Every two minutes a woman dies from giving life. This is not simply a statistic. It is a crisis that raises an uncomfortable question. How much of this crisis is a failure not of medicine, but of trust?

Lafiya was founded as a direct response to this crisis. We build healthcare infrastructure for women and girls in the most remote corners of Sub-Saharan Africa and are one of Nigeria’s largest family planning providers, supplying more than 650,000 women with reproductive healthcare. But the story of how we got here matters as much as what we have built.

In 2018, we were commissioned by Nigeria’s Federal Ministry of Environment to develop an entrepreneurship curriculum for more than two million rural women. Reading thick reports had not prepared us for what we found in the field. 

In visiting communities in Kaduna and Katsina States, we met Fatima (identified by a pseudonym), a 26-year-old aspiring writer and poet. Caring for three children and pregnant with her fourth, she simply wanted to take a break from pregnancy. She had convinced her husband. She had saved for the hour-long motorbike trip to the nearest clinic. 

When she arrived, there were no trained providers and the facility had been out of all contraceptive stock for four months. Fatima told us that while she was enrolled in the training programme to become an entrepreneur, the realities of her life would prevent her from following this through to completion.

Her story is one we hear again and again. One in four women in Africa wants contraception but cannot access it. 70 million women without a choice. The human cost goes beyond unfulfilled dreams. Nearly one third of maternal deaths globally occur in Nigeria. Women are dying not because solutions do not exist, but because solutions are not reaching them.

Alongside the injustice we witnessed, we saw an opportunity. We leveraged our network and private-sector experience in healthcare investment and management consulting to found Lafiya. But since inception, we have seen that the key element missing from the top-down, directive-driven approach was trust. The gap between what a health system can deliver and what populations receive is often neither a resource nor a clinical problem, it is a problem of trust.

So, we made a deliberate choice: to stop designing for communities and start designing with them. We listened and we let communities drive the change. From that shift, the Lafiya Sisters model was born. 

Contraception is a universally sensitive subject, and it is particularly so in communities under-served by the healthcare system. What changes minds is not a directive from a ministry or a visiting clinician, it is hearing what works from someone you trust, like a sister. Trained government-employed Lafiya Sisters deliver high-quality counselling and contraception directly in last-mile communities, meeting women where they are.

This grounded level of trust unlocks healthcare access in ways no facility-based model can replicate, breaking deep-rooted misconceptions and skepticism. Every family planning conversation takes place in a local language, with materials that portray women who look and dress exactly like them. 

The Lafiya Sister sitting with the patient has experienced the same dilemmas and deeply empathises with the choices presented. We do not bring external tools or practices; rather, we focus on adapting field-proven best practices to the needs of the communities we serve.

The results make the case that trust-based models outperform directive ones. In a quasi-experimental study in one of our operating states, contraceptive uptake rose from 2% to 72%, a 36-fold increase over 18 months. 

Seeing this scale of impact from a family planning model is rare. In conservative communities, with little previous exposure to contraception, it is extraordinary. Half of our clients are first-time users. In just five years, we have tripled state government financial commitments to reproductive health and are rolling out our digital data tool nationwide.

Lafiya is not doing this alone. In a co-creating partnership with the government, we work to identify the remaining gaps that define the scope of our work. Local governments lead in outlining challenges, Lafiya pilots, evaluates, and presents tailored solutions for local communities. 

Rigorously tested as our model is, it ultimately requires government buy-in to achieve the scale needed for our vision of universal access. This is translating into real systems-level change. We are rolling out our digital tool nationwide and have tripled state government financial commitments to reproductive health.

The lesson from five years of this work is that trust is not a soft feature of good healthcare. It is structural. It is the infrastructure on which everything else is built. When the model shifted from directive to community-centred, uptake did not improve incrementally. It multiplied. For health leaders navigating complex systems, this distinction matters. Investing in the relationships that make care acceptable is as important as investing in the care itself.

The dream we build towards is one where every woman has access to the tools she needs to choose her own future, on her own terms, in her own time. That is 70 million women, like Fatima, regaining their agency. 

Authors

Klau Pakos

Klau is a co-founder and the CEO of Lafiya. They bring close to a decade of experience in global health and development, much of it in Nigeria. Klau’s background sits at the intersection of research, operations and management consulting. They have led impact and digital projects for microfinance organisations in Latin America, and supported a Nigerian financial institution on growth and financing strategy. In the private sector, Klau built an expertise in procurement and supply chains, advising clients at Ayming UK to support some of the Fortune 500 companies in the US and Europe. Klau is a Forbes 30 Under 30 honouree, a Mulago Rainer Arnhold Fellow and a Senior Research Fellow at the Global Policy Institute.  Klau holds an MA in Philosophy, Politics and Economics from the University of Oxford.

Jefferson Chen

Jefferson is a co-founder and Board of Trustee member of Lafiya. Jefferson’s background is in commercial healthcare. He has worked at the largest health data company in the world, held a corporate development role at a NASDAQ-listed biotech, and served as a venture and growth equity investor in therapeutics, medical technology, and digital health companies across Europe and the United States. He  was honoured to be one of five Commonwealth Youth of the Year in 2024, representing more than 2 billion youth in 56 countries. Jefferson holds an integrated master’s in bioinorganic chemistry from the University of Oxford.

Declarations of Interest
No interests to declare.