If you are a Kenyan patient looking at treatment in India, there are two entirely different routes in front of you, and knowing which one applies to you changes everything about how you plan and what you budget.
The first route is the SHA overseas treatment benefit. It is real, it is running, and it does pay. It is also narrow. It covers 36 specific procedures, at a small number of contracted hospitals abroad, up to a fixed annual ceiling, and only if you follow the referral process before you travel.
The second route is the one most Kenyans travelling to India are already on. Their procedure is not on the list, so they pay privately, often with help from family abroad. That is not a failure of planning. It is simply how the majority of Kenya to India medical travel has always worked, and it remains completely legitimate.
We work with Kenyan patients on both routes. This guide sets out the rules honestly, including the parts that are inconvenient, so you can work out which route is yours before you spend money or make a decision you cannot reverse.
At a Glance: SHA Overseas Cover in 2026
| Item | Position as at August 2026 |
| Scheme | Social Health Authority, which replaced NHIF on 1 October 2024 |
| Overseas benefit live from | 14 April 2026 |
| Fund it sits under | Emergency, Chronic and Critical Illness Fund |
| Cap, general SHA member | Sh500,000 per beneficiary per year |
| Cap, civil servants under POMSF | Sh2.5 million per beneficiary per year |
| What the cap covers | Medical costs only. Flights, accommodation, visas and living costs are excluded |
| Eligible procedures | 36 gazetted interventions judged unavailable in Kenya |
| Hospitals abroad | Nine contracted facilities worldwide. In India, KIMS Hospitals (all branches) and Apollo Proton Cancer Centre, Chennai. (As of August 31st, 2026, SHA is in process of finalizing more institutions in India) |
| Referral must start at | A Level 6 national referral hospital |
| Self referral | Not accepted. No reimbursement after travel |
| Follow up | Each overseas hospital is twinned with a Kenyan facility that closes your file on return |
Why Most of What You Read Online Is Out of Date
This matters before anything else, because a great deal of the guidance still circulating describes a system that no longer exists.
Under NHIF, overseas referrals were comparatively easy to obtain and a private doctor's recommendation could carry a case a long way. That changed sharply. In late 2025 the Ministry of Health suspended overseas approvals altogether while it rebuilt the framework, and the documentation required rose from a handful of papers to a far heavier file. The rebuilt system opened on 14 April 2026 with a much tighter structure around it.
The practical effect is that any article, agent or well meaning relative describing the NHIF era process is giving you advice that will not work. If a facilitator tells you they can get SHA to pay for a hip replacement in India, they are either describing the old system or they are not being straight with you.
The rule that catches people out: You must have SHA's written commitment letter in hand before you travel. If you go first and apply afterwards, SHA cannot pay, and there is no reimbursement route to recover the money later. This is not a technicality that gets waived in sympathetic cases. It is the design of the scheme.
The 36 Procedures SHA Will Fund Abroad
The Benefits Package and Tariffs Advisory Panel identified 36 interventions that Kenya cannot currently deliver, and these were gazetted in September 2025. If your condition is not on this list, SHA will not authorise or pay for treatment abroad, regardless of how much cheaper or better the care might be elsewhere.
We have grouped them below and written the descriptions in plain language. The list is described by SHA as preliminary and subject to review, so it is worth checking the current position with SHA directly before you rely on it.
Advanced Orthopedic and Limb Reconstruction
| Procedure | What it involves |
| Wrist joint arthroplasty | Replacing a badly damaged wrist joint with an artificial implant |
| Metacarpal joint arthroplasty | Replacing the small joints of the hand to restore grip and finger movement |
| Ankle joint arthroplasty | Replacing the ankle joint, usually after arthritis or severe injury |
| Whole femoral replacement | Replacing the entire thigh bone with a custom implant, typically after bone cancer or major trauma |
| Proximal femoral replacement | Replacing the upper thigh bone near the hip, usually for tumour or extensive bone loss |
| Distal femoral replacement | Replacing the lower thigh bone at the knee after major bone loss |
| Proximal tibial replacement | Replacing the upper shin bone, most often for bone tumours around the knee |
| Allograft use | Reconstructing bone using donated human bone tissue, which requires a bone bank |
An important distinction if you have joint pain: Read this cluster carefully, because it is the most misread part of the list. Routine hip and knee replacement was removed from the gazetted list, along with adult kidney transplant, on the basis that Kenya can perform them. What remains covered is limb salvage and megaprosthesis reconstruction, which is a different category of surgery done mostly for bone tumours and catastrophic bone loss. If you need a standard hip or knee replacement, SHA will fund it in Kenya, not abroad.
Transplant and Pediatric Critical Care
| Procedure | What it involves |
| Complex congenital heart surgery requiring ECMO in children | Heart surgery in children supported by a machine that temporarily does the work of the heart and lungs |
| Liver transplant | Replacing a failing liver with a donor organ. Listed because Kenya has no paediatric liver transplant programme |
| Bone marrow transplant | Replacing diseased marrow with healthy blood forming cells to treat blood cancers and marrow disorders |
| Allogeneic bone marrow or peripheral stem cell transplant | Transplant using cells from a matched donor rather than the patient's own |
| Kidney transplant in children | Kidney transplantation for a child with advanced kidney failure |
Advanced Cancer Treatment and Nuclear Medicine
| Procedure | What it involves |
| Proton therapy | Radiation delivered as a proton beam, which stops at the tumour and spares surrounding tissue |
| CAR T-cell therapy | The patient's own immune cells are re-engineered in a laboratory to recognise and attack cancer |
| Bispecific T-cell engagers | Drugs that physically link an immune cell to a cancer cell so the immune system destroys it |
| PRRT with Lutetium-177 | A radioactive drug that binds to receptors on certain tumours and irradiates them from within |
| Yttrium-90 radioembolisation | Radioactive beads delivered through the blood supply directly into liver tumours |
| Microwave ablation of secondary tumours | Destroying tumours with heat through a needle, without open surgery |
| Intrathecal chemotherapy for retinoblastoma | Chemotherapy delivered into the spinal fluid for advanced childhood eye cancer |
| DOTA-TATE PET/CT scan | A specialised scan that finds and maps neuroendocrine tumours |
| FAPI PET/CT imaging | A newer scan that detects cancer and fibrotic disease by targeting a specific cell protein |
Fetal and Maternal Medicine
| Procedure | What it involves |
| Intrauterine blood transfusion | Transfusing blood directly to a baby still in the womb, usually for severe anemia |
| Intrauterine shunt placement | Placing fine drainage tubes to relieve fluid build up in the unborn baby |
| Intrauterine vesicocentesis, thoracentesis and paracentesis | Needle procedures to drain abnormal fluid from the fetus |
| Fetoscopy, amniotic band ligation and laser ablation | Keyhole surgery inside the womb to correct life threatening fetal conditions |
| Amnioreduction and amnioinfusion | Removing or adding amniotic fluid to manage pregnancy complications |
| Fetal reduction, cord occlusion and cordocentesis | Specialist procedures in high risk multiple pregnancies and fetal diagnosis |
Other Specialist Interventions
| Procedure | What it involves |
| Laryngeal transplant | Replacing the voice box to restore breathing, speech and swallowing |
| Transjugular intrahepatic portosystemic shunt (TIPS) | Creating a channel within the liver to relieve dangerous pressure in advanced liver disease |
| Advanced endometriosis excision | Complex surgery to remove deeply infiltrating endometriosis causing severe pain and infertility |
| Sacral neuromodulation | An implanted device that uses electrical signals to restore bladder or bowel control |
| Surgery for birth related brachial plexus injury | Repairing nerve damage in the arm caused during delivery |
| Extracorporeal photopheresis | A blood treatment using light activated medication to modify immune cells |
| Nerve ablation therapy | Selectively interrupting nerves to control severe chronic pain |
| Neural regenerative therapy | Emerging treatments aimed at repairing damaged nerve tissue |
What Is Not Covered
Because the list is defined by what Kenya cannot do rather than by what patients most often travel for, several of the commonest reasons Kenyans go abroad fall outside it entirely:
- Hip and knee replacement
- Adult kidney transplant
- Most routine oncology, including standard chemotherapy and conventional radiotherapy
- Cardiac surgery in adults, including bypass and valve procedures
- Spine surgery
- Fertility treatment and IVF
- Diagnostics and second opinions
If your procedure is in that group, the SHA overseas benefit is not available to you. That does not close the door on treatment in India. It simply means you are on the second route, which we cover further down.
The Referral Pathway, Step by Step
There is a formal approval sequence between you and the commitment letter, and each stage can stop the application. Working through it methodically is what gets a case approved.
- Confirm your SHA membership is active and your contributions are fully paid up. This is audited during the application, and arrears will hold the file until they are cleared.
- See a specialist and get your diagnosis and imaging documented properly. Your file needs to show clearly what you have and what treatment it requires.
- Get referred to a Level 6 national referral hospital. In practice this means Kenyatta National Hospital, Moi Teaching and Referral Hospital, or Kenyatta University Teaching, Referral and Research Hospital. A referral from a private doctor or a county hospital will not start the process.
- Obtain a formal declaration from a specialist at that hospital stating that the expertise, technology or infrastructure your treatment requires is not available in Kenya. This declaration is the heart of the application.
- Submit the application to SHA with the full supporting file. It then goes to peer review by the Claims Management Office, which assesses medical necessity independently.
- The receiving overseas hospital logs the admission request electronically and SHA verifies your membership status before authorising.
- Receive the commitment letter. Only at this point is the funding secured, and only then should you book travel.
- Travel and receive treatment at the contracted hospital named in your approval, not a different one.
- Report to your assigned Kenyan follow up facility on return. Your case file is closed and payment made after that follow up period, so this step is not optional.
Approval timelines vary with case complexity and how complete the file is at submission. Urgent pediatric cancer and transplant cases can be expedited. Build in more time than you expect to need, and treat an incomplete file as the single biggest source of delay.
Where SHA Will Send You in India
SHA has contracted nine facilities worldwide. Four are Acibadem hospitals in Turkey and the remainder include Saudi providers. In India, two are contracted: KIMS Hospitals and Apollo Proton Cancer Centre in Chennai.
Both are institutions we work with directly. KIMS operates across multiple cities and covers a broad specialist range including transplant, complex pediatric cardiac surgery and orthopedic oncology. Apollo Proton Cancer Centre in Chennai is the relevant centre for proton therapy, which appears on the gazetted list precisely because it is unavailable in Kenya, and it also delivers the advanced nuclear medicine and cellular therapy services on the list.
Because we already work with both, an SHA approved patient does not arrive as a stranger. We coordinate with the international patient desk at the receiving hospital, make sure the admission request is logged against your SHA approval correctly, and stay in contact with your family through the admission.
Choosing a hospital yourself does not work hereIf your procedure is SHA funded, you are not free to pick any hospital in India. Treatment at a facility that is not contracted with SHA will not be paid for, even if the hospital is excellent and the procedure is on the list. The empanelled list is updated periodically, so confirm the current position with SHA before you commit to anything.
What Sh500,000 Actually Covers
This is the section families most often skip, and the one that causes the most distress later.
For a general SHA member, the ceiling is Sh500,000 per beneficiary per year, which is roughly USD 3,800 depending on the exchange rate on the day. For civil servants and public officers under the Public Officers Medical Scheme Fund, the ceiling is Sh2.5 million, five times higher. If you or your spouse is a public officer, check which fund applies to you before assuming the lower figure, because it changes the arithmetic completely.
Two things about the cap are worth stating plainly. It is an annual limit per beneficiary rather than a limit per episode, so a complication requiring a second admission in the same year draws on the same pot. And it is a medical costs ceiling only. Flights, visas, accommodation, food, local transport and the cost of the family members travelling with you all sit outside it.
Set against the actual price of the procedures on the list, the cap functions as a contribution rather than as cover. The figures below are indicative ranges for planning purposes only and are not a quote:
| Procedure in India | Indicative range, USD | SHA contribution | Approximate balance |
| Liver transplant | 25,000 to 32,000 | 3,800 | 21,200 to 28,200 |
| Allogeneic bone marrow transplant | 26,000 to 35,000 | 3,800 | 22,200 to 31,200 |
| Proton therapy course | 25,000 to 40,000 | 3,800 | 21,200 to 36,200 |
| Pediatric kidney transplant | 13,000 to 16,000 | 3,800 | 9,200 to 12,200 |
None of that makes the benefit worthless. Sh500,000 is a meaningful contribution and it comes with a vetted hospital and a structured process. But you should plan the balance from the beginning rather than discovering it after you have arrived.
Planning the Balance: Where Journeys Go Wrong
The most damaging failures we see in Kenyan cases are not clinical. They are financial and they are avoidable.
The pattern repeats. A family raises money through community fundraising and personal savings, travels on a verbal understanding that the hospital will accept payment in stages, and completes the pre-operative workup successfully. Then, at the point the patient is declared ready for surgery, the hospital asks for the full amount before proceeding. The money is not there. The surgery is suspended, the family is stranded in a foreign country with a sick patient, and the fundraising has to start again from a much worse position.
Indian hospitals generally require a substantial deposit at admission and expect the bill cleared before discharge. Staged payment is often possible for high value cases, but it has to be negotiated and documented in advance with the hospital's international billing department. A verbal assurance from an agent is not an agreement with the hospital.
What protects you is straightforward:
- A written all inclusive quotation from the hospital before you travel, showing what is included and what is billed separately
- A staged payment schedule agreed in writing with the hospital, not with an intermediary
- A contingency of at least 20 to 25 percent above the quoted figure, because complications extend both the stay and the bill
- Clarity on what happens if the treatment plan changes after the specialists examine the patient in person
- Confirmation of how funds will actually reach India, since transfer limits and clearing times catch families out
If you have private cover or an employer scheme alongside SHA, or you are covered by a medical aid arrangement, it is worth understanding how overseas claims are handled before you travel. Our guide on insurance coverage for treatment in India explains the cashless, guarantee of payment and reimbursement routes in detail.
If Your Procedure Is Not on the List
Most Kenyan patients who travel to India for treatment are in this position, and always have been. Kenya was among the largest source countries for medical arrivals to India in 2025, at a scale far beyond anything the referral scheme handles. The overwhelming majority of those patients funded their own care.
There are practical reasons this will continue. The gazetted list is deliberately narrow. Only two Indian hospitals are contracted, which means the wider Indian network, including the large multi speciality groups most patients have heard of, is reachable only on a private basis. And the great majority of Kenyans already meet health costs out of pocket.
On this route you have far more choice, because you are no longer restricted to contracted facilities. You can be matched to the hospital and surgeon best suited to your specific case, in the city that makes sense for your treatment and your budget. What you give up is the SHA contribution, so the planning discipline described above matters even more.
For orthopedic cases in particular, our overview of the top orthopedic hospitals in India is a useful starting point, and our Chennai hospital comparison covers the city where several of the specialist cancer and transplant centres are based.
Travelling With Family: The Part Nobody Budgets For
A medical trip to India is rarely one person travelling. Under India's medical visa framework, attendants travel on a medical attendant visa, which is granted to a maximum of two people who must be blood relatives of the patient. Their visas run alongside the patient's.
Patients and attendants on medical visas are also required to register with the Foreigners Regional Registration Office after arrival, generally within fourteen days. It is a routine formality, but missing it creates avoidable trouble at the point of departure.
The practical consequence is that you are moving, housing and feeding up to three people for a stay that may run several weeks, and none of that is covered by SHA. For a short procedure a hotel near the hospital works well. For longer stays, particularly transplant and cancer treatment where recovery and monitoring extend the trip, a serviced apartment with a kitchen is usually both cheaper and easier on a recovering patient.
Our India medical visa and accommodation guide sets out the documentation, the visa categories and the accommodation options in full.
How We Work With Kenyan Patients
We are a medical travel facilitator, not a hospital and not a broker. Here is what that means in practice.
We start with a written specialist opinion, not a quotation. You send us your reports and imaging, and we come back with an assessment from a relevant specialist about what your case actually requires. Sometimes that opinion is that the treatment is available in Nairobi at a reasonable cost and travelling would gain you little. We would rather tell you that at the start than after you have spent money.
From there, depending on which route applies to you:
- For SHA approved cases, we coordinate with KIMS or Apollo Proton Cancer Centre, work alongside their international patient desk on the admission request, and keep your family updated through the approval and admission process
- For self funded cases, we match you to the right hospital and surgeon across our wider network rather than a restricted list, and obtain written itemised quotations you can compare
- We support your medical visa documentation and invitation letters for the patient and attendants
- We arrange airport pickup, accommodation appropriate to the length of your stay, and local transfers to appointments
- We coordinate with hospital billing on payment scheduling before you travel, so that admission holds no surprises
- We make sure your discharge summary, imaging and follow up instructions are handed over properly for continuing care in Kenya, which matters for SHA cases where the file closes at your assigned Kenyan facility
If you would like to see the full sequence of how a case runs from first contact through to going home, we have written it up in detail in From WhatsApp to Discharge.
Six Mistakes We See Most Often
- Travelling first and applying afterwards. There is no retrospective approval and no reimbursement route.
- Assuming a private doctor's referral is enough. The referral must originate at a Level 6 national referral hospital.
- Discovering contribution arrears during the audit stage. Check and clear your status before you apply, not during.
- Choosing a hospital that is not contracted with SHA. Excellence is not the test here, empanelment is.
- Budgeting to the cap instead of to the full cost. The cap is a contribution towards medical costs, not cover for the trip.
- Relying on pre 2026 guidance. The rules changed substantially and most published information has not caught up.
Not Sure Which Route Applies to You?
Send us your diagnosis and reports and we will tell you honestly whether your procedure falls under the SHA overseas list, what the realistic total cost looks like either way, and whether travelling is actually the right decision for your case.
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FAQs
No. SHA will only pay hospitals it has contracted. In India that currently means KIMS Hospitals and Apollo Proton Cancer Centre in Chennai. The list is reviewed periodically, so confirm the current position with SHA before you plan around it.
No. The Sh500,000 ceiling applies to medical costs. Travel, visas, accommodation, food and local transport are yours to fund, as are the costs of any family members travelling with you.
The balance is your responsibility. For most of the listed procedures the gap is substantial, so plan the balance before you travel rather than after you arrive.
Yes. Public officers covered under the Public Officers Medical Scheme Fund have a ceiling of Sh2.5 million rather than Sh500,000. Confirm which fund applies to you, because it changes your planning significantly.
Yes, on a self funded or privately insured basis. You lose the SHA contribution but gain access to the full Indian hospital network rather than the two contracted facilities. This is how the majority of Kenyan patients in India are treated.
It depends on case complexity and how complete your file is at submission. Urgent pediatric cancer and transplant cases can be expedited. The most common cause of delay is missing documentation, so assemble the file properly before you submit.
Diaspora Kenyans can register with SHA voluntarily and contribute from abroad, which keeps cover active for enrolled dependants resident in Kenya. Registration is completed through the SHA portal. Check the current requirements directly with SHA, since procedures for diaspora members have been evolving.
Yes. Each contracted overseas hospital is twinned with a Kenyan facility responsible for your follow up. That facility confirms your return, and your file is closed and payment made after the follow up period. Skipping it can affect settlement.
No. Both were removed from the gazetted list because Kenya can perform them domestically. The orthopaedic procedures that remain covered are limb salvage and megaprosthesis reconstruction, which are a different category of surgery.
No. Our coordination, hospital matching, visa support and case management are free to patients. We are paid a coordination fee by our partner hospitals.
Dr. Basim Parvez is a licensed physiotherapist and Senior Patient Consultant at HOSPIDIO, holding an MBA in Health Management. With extensive clinical experience and a compassionate approach, he assists patients navigating medical treatments. Dr. Basim also leverages his writing talent to simplify complex healthcare information, empowering patients to make informed decisions and fostering clarity and confidence in their medical journeys.
Guneet Bhatia is the Founder of HOSPIDIO and an accomplished content reviewer with extensive experience in medical content development, instructional design, and blogging. Passionate about creating impactful content, she excels in ensuring accuracy and clarity in every piece. Guneet enjoys engaging in meaningful conversations with people from diverse ethnic and cultural backgrounds, enriching her perspective. When she's not working, she cherishes quality time with her family, enjoys good music, and loves brainstorming innovative ideas with her team.