Between Tuesday, February 24 and Friday, February 27, 2026, Freedom Square at Makerere University will fill with a familiar choreography of anticipation. The air will fill with the rustle of academic gowns, the nervous laughter of graduands, and the careful positioning of proud families searching for familiar faces in a sea of crimson, green, and black. It is a moment of ceremony, yes, but also of reckoning.

Up close, the doctoral gowns feel heavier than they look. The deep crimson fabric, warm and deliberate, settles on the shoulders. Green panels edged in gold are gently pressed against the chest. Wide sleeves gently brush against clasped hands, soft bonnets rest low on foreheads, and tassels remain motionless. Beneath the regalia are steady breaths, quickened heartbeats, and bodies carrying the quiet fatigue of years spent balancing work, study, and life. These are garments worn not only for display but also for endurance, stitched to nights without sleep, to questions carried long before they were answered.

At this four-day Makerere University’s 76^th Graduation Ceremony, 185 doctoral degrees will be conferred. Each PhD will represent years of unanswered questions, interrupted sleep, financial strain, and relentless intellectual persistence. Among them will be Dr. Samalie Namukose, a woman whose academic journey was never separate from the health system she serves, only threaded through it.

For more than two decades, Samalie Namukose has worked inside Uganda’s Ministry of Health, rising steadily from Nutritionist to Assistant Commissioner for Health Services/Nutrition. She has helped write policy, coordinate national programs, supervise districts, respond to emergencies, and advocate for mothers and infants whose voices rarely travel beyond clinic walls. Her PhD did not pull her away from that world but plunged her deeper into it.

The Question That Would Not Let Go

Dr. Namukose’s doctoral journey began not in a library, but in a pattern she kept seeing and could no longer ignore.

Uganda’s nutrition policies are robust. They speak clearly about the importance of maternal and infant nutrition, especially in the first 1,000 days of life. Yet in health facilities across the country, nutrition services often appeared fragmented, present in principle, and inconsistent in practice. Mothers attending antenatal or postnatal care were weighed, yes, but not always counselled. Infants were measured, but follow-up was irregular. Nutrition existed, but it was not always integrated.

“I kept asking myself,” she recalls, “not whether nutrition interventions exist, but how well they are embedded in routine care, and what prevents health workers from delivering them consistently.”

That question shaped her PhD research at Makerere University’s School of Public Health, where she examined the integration of Nutrition Assessment, Counselling, and Support (NACS) into routine health services in the Tororo and Butaleja districts in Eastern Uganda.

At its core, NACS integration is deceptively simple: assess nutritional status at every health point, provide tailored counseling, and link clients to support within the same system and beyond. But in practice, it tests the very backbone of health systems: workforce capacity, financing, governance, supervision, and community linkages.

“When NACS is well integrated, health facilities can identify nutrition risks early, prevent deterioration, and provide timely support rather than responding only when malnutrition becomes severe,” she says.

Inside Resource-Constrained Health Facilities

What Dr. Namukose found was not a clear story of failure or success, but something in between. Many health facilities were offering basic nutrition education and assessments, and health workers were clearly trying their best. However, long patient queues, limited time, and a shortage of basic tools and job aids often hindered counseling and follow-up. Food demonstrations were rare. Growth monitoring was inconsistent. Efforts to improve quality occurred only sporadically.

In facilities without trained nutritionists, nurses, and midwives, already stretched thin, took on nutrition work alongside many other duties, leaving little room to support mothers and children in a steady, continuous way.

And yet, her findings revealed something deeply hopeful: “facilities with knowledgeable, motivated, and supported health workers delivered better nutrition services, even within the same constraints.” To Dr. Namukose, this showed that leadership, mentorship, and attitude mattered. Where nutrition was treated not as an extra task but as essential care, outcomes began to improve.

One of the strongest findings from Dr. Namukose’s research was that even when nutrition services were only partly integrated, they still made a visible difference. Mothers gained weight more steadily during pregnancy and in the early months of breastfeeding. Babies were born heavier and grew better in their first months of life. Across health facilities with more fully integrated nutrition services, children consistently showed healthier growth patterns.

These were not just numbers on a page; babies started life stronger, and mothers were better supported to care for them.

“To me,” she explains, “the improvements in maternal weight gain reflected the value of regular assessment and context-specific counseling. For infants, the better growth outcomes showed that a package of nutrition interventions, delivered consistently, can make a real difference during the most critical window of life.”

It was clear evidence that nutrition integration works effectively, though gradually and significantly.

The Fragility of Progress

Dr. Namukose’s research also exposed how fragile these gains remain. Weaknesses in financing and governance emerged as the greatest threats to sustainability. Nutrition services often depended on unpredictable partner funding rather than routine government budgets. Essential supplies, anthropometric tools, job aids, and therapeutic foods were frequently unavailable or externally dependent.

Her study captured glaring governance gaps that compounded the problem. For instance, nutrition was not always clearly positioned within accountability structures, and this, according to Dr. Namukose, often led to limited supervision and weak performance monitoring. Many districts lacked dedicated nutritionists altogether.

She notes that community follow-up was essential for sustaining behaviour change after clinic visits, especially for those who suffered most. Village Health Teams and care groups struggled without supervision, feedback mechanisms, or resources.

“Most nutrition-related behaviours, such as maternal diet, infant and young child feeding, and care practices, are shaped and sustained within households and communities,” says Dr. Namukose.

She contends that nutrition integration cannot rely on projects but must be embedded in systems.

A PhD Written in the Margins of Life

Conducting this research while holding a senior national leadership role in the Ministry of Health was, by her own admission, one of the hardest things she has ever done.

Dr. Namukose did not request study leave. Partly self-sponsored, she worked full days at the Ministry of Health, then wrote at night, often between midnight and 4:00 am, and again in the early mornings, on Saturdays, and on borrowed hours of Sunday.

“There were days when I sacrificed sleep completely,” she says quietly.

National emergencies such as COVID-19, Ebola, and MPOX repeatedly interrupted her doctoral journey, drawing her back into crisis response. To her, returning to her PhD after each interruption felt like re-entering a conversation mid-sentence, struggling to find the thread.

At one point, she simultaneously prepared for a Top Management Committee presentation, attended a doctoral committee meeting, and sat for Health Service Commission promotional interviews.

“The pressure from the supervisors kept me on my toes. The PhD forum was another motivating factor, consistently sharing updates, books, courses, encouragement, and invitations to PhD defenses. Peer support was tremendous. Without a supportive family, you can’t make it,” she remarks.

A Career That Prepared the Ground

Dr. Namukose’s PhD sits atop a formidable professional foundation. She holds Bachelor’s and Master’s degrees in Agriculture from Makerere University, a Postgraduate Diploma in Food and Nutrition Security from Wageningen University in the Netherlands, and a Postgraduate Diploma in Business Administration from Makerere University Business School. She has undergone extensive training in nutrition leadership, research methods, health systems, and quality improvement across Africa, Europe, and Asia.

Within the Ministry of Health, she has served as a Public Health Nutritionist, Senior Nutritionist, Principal Nutritionist, and now Assistant Commissioner, coordinating national nutrition interventions, designing training modules, mobilising resources, and overseeing district implementation.

She has played key roles in multi-million-dollar initiatives, from HIV-Free Survival programmes to Integrated Child Health Days, public food procurement policy, and the scale-up of Multiple Micronutrient Supplements (MMS) for pregnant women.

Her research has been published in leading peer-reviewed journals, including PLOS ONE and BMC Health, Population and Nutrition, ensuring that her findings speak both to policy and global evidence.

On a mission to keep research from gathering dust

Now a Doctor of Philosophy, Dr. Namukose has determined that her work will not sit quietly on a shelf. Her findings have already informed Uganda’s Health Sector Nutrition Strategic Plan, strengthening the case for financing, governance reform, and recruitment of skilled nutrition cadres. She continues to champion platforms, such as national nutrition symposia, that bring student research into policy dialogue and implementation spaces.

“Very often, excellent student research is left on the shelves. I plan to allocate some days during these symposia to nutrition students to showcase best practices and innovations,” she says.

Adding that, “I urge mothers and their infants to actively engage in self-care, growth-promotion, and monitoring activities to improve their own health and that of their children.”

Central to her recommendations is a call to embed nutrition services within routine health and community systems, with sustained government leadership, financing, and competent human resources.

Integration, she insists, is not achieved by guidelines alone, but through continuous engagement with frontline health workers and communities.

As graduation day approaches, Dr. Namukose’s thoughts turn outward. To frontline health workers delivering nutrition services under pressure, her message is one of respect and reassurance. Even with limited resources, the assessments they conduct, the counselling they provide, and the care they offer can change outcomes.

“Endeavor to participate in training programmes whenever available to bridge gaps in nutrition knowledge and skills, including on-the-job and rotational training to support cost-effective and efficient nutrition service delivery,” she asks.

To mothers and caregivers, she urges active engagement in self-care, growth monitoring, and nutrition programmes, especially those strengthened through digital innovation.

And to policymakers, her research offers both evidence and urgency that nutrition integration is no longer optional but foundational to maternal and child health.

When Dr. Samalie Namukose walks across the stage at Freedom Square, followed by applause, the true weight of that moment lies in health facilities where nutrition is no longer an afterthought. In mothers whose pregnancies are better supported. In infants whose growth curves bend upward, quietly, decisively.

Among the 185 PhDs conferred at Makerere University’s 76^th graduation, the School of Public Health Communications Office shares her story, which is a reminder that the most transformative scholarship is not always loud. It builds patiently, between policy meetings and midnight writing, between emergencies and examiners’ comments, until it transforms systems and lives from within.

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