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Terms of Reference for the Uganda National Conference on Health, Human Rights And Development (UCHD) 2023’s Coordinator

Center for Health, Human Rights and Development (CEHURD) is seeking for the services of a competent and experienced large events organiser to coordinated the upcoming Uganda National Conference on Health, Human Rights and Development for a duration of Five (5) months (June – October 2023).

Deadline for submission of applications is Friday 26th May 2023.

Download attachment below for details;

Business or Human Rights? The case of CEHURD and two others against JARO Hospital

CEHURD, has on several occasions challenged Ugandan electricity service providers and regulators for cutting off power supply in health facilities which often jeopardizes the enjoyment of the right to health. Whereas, hospitals are obliged to clear their electricity bills, the measures against such noncompliance should not be meted on babies in incubators, patients on life support and all other health services that operate on electricity.

By Seth Nimwesiga

This concept of business or human rights has attracted attention over the recent years alongside capitalism. It recognizes that businesses should be accountable for their actions. That they have a responsibility to respect human rights and to ensure that any risks against human rights arising out of their operations are prevented, addressed or mitigated.

Over the years, CEHURD has documented cases where business owners under the ambit of private health facilities detain patients for failure to pay medical bills. First, Patrick Obiga who in 2016 was involved in an accident and was rushed to International Hospital Kampala for emergency treatment. His family was able to pay twenty million shillings (20 million) of the thirty-eight million shillings charge, leaving a total of eighteen unpaid, and he was detained as a result. Following CEHURD’s interventions, Patrick was let go by the facility.

We assumed at the time that the media attention had sent a message to the facilities, but to our surprise, in 2022 another facility continued the practice that led CEHURD to engage the courts of law.

The High Court of Uganda delivered a landmark judgement against the detention of patients in private health facilities for non-payment of bills. This followed a case filed by Center for Health Human Rights and Development (CEHURD) and two others against Jaro Hospital and its proprietor, for detaining a 14-year-old boy whose parents could not cover, in time, a bill amounting to over 4 million Uganda Shillings after treatment. The decision is significant for several reasons.

First, it reemphasizes the need to protect the right to health as enshrined in international human rights law as well as in the domestic legal framework in Uganda.

Secondly, the ruling upholds the rule of law, it mandates that private healthcare facilities provide crucial essential healthcare services in a way that is both morally and legally compliant. Private hospitals have a duty to provide quality healthcare to patients, but they also have the responsibility to ensure that their business practices keep in line with the provisions of the law. The High Court of Uganda’s ruling flags the detention of patients as neither fair nor reasonable.

Thirdly, the case exposes the rampant concerns around power imbalances existing between companies doing business and individuals enjoying human rights. Patients who seek healthcare services are often vulnerable. Their enjoyment of human rights is often jeopardized by the demands of the health service providers. The case is a timely reminder that private health facilities ought to operate in a manner consistent with the rule of law and the protection of human rights.

In response to the judicial pronouncement, proprietors of private health facilities do, or threaten to demand collateral or indeed a cash deposit from patients before they receive any services. This raises questions of the intersectionality of business, human rights and the role of the state. The judge advises the facilities, in this case to explore alternatives of debt recovery to claim bills due rather than detain patients.

The detention of patients in private hospitals for non-payment of bills, as such, is a violation of human rights. Such false imprisonment in a non-designated detention facility is an actionable wrong which deprives individuals of their right to liberty and violates their dignity as well.

The judgement also demonstrates the role of different state actors, the judiciary in this case, which is a positive development in the area of business and human rights. The judiciary has sent out a strong message to businesses that they must respect human rights and that they will be held accountable for any violations.

However, more needs to be done to ensure that businesses respect human rights. For instance, several cases have sprung up regarding power blackouts in health facilities for governments non-payment of electricity bills. CEHURD, has on several occasions challenged Ugandan electricity service providers and regulators for cutting off power supply in health facilities which often jeopardizes the enjoyment of the right to health. Whereas, hospitals are obliged to clear their electricity bills, the measures against such noncompliance should not be meted on babies in incubators, patients on life support and all other health services that operate on electricity. Another example is a case where CEHURD challenged the failure of the health minister to regulate the cost of treating COVID-19. All this goes to show that beyond profit maximization, health workers swear an oath to save lives which should be prioritized in accordance with the law.

The state has a role to play in setting standards and regulations that promote human rights and hold businesses accountable for their actions. Businesses also need to take proactive steps to respect human rights and to prevent any negative impacts that their operations may have on human rights.

The case and judgment by the High Court of Uganda could not have come at a better time than now when conversations on the health insurance scheme for Ugandans have stalled in parliament. The Judiciary has struck. Both the legislature and executive arms should follow suit in setting the balance clear. The populace needs available, accessible, acceptable and quality healthcare. The capitalists want their money. Where are the answers?

The writer is a Strategic Litigation lawyer at Center for Health, Human Rights and Development (CEHURD).

Call for Expression of Interest to Conduct a Midterm Evaluation for the Joint Advocacy for Sexual and Reproductive Health and Rights (JAS) Programme in Uganda

The Center for Health, Human Rights and Development (CEHURD) with nineteen (19) partners are implementing a four-year programme titled: The Joint Advocacy for Sexual and Reproductive Health and Rights in Uganda (JAS) Programme in Uganda. The JAS programme is due for midterm evaluation to assess the progress so far made in the implementation. CEHURD therefore, seeks to engage a consultant / firm to support in the external evaluation of the programme that will inform decision making for the remaining period of implementation.

Deadline for application is Friday May 26th 2023.

The Unsung Heroes: Celebrating the Resilience and Dedication of Nurses in Uganda

Nurses are the backbone of our healthcare system, providing compassionate care, emotional support, and life-saving interventions to patients in need. This year, let us take a moment to highlight the challenges that nurses face in low-income countries like Uganda, where the shortage of equipment and supplies is a significant barrier to providing quality care.

By Christopher Ogwang

International Nurses Day is celebrated annually on May 12th to commemorate the birth anniversary of Florence Nightingale, the founder of modern nursing. This day is an opportunity to acknowledge the contributions of nurses to society, raise awareness about the challenges they face and find possible solutions to them.

Nurses are the backbone of our healthcare system, providing compassionate care, emotional support, and life-saving interventions to patients in need. This year, let us take a moment to highlight the challenges that nurses face in low-income countries like Uganda, where the shortage of equipment and supplies is a significant barrier to providing quality care.

Uganda, like many other low-income countries, is struggling with a severe shortage of healthcare equipment and supplies. According to a report by the World Health Organization (WHO), Uganda has only 1.2 hospital beds per 1,000 people and a severe shortage of medical equipment, including diagnostic tools, surgical instruments, and anesthesia equipment. This shortage of equipment has a direct impact on the quality of care that nurses can provide, as they often have to work with outdated or insufficient tools.

The shortage of equipment is particularly evident in lower-level healthcare facilities, such as health centers, which are often located in rural areas. These facilities often lack basic equipment like stethoscopes, blood pressure cuffs, and thermometers, making it challenging to diagnose and treat patients. 

On this Nurse International Day, let us take a moment to recognize the challenges that nurses in low-income countries like Uganda face every day. We must work together to address the shortage of equipment and supplies and ensure that nurses have the tools they need to provide quality care to their patients. By investing in healthcare infrastructure and supporting initiatives that provide equipment and supplies, we can help nurses in Uganda provide the care their patients deserve.

The writer is a Senior programme officer at CEHURD in the Campaigns, Partnerships and Networks Programme.

Parliament should save our ailing health system

The Ministry of Health has made significant strides in improving access to health services with 91 percent of  Ugandans now leaving with 5km of the health facility. Reduction of budget allocation to health will roll back the achievement made this far. Investment must now be directed at functionalising these health facilities. 

By Peter Eceru

Parliament is currently scrutinising Ministerial Policy Statements for the 2023/2024 Financial Year. The statements are the equivalent to the draft Budgets for the subsequent financial year. For most people, discussions on the budget does not make sense because it is perceived not to add value to their lives. Unfortunately, for millions of Uganda, whose lives depend on access to health care, is dependent on the public health delivery system these conversations are a question of life and death.

Adequate allocation to the health sector is critical to promoting equity in health service delivery. In the next financial year, the health budget allocation is projected to drop to about 6.5 percent of total budget from 7.7 percent as provided in the current budget. The drop is worrying development and must be arrested by Parliament during the current budget scrutiny. To put this into perspective, it is important to look at some macro-economic factors that have a direct impact on the health budget. 
In Uganda, the annual population growth rate is about 3 percent per year. The increasing population calls for increased investment in public health. Also, the Uganda shilling is projected to lose value against the dollar. This implies the cost of importing a unit of drugs and other health equipment will become more expensive in the coming year than it is this year. Prudent budget allocation will, therefore, demand that the allocation of resources to health should take into consideration these macro-economic considerations.

The Ministry of Health has made significant strides in improving access to health services with 91 percent of  Ugandans now leaving with 5km of the health facility. Reduction of budget allocation to health will roll back the achievement made this far. Investment must now be directed at functionalising these health facilities. 
In Uganda, 71.6 percent of the Out-patient Department attendance is at health centres II and III. Similarly, 56 percent of deliveries take place there. To foster health equity, public health financing must ensure that the quality of service at these lower health facilities is improved because they help decongest the higher health facilities.  
Improving the quality of health service delivery means investing in essential medicines and health supplies, strengthening human resources for health, investing resources in primary health care, ensuring that there are medical equipment and that they are functional, among others.

The draft budget does not respond to the above needs and in some cases, financing has been reduced.  National Medical Stores is projected to receive about Shs537.6 billion in the next financial year with a funding shortfall at Shs245 billion. The biggest funding gap for essential medicines is in health centre IIs accounting for about Shs17 billion. At the height of the drug stockouts earlier this year, we argued that funding was one of the driving factors for drug stockouts in the public health facilities. This budget making process gives Parliament an opportunity to conclusively address stock out challenges. 

Last year, Parliament allocated Shs23 billion for Uganda Blood Transfusion Service and made a proposal for progressive increase in the budget for blood collection, processing and distribution. Unfortunately, government has instead proposed a reduction in the budget for blood from Shs23 billion to Shs21 billion.  The reduction will mean that Uganda Blood Transfusion Service will be incapable of closing the gap of 150,000 units of blood needed by patients in Uganda with the possible result being that more Ugandans will die. 
Financing for service delivery, including health is usually dependent on availability of resources and we have consistently argued that we need to tap into all available opportunities including health insurance. 
We also need to aggressively ensure that every one pays their fair share of the tax that is due to them. Uganda currently loses more than Shs7 trillion annually to tax exemptions that would be channelled to service delivery. These have a direct impact on the country’s ability to provide quality health service delivery for its citizens. Government needs to urgently review its policy on tax exemptions.

The writer is the Program Coordinator- Advocacy at Center for Health Human Rights and Development (CEHURD)

A version of this article was published in the Daily Monitor on April 24th 2023.