By Nakibuuka Noor Musisi

Over the years, CEHURD has mastered the art of institutional development, planning and assessment. Slowly, the institution has zeroed to holding annual staff retreats to reflect on not just its strategic plan progress but also plan ahead annually. It’s also a time of the year when the institution builds staff capacities in various issues that surround its areas of engagement. This is not something done by every institution, yet in fact it’s a guiding tool to planning.

While the Institution may treasure this approach, some staff have a divergent view. I took a reflection of what staff thinks about this strategy. I must state that out of the about 28 staff, a few were spoken to (with program representation as key factor to this), not because I wanted to discriminate others but because they were out of office at the time of writing this article. The same questions were asked to the administration of CEHURD and the findings are startling. I had in mind that the newsletter quarter was up and writing about the staff retreat would be great especially that in about a few months, we will be in another retreat to review progress of the first half of the year.

The big deal about this year’s retreat is three fold. The capacity building sessions in various areas, Comprehensive sexuality education, Harm Reduction Model, leadership, team work etc.; team work and planning and most importantly the co- curricular activities that were wound up with a boat ride on the Nile waters. This seemed a very interesting moment for staff with all the music and refreshments that came with it. This is my opinion, but staff had moment’s to share about not just this year’s retreat but various others that the institution has held. My questions to them were; what do you like about the staff retreats and what don’t you like about them? I will verbatim write down the responses here

“Team building is usually strong in the retreats and also I get to know people’s personalities. I use his time to reflect on personal objectives and the organization” It however used to be tense, and I used to join it with fear, I hated this part of it, but of late I like it” Ms Nalukwago Assumpta.
Mr Serunjogi Francis noted that “While it’s meant for planning and reviewing progress on organizational side, the biggest component to me is team building. We never get time to sit and talk and laugh as staff, at office its work, and work and work. I do not like the fact however, that there is a lot of information shared within a short time. Our facilitators are cut short, they usually have a lot to share which we would consume in about two weeks and is provided in a short time”

Ms. Aguti Lillian noted that she likes the fact that “we plan together but is a hectic process.” While Mulindwa Dan Joseph gets be “notified of our weaknesses, learn things we do not know, strengthen relationships as employees, when you have grudge it’s time to reflect and forgive each other. It’s also a time to enjoy life outside of work. I do not like it’s part of working for long hours and sometimes somehow hectic.”

From the strategic Litigation program, Ms Rose Wakikona liked the fact the “We go to nice places, eat good food, have nice discussions that gave me a platform to learn more about CEHURD and how to implement work. It was however too long, with so many days away from home and was tired of the place by the time we left.”
Ms Primah Kwagala emphasized that “I like the planning in the retreat. I like the fact that we go to be together, run together, and have co- curricular activities other than work. We get to reflect on our lives, aspirations, we learn from what people are doing way beyond work. You get to plan and do things better at the end of the retreat. I hate it when sometimes you become the subject of the retreat. Its demoralizing because a person thinks they have no value they add to the team and come back determined to leave?”

Asking the same question to the grants and research officer, Ms Nassimbwa noted that, “I like the recreation, doing work but also relaxing and work planning. I decided never to say what I do not like”
Ms Kizito Claire stressed that “one get to know in-depth of programs and how projects relate to programs” and disliked nothing. While Ms Nakiyingi Vivienne highlighted that she likes the “fact that it’s a reflection moment, people get to know more about each other besides work and it eases minds when we play in evenings. I however do not like the fact that we never get to contribute to ideas as staff on where the retreat will take place, its ideal that our voices are heard on venues of choice as part of our contribution to the planning of the retreats right away.”

From the communications department, Ms. Nabunya Faith who is fairly new and has attended to just one retreat noted that “I loved the tea, work and sociability of everyone, I loved the sun and disliked nothing”
While from a different program, but fairly new- just like Faith, Mr Wasswa Paul elucidated “I liked the fact that we had excellent facilitators to build our capacities in various fields, loved the lake side engagements in the evenings, and daily work out for staff.”

Asked the same question, Mr Muhumuza Abdul Kharim likes the fact that retreats are “a time of reflection about self and organizational and also have an opportunity to build capacity in various fields. What I do not like is tricky o mention.”

These views, as you read, are divergent some with stronger expressions that makes you feel like we should have these retreats always or never again. You may be asking yourself he views of the administration of the institution. I did not hesitate to pause similar questions to them, Ms Nakanwagi Gertrude, Mr Kabanda David and Mr Mulumba Moses also have both good and bad sides of these retreats.

The retreats are an “opportunity to be together with staff unlike at work, but sometimes there used to be tension that came with them yet they should be a time for relaxing but this has changed” Ms. Nakanwagi Gertrude noted.
Mr Kabanda David highlighted that he likes them because “they happen twice a year and it’s that time when we genuinely dig deep into strategizing on how best work should be done. This helps me and every one to reflect on the career path but also work that has to be done in the year. It’s the time when someone sets targets which can be personal or work related. Is the time to sit and talk to people, we eat together and have fun. I also like the co- curricular activities that come with it. Sometimes however, you want people to do things and rework plans but they show you they are tired or even fade up of being tasked to refines work plans”

Wounding it up with a response from the Executive Director, Mr Mulumba Moses notified to me that “I like them because they are the only points in life when I usually connect with people that we work with. They give me a social life to understand people. The retreats have a component on mentor-ship which I find valuable and I think it’s important that it’s maintained. It’s also an opportunity for me as the head of the institution to move away from work and having to answer all questions, to rather a more relaxing moment. I love it for its not being a very serious but relaxing moment to connect with people. It however puts pressure on me to think, prepare, and make them relevant.

In most cases it takes me a lot of thinking such that am able to provide staff with more meaningful comments as they prepare their work plans. It takes me days of looking for best facilitators and it leaves me in a most pressurized and difficult situation. Sometimes these retreats are tense and one has to make had points for people to do more which sometimes is a problem and this makes me think twice about the retreat.”

I do not want to agree any better, these are just views that any institution would want, to make itself better. I want to thank staff that gave their responses and administration too. I hope these will help CEHURD plan better and or change approach to things.

By: Primah Kwagala

A pregnant woman went to Uganda’s largest hospital to deliver her baby. After her labor stalled, she was wheeled to the operating room, where her newborn was delivered by caesarean section. When the woman awoke from surgery, her baby was gone. No one at the hospital would tell her what happened to her child.

Another woman went to the same hospital to deliver twins. When she woke from surgery, she was handed one baby instead of two. The hospital said the twin had died, but there was no explanation of what went wrong and no body to bury. Months later, the hospital turned over a body, but DNA testing proved it did not belong to the grieving parents.

No mother should have to experience the pain of losing a child. When the hospital cannot explain what happened or even hand over a body for burial, it is a clear violation of the constitutional right to health. Uganda’s High Court agreed in a January 2017 ruling. So why hasn’t the hospital fully complied with the court’s order that it change its policies to ensure this doesn’t happen again?

As a human rights lawyer, I hear heartbreaking cases like this all too often. Our clients deserve justice. It is not enough for us to win these cases in court. We want proof that the hospital is taking steps to protect these precious lives.

We rejoiced last year when Lady Justice Lydia Mugambe ruled that Mulago National Referral Hospital had violated the parents’ right to health and freedom from torture when it failed to produce their baby’s body.

“The plaintiffs were denied an opportunity to carry out burial rituals for their child, which in my view would have constituted a fundamental part of their healing process,” Justice Mugambe said in her decision. “By denying them the opportunity to bury their baby, the defendants compounded their pain and subjected them to more psychological torture.”

It has been more than a year since the court handed down its ruling, which included financial damages to the bereaved couple and required that the hospital take steps to safeguard babies. We have received no report from the police, hospital or government on any progress toward improving hospital procedures.

We are seeking some simple, inexpensive fixes. Place surveillance cameras in the maternity wing to monitor the movement of babies. Hold midwives accountable when babies in their care disappear. Develop protocols for moving babies around the hospital to ensure they are always accounted for.

Some may say that the government cannot afford to install such safety measures in a public hospital. Yet in the financial year 2016-17, the public hospitals returned billions of Ugandan shillings to the government treasury.

Rather than spending money on paying legal fees and damages for rights violations, I am urging the executive director of Mulago National Referral Hospital to invest in making systems that work for the people who use them. That means establishing policies at Mulago Hospital to respect the movement and safety of babies, dead or alive. The Uganda Nurses and Midwives council should hold its members to account when babies in their care vanish.

Every life in this country matters. We must ensure our public hospitals are doing all they can to protect our newborns.

By: Wasswa Paul

Many cases filed by the Center for Health, Human Rights and Development [CEHURD] seek to challenge violations and omissions that infringe on the realization of the Right to Health in Uganda. Classical examples of these cases include Constitutional Petition No. 16 of 2011 [CEHURD and others vs. Attorney General that sought to challenge the lack of access to essential maternal health care services that killed pregnant women and babies and Civil Suit No. 111 of 2012 [CEHURD and others vs. Nakaseke District Local Government and others] that was filed by CEHURD on behalf of a pregnant woman who died in a hospital while awaiting obstetric care.

Whereas these cases are precedent setting in Uganda, achieving a successful outcome in litigation often requires a great deal of preparation. One of the tools CEHURD has continuously used to achieve a successful outcome in Litigation through preparation is engaging in Internal Moots.

Internal Moots are held to assist the Advocates to further conceptualize and appreciate the facts of the cases pending in Uganda’s Courts of Law while connecting the facts to the Law and Evidence on record.

They also assist the Advocates to buttress on the arguments raised in the pleadings and to identify the gaps in the pleadings and evaluate the evidence raised in support of the pleadings.

It is through such Internal Moots that CEHURD continues to win its cases as it Advocates for Social Justice in Health

By: Dennis Jjuuko

Uganda continues to grapple with a critical shortage of blood that is affecting services and putting patients’ lives at risk. The Health Ministry’s blood bank facility in Kampala, has only 150 units of blood remaining, not enough to meet requirements on an average day in the city. Nationally, Uganda needs at least 340,000 units of safe blood annually as recommended by the World Health Organisation, but usually only collects 200,000 a year according to the Director of Uganda Blood Transfusion Services. The country then faces a deficit of 140,000 blood units.

The shortage was recently “almost at crisis level”, which prompted a cancellation of hospital operations and prioritization of cases, and an extra 7 billion shillings (£1.4m) needed to procure donor and testing kits, and to fund blood donation drives, to get the service back on track for the next six months. The crisis came at a time of a proposed reduction of the health budget from 1,850tn shillings in the current financial year to 1,714tn in 2018-19. But, according to the just released National Budget Framework Paper that gives a picture of how much money each sector is likely to receive in a financial year, UBTS is proposed to get just Shs8.8 billion – a further reduction. The blood bank, as a result launched, an appeal for blood donation in coordination with National Social Security Fund.

Accident victims, cancer patients, women in labour, and children requiring transfusion, are on the rise, yet Ministry of Health figures show that Uganda’s blood needs are increasing at 20% per year. Investing less in blood means losing lives, yet this is something government can have control over.

It is important to emphasise that blood donation is a voluntary activity motivated by the need to save lives. As a result, the Center for Health, Human Rights and Development (CEHURD), as a Health Rights organization that takes availability and access to services as among the central tenets of a functioning health system, therefore joined and contributed to this drive of ensuring adequate stock of blood needed for saving mothers and other patients in need. CEHURD partnered with local council chairpersons of Nakwero A and Ndazabazadde villages and mobilized staff and residents who donated units of blood that surpassed CEHURD’s target. 50 units were the target and 74 units were collected on 17th February 2018.

In Uganda, access to essential health services for pregnant women and others in need is a public health crisis that CEHURD, not only as a health rights organization that challenges the circumstances under which mothers lose their lives (Petition 16), but also as a party interested in the sanity of the health system can contribute to. More than 16 pregnant women die every day in Uganda, with hemorrhage being among the leading direct causes of preventable death, contributing 42%.

CEHURD therefore responded to the blood deficit in the country and continues to encourage Ugandans especially youth to at least do that benevolent act every quarter of the year since the shelve span of blood is only 35 days, yet Uganda is in dire need for sufficient stock of blood if the health system is to effectively respond to emergencies.

 By Moses Mulumba

Industrial actions by health professionals (no matter the category) severely affect health systems and, when they last longer, create a bigger potential for collapsing health service delivery.

This situation raises a serious ethical and legal dilemma which has to be understood and managed well as human life is involved.

The importance of human resources for the functioning of health systems is not doubtable.  In fact, the World Health Organisation (WHO) indicates human resources for health as one of the six building blocks for a health system. Uganda continues to grapple with sustaining this important block.

As a result of the gaps in Uganda’s human resources for health, we have over time experienced threats of industrial actions across all levels.

On November 7, 2017, members of the Uganda Medical Association (UMA) began an industrial action which was grounded in three major asks: first, reviewing the supply chain management of medicines, vaccines and other medical supplies; second, immediate halt of the war on doctors including a request to disband the health monitoring unit; and, third, immediate increase in salaries and allowances of all doctors and improvement of working conditions.

A number of issues have been raised since, including the legitimacy of the industrial action by UMA. But I would like to concentrate on the legal and ethical questions.

In medical practice, the duty to act ethically lies at the very origins of the profession. The Hippocratic Oath focuses more on ethics of the physician’s conduct than on the science of efficiency that a health professional should apply. It is thus important for the striking doctors to maintain the highest level of ethical considerations.

One of such considerations is the requirement that emergency care must be provided during a strike. The ethical principles equally apply to the ministry of Health, which should ensure that all the required resources are made available to the doctors in service during this period in sufficient amounts.

This includes a sound governance structure for delivery of health services and showing signs of commitment to ending the strike.

We should not have an expectation of our health professionals practicing ethically in an unethical environment such as using unethical approaches to resolving the dispute.

I will address the legal theory which the ministry of Health has taken on the advice of the solicitor general. The ministry has argued that the current industrial action by UMA is illegal and they have relied on section seven of the Public Service (Negotiating, Consultative and Disputes Settlement Machinery) Act 2008.

Under this law, UMA was expected to issue a 90 days’ notice before withdrawing labour in essential services and they had to secure a certificate signed by the chairperson of the public service negotiating and consultative council.

This provision is, however, not a general rule as it has exceptions under section 8 of the same law, which allows withdrawal of labour due to unsafe and dangerous working environments even without issuing such a notice.

A close look at the demands of UMA indicates that part of their request is to improve the ‘dangerous’ working conditions its members are subjected to.

Without prejudice to the above, the ministry of Health can only get a competent declaration on the legality of this industrial action from the courts of law, and not the solicitor general whose comment is simply an opinion!

The ministry needs to explore more tenable legal interim solutions during this industrial action. For instance, while our Constitution and the Employment Act clearly forbid forced labour, one exception that would see the government compel doctors back to work is through declaring a state of emergency under section five of the Employment Act.

The consequences of such a declaration are, however, fatal for Uganda’s health system and this option only needs to be considered as a last resort.

It is also possible to do an interim legal task-shifting effort. This is specifically possible since the strike is only involving doctors.

Under the Medical and Dental Practitioner’s Act, a person authorised by the director general of health services may give medical or dental treatment in a government medical institution after undergoing appropriate training.

Under this option, the director general may authorise lower health professionals to undertake duties of medical and dental practitioners as long as they have what the law prescribes as appropriate training.

In summary, the ethical and legal dilemmas are real in this industrial action by health workers. This needs to be managed through utilisation of the appropriate principles of the rule of law and exploring dialogue.

Both doctors on strike and the ministry should not forget the basic ethical principles which are a basis for the protection of life, a cornerstone of the Hippocratic Oath.

The author is a lawyer practicing health law and policy at Center for Health, Human Rights and Development.

Source:  http://observer.ug/viewpoint/56000-address-the-ethical-legal-dilemmas-of-doctors-strike.html