By Daniel Omwoyo
Kenyans can now seek specialized medical treatment abroad under the government’s Social Health Insurance (SHI) scheme, a move the Ministry of Health says will help patients access life-saving care that is not yet available in the country.
Announcing the plan in Nairobi on Monday, Health Cabinet Secretary Aden Duale said the reform is a major step in strengthening universal health coverage. He stressed that no Kenyan should be denied critical treatment simply because the service cannot be provided locally. “This milestone reflects our commitment to quality healthcare while also building a stronger national health system,” he said.
The policy has been shaped by the Benefits Package and Tariffs Advisory Panel, which conducted a detailed review to determine which services would qualify for referral abroad. Unlike the previous system under the National Health Insurance Fund, the new process is rooted in the Social Health Insurance Act of 2023 and is designed to be more transparent and accountable.
Patients will only qualify if their SHI contributions are up to date and if the treatment they need is not available in Kenya. Hospitals overseas must be certified in their home countries and recognized by Kenyan regulators, with an obligation to partner with local hospitals for follow-up care once patients return home.
For now, thirty-six procedures that cannot be performed in Kenya have been approved for overseas treatment, though officials say the list will expand over time. Every referral will undergo a peer review to confirm that the service is medically necessary, and experimental or unproven treatments will not be funded. The government has also set a financial ceiling, with the maximum coverage for treatment abroad capped at KES 500,000, though this figure may be revised after contracts with foreign hospitals are finalized.
The Ministry of Health has directed the Social Health Authority to conclude agreements with accredited facilities abroad and to publish a list of approved hospitals and services. Officials maintain that the new framework will give Kenyans in need of specialized care fair, affordable, and high-quality access while ensuring greater accountability in how health insurance funds are spent.
