Government halts overseas medical referrals under SHA to curb abuse by cartels

Social Health Authority registration at Jaramogi Oginga Odinga Hospital, Kisumu on July 15, 2025. (Photo: SHA)

By Lucy Mumbi
Thursday, September 11, 2025

The move follows revelations of widespread abuse of the scheme by cartels and unregulated foreign hospitals.

The government has announced the suspension of overseas medical referrals funded by the Social Health Authority (SHA), following revelations of widespread abuse of the scheme by cartels and unregulated foreign hospitals.

Speaking during the launch of the Digital Health Transformation and TaifaCare Caravan in Eldoret, Uasin Gishu County, Health Cabinet Secretary Aden Duale said Kenyans seeking SHA support for treatment abroad will have to wait longer as the Ministry of Health enforces strict new vetting processes to seal corruption loopholes and prioritise local healthcare capacity.

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Duale maintained that the suspension of the SHA overseas medical package will remain in place until key reforms are fully implemented.

“In the next week, I will gazette the treatments that are not available in our country. The days of going overseas for treatment just because a doctor has referred you will no longer be there,” the CS said.

He explained that a comprehensive stakeholder review is ongoing to identify treatments not available locally, and only those will be eligible for overseas referrals. He stressed that foreign hospitals must be vetted, registered with the SHA and hold valid contracts to receive payments.

“The hospitals you are being referred to in India and elsewhere must first have a contract with SHA. We have had incidents where referral systems have not been genuine. Some people get commissions for referring patients to foreign countries for treatment, and that is what we want to stop,” he said.

Duale noted that some cartels have exploited the system by referring patients abroad for procedures that can be done locally, purely for financial gain. To curb this, the government has enlisted an independent benefit and advisory body based at the University of Nairobi to vet foreign hospitals and determine which ones meet the criteria for SHA accreditation.

Under the new rules, SHA will only cover overseas treatments that are unavailable in Kenya. The CS pointed out that many procedures sought abroad, including PET scans, advanced imaging, kidney transplants, open-heart surgeries and treatments for joint and spinal injuries, are already offered in the country.

In January, the ministry announced plans to fast-track the review of the overseas benefits package after persistent complaints from Kenyans.

On employment, Duale assured that all health workers under the Universal Health Coverage (UHC) programme will now be employed under terms approved by the Salaries and Remuneration Commission (SRC).

“All UHC workers are going to be employed under SRC rates, on permanent and pensionable terms. Tomorrow, I have a meeting with the Council of Governors, and we are working on modalities to transition them. The story of UHC workers, interns, and CBAs is now a closed chapter during my tenure as CS,” he said, adding that the era of health worker demonstrations has ended.

On the rollout of the Digital Health System, Duale hailed the platform as a “turning point” for Kenya’s healthcare sector.

“SHA and TaifaCare are a transformational step in building a health system that works for every Kenyan. From today, wananchi in Uasin Gishu and across the country can register, contribute, and access services with dignity without fear of being locked out due to cost or bureaucracy,” he said.

He added that Kenyans can now conveniently access healthcare services through USSD (*147#), the app, and community registration desks.

“With TaifaCare, health is now in your hands. Through USSD (*147#), the app, and community registration desks, we have made access simple, transparent and inclusive,” Duale said.