The Social Health Authority (SHA) will stop covering medical bills abroad unless patients prove the treatment is unavailable in Kenya, Health Cabinet Secretary Aden Duale has announced. He said the decision follows widespread abuse of the scheme by cartels and unregulated foreign hospitals.
On Wednesday, CS Duale clarified that only vetted and contract-bound hospitals will qualify for SHA payments overseas.
He explained that the government has launched a major cleanup of the SHA’s overseas treatment program to seal loopholes that cartels and unscrupulous agents have used to exploit vulnerable patients while bypassing proper referral procedures.
Speaking in Eldoret, Uasin Gishu County, during the launch of the Digital Health Transformation and TaifaCare Caravan, CS Duale said the temporary suspension of the SHA’s overseas medical package will remain in place until the ministry completes critical policy reforms.
The changes mean Kenyans seeking government-funded treatment abroad will now face longer waits as the Ministry of Health enforces strict vetting rules to block fraudulent referrals, curb corruption, and strengthen local healthcare capacity.
“In the next week, I will gazette the treatments that are not available in our country. The days of going overseas for treatment just because a doctor has referred you will no longer be there,” the CS said.
He added that the ministry is carrying out a comprehensive stakeholder review to identify treatments that cannot be done locally. Only those procedures will qualify for overseas referrals under SHA.
CS Duale emphasized that only overseas hospitals registered with the Social Health Authority (SHA) and holding valid contracts with the scheme will qualify to receive payments for referrals.
“The hospitals you are being referred to in India and elsewhere must first have a contract with SHA. We have had incidents where referral systems have not been genuine. There are people who get commissions for referring patients to foreign countries for treatment and that is what we want to stop,” he said.
Duale raised concern that some cartels have abused the system by sending patients abroad for conditions that local hospitals can already treat, purely for profit.
To curb this, the government has engaged an independent benefit and advisory body at the University of Nairobi to vet foreign hospitals and determine which ones meet SHA’s accreditation standards.
The CS also noted that many of the procedures Kenyans frequently seek abroad, including PET scans, advanced imaging, kidney transplants, open-heart surgeries, and treatments for joint and spinal injuries, are already available within the country.
