Want to get treatment abroad? Get SHA approval or foot your hospital bills
Health Cabinet Secretary Aden Duale (left) and the SHA Headquarters in Upper Hill, Nairobi.
If you are planning to travel abroad for medical treatment and expect the Social Health Authority (SHA) to pay, you had better get that approval in writing first.
Health Cabinet Secretary Aden Duale has said that without a formal commitment letter from SHA, the authority cannot pay your hospital bills.
"It is vital to clarify the legal framework governing overseas treatment," Mr Duale told Nation on Tuesday.
"If a patient travels abroad without a formal commitment letter from SHA, they are doing so outside the SHA framework. Without this prior authorisation, SHA is prohibited from assuming liability for those medical bills," said Mr Duale.
The warning comes as more Kenyans seek treatment abroad, many of them ending up stranded after assuming SHA would reimburse them later.
Last week, Nation spoke to two patients who had travelled to India for treatment. Both said SHA had verbally promised to authorise their care abroad. But the two, who are now stranded in India, had no authorisation letters from SHA.
"Somebody at SHA gave us a verbal authorisation, but now, they are not giving us any feedback. We are stranded here (India), and we need help. We do not have any written letter from SHA," said a relative of one of the patients.
Social Health Authority (SHA) signage at Mutuini Hospital in Dagoretti South Sub-County, Nairobi, on August 27, 2025.
What the law says
Under the Social Health Insurance Act, 2023, and the Public Procurement and Asset Disposal Act, SHA can only pay for treatments that have been pre-approved and carried out at facilities it has formally contracted.
Mr Duale said the government is tightening controls to curb misuse and ensure only vetted hospitals and treatments are approved.
Eight things you must know
Get prior approval: This is the most critical step. You must go through a peer review by the SHA Claims Management Office. If approved, SHA will issue a formal commitment letter stating how much it will cover.
Treatment must be eligible: SHA only covers procedures that are not available in Kenya. The Benefits Package and Tariffs Advisory Panel has advised on this, and 39 interventions have been gazetted. These include complex paediatric cardiac surgeries, pregnancy-related intrauterine transfusions, and operations such as full femur and tibia replacements, procedures that cannot currently be done locally.
Mr Duale said that treatments available in Kenya will not be covered abroad.
"If you decide to go for a hip replacement in India, it is not in the list of 39 interventions. That service is only reimbursable in Kenya because we have doctors and providers who can do it here," he said.
The hospital must be contracted by SHA: Treatment must be at a facility that SHA has officially empanelled. The authority has issued an expression of interest to bring eligible overseas facilities on board and is finalising the contracting process.
"We will share the list of hospitals. Kenyans will no longer just choose any hospital without verification. We will ensure the hospitals are accredited and capable of offering these services. All this will be digitised," the CS said.
The overseas hospital must have a local link: The foreign facility must be connected to a contracted health facility in Kenya. This ensures you get proper follow-up care when you return home.
Your Social Health Insurance Fund (SHIF) contributions must be up to date: You can only access these specialised services if these payments are current.
Do not travel on assumptions: Never fly out expecting SHA to reimburse you when you get back. The system works on pre-authorisation, not post-treatment claims.
Know the financial limits: SHA will pay a maximum of Sh500,000 for overseas treatment. Anything beyond that is your responsibility.
The treatment must be medically necessary: SHA will not fund unproven, experimental, or unconventional therapies. The procedure must be an established medical necessity.
Procedures available locally
Mr Duale pointed out that many medical procedures Kenyans seek abroad are available locally, including advanced imaging, kidney transplants, open-heart surgeries, and treatments for joint and spinal injuries.
Social Health Authority CEO Dr Mercy Mwangangi and Director of Funds and Finance Management Jonathan Leisen (left) before the Public Investments Committee on Social Services, Administration and Agriculture at Bunge Tower, Nairobi, on February 11, 2026
List of approved hospitals
SHA Chief Executive Officer Mercy Mwangangi had earlier told the National Assembly Public Investments Committee on Social Services, Administration and Agriculture that once the procurement process is complete, Kenyans will know the list of hospitals to be used abroad.
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