What Advocacy Looks Like: Lessons from My Aunty Nurse

Before the model primary health centre was built in Nnobi, my hometown, there was Aunty Nurse. This was in the early 2000’s, and back then, if you fell sick, you went to her “chemist shop”. It was a tiny space tucked between a carpenter’s workshop and an old woman frying akara over an open fire. I sat in front of that shop every morning waiting for the school bus, while watching her work. Her walls were covered with posters of diseases I would later study as a public health parasitologist. She taught our community using local names. Ukwu aba shoe—legs too swollen to enter shoes. That was elephantiasis. In this way she made medicine understandable, funny even. When the model primary health centre was finally built years later, Aunty Nurse moved there. She served and retired as a community health nurse in the facility that replaced her shop. But for an entire generation, before that health centre existed, she was the system.

I think about her now that Nigeria is trying to build that system at scale. Under the Renewed Hope Agenda and the push for Universal Health Coverage, the government has disbursed over N98 billion through the Basic Health Care Provision Fund. Thousands of facilities have been flagged as upgraded or revitalised. Yet as this push for primary healthcare grows stronger, the gap between policy and reality remains wide. Spot checks across the country show facilities marked as “revamped” with little visible change. Renovated buildings sit empty of staff. Upgraded centres lack drugs, water, or electricity. Community health workers are posted to facilities where they have nothing to work with.

It is chaos, but in the midst of such chaos I am reminded about health workers like Aunty Nurse, who despite the setbacks in the system remain steadfast in their service. They are not in fancy situation rooms, or in front of the media. They are in those hard-to-reach areas that barely make it in the news.

In global health, we often expect advocacy to deliver steady, if not quick results. We gather data. We write policy briefs. We demand change. And when funding dries up, when bureaucracy slows progress, when a disease stays invisible despite its toll, it is easy to feel defeated.

But I have learned to see advocacy differently.

Advocacy is a woman serving her community for decades and inspiring girls who watch her work. Advocacy is knowledge passed down, generation after generation. Advocacy is the fact that today, somewhere, a child in a remote village can still find a nurse in a small shop—because someone like Aunty Nurse existed first.

We measure advocacy in policy wins and budget allocations. But the most powerful advocacy I ever witnessed happened in a tiny room between a carpenter and a frying pan. It happened when Aunty Nurse explained an illness in words a woman could carry home. It happened in the trust she built, day after day, for years.

Advocacy is not always loud. Sometimes it is simply showing up. Sometimes it is women doing the work whether the system supports them or not.

The question is whether our billions will ever translate into that kind of presence. Will our policies produce a woman who stays, decade after decade, because her community needs her? And will that woman with her wealth of on-the-ground experience be given a seat at the table that decides how the people she serves, access healthcare?

Aunty Nurse did not wait for the perfect system. She built care with what she had.

The least our health system can do is give the next Aunty Nurse something to work with.

Advocacy is my Aunty Nurse. It is every health worker doing their best in broken systems with upgraded buildings.