PHM-Exch> Uganda: meeting with the UN Special Rapporteur on the Right to Health, 14/8/12

[Claudio Schuftan]

*By Denis Bukenya (PHM Uganda)*

 *1.  The Special Rapportuer’s Agenda      excerpts
*

In his capacity as the Special Rapportuer, Mr. Anand Grover, by his mandate
from the Human Rights Council is due to produce a report on Access to
Medicines  by March 2013. He is on a private visit to Uganda to conduct a
research in this capacity on the challenges to Access to Medicines. Uganda
being one of the countries with a manufacturing plant for generic drugs
made it of priority for him to get information first hand from the
stakeholders. To achieve this, he met with  civil society, Government
relevant ministries and the pharmaceutical companies that produce the drugs
to get information firsthand about their achievements, challenges and the
experiences.

 *2. Organizers and the Opening Remarks.*

The Center for Health, Human Rights and Development took center stage in
this meeting. An introduction was made by the Executive Director Mr. Moses
Mulumba who welcomed Anand.

 3. *The Panel Discussions*

*Mr. Kibira Denis *

(I) On the theme of Medicine systems/communicable and non-communicable
diseases the following concerns were raised:

a) The government of Uganda through NMS has devised means of circulating
the drugs to the different parts of the country through a system known as
the 'push system' which has caused a great challenge since the drugs that
are circulated may not represent the needs of the area requesting these
drugs hence affecting access. He proposed a need for the government to
relax this rigid policy and may be include the 'pull system' as a solution.

b) He also looked at the capacity of the national drug authority to control
the issue of counterfeits in the country. There is sometimes flooding of
markets with poor quality drugs due to the fact that the people who do the
control have no expertise to do it.

c) Mr. Kibira also spoke of the health care budget which is insufficient to
curb the preventable non-communicable diseases yet they are causing the
most deaths in the country.

 *Mr. Leonard Okello*

On challenges of Access to Medicines by persons living with T.B and
HIV (*Executive
Director* *Community Health Alliance Uganda*)

a) He expressed his concern of the referral process where the patients are
affected by the transport and the distances that they have to cover for the
treatment and yet in some instances these referral places do not have the
prescribed medicines for treatment. This is psychological torture to the
patients and may cause them to abandon treatment hence the risk of
resistance and  spread of the disease.

b) Some of the essential medicines are accessed at a time when the patients
have passed on due to the persistent stockouts.

c) The need to address the issue of under-staffing in the public hospitals
who cannot satisfy the needs of all the patients

d) He insisted that treatment is a good prevention strategy.

 *Ms. Tinah Ntulo from Basic Needs Uganda*

The essential drug should include Mental Health drugs. The government has
tried to include mental health drugs on the essential medicines drug list.
This has been affected by the push system where the requisitions for the
needed drugs are dictated by the government.

 *Mr. Mulumba Moses *

Access to a sustained supply of good-quality medicines is a critical part
of addressing both the current infectious disease epidemics and the
long-term quality of life and productivity of people. Good health also is a
human right. Reaching the people with the least access to resources and who
are affected by the conditions of poverty and are disproportionately
vulnerable to a wide array of diseases and chronic illnesses is the
challenge before us. The government of Uganda continues to allocate
inadequate funds to address these difficult issues. The international
community can do no less. As an example in the financial year 2011/12,
government allocated 12% of the entire budget to ministry of health, this
financial year 2012/13 that ministry budget was cut by almost 5%. Aside
from the government cutting health funds, we have seen the donor community
consistently pull out of financing the health ministry due to
misappropriated use of funds by government officials and yet for years, we
have failed to see these officials brought to account for their misdeeds.

 *4. Anand Grover’s Speech. *

Mr. Anand stated that he cherishes interaction with communities and civil
society. He informed participants of the purpose to his visit in Uganda. He
categorically stated that he is on a private visit in Uganda to do research
on the situation of access to medicines. Uganda being one of the countries
with a pharmaceutical manufacturing plant for generic medicines (Quality
Chemicals) made it of priority for him to visit and get information first
hand from the stakeholders. He expressed interest in the issues of generic
drug use in Africa a campaign he has been part of as a health right
activist.

 He emphasised on issues of his country visits/missions mandate stating
that every year he is meant to produce a report to the human rights
council. He explained to the members present that there are many
rapporteurs who deal with other Human Rights themes, but his is
specifically looking at the Right to Health and that it is important that
we interact with him on the Health Rights issues mainly on Access to
Medicines. Anand Grover encouraged people to write complaints to his office
so that they can formally be addressed. He took people through the
complaint procedure with the intention that, if there are pressing issues,
they could use the platform as a mechanism for redress with the United
Nations.

 *5. Reactions, Questions and Points of information from the Civil Society
Members Present. *

 *PHM Uganda through *Mr. Bukenya Denis working with the Center For Health,
Human Rights and Development presented a statement on behalf of the
movement on the call to action that was reached by the People’s Health
Assembly in South Africa (Cape Town). He stated that the Movement reaffirms
its commitment to the people’s charter for Health and the (Cuenca
Declaration) which are fundamental documents to the call for action*. By
and large, *he expressed concern on the issue of Global Health stating that
health is* *threatened by the crisis of capitalism, manifested in food,
ecological, financial, economic and political crises. These crises underpin
the global health inequities within and between countries and that there is
also a growing health crisis. He touched the issues of:

-The relegation of women’s health to maternity and family planning on the
one hand and the concerted attack on women’s reproductive and sexual rights
on the other is violating women’s autonomy, dignity and Human Rights, on
top of it limiting their access to medicines due to their lack of
information.

-Also, the emerging global trade and investment regime (driven by
multilateral,  and bilateral trade and investments agreements) is seriously
undermining universal social entitlements and the powers of states to
regulate activities of corporations and private financial institutions
hence posing a danger to access of essential medicines

Another issue he raised was that of the government of Uganda shifting
responsibility to non-state actors in the spirit of investors who provide
substandard services as in the example sited of the government contractors
that  build health centers and  do shoddy work which does not even last for
six months and yet they were handed over to the accounting authority. The
government, he thought, should be advised to supervise such work by
themselves so as to make the people contracted accountable.

 On the call to action welcoming the recent upsurge of interest in the
concept of universal health coverage, he alluded to what was stated that
there was a need to oppose the idea that this be achieved through the
promotion of a minimalistic insurance model that would operate within a
market system of health care or, worse still, be used as an excuse to
dismantle or undermine public hospitals and to promote corporate interest
in health care delivery. This was intended to sound a warning that
Universal health coverage must be achieved through organized and
accountable systems of high quality public provision. This has not been
included in the health system of Uganda, but is receiving great attention
in Uganda. He asked Mr. Anand to advice on the modes of counteracting the
government in the event they are corrupted by multinational corporations.

 Other issues discussed included:  the issue of the Anti-Homosexuality
Bill, how he could intervene on behalf of civil society on the 'stop stock
out campaign', issues of quality of the medicines and their accessibility
citing the example that, even though we have a manufacturing plant in the
country, they are enjoying a monopoly that ends up defeating the purpose of
reducing the cost of these drugs. Their drugs are twice as expensive as any
other imported one or even more.

 *Anand Reactions *

Discussing the issue of the Anti -Homosexual Bill, he stated that he had
already made an effort by approaching the government diplomatically on the
Human Rights implication of the Bill. He noted that, to date, the Bill has
been withheld. He also said that he has been engaged with the government on
many other issues to do with health and Human Rights which are making
headway in his opinion. On the issues of petitioning the government on the
stop stock out campaign, the quality of the medicines, their accessibility,
judicial training for the judiciary, issues of access by sexual minorities,
quality of syrups used by people living with HIV/AIDS, access and use of
the female condoms which has been neglected by the government
indiscriminately fundraising only for condoms, procurement being government
business, etc, he referred the people to the complaint mechanism that will
officially alert his office so that they can make the necessary
investigations and thence advise the government. He further responded by
saying that it is our responsibility to demand for information from
government "you must push the government to action" - " Never give up on
speaking out for what concerns you". This, he said over and over again. He
also said that the situation of quality of medicines has improved, but
substandard medicines & those not of quality cannot be tolerated in our
market. He urged us all to learn to communicate to communities this message
as they help in pushing the government to action. All issues of Quality
must be addressed. He also pledged support for the process of pushing
government to revise proposed laws that affect access to medicines. If they
don't do this and multi-nationals come over to start claiming rights, he'll
be at the forefront to fight them. And he hopes we'll support him in this.
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://phm.phmovement.org/pipermail/phm-exchange-phmovement.org/attachments/20120817/46f10c67/attachment.html>