Court Orders Audit of Maternal Health Facilities

A health worker attending to an expectant mother

The Constitutional Court has ordered the government to compile and submit to Parliament and court a full audit report on the status of maternal health in Uganda at the end of each of the next two financial years.

The panel of five Judges who include Alfonse Owiny-Dollo, Cheborion Barishaki, Kenneth Kakuru, Egonda Ntende and Christopher Izama Madrama also ordered the government through the Health Minister to ensure that all the staff who provide maternal health care services in Uganda are fully trained and all health centres are equipped within the next two financial years.  

The Judges also ordered that to meet the constitutional obligation of the state to uphold the rights of women and fulfill their reproductive rights, the government should prioritize and provide sufficient funds in the national budget for maternal health care in the next financial budget. 

The decision arises from a successful petition filed by civil society organization Center for Health, Human Rights and Development-CEHURD together with three others.   The others are Professor Ben Twinomugisha and two mothers including Rhoda Kukiriza and Inziku Valente whose daughters died in hospitals about ten years ago while giving birth at Arua Regional Referral and Mityana Hospital. 

The deceased are Sylvia Nalubowa and Jenniffer Anguko who bled to death and also lost their babies while giving birth in the absence of the doctors on duty.

The petitioners in 2011 sued the government in the Constitutional Court seeking a declaration that the absence of essential medicines, well-trained health officers and health supplies for pregnant women in government health centres was a violation of their constitutional right. Among others, they also asked the court to compel the government to increase the health budget and ensure the supply of essential medicines and other equipment to save the lives of women and their babies.  

Their lawyers led by Peter Walubiri argued that government had failed to provide affordable maternal health care services which threatened the ability of mothers to afford essential care. Court also heard that there was a shortage of mama kits at all levels of health centres as a result of mothers who were dying. 

But the government while defending this case, they relied on the affidavit of the then Health Ministry Permanent Secretary Dr Asuman Lukwago. Lukwago argued that the government had put in place and was implementing several policies to ensure improvement in the provision of maternal health services.

According to the evidence on-court record, the policies included a road map to accelerate the reduction of maternal morbidity, strategies for child survival, reproductive health commodities, sexual and reproductive health strategies and clinical treatment guidelines.

However, concerning the frequent stock-outs of essential drugs for maternal health, the government told the court that through the National Medical Stores, they regularly procured and delivered drugs and commodities to health centers but some of it was always lost through theft due to corruption of some health workers.

However, in their ruling, Justice Barishaki noted that although the government had put in place several policies, the implementation and evaluation of those policies was never done.  

Barishaki noted that the Attorney general didn’t tell the court what measures the government has undertaken to realize provisions of maternal health care services to women in Uganda. 

  He said that whereas Dr Lukwago had alleged that the implementation has always been a challenge, he only made a replication of statements the government normally uses in reports to attract donor funding.  

Barishaki also noted that even if the government says that it is encouraged by the reduction on maternal mortality rates, the levels reached are still not good enough taking into account the resources available to this government.

“The situation is not as rosy as Dr Lukwago would wish to portray, for example, the Ministry of Health’s annual Health Sector performance report for 2015 to 2016 found that some facilities in Uganda had individual maternal mortality rates as high as 2,578 maternal deaths per 100000 live births”, said Barishaki.  

The judges unanimously noted that the statistics given by the government when dealing with the maternal deaths in Uganda do not add up since the leading causes of maternal deaths in the country remain the same.

The Judges concluded with several declarations key of them is that failure to provide basic maternal health services in public health centres violates rights to women and it is therefore unconstitutional.

Also, that government of Uganda is accountable for the loss of Anguko and Nalubowa since the government couldn’t challenge negligence allegations levied against them by the petitioners.

As such they have awarded each of the mothers of the deceased 70 million shillings as general damages for psychological torture and violation of their rights to life and health.

The relatives have also been awarded 85 million shillings each for the loss suffered by the omissions of the medical personnel at Mityana Hospital and Arua Regional Referral Hospital.

According to the 2016 Uganda Demographic and Health Survey, 16 women in die each day in the country from complications related to pregnancy and child-birth.

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