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
Call for Abstracts: 2nd East African Symposium and Expo on Trauma, Injuries, and Emergency Care – 2025
At a ceremony held on 30th May 2025, themed ‘They taught us without saying a word’, the Makerere University College of Health Sciences (MakCHS) commemorated the silent teacher which are the cadavers (bodies) used in anatomy classes for medical students. In addition to a commemoration service, the event was used to create awareness and sensitise the public about the the importance of whole body donation.
The chief guest at the commemoration was Professor Mukadasi Buyinza, Deputy Vice Chancellor – Academic Affairs representing the Vice Chancellor, Professor Barnabas Nawangwe. The event attended by MakCHS students, staff and alumni was organised by students under Anatomy Society of MakCHS supported by Department of Anatomy and MakCHS leadership.
Welcoming guests to the event, Waziwu Mordecai–final year student of medicine and surgery who serves as President of the Anatomy Society, MakCHS explained that the reason for the gathering is three-pronged: to commemorate the silent teachers who make a profound contribution to medical education; to instill knowledge, compassion, and professionalism in future healthcare providers; and call on the community to support this noble act through awareness, advocacy, or future donation. ‘May the memory of our silent teachers live on in every life we will one day save’, he said.
The Anatomy society was founded in 2013 with aim of students providing peer mentorship to fellow students in lower years, such mentorship sessions help students appreciate better the anatomy of the human body. The society has supported:enhanced learning and mentorship; promoted academic participation including internal and external quizzes; and fostered connections including strengthen relationships between students across classes and with alumni.
Professor Elisa Mwaka, Head – Department of Human Anatomy welcomed all present for attending the ceremony. He thanked the College management led by the Principal, Professor Bruce Kirenga for the support provided in organizing the ceremony. He also expressed utmost appreciation to the Vice Chancellor for attending despite the competing priorities requiring his attention.
Professor Mwaka highlighted that we are here today, to pay our respect to the individuals whose bodies have been used for medical examination and research at MakCHS through offering prayers as well as sensitize people about willful/consented whole body donation.
Professor Mwaka explained that globally, sources of whole bodies for medical education and research are got through willed whole-body donation, unclaimed bodies in hospitals, imported bodies, executed persons among other means. In Uganda, unclaimed bodies in hospitals are used for medical as determined by the Uganda National Rules in the Penal Code Act of 1957.
In 2012 International Federation of Anatomy Associations (IFAA) recommended voluntary donation as the desirable and the only acceptable source for acquiring bodies. Almost all Africa countries and some European countries lack national body donation programs.
Speaking at the event, Professor Bruce Kirenga, Principal – MakCHS thanked Professor Mwaka for the insightful presentation. He welcomed Professor Buyinza to MakCHS and for accepting to attend despite the late invitation. He recognized the presence of the staff present and support towards the college activities.
Professor Kirenga underlined the importance of biomedical science under which human anatomy falls in medical education. ‘Biomedical sciences play a key role, once someone in grounded in the area, then he will be a good doctor’, he said.
The Principal also stressed that during his term of office operation efficiency will remain key ingredient for service delivery as well as rebuilding and rehabilitation of teaching and learning facilities. ‘Works to make the Biochemistry laboratory a model lab has commenced with a contract awarded to service provider; the refurbishment will be in phases’.
Professor Buyinza Mukadasi thanked the College, Human Anatomy department and the students for organizing the commemoration. ‘The amount of joy I have this morning, we should have done this a long time ago’, he said.
He expressed happiness at this commemoration for the silent teachers who unknowingly give so much to medical education and therefore mankind. He advised that community engagement to create awareness about the need for whole-body donation, regulatory compliance, and alignment to best practices.
He noted that disciplines like medicine is more like charity because medical practitioners give so much of themselves. ‘The number of people attending this ceremony is show of love for the discipline and commitment to the calling’ he said.
Professor Buyinza reiterated the commitment of Makerere University management to support MakCHS endeavours including this culture of commemorating the silent teacher. ‘Well-trained and season doctors are a result of the process explained here and the absence of bodies affects the quality of education provided and therefore the doctors produced’, he added.
Candles for the cadavers were lit and services representative of Anglican, Catholics and Muslims were conducted to remember the souls of the departed and wish them a peaceful rest. Ordinand Cosmas Ddembe for Anglican, Father Valentine Amuneke for Catholic and Dr. Haruna Kiryowa for Muslim preached the importance of respect for the dead and sacrifices of the dead for advancement of research and education in the medical field and health services.
Giving closing remarks, Professor Mwaka noted that setting up whole-body donation programs in Africa requires a holistic approach involving education, cultural sensitivity, legal structures, and partnerships with medical institutions.
Reasons why Africa has failed to establish body donation programs:
- Low awareness and willingness to donate bodies.
- Cultural and traditional beliefs
- Religious beliefs
- Fear of mishanding bodies
- Lack of legislation/ ambiguous regulations
- Lack of institutional policies and standard operating procedures
- Institutions should be encouraged to hold Services of thanksgiving or commemoration for those who have donated their bodies for medical education and research.
The following is required to change the current status:
- Cultural sensitivity and awareness
- Community engagement and awareness creation
- Educational campaigns
- Developing legal and ethical frameworks
- Building partnerships between hospitals and medical institutions
- Establishing local body donation systems i.e.,
- donation registration process,
- consent documentation,
- Logistical infrastructure necessary for the
- donation process.
- Effective communication, public trust,transparency.
- Training and professional development of healthcare providers.
- Global collaboration and funding: to share knowledge, best practices, and resources.
- Government support
- Funding and incentives
- Inclusion of body donation in national health strategies.
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