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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:
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 include; i.) Establishing an intravenous (infusion) line. ii.) Simple tracheostomy (establishment of emergency airway through an opening in the throat.) 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 of patient 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. ii.) Conjunctivitis 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) iv.) Urinalysis v.) Stool microscopy vi.) MCS of urine, wound swab, throat swab, HVS, etc vii.) Widal test viii.) ESR ix.) Genotype x.) Clotting time xi.) VDRL
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 iv.) Pharmacies v.) Laboratories 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 c.) Paediatrics 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. f.) Ophthalmology 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; i.) Schizophrenia 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 drugs 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 a.) Pathology 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. EXCLUSION a.)Partial Exclusion i) The HMO would pay 25% of the cost of management,while the remaining 75% would be borne by the contributor/employer.
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.
b.)Total Exclusion
i) Natural disasters e.g. earthquakes, landslides, etc ii) Extreme ports e.g. car racing, horse racing, polo, boxing, wrestling and mountaineering
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