Against the Odds: The Audacity of My Leadership Journey in Health Security

From Response to Systemic Change: Institutionalizing IPC in Nigeria

The dots were gradually connecting from the Ebola response, where I first saw the devastating gaps in IPC, to the development of Nigeria’s first IPC curriculum, where we laid the foundation for training a professional IPC workforce. The advocacy efforts that accompanied the curriculum development ensured that IPC was gaining traction at key decision-making levels. And now, in 2018, I was stepping into the system itself no longer just advocating for change but actively building it from within.

A Turning Point: The 2018 Lassa Fever Outbreak

During the 2018 Lassa fever outbreak, Nigeria faced an unprecedented surge in cases, with up to 44 healthcare workers infected. This was a wake-up call despite all the lessons from Ebola, IPC gaps remained a critical vulnerability in our health system.

As part of the dynamic review of the 2018 Lassa fever outbreak, IPC was identified as a major gap, reinforcing the urgent need for an institutionalized program. But for me, this moment carried even deeper significance. Two years earlier, in 2016, during an advocacy visit to Dr. Chikwe Ihekweazu, then CEO of NCDC, I had expressed my willingness to establish an IPC program at NCDC. That conversation must have resonated with him because, during the outbreak, NCDC engaged me as a WHO-supported IPC Consultant to lead IPC efforts for the Lassa fever response.

A pivotal moment Dr. Chikwe Ihekweazu and I at NCDC, following my visit with Prof. Ogunsola to advocate for the IPC curriculum. Looking back, it’s striking how everything continues to align. Chikwe later referenced this moment in An Imperfect Storm (p. 59), the excellent book he co-authored with his wife, Vivianne.

From Outbreak Response to Institutional Change

Stepping into NCDC during the outbreak wasn’t just about emergency response, it was an opportunity to build a lasting IPC system for Nigeria’s health sector.

As we tackled the Lassa fever outbreak, I saw that IPC efforts were confined to treatment centers, but IPC isn’t just for outbreaks it’s the backbone of a strong health system. It had to extend beyond treatment centers into routine hospital operations and communities.

I was determined to use this response as a launchpad to institutionalize IPC, anchoring it in the WHO Core Components of an IPC Program. My strategy for a national IPC program focused on:

• Ensuring hospitals provide safe, free from avoidable harm every day.
• Strengthening resilience so hospitals can rapidly scale up IPC during outbreaks.
• Preventing healthcare facilities from becoming amplifiers of infectious disease outbreaks.

As the lead of the IPC pillar of the Lassa fever EOC, I set out to strengthen IPC not only in treatment centers but across entire hospitals. I was particularly concerned about the risk posed to unsuspecting healthcare workers in hospital settings those who had low index of suspicion and poor IPC practices were most vulnerable to exposure.

A typical day at the Lassa Emergency Operations Center (EOC). Pictured here leading the IPC Pillar during the 2018 Lassa fever outbreak response.

I traveled across the country, assessing major treatment centers, but I didn’t stop there. For the first time, I conducted the WHO Infection Prevention and Control Assessment Framework (IPCAF) for entire hospitals laying the groundwork for the establishment of hospital-wide IPC programs.

I conducted nationwide assessments of Lassa fever treatment centers, performing IPCAF evaluations across entire hospitals.

Inspecting a busy Accident & Emergency Unit, where overcrowding made screening and triage a challenge.

Makeshift holding area for suspected Lassa fever patients at the Accident & Emergency Unit before and after our recommendation for a properly structured facility

Dialysis unit in a Lassa fever treatment center a key insight that led to the inclusion of IPC in dialysis within the VHF IPC Guidelines.

Excerpts from my recommendations following assessment tours of Lassa fever treatment centers across the country. In 2018, I had to make bold almost anachronistic recommendations at the time. But I knew that to push for change, I needed data and evidence to reinforce my position. The assessments provided exactly that.

Assessment team meeting with hospital and treatment center staff, discussing recommendations and next steps. These discussions laid the groundwork for hospital wide IPC programs aligned with WHO Core Components.

Developed a dashboard to monitor IPC practices in treatment centers. This has since evolved into an IPC Scorecard, now used for monitoring IPC practices across all hospitals as part of national and health facility IPC audits.

From Consultant to Leading Nigeria’s IPC Program

We took a systems approach in responding to the Lassa fever outbreak. I set an audacious target IPC unit at NCDC, ensuring IPC was not just for outbreaks but embedded in routine healthcare delivery. Reflecting on this period, I see Chikwe’s visionary leadership as "the serendipity that gave wings to my audacious vision."

As my consultancy wound down, something unexpected happened I was offered a role at NCDC to lead the IPC program within the Department of Prevention, Program, and Knowledge Management.

This was a pivotal moment. What started as advocacy had become reality I was now tasked with developing the vision for a National IPC Program one that was sustainable, fit-for-purpose, and tailored to Nigeria’s unique needs.

It was a moment of validation, but more importantly, a call to action. I had spent years pushing for this, and now, it was time to lead its implementation.

The Audacity of Leading Against the Odds

This journey reinforced a fundamental truth for me: bold visions are often met with skepticism until they are realized. From the Ebola outbreak to curriculum development, and now to institutionalizing IPC, I have repeatedly stepped into uncharted territory, pushing boundaries many thought impossible. At every stage, the odds were stacked against success yet I pressed on, knowing that if we were to build a resilient health system, IPC had to be a fundamental pillar, not an afterthought.

I often stood alone in meetings, making the case for a national IPC program and career pathways for IPC professionals, met with blank stares or outright doubt. But leadership is about seeing the future before others do and having the conviction to pursue it despite resistance.

Going from consultant to national program lead wasn’t just a milestone it proved that audacity, backed by hard work and strategic action, can shift paradigms. Leadership isn’t about waiting for permission; it’s about stepping into the gaps and creating solutions that didn’t exist before.

The skepticism was palpable the looks that said, "This is too ambitious." But I stayed the course, knowing that with grit, resilience, and unwavering commitment, the vision would take shape.

This is what it means to lead against all odds.

This is why I do what I do. For my colleagues the incredible men and women who step out every day to care for others. And every night, I stay awake asking myself, “Who takes care of the healthcare worker?”

Stay tuned for my next post in the series: Against the Odds: The Audacity of My Leadership Journey in Health Security.

I am bursting with excitement as I prepare to share the next chapter of this journey. It was 2019 the quiet before the storm the story of a National IPC Program that saw the future.

It will be about Turn Nigeria Orange, about PALS, about taking ownership, and about going local.

🚀 What does leading against all odds mean to you? Let’s discuss in the comments!

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