MPs to health providers: Fix teachers' cover or face action

Members of Parliament have demanded a clear and detailed policy document from companies running the teachers' medical scheme, amid rising complaints about poor service, delays, and questionable medication quality.

The National Assembly’s Committee on Education questioned officials from Medical Administrators Kenya Ltd and Bliss Healthcare over what MPs described as growing concerns from teachers on the quality of care they receive.

They cited issues ranging from generic drugs being prescribed as branded to long waiting times for treatment approvals.

"What I want you to note is that we have drugs dispensed as generic and as branded. Complaints have been raised, where teachers are granted substandard drugs," said committee chair Julius Melly.

The MPs also raised questions about the dual role played by Bliss Healthcare in the scheme, acting both as master capitator and service provider.

The committee sought clarity on how the company balances the two roles without conflict of interest.

Bliss Healthcare Chief Executive Officer Felix Wanjala pushed back against the claims, saying no client had raised a formal complaint.

"We are always responding to our client,s and any complaint raised is always addressed in terms of service. If an MP has anyone with a ca,se we will address it," Wanjala said.

He defended the quality of drugs dispensed, saying the use of generics should not be confused with poor quality.

"I do not want us to mix quality and generic. Let me pick an example of Panadol. It is the simplest that we know. Panadol is a brand name, but since it was the first molecule to be created so we call it an original molecule. Then, someone else comes and makes the same molecule that is called generic," the CEO added.

Wanjala also dismissed reports of delays, saying the company processes approvals within an hour.

But MPs disagreed, saying they had received multiple complaints from teachers who are forced to wait too long before receiving treatment.

Medical Administrators Kenya, Chief Operating Officer Parmanand Mishra, defended the scheme’s efficiency, saying it had removed the need for pre-authorisation for acute outpatient visits.

He said most admissions and discharges are approved within 30 to 45 minutes.

According to Mishra, some cases flagged for possible irregularities may require extra documents, which could affect turnaround times.

"This measure is essential in safeguarding members' benefits and protecting public funds from misuse or fraudulent claims," he said.

He also outlined how the scheme addresses high-cost procedures, chronic diseases, and advanced treatment, maintaining that costs are covered within members’ limits.

The consortium has 763 accredited service providers across all 47 counties, including partnerships with public hospitals in areas where private options are limited.

On delayed payments, Mishra said the Teachers Service Commission had cleared payments up to the end of November last year, but Treasury delays had affected subsequent quarters.

"This delay has affected the timely settlement of claims to service providers for services rendered during this period. While 36 providers have temporarily suspended services due to delayed payments, over 95% of the 763 contracted providers continue to serve members," he said.

He added that funding had finally been received last week, and the process of paying service providers is ongoing.