The Center for Health, Human Rights and Development (CEHURD) convenes the Annual National Inter-University Constitutional Law Moot Court Competitions. Since 2014, the moot court competition has seen more than ten (10) law schools in Uganda participate. The moot court competition is geared towards inculcating a better understanding of the Justiciability of the Right to Health and other human rights guaranteed by the Constitution of the Republic of Uganda, 1995 and recognized in several international instruments.
It also aims at aiding law students to improve their public speaking skills and give them an experience of the litigation process in Uganda. The CEHURD moot has built a cohort of young lawyers who appreciate the right to health and its Justiciability within the confines of Uganda’s legal system.

Rose (not real name), a 15-year -old girl of school going age, is now eight
months pregnant and about to deliver after being allegedly defiled by a
paternal uncle. Being an orphan with no immediate family to turn to, she
struggles daily to find decent shelter and meet her basic needs. While she
stays in the care of a well-wisher, her case was only reported to the Police
when she was five months pregnant. The delay in reporting her case was
caused by the alleged offender who has threatened the life of Rose and
anyone that attempts to provide shelter and seek justice for her.

Rose is a classic example of many girls whose stories have been
normalised in our societies. They barely see the light in the corridors of
courts of justice due to other contributing factors that have resulted into
immense physical and mental traumatic suffering.
Many children and young people are yet to receive justice for the abuses
inflicted upon them due to the failure of the different stakeholders playing
their respective roles in the chain of justice.

A gap in access to information
In 2019, 13,613 defilement cases were reported according to the Police
Annual Crime Report. Center for Health, Human Rights and Development
(CEHURD) has so far recorded 21 cases through their Community Health
Advocates and their toll-free line (0800313131). Many of these have not
received sufficient redress from the Police and the Courts of Law. The few
that have been settled out of court, are usually done so in ways that do not
favour the justice needs of the children affected. As such, access to justice
for children in Uganda remains a dream.

Access to sexual and reproductive health and rights (SRHR) information
continues to be among the most controversial and contentious topics in
Uganda’s legal and policy environment. This is because of the competing
approaches in policy debates and legal approaches that range from religious and cultural perspectives that inform our different backgrounds. A combination of factors such as limited access to a wide range of sexuality
information and education for both in and out of school young people, rape,
defilement and poverty continue to account for the numerous teenage pregnancies and child marriages in Uganda.

The lack of information among adolescent girls and young women such as
Rose shows that many of them are not empowered about their SRHR. It
further demonstrates the violence adolescent girls and young women go
through as a result of sexual violence coupled with the lack of SGBV shelters
from where they can receive psychosocial support.

Three out of 10 teenage girls become pregnant before they reach 20 years
of age and over 300,000 babies born in Uganda are born by adolescents
aged 15-19 years. Teenagers in rural areas are more likely to start child
bearing earlier than those in urban areas; 27 per cent and 19 per respectively. It is important to note that one of the major drivers of teenage
pregnancy is an early sex debut among young people. According to the
Uganda Demographic and Health Survey of 2016, 10 per cent of women
and 17 per cent of men have already had their first sexual encounter by the
age of 15.

Pursuing a child-friendly justice system
The current retrogressive regulations and policies coupled with lack of
sexuality education and other reproductive health and rights information and services have exacerbated the already bad state of young people’s health and well being.

As the world commemorates the Day of the African Child today in memory
of the thousands of black school children who took to the streets on June
16, 1976. They did this to protest the inferior quality of education and to
demand their right to be taught in their language. This is therefore a good
opportunity to not only create awareness about the needs of young people
but also to assess the state of their rights in Africa. It is also a good time to
amplify the need for a continued improvement in their education. The day
draws attention to the lives of African children and encourages people’s spirit of abundance to share something special with a child in Africa.

The Constitution of the Republic of Uganda defines a child as any one
below the age of 18 years. This year’s theme, “Access to a child- friendly
Justice system in Africa”, reminds us of the restrictions that our current
policies have. It is also an opportunity for duty bearers to help the Ugandan
child enjoy their right to access to friendly justice, sexuality education and
other health information and services. This access would counter the
problems of unplanned pregnancies, pregnancy related complications and
unsafe abortions that account for a sizable contribution to the maternal
mortalities in adolescent girls and young women. The outbreak of the
COVID-19 global pandemic and its rapid spread throughout the world,
Uganda inclusive, came with increased risk for the population, especially
young people.
The pandemic has equally put many health care systems to the test on the
competence of responding and containing the virus while observing human
rights, particularly the rights of young people.
In Uganda, the state’s response to minimise the spread, has been slow to
address sexual and reproductive health, maternal health, access to justice
and other needs of young people. This is further reflected by the supplementary budget allocations being requested by the institutions of
government to respond to the pandemic. Many of these barely have any
consideration for health and human rights.
Just a few weeks into the outbreak, access to services was already
problematic as a number of rights violations were cited. Numerous media
reports about teenage pregnancies, violence against children, defilement,
and rape, among others were and continue to be reported. All this has been
exacerbated by the lock down as imposed by the President of Uganda which
also caused temporary halting of court proceedings. This has further slowed down the speed at which young people can access justice during this time.
Meanwhile, they continue to experience human rights violations.
This comes at a time when the country continues to grapple with poor SRHR
indicators. This means that young people in and out of school continue to
bear the burden of these negative SRHR indicators. This burden includes
teenage pregnancies, problems accessing essential health commodities like
menstrual health products such as sanitary pads, HIV/AIDS and other STIs
medication, among others. Some of the factors that have contributed to this
state of affairs include the lack of information for young people to enable
them make informed health choices, lack of access to services and all these
are exacerbated by the weak policy and legal environment.

Recommendations
To undo this harm and correct the above indicators, the government needs
to take bold steps in establishing progressive laws and policies that are
aimed at eliminating the various injustices that continue to affect Uganda’s
children;

1. Fast track the passing of the National Policy on Sexual and
   Reproductive Health and implement the recently approved Age Appropriate Sexuality Education National Framework.
2. Fast track the effective implementation of the National strategy on
   ending child marriage and teenage pregnancies in Uganda of 2015
3. Develop comprehensive multi-sectoral strategies to avert the
   challenges and injustices that continue to ruin lives of children and young people and harmonise legislation on marriage to provide for 18 years as the minimum legal age for marriage.
4. Strengthen the enforcement of laws against defilement, rape and
   other forms of child abuse and establish youth friendly spaces at health units.
5. Facilitate the Courts of Law to hear and determine cases defilement,
   rape and other forms of child abuse to enable children access justice timely.
6. Finalise and pass the Adolescent Health Policy to update issues of
   adolescent health in national and global development trends and context.
7. Government establishes provisional shelters at police stations manned by the Child and Family Protection Unit, to avail SGBV survivors temporary accommodation pending medical examination and investigation of cases to avoid frustrations.
8. That the government ensures that children have access to psycho social support to meet their mental health needs. Train senior women and male teachers on how to provide counselling and deal with the different health needs of young people, including implementation of the Girl Child School Re-entry and Retention Strategy to give any girls who may report to school with pregnancies, an opportunity to continue with their studies.
9. Repeal all those laws and policies that compromise the protection and
   welfare of the children.

In a nutshell, as we celebrate the Day of the African Child, creating a child-
friendly justice system in Africa, and specifically in Uganda, requires a multi sectoral approach and meaningful collaborations. This collaboration should not only be among the different government line ministries and agencies but also with civil society organisations, parents, teachers and the media.

A version of this article was originally published in the Daily Monitor.

By Faith Nabunya

“My wife was left unattended in the postnatal ward for close to five hours until I paid Shs205,000 to have blood brought to Kibuli Musilm Hospital for her diffusion. Without any medical records, they told me to take my wife to either Mulago hospital ICU if I still needed her alive. For the three days I was in Kibuli hospital, I never got anyone to explain the state of my wife even during transfer to Case hospital. I was never given her medical records. It’s only at Case Hospital that I was told that my wife is anaemic due to over bleeding and she had suffered from liver damage. Justice should be served for my wife and it should be a lesson that all women deserve good health care,” Mr Rafaile Omony shares what happened to his now deceased wife.

On July 2nd, 2020, The Center for Health, Human Rights and Development filed a complaint with the Uganda Medical and Dental Practitioners’ Council (UMDPC) against Kibuli Muslim Hospital, challenging the violation of medical professional ethics, and human rights of Mr Omony. Omony’s wife, Scovia Mary Alupo, died on  October 27th, 2018 after undergoing a cesarean section, following which she bled to death.

Uganda suffers a persistently high maternal mortality ratio (MMR) currently at 336 per 100,000 live births which translates into 16 women dying every day during childbirth majorly because of lack of basic maternal health commodities like gloves, syringes, blood, medicines etc, which enable women to give birth safely. This is worsened by low political will to equip and sufficiently fund healthcare facilities, which sees two midwives working in more that 30 expectant mothers at a go. 

“Women die everyday due to severe bleeding while giving birth. Blood is an essential life saving commodity that can’t be replaced and so should be freely given to those who critically need it. Health facilities should be held accountable for any life lost due to failure to pay for blood. This is unacceptable and we need UMDPC to exercise its mandate of general supervision and disciplinary control over medical practice to uphold health and human rights”, Ms Edith Sifuna shares.

Dr. Katumba Ssentongo, the Registrar at UMDPC says that their role as UMDPC is to supervise and exercise discipline action to all dental and medical practice in Uganda. In two (2) weeks time after reviewing the complaint (CEHURD & Omony), Kibuli hospital will be notified through an official letter from the council to get their defence.

Ms Alupo has become one of these tragic statistics and we cannot leave her death unaccounted for. CEHURD has therefore petitioned UMDPC seeking that Kibuli Hospital and the concerned health care workers be investigated and found culpable for the professional misconduct exhibited. CEHURD equally intends to bring these human rights violations to the attention of the courts of judicature, seeking compensation for the family of Ms Alupo. “ We want UMDPC to take action against its members that violate the medical profession ethics fulfilling their mandate of monitoring and regulating the practice of medicine and dentistry as per the Uganda medical and dental practitioners’ Act” Ms Ruth Ajalo, a lawyer representing CEHURD adds.

The writer is a Communications Officer at Center for Health, Human Rights and Development.

By Jacqueline Twemanye

On 24th June 2020, CEHURD received a letter from Mayuge Central Police Station – Sexual Gender Based Violence (SGBV) desk, appreciating CEHURD for the support rendered to them in handling SGBV cases. This to us is confirmation that our efforts are not in vain. CEHURD has for years through it’s Community Empowerment Programme together with the Strategic Litigation Programme been engaging duty bearers and sensitizing people at the grassroots about the fight against SGBV. 
CEHURD has further empowered Community Health Advocates (CHAs) at community and district level to advocate for health and human rights. They have also played a big part in providing information on Sexual and Reproductive Health (SRH) issues and human rights violations especially SGBV cases from the community.

“Cehurd has trained us CHAs on how we can work in communities on different cases mainly those concerning violation of human rights. We have undertaken different trainings with police officers which has created a bond between us and police, and has helped solve different case. I appreciate CEHURD for  empowering us” – Mesach, CHA

According to the Uganda Police Force’s Annual Crime Report, gender-based violence cases that were reported and investigated increased by 4% (from 38,651 to 40,258 cases) between 2015 and 2016. UNHCR 2019 November Monthly Protection Update on Sexual and Gender Based Violence (SGBV) indicates that 4297 SGBV incidents were managed, documented and reported between January and November 2019 in refugee settlements.
CEHURD’s drive to sensitize communities on SGBV culminates from the increasing number of these cases. The National Action Plan on Elimination of Gender Based Violence in Uganda (2016-2020) frames the issue of GBV as an urgent development priority and factor to address in achieving Uganda’s Development Goals for 2020.

“For CEHURD to be recognised and appreciated by the Mayuge Central Police Station for providing legal support to survivors of sexual and gender based violence (SGBV) is a great milestone towards ensuring that SGBV survivors access justice through the Courts of Law.” -Ms Ruth Ajalo, Lawyer at CEHURD.The write is a Communications Officer, CEHURD.

The writer is a Communications Officer at Center for Health, Human Rights and Development.

By Edith Sifuna

Sophia (not real name) could not easily access transport to the nearby health centre for maternal services. She therefore resorted to seeking the services of a traditional birth attendant (TBA) in a neighbouring village. She could not trek the long distance to deliver her child since she had gone into labour late in the night while she was home alone. An elderly TBA was her only option to deliver the baby. Unfortunately, Sophia suffered from obstructed labour and by the time she accessed a boda boda to get to the health care facility, she had lost her baby and had passed out. The midwife on duty could only give her first aid as they waited for an ambulance from the nearby private hospital to take her for further treatment.
With the global outbreak of COVID-19, Uganda took steps to curb the spread of the virus. Some of these steps included the Presidential directives that put restrictions on movement. These restrictions included a ban on public and private transport, except for essential services. Sophia is one of the many expectant women in Uganda who have been reported to resort to TBAs to give birth from villages due to these restrictions. Women have lost their lives while giving birth, lost their babies and or left the labour ward with complications and other psycho-social effects. COVID-19 like many other pandemics attacked Uganda unprepared more so because of the need to strike a balance between control of the pandemic and provision of essential health services where maternal and child health have been at the peak.
Uganda’s maternal mortality ratio stands at 336 deaths per 100,000 live births according to the Uganda Demographic and Health Survey 2016, with an average of 16 women dying daily while giving birth due to preventable causes. This figure is less likely to reduce to the projected indicators in the Sustainable Development Goals (SDGs). Even if the State worked hard to achieve the set indicators, the effects of the COVID-19 pandemic already show a failure to achieve them. As part of ensuring that this pandemic is suppressed, the President of the Republic of Uganda working with the COVID-19 task force in the Ministry of Health provided directives to the country that were welcomed at the time. The country was in fear and everyone thought that these were indeed great directives. Reality, however, set in when expectant mothers continued to die and others delivered by the roadside or at the entrance of facilities due to movement restrictions.
The restriction on movement affected both women due for delivery and those due for antenatal care (ANC) visits. The World Health Organisation Guidelines (WHO), set at least eight antenatal care visits from the initial four as a measure for monitoring the well being of the expectant mother and the unborn
baby. These are unfortunately not possible for most expectant women due to the COVID-19 restrictions.
Many expectant women have instead been reported to have faced police brutalities while trying to access the health facilities. For example a video recording circulated on May 8th, 2020 showing a Local Defence Unit (LDU) officer shooting a boda boda rider and an expectant woman who were on their way to the hospital in Masaka. Both were reported dead. This happened despite the President relaxing restrictions on the movement of pregnant women on boda bodas.
Women have also failed to access necessary health care due to the economic breakdown brought about by COVID. Many have lost jobs and cannot earn a living. Additionally, movement restrictions especially in regard to public transport have caused a hike in transport fares, which many find too high to enable them access services. The current curfew which stops movement at 7pm has not made things easier.
These conditions, among others, have left expectant women with few options. The TBAs became the silent saviours of women’s lives. These were willing and ready to accord the much needed timely support for the expectant mothers in their communities for a number of reasons. First, they live within the communities and are therefore not affected by the movement restrictions. Secondly, the support and care TBAs accord women while they are in labour is sometimes not equivalent to the one provided in health facilities because the numbers attended to at a time is smaller.
It should be noted that in 2010, the Government of Uganda outlawed TBAs. They were banned from conducting deliveries as they lack formal training to handle emergency cases such as C-Sections and haemorrhage. Haemorrhage contributes to 46 per cent of maternal mortality among women according to the 2018/2018 Maternal Perinatal Death Survey Report (MPDSR). Despite the ban, the traditional birth attendants are still very active, providing maternity care during and after pregnancy, especially in rural communities. Expectant mothers’ preference to traditional birth attendants’ services has risen even higher during the COVID-19 period. Beyond proximity, the current socio-economic and mobility challenges have seen women run to TBAs even more. Unfortunately, the delivery places and services are of very poor quality and usually take place under unhygienic conditions with no referral systems.
Most TBAs in villages are old and have no training to offer timely technical assistance to expectant mothers but because they command a lot of respect, most people respect them and have resorted to their services.
The outbreak of the pandemic saw the designation of some facilities to handle COVID-19 cases. This meant that attention to general sexual and reproductive health and rights services including maternal health services was minimised. Managing COVID-19 remains Uganda’s priority. Furthermore, there are myths and misconceptions about the behaviour of healthcare providers as being harsh and rude, although they have been found to be this way, especially towards expectant mothers. On the other hand, TBAs are perceived as approachable, friendly and are known to deal well with financially constrained mothers as they sometimes go to the extent of giving them tea and food in addition to some herbal concoctions. These factors therefore make TBAs more attractive to expectant women in the communities. However, the services of TBAs have been known to increase maternal mortality, mother to child transmission of HIV/AIDS (MTCT) and postpartum haemorrhage. These indicators are expected to worsen if mothers continue giving birth with the assistance of TBAs who are not equipped to handle such emergencies and cannot easily refer the women to health facilities where they can be skillfully helped.
The presidential directives were put in place to protect Ugandans from COVID-19 and curb its spread in communities. However, the country has registered more maternal deaths than COVID-19 ones, which still stand at zero, due to the inability to access transport to health facilities. As CEHURD, we therefore recommend that the Ministry of Health strengthens the Public- Private Partnership (PPP) in this era to extend quality, accessible and affordable health services to all places in the country but more so to rural communities.
This can be done through working with different civil society organisations and other private actors to provide services and information to the masses. These collaborations are also an avenue to advocate for better service delivery and accountability. They also contribute to strengthening the local community structures such as Village Health Teams (VHTs), Health Unit Management Committees (HUMCs), and Community Health Advocates (CHAs).
VHTs if extensively trained and given the skills training, can take record of all expectant mothers in their constituencies and constantly monitor them till delivery time. They can further support them to access health facilities for ANC and child delivery, not forgetting social distancing and personal protection with protective gear, constant hand washing and use of alcohol-based sanitisers. They can also offer health education to their constituencies.
HUMCs can be further strengthened to continuously update the communities about the available services at facilities and encourage them to go for health care. They can further monitor the activities of the health workers and quality of services. However, health workers should be equipped with the adequate personal protective gear such as emergency drugs, gloves, masks and disinfectants, among others as they are also working in fear of their safety while dealing with different categories of people from diverse locations.
Lastly, Center for Health, Human Rights and Development (CEHURD) has trained a team of Community Health Advocates (CHAs) who are advocating for the realisation of right to health within communities. They also report cases such as Sophia’s. CHAs can sensitise communities about their rights and responsibilities amid COVID-19, record and report health rights violations and refer those who may need legal aid to CEHURD through the toll free line – 0800 31 3131. All this should be done in respect to MOH guidelines.
The right to health is inherent and ought to be protected especially the lives of mothers and their newborn babies. Health workers should be supported to save lives and mothers taken good care of while bringing life to earth. Despite the pandemic, reproductive and maternal functions are ongoing, even escalated by the lock down, characterised by high sexual engagement both consensual and non-consensual. COVID-19 is a big public health threat but not worse than maternal deaths, this is evidenced by the fact that mothers and babies have been and are continuing to be lost due to effects of the lock down. Under these circumstances, isn’t it time for the country to re-think its restrictions and prioritise access to quality maternal and child health services? It’s unacceptable for women to die at the hands of traditional birth attendants and COVID-19 should be a learning opportunity for the Ugandan government. At the moment, Uganda is exposed and we need to work harder to ensure that women’s lives are protected and not lose another woman due to preventable child-birth related complications.
For God and my Country.
The writer is a programme officer at Center for Health, Human Rights and Development (CEHURD).

A version of this article was originally published in the Daily Monitor on 11th July 2020.