Journal of Infrastructure Policy and Development 2026, 10(1), 026100012; https://doi.org/10.24294/jipd026100012

Background: Formal sector contributory health insurance schemes are central to advancing universal health coverage in low- and middle-income countries. Their successful implementation depends on beneficiaries’ knowledge, perception, and behavioural readiness, particularly among civil servants who often constitute the foundational population for such schemes in post-conflict settings. Methods: A cross-sectional survey was conducted among 321 civil servants in Borno State, Nigeria, using a structured questionnaire. Knowledge of the Formal Sector Contributory Health Scheme (FSCHS) was assessed using 16 items covering scheme components, benefits, and operational mechanisms. Perception was measured using 15 Likert-scale statements addressing affordability, accessibility, quality of care, and trust in scheme management. Descriptive statistics were used to summarise patterns in knowledge and perception. Results: The mean knowledge score was 6.24 ± 2.40 out of 16, indicating that respondents answered fewer than half of the knowledge items correctly on average. Although 68.0% of respondents crossed the predefined threshold for moderate knowledge, no respondent attained an excellent knowledge level. The mean perception score was 3.46 ± 0.52, with 58.8% expressing positive perceptions, 34.9% neutral perceptions, and 6.2% negative perceptions. Knowledge levels showed limited variation across socio-demographic and employment characteristics. Conclusion: Civil servants in Borno State demonstrate foundational awareness and generally positive perceptions of the FSCHS; however, important gaps remain in depth of understanding and confidence. The substantial proportion of respondents with neutral perceptions represents a critical implementation threshold that may influence uptake. Strengthening targeted beneficiary education, trust-building measures, and gender-responsive engagement strategies will be essential for improving uptake and ensuring the sustainability of the scheme.