When the Social Health Authority (SHA) announced a Ksh 500,000 cap on overseas medical coverage, it signaled a “local first” era for Kenyan healthcare. But if your condition falls within the 36 gazetted “unavailable” procedures, you need to act fast and follow a very specific legal path to unlock government funding.
The days of “private doctor referrals” to India are over. Here is the official 2026 step-by-step guide to navigating the new SHA overseas referral system.
Step 1: The “Local Exhaustion” Diagnosis
Before SHA considers an overseas application, you must prove the service is unavailable in Kenya.
The Rule: Referrals must originate from a Level 6 National Referral Hospital (e.g., Kenyatta National Hospital, Moi Teaching and Referral Hospital, or Kenyatta University Referral Hospital).
The Proof: A specialist doctor must sign a formal declaration stating that the technology, expertise, or infrastructure for your procedure is not present in the country.
Step 2: Checking the “36-Procedure” Eligibility
SHA will only pay for procedures listed in Legal Notice No. 5044. If you are seeking treatment for something not on this list—like a standard hip replacement or routine PET scan—your application will be rejected automatically.
Current Top 3 Requests: Pediatric liver transplants, bone marrow transplants for blood cancers, and complex fetal (unborn baby) surgeries.
Step 3: Finding an “Empanelled” Hospital
As of January 2, 2026, SHA CEO Dr. Mercy Mwangangi has officially invited overseas hospitals to apply for “empanelment.”
The Requirement: SHA will no longer send money to any random foreign hospital. The facility must have an active contract with SHA, be accredited in its home country, and be recognized by Kenyan regulators.
The “Twin” Requirement: The foreign hospital must be linked to a Kenyan hospital for follow-up care. This ensures that when you return, a local doctor can manage your recovery using the same protocols.
Step 4: The Claims Management Vetting
Once your documents are submitted (via the SHA portal or at Afya House), they undergo a Peer Review.
The Vetting: A board of Kenyan medical experts will review the “medical necessity” of your trip.
The Audit: They will also check your contribution status. If your SHA account until the balance is cleared.
