Duale: SHA Will Not Cover Medical Procedures Above KSh 500K, Reveals 36 Eligible Cases

The Social Health Authority (SHA) has announced that it will only cover medical procedures abroad if they are unavailable within Kenya.

The Benefits Package and Tariffs Advisory Panel has identified 36 specialized procedures eligible for overseas treatment, with SHA covering costs of up to half a million shillings per case.

Health Cabinet Secretary Aden Duale says this move aims to curb medical tourism and corruption, protect public resources, and ensure the sustainability of SHA’s overseas treatment program.

The transition from NHIF to SHA brought significant changes, not only to Kenya’s universal health coverage system but also to how patients access treatment abroad. The ministry has criticized past practices, noting that overseas treatment often drained both patients and public funds, turning illness into a profitable business for foreign medical facilities.

“That era is over. We have introduced a robust, transparent framework for overseas referrals that prioritizes patients while safeguarding our resources,” said CS Duale.

Under the new guidelines, patients cannot be referred abroad for procedures that can be done locally. Only the 36 interventions identified by SHA’s expert panel will qualify. These include:

Liver transplants
Bone marrow transplants for blood cancers
Pediatric kidney transplants
Joint repairs and bone replacements
Voice box transplants
Fetal blood transfusions and treatment
Stem cell transplants
Complex congenital heart surgeries
Advanced cancer treatments
Specialized nerve treatments, among others

“If a patient’s condition isn’t on this list, SHA will not cover treatment abroad. Strict vetting protocols are now in place,” CS Duale emphasized.

SHA has also introduced a cap of half a million shillings for overseas medical procedures. While some critics argue this may be insufficient for complex treatments, the ministry maintains that the measure ensures sustainability and encourages the development of local specialist care.

Additionally, any foreign hospital wishing to treat Kenyan patients must now be empaneled with SHA, with the authority already inviting applications from interested overseas facilities.

“This framework ensures we are not unnecessarily sending patients and funds abroad. Instead, we are strengthening our own healthcare capacity while providing a transparent safety net for truly complex cases,” added CS Duale.

The ministry stresses that these reforms are not just about cutting costs—they aim to build a stronger healthcare system for all 29 million registered Kenyans. By controlling overseas medical spending, the government hopes to upgrade local infrastructure, eventually enabling all 36 procedures to be handled within the country.