Treatment abroad from Kenya: how the SHA overseas referral actually works in 2026

Checked 11 September 2026. Everything on this page is quoted and linked, so you can read the source yourself. The rules, the money and the forms come from Kenyan government sources — the Regulations on Kenya Law, SHA's own site, and the Ministry of Health. Where the only public account of something is a Kenyan news report rather than a government document, we say so in the line itself and name the publication, the reporter and the date.

This page explains the paperwork and the money. It does not tell you what treatment to have. Only your doctor can do that.

Before anything else: this pathway is very new, and so far very narrow

SHA itself launched in October 2024. The overseas-treatment benefit did not. SHA's Chief Executive Officer, Dr Mercy Mwangangi, speaking on record to Citizen TV, said Kenyans would only be able to start using the overseas package from 14 April 2026 — describing that date as the point SHA had "finally been able to meet the merits of the law and do the contracting process" — Citizen Digital, Gov't to begin SHA's overseas healthcare cover on April 14, Mary Muoki, 10 April 2026 (source, read 11 September 2026). Before that date there were no contracted overseas providers to refer a patient to at all.

About six weeks later, Kenyan press reported that only one Kenyan patient had been formally cleared for treatment abroad since the benefit opened. The Eastleigh Voice, relaying Daily Nation's reporting and dated 25 May 2026, wrote: "Since the launch of SHA in October 2024, only one Kenyan has reportedly been formally cleared for treatment abroad" — The Eastleigh Voice, Only one Kenyan approved for treatment abroad as SHA introduces strict new medical referral rules, 25 May 2026 (source, read 11 September 2026).

Read that figure correctly. The article's own wording counts from SHA's October 2024 launch, but the overseas benefit itself had no contracted hospitals to refer anyone to until 14 April 2026. So the honest count is not "one approval in nineteen months" — it is one reported approval in roughly six weeks of the benefit actually existing. We could not confirm from the article whether that one approval was granted before or after 14 April 2026, but given the CEO's own account of only just finishing the contracting process on that date, an approval before it seems unlikely.

Two things worth holding at the same time. A six-week-old scheme with one reported approval is a real and useful signal — this route is new, it is slow, and very few people have been through it yet. It is not, on the evidence we have, proof that SHA is refusing to approve people. We found no figure published by SHA, the Ministry of Health or Parliament confirming an approval count directly; the "one Kenyan" figure traces to a single Daily Nation report, carried onward by The Eastleigh Voice, not to two independent outlets or to a named SHA official. Health Cabinet Secretary Aden Duale is on record, in the same Eastleigh Voice piece, describing the new framework as strict: "If a patient travels abroad without a formal commitment letter from SHA, they are doing so outside the framework and without prior authorisation. SHA is prohibited from assuming liability for such medical bills."

If you are deciding whether to start this process, weigh that in: it can work — the framework exists and providers are contracted — but as of the most recent reporting we could find, very few applications have been approved, and we do not know why, because SHA has not published a number or a reason.

Start here: the Ministry's own page is out of date

If you search for how to get treatment abroad from Kenya, you will probably land on the Ministry of Health page called "Getting Treatment Abroad". It lists six requirements. One of them asks for an "NHIF Form (referral for overseas treatment) signed by the Principal Member, the Specialist Doctor and stamped" — Ministry of Health, Getting Treatment Abroad (source, read 11 September 2026).

There is no NHIF any more. The Social Health Authority now describes it as the "defunct National Health Insurance Fund" in its own published notices (source, read 11 September 2026).

The Ministry page has not been changed. The document it offers for download is dated March 2023 (source), and the footer of the web page still reads "© Copyright 2022".

We are not saying the Ministry page is worthless. Four of its six points still describe real paperwork. We are saying: do not use it as your checklist in 2026, and do not let anyone else use it as their checklist for you. The rules that decide whether you are paid are now in the Social Health Insurance Regulations.

The rule that decides everything: Regulation 39

The law is the Social Health Insurance Regulations, Legal Notice 49 of 2024. Regulation 39 is called "Treatment outside Kenya". This is its first paragraph, word for word:

"(1) A beneficiary may access treatment outside Kenya where the— (a) contributions in favour of the beneficiary comply with section 27(1) and (2) of the Act and these Regulations; (b) treatment sought is not available in Kenya; and (c) treatment sought is being provided by a healthcare provider or health facility contracted by the Authority."

— Legal Notice 49 of 2024, regulation 39(1) (full text on Kenya Law, read 11 September 2026)

Look closely at (b) and (c). They are the two conditions that most people find out about too late.

• (b) The treatment must not be available in Kenya. Not "cheaper abroad". Not "faster abroad". Not available here.
• (c) The hospital abroad must already be under contract with SHA. You cannot choose any hospital in the world and ask SHA to pay for it afterwards.

If either of those is not true, SHA is not required to pay, and you are paying for yourself.

What you have to send, and who checks it

Regulation 39(2) says you must ask the Authority to authorise the treatment before you go, by providing two things: (a) "a referral for overseas treatment from the treating doctor or consultant submitted online in Form 2 set out in the First Schedule to these Regulations," and (b) "a duly filled referral form prescribed under the Medical Practitioners and Dentists Act (Cap. 253)" (Legal Notice 49 of 2024, regulation 39(2)).

That is two separate forms, not one. More on that below.

Regulation 39(3) says the referral must contain the name of the receiving hospital, your diagnosis including all test results, your medical history, clear medical reasons for the referral, and the signature of your treating doctor.

Regulation 39(4) says SHA's Claims Management Office must then confirm all of the following before approving:

"(a) the healthcare service for which the beneficiary is being referred is not available in Kenya; (b) the referral is to a healthcare service provider or health facility that is contracted by the Authority; (c) based on peer review undertaken by the Claims Management Office, the referral is medically necessary; (d) the financial implication of the healthcare service sought outside Kenya is within the limits of the benefits package; and (e) the treatment sought is not unproven, experimental or an unconventional therapy."

Regulation 39(5): only "where the Authority approves the request" does SHA undertake to pay.

So approval comes before travel. Nobody can give you that approval except the Authority.

The money: KES 500,000 per person per year

SHA publishes an Overseas Treatment Package on its Benefit Tariffs page. This is the whole entry, word for word:

— Social Health Authority, Benefit Tariffs (source, read 11 September 2026)

An honest note about this figure, because it matters. KES 500,000 is published by SHA, which is the body that pays. On that page SHA attributes the limit to Regulation 39. But the text of the Regulations does not contain that amount.

We checked two separate copies of the Regulations on 11 September 2026:

• the consolidated text on Kenya Law (source), where Regulation 39 states conditions and procedure and no figure, and the Schedules appear as headings without tariff tables; and
• the Ministry of Health's own 85-page copy of the Social Health Insurance (General) Regulations, 2024 (source%20Regulations,%202024_0.pdf)), which contains no monetary amount anywhere in it.

So the amount lives in SHA's published benefit tariff, not in the text of the Regulation the tariff points to. That does not make it wrong — SHA is the payer and it is SHA's own published figure. It does mean you should not treat it as a number fixed in law that cannot move.

We are telling you this rather than smoothing it over, because a number you are planning your family's money around should come with its provenance. Confirm the current limit with SHA in writing before you commit to anything.

What the limit means in practice

KES 500,000 is per person, per year. It is a ceiling on what the Authority pays, not an estimate of what treatment costs.

Anything above that ceiling is yours to find. Travel, the accompanying person, accommodation, and anything the package does not cover are separate questions you should ask SHA about directly, in writing.

We do not publish treatment prices on this site, because we have not verified any. Anyone who quotes you a price should be able to tell you who produced it and show you that hospital's own written quotation, on the hospital's letterhead, with a date.

Two forms, two different signatures

This is the part that is easy to get wrong.

The SHA form

The SHA Referral for Overseas Treatment Form (4 pages, PDF, read 11 September 2026):

• Part A — the patient's side. The sections we could read ask for an ID or passport number and a SHA number for each person named, the relationship of each person to the patient, a section "C. Details of the donor (where applicable)", and "D. Patient / authorized person's declaration", which you sign. (The first page of SHA's PDF did not yield machine-readable text when we checked it, so we are not describing the sections we could not read. Open the PDF and read page 1 yourself.)
• Part B — filled by your referring practitioner: provisional diagnosis, reason for referral, expected treatment, expected outcome, and "plan for review and follow-up upon return of the patient to the country". The section on the receiving facility asks for its name, city, country and its "SHA Healthcare Provider Number".
• Part C — "To be filled in by the Kenya Medical Practitioners and Dentists Council". The Council's Chief Executive Officer certifies that your doctor "is registered under Registration Number…, validly Licensed under current Practice License No:… and is of good standing", under the Council's official stamp.
• Part D — "To be filled in by the SHA DIRECTOR", who writes: "Approval is hereby given for … who has been referred by Dr … to travel abroad for medical/dental management in … (country)."

The KMPDC form

The KMPDC Referral Form for Medical Management Abroad, made under the Medical Practitioners and Dentists Act (Cap. 253) (5 pages, PDF, read 11 September 2026). It looks similar, but its final approval is signed by a different official:

• Part C — again the KMPDC Chief Executive Officer certifies your doctor's registration, licence and good standing.
• Part D — "To be filled in by the Director of Medical Services", under the "Official Stamp of the Ministry of Health".

So one form ends at the SHA Director, and the other ends at the Director of Medical Services at the Ministry of Health. Regulation 39(2) requires both.

⚠ A complication the official sources do not explain, and we will not pretend away. Regulation 39(2)(a) points to "Form 2 set out in the First Schedule". Form 2 as printed inside Legal Notice 49 is a short form — patient particulars, an undertaking by the principal member, and an undertaking by the physician in charge. It has no KMPDC certification section and no SHA Director approval section. The "SHA Referral for Overseas Treatment Form" that SHA actually publishes for download is a longer, different document that adds both. We checked both on 11 September 2026 and they are not the same form. Neither source explains the difference. Use the form SHA publishes on its own website, and ask SHA to confirm in writing that it is the current one.

⚠ The KMPDC form is also partly out of date. In Part A, where you tick your source of funding, the printed options still include "National Hospital Insurance Fund" — the body that no longer exists. We are pointing this out so that you are not confused by it, not so that you avoid the form. It is the form the Regulations point to.

The KMPDC form gives a dedicated contact for this exact subject: patient.referrals@kmpdc.go.ke, KMPDC Office Complex, Woodlands Rd off Lenana Rd, P.O. Box 44839-00100, Nairobi (source).

If someone is offering to fill in or fast-track either form for a fee, see questions to ask before you pay a facilitator for the SHA referral paperwork before you agree to anything.

The order to do things in

Based only on what the Regulations and the two forms say:

1. See a Kenyan specialist. The referral has to come from your treating doctor or consultant (regulation 39(2)(a)). No agent can start this for you.
2. Check your contributions are in order. Regulation 39(1)(a) makes this a condition before anything else.
3. Your doctor completes the medical part of both forms — diagnosis, test results, reason for referral, expected treatment, and the follow-up plan for when you come home.
4. KMPDC certifies your doctor — Part C on both forms, signed by the Council's Chief Executive Officer, under the Council's stamp.
5. The receiving hospital abroad has to be one SHA has contracted — and the form asks for that hospital's SHA Healthcare Provider Number. Get that number before you go further.
6. You ask the Authority to authorise the treatment. Regulation 39(2) puts this on you: "A beneficiary who requires treatment outside Kenya shall request the Authority to authorize the treatment". The referral goes in online, and the Cap. 253 form has to be filled as well.
7. Wait for approval. SHA's Claims Management Office reviews it against the five tests in regulation 39(4), including a peer review of whether the referral is medically necessary.
8. Only after approval does SHA undertake to pay (regulation 39(5)).

Steps 4 and 7 are done by institutions, not by you and not by a company you pay. Step 6 is yours — the Regulations put the request in the beneficiary's hands. If someone offers to speed up step 7, ask them to write down exactly who they will speak to and what they will say.

Which hospitals SHA has actually contracted

SHA ran a procurement for overseas providers — SPPP/SHA/001/2025–2026, published on its website on 14 April 2026 — and published the resulting list (tender page).

The document is titled "List of the First Nine (9) Overseas Healthcare Providers Contracted to Offer Services to Kenya's Social Health Authority Beneficiaries Referred for Specialized Treatment" (PDF, read 11 September 2026). Reproduced exactly as SHA printed it:

SHA's own note underneath it says this list is "not an exhaustive list as the contracting process is an ongoing process," that "more applications are still undergoing evaluation," and that "new applicants are welcome as the invitation to express interest is still open" (same PDF).

Please read the following four points before you use that table.

1. This is not our list and not our recommendation. It is the Kenyan government's published list of providers it has contracted. We have not verified any hospital ourselves. We make no statement about the quality, price, waiting time or results of any hospital on it.
2. We have reproduced the spelling exactly as SHA printed it, including "Workhardt" at number 5.
3. It is explicitly incomplete and it will change. Check the tender page for a newer version before you rely on it.
4. Being on the list does not mean SHA will pay for your case. All five tests in regulation 39(4) still have to be met.

Three of the nine are in India. That is the only reason Kenya and India appear on the same page here.

The two named officials who have talked publicly about the India hospitals name only two of the three, not all three. SHA CEO Dr Mercy Mwangangi, in the same 10 April 2026 Citizen Digital piece cited above, named the empanelled India facilities as KIMS Hospital Enterprises Private Ltd and Apollo Hospitals Enterprises Ltd (Apollo Cancer Centre) (source, read 11 September 2026). Health CS Aden Duale, quoted by name in an earlier Citizen Digital piece announcing the KES 500,000 cap and the 36-procedure list, is not quoted naming individual hospitals — Citizen Digital, SHA caps overseas treatment cover at Ksh.500K, lists 36 eligible procedures, Brenda Wanga, 29 January 2026 (source, read 11 September 2026). Neither of these named-official sources mentions Workhardt/Wockhardt Hospital at all.

We are not resolving this by editing SHA's own list. The PDF above is SHA's own published document and we reproduce it exactly, spelling error and all, because that is what it says. But the CEO's own public account of which India hospitals are contracted names only two of the three India entries on that PDF. We do not know why the two do not match — a contracting update, a reporter simplifying, or something else. What we can tell you is that they do not fully agree, and we are showing you both, dated, rather than picking one.

The list of what SHA treats as "not available in Kenya"

Regulation 39(1)(b) turns on whether the treatment is available in Kenya. SHA and the Benefits Package and Tariffs Advisory Panel (BPTAP) publish a "List of Interventions Not Readily Available in Kenya" (PDF, read 11 September 2026). It has 36 entries.

This is a list about money, not about medicine. It is what the Authority uses when it decides whether to pay. It is not a menu, and nothing here is a suggestion that any treatment is right for anyone.

The 36 entries, as published, unchanged in wording:

1. Wrist joint arthroplasty
2. Metacarpal joint arthroplasty
3. Ankle joint arthroplasty
4. Whole femoral replacement
5. Proximal femoral replacement
6. Distal femoral replacement
7. Proximal tibial replacement
8. Allograft use
9. Complex congenital heart surgery requiring ECMO in paediatrics
10. Liver transplant
11. Bone marrow transplant
12. Kidney transplant (paediatric)
13. Intrathecal chemotherapy for retinoblastoma
14. Laryngeal transplant
15. Intrauterine blood transfusion
16. Intrauterine shunt placement (bladder outlet obstruction, hydrothorax, cysts)
17. Intrauterine vesicocentesis, thoracentesis, paracentesis
18. Fetoscopy, amniotic band ligation, laser ablation
19. Amnioreduction, amnioinfusion
20. Foetal reduction, cord occlusion, cordocentesis
21. Advanced endometriosis excision
22. Sacral neuromodulation for urinary or faecal incontinence
23. Peptide Receptor Radionuclide Therapy, specifically Lutetium-177
24. DOTA-Tyr3-Octreotate PET/CT scan
25. Fibroblast Activation Protein Inhibitor PET/CT imaging
26. Microwave ablation of metastatic tumours
27. Chimeric Antigen Receptor T-cell therapy
28. Bispecific T-cell engagers
29. Allogeneic bone marrow or peripheral blood stem cell transplant
30. Transjugular intrahepatic portosystemic shunt
31. Yttrium-90 radio-embolization
32. Surgical management of birth-related brachial plexus injuries
33. Photopheresis (extracorporeal photopheresis)
34. Nerve ablation therapy
35. Neural regenerative therapy
36. Proton therapy

SHA's own note describes this as "an initial list," and says the Benefits Package and Tariffs Advisory Panel (BPTAP) "review the list periodically as mandated by law" (same PDF).

If your treatment is not on that list, that does not automatically mean you are refused. Regulation 39(4)(a) says the Claims Management Office confirms whether the service is available in Kenya. But it does mean you should ask SHA directly, in writing, before you spend money — because on SHA's published view, that treatment may be available here.

What makes a hospital abroad eligible at all

Regulation 36 sets the conditions. A healthcare provider outside Kenya is contracted where it is:

"(a) accredited by the relevant authority in its country of origin and recognized by the relevant authority in Kenya; (b) linked to an empaneled and contracted health facility in Kenya that will follow up on the treatment and management of a beneficiary upon his or her return to Kenya; and (c) providing a healthcare service that is not available in Kenya."

— Legal Notice 49 of 2024, regulation 36(1)

Point (b) is worth holding on to. The rules assume you are coming home. The overseas hospital is supposed to be linked to a Kenyan facility that will look after you afterwards, and the SHA form asks your referring doctor to write the follow-up plan before you leave.

If nobody has discussed with you what happens after you get back, a required part of the arrangement is missing.

What we could not source, and therefore do not state

We would rather leave a gap than fill it with a guess.

• How long SHA approval takes. No published time limit was found in Regulation 39 or on the SHA pages we read. We do not know.
• An official approval count. SHA, the Ministry and Parliament have published no figure. What we do have is one press-reported number — see "Before anything else: this pathway is very new, and so far very narrow" near the top of this page — which traces to a single Daily Nation report, not to SHA itself.
• Whether SHA pays travel, the accompanying person, or accommodation. The Benefit Tariffs entry covers the treatment package. We could not source the rest, so we do not state it. Ask SHA in writing.
• Whether anything else is payable on top of the KES 500,000 limit, for example from the Emergency, Chronic and Critical Illness Fund. Not sourced. Ask SHA.
• The SHA Healthcare Provider Numbers of the nine contracted providers. The form asks for that number; we did not find a published list of the numbers.
• Any hospital's price, waiting time, success rate or quality. We have verified none of these for any hospital anywhere, so we publish none.
• Indian visa fees and requirements for Kenyan citizens. A separate subject. We cover what the Government of India publishes on our page Indian medical visa from Kenya.

Who to ask, and where

These are published government contacts. We are quoting them, not adding to them.

• SHA — toll free 0800 720 601; SHA Building, Community Area, Ragati Road, P.O. Box 30443–00100, Nairobi (source, read 11 September 2026).
• KMPDC, for referrals abroad — patient.referrals@kmpdc.go.ke; KMPDC Office Complex, Woodlands Rd off Lenana Rd, P.O. Box 44839-00100, Nairobi (source).
• Ministry of Health — Afya House, Cathedral Road, P.O. Box 30016–00100, Nairobi; +254-20-2717077 (source).

Ask in writing and keep the reply. A message, an email, a stamped letter — anything you can show later.

About this page

Infirmy connects patients with hospitals and medical facilitators in India. We have an interest in you reading this. So:

• We have no providers listed and we name no hospital as ours. The nine providers above are named by the Kenyan government, not by us.
• We take no money from patients.
• We cannot approve, speed up or influence an SHA referral, and neither can anyone else who is not SHA.
• Where we did not have a source, we said so above instead of writing something that sounds right.

If any fact on this page turns out to be wrong, or a government page changes after 11 September 2026, we will correct it here and date the correction.

This is general information about process and paperwork, not medical advice. Infirmy does not diagnose, recommend a treatment, or tell anyone what care to seek.