Section 6.12 · Pillar 2 · Health Systems, Governance & Infrastructure Transformation
Health Financing Reform: National Health Insurance Authority (NHIA)
Full implementation of the NHIA Act 2022 with amendments expanding benefits and linking payment to quality.
The issue
Transformation is impossible without sustainable financing. The NHIA Act 2022 should be fully implemented, with amendments to expand coverage, reimbursement pathways, and quality-linked payment.
Priority components
What good looks like in this domain, expressed as the components an institution should be able to show.
- 01Expand the minimum benefit package to explicitly include essential clinical services provided by nurses, pharmacists, dietitians, and laboratory scientists, including medication therapy management, immunization, NCD screening, medical nutrition therapy, and antimicrobial stewardship consultations
- 02Cover medical nutrition products, including therapeutic oral nutritional supplements, enteral formulas, and parenteral nutrition components, for patients meeting clinical criteria
- 03Establish reimbursement mechanisms for community-based providers, including community pharmacists and nurse-led clinics where applicable, to deliver preventive and chronic care services at the Primary Health Care level
- 04Link facility accreditation and capitation payments to quality metrics, including nutrition screening rates, medication error reporting, and multidisciplinary team documentation
Implementation
What this domain requires in practice: the standard, the pack, the measurement, the tools and the evidence.
Standards
No approved ASQAT standards have been published for this domain yet. The standards layer is in place so that approved statements can be released without restructuring the platform.
Measurement
Measurement specifications for this domain are being developed. Indicator definitions are published only once the numerator, denominator and data source are agreed.
Measurement frameworkResources
Implementation resources for this domain are currently in development. Approved policies, procedures, checklists and tools will be released through the resource library.
Open the libraryAwaiting approved content
Evidence in practice
No approved implementation evidence has been published for this domain yet. Case studies are published only after review of what was measured and how.