Mahdi Garba (Lead writer)
Nusaiba Idris Muhammad, 23, lives with her low-income family in Shagari Quarters, Kano. She battles with the life-threatening symptoms of Sickle Cell Disease (SCD), as well as the high medical bills that comes with it.
“In one visit to the hospital when drugs are prescribed for me, my family spends at least N10,000,” she said, recalling how things were before her enrolment into an insurance programme that covers her hospital and medical bills. “Despite the high cost of our drugs, now I get them all for free.”
Globally, Nigeria bears the highest burden of SCD, with an estimated 2% to 3% of the population battling with the disease.It is estimated that the monthly cost of treating SCD patients ranges from ₦70,000 to ₦1 million driven by recurring hospital admissions, regular medical consultations, physiotherapy, and nutritional supplements.
AbbaCare, inspired by the United States’ ObamaCare, offers 100% health insurance coverage to people living with SCD in Kano, Nigeria. Launched in November 2024 by current state governor Abba Kabir Yusuf through the Kano State Contributory Healthcare Management Agency (KSCWMA), the programme aims to alleviate the financial burden on low-income families struggling to afford SCD treatment.
Dr Rahila Aliyu Muktar, the Executive Secretary of KSCWMA, noted that the motivation for introducing AbbaCare stems from the data that shows that Kano has the highest prevalence of SCD in Nigeria.
“If Nigeria has the highest number of SCD patients in the world, in a nutshell, you can say that, Kano has the highest number of SCD patients [globally],” she said. “It is imperative that as an agency that provides financial risk protection, we look into this group of people and see how we can provide care to them, looking at the fact that the majority of them come from the vulnerable side –the poor.”
Funding and legal instruments enable Abbacare
According to Dr Rahila, currently, about 7,000 out of the 44,000 SCD patients across Kano’s 44 local government areas (LGAs) have been enroled under AbbaCare and beneficiaries are not expected to pay a dime to access care.
The KSCWMA pays ₦570 as capitation daily on each patient for primary care services accessed, and it operates a fee-for-service plan at the three participating secondary health facilities such as Murtala Mohammed Hospital, Hasiya Bayero Hospital and Isyaka Rabiu Hospital, where they make a claim at the agency for the services they have provided for SCD patients. However, all three hospitals are centralised only within the eight LGAs namely -Kano Municipal, Dala, Nasarawa, Gwale, Fagge, Tarauni, Ungogo and Kumbotso, leaving beneficiaries from remote LGAs without easy access to the insurance unless they come into the city centre.
She explains that the state has dedicated a part of the Basic Healthcare Provision Fund (BHCPF) to SCD care. Additionally, Kano State Governor has passed the premarital screening law that mandates all intending couples to undergo genotype, Hepatitis B, C, and HIV/AIDS tests with violators charged with up to a ₦500,000 fine or a five-year jail time.
Dr Rahila added that to reduce the health implications SCD has on people in the state, the governor also directed the Kano State Health Trust Fund (KHETFUND) to procure free Hydroxyurea — a drug that reduces the risk of health complications in people with SCD.
She mentioned that there are mechanisms that have been put in place to ensure the medicine is of good quality, as the Kano State Drugs and Medical Consumables Supply Agency (DMCSA), the arm in charge of providing the medication, guarantees standard quality.
“As we are trying to support them and give them Hydroxyurea that will reduce complications in them, we are also saving the government [expenditure] on SCD patients who visit these hospitals three to four times in a month,” she explained. “These are strategies we are pulling together to support people living with SCD across Kano State.”
According to Abdullahi Ibrahim, a founding member of the Kano Sicklecell Awareness Initiative — a group that creates awareness on the dangers of the disease and advocates for genotype testing — AbbaCare is a welcome development.
Image credit: Nigeria Health Watch
“Since we started our group in 2015, our advocacy revolves around how to create awareness on the disease and reduce the suffering of SCD patients in Kano. We have been to radio, TV stations, and rural communities to do this. Many of our members are beneficiaries of the AbbaCare programme, which is commendable,” the group leader with over 1,000 members explained, adding that some of their members also work as administrative staff of the programme.
Enrolment hiccups
According to Dr Rahila, because some of the patients come from the hard-to-reach areas, they do not a National Identification Number (NIN), which is a requirement to enable enrolment into the system.
“It is very important we enrol them through the NIN for transparency, accountability, and to avoid duplication. [Patients] under five or seven [years] do not have NIN,” she said, adding that getting officials from the National Identity Management Commission (NIMC) to enrol them has been challenging.
Image credit: Nigeria Health Watch
She further explained that they often call the chairmen of LGAs to assist them and reach out to NIMC coordinators in the state for support in making NIN application easier for the hard-to-reach indigenes.
“The National Health Insurance Authority (NHIA) has a system whereby they can do this enrolment. So, if they can provide the NIMC machine at our enrolment centres, it will ease our problems,” she stated.
Another concern which Dr Rahila noted is the inconsistent quality of care at the hospitals, largely due to fluctuations in staffing. The human resource challenge is significant, with varying levels of expertise. “One day, a consultant might be available, while the next day, it’s a medical officer or even a junior officer,” she said, adding that they are still pushing the state’s Healthcare Management Board to see that qualified professionals are assigned to these facilities to take care of the SCD patients under the programme.
However, Dr Rahila expressed hope that after one year of the commencement of the AbbaCare insurance programme, there will be improvement.
Dr Rahila advices other states that would like to replicate what AbbaCare is doing to pay attention to the quality of care they provide in their selected facilities. “I will advice them to enter into a service-level agreement with the facilities in charge to show them that they need to deliver the quality of care that is being agreed upon, because [people living with SCD] are vulnerable.”