Sexual Health Education must be treated as a Human Rights to Health

SEX EDUCATION

The ban on Comprehensive Sex Education in Uganda’s schools needs challenging. That Uganda has a Ministry of Ethics and Integrity that is entire engrossed with sexual morality but does not support sexual health education in school is shameful. Sexual Health needs to be framed and presented as a human rights to health in line with various international instruments incorporating a right to health. This is also consistent directly with requirements of Sustainable Development Goals 3, 4, and 5.

In the last couple of years, Uganda has enacted some of the most ridiculous laws signifying a firm presence of the state in the private lives of citizens. Many conservative as well as liberal societies have long tended to limit the extent to which the state can regulate individual private space. The pursuit of individual liberty, human rights, and social order becomes relevant in the global neoliberal milieu with minimal state interference.

Laws that regulate sex, sexuality and sexual conducts in any society tends to be repressive to women and minorities. This reinforces a gender bias, where women are the object of moral agents, while the men, are left to their own vices and unconstrained. Such laws have limited the full and equal participation of women in the labor market, public administration and other realms of decision-making.

Nonetheless, Lokodoism is in full control over our society with this notion that the state can police, restrict and control women’s public and private appearances. Ridiculous laws such as Anti-Miniskirt laws, or the full time obsession with brothels or homosexuality are indicators of how the state is in private spheres. It is the culture of Lokoidoism that drives hostility women’s liberty, and to sexual health education thereby limiting the natural potential of developing a societal self-regulating mechanism in line with its normative values.

The strong presence of the state presupposes that sex and sexuality as a concept are aggregated within a homogeneous cultural framework across the country. This is far from the truth as Uganda has diverse cultures with equally very diverse sexual practices and belief systems about sex, sexuality, motherhood, safe sex, marriage, and so forth.

World over, schools operate a Sexual Health Education (SHE) in their high schools for pre-adolescent, adolescents and youths. This helps young people to become competent in decision-making on sex related matters and handle personal growth and development through puberty with dignity. For us in Uganda, SHE is critical for the fight against HIV/AIDS, healthy reproductive health, and for staving off early and unwanted pregnancies.

 In most sub-Sahara Africa where sex matters remains a taboo, there is an expectation that parents initiate sex education to their kids. None of that happens. Some cultures consign such duties to Aunties and Uncles. With changes in family structures,  geographies and economics, families hardly interact. This is where the school setting becomes a prime place for a progressive comprehensive sexual health education. Otherwise, children are left to the vagaries of social/ electronic and mainstream media where they access alien cultural contents that are perverted, commercialized and exciting forms of sexual portrayals, symbolic imagery, lurid acts, etc. Moreover, alien cultures of sex and sexually that confront our children are associated with substance use – drugs, alcohol, weed, street drugs etc, most of which are already on our streets.

There is absolute need for continued SHE in our schools. The Gender Minister, Hon. Janat Mukwaya was ill advised into suspending the program when she could have called for a review.  Certain an impact evaluation should have sufficed. This article recommends a multipronged approach involving various line Ministries; Education, Ethics, Health as well as Cultural institutions and Faith-based Organisations to formulate a comprehensive SHE in our schools. This would ensure that the content of the Comprehensive Sex Education conforms to, is relevant and consistent with a national agenda such as National Development Plan.

With the advent of HIV medication that promises an HIV free generation, early sex education became a societal imperative; a tool for youths, especially females, to nurture ability to make informed sex-related decision and experience sexual health as young people. Our major concerns are reverting and preventing new HIV incidences. Studies are showing that female youths are extremely vulnerable and at higher risk of contracting HIV/AIDS and other STIs/STDs before turning 24 years.

Sexual Health Education is just one aspect of health spending; the state must guarantee wide ranging social safety measures through social policies on poverty reduction, income equality, legal and human rights including safeguarding equal rights to health resources for youths.

END.

Museveni is riding the ghost of Art 269 in Kampala

POLITRICKS

The Lord Mayor, Erias Lukwago must be applauded for turning down an invitation to meet with Mr. Museveni over the fate of Kampala’s evictions.  The “Muloodi” was right. In reiterating that the whole purpose of meeting Mr. Museveni was to devise plans to implement the agenda of ousting opposition from Kampala, Muloodi interpreted it right. The Kampala Minister, already known for her sentimental enthusiasm bordering a flirt with Mr. Museveni, appointed herself a campaign manager in Kampala for the President in 2021.

The events that are taking place in Kampala right now, in which KCCA is forcefully evicting vendors from the street is reactionary, populist, poorly thought and lacks both in strategy and philosophy. Cast against a simple test of urban planning, KCCA will continue to ride against a tide of angry Ugandans, deporting them from the city. Nevertheless, they will return the next day.

Kampala is not necessarily a bedrock of opposition although it votes for Opposition candidates. Kampala of today is multicultural city, with fewer ethnic monopoly and more disenfranchised hustlers. Most of them do not actually vote in the downtown core. The real voters of Kampala are the slum dwellers who are also the same street vendors. Kampala is not only for the upper class. It is a melting pot for the poor, the impoverished, the wretched and the hustlers who must learn to co-exist. You cannot clean a city by deporting people. You build a culture and superior infrastructure to accommodate diversity.

Since the NRM issued Legal Notice No. 1 in 1986 that effectively banned Parties and restricted them to their headquarters, most of the Party headquarters were situated in Kampala – and still are. Kampala therefore became the epicenter of political activism with Makerere University and UPC remaining active ingredients in challenging the status quo. With the promulgation of the 1995 constitution, the ban on political party activities in the countryside was entrenched in the dreaded article 269. In that article, everyone in Uganda forcefully became NRM and all institutions of government were fused with the NRM party – still many are!

The countryside was deprived of political activism and all political parties obeyed. One would imagine that the Parties would change headquarters, say UPC would retreat to Kisoro, and DP to Teso.  Unfortunately, DP nd Conservative Party of Mayanja Nkangi were in bed with the regime. UPC and its President, Dr Milton Obote were singled out and targeted for destruction through intense propaganda to objectify and destroy them.  Unfortunately, UPC, on its own, is like Cancer. The more they attacked UPC, the more the Party gained political currency to remain afloat.

The challenges that Museveni meets in Kampala today are the repercussions of the article 269. Kampala was exposed to political activism they developed such a culture of defiance and became the political elites. The countryside remained docile, alienated from politics and continue to “sleep” with the “peace” that was “ushered in” by the NRM.

 The rural folks are now waking up because the economic hardship cannot permit a sound sleep. Even the ghosts of Luwero, Northern Uganda and Teso are haunting the country. Rural folks are suffering from Museveni-era economic programs dictated by structural adjustment programs. They know it has stifled the fundamental change promised at inception in 1986 at the steps of Parliament of Uganda and now they are destined to no change.

Our “Muloodi” was right. Attending a Kisanja Hakuna Muchezo planning is counterproductive and subversive to the Opposition. The economy needs fixing and opening up to include the street people in Kampala. As it is,  the economy is cluttered with “greedy bastards” as Dylan Ratigan described in his 2012 book “Greedy Bastards:  How we can stop Corporate Communists, Banksters, and other Vampires from Sucking America dry”. It is not as flowery as Mr. Museveni wants us to believe.

The exclusion of indigenous Ugandans from the formal markets has generated second tier markets on the verandas and streets, where informal economies are contested. Expelling those people from the streets is not only immoral, but also politically suicidal.  Hon Betty Kamya can as well become the de-campaigning manager of Mr. Museveni in 2021 as they ride on the ghosts of Art. 269.

END

Debating National Paradox of Alcoholism

ALCOHOLISM

The reading from Hon. Nobert Mao in the DM on November 16, 2016 edition left me wanting more. The debate on Hon. Betty Nambooze’s proposed bill to regulate alcohol business in Uganda is one that needs courage and sober recollection. It is unfortunate that the proposed bill has already cultivated bad blood between ”School Teacher” –Hon Betty Nambooze and the ”Classroom Monitor” – Hon Moses Kasibante. Both of these people are amiable, however, disagreement should not translate into hate mongering.

I find such feuds unnecessary because public issues must be debated in public realms, and not personalised. Unfortunately, the unpolished egos of our politicians makes the distinction between public and private very grey. Any challenge to their causes ends up brewing a storm in a class of mwenge, as Hon. Mao put it.

However, that aside, there is merit in paying keen attention to Hon. Betty Nambooze’s preposition, that should actually become a bipartisan affairs for MPs from all aisles of the House. A caveat should be placed here, that if there are MPs who feel that the proposed bill, in its current form may infringe on particular interests of their electorates, then s/he should move a motion to amend, not to kill the bill.

While debating the perils of this matter, one should ask the fundamental question – is alcoholism a national problem?

I spent a number of months in rural Uganda, working silently on some projects in 2014 and mid this year. My experiences attest to Hon. Nambooze’s concern: Alcoholism is a national problem. I believe that many would agree that this problem of alcoholism is a national catastrophe. How then can we address it? Even before we address the matter, what are the causes and social structures that transmits and sustains it?

It is quite easy to enumerate the effect of alcoholism. After all, the tradition in Uganda is always to jump onto the signs and symptoms, or to mitigate effect, rather than locate triggers and turn it off  from the source.

Ugandans have resorted to excessive alcoholism to the point that we are already in the Guinness book. It is not that consumption of alcohol is bad per se. However, if it deleterious devours the work force, rip apart families and disposes a large chunk of our population into mental health state, then we must address the matter with some dedication. There is need to conduct an assessment of the economic cost of this vice to the nation. Would regulating the hours of sale make a difference? Would a combination of taxation, regulations and penalties reduce the vice? There are many questions because this is social and behavioural matters that are complex and inextricably intertwined within our cultures and politics.

First, it is absolutely important to view this alcohol consumption in the context of substance use. Many youths in Uganda consume both alcohol and marijuana simultaneously. Some even snort petrol and smoke tea bags to get high. These behaviours are signals of culpability to a more profound street drug misuse – cocaine, methadone, etc.

Second, the chain effect of all these leads to various risky health behaviours, such as unprotected sex, rape, suicide, crime, and violence. The one that must concern the nation the most, is the decay in manpower, but also the redundancy of the nearly 80% youthful population. If every able bodied person in Uganda gets inebriated by 9:00am in the morning, and remains vegetated for the rest of the day, when do they partake in economic production?

The issue of alcoholism also erodes our values. Uganda is a highly Christian society where the sanctity of family and the fear of the Lord rests heavily in their hearts. Alcohol has ripped apart families, made people impotent and sterile. The attendant violence has negative impact on women, children and the elderly. Even Muslim youths now hide alcohol in the Kanzoo! The Nambooze bill therefore requires the exercise of probity.

Lastly, and most importantly, these negative or rather suicidal mannerism should be carefully traced to the role and nature of our governance. The government runs an economy that creates losers and winners in absolute terms. The winners are those who feed off of the muscles and benevolence of the state as active agents in economic production. The losers are those who have fallen through the crux of the liberalized markets. The politics of repression then kicks them hard into a narrower economic space designated for such losers. The socials pace dynamics shared by such "wretcheds" of the liberal economy tend to reproduce itself. Those ensnared in it have limited options, mostly risk prone and that, to them are the means and an end to life.

End.

Uganda's Health Service Delivery Strategy needs a rethink

STRATEGY

I previously questioned the endemic nature of the problems that is steadily driving our health service delivery system to crumble. The editorial of the Daily Monitor on October 5, 2016 remarked on the Health Ministry’s plan to close nearly 7000 Health Centre IIs in the country. The commentary cited the Permanent Secretary, Ministry of Health, saying that the Ministry (read government), could not raise the human resource capacity – nearly 63,000 health workers, needed to sustain these centres.

One of the most ornamental features of the Uganda health service delivery system is its elaborate structure. The system was properly structured to reach close proximity to the people who need health care services the most. The Health centres I and IIs are at the grassroot - the Villages and Parishes. These are the location where these services are needed the most, even if they have been the least effective. This is where nearly 83% of Uganda’s population can access health care.

When you study the statistics of infant mortality and child-maternal mortality rates in Uganda, you start to realize a structural problem starting with distance (access) to health centres, lack of qualified professionals, and difficulties to access and negotiate for health resources, as the key drivers of these deaths. Most of them are preventable deaths, which occasions our children, expectant mothers and the population.

Scrapping these centres therefore, is not only alienating the rural hard-to-reach population from any forms of social assistance, it is a matter of inequity, a moral, ethical and human rights issue. It is symbolic of a retreat by government from the social lives of the rural population.

Nonetheless, the Uganda health care service delivery strategy needs a rethink. A major paradigmatic shift is now inevitable.

There is need for an ideological streamlining of health service provision. Uganda should rethink of a new definition of its healthcare and how they want it formatted to reach the most needy and on a sustainable, cost-effective, efficient and reliable way.

The biggest challenge lies in the conceptualization of health service provision that moves away from curative downstream emphasis. The Curative is the biomedical model where ill-health is acquired by microorganisms or injuries, and the doctor cures it. These tend to promote individualistic consideration of health as a function of lifestyle choices, when many Ugandans really have limited healthy choices at their disposal to begin with.

The shift from traditional conceptualization needs to happen, and very fast, given the parlance of neoliberalism. First, government must own up to a provision of quality health services to its population as a matter of human rights. Second, we have to employ a wide range of interventions, mostly psychosocial, which views health not as the presence of disease, micro-agents, etc., rather, a cumulative effect of social and material relations; and the complex dynamics within the environment as determined by the mode of production in our contemporary society.  

The expanded definition of health care would allow the diversifying of health resources to address upstream, mid-steam, downstream and health research, in proportions that make absolute sense to productivity in the economy.  Right now, healthcare means hospitals and medicine. We are tired of seeing decaying hospitals, commentaries about lack of drugs and doctors’ shortages. By diversifying, we start to remove costs from downstream and spreading it to address the inherent causes of disease, ill-health and endemic poverty that ties the masses in that trap of vulnerability.

I believe that much of the public expenditures in health sector is ineffective. That money should be reinvested in critical areas where the causes of ill-health are located. People get sick because of a variety of factors, mostly, entrenched socio-economic inequalities, chronic repression, unjust society, corruption, and deliberate exclusion from decision-making and so forth. These are the primary factors that lead to decay and lapses in health service infrastructure, brain drain, unethical practices, negligence, suboptimal deliveries of health resources and unequal access to health resources due to gender and ethnic based inequities.

END

What is it with Uganda’s Health-Scare Sector?

 HEALTH-SCARE

The state of health care services in Uganda has literally collapsed. At least, from the experiences of Ugandans who are confronted by its failures. The bad state of the healthcare is only symptomatic, something that the public has consensus over. Painfully, nobody seems able to do anything about it.

There is a pattern to this state engineered collapse of public institutions. To understand this pattern, one needs to study the state’s ability to balance public and private sector perfomance. The sole purpose of the liberalization of the economy is to enhance the exploitation of the many by a few. The “few’, may be corporations, or individuals who comprise market players. Corporations are the key institutions of a developed capitalism. Corporations become the new governors, per se, in a Uganda-type neoliberalism where government has gone to sleep.

The market-based economy is a tricky one to follow because of the complex market dynamics. It requires that government concede its’ control of the market, thereby retreating from providing direct social services to its people. This would allow private entities, and players such as international corporations to take over these roles. Your water, power, health insurance and healthcare, roads, etc to be provided by a private agent.

 Governments are then restrained by series of forced rules, to deregulate, implement structural adjustments (retrenchment to reduce government workers) and institute tax regimes that favor these corporations. In other words, government becomes a passive player to an extent.  This classical liberalism does not work in most of the African continent where the World Bank and IMF imposed it. Our people’s consumer mannerisms are still too remote to act as a conscious consumer in a free market would. There might just be a handful of conscious consumers in the free-market.

The World Bank’s recent poverty assessment report for Uganda for 2006 – 2013, illuminates such gloom of free-market economy. Nearly 80% of Ugandans are still poor to afford quality private healthcare services. Even the country is unable to attract high-impact investors because of the nature of our markets. As such, Uganda’s tax-base is not expanding as anticipated. Uganda is now drowning in debts, with Shs 6,400 Trillions due in interests to foreign debts payable in 2016/17 financial year. This is interest, not even the principal.

Has the liberalization of economy helped us, Ugandans? What else should Uganda do differently to benefit from this entrenched imperialism?

The answer to these questions calls for a debate by experts and academics. What is clear is that liberalization of the economy, with absolute lack of regulation does not, and did not benefit Uganda and most of these African countries. Even the countries which we consider to be the mother of capitalism, have developed social safety mechanisms to safeguard their citizens. Most of these countries operate under welfare regimes where healthcare, pensions, employment, education etc., are safeguarded from the vagaries of free-markets a matter of citizenship rights. In Uganda, we left all to the vagaries of the liberal markets.

The open market has allowed for proliferation of lumpen businesses in cahoot with state agents to utterly rob Ugandans. Often, the competition is not fair or just. Some businesses, in which state players have interests, tend to benefit disproportionately than others. These benefits are varied, from taxation waivers, tax evasion, kickbacks, low interest rate loans, state bailouts, bribe seeking, and irregular contracting, money laundering, to repatriation of profits and illegal offshore bankings .

On its part, the government has continued to withdraw from offering quality public service in the pretext of non-interference in the private sector.

It appears then that the decay in the healthcare services is a method of state control over the citizens. The health Ministry in 2016/17 fiscal year received Shs 1.853Trillions in comparison to Security of Shs 1.588 Trillion and Agriculture, the backbone of the economy that got a paltry shs 824 Billions. How do we explain that security and agriculture are highly functional and healthcare is not?

END.