For close to 15 years, I have been working as a health and human rights advocate, focusing on ensuring social justice in health systems for the most vulnerable.
Unsurprisingly, I have witnessed that women, mothers and young girls continue to be the major users of the health system. This is largely because of the critical maternal function they perform in society.
My experience with health systems is much longer than my professional life. I grew up in a home with a mother who was a nurse, working in a private not-for-profit nursing home, who also had her own small clinic.
I have fresh experiences of verbal autopsies and hearing the stories of how women died. I still remember the number of women with babies that flocked both the health facility and my mum’s clinic. They needed treatment interventions, but always had difficulty meeting the bills for care.
Even at that time, I remember a number of cases of maternal-related complications at both childbirth and a few days after the delivery. I grew up knowing child delivery as Lutalo lwa Bakyala, (battle for the women).
Going through child delivery was and still is a matter of life and death. I also remember a number of cases that involved young girls, and, at one time, a married woman that died after an unsafe abortion.
Emergency cases of post-abortion care after unsafe terminations were as common then as they are today.
Lack of access to contraceptives, deplorable maternal health services and a highly restrictive legal environment on access to safe abortion services continue to dominate our health system.
Why do women and girls continue to face disproportionate gaps in access to healthcare and rights? Why has the global community not done enough? The global solidarity espoused in compacts like the Sustainable Development Goals (SDGs) are not realised.
In Uganda, reproductive rights seems to be an issue for only women. We invest less and yet seem to be more interested in controlling the tail end of the consequences (the women’s actions on their bodies) - and this seems to be okay nationally and globally.
In Uganda, we still lose16 women every day to preventable issues in pregnancy and childbirth. I have witnessed, advocated and litigated cases in which women are struggling to have what would ideally be basics for controlling their bodies. From access to kits to support safe deliveries for women and their newborns to the contraceptive method of their choice.
From my mother’s practice, I have witnessed the real struggle women, mothers and young girls go through to be empowered to have information, resources and the courage to access the most basic reproductive rights services. How can we ensure that regardless of where a woman enters the health system, she receives the quality and acceptable services she deserves?
A population’s health and wellbeing is primarily a national responsibility. Every state owes all of its inhabitants a comprehensive package of essential health goods and services under its obligations to respect, protect, and fulfil the human right to health.
But at the same time, health is also a global responsibility, which creates duties on other states to ensure a safe and healthy world, with particular attention to the needs of the world’s poorest people.
This particular responsibility on other states is often misunderstood, underrated, abused and lately traded as part of politics. Uganda provides a clear example of the impact donor policies can have on national priorities.
As a country, we are dependent on external donor financing for healthcare. In effect, the United States, one of Uganda’s largest providers of global health assistance, is disrupting our national priorities and undermining the progress we have made as a nation.
The recent developments on the reinstatement and expansion of the Global Gag Rule demonstrates the consequences of the repressive political decisions from other countries and how these can affect population health and wellbeing in countries like Uganda.
The Global Gag Rule wreaked havoc by cutting off funding for much needed health services, especially amongcommunities that are already underserved.
For instance, as a result of the Global Gag Rule, we had to close down our work halfway into a four-year USAID-funded project on advocacy for better health, despite progress and our good performance on the project.
The only reason cited in this project closure was our failure to sign the new addendum (incorporating the Global Gag Rule) when our sub-grant was up for renewal.
The closure of the project brought an immediate termination of our advocacy interventions that promoted accountability and follow-up on the supply chain of essential medicines in the country.
Under this project, we led an advocacy and accountability strategy, which focused on ensuring the national medical stores properly managed their stock of key medications and supplies, including anti-malarial drugs and HIV-testing kits. The goal for our work was to avoid wasted and expiring stock and ultimately to ensure patients had the medicines they needed at the facilities where they access healthcare.
It is not an easy choice to comply and keep the funding, or refuse and lose access to those resources - jobs and indeed lives are on the line.
My hope for Uganda and the world is for a future where no woman, mother or young girl dies simply because of their biological composition.
Mr Mulumba is the executive director, Centre for Health, Human Rights and Development (CEHURD).