Delivering free primary healthcare in Nigeria with microclinics

In February, 315 community members received free healthcare at Care Circle in Surulere, Lagos, a 50% increase on January that brings the total since the clinic opened five months ago to 1,370 patients. Of those, 41% were visiting for the first time and 59% returned for ongoing care, which suggests families are building a regular relationship with the clinic.

The average monthly household income among patients was about 11,400 naira (roughly £6) for a family of four, working out to about £1.50 per person per month. This is lower than January, which suggests Care Circle is increasingly reaching families with the fewest financial resources. We spent about £310 (US$391) on medications and nurses' salaries.

Earlier months saw a slower ramp-up than expected, partly due to government home demolitions in the area causing displacement and instability. With conditions calming, patient numbers have now picked up, and the slower early months also meant we could stretch the clinic's operating funds and extend its runway through to the end of April.

In February, 303 community members received free healthcare at Safe City in Oworoshoki, Lagos, bringing the clinic's total since launch to over 7,250 patients and 681 treated in the first two months of 2026 alone.

Patient visits dipped slightly from January due to government-led home demolitions in Oworoshoki, which displaced residents and created instability in the area. Despite this, Safe City stayed fully operational and slightly exceeded its monthly target. Of the 303 patients, 35% were visiting for the first time and 65% were returning, a continued increase in repeat visits that shows how central the clinic has become for ongoing care.

The average monthly household income among patients was about 24,400 naira (roughly £13) for a family of four, which works out to about £3.30 per person per month. We spent about £303 (US$384) on medications and staff salaries.

Mrs Victoria, one of Safe City's oldest patients and a grandmother in Oworoshoki, shared her experience on video, describing how the clinic has changed her life.

With solar panels now installed and power issues resolved, the team is well placed to maintain this pace heading into Q2.

In January, 378 patients received free healthcare at Safe City, our clinic in Oworoshoki, Lagos, bringing the total since launch to 6,953. Patient visits picked up as residents returned to Lagos after the holiday season, following a quieter December.

Of the 378 patients, 40% were visiting for the first time and 60% were returning. New patients continue to hear about the clinic through word of mouth from their neighbours. The average monthly household income among patients was about 21,700 naira (roughly £12) for a family of four, which works out to about £3 per person per month. We spent about £375 (US$474) on salaries and medications.

On the infrastructure side, we have finalised plans with local engineers to install a small solar generator at the clinic. The community helped raise funds alongside Kwanda's contribution, and the vendor will install the system within the next few weeks, which will help keep the clinic running smoothly as patient numbers continue to grow.

In January, 212 community members received free healthcare at Care Circle, our clinic in Surulere, Lagos. This brings the total to over 1,050 patients since the clinic opened four months ago, with 51% of January's patients visiting for the first time and 49% returning for ongoing care.

The average monthly household income among patients was about 13,700 naira (roughly £7) for a family of four, which works out to about £1.75 per person per month. We spent about £310 (US$390) on medications and nurses' salaries.

Care Circle is ramping up as expected, and as more families in Surulere discover the clinic, we anticipate patient numbers continuing to grow through Q1.

During this two-month period, we provided free healthcare services to 412 patients, bringing the total number of patients served since launch to 843. Most patients had very low household incomes, averaging N10,819 (around $8) per month for a family of four, and nearly all were uninsured.

Malaria remained the most common condition treated, followed by hypertension and other common illnesses such as respiratory infections, diarrhoea, skin rashes, and body pain. Over half of patients seen during this period were first-time visitors, while 42% were returning patients.

Patient feedback suggests that Care Circle is becoming a trusted source of care within the community. In post-visit surveys, 98% of patients rated the care they received as excellent, with the remaining patients rating it as good. Patients also travelled from surrounding neighbourhoods, sometimes for up to two hours, to access affordable healthcare.

In the last 2 months, we spent $866 ($407 in November, and $459 in December) to provide care to 421 people at Care Circle, including on medications, staff salaries (2 months) and Christmas bonuses!

As Care Circle continues to grow, the team will focus on maintaining quality care while reaching more underserved households in Surulere and nearby communities.

Activities:

• Provided free primary healthcare services to 412 patients in November and December

• Diagnosed and treated malaria, hypertension, and other common illnesses

• Served predominantly uninsured patients from low-income households

• Collected post-visit patient feedback to assess quality of care

• Delivered care to patients travelling up to 20 km from surrounding communities

In December, as is common during the Christmas season, many Oworoshoki residents travelled from Lagos to their hometowns, leaving the area quieter than usual. Even in the calm, Safe City remained open for those who needed care, and over 300 sick community members came in for support. This brings Safe City’s total impact to 6,575 people since launch.

This month, 31% of patients were new and 69% were returning, showing how deeply Safe City is loved and how firmly it has become part of daily life in Oworoshoki. The average monthly income of patients in December was just N11,067 ($8), highlighting the continued importance of accessible, life-saving care for our community.

Activities:

• Provided primary health care services to over 300 community members throughout December

• Treated conditions including malaria, respiratory infections, and minor injuries

• Recorded patient data showing 31% new and 69% returning patients, with average monthly income of ₦11,067

• Recruited and onboarded Nurse Jennifer through a competitive selection process with over 40 candidates

• Completed AHA approach training and induction at other clinics for the new nurse

In the coming months, we will continue delivering consistent, affordable care while supporting Nurse Jennifer to fully settle into her role and further strengthen service delivery at the clinic.

In just one year, Safe City has helped 6,268 people, around 2,000 more than our original target.

On 30 November 2024, Safe City opened its doors to the Oworoshoki community, offering free healthcare to people who were suffering and earning so little, they couldn’t afford care. Since then, we’ve welcomed patients of all ages, from one-year-olds to 89-year-olds. We’ve supported mothers and fathers with multiple children earning just $20/month or less, and thousands of children who made up over 30% of patients each month.

In November alone, we treated 595 people. Of these, 30% were new patients, 95% had no insurance, and visitors came from eight different communities. One patient travelled over 23km, almost an hour in Lagos traffic, to reach us. Even after a full year, Safe City continues to reach new neighbours, near and far, showing just how urgent the need for care remains.

After opening in the last week of September, Care Circle had its first full month of operations in October and helped 226 patients, with patients earning just an average of $9/month. This means that in the month of October alone, Kwanda helped to deliver free health care to almost 700 people (692 total) across Care Circle in Itire Surulere and Safe City in Oworoshoki, Nigeria.

Patients of all ages flocked in - with 4 one year olds being our youngest and an 88-year old Grandma the oldest. Out of the 226 patients helped in Care Circle, 14 patients were repeat patients from September!! It is so exciting as patients are now beginning to recognise that Care Circle is here to stay as their new health home in their community and coming back as repeat patients for follow-ups and spreading word to their neighbours.

Patients like Mrs Oge are also enjoying the new care! In Care Circle’s post-visit survey, 96% of patients rated the services received as “excellent”, and the remaining 4% as good!

Patients are spreading so rapidly to other communities near and far! Of particular note, a mom came in with her 3 kids to Care Circle (ages 4-6) from Ikotun, a community 20km away (this is about a 2 hr commute!!) to receive care from Care Circle. She stated “we hope this comes to our community soon.” Mrs Oge travelled 2 hours to visit Care Circles because no other means for affordable care was close to her and her kids in their home area.

Patients like Mrs Oge are also enjoying the new care! In Care Circle’s post-visit survey, 96% of patients rated the services received as “excellent”, and the remaining 4% as good!

As Safe City approaches its one-year anniversary, the free healthcare clinic in Oworoshoki, Nigeria has now reached a total of 5,673 people since inception. With 466 people helped in October alone, Safe City continues to exceed the initial monthly impact target of 300-400 patients.

40% of patients seen in October (187 people) were new patients who had never visited the clinic before. This demonstrates that even as Safe City matures in the community, new families continue to discover and access its services.

Hear from Mrs Emako, a returning patient that shares her experience at Safe City:

Distribution by illness

In October, Safe City's nurses treated:

• 32% Malaria cases — slightly higher than previous months

• 22% Upper respiratory tract infections — predominantly in children and one of the leading causes of death in the country

• 16% Hypertension management — most common in older patients

• 30% Other conditions including diabetes, anorexia, wound dressings, and ear infections

The average monthly household income of patients in October was N14,801 ($10/month) for a 4-person household. With an average of 2 children per household, the adjusted monthly income per person is approximately $3/month. Around 90% of patients seen this month were uninsured.

These numbers continue to highlight Safe City's impact in reaching people with severely limited financial and physical access to healthcare.

Patient demographics

• 44% Children under 18 (higher than previous months)

• 27% Children under 10

• Oldest patient: 88-year-old grandmother treated for diarrhea and weakness

• Youngest patients: Five 1-year-olds with respiratory infections and malaria

• 64% Female

• 36% Male (a slight increase from ~30% in previous months)

While 95% of patients live in the Oworoshoki community, Safe City welcomed patients from three other nearby communities lacking affordable healthcare: Bariga, Sawmill (5km away — the farthest distance traveled), and Gbagada.

Financial overview

$448 was spent from the Kwanda budget on staff salaries, medications and supplies.

This month, Safe City recycled 4lbs of plastic and generated N46,000 in income from 4 months of recycled plastic through its partnership with Wecyclers. This income was reinvested into clinic operations, allowing the clinic to spend approximately $30 less from the Kwanda budget this month.

Looking ahead

Safe City is on track to celebrate its one-year anniversary at the end of November. In just 11 months, the clinic has become a vital healthcare resource for thousands of Nigerians in Oworoshoki — providing care to moms rushing in before closing time, grandmothers seeking treatment, and countless children who would otherwise miss school due to treatable illnesses.

Through early intervention and preventive care, Safe City is reducing deaths from malaria and other treatable diseases, while properly managing chronic conditions like diabetes and hypertension that would otherwise go undiagnosed.

In the final week of September, Care Circle opened its doors in the Itire, Surulere community and within just one week, 209 patients received free care. This strong start brought our total reach in September to 648 patients across its two free clinics in Nigeria.

Developments

• Patient numbers grew from 104 on launch day to 209 by the end of the week.

• A recycling station is being finalized in partnership with WeCyclers, allowing patients and community members to exchange plastics for cash to support clinic operations. This initiative is set to begin in November.

Activities

• Care Circle officially launched in the final week of September

• 209 patients received free healthcare during the first week of operations

• 100% of patients were new, with no prior treatment history at the clinic

Beneficiaries

One of the first patients was Mr. Olayinka, a father in his 60s who said:

It’s been more than 6 months since I was last able to visit a hospital. I’ve been stooling so much in the past week and felt very weak. I saw the new clinic opened near my house and received free treatment here. Without this clinic, I don’t know what I would have done.

His story reflects the clinic’s core mission: to serve Nigerians who live on very low incomes and lack access to healthcare.

In total, Care Circle treated 209 patients in its first week. Common conditions included:

• Malaria (22%)

• Respiratory infections (20%)

• Hypertension (21%)

• Peptic ulcers (2%)

• Skin rashes (6%)

All treatments were provided at 100% no cost.

Patient demographics

• By income: Average household income was N15,633/month (~$11), typically supporting four people—equivalent to $3/person/month

• By insurance status: 98% were uninsured

• By age: 30% were aged 36–50; children and teens made up 17%, with the youngest patients aged 1 and the oldest aged 81

• By gender: 70% female, 30% male

• By location: 98% were from Itire, while others traveled up to 7km from areas like Ojuelegba, Aguda, and Ilasa

Financials

In September, approximately $280 was spent on staff salaries and medications. Since staff began mid-month (including a week of training and onboarding), only half of the monthly salary budget was used.

This month, Safe City treated its 5,000th patient, specifically treating 439 patients from 7 communities in September alone! On average, each patient who walked through Safe City’s doors in September survives on just $5/month in income, showing that Safe City continues to impact patients who really have no other option for healthcare due to immense poverty in Oworoshoki. This month, one patient travelled over 12 km via a 1hr bus ride to access Safe City’s free healthcare!

As kids return to school in September, Safe City saw a slight drop in the percentage of kids who walked into the clinic compared to August. Still, this month, Safe City treated 162 kids below age 18, significantly impacting the demographic most vulnerable to deaths from simple illnesses like malaria if not treated early. This month, patients presented with a wider array of illnesses, including Urinary tract infections, eye infections, and ulcers, with only 29% presenting with malaria compared to last month 38%. Safe City continues to serve as a life raft for Oworoshoki.

• In the last 4 weeks, Safe city treated 439 patients! Here’s the impact by distribution:

Distribution by illness:

• 29% had malaria

• 15% had respiratory illnesses

• 18% came for hypertension management

• 38% presented with other illnesses: UTIs, eye infections, peptic ulcers, diabetes, and more

Distribution by income:

• The average monthly household income for September patients was N32,600 ($23/month)

• Adults reported an average of two dependents, meaning most families survive on about $5/person/month—well below Nigeria’s poverty line

Distribution by age:

• The largest group was children under 18 (162 total), with 108 of them under age 10

• Middle-aged adults (ages 36–50) were the next largest group

Distribution by gender:

• 72% of patients identified as female, a 2% increase from August

Distribution by location:

• 96% of patients were from Oworoshoki

• Patients also came from seven nearby communities: Gbagada, Bariga, Ikeja, Ojota, Sawmill, and Ketu

• One patient from Ikeja took a 1-hour bus ride and walked 20 minutes to reach us!

I came in late when Safe City was almost closing for the day. If I had gone to a government hospital far away from home, they would have turned me away and asked me to come back

But at Safe City, she was helped instantly at no cost by Nurse B and Nurse Chioma. Amarachi came with her little baby, and they were helped instantly!

Challenges:

• Our walls were starting to stain from high foot traffic, but community volunteers cleaned them and they now look as good as new!

• Power outages have been frequent due to the rainy season. While our community partners cover utilities, we’re currently fundraising for a solar power unit. So far, we’ve raised N120,000 from donations and another N35,000 this quarter from recycling, just about $500 short of our N900,000 goal.

In the meantime, the clinic continues to function normally. Our WiFi is backed up by a mini UPS, and we plan to add another to prevent EMR disruptions during outages.

Financials: ~$450 was spent on salaries and medications to care for the 439 people who visited Safe City in September.

Care Circle officially launched this week! Over the past two weeks, we completed renovations, furnished the space, and set up the facility, trained staff on EMR technology, ran a community publicity campaign, and held our medical outreach launch event.

From day one, Care Circle has been running on an Electronic Medical Record (EMR) system powered by Ajirmed, a Nigerian-based company. This system will help keep patient data secure, enable analysis and trend tracking, and reduce paper and filing costs. Ahead of launch, Care Circle’s medical team completed EMR training with Mr. Dipo, Ajirmed’s EMR expert. Nurses Benedeth and Sylvia trained alongside him to ensure smooth implementation.

• Number of patients helped: from 0 to 104 on launch day.

• The clinic space is fully furnished and set up to be ready on day one.

• Staff trained on EMR with Ajirmed and equipped from the start.

• Team shadowed staff at other AHA clinics to learn the “AHA way.”

• Community outreach on September 18th included door-to-door engagement, distribution of flyers, and traditional drumming in Surulere.

• An official launch event was held on September 20th, supported by volunteer nurses and physicians. In three hours, 104 patients received free primary care and health education, with additional patients redirected to return on Monday.

• The clinic transitioned into full daily operations on September 22nd.

Financials:

Renovation costs were largely as forecasted, with about 99% of phase 1 funding now utilised. As Care Circle moves into operations, we look forward to securing phase 2 funding to cover staff salaries and medications. This will allow Care Circle to directly serve an estimated 300–400 patients per month in Surulere with free primary healthcare.

This August, Safe City treated its highest number of patients yet—786 in a single month—bringing the total number of people reached with free primary healthcare to 4,768 in just nine months. Over half of this month’s visits were returning patients, while 44% were new, showing that even as the clinic matures, word continues to spread among neighbours in Oworoshoki.

Safe City continues to serve those who would otherwise go without care: 97% of patients were uninsured and living on an average monthly income of $29 while supporting a household of four. While this figure is slightly higher than in previous months, it remains far below the poverty line. The clinic has become a true medical home and safe haven for mothers, children, and fathers alike, people whose lives have been improved or even saved thanks to your support through Kwanda. On behalf of our Oworoshoki friends, thank you for the real, tangible change you’ve made possible.

Developments:

• In August, 786 people received care, bringing the total number of patients treated from 3,982 to 4,768.

• Patients also recycled approximately 3 pounds of waste this month. The clinic will receive funds generated from the past four months of recycling through WeCyclers by the end of September.

Activities:This month, Safe City's medical team treated:

• 193 malaria patients, many of them children under 10 at high risk of severe illness or death

• 94 hypertensive patients

• 134 respiratory infections

• Over 300 patients with other illnesses, including rashes, insomnia, and peptic ulcers

Hear from Mrs Kehinde, one of Safe City’s patients, this month:

Challenges:Young adults aged 19–25 remain underrepresented among clinic visitors. We suspect this is due to work hours conflicting with the clinic’s weekday schedule (Monday–Friday, 8 am–4 pm). We’re exploring possible solutions, including telemedicine, and would welcome any thought partnership on identifying and addressing the root cause.

Financials:

About 54% of Safe City’s six-month budget has helped provide free care to 2,044 patients.

Over the past two weeks, we completed all renovations at Care Circle Surulere, including painting, branding, blind installation, and final equipment purchases. We also welcomed two incredible nurses, Benedeth and Sylvia. We also finalized plans for the clinic’s official launch: a large community outreach event on September 14, followed by a medical outreach and ribbon-cutting on September 20. Full-time operations will begin shortly after.

Activities:

• Completed painting and added branding to the reception area

• Purchased and installed blinds throughout the clinic

• Acquired and organized remaining equipment (BP machines, weighing scales, mattresses, laptop, phone)

• Hired and confirmed two nurses: Lead Nurse Benedeth (25+ years experience) and Nurse Sylvia (10+ years)

• Conducted deep cleaning and fumigation of the clinic

• Finalized launch plans: Sept 14 community parade, Sept 20 medical outreach and ribbon cutting, followed by weekday clinic operations

Challenges:

Operations ran smoothly overall. The only delay was finalizing staff interviews and ensuring full buy-in from Surulere stakeholders. To support community ownership, our partners and local residents were deeply involved in hiring decisions. With a high volume of applications and coordination across groups, the process took longer than expected but we’re now fully staffed with two excellent registered nurses.

For future hiring, we’re exploring affordable applicant tracking systems and calendar tools to streamline the process.

Meet Nurse Benedeth, our lead at Care Circle. She brings 25+ years of experience, including 16 years as a matron in a Lagos government hospital. She’s kind, highly skilled, and a passionate advocate for health equity. She’ll be working alongside Nurse Sylvia, who has over 9 years of experience. Both nurses were selected from a pool of over 50 candidates and vetted by the AHA, community partners, and the Surulere clinic committee.

Care Circle’s services will be supported by our network of volunteer physicians.

Next steps:

Staff orientation begins next week. Nurses Benedeth and Sylvia will undergo a five-day immersion at our Safe City and Gbagada clinics to train in operations, EMR tools, and best practices, ensuring they’re fully prepared for day one.

Finances (last 3 weeks):

We’ve now used about 94% of Phase 1 funding. The remaining 6% will go toward clinic decor and initial medication procurement in the coming week.