Benefit Package for the Tertiary Institutions Social Health Insurance Programme (TISHIP)

Benefit Package for the Tertiary Institutions Social Health Insurance Programme (TISHIP) 
 
      PRIMARY LEVEL CARE  
1     Consultation with General Practitioners and prescribed drugs 
2     Health prevention and promotion 
      Family planning services excluding commodities  
      Dental care 
      HIV/AIDS 
        
3     Management of simple infections/ infestations  
a     Malaria  
b     Respiratory tract infections  
c     Urinary Tract Infections  
d     Gastroenteritis  
e     Conjunctivitis  
f     Primary Ear, Nose and Throat infections  
g     Urinary tract infections  
h     Diarrheal diseases  
i     Enteritis/ typhoid fever  
j     Helminthiasis 
k     Schistosomiasis 
l     Pelvic inflammatory disease  
m     Mumps  
n     Skin infections/ infestations such as Chicken pox, scabies and fungal diseases  
o     Snake and Scorpion Bites 
        
4     Management of minor injuries  
a     Minor Surgical Procedures: incision & drainage, suturing of lacerations, minor burns,  simple abrasions, etc 
5     Primary dental care 
6     Management of non-communicable diseases  
a     Screening and referral for Cancers, Diabetes and Hypertension.  
b     Management of uncomplicated Hypertension and Diabetes.  
c     Management of neurosis 

7     Special Maternal, Neonatal and Child Health (MNCH) Services  
a     Antenatal care  
      o   At most 4 visits except in emergencies  
      o   Routine drugs to cover duration of pregnancy 
      o   Routine urine and blood tests  
      o   Pelvic & obstetric scan (at least twice if available) 
      o    Referral services with complications  
b.     Management of simple sexually transmitted infections (STI) and urinary tract infections (including Laboratory diagnosis)  
c.     Deworming  
d.     Management of uncomplicated Lower respiratory tract infection, such as Pneumonia  
e.     Postnatal services  
f.     Neonatal Care (Cord care, Eye care, Management of simple neonatal infections) for 12 weeks 
        
8     Childbirth services  
a.     Normal delivery (spontaneous vaginal delivery) by skilled attendant  
      o    Normal delivery  
      o   Repair of birth injuries and episiotomy  
b.     New born care and prompt referral 
        
9     Basic and Comprehensive Emergency obstetric care 
a.     Essential drugs for Emergency Obstetric care (EmOC 
b.     Blood transfusion services – Screening etc 
1     Basic laboratory investigations  
      a.      MP  
      b.      Widal 
      c.       RBS  
      d.      Urinalysis  
      e.       Urine/Stool Microscopy 
2     Management of sickle cell disease 
3     Allergic conditions 
4     Poisoning 
5     Accidents and Emergency 
6     Other conditions as may be listed by NHIS from time to time 
 SECONDARY LEVEL CARE  
1     Consultation and treatment by specialist such as surgeons, paediatricians, ophthalmologist, etc 
2     Emergency cases outside place of residence. 

3     Admission (maximum of fifteen days cumulative per year) 
4     Procedures that cannot be handled at primary level of care such as  
a     Treatment of moderate to severe infections and infestations  
b     Management of severe malaria. 
c     Management of meningitis, septicaemia, etc. 
d     Management of complicated RTIs. 
e     Management of complicated typhoid fever, etc 
        
5     Basic and Comprehensive Emergency obstetric care  
6     Management of Preterm/Pre-labour Rupture of Membrane (P/PROM)  
a     Detection and management of pre-eclampsia using Magnesium Sulphate 
b     Blood transfusion services – Screening etc 
c     Management of Postpartum Heamorrhage 
d     Eclampsia  
e     Caesarian section  
f     Operative Management for ectopic gestation  
g     Management of intra-uterine fetal death  
h     Management of neonatal infections.  
i     Management of puerperal sepsis  
j     High risk deliveries – 1st delivery, mal-positioning/mal-presentation, multiple deliveries, etc. 
        
7     Surgeries  
a     Appendicectomy 
b     Hernia repair  
c     Hydrocelectomy 
d     Management of Fractures 
        
8     Dental care  
a.     Amalgam filling  
b.     Simple and surgical tooth extraction  
        
9     Management of non-communicable diseases  
a.     Management of complicated Diabetes and Hypertension  
b.     Management of substance abuse  
c.     Management of Sickle cell disease 
        
10     Management of emergencies  
      Management of emergencies such as accidents, severe asthmatic attack, severe shock, moderate to severe poisoning etc.  
11     Psychiatry, such as Management of psychoses  
12     Laboratory investigations at secondary level of care  
i.     Genotype  
ii.     Lumbar puncture  
iii.     Urea/electrolyte/creatinine  
iv.     Bilirubin (total and conjugated)  
v.     Alpha feto protein  
vi.     Ketone bodies  
vii.     Urine m/c/s  
viii.     Occult blood in stool  
ix.     Sputum/m/c/s  
x.     Urethral/wound/ mcs 
xi.     Blood m/c/s  
xii.     Ear/Eye/throat swab/ m/c/s  
xiii.     Aspirate pus m/c/s  
xix.     HVS m/c/s  
xv.     Skin snip for microfilaria  
xvi.     AFB for TB  
xvii.     Gram stain  
xviii.     Mantoux test  
xix.     Grouping and crossmatching 
xx.     Hepatitis B surface antigen screening  
xxi.     Screening for HIV 1 & 2  
xxii.     RBC Count   
xxiii.     FBC  
xxiv.     Reticulocyte count  
xxv     Plateletes count  
xxvi.     Prothrombin/thromboplastin time  
xxvii.     Blood bag  
xxviii     Donor screening