In 2014, Mohammed Keana accompanied a group of colleagues from the London School of Health & Tropical Medicine (LSHTM) who were engaged in a research programme in Gombe State to try out the street food in the state's capital. What followed was profound and gave him a lifelong purpose.
While waiting for his colleagues to finish their meal, he noticed a group of poorly clothed boys, commonly referred to as Almajiri. They stood nearby, eagerly waiting for his colleagues to finish eating, so they could eat the leftovers left behind.
"My attention was just on them [the Almajiri] and I began to question why this is happening. After eating, I became very rattled by the way they rushed the plates. I remember calling Professor Chidi Odinkalu and asking him why we still have children in the name of Almajirancin in Nigeria begging on the street instead of being in school. His answer was instructive: every Nigerian problem is solvable."
The Almajiri system is practiced in northern Nigeria and involves children, mostly between the ages of 4 -15, sent by their parents to pursue Qur'anic education. While families send food items and basic care essentials; however, some Qur'anic teachers have been known to seize some these items, as a result leading the children to resort to street begging to ensure they have a meal.
Emerging in the 11th century, as a revered and organised system of learning Qur'anic literacy and Islamic law, the informal learning space known as Tsangaya schools in Hausa, were initially funded by the emirate's treasury and parents. However, these schools were systematically defunded after colonial rule as the northern region tried to establish Western education. This lack of financial support has endured since the colonial era, contributing to the present-day issue of street begging.
Tsangaya represents a more traditional form of Islamic schooling that differs significantly from the formal Islamic school system, which features classrooms with desks and chalkboards. Tsangaya schools function as boarding schools, drawing students from far-flung areas to reside with their teachers until they have mastered the curriculum. These students are known as Almajiris.
Currently, an estimated 10 million Almajiris live in Nigeria, and many lack access to formal healthcare services. Due to their unhygienic living conditions, Almajiris are highly susceptible to a greater prevalence of diseases.
Dr Vinah Kehinde, registrar of Jos University Teaching Hospital (JUTH) and vulnerable children and public health expert, noted that street children like the Almajiris often face institutionalised marginalisation that manifests as a lack of physical, social and psychological access to healthcare services.
Keana, troubled by his experience in Gombe -- especially their unhygienic lifestyle and lack of proper healthcare, started the Almajiri Child Rights Initiative (ACRI) in 2018 to inspire policy change and tackle the social exclusion of Almajiris in Nigeria.
"The Almajiri children are vulnerable; their lifestyle and the way they eat, they can easily get diseases and infections or get bitten by snakes, but that's not [only] the problem. The problem is that if they get all of these, they do not get any help. Some of them die from non-treatment," Keana said.
The Almacare healthcare management system
"I do not know my surname because I do not know my father," Ashiru, a young boy barely 10 years old, said when asked about his parents. At the beginning of 2024, he was brought to Mallam Abubakar's Tsangaya, an Almajiri school located deep in the heart of Dei-Dei, a suburban community in Nigeria's Federal Capital.
By October 2024, Ashiru began experiencing intense itches on his arms, legs and head. The rash became more severe at night, and the skin around the affected areas soon became scaly patches. On October 16, 2024, Ashiru was taken to Dr Sakil's clinic, the nearest clinic they could access, where he was diagnosed with scabies. "It was itching, but when they took me to Dr Sakil's place, he gave me medicine, one to drink and one to rub on my body, and when I took it, I felt relieved and cured," Ashiru said.
Through its Almacare health management system for the Almajiri, ACRI insures Tsangaya schools across Katsina, Bauchi and the Federal Capital Territory (FCT) at the nearest primary health centre (PHC) or private clinic for quick healthcare delivery, while ACRI pays the accumulated bills at the end of each year.
Keane noted that ACRI conceived the Almacare project akin to a solutions-oriented policy advocacy tool for government to replicate as a response to the dearth of healthcare for the Almajiris.
In 2019, the Almacare pilot programme began at a Tsangaya school in Jos, Plateau State, where ACRI paid for drugs at the closest pharmacy where the Almajiris can access the drugs anytime they need them. In 2024, Almacare scaled its initiative to work with healthcare centres to provide comprehensive healthcare coverage to the Almajiris all year long. As an incentive to make sure the teachers promptly take the Almajiris to the PHC whenever they are sick, the children of these Qur'anic teachers are also enrolled as beneficiaries of Almacare. Each Almajiri has a customised hospital card which is used to record their visit to the clinic, this allows ACRI to keep record and make payment seamless.
Their Qur'anic teachers are also trained by ACRI on basic child safeguarding and how to identify and transport sick children to the nearest healthcare centre. Mallam Abubakar Mohammed who heads the Tsangaya school in Dei-Dei noted that as a rule, children at his school are mandated to report themselves to him whenever they are ill.
"We observe the children carefully all the time to find out when something is wrong with any of them. When a child is sick, their friends also report them to us and we do the needful. We also tell them that if they do not report to us when they are sick, they will be punished," Mallam Abubakar said.
Aside from Ashiru, two other Almajiris from Mallam Abubakar's Tsangaya school have also accessed prompt healthcare services through the Almacare health management system.
Since 2019, ACRI have provided free healthcare service to 400 Almajiris across the Tsangaya schools it operates in, however, Keane says ACRI's goal for the Almacare project is to make it apparent to Nigeria's government the feasibility of inclusive healthcare system for the millions of vulnerable children in Nigeria. "There is a National Health Insurance provision for vulnerable children like the Almajiri children, so our goal is to be able to demonstrate this and then advocate to government to scale it to reach as many Almajiri children as possible using that National Health Insurance Scheme provision," Keana said.
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Irregular migration slows things down
The irregular movement pattern of the Almajiris means that children can be transferred to any school at any time and leave without notice. According to Keana, this disrupts data management for the project, "some come for few months and leave to another place, to another community. Also having more children coming into a school you have already insured is [another] challenge."
To mitigate this, ACRI is developing a digital platform that will allow it to seamlessly integrate all its beneficiaries. This will also include deploying telemedicine to facilitate quick and easy medical consultations.
However, following up with the Almajiris to make sure they diligently adhere to their medication, appears to be another challenge. For instance, Ashiru had already stopped taking medication for his scabies infection, despite the fact that the rashes on his skill had not completely healed.
JUTH's Dr Kehinde added that there is a need for Almacare to scale the health and nutritional education of the Qur'anic teachers in charge of the Tsangaya schools as this will equip them to better care and follow up with the Almajiri children under their care. Stressing the importance of psychological care for vulnerable children, she recommended the addition of mental healthcare to Almacare.
