Kampala wakes early, but for some girls, the day begins already heavy. In Uganda, nearly three-quarters of the population is under 30, growing up happens fast, and often without protection. One in four Ugandan girls aged 15–19 has already begun childbearing, giving Uganda the highest teenage pregnancy rate in East Africa.

Layered onto this is displacement. The country hosts about 1.7 million refugees, many living in cities like Kampala, where survival depends on navigating systems not designed with them in mind. Also, nationally, 1.4 million people live with HIV, and 70 per cent of new infections among young people occur in adolescent girls, a reminder that vulnerability is rarely singular. When COVID-19 shut the country down, the consequences were immediate, with pregnancies among girls aged 15–19 rising by 25.5 per cent, while pregnancies among girls aged 10–14 surged by 366 per cent.

The numbers tell a story of youth, risk, and quiet urgency. But they do not tell it all. For years, Olivia Nakisita, a public health researcher,has followed how adolescent girls, many of them refugees, navigate pregnancy in Kampala: how far they must travel for care, how early they arrive or delay, and how often services that exist fail to meet them where they are. Her work lives at the uneasy intersection of policy and lived reality, where access does not always translate into care.

February 25^th 2026, is the day that her work on whether urban health systems are truly ready for the youngest mothers they now serve will bring her to Freedom Square at Makerere University, where she will graduate with a PhD in Public Health.

Her doctoral journey, focused on maternal health services for adolescent refugees in urban Uganda, has unfolded at the intersection of scholarship, community service, and the daily realities of young girls navigating pregnancy far from home.

The Work That Came Before the Question

Long before she began writing a PhD proposal, Olivia Nakisita was already immersed in adolescent health. As a Research Associate in the Department of Community Health and Behavioral Sciences at Makerere University’s School of Public Health, she taught graduate and undergraduate students, supervised Master’s research, and worked closely with communities. Beyond the university, she led New Life Adolescent and Youth Organization (NAYO), a women-led organisation she founded in 2021 to strengthen access to sexual and reproductive health and rights (SRHR) information and services for adolescents and young people.

It was through this community work that a troubling pattern began to surface.

“During our community service,” she explains, “we noted increasing teenage pregnancies, and we also noted challenges with access to maternal health services by teenage pregnant girls.”

Among those girls were adolescents living as urban refugees in Kampala, young, displaced, often poor, and navigating pregnancy in a city not designed with them in mind.

For Nakisita, the concern deepened through her academic training in Public Health Disaster Management, one such programme that prepares multidisciplinary professionals with the technical expertise and leadership competencies required to plan for, mitigate, respond to, and recover from complex disasters through a public health lens. This programme sharpened Nakisita’s interest in how displaced populations survive within complex urban systems. Uganda’s integrated health model, where refugees and host communities are expected to use the same facilities, appears equitable on paper. In practice, it can be unforgiving.

“I got interested in understanding how these refugees who get pregnant manage to navigate the complexities of integration in host societies like Kampala,” she says. “This was driven by the desire to address their needs and to inform and evaluate existing refugee health policies.”

That desire became the foundation of her PhD.

Asking Hard Questions in a Crowded City

Her doctoral research, “Maternal Health Services for Adolescent Refugees in Urban Settings in Uganda: Access, Utilisation, and Health Facility Readiness,” was conducted in Kampala between November 2023 and August 2024. It combined quantitative surveys with qualitative interviews, engaging 637 adolescent refugees aged 10–19 years, alongside health workers and facility assessments.

Her findings showed high perceived access to maternal health services. Clinics existed. Services were available. Yet utilisation, particularly of antenatal care (ANC), lagged. “About three-quarters of the girls attended at least one antenatal visit,” she explains, “but only about four in ten attended in the first trimester.”

And that gap matters. Public health research shows that early and regular antenatal care allows health workers to detect high-risk pregnancies, initiate supplements such as iron and folic acid, monitor fetal development, and provide psychosocial support. Without it, risks compound silently.

By contrast, her study found that facility-based deliveries were remarkably high, with nearly all adolescent refugees (98.3%) giving birth in health facilities, suggesting that the system was reachable, but uneven.

Where the System Falls Short

Her research went beyond utilisation to examine whether health facilities were actually ready to serve adolescent refugees.

Findings show that lower-level health centres in Kampala were moderately prepared to offer adolescent-friendly maternal health services. Some staff were trained. Some spaces existed. Despite this, critical gaps remained. For instance, facilities lacked essential equipment and supplies. Non-provider staff were often untrained. Separate, private spaces for adolescents were limited. Language barriers complicated care. Overcrowding strained already stretched health workers.

In her qualitative interviews, health workers expressed empathy and willingness to help. Many relied on peer educators and community health workers to reach adolescent refugees. But good intentions were not enough.

“They recommended training of healthcare workers, translators for refugees, and improvement in the availability of essential drugs, supplies, and equipment,” Nakisita notes.

She notes that readiness is not just about infrastructure but about the people, preparation, and priorities.

Research with an Emotional Cost

For Nakisita, working with adolescent refugees required care, not only methodologically, but emotionally.

Finding participants in Kampala was itself a challenge. Unlike settlement settings, urban refugees are dispersed, often invisible. Ethical considerations were constant. Adolescents who had given birth were legally considered emancipated minors, but their vulnerability remained.

Though the thesis focused on systems rather than personal narratives, Nakisita’s earlier work with adolescents informed every decision she made. It shaped how she framed questions, interpreted data, and weighed policy implications. This was not detached research, but careful, deliberate, and grounded.

The Scholar Formed by Continuity

Nakisita’s PhD sits atop more than 18 years of experience in training, research, and community service. She is an alumna of Makerere College School (UCE), 1996 and Greenhill Academy Secondary School (UACE), 1998, a long journey through Uganda’s education system before her Diploma in Project Planning and Management at Makerere University completed in early 2000s.

She would later return eight years later to Makerere University for her Bachelor’s degree in Social Sciences and a Master’s in Public Health Disaster Management, and now a PhD in Public Health.

Her academic rigor is reflected in extensive training across SRHR, impact evaluation, research methods, ethics, disaster resilience, and humanitarian health. She has presented at regional and international conferences and published in peer-reviewed journals on adolescent health, refugee maternal care, gender-based violence, and health systems readiness.

As a PhD student, she supervised three Master’s students to completion, with another currently progressing, quietly extending her influence through mentorship.

When Evidence Demands Action

If policymakers were to act on one lesson from her research, Nakisita says; “Emphasis should be given to maternal health services for adolescents.”  “They are high-risk mothers,” she adds.

Her findings call for targeted community-based interventions, outreaches, home visits, and financial support for adolescents who cannot afford prescribed drugs, delivery requirements, or critical tests like ultrasound scans.

They also call for health systems to move beyond one-size-fits-all models, recognising that age, displacement, and poverty intersect to shape how care is accessed and experienced.

Now that her PhD is complete, Nakisita plans to translate research into action. Several papers from her study have already been published. A policy brief is planned to influence decision-making in urban and humanitarian health settings.

When asked what she would say directly to adolescent refugee girls navigating pregnancy in unfamiliar cities, her response is simple and direct.

“If it happens,” she says, “as soon as you find out, go to the nearest health facility and seek care. Always return for the visits as asked by the health worker. Ensure that you deliver in a health facility with a skilled health worker.”

Arrival, Without Illusion

When Dr. Olivia Nakisita steps onto the graduation stage at Freedom Square, applause will follow. But the true significance of that moment lies in health facilities still struggling to adapt; in adolescent refugees whose pregnancies unfold quietly in rented rooms and crowded neighborhoods; in policies waiting to be sharpened by evidence.

Her scholarship does not promise quick fixes but offers clarity.

Among the PhDs conferred at Makerere University’s 76^th graduation, her work reminds us that some research does not begin in libraries and does not end with theses. It lives on in the slow, necessary work of making health systems see those they have long overlooked.

— Makerere University School of Public Health Communications Office, Graduation Profiles Series, 76^th Graduation Ceremony

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