Thousands Stranded as SHA Suspends Reimbursements for Specialized Care Abroad

In a major blow to thousands of patients seeking specialized care, the Social Health Authority (SHA) has confirmed it will not finance medical treatments undertaken overseas until a rigorous new procurement process is finalized. The directive leaves Kenyans who have already traveled abroad for life-saving procedures to foot their own bills, as the authority transitions from the now-defunct NHIF framework.

The SHA leadership, led by CEO Dr. Mercy Mwangangi, recently clarified to the National Assembly that the delay stems from strict legal requirements under the Social Health Insurance Act 2023. Unlike the previous system, the SHA is now mandated to formally empanel and contract specific foreign hospitals before any payments can be authorized. This “procurement hurdle” means that even for procedures previously covered, the tap has been temporarily turned off.

To streamline future claims, the Ministry of Health has gazetted a list of 36 specialized medical procedures—including liver transplants, bone marrow surgery, and advanced oncology—that will be eligible for coverage. However, even once the system is live, the SHA has introduced a strict Ksh 500,000 cap on overseas treatment. This ceiling is designed to prevent the fraud and overpayment scandals that previously plagued the NHIF, though it may leave families with significant balances for high-cost surgeries.

The government has assured the public that the process to prequalify and contract overseas facilities is “ongoing” and expected to be completed by the end of March 2026. Until then, patients are advised that no retrospective payments will be made for treatments sought before these contracts are signed. For those already in foreign hospital beds, the message from the authority is clear: the financial burden remains a personal responsibility for the time being.