Ashoka Paschal_Achunine_HEI_Nigeria Headshot
Ashoka Fellow since 2023   |   Nigeria

Paschal Achunine

Health Emergency Initiative
Paschal is transforming the way the healthcare sector delivers emergency medical care, before and after patients reach the hospitals by empowering and training citizens as first responders in…
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This description of Paschal Achunine's work was prepared when Paschal Achunine was elected to the Ashoka Fellowship in 2023.


Paschal is transforming the way the healthcare sector delivers emergency medical care, before and after patients reach the hospitals by empowering and training citizens as first responders in post-crash care and support.

The New Idea

Paschal is increasing the number of accident victims accepted in hospitals without administrative bottlenecks, and the completion of treatments of low-income people who may not have the initial deposit required by hospitals. He is systematically identifying and empowering local actors to become first-care responders, protecting human life in distress through a combination of restorative care that alleviates suffering and enables individuals to regain independence following an emergency, illness or injury. With minimum resources, Paschal is reviving and bringing new life to the emergency healthcare system. He is leveraging the existing structure to increase the number of patients treated with the minimum amount of resources.

He is improving the first care response for people that have accidents through the empowering and training of citizens. These are citizens who normally run to accident scenes like truck drivers, artisans, market women, roadside auto-mechanics and tire vulcanisers.

Paschal's approach to improving emergency healthcare in Nigeria is multifaceted and innovative. By combining behavioral change, technology, and mass media, he has created effective awareness and informative programming to educate citizens about the importance of early intervention post-crash care, timely first-aid, and cross-sectoral referral systems. Moreover, Paschal facilitates advanced training programs for individuals, empowering them to respond to emergencies and serve as initial first responders.

The Problem

Across the globe, about 930 million people spend at least 10% of their household income on healthcare according to the World Health Organization. And to further buttress the lack of access to healthcare services, statistics show that for half of the world’s population, the nearest doctor or nurse can be hours, or even days away, and in many cases the health facilities that are reachable are unaffordable, understaffed, and under-resourced. In Nigeria, despite the National Health Insurance Scheme (NHIS) established in 2006 to achieve Universal Health Coverage (UHC), 77% of Nigerians still incur catastrophic out-of-pocket health expenditure. Plus, the exacerbating effect of the COVID-19 pandemic has forced millions of vulnerable Nigerians further into extreme poverty and they choose between spending on food or spending on life-saving medicines.

No one chooses to live in poverty. Yet, according to the World Bank, 4 in 10 people live below the national poverty line in Nigeria. And they are faced with severe fear and uncertainty. This situation is particularly concerning as rural communities, which make up approximately 75% of the population, are burdened with a high prevalence of diseases such as malaria, diarrhea, and malnutrition. Therefore, making access to basic health services in rural areas of Nigeria and by extension sub-Saharan Africa a significant challenge. Families who live across marginalized and rural communities spend about $100 at least four (4) times per year to access health services. Yet, 99% of these vulnerable households earn an income between $100 - $300 annually, and they face a high burden of disease and a higher health disparity. Moreover, around 55% of these families spend about half this amount on transport as they often have to travel long distances of more than 5 km to access any kind of medical assistance or to find quality medicines, which can be prohibitively expensive.

A 2017 report by USAID for global development states that Nigeria with an annual population growth rate of about 3.2% holds one of the worst health indicators in the world. They predict the population rate to reach 440 million people by 2050. The situation is alarming also considering the persistently low and inequitable distribution of health services and quality medicines plus the rapidly rising population coupled with brain drain and massive migration of health professionals, which leaves the health workforce density at 1.95 per 1,000 population i.e., one doctor sees as many as 250 patients daily. Additionally, essential medicines are often out of stock, and lower-level health facilities lack qualified personnel, while private hospitals are prohibitively expensive, requiring over 50% deposit of the cost of care before administering any treatment. Mothers and their newborns are subjected to medical detention due to their inability to pay hospital bills, which is a violation of their human rights and poses a risk to their physical and mental health.

Nigeria also suffers a significant number of road accidents, going by the statistics from the World Health Organization, road accidents are a leading cause of loss of lives. An estimated 41,693 people are killed annually on Nigerian roads, which accounts for about 2.82% of the global total. On average, there are about 36 road accidents daily in Nigeria, which often result in high casualties. And rapid response to emergencies such as heart attacks and accident victims is crucial, with a 20-minute window for the former and a 2-hour window for the latter. However, the sad reality in Nigeria is that most people do not have the necessary knowledge of CPR or first response to help in such situations, and even when they have the knowledge and are willing to help, the fear of legal consequences and police harassment in the event that something goes wrong holds them back.

Although hospitals are supposed to provide emergency care, in practice, they often fail to do so. Patients are required to pay upfront fees of between 15 to 20 USD before they can be admitted, which is a significant challenge for most Nigerians. The same policy applies to people arriving by ambulance, despite the law stating that they should be admitted without delay. This policy has led to many otherwise avoidable fatalities, such as that of a family who experienced a fire incident, and their children who suffered 3rd-degree burns were denied access to treatment until a deposit was made. In the end, of the three children that suffered the burns, only one eventually survived because of the initial delay.

In summary, Nigeria's healthcare system faces many challenges, particularly in the area of emergency care. A lack of knowledge about first response, coupled with the fear of legal repercussions, hinders many well-meaning individuals from helping those in need. Additionally, the financial burden placed on patients and the strict policies of hospitals further compound the problem, leading to devastating consequences for those who need urgent medical attention. With around 600 million people living in communities without emergency care in sub-Saharan countries, the problem is of a massive scale.

The Strategy

Paschal and his team are tackling the issue of road accidents, the leading cause of deaths in Nigeria, with a proactive approach. They have signed an MOU with the Nigerian police and other government authorities to acknowledge that citizens can be trained as first responders with full backing from the authorities. The team has taken an innovative approach by focusing on commercial and taxi drivers as potential first responders, given their high likelihood of encountering accidents on the road.

Paschal, through a partnership with Lay First Responders International, USA, offers different training courses for different partner organizations in Nigeria. These include a 10-hour course designed for citizen first responders in private corporations and government agencies; a 6-hour course for high school students and bystanders; and a 1-hour course for general information and advocacy. The courses cover topics such as CPR, managing heart attacks, helping accident victims, and crowd control among others. The citizen first responders who complete the training are given government-recognized vests, which they put on when they get to accident scenes. This recognized uniform empowers them to initiate crowd control, clear the area and begin first aid before calling for an ambulance. Meanwhile, the high school students who complete the 6-hour course act as first responders in their schools and commit to sharing their knowledge with at least four fellow students. To date, Paschal and his team have trained 34,790 people in 6,550 training sessions who have gone ahead to address 9,622 emergencies.

Paschal is also focused on maximizing the number of patients treated with minimum resources. He is also addressing poor access to health services by leveraging the existing structure of hospitals, paying for the initial down payments required by the hospital to the patient, and covering medical detentions, laboratory testing, some drug prescriptions, minor surgeries, malnutrition, acute diarrheas, measles, malaria, blood transfusion, and provision of oxygen supply for non-chronic diseases. With over 1000 social workers across Lagos, Oyo, Delta, Edo, Plateau, Anambra, and Imo states, who are equipped with digital health workflows, they help identify acute cases that require immediate medical attention and can be resolved within a week or two at a low-cost. These social workers, who are attached to different hospitals, access the files of the patients, verify that the patients do not have the resources to pay for the bills and liaise with the hospital to ensure that treatment and care commences.

So far, Paschal and his team have supported over 5,500 patients with an average bill of $80 per person. In rural communities across Lagos, Oyo, Anambra, and Imo, Edo, Delta, Plateau states, he has facilitated over 3,000 drug prescriptions. Paschal's funding strategy involves a network of institutional and individual donors that make annual contributions to the work he does. For institutional funders, he has Microsoft, The Rockefeller Foundation, Total Energies E&P, Multichoice Nigeria, Spectranet, ACT Foundation, UPS Foundation, Sterling Bank, Citi-Trust, Tolaram's, among others. He also has a network of 5,000 individuals that support his strategy with annual contributions in cash and in kind.

Paschal and his team are working on rolling out their iResponder app, which will allow a lot of people download it to report live accidents. Once accidents are reported on the iResponder app, the closest first responder will receive a notification and directed to the location for quick first aid and ambulance lift-off to the hospital.

The Person

Paschal was born and raised in Southeast Nigeria in a low-income family, which gave him a firsthand experience of the challenges faced by people from economically disadvantaged backgrounds. As a young child (11years old), he witnessed his father die of a cardiovascular ailment, and he feels that if someone with knowledge of CPR had been around him, he wouldn’t have died. This experience left him thinking of ways he could make a positive difference in the lives of others and prevent similar tragedies from occurring.

Despite his very challenging background, Paschal worked hard to obtain a good education and to achieve his goals. He began his career in banking and quickly rose through the ranks, becoming a branch manager and eventually becoming a Team Lead/Departmental Head. Throughout his career, Paschal maintained a strong commitment to helping others. He was involved in social work and frequently made donations to low-income communities in Lagos, where he lived. His passion for helping people was further fueled by his experience working in rural communities during the compulsory one-year national youth service.

In 2008, after Paschal's daughter was born, he encountered a woman at the hospital who had given birth but couldn't pay her bills and as such was placed on a medical detention by the hospital. Paschal paid the equivalent of $100 to help free her from medical detention. This event marked a turning point in his life and changed his view about access to basic healthcare services, He learned about more women in medical detention and others who were excluded from care due to their inability to make upfront payments. He was inspired to do something about the situation, and this led him to write the entire plan of his non-profit, Health Emergency Initiative in a diary, but he did not act on it at the time. It wasn't until 2015 when a Catholic priest encouraged him to start his work as a social entrepreneur that Paschal decided to quit his job and focus on Health Emergency Initiative; to provide critical healthcare services and emergency medical care to people in underserved communities across Nigeria.