Health
Dr. Achola’s PhD Study Uncovers Family Planning Barriers in Adjumani refugee hosting district
At precisely 10:53 AM, on 14th January 2025, the air in Freedom Square buzzed with anticipation as Dr. Crispus Kiyonga, Chancellor of Makerere University, delivered the life-changing words: “By virtue of the authority entrusted to me, I confer upon you a degree of Doctor of Philosophy of Makerere University.” In that moment, Miss Achola became Dr. Achola, a title that resonated deeply with her sister and father, Ms. Evelyn Nyafwono and Mr. Owino Vincent Olele, who stood nearby joyfully with open arms to receive her.
As Achola bagged her doctoral award, she walked majestically toward her excited lecturers and mentors, who eagerly queued to congratulate her. Her sister, Evelyne Nyafwono, and father, Mzee Owino, could hardly contain their excitement. The rhythmic beats of the cultural ensemble filled the air with celebration, while the vibrant melodies of ethnic music and dance, expertly crafted by Dr. Milton Wabyona and his talented team, wove around her. Each step she took was a heartfelt tribute to her journey, a celebration of hard work and achievement that enveloped her in warmth and joy.
Yet, as Dr. Achola reveled in her triumph, a bittersweet shadow hung over her heart. Her beloved mother, Veronica Abbo Owino (RIP), who had always been her greatest supporter, was not there to share in the joy, having passed away midway through her PhD journey.
In the beginning…
Back in time, 2015 was the year. Ms. Roselline Achola, while working with the United Nations Populations Fund as a Technical Specialist for Maternal Health and Reproductive Health Commodity Security/family planning, was charged with the responsibility of ensuring that there is increased access to voluntary information and services to both men and women who need family planning in Uganda and beyond. She was in charge of the Global Program for RHCS.
At the time, as a team leader, she was supervising an assignment that the UN had contracted an expert – Dr. Christopher Garimoi Orach, a Professor of Community Health, to undertake in developing the first family planning costed Implementation Plan for Uganda.
Achola found her motivation for pursuing a PhD, particularly in family planning, due to its cost-effectiveness in improving maternal and child health in resource-limited countries like Uganda.
“We began with the ambitious idea of evaluating the entire family planning program in Uganda, but that proved impossible at the time. I then went silent for two years, not mentioning anything. One day, Prof [Garimoi Orach] called to ask why I was quiet. I explained that I was overwhelmed with UN work and may not manage to juggle with academics. He fell silent too but continued to check on me and offered encouragement,” Achola recalls.
“Why family planning? It was my mandate to ensure the effective implementation of the family planning program in Uganda by supporting the Ministry of Health and implementing partners. I always felt a deep sadness reading about women dying in childbirth while having their 12th or 13th child, knowing that contraception could help them regulate their births and reduce the risk of dying from pregnancy-related complications associated with too many pregnancies,” recalls Achola.
In 2019, she officially enrolled in the PhD program at Makerere University hosted by the Department of Community Health and Behavioural Sciences at the School of Public Health (MakSPH). This was after submitting a concept that was quickly approved, granting her provisional admission. “It wasn’t an easy path though; I remember going nearly a year without progress until my lead supervisor encouraged me to continue working on my proposal. I had almost lost hope due to the demands of my job at the United Nations and had set aside my academic aspirations. This burden weighed heavily on me until I resumed my efforts, ultimately leading to the acceptance of my proposal.”
Inspired by the challenging conditions in Adjumani district in the West Nile region with several refugee settlements—where low family planning uptake and domestic violence related to its use were prevalent—Achola chose to study decision-making around the issue especially in Nyumanzi, Pagirinya and Mirieyi settlements including the surrounding host communities. Her goal was to develop recommendations to address the barriers faced by women and girls in these refugee-affected areas.
Uganda is a leading Africa’s largest refugee-hosting country with more than 1.6 million refugees residing in various settlements established in 12 districts within its borders, as per the latest National Population and Housing Census data from 2024. Adjumani is home to over 250,000 refugees, with more than half of them being female. Here, 1,310 respondents comprising both men and women were involved in the quantitative study.
The major highlight of her research was the low uptake of family planning methods in Adjumani, where only about one-third of the population utilizes modern contraceptives. She explored decision-making processes at individual, family, community, and institutional levels, identifying key factors influencing family planning use.
Her findings show that fear of harassment from family members and concerns about side effects deter many from using contraceptives, while motivations include limiting family size and financial constraints. To enhance family planning uptake, Dr. Achola recommends community outreach strategies to raise awareness about its benefits and promote couple counseling.
“I want to take this opportunity to once again thank SET SRHR for the scholarship that saw progress this far, the Tuition and initial research was supported by SET SRHR. The Mak-RIF support was equally timely because it supported the intervention and evaluation components of my PhD study. Both funds played a big role in enabling me to complete this study and have the achievement today,” says Achola.
While decision-making is a key part of everyday life, Dr. Achola found that it involves complex processes with four dynamic pathways: starting ideas, thinking them through, consulting others, and finally making a decision. Gender dynamics too play a definitive role in contraceptive use, as women often have less power and men typically dominate health decisions.
“I am so excited that my work has resulted in the development of a model for decision-making pathways. These include the idea inception, cognitive process, consultation, and making a decision I sincerely hope that this contribution will enhance the improvement of maternal and child health in humanitarian settings across Uganda and Sub-Saharan Africa, ultimately reducing pregnancy-related deaths associated with the non-use of family planning among both refugee and host populations,” says Achola.
At first, the language barrier stood in her way during her investigation with interpreters often sharing only what refugees wanted to hear instead of her intended messages. “Cultural norms favoring large families made it hard to communicate contraception information. Limited funding also slowed our progress in Adjumani. Although delays in getting my papers published affected my PhD requirements, I’m relieved that it’s finally complete and here we are,” she says.
How her PhD will impact family planning programs in Uganda
Dr. Achola’s research uncovered several key factors influencing contraception use, highlighting a pressing need for targeted solutions. To make a meaningful impact on family planning programs in Uganda, she advocates for community-based strategies that connect people with essential information and services to help them make informed decisions. She views community dialogues and outreach events as vital tools to spark conversations about the benefits of family planning and encourage couples to seek counseling together. “This approach will be instrumental in creating a supportive environment where families can make informed decisions about their health and future.”
With her background as a public health specialist and technical advisor to the Ministry of Health on family planning, she is eager to integrate the four decision-making pathways into all family planning efforts. She recognizes how influential significant others can be in shaping contraceptive choices, whether through encouragement or hesitation. By involving them in the planning process, she aims to develop more effective strategies and hopes her recommendations will be included in the Ministry of Health’s plans, thereby strengthening support for family planning initiatives at every level.
Achola firmly believes that family planning is a cost-effective way for the government of Uganda to reduce maternal and child mortality rates. And that by choosing to space births, mothers bond with their babies and allow themselves time to heal before the next pregnancy, thus allowing their bodies to heal and rejuvenate for the next pregnancy.
“When mothers space their childbirth for at least two years, their health improves, which reduces the risks of pregnancy-related challenges. Babies born with at least a two-year gap have a higher chance of survival than those born less than two years apart,” she stresses.
The next steps…
Achola resonates with the sentiment that “Research never ends.” She recognizes there’s still much to explore in her field and believes her work paves the way for others to examine how culture influences family planning perceptions and practices. This broader perspective can lead to more comprehensive results, with an emphasis on the role of family in decision-making. Achola also imagines future research that will dig deeper into these processes through longitudinal studies with key stakeholders. She also sees the importance of exploring decision-making pathways before applying her findings to larger populations, especially since her study focused on a refugee community in Adjumani, which may differ from other groups in Uganda. For her, the possibilities for further exploration are enormous and stresses that the journey of research is a shared and ongoing adventure. She is, therefore, set to continue with research in this area as a post-doctoral undertaking.
Upon achieving her PhD, Achola feels a renewed sense of determination and purpose in her field. “I will not look back,” she declares with conviction. “I will continue my work in sexual and reproductive health and rights (SRHR) and family planning, where I have developed passion, skills and expertise, positioning me as a leader in this area.”
She is committed to advising government bodies and engaging with the international community and development partners to advance this important field. Additionally, Achola plans to continue teaching in Public Health, nurturing the next generation of specialists and mentoring aspiring doctoral candidates. With her steadfast commitment, she is ready to make a lasting impact, inspiring others to embark on this important journey alongside her.
Health
Makerere-Incubated Safe Bangle Technologies Wins Prestigious World Summit Award for Innovation Against GBV
By Joseph Odoi
In a groundbreaking achievement, SafeBangle Technologies, an innovation incubated at Makerere University, has won the prestigious World Summit Award 2025 for its groundbreaking contribution to the fight against gender-based violence (GBV) in Africa. This remarkable honor comes in recognition of the development and implementation of a real-time domestic violence reporting bracelet.
The award was presented to the SafeBangle team that was represented by Saul Kabali, Messach Luminsa, and Janet Christine Nabaloga from SafeBangle Technologies at the WSA Global Congress in Hyderabad, India, where Uganda’s innovation potential was proudly showcased on a global stage.
The award was conferred in the Inclusion & Empowerment category for Safe Bangle’s cutting-edge solution; a wearable safety bracelet designed to address the pressing challenge of gender-based violence (GBV) across Africa.
The SafeBangle is a smartwatch-like, real-time domestic violence reporting bracelet that allows users to send SMS alerts via a single button press. Its core mission is to create a safer, more secure environment for women and children in Africa through innovative, affordable tech solutions.
According to Saul Kabali and Messach Luminsa, the innovators behind SafeBangle from SafeBangle Technologies, hosted at the Resilient African Network Lab. This award is very timely and a recognition that cements the importance of community rooted technology.
The team further stated that ‘’This award is a powerful affirmation of our mission and refuels our commitment to empowering Ugandan women and girls through innovation and technology. It influences our next steps by opening doors to new partnerships, increasing our credibility, and accelerating efforts to scale the SafeBangle nationally. We’re now more equipped to positively impact the daily lives of Ugandan women and girls through our SafeBangle bracelet.
To further the innovation, the team has called upon government to support the Safe Bangle Innovation
‘’Governments can support us by providing funding, facilitating policy support, and creating collaborative platforms for innovation. NGOs can help with grassroots outreach, and connect us to potential donors and funders interested in solving Sexual and Gender Based Violence amongst vulnerable communities; and tech partners can enhance scalability through infrastructure, data insights, and capacity building.
Moving forward, the team emphasized the importance of uniting innovation, partnership, and purpose to scale impact. “As we empower communities, invest in local solutions, and promote collaboration, we can transform how technology protects and uplifts women and girls across Uganda,” added the award-winning team.
The Story Behind the Safe Bangle Bracelet Innovation
According to the Safe Bangle innovators Saul Kabali and Messach Luminsa , ‘’The inspiration behind SafeBangle came from a deeply personal place. ‘’We heard countless stories of women who couldn’t call for help during moments of danger. We were deeply affected by the story of Aisha, a young woman in a rural village who was attacked while walking home alone at night. With no way to call for help, she felt helpless and vulnerable. This incident made us realize the critical need for immediate reporting alert tools, accessible to women like Aisha. We knew technology could play a crucial role and this incident awakened a strong desire in us to create a solution’’
To Makerere University School of Public Health’s Dr. Juliet Kiguli, who collaborated closely with the team during the rollout of the bracelet, this award is a vote of confidence in the work of Makerere University, whose core function focuses on teaching, learning, community engagement, research, and innovation, all contributing to the university’s efforts in addressing domestic violence.
‘’The award-winning innovation stems from the findings of a longitudinal study led by the Makerere University School of Public Health.
While carrying out a study after the Covid-19 Pandemic, we identified gaps when it comes to reporting and response to Gender Based Violence (GBV) among women in informal settlements. Therefore, we used to incorporate the SafeBangle intervention to solve the problem of lack of affordable and immediate reporting mechanisms for violence using a bracelet that reports violence in real time
We’re excited about the progress so far, and with this recognition, we hope that more like-minded partners will join us to scale this initiative and ultimately help make the world a safer place for all.” Added Dr Kiguli of the Safe Bangle innovation potential
The research team, comprising Dr. Juliet Kiguli (Principal Investigator), Dr. Roy Mayega (Deputy Chief of Party, RAN), and Dr. Agnes Nyabigambo (Study Coordinator), piloted the bracelet under the PEER (Partnerships for Enhanced Engagement in Research) program with support from USAID and the National Academies of Sciences.
A consortium of partners, including SafeBangle Technologies, Makerere School of Public Health/RAN , the Medical College of Wisconsin, and Somero Uganda, implemented the rollout of the Domestic Violence Real-Time Reporting Bracelet. The initiative was supported by USAID and the National Academy of Sciences in Washington, DC. Key contributors to the project included Dr Juliet Kiguli Roy Mayega from Makerere University School of Public Health, Dr. Kelly Robbins, Dr. Lina Stankute-Alexander, Dr. Brent Wells, Dr. Melissa Trimble, and Uganda’s Dr. Gloria Kasozi at USAID. Wisconsin Madison Medical University’s Prof. Julia Dickson-Gomez was also a collaborator.
In terms of the acceptability of the SafeBangle innovation as a solution to GBV, the team has piloted the technology with more than 1,000 users, resulting in a 63% reduction in response times
During the event, SafeBangle Team participated in the “Equity by Design” panel, sharing insights on inclusive technology development with global experts including Dorothy Gordon, Abhishek Singh from India’s Ministry of Electronics and IT, Baroness Beeban Kidron, and representatives from UNESCO and WE Hub.
About SafeBangle Technologies
SafeBangle Technologies is a Ugandan social enterprise hosted at Resilient African Network Lab focused on addressing gender-based violence through innovative safety solutions. The company combines wearable technology with an interactive web platform to provide real-time reporting of violence and physical assaults, even in areas without internet connectivity. Founded in 2018, SafeBangle operates with a mission to make safety accessible and affordable for vulnerable populations, especially women and children.
Health
A Humble Petition from the Marabou Storks of Kampala to His Excellency, President Yoweri Kaguta Museveni
Your Excellency,
We send you warm greetings from the skies above Kampala — from your old, bald-headed friends, the Marabou Storks, or as we are fondly called, the Kalooli. We are not the prettiest of birds, with our wrinkled faces, hunched shoulders, and sharp beaks, but we carry an important duty. Where others see waste and decay, we see purpose. We are nature’s cleaners, recycling what would otherwise rot and cause harm.
Some count us among Africa’s “Ugly Five,” alongside hyenas, vultures, wildebeests, and warthogs, but we take no offense. Beauty was never the Creator’s mission for our mission, but service was. We glide quietly between life and death, keeping the balance, cleaning the mess, and doing the work that must be done.
Today, we come to you not with complaints, but with a plea for partnership, to protect our shared home and ensure a cleaner, healthier Uganda for all. We still remember the day in 2008, Mr. President, when you gave the Uganda Wildlife Authority and the Kampala Capital City Authority instructions to “kindly relocate us” from the esteemed grounds of State House, Nakasero. We don’t harbor angry feelings. Truly. We realized back then, as we do now, that not everyone finds our odd looks or the noble scent that naturally results from a lifetime of cleaning your lovely nation appealing.
Your Excellency, we are modest. And forgiving. We maintained our composure even when we were discussed in Parliament in 2020, when honorable members referred to us as “health threats” and asked that we leave the Parliament gardens. We birds, after all, literally have thicker skin!
We are better citizens now. Thanks to Makerere University‘s kind hospitality, we have discovered a new haven. We express our deep thanks to Vice Chancellor Professor Barnabas Nawangwe for preserving the ancient trees, the very canopies that now provide us with protection, generation after generation. Students here lovingly refer to us as “the real professors of Makerere,” observing us as we keep a watchful eye on campus life with our sage, steady gaze. Some people think it’s a blessing to see a Kalooli before an exam. We take selfies with other people. We have kind of turned into little celebrities, sir. We appreciate the tranquility, love and peace you provided, with your comrade freedom fighters. They bring uhuru to these trees, and our kids pray for you every day for more life.
However, we come before you today not just to reminisce, but to raise important concerns not for ourselves alone, but for the survival of Uganda’s fragile ecosystem.
We are concerned about the growing crisis in waste, plastics, and environmental decay.
Your Excellency, you are a man who loves numbers. Allow us to present some:
- 768 metric tons — that is the amount of food waste produced DAILY in Kampala alone.
- 65% to 79% of solid waste in Kampala landfills consists of food waste.
- The dairy industry in Uganda loses $23 million annually from waste alone, according to the Food Rights Alliance.
- 135,804 tons of plastic waste generated in the Kampala Metropolitan Area recently.
- 42% of that waste remains uncollected, leading to clogged drains, flood risks, pollution of wetlands, and of course, diseases.
- Shockingly, 10% of this waste ends up in Uganda’s precious water systems!
Your Excellency,
It might surprise you but it’s true. Between 2018 and 2021, Uganda produced 12,330 tons of recycled polyethylene (rPET). And that’s not all conservative estimates predict a 91% increase in production between 2022 and 2025, should imports stay the same.
Mr. President, we Marabou Storks have served loyally as your unpaid, unsung environmental officers. While your citizens discard waste carelessly, we fly across the city, scavenging, sorting, and managing organic decay. We are your frontline solid waste managers, yet without uniforms, pensions, or even a simple “thank you.”
We join you in mourning the tragic loss of life that occurred at Kiteezi Landfill. We experienced devastation because the birds that live there consider that place their territory. We directly observed your people’s struggle to survive while they navigated hazardous unstable waste piles. Our deepest condolences go out to the families who lost loved ones and to every Ugandan citizen. The disaster served as a harsh reminder that waste mismanagement impacts people directly beyond just environmental concerns. Working together as environmental custodians we ask you to take action to prevent more deaths from occurring beneath waste mountain piles.
Just for context, Mr. President, since you fondly like science, here is the scientific truth about us
You may recall Dr. Derek Pomeroy and Mr. Michael Kibuule, distinguished researchers at Makerere University, who in 2021 published the history of our kind in Uganda. They noted:
- Over 1,200 nesting pairs once graced Kampala city alone.
- Over 800 Marabous nested at Makerere University.
- Uganda likely hosts the largest urban colony of Marabou Storks in the world.
Dr. Pomeroy and Kibuule should receive Katonga medals because we recognize their devotion to us. They have loved us. Dr. Pomeroy first came to Uganda in 1969 to work in Makerere University‘s Department of Zoology. He developed deep affection for us and demonstrated excellent understanding. He has written affectionately about us. He knows we are innocent. Dr. Pomeroy maintains his affiliation to Makerere University while conducting independent research as both a Zoologist and an ecologist.
Mr. President, in the beginning, our existence was in the untamed savanna. We transitioned to urban areas alongside human development to assist with cleanup duties rather than to create any disturbance. We came to clean up the areas where you discarded bones and waste. Ronald Norman Magill stated that despite being part of Africa’s “Ugly Five,” we remain crucial to ecosystems because our simple and gritty nature is what makes us indispensable. Our role includes feeding on dead animals and decomposing matter to prevent diseases and sustain soil health through silent and selfless recycling of life.
Your Excellency, here are our humble pleas to you, Our President
- Please urge your people to plant trees.
Our homes are disappearing completely. Sky scrapers are popping up everywhere we used to patch. Your Excellency, we merely ask that you recognize our role and protect our habitats; we are not opposed to development. In order to locate nesting sites, we now have to travel a considerable distance between Kiteezi, Lubigi, and the University. For all creatures, feathery, four-legged, and two-legged—healthy trees translate into richer soils, cleaner air, better rainfall, and cooler cities. - Please strengthen plastic waste management.
Your laws Mr. President, the 10-Year Restoration Plan, the National Environment Act 2019, and the Extended Producer Responsibility rules are all positive steps, but laws that do nothing are just as useful as wings on a tortoise. Please advocate for implementation, particularly in the areas of public education on responsible dumping and enforcement. We implore you to encourage your people to stop illegal dumping, sort their waste, recycle, and treat the environment as a gift rather than a trash can. - Please invest boldly in waste infrastructure.
Your Excellency, - If Parliament can enjoy a small patriotic “thank you” of the legendary “100 silver coins” for safeguarding peace, surely a few crumbs can reach us, the Marabou Storks; Kampala’s tireless, unpaid sanitation workers, as a token of national gratitude. Imagine what a few billion shillings for KCCA, for trucks, bins, and civic education could achieve. A cleaner Kampala would mean less wandering for us and less embarrassment for you when tourists meet our noble, bald-headed selves. At least then, we would feast in dignity, not after cross-country marathons over scattered rubbish.
- Support Community Environmental Heroes.
Students, youth, schools, churches, and communities are already doing cleanup drives. Support them with grants, incentives, recognition, and encouragement. Empower a new generation of eco-warriors.
Mr. President, we, Marabou Storks are no longer the nuisance you once sought to relocate.
We are living proof that resilience, adaptation, and hard work can co-exist even in a changing, urbanized world.
All we ask now is for you and your government to join wings with us, birds and humans alike to clean up Kampala, to green Uganda, and to create a legacy that future generations will bless you for.
Let us work together, so that Uganda shines not under mounds of waste, but under canopies of trees, rivers flowing freely, and skies where even the humble Kalooli can soar proudly.
Yours sincerely,
The Marabou Storks of Kampala
The writer is a science and health communicator
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