The government has released a list of 36 specialised medical services that are unavailable in Kenya.
In a Gazette Notice dated September 19, Health Cabinet Secretary Aden Duale said the services are eligible for treatment overseas under the Benefits Package and Tariffs Advisory Panel.
According to the notice, a majority of the services entail highly specialised joint and limb replacement procedures due to lack of dedicated facilities and training.
Duale, however, clarified that each patient seeking treatment overseas would only access up to Ksh50,000, though the figure could be adjusted to accommodate contracts with health care providers abroad.
“The maximum limit payable for overseas treatment is capped at Ksh500,000, ensuring value for money and quality care,” said Duale adding that the initiative is part of government's effort to ensuring that Kenyan patients are not denied access to procedures that are not yet available in the country.
In a statement by the ministry, to access the medical covers overseas, Kenyans must have their Social Health Insurance contributions up to date to be eligible.
“Ministry of Health through Social Health Authority(SHA) is proud to announce new era for specialized medical care for all Kenyans under the new Social Health Insurance (SHI),” the statement read.
Specialised Medical Procedures Overseas
Duale stated that Claims Management Office will review referrals, ensuring that medically necessary and compliance with financial limits.
“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 ,” part of the gazette notice read.
The list of medical services currently not available in Kenya include specialised joint and limp replacement procedures, paediatric procedures as well as specialised therapies.
Specialised joint and limp replacement procedures
According to the notice, a majority of the medical services not available in Kenya entail highly specialised joint and limb replacement procedures since the country lacks dedicated joint replacement centres and adequate training to perform these surgeries.
They include wrist, metacarpal and ankle joint arthroplasty, proximal and distal femoral replacements, and proximal tibial replacement.
Paediatric procedures and services
Complex paediatric transplant procedures and services including paediatric liver and kidney transplants, bone marrow transplants, and laryngeal transplants are also not available in the country.
Other procedures such as intrauterine blood transfusion, shunt placement for bladder outlet obstruction, vesicocentesis, thoracentesis, paracentesis, fetoscopy, amniotic band ligation, laser ablation, amnioreduction, amnioinfusion, foetal reduction, cord occlusion and cordocentesis are also not available.
Therapies
Therapies including Peptide Receptor Radionuclide Therapy, such as Lutetium-177, DOTA-TATE scans, Fibroblast Activation Protein Inhibitor PET/CT imaging, microwave ablation of metastatic tumours, Yttrium-90 radioembolization and Chimeric Antigen Receptor T-cell therapy are also not available in Kenya.
The notice also listed sacral neuromodulation for urinary and faecal incontinence, surgical management of birth-related brachial plexus injuries, photopheresis, nerve ablation therapy, neural regenerative therapy and proton therapy are not offered.
Duale revealed that the list was prepared after consultation with relevant stakeholders, in line with the Social Health Insurance Regulations.
