Duale unveils new framework for overseas treatment under SHA

The Ministry of Health has rolled out a new structured framework to guide Kenyans seeking specialised medical treatment abroad under the Social Health Authority (SHA).

In a statement, Health Cabinet Secretary Aden Duale said the move marks a new era in accessing life-saving procedures unavailable locally.

The framework will be implemented through the Social Health Authority (SHA) as provided under the Social Health Insurance Act, 2023, and relevant regulations.

“This milestone is a testament to the government’s commitment to ensuring that no Kenyan is denied access to life-saving, specialized medical and surgical procedures not yet available locally, while simultaneously strengthening our national health system,” said Duale.

He noted that Kenyans will only qualify for treatment overseas if the required services are not available in the country, their contributions are up to date, and the care is accessed through a SHA-contracted facility.

“Overseas facilities must be accredited in their home country and officially recognized by the relevant regulatory body in Kenya. Overseas providers must be linked to a contracted health facility in Kenya to ensure continuous follow-up care upon the beneficiary’s return,” he said.

Duale revealed that the Benefits Package and Tariffs Advisory Panel (BPTAP) has already gazetted an initial list of 36 medical services not available in Kenya, noting that the list will be expanded progressively through a comprehensive Health Technology Assessment.

He added that approvals for overseas treatment will undergo a peer review process by the Claims Management Office to ensure medical necessity, with only proven and conventional therapies considered.

The government has capped the maximum payable amount for treatment abroad at Ksh500,000, subject to review after rate negotiations with accredited international providers.

Duale further directed the SHA Board to immediately begin empanelling and contracting overseas facilities, and to publish the approved list for public access.

“This new framework guarantees a transparent, evidence-based, and accountable system for Kenyans seeking treatment abroad, ensuring value for money and quality care,” he said.