EXPLAINER: Understanding SHA’s Overseas Treatment Benefit Package

Social Health Authority Headquater/HANDOUT

The Ministry of Health has rolled out the Social Health Authority (SHA) Overseas Treatment Benefit Package, a new framework designed to help Kenyans access specialized treatment abroad when services are not available locally.

This is in line with the Social Health Insurance Act, which seeks to streamline healthcare financing and ensure equity in access to care.

Under the new plan, Kenyans who qualify will be able to receive treatment outside the country at a set annual rate of Sh500,000, specifically for procedures or services that cannot be offered in Kenya.

According to Health Cabinet Secretary Aden Duale, the move is not only anchored in law but also part of efforts to improve coordination between local and foreign hospitals, while ensuring accountability in the use of public health funds.

“This package aligns with the law. SHA has started contracting hospitals and is implementing a new system to improve coordination among all stakeholders,” CS Duale explained during the announcement on Sunday, August 17, 2025.

CS Duale addressing the media.

Duale also stressed the importance of accountability in the use of taxpayer funds. He emphasized that the package is about both equity and efficiency.

For the first time, Kenyans who require treatment outside our borders will not be left at the mercy of unregulated referrals or unbearable costs. The Social Health Authority will walk with every patient, from referral to follow-up,” Duale said.

“Every shilling will be accounted for. By tying treatment abroad to contracted hospitals and MoUs with local facilities, we are ensuring that public resources are not abused in the name of medical tourism.” 

The Process of Accessing Overseas Treatment

The benefit package has a clear four-step process to ensure patients, hospitals and SHA are all properly aligned. This structure ensures that treatment abroad is not handled in isolation but is tied to ongoing care in Kenya for better health outcomes. They include:

• Preauthorization – Before a patient travels, overseas hospitals must request preauthorization from SHA. This ensures the treatment is approved in advance and meets the criteria for coverage.

• Notification – Hospitals abroad are required to notify SHA upon the admission and eventual discharge of Kenyan patients.

• Claim – Claims for services provided will be submitted online for adjudication and payment, ensuring transparency in the process.

• Follow-up Care – Once patients return to Kenya, they will continue receiving follow-up care locally through a linked, contracted health facility.

  
  

For an overseas hospital to be eligible to treat Kenyan patients under the scheme, it must meet certain conditions set by SHA. These include: Being formally contracted by SHA, holding accreditation in its empanelled and contracted, through a Memorandum of Understanding (MoU).

“This is about protecting Kenyans. We cannot allow patients to fall into the hands of briefcase clinics. Every hospital abroad must be vetted, accredited and linked back to Kenya,” Duale noted.

“That way, patients are guaranteed continuity of care and our health system grows stronger.”

The Overseas Treatment Benefit Package is significant because Kenyans have long sought specialized treatment abroad, often at very high costs.

Diseases such as certain cancers, rare organ conditions and advanced surgical needs sometimes require referrals outside the country. However, without structured systems, patients and families have previously borne the financial and logistical burden alone.

By setting a capped annual benefit of Sh500,000, SHA is providing a predictable and transparent way of supporting patients who need critical services not available locally.

At the same time, the insistence on formal contracts and MoUs ensures accountability and strengthens health system partnerships.

“This package is a bridge of hope. It says to every Kenyan: if the treatment you need is not here, your country will stand with you to seek it elsewhere, fairly, transparently, and sustainably,” Duale explained.