Mulago fees structure versus right to health
On September 17, the Minister of Health, Dr Ruth Aceng, during the launch of the new Mulago Specialised Women and Neonatal Hospital, brought to the nation’s attention that government had prescribed certain fees, which patients have to pay before accessing services at the facility.
This is a commendable and good initiative on the part of government as far as improvement of health service delivery is concerned. However, this raises complex human rights issues in the context of the right to health, which must be addressed in order to ensure that the right to health for all citizens is promoted irrespective of their economic or social status.
The impressive health facility, intended to handle high risk antenatal services, reproductive medicine and intro-vitro fertilisation, must not become a bar to the enjoyment of the right to health of the poor, marginalised and vulnerable people. This is the only opportunity when doors ought to be opened for all Ugandans to access affordable and quality health services.
If I may use an illustration, where else should Ugandans go for quality and affordable treatment if they are being indirectly blocked from accessing the only National Referral Hospital in the Country?
I am deeply concerned that if this restriction is not dealt with in terms of formulating a progressive policy and budgetary plan, the right to health embodied in various international and regional instruments will be violated. These instruments impose a positive obligation on the State to ensure that there is progressive realisation of the right to health.
The right to health means that every person has the right to the highest attainable standard of physical health and this includes access to all medical facilities. The World Health Organization Constitution (1946), to which Uganda is a party, envisages the highest attainable standard of health is a fundamental right of every human being and as such, creates an obligation on the State to ensure timely, quality, acceptable, appropriate and affordable health care to its citizens.
No matter what level of resources we have in Uganda, progressive realisation of the right to health requires that government takes immediate steps within their means towards the fulfilment of these rights.
Therefore, in light of the aforesaid obligations, the fees structure on the face of it impinges on two universally recognised core components of the right to health, namely Accessibility and Availability. These are defined under Article 12 of UN General Comment 14 of the Committee on Economic, Social and Cultural Rights.
Availability refers to the need for a sufficient quantity of functioning public healthcare facilities, measured by means of location. On other hand, Accessibility requires that health facilities must be accessible to everyone measured in terms of nondiscrimination, physical accessibility, economical accessibility (affordability) and information accessibility.
Therefore, it is the State’s obligation to promote the right to health by allocating maximum available resources to progressively realise this goal. For this reason, I beseech the Minister of Health to advise the Cabinet on the crucial need to adopt a rights-based approach to health.
This requires that health policies and programmes must prioritise the needs of those furthest behind first towards ensuring greater equity, a principle that has been echoed in the recently adopted 2030 Agenda for Sustainable Development and Universal Health Coverage.
It, therefore, follows that the right to health must be enjoyed by all citizens without any impediments on grounds of status, social or economic discrimination.
Government’s focus must be premised on bringing the services closer to the poor, disadvantaged and marginalised people in that they should not be unconstitutionally excluded from enjoying good health.
The fees structure violates the principles of non-discrimination, the right to health, the right to live a decent life among others. To the ordinary Ugandan, it is so unfair, exorbitant and a direct impediment to access of a national facility.
For instance, the requirement that patients pay a consultation fee of Shs50,000 and admitted patients pay Shs80,000 per day is irrational.
Health is a critical and sensitive issue hence full support is expected to flow from government as the key stakeholder.
The fact that the minister stated that there is a committee established to assess the eligibility of the patients for purposes of waiver on some terms is not enough.
Is there any possibility that a person can determine whether or not in the next 45 minutes they will need to be accommodated in the Intensive Care Unit so as to lodge an application for a waiver to that committee? This is not possible and should not form any basis for any justification by the state.
Mr Byansi is lawyer & human rights activist.
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