In Cameroon’s Northwest region and across Nigeria’s northeast, community health workers (CHWs) face daunting odds but share a single mission: to save lives. As hospitals shut down and health workers flee targeted attacks, CHWs deliver polio vaccines and vitamin A, screen children for malnutrition, refer obstetric emergencies and provide psychosocial support to communities cut off from care.
The Cameroon Anglophone Crisis has led to over 6,500 deaths and displaced more than 600,000 people in Cameroon and neighbouring Nigeria, most of whom need humanitarian support, according to the International Crisis Group. Violence and insecurity have crippled public services, with the health sector among the hardest hit, as hospitals and health personnel suffer repeated attacks from both government forces and armed separatist fighters. Looting, destruction of infrastructure, and attacks have driven health workers away, leaving many clinics in “red zones” closed and communities exposed to preventable diseases.
Similarly, in Nigeria’s northeast region, years of insurgency and banditry in Borno, Yobe, and Adamawa have devastated the health system. As of December 2023, Borno hosted about 1.7 million internally displaced persons (IDPs) and nearly 886,000 returnees. Attacks on civilians are frequent, dozens of health facilities have been destroyed or abandoned, and many skilled health workers have fled. In the aftermath, community health workers are stepping in to fill the gaps.
Impact on Child Health and Immunisation
Cameroon is one of the world’s most neglected displacement crises, according to the Norwegian Refugee Council, and ranks among the top ten most conflict-affected countries in the ACLED Conflict Index (2024). The protracted crisis in the Northwest and Southwest has crippled the health system; nearly 40% of facilities are non-functional, and many health workers are displaced. Routine immunisation has dropped by over 60% in conflict-affected areas, with coverage below 30% in some communities, exposing thousands of children to preventable diseases like measles and polio. In the Northwest, full vaccination coverage for children aged 12–23 months decreased from 83% in 2014 to 68% in 2018, according to the MICS 5 & DHS surveys.
Community health workers collaborate with non-governmental organisations (NGOs) such as the Community Initiative for Sustainable Development (COMINSUD), which runs vaccination drives and distributes mosquito nets to prevent child deaths amid weakened health services. Working with COMINSUD in partnership with the World Food Programme, CHWs in the Benakuma and Wum health districts identified and treated over 200 malnourished children within six months in 2021.
In Nigeria’s affected states, one-third of health facilities have been destroyed or damaged, and insecurity endangers health workers and disrupts routine immunisation. Displacement and access restrictions erode service continuity, pushing families to rely on mobile and community-based outreach for child health and nutrition.
Rabi Mani, 30, and her husband fled Goronyo LGA in Sokoto State with their five children due to insecurity. In their new abode, they often went to bed hungry, and during a door-to-door visit, community nutrition mobilisers found their two-year-old son, Nasiru, severely malnourished with a mid-upper arm circumference (MUAC) of 11.6 cm. They referred him to the Outpatient Therapeutic Centre at the Taloke Primary Healthcare Centre, where he was given ready-to-use therapeutic food. A mobiliser followed up weekly, counselling Rabi on nutrition and hygiene. Within weeks, Nasiru’s MUAC rose to 14.2 cm, his eyes brightened, and his smile returned. Without timely intervention and consistent follow-up, children like Nasiru could be lost.
Women Leading Community Health Efforts
Women in Cameroon’s Northwest are at the forefront of community health work. Chifu Elizabeth Nsoni provides health interventions in one of the resettlement camps in Upkwa, Menchum Division. The camp, long-marked by underinvestment, was originally established after the 1986 Lake Nyos disaster, and is now further strained by the ongoing armed conflict. Nsoni’s motto, “humanity first,” keeps her going despite the insecurity.
“I have sufficient training to assist my community, and I willingly offer my services every time they are needed,” she says.
Miranda Nonsi, another CHW, has worked in Bafut, Oku and Mbapi to identify and assist people living with epilepsy.
“I have addressed cases that, if neglected, could worsen stigma, discrimination, and mistreatment,” she says.
Community health workers also refer women for maternal health services. One such referral helped Fadimatou, who had lived with obstetric fistula for 10 years and lost four babies during childbirth, receive free treatment from the Cameroon Baptist Convention Health Services (CBCHS) and the Fistula Foundation.
"It feels too good to be true living without leakage," she said.
Mental Health Support in Emergencies
Across the border in Nigeria, CHWs are the link to mental health services for women like Fatima, who fled with her family to the IDP camp in Goronyo after bandits attacked her village. When community nutrition mobilisers from the Life Helpers Initiative (LHI) Health Programme in Sokoto State found her, she was depressed, had stopped talking and eating, and struggled to sleep. Her blood pressure was dangerously high, and her young son, Basiru, had a severe skin infection, malaria, and typhoid.
"I just sat there watching. I didn't have the strength to take him to the hospital," she recalls.
The mobilisers referred her and her son to a mobile clinic for treatment. A mental health nurse from LHI began visiting her daily. With regular follow-ups, care, and emotional support, Fatima began to speak, eat and sleep again.
"In our community, people don't believe that women can suffer from mental distress," she says. "If not for LHI, my son and I would have died." Today, Fatima helps other women in the camp seek care.
Bridging the Healthcare Gap
Where devastating attacks on health facilities and personnel limit access to healthcare, locals rely on trusted community health workers.
“Malaria is rampant here, and we also see typhoid and various skin diseases that require urgent care,” says Njeti Martha, a nurse in Ako, Donga Mantung, Cameroon.
“As a state nurse, I cannot travel outside Ako Urban to attend to patients due to threats and insecurity. Community health workers are stepping in to provide essential care and support. The population relates to community workers because they come from and serve in the same localities. Threats and attacks on them are often minimised, especially since they are not directly linked to government structures but rather serve under local and international organisations through various projects. I really value their support.”
Local and international health establishments offering services in the restive regions of Cameroon echo this sentiment.
“Community health workers are trusted, community-rooted, and vital in crises,” says Paediatric Adolescent Treatment Africa (PATA) Country Representative Dr. Fozao Vanessa. “They deliver drugs, track patients, provide psychosocial support, reduce stigma, and work with healthcare providers to ensure treatment continuity, especially for HIV.”
In Nigeria, Dooshima Mary Agur, a health worker in Benue State, says that community health workers help many IDPs, who suffer from communicable diseases such as diarrhoea, pneumonia, malaria and typhoid, as well as skin infections and child malnutrition.
Nigeria’s task-shifting policy, adopted in 2014, recognises the role of community health extension workers, particularly in rural and hard-to-reach areas. It allows them, under supervision, to deliver components of maternal, newborn and child health, where higher cadre staff like doctors and nurses are scarce. With proper training, mentorship, and supervision, CHWs provide interventions in underserved communities
Yet CHWs in both countries face constraints: limited numbers, irregular and low pay, inadequate training, and a lack of protective gear and supplies.
“We work temporarily on projects such as the distribution of treated mosquito nets and health campaigns such as polio vaccination, vitamin A supplementation, deworming or mass drug administration. We do not have a fixed salary; our income depends on the projects available,” says Ngong Beltha in Cameroon.
“It has been more than a year since we conducted the mosquito net distribution campaign in some communities of Benakuma, and we are yet to be paid,” she adds.
While non-state actors, working with community health volunteers, deliver routine immunisation, nutrition, WASH and malaria services, their scale and continuity depend on predictable funding and coordination. This, says Oladele Matthew, Programme Director of the Initiative for Social Development in Africa (iSODAF), leads to fragmented health services. While international aid has provided support, vertical programmes and a lack of dedicated funding continue to leave gaps in care for the most vulnerable. These challenges were further compounded by USAID’s exit in February 2025.
For effective and sustainable community health programmes, Oladele emphasises that emergency preparedness must be built into health planning and budgets. This includes adequate supplies, functional mobile clinics, trained rapid-response teams and strengthened early warning systems. All of these must be coordinated across national and state emergency management agencies and health and other ministries to sustain services during crises.
Across Cameroon and Nigeria, community health workers bridge the gap between overstretched health systems and communities in crisis. From immunising infants and treating malnutrition to supporting maternal and mental health, their proximity and trust enable lifesaving work where formal services are out of reach. The effectiveness and safety of these frontline healers depend on fair pay, steady supervision, reliable supply chains and predictable funding, which are essential for functional health systems that serve communities in crisis.
This collaborative report was written by Sylvie Yukfu (Cameroon) and Edoamaowo Udeme (Nigeria) with the support of the Africa Women Journalism Project.
