Lessons from Kano’s health insurance scheme

Nigeria’s journey toward Universal Health Coverage has often been slowed by familiar barriers: low insurance penetration, high out-of-pocket spending, weak trust in public systems, and the difficulty of reaching poor and vulnerable households before illness pushes them deeper into poverty. Yet Kano State is showing that these barriers are not insurmountable. They can be broken when policy is matched with disciplined execution, community presence, and leadership that treats health insurance not as paperwork, but as protection for real people.

At the centre of this progress is the Kano State Contributory Healthcare Management Agency (KSCHMA), led by Dr. Rahila Aliyu Muktar. In three years, the agency has moved from promise to measurable impact. Total enrolment rose from 497,262 in June 2023 to 1,187,119 by May 2026, a 139 per cent increase that brought more than one million Kano residents into health insurance coverage. This is not a routine administrative achievement. It is a signal that Kano has built one of Nigeria’s most dynamic state health insurance systems.

The evidence is striking. Under the Basic Health Care Provision Fund gateway, Kano expanded primary healthcare-linked coverage from 108,664 beneficiaries to 580,484, representing 434 per cent growth. The state-funded Vulnerable Healthcare Programme grew even more dramatically, from 4,903 to 47,325 beneficiaries. These numbers matter because they speak directly to the people most likely to be excluded from formal health financing: pregnant women, children under five, persons with disabilities, sickle cell patients, low-income retirees, orphans, widows, inmates and other vulnerable groups.

What makes Kano’s story compelling is not only the scale of enrolment, but the method behind it. KSCHMA decentralised registration through 44 local government liaison offices, café registration centres, and a self-service portal. It took enrolment closer to communities rather than waiting for communities to find their way to headquarters. That shift reduced distance, waiting time and confusion. More importantly, it turned health insurance from a distant government scheme into a local service people could understand, question and access.

Kano has also opened new financing pathways for Universal Health Coverage. Through its Zakat and Waqf-linked ethical health financing model, faith-based institutions now pay premiums for indigent beneficiaries. The programme enrolled orphans, Almajiri children and pregnant women at zero personal cost, showing that domestic philanthropy can be organised into a credible health insurance financing channel.

The agency’s custodial health insurance model is another bold example. By enrolling inmates in correctional facilities and training facility health workers on referral pathways, KSCHMA affirmed a simple but often ignored principle: loss of liberty should not mean loss of the right to healthcare.

Quality assurance has received similar attention. The agency conducted 968 supportive supervisory visits across accredited facilities, resolved thousands of enrollee complaints, and tracked service utilisation through surveys and digital systems. In 2025 alone, 605,582 enrollees accessed healthcare services, representing a 56 per cent utilisation rate.

Digital transformation has strengthened this progress. KSCHMA deployed a primary healthcare service utilisation portal, trained more than 1,000 providers across hundreds of facilities, introduced electronic medical records in high-volume hospitals, upgraded its website and contact centre, and adopted digital financial management. These reforms may sound technical, but their meaning is human: better data, faster decisions, fewer errors, stronger accountability and a health insurance system that can grow without collapsing under its own paperwork.

Kano’s recognition as one of Nigeria’s top-performing State Social Health Insurance Agencies is therefore not accidental. It reflects institutional sweat. It reflects political support from the Kano State Government. It reflects field work, community engagement, provider management and the patience required to make public systems function in difficult environments.

The next task is consolidation. Enrolment must continue to translate into timely, respectful and quality care. Facilities must be ready. Data must remain clean. Communities must keep receiving clear information. But Kano has already sent a powerful message to the federation: with commitment, hard work and accountable leadership, health insurance can become more than a policy promise. It can become a lifeline.

Sadiq Abdullateef sent this piece from Kano.

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