A Comprehensive Review of the Contributory Health Insurance Legal Framework in Nigeria: Focus on the Borno State Contributory Healthcare Management Agency Law, 2018 (as amended).

The Borno State Contributory Healthcare Management Agency (BOSCHMA) Law (2018) established a contributory health insurance framework covering public, private, and informal sectors, with explicit provisions for vulnerable groups such as internally displaced persons (IDPs), women, children, the elderly, and persons with disabilities. However, its implementation in a post-conflict setting faced challenges of financial instability, governance risks, systemic weaknesses, and conflict-related disruptions.This article employs doctrinal legal analysis supported by policy review and comparative evidence to critically assess both the 2018 Law and the BOSCHMA Bill, 2025, within Nigeria’s decentralized health insurance landscape. Drawing on legislative texts, policy documents, and international comparators, the analysis examines institutional design, financing arrangements, and service delivery provisions, evaluating their alignment with Universal Health Coverage (UHC) principles and responsiveness to Borno’s conflict-affected population.Findings highlight significant progress in the 2025 Bill, including the harmonization of references with the National Health Insurance Authority (NHIA) Act 2022, legislated percentage-based contributions for public servants, and statutory provisions mandating transparent, evidence-based identification of indigent and vulnerable populations. These reforms directly address weaknesses in the 2018 Law, particularly the outdated references to the repealed NHIS Act and ambiguities in defining vulnerable groups. Nonetheless, operational challenges remain, including ensuring sustainable financing, institutional capacity-building, public trust, and delivery of guaranteed benefit packages in fragile settings.The review recommends embedding transparent beneficiary identification systems, defining explicit benefit entitlements, strengthening governance and accountability frameworks, and institutionalizing robust monitoring mechanisms. Lessons from national reforms and global post-conflict models provide actionable pathways for implementation. The Borno case—now reinforced by the 2025 Bill—offers critical insights for advancing UHC in fragile and conflict-affected contexts worldwide.