Accreditation Procedure

Introduction
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 accreditation is bestowed upon Regional Managers assisted by Quality Assurance Officers.

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

      • Types of accreditation
        There are three kinds of accreditation namely :Primary Accreditation (New-accreditation)
      • Renewal Accreditation (Re-accreditation)
      • Reinstatement

Categories of health facilities
Health facilities are categorized as follows:

  1. Hospitals
  • Referral hospital(National referral, Zonal referral Regional referral and District Hospital levels)
  1. Health Centers
  2. Dispensaries
  3. Diagnostic Centres
  4. Specialised clinics (Medical, Dental and Optical)
  5. Pharmacies
  6. Specialized Polyclinic

Basic Accreditation Criteria


For health facilities to be accredited by the Fund 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;i
  • Adequate infrastructure according to level/category of the facility;
  • Adequate number of medical and non-medical staff according to level of the facility.
  • Functional medical equipment.
  • Well defined operations of the facility in delivery of services.

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

  • A Health facility shallfill a special application form and submit it to the nearby NHIFoffice within the Region where the facility operates.
  • Fund’s 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 will submit a pre-accreditation report to the Head Office together with relevant information:

Upon signing of the accreditation agreements and orientation on how to deliver services to NHIF beneficiaries as per MOH guidelines the facility will now be ready to start providing services to beneficiaries.