SHIA — Social Health Insurance Authority
Caymis Bulsho (EPHS core)
Social Health Insurance package = EPHS 2020 core benefits
Active · v1
| Intervention | Facility level (lowest) | Tariff (USD) | Needs pre-authorization |
|---|---|---|---|
| Access to care | |||
| Common signs & symptoms | |||
| Outpatient consultation and treatment | PHU | $5.00 | No |
| Continuity & care planning | |||
| Registration, triage and care planning | PHU | $5.00 | No |
| Emergency care | |||
| Emergency stabilisation and referral | Health centre | $10.00 | No |
| Emergency surgery | Regional referral | $120.00 | Yes |
| Communicable diseases | |||
| HIV / TB / malaria / hepatitis | |||
| Testing and treatment | Health centre | $10.00 | No |
| Immunization | |||
| Routine EPI vaccination | PHU | $5.00 | No |
| Neglected tropical diseases | |||
| NTD diagnosis and treatment | Health centre | $10.00 | No |
| Outbreak surveillance | |||
| Case detection and notification | PHU | $5.00 | No |
| Life course, growth & development | |||
| Adults & older people | |||
| Screening and chronic-care follow-up | Health centre | $10.00 | No |
| Childhood & adolescence | |||
| Growth monitoring and IMCI | PHU | $5.00 | No |
| Nutrition | |||
| Management of acute malnutrition | Health centre | $10.00 | No |
| Non-communicable diseases | |||
| Cancer | |||
| Cancer screening and referral | District hospital | $120.00 | Yes |
| Cardiovascular & pulmonary | |||
| Hypertension and asthma management | Health centre | $10.00 | No |
| Diabetes | |||
| Diabetes diagnosis and management | Health centre | $10.00 | No |
| Injuries | |||
| Injury and trauma management | District hospital | $25.00 | No |
| Mental health | |||
| Mental-health assessment and treatment | District hospital | $25.00 | No |
| Rehabilitation | |||
| Rehabilitation | |||
| Physiotherapy and assistive devices | District hospital | $120.00 | Yes |
| Reproductive, maternal & newborn health | |||
| Antenatal care | |||
| ANC visits (4+), tetanus, iron/folate | PHU | $5.00 | No |
| Delivery | |||
| Caesarean section | District hospital | $120.00 | Yes |
| Normal delivery by skilled attendant | Health centre | $10.00 | No |
| Family planning | |||
| Counselling and contraceptives | PHU | $5.00 | No |
| Postnatal & newborn care | |||
| Postnatal visits and newborn care | PHU | $5.00 | No |