02/05/2023
NIHMA (National Health Insurance Management Authority) is a compulsory National Health Insurance scheme that aims at providing for a sound and reliable healthcare financing for Zambian households and the entire health sector. NIHMA is important because it ensures equitable distribution of health facilities between rural and urban communities and it also ensures appropriate patronage of all levels of health care.
The following are some objectives of NIHMA:
(1) It aims at protecting families from financial hardships of huge medical bills.
(2) It aims at limiting the rise in the cost of health care services.
(3) It ensures the equitable distribution of health care costs among different income groups.
(4) It aims at maintaining high standards of health care delivery services within the Scheme.
(5)To ensure efficiency in health care services.
(6) It aims at improving and harnessing private sector participation in the provision of health care services.
(7)To ensure the availability of funds to the health sector for improved services.
(8)To ensure that every Zambian has access to good health care services.
NIHMA is a good initiative as it helps many Zambian people especially the vulnerable and the poor to access healthcare. The following are some of the benefits of having NIHMA:
a) Registration and Consultation – This helps to cover the costs related to Registration and
Consultation of patients.
b) Pharmaceutical Services and Blood products – it covers for the costs of medicines prescribed in Generic names, Blood products and medical consumables. It includes a
medicines list recommended from time to time to meet members evolving needs.
c) Investigations – It provides for the costs of Investigations, Imaging and other
Diagnostic tests as per the Investigation List in the benefits package.
d) Surgical Services – It covers for the cost of medical Procedures, Minor, Major and
Specialized surgical services listed in the benefit package.
e) Inpatient Care Services - This covers for the costs of daily patient admission, Intensive
Care Unit, High Dependency Unit Services for the daily admission costs depending on
the level of the facility and the agreed DRG bundled fee schedule which includes costs
of drugs, staff, lab investigations, medical consumables, catering, laundry, cleaning,
disinfection, admin costs and Capital maintenance of Buildings and equipment.
f) Physiotherapy and rehabilitation services - This is provided to inpatients and
outpatients where the facility has specialties for these services.
g) Spectacles - The NHIS also pays for visual corrective spectacles to the member once
every three years.
h) Dental and Oral health Services - It covers services for inpatients and outpatients
related to oral health. This includes dental conservation surgeries (Carries and dental
filling), gum diseases, dental extractions, and root canal treatment.
i) Medical/ Denture/Orthopedic Appliances – It is provided for supportive orthopedic
and medical appliances which are determined by the NHIMA from time to time.
The NHI model requires compliance and support from all stakeholders as NHI scheme will be a big game changer in the provision of both public and private services countrywide.
The accredited private health facilities will play an important role in the progressive realization of Government’s vision of Universal Health Coverage. It is recognized that Government alone will not be able respond to all the health needs of citizens and legal residents. Accreditation of private sector facilities by NHIMA will increase access and availability to insured services, provide members choice for service provision, would help to reduce waiting times and decongest government facilities. An added benefit would be that if NHI members are prescribed drugs or ordered to conduct investigations that are not available in an accredited government facility, the NHI members would be able to collect those drugs from an accredited private pharmacy and conduct the investigations at an accredited Laboratory or diagnostic center. Private Hospitals will complement the choice of facilities for members and help
decongest public facilities. Further Private providers will be able to rely on Zambia’s largest medical scheme to extend services to previously uninsured in Urban, peri urban and rural areas. The volumes of services provide a unique business opportunity for both public and private sector to expand their offerings to an ever-expanding membership base.
