The Social Health Authority (SHA) has issued a detailed public statement clarifying how its oncology pre-authorization process works, following rising public debate and media scrutiny over alleged inconsistencies in cancer care approvals. The clarification, dated January 20, 2026, comes in response to a story published in the Daily Nation that raised questions about fairness, transparency, and equity in access to oncology services under the national health insurance framework.
In its statement, SHA acknowledges public concern and emphasizes that scrutiny is both expected and welcomed. According to the Authority, the goal of the clarification is to help Kenyans understand how cancer-related pre-authorizations are handled, why two patients with similar diagnoses may receive different approvals, and what safeguards are in place to prevent interference, favoritism, or abuse of the system.
How SHA’s Oncology Pre-Authorization System Works
SHA explains that all cancer-related pre-authorizations are processed through a fully automated digital system. This system operates strictly within benefit limits, access rules, and gazetted tariffs as outlined in Legal Notice No. 56 (LN 56). Once a healthcare provider submits a pre-authorization request, approvals are generated automatically based on predefined rules embedded in the system.
Importantly, SHA stresses that individual staff members do not have the authority to manually alter or arbitrarily adjust approvals. This automation is intended to reduce human bias, eliminate discretionary decision-making, and promote fairness across all beneficiaries. By relying on standardized digital workflows, SHA says it ensures that decisions are consistent with national policy rather than personal influence.
Why Cancer Approvals May Differ Between Patients
One of the key concerns raised in the public discourse is why patients with the same general diagnosis—such as breast cancer—may receive different approval outcomes. SHA strongly refutes the idea that such differences imply preferential treatment or discrimination.
According to the Authority, cancer care is highly personalized. Even when patients share a broad diagnosis, their clinical profiles, diagnostic requirements, and treatment pathways often differ significantly. SHA outlines several factors that can influence approval outcomes.
These include prior utilization of benefits, which determines how much funding remains within a patient’s annual oncology package. The stage of care also matters, as diagnostic work-ups, active treatment phases, and follow-up care are treated differently under benefit rules. Clinical complexity, such as tumor characteristics or whether tests are required sequentially or concurrently, can further affect approvals.
Additionally, the completeness and structure of the pre-authorization request submitted by healthcare providers plays a critical role. Incomplete or poorly structured submissions may lead to different outcomes compared to comprehensive and well-documented requests. SHA also notes that beneficiaries are free to seek care at any SHA-contracted cancer facility, and variations in provider practices can influence the type and sequence of services requested.
SHA emphasizes that these differences reflect the application of uniform benefit rules to diverse clinical circumstances, not favoritism or inequity.
Uniform Tariffs for Oncology Diagnostics
To further address transparency concerns, SHA reiterates that claims reimbursement for oncology diagnostics is based on uniform, gazetted tariffs. These tariffs apply equally across public, private, and faith-based health facilities. By standardizing reimbursement rates, SHA aims to prevent cost disparities and ensure sustainability of the national health insurance pool.
The Authority notes that these tariffs are publicly available on its official website and are designed to promote fairness and predictability for both healthcare providers and patients. Uniform pricing, SHA argues, is a cornerstone of equitable access to cancer care nationwide.
Safeguards Against Interference and Abuse
Responding directly to allegations of influence-peddling and system manipulation, SHA states unequivocally that it does not condone or tolerate preferential access to benefits based on personal influence or connections. The digital pre-authorization system includes real-time utilization tracking and audit trails to prevent duplication, inappropriate use of benefits, and unauthorized interference.
Any credible allegations of system manipulation are subject to investigation. SHA encourages the public and healthcare providers to report suspected cases of fraud or interference through its official fraud reporting channels. This, the Authority says, is part of its broader commitment to accountability and integrity.
Ongoing Reforms to Improve Cancer Care
Looking ahead, SHA reveals that it is implementing ongoing improvements aimed at strengthening equity and sustainability in cancer care. One major initiative is the integration of National Cancer Control Programme (NCCP)-aligned clinical pathways into the pre-authorization workflow.
This integration is expected to support more standardized diagnostic panels, improve the quality and clarity of provider submissions, and enhance the overall patient experience. By aligning approvals more closely with nationally recognized clinical pathways, SHA hopes to reduce confusion, delays, and inconsistencies.
Commitment to Transparency and Public Engagement
SHA concludes its statement by reaffirming its commitment to transparency and open engagement with the public. Beneficiaries and members of the public are encouraged to seek information or clarification through SHA’s official communication channels, visit SHA offices located in all counties, or access services at Huduma Centre desks nationwide.
The Authority also provides multiple contact options for general, customer service, and media inquiries, signaling its willingness to engage constructively with stakeholders.
As cancer care continues to be a sensitive and critical issue for thousands of Kenyan families, SHA’s clarification seeks to restore public confidence by explaining the systems, rules, and safeguards that govern oncology approvals. Whether this detailed response will fully address public skepticism remains to be seen, but it marks a significant step toward openness in one of the country’s most closely watched health policy debates.
