Uganda Government Never Ready on Maternal Health Issues

By Esther Nakkazi

The courts adjourned the Constitutional Court case on preventable maternal death in Uganda last week after the government asked for more time to prepare their defense.

It was the only one time in four that the judges raised quorum but had insufficient defense. However, public interest remains high showing the increasing public alertness to their health rights and intolerance of poor health delivery by the government.

In this unprecedented case in East Africa, Civil Society Organisations and families of two women who died in childbirth are suing the Uganda Government for non provision of essential services for pregnant women and their newborns which breaches its fundamental obligation to uphold the Constitution and violates the right to health and the right to life.

David Kabanda the lead counsel said it is important that the government treats the case with the urgency it deserves but lobbying would continue. The next hearing is expected early September this year.

“They have not put in substantial affidavits in reply. But they have acknowledged that the evidence is overwhelming and will need technical support to be able to reply,” said Kabanda. The government said it is waiting for affidavits from the ministry of Health and Finance.

Previously, there was lack of quorum by the judges, a sign that the government was not serious and was not ready but the public turn up was high as about 750 people marching in three spots in Kampala, Arua and Mityana.

“It appears that the case is not being treated with the urgency it warrants despite the life and death issues being considered in this petition,” said Asia Russell from the US-based lobby group, Health Global Access Project (Health GAP).

Uganda’s maternal mortality rate is 435 deaths per 100,000 live births, while the infant mortality rate is estimated at 76 deaths per 1,000 live births.

In Uganda, 16 women die everyday in childbirth.

“The mere fact the violation continues is important that the constitutional court hears this case expeditiously. The turn up of a huge number of people in the court cases points to the fact that it is of public interest,” said Moses Mulumba the chief petitioner of the case.

The petition calls upon the judiciary to pronounce the escalating maternal deaths in Uganda as an issue that violates the Constitutional rights of Ugandans.

It highlights the case of Sylvia Nalubowa, a mother of seven children in Mityana and of Jennifer Anguko, a mother of three both of whom died as a result of the government’s failure to fulfill its constitutional obligations to provide basic maternal health care.

In May this year, the Centre for Health Human Rights and Development (CEHURD), a Ugandan NGO, and the families of Sylvia and Jennifer sued the government through the Ugandan Constitutional Court alleging the women’s deaths were caused as a direct result of Uganda’s failing healthcare system.

CEHURD officials 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.

“Years have passed and the population is singing the same song over and over. No drugs, personnel are inadequate, personnel are rude to the sick... and the list continues. Where is government in all this,” asked William Kibaalya a social worker managing social welfare programmes for children in Uganda.

Lobbying the public outside court

But with the no show by the judges, the civil society has devised other ways of putting pressure on the government to pay attention.

Campaigners have initiated an online petition targeting the international community and a book collecting signatures of people affected by maternal deaths in Uganda.

The online petition, with an open letter to President Yoweri Museveni and the speaker of Parliament Rebecca Kadaga is urging the government to pay attention because this is a matter of life and death.

And a book launched two months ago has so far attracted 1,700 signatures from people who have been affected by maternal deaths- orphans, widowers and all those who have had a relative die in childbirth.

“We want to keep the momentum at the grassroots and also build pressure on the government that is why we have the book and now the online petition,” said Mabel Kukunda, advocacy and networking officer, Uganda Network of Health Consumer Organizations (UNHCO).

“We are hopeful that the Justices will acknowledge the plight of mothers in Uganda, and deliver a ruling that compels government to dramatically increases investments in essential medicines, in recruitment and remuneration of health personel and in equipping health facilities so that women get the services they need to survive and thrive before, during and after delivery,” the online petition reads.

 Background to the case

Sylvia Nalubowa died on 10 August 2009 from complications of obstructed labor while giving birth to her second twin baby in the eighth pregnancy.

Earlier, her husband Stephen Sebiragala was referred to Mityana district hospital about 15 kilometers away after being turned away twice at health centres with a midwife missing in one and a twin born in another health centre but the case became complicated.

At Mityana Hospital the staff demanded sh50, 000 ($ 20) before Sylvia could be attended to which was meant to purchase a ‘Mama kit’, a requirement of the cost sharing policy in Uganda, where mothers are expected to carry a kit containing basics to be used in the delivery of new babies.

Sebiragala, the widower 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. But even then, there was no medical doctor in theater so both Sylvia and the second twin died at Mityana hospital.

Jennifer Anguko, a mother of three was admitted to Arua Hospital on December 10 2010 with intense labor pains and waited for 15 hours for a doctor to carry out a caesarean section.

She died of obstructed labor after the uterus ruptured. Four other women died in the maternity ward that same day.

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.

“Our hope is in the decision by Constitutional Court to compel government on its obligations to address the crisis of maternal mortality,” said Russell.

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