SHA Explains Oncology Pre-Authorization Amid Public Concerns

The Social Health Authority (SHA) has clarified its pre-authorisation process for cancer treatment following public scrutiny over alleged inconsistencies in approvals. In a statement issued on Tuesday, SHA addressed a report published in today’s Daily Nation concerning oncology services. The authority said it welcomes public oversight but emphasised that differences in approval amounts are not indicative of preferential treatment. “All cancer-related pre-authorisations under SHA are processed through a fully automated digital system, in line with the benefit limits, access rules, and tariffs set out in Legal Notice No. 56 (LN 56),” the statement reads. “Individual staff members do not have the ability to arbitrarily adjust approvals.” SHA explained that while patients may share similar diagnoses, their clinical needs and treatment plans often differ. Factors such as prior benefit utilisation, stage of care, clinical complexity, and the completeness of the pre-authorisation request all influence the final approval. The authority noted that beneficiaries are free to seek care at any SHA-contracted facility. “Differences in approvals do not imply preferential treatment, but reflect the application of uniform benefit rules to differing clinical circumstances,” the statement added. On the issue of costs, SHA said claims are reimbursed using uniform tariffs across public, private, and faith-based facilities. The tariffs, publicly available on SHA’s website, are designed to ensure fairness, transparency, and sustainability of the health insurance pool. SHA also highlighted measures in place to prevent abuse of the system. “The digital pre-authorisation system includes real-time utilisation tracking and audit trails designed to prevent duplication, inappropriate use of benefits, or unauthorised interference,” the authority said. It further urged the public to report any credible allegations of system manipulation via [email protected]. In a bid to enhance equity and patient experience, SHA said it is embedding National Cancer Control Programme (NCCP)-aligned clinical pathways into the pre-authorisation workflow. This move aims to standardise diagnostic panels, clarify provider submissions, and improve the overall patient journey. Transparency remains a core priority for SHA. The authority encouraged beneficiaries to seek information directly through official channels, including county SHA offices and Huduma Centre Desks. General inquiries can be directed to [email protected] or [email protected], while media queries can be sent to [email protected]. Toll-free lines 147 and 0800 720 601 are also available for enquiries. The clarification comes amid growing public interest in cancer care accessibility and insurance benefit approvals. The automated system, SHA said, ensures that all decisions are based on predefined rules and that no patient receives undue advantage. SHA’s statement reinforces its commitment to fair and equitable cancer care. It stresses that approvals are influenced by clinical and administrative factors rather than personal connections. The authority reiterated, “SHA does not condone, permit, or tolerate preferential access to benefits based on personal influence or connections.” By detailing the mechanics of its pre-authorisation system, SHA aims to restore public confidence and improve understanding of oncology service approvals. As the conversation around healthcare benefits continues, SHA urges beneficiaries and healthcare providers to engage through proper channels to ensure transparency, accountability, and efficient delivery of cancer care.