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943-1760-1-RV.Pdf ANALYSING HUMAN RIGHTS ACCOUNTABILITY TOWARDS ENDING PREVENTABLE MATERNAL MORBIDITY AND MORTALITY IN UGANDA By Agaba Daphine Kabagambe A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy in the Faculty of Law, University of the Western Cape Promoter Professor Ebenezer Durojaye Head of Project (Socio-Economic Rights) Dullah Omar Institute Faculty of Law, University of the Western Cape February 2017 DECLARATION I Agaba Daphine Kabagambe, declare that Analysing ‘Human Rights Accountability’ towards ending preventable Maternal Morbidity and Mortality in Uganda is my original work and has not been submitted for examination or degree in any other University or institution of higher learning. While, numerous materials and resources have been referred to, they have been properly referenced and duly acknowledged. 1 http://etd.uwc.ac.za/ ACKNOWLEDGMENTS The completion of this thesis would not have been possible without the support of a number of people. First, I am very appreciative of my supervisor Professor Ebenezer Durojaye for having selected me to pursue this PHD. His insightful and thought-provoking feedback has been very instrumental in enhancing my work both for the thesis and for assignments under the Socio-economic rights project. His quick response to the various drafts of my work not only allowed for their gradual improvement but also for the completion of my thesis on time. Also, his continuous guidance and support kept me on course throughout the difficult stages of the PHD process. I am sincerely grateful for the management and staff of Dullah Omar Institute for Constitutional Law, Governance and Human Rights under the supervision of Professor Jaap De Visser for creating a very favourable working environment. I am also thankful for the technical support of my colleagues especially those in the Socio-Economic Rights Project- Gladys Mirugi-Mukundi and Keathélia Sapto. I would also like to thank my fellow PHD colleagues; Meseret Kifle, Shehaam Johnstone, Alois Madhekeni and Annette May for the emotional support and intellectual stimulation throughout this process. I am especially grateful to all the administrative staff especially Nadia Cassiem, Virginia Brookes, Debbie Gordon and Mandy Cupido for their financial, technical and emotional support, which cushioned me from distractions, thus allowing me to concentrate on my work. I am also thankful for the researchers especially Maria Assim and Kristen Peterson whose words of encouragement often came in handy during the trying times of this tumultuous journey. I am particularly indebted to my family for always believing in me and for constantly reminding me that I had what it took to successfully complete my PHD. Special thanks go to my parents for their financial and emotional support. I am also grateful for my siblings and my friends for being my rock throughout this journey. 2 http://etd.uwc.ac.za/ DEDICATION This work is dedicated to my family- my parents and my siblings. 3 http://etd.uwc.ac.za/ ABSTRACT The persistence of preventable Maternal Morbidity and Mortality (hereafter MMM), in the developing world, despite ground breaking technological and scientific advances, is unacceptable. There is no cause of death and disability for men between ages 15 and 44 that comes close to the large scale of maternal mortality and morbidity.1 Thus, the prevalence of high MMM ratios indicates the side-lining of women’s rights. Surprisingly, the causal factors of preventable MMM and interventions needed to reverse the pervasively high numbers are now well known. Yet, hundreds of women continue to die daily and to suffer lifelong illnesses while giving birth. In Uganda, despite various regulatory, policy and programmatic strategies, the most recent survey revealed that the maternal mortality ratios were at a staggering 438 per 100,000 live births.2 This study attributes the continued prevalence of high MMM rates to lack of accountability that would ensure services and resources are being maximized and redistributed equitably. Lack of effective accountability mechanisms in place encourages unbridled financial, human and technical resource wastage, diversion, non-utilization and embezzlement of funds. It is not enough that medical equipment, personnel and finances are increasingly being allocated to the health sector by the Government. Without effective tracking and supervisory mechanisms, these additional financial, technical and human resource allocation will most likely not translate into reduced MMM rates. Sadly, in Uganda, the role of accountability towards the operationalization of human rights is underappreciated. In fact, many health sector practitioners are unaware of the ways in which accountability can be implemented. Despite the recent infiltration of the term ‘accountability’ into laws and policies, it remains an elusive and fuzzy concept. Further still, as demonstrated throughout the study, accountability has been popularized by international and regional human rights monitoring mechanisms such as the UN treaty bodies, African Commission but at the domestic level, great strides have yet to be made in infusing human rights accountability into laws, policies, programs and practices in a way that will reverse the high MMM. The domestication of accountability is vital because human rights ideals are only turned into actual implementable strategies at the national level. A direct focus on Uganda would allow for the undertaking of the country’s own specific challenges within its domestic context. 1 Report of the Office of the United Nations High Commissioner for Human Rights on Preventable Maternal Mortality and Morbidity and Human Rights A/HRC/ 14/39 (16 April 2010) Para 17. 2 Uganda Bureau of Statistics Demographic and Health Survey (2011) Kampala, 236. 4 http://etd.uwc.ac.za/ Therefore, the main purpose of this study is to analyse accountability mechanisms towards combating Maternal Morbidity and Mortality (MMM) in Uganda. The study elaborates upon an accountability framework for MMM that is human rights compliant. The framework relies on three major interrelated aspects; responsibility, answerability and enforcement. Subsequently, an attempt is made throughout the study, to advance the proposed framework to the administrative, legal and social structures operating within Uganda in a bid to find comprehensive accountability strategies for curbing preventable maternal deaths and morbidities. 5 http://etd.uwc.ac.za/ TABLE OF CONTENTS DECLARATION .................................................................................................................................... 1 ACKNOWLEDGMENTS ...................................................................................................................... 2 ABSTRACT ........................................................................................................................................... 4 LIST OF ABBREVIATIONS .............................................................................................................. 10 CHAPTER ONE: INTRODUCTION ................................................................................................. 11 1.1 BACKGROUND TO THE STUDY ......................................................................................... 11 1.2 STATEMENT OF THE PROBLEM ....................................................................................... 13 1.2.1 A synopsis on Maternal Mortality and Morbidity .................................................. 13 1.2.2 The impact of non-implementation of Accountability on MMM ............................. 16 1.3 RESEARCH QUESTIONS ..................................................................................................... 20 1.4 LITERATURE SURVEY ......................................................................................................... 21 1.5 RESEARCH METHODOLOGY ............................................................................................. 25 1.6 SCOPE/LIMITATIONS ............................................................................................................ 25 1.7 STRUCTURE OF THE THESIS ............................................................................................ 27 CHAPTER TWO: ROLE OF ACCOUNTABILITY TOWARDS THE REDUCTION OF PREVENTABLE MATERNAL MORTALITY AND MORBIDITY .................................................. 29 2.0 INTRODUCTION ..................................................................................................................... 29 2.1 UNDERSTANDING ACCOUNTABILITY ............................................................................. 30 2.2 ACCOUNTABILITY FRAMEWORK FOR MATERNAL MORTALITY AND MORBIDITY .......................................................................................................................................................... 33 2.3 MAIN ‘BUILDING BLOCKS’ OF ACCOUNTABILITY......................................................... 34 2.3.1 Responsibility ...................................................................................................... 36 2.3.2 Answerability ....................................................................................................... 40 2.3.3 Enforcement ........................................................................................................ 41 2.4 PREVENTABLE MATERNAL MORTALITY AND MORBIDITY, VIOLATION OF WOMEN’S RIGHTS ......................................................................................................................
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