In 2011, the Centre for Health Human Rights and Development (CEHURD) and 3 other persons petitioned the Constitutional Court (C.P No. 16 of 2011) over the state of the maternal health in Uganda. Among others the issue raised for court determination was the unacceptable high maternal deaths in Uganda which is due to Government’s non-provision of the basic minimum maternal health care and the non-attendance and improper handling by the health workers of expectant mothers as unconstitutional. The above petition was premised on statistics which indicated as nearly as 16 women died every day in the country as a result of poor health care.
Just as we thought that hope was on the way as the judiciary would intervene against this hopeless situation, the Constitutional Court in its wisdom thought that by them adjudicating by compelling government to fulfill its obligation of providing access to quality maternal services to Ugandan women would be dictating on to the activities of the executive branch of government which is not the mandate of the judiciary. They thus dismissed the petition on grounds that it raises a political question (matters not resolved by the judiciary).
This did not help the fate of the women at all.
Fast forward, in September 2018, government opened the New Mulago Maternal and Neonatal hospital which was constructed under a loan from Islamic Development Bank worth 42 million US Dollars. The Hospital will offer a wide variety of services such as antennal care, delivery and post-natal, genealogy among others.
According to the Nile Post, construction of the facility cost Uganda USD 25,148,067 about 95 billion shillings and equipping the facility cost USD 8,026,456 about 30 billion Uganda shillings (Article: “Mulago Women’s Hospital Ready to Receive Patients” Thursday 20th September 2018). We hoped in a struggling economy like Uganda, Shillings 125 billion would cut the ratio of maternal death to very low figures. Alas! When the rates for facility users were released by the minister of health, the English grandmother was heard saying “let the sleeping dogs lie”.
Briefly, some of the outrageous rates as released by the minister are; consultation 50,000/=, Antenatal 890,000/=, examination under anesthesia 800,000/=, PAP Smear 150,000/= fistula reconstruction 2,500,000/=, Normal delivery 800,000/=, caesarian section 2,000,000/=, DNA testing 500,000/=, Post mortem 150,000/=.
Although the minister of health declared the rates humble at the prevailing market prices in the country, if truth is to be said, the honorable minister could have compared her prices to medical facilities abroad and not in Uganda. To assure the honorable minister, the average medical fees in affordable private clinics which are used by majority Ugandans are far cheaper than the new rates of the public Mulago Women’s Hospital.
Even fistula where Rotary International and the Kabaka of Buganda have organized runs for women because of the worst toll it has taken because women can’t afford to get the proper treatment, the minister proposed 2,500,000/= ($750) and she says it is little money!! How about charging for a post-mortem that is being carried out in a government hospital!!
These prices are very high for the poor population of women in the country and the new hospital does not offer a solution to the 16 women who die on average everyday from birth related complications.
At the outset, it is important for the minster to know that sexual and reproductive health rights including maternal health are human rights and human rights violations occur when a duty bearer, commonly a state, fails to meet an obligation in respect to the right. In the words of Prof. Paul Hunt “the right to health, including sexual and reproductive health, encompasses both freedoms, such as freedom from discrimination, and entitlements”. Therefore, Hon Minister, the obligation to respect women’s reproductive health rights requires that the state refrains from interfering with the enjoyment of rights by denying or limiting equal access for all persons to reproductive health services. States must provide comprehensive services indiscriminately for all and this should be based on the criteria of ‘availability, accessibility, acceptability and good quality’. You must ensure the availability of affordable, quality sexual and reproductive health service and commodities to all individuals who need them and these should be available in adequate numbers and accessible geographically, financially/affordable to all regardless of social-economic status.
I call upon you Hon Minister and the state to adopt a human rights based approach in setting the prices for treatment in the new women’s hospital and in all hospitals and centers that provide maternal/ reproductive services to Ugandan citizen. Human rights based approach recognizes the existence of rights and reinforces the capacities of duty bearers (you the state) to respect, protect and fulfill these rights. The approach requires government to fulfill all rights based on the principles of inclusion and non-discrimination. It requires participation and empowerment of the rights holders and also provides for holding duty-bearers accountable to fulfill their human rights obligations. A human rights-based approach to reproductive health recognizes that all human rights are universal, interrelated, indivisible, and interdependent and are inherent in all human beings. It acknowledges that sexual and reproductive rights cannot be realized without the realization of other broader human rights such as freedom from discrimination which madam minister an afraid the state is clearly violating by setting such high prices that an ordinary Ugandan woman who lives on less than a dollar a day can’t afford
If these prices remain as they are now, then there is no value for government borrowing all that money for a service which majority citizenry will not use yet will pay the loan with interest.
In fact, I can’t help but wonder what category of people the minister targeted when opening this hospital and coming up with the costs. Clearly it is not the ordinary Ugandan with no medical assurance and even if we are to consider the so called elites and middle class. Take an example of a primary teacher who earns less than USD 200, Most Civil servants earn about USD 300. How will they afford fistula operation of 2,500,000 (USD 750) notwithstanding other daily expenses? Later on think about a lady who sells tomatoes in Nakasero whose business capital is not even USD 100 and should my sisters from Serere dream of being referred to this hospital!
Madam minister, if you’re really concerned of our health as Ugandan women, if really your target was us and not yourself, your other cabinet members and members of parliament who Mr Chris Obore, the Director Communication and Public Affairs confirmed to us are entitled to medical insurance together with a limited number of their immediate family members.Not to mention that they earn monthly USD 5,000 and more, then you should with immediate effect ensure that these rates are revised very low and very soon.
For how long shall people keep on fundraising for medical help and yet citizens pay taxes. If these prices remain as they are now, then there is no value for government borrowing all that money for a service which majority citizenry will not use yet will pay the loan with interest.
The New Mulago women’s hospital does not reflect anything like Public Hospital. It will be very honest for government if this service is privatized and we the citizens know that we are dealing with private investors.
Honorable minister, this remedy is clearly not for the 16 women who die every day but for those who always live. How tragic that we shall continue to burry our own who are unfortunate not to have a lot of money.
 New Vision September 20 2018 page 18