Implementation pack · Section 6.12
Health Financing Reform: National Health Insurance Authority (NHIA)
Full implementation of the NHIA Act 2022 with amendments expanding benefits and linking payment to quality.
Framework only Framework guidance for this domain
Status
Implementation pack in development
This implementation pack is in development. The framework content for the domain is published and available now.
01Purpose
Full implementation of the NHIA Act 2022 with amendments expanding benefits and linking payment to quality.
02ASQAT direction
Within 12 months, ASQAT should evaluate the insurance processes of the NHIA with a view to making recommendations for greater efficiency.
03Desired institutional state
The desired institutional state for this domain has not been approved yet. The priority components below describe what the framework asks institutions to be able to show.
04Priority components
- 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
05Initial actions
A recommended action sequence will be published once approved. Actions are not invented beyond approved ASQAT content.
06Leadership responsibilities
Leadership responsibilities for this domain are in development.
07Workforce responsibilities
Workforce responsibilities for this domain are in development.
08Measurement
Measurement specifications for this domain are being developed. Indicator definitions are published only once the numerator, denominator and data source are agreed.
09Evidence expectations
Evidence expectations for this domain are being defined with the measurement specifications.
10Tools and resources
Implementation resources for this domain are currently in development. Approved policies, procedures, checklists and tools will be released through the resource library.
11Related domains
12Implementation evidence
No approved implementation evidence has been published for this domain yet. Case studies are published only after review of what was measured and how.