Every morning, before the first light of dawn, 65-year-old Malam Idris Bunun Fadan Mai checks his blood pressure. The resident of Misau, the headquarters of Misau Local Government Area in Bauchi State, lives several kilometres away from the nearest hospital. But thanks to the tireless visits of community health volunteers, Malam Idris can now monitor his condition and stay healthy.
‘I check myself every morning and take my medicine. If not for these volunteers, it would have been very tough,’ he said, his face calm yet marked by years of quiet endurance.
Narrating how he was diagnosed with hypertension and had to be on medications to regulate his blood pressure, he said: ‘There was a time I hit my head on the door while going to the toilet. Fortunately, I was working with the Ministry of Health then, and the Permanent Secretary asked me to go to the hospital.’
Across West Africa, from Bauchi in northeastern Nigeria to Suhum in Ghanas Eastern Region, men and women like Idris rely on local volunteers for their survival.
These are the Community Health Influencers, Promoters and Services (CHIPs) and grassroots health workers – ordinary citizens filling the gap where health systems fall short.
They bring essential health services straight to people’s homes – from blood pressure checks to health education and treatment referrals. But despite their impact, they work under immense strain, facing little or no government support, misunderstanding from residents, and the daily challenges of unpaid labour.
Battling the silent killer in Bauchi
When 45-year-old Amina Abdullahi began experiencing dizziness and headaches, she assumed it was stress. It was not until some health volunteers visited her home in Misau that she discovered her blood pressure was dangerously high.
‘Yes, I used to feel dizzy and had frequent headaches. When they tested me, they confirmed that I had high blood pressure. It has been about a year now, and we are very grateful for their support,’ she said.
Amina and Idris are among hundreds in Bauchi whose lives have been transformed by CHIPs volunteers.
Many Nigerians sitting on time bomb – Health experts
Hypertension has become alarmingly prevalent in Bauchi State. In January 2020, Governor Bala Mohammed revealed that about 150 people died in Azare – Katagum Local Government Area – within 30 days, from hypertension and related illnesses.
Worried by the prevalence of hypertension in the country, a Nigerian cardiologist, Dr. Ahmed Abdulrahman Mohammed, revealed that hypertension, caused by persistently high blood pressure, has become the leading cause of death in Africa after road accidents.
Dr. Mohammed, who was the overall best graduate of cardiology in 2012 from the Memorial Saad Medical Centre, University of Cairo, Egypt, disclosed this during an interactive session with journalists in Bauchi.
The Bauchi-born medical expert lamented that Nigeria’s health sector continues to suffer setbacks due to poor technological advancement, irregular power supply and inadequate medical equipment in hospitals.
According to him, his decision to specialise in cardiology was driven by the shortage of heart specialists in the country and the frequent death of patients suffering from cardiovascular diseases.
‘I chose cardiology because I was disturbed by the number of lives lost daily to heart-related illnesses. Nigeria needs more trained experts in this field,’ he said.
Dr. Mohammed stressed that countries that have made significant progress in medicine are those that invested heavily in modern technology.
He therefore urged the Nigerian government and medical institutions to give more priority to the health sector to encourage young people to pursue medical specialties like cardiology.
Similarly, a Consultant Cardiologist at Providence Multi-Specialty Hospital, Abuja described hypertension as a silent killer that often shows no symptoms until it leads to stroke or heart failure.
Many people don’t know they are living with very high blood pressure, said Dr. John Asekhame. If not detected and managed early, it can make someone slump and die suddenly.
The American Heart Association (AHA) also warned that sudden cardiac arrest – one of the complications of untreated hypertension – can occur without prior symptoms and accounts for nearly half of all heart-related deaths.
In a 2016 article titled Heart-stopping conditions could come with warning signs, Prof. Sana Al-Khatib of Duke University Hospital noted that people with risk factors such as diabetes, high cholesterol, or a family history of heart disease should take any warning signs seriously.
‘Even if the symptom seems minor, don’t ignore it. Go to the hospital and ask the right questions,’ she advised.
Volunteer network saving lives
In Bauchi State, volunteers like Comrade Yusuf Aliyu Fada, Chairman of the Ibrahim Ali Pate Usman Foundation, lead local health outreaches, visiting homes and checking people’s blood pressure for free.
‘We try our best to check BP for people around the PHC. Even without payment, we still help those in need.
Some call us to their houses; others come to our outreach centres. We just want people to stay alive,’ he said.
He recalled a case where his 50-year-old neighbour suffered constant headache.
‘When I checked his BP, it was 200/250. I told him to start treatment immediately. Now, he is fine, he said.
‘Yet, the work comes with challenges. People think the government pays us, but that is not true. Only one local government gives us a small allowance, he added.
Another volunteer, Abdullahi Muhammad Mubarak, noted that residents often misunderstand their mission. ‘Some people think were showing off., but we are farmers and small business owners. We just want to help our community,’ he said.
Parallel effort in Ghana
Across the border in Suhum, Ghana, a similar story unfolds. The Youth Aid Initiative (YAI), founded in 2015 by two university graduates, leads volunteer-led campaigns against diseases such as tuberculosis, malaria, HIV, and neglected tropical skin infections.
However, the volunteers do not conduct tests on suspected clients themselves. Instead, when they identify a potential case, they promptly notify the disease control officers at the nearest health centre.
The officers then accompany the volunteers to the affected communities to examine the clients and collect samples from those requiring laboratory testing.
Diagnosis is made by the disease control officers based on both laboratory results and physical examinations. Once confirmed, the clients are supported by the volunteers and the Non-Governmental Organisations (NGOs) to access treatment at designated health facilities, while follow-up monitoring is jointly carried out by the volunteers and the disease control officers.
‘We use local volunteers because they know the people and understand their language,’ said founder Bright Owusu.
‘That trust helps us to reach communities where hospitals can’t.
‘However, sustaining the work is tough. Our volunteers started with so much energy, but now, due to the economy, many struggle to continue,’ Bright lamented.
‘Still, their dedication keeps us going,’ he added.
Like many grassroots health organisations, the Youth Aid Initiative in Ghana has struggled with limited funds, volunteer fatigue, and logistical constraints.
Government’s response in Bauchi
Meanwhile, the Bauchi State Government has expanded its hypertension screening programme from 24 to 132 primary healthcare centres as part of efforts to curb the rising cases of the disease across the state.
Deputy Director of Public Health at the Bauchi State Primary Health Care Development Board, Umar Hassan Waziri, disclosed this in an interview with our reporter, noting that hypertension remains a major health concern not only in Bauchi but across Nigeria.
According to Waziri, the state records a hypertension prevalence rate of about 23 to 24 per cent, prompting the need for an intensified response.
He said the intervention by Population Services International (PSI) through its Healthy Heart Africa programme, launched in January 2023, has been instrumental in improving screening and early detection.
‘PSI began screening in 18 states, including Bauchi, selecting six local government areas-Bauchi, Toro, Alkaleri, Ningi, Katagum, and Gamawa. In each LGA, three primary health centres were designated for daily screening, with a general hospital serving as a referral point. That gave us 24 active facilities’, Waziri explained.
He said that before the intervention, the state lacked clear data on hypertension cases.
‘With PSIs support, we’ve been able to detect and manage cases that would have otherwise gone unnoticed,’ he added.
According to him, between 2023 and now, 1,284,662 people have been screened, out of which 125,162 showed elevated blood pressure while about 54 were confirmed hypertensive.
Waziri said PSI has also donated essential materials such as weighing scales, BP apparatuses, and free drugs to the 24 facilities.
He commended PSI for providing free services, drugs, and capacity-building for health workers, adding that proper training had long been overlooked in managing the condition.
‘With the support of Dr. Rilwanu Muhammad under the PHC Board, we’ve gone this far’, he said.
Waziri revealed that PSIs involvement followed an advocacy visit to the National Primary Health Care Development Agency, after which Bauchi leaders approved collaboration due to the silent rise in hypertension cases.
He said the government has now incorporated the programme into its Annual Operational Plan (AOP) to ensure sustainability beyond PSIs presence.
‘We are scaling up to 132 PHCs out of the 212 in Bauchi. This step shows the governments commitment to sustain the project by funding it directly’,he said.
A region’s lifeline
Whether it is volunteers like Yusuf Fada in Misau or Conne David in Suhum, one truth binds them – their unpaid service keeps hundreds alive.
In places where hospitals are miles away and ambulances never come, they have become the first responders, counselors, and sometimes the only hope for patients battling chronic illnesses.
But the question remains how long can goodwill sustain a service the state should guarantee? Until West African governments strengthen rural healthcare systems, these volunteers – unsung and unpaid – will continue walking dusty roads, carrying blood pressure cuffs, and saving lives one household at a time.
‘Whether in Misau or Suhum’, Idris said with a faint smile, ‘they are the reason many of us still wake up to see another day.’