(KAMPALA) The Coalition to Stop Maternal Mortality, a civil society group of more than 40 organizations advocating for improved access to services to correct Uganda’s epidemic of preventable maternal deaths, today marked the opening of Constitutional Court Petition 16 of 2011, originally filed on March 4, 2011 by the Centre for Health, Human Rights and Development (CEHURD) on behalf of the families of Jennifer Anguko and Sylvia Nalubowa, two women who suffered preventable deaths while in labor. The case alleges the government is failing to fulfill fundamental health rights, resulting in an epidemic of preventable deaths of Ugandan women. More than 16 women die daily in Uganda from preventable causes including hemorrhage, sepsis, unsafe abortion, obstructed labor, and pre-eclampsia. Uganda’s severely high rates of teenage pregnancy also contribute to preventable maternal deaths—25% of young women 15-19 in Uganda is pregnant or a mother, one of the highest rates in sub-Saharan Africa, a statistic that has remained unchanged since 2006 (source: Uganda Demographic Health Survey, 2016).
Constitutional Court first dismissed the case in 2012, on the grounds that the Court lacked standing to hear the case on its merits. CEHURD appealed the ruling in 2013 to the Supreme Court (Constitutional Appeal No. 1 of 2013). On September 30, 2015 the Supreme Court ruled that Constitutional Court must proceed and hear the petition on its merits.
On the day, just one kilometer away at the Serena Conference Center, Uganda’s National Budget Speech for Financial Year 2019/20 was to be delivered. “Government has previously told Court that it does not have enough money to fight maternal mortality. But today’s FY2019/20 budget speech contradicts that claim,” said Flavia Kyomukama of AGHA Uganda. “Time and again, more funding can be found—as long as it is for defense, security, infrastructure, or fighter jets. Court can play a role to address this crisis, and the rulings in this case will have life and death implications for health rights in Uganda.”
The Appropriations Bill 2019/20 shows a 20.9% expansion in the overall budget from FY 2018/19 (UShs 40.5 trillion compared with UShs 32.7 trillion for FY 2018/19). That increase would be spent mainly on Security (increasing from 6.3% of the budget in 2018/19 to 9.3% in 2019/20) and Works and Transport (increasing from 14.6% to 16.2%). The Health budget share shrinks from 7.1% to 6.4% (although the absolute amount increases from UShs 2.3 trillion to UShs 2.59 trillion). By contrast, classified expenditure and assets would increase dramatically from UShs 934 billion in FY2018/19 to UShs 2.582 trillion (the same size as the entire health budget). External financing for the health sector is estimated to be 52% of the budget, according to the Civil Society Budget Advocacy Group (CSGBAG) sector budget analysis, released April 2019.
Despite the need to increase salaries of health workers the wage budget for health workers would remain stagnant at UShs 593 billion. While National Medical Stores (NMS) has a projected increase from UShs 300 billion to UShs 329 billion, only UShs 19 billion of that increase would be for increased funding for supplies and services—UShs 10 billion would be for increasing NMS’ staff wages and salaries. The share of funds available to local government health facilities for essential maternal health services would be virtually stagnant, with PHC grossly underfunded. Because the number of Districts is continuing to increase, this amounts in a further funding decrease. The declarations being sought by CEHURD and the families in Constitutional Court Petition 16 of 2011 would help remedy these gross inequities, according to the advocates. “Deaths from maternal mortality could be largely eliminated in Uganda,” said Nicholas Niwagaba of Uganda Network of Young People Living with HIV/AIDS (UNYPA). “What we are missing is political will.”