In alignment with the Federal Government of Nigeria’s goal of Universal Health Coverage (UHC), and as part of efforts to improve access to healthcare for all residents, the Government of Kaduna state in 2018 signed into law, the Kaduna State Contributory Health Management Authority (KADCHMA) to provide a legal framework for the operationalization of a social health insurance scheme. The agency was also given the mandate to include as part of its coverage population, the vulnerable persons in the state as defined by its establishing law. In addition, the government also committed to paying the premium for these vulnerable persons through the 1% Consolidated Revenue Fund (CRF). This is with the understanding that among this vulnerable population, there are the indigent who cannot afford the periodic financial contributions required to participate in the scheme, and without adequate provision for them by the government, they will be denied life-saving health interventions.
Across the state, no reliable data existed that identified these vulnerable population who must be covered under the scheme. In addition, there was also no reliable data on the poorest of the poor within these vulnerable groups until a pilot study was conducted late last year. As part of the Global Fund-supported Resilient Sustainable Systems for Health (RSSH), HSCL, through Management Sciences for Health (MSH) – the principal recipient, supported the identification of the poorest of the poor among the vulnerable population in Kaduna State; through engagements with stakeholders within the social sector in the state, a protocol was designed which provided a step by step guide on the identification process, recruiting and training data enumerators, conducting field survey in identified Local Government Areas (LGAs), conducting data cleaning and analysis, and designing a vulnerable population database.
Our overarching approach to determining the poorest
of the poor population in Kaduna State employed a mix of Geographical Mapping, Community Based Targeting, and the use of the Poverty Probability Index (PPI). Based on available data from the Kaduna State Bureau of Statistics (KSBS), the survey’s target populations defined as LGAs where the vulnerable population in the state are most likely to reside, were identified across all three senatorial zones of the state. In each community, the community leader, or a group of its members with local knowledge of families’ living conditions guided the listing of vulnerable households. These listed households were then visited where the 
PPI are tool was administered, this generated a PPI score for each household based on easy to observe characteristics such as location and quality of dwelling, ownership of durable goods, among others.
The created database which has been validated and received by the state will support KADCHMA in effectively targeting residents of Kaduna State who fall under the vulnerable category. Other social service parastatals in the State are also able to rely on the data from this survey for planning, designing and implementation of their social interventions. The protocol and rigor of the exercise also serve as a benchmark for future surveys that will be conducted in the state and beyond.
