By Avako Specioza

The tobacco industry has for a long time affected innocent lives world over through several ways including; advertising and encouraging direct smoking of cigarettes, secondhand smoke exposure, smoking of other combustible tobacco products , smokeless tobacco and electronic nicotine delivery systems (ENDS) among others. Cigarettes were manufactured as far back as the 17th century in America and in Uganda, British American tobacco introduced tobacco growing in the 1920s. During this time the industry grew and became a force to be reckoned with. Tobacco came to be known as one of Uganda’s leading cash crops and the industry recruited many people to cigarette smoking which has to date had exponential adverse effects on public health of the nation.

The scope of the burden of disease and death that tobacco smoking imposes on the public’s health is extensive. Tobacco smoking has serious ramifications on public health as it is one of the leading causes of death in the world. Tobacco smoking kills more people annually than AIDS, Malaria and tuberculosis combined. Tobacco has passed the test of being the most toxic legal product which kills its users when used according to prescription. The World Health Organization has stated that tobacco kills up to half of its users because it contains more than 7000 chemicals, of which at least 250 are known to be harmful and at least 69 are known to cause cancer.

The WHO report on Global Tobacco Epidemic 2008, confirms that the global tobacco epidemic is one of the greatest public health threats of modern times as smoking causes so many deleterious health effects. Some of these health effects include; diminished health status, susceptibility to acute illnesses and respiratory symptoms, death, coronary heart disease, cancers of any organ of the body, chronic obstructive pulmonary disease or COPD, pre-mature births, among others.

The tobacco companies use a business model that is focused on maintaining or increasing new users of their products, even if this means targeting adolescents. This is achieved by marketing products that promote adolescents perception that increase the probability of experimentation and continued use. Over the years, the tobacco industry has created distinct lifestyle images associated with different brands, and their marketing strategies include package design, product placement, advertising, promotional activities and pricing.

Uganda has taken a great leap in tobacco control interventions through ratification of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) and consequently the enactment of the Tobacco Control Act of 2016. This Act provides for control interventions including; large pictorial health warning of not less than 65%, restrictions of the tobacco industry’s advertisement of its products, smoke free policies in public places, 50 meters smoke free space from residential or business areas, restrictions on tax incentives given to the tobacco industry, restricting minors from purchasing tobacco products among others.

With all its insidious acts and plans, the tobacco industry strives to maintain customers, encourage those that have quit resuming smoking and recruiting others especially the youth. This therefore makes the implementation of the tobacco law more apparent than before. Furthermore this calls for concerted efforts of the government departments, civil society, the police and all members of the public to ensure implementation of the tobacco law, a smoke free environment and support to patients who are addicted to quit smoking. Effort should therefore be directed to ensure that commercial interests of the tobacco industry do not override public health.

By Denis Jjuuko

Sexual Reproductive Health and Rights (SRHR) continue to be among the most controversial and contentious topics in Uganda’s cultural, religious and policy environment. This is because of the competing approaches in the policy debates that range from religious and cultural perspectives, to legal approaches. However, a combination of factors such as: limited access to a wide range of family planning services by those in need; access to sexuality education has led to an increasing number of unwanted pregnancies, among teenagers for instance, which stands at 25%. A significant number of these end in induced abortion, posing a serious public health, human rights and social equity dilemma that affects millions of women in sub – Saharan Africa, including Uganda, albeit the ambiguous regulations on abortion.

Uganda’s dwindling maternal health record is partly evident in her highest rates of unsafe abortion in Eastern Africa. The estimated rate of 54 abortions per 1,000 women of reproductive age is far higher than the average of 39 abortions per 1,000 women for East Africa. Unsafe abortion is among the leading causes of maternal morbidity and mortality in Uganda, contributing approximately 26% of the estimated 6,000 maternal deaths every year, and an estimated 40% of admissions for emergency obstetric care. It equally places a huge cost on the public health system; approximately Ushs 7.5 billion (US$13.9million) are spent annually to treat complications. Poor, rural women are at increased risk of unsafe abortion, 68–75% experienced complications, compared with the 17% complication rate for non-poor urban women.

The country’s restrictive abortion laws permit termination of pregnancies only to save the life of a pregnant woman. However, conflicting and restrictive interpretations of the abortion provisions under the 1995 Constitution of Uganda, the Penal Code Act of 1950 and National Reproductive Health Policies have created confusion about the correct legal status of terminating pregnancies. Because the government has not operationalized Article 22(2) of the 1995 constitution of Uganda as a way of clarifying the parameters for legal abortions, healthcare providers are unable to provide safe and legal services, while law enforcement officials and judicial officers do not effectively enforce or implement laws that permit abortion, thus denying women and girls access to safe and legal services. Inadequate regulations have also led quark doctors to freely advertise abortion services without clarity on their degree or level of safety. This environment further risks the lives of young girls and women, due to the complications that arise, thereby making unsafe abortion a public health dilemma. However, this can be averted by creating a progressive SRHR legal and policy environment as a central tenet to preventing and reducing the unacceptably high rates of maternal death in Africa.

It was upon this background that CEHURD convened a socio-cultural dialogue on 6th and 7th March 2018 at Hotel Africana to discuss SRHR in Uganda and find sustainable strategies for addressing the deficit created by a regressive SRHR environment as a critical element for good health and wellbeing of people, quality education that encompasses access to information for living healthy lives, and promoting gender equality.

The dialogue involved examining the status of the SRHR environment in Uganda; tracking progress of achieving Sustainable Development Goals 3, 4; discussing strategies of harnessing the population dividend for holistic development within a progressive SRHR environment; and defining roles, responsibilities and accountability mechanisms of key sectors for a progressive SRHR environment.

The dialogue targeted policy makers, technical people in the different line ministries, civil society organisations, religious and cultural leaders, law enforcement institutions, service providers and academics alike. The dialogue involved use of videos, panel discussions, and questions and answers questions, and participants agreed to a need to reduce on teenage pregnancies as a way of solving the unsafe abortions equation. They also agreed to a need for clear regulations and implored different SRHR stakeholders contribute to a progressive SRHR environment.

By Ms. Nakibuuka Noor Musisi

Today CEHURD was pleased to work with but also host officials from Ministry of Health and WHO country office to deliberate on the finalization and road map of the gender and human rights mainstreaming manual for health professionals.

This manual stems from the fact that the Uganda Gender Policy 2007 calls upon all sectors to mainstream gender in their respective sector plans and interventions. As a way of trying o implement this policy, the Ministry of Health and Who country office together with development partners came together to develop this manual aimed at building the capacity of health sector staff to mainstream gender and human rights into health service delivery. In addition, the manual is also responsive o the Country’s Public Finance Management Act, 2015, which reinforces the need for health workers to be more responsive to gender and human rights.

It’s also not in contention that there is a knowledge and practice gap between duty bearers and rights-holders in health service delivery that leads to limited service delivery and the violation of human rights, including the right to the highest attainable standard of physical and mental health. Worse still there has been limited attention given to gender issues in the health sector which has led to iniquities in accessing health services and interventions that are not gender-responsive. This manual therefore is designed to empower the duty-bearers and rights-holders with knowledge and skills to appreciate the importance of mainstreaming human rights and gender in health.

One would think that partners have no stake in this process but the reverse is true. Over the years, I have come to believe that bringing technical expertise from various areas to one room makes more sense than having individual organizations work on specific processes. Of course, we are development partners in the health sector and hence our intervention and input into policies and processes is fundamental. Working with the Ministry, WHO and other civil society organizations has proved to me that partnerships are critical in moving processes. As we speak, the Gender and human rights manual has rather taken progressive steps, been approved by the Senior Management team within the Ministry of Health, as well as the Health Policy Advisory Committee and will be up for discussion at the Top management level.

It’s not surprising that even at this level, partners have come together to discuss the road map. With a question, what next after top management approves? This is where synergizing becomes key. We have planned and agreed on a road map that will ensure that at various levels (both national and district), the manual is not only shared, but health service providers and District officials,, policy makers among other are sensitized on how best to use this manual for impact. It’s anticipated that these are key in not just providing services but also coming up with human right and gender responsive policies, by laws and Ordinances among others.

By: Ms. Joy Asasira

As we celebrate yet another women’s day, that is commemorated every year on March 8th. At CEHURD, we continue to #PressforProgress in our fight to address preventable maternal mortality in Uganda. The standards have been set, Goal 3 sets a target to reduce the global maternal mortality ratio to less than 70 per 100,000 live births, Abuja Declaration obliges governments to allocate at least 15% of the total national budget to the health sector. Whereas Uganda has made progress, but we still have along way to go, the maternal mortality ratio still stands at 336/100,000 live births. For very maternal death in Uganda, six (6) women suffer severe morbidities- anemia, infertility, pelvic pain, incontinence, and obstetric fistulas.

At CEHURD we have continued to highlight the plight of our women who die needlessly due to pregnancy related causes. The positive judgment from the High Court against the Nakaseke District Local Administration ( Civil Suit No.111 of 2012 )that recognized that Nanteza Irene’s maternal health rights were violated, when she was neglected for eight (8) hours in in the hospital without proposer care while she experienced hemorrhage and a raptured uterus.

The task ahead is still a daunting one, the maiden maternal health case that was filed by CEHURD and the families of Jenifer Anguko (Arua) and Sylvia Namubiru (Mityana) in constitutional Petition No. 16 of 2011 where CEHURD sought a court’s pronouncement that the non-provision of basic indispensible health maternal commodities in government health facilities and rampant maternal mortality is also caused by the government’s non-provision of basic minima maternal health care packages, which constitutes a violation of their right to health. This case is yet t be heard on its merits since its filing in 2011, but we shall not relent, and we also implore the Constitutional Court of Uganda to hear this case, because justice delayed is justice denied!

As we celebrate women, there is no doubt that the unique reproductive health needs and roles of women, put them at risk of negative health outcomes without access to appropriate services. Many of these are preventable with adequate resource allocation, availability of health services and women’s empowerment.

At CEHURD, we celebrate the women, we recognize their role and contribution to a strong and flourishing society. It is with this that we continue to #PressforProgress to ensure that the women of Uganda do not die or suffer due to preventable maternal mortality causes. As Professor Muhmoud F. Fathalla, who is unarguably the greatest Women’s health Rights champion stated, “Women are not dying because of diseases we cannot treat, they are dying because societies have yet to make the decision that their lives are worth saving.”

#maternalhealthug

#petition16

By Ms. Noor Nakibuuka

Today, Uganda joins the rest of the world to commemorate the International Women’s day. As a woman, mother and an advocate for women’s rights, it can’t go without saying that this day brings memories to me but also the institution I work for.

For years, the Center for Health, Human rights and Development has stood out as an institution that among others, advocates for women’s rights. Today we celebrate the women we have empowered, advocated for, and those that have benefited from our services as an institution.

At CEHURD’s inception in about 2009, the maternal health rate for example stood at about 438/100,000 live births in Uganda. As we #pressforprogress, we celebrate 336/100,000 live births today. Our contribution as an institution cannot go without notice. We have litigated, sensitized communities, held talk shows, and engaged various line ministries, local governments among others to ensure that women’s rights are upheld and respected. These successes wouldn’t have been, but with women, the mothers of this nation.

On such a day, one usually wants to recall the country’s progress towards women. Allow me commend the state for its efforts towards ensuring that women access health care, that the legislation protects their rights, land rights are not violated, and violence is restricted in homes among others. This is not to say, that these have ceased being challenges but it’s important to give credit for the progress we have achieved this far. Indeed the Constitution of the Republic of Uganda accords women special treatment with specific provisions that uphold their unique status and natural maternal functional role they play in society. The Domestic violence legislation, penal code Act, HIV prevention and Control Act, Land acquisition Act among others in one way or another protect women and we cannot fail to highlight this as progress in realizing women’s rights

While I commend the state for this progress, I want to give special attention to women at various levels that have worked so hard to ensure that the legislations and all strategies targeting women are indeed put into practice. Women ministers, women members of parliament, women in various positions within various institutions including civil society organizations, academia, agricultural sectors, local government levels, health institutions, media, stay home women, market vendor women, etc we celebrate you, we are proud of you, for you the nation was born.

I want to thank you for being women, for enduring all that it takes to see the nation smile, for being great mothers, advisors, counselors, teachers, service providers, musicians, for being the voice of the voiceless. We celebrate you

Happy women’s day