By Ikechukwu Ezekiel Emeka
On the first night the solar light came on at a neglected health post in Onicha Local Government Area of Ebonyi State, the glow travelled farther than expected. It lit the cracked walls of a long-abandoned building. It reassured a midwife struggling to deliver care with a torchlight. And it reminded a nearby community that the health system of the country had not entirely forgotten them.
For years, the health post had existed in name only. Weeds overtook the compound. Patients stayed away groaning in the dark, suffused by varying degrees of pain, some even life threatening, day after day without any serious sign of their problems abating in sight. Health workers learned to improvise or give up.
Then a young National Health Fellow arrived, notebook in hand, asking questions that had not been asked in a long time. Why was this place not working? Who should be here? What would it take to bring it back to life? That moment, small and local as it might appear to an onlooker, captures a much larger story unfolding quietly across Nigeria’s 774 local government areas.
The National Health Fellowship Programme was launched in 2025 with a bold but understated idea – to place one trained young Nigerian in every local government area to help strengthen primary healthcare from the inside. Not as a visitor. Not as an inspector. But as part of the system.
In Onicha LGA, the fellow met a familiar reality. Health centres existed, but many were shells. Some had buildings but no staff. Others had staff but no equipment. A few were simply dark, making night-time care almost impossible.
Facilities without supported from the Basic Health Care Provision Fund were often neglected. Women in the community were ageing without understanding the diseases shaping their lives. Children were growing up believing open defecation was unavoidable and mental health was not something people discussed. Health workers were overstretched, communities disengaged, and trust in public facilities was fragile.
It would have been easy to write a report and move on but instead, the fellow decided otherwise. He stayed with the determination to find answers to the questions that burdened his heart. Rather than beginning with infrastructure, the work began with people.
At a Catholic women’s August meeting in Ukawu, one of the largest gatherings of women in the area, the fellow and a small team asked simple questions like ‘Do you know what hypertension is?’ ‘Have you heard of dementia?’ ‘Do you believe old age is a curse?’ and more.
The answers revealed a quiet gap. Many women, most of them farmers and traders in their forties and fifties, had never heard of several age-related diseases. They had cared for elderly relatives without knowing why memory failed or joints stiffened. Illness was often accepted as fate.
By the end of the session, something shifted. Hypertension, diabetes, arthritis, and dementia were no longer abstract terms. They were conditions with causes, symptoms, and management strategies. Old age, the women agreed, was not a curse. It was a phase of life that deserved care. That change in understanding may not make headlines, but it changes lives.
A few weeks later, the fellow stood before hundreds of secondary school students at Saint Michael’s College in Oshiri. When asked to define mental health, most could not. When asked where to seek help for emotional distress, many were unsure. Open defecation, they said, was simply how things were done in rural areas. After structured discussions on mental health, sanitation, and hygiene, the atmosphere equally changed.
Students began to connect poor sanitation to disease outbreaks they had seen and thought were fate visiting anger on them. They learned that mental health was not weakness and that help could be sought. Many volunteered, without prompting, to take part in community efforts to reduce open defecation. These were not dramatic gestures. But they were seeds planted early.
Education alone was not enough. The fellow turned next to the physical state of health facilities. With ward development committees and community leaders, abandoned health posts were identified and assessed. Some had stopped functioning simply because no one had taken responsibility. Others needed modest repairs, lighting, or staffing.
In several facilities, solar lights replaced darkness. Weeds were cleared by mobilised youths. Broken equipment was reported and fixed. Waste disposal systems were improved. In one location, a dilapidated pit latrine that posed a public health risk was reconstructed and made usable for the people.
None of this required massive new infrastructure. It required coordination, follow-up, and someone whose job it was to care enough to insist that things change. Gradually, people began to return to the facilities. Trust, once broken, started to rebuild.
The story was not without tension. At first, some local health workers were suspicious. Who was this fellow? What authority did they have? Others feared scrutiny or job displacement. Weak communication between federal, state, and local authorities made the programme seem unclear in its early days. Over time however, persistence mattered. As the fellow supported immunisation campaigns, assisted in planning processes, and helped track health funds, perceptions changed. Health workers began to see an ally rather than a threat. Communities saw results rather than promises. The same pattern played out in many local government areas across the country.
Onicha’s experience is not exceptional. It is representative. From Ebonyi to Ekiti, Akwa Ibom to Kebbi, National Health Fellows have been embedded in communities that rarely feature in policy debates. They have supported maternal and neonatal mortality reduction initiatives, strengthened the process of monitoring the Basic Health Care Provision Fund, revived dormant facilities, and helped ensure that national health reforms reach the people they were designed for.
What links these efforts is proximity. Fellows live where they work. They understand the terrain, geographical, cultural, and political. They speak the language of both policy and people. In a system where many reforms falter at the last mile, proximity made the difference.
The strength of the National Health Fellowship Programme lies in its quiet design. It does not rely on grand announcements. It relies on presence. It trusts young professionals with responsibility and supports them with training and mentorship. It focuses on strengthening what already exists rather than constantly building anew.
Most importantly, it recognises that healthcare systems are human systems. Buildings do not deliver care. People do. Yes, the programme may not be perfect but it undoubtedly pointed the way to navigate. One fellow per local government area is often not enough, especially in large or hard-to-reach regions.
Moving ahead, clearer role definitions and stronger coordination across government levels would reduce friction as witnessed in this pilot scheme. Mobility support would go a long way to improve reach. These challenges must however be seen and treated as challenges of growth, not of failure.
Back in Onicha, the solar light still shines at night. It allows health workers to do their jobs with dignity. It reassures mothers arriving late with sick children. It signals, quietly, that someone is paying attention. Multiply that light across 774 local government areas, and a different picture of Nigeria’s health system begins to emerge. It is not perfect. It is not finished. But it is moving.
The National Health Fellowship Programme will not solve all of Nigeria’s health challenges. But it has shown what is possible when reform is grounded in communities and powered by people who care enough to stay.
Sometimes, national progress begins with something as simple as turning the lights back on.
Emeka is a National Health Fellow from Onicha LGA, Ebonyi State with impact-making efforts in Onicha, Ebonyi State.
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