Masaka, Uganda—In a small, sunlit room at the Buwunga Health Center III in Masaka District, Bridget Nakankaka, 25, leans forward, her eyes bright with purpose.
"I used to wonder if I would ever escape the cycle of poverty I was in," she says. "Now, I am helping other young women do just that."
Growing up, Bridget's life was marked by hardship.
Her parents separated when she was five years old, and Bridget and her siblings were taken in by their maternal grandmother. As the firstborn, Bridget faced challenges similar to many of Uganda's young women, including caring for her three younger siblings at a very young age while struggling to attend school.
Despite these challenges, with her mother and grandmother's support, Bridget managed to stay in school, eventually earning a bachelor's degree in Art and Design with Education. But even with her degree, Bridget struggled to find employment. In a move that would prove pivotal, she chose to volunteer at a PATH-supported local public health facility to implement an HIV prevention and family planning integration program. Bridget volunteered as a peer supporter and counseled young pregnant women.
This volunteer work, however, came with its own challenges. As a peer supporter, Bridget struggled to meet basic needs such as food, shelter, and health care for herself and her siblings. "The facility offered a small lunch allowance, but I'd go without lunch and save it to care for my siblings," she says.
Addressing the health crisis facing Uganda's young women
Bridget's story echoes the struggles of countless young women in Masaka District. Here, the HIV crisis looms larger than ever, with infection rates among young women aged 15 to 24 at 8.1 percent—dwarfing the national average of 5.4 percent. This stark reality underscores the unique challenges faced by Masaka's youth and, by extension, young women across Uganda.
In Uganda, one in four women becomes a mother before her eighteenth birthday, while only 38 percent of young women use modern contraceptives. This leaves a third with unmet family planning needs. The consequences are dire: unintended pregnancies and HIV infections are widespread. Complications from childbirth and HIV/AIDS remain major causes of death for young women across sub-Saharan Africa.
Moreover, young women are three times more likely to acquire HIV than their male peers, and they represent 29 percent of all new HIV infections in Uganda. At the same time, stigma and opposition from partners, family, and the community hinder the effective use of HIV prevention products like pre-exposure prophylaxis (PrEP).
The Ugandan Ministry of Health's strategy for integrating sexual and reproductive health and HIV prevention services presents an opportunity to reimagine service delivery to better meet the needs of young women.
“I used to feel helpless. Now, I am part of the solution. We are not just talking about change; we are making it happen.”— Bridget Nakankaka
An innovative approach to youth-led health solutions
To address these challenges, PATH, in collaboration with the Uganda Ministry of Health, received funding from the Beckon Foundation for the HIV Prevention and Family Planning Integration project for young women. This initiative engaged young women and related stakeholders in designing user-friendly HIV prevention and family planning services in Uganda.
Using a human-centered approach, PATH partnered with young women to explore and develop more holistic, discreet, acceptable, convenient, and respectful integrated service-delivery models for both new and existing HIV prevention and family planning services. The project involved young women like Bridget, who not only use the services but are active participants in designing integrated health services delivery models.
The project engaged four young women—two from each implementing districts (Masaka and Nakasongola)—identified through health facility providers in adolescent clinics. Bridget, recommended by the head of a local public health facility where she volunteered, was among those selected.
These young women received training in the human-centered approach, data collection, project proposal procedures, qualitative research, research ethics, and effective communication skills. The goal was to transform them into peer researchers who can work with and inspire their peers in designing youth-friendly, integrated service-delivery models for HIV prevention and family planning services in Uganda.
PATH's Justine Tumusiime, center, project peers Carolyne Naddunga, Nagawa Brenda, and Jesca Nasunku, and research mentor Olivia Owori, visit Nakasongola District, Uganda to support young women. Photo: Erisa Kijjambu/PATH.
Dr. Betty Mirembe, PATH Uganda Country Director, explains, "By partnering with the Ministry of Health and involving young women in the research and design process, we're ensuring that the services we develop truly meet their needs and align with national health strategies."
For Bridget, this meant intensive training in human-centered design, data collection and analysis, and effective communication.
"I have gained skills I never thought possible," she says, her voice filled with pride. "I am now proficient in collecting both qualitative and quantitative data. I can collect and analyze data, write reports, and even contribute to research papers."
PATH's Dr. Joseph Kayaya and PATH Uganda Country Director Dr. Betty Mirembe present a certificate of completion for human-centered design training to Bridget Nakankaka. Photo: Erisa Kijjambu/PATH
Sowing change for a bigger impact in the community
The impact of this approach is already evident. Bridget recently contributed to an abstract accepted for presentation at AIDS 2024 in Germany, a significant achievement for someone who once struggled to find any employment.
But the project's impact extends far beyond individual success stories. Early data suggest a marked increase in young women accessing integrated HIV prevention and family planning services in the project districts. Health facilities report a 30 percent rise in young women seeking these services, with many citing the peer-led approach as a key factor in their decision to seek care.
Engaging young women as peer researchers has created a pool of individuals equipped with knowledge and tools who can support and mentor other young women in sexual and reproductive health, HIV and AIDS prevention and care, and life choices within the project districts and villages. This approach is to enhance young women’s decision-making abilities and reduce risky behaviors.
“This project demonstrates the power of collaboration between government, international organizations, and most importantly, our youth. It's a model we hope to replicate across the country.”— Dr . Betty Mirembe, PATH Uganda Country Director
"This project demonstrates the power of collaboration between government, international organizations, and most importantly, our youth. It's a model we hope to replicate across the country," added Dr. Mirembe.
For Bridget, the most profound change has been personal.
"My passion for ensuring young women have access to quality health services has grown," she says. "I understand the challenges they face because I have lived them. Now, I can make a real difference."
Her story resonates with many in Masaka. Sarah, a 17-year-old peer of Bridget's, says, "Seeing someone like us succeed gives us hope. Bridget understands our struggles because she's been there. She shows us that we can overcome our challenges."
Looking back, Bridget reflects on her journey from volunteer to changemaker. "I used to feel helpless," she admits.
"Now, I am part of the solution. We are not just talking about change; we are making it happen."
