Convention of Rights 26: The right to health

The United Nations Convention on the Rights of Persons With Disabilities (CRPD) forms the foundation of disability rights laws in Uganda and is the model for the Persons With Disabilities Act (PWDA) 2006. The CRPD underlines and recognizes that persons with disabilities (PWDs) are entitled to all the human rights enunciated in the The Universal Declaration of Human Rights. If you are a PWD the rights in the CRPD are your rights, if you do not have a disability it is your duty to uphold and promote these rights.

Article 25 of the CRPD says PWDs have the right to the best standard of health, the same as anyone else and without discrimination. Appropriate measures should be taken to ensure access to health services that are gender sensitive, particularly:

a, PWDs shall have the same range, quality and standard of health care at affordable prices as other people, including sexual and reproductive and general health programs.

b, PWDs that require health services because of disability should have them provided. That includes early identification and intervention, and services designed to limit further disability, that includes children and older persons.

c, health services should be provided in the people's community, including rural areas.

d, health professional's are required to provide the same quality care to PWDs as others, including providing informed consent, educating about human rights, dignity, autonomy and meet the needs of PWDs through their training and high ethical standards in public and private health care.

e, PWDs should not face discrimination in the provision of health insurance and life insurance where permitted by the law, and it should be provided in a fair and reasonable manner.

f, neither health services nor health care, nor food and fluids should be denied through discrimination because of disability.

No one can guarantee health, but the government and society can tackle many of the underlying determinants of health. This right therefore, is about the right to access the institutions that are put in place by laws, policies and programs that promote and protect health. This right is about the right to live in a healthy environment with things like a clean supply of water and good sanitation. 

The right to health is not an isolated right, it interacts with other rights, like the right to access education, employment and a good standard of living. Foreinstance, poor and uneducated people are more likely to suffer from ill health than people with economic security and good living conditions. Governments are not responsible for ensuring good health but they are responsible for maintaining the factors in the social, economic, legal, and physical environment that affect health (see Human Rights: Yes!).

In the past disability was viewed as a health issue. In reality PWDs experience disease and sickness in the same way as other people. Of course some disabilities make people more vulnerable to health issues or may cause secondary problems like pressure sores; and some health problems can cause disability too. When disability is seen as a medical issue that can be cured, the underlying social problems like discrimination and barriers are not tackled. For this reason the CRPD looks at disability as a social issue (see The Social Model of Disability).

This 2014 qualitative report Perceptions and experiences of access to public healthcare by PWDs and older people in Uganda used focus groups and interviews with older people in Uganda’s Kamwenge district, and PWDs from the Gulu region. The report looks at the perceptions of health care this section of the population has, its findings are summarized as follows:

Our findings show that a sense of community marginalization is present within both older persons and persons living with disabilities. These groups report experiencing political sidelining, discrimination and inequitable access to health services. This is seen as the key reason for their poor health. Clinical services were found to be of low quality with little or no access to facilities, trained personnel, and drugs and there are no rehabilitative or mental health services available.

People were also interviewed for the report and their comments were analyzed under 5 themes. These themes reflect the underlying concerns of PWDs and the elderly about the health services they access and want to access:

Theme 1: Marginalized and Stigmatized: `When somebody gives birth to a disabled child, that child is not treated the same as other children and they are segregated and usually marginalized. This does not stop there but persists into later states of life. This greatly affects the health of disabled people’.

Theme 2: Political Marginalization: `The community leaders don’t care about us. They never invite us to their meetings or even inquire from us… it’s like we never existed… the leaders only come during election time… the community leaders go and tell us to form committees for old people, persons with disabilities, youths, we do so… they even bothered us to make a constitution, we got a certificate and then they asked us for money –asked us to make circles- we paid! But we have never heard from them until now. We have never got money or heard from them since’.

Theme 3: Inequity in health: `I think there are different levels of healthy, and we as disabled persons, we have the lowest level of health’... `For instance, if a blind person goes for a HIV/AIDS test, instead of helping that person, the health workers instead ridicule that person and ask them `even you with your blindness, how could you get someone to give you HIV/AIDS?’ this discourages us from testing and so most of us don’t know our HIV/AIDS status’.

Theme 4: Lack of access to appropriate medicine and health services: `We get prescriptions but cannot afford to buy the medicines. You walk to the health center, they write you a paper. Now, where to we get the money to buy the medicines?’

Theme 5: The need to expand quality rehabilitative and mental health services: `I use a wheelchair but at times it breaks down. The chair was a donation but when it breaks down, I have no means to repair it because it is very expensive to carry out repairs and what I earn cannot cover this’.

The report concludes that the government is failing to provide adequate health care because the right to health as well as interrelated rights are not being promoted, fulfilled or protected for the elderly or PWDs. Furthermore the Ugandan government is not progressively realizing its obligations in international law following its ratification of the CRPD and the Committee on Economic, Social and Cultural Rights (CESCR).

If you are a PWD you have a right to high quality medical care the same as everyone else.

In Uganda: Disabled Women Experience Double Discrimination.
Giving birth in Uganda is a dangerous and dirty business. The clinics where the impoverished can afford to give birth are so awful, unclean and ill equipped that many women would rather take the chance and birth at home, even though they may not have the proper or sanitary instruments necessary to guarantee a healthy and safe delivery. As a result, both infant and mother mortality are heartbreakingly high because of infection and lack of proper care. Often the mothers are left alone, in their pain and without support, only to be treated indifferently and harshly during the birth itself.

This is written in Article 25 of the CRPD in the following way:

Article 25

Health

States Parties recognize that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability. States Parties shall take all appropriate measures to ensure access for persons with disabilities to health services that are gender-sensitive, including health-related rehabilitation. In particular, States Parties shall:

(a) Provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes as provided to other persons, including in the area of sexual and reproductive health and population-based public health programmes;

(b) Provide those health services needed by persons with disabilities specifically because of their disabilities, including early identification and intervention as appropriate, and services designed to minimize and prevent further disabilities, including among children and older persons;

(c) Provide these health services as close as possible to people’s own communities, including in rural areas;

(d) Require health professionals to provide care of the same quality to persons with disabilities as to others, including on the basis of free and informed consent by, inter alia, raising awareness of the human rights, dignity, autonomy and needs of persons with disabilities through training and the promulgation of ethical standards for public and private health care;

(e) Prohibit discrimination against persons with disabilities in the provision of health insurance, and life insurance where such insurance is permitted by national law, which shall be provided in a fair and reasonable manner;

(f) Prevent discriminatory denial of health care or health services or food and fluids on the basis of disability.