Bilkisu Abdullahi Usman, a 50-year-old widow in Kano State, Nigeria, lives in a rural farming community with a dry climate, seasonal droughts and limited health infrastructure. As Global Health Advocacy Incubator staff sat with her in one of our sessions to document patient stories on hypertension and health systems in Nigeria, Bangladesh and India, her ordeal became quite obvious. Supporting herself and her children through subsistence farming, she earns less than N10,000 monthly (less than US$7).
After marriage, Bilkisu found herself isolated like many women in her community, separated from her own family and expected to adapt to her husband’s household with little say and limited support. She was 35 when she began experiencing sharp shoulder pain. At the time, she “thought it was from hard work or harmattan cold,” she recalls —referring to the dry, dusty wind that blows from the Sahara across West Africa between November and March, often bringing a sharp chill in the mornings and nights. Hot water compresses provided no relief, so she visited a nearby public hospital, where she was diagnosed with high blood pressure (hypertension).
“I didn’t know something like BP could give you pain,” she says. Her husband took responsibility for her care, purchasing medications and attending check-ups. Her husband often bought medications from any available pharmacy and in some cases, followed the pharmacist’s advice instead of the doctor’s prescription. This arrangement sometimes resulted in proxy treatment, which led to irregular blood pressure monitoring and treatment decisions made without her full understanding or awareness. For many women in Bilkisu’s community, men oversee their health care decisions.
But everything changed when her husband died.
Now responsible for purchasing her own medication, Bilkisu faced an impossible financial burden. Drugs like Amlodipine and Lisinopril cost N3,000-5,000 (about US$2 to US$3.50) monthly in public pharmacies (or more in private facilities), which is up to half of her farming income. During medical emergencies when her blood pressure spikes, she can get dizzy, faint or experience chest tightness. At such instances, costs can exceed N30,000 (about US$20). For someone without savings or health insurance, these expenses can be devastating.
The consequences for her family were immediate. Her 15-year-old son dropped out of school to support her by working odd jobs. “He wanted to go back to school, but I told him to wait until I [got] better,” she says. Without her medication, Bilkisu’s health worsens, making it harder to farm and earn the money she needs for treatment. This creates an impossible choice between buying medicine and feeding her family.
“If I could just go to the Primary Health Center and get my BP medicine for free, my son would be back in school and I wouldn’t be missing my doses,” Bilkisu pleads. “I just want to stay alive to care for my children.”
The intersection of poverty, gender norms and a weak health system has left women like Bilkisu caught in ongoing cycles of suffering and hardship.
Her story demonstrates that strategic improvements to Nigeria’s health system could prevent similar hardships. That is why GHAI has partnered with the Gammun Center for Care and Development Nigeria to provide strategic and technical engagement with key government and non-government stakeholders—including the media and civil society partners—to support evidence-based policies, increase resource allocation and strengthen the effective use of appropriated funds for NCDs. Such efforts are critical to improving Nigeria’s health system and preventing similar hardships. Ensuring the availability of affordable medications at primary health care centers, expanding health insurance coverage, and providing targeted support for patients wwill directly address the challenges faced by Bilkisu and many others.
