1. Pharm. Dr. Mrs. C.O. Olumese UBTH Benin City 08072220360 08023381884

2.  Introduction  Definition  Objectives of NHIS  The NHIS Council  Contributors  Stakeholders In NHIS  Health Maintenance Organizations (HMOS)  NHIS Operators  Steps To Take In Enrolment Into NHIS

3.  Payment Systems For Services Rendered  Guidelines For The Registration Of Pharmacies And Pharmacists  Guidelines On Registration Of Government Hospitals  Contractual Agreement With HMOS  Contractual Agreement With NHIS

4.  The quality of health of a country’s population no doubt enhances productivity, economic growth and development.  In spite of the resource constraints, government is committed to improving health care delivery in Nigeria  The National Health Insurance Scheme (NHIS) is one of the government’s efforts in this regard.

5.  It is the national pooling of contributions from the incomes of eligible persons to provide standard healthcare services to them and their dependants.  The Scheme was established by the National Health Insurance Scheme Act, 1999 (No. 35 of 1999).

6.  To ensure that every Nigerian has access to good health care services.  To protect families from the financial hardship of huge medical bills.  To ensure the availability of funds to the health sector for improved services  To ensure the equitable distribution of health care costs among different income groups.  To limit the rise in cost of health care services

7.  To ensure efficiency in health care services  To ensure adequate distribution of health facilities within the federation.  To ensure adequate patronage of all levels of health care  To maintain high standard of health care delivery services within the scheme  To improve and harness private sector participation in the provision of health care services

8. Responsibilities:  To manage the scheme in accordance with the provision of the act  To determine the overall polices of the scheme including the financial and operative procedures of the scheme  To ensure the effective implementation of the polices and the procedures of the scheme

9.  To assess from time to time, the research consultancy and training program relative to the scheme  To arrange for the financial and medical audit of the zonal health insurance offices established under the section 21 of the act.  To ensure public awareness about the scheme

10.  To coordinate quarterly returns from the zonal health insurance offices  To coordinate manpower training under the scheme.  To set guidelines for effective corporation with other organizations to promote the objective of the scheme  To carry out such other activities as are necessary and expedient for the purpose of achieving the objective of the scheme as set out in the act

11.  any employer who has a minimum of 10 employees  15% of the basic salary to be contributed  5% by the employee  10% by the employer

12.  THE INSURED  THE EMPLOYERS  HEALTH CARE PROVIDERS.Primary health care providers.Fee-for service health care providers a. Secondary health care providers b. Tertiary health care providers

13.  DEFINITION : The HMO is a private or public institution body, corporate or a provident association registered by the scheme to utilize its administration to provide health care services through health care facilities approved by the scheme.

14.  Zonal HMO  National HMO  Function of HMO 

15.  To collect contributions from eligible employers, employees and other contributors to the NHIS.  To ensure that all contributors have easy and unhindered access to and receive appropriate health care services from the accredited health care providers.  To make payments to health care providers for service rendered.  To maintain quality assurance in the delivery of health care benefits to the insured persons.  Rendering returns to the scheme as required.

16.  Registration requirements  Registration with corporate affairs commission  certificate of incorporation, articles of association and trust agreement e.t.c.  evidence of financial viability  Maintenance of account with NHIS approved banks  Insurance with an NHIS approved insurance company

17.  Completion of prescribed application form including the following information ◦ Names and addresses of the principal officers ◦ Ownership structure and composition of the organization  Possession of necessary staff and infrastructure including computerization  Payment for stipulated registration, guidelines and other sundries.

18.  NHIS council  Health Maintenance Organization  Heath Care Providers  State Health Insurance Arbitration Boards  Standards Committee  State Health Insurance Boards

19.  Fill an NHIS registration form and select any hospital of your choice from the NHIS accredited list of hospitals / clinics as your primary health care provides  Get enrolled  Receive NHIS ID card  Attend hospital when in need at no extra cost

20.  CAPITATION- payment made in advance to a health care provider  FEE FOR SERVICE- paid for specific services and prices per item

21.  Approval and be registered by the HMO despite being registered by PCN  The pharmacy shall be pharmacists owned  Standards Of Premises

22.  OBLIGATION OF THE GOVERNMENT OR PRIVATE PHARMACY  OBLIGATIONS OF THE HMOS

23.  REGISTERED PROVIDER: means a Pharmacy registered under the scheme.  ‘DRUG’: includes any substance or mixture of substances listed in the NHIS formulary  ‘ARBITRATION BOARD’: means the National Health Insurance Arbitration Board

24.  ‘BILL’: means the sum total of drug costs on all prescriptions presented for payment and the agreed professional charge calculated per prescription.  ‘SUBSCRIBER’: means anybody who contributes to the fund and is therefore insured under the regulation establishing the scheme.

25.  PRIMARY MEDICAL CENTRE: provide enlistment and initial encounter facilities for enrollees of NHIS outpatient facilities shall have the following minimum features  - Waiting and reception areas  - Consulting room  - Treatment room with cabinet, dressing, injection, trolley wash hand basin injection trolley etc.  - Adequate Dangerous Drug Act cupboard  - Patients toilet facilities  - Drug dispensing room  - Sterilizer

26. both out patient and in patient services for general, medical, surgical, pediatric and maternal care. They should also have diagnostic and treatment facilities like:  - Laboratory including blood bank  - X-ray and allied diagnostics  - Surgical operating theatre  - Pharmacy dept  - Lying in ward with locker for each bed  - Separate ward for male and female  - First stage labor room

27.  Sterilizer  Isolation and sluice room  Public health facilities  Fire extinguisher  Nurses bay  Doctors room  There shall be appropriate administrative outfit for proper co-ordination.

28.  PERSONEL:  Primary Care: one (1) medical practitioner 2 registered nurses 2 hospital assistants 1 administrative staff Dispensary (supervised by qualified pharmacists).

29.  Secondary / Comprehensive Health Care Centre  Not less than one (1) registered medical practitioner in relevant areas of medical practice and specialties  Not less than four (4) registered nurses and midwives  Not less than four (4) hospital assistants  Not less than two (2) admin staff.

30.  THANK YOU FOR LISTENING!