Government Clarifies Social Health Authority Coverage for ICU, HDU Patients

NAIROBI, Kenya – The Ministry of Health has clarified the scope of coverage provided under the Social Health Authority (SHA) for patients admitted to Intensive Care Units (ICU) and High Dependency Units (HDU), following widespread public concern about the new program’s benefits.

In a statement, Health Cabinet Secretary Deborah Mlongo Barasa addressed confusion over SHA’s benefit framework and tariffs.

The ministry emphasized that SHA operates on gazetted tariffs published in November 2024, aimed at ensuring sustainable healthcare access while maintaining a shared cost model.

Under SHA, coverage for ICU and HDU services follows a per diem payment structure, depending on the hospital’s classification:

Level 4 facilities: Ksh3,360 per day
Level 5 facilities: Ksh3,920 per day
Level 6 facilities: Ksh4,480 per day

However, beneficiaries may face co-payments if hospital charges exceed these specified limits.

Each household has an annual access cap of 180 days, applicable uniformly across public, private, and faith-based hospitals.

“SHA members will top up any amount that exceeds the above cover limit,” the ministry clarified, encouraging patients to seek services at empanelled and contracted Level 4-6 facilities for cost transparency.

The ministry acknowledged ongoing challenges in implementing SHA but reiterated its commitment to addressing gaps in critical areas like cancer treatment, renal care, maternity, and outpatient services.

To resolve these issues, the government is forming a review committee under Social Health Insurance Regulations.

The committee will assess tariffs and benefits, gather stakeholder feedback, and propose both short- and long-term solutions.

“SHA is proactively addressing emerging challenges to ensure seamless access to all services… We are committed to removing barriers that may hinder access,” the statement read.

The government has urged Kenyans, particularly informal sector workers, to enroll in SHA and undergo means testing to determine appropriate premiums.

“We encourage all Kenyans to remit their premiums to ensure the continuity of service delivery,” the ministry concluded.