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Uganda’s Leap Forward on the Right to Health

In May 2011, Mugerwa David took his wife Nanteza Irene to the Nakaseke District Hospital in Uganda to deliver their baby. Upon examination, Mrs. Nanteza was told she could expect a normal birth. But soon after, the nurses on duty realized that her uterus had ruptured and that she needed a caesarean section immediately. The doctor was called, but he was not on the hospital premises.

Hours later, the hospital did little as Nanteza wailed in pain. Her family’s cries for an ambulance to transfer her to another hospital were futile. She lost her baby and bled to death. The cause was recorded as hemorrhage due to a ruptured uterus.

Although the 1995 Constitution of the Republic of Uganda does not expressly guarantee the right to health, it does protect maternal health rights. And the state includes medical services in its National Objective Principles of State Policy, a nonbinding document meant to provide guidance for state policy.

Yet Uganda’s maternal mortality rate is obscene. Sixteen women die every day due to avoidable maternal health causes, including unsafe abortion and obstetric complications such as severe bleeding, infection, and hypertensive disorders. Thankfully, activists in Uganda are using strategic litigation to help prevent these needless deaths.

With help from community paralegals from my organization, the Center for Health, Human Rights, and Development, Mugerwa David and his three children filed suit against the Nakaseke district government, which administers and oversees the hospital and its employees.

In April of this year, the High Court of Uganda delivered its judgment in favor of Mugerwa and his three children. In his ruling, Justice Benjamin Kabiito cited the medical services and women’s rights provisions in the constitution, concluding that Nanteza Irene’s human and maternal health rights, and the rights of her children and spouse were violated. The court explicitly declared that her right to basic medical care was violated, found that the district government was liable for the failure to ensure emergency obstetric care, and awarded general damages to Mugerwa and his children.

This case is groundbreaking. It is the first to set a precedent for litigating a right-to-health claim in Uganda. Social and economic rights, like the right to health, have not received adequate attention in state budgets or laws and polices. Previously, and as recently as 2011, the courts interpreted this as a “political question” that should be left to the executive branch.

Now, as Uganda undergoes amendments to its 1995 constitution, the High Court’s decision leaves no doubt about the justiciability of the right to health. Now, human rights activists have a stronger hand in their efforts to explicitly include the right to health in the constitution, and to realize budget commitments made in the Abuja Declaration of 2011, which calls for 15 percent of the national budget to go to the health sector.

But for Mugerwa, the victory was less about policy, declarations, or rights; it was about accountability and hope. “The court has given me justice,” he said at a press conference held in Kampala soon after the judgment was read. “I’m hopeful that from now on, doctors and health workers across Uganda will be more careful in handling patients that go to them when in need.”

The Center for Health, Human Rights, and Development is a grantee of the Open Society Foundations.

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