By Goodluck Musinguzi
Ten years ago two mothers died out of negligence and corrupt tendencies by health workers at Mityana Hospital and Arua Regional Referal Hospita. It has taken 9 years for the Constitutional Court to determine the case that has made Maternal Health and Right to Health be recognised in the Constitution.
On 19th August 2020, after 9 years, the Constitutional Court gave its judgment in constitutional petition number 16 of 2011 filed by CEHURD, Prof Ben Twinomugisha, Rhoda Kukiriza, and Inziku Valente regarding the Right to Maternal Health and Right to Health broadly.
The petitioners were challenging actions and omissions of the Government of Uganda for failure to provide Minimum Maternal Health Services. Among the issues raised included a)Non-supervision of public health facilities and,b) Unethical behavior of health workers towards expectant mothers which are said to have led to the death of women during childbirth.
- The 3rd and 4th petitioners are awarded UGX 70,000,000/= each as general damages for the psychological torture, violation of the rights to life, health, and cruel and degrading treatment of their loved ones.
- j)The 3rd and 4th petitioners are each awarded exemplary damages of shs. 85,000,000/= for the loss suffered as a result of acts and omissions of the medical personnel at Mityana Hospital and Arua Regional Referral Hospital.
The 3rd Petitioner Rhoda Kukiriza pleaded with the health workers to handle her daughter-in-law but in vain until she finally died. In her averment, expectant women die while yearning for the support of a health worker nurse or doctor.
The 4th Petitioner, Inziku Valenti believes that if nurses had the requisite experience in the matter and offered care to her daughter Jennifer Anguko , she would not have died.
In his Judgement Justice Chebrion Barishaki says as time passed,while at Mityana Hospital, nurses asked the late Sylvia Nalubowa’s mother-in-law money and supplies but she did not have the amount requested. Then late Nalubowa begun bleeding and a doctor on call never allowed to attend to her. She and her unborn baby died at the hospital.
The late Jennifer Anguko went into labour at 11:00am at Arua Regional Referral Hospital started bleeding at approximately 2:00 pm. The nurses left Ms Anguko unattended and told her sister and husband to try and stop her bleeding with old pieces of cloth.
A doctor was not called until about 7:30 pm he was delayed in arriving and the late Anguko and her unborn child died at the hospital.
The death of a woman in labor in Mityana hospital is a great pity. Sylvia Nalubowa arrived at the hospital at 7:00 pm and died at 2:00 am the following day.
This was with the full knowledge of the so-called senior midwife and three nurses. Nalubowa was ignored because she was a poor woman! Who will redeem Uganda?
Later, it was discovered that the nurses who were supposed to be on duty, were attending computer lessons! On June 9, 2010 a profusely bleeding Tom Jjulunga was sent away from Rubaga Hospital because nobody knew who would foot his bills! This level of professional negligence in the health sector seems to be rampant and is frightening.
In the Mityana incident, health ministry officials said it was the first time in Uganda’s history that a mob had attacked a hospital. Although the then director of health services, Dr. Sam Zaramba, described the action by the crowd as unacceptable, the truth is that it was a spontaneous expression of the bitterness and frustration of poor people.
It is good the health ministry has sent a team to Mityana Hospital to investigate Nalubowa’s case. However, it is evident the Mityana case is only the tip of the iceberg.
The probe should go beyond Mityana to establish what routinely goes on in our hospitals and health centers and make a comprehensive report and recommendations to change the trend.
When Sylvia Nalubowa went into labor in Uganda’s Mityana district in August 2009, she had been taken to a local health center where she expected to have a normal birth, supervised by a midwife.
After she had delivered her first baby the midwife realized there was a twin on the way. The midwife 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 in Central Uganda, the nurses asked for her maternity kit. This is commonly known as a “mama kit” and contains a plastic sheet, razor blades, cotton wool or gauze pad, soap, gloves, cord ties, and a child health card. All mothers delivering babies in Ugandan hospitals and clinics are expected to bring their own “mama kits” when they go into labor.
But Nalubowa had used her “mama kit” at the first health facility when delivering her first child. The nurses would hear none of her excuses and demanded money to purchase the kit before they could attend to her.
Nalubowa and her baby died.
Jennifer Anguko died under similar circumstances. She arrived at the Arua hospital in North-Western Uganda at 8.30 am on December 10, 2010, but was not attended to for 12 hours by which time her condition and cries for help were out of control.
One hour later she was taken to the theatre but she and her baby died during the procedure. The cause of her death listed in the post mortem report was a ruptured uterus.
The women’s cases are two of many
Sixteen women die in Uganda every day during childbirth in instances that could be avoided. In 2011, the World Health Organisation reported that Uganda registers up to 440 deaths for every 100 000 live births.
Most maternal deaths in Uganda are due to severe bleeding, infection, hypertensive disorders, and obstructed labor. Others are due to causes such as malaria, diabetes, hepatitis, and anemia. All these are aggravated by pregnancy.
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 are not paid. Patients also say that they are often met by health staff who are unenthusiastic about attending to patients expecting free services.
In 2013, the doctor to patient ratio in Uganda was estimated at one doctor for just under 25 000 patients. The nurse to patient ratio sat at one nurse for 11 000 patients.
The country’s public health system has a tiered structure with two national referral hospitals, 11 semi-autonomous regional referral hospitals, and a well-established district health system with healthcare centers in 56 districts.
Health care services are financed through general tax revenue and donor funding. Although user fees for health services in public facilities were abolished in 2001 patients are still expected to make direct out-of-pocket payments for some services and drugs.
Fighting for a right
In 2011 lawyers at the Centre for health, Human Rights and Development, a non-profit, research, and advocacy organization, began gathering evidence to hold the Ugandan government to account for Nalubowa and Anguko’s deaths.
The case is now before the country’s Constitutional Court.
In what has turned into a landmark case, the center has argued that failing to provide essential maternal health commodities in government health facilities is an infringement on women’s rights. The rights to life as well as health are guaranteed under the country’s constitution as well as international human rights instruments the government has signed up to. These include the:
- International Covenant on Economic Social and Cultural Rights (ICESCR),
- Convention of Elimination of All forms of Discrimination Against Women (CEDAW), and
- Maputo protocol.
The court erred
At the first hearing before the Constitutional Court government lawyers objected to the case. They 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 agreed and dismissed the case.
But the center appealed to the Supreme Court, the highest court of appeal in Uganda. It argued that the justices of the Constitutional Court erred in denying them an opportunity to hear the case based on its merits.
In October 2015 the Supreme Court’s seven judges agreed. They made a unanimous ruling that the Constitutional Court judges had erred in dismissing the case. In their judgment, they argued that the case had key questions that needed constitutional interpretation for the people of Uganda.
They contended that there is nothing the executive or legislature can decide on that may not be subjected to judicial review – especially if it is done in line with the constitution. And they have ordered the Constitutional Court to hear the case which is now before the Constitutional Court pending a hearing by a new panel of judges.
Making health care a priority
The case has contributed to jurisprudence to help people realize their social-economic rights in Uganda.
But it has also catalyzed improvements in health service provision. Since the case was initially heard government funding for the health sector has improved from US$ 215 million (UGX 737.60 billion) to US$ 328 million (UGX 1127.48 billion) and more health workers have been recruited. Mothers, however, are still expected to bring their own “mama kits” when going into labor.
There has also been a reduction in maternal deaths. These have fallen from 440 deaths for every 100 000 live births in 2010 to 343 by 2015.
Most importantly, civil society organizations are now, more than ever, alert to demanding women’s health care rights.