After a long nine years of waiting, the Centre for Human Rights and Development (CEHURD) finally received the judgment in the famous Petition 16 maternal health case on 19th August, 2020. The Constitutional Court agreed with CEHURD submissions and all judges accepted all the grounds of the petition. Through this judgment, the right to maternal health care (and the right to health broadly) has been granted a place in Uganda’s Constitution. This judgment recognizes provision of basic maternal health care services and emergency obstetric care as an obligation by the government. It’s through unremitting advocacy, litigation and activism that CEHURD achieved this landmark decision. It took a whole movement/coalition on maternal health to realize what a few thought would be possible. CEHURD now turn their efforts to the implementation. Investing in maternal health is a political and social imperative, as well as a cost effective investment in strong health systems overall. The #Petition16 judgment entails some very powerful declarations and orders on health financing. This case creates positive jurisprudence and makes it possible for people to sustain a cause of action in the right to health against the state for failing to provide the basic minimum health care package.
Values, Policies and Rights
This paper addresses interventions to address intimate partner violence (IPV) against women and girls by engaging with faith communities and their leaders. Two community surveys were conducted, one before and one after the intervention, in three health areas in Ituri Province in the Democratic Republic of Congo. Questionnaires were interviewer-administered, with sensitive questions related to experience or perpetration of violence self-completed by participants. The study showed significantly more equitable gender attitudes and less tolerance for IPV after the interventions. Positive attitude change was not limited to those actively engaged within faith communities, with a positive shift across the entire community in terms of gender attitudes, rape myths and rape stigma scores, regardless of level of faith engagement. There was a significant decline in all aspects of IPV in the communities who experienced the intervention. This intervention was premised on the assumption that faith leaders and faith communities are a key entry point to influence an entire community. The research affirmed this assumption.
This study examines determinants of gender attitudes among some of the poorest and most vulnerable adolescents in Tanzania using an ecological model. Data come from baseline interviews with 2458 males and females aged 14–19 years conducted within a larger impact evaluation. Secondary school attendance was associated with more equitable gender attitudes. Females had less equitable gender attitudes than males in the sample. Having had sexual intercourse was associated with more gender equitable attitudes among females, but the reverse was true among males. Addressing gender inequity requires understanding gender socialisation at the level of social interactions. The finding that females had more inequitable gender attitudes than males in the study is argued by the authors to suggest that more emphasis be given to highlighting the rights of women with female adolescents.
To gain a picture of the extent of the health reforms over the first 10 years of the Kenyan constitution, the authors developed an adapted health-system framework, guided by World Health Organization concepts and definitions. The analysis revealed multiple structures (laws and implementing public bodies) formed across the health system, with many new stewardship structures aligned to devolution, but with fragmentation within the regulation sub-function. By deconstructing normative health-system functions, the framework enabled an all-inclusive mapping of various health-system attributes (functions, laws and implementing bodies). The authors believe their framework is a useful tool for countries who wish to develop and implement a conducive legal foundation for universal health coverage. Constitutional reform is argued to be a mobilizing force for large leaps in health institutional change, boosting stakeholder acceptance and authority to proceed.
Global and national responses to the COVID-19 pandemic highlight a long-standing tension between biosecurity-focused, authoritarian and sometimes militarised approaches to public health and, in contrast, comprehensive, social determinants, participatory and rights-based approaches. Notwithstanding principles that may limit rights in the interests of public health and the role of central measures in some circumstances, effective public health in a protracted pandemic like COVID-19 requires cooperation, communication, participatory decision-making and action that safeguards the Siracusa principles, respect for people’s dignity and local-level realities and capacities. Yet there is mounting evidence of a dominant response to COVID-19 where decisions are being made and enforced in an overcentralised, non-transparent, top-down manner, often involving military coercion and abuse in communities, even while evidence shows the long-term harm to public health and human rights. In contrast, experiences of comprehensive, equity-focused, participatory public health approaches, which use diverse sources of knowledge, disciplines and capabilities, show the type of public health approach that will be more effective to meet the 21st century challenges of pandemics, climate, food and energy crises, growing social inequality, conflict and other threats to health.
As the state and non-state actors take steps in dealing with COVID-19, the author argues for an awareness of the need to urgently strike a balance between prevention approaches and rights with collective responsibilities. From a right to health perspective, it is important for the government of Uganda to ensure that prevention and treatment measures and commodities are available, accessible, and affordable for the most vulnerable communities including: the older persons, those under incarceration, refugees and very poor people. Community participation and solidarity are pillars that have historically been critical in controlling and managing similar outbreaks in Uganda. The author argues for an attentiveness to ensure that research and clinical trials comply with key ethical and human rights principles and that government makes full use of the policy space Uganda has in intellectual property as an LDC to enable it utilise new innovations. The paper points to the need to review and ensure provisions under the Public Health Act enable an effective and equitable response to pandemics like COVID-19, to ensure regulatory approval for new medicines and attention to developing new formulations for the prevention and treatment of COVID-19.
The securitised interventions by the South African, Kenyan and Zimbabwean governments are argued by the author to be fundamentally out of tune with the needs of the moment and ineffective in dealing with the pandemic’s multiple crises. They note that lockdown regulations have been used as a cover for suppressing legitimate concerns around the socio-economic fallout from nationwide lockdown measures that have undermined livelihoods and disproportionately affected poor people. This pattern of conduct calls into question the use of securitised approaches to the global health emergency and what it means for the broader public health response that is needed. In South Africa, Kenya and Zimbabwe, the brutality and heavy-handedness of the security forces is argued to not be new and that the current responses are rooted in systemic problems and failures of accountability in policing in poor communities.
The current context indicates that exceptional measures designed to combat the spread of COVID-19 need to be continually evaluated, taking into account the positive obligations that States bear to protect life, access to health and health security, and the extent to which these obligations should be shaped by countervailing negative rights. The authors indicate that striking an appropriate balance between these positive obligations and countervailing negative rights, in this rapidly evolving environment, can only be successfully achieved in an environment of democratic, judicial and scientific contestation. Moreover, in the context of positive obligations, it is imperative to emphasise the least coercive means through which public health can be achieved. This report provides a human rights analysis using this lens of a cross section of jurisdictions from different countries globally, including South Africa and Zimbabwe.
The authors interrogate the relationship between gender based violence (GBV) and COVID-19 in Uganda through documentary reviews and in-depth interviews from selected key informants. The authors find an increase in cases of GBV that calls for government ministries and agencies to prioritize measures to address the issue. They recommend gender sensitization of communities on GBV and its effects especially in situations of health related emergencies. The authors find that the majority of the fights are heightened by men having limited funds to fulfil their provisioning roles, and recommend that vulnerable households should be identified and provided with food. They also argue that is important to provide women with a platform where they can air their views and concerns about COVID-19 and GBV.
This brief is one of a weekly analysis of constitutional issues arising from COVID-19 and the responses to it. In this instalment, the author outlines the role of the courts and the arrest and the use of force by the police and the military in enforcing the lockdown, following the judgment in Khosa v Minister of Defence and Military Veterans  ZAGPPHC 147 in South Africa. The author finds that arrest in the context of COVID-19 runs the risk of subverting the very purpose of the lockdown regulations, by exposing enforcement officers and arrested civilians to a greater risk of contracting the virus. The South African Police Service has released guidelines on the use of force by security services, in a circular dated 19 May 2020 that set out principles on the use of force, the prohibition of torture and provide information on where to make complaints about police misconduct. The author proposes that thorough investigation and action on those implicated in any injury related to lockdown enforcement and ensuring an effective complaints mechanism are the crucial.