In May 2024, Gbenga Ogundimu (not real name), a resident of Alayabiagba ward in the Ajeromi-Ifelodun local government area in Lagos, appeared pale and emaciated. He had been coughing for a couple of weeks and had progressed to him coughing up blood.
Ogundimu believed it was a spiritual attack and he intensified efforts to seek spiritual cleansing so that he could be healed.
Meanwhile, Kehinde Omolade, a Traditional Birth Attendant (TBA) and a local herb seller popularly referred to as ‘elewe omo’, knew that Ogundimu was not suffering from a spiritual attack but her advice for Ogundimu to seek medical attention fell on deaf ears.
When Omolade realized that Ogundimu wouldn’t visit the hospital as recommended, she called Tolu Primary Health Centre (PHC), one of the health facilities that offer free Tuberculosis (TB) treatment in Ajeromi-Ifelodun.
“I made sure I gave an appropriate description of the man while reporting the case to Tolu PHC. They went to his house with their ambulance to take him to the hospital. Ogundimu’s mother, who was embarrassed that an ambulance was in front of their house, initially denied that there was no sick person in the house,” Omolade narrated.
After some time, Ogundimu was identified and was taken to the hospital. He tested positive for Tuberculosis and was placed on medication, which facilitated his recovery.
When it dawned on Ogundimu that he was not suffering from a spiritual attack but TB, he expressed his gratitude to Omolade and gave her 1,000 Naira which was what he could afford as a token of appreciation for saving his life.
Outlook of Infectious diseases in the Country
In Nigeria, infectious diseases remain a significant public health concern, accounting for 68% of deaths in children under five, according to the World Health Organisation (WHO). Lagos State, with its population of over 20 million, frequently grapples with infectious diseases such as tuberculosis, cholera outbreaks, measles, and Monkeypox popularly shortened to Mpox.
In Lagos, two municipal local government areas, Ajeromi-Ifelodun and Somolu, stand out for their vibrant communities and unique challenges.
With dense populations, poor sanitation systems, and limited access to clean water, these local government areas have long been vulnerable to outbreaks of infectious diseases like cholera, Mpox, Lassa fever, and measles.
Ajeromi-Ifelodun and Somolu epitomise the intersection of vulnerability and resilience, with poor waste management, economic marginalisation, and limited healthcare access exacerbating these issues.
However, an innovative intervention by Dr. Ameyo Stella Adadevoh (DRASA) Health Trust is changing this narrative, equipping residents with the knowledge and tools to fight against these threats.
The Strengthening Community Knowledge and Response on Infectious Disease Prevention (SCKaR-IDP) project is a community-based surveillance and behaviour change initiative put up by the DRASA Health Trust.
The project is aimed at equipping key groups at the grassroots level, such as market women, artisans, transport workers, religious leaders and youth, with the skills to prevent and control infectious diseases. The project represents a bold step toward achieving health security through grassroots participation.
“The communities we work in are underserved. They face poor sanitation, lack of clean water, and economic hardships, making them highly susceptible to infectious diseases.
“Addressing these challenges requires a collective effort from within the community,” said Christopher Aliu, Health Security Program Manager at DRASA.
Equipping Health Champions: A Grassroots Solution
To combat these issues, DRASA between March and April 2024, equipped 2,089 Health Champions from the two LGAs. These individuals, comprising market women, hairdressers, butchers, traditional birth attendants (TBAs), artisans, transport workers, and religious leaders, received training on identifying symptoms of infectious diseases, reporting cases, and promoting preventive measures.

“We wanted people who were already central to community life. These groups interact with hundreds daily, making them ideal for spreading awareness and driving change,” explained Aliu
Through on-site trainings and informational materials, participants gained knowledge about infectious diseases, including cholera, tuberculosis, and HIV/AIDS.

As a result of these efforts, the DRASA health security programme manager said the post-intervention assessments revealed a 43.2% increase in the residents’ understanding of infectious diseases, with significant improvements in knowledge about causes, symptoms, and prevention strategies.
Voices of Transformation: The Health Champions Speak
For many Health Champions, the training was a transformative experience that reshaped their personal habits and empowered them to become agents of change.
Kehinde Omolade, a TBA, whose insistence helped save the life of Gbenga Ogundimu, is one of DRASA’s Health Champions.
Since the training, Omolade, who lives in a shared apartment with a shared toilet and bathroom, understands the importance of personal hygiene and environmental sanitation.

“I now understand the health implications of abandoning faeces in potties within the compound after my neighbour’s children might have defecated, and I take it upon myself to sensitize my neighbours to maintain a high level of hygiene.
“It was normal for the children to defecate in the potties and leave them till their parents were back to dispose of them into the latrine. It was also normal for us to pile up waste within the compound and throw them in the canal.
“But, being a Health Champion with DRASA Health Trust has exposed me to these abnormalities and I have become a change agent who now sensitizes my neighbours and friends such that they now call me agbepo – trash collector.
Kaosarat Sulaimon, a passionate advocate for children’s hygiene in Oluwa Akere ward in Ajeromi-Ifelodun LGA, shared how she uses biscuits to incentivize kids to wash their hands.
“Our community used to be very dirty. It was a place where people were less conscious of their personal hygiene. But after the training, I became a champion.
“I started with my family before moving to the public. “Now, children in my community know they must wash their hands after school. It’s rewarding to see this behavioural shift,” she said.
Sulaiman was not alone, traditional birth attendants like Adama Alexander have also embraced new practices, courtesy of DRASA’s engagement.
“Before, we didn’t understand the risks of not wearing gloves during deliveries,” he admitted, but noted that as a Health Champion trained by DRASA, he now understands how diseases like HIV and syphilis can be transmitted.
“We now take precautions to protect ourselves and the women we help,” he said.

Sharing a similar experience, Sanni Akeem, who is a religious leader in Ojora, Ajeromi-Ifelodun, demonstrates how he leveraged his influence to dispel health-related myths.
“A child in my neighborhood was thought to be cursed because she couldn’t walk,” Akeem said.
The Health Champion sensitized the child’s parents that she was sick and not cursed, and advised them to go to a medical outreach that was organised by the LGA where the person was given deworming medicine.
“After she was dewormed, she regained her strength and it was a turning point for the community,” he said with delight.
For artisans like Salam Wasiu, the engagement with DRASA prompted practical changes. Wasiu, who is the Secretary, Motor Mechanics and Technician Association of Nigeria, in Somolu LGA, said, “before, we usually defecate wherever and whenever we have the urge. But after this engagement, we made contributions among ourselves and we built a toilet where none existed before. We now penalize members who don’t maintain cleanliness.
“Though resistance was high initially, we persisted,” he said.
Wasiu who expressed delight about the state of hygiene among his colleagues in Somolu said, “now, mechanics in Somolu are aware that they should wash their uniforms daily, clean their surroundings, wash their hands regularly, especially after fixing a car.”

Health Champions in Action: Evidence of Impact
The intervention has spurred visible improvements in hygiene and public health. In Achakpo Market, butchers now wear white uniforms and adhere to strict cleanliness protocols.
“We’ve enacted laws to ensure meat handling meets hygiene standards,” said Akinleye Wasiu, Secretary of the Butchers Association in Ajeromi.
In one case, Ayodele Temidayo, another trained Health Champion in Apeleyin Ward, Somolu LGA, identified a leaking septic tank that posed a cholera risk.
“I had to make an anonymous report to the Lagos State Environmental Sanitation Corps (LAGESC) who came to inspect and give a timeline for the septic tank to be fixed and were informed about the dangers of leaving the septic tank unattended to.
“Now, people are more aware of the importance of maintaining a clean environment,” she said.

For Mrs Oluwaseun Ogunsina, a community informant in Akoka-Anuoluwapo Ward, she has been going from one location to another to inform people about personal hygiene, environmental hygiene and how to prevent infectious diseases.
“Myself and other community informants have been to communities like Ago Egun in Bariga because of the poor waste management in the community and the risk it poses to people’s health.
“Though not easy at first, we can begin to see people’s actions and attitudes towards cleanliness changing,” she shared.
Corroborating the evidence of impact, Aliu, the DRASA representative, said the intervention proved invaluable during recent cholera and outbreaks in the state. Health Champions, he said, promptly reported suspected cases to their local health authorities, enabling faster responses.
“We’re seeing an increase in early reporting, which is crucial for containment,” he buttressed.
Commending the initiative, Mrs Adebukola Adeniji, the Disease Surveillance and Notification Officer (DNSO) at Somolu LGA, said the intervention by DRASA has been useful in curbing the spread of infectious diseases in select LGAs in Lagos State.
She also noted that the intervention has made it easier for grassroots community members to report suspected cases that could lead to outbreaks.
“The trained Health Champions have helped report and flag cases, which we consider to be vital. We need information to control the spread of outbreaks, and if these information are not available, there is nothing we can do,” Mrs Adeniji explained.
She also noted that the DRASA intervention is contributing to achieving National Health Security based on the community-led approach that the organization has adopted to reduce the spread of infectious diseases.
Challenges and Constraints
Notwithstanding its success, the project faced significant hurdles, including managing community expectations.
Aliu said people expected financial incentives, which the DRASA Health Trust does not provide and “this sometimes affected participation.”
Similarly, he explained that the limited capacity of Primary Healthcare Centers (PHCs) in these areas was affecting the intervention.
For instance, he said during the cholera outbreak in July 2024, free treatment ended when the outbreak was declared over, leaving patients unable to afford care.
“It’s heartbreaking when people turn back because they can’t pay,” Aliu bemoaned, saying strengthening PHCs was essential for sustaining the progress.
On the part of the Health Champions, misinformation, ignorance and resistance to change also posed barriers.
“Some people dismissed hygiene campaigns, saying hunger was a bigger problem,” Temidayo said, but noted that practical examples, like seeing a family affected by cholera, helped change minds.
“Being a TBA and herb seller, people come to me to prescribe herbs for infectious diseases. Whenever I decline and refer them to hospitals, they insult me and think I don’t need money. I never allowed that to deter me but kept on sensitizing them to maintain a high level of hygiene and to seek medical help when needed,” Omolade shared.
A Model for Community-led Health Security
Evidently, nine months after the intervention, Ajeromi-Ifelodun and Somolu are witnessing a wave of behavioural change. Health Champions have become trusted voices, fostering a culture of hygiene and vigilance.
The project has expanded community-level disease surveillance, aligning with Nigeria’s National Action Plan on Health Security, but Aliu emphasised the importance of scaling up such initiatives.
“Communities play a crucial role in disease surveillance and response. This project shows that grassroots empowerment can transform public health,” he said.

Looking Ahead
For DRASA and its Health Champions, the journey is far from over. Sustaining these gains will require continued investment in community education, better-equipped PHCs, and policies that support underserved communities.
As Sulaimon aptly put it, “We’re not just fighting diseases; we’re building a healthier future for everyone.”
This grassroots approach holds promise not just for Lagos but for similar communities across Nigeria and beyond. It is a testament to the power of collective action, resilience, and the enduring impact of equipping people with knowledge and agency.
Strengthening Nigeria’s health security and governance requires sustained investment in community-led initiatives. By equipping local health champions and fostering accountability at the grassroots level, the project aligns with the Federal Ministry of Health and Social Welfare’s pillars of the health sector reform, ensuring that communities are not just beneficiaries, but active participants in achieving National Health Security.
To scale and sustain these efforts, there must be increased funding for primary healthcare centres (PHCs), and continuous training for community health workers, enabling us to strengthen our defences against infectious disease outbreaks.
This story was cross published with the Nigeria Health Watch.