Reaching the Last Mile: Inside HHF’s Community Health Assessment in Abeokuta, Nigeria
By Joeffrey Kurah, Community Health & Outreach Lead (Nigeria), Humanity & Health Foundation
A schoolteacher in Awowo, a cluster of farming settlements outside Abeokuta, Ogun State, sees ten to fifteen children a week come to class with fever, vomiting, or diarrhea. There is no school health system to catch them. Most are simply sent home to households that, in many cases, are twenty minutes to over an hour’s walk from the nearest neighbor, let alone a clinic.
This is the picture that emerged from a Community Health & Health Literacy Landscape Assessment conducted by Humanity & Health Foundation across three communities in Abeokuta: Obada, Awowo, and Oluwo/Panseke, each representing a different level of urbanization, infrastructure, and access to care. The assessment combined household visits, interviews with residents and a schoolteacher, and direct observation across five dispersed farming settlements. What it found isn’t unusual for the region. But it is a clear, specific picture of what “last mile” health access actually looks like on the ground, and it’s now shaping HHF’s next community engagement in the area.
Key Takeaways
- Three communities near Abeokuta, Obada, Awowo, and Oluwo/Panseke, show three different faces of the same access gap: distance, cost, and a heavy reliance on self-medication before formal care.
- Fever, malaria, typhoid, and undiagnosed childhood illness are the most consistently reported health concerns across all three communities.
- Health literacy is low and inconsistent, with residents relying heavily on traditional remedies, patent medicine vendors, and a “wait-and-see” approach before seeking formal care.
- HHF’s response:the Healthy Families, Healthy Children Initiative- uses a decentralized, household-by-household model built around the reality that Awowo is not one community but many scattered ones.
Three Communities, One Region
Obada, Awowo, and Oluwo/Panseke sit within Abeokuta, Ogun State, but they are not the same place. Obada is a densely populated peri-urban community with relatively better access to care, including a Primary Health Centre. Awowo is a transitional peri-urban and rural settlement, really a collection of dispersed villages and family compounds spread across a wide geographic area with limited health infrastructure. Oluwo/Panseke sits within Abeokuta town itself but faces its own significant challenges in healthcare access, sanitation, and water supply.
Across all three, the population skews young; children, youth, and working-age adults, with fewer elderly residents. Livelihoods are largely informal: farming, trading, artisan work. Schools exist in each community, but none currently offer structured health services.
What the Assessment Found
Common health concerns.
A health worker in Obada identified malaria and hypertension as the community’s major concerns, citing transportation costs and reliance on traditional treatment as key barriers to care. In Awowo, a resident described ulcer, body pain, dizziness, vision difficulties, knee pain, and mental health–related concerns as common. In Oluwo/Panseke, residents reported malaria, fever, skin infections, and sanitation-related illness, including toilet infections and menstrual health issues, driven largely by poor hygiene and unsafe water sources.
Child health.
Across all three communities, undiagnosed illness in children came up repeatedly and unprompted. Fever, diarrhea, vomiting, and stomach pain are frequent, diagnosis is limited, and treatment is often delayed. Schools lack the facilities to do anything but send sick children home with no system to ensure they’re seen by anyone afterward.
Access to care.
Long distances to healthcare facilities, high transportation costs, and limited emergency services push people toward delay and self-treatment by default, not preference. In Awowo specifically, some households are between twenty minutes and over an hour’s walk apart, meaning even a single centralized clinic or event would exclude a large share of residents simply by geography.
Water, sanitation, and hygiene.
Hygiene practices are inconsistent, formal sanitation systems are often poor or absent, and many households depend on well water that isn’t reliably safe, worsened by water scarcity in the dry season. These conditions are directly linked to the waterborne and hygiene-related illness residents report.
Menstrual health and social vulnerability.
Adolescent girls face limited access to affordable menstrual products and menstrual hygiene education, contributing to school absenteeism. The assessment also surfaced a harder finding: early marriage among adolescent girls is common in some Awowo settlements, with reports of girls being pressured into marriage between the ages of 10 and 16, a pattern connected to low educational attainment, limited health knowledge among young mothers, and the intergenerational continuation of low health literacy.
Health literacy.
Health literacy is generally low and inconsistent across all three communities. Residents draw health information mainly from limited engagement with health facilities, schools, and informal or street-based sources. The dominant pattern is a “wait-and-see” approach:self-medication and traditional remedies first, formal care only once symptoms become severe, reinforced by strong cultural trust in traditional providers, ritual practices, and Traditional Birth Attendants (TBAs).
What’s Already Working
None of this means the communities are starting from nothing. The assessment also identified real assets to build on: Primary Health Centres already present in Obada and Awowo, even if reach is limited by distance; Patent Medicine Vendors who are widely accessible and already trusted as a first point of contact; schools that serve as natural gathering points for children and families; and a network of Traditional Birth Attendants and native care providers who already play a central, trusted role in informal service delivery.
High trust in traditional and local care providers is, in many ways, an entry point rather than only a barrier; the goal isn’t to replace these relationships but to build referral pathways through them.
HHF’s Response: The Healthy Families, Healthy Children Initiative
Based on this assessment, HHF developed a targeted Community Engagement Action Plan for Awowo and its surrounding farming settlements, running August through November 2027. The goal is direct: improve child health outcomes, family health literacy, hygiene practices, and healthcare-seeking behavior among the households most affected by geographic isolation.
Because Awowo isn’t a single, centralized community, a one-time outreach event would miss most of the people it’s meant to reach. Instead, the plan uses a decentralized approach built around where people already are: household outreach visits, small-group health education sessions, school-based activities, community dialogue meetings, and dedicated sessions for adolescent girls, delivered through schools, churches, and mosques, community leaders, and word of mouth, the channels residents already trust.
- Reach at least 100 caregivers and community members through health literacy sessions within three months
- Reach at least 200 children and adolescents through school and community-based health education
- Train 15 teachers, volunteers, and community influencers as local health champions
- Conduct at least 15 household outreach visits across isolated village clusters
- Facilitate referrals of at least 50 individuals needing medical assessment to the nearest Primary Health Centre
Why This Approach
A centralized program would be easier to run and harder to justify here. The dispersed settlement pattern means transportation is a real barrier for participants, not an inconvenience, so the plan goes to households and gathering points rather than asking residents to come to it. Teachers, community volunteers, and local leaders will be trained as ongoing health champions specifically so the impact doesn’t end when the initial activity period does; existing Primary Health Centre staff will be engaged to strengthen referral pathways for the longer term.
Common Questions
Why not just build a clinic in Awowo?
Distance is only one barrier among several; low health literacy, self-medication habits, and delayed care-seeking would remain even with a nearby facility. Health education and trusted referral pathways address the behavior gap that infrastructure alone doesn’t close.
Why focus specifically on households, not just one central event?
Because some households are over an hour’s walk from the nearest neighbor, a single centralized activity would systematically exclude the most isolated, and often most vulnerable, families.
What happens after the initial twelve-month period ends?
Sustainability is built into the design: trained teachers and volunteers continue as health champions within schools and settlements, and Primary Health Centre staff are engaged to keep referral pathways active going forward.
Moving Forward
What stood out most across every household visit and community conversation wasn’t a lack of will; it was a lack of reach. Families in Awowo, Obada, and Oluwo/Panseke are already managing real health challenges with the resources they have; what’s missing is consistent access to information and care that meets them where they are.
At Humanity & Health Foundation, we believe this is exactly where community-based, decentralized engagement earns its place, not as a substitute for stronger health systems, but as the connective tissue that helps families use the care that does exist, sooner and more effectively.
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About the Author
Joeffrey Kurah serves as Community Health & Outreach Lead (Nigeria) for Humanity & Health Foundation, based in Ogun State. His work centers on community health and health literacy assessment, household-level outreach, and the design of decentralized engagement models for dispersed and underserved settlements across the Abeokuta region.
Disclaimer: This article is based on findings from HHF’s Community Health & Health Literacy Landscape Assessment and Community Engagement Action Plan for Awowo, Obada, and Oluwo/Panseke, Ogun State, Nigeria (2026). It is intended for educational and public reporting purposes and does not replace formal program evaluation or peer-reviewed research.
Joeffrey Kurah is a social impact leader, community development practitioner, and Community Health & Outreach Lead (NIG) with Humanity & Health Foundation (HHF). He is also the Founder & CEO of GreenHER Global, a climate-smart agribusiness that leverages technology to connect women farmers to markets, reduce post-harvest losses, and improve food security. Based in Abeokuta, Ogun State, Nigeria, Joeffrey is passionate about advancing health literacy, sustainable agriculture, youth leadership, and the empowerment of women and girls. Through community engagement, volunteerism, innovation, and strategic partnerships, he works to design and implement initiatives that strengthen livelihoods, improve community resilience, and create lasting social and economic impact in underserved communities.
- Joeffrey Kurah
