Uganda’s Constitutional Court has delivered a major victory for health justice. What comes next for the struggle against maternal mortality in Uganda?

In advocacy for health rights in Uganda, victories can be too few and far between. On August 18 there was a rare health rights victory in Uganda, worthy of celebration not only here but also in countries around the world where governments are failing to deliver maternal health rights, and health rights for all others who suffer the harm of grievously inequitable health systems. 

After nine long years, Uganda’s Constitutional Court finally delivered a ruling on a case brought against the government of Uganda on behalf of the families of two women who had died preventable deaths in childbirth, Sylvia Nalubowa and Jennifer Anguko. The Justices unanimously agreed that the Constitutional rights of Ms. Anguko and Nalubowa had been violated. The remedies that they ordered the government to adopt could trigger sweeping changes in order to remedy the harms that killed them. 

These remedies include:

•  Increased health sector funding to equip clinics and hospitals with the health workers and commodities they need to save the lives of pregnant women
•  Expanded training of health workers in obstetric care; and
•  A requirement that the government of Uganda report to Parliament with a copy of the report shared with the Constitutional Court on their compliance with the ruling starting with the new financial year (2020-21 and 202-22).

It is hard to overstate the importance of these Judicial pronouncements. They represent a seismic shift, long overdue, for women in Uganda, at least 16 of whom die every day from haemorrhage, pre-eclampsia, sepsis, obstructed labour, and unsafe abortion. 

But this historic judgement reaches even further—it touches all Ugandans. The Justices used this ruling to affirm for the first time that the right to health is enshrined in the Constitution for all Ugandans. As a result, Ugandan advocates have a powerful new tool to use to fight to eliminate the preventable suffering and death experienced routinely by countless people around the country.   

How did we achieve this powerful victory? For civil society organizations fighting to win quality maternal health care services, it started with lawyers from the Center for Health, Human Rights and Development (CEHURD) filing a lawsuit in 2011 in order to hold the government to account, with a precedent-setting case that hinged on the argument that the public health crisis of preventable maternal morbidity and mortality in Uganda constituted a violation of the Constitution. We knew strategic litigation would be necessary but not sufficient to carry the day. We had to build a national movement, showing the Judiciary just how deeply felt this issue is. So CEHURD and Health GAP together with scores of Ugandan civil society organizations founded the Coalition to Stop Maternal Mortality in Uganda, a powerful base for our advocacy. We accompanied the Constitutional Court case with grassroots mobilization and pressure campaigns focused on decision makers in Parliament and the Executive. Campaigns were accompanied by relentless media and communications work that redefined maternal mortality in Uganda as a preventable crisis driven by neglect of the health sector. Along the way, for example, in 2012 we secured an unprecedented UShs 49.5 billion ($13.7 million) in emergency funding to recruit and retain 6,172 new health workers—an investment that was possible because of the focus we generated through this civil society movement. 

At each mention of the case, people directly affected by the neglect of the health sector packed the Courtroom. CEHURD was simultaneously continuing to litigate maternal health rights in lower courts, creating new case law on matters like the supervisory roles of local governments, the right to emergency obstetric care and safety of babies in public hospitals, all of which were eventually cited in the celebrated ruling. 

The most important lesson is that we never accepted defeat. Knowing that you are part of a powerful movement for health justice lessened the blows that came from inevitable delays and setbacks. And that lesson is very timely, because now our struggle will become tougher. We are entering the next chapter of advocacy: winning implementation and enforcement of this historic ruling. This will involve a new normal: making policy makers and budget holders get used to prioritising maternal health as ruled by the court. We know new, more daunting barriers will emerge. The government response to COVID-19, for example, has resulted in a preventable spike in maternal deaths and other rights violations, because the country refused to safeguard the health and lives of the most vulnerable as part of the national COVID-19 response. Meanwhile, health funding has shrunk as a share of the national budget since this Court case was filed. By contrast, expenditure for defense and security has skyrocketed dramatically from UShs 934 billion (USD 260 million) to UShs 2.582 trillion (USD 717 million) which is the same size as the entire health budget. 

Correcting gross government underfunding and neglect of maternal suffering and death is exactly what has powered our advocacy over nine years, and this ruling catapults our work forward, onward to the day that will mark our next victory.