Growing up as a teenager in Kano State, Nigeria, in the 1980s, I loved to read. Used copies of Ebony magazine were especially treasured. They offered a rare window into the lives, struggles and aspirations of African Americans, and a way for me to feel connected to a community far beyond my immediate environment.
Through Ebony, I was introduced to towering figures such as Dr. Martin Luther King Jr. and Supreme Court Justice Thurgood Marshall. Their courage, moral clarity and commitment to justice shaped how I thought leadership and service.
King is rightly remembered for his leadership in the civil rights movement but far less attention is paid to his views on health and justice. He once observed, "Of all the forms of inequality, injustice in health is the most shocking and inhuman."
Years later, I came to fully understand the power of King's words.
In medical school, I dreamed of becoming a plastic and reconstructive surgeon at a fancy hospital abroad. That dream began to change during my National Youth Service, the mandatory one-year service in Nigeria following graduation and housemanship for medical doctors.
Serving as a medical officer in a busy hospital in Abuja opened my eyes to the lack of preventive care. It was painful to see a malnourished child who had been running a fever for days, treated with local concoctions and brought to the hospital already in shock and on the verge of death.
These experiences revealed the deep injustice in the health system and how it has routinely failed my fellow Nigerians and were also a wake-up call to a popular but often ignored mantra: prevention is better than cure.
King's call for justice in health care resonated deeply. His vision inspired my conviction that universal health coverage is non-negotiable if we are serious about justice for all — and the title of my TEDx Talk, "Without health, we have nothing."
I am firmly convinced that the most humane, cost-effective and evidence-based response to health injustice in low- and middle-income countries such as Nigeria lies in strengthening primary health care, mobilizing local resources to finance health care and applying what we know about the science of human behavior to deliver care.
It's a principle that the global health community endorsed in 1978 when representatives from 134 countries and 67 international organizations, along with nongovernmental groups and civil society organizations, convened in Alma-Ata, Kazakhstan, and adopted the Alma-Ata Declaration, a landmark commitment to make primary health care — the level of care in people's daily lives — the foundation for achieving "Health for All." The Declaration called on governments to ensure that essential health services are universally accessible, equitable and grounded in community participation.
Nearly five decades later, many governments have drifted away from these principles.
Rwanda offers a compelling example of what is possible when this approach is taken seriously. Through a nationwide network of more than 50,000 community health workers, the country has strengthened access to basic services, improved health outcomes and reduced health injustice.
In 2019, I was part of a team of George Washington University's Atlantic Fellows for Health Equity that shadowed a community health worker in a village in Butaro District. He walked us through how this straightforward primary health care approach, treating pneumonia early within the community. Rwandan community health workers are trusted community members elected by their villages to provide basic services. They are often women with primary education who receive about three months of initial training in maternal and child health, focusing on malaria, pneumonia, diarrhea and nutrition, before serving their communities. This training follows national guidelines and is reinforced through ongoing supervision, refresher sessions and increasingly, digital learning tools.
The community health worker explained that when a child presents with cough, fever and breathing difficulty, he assesses the respiratory rate. If it's elevated, he gives an oral dose of amoxicillin under WHO guidelines before accompanying the child to the district hospital. This is especially critical in settings where delays in reaching district hospitals can be fatal.
We're now in a new era of global aid. The United States, long the largest funder of global health, is now reshaping its strategy. The current U.S. approach emphasizes working more closely with national governments while also advancing U.S. interests. It serves as a much-needed wake-up call for governments in low- and middle-income countries that have relied heavily on foreign aid yet often did not devise strategies to draw upon their own resources as well.
I have written about ways national governments can raise funds locally. These include engaging diaspora communities and exploring ways to channel 1% of diaspora remittances — the money sent back to family members — toward health insurance. Another important step would be to work with citizens to redirect high out-of-pocket health spending to buy health insurance..
Then there's the money that flows out of a country illegally — when companies or powerful individuals hide money overseas, for example, avoid paying taxes or steal public funds and park them abroad. Africa loses an estimated $88–$90 billion every year to illicit financial flows, money that could otherwise be invested in health systems, education and broader development.
Another important point in the effort to bring health equality: Behavior matters. However, most social interventions in low- and middle-income countries focus on improving knowledge — often neglecting the importance of motivating people to change their behavior. As Peter Drucker, the legendary American management guru, has said: "culture eats strategy for breakfast."
For the past 18 months, I have led a project in Nigeria that uses social media messaging and community pharmacists to increase HPV vaccine uptake among girls aged 9–14 years. Some key insights: Most caregivers who engage with our social media content or with these designated pharmacists come to recognize the importance of the HPV vaccine for their daughters. They're also more likely to vaccinate their girls when they have support from family and friends, as well as clear information and easy access to the vaccine.
My first daughter, Yagazie, was born with congenital heart defects and had to travel more than 15 hours from Abuja to India for life-saving surgery, a journey that underscored how much suffering could be avoided if specialized care were available closer to home. That experience continues to shape my belief that the 2026 MLK Day should serve as a reminder that leaders have a responsibility to remove health injustices and ensure dignified and humane life for all people, guided by Dr. King's enduring challenge: "Life's most persistent and urgent question is: 'What are you doing for others?' "
Dr. Ifeanyi Nsofor is co-founder of the Africa Behavioral Science Network, and Senior Atlantic Fellow for Health Equity at George Washington University.
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