In April 2020, the accused was arrested for allegedly committing the offence of Supply of Drugs to procure abortion contrary to Section 143 of the Penal Code Act, Cap. 120 of the Laws of Uganda. He was arraigned in court, formally charged and subsequently remanded to Kitalya Maximum Security Prison, Wakiso District, Uganda. This affected the accused’s work and the eventual closure of his pharmacy.
By Peter Eceru – Programme Coordinator, Advocacy – CEHURD
Currently, the East African Legislative Assembly is undertaking regional consultations on the Sexual and Reproductive Health Bill, 2021 in the all-members states. The Bill is premised on Article 118 of the treaty for the establishment of the East African Community which provides for cooperation in health and promotes the management of health delivery systems and better planning mechanisms to enhance the efficiency of health care services. The East African Community treaty also seeks to harmonise national health policies and regulations in order to achieve quality health care in partner states. The treaty also looks at cooperation in the development of specialised health training, health research, reproductive health, pharmaceutical products and preventive medicines.
The Bill further seeks to strengthen the mechanism that facilitates attainment by the Community of the goal to ensure universal access to sexual and reproductive health care services by 2030. These services include family planning, information and education, and the integration of reproductive health into national strategies and programmes. This goal is enshrined in the EAC Integrated Reproductive Maternal, New-born Child and Adolescent Health Policy Guidelines 2016-2030, and the EAC Sexual and Reproductive Health Rights Strategic Plan.
The Bill recognises the obligation of Partner States under several international, continental and Community frameworks, to respect, protect and fulfil the right to health. They do this by facilitating, providing, and promoting the highest attainable standard of health and providing measures toward the full realisation of the right to health. Bill will strengthen the mechanism to facilitate the attainment of the Community goal of ensuring universal access to sexual and reproductive health care services, including family planning, information and education.
The Reproductive, Maternal, Newborn, Child and Adolescent Health indicators in the East African Community member states are worse than the average in the rest of Africa. High maternal and mortality rates for children under five, high unmet need for contraceptives and adolescent fertility rates demonstrate a need for collective action across the community to respond to the sexual and reproductive health challenges. In 2020, 39,000 children in East Africa were born with HIV infections that could have been easily prevented. During the same period, 62,000 mothers died from childbirth complications that could have been easily addressed. Two hundred million girls and women are estimated to have undergone genital mutilation. Additionally, cervical cancer remains a leading cause of cancer-related deaths in African women, where the estimated rate of deaths is 94 women per 100,000. Currently, 19 million women in East Africa cannot access modern contraception and a further 2.5 million are at risk of death due to complications from unsafe abortions. The Covid-19 pandemic led to a very big increase in violence against women and girls all over the East African Community putting the future of millions of women and children in jeopardy.
Indicators across the different countries in the region vary in terms of severity. For example, South Sudan has the highest maternal mortality rate within the Community with 1,150 deaths per 100,000 women who give birth, while Rwanda has the lowest at 248 deaths per 100,000 women giving birth. These variations demonstrate the need for collaborative health systems planning and how this would benefit the region in dealing with high mortality rates within the East African Community Member states. Various countries have over time developed best practices that can be shared across the Community. In Uganda, a weekly maternal death surveillance enables the ministry to follow up on maternal deaths and investigate the causes. This enables timely response.
To strengthen regional Health Information Management Systems, it is critical to have a regional framework to guide this. The collection of data on for example contraceptive use, sexual and reproductive health and the wider reproductive, adolescent maternal newborn remains uncoordinated across the Community. In Uganda, this information is collected through the Uganda Demographic Health Survey and the Health Information Management Systems. In the case of partner states, different information is collected among partner states and this information is collected along different time periods. This makes it difficult to utilise the information for the purpose of regional planning and collective decision-making. Sound and reliable data is the foundation for decision-making across all health system building blocks and is essential for health system policy formulation and implementation, governance and regulation, health research, human resource development, service delivery and financing.
The consultations on this Bill are therefore a very important process in strengthening regional integration and specific emphasis on the promotion of sexual and reproductive health in the EAC partner states.
The Center for Health, Human Rights and Development (CEHURD) has been implementing its five-year strategic plan (2020 – 2024) since January 2020. Strategic plan implementation is now 2.5 years and due for a mid-term review to assess progress and whether we are on course. CEHURD wishes to engage the services of a consultant with expertise in formulation and evaluation of strategic plans with an advocacy focus and who has a good understanding of issues of health, human rights sexual and reproductive health and rights (SRHR).
Please find below the Details and Terms of Reference;
Sickle cell disease is incurable. However, if detected early, the symptoms can be minimised. The greatest burden of sickle cell disease is in Sub-Saharan Africa, in Uganda, estimates suggest that 15,000 babies are born each year with sickle cell disease. In cases of married couples, majority of the partners do not know of their partners’ genotypes which clearly points to the fact that Sickle cell disease screening before or even after marriage is not prioritized there’s a need for the government intervention and action.
By Pauline Namuli
Sickle cell disease continues to claim lives in Uganda but with effective treatment and care of patients, a number of lives can be saved. People with sickle cell disease suffer from a number of complications, including anaemia, life-threatening bacterial infections, strokes, and general organ failure, and may also endure severe pain also known as pain crises. Symptoms differ from individual to person, the condition has a severe impact on the sicklers ranging from their education, work, and psychosocial development. The disease is a hereditary condition that affects 20 per cent of the Ugandan population. Currently, around 33,000 babies are born annually with the disease of which, 80 per cent before the age of five years. Sickle cell disease is incurable. However, if detected early, the symptoms can be minimised.
Worldwide, Sickle cell disease contributes a significant burden that is not amply addressed. The greatest burden of sickle cell disease is in Sub-Saharan Africa. In Uganda, estimates suggest that 15,000 babies are born each year with sickle cell disease. The world health Organization has indicated the need to improve disease prevention, awareness, and early detection. The Ministry of Health has made significant strides in addressing the sickle cell disease burden by introducing newborn screening programs in selected districts with the highest disease burden. The increased attention is aimed at reducing sickle cell mortality while increasing care and management outcomes. Sickle Cell disease care and management go beyond dealing with the challenge of the disease but also includes dealing with society-related challenges. The people are often stigmatized and discriminated against largely because of myths/beliefs associated with the disease and this often forces families to hide their sick and this is driven. Stigmatization and discrimination are largely a result of ignorance about the disease. While studies have demonstrated that many individuals have heard about Sickle Cell disease this information has not been heard from a health worker. This increases the proportion of spread of nonprofessionally verifiable information which perpetuates stigmatization and discrimination. It is therefore important to have information from professionals on causes, signs and symptoms, and prevention strategies.
Screening services across the country still remain substantially low yet it clearly influences family decisions and subsequently control of the disease in the country. In cases of married couples, majority of the partners do not know of their partners’ genotypes which clearly points to the fact that Sickle cell disease screening before or even after marriage is not prioritized yet it may also influence personal or family decisions. To respond to this, it is imperative to increase access to screening services and information.
Treatment for Sickle cell disease continues to be a huge challenge. It’s important to note that the sickle cell treatment in Uganda is costly and a number of them cannot afford it. According to the Ministry of Health estimates, 80% of sickle cell disease patients die before the age of five as a result of medical complications, while the disease is responsible for around 16% of early infant mortality in the country.
In 2020, during the commemoration of World Sickle Cell Day, the ministry of health launched guidelines on sickle cell treatment to standardize the type of treatment given to patients by health personnel at certain points of care. At the launch, it was also revealed that it was in the final stages of adding the relatively new sickle cell drug hydroxyurea, which is also used in cancer treatment, to the list of essential drugs recommended for sickle cell patients. Currently, families caring for patients say the drug is still too expensive for many caretakers and patients. A 250mg target costs between UGX 1,000 to UGX 2,000 while a 500mg costs up to UGX 3,000 shillings. This requires an annual cost of about UGX 1,100,000, which is way beyond most people’s ability to pay.
Based on the information provided, there’s a need for the government intervention and action such as adding the primary drug for treatment on the essential medicines list as well as decreasing the drug price and making it more affordable for the patients so as to improve the quality of life for sickle cell patients and to reduce on their mortality rate.
The writer is an intern at Center for Health Human Rights and Development.
The Center for Health, Human Rights, and Development (CEHURD) with support from Swedish International Development Cooperation Agency (Sida) wishes to develop a community advocacy dashboard to allow grassroots community structures and partners to identify, document, and report Sexual and Reproductive Health Rights (SRHR) violations. The platform will be a central web-based online system where Community Health Advocates (CHAs) will identify, document, and remotely report any health rights violations in their communities. The 24/7 hour-up time online system will enable CHAs to submit identified SRHR and health rights complaints along with the associated evidence to support CEHURD’s case follow-up and advocacy.
