CEHURD and Maternal Health Accountability

Center for Health, Human Rights and Development, commonly cited as CEHURD, and 3 Others v Attorney General, Constitutional Petition Number 16 of 2011, is one of the most important Ugandan decisions on constitutional accountability for maternal health. The case was decided by the Constitutional Court in 2020 after the Supreme Court had earlier held that the petition should be heard on its merits. Its importance lies in that movement from jurisdiction to substance. The question was no longer whether courts could hear a health rights claim. The question became whether failures in public maternal health services could amount to violations of the Constitution.

The petition was brought by CEHURD, Professor Ben Twinomugisha, Rhoda Kukiriza and Inziku Valente against the Attorney General. They complained that the Government of Uganda had failed to provide basic and minimum maternal health services in public health facilities. The alleged failures included lack of essential maternal health commodities, shortage of doctors and midwives, inadequate emergency obstetric care, poor supervision, inadequate budgetary prioritisation and unprofessional conduct by some health workers. The petition was also connected to the deaths of women during childbirth in public facilities, deaths the petitioners linked to systemic failure rather than isolated misfortune.

The legal issue was whether those acts and omissions violated constitutional protections, including the right to life, women’s rights, dignity and the broader constitutional commitment to social justice and health. The Attorney General could not simply say that the matter was political, because the Supreme Court had already rejected that threshold objection in the 2015 CEHURD appeal. The Constitutional Court therefore had to confront the harder merits question: what does the Constitution require from the State when women depend on public facilities for childbirth and emergency care?

The Constitutional Court held in favour of the petitioners. It found that the Government’s failure to provide basic maternal health care services in public facilities was inconsistent with Uganda’s constitutional obligations. The Court recognised that maternal health is not merely a policy preference or charitable concern. Where state omission predictably endangers life, dignity and the special protection owed to women, the matter becomes constitutional. This was a significant move because it placed women’s reproductive health within the language of rights and public accountability.

The rule from the case is that the State has a constitutional obligation to respect, protect and fulfil basic maternal health rights. A failure to provide minimum maternal health care and emergency obstetric services may violate the Constitution, especially where preventable harm or death follows from denial of timely and appropriate care. The Court also accepted that progressive realisation may apply to health rights, but it refused to treat progressive realisation as an excuse for indefinite delay. The State must take concrete, deliberate, reasonable and measurable steps within available resources.

That treatment of resource constraints is one of the strongest parts of the decision. It would be unrealistic to pretend that health systems are built without money, trained personnel, medicines, electricity, ambulances, operating theatres and supervision. A court cannot wish those resources into existence. Still, scarcity does not answer every constitutional complaint. The Government must show that it has made reasonable choices, used resources responsibly and prioritised minimum duties connected to life and dignity. A general statement that funds are limited is not enough, especially when the affected group is vulnerable and the service is basic.

The judgment is also important because it treats maternal health as a justice issue. Maternal deaths in public facilities often affect women who are poor, rural or unable to afford private care. In ordinary public discussion, such deaths may be described as tragic but unavoidable. The Court’s reasoning resists that easy description. It suggests that when preventable deaths are linked to missing supplies, absent staff, neglect or weak emergency care, the issue may be constitutional as well as medical. That does not make every bad outcome a rights violation. It means the State must account for systemic failure.

The case builds directly on the Supreme Court decision in Center For Health, Human Rights and Development and Others v Attorney General, Constitutional Appeal Number 1 of 2013. In that appeal, the Supreme Court held that health rights claims should not be dismissed merely because they involve policy or resource allocation. The 2020 Constitutional Court decision gave content to that holding. The Supreme Court opened the door to adjudication, while the Constitutional Court decided what constitutional responsibility could mean in practice.

The remedies granted by the Court also deserve attention. The decision did not stop at declarations. It required state action, including measures related to maternal health funding, staffing, equipping public health facilities, audits and reporting. That remedial style may suggest a move toward structural accountability. A declaration can name a wrong, but follow up duties can push the responsible institutions toward actual implementation. At the same time, structural orders require care. If they are too vague, they may be ignored. If they are too detailed, they may place courts in a managerial role for which they are not designed.

This balance is one of the more interesting aspects of the case. The Court did not claim to be the Ministry of Health. It did not draft a full health budget or decide the exact number of midwives for every facility. Instead, it required the State to take constitutional obligations seriously and to account for implementation. That is a modest but meaningful judicial role. It respects separation of powers while refusing to allow separation of powers to become a shield for inaction.

For lawyers and civil society organisations, the case offers a practical model for public interest litigation. The petitioners did not rely only on broad statements about poor health care. They connected concrete failures to constitutional provisions and to the lived experiences of women who needed emergency maternal care. Strong litigation in this area is likely to require policy documents, affidavits, medical evidence, budget information, international human rights standards and clear remedial proposals. A court is more likely to engage where the claim is specific enough to be answered.

For government, the case is a reminder that policies on paper are not the same as constitutional compliance. A maternal health strategy may exist, but the question is whether the State has taken reasonable steps to implement it. Are essential supplies available in public facilities? Are emergency services functional? Are staff trained and supervised? Are budget decisions consistent with known risks to women’s lives? These questions may be uncomfortable, but constitutional accountability is often uncomfortable because it asks whether official promises reach ordinary people.

There is also room for cautious critique. Courts can highlight failures and require accountability, but long term health improvement depends on administration, public finance and political commitment. A judgment cannot by itself stock a rural health centre or change the behaviour of every health worker. That limitation should not weaken the legal importance of the case. It simply means litigation is one part of a wider accountability ecosystem that includes Parliament, professional bodies, local government, civil society, media and communities.

The case also fits within a wider African and comparative conversation about social rights. Courts in countries such as South Africa, Kenya and India have considered state duties relating to health, dignity, emergency care and minimum obligations. The Ugandan decision is valuable because it grounds that conversation in Uganda’s own Constitution and in the realities of public maternal health. It avoids treating social rights as vague aspirations. Instead, it sees them as commitments that require reasonable, measurable and accountable implementation.

CEHURD and 3 Others v Attorney General is therefore a landmark not only because it concerns maternal health, but because it explains what constitutional government should mean when public systems fail. A Constitution that protects life, dignity and women’s rights must have something to say when preventable maternal deaths are linked to state omission. The decision does not make courts responsible for running hospitals. It makes public authorities answerable when basic health obligations are neglected. That is its lasting precedent.

Source note. This article is based on Center for Health, Human Rights and Development (CEHURD) and 3 Others v Attorney General, Constitutional Petition Number 16 of 2011, [2020] UGCC 12, Constitutional Court of Uganda, judgment delivered on 19 August 2020, with reference to the Supreme Court justiciability decision in Center For Health, Human Rights and Development (CEHURD) and Others v Attorney General, the Constitution of the Republic of Uganda, 1995, and the general statutory background of the Public Health Act. It is prepared for public legal education only and should not be treated as legal or medical advice for any specific case.

Suggested citation

Ronald Serwanga, “CEHURD and Maternal Health Accountability” East Africa Legal Insight (26 June 2026).