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  • 1. Allied Services CBSHIP: MHAs and CSOs Presented at In-house Departmental Training D r. Ya k u b u A d o l e A g a d a - A m a d e Assistant General Manager HMO & Allied Services Division Department of Standards & Quality Assurance National Health Insurance Scheme Abuja, Nigeria
  • 2. Outline Introduction MHA and CSOs Conclusions
  • 3. Introduction P ro g ra m m e M a n a ge rs Te c h n i ca l Fa c i l i tato rs C o m m u n i t y B a s e d I n s u ra n c e S c h e m e
  • 4. Introduction Programme Managers (PMs) Bodies responsible for community mobilization and sensitization Benefit package of the programme Determination of Contribution rate financial management Administration Monitoring of HCF. They include Board of trustees (BoTs), HMOs, CSOs, Technical Facilitators (TFs) etc
  • 5. Introduction Obligations of PMs Conduct advocacy outreaches targeting policy makers at State and LGA levels Conduct advocacy activities to sensitize and mobilize community, religious and opinion leaders and the leaders of groups, to generate awareness for the establishment of CBSHIPs Conduct IEC activities to sensitize and mobilize community members and occupation based groups (including cooperatives) to buy-in to CBSHIP Generate 10 and 20 data (surveys, etc) for the purpose of programme planning, monitoring and evaluation
  • 6. Introduction Obligations of PMs contd. Determine benefit package and contribution rates in consultation with NHIS and community members Sign contractual agreement with participating communities and occupation based groups Pool contributions collected Ensure prudent financial management of pooled resources, Sign contractual agreements with service providers Purchase health care services on behalf of participating communities and occupation based groups Conduct medical auditing and quality assurance
  • 7. Introduction Obligations of PMs contd. Conduct health promotion and prevention activities Conduct capacity building activities for the BOTs and participating HCF Supervise and monitor Programme activities Generate and contribute additional funding into CHISNEF Assist new participating communities to set up Board of Trustees (BOTs) Send regular reports/feedback to the NHIS, its agents, communities & faclilities.
  • 8. Introduction Technical Facilitator (TFs) NHIS accredited bodies engaged to provide both initial and on-going technical facilitation (or programme management where applicable) for the establishment and implementation of CBSHIPs. They include all NHIS accredited HMOs Civil Society Organizations (CSOs) Non-governmental organizations (NGOs), Faith Based Organizations (FBOs) Community based Organisations limited liability companies, or companies limited by guaranty.
  • 9. Introduction Functions of Technical Facilitators (TFs) Generate 10 and 20 data (surveys, etc) for the purpose of programme design and monitoring Determine benefit package and contribution rates in consultation with community members Conduct medical audit and quality assurance Conduct capacity building activities for the BOTs and participating healthcare faclilities Supervise and monitor Programme activities Assist new participating communities to set up BOTs Send regular reports/feedback to the NHIS, communities & faclilities
  • 10. Introduction Definition of CBSHIP Not-for-profit health insurance programme for a cohesive group of households /individuals or occupation based groups, Formed on the basis of ethics of mutual aid the collective pooling of health risks, Members take part in its management
  • 11. Introduction Management Models Management Models available for user groups BOTs as PM BOT as PM with external TFs TFs as PM. Note: BoT is Board of Trustee
  • 12. Mutual Health Associations & Civil Society Organizations D ef i n i t i o n B e n ef i t p a c ka ge
  • 13. DefinitionsMutual Health Associations(MHA) Civil Society Organizations (CSOs) privately or publicly incorporated CBOs and Faith FBOs etc are body registered by NHIS solely to access health care services the multitude of through HCF accredited by NHIS associations/ organizations run by a BoT elected by members. around which society non-profit organization voluntarily organizes itself formed on the basis of solidarity and represent a wide range and the collective pooling of health risk by community of interest members accredited by NHIS as PMs governed by the constitution/ bylaws and members take part in or TFs in the CBSHIP. its management.
  • 14. Conditions for Accreditation Register with the CAC Original Certificate of Incorporation and Incorporated Trustees Form shall be sighted and verified. Constitution/Byelaws Complete the prescribed NHIS application forms, providing the following information:- Composition of the BoT Names and addresses of the principal officers of the BoT CSOs identify with Local/State Government as applicable. Complete the prescribed NHIS application forms Composition of the Trustees
  • 15. Conditions for Accreditation Possess necessary staff and infrastructure including computerization Pay the stipulated registration fees for guidelines and other sundries Maintain current accounts with NHIS-accredited banks Evidence of registration with relevant professional/occupational bodies (where applicable. Evidence of Audited Account/Statement of Affairs CSOs Min working capital of N5M where the TF functions as PM Re-insurance with an NHIS accredited ins co, where the TF functions as PM
  • 16. Procedure for Accreditation MHA/CSO Evidence of visited by NHIS current tax for clearance of Accreditation members of Basic the BoT registration doc, such as the CAC Payment of reg fee A copy of the payable by Application for byelaws, rules accreditation any MHA or and regulations CSOs shall be signed and verified by names, N10k authorized addresses and persons official positions of Mgt of the MHA/CSOs CSOs The CSO etc shall pay an accreditation.
  • 17. Rules and Regulations MHA &CSO Registration with the NHIS Issuance of accreditation letter by NHIS Accreditation is for a period of 2 years at the first instance. Can not discriminate against any member on grounds of race, r