Health Equity Advocate Blog Post

Fiona Anita Igwe

Founder and Director, Fionita's Project CIC

Dr Fiona Igwe is a global health professional and health equity advocate with over a decade of experience leading community-driven health initiatives. She is the Founder of Fionita’s Project, delivering programmes in health education, first response, and prevention across communities globally. She also works in kidney health, advancing equitable research, patient involvement, and strategies to address health inequalities across systems and practice.

Why this matters to me:

I have seen first-hand how preventable deaths and poor outcomes are often the result of systems that were never designed for everyone. My work is driven by a commitment to ensuring that communities most affected by inequities are no longer invisible within the systems meant to serve them.

The Equity Issue

The core inequity I address is the systemic exclusion of underserved and underrepresented communities from access to life-saving health knowledge, early intervention, and equitable participation in healthcare systems and research.

Through Fionita’s Project, this manifests in very tangible ways: individuals lacking basic first aid knowledge during emergencies, young people without access to sexual and reproductive health education, and communities experiencing period poverty, maternal health disparities, and limited access to preventative care. These are not isolated challenges, but structural gaps in how health education, resources, and support are distributed.

In parallel, within kidney health, inequities are evident in the disproportionate burden of chronic kidney disease among Black communities, coupled with limited engagement in early detection and prevention pathways and low representation in clinical research. This results in delayed diagnoses, poorer outcomes, and reduced access to innovative treatments. Communities facing the highest burden of chronic conditions are often the least represented in the very research designed to improve treatment outcomes.

These inequities persist at the intersection of race, socioeconomic status, and systemic neglect, where those most affected are often the least prioritised in both service design and research.

Without intentional intervention, these systems continue to reinforce cycles of disadvantage, leaving communities underserved, underrepresented, and at greater risk of poor health outcomes.

What’s Driving the Inequity?

Beneath these inequities are deeply embedded structural and institutional failures that go far beyond individual behaviour. A key driver is the persistent exclusion of lived experience from system design. Across both community health and kidney care, services, research, and policies are often developed without meaningful input from those most affected. This results in interventions that are misaligned with real needs and fail to reach the communities they are intended to serve.

Data blind spots further reinforce this cycle. When underserved communities are underrepresented in research and evidence generation, the data used to inform decisions becomes incomplete. In kidney health, this contributes to a limited understanding of how chronic conditions present and progress across different populations, ultimately affecting diagnosis, treatment pathways, and outcomes.

Cultural and institutional norms also play a significant role. Traditional models of engagement often assume that communities will adapt to systems, rather than systems adapting to communities. This overlooks barriers such as accessibility, trust, and relevance, particularly in communities where there has been historical underinvestment or exclusion.

Power dynamics remain central to the issue. Decision-making continues to sit within institutions that are often removed from the realities of the populations most affected. Without shifting power, embedding accountability, and resourcing community-led approaches, efforts to address inequity risk remaining performative rather than delivering meaningful, sustained change.

Implications for Health, Research, or Care

These inequities have direct and measurable consequences for patient outcomes, particularly in communities with limited access to healthcare. Through Fionita’s Project, I see first-hand how a lack of basic health education and first-response capacity leads to preventable emergencies, delayed care, and avoidable loss of life. In many settings, whether due to geography or socioeconomic barriers, individuals rely on community-level interventions as their first and sometimes only point of care.

In healthcare systems, particularly in under-resourced settings such as parts of Nigeria, structural challenges including poor infrastructure, inconsistent power supply, outdated equipment, and limited access to continuous professional training directly affect the quality of care. Combined with low wages, this contributes to workforce instability and ongoing brain drain, further weakening service delivery.

In research, the continued underrepresentation of underserved communities reduces the relevance and applicability of evidence, limiting innovation and equitable access to new treatments, particularly in areas such as kidney disease.

For decision-makers, this is both a systems and sustainability issue. Without investment in prevention, workforce development, and inclusive research, health systems will continue to produce unequal outcomes, reduced trust, and missed opportunities for early intervention.

What Needs to Change.

Addressing these inequities requires a shift from intention to accountability. Systems must move beyond consultation and actively embed lived experience into decision-making, programme design, and research leadership, with communities resourced as equal partners rather than participants.

Institutions, funders, and regulators must treat equity as a measurable outcome. This means setting clear targets for representation in clinical research, ring-fencing funding for community-led delivery, and investing in prevention through health education and early intervention models such as community first responders.

There also needs to be greater focus on the people delivering care. Without investment in training, fair pay, and safe working conditions, particularly in under-resourced settings, workforce gaps will continue to directly impact the quality of care.

Progress should be evidenced through outcomes, not intentions: earlier diagnoses, increased research participation from underserved communities, improved patient trust, and stronger community health capacity.

Equity must be built into how systems are designed, funded, and held accountable from the outset.

Question for the Sector

What would it look like to build health and research systems that start with communities, rather than trying to reach them later?