Lawyers at the lawyers at the Centre for Health
HEALTHCARE
When Sylvia Nalubowa went into labour in Mityana in Uganda in August 2009 she was taken to a local health centre, where she expected to have a normal birth, supervised by a midwife.
The midwife, after she had delivered the baby, realised there was a twin on the way. She recommended that Nalubowa be taken to the district hospital where a doctor could handle the second delivery.
But when she arrived at the Mityana District Hospital, the nurses asked for her maternity kit. This, commonly known as a “mama kit”, contains a plastic sheet, razor blades, cotton wool or gauze pad, soap, gloves, cord ties and a child health card. All mothers are expected to bring their own “mama kits” when they go into labour.
But Nalubowa had used hers at the first health facility for her first child and the nurses would have none of it. They demanded money to buy a kit before they would attend to her.
Nalubowa and her baby died.
Sixteen women die during childbirth in Uganda every day in cases that could be avoided. In 2011, the World Health Organisation reported that Uganda had up to 440 deaths for every 100 000 live births.
This is unlike Rwanda, where maternal mortality decreased by 77% between 2000 and 2013 and currently is at 320 deaths for every 100 000 live births.
Most maternal deaths in Uganda are the result of severe bleeding, infection, hypertensive disorders and obstructed labour. Others are owed to causes such as malaria, diabetes, hepatitis and anaemia.
The Ugandan government is committed to providing all citizens with free health services. But it is common to go to a government health facility and find that medicines are not in stock and health workers have not been paid. Patients also say staff are half-hearted about attending to patients expecting free services.
In 2013, the doctor-to-patient ratio in Uganda was estimated at one doctor for nearly 25 000 patients. The nurse-to-patient ratio was one to 11 000. Healthcare services are paid for from tax revenue and donor funding. User fees in public facilities were abolished in 2001, but patients are still expected to make direct out-of-pocket payments for some services and drugs.
In 2011, lawyers at the Centre for Health, Human Rights and Development, a nonprofit research and advocacy organisation, began gathering evidence to hold the Ugandan government to account for Nalubowa’s death and that of another woman who died in similar circumstances.
The case is now before the country’s Constitutional Court.
The centre has argued that failing to provide essential maternal health commodities in government health facilities is an infringement of women’s rights.
The right to life and health are guaranteed under the country’s Constitution, as well as by international human rights agreements the government has signed.
At the first Constitutional Court hearing, the government’s lawyers argued that the judiciary was not competent to hear a case that required the executive arm of government to allocate resources to the health sector. The court dismissed the case.
The centre appealed to the Supreme Court, arguing that the Constitutional Court had erred in not hearing the case based on its merits. In October 2015, the Supreme Court’s seven judges agreed. They said the case asked key questions that needed constitutional interpretation for the people of Uganda.
They ordered the court to hear the case, and a hearing by a new panel of judges is pending.
But the case has already contributed to improved jurisprudence on socioeconomic rights in Uganda and has brought about improvements in the country’s health services.
Since the case was initially heard, government funding for the health sector has been increased from $215-million to $328-million a year and more health workers have been recruited.
There has also been a reduction in maternal deaths, from 440 for every 100 000 live births in 2011 to 343 by 2015. But mothers are still expected to bring their own “mama kits” when going into labour. Most importantly, civil society organisations are now, more than ever, alert to demanding women’s healthcare rights. – theconversation.com
Moses Mulumba is the executive director of the Centre for Health, Human Rights and Development at the Ugandan Christian University. Primah Kwagala, a human rights lawyer at the centre, played a key role in the writing of this article