The Social Health Authority (SHA) has issued a detailed explanation of its cancer treatment pre-authorisation system following rising public concern over alleged inconsistencies in approvals. The authority responded after a recent media report questioned how oncology services are approved and reimbursed.
In a statement released on Tuesday, SHA said it welcomes public scrutiny but stressed that variations in approval amounts are not a sign of favoritism. Instead, all cancer-related requests are processed through a fully automated digital system guided by benefit limits, access rules, and tariffs outlined in Legal Notice No. 56.
SHA explained that although patients may have similar diagnoses, their treatment needs often differ. Factors such as the stage of illness, previous benefit use, clinical complexity, and the completeness of submitted medical documents all affect the final approval outcome. The authority added that beneficiaries are free to seek care from any facility contracted under SHA.
The agency further clarified that reimbursement rates are uniform across public, private, and faith-based health facilities. These tariffs, which are publicly available, are designed to promote fairness, transparency, and long-term sustainability of the national health insurance fund.
To safeguard the system, SHA said it has built in digital checks, including real-time tracking and audit trails, to prevent duplication, misuse of benefits, or unauthorized changes to approvals. The authority also revealed that it is integrating National Cancer Control Programme clinical pathways into the system to standardize care, improve provider submissions, and enhance the patient experience.
SHA encouraged patients to seek accurate information through official channels, including county offices and Huduma Centre desks. The authority emphasized that no patient receives special treatment and that all decisions are based on predefined clinical and administrative criteria.
The clarification comes amid growing public interest in access to cancer care and insurance benefits. By outlining how the pre-authorisation system works, SHA said it aims to rebuild trust and improve public understanding of oncology approvals.
SHA reaffirmed its commitment to fairness and equity in healthcare delivery, stating that it does not tolerate preferential access based on personal influence or connections. The authority urged both patients and healthcare providers to engage through proper channels to ensure transparency, accountability, and efficient cancer care services across the country.
