Article
3 of the Universal Declaration of Human Rights states that: “Everyone has the
right to life, liberty and security of person”. Article 25 states that:
“Everyone has the right to a standard of living adequate for the health and
well-being of himself and of his family, including food, clothing, housing and
medical care and necessary social services…”
Article
11 of the International Covenant on Economic, Social and Cultural Rights states
that: “The States Parties to the present Covenant recognize the right of
everyone to adequate standard of living for himself and his family, including
adequate food, clothing, housing, and to the continuous improvement of living
conditions”.
Paragraph
1 of the Vienna Declaration and Program of Action states that: “The World
Conference on Human Rights reaffirms the solemn commitment of all States to
fulfill their obligations to promote universal respect for, and observance and
protection of, all human rights and fundamental freedoms for all in accordance
with the Charter of the United Nations, other instruments relating to human
rights, and international law. The universal nature of these rights and
freedoms is beyond question”.
Paragraph
25 of the Vienna Declaration and Program of Action states: “The World
Conference on Human Rights affirms that extreme poverty and social exclusion
constitute a violation of human dignity and that urgent steps are necessary to
achieve better knowledge of extreme poverty and its causes, including those
related to the problem of development, in order to promote the human rights of
the poorest, and to put an end to extreme poverty and social exclusion and to
promote the enjoyment of the fruits of social progress. It is essential for
states to foster participation by the poorest people in decision-making process
by the community in which they live, the promotion of human rights and efforts
to combat extreme poverty”.
Paragraph
13 of the Vienna Declaration and Program of Action states in part that: “States
should eliminate all violations of human rights and their causes, as well as
obstacles to the enjoyment of these rights”.
The
1948 constitution of the World Health Organization (WHO) defines health as “A
complete state of physical, mental and social well-being, and not merely the
absence of disease or infirmity”. The constitution further defines health as a
human right: “The enjoyment of the highest attainable standards of health is
one of the fundamental rights of every human being without distinction of race,
religion, political belief, economic or social conditions”.
An
examination of the health record during the colonial period from 1900 to the
1960s reveals that the delivery of health care services was inadequate. The
services were essentially of a curative nature and largely for colonial armies
and other white personnel. A report issued on October 9, 1962 when the country
attained independence stated that Uganda had inherited a country with
inadequate medical facilities and a very high mortality rate, meaning that the
right to health had not been fulfilled. The independence government set about
providing an answer.
The
government embarked on a comprehensive health care program, pioneering many
low-cost health and nutrition programs. There was a highly organized network of
vaccination centers and immunization programs reached 70 percent of the
population. Physical and human capacity building received strong support. From 1966 to 1970, 20 new rural hospitals
were constructed compared to a total of 26 hospitals during the entire colonial
period from 1900 to 1962; medical doctors, nurses, midwives and others were
trained in the country and abroad. Water supply was provided by constructing
wells, hand-pumped boreholes and water tanks. By 1970, the country had achieved
a broad-based health-care network even in the rural areas. The implementation
of the health program was among the greatest success stories during the second
plan period from 1966 to 1971.
The
government hospitals were administered in British fashion where treatment was
free. By 1971, health care institutions were staffed by experienced teams of
doctors, nurses and paramedical staff who received adequate salaries. Consequently,
between 1959 and 1969, infant mortality declined from 160 to 120 per 1000 live
births. In its 1993 report, the World Bank observed that from 1963 to 1970, the
country’s health sector services had developed into one of Africa’s best.
From
1971 to 1986 Uganda experienced a breakdown in peace and security and the
violation of all human rights in all parts and sectors including the delivery
of health services. The Commonwealth report of June 1979 observed that
hospitals were short of drugs, cholera had spread in south west of the country
and undernourishment was common. In the cities water and sewerage systems had
broken down with raw effluent flowing into Lake Victoria, not far from the
intake to Kampala’s water works, which could not filter or chlorinate properly.
Political instability and withdrawal of some
donor financial support made it difficult to provide adequate health services
between 1980 and 1985.
When
the National Resistance Movement (NRM) government came to power in 1986, it was
determined to provide adequate health services to all Ugandans. Point number 6
of the Ten-Point Program stated that for the majority of Ugandans there was no
clean water, hygienic housing and doctors. The country needed the right type of
leadership to ensure that there was a large number of medical and health
assistants and the availability of medicines. It was also stated that one of
the most important pre-requisites was the elimination of corruption among the
medical staff.
Performance
under the leadership of the NRM has fallen short of what was promised. The
implementation of structural adjustment called for balanced budgets and a focus
on productive sectors. Education, housing, food security, water and sanitation
and health services were not treated as ‘productive sectors’ and did not
receive adequate government support. Instead it was decided to promote private
healthcare services and to charge user fees to provide funds for running
hospitals including the supply of drugs, supplies and equipment. With poverty
running high many patients could not afford to pay and stayed away from health
centers or came to the hospitals when it was too late with obvious
consequences. Those that went to the clinics more often than not could not get
medicines which due to corruption had found their way into private clinics. Access
to healthcare inside and outside Uganda has become a privilege for the rich.
Reports
from Ugandans and other sources in recent months have painted a very bleak
picture of a health system about to collapse. Complaints have included acute
shortages of drugs and supplies, staff and high levels of absenteeism as many
health personnel engage in other activities to make ends meet. Ugandans
especially children and women are dying from diseases and complications that
are preventable or curable. This violation of a fundamental human right must
not be allowed to continue. Those responsible must be held accountable.
The
poor heath situation is particularly disturbing when it is happening in a
country whose government has been praised as a ‘success story’ in rapid
economic growth, low inflation and diversified exports. With political will and
commitment, the situation can be reversed and it is not too late. What is
needed is government strategic intervention to allocate more resources, reduce
corruption and improve the working conditions of staff to reduce absenteeism
and stem flight to greener pastures. Declaring free medical services in the
absence of these reforms will not produce the desired results.