The Social Health Authority (SHA) has unveiled a new framework allowing Kenyans to seek medical services abroad for conditions unavailable locally. This comes after Health Cabinet Secretary Aden Duale suspended foreign referrals in 2023 following widespread abuse by cartels and unregulated hospitals.
According to SHA, 36 procedures have been identified as lacking in Kenya due to insufficient expertise, inadequate oncology infrastructure, or absence of advanced implants and technology. These include complex operations such as liver and bone marrow transplants, wrist joint arthroplasty, paediatric kidney transplants, and laryngeal transplants.
The reforms are guided by the Social Health Insurance Act, 2023, which introduces a structured and transparent process. Duale noted that only empanelled and contracted overseas hospitals will receive payments, ensuring accountability. Additionally, patients can only access foreign care if the service is certified unavailable in Kenya, and their contributions to SHA are up to date.
To enhance continuity of care, contracted hospitals abroad must be linked to local facilities, ensuring post-treatment follow-up. However, coverage has been capped at Sh500,000 per patient, with the ceiling expected to be reviewed after rate negotiations with international hospitals.
While the move promises streamlined referrals and better oversight, it also highlights the plight of patients like Mary Wanjiku. Diagnosed with kidney failure in her 20s, she now requires a third transplant, estimated to cost Sh15 million in India. With SHA limiting payouts, she faces an uphill financial struggle.
The initiative, though commendable for plugging loopholes, poses difficult realities: high medical bills, capped support, and long-term reliance on foreign hospitals. For Kenya, the bigger challenge remains strengthening local capacity so that life-saving treatments are not forever outsourced.