By: Wasswa Paul

Many cases filed by the Center for Health, Human Rights and Development [CEHURD] seek to challenge violations and omissions that infringe on the realization of the Right to Health in Uganda. Classical examples of these cases include Constitutional Petition No. 16 of 2011 [CEHURD and others vs. Attorney General that sought to challenge the lack of access to essential maternal health care services that killed pregnant women and babies and Civil Suit No. 111 of 2012 [CEHURD and others vs. Nakaseke District Local Government and others] that was filed by CEHURD on behalf of a pregnant woman who died in a hospital while awaiting obstetric care.

Whereas these cases are precedent setting in Uganda, achieving a successful outcome in litigation often requires a great deal of preparation. One of the tools CEHURD has continuously used to achieve a successful outcome in Litigation through preparation is engaging in Internal Moots.

Internal Moots are held to assist the Advocates to further conceptualize and appreciate the facts of the cases pending in Uganda’s Courts of Law while connecting the facts to the Law and Evidence on record.

They also assist the Advocates to buttress on the arguments raised in the pleadings and to identify the gaps in the pleadings and evaluate the evidence raised in support of the pleadings.

It is through such Internal Moots that CEHURD continues to win its cases as it Advocates for Social Justice in Health

By: Dennis Jjuuko

Uganda continues to grapple with a critical shortage of blood that is affecting services and putting patients’ lives at risk. The Health Ministry’s blood bank facility in Kampala, has only 150 units of blood remaining, not enough to meet requirements on an average day in the city. Nationally, Uganda needs at least 340,000 units of safe blood annually as recommended by the World Health Organisation, but usually only collects 200,000 a year according to the Director of Uganda Blood Transfusion Services. The country then faces a deficit of 140,000 blood units.

The shortage was recently “almost at crisis level”, which prompted a cancellation of hospital operations and prioritization of cases, and an extra 7 billion shillings (£1.4m) needed to procure donor and testing kits, and to fund blood donation drives, to get the service back on track for the next six months. The crisis came at a time of a proposed reduction of the health budget from 1,850tn shillings in the current financial year to 1,714tn in 2018-19. But, according to the just released National Budget Framework Paper that gives a picture of how much money each sector is likely to receive in a financial year, UBTS is proposed to get just Shs8.8 billion – a further reduction. The blood bank, as a result launched, an appeal for blood donation in coordination with National Social Security Fund.

Accident victims, cancer patients, women in labour, and children requiring transfusion, are on the rise, yet Ministry of Health figures show that Uganda’s blood needs are increasing at 20% per year. Investing less in blood means losing lives, yet this is something government can have control over.

It is important to emphasise that blood donation is a voluntary activity motivated by the need to save lives. As a result, the Center for Health, Human Rights and Development (CEHURD), as a Health Rights organization that takes availability and access to services as among the central tenets of a functioning health system, therefore joined and contributed to this drive of ensuring adequate stock of blood needed for saving mothers and other patients in need. CEHURD partnered with local council chairpersons of Nakwero A and Ndazabazadde villages and mobilized staff and residents who donated units of blood that surpassed CEHURD’s target. 50 units were the target and 74 units were collected on 17th February 2018.

In Uganda, access to essential health services for pregnant women and others in need is a public health crisis that CEHURD, not only as a health rights organization that challenges the circumstances under which mothers lose their lives (Petition 16), but also as a party interested in the sanity of the health system can contribute to. More than 16 pregnant women die every day in Uganda, with hemorrhage being among the leading direct causes of preventable death, contributing 42%.

CEHURD therefore responded to the blood deficit in the country and continues to encourage Ugandans especially youth to at least do that benevolent act every quarter of the year since the shelve span of blood is only 35 days, yet Uganda is in dire need for sufficient stock of blood if the health system is to effectively respond to emergencies.

 By Moses Mulumba

Industrial actions by health professionals (no matter the category) severely affect health systems and, when they last longer, create a bigger potential for collapsing health service delivery.

This situation raises a serious ethical and legal dilemma which has to be understood and managed well as human life is involved.

The importance of human resources for the functioning of health systems is not doubtable.  In fact, the World Health Organisation (WHO) indicates human resources for health as one of the six building blocks for a health system. Uganda continues to grapple with sustaining this important block.

As a result of the gaps in Uganda’s human resources for health, we have over time experienced threats of industrial actions across all levels.

On November 7, 2017, members of the Uganda Medical Association (UMA) began an industrial action which was grounded in three major asks: first, reviewing the supply chain management of medicines, vaccines and other medical supplies; second, immediate halt of the war on doctors including a request to disband the health monitoring unit; and, third, immediate increase in salaries and allowances of all doctors and improvement of working conditions.

A number of issues have been raised since, including the legitimacy of the industrial action by UMA. But I would like to concentrate on the legal and ethical questions.

In medical practice, the duty to act ethically lies at the very origins of the profession. The Hippocratic Oath focuses more on ethics of the physician’s conduct than on the science of efficiency that a health professional should apply. It is thus important for the striking doctors to maintain the highest level of ethical considerations.

One of such considerations is the requirement that emergency care must be provided during a strike. The ethical principles equally apply to the ministry of Health, which should ensure that all the required resources are made available to the doctors in service during this period in sufficient amounts.

This includes a sound governance structure for delivery of health services and showing signs of commitment to ending the strike.

We should not have an expectation of our health professionals practicing ethically in an unethical environment such as using unethical approaches to resolving the dispute.

I will address the legal theory which the ministry of Health has taken on the advice of the solicitor general. The ministry has argued that the current industrial action by UMA is illegal and they have relied on section seven of the Public Service (Negotiating, Consultative and Disputes Settlement Machinery) Act 2008.

Under this law, UMA was expected to issue a 90 days’ notice before withdrawing labour in essential services and they had to secure a certificate signed by the chairperson of the public service negotiating and consultative council.

This provision is, however, not a general rule as it has exceptions under section 8 of the same law, which allows withdrawal of labour due to unsafe and dangerous working environments even without issuing such a notice.

A close look at the demands of UMA indicates that part of their request is to improve the ‘dangerous’ working conditions its members are subjected to.

Without prejudice to the above, the ministry of Health can only get a competent declaration on the legality of this industrial action from the courts of law, and not the solicitor general whose comment is simply an opinion!

The ministry needs to explore more tenable legal interim solutions during this industrial action. For instance, while our Constitution and the Employment Act clearly forbid forced labour, one exception that would see the government compel doctors back to work is through declaring a state of emergency under section five of the Employment Act.

The consequences of such a declaration are, however, fatal for Uganda’s health system and this option only needs to be considered as a last resort.

It is also possible to do an interim legal task-shifting effort. This is specifically possible since the strike is only involving doctors.

Under the Medical and Dental Practitioner’s Act, a person authorised by the director general of health services may give medical or dental treatment in a government medical institution after undergoing appropriate training.

Under this option, the director general may authorise lower health professionals to undertake duties of medical and dental practitioners as long as they have what the law prescribes as appropriate training.

In summary, the ethical and legal dilemmas are real in this industrial action by health workers. This needs to be managed through utilisation of the appropriate principles of the rule of law and exploring dialogue.

Both doctors on strike and the ministry should not forget the basic ethical principles which are a basis for the protection of life, a cornerstone of the Hippocratic Oath.

The author is a lawyer practicing health law and policy at Center for Health, Human Rights and Development.

Source:  http://observer.ug/viewpoint/56000-address-the-ethical-legal-dilemmas-of-doctors-strike.html

By Wasswa Paul

On Friday 20^th October 2017, Center for Health, Human Rights and Development [CEHURD] with support from Right Here Right Now held the 4^th Annual National Inter-University Constitutional Law Moot Court Competition at Kampala International University. The theme of the Moot was “Litigating the Right to Health”.

The Moot saw 10 Universities accredited by the Law Council to teach Law in Uganda participating, these included; Cavendish University, Islamic University in Uganda- Kampala Campus, Islamic University in Uganda- Mbale Campus, Uganda Pentecostal University, Bishop Stuart University-Mbarara, Makerere University, Uganda Christian University Mukono & Kampala amongst others.

Students argued for and against the case of William Ozodreka, a secondary school student living with HIV/AIDS who advocated for the teaching of Comprehensive sexuality education in his school. The School which was unwilling to teach Comprehensive sexuality education dismissed William Ozodreka and after his dismissal, he was tortured by the School’s officials. Activists took up the case and approached the High Court of the Republic of Ford to seek appropriate redress. In the High Court, students made a case for the teaching of Comprehensive Sexuality Education. They argued that the Ban on the teaching of C.S.E is unfounded in Law as it deprives secondary school going children a chance to know and learn about body changes, live responsible lives so as to become better citizens.

When William Ozodreka decided to change strategy after having noticed that the High Court was not the most appropriate forum to entertain his suit, he went to the Constitutional Court to which students argued that the ban on Comprehensive sexuality education in schools is unconstitutional as it deprives students in secondary schools a right to education and access to information. Students who argued against the William’s case raised the Political Question Doctrine and the case was dismissed on Technicalities.

In the Final round, an appeal was filed by William Ozodreka in the Supreme Court and students were expected to formulate grounds of Appeal in the Final Round and to argue for and against the Appeal.

The final round of the Moot was presided over by Her Lordship Lady Justice Dr. Esther Kitimbo Kisaakye and other panelists included Professor Ben Twinomugisha of the School of Law-Makerere University, Her Lordship Rtd Justice Elizabeth Nahamya, Dr. Daniel Ruhweza of the School of Law- Makerere University and Ms. Primah Kwagala, the Program Manager of the Strategic Litigation Department of the CEHURD.

Once the students made presentations before the Judges, the judges awarded marks to each of the  presenters and they gave their observations about each presenter’s oral submissions.

At the end of the Competitions, out of the 10 Universities that participated, Uganda Christian University- Kampala Campus emerged as the 1^st Runner Up and Makerere University emerged as the overall winner of the 4^th Annual National Inter-University Constitutional Law Moot Court Competitions with the Best Memorial as-well. The  winner team took home a trophy.

Makerere’s Mr. Murungi Patrick emerged,  best Oralist in the final round of the competitions and he was awarded a 3 month Internship at the Center for Health, Human Rights and Development.

Moots are organized by CEHURD to enable students learn the Art of litigating cases that essentially touch on the Right to Health within Uganda’s Legal framework and Courts of Law they are also trained in legal writing, arguing cases in court, preparation of court pleadings, professional conduct and demeanor while in court.

In a bid to improve access to Quality HIV services as well as addressing Sexual and Gender Based Violence (SGBV), the Center for Health Human Rights and Development with support from International Development Law Organization (IDLO) and ViiV Health Care is conducting capacity building exercises for different stake holders in Mukono and Gomba Districts.

During these engagements, it has been realized that parents have a great role to play in regards to reducing cases of SGBV among Adolescent Girls and Young Women (AGYW). The Capacity Building exercises conducted are aimed at enhancing capacities and knowledge of different stakeholders by equipping them with knowledge and skills to demand and provide quality HIV related service for AGYW as well as protection against SGBV and discrimination. The training workshops are targeting Community Paralegals, Community Based Organization Actors, Police officials, Health service Providers, District Officials, Justice and Law Sector actors among others.

During the training for Community Paralegals for example, AGYW gave their experiences on how Parents can be of great importance when it comes to reducing cases of SGBV which are among the reasons for increased prevalence of HIV amid AGYW.

Ms. Annette a resident of Kasawo in Mukono narrated her story about how she survived being defiled by her Father’s friend. When I was 15 years a friend to my dad once called me and asked me if we could go to the shop and he buys me something to eat. When we reached a dark corner on our way to the shop, he grabbed me and dragged me to the bush. I was not aware of what was going on. He immediately rushed to my knickers. Thank God our senior woman teacher had told us how to deal with such a situation. Our teacher had told us that if a man rushes to your under garments with force, pretend as if nothing is wrong but make sure you kick or beat them hard on their private parts and run. When I was in that situation, the old man tried to tear up my knickers but all I did was to tell him I could remove them myself as I concentrated to save myself from that beast. As he approached me all relaxed, I managed to kick his private parts and ran off as he was nursing his pain. Annette sadly noted that she could not report that incident to her father because she first of all feared her parents a lot and did not think anyone could believe in her. This therefore means that parents must be free with their daughters to give them chance of disclosing to them worst experiences they go through in life and thus finding ways of helping them out.

It was also comprehended that parents have a role to respect their responsibility of paying school fees for their children to offer them a chance of acquiring knowledge and thus enabling them to make informed decisions in life. Many parents have abandoned their responsibility of taking their children to school which has exposed them to risks as they try to look for school fees elsewhere.

Ms. Allen Mutyaba a resident of Kanoni narrates her sorry of how she experienced SGBV just because her parents failed to raise her school fees. When I was 14 years old my parents could not afford paying my school fees. A Good Samaritan, a friend to my mother, asked my parents if she could go with me to her home and take me back to school. She got me back in school but my excitement turned into pain and tears shortly after her husband started coming to my bedroom at night when his wife was asleep. He threatened to send me back to the village if I told anyone about it. Often times when I refused he would insert his penis in my mouth. This went on for three years, all because of my need for school fees. On day I heard rumors that this man was HIV Positive. This news gave me courage that one night I slept with a knife, ready to stab him if the attempted to force himself on me. When he came to my room I stabbed him on the thigh and in the morning I reported him to his wife who immediately took me back to the village as she claimed I was going to spoil her marriage. On telling my mother about the whole story she took me for an HIV test. I would ably confirm that testing negative was the first miracle I ever witnessed since this man was HIV positive.

Many AGYW out there go through such cases and remain silently violated. This why CEHURD has come up to empower these AGYW as well as engaging with parents and caretakers to remind them about their roles and responsibilities when it comes to addressing SGBV among AGYW.

CEHURD is therefore employing Legal Empowerment and Social accountability mechanisms to address the existing systematic inequalities and obstacles to health service access as well as responding to Sexual and Gender Based Violence (SGBV). This will therefore lead to systemic improvements that will benefit all Adolescent Girls and Young Women in the targeted communities.