SHA proposes higher treatment limit for cancer patients

A woman being screened against breast cancer. [File, Standard]

The Social Health Authority (SHA) has announced plans to progressively increase treatment limit for cancer patients.

In the plan, the cancer treatment package will be increased from the current limit of Sh550,000 to Sh1 million over the next three years.

Appearing before the National Assembly Departmental Committee on Health, the authority’s Chief Executive Officer Mercy Mwangangi said the move aims at easing the financial burden on thousands of patients undergoing treatment.

According to Dr Mwangangi, 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.

Mwangangi appeared before the Endebess MP Robert Pukose led committee alongside Health Cabinet Secretary Aden Duale and Principal Secretary Mary Muthoni.

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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.

Ms Mwangangi noted that the review follows concerns from cancer patients who say the current limit is insufficient given rising treatment costs.

“About 10 per cent 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.

According to her, 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 said.

To enhance affordability, she also said SHA is reviewing cost drivers such as pharmaceuticals, which account for a significant share of treatment expenses.

Mwangagi further 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, adding that SHA has hired medical doctors to support clinical claims review.

Her sentiments were echoed by Engineer Anthony Lenaiyara, Acting CEO of the Digital Health Agency, who said the 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.

Health CS Aden Duale in his sentiments 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.