The Social Health Authority (SHA) has introduced a new reimbursement formula that directly links payments to public health facilities with the number of prescribed medicines they dispense.
Through the new formula, patients will receive their prescribed drugs at treatment health facilities instead of being directed to purchase them from private chemists.
Further, the policy seeks to ensure beneficiaries under the Primary Healthcare Fund (PHF) receive the full package of services they are entitled to, including medicines, at the point of care.
In a public notice issued on July 21, 2026, SHA stated it had identified gaps in medicine dispensing in some contracted Primary Healthcare (PHC) facilities, resulting in beneficiaries receiving only part of the services covered under the PHC package.
The authority emphasized that the new reimbursement model is designed to improve accountability and ensure facilities consistently provide prescribed medicines to patients.
“SHA therefore expects all contracted PHC facilities to provide and accurately record the complete package of care, including prescribed medicine, to ensure beneficiaries receive the services which they are entitled,” SHA directed.
SHA Non-Gaps in Medicine Dispensing
According to SHA, PHC facilities are expected to provide a complete episode of care in line with Ministry of Health treatment guidelines.
Among the services patients should receive are consultation, diagnosis, clinically indicated investigations, treatment and the dispensing of prescribed medicines.
However, reports that some patients have been leaving facilities without the medicines prescribed during consultations raise concerns over the quality and completeness of care being offered under the program.
To address the challenge, SHA will use data from the Digital Health Agency platform to monitor the medicine-dispensing performance of contracted facilities.
Additionally, reimbursement for medicine-related services will now be tied to the actual number of medicines dispensed and recorded in the approved digital system, according to SHA.
Also Read: SHA Lists Documents Needed for Children Living with Guardians to Get Healthcare
How the New Reimbursement Formula Will Work
The reimbursement model will be implemented through a four-step process where SHA will determine a facility’s monthly entitlement using the existing weighted global budget capitation model as the first step.
After the monthly entitlement reimbursement, the authority will separate the pharmacy component as a fixed portion of the total resource allocation.
Remaining funds will continue to cover consultations, diagnostic services, staff costs, consumables, overheads, and other healthcare delivery expenses under the new formula.
In the third stage, SHA will calculate a facility’s medicine-dispensing rate.
The rate will be calculated by comparing the number of prescribed medicines against the number dispensed to patients and recorded in the approved system using the formula: Dispensing Rate = Medicines Dispensed ÷ Medicines Prescribed.
However, the authority explained that the dispensing rate applies only to the pharmacy component of the facility’s payment.
The authority further clarified that the non-medicine portion of the reimbursement will not be affected by the performance measure.
Payments covering consultations, diagnostics, staffing and other operational services will also remain unchanged.
According to SHA, the formula will encourage facilities to maintain adequate stocks of medicines and reduce instances where patients are referred to private clinics.
SHA Call to Primary Healthcare
The authority has called on all contracted PHC facilities to ensure prescribed medicines are consistently dispensed and accurately captured in the approved digital systems.
SHA further advised that the PHC facilities ensure beneficiaries receive complete healthcare services.
Members of the public can make inquiries to the authority through the toll-free number 147 or the email [email protected].
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