PRIMARY HEALTH CARE PROVIDERS
These refer to the entry point of first contact of individuals with the NHIS.They serve as the gatekeepers to the Scheme. The providers promote curative and rehabilitative services. They include:
- In the rural areas;
- In the urban centers;
Private General medical practitioners' clinic
Nursing and maternity homes
Out-patient Departments of General hospitals, Specialist hospitals, Teaching hospitals, Federal medical centers, Federal Staff hospitals, Armed Forces and other uniformed services hospitals
University medical centers
Federal Staff clinics and Armed Forces and other uniformed Forces clinics.
BENEFIT PACKAGE BY PRIMARY PROVIDERS IN THE NHIS
The services provided at this level encompass the components of primary health care. It is intended to provide essential but basic health care for all. It functions in collaboration with the secondary and tertiary care levels through an established referral system. Services provided at the level include:
1. Access to curative services for Common Ailments and Injuries;
(a) Surgical procedures
i.) Drainage of simple abscess(I&D)
ii.) Minor wound debridement
iii.) Circumcision of male infants
iv.) Evacuation of impacted faeces.
v.) Corrections of cases of simple congenital abnormalities such as polydactyl (multiple toes and fingers).
vi.) Drainage of paronychia(infections of the nail bed
vii.) Other procedures as may be listed from time to time by the NHIS
(b.) Internal Medicine
i.) Malaria and other uncomplicated febrile illnesses.
ii) Diarrhoeal diseases
iii.) Acute respiratory tract infections
iv.) Uncomplicated pneumonia
v.) Simple anaemia(not requiring blood transfusion)
vi.) Simple skin infections e.g. Tinea infections, herpes zoster (shingle), herpes simplex etc.
vii.) Worm infestation
viii.) Other uncomplicated bacteria,fungi,parasitic,and viral infections and illnesses
ix.) Follow-up treatment of chronic illnesses e.g. hypertension, diabetes mellitus, sickle cell, asthma, glaucoma.
x.) Dog bites, snake bites, scorpion stings
xi.) Arthritis and other minor musculoskeletal diseases
xii.) Other illnesses as may be listed from time to time by the NHIS
2. Maternity and Child Health Services;
(a) Maternal Health Services
i.) Routine care for uncomplicated pregnancy (prenatal, ante-natal &post natal)
i.e. 2nd,3rd and 4th pregnancies.
ii.) Delivery services for up to 4 normal pregnancies
iii.) Family planning services including family planning education on; Safe period,
Pills, Condoms and other methods (implant and surgical contraception)
iv.) Acute pelvic inflammatory diseases.
v.) Vagina discharges.
vi.) Other illnesses as may be listed from time to time by the NHIS
(b) Childhood Health Services
i.) Growth Monitoring
ii.) Oral rehydration
iii.) Feeding problems and nutritional services.
iv.) Routine immunization based on the NPI schedule, which are distributed
via the HMO network of Providers.
v.) Health Education
vi.) Treatment of common childhood illnesses, e.g. Malaria, Other febrile
Illnesses, Diarrhoeal diseases, uncomplicated malnutrition, failure to thrive,
Measles, upper respiratory tract infections, uncomplicated pneumonia and
Childhood exanthemas, Skin diseases and viral illnesses)
vii.) Other illnesses as may be listed from time to time by the NHIS
3. Health Education to Prevent and Control Health Problems;
(a) Voluntary Counseling and Testing (VCT) for HIV/AIDS and other STIs
(b) Health Education on control of other communicable diseases e.g. Cholera and
non-communicable diseases; such as Hypertension, Diabetes mellitus etc.
4. Essential Drugs from NHIS Accredited Pharmacy Providers
This is based on the NHIS essential drugs and price list. Note that the beneficiary is
expected to make a co-payment of 10% of the total cost of drugs prescribed.
5. Accident and Emergency Services
Enrollees requiring emergency treatment shall visit his/her primary provider or the
nearest Health facility. He is to offer First Aid treatment before referral. The procedures
i.) Establishing an intravenous (infusion) line.
ii.) Simple tracheostomy (establishment of emergency airway through an opening in
iii.) Management of convulsion, coma, etc.
iv.) Control of bleeding
v.) Cardio-pulmonary resuscitation
vi.) Assisted respiration (e.g. Ambubag, etc)
vii) Immobilization of fractures (using splints, neck collars) to ease transportation
viii.) Aspiration of mucus plug to clear airways.
6. Primary Eye Care Services
Treatment of minor eye ailments including:
i.) Eye Examination excluding provision of lenses.
iii.) Parasitic and allergic ailments
iv.) Simple contusion, abrasions, etc.
v.) Other illnesses as may be listed from time to time by the NHIS.
7. Primary Mental Health Services;
i.) Anxiety neurosis
ii.) Psychosomatic illnesses
iii.) Insomnia (sleeplessness)
iv.) Other illnesses as may be listed from time to time by the NHIS.
8. Routine Laboratory Investigation;
i.) Malaria parasite
ii.) White blood cell count (WBC)
iii.) Haemoglobin estimate and packed cell volume (PCV)
v.) Stool microscopy
vi.) MCS of urine, wound swab, throat swab, HVS, etc
vii.) Widal test
x.) Clotting time
SECONDARY CARE PROVIDERS
Secondary health care providers offer specialized services to patients referred from the primary health care levels through the HMOs. Occasionally particularly in cases of emergencies, direct referrals without recourse to the HMOs can be made. However, the HMOs must be notified immediately after. They include:
i.) General/Division Hospitals (Out-patient) specialist care and in-patient care for medical, surgical, paediatrics, obstetrics and gynaecology etc.
ii.) Specialist Hospitals/Reference Hospitals
iii.) Federal Medical Centers
vi.) Dental clinics
vii.) Physiotherapy clinics
viii.) Radiography centers, etc
ROLES OF SECONDARY HEALTH CARE PROVIDERS
The secondary health care providers offer specialized care on referral. Such services include;
1. Specialist Care for Medical, Surgical, Paediatric and Obstetric and Gynaecology cases. Such cases include;
a.) Surgical Procedures
Procedures that can not be handled at the primary level of care are undertaken at the secondary and tertiary levels, depending on the complexity and the competence of the facility and its personnel, except those conditions listed on the exclusion list.
b.) Internal Medicine
Cases that cannot be treated at the primary level due to lack of facilities; personnel or skills must be promptly referred to either a secondary or tertiary centre, except those conditions on the exclusion list.
b, i.) HIV/AIDS
i.) Management of cases requiring admission
ii.) Treatment of opportunistic infections
Cases that cannot be handled at the Primary level, except procedures that are on the exclusion list. Simple congenital abnormalities, e.g. cleft palate, and life-threatening congenital abnormalities, e.g. Tracheosophageal Fistulae, etc, would be handled at the Secondary level.
d.) Obstetrics and Gynaecology
i) Specialist consultation
ii) Multiple pregnancy/High risk pregnancies
iii) Caesarian sections
iv) Ectopic pregnancies (pregnancies outside the womb)
v.) Other obstetrical and gynaecological procedures that are not listed on the exclusion list
e.) Dental Health
Dental services under the auspices of the NHIS are paid for on a Fee-for-Service basis and shall be referred appropriately to the dental surgeon.
Simple extraction and amalgam fillings will be provided.
i.) Specialist consultation
ii.) Eye problem, e.g. major trauma, pterygium, glaucoma, cataract extraction and other simple ophthalmologic surgical procedures
iii.) Removal of foreign bodies
iv.) Refraction, excluding provision of spectacles and contact lenses
g.) Ear, Nose and Throat
i.) Specialist consultation
ii.) Antral wash-out
iiii.) Minor treatment e.g. removal of foreign body
iv.) Surgical operations, e.g. Tonsillectomy, Polypectomy, Tracheostomy, Adenoidectomy, Myringotomy
v.) Other ENT procedures except those on the exclusion list.
2. Specialized Mental Health Services for treatment such as;
ii.) Bipolar affective disorders (e.g. Depression)
iii.) Organic psychiatric disorders.
iv.) Childhood behavioural disorder
v.) Other specialized mental illnesses not on the exclusion list.
3. Restorative and Rehabilitative health services (Physiotherapy)
i) Post-surgical procedure within the prescribed 15 days
ii) Post-traumatic rehabilitation
iii) Simple chest drainages
iv) Palsies within 15 days after initial treatment.
v) Post-CVA therapy within 15 days (For treatment of people with stoke)
4. Pharmacy services;
i) Prescribed drugs as contained in the National essential drug list
ii.) Payment of 10% co-payment by the beneficiaries at the point of collecting prescribed
iii.) Pharmaceutical care to be provided by to be provided by the NHIS accredited Pharmacists.
5. Radiological/Medical Imaging Services
Radiological/medical imaging services are paid for on fee-for-service basis. Services include radiological and imaging services except those on the exclusion list.
6. Diagnostic Laboratory Services
Medical Investigations, excluding post-mortem, should be referred to accredited facilities at the Secondary or Tertiary level of care.
b.) Medical Laboratory Services
Medical laboratory tests not covered by primary care and based on referral from the secondary care medical professional. It includes every test not on the exclusion list.
TERTIARY HEALTH CARE SERVICES
This consists of highly specialized services based on referral from the secondary care level through theHMOs. Tertiary care Providers include:
i.) Teaching Hospitals
ii.) Specialist Hospitals
iii.) Specialty/specialized hospital (Orthopaedic, psychiatry, etc)
iv.) Federal Medical Centres
v.) Military Reference Hospitals.
ROLE OF TERTIARY CARE
Services at this level include all services provided at the secondary level of care, and other highly specialized services referred from the secondary levels.
i) The HMO would pay 25% of the cost of management,while the remaining 75% would be borne by the contributor/employer.
- Open Reduction
ii.) For Life-saving emergency tretament requiring high technology investigations such as CT Scan,MRI,as well as underlisted screenings,the HMO would pay 10% of the cost,while the other 90% would be borne by the contributor/employer.
- Prostatic Specific Antigen(PSA)
- Tumor markers
- Hormonal Assays
- Fluoroscopic dye studies
- Radio opaque studies(Barium Meal,Swallow,I.V.U)
- Occupational/Industrial injuries
- Injuries resulting from
i) Natural disasters e.g. earthquakes, landslides, etc
ii) Extreme ports e.g. car racing, horse racing, polo, boxing, wrestling and
- Family planning commodities e.g. condom
- Drug abuse and addiction
- Terminal illnesses, including cancers
- Domiciliary visits
- Periodic Medical check-ups unrelated to the illnesses
- Transplant and cosmetic surgeries
- Open heart surgery
- Provision of Contact lens and spectacles
- Provision of Hearing aids and Associated appliances
- Management of cerebro-vascular accident(Stroke) beyond the initial treatment
- Treatment of Tuberculosis and leprosy
- Chronic renal failure
- Congenital abnormalities involving major/extensive surgical repairs
- Separation of Siamese twins.
- Chronic congenital defects e.g. Hirchsprung disease
- Infertility Management
- Scaling and Polishing
- Maxillo-facial surgeries
- Root canal treatment