Unsafe Abortion:Health advocates drag Uganda’s Parliament to Court

By Beatrice Nyangoma

Dr. Charles Kiggundu a Senior gynacologist at Mulago National Referral hospital sees atleast 15 women who have undergone unsafe abortion. These are as young as 9 and 15 years and as old as 40 years.

He says that these have various reasons why they decide to terminate pregnancies.

“I have a university student who has been impregnanted five times by her father and she has procured abortion five times. Many girls opt to terminate pregnancies that are as a result of incest and rape.”he says

He says that as much as this girl can afford to have a safe abortion, many of the others use rudimentsry means to terminate pregnancies.

Dr. Kiggundu emphasises that lack of a clear legislation in Uganda has led to many girls and women procuring unsafe abortion most of whom resulting into deaths.

“Unsafe Abortion continues to constitute a serious public health, human rights and social equity issue that affects millions of women in sub – Saharan Africa, and causes 29,000 deaths annually.”he says

“Women of all social standings seek abortion services, but it is mostly young women and poor women who die or suffer long term consequences from unsafe abortion due to the severe socio-economic deprivation they encounter. Providing access to safe abortion is a critical step towards reducing the unacceptably high rates of maternal death in Africa.” Kiggundu notes  

According to World Health Organisation, of the 6.4 million abortions in Africa carried out in 2008, only 3% were safe. One quarter of unsafe abortions occurred among adolescents aged 15-19, and 60% were among women under age 25. Additionally, unsafe abortion accounts for 13% of global maternal deaths and up to 40% of maternal mortality in African countries.  

Meanwhile, Uganda has one of the highest rates of unsafe abortion in Eastern Africa. It is a leading cause of maternal morbidity and mortality in the country, contributing to approximately 26% of the estimated 6,000 maternal deaths every year, and the estimated 40% of admissions for emergency obstetric care. Unsafe abortion places a huge cost on the public health system; approximately Ushs 7.5 billion are spent annually to treat complications.

A national abortion incidence study found that 15 out of every 1,000 Ugandan women of reproductive age were treated for abortion complications in 2003. Poor, rural women are at increased risk of unsafe abortion, 68–75% experienced complications, compared with the 17% complication rate for non-poor urban women.

According to Kiggundu, Uganda’s restrictive abortion laws permits abortion only to save the life of a pregnant woman. However, conflicting and restrictive interpretations of the abortion provisions under the 1995 Constitution of Uganda, the Penal Code Act and National Reproductive Health Policies have created confusion about the correct legal status of abortion.

According to a study conducted by Human Rights Awareness and Promotion Forum- HRAPF between 2011 and 2015, in seven main police station in Kampala, atleast four people were arrested every year in relation to abortion. Linette du Toit, the Research and Advocacy Officer at HRAPF says that nationally 182 arrests were made on abortion charges noting that few of the health workers are arrested.

Its a gainst this background, that  Prof. Ben Twinomujuni a Law don at Makerere University together with Center for Human Rights and Development-CEHURD filed a petitioned seeking that the constitutional court  orders the Executive and Legislative arms of government to pass a law  regulating termination of pregnancies to reduce maternal mortality rates that arise from  unsafe abortions.

The law dons in their petition filed on March 3 2017, contend that the existing legislation only permits abortion in exceptional circumstances such as a life of a mother at risk, but doesn’t protect young girls and married women who may get unwanted pregnancies hence resorting to unsafe abortion methods.

The petitioners argue that other African countries like Kenya, Rwanda, Ethiopia, Ghana and Tunisia, which are similar in social and economic circumstances as Uganda, deliberately developed laws to protect the rights of women by prescribing circumstances under which a woman is allowed to terminate her pregnancy.

“We do not see any reason as to why Uganda should not borrow a leaf from its neighbours and take an essential step to   protect the lives of women who continue dying day by day due to unsafe abortions,” reads part of the petition.

“Because the government has not operationalized Article 22(2) of the 1995 constitution of Uganda as a way of clarifying the parameters for legal abortion, healthcare providers are unable to provide safe and legal abortion services, while law enforcement officials and judicial officers do not effectively enforce or implement laws that permit abortion thus denying women and girls access to safe and legal abortion services.”Twinomujuni notes

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I attempted suicide eight times after testing HIV positive-Beauty Queen

By Beatrice Nyangoma

There is no easy time to any one as a time when one tests HIV/AIDS positive. In fact one of the first thoughts that come to one’s mind is death! One thinks that they are dead or about to die but they are just buying time.

Martha Clara Nakato 21, tried unsuccessfully to commit suicide eight times after she tested HIV positive at the age of 14. Whereas most people go for testing after having unprotected sex, Clara was still a virgin, in fact she tested having accompanied her twin brother who had had several unprotected sexual encounters and felt at risk.

“My twin brother Wasswa asked me to accompany him for an HIV test, at my age I did not find it really important to test because I was still a virgin and I mean I did not have any information on HIV. But you know, as a teenager, I was inquisitive and just wanted to go through what my twin brother was so I took the test that we both at the same time.” she narrates

As the twins waited for the results, Martha was strong because she expected the obvious results, there was no way her results could turn out positive.

“I was instead feeling nervous on behalf of my brother. At that time Wasswa was not even talking to me, he was shivering. He started telling me the girls she had slept with and those he suspects could have infected him in case the results came out positive, I felt pity for him.” she adds

Results coming out, Nakato was found HIV positive instead and her twin brother Wasswa was negative. “I told the nurse that there was a mistake, it’s my brother who is positive and not me. The nurse meant what she was telling me! It was true; I was positive of HIV/AIDS.” she added.

But how did Martha get infected?

“The health facility from which we tested was near our home and our dad was known to most of the facility staff. I requested the nurse to take me home because all I could think about was going to a high way and get knocked by a vehicle, but I wanted my father to know my status first.”

Nakato with the company of her brother and the nurse broke the news to her father. He was however furious at the nurse who made HIV/AIDS tests on her children without his consent and he even threatened to take a legal action against the health facility.

She was instead confused as the only person whom she expected to understand her situation was not helping either. “I mean, I knew nothing about sex, I was still a virgin and am tested positive and the only person who I expected to stand with and support me was instead angry that I knew my status.” she says

That evening, Nakato went to a shop and bought rat poison to end her life because she had no one left to listen to her problems but also she felt  dead anyway.

Nakato was however unsuccessful after she was rushed for medical attention before it would have any impact on her.

Her father would the following day tell her how she was born with the HIV virus and that her mother had died of HIV as opposed to lung cancer like they claimed.

“Growing up we knew that our mother had died of lung cancer but it wasn’t until I tested HIV positive that my father spoke the truth. The doctors were able to prevent the virus from passing on from my mother to my twin brother but it was the case for me because I came two hours later.” she says

Having known how she acquired the virus, Nakato did not want to go through the long term ailment like her mother and so she tried several means of ending her life. From over drinking alcohol, to jumping from buildings to drowning herself in a swimming pool but unsuccessfully.

But how did she reach 14 years without falling sick like many other children born with the virus?

“I happen to come from a well to do family where we had a family doctor who would be there in case of any ailment. So it was very hard to know what I was suffering from because my job was to only take the medicines given to me without knowing what exactly I was taking.”she notes

Her father also told her that she had been taking Septrine since her childhood as one of the medication for the virus.

Nakato’s father later took her to Kamwokya Caring Community where she used to pick her medication. From there she started interacting with the people in her same category and learnt how to move on positively.

However, Nakato recalls that the biggest challenge was at school she would regularly falling sick and would miss classes.

“I told some of my close friends at school about my status and they instead spread the word around the school. Everyone was looking at me as a walking dead person. I felt like leaving school and wait for my day to die since I  had attempted to commit suicide for eight times and I was unsuccessful.”

Nakato was forced to change to a day school because she needed frequent medical attention and she couldn’t handle the stigma at the boarding school.

In 2014, while in senior six, Nakato was introduced to The Aids Support Organization-TASO from where she got a different picture to life.

“I met my age mates who were going through situations that were worse than mine. Some of them had lived  reckless lives but they were positive towards life. They were adherent to the drugs, they studied what the disease they are living with requires and they were making changes in society. I was inspired, and since then I have preached about HIV/AIDS with evidence.” she says beaming with a smile

In her advocacy work, Nakato has met thousands of youth in schools and tertiary institutions to sensitize them on HIV/AIDS.

“I joined music, dance and drama clubs and last year I contested for the Young positives beauty pageant and I was voted as the queen for the central region. This pageant has taken me to places and I have also inspired more young positive girls to look at life differently. I hope to do more work after I complete my bachelors’ course at Kyambogo university.” she adds

Nakato appeals to the government to construct or gazette youth friendly corners in health facilities so that they get the right counseling about HIV.

“I think I attempted suicide because I had no one to talk to me before and after testing. This is a component missing in our health facilities that a 15 year old will wait from the same health Centre reception with a 40 year old and both will be attended by the same person and yet these two age groups have different information needs.” Nakato says

The Uganda Population-Based HIV Impact Assessment (UPHIA) national survey conducted in August 2016 and March this, the prevalence of HIV among adults aged 15 and 64 in Uganda is 6.2%.

The survey also indicates a prevalence of 0.5% prevalence among children aged 0-14 years which is about 95,000 children living with HIV. It also reveals that among the young adults, there is a disparity in HIV prevalence by sex. HIV is almost four times higher among females than males aged 15-24 years.

Kisoro district Teenage pregnancy rates alarming

By Beatrice Nyangoma

Immaculate Akankwasa 19, a resident of Karumere village, Kisoro town council in Kisoro district vividly recalls the day she went to hospital for a pregnancy test and she was found positive. At the age of 14 years, Immaculate had her dreams of being a nurse washed away. She could not be allowed to sit her Primary Level Education examinations and so she moved in with the father of the pregnancy.

“My parents forced the man responsible for the pregnancy to marry me and take care of me. After giving birth, the man asked me to go back to school and that he would be paying for my school fees. But when I reached senior two, he told me that he was tired of paying and he suggested that I sit home as he takes care of me.” she says.

Akankwasa would later get her second pregnancy unexpectedly because she had wanted to quit the marriage because the man had started mistreating her.

“I had started doing petty jobs like washing clothes for people in the village and I was planning to go back to my parents but then I realized I was pregnant again. Two months after giving birth, the man chased me from the house and I was left homeless with two children.” she says

Akankwasa is one of the girls that contribute to the statistics recorded by the Kisoro hospital every month of teenagers carry unwanted pregnancies.

According to Annie Modesta Budongo, the in-charge of the women’s ward at Kisoro hospital, the hospitals records an average of two girls who show up at the facility to get maternity services. She adds that every month the hospital records at least one case of botched abortion.

“We get girls as young as 13 years who come for antenatal services while others come seeking ways of getting the pregnancies terminated.” she says

In the month of July this year, Kisoro hospital recorded 250 deliveries out of which 61 were mothers aged between 10 and 19 years while 50 of a total of 256 deliveries were reported in September.

Francis Munyarubanza, the Kisoro district Education Officer notes that teenage pregnancies have increased the number of girls dropping out of school.

He notes that out of the 11,000 girls that enrolled in primary one in 2010, only 2,234 sat for the Primary Leaving Examinations meaning over 8,000 girls had dropped out.

“We don’t know what to do when it comes to teenage pregnancies. Whereas some girls drop out because of finances, the general picture shows that the highest percentage drop out because of unwanted pregnancies.” he notes

The situation is not unique to Kisoro district as Kabale teenage pregnancy statistics are equally alarming.

According to Mandera Immaculate, the Acting District Health officer, the district recorded 2,264 girls between the age of 10 and 19 out of the 15,278 women who went for antenatal services which is 14.8%.

Mandera notes that 1,637 teenage girls delivered from the public health facilities out of a total of 10,510 mothers which is 15.7%. In the same year 2015/16, 1,461 teenage girls sought for family planning services out of the 18,723 clients registered at health facilities which 7.8%.

Contraceptives an option?

On 29th September, the ministry of health rejected to launch revised guidelines that would see teenage girls access to contraceptives from public health facilities on grounds that the ministry had not made enough consultations with the stakeholders.

Budongo notes that even in the absence of approved guidelines by the ministry, she still gets cases where girls seek emergency pills. She adds that although she issues the contraceptives to them, she fears that she does this putting her job at risk.

“I am human too and a parent. I don’t feel comfortable when I deny such a girl in need contraception to secure her future. But I know the ministry has no policy for that and the only way explanation I can have in defense is that the family planning registration book has provision where we can record the teenagers.” she says

However, Ruzaza Christopher, the health services coordinator at the Diocese of Buhabura notes that the ministry of health officials should not pretend that they do not see what is happening in the country. He notes that the longer the government delays to launch the guidelines the more girls will drop out of school because of unwanted pregnancies.

“Let us put other factors aside and allow the girls who cannot abstain from sex to have access to contraceptives instead of letting them drop out of school. There is nothing as bad as a child growing up knowing that he/she was an unwanted child.” he says

He adds that the health ministry only needs to package the information well so that the girls know the side effects of contraceptives and how they risk getting infected by HIV.

Ruzaza however notes that the government needs to invest more in family planning commodities at health facilities if the policy is going to be effective.

“We already have an unmet need for contraceptives as a nation. This implies that if we are to have that provision for the teenagers, we need to double the supply.” he adds.

Dr. Stephen Nsabiyumva the Kisoro District Health Officer notes that the policy on contraceptives for teenage girls has been delayed. He says that the ministry of health has the mandate to ensure that the girls are not impregnated by provision of youth friendly services including contraception.

“Regardless of religion, culture and morality, we need the contraceptives urgently. We cannot continue looking at our girls dropping out of school and ending up in miserable lives and yet we can do something to prevent this.” he said

However, his education counterpart Runyabuzanza disagrees saying that this is likely to lead to more moral decay among the girls.

“I think we need a comprehensive policy on parenting. Giving girls contraceptives will just worsen the situation. Yes the statistics are alarming but contraceptives are not the solution. Let the ministry look at the other drivers of sexual promiscuity and address them as a whole.” he said

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Improving skills of mid wives, the easy way

Every person who has a career has desire to improve his/ her skills through further training. However, the thought of abandoning the family and sometimes taking study leave, which is rarely approved by the employers makes career advancement difficult.

However, in in Uganda, over 700 midwives will acquire skills from wherever they are, courtesy of a funding by GSK through Amref Health Africa.

The project coordinated by Amref Health Africa and funded by GSK is worth 250,000 pounds between 2015 to 2020 targets at increasing the number of the midwives at lower health centers and also improve their skills.

Andrew Wabwire, the E-learning project coordinator at Amref health Africa, says that the project targets midwives who are already working and cannot get study leave. He notes that the project targets the midwives from their local areas.

“We have midwives who are willing to enhance their skills but they are not able to obtain study leave from their employers while others have families and cannot go to school every day. So with this project we aim at targeting midwives who are working in hospitals that also have medical schools.” he says

The funding will be used to procure ICT equipment for the hospitals, medical schools and training the tutors. The nursing and midwifery schools to benefit include Mulago, Nsambya, Mengo,, Soroti, Lubaga, Arua, Kagando, Masaka, Jinja, Public Health Nurses College-Kyambogo, Kabale, Kagando and Lira.

However, according to Mrs. Meryce Mutyaba, the Principal Tutor at Mengo School of Nursing and Midwifery notes that the ministry of education needs to increase on the number of tutors if this project is to be successful.

She notes that the number of midwifery students at the school has increased over the years and yet the number of tutors remains the same.

“It is difficult to manage full time students and at the same time monitor those on e-learning. The education ministry recommends a ratio of 1 tutor per 30 students, but here at Mengo we are as high as 1:70. This compromise the quality time a tutors would be spending with each student.” She adds

Mutyaba notes that whereas the project will ensure that the health centers have skilled work force, there is need for the education ministry to streamline career guidance to address attitude issues which have left many mothers and babies die on the wards because of careless midwives.

“Midwifery is a calling. One has to love their job before anything else. Someone can have the training and skills but when they have a poor attitude towards work, they will not perform, and therefore students have to be mentored before enrolling.” she said

Sam Mbowa, the GSK Uganda, French and East Africa manager notes that the government should ensure that the trained midwives do not leave Uganda for greener pastures.

“This is a huge investment into the health sector and therefore we have to provide resources and motivate the midwives to stay and work from here.” he says

Uganda is a signatory to the Africa Medical Councils protocol on health workforce immigration that was signed in 2016. The protocol is aimed at managing the immigration of health workforce both internally and externally.However, according to the registrar for the Uganda Medical and Dental Practitioners Council, Dr. Katumba Ssentongo, the process of implementing the protocol in Uganda has been slow because the council is understaffed.

“We have done some work in line with the protocol but the not as much as the pace our counterparts are moving. We have less staff and thus we only do that which is within our means.” he said

 

 

 

 

 

 

 

 

 

 

Teenage pregnancies and the contraceptives debate, the girls stand to lose with no decision

By Beatrice Nyangoma

Immaculate Akankwasa 19, a resident of Karumere village, Kisoro town council in Kisoro district vividly recalls the day she went to hospital for a pregnancy test and she was found positive.

At the age of 14 years, Immaculate had her dreams of being a nurse washed away. She could not be allowed to sit her Primary Level Education examinations and she was married off to the father of the pregnancy.

“My parents forced the man responsible for the pregnancy to marry me and take care of me. After giving birth, the man asked me to go back to school and that he would be paying for my school fees. But when I reached senior two, he told me that he was tired of paying and he suggested that I sit home as he takes care of me.” she says.

Akankwasa would later get her second pregnancy unexpectedly because she had wanted to quit the marriage because the man had started mistreating her.

“I had started doing petty jobs like washing clothes for people in the village and I was planning to go back to my parents but then I realized I was pregnant again. Two months after giving birth, the man chased me from the house and I was left homeless with two children.” she says

Akankwasa regrets having left school because of a man she thought would love her forever. she wishes she could turn back the time to make better decision of staying in school.

Annie Modesta Budongo, the in-charge of the women’s ward at Kisoro hospital says that at least two girls show up at the ward seeking maternity services everyday . She adds that every month the hospital records at least one case of  a teenager seeking for abortion or has aborted else where unsuccessfully.

“We get girls as young as 13 years who come for antenatal services while others come seeking ways of getting the pregnancies terminated.” she says

In the month of July this year, Kisoro hospital recorded 250 deliveries out of which 61 were mothers aged between 10 and 19 years while 50 teenagers out of 256 deliveries were recorded in September.

Francis Munyarubanza, the Kisoro district Education Officer notes that teenage pregnancies have increased the number of girls dropping out of school.

He notes that out of the 11,000 girls that enrolled in primary one in 2010, only 2,234 registered for the Primary Leaving Examinations in 2017 meaning over 8,000 girls had dropped out.

“We don’t know what to do when it comes to teenage pregnancies. Whereas some girls drop out because of finances, the general picture shows that the highest percentage drop out because of unwanted pregnancies.” he notes

The situation is not unique to Kisoro district as Kabale teenage pregnancy statistics are equally alarming.

According to Mandera Immaculate, the Acting District Health officer, the district recorded 2,264 girls between the age of 10 and 19 out of the 15,278 women who went for antenatal services which is 14.8% in 2015/2016.

Mandera notes that 1,637 teenage girls delivered from the public health facilities out of a total of 10,510 mothers which is 15.7%. In the same year, 1,461 teenage girls sought for family planning services out of the 18,723 clients registered at health facilities which 7.8%.

Contraceptives an option?

Budongo notes that even in the absence of approved guidelines by the ministry, she still gets cases where girls seek emergency pills. She adds that although she issues the contraceptives to them, she fears that she does this putting her job at risk.

“I am human too and a parent. I don’t feel comfortable when I deny such a girl in need contraception to secure her future. But I know the ministry has no policy for that and the only way explanation I can have in defense is that the family planning registration book has provision where we can record the teenagers.” she says

On 29th September, the Ministry of Health rejected to launch revised guidelines that would see teenage girls access to contraceptives from public health facilities on grounds that the ministry had not made enough consultations with the stakeholders.

Prof. Anthony Mbonye, the Director General of Health at the Health Ministry during the second national conference on unsafe abortion informed the participants that the ministers withheld the guidelines on grounds that they were approved by junior officers. He however noted that he strongly believes that girls should have access to contraceptives.

“I strongly believe, and they can fire me because of my opinion but I strongly believe that the adolescents should get access to contraceptives! In Uganda women of reproductive age have access to contraceptives. It doesn’t mean that we go to their homes and churches to distribute them.”he said

However, Ruzaza Christopher, the Health Services Coordinator at the Diocese of Buhabura notes that the ministry of health officials should not pretend that they do not see what is happening in the country. He notes that the longer the government delays to launch the guidelines the more girls will drop out of school because of unwanted pregnancies.

“Let us put other factors aside and allow the girls who cannot abstain from sex to have access to contraceptives instead of letting them drop out of school. There is nothing as bad as a child growing up knowing that he/she was an unwanted child.” he says

He adds that the health ministry only needs to package the information well so that the girls know the side effects of contraceptives and how they risk getting infected by HIV.

Ruzaza however notes that the government needs to invest more in family planning commodities at health facilities if the policy is going to be effective.

“We already have an unmet need for contraceptives as a nation. This implies that if we are to have that provision for the teenagers, we need to double the supply.” he adds.

Dr. Stephen Nsabiyumva the Kisoro District Health Officer notes that the policy on contraceptives for teenage girls has been delayed. He says that the ministry  has the mandate to ensure that the girls are not impregnated by provision of youth friendly services including contraception.

“Regardless of religion, culture and morality, we need the contraceptives urgently. We cannot continue looking at our girls dropping out of school and ending up in miserable lives and yet we can do something to prevent this.” he said

However, his education counterpart Runyabuzanza disagrees saying that this is likely to lead to more moral decay among the girls.

“I think we need a comprehensive policy on parenting. Giving girls contraceptives will just worsen the situation. Yes the statistics are alarming but contraceptives are not the solution. Let the ministry look at the other drivers of sexual promiscuity and address them as a whole.” he said

The newly released data from the Uganda Demographic and Health Survey 2016 (UDHS) conducted by the Uganda Bureau of Statistics between June 12 and December 18, 2016, indicate a 1 per cent increase in teenage pregnancy from 24 per cent in 2011 to 25 per in 2016.

The report indicates that Teso sub-region has the most numbers of childbearing adolescent girls, standing at 31 per cent, and Kigezi sub-region with the lowest at 16 per cent. Tooro, Bunyoro and north-central sub-regions also have high levels of teenage pregnancy, standing at 30, 29, 30 per cent respectively while Kampala City registered the lowest rate of teenage pregnancy at only 17 per cent.

 

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Jinja hospital mental health department understaffed

Sarah Mudondo, a resident of Namayingo district has been taking care of her 24 year old son who suffers from mental illness. Her son has been admitted at Jinja Regional Referral hospital for over one month now. Mudondo says that she spends more than Shillings 20,000 on drugs and food daily.

 “I have spent over four weeks here but am now failing to manage looking after the patient because i have to spend at least 20,000 shillings to buy drugs and food. Most of the prescribed drugs are out of stock here. So the only option is to buy.” she says

Edith Alitwala, a senior Nursing Officer in the Psychiatry Department, says there are only four nurses instead of 8. 

 According to Alitwala, the number of mental health patients has almost doubled in the previous three months. She explains that they used to receive between 20 and 30 patients daily, but the number has increased to over 60 patients.

Alitwala also notes that the unit is faced with a challenge of essential drug stockouts, adding that sometimes the unit  spends over two years without receiving Phenytoin and Injectable Fluphenzine, the two most essential drugs for mental illness.

Alitwala emphasizes that the failure by the hospital to provide meals to the patients is a big setback. She says that in most cases they are forced to suspend medication to patients especially with HIV when they learn that the patient has not eaten.

 She also cited insecurity as another challenge in the hospital. The mental health unit relies on the guards at the main gate, which is a very long distance from the unit.

“We have two nurses on night duty and there is a time when a patient wanted to strangle a nurse.  They had had to call security personnel at the main entrance, which is very risky.”she said.

 The Mental health department of Jinja Regional Referral Hospital was established in 2010 following the decentralization of mental healthcare to regional referral hospitals to reduce at Butabika Referral Hospital.

Experts task government to prioritize reproductive health needs for teenage girls

On the International Day of the Girl Child, a network of Ugandan society groups, health workers, young people, and other concerned citizens harshly criticized a decision by Ministry of Health executive leadership to halt the release of the Sexual and Reproductive Health and Rights Guidelines and Service Standards.

Last month, the state minister for primary health Joyce Moriku at the closing ceremony of family planning conference declined to launch the national guidelines and service standards for sexual and reproductive health and rights noting that stakeholders had been involved in the compilation of the guidelines.

Now the civil society have tasked the ministry to release the guidelines in a bid to reduce the teenage pregnancies.

According to the 2016 Uganda Demographic Health Survey 25% of adolescent girls and young women aged 15-19 in Uganda is pregnant or a mother, one of the highest teenage pregnancy rates in sub-Saharan Africa. Shockingly, this statistic has remained unchanged since 2006, despite massive funding by donor governments in reproductive health services.

Denis JJuuko the program officer for CEHURD,  notes that there is a big In Uganda, teenage pregnancy has drastic and far-reaching health, development, and economic affects at the individual, family, community and national levels. These include preventable death in childbirth, high risk of unsafe abortion, lack of access to education, poverty, lost economic growth, and more. Despite the catastrophic consequences of teen pregnancy, Ministry of Health has not only failed to invest in interventions that work, but also is fixated on thwarting actions that drive life saving services even further out of the hands of young women.

“Upon rejecting the guidelines, which are designed to focus attention on the services delivery needs of young women and girls agenda 15-19, Ministry of Health officials made inaccurate claims, for example that they “had not been consulted” and that the Guidelines intended to distribute contraceptives to 10 year olds.” said Patrick Mwesigye, the team leader for Uganda outh and Adolescent Health Forum

Experts pointed out that sexual activity among Ugandan teenage girls is an issue that the Ministry of Health has refused to address with evidence-based responses.

“Instead of ensuring a robust policy environment based on human rights and community needs, there is a policy desert. This must stop. We have to address the reality Ugandan girls are facing. These actions are making life for Ugandans more dangerous, by tying the hands of our policy makers and health workers. We need access to services based on science and evidence, and that includes sexual and reproductive health services such as Pre Exposure Prophylaxis for HIV prevention, contraception, and more for young people who are sexually active,” Jjuuko noted

Uganda’s rate of maternal mortality and morbidity due to unsafe abortion is higher than the regional average, and teenagers are at particularly high risk of complications from unsafe abortion—due to stigma, fear, isolation and criminalization.

This abrupt reversal is not the first of its type—Coalition members pointed to the ban on Comprehensive Sexuality Education announced in 2016, as well as the withdraw in 2015 of the Standards and Guidelines on Prevention of Maternal Mortality Due to Unsafe Abortion as part of an alarming trend in top Ministry of Health management sabotaging evidence based policies and approaches to prevent unnecessary suffering and death. Infighting and attacks among Executive Management has also created distraction from core work and demoralization among staff.

 

Empowering Girls in Emergencies is Crucial to their Survival- Save the Children

Press Release

On October 11, we celebrate girls, a source of joy, energy and inspiration. Every one of us can point to a girl that has made a remarkable difference in our lives. They are our daughters, grand-daughters, sisters, cousins and friends.

As we commemorate the day of the girl child, we are reminded of the millions of girls caught up in crises all over the world. The theme this year, ‘EmPOWER girls: Before, during and after crises’ is cognisant of the need to ensure that girls are able to survive in a rapidly changing world that grapples with conflict, climate change, violent extremism and forced displacement.

In Uganda, we continue to host over one million refugees from neighbouring countries such as South Sudan and the Democratic Republic of Congo. Women and children are the majority of those affected by this displacement. We are seeing young girls separated from their parents, having limited access to education and having to take care of younger siblings at a time when they can barely take care of themselves.

The United Nations Girls Education Initiative highlights that women and girls are uniquely and disproportionately affected by conflict. Insecurity, displacement and breakdown of social support systems coupled with limited access to financial resources, social capital and legal support leave girls at risk of discrimination and exploitation on many fronts.

Research has shown that girls are almost two and a half times more likely to be out of primary school if they live in conflict-affected countries, and nearly 90 percent more likely to be out of secondary school than their counterparts in countries not affected by conflict. In Northern Uganda, data indicates that violent conflict has had little effect on the education of boys from the wealthiest one-fifth of households. However, the poorest girls from the same area are twice as likely to face risk of extreme education poverty.

We must work together to ensure that girls are protected before, during and after crises. We need to strengthen our engagement with local authorities and communities to ensure that social support systems necessary to ensure that girls are safe and protected continue to function even when communities experience political, economic and social shocks as is common during emergencies. We need to ensure that there are strong policies on protection of women and girls in conflict and that these are implemented effectively.

Through our work in Northern Uganda, responding to the needs of the displaced we have found that protection, education and access to basic services continue to be among the greatest needs for girls in the refugee settlements. We are also helping children recover from emotional and psychological trauma caused by conflict and hunger, which has left them scarred by the past, wondering about today and hoping for a better future.

We continue to work with the government and partners to help children recover and survive. Save the Children is running an Accelerated Learning Programme that follows an approved fast-tracked curriculum to assist conflict and poverty affected children with opportunities to join, re-join and complete their formal education or access relevant vocational skills and livelihood trainings. A good number of girl mothers have enrolled too, and some come to class with their babies. They have a thirst to learn, because they know what education can accomplish for them as individuals, their children and their future.

 

Despite these great efforts, dropout rates among girls remain high, especially in the higher levels, further underpinning the challenges that girls face when attending school.  These include early marriage, household chores, responsibility over siblings, poor menstrual management and for many, the need to sacrifice their own education so that their younger brothers and sisters can go to school. No single girl should have to make this sacrifice – every child, girl or boy, has a right to an education and should enjoy this right.

We need to invest in education systems as a sustainable means to ensure access for all girls and boys and improve its quality. This should include system strengthening, school building, and training and remuneration for teachers. We also need to scale up funding and support for quality complementary and catch-up programmes to provide educational opportunities to children for whom the formal system is inaccessible.

To get all children back into school, particularly girls, we ask the international community to increase funding to help refugee host countries like Uganda provide children with a quality education. Currently refugee education gets only a fraction of the funding it needs. We also call on the Ugandan Government to develop and implement policies that ensure refugee children can attend school and learn from a quality education.

At Save the Children, we are committed to doing whatever it takes to ensure that all children learn, survive and are protected by 2030. We continue to work towards achieving significant breakthroughs in the way the world treats children and girls are no exception. We believe that working together with children and their communities, partners, donors and government can result in real transformation.

Nelson Mandela said that there can be no keener revelation of a society’s soul than the way in which it treats its children. We owe it to our girls to ensure that they have equal access to opportunities, are protected from harm and have hope for the future. Indeed, they are our future.

Brechtje van Lith

Country Director

Save the Children

 

Adjumani General hospital cracks away, earlier report warns the facility is unfit for harbouring human life

By Beatrice Nyangoma

Adjumani General hospital structures have developed cracks causing worry that it may collapse on patients. The cracks started with the Out patients structure in 2012 that was last year rebuilt, according to Michael Ojja, the hospital administrator.

Ojja says that the cracks have developed in the rest of the hospital walls and some of the wards have now been corded off because they may fall any time.

“We are afraid that the hospital walls may fall on to the patients any time. We have now decided that some of the wards be vacated for the safety of the patients.” he said

He however notes that the Ministry of Health and the district leaders have not supported the hospital to get funds such that renovation works can be done despite a warning report on the state of the hospital.

In January 2014 a joint team from the Ministry of Health and the Belgian Technical Cooperation declared parts of Adjumani hospital “unfit for harbouring human beings”.

According to Ojja, by the time the assessment was made three years ago, structures which had cracks on the walls included the out-patient department, the hospital boardroom and maternity ward. He however notes that the cracking has now included the patients’ wards.

A preliminary report showed that the soil texture cannot carry the weight of the structure, and that there was a problem with the design. The team recommended that the affected parts of the structure be demolished before general renovation takes place.

The hospital was constructed for the 232,813 people of Adjumani in 1997. However, according to Ojja the hospital now receives additional population of refugees of 217,000 meaning the facility is recording almost of the population planned for.

Statistics from the hospital show that in the 2015_20016 financial year, Adjumani hospital received at least 67,361 patients at the out-patient department, conducted 1,887 deliveries and admitted 10,937 patients.

Ojja however notes despite the sky rocketing number of patients, the hospital budget has been cut to almost a half. “This hospital was constructed  with a bed capacity of 100 patients but we are operating on a 200 bed capacity meaning that half of the admitted patients actually sleep on the floor. Between 1997 and 2001, we used to receive over 200 million Shillings every financial year but this has reduced to less than 130 million Shillings.” he said

He adds that the hospitals only source of local financing which is the private wing has also been frustrated by local politicians who opposed to charging  patients.

“The local politicians have failed our efforts to complement on the government funding. They stopped us from charging patients in the private wing claiming that this is a public facility and therefore services must remain free of charge.” he added

He says that the hospital received 2 billion shillings from the government that saw the outpatient structure reconstructed adding that the hospital now requires over 10 billion shillings for general reconstruction.

Dr. Sarah Byakika the commissioner for planning at ministry of health on the sidelines of  the African Regional Meeting during the Harmonisation for Patient-Centred Universal Health Coverage meeting in Entebbe, Uganda on the 5th of July 10, 2017 said that the government has not yet got funds for the reconstruction of the hospital.

“The ministry of health is aware of the Adjumani hospital needs but we have not yet got funding. We have however renovated some other hospitals that fall in the category of Adjumani hospital.” she said

Dr. Mugagga Kaggwa, a medical Officer with World Health Organization with specialization in Health Management during the says that the government should focus on strengthening the infrastructure in order to achieve a patient centred health care.

“WHO is now focusing on health care that is patient centered and Uganda cannot achieve this if we undermine the quality of the health facilities that house the patients. The state of the health facilities contributes a lot to the psychological state of patients.” he said

beatricenyangoma@gmail.com

 

How shortage of human resource is affecting service delivery at Jinja Regional Referral Hospital

By Beatrice Nyangoma
Human resource is the biggest component in any health care system. However, Uganda’s health care services have been affected because generally there is a shortage of medical doctors.
Jinja Regional Referral hospital a facility located in Jinja town and it serves a population of the entire Busoga region that is over 60,0000. The hospital receives  referrals from health centres in the districts of Iganga, Buikwe, Namutumba, Luuka, Mayuge, Bugiri, among others. However one of the biggest the challenge the hospital is faced with is shortage of health workers.
Dr  Dan Baliwo Nsereko, the Deputy Director the hospital has decided to close some of the hospital units such as the cancer treatment center.The centre was refurbished with support from Twegaite International Organization; a US based non-government organization bringing together Ugandans from Busoga region and their friends in the diaspora.

The centre was refurbished in response to government’s plans to decentralize cancer screening and treatment. However, the centre has remained under lock and key leaving cancer patients with nowhere to turn for help.

He says the facility can accommodate 50 patients but lacks equipment and staff to run it.  According to Dr Nsereko, the centre needs an oncologist, a surgeon and at least three nurses.

He says currently all suspected cancer patients are referred to Uganda Cancer Institute-UCI for treatment.

James Wako, a prostate cancer patient from Namulesa village, says he spends at least  50,000 Shillings to travel to UCI for treatment, adding that at times he has to wait for days when the institute lacks some drugs.

“It is very expensive for me to travel every month to get drugs as simple as Morphine. If Jinja ward was operational, I would be happy,” he said.

According to Alitwala, the number of mental health patients has almost doubled in the previous three months. She explains that they used to receive between 20 and 30 patients daily, but the number has increased to over 60 patients.

Alitwala also notes that the unit is faced with a challenge of essential drug stockouts, adding that they have spent over two years without receiving Phenytoin and Injectable Fluphenzine, the two most essential drugs for mental illness.

Sarah Mudondo, a care take to one of the patients who has spent four weeks in the facility. She says that she spends more than Shillings 20,000 on drugs and food daily.

Alitwala emphasizes that the failure by the hospital to provide meals to the patients is a big setback. She says that in most cases they are forced to suspend medication to patients especially with HIV when they learn that the patient has not eaten.

She also cited insecurity as another challenge in the hospital. The mental health unit relies on the guards at the main gate, which is a very long distance from the unit.

“We have two nurses on night duty and there is a time when a patient wanted to strangle a nurse.  They had had to call security personnel at the main entrance, which is very risky,” she said.

The hospital’s intensive Care Unit also lies underutilized due to lack of specialists. The 13-bed ICU unit is the largest in eastern Uganda.

The 5 billion Shillings facility, donated by ASSIST International, was commissioned in September 2011. It is equipped with cardiac monitors, ventilators, pulse oximeters and defibrillators capable of treating patients with critical illnesses of the lung, heart and kidneys.

It was expected to serve patients in eastern Uganda and reduce referral cases to the National Referral Hospital in Mulago.  However,  the hospital does not have the technical expertise to run the facility.

An ideal intensive care unit requires doctors with specialty in anesthetics, cardiology and emergency medicine. It also needs physiotherapists, dieticians, speech therapists and nurses. The role is nurses is however limited to delivery of medicines, prescribed by the doctors and monitoring blood pressure, heart rate and oxygen levels.

However, the ICU at Jinja Referral Hospital does not have all the specialists needed to keep it functional.

The hospital principal Nursing Officer Aceng Florence says that the facility requires at least 30 nurses to operate effectively. She notes that at the moment, they cannot admit more than three patients at a time due to shortage of staff. The unit has only three nurses.

In an ideal situation, according to Aceng, one patient should be attended to by at least four nurses, and 12 nurses should therefore be in place to work every 24 hours.

Christine Akello, one the nurses at the unit says that running the unit hectic especially when there are emergencies such as accidents. She notes that since the start of this year, the unit has admitted only 11 patients and others have been turned away because there are no doctors to attend to them.

Muhammed Khalifa Mbhete, the Jinja central division Councillor and chairperson of the health committee says that the state of Jinja hospital is generally appalling. He notes that every department in the hospital has an essential component missing.

However, like other units that lack staff, there is hope that the unit will get more staff following a request by the hospital administration to the Health Service Commission two years ago.

beatricenyangoma@gmail.com

Eye patients appeal to government to train more specialists

By Beatrice Nyangoma

 

On  27th June,2017, Gilbert Onegi 43 a resident of Oduk village, Abira West Parish in Zombo district trekked a distance of over 50 kilometers to Nebbi hospital to have his 3 year old Jonathan Rwot Omiyo treated of an eye complication.

Onegi’s travel to Nebbi hospital followed radio announcements that the hospital would be hosting a medical camp where several eye specialists would provide eye screening and treatment services at no cost.

To Onegi, this was a life time opportunity to have his son who had suffered for three years of an eye complication treated and have a new life free of pain.  Onegi ensured that he was at the hospital by 8am so that he is among the first people to be attended to. However, by the time he arrived, he found over 50 other patients lined up for the same service.

Because of the severity of the condition of Rwot’s eye, the doctors made Onegi jump the line and he was seen among the first patients.

Rwot’s left eye is protruded from the ball, red in color and it is teary. His father says that the eye started swelling when he was four months. He says that efforts to get treatment from different medical facilities were futile as all the medicines prescribed were not helpful while the swelling continued.

“This boy has been staying with his mother who left me for another man. For almost a year, I have been sending some money to her mother for treatment but things never changed. But at the start of this year, I decided to pick him and I have since been looking after him. But he cries every night because of pain. When I heard about this camp I borrowed money to bring him.’ he said

But according to Dr. Ben Watmon an eye specialist from Gulu Referral hospital said  the boy’s eye condition is one known as Retinoblastoma cancer which is in its advanced stages and may be difficult to reverse. He said that from the clinical observations, the tumor is already grown and is visible.

“This type of eye infection starts in babies as early as one month. During the night, the eyes close as that of a cat. This eye is now a burden to the child and therefore we have to remove it to reduce the pain but also prevent the suspected cancer cells from spreading into the body and then he will start on chemotherapy.

Ideally, chemotherapy should have been the first thing to do then the eye is removed but since it’s too late we shall remove the eye and then refer him to  Ruharo hospital in Mbarara district which is the only facility in Uganda that gives chemotherapy services. This boy could have maintained the eye but because we have few eye specialists in the region, he could not get early screening.’ He said

Uganda is a signatory to the World Health Organization strategy for elimination of avoidable blindness by the year 2020. Figures from the Health Management Information System indicate that eye diseases are among the top ten causes of morbidity in Uganda. It is estimated that between 300,000 to 350,000 people in Uganda are blind and over 1.2 million have visual impairment.

However, despite the commitment, Uganda is faced with acute shortage of ophthalmologists (eye specialists). According to a 2012 report by Sightsavers International, a charity organization dealing in eye related illness in Uganda, there are only 41 eye specialists, of which 26 of them are in Kampala while only 15 are shared by the rest of the country.

Dr. Charles Keneddy Kissa the Nebbi Hospital Medical Superintendent says that the hospital has a fully equipped eye clinic but it is non- operational because it lacks a specialist. He says that  patients with eye related complication are referred to Arua Regional Referral hospital which is over 70 kilometers away. He however adds that the hospital operates an outpatient eye  clinic that manages minor eye diseases such as allergies.

The burden of eye diseases at Nebbi hospital

 

Dr. Kissa says that the hospital registers a big number of people with eye problems. He say in the financial year 2015/2016, the hospital recorded 1,180 eye patients out of the total 49,809 patients which is about 2.3 percent.

“This is a big number of people most of whom end up losing sight which could be reversed if we had an eye specialist. We now depend on well -wishers who offer to treat our patients through medical camps.” he says

During such camps like the one that started on 26th June Monday and ended on Friday 30th July, very many people turn up because there is a service delivery gap.

The camp was organized by Ministry of Health with support from Amref Health Africa, attracted a total of 106 patients of which 42 underwent corrective surgery. “We had planned for round 80 patients from Nebbi district. However, we got more patients coming from as far as Zombo, Pakwatch, Arua while others come from as far as Democratic Republic of Congo.” He said

He adds that due to logistical challenges, many of the patients go unattended to nd instead priority is given to those who have higher chances of recovery.

Information obtained from the Health Management Information System indicates that between 300, 000 to 350, 000 people in Uganda are blind and over 1.2 million others have visual impairment.

Dr. Wotmon noted that of these, 170, 000 are blind due to cataract and that the number increases annually by 20% representing 34, 000 new cases every year.

Cataract is the clouding of the eyes. The clouds change the lens of the eyes leading to sight loss or reduction. Cataracts are common among the elderly but children and other age groups can also succumb to this condition. Patients suffering from cataracts can regain their vision only if they undergo a minor surgery. However, Watmon notes that many of the patients resort to using traditional herbs instead of seeking medical attention.

In order to deal with this, Dr. Wotmon said, the country needs to carry out at least 34, 000 cataract operations annually. But he said that unfortunately government is currently able to conduct only 10, 000 cataract operations annually, leaving the lives of the eye patients at big risk.

However some of the causes are preventable. The preventable causes of blindness and visual impairment include cataracts, trachoma, Onchocerciasis (River Blindness), vitamin A deficiency, measles, and injuries on the eyes, bacteria, viruses and fungus among others.

Dr. Kissa however appeals to the government to train more eye specialists such that the hospital can attend to patient on a daily basis.

“Whereas the medical camps are very important in service delivery to eye patients, they are not sustainable and they are expensive. For example the hospital has to feed the specialists that come to treat during the camp period and also provide some of the consumables. By the time the camp ends, we find the medical supplies are out of stock.” he said

He also adds that in cases where partners support medical camps, the health ministry should also support more by providing consumables that are very expensive such as the artificial lenses that cost round 1,000 dollars each which is about Shs.3, 500,000.

The Ministry of Health notes that vision impairment is the leading cause of disability. Worldwide about 45 million people are blind while 135 million others have visual impairment.

beatricenyangoma@gmail.com