Electricity is considered a luxury in parts of Africa. When it comes to its supply in public health facilities however, it can mean life or death.
When Uganda’s privatized electricity supplier shuts off power to hospitals, the results are catastrophic. In 2012, 150 babies on oxygen concentrators at a hospital in Jinja died after utility company UMEME Uganda Limited turned off the electricity with no prior notice. In 2015, Kiboga District Hospital was without power for over a month. UMEME disconnected the supply because the government of Uganda had not paid the bill of over 100 million Uganda Shillings (US$26,600).
The utility has a right to be paid for the services it provides. But when it comes to hospitals, the consequences are too grave for such hard and fast rules. We need stricter regulations that ensure the unbroken supply of electricity to hospitals, even if the government fails to pay its bills. Otherwise, more patients will die.
If UMEME gave hospitals sufficient warning that the power was going to be turned off, these facilities could make arrangements for temporary measures such as generators. But that’s not what happens; my law firm has handled cases in which the utility sent agents to disconnect the power to hospitals with no warning.
This costs lives.
Kiboga’s district hospital, for example, serves 100,000 people. When it went without power for a month, doctors said they were unable to provide even basic first aid such as sutures because they could not sterilize tools. Vaccines and blood went bad because of the lack of refrigeration. Laboratories could not perform diagnostic services without power. The maternity wing was in complete darkness, and Cesarean sections could not be performed. Mothers died on their way to the capital Kampala or private clinics to access emergency obstetric care.
Even so, UMEME did not reconnect the electricity supply.
The issue of power outages in public facilities is not peculiar to Uganda. Kenya, Tanzania, South Africa, and Malawi have reported power outages causing deaths. Yet governments have yet to set regulations that would ensure private utilities provide uninterrupted power to hospitals.
Uganda’s constitution guarantees the right to life and the protection of human rights, as do many other nations in Africa. The law firm where I work, Center for Health, Human rights and Development (CEHURD), recently sued UMEME, arguing that it denied those basic rights by cutting off power to hospitals.
To our dismay, the High Court dismissed the case in September, on grounds that corporations have a contractual obligation to recover their money and governments ought to pay their outstanding bills.
UMEME certainly has a right to be paid for the services it provides. No one is arguing that the government has a right to skip payments. But doesn’t the right to life supersede the right to be paid? UMEME has a moral obligation to preserve life. More people will die if we fail to hold multinational corporations to account for the preventable loss of life.
Ultimately, UMEME can use the courts to recover money owed because courts are well equipped to enforce contracts. Patients who die for lack of proper medical care have no such recourse.
This is not a challenge without solutions. The United Nations has offered guidance on how to manage businesses while respecting human rights. Businesses must respect, protect and remedy individuals when they violate fundamental human rights.
In 2001, Uganda privatised the provision of electricity by granting concessions to non-state actors. Since then, electricity service has become commercialised and unaffordable to an increasing number of rural communities.
Under international human rights law however, privatisation does not relieve the state of its responsibility to ensure that social services are accessible. The state is obliged to ensure that lives always come before profits, even when private service providers are involved.
The government's failure to develop infrastructure sufficient to regulate electricity supply to health facilities is a violation of Ugandan and international law, as is the failure to provide alternative power sources due to insufficient government funding.
In Uganda and many other countries across Africa, the push for privatization was prompted by the World Bank, which tied aid to efforts to remove government ownership of public services. The World Bank’s intent was to promote accountability and good governance. We now need regulations that prohibit distribution companies from cutting power to health facilities. This will protect the vulnerable and ensure that no power outage occurs in hospitals. This will save innocent lives.
Primah Kwagala manages strategic litigation at the Center for Health, Human Rights and Development in Uganda. She is a 2018 Aspen New Voices Fellow.