Unresolved healthcare crisis leaves 360,000 teachers without coverage

Over 360,000 teachers and their dependents continue to face uncertainty over their healthcare cover after the Social Health Authority (SHA) declined to onboard them, citing a Sh17 billion shortfall and lack of necessary infrastructure.

Despite government efforts to provide adequate healthcare for educators, these ongoing financial and logistical challenges have left teachers relying on a system criticized for poor service delivery.

Teachers Service Commission (TSC) CEO, Nancy Macharia, revealed during a National Assembly Education Committee meeting that although the government had allocated Sh20 billion for the medical scheme, SHA insisted that it required Sh37 billion to accommodate the teachers.

She noted that this funding gap was not a new issue, as it had previously hindered a similar effort under the now-defunct National Health Insurance Fund (NHIF).

"This budget deficit has been a consistent obstacle," Macharia explained.

"Even last year, when we considered transitioning to SHA, they told us they lacked the necessary infrastructure and needed Sh37 billion. We currently run the scheme with Sh20 billion."

Macharia highlighted that the TSC had made multiple attempts to enroll teachers in a public health insurer but was continuously informed that SHA lacked the necessary infrastructure across the country to effectively serve them.

"Last year, when we had issues with Minet, we wanted to move our teachers to SHA. We have always wanted to have our teachers under the national insurer, even during the NHIF days," she said.

"We held a meeting with SHA before renewing our contract with Minet for this final year, and they told us they didn’t have enough structures. They said they would need Sh37 billion to enroll our teachers, but even then, they were not ready to take them on this year."

In December 2022, TSC renewed its three-year contract with Minet Insurance, which is set to run until November 2025.

However, the Minet-administered scheme has faced growing criticism over its inefficiencies, delays, and poor service delivery, leading to frustrations among teachers and lawmakers.

The committee chair, Julius Melly, described the system as dysfunctional, citing a troubling case where a teacher was detained in a Nairobi hospital for 90 days due to delayed payments.

"What kind of insurance cover is this? It’s a mongrel; it has no head or tail. You have an insurer, a lead consortium, an administrator, a capitator, it’s a very funny type of insurance. You must get out of this thing," Melly said.

Teso South MP, Mary Emase, drew attention to numerous instances where teachers were denied treatment or subjected to long waiting periods due to delayed approvals.

"Some are told they’re pretending to be sick. Teachers at Bungoma Life Care have waited endlessly for approval," she said.

Igembe North MP, Julius Taitum, questioned the lack of competition in the procurement process, suggesting that the current setup might discourage other insurers from participating.

"Is it that other insurers avoid applying because they know it’s being handled haphazardly, to the detriment of teachers?" he posed.

To address the delays and inefficiencies, Luanda MP, Dick Maungu, proposed breaking down the scheme by job group or region to improve efficiency.

"With Bliss Health Care being the master capitator and considering the large number of teachers, it becomes difficult for them to handle approvals in time, and that’s where the delays come in. Why is it not possible to cluster teachers to narrow it down? Currently, the system is overwhelmed," Maungu said.

Baringo North MP, John Makilap, also supported calls to split the scheme into cohorts, warning that without substantial reforms, teachers would continue to suffer beyond the current contract period.

"This amorphous setup won’t work. We must divide them into cohorts or transition to SHA," Makilap said.

Taitum further called for a full investigation into the consortium managing the scheme.

"Teachers won’t get justice from this setup. We need a full-day interrogation of the service provider," he said.

While TSC Director of Legal Services, Cavin Anyour, defended the current arrangement, claiming that the Minet-led consortium was composed of top-tier insurers, he acknowledged the ongoing challenges.

"Minet leads a group of eight top providers. Those who were left out lacked the capacity to deliver," Anyour said.

Macharia reiterated that budget constraints and delayed government disbursements have hindered the efficiency of the scheme.

"If our teachers were to get the best medical services, they need to be fully insured. But we are unable to do that because of budgetary constraints. We also need timely disbursements to the consortium, because most times we delay," she said.

With calls for urgent reforms, legislators have urged the government to restructure the scheme and explore more viable options to ensure that teachers receive the healthcare services they deserve.