The Kenyan government, through the new Social Health Authority (SHA), has unveiled a structured framework for citizens seeking specialized medical treatment abroad. Health Cabinet Secretary Aden Duale stated that the initiative is designed to guarantee access to critical, life-saving procedures that are unavailable within Kenya’s borders.
A central feature of this new policy is the introduction of a payment cap for overseas medical care. The government will cover a maximum of Ksh. 500,000 per patient, an amount that could be adjusted following negotiations with contracted international healthcare providers. The policy was developed with guidance from the Benefits Package and Tariffs Advisory Panel (BPTAP) to ensure a transparent and sustainable system.
To prevent misuse and ensure accountability, the framework sets out clear conditions that must be met before a patient can be referred for treatment abroad. These include:
- The required medical service must not be available in Kenya.
- The patient’s contributions to the Social Health Insurance (SHI) scheme must be current.
- Treatment must be provided by an overseas facility that has an active contract with the SHA and is accredited in its home country.
- The foreign hospital must have a formal link with a Kenyan hospital to facilitate seamless follow-up care for the patient upon their return.
Furthermore, all referrals will be subject to a peer review by the Claims Management Office to verify the medical necessity of the treatment. The policy explicitly excludes coverage for unproven, experimental, or unconventional treatments.
The government has instructed the SHA Board of Directors to fast-track the contracting of foreign medical facilities and to publish a comprehensive list of accredited providers for public access.