Health
Rising to the Top: Carol Nabbanja’s Journey to Becoming the Best Graduating Student from MakSPH
Carol Esther Nabbanja, 22, is set to graduate with First Class Honours in Bachelor of Environmental Health Science (BEHS) from the Makerere School of Public Health as the best-graduating student in the school this year. She graduates in Makerere University‘s 73rd Graduation ceremony today.
With a CGPA of 4.61, she has emerged as the best-graduating student in the MakSPH this year. She graduates alongside her other 43 classmates who made it to the graduation list this year.
Born in Kitemu village, Nsangi Parish, Wakiso District, to Samuel Mawejje, and Alice Naggawa, Nabbanja is the third born of four siblings and first to come to Makerere University, the very first to be on a government scholarship, and the very first to go through Kings College Budo.
Right from her childhood, Nabbanja has always been passionate about health and clean environments, which started from her early years as a head monitor at a government-aided St. Charles Primary School, where she did her nursery to primary five and the sanitation prefect at Clevers Origin Junior School.
While at St. Charles, Naggawa, Nabbanja’s mother was not convinced that she would make a foundation for a great future. She wanted better for her daughter. Nestled in the bustling streets of Kitintale, lies Clevers Origin Junior School, a beacon of hope for many students in the area. For Naggawa, her daughter’s joining the school would mark the beginning of a new chapter in her life.
She approached the owner of the school, Christopher Mugwanya, who happened to be her brother. Despite being a private school, Mugwanya, a kind-hearted and supportive uncle, offered the Nabbanja a half-bursary based on academic merit and family relationship. “I was overjoyed and couldn’t wait to start his new journey at Clevers Origin,” says Nabbanja.
Settling into her new school, Nabbanja encountered some challenges in mathematics, but her uncle was there to help. “I had some challenges in math, but he ably supported me, he gave me food, visited me when my mother couldn’t make it, and sometimes I would stay at his place over the holidays. He was really supportive. I was able to overcome my difficulties in math and excel in my studies. In fact, my grades improved and I found a newfound passion for learning. I am grateful for the support from my uncle and I feel proud of my academic achievements so far.”
Because of her unwavering determination and hard work, the School was convinced that she would sit her Primary Leaving Examinations (PLE) in Primary Six.
“I did PLE in P.6. The centre I registered at was in Nateete and I was the only first grade there but I didn’t want those results. I decided to wait for my actual time, and when it came, I excelled. I got aggregate 5,” says Nabbanja.
She was the best-performing female academician in her cohort. This was a significant achievement, as her cohort had the best grades since the school was founded. “I was also awarded the best female academician during my time at the school. I, in fact still have the certificate. I have also always been pertinent about health, and so I took up positions like the Sanitation Prefect,” says Nabbanja.
Nabbanja also had a passion for cleanliness and health. As the Sanitation Prefect, she made sure that the school environment was clean and hygienic at all times, something that was important to her from a young age. “I always loved a clean environment and to have everything in its place, so my interest developed that early.”
Joining Kings College Budo
Given her outstanding performance, Nabbanja was offered several scholarships to join Secondary School. “I was the very first from that Clevers Origin Junior School to ever go to Kings College Budo—we were two students that performed well, a boy who got 4 and me who got 5 and joined Budo on merit. My parents were offered other offers of schools giving me scholarships but Budo was exceptional. We had to make a decision that would set for me a good standard.”
Her journey to Makerere School of Public Health was paved at Budo. She was initially worried about School fees and how her father, a taxi driver would raise money to support her education.
“On joining my S.1, my parents were worried about the high fees, and the fact that I had studied on bursaries up to this point, they were not financially ready. We were paying about Shs1.4M. My mother talked to the Deputy Head Teacher, Rebecca Kiwanuka, who told her to let me join and that things would work out in the long run. Fortunately, my parents paid fees for S. 1,” says Nabbanja.
Unsure of how the second term would go, by sheer luck, Ligomarc Advocates, a financial and corporate law firm located at Social Security House in Kampala was celebrating 10 years and the partners decided to go back to their high schools and support students who were having financial issues
“By God’s grace, after the meeting between the School administration and the law firm, Mrs. Kiwanuka, our deputy head teacher informed me that I had gotten a sponsor,” Nabbanja says.
Ligomarc Advocates did not only sponsor her education but also provided opportunities for her to work with them during school breaks.
“Ligomarc took me for the 6 years I was at Budo. They were not just sponsors but also supporters, they supported me financially, came for V.Ds [Visitation Days], and also gave me an opportunity to work with them as an office attendant during my vacations. I also assisted the administration, delivering letters here and there. They supported me beyond just academics,” she says.
Budo was a turning point in Nabbanja’s life. It exposed her to new experiences and taught her valuable life lessons that have stayed with her to this day. She thrived in her studies, maintaining an average of 94 and earning 10 out of 8 aggregates in S.4 and 16 out of 20 in S.6.
Nabbanja never lost sight of her goals and was motivated by quotes from her late headmaster, Mr. Patrick Bakamale, such as “In this era of information and technology, we need to have the power of selection,” and “Focus on roots not fruits.”
Shaping her dream
Growing up, Nabbanja had always been fascinated by journalists, with the thrill of being on TV. “I used to hear that they earn 1 million, so that excited me.” However, it was her frequent trips to the dentist that truly sparked her interest in the field of dentistry. As she watched the dentists work their magic, Nabbanja was drawn to their ability to improve people’s dental health and change their lives for the better. “As a child I had so many dental issues, even at home. When I would visit the dentist, I would see a guy in a coat, doing some good work so I realized he doesn’t even work the night shift and it made me want to become a dentist,” she added.
Despite being tempted to pursue a career in law due to the time she spent at Ligomarc Advocates, Nabbanja held firm to her dream of attending medical school and becoming a dentist. She was determined to help her siblings, and others, achieve the confident smile they deserved.
However, her dream course, Dental Surgery, eluded her by just one point. Instead, she was given the opportunity to study Environmental Health Science, a subject that would soon become her passion.
“I didn’t know much about MakSPH, actually my first few days were not that pleasant. I kept thinking about my friends who were doing my dream course even though they were on private not government sponsorship, but my mother didn’t have the money,” she says.
Ruth Mubeezi Neebye, an Assistant Lecturer in the Department of Disease Control and Environmental Health would later become Nabbanja’s mentor. According to Nabbanja, she has equally been inspired by Dr. Esther Buregyeya and Dr. David Musoke.
Throughout her time at MakSPH, Nabbanja has consistently stood out as a top performer, earning high grades and impressing her professors and peers alike. Despite her impressive academic record, she remains humble and grateful for the support she has received from her family, friends, and sponsors along the way.
Nabbanja, a sports personality
As a student at Makerere School of Public Health, Nabbanja was a standout in both academics and sports. She fell in love with swimming. As a member of the Makerere University swim team, Nabbanja excelled in competitions and brought home medals for the university. She found solace in the sport, using it as a way to relax after long days of lectures and studying. Swimming also provided her with the opportunity to travel and make new friends, as well as to work on her physical and mental health.
“Swimming gives you a lot of opportunities, so that inspired me as well. Very many people travel on University tickets, and since I love outdoor life and traveling, I looked at this as an opportunity. Swimming teaches you to read, and do other things like jogging before joining the pool. It is also an individual sport because when you don’t swim for a month, your time is cut,” says Nabbanja.
Journeying to First Class
For some students, University education is just a three-four-year period of attending lectures and socializing with peers. But for others, it’s a stepping stone to a brighter future. And that’s exactly what happened to Nabbanja, the best-graduating student from Makerere School of Public Health (MakSPH). She has not only excelled in academics but was also a talented swimmer who represented the University in various competitions.
Nabbanja’s success journey started with a clear plan and a strong determination to succeed. She believed that becoming a first-class student was not only about attending lectures but also about being self-aware and taking control of one’s own learning process. Nabbanja made a habit of reflecting on what was learned each day and relating it to real-life situations.
When asked about her experience at MakSPH, Nabbanja had nothing but praise for the staff and their professionalism. She says she never encountered any corrupt practices and appreciated the well-defined structure that made it easy to know where to go for assistance. Marks were received on time and she never felt lost or unsure of what to do next.
“The staff is also supportive, right from the reception, everyone is helpful—when inquiring about offices, or office protocol. We also get our marks on time, usually a week into the new semester. The service delivery is good and we are not tossed around.”
Nabbanja’s journey serves as a testament to the power of hard work, determination, and support from family and sponsors.
By Davidson Ndyabahika and Samantha Agasha
Researchers at Makerere University School of Public Health (MakSPH) are urging the Ugandan government to boost healthcare funding to enhance reproductive health services. Dr. Dinah Amongin, an obstetrics and gynecology expert at MakSPH, has expressed concern about the lack of access to family planning methods, which forces women to use less preferred options due to unavailability.
Dr. Amongin notes that within just six months to a year of using contraception, some women encountered issues and switched methods. This highlights the need for the Ministry of Health to improve the availability of various contraceptive options. A rights-based approach to contraception ensures that women have access to a range of methods, preventing situations where desired options are unavailable at health facilities.
“Stockouts are a significant issue, and this extends to parliamentary discussions on health sector budgets. As we focus on human capital development and improving maternal and newborn health outcomes, we must consider crucial components like preventing unwanted pregnancies through family planning. The budget allocation for the health sector directly impacts this issue. When women cannot access their preferred contraceptive methods due to stockouts, it reflects a failure in our legislative and budgeting processes. This situation forces women to switch to fewer desirable methods, which is not acceptable,” says Dr. Amongin.
Adding that; “These are things we need to continue discussing as a country but we must invest into family planning. We can talk about human capital development but until we step up and actually support women to prevent unwanted pregnancies, support them in their decisions of whether she wants to use a method for contraception or not. That is her choice. We must make sure access to the methods of her choice is actually addressed.”
Dr. Amongin’s comments follow a recent study on the I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023. The study highlights that social support significantly improves women’s ability to make informed contraceptive choices, potentially leading to better reproductive health outcomes.
Part of the Innovations for Choice and Autonomy (ICAN) project, the study shows that self-injection with DMPA-SC (Sayana Press) could increase contraceptive use, especially among women with limited access to healthcare. Despite the rollout of this method in 2017, its use remains low in Uganda. Sayana Press as popularly known is a subcutaneous depot medroxyprogesterone acetate (DMPA-SC). It is a hormonal birth control shot, administered under the skin and is an all-in-one contraceptive that puts women in charge of their reproductive health.
Social support boosts self-efficacy, enhances privacy, and reduces access barriers, making self-management easier. Family planning helps manage the number and timing of children, lowering maternal and infant mortality rates and reducing complications from pregnancy. Conversely, unmet contraceptive needs can lead to unintended pregnancies and their associated risks.
In Uganda, 52% of pregnancies are unwanted or mistimed, with over 43% due to unmet family planning needs. The country’s youthful population complicates the issue, with 50% under 17 years old, at least according to the recent National Population Census. Notably, 10% of girls, one in every 10 girls you encounter, has already had sex before she turns 15 years, and 20% of boys, two in 10 boys have engaged in sexual intercourse by the same age.
Methods of contraception include oral contraceptive pills, implants, injectables, patches, vaginal rings, intra uterine devices, condoms, male and female sterilization, lactational amenorrhea methods, withdrawal and fertility awareness-based methods.
Global statistics show that 77.5% of women aged 15–49 had their family planning needs met with modern methods in 2022, up from 67% in 1990. In sub-Saharan Africa, the proportion of women who have their need for family planning satisfied with modern methods (SDG indicator 3.7.1) continues to be among the lowest in the world at 56 per cent. Nevertheless, it also increased faster than in any other region of the world, having more than doubled since 1990, when this proportion was only 24 per cent.
Among 1.9 billion women of reproductive age (15-49 years), an estimated 874 million women use a modern contraceptive method and 92 million, a traditional contraceptive method. The number of modern contraceptive users has nearly doubled worldwide since 1990 (from 467 million). Yet, there are still 164 million women who want to delay or avoid pregnancy and are not using any contraceptive method, and thus are considered to have an unmet need for family planning.
Slow progress is due to factors like limited method choices, restricted access, fear of side effects, cultural opposition, and gender-based barriers.
Between 2015 and 2019, there were 121 million unintended pregnancies annually worldwide – 48 per cent of all pregnancies. Despite decreases in the rate of unintended pregnancy in all regions over the past three decades, nearly one in 10 women in sub-Saharan Africa, Western Asia and Northern Africa, and Oceania (excluding Australia and New Zealand) continue to experience an unintended pregnancy every year
In Uganda, where healthcare services are stretched thin and women juggle numerous responsibilities, accessing contraceptives can be challenging.
Dr. Amongin emphasizes that self-injection methods like DMPA-SC, also known as Sayana Press could ease the burden on women facing long queues and logistical challenges at health facilities. “This method allows for discretion and reduces the need for frequent visits, which is crucial for women with busy lives,” she says.
Researchers argue that the health sector’s budget should include substantial funding for family planning. The high cost of inaction is evident: neglecting family planning leads to unplanned pregnancies, which ultimately burdens families and the nation. Addressing this issue early in the life cycle is crucial to prevent these long-term consequences.
“This is the gist of the matter behind all our research, that a woman’s preference needs to be respected. The health facilities must stock commodities so that when a woman is in need, she actually gets it,” noted Dr. Amongin.
Dr. Peter Waiswa, an Associate Professor at MakSPH, stresses the importance of informed choice in family planning. ICAN studies across Kenya, Malawi, Nigeria, and Uganda show that self-injection benefits all women, including young adolescents. “Supporting young people to make informed choices helps prevent unintended pregnancies,” says Prof. Waiswa.
“We spent four years trying to understand which women benefit from injecting themselves. And we found that all women benefit from it, including younger children. Because younger children in Uganda, whether we hide our heads in the sand or not, especially those 12 years and above are having sex and some of them using contraceptives,” Professor Waiswa says.
What is factually true is that by age 18, 60% of Ugandans have reported having sexual intercourse. Despite the benefits, dropout rates from family planning methods remain high due to side effects and lack of support. Dr. Waiswa also, a Public Health specialist, critique and dreamer for better health systems for mothers, newborns and children in Africa calls for better education and support to address these issues.
“As a way of being supported in a safe space whereby people are not asking questions, they are not fearing parents, they are not fearing other people, then they can use the methods. What we did in Mayuge and Oyam, we trained women who are users of family planning. To identify people who need to use family planning but are not currently using and then they go and see whether they can use or not. And we found that when people are supported, those groups which are currently not being reached can be reached by family planning,” argues Prof. Waiswa.
A 2021 study found that contraceptive discontinuation significantly impacts the effectiveness of family planning services, leading to higher fertility rates, unwanted pregnancies, and induced abortions.
Analysis of data from PMA 2020 show that 6.8% of women discontinued contraceptive use, with discontinuation linked to factors such as age, marital status, method type, and health concerns. The study suggests prioritizing interventions to encourage contraceptive use among young people and promoting partner involvement and awareness, as many contraceptive methods are not discreet.
Prof. Waiswa is concerned of the high dropout rate from family planning methods, where many women discontinue use due to side effects, a need for better education and support.
“We need to see how to educate women so that they are informed when they are choosing a method to use. They need to have enough information because when they discontinue, the method can be ineffective, can cause side effects, but also these methods are expensive, so they waste money. There are a lot of those who change to other methods. We are learning a lot on the use of family planning why we still have a large unmet need,” says Prof. Waiswa.
Ms. Roseline Achola, Technical Specialist for Sexual and Reproductive Health and Self-Care at the Ministry of Health, hailed the MakSPH study on self-injection contraception. She noted that the findings will help her enhance support for self-care initiatives. However, she expressed that only 29% of women willing to self-inject as indicated in the study is still low, highlighting a need to address barriers to increase acceptance as well as managing sexually active adolecents. “We must discuss how to handle minors seeking contraception to prevent unintended pregnancies,” she says.
On Friday August 23, 2024, the Daily Monitor reported, an increase in young girls adopting family planning to combat teenage pregnancies and school dropouts. Quoting data from the Uganda Health Information System, statistics show that between March 2023 and March 2024, 2,476 girls under 15 had their first antenatal care visit, and 1,755 gave birth. The highest number of pregnancies among this age group was in Oyam district.
In this period, Lango subregion saw 52 pregnancies among this age group, with Oyam district recording the highest at 10 cases. The 2021 UNFPA fact sheet indicates that Busoga region, particularly Kamuli and Mayuge districts, has the highest rates of teenage pregnancies, with 6,535 and 6,205 cases respectively.
“As the country, it’s clear that adolescents are limited to access to contraception because of so many reasons. For us as a Ministry, any woman between the age of 15 to 49 is a woman of reproductive age and that tells you that she is capable of getting pregnant and when such a girl of probably 15 years goes to a facility to seek for contraception, it rings a message that actually she is sexually active. So how do we handle her? So that is a matter of discussion for the country.
It is a matter that the nation needs to decide on, because we all know the girls are getting pregnant, the girls want to use contraception, but they have no access because of the fact that they are children,” wondered Achola.
Unintended pregnancies and Uganda’s abortion paradox
Abortion in Uganda, is largely illegal except in specific circumstances. It contributes to maternal death due to unsafe practices. Between 2010 and 2014, WHO reported that 30.6million abortions conducted were safe and 25.1million were unsafe. 97% of these occurred in developing countries. In East Africa, the total number of abortions per year according to the Lancet are around 2.65million.
The Ministry of Health’s HMIS data show a rise in abortion cases, with 96,620 reported between July 2020 and June 2021in both government and private health facilities.
Another recent study on the quality of post-abortion care by MakSPH researchers Assoc. Prof. Lynn Atuyambe, Dr. Justine Bukenya, Dr. Arthur Bagonza and Mr. Sam Etajak highlights the need for accurate post-abortion care data to improve healthcare planning and policymaking.
Dr. Arthur Bagonza, a Public Health Consultant and Research fellow with specialization in health systems at MakSPH and one of the uality of post-abortion care has called for accurate abortion data to improve healthcare planning and policymaking. He notes that health workers often avoid documenting abortion data due to legal fears and calls for reforms to restrictive laws to ensure accurate reporting without legal repercussions.
“All assessed health facilities reviewed in our study achieved a 100% timeliness rate for report submissions. However, significant disparities were observed in data accuracy between different levels of health facilities, with lower-level facilities (HC IIs and HC IIIs) showing higher rates of data discrepancies,” says Dr. Bagonza.
According to Dr. Amongin, the high incidence of early sexual activity among Uganda’s youth is a pressing public health issue.
“We know as a country many women continue to die following unsafe abortions; abortions for pregnancies that they did not want. And these abortions are highest among adolescents and also other women categories.
We would want to ensure that we actually enhance access to contraceptives, but making it easier for them to have it and putting the power in the hands of a woman to as much extent as we can. So that a woman can practice what we call self-care, but of course she also will need the support of the healthcare system. But we want this power in women’s hands because of all the challenges that the women actually can encounter in accessing these methods,” she said.
On her part, Achola insists that abortion should not be a last resort for women and urges them to abstain or use protective means in order to avoid unwanted pregnancies. She notes that as long as abortion remains illegal in Uganda, many health workers will avoid addressing it, leading people to unsafe alternatives.
“I can’t be happy because abortion means we have failed to give people a method of their choice to prevent that pregnancy. Or the people are not able to access contraception to prevent unintended pregnancies. Abortion is not the last resort, it’s not a solution because it has its own complications as well,” says Achola.
Despite this, Achola, notes most of the women who walk in health facilities with post-abortion complications must be attended to. “Whereas we don’t encourage people to do abortions, as Ministry of Health we are mandated to handle all complications for anyone who walks in our facilities because our priority is to save life. We want to urge women to avoid certain things. Why should you wait for unintended pregnancy to occur and then abort?”
Dr. Charles Olaro, a Senior Consultant Surgeon and the Director Health services – Curative in the Ministry of Health highlights the financial burden on individuals seeking health services and suggests exploring private sector opportunities and community-based approaches to improve access. “We need to balance values and rights while addressing access barriers,” he notes.
According to Dr. Olaro, the autonomy and agency of women in sexual and reproductive health, particularly in African cultures remain a challenge where social norms may require women to defer decisions to their partners.
He notes that there is a high burden of abortion and self-harm, with a significant portion of maternal mortality attributed to sepsis, which is often a result of unsafe abortions in Uganda.
“We still need evidence to ensure that access barriers are addressed. And this is a question I keep on asking Makerere University, yes, we have a young population but how are these people accessing contraceptives. Other issue we have to deal with is complex. I know we have to do a balance between values and rights, but we will be able to look at that when they gain the success to do it.”
Dr. Olaro points out that individuals often face a financial burden in health services, spending more on prescriptions than on the medications themselves. He suggests exploring private sector opportunities and a community-based approach to improve access to healthcare.
NB: The PMA surveys are spearheaded by Associate Professor Fredrick Makumbi and Dr. Simon Kibira of MakSPH, with support from the Uganda Bureau of Statistics and the Ministry of Health. The initiative also receives funding from the Bill & Melinda Gates Foundation, The Children’s Investment Fund Foundation (CIFF), and is supported by the Bill & Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins University and Jhpiego.
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