Borno State Contributory Health Insurance Buffers Vulnerable Populations' Health Needs
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Borno State Contributory Health Insurance Buffers Vulnerable Populations’ Health Needs

4 Mins read

Baba Sarki Ismail (Lead Writer)

In camps erected across Maiduguri, Borno State’s capital, countless families struggle to survive amid the humanitarian crisis. The Boko Haram conflict in northeast Nigeria has brought devastation to the region, displacing communities.

For 17-year-old Hasiya Abdullahi, the effects of this crisis have worsened her mental health. As a child, Hasiya’s health concerns began to manifest, necessitating constant medical attention. Despite her parents, Musa and Kalthum’s devotion to her care, professional help remained difficult to find, especially in the wake of the conflict.

Health Insurance in Nigeria
The Wheelchaire That Conveyed Hasiya. Image credit: Nigeria Health Watch

Desperate for a solution to Hasiya’s mental health struggles, her parents turned to traditional and spiritual healers. Kalthum, Hasiya’s mother, recalled the futile efforts, “it did not work, and we left her like that. We don’t have the money to send her to a psychiatric hospital.”

Too sad a tale

In 2023, Hasiya became a victim of several sexual assaults without her parents’ knowledge. While Kaltum, headed out each day in search of menial jobs to provide for her family, Hasiya also embarked on her way. Unknown to her family, some men in her neighbourhood had been taking advantage of her vulnerability and exploiting her need for money and food.

Devastatingly, the abuse led to an unplanned pregnancy and for eight months the pregnancy went unnoticed, “I did not notice the pregnancy until three weeks to her delivery,” Kalthum said. The pregnancy exacerbated Hasiya’s mental health, making her suffer deeply. “I was so scared. I didn’t understand what was happening,” Kalthum explained, “they took advantage of my daughter because she couldn’t protect herself.” She cried.

In May 2024, Hasiya gave birth to a baby girl who tragically passed away 23 days later. After the birth, Hasiya’s family reported that she began to suffer from body swelling and fainting spells. It seemed like there was no hope until the intervention of the Borno State Contributory Healthcare Management Agency (BOSCHMA).

Health Insurance in Borno state
BOSCHMA Team At Hospital Facility. Image credit: Nigeria Health Watch

Offering necessary health intervention for the vulnerable.

BOSCHMA renders several schemes and programmes which cover the medical needs of residents of Borno State within different socio-economic status. These include the formal scheme which covers public and private sectors; informal scheme which covers individuals and families; and the vulnerable group programme which covers pregnant women, people with disabilities, children under the age of five, elderly people above 65 years old, those living in extreme poverty, and people with special needs.

BOSCHMA provides more than just free medical assistance. Since its establishment in 2019, it has accredited 183 primary healthcare facilities across 24 Local Government Areas (LGAs) and partnered with all the secondary healthcare facilities as referral centres. According to Dr. Abba Saleh, the Executive Secretary of BOSCHMA, the reason the rest of the LGAs in the state are yet to be reached, is because of the crisis in the location however, “with relative peace in these areas, we are scaling up our operations to the remaining LGAs so that we will cover all 27 LGAs of the state.” Dr Saleh said.

Borno State Contributory Healthcare Management Agency (BOSCHMA)
Image credit: Nigeria Health Watch

Hope for Hasiya

Dr Saleh still remembers the day they found Hasiya, “she was in a critical condition, both physically and mentally. We knew we had to act fast,” he said. BOSCHMA’s team quickly arranged for her to be moved to Umaru Shehu Ultra-Modern Hospital, where she received medical attention, and her medical bills were fully covered.

We provided her with not just medical care but also psychological support,” Dr Saleh explained, adding that Hasiya would have lost her life if she was left unattended to. “Hasiya lost a lot of blood after she delivered the baby, and this was why she had health complications which was evident by her swollen body. She had anaemic heart failure.” Dr Saleh said.

Two days after BOSCHMA referred Hasiya to the hospital, the staff and management of the hospital went on strike. Three staff members from the agency had to donate their blood for Hasiya and she was eventually discharged after making a full recovery.

Despite success, obstacles remain.

Nigeria has a significant problem with sexual assault and violence especially against women with mental illnesses. Although there is a lack of official data and statistics to quantify the scope of this issue, vulnerable groups face the heightened risk of exploitation and abuse due to their condition.

Therefore, BOSCHMA’s health interventions for vulnerable groups offers a glimmer of hope and a model for comprehensive healthcare solutions in similar crises. Through their intervention over 100,000 people have been enrolled into quality healthcare services across the state.

Borno State Contributory Healthcare Management Agency (BOSCHMA)
Image credit: Nigeria Health Watch

However, despite their successes, BOSCHMA faces significant challenges. Limited resources and funding make it difficult to reach every person especially those who are displaced and are in need. “We are doing our best, but the demand is overwhelming,” Dr Saleh noted. “We need more support from individuals, donors, and organisations to scale up our operations.”

Hasiya’s recovery is one among many stories that demonstrate the effectiveness of their interventions. Additionally, data on reduced maternal mortality rates and improved healthcare outcomes in the state underscores the agency’s positive impact.

”I have nothing to say about this except to thank God for bringing BOSCHMA to save our daughter’s life. We had nothing and we were helpless before they came to our rescue. Although the baby died later but Hasiya who was critically ill have recovered and she is doing well now,” Hasiya mother, expressed her happiness over her daughter’s health.

She further added that “I wish we can get further support to take care of Hasiya and the family, we are in a desperate living conditions. I must go out every day to beg on streets in order to get something for the family to eat and this was the reason why Hasiya goes out to the street while I am away. It disturbed me, but there was nothing I could do.”

Health Insurance
BOSCHMA ES Supervising Drugs Supplies. Image credit: Nigeria Health Watch

According to Hasiya’s mother, if they have what to eat, this should reduce her daughter’s vulnerability to potential sexual assault “She will be at home and won’t be going out”. 

“In Borno State, we have not more than 2.5% of the population that are covered by health insurance. So far, we have over 1% of the population already covered by our scheme and we are scaling up the operations through awareness and sensitisation for people to participate in the health insurance,” Dr Saleh added.

According to Dr Saleh, the health space does not operate in isolation, it spans across all the sectors in the society and, “participation by everyone will go a long way to improve our state healthcare system”.

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