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“Experts from Below”: Why Local Health Educators are Leaders, Not Just Helpers, during Outbreak Response in Lagos, Nigeria

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In this blog, Olawale Fathiah Olamide, of the Humanitarian Observatory for Central and Eastern Europe, and the Centre of Migration Research, University of Warsaw, dives into the ways in which local actors co-define humanitarian governance through their interactions with international humanitarian ‘experts’. During the COVID-19 pandemic, and Cholera epidemic responses in Lagos, Nigeria, local health educators took an important role as ‘translators’ of international scientific knowledge to make it relevant for people in their everyday lives. The blog ends with a call to include local actors as active participants in sector-wide reform efforts, rather than simply as passive implementing partners.

“Experts” usually arrive on planes with clipboards and standardised plans based on international best practices. They provide the “what” and the “how” based on this expertise. But in the busy, high-pressure environment of Lagos, a sprawling megacity in southwest Nigeria, where over 20 million residents hustle for a living amidst narrow streets and vibrant markets, the “how” and the “why” in practice come from a different group: local health educators.


Photo by Ninthgrid : https://www.pexels.com/photo/medical-checkup-in-a-lagos-clinic-30678208

As a final-year health education student at the University of Lagos and a local resident, I experienced the quiet tension of the COVID-19 pandemic and the sudden alarm of recent cholera outbreaks. Volunteering at the grassroots level through the Health Education Students Association of Nigeria, an association for public health education students for health mobilisation, I observed that we are not merely “implementing partners” hired to check off boxes. We are the “experts from below” who turn cold science into the warm language of community trust.

The Myth of the “Implementing Partner”

The traditional humanitarian model views local staff as the last link in a chain, the people who distribute flyers or set up wash stations. This often leads to accusations of ‘risk dumping’, and of presenting extractive relationships as equal partnerships. This view also dangerously limits the agency, expertise, and knowledge of national partners. When a Cholera outbreak strikes a community on the Lagos Mainland, an international protocol might dictate the distribution of chlorine tablets. But as a local health educator, my expertise begins where the protocol ends. I know that in a particular neighbourhood, people will not use those tablets because of a long-standing rumour about their effects on fertility or because the taste reminds them of a poorly handled previous intervention. My role was not just to “implement” the distribution; it was to redesign the approach in real time. Rather than simply handing out tablets with a leaflet, we worked through community leaders, the people residents already trusted. In their own language, we explained the precise components of the chlorine tablets, how they worked, andwhat they did not do. We addressed the fertility rumour head-on, breaking downthe science in terms that were accessible and credible within that specific cultural context. Those leaders took the tablets publicly themselves, demonstrating their safety by example. This act of visible, trusted endorsement did more than any poster or protocol ever could. This is humanitarian governance in its most basic form, making decisions that determine whether an intervention lives or dies at the doorstep.

COVID-19: Navigating the Currency of Trust

During the COVID-19 mobilisation, the challenge was not just the virus; it was the “infodemic” and the deep-seated scepticism toward directives from above. The National Centre for Disease Control (NCDC) led the national response with evidence-based guidelines on social distancing and mask-wearing. However, I remember standing in local markets, realising that the standard posters about social distancing seemed like they were made for another world entirely. In a city where the “hustle” is essential and space is limited, telling a trader to stay home without a safety net feels less like health advice and more like a threat. As volunteers at the grassroots level, we did not simply repeat the NCDC’s guidelines; we negotiated them, and we listened to their fears to find a middle ground. We looked for the gaps where the official story failed to match the daily reality of Lagosians, and we spoke with them, acknowledging that while the virus was a risk, so was hunger. We acted as mediators, humanising the response by acknowledging both economic fears and fear of the virus. We were not just “mobilising”; we were adjusting the response to fit the city’s human landscape. Together with community members, we co-created a set of practical adaptations grounded in their daily reality. We reiterated the core guidelines, but we reframed them around what mattered most to the people in front of us. We were candid about the dangers of non-compliance, not in a way that felt like a threat, but as a genuine appeal, that health is greater than wealth, and that losing one’s health meant losing the ability to work at all. Crucially, we did not ask people to choose between their safety and their livelihood; instead, we showed them how to run their businesses while following the guidelines, making compliance feel possible, rather than punishing. These were not adaptations handed down from above, they were built in conversations with the very people they were meant to serve.

Cholera: The Expert Knowledge of the Streets

In the Cholera response, the expertise from below was even more detailed. Outbreak response is often seen as a logistical challenge, but in Lagos, it is a social one. While experts analysed data on a screen, we were on the ground identifying the specific water vendors who earned the community’s trust. I recall times when our intervention worked not because we had better medicine, but because we knew which community leader should be the first to drink the treated water in public. This is not support work; it is strategic leadership. We understand the power dynamics, the religious nuances, and the informal networks that international organisations often overlook. We realise that a health message in Lagos is only as strong as the person delivering it.

Shifting the Arena

The Hague Humanitarian Studies Centre highlights the need for “locally led” Observatories. My experience indicates that these observatories already exist; they are found in the weekly meetings of health educators in Akoka, Yaba, and beyond. If the humanitarian sector is serious about reform, it must stop seeing us as the final link in its chain. We are the first responders and the permanent residents. We do not just “act” in the humanitarian space; we shape it. It is time to understand that the most skilled expert is not always the one with an international degree – often it is the one who knows how to make a mother in a crowded Lagos street feel safe enough to trust the cure.

To learn more about the official response efforts:

  • Lagos State Ministry of Health: Follow org for updates on state-specific interventions and emergency hotlines.
  • Nigeria Centre for Disease Control (NCDC): Visit gov.ng for national situation reports and public health advisories.

To learn more about the Humanitarian Observatory for Central and Eastern Europe (HOCEE) at CMR UW: https://www.migracje.uw.edu.pl/projects/humanitarian-observatory-for-central-and-eastern-europe-hocee/

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This blog is part of the ‘Humanitarian Observatories: Building a Knowledge and Advocacy Network on Humanitarian Governance’. This project has received funding from the European Union under the Horizon European Research Council (ERC) Proof of Concept.

Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or European Research Council Executive Agency (ERCEA). Neither the European Union nor the granting authority can be held responsible for them.