It began, as it does for many, in the wards of the University of Portharcourt, Nigeria. Training as a medical doctor, learning to diagnose, treat, and care. But even then, a deeper discomfort was forming. The patients were not just sick. They were poor, unprotected, and structurally abandoned. They mirrored the vulnerable people I helped in my village the preceding year, supporting my mother who was the Primary Health Care (PHC) Coordinator of my Local Government Area. Some could pay. They were wealthy and powerful. Access to care was timely. They could leave the country at will for better care. As a member of the respected graduating Millennial Class (Final Class 2000) of Uniport, and the highly revered Christian Medical and Dental Association of Nigeria (Student’s Arm), I believed in the impossible. My life mission, stated in my class yearbook, was clear: To unite medicine and missions in the best possible way and shortest possible time. Reality was yet to dawn.

Offering healthcare as a house officer, youth corps member, and medical officer in urban and rural hospitals, prisons, a government house clinic, homes, streets, on phone, and in over 100 medical mission outreaches, the experience was the same. Most patients were not just sick. They were poor, unprotected, and structurally abandoned. They mirrored the vulnerable people I helped in my village supporting my mother who was the Primary Health Care (PHC) Coordinator of my Local Government Area. Access to care was also poor. Ability to pay was limited. A defining experience occurred. While heading a general hospital, I was called at 10 pm to attend to a woman who did not book for antenatal care, showed up few minutes before delivery, and was bleeding profusely after delivery. With a kerosene lantern, I removed much of the retained placenta, arresting the bleeding. I drove the ambulance I renovated myself as the driver was unreachable and landed her at 12 midnight in a private hospital of a high-ranking government official. I considered this the only place where the embarrassment of mortality would prompt an urgent intervention to save her life. Despite being overjoyed to see the woman and her baby a week later, a deeper discomfort emerged. The health service offered in my medical school textbooks were a mirage in Nigeria and could only become reality abroad. I chose to face the battle in Nigeria. Nonetheless, it was clear that treating one patient at a time felt necessary but was insufficient. I decided on a public health career to help. That would be sufficient, so I thought.

My public health training started with community health (a community targeted version of public health). The quick training deepened public health lessons from my mother. One day, I met a HIV positive woman who was bullied in the hospital for not accepting admission. The ‘caregiver’ was too impatient to listen to her story… she had been driven by her people – family members of the late husband from whom she got the virus and was left with some of the children who were positive. I resolved that community health was helpful, but the main problems were upstream. The solutions had to be too. Recognising that money and policy are the lifeblood of any healthcare system, the path turned toward health systems economics, financing and policy. This was a season of rigorous formation – advanced degrees, deep research, and a sharpening focus on the question that would define the years ahead: how do we make healthcare affordable, equitable, and sustainable for the average Nigerian? The academic architecture was being built. So was the mandate.

Joining the faculty at University of Nigeria, I rose through academic ranks, contributing to landmark research on health financing and policy through the Health Policy Research Group (HPRG), and later, HIV/AIDS related research through the Centre for Translational and Implementation Research (CTAIR). I also mentored young researchers who would carry the work further. This period was about establishing a body of evidence substantial enough to demand policy attention.

Systems determine outcomes. And outcomes require people who understand both. The bridge between research and policy became real and consequential in this period. I became immersed in the power arena of the health sector where decisions are made, helping shape policy and strategy, and advising various entities within the health ecosystem to shape and implement reforms within a very complicated political economy. Supporting government parastatals, development organisations, national assembly, and faith-based organisations, this was the Pracademic identity in full expression.

Beyond publishing findings, I’ve often felt like a biblical Daniel in a hostile Babylon, carrying the trust of the academia, ensuring that evidence entered the rooms where decisions are made. Researchers produce evidence that has helped shape policy but policy isn’t necessary the basis for decisions when it matters most – when budgets are being decided and budget releases are being prioritized. Government policies were buried in endless stakeholder power tussles, their only chance of implementation also resting on very few Daniel-type government appointees whose interests were beyond personal gain.

I have learned more than I have offered. Most importantly, the way interests and access to human, institutional and financial resources shape agendas, how this translates to power tussles over decisions on public resources, and how such influences determine the speed of implementation and outcome of even the best interventions.

“Policy is compassion at scale.”

Now, as a Professor of Public Health and Health Systems Economics, my work has found its clearest articulation. The hourglass is visible. The challenge is understood. And the mandate is plain: to stand at the narrow neck where evidence, power, and political economy meet, and do the work of transformation. The inaugural lecture is not a conclusion. It is a beginning.

Having gathered experience from working in the academic, policy, and even the intensely political fields, I now feel better placed to support evidence-informed policy making that will lead to a strengthened health system in Nigeria. The scope of my contributions to achievement of Universal Health Coverage and broader human capacity development within Nigeria and globally will include helping to design the future health financing system, and the future healthcare system (including faith-based healthcare which leverages compassion driven hearts to serve Africa’s huge vulnerable population). It also includes equipping academics to become pracademics, directly or indirectly, and practitioners themselves to become pracademics.

Strategic communication has emerged as an unavoidable reality for me. The responsibility of a pracademic means a straddle of academia, consulting and activism. Most importantly is how to observe the environment including the board room, staff, bureaucrats and development partners, operators, funders, civil society, the media and the citizens, predict behaviours and outcomes, and inform strategic action through effective communication. Doing so means moving research outputs, policies, and strategies beyond articles to impactful instruments, and telling stories of transformation.

The lessons learned so far are helping me build generations and institutions. Through the Institute for Excellence in Healthcare and Leadership, I will continue to unleash a deep longing – a system to influence generations of young faith-driven doctors towards becoming excellent and effective health sector leaders. Through MedWHOLE, I will continue to work to transform communities, changing one life at a time.