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.
On August 20, 2025, Makerere University School of Public Health (MakSPH) convened a timely workshop on Strengthening Equitable Partnerships in International Research Collaboration in Uganda. Held at the MakSPH Auditorium, the event brought together researchers, policymakers, and institutional leaders to reflect on how Uganda, and indeed the wider region, can engage more effectively and derive greater benefit from global research collaborations.
Delivering the keynote address, Prof. David Musoke Serwadda, a Professor Emeritus at Makerere University and a globally recognised HIV researcher and epidemiologist, urged a rethinking of how international research partnerships are structured. A former head of the Institute of Public Health (IPH) and later Dean of the School, serving between 2003 and 2009, Serwadda is also the founding director of the Rakai Health Sciences Programme (RHSP), which is one of Uganda’s most influential research initiatives on HIV. While acknowledging the many benefits Uganda has gained from global research collaborations, he cautioned that too many times, these partnerships remain transactional, shaped by donor priorities, bound to project cycles, and offering limited long-term value to local institutions once projects close.
Prof. Serwadda, himself a globally recognised and well-accomplished researcher, with over four decades of experience and numerous awards for his contributions to science and global health, observed that Ugandan partners are many times included in research projects for visibility rather than substance, often excluded from core roles such as Principal Investigators or from influencing agenda-setting, budget control, and authorship. “Partnerships are not an end in themselves; they exist to help us achieve mutually agreed objectives built on shared responsibility and reciprocal obligations. Too often, Southern institutions are brought into projects late, simply for optics. That is not equitable collaboration,” he insisted.
During his talk, he stressed that this imbalance undermines both research quality and sustainability, noting that normally, when local researchers are sidelined, studies often fail to align with national priorities or build capacity that endures. By contrast, partnerships that are grounded in mutual respect, fair resource sharing, co-design, and shared decision-making have the impact of producing knowledge that is globally relevant and locally impactful.
“Equity in partnerships is about fairness, ensuring that all partners, regardless of context, can contribute meaningfully. This also requires responsibility on our part in the Global South. We must insist on involvement from project conception, negotiate fair terms, and strengthen our own systems to manage collaborations effectively,” Prof. Serwadda advised, emphasising that strong institutions, clear strategy, agenda and objectives are key for local institutions to engage in mutually fair and beneficial research collaborations at the global and continental stage.
As Director and later Dean of MakSPH, Prof. David Serwadda spearheaded numerous research collaborations and attracted substantial grants that elevated the School and the University’s global standing. Today, MakSPH is recognised as Makerere University’s flagship unit for its wide-ranging partnerships and robust research management systems. Since its beginnings as a small Department of Preventive Medicine in 1954, through its transformation into the first Institute of Public Health in sub-Saharan Africa in 1975, its elevation to School status in 2007, and most recently its reinstatement as a standalone School with college status within Makerere University in January 2025, a status first granted in 2001, MakSPH has built a 70-year legacy of advancing public health through research, training, and policy engagement.
The School’s evolution, as often couched by its leadership, has been anchored on strategic and strong partnerships. These collaborations, be they local, regional or global, have driven health systems innovation, strengthened capacity, and informed policy, making partnerships the cornerstone of the School’s past achievements and future ambitions. At the celebration of the School’s 70th Anniversary, marked in December 2024, Makerere University Vice Chancellor Prof. Barnabas Nawangwe hailed MakSPH’s research output, community impact, and strong partnerships cultivated throughout the years. The Mak VC cited the School’s pioneering role in the HIV response led by Prof. Serwadda in the 1980s, the establishment of nutrition centres such as the Mwana Mugimu Unit at Mulago Hospital and across Uganda by the late Prof. John Kakitahi in the 1990s with support from Rotary International, and community projects like Kasangati Health Centre along Gayaza Road with support from the Rockefeller Foundation in the late 1950s, which advanced public education on healthy environments and wellness.
“The School of Public Health brings in almost half of all research grants at Makerere University, both in number and value, and these partnerships have been central to tackling Uganda’s public health challenges. From pioneering HIV/AIDS work that shaped global prevention strategies to interventions in maternal health, malaria, and infectious diseases, MakSPH has consistently combined academic excellence with community service. Its leadership during the COVID-19 pandemic further showed its ability to respond to national health emergencies with evidence-based solutions that directly benefit the people,” Prof. Nawangwe said with gratitude for the work done by the School through collaboration.
In 2024, the School had over 350 peer-reviewed publications in high-impact international journals as a result of this wide network and partnerships. MakSPH currently maintains a strong mix of North–South and South–South collaborations. Within the continent, the School is actively working in more than 25 countries, often partnering with multiple institutions within individual countries to advance research, capacity building, and policy influence. One such recent collaboration is the Partnership to Enhance Technical Support for Analytical Capacity and Data Use in Eastern & Southern Africa (PERSuADE) Project, funded by the Global Fund. Under PERSuADE, MakSPH, the prime grant recipient, hosted the secretariat led by Dean Prof. Rhoda Wanyenze as Principal Investigator, tasked with overall coordination across 12 countries, while a Steering Committee chaired by Prof. David Serwadda provided oversight.
PERSuADE was implemented in two phases between 2018 and 2023. The project brought together 12 universities and 12 Ministries of Health in East and Southern Africa to strengthen analytical capacity and promote data use in national health programmes, cascading skills to districts and lower facilities. In its second phase, the project trained over 1,500 health staff, including 934 at the sub-national level, in data analysis and use, and generated more than 80 analytical outputs on HIV, TB, and malaria. These informed National Strategic Plans in seven countries and improved programme strategies in all 12. Sixteen in-service staff from seven countries received specialised training in HIV key population surveillance, health information systems, and data use. The project also piloted the Maturity Index Model in five countries, helping ministries track progress in institutionalising data-driven decision-making.
In Uganda, the PERSuADE project was implemented in Kiboga, Buikwe, Kasanda, Mukono, and Mityana districts, selected by the Ministry of Health. According to the Principal Investigator, Prof. Rhoda Wanyenze, strengthening data analysis and use has greatly enhanced the capacity of Ministries of Health to deliver targeted interventions that directly benefit communities. She noted that improved analytical skills at national and subnational levels now enable ministries to identify disparities in HIV, TB, and malaria burdens, while district and facility health workers can use data to strengthen local service delivery. “With better data, districts can plan more efficiently, allocate medicines, and implement tailored prevention campaigns to address specific risks, raise awareness, and reduce new infections,” she said, emphasising the role of equitable collaboration as a key success factor in Uganda and across the continent for this partnership.
Indeed, during a learning visit to Uganda in September 2024, Dr. Estifanos Biru Shargie, Senior Specialist for Monitoring, Evaluation, and Country Analysis at the Global Fund, commended the PERSuADE Project for strengthening local capacity and fostering sustainable health system improvements through South-South partnerships among schools and ministries. “The impact has been significant. In Kiboga, I was impressed by how teams mapped gaps in services and addressed them over four years, using data to inform decisions and monitor progress. Working with Makerere University School of Public Health has been an honour. The School blends academic excellence with practical implementation, backed by strong financial management and a long-standing relationship with the Ministry of Health. Their coordination, networking, and efficiency have been exemplary,” Dr. Shargie said.
Another currently ongoing initiative at the School is the African Leadership and Management Training for Impact in Malaria Eradication (ALAMIME) program, led by MakSPH with ten participating institutions across nine malaria-endemic countries, funded by the Bill & Melinda Gates Foundation. Co-led by Prof. Elizeus Rutebemberwa and Prof. Dosithée Ngo Bebe, ALAMIME is cultivating the leadership Africa needs to defeat malaria by strengthening institutions, building capacity, and fostering regional networks. In 2024 alone, the program trained over 250 participants, nearly half women, from national malaria programs, ministries, and NGOs. Through structured training, alumni-led webinars, and cross-country exchanges, the program has demonstrated how equitable, multi-country partnerships translate investment into sustainable systems and shared momentum toward malaria elimination.
For nearly 15 years now, MakSPH has also hosted the NTU–Mak Partnership, a collaboration between Makerere University and Nottingham Trent University, first conceived in 2010, with Assoc. Prof. David Musoke and Prof. Linda Gibson as the Uganda and UK Co-Leads. One of the key reasons for the success of this partnership is equity, and it has since attracted over £1.4 million in grants, trained more than 900 Village Health Teams in Wakiso District, supported over 350 practitioners in antimicrobial stewardship, and facilitated exchanges for more than 200 students and faculty. It has also equipped community health workers to respond to non-communicable diseases, antimicrobial resistance, and the COVID-19 pandemic, while generating over 30 peer-reviewed publications and convening global platforms such as the first International Community Health Worker Symposium, held in Kampala in 2017.
Dr. Musoke, the Co-Principal Investigator for the project on strengthening equitable research collaborations in Uganda, described the NTU-Mak partnership as a model North–South partnership that has produced both joint scholarship and lasting institutional ties. He noted that its success has inspired wider collaborations, as the current project on equitable partnerships builds on this foundation. Emerging from a British Academy regional workshop in Nairobi in 2024, MakSPH extended its engagement to Mountains of the Moon University (MMU), Uganda Martyrs University (UMU), and the National Agricultural Research Organisation (NARO). Together with Nottingham Trent University, these institutions are now advancing reforms to embed equity in research partnerships across Uganda’s research ecosystem.
Health
Mak and UNICEF Uganda Sign MoU to Strengthen Child Rights through Research, Training, and Innovation
Makerere University (Mak) and United Nations Children’s Fund (UNICEF) Uganda have signed a Memorandum of Understanding that launches a two-year, renewable partnership aimed at advancing child rights and well-being through rigorous research, capacity building, and policy-driven innovation.
The agreement was signed on Thursday, 14 August 2025, by Makerere Vice Chancellor Professor Barnabas Nawangwe and UNICEF Uganda Representative Dr. Robin Nandy in the Vice Chancellor’s Boardroom at Makerere’s Main Building.
The MoU enlists a focused collaboration on generating child-focused data and research to inform policy and program design, analyzing how health, nutrition, education, and protection initiatives affect children, and strengthening the social sector workforce through targeted training, curricula, and performance standards.
It also emphasizes knowledge management, wide dissemination of findings to stakeholders, policy and legislative advocacy for child rights, and active student engagement through internships, skilling opportunities, and communities of practice. The renewed partnership is designed to bolster evidence-based policy-making and drive program improvements that contribute to Uganda’s progress toward the Sustainable Development Goals by 2030.
“The signing of this MoU deepens Makerere’s long-standing commitment to the well-being of Uganda’s children and Africa’s future,” said Vice Chancellor Nawangwe. “I thank Dr. Nandy for his leadership and for the continued collaboration that will expand our capacity to deliver research with immediate, practical benefits for communities.”
UNICEF’s Dr. Nandy stressed that the partnership reflects UNICEF’s global mission to protect and promote every child’s rights while translating research into policy and action. He highlighted Makerere’s proven strength in research leadership as a critical asset in the effort to generate robust evidence for government decision-making and resource allocation.
“This partnership shows our commitment to combine academic knowledge with practical results,” said Dr. Nandy. “Using Makerere’s research skills to create important information about child welfare issues and solutions, making sure that every project we start is based on solid data and aims to safeguard and support children’s basic rights.”
The partnership builds on Makerere University’s established research strengths and UNICEF’s global mandate to protect children. It complements longstanding collaborative work through Mak’s School of Public Health (MakSPH) and other faculties, reinforcing a broader university-wide commitment to evidence-based policy and community impact.
Since 2016, Makerere has participated in more than 30 UNICEF-supported research projects, which emphasize a deep mutual trust and shared mission. The Vice Chancellor noted that this history laid a robust foundation for the new MoU while also underlining opportunities to broaden collaboration beyond the health sector.
Among the notable prior initiatives is MakSPH’s joint work with UBOS and UNICEF, supported by EU funding, on the first comprehensive Food Security and Nutrition Assessment in ten districts of Northern Uganda and the West Nile region (2019). The findings of this work informed targeted nutrition programs and strategies to combat malnutrition among vulnerable populations, shaping policy directions at local and national levels.
In 2023, MakSPH, in collaboration with the National Planning Authority (NPA) and UNICEF, along with FHI360 and the Ministry of Health, produced an updated Situation Analysis of Newborn Health in Uganda. The document has guided the ministry’s national strategy development, including costed investments to improve newborn health across the country.
Professor Rhoda Wanyenze, Dean of MakSPH, hailed the partnership as a continuation of a long-standing relationship, noting that UNICEF’s support was instrumental in establishing the Makerere University Centre of Excellence for Maternal Newborn & Child Health (MNCH) in 2013.
“It’s such a delight, a great honor to finally get to this event where we can formalize our partnership with UNICEF. The partnership between UNICEF and Makerere has been a long-standing one, and we have worked together for decades, which has driven critical research and informed national policies,” she said. She emphasized that both institutions share a passion for tackling adolescent health challenges, particularly early pregnancies and marriages, which remain persistent barriers to progress.
The MoU extends collaboration beyond the School of Public Health. The Vice Chancellor noted productive partnerships across other departments, including the Department of Journalism and Communication and the College of Humanities and Social Sciences, emphasizing how diverse disciplines can contribute to evidence-based policy and community well-being.
Another important example is the Caring for the Caregiver (CFC) intervention led by the Makerere Institute of Teacher Education and Research (MITER) in the College of Education and External Studies (CEES). This was implemented in partnership with the Ministry of Health, UNICEF Uganda, and international partners. The evaluation examined caregiver emotional wellbeing, social support, and parenting stress in rural Uganda, contributing to the growing evidence base for nurturing care in resource-constrained settings.
Also, the School of Statistics and Planning in the College of Business and Management Sciences (CoBAMS) has partnered with UNICEF to tackle urgent socio-economic and public health challenges. A key example is the Socio-economic Impact Assessment of the 2022 Ebola Virus Disease outbreak in Mubende and Kassanda districts, which examined household-level shocks, community coping strategies, and the wider disruption of livelihoods. The study’s findings have informed national policy dialogue and action planning, emphasizing that there must be stronger preparedness measures.
According to the Vice Chancellor, the university’s broader engagement with UNICEF as a driver of research, innovation, and community outreach benefits children and families throughout Uganda.
For Dr. Nandy the partnership will support student involvement in real-world operational and programmatic work, creating pipelines for young scholars to contribute to child welfare initiatives.
Both parties expressed a shared vision of translating research findings into concrete actions that strengthen child protection and opportunities for learning and development. The collaboration is expected to yield new efforts for effective interventions, sharpen the policy dialogue, and catalyze scalable innovations that improve the daily lives of Uganda’s children.
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