Health Cabinet Secretary Aden Duale has issued a detailed clarification on how the Social Health Authority (SHA) operates when it comes to facilitating treatment abroad amid concerns that the government healthcare system was dysfunctional outside Kenya.
In a statement on Thursday, Duale reiterated that, unlike the defunct National Hospital Insurance Fund (NHIF), SHA followed a legally mandated process empanelled under a contract.
Duale explained that, unlike NHIF, the SHA is governed by strict procedures under the Social Health Insurance (SHI) Act, the Public Procurement and Asset Disposal Act, and guidelines from the Office of the Attorney General (OAG).
One of the key points of contention that the CS sought to address was the issue of what qualifies one to be treated under SHA abroad. According to Duale, SHA cannot simply approve or fund overseas treatment arbitrarily.
"SHA’s workings are different from the repealed old fraud NHIF insurance system,” said Duale. "SHA can only pay healthcare providers that are empaneled and under contract. That is the law.”
The process of facilitating treatment abroad starts with confirming that the required medical treatment is not available in Kenya. Also, the patient must be a compliant contributor under the SHI Act.
Once the conditions are met, the overseas medical institution must meet several different criteria, including being accredited in its home country and recognised in Kenya. The facility should also be linked to a local, contracted health provider for post-treatment follow-up.
The SHA board must also approve any agreement with foreign institutions before any treatment is facilitated.
In addition, contracts must also be vetted and approved by the Office of the Attorney General from the initiation process to the execution of treatment.
Duale explained that these intricate steps were in place to ensure accountability and avoid the mismanagement that plagued the previous NHIF system.
The CS also revealed that while the preferred procurement method for securing medical services abroad was through open tendering, SHA was working on a Specially Permitted Procurement Procedure, to be approved by the National Treasury, which will allow the authority to partner with foreign hospitals under clear, regulated terms.
A benefits panel, the Benefits Package and Tariffs Advisory Panel (BPTAP), will also be tasked with publishing an official list of procedures eligible for overseas treatment, although this list has not yet been gazetted.
Duale also noted that the Ministry of Health has already submitted the “Quality Care and Patient Safety Bill” to Parliament, aimed at strengthening standards and regulation in healthcare delivery.
The elaborate response from the CS came after a report from a local news outlet highlighting the plight of a baby who is in urgent need of medical attention abroad.
