According to section 9 of the National Health Insurance Fund Act, Cap 395 R.E. 2002, the authority to grant accreditation to health care provider is vested into the Fund’s Board of Directors. At the management and operational levels this important role of accreditationis bestowed upon Regional Managers assisted by Quality Assurance Officers.

In order to spearhead the spirit of Public Private Partnership, accredited Health facilities may be owned by one of the following owners Government, Faith Based Organizations, private individuals or Non-Government Organizations.

Types of accreditation
There are three kinds of accreditation namely :

      • Primary Accreditation
      • Renewal Accreditation
      • Reinstatement:

Categories of health facilities
Health facilities are categorized as follows :

  1. Hospitals
      • Referral hospital
      • Regional hospitals
      • District hospitals
  2. Health Centers
  3. Dispensaries
  4. Pharmacies
  5. ADDO Shops

Basic Accreditation Criteria
For health facilities to be accredited they have to satisfy the following criteria:

      • Should have an operational experience of not less than 3 years, unless the health facility is at a strategic location;
      • Registration with the Ministry of Health and Social Welfare (MoH&SW) supported by a valid original Registration Certificate and Practicing Registration/License of practitioners;iii.
      • Adequate infrastructure according to level/category of the facility;
      • Adequate number of medical and non-medical staff; and
      • Functional medical equipment.

Accreditation Process
For a health facility to be accredited, the process shall be as follows:

      • Health facility will fill a special application forms and submit it to the nearby Fund office
      • Quality assurance officers will conduct a pre-accreditation inspection to determine level of quality of service the facility is capable of offering to beneficiaries
      • Regional manager/Regional Fund Administrator will submit a pre-accreditation report to the Head Officetogether withrelevant information:
      • Upon signing of the accreditation agreements and orientation on how to fill claims forms the facility will now be ready to start providing services to beneficiaries