How SHA Referrals Work: Getting to See a Specialist

You need to see a cardiologist. Or an orthopedic surgeon. Or a neurologist.

Under SHA, you often can't go directly. You need a referral first.

Here's how the referral system works and how to navigate it.

Table of Contents

• Why Referrals Exist
• When You Need a Referral
  • Typically Need Referral
  • Often No Referral Needed
• How to Get a Referral
  • Step 1: Visit Primary Care
  • Step 2: See the Doctor
  • Step 3: Receive Referral Letter
  • Step 4: Book Specialist Appointment
  • Step 5: See the Specialist
• What the Referral Contains
• Self-Referral: When It Works
  • Emergency Cases
  • Return Visits
  • Private Facilities
• Referral to Higher Level Facilities
  • Getting to National Hospitals
• Common Specialist Referrals
  • Cardiology (Heart)
  • Orthopedics (Bones/Joints)
  • Gastroenterology (Digestive)
  • Neurology (Brain/Nerves)
• Tips for Smoother Referrals
  • 1. Be Clear About Symptoms
  • 2. Bring Records
  • 3. Ask Questions
  • 4. Follow Up
  • 5. Keep Copies
• Problems With Referrals
  • Problem: "The Hospital Says My Referral Is Invalid"
  • Problem: "I Can't Get a Referral But I Need a Specialist"
  • Problem: "Waiting Time Is Too Long"
• The Bottom Line
• Next Steps

Why Referrals Exist

The referral system serves several purposes:

When You Need a Referral

Typically Need Referral

Often No Referral Needed

Note: Rules vary by facility. Verify before visiting.

How to Get a Referral

Step 1: Visit Primary Care

Go to a SHA-accredited primary care facility.

Bring:

• Your ID
• Any previous medical records
• List of symptoms and concerns

Step 2: See the Doctor

The GP will:

• Take your history
• Examine you
• Order tests if needed
• Determine if specialist care is needed

Step 3: Receive Referral Letter

If specialist care is needed:

• GP writes referral letter
• Letter includes diagnosis/suspected condition
• Recommends specific specialist type
• May suggest specific hospital

Step 4: Book Specialist Appointment

With referral letter:

• Contact the referred facility
• Book specialist appointment
• Bring referral letter to appointment

Step 5: See the Specialist

• Present referral letter and ID
• Hospital verifies SHA status
• Specialist consultation proceeds
• Covered under SHA

What the Referral Contains

A proper referral letter includes:

Self-Referral: When It Works

Sometimes you can see specialists directly:

Emergency Cases

No referral needed for:

• Chest pain (cardiology)
• Stroke symptoms (neurology)
• Severe abdominal pain (surgery)
• Any emergency

Go directly to emergency department.

Return Visits

If you're already under specialist care:

• Follow-up visits don't need new referral
• Ongoing treatment continues
• Same specialist can be seen

Private Facilities

Some private facilities may see you without referral:

• You pay full cost
• SHA may not cover without referral
• Verify coverage before visiting

Referral to Higher Level Facilities

Kenya's health system has levels:

Referral chain: Level 2 → Level 4 → Level 5 → Level 6

Getting to National Hospitals

To access Kenyatta National Hospital or similar:

1. See local facility first
2. Get referral to Level 5
3. Level 5 may refer to Level 6 if needed
4. Bring all referral letters

Common Specialist Referrals

Cardiology (Heart)

When referred:

• Chest pain after initial workup
• Abnormal ECG
• Heart murmur detected
• High blood pressure not responding

What to expect:

• ECG, Echo, stress test
• Medication review
• Possible procedures

Orthopedics (Bones/Joints)

When referred:

• Persistent joint pain
• Suspected fractures
• Back problems
• Sports injuries

What to expect:

• X-rays, MRI
• Physical examination
• Treatment plan (physio, surgery)

Gastroenterology (Digestive)

When referred:

• Persistent stomach issues
• Blood in stool
• Difficulty swallowing
• Liver problems

What to expect:

• Endoscopy, colonoscopy
• Ultrasound
• Specialized treatment

Neurology (Brain/Nerves)

When referred:

• Persistent headaches
• Seizures
• Numbness/weakness
• Memory issues

What to expect:

• Neurological exam
• CT scan, MRI
• EEG if needed

Tips for Smoother Referrals

1. Be Clear About Symptoms

Help your GP understand why specialist is needed. Be specific about:

• When symptoms started
• What makes them worse/better
• Previous treatments tried

2. Bring Records

Bring any:

• Previous test results
• Medications you're taking
• Past referral letters
• Old medical records

3. Ask Questions

Before leaving GP:

• "Why do I need a specialist?"
• "Which hospital should I go to?"
• "How soon should I be seen?"
• "What should I expect?"

4. Follow Up

If referral is for something urgent:

• Book specialist ASAP
• Call to confirm appointment
• Follow through with the visit

5. Keep Copies

Keep copies of:

• All referral letters
• Specialist reports
• Test results
• Treatment plans

Problems With Referrals

Problem: "The Hospital Says My Referral Is Invalid"

Possible causes:

• Referral from non-accredited facility
• Referral letter incomplete
• Wrong specialist type

Solution:

1. Get referral letter from SHA-accredited facility
2. Ensure letter is complete
3. Confirm specialist type needed

Problem: "I Can't Get a Referral But I Need a Specialist"

Options:

1. Explain your symptoms more clearly
2. Ask specifically why specialist isn't needed
3. Seek second opinion at another facility
4. Go private (pay out of pocket)

Problem: "Waiting Time Is Too Long"

Options:

1. Ask about cancellation lists
2. Check other SHA facilities
3. Consider private (faster, costlier)
4. Mark urgency if situation worsens

The Bottom Line

SHA's referral system:

• Starts with primary care
• GP provides referral letter
• You see specialist at referred facility
• Coverage applies with proper referral

To navigate successfully:

1. Start at primary care
2. Get proper referral letter
3. Book specialist appointment
4. Bring referral and ID
5. Keep all documents

Referrals exist for a reason. Work within the system for best coverage.

Next Steps

1. Find your nearest SHA primary care facility
2. Start there for any specialist needs
3. Keep medical records organized
4. Read: SHA Outpatient Coverage
5. Explore: Complete SHA Benefits Guide