NAIROBI, Kenya – The Social Health Authority (SHA) has rejected claims that well-connected Kenyans receive preferential treatment when accessing health services, insisting that variations in approval levels are driven by clinical differences rather than influence or status.
The authority was responding to concerns raised in a Daily Nation report published on Tuesday, which suggested that patients without political or social connections often receive lower benefit approvals compared to others granted higher authorisation for similar conditions.
In a statement, SHA explained that patients may present with the same broad diagnosis and seek care at the same hospital, yet require different diagnostic tests, treatment pathways or levels of care — all of which affect approval outcomes.
“Two patients may share a diagnosis but differ significantly in clinical profile, stage of care and treatment needs,” SHA said, adding that approvals reflect these differences rather than favouritism.
The authority noted that pre-authorisation requests, including those for cancer care, are processed through an automated digital system, leaving no room for individual staff members to arbitrarily alter approvals.
“Individual staff members do not have the ability to adjust approvals outside the system,” SHA said.
According to SHA, several factors influence approval decisions, including the stage of treatment, remaining balance within a patient’s annual oncology package, the complexity of the case, the completeness and structure of hospital submissions, and the choice of healthcare facility.
“As a result, differences in approvals do not imply preferential treatment, but reflect the application of uniform benefit rules to differing clinical circumstances,” the authority said.
SHA further warned that any attempt to manipulate the system or secure unfair access to health packages would be investigated.
At the same time, the authority announced ongoing efforts to improve access to cancer care, including the integration of the National Cancer Control Programme (NCCP) into its processes.
The move, SHA said, will support more standardised diagnostic panels, clearer provider submissions and an improved patient experience across the health system.
