A Bill that aims to improve access to sexual and reproductive health services for women and girls in six East African countries faces a tough uphill battle to approval, with opposition from conservatives who claim that it would promote abortion and LBGTQ rights

Over the past week, the East African Legislative Assembly (EALA) has conducted public hearings on East African Community Sexual and Reproductive Health Bill 2021 in its six member states, Burundi, Kenya, Rwanda, South Sudan, Tanzania and Uganda.

Various members of the legislative assembly have been trying for five years to pass a Bill to address the very high maternal mortality and teen pregnancy rates in region.

At the public hearings in the capital cities of the member states, the Bill received support from a range of maternal health and sexual and reproductive health practitioners, academics and activists, particularly in Kenya.

But it also faced opposition from a number of conservative and religious organisations, including international right-wing organisations such as CitizenGo and Empowered Youth Coalition, some of which made objections at public hearings claiming that the Bill is pro-abortion and pro-LBGTQ rights.

In the past, various Catholic organisations have opposed the Bill, and at the Nairobi hearings held last week, the Catholic Doctors Association was one of the groups opposing the Bill.

Ending female genital mutilation

The aims of the Bill are to protect and facilitate the SRH and rights of all people in the region, provide for the progressive realisation of SRH information and services and prohibit harmful practices such as female genital mutilation and forced sterilisation.

It also aims to prevent newborn, child mortality and maternal mortality and “facilitate and promote reduction and elimination of unsafe abortions, HIV and other sexually transmitted infections, early and unintended pregnancies”.

Article 16 of the Bill states that a woman should be able to terminate her pregnancy if, in the opinion of a health professional, there is a need for emergency treatment, it endangers her mental or physical health or life, or is the result of rape or incest.

But it also provides for member states to use their own laws to decide what to do in such situations.

The region is in desperate need of improved SRH services. According to a 2020 EALA scorecard (see below), many member states are lagging behind in agreed-on targets on reproductive health and HIV, particularly South Sudan, which is not on track to meet any targets.

South Sudan’s maternal mortality rate of 730 women per 100,000 is one of the worst in the world, while only Rwanda and Tanzania are on track to meet maternal mortality targets.

EALA has tried to introduce a Bill on SRH since 2017 but faced various obstacles, including having to start from scratch when the term of the previous assembly ended and new representatives were sworn in. 

The current Bill has been introduced by South Sudan’s EALA representative Kennedy Mukulia as a Private Members’ Bill.

However, Mukulia has faced vilification and online harassment including a CitizenGo petition calling for his removal for sponsoring the Bill.

The Bill aims to give expression to Article 118 of the East African Community (EAC) Treaty, in terms of which member states have committed to providing reproductive health services to their citizens. But a number of member states do not have laws or policies in regard to a number of issues and the Bill aims to provide guidance in cases where there are legal vacuums. 

The EALA General Purpose Committee has 30 days to send a report on the public hearings to the Speaker, and thereafter it should be tabled and debated. However, it still faces an uphill battle in the male-dominated legislature, where a number of members objected to earlier versions of the Bill. 

Should the Bill be passed, each member state will have to report to the secretary-general of the EAC on the status of its implementation every two years.

The secretary-general is obliged to report to the EALA on each country’s progress, and one state can even bring legal action against another at the East African Court of Justice.

Teen girls ‘desperately need’ SRH services

Almost one-third of women in developing countries had their first baby in their teens, a UNFPA  report released last week shows.

“When nearly a third of all women in developing countries are becoming mothers during adolescence, it is clear the world is failing adolescent girls,” said UNFPA Executive Director Dr Natalia Kanem. “The repeat pregnancies we see among adolescent mothers are a glaring signpost that they desperately need sexual and reproductive health information and services.”

“Complications in pregnancy and childbirth are the leading cause of death among girls aged 15 to 19 years, who are also far more likely to suffer a litany of other violations of their human rights, from forced marriage and intimate partner violence to serious mental health impacts of bearing children before they are out of childhood themselves,” according to UNFPA. - Kerry Cullinan, Health Policy Watch

Kenya has become the latest member state of the continental body-Africa Union-to ratify a Treaty that will pave way for the establishment of an African Medicines Agency (AMA).

The specialized agency that will help state parties and regional economic communities enhance its capacity to regulate medical products is born out of the Union’s Accord which came into force in November last year.

“It will help the parties improve access to quality, safe and efficacious medical in the continent,” the memorandum from the ministry of foreign affairs reads in part.

In her recommendation to the House dated May 30, CS Rachael Omamo wants the legislators to consider and approve the action and further direct the particular CS to prepare and deposit the relevant instruments to the Union’s chairperson.

Already 17 other member states under the Union which include Algeria, Benin, and Burkina Faso, have also ratified the agreement while 26 others among them Tanzania, Uganda, Rwanda, Ghana and Cameroon have signed it.

The document tabled in Parliament seeking the country’s nod shows that the ratification process was approved by the cabinet during its meeting on May 12 this year.

AU’s decision to have the agency is based on weak regulatory systems that have seen the circulation of substandard and falsified medical products in most of the member states.

“This has posed risk to public health, harming patients and undermining the confidence in healthcare delivery systems,” reads the document.

In defending the move to sanction it, Omamo in her communication said this demonstrates the country’s commitment to having improved regulation of medicines and technologies.

Among the positive impacts, the country will benefit from our access to the African continental free trade area, African industrialization and ease of doing business among others.

On the financial implications, Omamo states that the agency will be supported by donor partners at the initial stages and thereafter financed by the member states with amounts to be assessed.

Under the Treaty, the medical institution which will develop its rules, membership and resources shall among other things complement national and regional bodies in their mandates.

It will contribute to the capacity building towards improving access to quality healthcare within the universal health coverage and sustainable development goals.

“AMA defines acceptable standards in the regulation of medical products in the continent. Its establishment is therefore timely and critical,” reads the letter.

It states:

“AMA intends to provide a platform for coordination and strengthening of ongoing regional and continental harmonization initiatives, serving to pool expertise and capacities for optimal use of limited resources.” - FELIX KIPKEMOI, The Star

Rwanda plans to produce Covid-19 vaccines next year after Germany-based pharmaceutical BioNTech launched the construction of the facility to house its two modular container prototypes in the country on Thursday.

The BioNTainers are expected to produce 50 million doses per year using the mRNA technology used for Pfizer and Moderna vaccines.

The containers will be delivered to Rwanda by the end of the year, with manufacturing expected to commence 12 to 18 months after installation.

During the groundbreaking ceremony on Thursday at the Kigali Special Economic Zone, Rwanda President Paul Kagame said the plant would be a significant milestone in addressing vaccine inequality.

“Rwanda intends to build on this investment by putting in place conditions to attract other manufacturers and innovators. Rwanda fully supports BioNTech’s commitment to power this factory with green energy, and we will work together to achieve that,” President Kagame said.

Figures by the World Health Organisation (WHO) released in June show that only two African countries (Mauritius and Seychelles) have fully vaccinated 70 percent of their total population. Rwanda expects to achieve this target by the end of the month.

Shipping containers

BioNTech says one of the containers will produce the mRNA vaccines while the other will make formulated bulk drug products. There are plans to use the same facility to manufacture malaria and tuberculosis vaccines.

The modular systems consist of 12 shipping containers housing the same manufacturing process and equipment used in its factory.

The Kigali plant is the first mRNA technology manufacturing hub with similar facilities to be set up in Senegal and South Africa.

Egypt, Kenya, Nigeria and Tunisia will receive technology to produce mRNA vaccines.

“We have reached the next milestone with the construction start of the first African mRNA manufacturing facility based on our BioNTainers – just four months after we introduced the BioNTainer concept in February,”  Prof Ugur Sahin, the CEO and co-founder of BioNTech, said.

 He added that the factory would be the first in an African network to provide sustainable production capacity for mRNA pharmaceuticals.

“The goal we pursue together with governments and regulatory authorities is to produce vaccines for Africa here with highly skilled professionals from Africa,” he said.

Vaccine imports

BioNTech says it will work with staff from its sites in Germany to accelerate the training of about 100 personnel who will be running the production and all associated laboratory and quality assurance tasks on site. Some 20 local personnel will also undergo training.

According to WHO, Africa imports approximately 99 percent of vaccines administered. Developing the new vaccine manufacturing facilities will significantly reduce the continent’s import dependence.

Last year, the WHO established its global mRNA technology transfer hub to address supply shortages and boost vaccination rates in developing countries. - BERNA NAMATA, The EastAfrican