In the remote, rugged lands of Amudat District in Karamoja Sub-region, where health services are often stretched thin and traditions such as female genital mutilation (FGM) and child marriage persist, one woman has quietly stood as a guardian of women and children for more than two decades. Esther Acheng, the Amudat Assistant District Health Officer (ADHO) in charge of maternal and child health (MCH)
Acheng’s journey began in 2000, when she graduated from Matany School of Nursing as an enrolled nurse. At school, she was recognised with a certificate of merit for good conduct – a trait that would define her career. Her first assignment was at Matany Hospital paediatric ward, where she worked tirelessly as the officer-in-charge for two years. Even then, her dedication earned her a glowing recommendation for her hard work.
From Matany, she joined Moroto Catholic Diocesan health facility, where she would serve for 15 years. It was here that her passion for reproductive and child health deepened. In 2008, the Catholic Diocese awarded her a scholarship to pursue a diploma in nursing. By 2012, the facility was recognised by the district as the best performing in the region, a testament to her leadership and commitment.
Seven years later, Acheng was promoted and transferred to Amudat District Local Government, where she surrently serves as ADHO. Her work has not gone unnoticed: last year, she was recognised by the Ministry of Health for her outstanding contribution to safe motherhood. This year, she has again been nominated, unopposed, for the same award.
But Acheng’s story is not only about hospital wards and official recognition. She has quietly taken on another mission: protecting vulnerable girls. For the past four years, she has supported children from disadvantaged families, including those who have fled FGM and child marriages. At a local safe centre, she has sheltered and supported 12 girls. With the help of other well-wishers, some have progressed to secondary school. Acheng personally supports two girls in secondary school and six in primary school, ensuring their dreams of education are not cut short by harmful traditions.
‘To me, saving a mother’s life or giving a girl a chance to escape FGM is not just work, it is my calling,’ she says softly, her eyes reflecting fortitude and compassion. Sarah Narupei, a retired health worker in Moroto District, lauds Acheng for her selflessness beyond professional duties. ‘She is not just a health worker – she is a mother to many. Despite growing up in a humble family, she has used her position to change lives, especially for vulnerable children. She pays tuitionfor some of them and ensures they stay in school.’
In a region where maternal mortality remains a challenge and girls continue to face the risk of harmful cultural practices, Acheng represents the bridge between health, hope, and humanity. She is not only a nurse and health officer but a mother to many, a mentor, and a quiet warrior for change. Reflecting on her inspiration to join nursing, she recalls: ‘A nurse in our village worked so well at the health centre and always looked smart in her uniform. I wanted to be like her.’ Early in her career, while working at Moroto Catholic Diocesan health facility, which had no midwife, Acheng oversaw numerous safe deliveries, which became a defining moment in her passion for maternal health.
‘I used to work alone, but our health facility delivered many mothers safely, and that’s why I was recognised in 2012.’
‘I was helped by others to study, and I feel I should give back to God with the little I have,’ she explains. These children are identified through integrated outreaches, Village Health Teams (VHTs), the safe centre at Kalas Girls Primary School, and social networks like the Karamoja Development Forum. ‘All the girls I’m helping are still in school; one of my former girls is now a midwife,’ she shares. Funding their education and basic needs is a constant challenge, but she negotiates with schools and relies on her salary, allowances, and contributions from well-wishers.
Background
Acheng was born on October 22, 1976 in Aremo Central, Morulem Sub-county, Abim District, to Mary Amollo and Paulino Ochan.
She began her education at Morulem Girls Primary School in 1986, where she sat for her Primary Leaving Examination (PLE). She then attended Kangole Girls Secondary School, completing Senior Four (UCE) in 1996 before pausing formal education. She later pursued a certificate in nursing, which became the foundation for her further professional development, eventually upgrading her qualifications to a diploma and bachelor’s degree in nursing.
During her school years, Acheng held several leadership positions, including dormitory captain at the primary level and class administration coordinator at secondary school. She was also an active choir member.
‘I come from a polygamous family; we are 23 children. Out of all of us, only 10 managed to complete tertiary education-four became health workers and seven became primary school teachers. The rest dropped out of school because our parents were peasants and could not afford to support all of us,’she said.
‘I, too, was supposed to drop out of school in Primary five. However, I approached the headteacher of my primary school, a nun, who allowed me to stay in school during the holidays if I helped dry and clean beans left in the food store for the next term. That’s how I managed to complete my primary education, sitting for my PLE in 1992 (I had started Primary One in 1986),’
Acheng says Secondary school brought its own challenges. ‘I was almost forced to drop out in the second term of Senior one, but I sought help from my stepsister, who assisted me until I completed my certificate in nursing. After S4, someone approached my parents to propose marriage, but I refused. My father was so impressed with my decision. That same vacation, I began teaching at my former primary school, Morulem Girls,’said.
The nurse says she faced constant struggles in getting school requirements, and her stepsister often helped by paying her school fees. ‘These experiences are why I deeply sympathise with vulnerable children-I understand exactly what it feels like to struggle to stay in school. Even my siblings faced similar challenges. My brother and sister, whom I supported, dropped out, except for the last-born sister, who joined S1 the same year I finished my certificate. I started paying her school fees, determined to ensure she stayed in school,’she said.
Acheng enjoys singing and dancing, and she is among the elder children in her family. She is married and has four children-three boys and one girl. Two of her children are currently at university, one is in Senior Six, and another in Senior One. Working in Karamoja comes with challenges, particularly interference from traditional birth attendants, who often encourage women to deliver in villages instead of health facilities.
Despite this, Acheng has introduced innovative approaches to reach mothers in hard-to-reach areas, including integrated health outreaches, radio talk shows, and spot messages. On working with cultural leaders and traditional birth attendants, she says, ‘They are referral points for pregnant mothers, but some don’t cooperate, taking deliveries into their own hands.’
Beyond her professional work, Acheng has held multiple leadership and community positions. She serves as deputy chairperson of the Health Committee in Amudat District, coordinator for the African Women Economic Empowerment Council, treasurer for Ethur Community Amudat, and treasurer of the Amudat Savings Initiative. She is also a board member of Hope for Karamoja Children Foundation and a member of the Health Unit Management Committee at Kosike HCIII in Amudat District.
Reflecting on her childhood, she recalls, ‘In Primary Two, I was given scholastic materials for being the most disciplined at school.’ She also notes with pride that all her children aspire to pursue medical courses.
Delicate balance
Balancing her office duties with her support for vulnerable children is demanding.
‘It is hard, but I plan all that I am supposed to do the next day every evening. I use my salary and allowances to pay their school fees, and some well-wishers contribute too,’ she notes. Her motivation comes from her commitment to humanity: ‘The work for humanity, most especially saving mothers, keeps me going after 25 years in service.’ Acheng credits her family and mentors for her journey.
‘My biggest support has been my family, including my sister Awili Santina Obin and her husband, my husband Gabriel Okangas, a nun called Rev Sr Dinavence Tushabomwe, Brother Gunther and the hospital administrator at Matany Hospital,’ she lauds. Her legacy is one of nurturing future champions in safe motherhood and promoting good leadership across Karamoja and Amudat.
What ought to be done
Looking forward, she dreams of accessible, quality maternal and child health services throughout the region in the next decade. She emphasises the continued fight against FGM and child marriage: ‘Communities must be sensitised, and the FGM Act of 2010 strengthened. Young girls should know their rights, prioritise education, avoid early marriage, and always liaise with the health department and security services.’
Amudat district, in the Karamoja Sub-region, continues to face significant challenges in reproductive health, including persistently high maternal and newborn mortality rates. The maternal mortality ratio in Karamoja remains among the highest in the country. Daily Monitor reported in August that many health facilities in the district fail to meet the standards required for basic emergency obstetric and neonatal care.
Utilisation of maternal and neonatal services is also low, as many women do not attend sufficient antenatal visits or follow-up postnatal care. A large number of births still occur without the presence of a skilled health provider. Health centres, particularly those at lower levels, often lack essential infrastructure, equipment, medicines, and trained personnel. Poor roads, difficult terrain, and the remoteness of many communities make travel to health facilities challenging. In addition, many people cannot afford transport costs or any applicable fees, further limiting access to care.
Some practices discourage contraceptive use, encourage polygyny and early marriages, impose taboos on certain foods that affect nutrition during pregnancy, and limit women’s decision-making power. Low male involvement in family planning remains a critical issue. When men are excluded, contraceptive uptake is lower, discontinuation rates are higher, and conflicts over family planning can arise.
What Others Say
Sr Pross Nantege, Head teacher of Kalas Girls Primary School in Amudat District,
Acheng is passionate about her work and dedicated to helping vulnerable children, especially girls who are victims of FGM and early marriages. She described Acheng is a woman who grew up as a well-behaved girl – a trait that has helped her excel in everything she does. Acheng is a committed and trustworthy leader who has a deep passion for her work and for children. She loves supporting children in schools by paying their tuition and providing scholastic materials.
Daisy Awilo Omech, project monitoring and evaluation officer, ActionAid Uganda,
‘Acheng is an exceptional health officer whose dedication to maternal and child health is inspiring. She often visits expectant mothers in remote villages to ensure they receive proper care. Her guidance has empowered many women to seek professional healthcare.
‘She is respected not just for her professionalism, but also for her kindness, patience, and ability to make every mother feel valued and cared for. Her work has saved countless lives uplifted the community.’
Emmanuel Koriang, project officer at ActionAid Uganda
‘ Acheng is one of the most dedicated assistant district health officers in charge of maternal healthcare. She has helped reduce risks associated with home births and traditional birth attendants. She is compassionate, patient, and always ready to offer guidance and support to both mothers and healthcare staff.
Her initiatives in maternal health education, antenatal care, and postnatal follow-ups have greatly improved the wellbeing of mothers and children in the district. Women call her ‘Mama Health’ because of her selflessness. She treats every patient equally and is a role model for healthcare workers in the region.’