The Ministry of Health has announced a new framework under the Social Health Insurance (SHI) scheme, capping overseas medical treatment at Ksh.500,000. The move is aimed at ensuring transparency, accountability, and cost-effective access to specialized healthcare not yet available in Kenya.
Health Cabinet Secretary Aden Duale stated that the decision followed recommendations from the Benefits Package and Tariffs Advisory Panel (BPTAP). The panel assessed medical procedures and identified services eligible for overseas referrals in line with the Social Health Insurance Act, 2023 and related regulations.
Conditions for Overseas Treatment
According to the guidelines, Kenyans can only access treatment abroad if:
- The services are not available locally.
- Their SHI contributions are up to date.
- Treatment is offered by a Social Health Authority (SHA)-contracted health facility abroad.
- The referral undergoes a peer review mechanism to confirm medical necessity.
The Ministry also revealed that an initial list of 36 healthcare services unavailable in Kenya has been gazetted, with more to be added through ongoing Health Technology Assessments (HTA).
Transparency and Accountability
The maximum financial support for overseas treatment is capped at Ksh.500,000, subject to review once rate negotiations with accredited providers are finalized. The SHA Board of Directors has been directed to fast-track the empanelment and contracting of overseas facilities and 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,” the Ministry said in a statement.
The policy is expected to strengthen Kenya’s health system while still offering lifesaving options for patients requiring highly specialized care not available locally.
