberate actions to ensure availability of personal protective equipment (PPE) at all times, as relevant to the roles and tasks performed, in adequate quantity and appropriate fit and of acceptable quality. There should also be adequate, locally held, buffer stock of PPE. Ensure adequate training on the appropriate use of PPE and safety precautions., maintaining appropriate safe staffing levels within health facilities, provide assurance of provision of free health coverage for health workers for work related risks, especially for those working in high-risk areas.
The media has in the recent past reported cases of abuse of patients, health workers and other health users in health facilities. These included cases of sexual abuse of health workers, patients and care givers with in the health facilities. Relatedly, there have been cases of health workers and non-health workers administering medication with disastrous consequences to the patients. It is against this background that the WHO declared September 17th a world patient safety day to raise global awareness about patient safety and call for solidarity and united action by all to reduce harm. Safety plays an important role in the daily operation of any health care facility. Safety means that there is absence of preventable harm to a patient during the process of receiving health care. Effective safety management not only assures employees that they have a safe working environment, but also allows patients to enjoy an atmosphere that is free from unnecessary risks and hazards. Having an effective safety program that addresses pertinent safety issues within the facility, as well as within the community will give the administration confidence that the facility is delivering the highest quality of patient care.
While Uganda committed to achieving Universal Health Coverage, safety which is one of the key pillars continues to be hugely ignored. Patients and other service users will be more comfortable when they are assured of safety when they go to a health facility be it private or public. Safety encompasses the need, use and quality of interventions provided by the health system.
Out of the realization and concern for the safety of patients, the Ministry of Health put in place a Patient Rights and Responsibilities Charter 2009 – an official document that offers guidance on various patient rights and responsibilities in the national health care system. Prominent in the document is the notion of human dignity and the provision of moral ground towards improving standard health services in the country. While the country has an elaborate legislation in relation to safety of patients, the challenge for the country relates largely to the implementation and how health facility administrators construe safety. In most health facilities, Health Facility safety committees have not been established. The law requires that each health facility should have in place a safety committee which is supposed to oversee safety issues and make recommendations on how to better safety in health facilities. Most health facilities have confused this with the Infectious Disease Control committee which have been active because COVID.
The COVID pandemic has demonstrated that the safety of patients is closely related to the safety of health workers. It has also reminded all of us of the vital role health workers play to relieve suffering and save lives. In addition to physical risks, the pandemic has placed extraordinary levels of psychological stress on health workers exposed to high-demand settings for long hours, living in constant fear of disease exposure while separated from family and facing social stigmatisation. The World Health Organisation recently highlighted an alarming rise in reports of verbal harassment, discrimination, and physical violence against health workers in the wake of COVID-19. No country, hospital or clinic can keep its mothers and children safe without keeping its workers safe.
It is important to remind the government that it has a legal and moral obligation to ensure the health, safety and wellbeing of health facility workers, health facility users and make seeking health services a dignified process. To do this government needs to take deliberate actions to ensure availability of personal protective equipment (PPE) at all times, as relevant to the roles and tasks performed, in adequate quantity and appropriate fit and of acceptable quality. There should also be adequate, locally held, buffer stock of PPE. Ensure adequate training on the appropriate use of PPE and safety precautions., maintaining appropriate safe staffing levels within health facilities, provide assurance of provision of free health coverage for health workers for work related risks, especially for those working in high-risk areas.
Considering the significant burden of risks and harm women and new-borns are exposed to due to unsafe care, compounded by the disruption of essential health services caused by the COVID-19 pandemic, the campaign is even more important this year. For the world safety day 17th September, 2021, we call on government and other stakeholders to act now for safe and respectful child birth under the theme “Safe Maternal and new born care.”
The writer is an Advocacy Expert at the Center for Health, Human Rights and Development.
