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Groundbreaking Ugandan case that challenges the state's failure to protect maternal health

On the 27th of May 2011 the Centre for Health Human Rights and Development (CEHURD), a Ugandan NGO, and the families of two mothers who died in government hospitals in 2009 in Uganda approached the Ugandan Constitutional Court alleging the women’s deaths were caused as a direct result of Uganda’s failing healthcare system. The Constitutional Court will begin its hearing of this landmark case this Thursday on July 7th 2011.

It is critical that you speak up for these women. Raise your voices in support of the right to health in Uganda, distribute this widely. Please send messages of support to CEHURD.

E-mail info@cehurd.org or phone +256 414 532283

Send letters to the Ugandan government asking them to comply with their international duties. Be a voice for the mothers who have either lost their lives or their babies. It’s not too late to save the lives of hundreds of mothers and babies.
CEHURD is a Ugandan based non-profit, research and advocacy organization which is pioneering the justifiability of the right to health in the East Africa Region. CEHURD realizes this through a comprehensive set of programs including a public health law resource centre; litigation, both strategic and pro-bono representation; research, analysis and publications; capacity building; and public policy (please visit http://www.cehurd.org/).

Background to the Case

To give you specific details of the case, the petitioners claim that Sylvia Nalubowa and Anguko Jennifer died as a result of the government’s failure to fulfill its constitutional obligations to provide basic maternal healthcare to expectant mothers. The petitioners urge the Court to declare that the continuous failure to implement effective policies on maternal healthcare, under-staffing, and the non-availability of basic maternal commodities in government hospitals amount to violations of pregnant women’s rights to health and life.

The petitioners argue that the tragic deaths of Sylvia Nalubowa and Anguko Jennifer are but two manifestations of a larger problem of an unacceptably high rate of maternal mortality in Uganda.  They hope that a declaration to this effect by the Court will force the Ugandan government to increase its budget for maternal healthcare. In addition the petitioners seek compensation for the families of the Sylvia Nalubowa and Anguko Jennifer.

Sylvia Nalubowa

Sylvia and her husband Stephen Sebiragala were both farmers and the proud parents of seven children.  Both were excited for the birth of their eighth child.  However, because the antenatal clinic in her area did not have adequate scanning facilities, she was not aware that she was having twins. When Sylvia went into labour on August 19 2009 she was turned away from Banda Health Centre as the midwife was absent.  She had to proceed to Maanyi Health Clinic where her first twin was born.

When Sylvia failed to respond to a drip in order to induce more contractions, she was rushed to Mityana District hospital which should ideally be better equipped and with specialized professionals. With the absence of an ambulance, the family had to improvise with the means to reach the hospital which was about 15 kilometres away. At Mityana Hospital the staff demanded sh50, 000 (equivalent to 25 USD) before Sylvia could be attended to which was meant to purchase a Mama kit.  Suffice to say, the family did not have this type of money with them. Tragically the widower Sebiragala says that if he had not had to spend so much money transporting his wife, he would have had enough money to save the lives of both Sylvia and his child. Ironically, it might not have made much difference as allegedly there was no medical doctor in theater to take care of Sylvia. Both Sylvia and her second twin did not survive this traumatic experience.

As part of the cost sharing policy in Uganda, mothers were expected to carry a kit containing basics to be used in the delivery of new babies which is now commonly called the ‘Mama Kit.’[1] This cost sharing policy started in 1993 with the decentralisation policy where local governments had a mandate to decide on financing options for health care in their districts. However, in the 2001 presidential campaign, all presidential candidates were opposed to fees in public health facilities all user fees at first level government health facilities in Uganda were abolished.  This was also seen as a move towards encouraging access to the minimum health care package. Although this was abolished, it is a common practice to require mothers to carry these in hospital as the government always default in providing them.

Anguko Jennifer

Anguko was a councilor representing Uriama and Bileafe sub-counties in the Arua district. She was a strong, hard working woman. She had three children and was married to a primary school teacher. She had many dreams including extending sanitation facilities in her village.  When she was admitted to Arua Hospital on December 10 2010 with intense labor pains she was asked to wait for a doctor to carry out caesarean section.  Anguko waited for over ten hours until she died horribly and in great pain.  A post-mortem revealed that her cause of death was uterus rupture. Anguko, a mother of three, was not the only mother to have passed away – allegedly four other women died in the maternity ward that same day.

And so this saw the tragic end to the lives of both Sylvia and Jennifer. Both of them were wives, daughters and mothers who were just trying to do the best they could in difficult social and economic circumstances.  According to a report developed by the WHO, UNICEFF, UNFPA and The World Bank, the lifetime risk of maternal death in Uganda is 1 in every 35 women.  For South Africa, the lifetime risk is 1 in every 100 women while in the United Kingdom it’s 1 in every 4 700.[2] The same study showed that the maternal mortality ratio (deaths per 100 000 live births) in 2008 was 6 300.[3] In comparison, South Africa’s MMR was 4 500[4] and in the United Kingdom it was 90.[5] That was an estimated 6 300 mothers killed due to government negligence. Each one of these women is likely to have people who love them – husbands, mothers, fathers and children. This means that 6 300 families were ruined, and these are deaths that could have been easily avoided.


[1] The mama kit package contains a meter piece of cotton cloth, laundry soap, a pair of gloves, a piece of cotton wool, small gauze, cord ligature, and a meter of polythene sheet for the delivery table.

[2] Trends in Maternal Mortality: 1990 – 2008. Estimates developed between the WHO, UNICEF, UNFPA, and the World Bank. Pg 26

[3] Rounded to the nearest 100

[4] Rounded to the nearest 100

[5] No rounding