This move, announced by Health Cabinet Secretary Aden Duale, aims to curb excessive medical tourism, reduce corruption in referral processes, and protect SHA's resources while prioritizing the development of local healthcare capacity.

CS Duale emphasized: “That era is over. We have introduced a robust, transparent framework for overseas referrals that puts the patient first and protects our resources.” He added that the changes prevent unnecessary export of funds and patients abroad, stating: “This new framework guarantees that we are not exporting our patients and our money to support the health systems of other nations unnecessarily. Instead, we are investing in our own capacity while providing a transparent safety net for the few complex cases that truly require it.”

Key rules under the updated policy:

-Overseas treatment will only be funded for the 36 identified procedures that cannot currently be performed adequately in Kenya.

-The maximum reimbursement is KSh 500,000 per eligible case—any costs exceeding this cap will not be covered by SHA.

-Patients must obtain prior approval from a specialized vetting team.

-Foreign hospitals must be empaneled (formally contracted and approved) by SHA to qualify for payments.

-Coverage applies only to individuals with active, up-to-date Social Health Insurance contributions.

The Benefits Package and Tariffs Advisory Panel compiled the preliminary list of 36 eligible interventions, which includes highly complex or rare treatments such as:

Liver transplants Bone marrow transplants Pediatric kidney transplants Complex congenital heart surgeries Stem cell transplants Joint repairs and bone replacements Voice box (larynx) transplants Fetal blood transfusions and related treatments Advanced nerve treatments Modern/specialized cancer therapies Bone marrow transplants for blood cancers And other similarly advanced procedures

The government views this as a temporary measure to manage costs sustainably, with plans to gradually build expertise and infrastructure in Kenya so that more of these procedures can eventually be handled locally.

Critics have raised concerns that the KSh 500,000 cap may prove insufficient for truly high-cost interventions like organ transplants or advanced oncology care, potentially leaving patients to cover massive shortfalls out-of-pocket.

The framework is part of broader SHA reforms following the transition from NHIF, focusing on transparency, efficiency, and long-term self-reliance in Kenya's healthcare system.