Example 5: Uganda National Health Consumers’ Organization: Developing a patients’ charter 

Project Type: Advocacy

The Organization 

Uganda National Health Consumers’ Organization (UNHCO), Kampala, Uganda
E-mail: info@unhco.or.ug, Web: http://unhco.or.ug/

Uganda National Health Consumers’ Organization (UNHCO) is a health rights advocacy organization that empowers citizens to demand and hold service providers and policy makers accountable. It uses the rights-based approach to raise community awareness on the right to health, so that citizens view health as an entitlement and not a privilege. This approach also aims to make communities aware of the standards and guidelines at each level of service delivery, so they know what to demand, and what their responsibilities are for effective delivery of health services. Using this approach, communities are empowered to demand and participate in improving quality service delivery at each level of the health care system.

UNHCO establishes and strengthens mechanisms for engagement between consumers, service providers, and policy makers. The mechanisms include community dialogue meetings, suggestion boxes, and Health Unit Management Committees (HUMCs). Community members use the mechanisms to provide feedback about health service delivery. UNHCO also builds capacity of the community structures both existing and new including health workers, local politicians, partner Community Based Organizations (CBOs), and community advocates. The community structures are empowered to monitor and hold duty bearers accountable. They also increase health consumers’ awareness about their rights and responsibilities, standards, and feedback and redress mechanisms.

In an effort to empower communities to engage service providers and policy makers, UNHCO employs social accountability tools in different communities of operation. The tools include citizens’ report card and community score cards to generate issues for advocacy but also to cause duty bearers to address identified gaps in health care delivery.

Right to High-Quality Health Care

Uganda Const. (Social and Economic Objective No. XX of the 1995): “The State shall take all practical measures to ensure the provision of basic medical services to the population.” Source: Eastern Africa Centre for Constitutional Development,  www.kituochakatiba.org 

Patients’ Charter

“The objective of the [P]atients’ [C]harter is to empower health consumers to demand high quality health care, to promote the rights of patients and to improve the quality of life of all Ugandans and finally eradicate poverty nationwide.” The Republic of Uganda, Patients’ Charter (2009), http://unhco.or.ug/library/?did=11 

To create a critical mass for advocacy for addressing community concerns both at the community and national level, UNHCO has led the formation of coalitions and alliances as need arises. UNHCO is currently leading the following coalitions: Voices for Health Rights (VHR), Coalition to Stop Maternal Mortality in Uganda, Communities of Change, CSO Coalition on Pharmaceutical Procurement and Supply Chain Management (PSM) for Accountability in Uganda, and the Health Accountability Platform.

The Problem

According to the World Health Organization, Uganda ranks among the world’s lowest in health status. Almost 30 years since the National Resistance Movement came to power in 1986, destruction of health infrastructure and loss of human resources continue to depress health care statistics. Indeed, Uganda attempts to provide health care services to a larger and rapidly growing population with fewer resources than it had in the 1970s. Moreover, the spreading of disease (particularly malaria, HIV/AIDS, tuberculosis, diarrhea, cholera, measles, and non-communicable diseases) and a general unawareness of legal rights make the delivery of health care in Uganda a particular challenge.

Actions Taken 

In an effort to legalize the right to health in Uganda, UNHCO spearheaded the development of the Patients’ Charter, whose objective is to provide a policy and legal framework for empowerment of health consumers, enabling them to demand for high quality health care and promote accountability in the health sector. UNHCO continues to use the Patients’ Charter as a tool for legalizing the right to health in Uganda.

UNHCO sits on different Ministry of Health committees to inform policy and practice. These include the Health Policy Advisory Committee (HPAC), Public Private Partnership in Health (PPPH), Sector Working Groups, and Quality Assurance Committees. Under these committees, UNHCO works to ensure that consumer concerns are part of the planning of the sector. It also ensures that the sector uses the rights-based approach in policy implementation.

UNHCO was instrumental in developing the Patients’ Charter. The Charter adopts a rights-based approach to health care delivery and provides a policy and legal framework for health care consumers—enabling them to demand high quality care and accountability. The Ugandan Government adopted the Charter, and the Ugandan Ministry of Health (MOH) working in conjunction with UNHCO, is now taking steps towards implementing it.

Results and Lessons Learned 

The Ugandan Government’s commitment to working with civil society organizations to formulate a new health policy that provides greater access, transparency, and accountability is a great step toward better health care. The Charter specifically lays out the obligations of health care providers and the rights of health care consumers; however, considerable efforts are necessary to narrow the gap between health care policy and implementation.

For this reason, UNHCO began innovative work to ensure the implementation of the Patients’ Charter, including an effort to spell out the rights and obligations contained therein to the health Sector Strategic Investment Plan III (HSSIP) (2010/11-2014/15). UNHCO also monitors HSSIP and the national budget to measure the extent to which they comport with the priorities of the HSSIP.