By Nakibuuka Noor Musisi

The campaign to prevent maternal mortality in Uganda is increasingly challenged with the factors that unfold daily. As different stakeholders fight to prevent maternal deaths, expectant mothers continuously run away from the health facilities that are expected to provide basic services to them.

Massive shortage of trained, motivated and equitably deployed professional health workers to attend to births, lack of access to emergency obstetric care, lack of access to quality antenatal care, and lack of access to family planning services, haemorrhage, sepsis among others have been identified as some of the leading causes of maternal mortality in the country. But, today safety of new-born babies within the public health facilities can also be attributed to the maternal mortality rate.

Musimenta Jennifer is one of the few outspoken women that came up to report her case. Many more have suffered the same fate but never come out to speak. Musimenta delivered two children on the 14th day of March 2012 and was informed that one child died but she never saw the body of her child. She demanded for her medical records all in vain. She moved up and down with the mortuary attendant looking for her child in vain. Up to present day, she has one child even though her discharge form shows that she delivered twins.
“We looked for the body of the second child for three days and on the third day, the nurse gave us a fresh baby wrapped in a box. I refused to take the body because it was wrapped in clothes different from what we had given the nurse that helped my wife deliver. The body looked so fresh yet the nurse claimed she had put it in a box immediately after delivery. I went to police and was advised to take a DNA test which I took and the test revealed that the DNA component from the sample of the dead child was not related any of us” Michael Mubangizi the husband to Musimenta Jennifer narrated.

The couple approached the Centre for Health, Human rights and Development (CEHURD), whose Vision is to realize social justice in public care systems in East Africa. CEHURD decided to institute a case in the High Court of Uganda for rights violation (Civil suit No.212 of 2013). Just as CEHURD was in the final stages of filing the case (Case was filed on 18th July 2013), the Uganda Medical and Dental practitioners council passed a ruling (10th July 2013) in which it “barred Dr. Asinja Kapuru from carrying out any form of medical practice in Uganda for a period of two years” Page 5, last paragraph of the ruling. Dr. Kapuru had been reported by Mr. Bukenya and Ms. Navbakiibi in 2006 for loss of a baby at mulago national referral hospital. The couple delivered a baby boy by cesearean and was given a dead baby girl despite the fact that medical records showed the reverse.

The council did not leave it at that but took note of the fact that “there is poor customer care at the hospital and there is poor communication between the hospital and staff and the consumers of their services” Page 6 of the ruling. It was also concerned with the attitude of the Hospital administrators towards patient complaints that it noted to be deplorable. The Council recommended that “Mulago administration puts in place a system that ensures timely and effective healing of clients concerns”

This system “failure” has and will largely contribute to maternal mortality. Instead of women going to facilities for safe delivery they will shun them for fear of the safety of their new born babies. This is coupled with many other complications including fistula.
There is need to sensitize not only the community but also health workers and the public on their rights and responsibilities. Health workers need to be reminded of their obligations towards patients and that they swear before being licensed to practice.

By, James Zere,
The Ugandan health sector has recently taken a new dimension driven especially by the low levels of resources committed by the government to the sector. Innovators have moved to harness the potential in the rapidly developing mobile communication network to bring health services closer to the people and in other instances to place health services in the hands of the people themselves.

Also referred to as teleHealth or mHealth, eHealth has recently been piloted across the country by various stakeholders in health sector as the country struggles to realise Universal Health Coverage. EHealth itself has been defined severally depending on the context in which it has been applied however, it can simply be understood as the use of electronic, information and communication technology in the provision of health services. EHealth in Uganda today consists of a cross-range of activities including the most basic like calling into the local radio station to get medical advice from the doctor’s show to the more complex like personally using a phone application to diagnose your health condition.

UNICEF Uganda under its ICT for Development program has taken the lead in implementing various innovations aimed at supporting the health sector; Sateliffe has also developed the Uganda Health Information Network for collection and communication to health information between the health workers at the community level and those at the higher levels of the health sector; students of Makerere University in 2011 developed WinSenga a mobile application to promote maternal health status of babies in their wombs using just a smart phone and followed this in 2012 with Matibabu, an application for taking a malaria test using just a phone and without using a needle at all; and the Uganda National Drug Authority has also developed an SMS based initiative for checking the authenticity of medicines by sending a unique code attributed to the medicines to a designated number for verification.

The government has caught up with the tide and commissioned the development of the National eHealth Policy. However, due to several legal issues pertaining to eHealth implementation, the Ministry of Health also issued a Moratorium in January 2012 vide Reference No. ADM 45/273/01 halting the implementation of any new eHealth initiatives or projects subject to certain administrative approval measures until the Ministry develops comprehensive policy guidelines for the same in Uganda.

The moratorium was a timely intervention for a rapidly developing highly unregulated sector which has the capacity to impact several people in different ways. Despite the potential of eHealth as demonstrated by this pilotitis map developed by UNICEF, there is need to define the regulatory and administrative framework in which eHealth is being implemented. Pertinent issues like data protection and governance which arise in eHealth implementation therefore need to be addressed if most of these very timely interventions are to cross the pilotitis threshold into actual solutions that make the lives of the everyday Uganda better to live.

By, Serunjogi francis.
Following of the constitutional court’s ruling that constitutional petition No. 16 of 2011 raised a political question which the constitutional court had no power to determine, CEHURD appealed to the Supreme Court asserting that the petition was fully with in the mandate of the constitutional court. The first hearing of the Appeal was scheduled for Friday September 20, 2013 at Supreme Court in Kololo.  Human Rights Advocates and legal experts point out that the appeal of this erroneous ruling addresses not only for the right to health, but also the human rights of all Ugandans.

As a means of enforcing the justiciability of the right to health, on 3 March 2011, Petition Number 16 of 2011 was filed in Uganda’s Constitutional Court by the Centre for Health, Human Rights and Development (CEHURD) and others. This ground breaking case argued, among others, that by not providing essential health services and commodities for pregnant women and their new-borns, Government was violating fundamental human rights guaranteed in the Constitution, including the right to health, the right to life, and the rights of women. However, court dismissed the case on grounds of the political question doctrine.

Legal experts argue that the Constitutional Court has the mandate to interpret the Constitution on the matters raised by this case on maternal mortality such as the right to health, the right to life and the rights of women, and all other human rights. This therefore means that if the Supreme Court overturns the ruling by the Constitutional Court, Petition Number 16 of 2011 will be heard on its merits and Constitutional Court will have the chance to play a constructive role in correcting the preventable crisis of 16 pregnant women dying every day in Uganda.

Imagine the frustration therefore when after the hustle and bustle of securing a hearing date in the Supreme Court, the state failed to show up forcing to the Supreme Court to grant an adjournment. The hearing could not be started because the government was not represented in court, counsel for the appellants conceded to the adjournment which could well be heard in the new year (2014) since all of the dates for this year have been committed to other cases. This however doesn’t deter the spirit of the maternal rights movement and very soon the Supreme Court will make a ruling and the government will be obliged to provide for the rights of the mothers.

By, James Zere
All governments have endorsed human rights including the right to health in national constitutions or international law. Yet governments fail to abide by their obligations. We need an international treaty that reinforces and enforces the right to health, builds capacities to realize it, sets up systems to monitor progress, and holds governments accountable. People everywhere need knowledge and support to claim their rights. A Framework Convention on Global Health (FCGH) can transform people’s health and well being by empowering people everywhere to claim their rights (JALI Manifesto, para. 7).

Lack of access to essential medicines is one of the most serious challenges inhibiting access to proper health care services in the Uganda. When medicines are not available, affordable, of assured quality and properly used, health is compromised and lives are lost.

Access to medicines in Uganda is primarily funded by the donor communities together with the Central Government yet the funds from the donors are usually channeled through the government. The government has on several occasions failed to come through on its obligation to provide medicines and this aggravates the loss of lives in a country where thousands of lives of are lost annually to easily manageable diseases like Malaria, HIV/AIDS and Tuberculosis.

A lot of effort has been put into explaining the government’s right to health obligations as provided in the international instruments however the right still remains largely unimplemented across many states in Uganda.
JALI, an acronym for the Joint Action Learning Initiative, is leading efforts to mobilize for the creation of a Framework Convention on Global Health (FCGH) whose purpose is envisaged to be to clarify the international standards on the right to health and to enable a universal level of health care coverage based on the needs of the people.

A FCGH should be able to clarify the obligations of the government as far as provision of basic commodities like essential medicines to the public and would propose accountability mechanisms for the government and other stakeholders to put in place through which the government would be held accountable where it failed to implement its international obligations.

The WTO’s Trips Agreement amongst its principles seeks to foster technology transfer and technical support for developing economies however without an enabling environment these provisions remain largely on paper to be strategically implemented by the member states depending on their national strategic objectives. Funding for procurement of medicines for example is usually conditional and usually involves an obligation to procure medicines from a manufacturer in the donor country and this effectively stifles local manufacturers.

A FCGH should be able create links between the international Intellectual Property aspirations and the Global Health aspirations and foster a reconciled position in which the provisions of both regimes would be fostered both at the national level and the international level to promote access to pharmaceutical products.

By, Florence Nabweteme
More than four in 10 births are not planned leading to unintended pregnancies which on many occasions end up in abortion – according to the 2011 Uganda Demographic and Health Survey (DHS). Over 900,000 of Uganda’s annual 2.2million pregnancies are unintended and unplanned. About 400,000 of the unintended pregnancies end up in abortion. Government spends 7.5 Billion Uganda Shillings of taxpayers’ money on treating complications from unsafe abortion every year, which could be avoided at very little expense.

According to a study carried out by Guttmacher institute “Unintended pregnancy and abortion in Uganda” 2013, one in three never-married women aged 15 to 24 years admitted to having had sex and similarly one in three married women are not using contraceptives even though they do not want to get pregnant, this has resulted into increased numbers of unwanted pregnancies. This has been attributed to limited or sometimes lack of reproductive health choices such as contraception hence resorting to abortion which is mostly unsafe.

Other causes of premarital sex among the adolescents is the secrecy surrounding sex as a topic that has left young people mostly those in problems related to reproduction seeking for this information from social networks like Facebook, YouTube and Twitter. When these adolescents get pregnant they resort to unsafe abortion because of lack of choices.

Abortion in Uganda is widely regarded as illegal and condemned both culturally and religiously. Religious moral codes provide that life begins at conception and should never be terminated and that no circumstance would warrant an entitlement to terminate a pregnancy. However, the Ministry of Health National Policy Guidelines and service standards for Sexual Reproductive Health and Rights provides for circumstances where an abortion maybe permitted like in instances of sexual violence, coercive sex, rape and incest and illnesses which would endanger the health and life of the mother.

According to Dr. Charles Kiggundu, a gynaecologist at Mulago National Referral Hospital while making a presentation during a meeting convened by the Centre for health Human Rights and Development (CEHURD) within the Coalition to Stop Maternal Mortality due to Unsafe Abortion (CSMMUA) pointed out that, “most women resort to aborting as it seems risky giving birth in Uganda as two out of every three pregnancies are high risk and any woman who decides to have a baby has put one leg in the grave and the other is fighting not to join.”

Despite campaigns on abstinence and use of contraception, unsafe abortion remains a big problem and as such, there is need for interventions to save lives of young women. Media plays a great role in dissemination of information, but the question still remains, “What kind of information are they giving the public?”

In response to that question, CEHURD trained and continuously mentor media fellows to report on Sexual Reproductive Health and Human Rights issues with an informed point of view and with objectivity. This fellowship targets all media houses – print, broadcast and social media users. The participants have managed to report and create more awareness of the issue of unsafe abortion and interventions to reduce the incidents among young people, which has changed people’s perception on various issues.

CEHURD also organized a lawyers’ meeting to unpack the legal and policy framework on abortion in Uganda. The meeting was attended by different legal and health professionals.
According to Justice Damalie Lwanga, majority of the judicial officers are conservative and bent on enforcing archaic laws that were imported from the colonial era and are sometimes clouded by their moral values which influence their decisions. Abortion is a complex issue and sometimes needs someone to review the cases with a human rights perspective.

In addition to the commitment by the Ministry of Health to address unsafe abortion with the Post-abortion Care training being rolled out in different health centres, there’s need for legal backing and Sensitization of judicial officers to harmonize the laws in place and interpret them in a progressive manner. The WHO definition of health of the mother includes the mental and physical health of the mother and the Maputo protocol ultimately entitles every woman to a safe abortion if they need one.

As such there is still need for reform in the legal and policy regime to include reproductive health rights and progressively realize economic, social and cultural rights which will in turn increase access to safe abortion as we work towards a Uganda where no woman will suffer or die due to lack of reproductive health choices.