Harnessing health innovations to build communities where girls and women thrive

Women’s day is commemorated every year to celebrate and reflect on the role of women in society. The rights of women and taking stock of how these rights have been protected or infringed upon. Wit the theme for this year’s Women’s Day is, “think equal, build smart and innovate for change,”this theme seeks to put innovation by women and girls, for women and girls at the heart of efforts to achieve gender equality.

What does this theme mean for Uganda’s women and girls that make up over 50% of the population? We need to continue to the real issues that affect the lives and women and girls in Uganda. Having closely followed the current discourse in Uganda about the issues that result in death, permanent complications and disease for this gender, it is becoming increasingly clear that we cannot let this women’s day commemoration go by without a reflection on whether our women and girls have benefitted from technological advancement in the field of health and more specifically Sexual Reproductive Health and Rights.

A 2017 UNAIDS study found hat young girls between the age of 15-24 are disproportionately affected by HIV infection, with the HIV prevalence among adolescent girls at 9.1% is higher a than the national prevalence rate that stands at 7.3%. Government statistics also indicate that 1 in 4 girls iseither pregnant or has already had a baby by their 19thbirthday. We cannot have a meaningful conversation about the state of Sexual Reproductive Health and Rights of women and girls in Uganda without reflecting on the  high numbers that die annually due to pregnancy related complications, this is very critical since adolescents have been noted to have an increased risk of death during pregnancy or childbirth compared with older women. Of women that die due to pregnancy related causes and therefore there is no surprise that 57,000 abortions took place amongst adolescents in Uganda in 2013.

Other female experiences like menstruation have had dire consequences on the well being of the female gender. The critical unavailability of sanitary products in Uganda like in all developing countries is a major barrier to education for girls of school-going age. The inability to effectively manage menstruation contributes to absences of up to 4-5 school days each month, equating to as much as 20% of the academic year intentionally skipped, simply due to menstruation. Eventually many of these girls drop out of school entirely, increasing their likelihood of early pregnancy health complications and early marriage, and further limiting their future career and economic opportunities.

All is not lost and I am sure that it is no coincidence that this year’s theme for women’s day celebrates the role of innovation in promoting gender equality. Innovations like methods of contraception that can delay and altogether prevent pregnancy, re-usable pads and the menstrual cup that can be utilized for 10 years. This is not to mention programs like Sexuality education and School Health Programs that seek to impart young people with knowledge and information to enable them make healthy life choices become critical. Above all, Sexual Reproductive Health innovations, programs and methods for delivery of the same that are tailored to the unique needs of women especially those still going through physical development are very critical.

As we commemorate the International Women’s day, we need to prioritize these innovations that cannot only improve the quality of lives of our women and girls, thisrequires putting in place enabling laws and policies, ensuring availability of funds to support such programs and above all protecting the rights of women and girls from derogation.

 

By Joy Asasira

How and why the general public should support implementation of the tobacco control law

Creating public awareness on tobacco control and encouraging the public to adhere to, comply with and support implementation of the public health and tobacco control laws in place will help reduce the morbidity and mortality of cancers caused by tobacco smoke.

In Uganda today, Tobacco use has remained a significant public health challenge and a leading cause of many non-communicable diseases including heart diseases and lung cancer.

According to the World Health Organization, tobacco kills more than 7 million people each year. More than 6 million of those deaths are the result of direct tobacco use while around 890,000 are the result of non-smokers being exposed to second-hand smoke. Current scientific evidence has established that tobacco consumption and exposure to tobacco smoke causes disease, disability and death (The Global Adult Tobacco Survey: Country Report 2013). These are preventable deaths we all can commit to end if only we raise awareness on tobacco control and adhere to public health policies.

Parliament as the Legislative body in Uganda exercised its mandate under Article 79 (1) of the Constitution and enacted the Tobacco Control Act 2015 with the objective to among others control the demand, supply, production and consumption of tobacco and its related products.

There has however been a lot of misconceptions and misguidance about the Tobacco Control Act 2015 by the general public but also a deliberate move by the tobacco industry to sabotage the smooth implementation of the law. For example some of the arguments that have been forwarded by the Tobacco industry is that the Act is against the rights of farmers in Uganda and their legitimate right to trade in tobacco and its related products. As such, we need to educate ourselves and others on the law through supporting the Tobacco Control cause and complying with the public health/tobacco control laws in place.

It is also important that the public supports implementation of the law because it is all our responsibility to monitor tobacco use and protect people from tobacco smoke, offer help to those who want to quit smoking, warn people about the dangers of smoking tobacco in public places, and promote a smoke free environment.

The public enjoys a number of rights under the Constitution of Uganda and Tobacco Control Act including the Right to a clean and healthy environment as well as the right to a tobacco smoke free environment, the right to health among others. The law inter alia prohibits smoking in public places, workplaces, any means of public transport, or any outdoor space that is within 50 meters of any public place, workplace, public transport terminal, a place that provides services primarily to children, or a place of service or consumption of food/drink.

It is important to note that an individual’s right to smoke is not prohibited by law as thought by the general public and the tobacco industry, rather the law places a limitation on smoking in public places. This helps to ensure that in the enjoyment of one’s rights and freedoms, the fundamental or other human rights and freedoms of others are not infringed or violated upon by individuals smoking in public. (Article 43 of the Constitution).

The public should henceforth support the implementation of the law by ensuring that owners of public places   display notices on premises prohibiting smoking in such places, ordering people found smoking in public places to cease smoking immediately, requiring such person to leave/disembark the place, causing arrests of such person, or contacting a law enforcement agent/authority.

The Act also regulates the Tobacco Industry (manufacturers, wholesale distributors, importers of tobacco products, persons/entities working on their behalf to further their interests) by placing a comprehensive ban on all forms, methods, and means of tobacco advertising, promotion and sponsorship, restricts the sale and display of tobacco and tobacco products, bans the importation, manufacture, distribution, processing for sale, offering for sale, or bringing into the country electronic nicotine delivery system/cartridges with nicotine, water pipe tobacco delivery system, and smokeless or flavored tobacco products. The public should ensure that such is complied with.

Just like all other businesses that are regulated by Government, the control of tobacco smoking in public places and regulation of its advertisement and promotion is not a unique thing. The public should therefore disregard the arguments by the Tobacco industry that the Tobacco control law bans them from conducting in a lawful trade. The public should instead join and support the government in promoting public health.

It should therefore be noted that the Act does not ban the Tobacco Industry from practicing their trade as provided under Article 40(2) of the Constitution of the Republic of Uganda 1995 but puts in place a regulation on the conduct of their trade. The public health issue comes into context where the public needs to be protected from the harmful effects of certain trades.

As such, we should all join hands to make healthy lifestyle choices and avoid using tobacco and related products and educate ourselves and others to support the Tobacco Control cause through complying with the tobacco control laws.

 

By Esther Dhafa and Komakech Job

U.S. abortion politics felt globally: The chase of the global gag rule

On January 23rd, 2017, U.S president Donald Trump issued Presidential Memorandum reinstating the Mexico City Policy popularly referred to as the Global Gag Rule within Civil Society Organizations due to its restrictive nature on health services and advocacy particularly on Sexual Reproductive Rights for women and marginalized groups in societies that receive U.S. funding. Trump`s administration renamed the policy as Protecting life in Global Health Assistance; as the name suggests, the policy now applies to all U.S. global health assistance amounting to nearly USD $9 billion and includes funding for HIV/AIDS, tuberculosis, malaria, maternal and child health, family planning and reproductive health, nutrition, global health security, zika virus, and WASH at household and community levels. Non- U.S. NGOS who receive any global funding have 2 choices; Accept U.S. global health assistance and restrict their activities on abortion or refuse U.S. global health assistance and find other funding.

This policy has instilled fear on NGOS and caused them to self – censor and not ask questions about the policy because they are afraid of potentially losing U.S. funding. This has led to them over restricting their activities to be sure they are in compliance with the policy. Other NGOs have discontinued partnerships, stopped participating in coalitions, and no longer apply for some grants and unnecessarily stopped certain activities, which causes irreparable damage to their beneficiaries and civil society partnerships. President Trump’s policy masquerades under the guise of preserving life, but it endangers life. Restricting abortion information and access threatens and endangers women’s lives and families at large socially and economically.

Impacts of the Global Gag Rule have resulted into shut down in clinics, reduced access to contraceptives and HIV services, limited rural communities` access to health care, disrupted referral networks, and weakened civil society partnerships, coalitions, advocacy efforts around unsafe abortion. These impacts will worsen over time as more NGOs lose funding and are forced to restrict activities. Trump’s policy does not protect life. Women’s sexual reproductive health rights and health rights of marginalized persons are important and should matter.

Together we can make a difference by standing tall against the GGR and rising above its inhuman nature. It is important to monitor, document and report changes in relationships with sub-grantees and organizations affected by declining the funds or refusing to comply to continue mitigating or countering the impact of GGR to feed into data to push for the repealing of the unjust policy targeted at dehumanizing marginalized groups in society globally. This should be a wakeup call for the Ugandan government to prioritize Heath funding in the national budgets rather than largely depend on foreign aid that often comes with strings attached to the disadvantage of its citizens.

 

By Amuron Dorothy

Concerns and experiences: Improving Family Planning services in Uganda

Family planning services and contraceptives are critical in the prevention of unintended pregnancies, miscarriages, unsafe abortions and maternal deaths. Henceforth, improving the health of women and the overall well-being of families. There has been laudable effort from Government of Uganda, with support from development partners and civil society actors to ensure access to family planning goods and services.

However, in spite of these efforts, contraceptive access and use in Uganda remains a major challenge. To understand the major challenges, CEHURD, in partnership with Center for Reproductive Rights undertook a fact-finding exercise to collect experiences from women, men, service providers, policy makers and other relevant stakeholders with provision, access and utilization of contraceptives. The report summarized the key findings and identified the gaps highlighting what communities go through while accessing and using contraceptives as indicated below;

To amplify the findings as share the community findings, CEHURD held dissemination workshop involving various stake holders including; policy makers, development partners, civil society organisations, Justice Law and Order Sector, Ministry of Health, Local Governments and the communities. This also marked the launch of the Contraceptive access and use in uganda. The event had an aspect of experience sharing from the communities, learning from the experts who shared experiences as service providers, the policy makers who clarified on the budgeting process and parliaments commitiment on the issues of health and the Ministry of Health technocrats who responded on issues of policy and guidelines.

Key highlights from the event

  • Parliament is progressively though at a slow pace committing itself to the Abuja deceleration 2015 in increasing the health budget. The health budget has increased from 7.5 in 2018 percent to 8 percent allocation in 2019, with the current overall budget of 2 trillion where 16 billion has been allocated for reproductive health services and commodities.
  • MoH has come up with the human rights approach and developed guidelines to help them implement their work without violating people rights.
  • Challenge within the law that does not cater for the minors and clearly indicates the consent age as 18 years where health workers are not allowed to give services to people who have not consented.
  • Unmet need of married women is at 28 percent and 32 percent for sexually active unmarried women while the contraceptive prevalence rate is at 38 percent for married women and 51 percent for sexually active unmarried women, with 52 percent of un planned pregnancy in Uganda which has led to 1 in 4 girls having a child or pregnant with first child at 19 years.
  • Contraceptive use and accessibility is determined by working hours yet the peak hours are during public holidays, evenings, night hours and weekends as most of the public facilities are always closed yet it’s when the clients need the services most.

The report was jointly launched by the Executive Director CEHURD, Hon Members of Parliament, Ministry of Health, Center for Reproductive Health Rights country representatives and Uganda Medical Association President. The report was handed to the Ministry of Health for referencing and also respond to the recommendations.

 

By Angella and Chris

Commemoration World cancer day 2019 – CEHURD

CEHURD has today 4th February 2019 joined the rest of the World to Commemorate World cancer day for the year 2019. As an institution devoted to advancing the right health, we call upon all stake holders to join hands as we make healthy lifestyle choices and avoid using tobacco and related products and educate ourselves and others to support the Tobacco Control cause through complying with the public health/tobacco control laws in place.

Background:
Each year on the 4th of February different people, organizations and Ministries come together to commemorate the World Cancer Day and support, raise a collective voice, take personal action, raise awareness on cancer, and urge their governments to do more in curbing cancer and related diseases. The theme for this year is “I am and I will, your story and your commitment”. The Center for Health Human Rights and Development (CEHURD) joins the rest of the World to commemorate this day, highlighting our story and commitment in using the law to curb Cancer and related illnesses. For this year, we specifically want to highlight the harm caused by tobacco as a major cause of cancer and how the use of legal tools is key in curbing this public health crisis.
Facts about Tobacco and Cancer:

Tobacco use remains a significant public health challenge, danger and burden in Uganda and a leading cause of Cancer and Non communicable diseases. The 2011 World Health Organization (WHO) Global status report on NCD’s states that exposure to tobacco smoke remains one of the four main behavioral risk factors that contribute to NCD’s. It’s important to note that Tobacco alone accounts for 6 million deaths each year and this toll comes up to 13,000 people losing their lives daily from tobacco related illnesses and diseases. These are preventable deaths we all can commit to end if only we raise awareness on tobacco control and adhere to public health policies.
Dr Noleb Mugisha, the Principal Medical Officer and Head of Comprehensive Community Cancer Program at the Uganda Cancer Institute notes that there are various diseases related to tobacco use and these have been scientifically proven like Cancer, Cardiovascular diseases, Respiratory disease, Reproductive complications, Postoperative complications, Diabetes and others.

The 2004 Surgeon General’s Report shows that Tobacco use is a major risk factor for the development of many forms of cancer and evidence is sufficient to infer a causal relationship between smoking and cancers of the lung, larynx, esophagus, pancreas, bladder, kidney, cervix and stomach. Results from the 2011 Global Youth Tobacco Survey indicate that 19.3% of young men and 15.8% of young women use tobacco. Raising awareness and education on Tobacco control in order to take action against Cancer is therefore key.
Strategies for curbing this public health crisis:

We need to create public awareness on tobacco control, adhere to and comply with the public health and tobacco control laws, and help reduce the morbidity and mortality of cancers caused by tobacco smoke through monitoring tobacco use and prevention policies, protecting people from tobacco smoke, offering help to those who want to quit smoking, warning people about the dangers of tobacco and promoting a smoke free environment.

Uganda ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) in 2007 developed in response to the globalization of the tobacco epidemic. In a bid to curb the tobacco epidemic, Uganda also enacted and passed the Tobacco Control Act 2015 aimed at controlling the demand and supply for production and consumption of tobacco products to the people. It also aims at promoting the health of persons and reducing tobacco related illnesses and deaths.

The Constitution under Article 39 guarantees the citizens right to a clean and healthy environment. It is therefore important to protect the environment from the effects of tobacco consumption and exposure to tobacco smoke.

The Public Health Act Cap 281 mandates every local authority to take all lawful, necessary, and reasonably practicable measures for preventing the occurrence of any outbreak or prevalence of infectious, communicable or preventable diseases to safeguard and promote the public health of individuals.

The Penal Code Act Cap 120 under Section 228 (f) makes it an offence for a person to dispense, supply, sell or give away any poisonous/dangerous matter in a manner so rash and negligent. The Tobacco Control Regulations will also soon be finalized and passed by Ministry of Health.

Conclusion:
As such, let us all join hands to make healthy lifestyle choices and avoid using tobacco and related products and educate ourselves and others to support the Tobacco Control cause through complying with the public health/tobacco control laws in place.

LET US JOIN HANDS AND KICK CANCER OUT OF UGANDA!!!.