SHA caps overseas treatment cover at Ksh.500K, lists 36 eligible procedures

The Social Health Authority (SHA) will only cover treatment cost for medical procedures that are not available in Kenya.

The Benefits Package and Tariffs Advisory Panel has identified 36 such procedures that will be covered at the maximum cost of half a million shillings.

Health Cabinet Secretary Aden Duale says this is necessary to stop medical tourism and corruption between local and foreign doctors as well as ensure the sustainability of SHA’s overseas treatment.

The transition from NHIF to SHA came with changes in not just the architecture of the universal health coverage locally but also with how patients could access it overseas.

The ministry insists that overseas treatment drained both the patient’s and the public purse, turning sickness into a lucrative business through medical tourism.

“That era is over. We have introduced a robust, transparent framework for overseas referrals that puts the patient first and protects our resources,” said CS Duale.

According to the Health CS, no longer can a patient be referred abroad for a procedure that can be done at home.

A specialized team of experts, the Benefits Package and Tariffs Advisory Panel has identified 36 interventions that Kenya currently cannot handle.

These include liver, bone marrow and pediatric kidney transplants, joint repairs, and bone replacement, bone marrow transplants for blood cancers, voice box transplants, fetal blood transfusions and treatment, stem cell transplant, complex congenital heart surgery, nerve treatment, modern cancer treatment amongst others.

If your condition isn't on that list, the SHA won't foot the bill,

“These are the only conditions for which SHA will authorize treatment abroad. Furthermore, we have introduced strict vetting protocols,” stated Duale.

The overseas treatment safety net has a ceiling. SHA will now cap overseas payments at half a million shillings.

While critics argue that this might be low for complex cases, the ministry insists this ensures sustainability and encourages the growth of local specialist care.

The ministry is tightening the loop even further; the guidelines now dictate that for any foreign hospital to receive a Kenyan patient, they must be empaneled with SHA.

The authority has already invited interested overseas health facilities to apply to contract with it.

“This new framework guarantees that we are not exporting our patients and our money to support the health systems of other nations unnecessarily. Instead, we are investing in our own capacity while providing a transparent safety net for the few complex cases that truly require it,” added CS Duale.

The ministry maintains that these guidelines aren’t just about saving money, they are also about building a health system that works for all 29 million registered Kenyans.

By tightening the tap on overseas spending, the government hopes to force an upgrade in local infrastructure, ensuring that one day, the 39 items on that list will be treated right here at home.