Decolonise public health in Uganda

The Health Committee of Parliament is currently scrutinising the Public Health (Amendment) Bill, 2021. The Bill seeks to repeal obsolete provisions of the Public Health Act, revise fines and offences and repeal the Venereal Diseases Act, among other things.

The Public Health Act is one of the colonial era laws that has never been amended and views health users as subjects with no rights.

The amendment therefore provides an opportunity to decolonise Uganda’s public health system and put in place legislation that recognises health users as citizens with rights and obligation in strengthening the country’s health system.

This decolonisation process requires that Ugandans undertake a legal audit of its laws and policies to assess them through the human rights lenses and craft them based on the current scientific evidence.

The debates on the Public Health (Amendment) Bill, 2021 have unfortunately been strongly skewed around mandatory vaccination and the punitive actions for non-compliance.  While this debate, especially in light of the recent Covid-19 pandemic is commendable, it has denied Ugandans an opportunity to engage on the wider public health concerns and what these actually means for public health delivery.

 The Public Health Act is the principal health legislation and ought to cover the entire health delivery component of this country. 

The Bill carries forward the colonial legacy of prioritisation of criminal sanctions for violating provisions of the law instead of promoting alternative approaches of encouraging compliance. Criminal sanctions must be treated as a last resort.

Criminal sanctions have been demonstrated to have no positive impact in promoting adherence to public health norms and standards. Custodial sentence was a hallmark of colonial public health legislation across the continent. The Bill should provide alternative sanctions to those found in breach of the law.

Scholars have also argued that criminal law is likely to be of minimal significance in influencing conduct, other factors such as fear of infection are likely to be of greater effect in influencing sexual practices. To realistically achieve the intended legislative objective, other modalities for compliance should be explored such as public awareness and education, incentives for observing the law, and disincentives for breaking it

Throughout, the Bill makes no provision for the rights of health users. Both the principal Act and the Amendment Bill do not provide for confidentiality of the information received during the management of patients. In the course of providing treatment to patients, health facilities access a lot of information relating to patients and it is important this data is protected by the law.

 During the Covid-19 pandemic, it was not rare to see personal health information about patient health status leaked on social media. Research has demonstrated that health users are more comfortable when information related to their health remain confidential.

The law still carries forward the legacy of colonial public health laws as it does not address issues of consent to get treatment, safety of information that is received by the health facilities in the process of provision, confidentiality.

As a principal law governing the health sector it is important that the Bill clearly provides for, not just the obligations of the health users but also protects their rights. It is important that the law clearly provides for mechanisms through which information received may be disclosed without breaching the right to privacy.

It is certainly important to note that every health system needs patient information for facilitation of health planning, but this information must be kept and used in a manner that ensures anonymity and maintenance of confidentiality.

This implies therefore that the law must provide for mechanisms through which  non-identifiable patient data is generated to guide planning while at the  same time protecting personal information. Safe guard must be created to avoid abuse of the information collected. Both the principal law and the amendment does not address this.

The writer is programmes coordinator-advocacy at Centre for Health Human Rights and Development