Health Cabinet Secretary Aden Duale has gazetted 36 ailments that cannot be treated locally and will now be covered for overseas treatment under the Social Health Authority (SHA).
In a gazette notice dated Friday, September 20, 2025, Duale said the decision was made in consultation with the Authority and on the recommendation of the Benefits Package and Tariffs Advisory Panel (BPTAP).
“Pursuant to the provisions of Regulation 39(1)(b) and Regulation 49(1) and (2) of the Social Health Insurance Regulations, 2024, the Cabinet Secretary for Health, in consultation with the Social Health Authority and on the recommendation of the Benefits Package and Tariffs Advisory Panel (BPTAP), gives notice to the public of the list of healthcare services not available in Kenya as set out in the Schedule below,” read the notice.
Duale also outlined the reasons why the 36 ailments cannot be treated within Kenya.
Among the ailments to be covered by SHA is wrist joint arthroplasty, which the government justified due to the lack of dedicated joint replacement and implant availability in the country.
Duale Lists Healthcare Services Unavailable in Kenya to be Covered by SHA
Another condition is metacarpal joint arthroplasty, which Duale said cannot be managed locally because of limited access to prostheses and expertise.
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For ankle joint arthroplasty, the justification provided is a lack of surgical expertise and advanced implants.
Whole femoral replacement will be treated abroad because of the absence of access to mega-prostheses, while proximal femoral replacement will be covered overseas due to inadequate oncology infrastructure in the country.
| No. | Healthcare Service | Justification |
| 1 | Distal femoral replacement | Lack of implants and training |
| 2 | Proximal tibial replacement | Not routinely performed due to resource limitations |
| 3 | Allograft use | No national bone bank |
| 4 | Complex congenital heart surgery requiring Extracorporeal Membrane Oxygenation (ECMO) in paediatrics | Lack of ECMO capacity and ICU support |
| 5 | Liver Transplant | No paediatric liver transplant program |
| 6 | Bone Marrow Transplant | No dedicated Bone Marrow Transplant (BMT) units |
| 7 | Kidney Transplant (paediatric) | Underdeveloped paediatric nephrology services |
| 8 | Intrathecal chemotherapy for Retinoblastoma | Limited access to specialised paediatric oncology |
| 9 | Laryngeal transplant | No national legal framework for larynx transplantation |
| 10 | Intrauterine blood transfusion | Lack of foetal therapy centres and trained maternal-foetal specialists |
| 11 | Intrauterine shunt placement (bladder outlet obstruction, hydrothorax cysts) | No capacity for intrauterine surgical procedures |
| 12 | Intrauterine vesicocentesis, thoracocentesis, paracentesis | Lack of interventional radiology in maternal-foetal settings |
| 13 | Fetoscopy, amniotic band ligation, laser ablation | Absence of fetoscopic instruments and trained personnel |
| 14 | Amnioreduction, amnioinfusion | Rarely performed due to risk and limited technical skills |
| 15 | Foetal reduction, cord occlusion, cordocentesis | Lack of access to selective foetal reduction tools and protocols |
| 16 | Advanced endometriosis excision | Limited advanced laparoscopic skills among gynaecologists |
| 17 | Sacral neuromodulation for urinary/faecal incontinence | No neuromodulation equipment or trained urogynaecologists |
| 18 | Peptide Receptor Radionuclide Therapy (PRRT), specifically Lutetium-177 | Lack of licensed radiopharmaceutical medicines and requisite nuclear medicine infrastructure |
| 19 | DOTA-Tyr3-OctreotateTATE Positron Emission Tomography Computed Tomography scan (DOTA-TATE scan) | Diagnostic unavailability for neuroendocrine tumour staging |
| 20 | Fibroblast Activation Protein Inhibitor Positron Emission Tomography Imaging (FAPI PET scan) | FAPI-based imaging is unavailable nationally despite its value in detecting fibrotic and neoplastic lesions |
| 21 | Microwave ablation of metastatic tumours | No national capacity for percutaneous microwave tumour ablation |
| 22 | Chimeric Antigen Receptor T-cell therapy (CAR-T cell therapy) | Highly specialised therapy not yet authorised or available in Kenya |
| 23 | Bispecific T-cell engagers | Lack of regulatory pathway for bispecific antibody-based immunotherapies |
| 24 | Allogeneic bone marrow/peripheral blood stem cell transplant | Only autologous transplants performed with limited centres; allogeneic capacity inadequate |
| 25 | Transjugular Intrahepatic Portosystemic Shunt | Limited only by unavailability of essential tools and consumables |
| 26 | Yttrium-90 (Y-90) radio-embolization | Lack of access to Yttrium-90 isotopes and delivery systems |
| 27 | Surgical management of birth-related brachial plexus injuries | Lack of neurophysiology equipment and trained personnel |
| 28 | Photopheresis (ECP – Extracorporeal Photopheresis) | Not available |
| 29 | Nerve Ablation Therapy | Lack of neurophysiology equipment and trained personnel |
| 30 | Neural Regenerative Therapy | Lack of neurophysiology equipment and trained personnel |
| 31 | Proton Therapy | Not available |
Guidelines for SHA Overseas Treatment
At the same time, the Health CS unveiled guidelines that citizens registered with SHA must follow when seeking treatment abroad.
The new guidelines for overseas treatment are as follows:
- Legal Mandate: The Social Health Insurance Act mandates that SHA can only make payments to healthcare providers who are impanelled and have a contract with the Authority.
- Eligibility for Treatment Abroad: A beneficiary can only access treatment outside Kenya if the healthcare service is not available locally. The beneficiary’s contributions must also be up-to-date. The treatment must also be provided by an SHA-contracted health facility.
- Provider Requirements: Overseas facilities must be accredited in their home country and officially recognized by the relevant regulatory body in Kenya. A key requirement is that the overseas providers must be linked to a contracted health facility in Kenya to ensure continuous follow-up care upon the beneficiary’s return.
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- List of Services: The Benefits Package and Tariffs Advisory Panel (BPTAP) has already developed an initial list of 36 healthcare services not available in Kenya, which has been gazetted. This is a preliminary list, as the process of identifying additional interventions is continuous and will be guided by a comprehensive Health Technology Assessment (HTA).
- Approval Process: Referrals for overseas treatment will be subject to a peer review mechanism by the Claims Management Office to ensure medical necessity. The treatment sought must also fall within the financial limits of the benefits package and must not be an unproven, experimental, or unconventional therapy.
- Financial Limits: The maximum limit payable for overseas treatment/procedures is capped at Ksh500,000, subject to review upon completion of contracting and rate negotiations with accredited providers abroad.
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