WELCOME TO DHML
THE NATIONAL HEALTH
There has been an exponential
increase in the cost of medical
care and treatment because of
technological advancement. This
has put new demands on the
military health facilities.
The National Health Insurance
Scheme (NHIS), is a social health
insurance programme, introduced by
the Federal Government of Nigeria
through Act 35 of 1999.
It is aimed at complementing other
sources of financing the health sector
and to improve access to health care
for the majority of Nigerians.
The aim of this presentation is to
acquaint military policy makers
with the operations of the DHML
as HMO for the military sector of
• The main objectives of the scheme
• Role of the Defence Health Maintenance Ltd
• Operations of the scheme
• Source of funding
• Benefits of the scheme
• Services covered by the scheme
• Services excluded from the scheme
OBJECTIVES OF THE NHIS
To ensure that every Nigerian has
access to good health care services.
To protect families from the
financial hardship of huge medical
To limit the rise in the cost of health
To ensure equitable distribution of
health care cost among different income
To maintain high standard of health
care delivery within the scheme.
To ensure efficiency in health care
To improve and harness private sector
participation in the provision of health
care services. 7
To ensure adequate distribution of
health facilities within the federation.
To ensure equitable patronage of all
levels of health care.
To ensure the availability of funds
to the health sector for improved
THE DEFENCE HEALTH MAINTENANCE
The Defence Health Maintenance Limited
(DHML) is a corporate body.
It was established by the Ministry of Defence as
a health maintenance organization (HMO) in
response to the challenges of providing the best
possible health care for the combat readiness of
It brings together the health care resources of
the Army, Navy and Air Force and supplements
this with network of civilian health care
professional and facilities.
The DHML register enrollees of the
scheme with Military Primary Care
Providers (PCP) of their choice.
The PCP is the health care professional or
medical establishment who patients first
see for their health care needs.
The DHML currently operates over 138
health facilities spread across the Country.
The Organizational Structure of the Defence
Health Maintenance Limited is as shown
AGM HEALTH SERVICES AGM ADM/FIN
SNR MANAGER HEALTH
SERVICES SNR MANAGER ADM/PER SNR MANAGER FIN/ACCT
MANAGER ADM/PER MANAGER FIN/ACCTS
M&E UNIT EPIDEMOLOGY ICT
GSO DHQ GSO AHQ Col GSO NHQ Navy GSO NAF Group. Capt
(Medical) Capt. (Medical) (Medical)
NORTH WEST NORTH NORTH EAST SOUTH WEST SOUTH EAST ZONE
ZONE (Col ) CENTRAL ZONE ZONE (HQ ZONE (Col )
Medical (Group. Capt. ) ZONE (Col ) Annex) Medical (Navy Capt.)
Medical Medical 12
OPERATIONS OF THE SCHEME
Each employee wishing to participate in
the scheme registers with the NHIS and is
assigned a registration number.
The employee selects an accredited HMO
and supplies all the necessary personal
The NHIS then issues an ID card to the
enrollee and his eligible dependants. The
primary care provider (PCP) takes care of all
the primary health care needs of the enrollee
based on NHIS benefits.
OPERATIONS OF THE SCHEME (Contd)
The PCP could refer the enrollee to a
secondary or tertiary provider accredited by
the NHIS subject to the approval of the HMO.
The HMO pays the PCPs a pre-agreed
global capitation of N550 monthly.
All claims for specialist treatment are
presented to the HMO for verification and
re-imbursement at a pre-agreed fee-for-
service tariff as prescribed by the NHIS.
The Federal Government pays the full
Premium for all its Uniformed Officers; the
Armed Forces, the Police, Customs,
Immigration, Prisons and Civil Defence Corps
Personnel. No deduction is made from the
salaries of the above mentioned. DHML is
funded like any other HMO by the NHIS only.
It does not receive subvention from the
Ministry of Defence or the Services.
BENEFITS OF THE NHIS
All enrollees of the NHIS are entitled to the following
Out-patient care, including necessary consumables.
Prescribed drugs, pharmaceutical care and
diagnostic tests as contained in the National Essential
Drug and diagnostic lists.
Maternity care for up to four (4) live births for
every insured contributor/couple in the formal sector.
Preventive care, including immunization as it
applies to the National Programme on Immunization,
health education, family planning, ante-natal and
BENEFITS OF THE NHIS (Contd)
Consultation with specialist such as physicians,
pediatricians, obstetricians, gynecologists, general
surgeons, orthopedic surgeons, ear nose and throat (ENT)
Hospital care in a standard ward for a stay limited to a
cumulative 15 days per year.
Eye examination and care excluding provision of
spectacles and contact lenses; a range of prostheses
limited to artificial limbs produced in Nigeria.
Preventive dental care and pain relief including
consultation, dental health education, amalgam filling, and
AREAS NOT COVERED BY NHIS
Occupational/industrial injuries. These are
covered under the workman compensation Act.
High technology investigation, such as CT scan
& MRI except in life- threatening emergencies.
Injuries resulting from conflicts, social unrest,
riots wars and natural disasters e.g earthquakes
or land slide.
Family planning commodities and condoms.
Injuries arising from extreme sports e.g car
racing, polo, boxing, wrestling etc.
AREAS NOT COVERED BY NHIS (Contd)
Drug abuse/addiction, terminal illnesses
including all cancers.
Periodic check-ups unrelated to illness.
Surgery such as: Transplant and
cosmetic surgery, open- heart surgery,
laminectomy and neurosurgery (except
The challenges facing the Nigerian military in the
course of implementing the NHIS include the
• The exclusion of injuries sustained at war theatres,
riots, unrest etc from NHIS benefits.
• No provision is made for Infrastructural
• Non inclusion of retirees into the scheme.
• No provision for ration for in-patients.
• No provision for medical evacuations abroad.
• Acute shortage of medical manpower to meet the
•Partial release of enrollee ID Cards from NHIS.
The exclusion of retirees and some medical
conditions as well as other amenities from the
scheme as mentioned above has some
implications for military policy makers. This
means that services would have to continue to
make budgetary provisions to take care of these
• Efforts should be made to bring retirees into
• Alternate source of funding be advocated.
• The formation of Armed Forces Medical
Services/Board, to enable it access funds and
other services directly from Government and
other International Agencies .
• Acute shortage of medical manpower to be