Dr Mercy Mwangangi, the SHA CEO.Kenyans seeking specialised treatment abroad can now seek funding from the
Social Health Authority beginning April 14.
This benefit, which was offered under
the defunct NHIF, was suspended when SHA took over in October 2024 but has now been restored.
SHA CEO Dr Mercy Mwangangi told The Star Health the new package will only be
available to paid-up members and is limited to procedures that are not
available locally.
She said the Benefits Advisory Panel, led by Prof Walter Jaoko, identified 36 such procedures, mainly involving highly
specialised care.
“We’re very pleased to inform Kenyans that starting on the 14th April, Kenyans
can come to SHA and access the overseas treatment package. There’s been a lot
of hue and cry from Kenyans wanting to access this package, and we’ve finally
been able to meet the merits of the law, we’ve finally been able to do the
contracting process, we have nine providers who have already come in,” she
said.
She explained that many of the procedures that used to take Kenyans to India will
no longer be funded.
“For example, kidney transplants for
adults are no longer eligible because we have providers locally. However,
paediatric kidney transplants are still eligible because that speciality is not
well developed in Kenya,” Dr Mwangangi said.
Other procedures, such as hip and knee replacements, have also been removed
from the overseas list due to increased local capacity, while more complex
interventions – including some congenital heart conditions in children and
advanced cancer treatments like proton therapy – remain covered.
Under the new system, patients must go through a detailed referral and
approval process before qualifying for treatment abroad. Dr Mwangangi said the
aim is to ensure that overseas care is only used when necessary.
“Step one is that you must be seen by a doctor in Kenya who will provide a
referral note confirming that your condition cannot be managed locally,” she
said. “The doctor must then fill out a KMPDC referral form, which is certified
by the regulator.”
Patients must also submit a SHA referral form confirming active membership,
a comprehensive medical report, a treatment plan from the overseas hospital,
and a proforma invoice indicating the expected cost.
“All these documents are then submitted to SHA for review. The case is
assessed internally by a team of doctors and relevant experts to confirm that
the procedure is not available locally and that the request meets the approved
criteria,” she said.
If approved, SHA will cover up to Sh500,000 per patient annually. Any
additional costs must be met by the patient.
The package does not cover travel, accommodation or other logistical
expenses, meaning patients will still need to raise significant funds to access
care abroad.