Duale Introduces Structured Framework for Overseas Medical Treatment
Offshore treatment centers must be accredited within their original country and authorized by the relevant Kenyan regulatory bodies
Duale emphasized that the list will be supplemented step by step as other services are going to be reviewed using a Health Technology Assessment to make sure only those interventions that are necessary and evidence-based are included. Phot/ Courtesy
By Juliet Jerotich
The government has introduced a new system under the Social Health Authority (SHA) to cater to Kenyans in need of specialized treatment outside the country. This is a move brought forth by Health Cabinet Secretary Aden Duale, with an objective to present an open and organized way to seek life-saving interventions which are not locally available.
Eligibility and Conditions for Overseas Care
From Duale, Kenyans will only be considered for foreign treatment if available medical services in the country are lacking. Beneficiaries must also be contributors in good standing with the Social Health Authority and be treated only at SHA-contracted facilities.
Offshore treatment centers must be accredited within their original country and authorized by the relevant Kenyan regulatory bodies. Additionally, the providers must also have an official affiliation with a contracted facility within Kenya to facilitate follow-up care on an ongoing basis upon the patient’s return,” Duale explained.
List of Covered Services
The Benefits Package and Tariffs Advisory Panel (BPTAP) has already made available a preliminary list of 36 specialized medical interventions yet to be found in Kenya. Duale emphasized that the list will be supplemented step by step as other services are going to be reviewed using a Health Technology Assessment to make sure only those interventions that are necessary and evidence-based are included.
Approval and Peer Review Process
Requests for foreign treatment will be subjected to strict scrutiny by the Claims Management Office. Cases will be on a peer review basis in order to determine the medical necessity of the intended procedure. Only standard and proven therapies will be considered, without risk and with the use of resources on effective interventions.
Financial Limits and Oversight
The government also capped the ceiling of reimbursable foreign treatment at Ksh500,000. This can be renegotiated after negotiations with accredited international healthcare facilities. Duale also instructed the SHA Board to proceed with contracting foreign facilities as fast as possible and publishing the approved list online for transparency purposes.
Commitment to Quality and Accountability
This arrangement is a major step towards making it possible that no Kenyan is denied access to crucial overseas medical treatment while supporting our domestic health care. It offers an evidence-based, responsible, and cost-effective mechanism of overseas treatment,” Duale said.
The new framework under SHA aims to provide Kenyans with facilitated counsel, financial openness, as well as increased access to life-preserving specialized medical interventions abroad without losing continuum of care locally.
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