Saturday, September 20, 2025 - The Ministry of Health has released a list of 36 specialised medical services currently unavailable in Kenya, allowing eligible patients to seek treatment abroad under the new Social Health Insurance (SHI) scheme.
The Government has capped the maximum benefit for overseas
treatment at Ksh 500, 000.
In a Gazette Notice dated September 19th, Health
Cabinet Secretary Aden Duale stated that the listed procedures, many involving
complex joint and limb replacements, are not offered locally due to a lack of
specialised facilities and trained personnel.
“The maximum limit payable for overseas treatment is capped
at Ksh 500, 000, ensuring value for money and quality care,” Duale said.
Patients seeking treatment abroad must have up-to-date SHI
contributions.
The Claims Management Office will vet referrals to ensure
medical necessity and compliance with financial limits.
Unavailable services include wrist, metacarpal, and ankle
joint arthroplasty, proximal and distal femoral replacements, and proximal
tibial replacements.
Also listed are paediatric liver, kidney, bone marrow and
laryngeal transplants.
Other missing procedures include intrauterine blood
transfusions, fetoscopy, laser ablation, cordocentesis and foetal reduction.
Advanced therapies such as Lutetium-177 PRRT, DOTA-TATE
scans, microwave ablation, CAR T-cell therapy, and proton therapy are also not
available.
Additional treatments like sacral neuromodulation,
photopheresis, nerve ablation, and neural regenerative therapy are excluded
from local care.
Duale noted that the list was compiled in consultation with
stakeholders and the Benefits Package and Tariffs Advisory Panel, in line with
the Social Health Insurance Regulations, 2024.
The initiative aims to ensure Kenyans are not denied access
to life-saving procedures unavailable within the country.
The Kenyan DAILY POST
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