The Social Health Authority (SHA) has announced the implementation of an overseas healthcare program aimed at enabling Kenyan patients to access treatment abroad when such services are not available locally.
In a notice on Friday, January 2, SHA invited Expressions of Interest (EOIs) from qualified and licensed overseas healthcare providers to offer specialized medical services to beneficiaries of the Social Health Authority, in line with the Social Health Insurance Act (SHI Act) No. 16 of 2023.
The program covers beneficiaries under the Social Health Insurance Fund (SHIF) and the Public Officers Medical Scheme Fund (POMSF).
"For beneficiaries under the POMS, the services covered shall be inclusive of the list of interventions not readily available in Kenya, and those negotiated and agreed between the Authority and the respective overseas healthcare provider or health facility with capacity to offer the required intervention," the notice read.
Under the program, SHA will purchase specialized healthcare services on behalf of eligible beneficiaries from contracted overseas providers.
Read More
For SHIF beneficiaries, services will be limited to interventions listed by BPTAP as unavailable in the country, with periodic updates published by the Authority.
For POMSF beneficiaries, the scope extends to additional specialized treatments upon referral, subject to negotiated and approved costs.
The cost elements covered under the program include medical evaluation costs, including laboratory tests and imaging services and the cost of the treatment or medical intervention
Others are accommodation before, during, and after treatment, including post-discharge reviews pending issuance of a fit-to-fly certificate, transfers between healthcare providers where necessary due to emerging medical conditions and any other incidental medical expenses deemed necessary.
Interested overseas healthcare providers must meet strict eligibility and mandatory qualification criteria.
It includes valid registration or incorporation under applicable laws, authorization by their respective national health regulators, and proven capacity to deliver the specialized services listed by SHA.
Providers are also required to demonstrate corporate governance compliance, accreditation by recognized bodies in their country of origin, and recognition by relevant Kenyan authorities.
Additionally, overseas facilities must have linkage or partnership arrangements with contracted healthcare facilities in Kenya to ensure continuity of care and follow-up upon a patient’s return.
SHA further requires valid and up-to-date licenses for specialist doctors who will be expected to deliver the services procured under the program.
The authority noted that eligible overseas healthcare providers can access tender documents free of charge from the SHA website, the Public Procurement Information Portal, and the respective county and sub-county offices.
Applications must be submitted electronically through SHA’s official email within 14 days from the date of commencement.
Incomplete applications will lapse automatically but may be resubmitted as new applications once all mandatory documentation is provided.
Successful applicants will be notified in writing and required to execute contracts within seven days.
Initially, contracting will be undertaken manually, after which executed contracts will be countersigned by the Accounting Officer of SHA.
SHA emphasized that the overseas contracting notice will remain open and subject to periodic updates, depending on service needs and necessary approvals.
In terms of transparency and oversight, the authority said it reserves the right to verify submitted information, negotiate tariffs, and continuously empanel overseas healthcare providers as required.
A list of contracted overseas healthcare providers will be published in the Kenya Gazette, on the SHA website, and through other lawful platforms to enhance transparency and accountability.
SHA added that it may levy administrative fees where applicable under the contract terms.
This comes weeks after SHA issued new directives to healthcare providers affected by facility-level mismatches, announcing the completion of the first batch of contractual and facility record reviews.
On Monday, December 22, the authority issued a notice informing healthcare providers that verified facility licensing records have been cross-checked against the Kenya Medical Practitioners and Dentists Council (KMPDC), and the applicable Kenya Essential Package for Health (KEPH) Level has been confirmed.
According to the notice, facilities are required to amend their contracts to align with their declared status, with those who have completed this process already being cleared.
"SHA verified facility licensing records with the Kenya Medical Practitioners and Dentists Council (KMPDC). SHA also confirmed the applicable Kenya Essential Package for Health (KEPH) Level. Facilities needed to amend their contracts to align with their declared status. Those who have finished this process have been cleared," the notice stated.
SHA revealed that claims submitted during the amendment period have been reviewed in accordance with the updated contract status, with validated claims set to be paid by Wednesday, December 24, 2025.
"SHA reviewed claims submitted during the amendment period in accordance with the updated contract status. Validated claims will be paid by Wednesday, 24/12/2025," the authority announced.
