PHM-Exch> Ugandan Government's Failure to Protect Maternal Health: Support Constitutional Challenge

[Claudio Schuftan]

From: Leslie London <Leslie.London at uct.ac.za>
from>>> Moses Mulumba <mulumbam at gmail.com> 2011/07/06 11:34 AM >>>From: Varsha
Lalla <lalla at section27.org.za>


 *7 JULY 2011: UGANDAN CONSTITUTIONAL COURT TO BEGIN HEARING ON
GROUNDBREAKING CASE THAT CHALLENGES STATE FAILURE TO PROTECT MATERNAL HEALTH
IN UGANDA

*

*On the 27th of May 2011 the Centre for Health Human Rights and Development
(CEHURD), a Ugandan NGO, and the families of two mothers who died in
government hospitals in 2009 in Uganda approached the Ugandan Constitutional
Court alleging the women’s deaths were caused as a direct result of Uganda’s
failing healthcare system. The Constitutional Court will begin its hearing
of this landmark case this Thursday on July 7th 2011. *

*It is critical that you speak up for these women. Raise your voices in
support of the right to health in Uganda, distribute this widely. Please
send messages of support to CEHURD.*

**E-mail info at cehurd.org or phone +256 414 532283 <%2B256%C2%A0414%20532283>

*Send letters to the Ugandan government asking them to comply with their
international duties. Be a voice for the mothers who have either lost their
lives or their babies. It’s not too late to save the lives of hundreds of
mothers and babies.*CEHURD is a Ugandan based non-profit, research and
advocacy organization which is pioneering the justifiability of the right to
health in the East Africa Region. CEHURD realizes this through a
comprehensive set of programs including a public health law resource centre;
litigation, both strategic and *pro-bono* representation; research, analysis
and publications; capacity building; and public policy (please visit
http://www.cehurd.org/).

****

*Background to the Case*

To give you specific details of the case, the petitioners claim that Sylvia
Nalubowa and Anguko Jennifer died as a result of the government’s failure to
fulfill its constitutional obligations to provide basic maternal healthcare
to expectant mothers. The petitioners urge the Court to declare that the
continuous failure to implement effective policies on maternal healthcare,
under-staffing, and the non-availability of basic maternal commodities in
government hospitals amount to violations of pregnant women’s rights to
health and life.

The petitioners argue that the tragic deaths of Sylvia Nalubowa and Anguko
Jennifer are but two manifestations of a larger problem of an unacceptably
high rate of maternal mortality in Uganda. They hope that a declaration to
this effect by the Court will force the Ugandan government to increase its
budget for maternal healthcare. In addition the petitioners seek
compensation for the families of the Sylvia Nalubowa and Anguko Jennifer.

*Sylvia Nalubowa*

Sylvia and her husband Stephen Sebiragala were both farmers and the proud
parents of seven children. Both were excited for the birth of their eighth
child. However, because the antenatal clinic in her area did not have
adequate scanning facilities, she was not aware that she was having twins.
When Sylvia went into labour on August 19 2009 she was turned away from
Banda Health Centre as the midwife was absent. She had to proceed to Maanyi
Health Clinic where her first twin was born.

When Sylvia failed to respond to a drip in order to induce more
contractions, she was rushed to Mityana District hospital which should
ideally be better equipped and with specialized professionals. With the
absence of an ambulance, the family had to improvise with the means to reach
the hospital which was about 15 kilometres away. At Mityana Hospital the
staff demanded sh50, 000 (equivalent to 25 USD) before Sylvia could be
attended to which was meant to purchase a Mama kit. Suffice to say, the
family did not have this type of money with them. Tragically the widower
Sebiragala says that if he had not had to spend so much money transporting
his wife, he would have had enough money to save the lives of both Sylvia
and his child. Ironically, it might not have made much difference as
allegedly there was no medical doctor in theater to take care of Sylvia.
Both Sylvia and her second twin did not survive this traumatic experience.

As part of the cost sharing policy in Uganda, mothers were expected to carry
a kit containing basics to be used in the delivery of new babies which is
now commonly called the ‘Mama
Kit.’[1]<#130ff7c355b62c22_130f58e0a27a7f9c_130f5818fc9558c5__ftn1>This
cost sharing policy started in 1993 with the decentralisation policy
where local governments had a mandate to decide on financing options for
health care in their districts. However, in the 2001 presidential campaign,
all presidential candidates were opposed to fees in public health facilities
all user fees at first level government health facilities in Uganda were
abolished. This was also seen as a move towards encouraging access to the
minimum health care package. Although this was abolished, it is a common
practice to require mothers to carry these in hospital as the government
always default in providing them.

*Anguko Jennifer*

Anguko was a councilor representing Uriama and Bileafe sub-counties in the
Arua district. She was a strong, hard working woman. She had three children
and was married to a primary school teacher. She had many dreams including
extending sanitation facilities in her village. When she was admitted to
Arua Hospital on December 10 2010 with intense labor pains she was asked to
wait for a doctor to carry out caesarean section. Anguko waited for over ten
hours until she died horribly and in great pain. A post-mortem revealed that
her cause of death was uterus rupture. Anguko, a mother of three, was not
the only mother to have passed away – allegedly four other women died in the
maternity ward that same day.

And so this saw the tragic end to the lives of both Sylvia and Jennifer.
Both of them were wives, daughters and mothers who were just trying to do
the best they could in difficult social and economic circumstances.
According to a report developed by the WHO, UNICEFF, UNFPA and The World
Bank, the lifetime risk of maternal death in Uganda is 1 in every 35 women.
For South Africa, the lifetime risk is 1 in every 100 women while in the
United Kingdom it’s 1 in every 4
700.[2]<#130ff7c355b62c22_130f58e0a27a7f9c_130f5818fc9558c5__ftn2>The
same study showed that the maternal mortality ratio (deaths per 100
000
live births) in 2008 was 6
300.[3]<#130ff7c355b62c22_130f58e0a27a7f9c_130f5818fc9558c5__ftn3>In
comparison, South Africa’s MMR was 4 500
[4] <#130ff7c355b62c22_130f58e0a27a7f9c_130f5818fc9558c5__ftn4> and in the
United Kingdom it was
90.[5]<#130ff7c355b62c22_130f58e0a27a7f9c_130f5818fc9558c5__ftn5>That
was an estimated 6 300 mothers killed due to government negligence.
Each one of these women is likely to have people who love them – husbands,
mothers, fathers and children. This means that 6 300 families were ruined,
and these are deaths that could have been easily avoided.

 ------------------------------

[1] <#130ff7c355b62c22_130f58e0a27a7f9c_130f5818fc9558c5__ftnref1> The mama
kit package contains a meter piece of cotton cloth, laundry soap, a pair of
gloves, a piece of cotton wool, small gauze, cord ligature, and a meter of
polythene sheet for the delivery table.

[2] <#130ff7c355b62c22_130f58e0a27a7f9c_130f5818fc9558c5__ftnref2> Trends in
Maternal Mortality: 1990 – 2008. Estimates developed between the WHO,
UNICEF, UNFPA, and the World Bank. Pg 26

[3] <#130ff7c355b62c22_130f58e0a27a7f9c_130f5818fc9558c5__ftnref3> Rounded
to the nearest 100

[4] <#130ff7c355b62c22_130f58e0a27a7f9c_130f5818fc9558c5__ftnref4> Rounded
to the nearest 100

[5] <#130ff7c355b62c22_130f58e0a27a7f9c_130f5818fc9558c5__ftnref5> No
rounding
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