Cancer screening equipment at a hospital in Nairobi. Once a diagnosis is confirmed, physicians develop a treatment plan based on the Ministry of Health’s treatment. guidelines. Cancer is not just a medical diagnosis; it
is a financial and emotional crisis. The high costs of treatment, diagnostics,
and supportive care often overwhelm families, forcing them to sell assets,
deplete savings, or rely on perpetual borrowing and community fundraising to access care.
Today, this is changing. The Social Health
Authority (SHA) has introduced a fully coordinated pathway that guides patients
from diagnosis to treatment and beyond, providing support at every stage.
The Cabinet Secretary for Health recently highlighted this progress during an update to the National Assembly,
where he detailed how SHA is enhancing equity, flexibility, and coverage for
cancer patients.
No longer constrained by rigid limits or
fragmented care, patients now receive tailored treatment, including surgery,
chemotherapy, radiotherapy, and critical care, while essential medical supplies
and medications are covered. This is a system designed around patient need,
restoring hope and dignity to the cancer journey
The journey begins at a primary care
facility, where patients are assessed and referred to higher-level contracted
hospitals for diagnostics or specialised treatment. This structured pathway
prevents unnecessary self-referral, ensures continuity of care, and protects
patients’ benefit entitlements.
Historically, cancer diagnosis was not
covered under public financing. This stage is critical, as it allows clinicians
to accurately determine the type and stage of cancer before treatment begins.
Diagnostic tests, including histology, immunohistochemistry, tumour markers,
MRIs, CT scans, PET scans, and bone scans, are covered under the oncology
benefits package at clearly defined tariffs.
If the oncology package limit is reached,
patients can still access imaging services through the household benefit
package, ensuring uninterrupted care. When fully utilised, SHA supports the
cost of these diagnostic services at approximately Sh120,000 per patient.
Once a diagnosis is confirmed, physicians
develop a treatment plan based on the Ministry of Health’s treatment
guidelines. This model standardises regimens, drug choices, dosages, and
cycles, reducing unnecessary variations and improving outcomes. Treatment
guidelines are automated into SHA’s digital systems, allowing seamless
pre-authorisations and reducing paperwork delays.
One of the most significant reforms is the
removal of rigid caps on chemotherapy cycles. Instead of being restricted to
six annual cycles as before, patients now receive clinically indicated sessions
within a flexible annual limit. This ensures care is driven by medical need,
not administrative ceilings.
Patients receive the chemotherapy
administration at Sh5,500 per session and medications covering up to Sh400,000. Advanced therapies, including brachytherapy, SBRT/SBRS, radiotherapy,
hormonal therapy, and immunotherapy, are also included.
Surgical procedures are covered under a
separate surgical benefit package, including biopsies (Sh16,800–Sh50,000),
TURBT for prostate cancer (Sh168,000), and mastectomy for breast cancer (Sh134,000), reducing the financial shock at critical stages of treatment.
For patients requiring intensive care,
inpatient admission includes access to critical care services at Sh28,000 per
day for up to 12 days, as well as palliative care when needed.
While the oncology package limit is Sh550,000, comprised of Sh400,000 from SHIF and Sh150,000 from ECCIF, the
actual value of coverage extends far beyond this.
The SHA benefits package is designed to
provide complementary coverage across multiple services. Cancer patients
continue to access a wide range of benefits, including inpatient care, surgical
procedures, and general household radiology services, among other benefits.
When
utilised, these combined services can provide total support of approximately Sh1 million per patient per year, including the Sh550,000 allocated
specifically for the oncology package.
SHA has contracted 140 healthcare
facilities nationwide to deliver cancer care. To date, 33,101 patients have
benefited from the oncology package. The Authority has paid out Sh5.8 billion
in cancer claims, with an additional Sh774.6 million under processing,
demonstrating both reach and accountability.
Aware of the changing economic landscape,
rising disease burden, and escalating healthcare costs, SHA has been actively
engaging with both patients and healthcare providers to gather feedback on the
current benefit package. Through this process, we have received valuable input
and several value propositions aimed at enhancing the scope and effectiveness
of coverage.
In response, SHA has forwarded these recommendations to the
Benefits Technical Advisory Panel (BTAP) for detailed review and consideration.
We are also providing support to ensure a comprehensive evaluation of the proposed
enhancements. Looking ahead, we anticipate an expansion in the benefit
allocation, as the Ministry of Health (MoH) has expressed its commitment to
actualise the recommendations put forward by the BTAP.
Additionally, SHA has implemented targeted
measures to reduce cancer treatment costs, ensuring that patients avoid
out-of-pocket expenses. To make essential medicines more affordable, SHA is
implementing the MOU negotiated by the Ministry of Health with Major private
healthcare providers, including Roche Pharmaceuticals, to reduce the price of
medicines like Herceptin for breast cancer from Sh120,000 to Sh40,000 per
cycle, giving thousands of patients access to life-saving treatment within SHA
rates and without co-pay.
The impact of SHA’s reforms goes beyond
bills and reimbursements. They are rebuilding trust; trust that a cancer
diagnosis does not have to lead to financial ruin, trust that government health
programs can be equitable and patient-centred, and trust that every Kenyan has
the right to fight cancer with dignity.
Dr. Mercy Mwangangi is the Chief
Executive Officer at the Social Health Authority (SHA)