The Social Health Authority (SHA) has unveiled plans to gradually raise Kenya’s cancer treatment package from the current Ksh550,000 to Ksh1 million within the next three years.
Appearing before the National Assembly’s Departmental Committee on Health, SHA Chief Executive Officer Dr. Mercy Mwangangi said the review is being implemented in collaboration with the Benefits and Tariffs Advisory Panel (BPTAP), which is mandated to recommend benefit rates for the Social Health Insurance schemes.
The BPTAP, headquartered at the Centre for Epidemiological Modelling and Analysis (CEMA) of the University of Nairobi, consists of epidemiology, health economics, actuarial science, and clinical medicine experts, ensuring policy decisions are grounded in data and evidence.
Dr. Mwangangi told MPs that the review comes in response to increasing complaints from patients suffering from cancer who claim the current package is insufficient considering the high cost of diagnosis, medication, and hospitalization.
“About 10 percent of cancer patients have reported exhausting their limits. We plan to progressively increase the package to Ksh600,000 in the first year, Ksh800,000 in the second year, and Ksh1 million in the third year,” she said.
She also revealed that SHA is developing a differentiated cancer treatment model to align coverage with the varying costs and treatment protocols of different cancer types.
“We currently support about 35,000 cancer patients, yet data indicates the number is closer to 50,000. A differentiated model will ensure treatment and reimbursement match specific cancer profiles and cost structures,” she explained.
To make treatment more affordable, SHA is also reviewing key cost drivers such as pharmaceutical prices, which account for a large portion of total treatment expenses.
Dr. Mwangangi assured legislators that SHA has fortified its fraud detection systems to protect public funds. “Our system is designed to identify irregularities in real time. Suspicious claims are isolated, placed under surveillance, and only cleared once verified,” she said, adding that the authority has engaged medical doctors to support the clinical claims review process.
She appeared alongside Health Cabinet Secretary Aden Duale and Principal Secretary Mary Muthoni before the committee chaired by Endebbes MP Dr. Robert Pukose. Also present were Digital Health Agency CEO Eng. Antony Lenaiyara and Director-General for Health Dr. Patrick Amoth.
Eng. Lenaiyara disclosed that the Digital Health Agency has geofenced all empanelled health facilities to prevent fraud. “OTP codes now only work within a 500-meter radius of each facility to stop code sharing,” he noted.
Meanwhile, CS Duale said investigations into fraudulent billing are ongoing. “Several files have already been forwarded to the DPP. We expect prosecutions soon,” he told MPs.
Duale added that verification of Ksh5.2 billion in pending facility claims will be finalized within a month to ensure timely payments to facilities owed less than Ksh10 million. He further revealed that the government plans to amend the law to allow maternity services to be covered under SHA at Level 2 and 3 facilities, especially to benefit women in rural areas.
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