Deadline: Wednesday, 2nd March, 2022
We continue to resound that health workers must operate in a safe environment without fear of being arrested, intimidated or harassed as they provide Sexual and Reproductive Health Rights services. In turn, women should be able to seek care knowing that they will not suffer stigma or be denied service.
CEHURD
On 1st February 2022, the Chief Magistrate of Lugazi Court dismissed the case of Uganda vs Fredrick K (Criminal Case No.56 of 2020) for want of prosecution.
Mr Fredrick K, a senior clinical officer from Buikwe District was arrested after saving a life – providing a post abortion care service. Two years later, CEHURD, and the Legal Support Network have worked to ensure that he is freed.
We continue to resound that health workers must operate in a safe environment without fear of being arrested, intimidated or harassed as they provide SRHR services. In turn, women should be able to seek care knowing that they will not suffer stigma or be denied service.
Restricted environment and the misinterpretation of abortion laws restrains health workers from providing post abortion care services for fear of arrest which in turn has led to the inability of women to access the services.
With unsafe abortions contributing to the high maternal mortality rate in Uganda (according to the UDHS 2016), there is need to address the underlying factors that drive these deaths ie the restrictive legal and policy environment, misinterpretation of the law due to inadequate knowledge among others.
Story;
In November 2019, Mr Fredrick K, a senior clinical officer at Mukisa Medical Clinic was approached by a patient who had carried out an abortion in Buikwe District. She was in critical condition. Mr Fredrick K was able to provide Post-Abortion Care to her and thereafter referred her to Lugazi Referral Hospital for an abdominal scan. A few days later, the patient returned to his facility for further therapy. On finding that she had not had the scan as he had recommended, Mr Fredrick referred her back to the hospital.
On April 6, 2020, police officers from Lugazi Central Police Station arrested Mr Fredrick on accusations of having carried out an abortion on the teenager girl, which is a criminal offence under sections 141 and 143 of the Penal Code Act. The Ugandan Constitution does not explicitly prohibit abortion.
On May 11, 2020, the Legal Support Network applied for bail for Mr Fredrick, basing on the standards and guidelines by the Ministry of Health that permit health workers to provide Post-Abortion Care.
A CEHURD compilation.
”The budget framework papers indicate a number of unfunded priorities which will significantly affect quality healthcare. As a country, we have not been successful in increasing financing for the health sector”
By Peter Eceru
The Covid-19 pandemic has not only painfully exposed the gaps in the health systems and infrastructure, but also the high levels of vulnerabilities of individuals, and households. Most poor and vulnerable people in Uganda have limited resources to cope with the economic and health impacts of the pandemic. Ugandans at the base of the pyramid who are majorly women, experience enormous hardship when out-of-pocket payments, formal or informal, are high in relation to households’ ability to pay for health care. As a result, lack of financial protection reduces access to health care, therefore, undermining the health status and exacerbating health and social-economic inequalities.
With the aim of ensuring access to affordable quality health and reduce out of pocket cost for Ugandans several initiatives have been enforced including the elimination of user fees in 2001 The user fees at health facilities were used as an additional source of revenue to fund health care. Unfortunately, over the last 10 years, government contribution towards health care as a percentage of the national budget has reduced from 8.9% in 2010/11 to 6.1% in 2020/21 and this burden has been shifted to the donor community and households. Similarly, government contribution as a percentage of the national health budget reduced from 74.2% to 57% over the same period. This clearly demonstrates that the health of citizens is being gradually scaled down in terms of government prioritisation. What is even more worrying is that of the 57% government contribution towards the health budget, 53% is spent on recurrent expenditure such as salaries, oils and fuels, allowances and only 4% is spent on capital expenditure.
In the budget Framework Paper for the financial year 2022/23 that was laid before parliament on the 21st of December, 2021, it is evident that there will be no significant change. The budget framework papers indicate a number of unfunded priorities that will significantly affect the quality of health care. The unfunded priorities include; wage enhancement is unfunded to the tune of 47.9Bn, procurement and maintenance of equipment to the tune of 12.3 Bn, the Phased establishment of the national ambulance service- 20.8Bn shillings among others. This means that the health care system will still deal with challenges of unmotivated staff, inability to kick start the national ambulance service,
The World Health Organisation recognises that there are 3 inter-related domains that are fundamental to achieving and maintaining universal access to health care- raising sufficient funds for health care, reducing financial barriers to access by pooling funds in a way that prevents out of pocket costs and allocating funds in a way that promotes quality, efficiency and equity. Over the last ten or so years government has failed on all the 3 domains. As a country, we have not been successful in increasing financing to the health sector as a percentage of the national budget. The World Health Organisation argues that for a country to be able to achieve Universal Health Coverage, it must allocate about 15% of its budget towards health. Uganda has for most of the last 10 years allocated less than half of that. To be able to achieve our health targets as set out in the NDPIII Uganda, the programme Implementation Plan for Human Capital Development projects an expenditure of more than 9 trillion shillings in the 2021/22 FY. However, in the same financial year, the government allocated only 2. 7 trillion shillings leaving a funding gap of 6.3 trillion shillings. In terms of pooling resources, parliament passed the National Health Insurance Scheme Bill in 2021, but this was not assented to by the President and in accordance with the ruling of the Speaker of parliament, this was one of those bills that abetted. As a result, out-of-pocket expenditure on health is over 40% which is more than twice the World Health Organisation recommended.
Maternal, reproductive and new-born health is a key determinant of the opportunities that women and their children have in life. The budget must therefore ensure that pregnant mothers are capable of accessing a doctor regardless of where she is, be able to access blood whenever she needs it during childbirth among others. Women should have a right to safely bear children and to freely decide whether to have them, how many to have and when to have.
Peter Eceru is a Programme Coordinator-Advocacy, Health and Human Rights Advocacy at Center for Health, Human Rights and Development (CEHURD)
A version of this article was published in the Daily Monitor Newspaper on Wednesday 2nd January 2022.
Kampala – Uganda. Center for Health, Human Rights and Development (CEHURD) on behalf of the Uganda Medical Association (UMA) and the Federation for Uganda Medical lnterns (FUMI), has issued a notice of the intention to sue in response to the Ministry of Health’s directive for medical interns to vacate hospital premises. UMA and FUMI are exercising a constitutional right to carry out industrial action geared at resolving the challenges faced in the day-to-day execution of their work, training, service delivery and welfare. The challenges range from lack of proper supervision, lack of accommodation, poor remuneration and poor working environment, among others.
By virtue of their appointment by the Ministry of Health, medical interns play a vital role as frontline workers in this era of the Covid 19 pandemic. It is therefore inconceivable that the Ministry of Health has resorted to illegally denying the medical interns their constitutional right to practice their trade and complete their medical training.
On 9th August 2021, His Excellency The President of Republic of Uganda following a meeting with the leadership of UMA, directed that the Government addresses the challenges of UMA and FUMI by, among others, enhancing the remuneration of the medical interns.
Unfortunately, instead of fast-tracking the implementation of the presidential directives aimed at resolving the grievances that led to the strike, the Ministry of Health has resorted to irregular, unorthodox and unconstitutional means of resolving a lawful industrial action. Directing medical interns on strike to vacate the hospital premises within one week is not only unacceptable and unjustifiable in a free and democratic society like Uganda, it is also a callous decision.
In light of this, we point out that the directive does not only undermine constitutionally guaranteed fundamental rights and freedoms of medical interns, it also offends the Directive/ Guidance by His Excellency the President of the Republic of Uganda. These actions are also irregular, illegal, arbitrary, high handed and certainly challengeable in the Civil Courts of Law.
Call to action
We call upon the Ministry of Health to recall the directive to the medical interns to leave their stations within two days or else we risk creating a crisis in the delivery of health services.
For more information contact: info@cehurd.org and copy in kenganzi@cehurd.org or call +256 778 723 449
Find the press statement and a copy of this letter attached here.
What if we consider the human rights angle before looking at someone’s HIV status? Whether one is sick or healthy they are human beings. It is true AIDS kills but to note is the fact that stigma and discrimination are silent killers. Many people especially the young people living with HIV continue to drop out of treatment, relapse and give up because of stigma attacks.
By Sarah Akampurira
In the early 1980’s, an unknown virus surfaced in Uganda that caused a lot of fear, panic and speculations especially whenever an Individual would lose a little weight showing signs of persistent cough, diarrhea or fever. Speculations of one being infected with the Human immunodeficiency Virus (HIV) would be accompanied by stigma, negative utterances and fear to associate with him/her. This has continued to date affecting the young and old people living with HIV.
A lot of strides have been made by government and other partners to create awareness on HIV, signs and symptoms, transmission, prevention, care and treatment as well as availability of ARVs’ services and indeed, majority of Ugandan adults understand a fact or two about HIV. This knowledge base has a lot of real and anticipated positive consequences in the fight against HIV in Uganda.
What if we consider the human rights angle before looking at someone’s HIV status? Whether one is sick or healthy they are human beings. It is true AIDS kills but to note is the fact that stigma and discrimination are silent killers. Many people especially the young people living with HIV continue to drop out of treatment, relapse and give up because of stigma attacks.
These are our relatives, friends, workmates that due to our behavior/utterances we continue to send them to “early graves”. On this day as we commemorate World AIDS Day, I call upon all of us to stop fueling acts of discrimination and stigma against People Living with HIV.
Have you ever imagined the young boys and girls born with HIV who even at some point don’t understand why they are subjected to swallowing tablets on a daily basis and the kind of negativity they deal with in schools, playgrounds without even knowing why? I believe some positive energy, inclusion, dialogue, involvement can contribute greatly to achieve: the overarching goal to bring Uganda to a national coverage of 95-95-95 percent ensuring 95 percent of individuals know their diagnosis, 95 percent of those are on treatment and retained, and of those on treatment, 95 percent have obtained and maintained viral suppression.
To win the fight against HIV requires your effort as well as mine, the government won’t do it alone, research and science won’t but rather an amalgamation of efforts. Together we can actualise this year’s, theme End inequalities. End AIDS.
