The Social Health Authority (SHA) has announced plans to
progressively increase the cancer treatment package from the current limit of
Sh550,000 to Sh1 million over the next three years, in a move aimed at easing
the financial burden on thousands of patients undergoing treatment.
Appearing before the National Assembly Departmental Committee on
Health, SHA Chief Executive Officer Dr. Mercy Mwangangi said the proposed
adjustment is being undertaken in consultation with the Benefits and Tariffs
Advisory Panel (BPTAP), the body mandated to review and recommend benefit rates
for the Social Health Insurance schemes.
Dr. Mwangangi appeared alongside Health Cabinet Secretary Aden
Duale and Principal Secretary Mary Muthoni before the Committee chaired by
Endebes MP Dr. Robert Pukose.
Also in attendance were Digital Health Agency CEO Eng. Antony Lenaiyara
and Director-General for Health Dr. Patrick Amoth.
The BPTAP, domiciled at the Centre for Epidemiological Modelling
and Analysis (CEMA) at the University of Nairobi, brings together specialists
in health economics, epidemiology, actuarial science, and clinical
sciences—ensuring evidence-based recommendations.
Dr. Mwangangi noted that the review follows concerns from cancer
patients who say the current limit is insufficient given rising treatment
costs.
“About 10 percent of cancer patients have reported exhausting
their limits. We plan to progressively increase the package to Sh600,000 in the
first year, Sh800,000 in the second year, and Sh1 million in the third year,”
she said.
She added that SHA is also developing a differentiated cancer
treatment model that aligns coverage to the clinical and cost variations across
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 enhance affordability, SHA is reviewing cost drivers such as
pharmaceuticals, which account for a significant share of treatment expenses.
The CEO also assured MPs that SHA has strengthened fraud detection
systems.
“Our system is designed to identify irregularities in real time.
Suspicious claims are isolated, placed under surveillance, and only cleared
once verified,” she said, noting that SHA has hired medical doctors to support
clinical claims review.
Eng. Lenayiyara added that the Digital Health Agency has geofenced
all empanelled health facilities so that One-Time Password (OTP) codes only
function within a 500-meter radius, curbing cases where codes were shared for
fraudulent claims.
Meanwhile, CS Aden Duale said investigations into fraudulent
billing are at an advanced stage.
“Several files have already been forwarded to the DPP. We expect
prosecutions soon,” he told the Committee.
Duale further noted that verification of Sh5.2 billion in pending
facility claims will be completed within a month to facilitate payment of
facilities owed below Sh10 million.
He also disclosed that the government will seek amendments to
allow maternity services to be covered under SHA at Level 2 and 3 facilities,
addressing gaps that particularly affect rural communities.
