From Canada to Uganda – My Internship Experience at CEHURD

By Jillian Ohayon

My name is Jillian, I got an opportunity to work at CEHURD for the summer of 2017. I am a Law student at McGill University in Montreal, Canada. While at CEHURD I have had the opportunity to participate in a variety of interesting meetings and projects.

On my first day here, I had the chance to attend a hearing at the Constitutional Court. After that, I spent a few weeks involved in preparatory work with the Community Empowerment Program before spending four days in the field in the district of Gomba. There, I had the chance to speak with adolescent girls and young women about their level of satisfaction with HIV-related services and their experiences with gender-based violence. I found this to be both challenging and rewarding. I also had the chance to speak with various stakeholders about these issues to try and evaluate where the capacity gaps lie and where CEHURD would be best placed to come in and help.

I also worked with RDA, looking at the National Health Insurance Scheme Bill, with a specific focus on reproductive sexual health rights working with another intern creating a document critically analysing the bill by highlighting potential challenges, as well as comparing its objectives and design for implementation to other jurisdictions.

Finally, during my internship period, I have had the opportunity to attend multiple meetings on a variety of topics. These have included meetings between advocates from CEHURD and Burkina Faso, a sensitization training on unsafe abortion for police representatives, and a stakeholders meeting on the Day of the African Child.

My time in Uganda has been great. My favourite part about being here has to be the greenery and the sunshine! I really love Kampala, and have met some amazing people and made some great friends. The city is so vibrant and exciting, and I never feel at a loss for something to do. I am so glad that I decided to come and spend my summer in Kampala working at CEHURD!

Different countries, similar health challenges: An exchange visit to Zimbabwe

Learning, re-learning and unlearning is what kept on my mind when I received an invite from the Community working group on Health (CWGH), Zimbabwe early this June for an exchange visit to one of their communities in Goromonzi. Zimbabwe is known for its advanced engagement of communities in health system governance. With the efforts and skills of CWGH, there is registered success in community participation. Anyone engaged in community work, would want to visit CWGH to learn from their experience. How treasured, I was to practically see what it means for communities to own processes- I should say, Uganda still has a long way to go and we have a lot to do to get closer to Zimbabwe, to see communities participate in health systems governance.

The team from Uganda, Malawi, South Africa and Zambia visited Mwanza Rural Health Center in Goromonzi. The community here is more than blessed; it’s more than happy for the works of CWGH. But did it do? CWGH worked with the Training and Research Support Center (TARSC) to initiate baby steps but progressively and strategically aimed at ensuring that health center committees (Uganda’s equivalent of Health Unit Management Committees (HUMCs) play their role in advancing the realization of the right to health in Zimbabwe.

“In 1980, the HCCs were present but for lack of guidelines, funds, skills among others etc they died a natural death. CWGH vowed to reactivate them” Itai Rusike Executive Director CWGH noted. But together with TARSC we developed guidelines and followed the process through its adoption by the Ministry of Health through the Public health advisory board.” He added.

While countries like Uganda have such guidelines that explicitly state the roles and responsibilities of HUMCs, composition etc we still lack the experience Zimbabwe has. The functionality of HUMCs in Uganda is affected by so many challenges yet they would play a critical role in monitoring provision of services if the governance structure was supportive. There is fissure between operationalization of the HUMCS guidelines and the decentralized system of governance leading to non-functionality of this structure. This may be attributed to lack of a legislation to enforce their functionality- given that policies are not law in the country. Limited community knowledge on roles of HUMCs as strategy for their involvement, leaving a gap for communities to hold them accountable.

The availability of guidelines is sometimes not enough if its not followed by practical implementation of the same. Ideally this would necessitate tools development, hands on trainings, facilitation of such structures to be able to accomplish their roles. “Having guidelines wasn’t enough so a standard training manual for HCC was developed and adopted by the Ministry of Health through the Public Health Advisory Board. These have since become documents for recognition and used by everyone. HCC are now recognized by the Ministry, Local Governments and partners” Itai Added.

The Health Center Committees in Mwanza demonstrated what a community owned process means, the value, roles and responsibilities of communities were all laid out- this to me was a lesson to bring back home. The availability of clear guidelines, followed by trainings and facilitation of HCCs empowered them to realize and fulfil their roles and responsibilities. They managed to mobilize communities to build a waiting mothers ward at this health facility, why? In the past the facility and District as a whole registered many maternal deaths and this was majorly because of the long distance mothers had to trek to the nearest health facility, Makumbe District Hospital, which is 90km away from Mwanza. The solution?, with CWGH’s interventions and trainings of HCCs on their roles, there have been significant changes. Today mothers wait from this ward 3 weeks before delivery with food to mothers, electrify, water, name it provided by the communities.

“When the community realized that we had the power to advocate for our own rights, the HCC, to which I am the Vice chairperson, opted to look out for resources to put up a waiting ward for mothers. From household meetings, village level, crying out to members of parliament, the army, the ministries and to CWGH, we managed to build a waiting home for mothers.” Mr. Munyongani Augustine.

Listening to these stories and how committed communities are to own processes, makes me think that its possible for us to engage the communities further especially where the state has failed. Many of the cases for instance that Center for Health, Human Rights and Development has litigated have a bearing of long distances to health facilities. This however does not mean that the state sits back but rather works with communities to ensure universal access to health for all.

This exchange visit was wound up with an Annual meeting for the CWGH. This event displayed what it means for the people to participate in health systems. With a room full of thousands of people, Mr Itai Rusike the Executive Director of CWGH was not seen on the floor to speak- wow- but people that are faced with the challenges or those having the power to change for the betterment of the right to health and the communities!

While giving his key note address, Mr. Mulumba Moses the Executive Director of CEHURD (Uganda) left a strong message for us to critically think through and analyze from country perspectives. “Health is political and anything political is about power and resources. When engaging on power and resources, it means dialogue or descent. CSOs over dialogue and are taken for granted for the diplomatic approach they use. Sometimes we need to go beyond the dialogues and descent for change” Mr. Mulumba noted.

The voices of the speakers almost pointed to the same things. The challenges faced by the health system in Zimbabwe. At one point I wondered whether some of these were literature written about Uganda and were just being selected and placed onto Zimbabwe by the speakers- but it’s the truth. Some of these messages are:

No woman should die while giving birth, People are dying , children are dying while in hospital, on the way to hospital etc. Collective efforts are very key here- Executive, Legislator and Judiciary” Senator Anna Shiri (parliament of Zimbabwe)

There are areas of serious concern in our health systems. Some facilities lack basic medicines, equipment’s, understaffed while nursing students from colleges are not employed and as result people are dying of preventable diseases”. Mr Elasto Mugwadi- Chairperson Zimbabwe Human Rights Commission.

“We are neglecting to demand what is a right to us. Health is our right and therefore we don’t have to get a mercy of a politician on our health. It is time that citizens are mobilized to demand that our health be paid for just like they are paying for their own health (the VIPS)- Politicians shouldn’t use public resources to seek for health outside this country, they should get from their pensions. Doesn’t government have money to pay to our health sector? We have the money, it’s a matter of citizens beginning to demand that government prioritizes our health not their health” – Hon P. Sibanda Parliament portfolio committee on health , Zimbabwe.

Indeed we are different countries facing similar health challenges right from the community level to national level. The time is now for us to stand up and advocate for our rights. Remember “Anything for us, without our involvement is not for us” Together we can.

Engaging Parliament to clarify the legal and policy frame work of Abortion in Uganda

CEHURD within the Coalition to Stop Maternal Mortality Due to Unsafe Abortion (CSMMUA) held a meeting with Uganda Women’s Parliamentary Association (UWOPA) to clarify on the legal and policy framework on sexual and reproductive health.

The meeting was also used as an avenue to discuss evidence based approaches explored in addressing the sexual and reproductive health dilemma of unsafe abortion even where the law is restrictive.

In Uganda, unsafe abortion is one of the leading causes of maternal morbidity and mortality, contributing to approximately 26% of the estimated 6,000 maternal deaths every year and an estimated 40% of admissions for emergency obstetric care.

The meeting was motivated by a conviction that as policy makers, Members of Parliament (MPs) have a role to play in advancing Sexual and Reproductive Health issues in the development of laws around the subject and also interact with communities in their various constituencies.

The meeting paved a way for an open discussion on unsafe abortions that are a public health issue suggesting the different stakeholders’ roles, policy makers inclusive, in reducing abortion related deaths in Uganda.

Discussions at the meeting were centered on the law and politics of maternal health and sexual reproductive health in Uganda, the question of reproductive justice, reproductive oppression, and the status of 5 A annex ward at Mulago hospital.

International Day of the African Child 2017: Promote Child Health for the 2030 Agenda for Sustainable Development

The Center for Health, Human Rights and Development (CEHURD) today joins the rest of the world to commemorate the International Day of the African Child (IDAC) 2017 under the theme: the 2030 Agenda for Sustainable Development for Children in Africa: Accelerating Protection, Empowerment and Equal Opportunity.

As part of celebrations, CEHURD under the Advocacy for Better Health on the eve of the day held a dialogue to deliberate on the challenges and interventions relating to child health.

A panel constituting of a student representative from the Kyambogo Primary School, a midwife from Mulago National Referral Hospital, a community representative and the Deputy Head of Department – Uganda Police Child Protection Unit discussed the various challenges faced in realizing children’s health in Uganda today.

Challenges including child theft at health facilities, inadequate nutrition of children and other underlying causes of child morbidity and mortality such as insufficient and unmotivated health workers and the limited access to commodities related to newborns like the resuscitation devices in health facilities across the country topped the discourse.

Sarah Kedi a pupil of Kyambogo Primary School said that as children they face a number of health challenges including the inability for the girls to take a bath while at school during their menstruation periods. “I call upon government to support the children by providing sanitary towels to students who need them, this will improve sanitation in schools,” she stated.

On issues relating to child morbidity and mortality, communities were called upon to motivate mothers to visit health facilities to receive antenatal care and deliver from hospitals. They were further urged to share the right information with the mother as misinformation may lead them to shun away from the visiting the hospitals contributing to the newborn low scores that can have a negative impact on the child’s growth.

Sister Mary Adong a senior midwife at Mulago hospital, called upon mothers not to value other things than the health of their newborns. She said, mothers forget to do specific things for the health of their babies and yet every baby needs quality antenatal care in order to be bright and healthy.

Instituted in 1991 by the Assembly of Heads of State and the then Organization of African Unity (OAU), the IDAC IS in memory of the 16th June 1976 student uprising in Soweto, South Africa. During that time, students marched in protest against the poor quality of education they received and demanded to be taught in their own languages. Since then, OAU and later the African Union (AU) as well as member states, including Uganda, commemorate the day on 16th of June annually.

CEHURD calls on Uganda Police and Mulago Hospital to comply with Court as Decision on Missing Baby wins Judge an International Award.

The Center for Health, Human Rights and Development (CEHURD) has today the 7th June 2016 held a Press Conference at its Offices in Ntinda applauding the judiciary of Uganda for upholding the health and human rights of Ms. Jennifer Musimenta and her husband Michael Mubangizi.

This follows the success reached after a decision made by Lady Justice Lydia Mugambe won an international award, the People’s Choice Gavel Award, in the annual Gender Justice Uncovered Awards hosted by Women’s Link Worldwide. In this ground breaking decision, Lady Justice Lydia Mugambe held that the human right to health and access to information of a couple that lost a baby at Mulago Hospital under mysterious circumstances were violated by Mulago Hospital Personnel.

Please find the Official Press Statement HERE