Cancer treatment that costs Ksh120,000 per session will now cost only Ksh40,000, while treatment abroad is for a maximum of Ksh500,000 per person per year.
Kenya’s Social Health Authority (SHA) aims to ensure that no Kenyan dies or suffers because they can’t afford medical care. The three-part system covers everything from basic check-ups to complex surgeries and life-saving treatments.
SHA introduced comprehensive tariffs across three distinct funding mechanisms designed to ensure universal health coverage for all Kenyans: the Primary Healthcare Fund (PHF) Tariffs, the Social Health Insurance Fund (SHIF) Tariffs and the Emergency, Chronic and Critical Illness Fund (ECCIF).
How SHA Works – Three Main Parts:
1. Primary Healthcare Fund (PHF) – Basic Healthcare
This covers your everyday health needs and preventive care.
Outpatient Services:
- Cost: Ksh900 per person per year. This is a yearly capitation fee, not per visit.
- What you get: Doctor visits, basic tests, treatment for ongoing conditions like diabetes
- Where: Local clinics and health centres (Level 2-4 facilities)
- How it works: Once you’re registered, you can visit as many times as needed throughout the year. There will be no additional charges per visit for the covered services.
Maternity Care:
- Normal delivery: Ksh10,000
- Cesarean section: Ksh30,000
- Hospital stay: 2 days (normal), 3 days (cesarean)
If You Need to Stay in Hospital:
- Cost: Ksh2,240 per day (at Level 3 facilities)
- Limit: 180 days per household per year
2. Social Health Insurance Fund (SHIF) – Specialised Care
This covers more serious health conditions and specialised treatments.
Managing Chronic Diseases and outpatient lab packages (annual rates):
- Diabetes: Ksh4,300
- High blood pressure: Ksh2,850
- Sickle cell disease: Ksh6,800
- Asthma/breathing problems: Ksh700
Hospital inpatient service tariffs:
- Local hospitals (Level 4): Ksh3,360 per day
- Regional hospitals (Level 5): Ksh3,920 per day
- National hospitals (Level 6): Ksh4,480 per day
- Limit: 180 days per household per year
Kidney Problems:
- Dialysis: Ksh10,650 per session
- Peritoneal dialysis: Ksh85,200 per month
- Kidney transplant: Ksh700,000
- Check-ups before transplant: Ksh150,000 per year
- Care after transplant: Ksh200,000 per year
Surgery (over 550 different operations covered):
- Appendix removal: Ksh67,200
- Gallbladder removal: Ksh89,600
- Hip replacement: Ksh336,000
- Heart surgery: Ksh952,000
- Heart procedures (angioplasty): Ksh560,000
- Bone marrow transplant: Up to Ksh5 million
- Surgery costs range from Ksh8,960 to Ksh1,500,000
Mental Health:
- Mental health treatment: Ksh67,200 per admission
- Hospital stay: Daily rates apply based on hospital level
Cancer Treatment:
Kenya’s Health Cabinet Secretary Aden Duale announced that the Ministry of Health has partnered with Swiss giant Roche Pharmaceuticals to make cancer treatment much more affordable.
What’s Changed:
- Cancer treatment that cost Ksh120,000 per session will now cost only Ksh40,000
- The Social Health Authority (SHA) will pay the full amount – patients pay nothing
- This treatment is available at all SHA-approved hospitals (government, private, and faith-based)
What This Covers: The cheaper treatment is a special medicine (600mg SC biologics) that treats breast and stomach cancers. These two types of cancer affect 1 in every 5 cancer patients in Kenya.
Why This Matters: Cancer kills nearly 29,000 Kenyans every year, and this partnership is part of Kenya’s bigger plan to make healthcare affordable for everyone.
- Maximum coverage per year: Ksh400,000 per patient
- Chemotherapy session: Ksh5,500
- Radiation therapy session: Ksh3,600
- PET scan: Ksh53,500
- CT scan: Ksh6,900 (reduced from Ksh9,600)
- MRI scan: Ksh11,000
Medical Scans and Tests:
- MRI: Ksh11,000
- CT scan: Ksh6,900
- Mammography (breast scan): Ksh3,000
- Heart ultrasound: Ksh3,500
- Limit: 2 scans per household per year
3. Emergency, Chronic and Critical Illness Fund (ECCIF) – Life-Threatening Situations
This covers emergency care and critical conditions when you need immediate help.
Ambulance Services:
- Within 25km of your location: Ksh4,500
- Beyond 25km: Ksh75 for each additional kilometre
Intensive Care:
- ICU (most serious): Ksh35,000 per day (maximum 14 days)
- High Dependency Unit: Ksh10,000 per day (maximum 10 days)
- End-of-life care: Ksh5,000 per day (maximum 60 days)
Emergency Services:
- Cost ranges from Ksh3,800 to Ksh97,900, depending on how serious your condition is
Mortuary Fees:
- Mortuary fees: Ksh600 per day for up to 7 days (total Ksh4,200)
Equipment for People with Disabilities:
- Hearing aids (under 18 only): Ksh55,000
- Crutches: Ksh900
- Walking frames: Ksh500
- Special shoes: Ksh1,000
Treatment Abroad:
- Maximum: Ksh500,000 per person per year
- Only for treatments not available in Kenya
- Will start 6-12 months after SHA began in October 2024
