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National Health Act, 2003 (Act No. 61 of 2003)


National Health Insurance Policy towards Universal Health Coverage

Chapter 5 : National Health Insurance Coverage

5.3 Service coverage

5.3.3 Expanding access to laboratory services


128. Pathology services will be provided in line with the National Health Act (No. 61 of 2003) which requires the setting, monitoring and enforcing of quality control standards applicable to pathology services to ensure patient safety. NHI will cover comprehensive pathology services delivered at the different levels of care and as defined by the NHLS Act and the NHI Benefits Advisory Committee. NHI will also contract with certified and accredited private laboratory service providers based on need.


129. The NHI Benefits Advisory Committee will determine the laboratory services to be covered under NHI. The laboratory investigations to be covered should be requisitioned for a specified clinical indication and not merely as a routine procedure. Laboratory services at the PHC level will be in line with the Essential Laboratory List.


130. NHI will cover diagnostic pathology laboratory services provided that when referring patients to higher level of care, all previous relevant information including all the available and pending laboratory test results are provided to avoid unnecessary duplication and repeat testing.