The Social Health Authority (SHA) has tightened requirements for hospitals seeking to offer cancer treatment to its beneficiaries, warning that facilities must prove they are qualified before receiving payments for the services.
Under new rules announced on Thursday, October 15, SHA and the National Cancer Institute of Kenya (NCI) will only contract facilities with valid certification, approved cancer treatment services, the required equipment and qualified medical personnel.
The directive affects hospitals seeking to provide services such as chemotherapy, radiotherapy, brachytherapy and surgical oncology under the public health insurance scheme.
In a joint notice, the two institutions directed healthcare facilities to verify their certification status and update their applications on the SHA e-contracting platform.
“SHA will only contract facilities to offer cancer services to its beneficiaries upon verification of valid NCI certification, the approved service scope, capacity, personnel and applicable regulatory approvals,” the notice stated.
Facilities without valid NCI certification have been directed to contact the institute for assessment and certification. Hospitals seeking to offer services beyond those covered by their existing certificates must also obtain the necessary approvals.
The changes are intended to ensure that hospitals receiving public funds have the capacity to provide the cancer treatment services they advertise.
The announcement comes as Kenya continues to face a significant cancer burden, with many patients struggling to access timely diagnosis and treatment.
According to the World Health Organization’s International Agency for Research on Cancer, Kenya recorded 44,726 new cancer cases and 29,317 cancer-related deaths in 2022.
The Ministry of Health’s National Cancer Control Strategy 2023-2027 also identifies late diagnosis and limited access to treatment as major challenges facing patients.
SHA’s published benefit arrangements include an annual cancer benefit limit of up to KSh800,000, subject to the applicable rules and conditions. The authority’s tariffs cover specific services, including chemotherapy and radiotherapy, at set rates.
However, the new certification requirements do not mean that all uncertified cancer centres have already been closed. They determine which facilities can qualify for SHA contracts to provide cancer services.
The directive comes as SHA extends the transition period for existing healthcare provider contracts to December 31, 2026. The new contracting cycle is scheduled to begin on January 1, 2027.
Patients seeking treatment have been advised to confirm whether their hospital is certified by NCI and contracted by SHA for the specific cancer service they need.
They should also establish which costs are covered by SHA before beginning treatment to avoid unexpected bills.
