Cancer patients in Kenya are set to benefit from an enhanced treatment package after the Social Health Authority (SHA) announced plans to progressively raise the cancer care limit from the current Sh550,000 to Sh1 million over the next three years.
The proposal, aimed at easing the financial strain on thousands of patients, was revealed by SHA Chief Executive Officer Dr. Mercy Mwangangi when she appeared before the National Assembly Departmental Committee on Health.
Dr. Mwangangi, who was accompanied by Health Cabinet Secretary Aden Duale and Principal Secretary Mary Muthoni, told the Committee, chaired by Endebes MP Robert Pukose, that the review is being conducted in consultation with the Benefits and Tariffs Advisory Panel (BPTAP).
The panel, domiciled at the University of Nairobi’s Centre for Epidemiological Modelling and Analysis (CEMA), is responsible for reviewing and recommending benefit rates for social health insurance schemes.
“The review responds to concerns from patients who say the current limit is inadequate given the rising cost of cancer treatment,” said Mwangangi.
“About 10 percent of cancer patients have already exhausted their limits. We plan to raise the package to Sh600,000 in the first year, Sh800,000 in the second year, and Sh1 million in the third year.”
She added that SHA is developing a differentiated cancer treatment model to align coverage with the clinical and cost variations across different cancer types.
Currently, SHA supports about 35,000 cancer patients, although data suggests the number could be closer to 50,000.
“To make treatment more affordable, we are also reviewing major cost drivers such as pharmaceuticals, which contribute significantly to treatment expenses,” she said.
Mwangangi assured legislators that SHA has strengthened its fraud detection systems to safeguard public funds.
“Our system identifies irregularities in real time. Suspicious claims are flagged, investigated, and only cleared once verified,” she explained, adding that medical doctors have been hired to support claims review.
Digital Health Agency CEO Antony Lenaiyara told MPs that all empanelled health facilities have been geofenced to curb fraudulent claims.
“One-Time Password (OTP) codes can now only function within a 500-meter radius of the registered facility,” he said.
Health CS Aden Duale disclosed that investigations into fraudulent billing are at an advanced stage, with several cases already forwarded to the Director of Public Prosecutions (DPP) for possible prosecution.
He also said verification of Sh5.2 billion in pending facility claims would be completed within a month to allow payment of facilities owed less than Sh10 million.
Duale further announced that the government plans to amend existing laws to allow maternity services to be covered under SHA at Level 2 and 3 facilities, an intervention he said would help bridge service gaps in rural communities.
