SPECIAL REPORT: Jigawa’s health intervention scheme gives hope to thousands of vulnerable people

Ahmadu Umaru was elated after enrolling in a healthcare intervention programme of the Jigawa State Government in June.

Mr Umaru and others selected from poor nomad settlements in Buji Local Government Area converged at the primary healthcare facility at the council headquarters in Buji town to enrol in the programme. He said being free from out-of-pocket spending would allow him to attend to other needs.

“I am delighted to be selected as beneficiary because I will no longer have to sell my livestock to finance my medication. We thank Governor Umar Namadi. May Allah protect him against his enemies,” Mr Umaru told PREMIUM TIMES.

Possible Hope for Poor Jigawa residents

The majority of Jigawa’s six million people are poor. The North-west state has a multidimensional poverty index of 0.385, the third worst in Nigeria, according to the Nigeria Bureau of Statistics.

The state also has one of the worst healthcare indices in Nigeria with a Maternal Mortality Ratio (MMR) of 424.1 in 2020, indicating that about 424 of every 100,000 pregnant women in Jigawa died during childbirth. It is one of only 10 states in Nigeria with a worse MMR than the national average.

It is such terrible health indices that the state government hopes to reverse with its new scheme, which focuses on poor vulnerable people.

The healthcare intervention scheme

After capturing it in the 2024 budget, the state government kicked off the N1 billion healthcare intervention programme on 1 October. The government’s goal is to provide free primary healthcare services to vulnerable people for an initial period of 12 months. It said the scheme avails enrollees “access to the full range of quality health services they need, when and where they need them, without financial stress.”

Under the first phase of the programme, about 143,500 people were enrolled from across the 27 local government areas of the state. The state’s Contributory Health Management Agency (JICHMA) conducted the enrollment after the State Executive Council approved the release of N1 billion for the ‘Danmodi Healthcare Programme’ on 12 February.

The beneficiaries are 43,050 children under five and 35,875 pregnant mothers. People living with disabilities received 25,830 slots, orphans received 14,350 slots, elderly persons (65 years or older) received 8,610 slots, people living with sickle cell disease and the poorest of the poor received 7,175 slots each, and people living with HIV received 1,175.

Pregnant women and children under five already enjoyed free basic medical services in Jigawa’s public hospitals. However, with the new scheme, the state government seeks to extend such free services to include secondary healthcare and surgeries for the poor and vulnerable. An official bulletin seen by PREMIUM TIMES states that enrollees are entitled to free primary and secondary healthcare services, including advanced investigation, Endoscopy, CT Scan, Magnetic Resonance Imaging (MRI), Dialysis, and Open Reduction and Internal Fixation (ORIF) – a surgery used to stabilise and heal a broken bone.

To access the services, an enrollee can register at an accredited health facility outside the political ward where they enrolled.

The government said the arrangement was deliberate to meet the principles of Universal Health Coverage (UHC).

At some of the enrollment centres visited by PREMIUM TIMES in June, the beneficiaries and officials who spoke with our reporter expressed optimism about the programme and satisfaction with the selection processes.

A beneficiary, Fadimatu Muhammad, a resident of Rijiya in Gumel town with a two-month-old pregnancy, told PREMIUM TIMES that she was selected because she falls into the vulnerable category.

Mrs Muhammad said she has benefited from previous government intervention programmes but is benefiting for the first time in healthcare, describing the intervention as a continuation of goodies.

She said several women in her area are benefitting from the free maternal and child healthcare, but this package extends beyond basic maternal health.

The JICHMA registered 500 vulnerable persons from each of the 287 political wards in the state. The Primary Healthcare Manager in Birnin Kudu Local Government Area, Bello Abdulkarim, said the council area with 11 political wards enrolled 5,500 persons.

“At the local government level, we formed a 12-member committee which includes senior district heads, the chief imam of Birnin, and representatives

of community-based organisations, media, people with disability, and the representative of the nomads,” Mr Abdulkarim said.

The official said the committee included people from different backgrounds to ensure the intended beneficiaries were selected for the programme.

“The selection process was scaled down to the ward heads who know the vulnerable groups in their respective villages. Even at that, the ward heads conducted the selection processes on the supervision of community-based organisations,” Mr Abdulkarim said.

He said the beneficiaries were digitally selected at the ward level, with their profile appearing on the central saver at the JICHMA’s head office in Dutse, as registered beneficiaries.

A beneficiary, Salaha Musbahu, from Wurno village in Birnin Kudu Local Government Area, said she got to know about the scheme through her village head and was selected because she is pregnant.

Mrs Musbahu said she was among several pregnant women and other vulnerable groups selected for the intervention in her location.

Another resident from Wurno village, Unguwa Ibrahim, 85, said he was delighted with the introduction of the health intervention programme because it made him stop begging for help.

“Before this intervention, I used to beg people for assistance to have medical care. This is the first of its kind in my area. Before this intervention, I usually sought assistance to address my healthcare needs, but with this development, I will have access to all the medical examinations and treatment because they are free of charge,” Mr Ibrahim said.

30 per cent of vulnerable populations targeted for the intervention

The Technical Adviser on Health to the Governor, Isa Surajo, said the programme aims to accelerate the state’s journey towards achieving universal health coverage, with at least 30 per cent of the vulnerable populations covered.

Mr Surajo said the programme targets quality healthcare services for vulnerable populations to stop them from making out-of-pocket expenses on healthcare.

“They will be provided with social insurance that will cover their health services for one year, which is subject to renewal,” Mr Surajo said.

Health insurance is among the 17 domains encapsulated in the 12-point agenda of Governor Umar Namadi, with a commitment to providing basic health services for vulnerable groups.

He said the major overall target is to ensure comprehensive development of the state through addressing poverty and creating wealth.

“The governor believes you cannot create wealth with an unhealthy population. The predominant population of Jigawa spends huge amounts in purchasing healthcare services,” Mr Surajo added.

He said the intervention also addresses poverty through improved healthcare services and universal healthcare coverage.

“Each beneficiary will benefit from free healthcare services up to the secondary level, and that is tantamount to saving a huge sum of money being spent as out-of-pocket expenses. The money will be saved for other economic activities within the state, addressing poverty.

“The first phase of the programme covered 4.3 per cent of the vulnerable population, but we are targeting 30 per cent of that population within the next few years”, Mr Surajo said.

Checking corruption in the programme

The Director of Claim Management at JICHMA, Ahmad Rufa’i, said a beneficiary can claim over a million naira or above after a treatment, depending on the sickness.

Mr Rufa’i said his office, saddled with paying the claims, uses the profile of the beneficiary to verify the actual medical services rendered to a client before payment.

At the enrollment stage, each beneficiary is provided a means of identification, including phone contact for easy verification when it comes to payment, the official said.

Expanding the Social Protection – Governor

After the beneficiaries were enrolled in June, the scheme took off on 1 October. The governor said the scheme was part of his administration’s commitment to expanding social protection to cover a large proportion of the vulnerable segments of the state population.

“The programme is specifically designed to guarantee that very low-income and vulnerable individuals can access essential healthcare services in all areas, safeguarding them from the risk of falling into poverty as a result of huge out-of-pocket medical expenses,” the governor said at the take off ceremony.

“By prioritising these objectives, we aim to create a healthcare system that is inclusive, equitable, and sustainable for all citizens, ultimately fostering healthier and more resilient communities.

“Together, we will continue to make a significant difference in the lives of our most vulnerable citizens. Let us continue to forge ahead with optimism, knowing that we are contributing to a healthier and brighter future for all,” Mr Namadi said.

He also commended UNICEF, which supported the expansion of the programme to cover an additional 3,300 enrollees selected from six local government areas classified as “zero dose” LGAs: Dutse, Buji, Gwaram, Birniwa, Kafin-Hausa, and Kiyawa.

Mr Namadi said all enrollees with the scheme’s identity cards could start visiting the basic health facilities in which they are registered for free services. They are also eligible for referral to secondary health facilities where needed.

We are inspired – WHO

The country head of mission for the World Health Organisation (WHO), Walter Mulombo, said the organisation was inspired by Mr Namadi’s investment in healthcare since he assumed office.

Mr Mulombo spoke through a representative at the scheme’s launch at the Banquet Hall of the Government House in Dutse.

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“The recruitment of over 1,250 healthcare workers and the provision of staff accommodation are significant achievements that will ensure our health facilities are equipped to meet the needs of the population effectively.

“As partners, we are proud to be associated with this administration in its commitment to improving healthcare for all residents,” he said.