NAIROBI, Kenya — Kenyans in need of specialised treatment unavailable locally will now be able to access care abroad under a new structured framework introduced by the Ministry of Health.
Health Cabinet Secretary Aden Duale on Friday announced that the Social Health Authority (SHA) will oversee the initiative, which is anchored in the Social Health Insurance (SHI) scheme.
“This milestone is a testament to the government’s commitment to ensuring that no Kenyan is denied access to life-saving specialised medical and surgical procedures not yet available locally,” Duale said.
The new policy comes after the Benefits Package and Tariffs Advisory Panel (BPTAP) identified 36 medical services that cannot currently be offered in Kenya.
The list has been gazetted and will expand as new gaps are identified through ongoing Health Technology Assessments.
Strict Criteria for Overseas Treatment
Under the framework, only SHI contributors with up-to-date payments will qualify for referral abroad—and only if the treatment they require is unavailable in Kenya.
Referrals will be subject to peer review by the SHA’s Claims Management Office to determine medical necessity and ensure compliance with financial limits.
The ministry has capped coverage for overseas care at Sh500,000, with adjustments possible after negotiations with foreign hospitals.
Accredited hospitals abroad will only be considered if recognised by their home-country regulators and linked to contracted Kenyan facilities to provide follow-up care upon patients’ return.
Treatments deemed experimental, unproven, or unconventional will not be covered.
Transparency and Accountability
Duale said the SHA Board has been directed to fast-track the empanelment and contracting of international hospitals, with the official list to be published soon.
“This new framework guarantees a transparent, evidence-based, and accountable system for Kenyans seeking treatment abroad, ensuring value for money and quality care,” he added.
The government said the reform marks a break from the former National Health Insurance Fund (NHIF) model, embedding stricter legal, financial, and medical safeguards under the Social Health Insurance Act, 2023.
