TSC: Over 360,000 teachers face healthcare uncertainty as SHA declines onboarding

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

Teachers Service Commission (TSC) CEO Nancy Macharia told the National Assembly Education Committee on Thursday that although the government had allocated Sh20 billion for the medical scheme, SHA insisted it required Sh37 billion to absorb the teachers.

The same funding gap, she added, had derailed a similar attempt under the now-defunct National Health Insurance Fund (NHIF).

“This budget deficit has been a consistent obstacle. 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 said.

She noted that the Commission had made several attempts to bring teachers under a public health insurer but was informed that SHA lacked sufficient structures countrywide to serve them adequately.

“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,” Macharia 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 enrol our teachers, but even then, they were not ready to take them on this year.”

The TSC renewed its three-year contract with Minet Insurance in December 2022, which is set to run until November 2025. However, the Minet-administered scheme continues to face criticism over poor service delivery, inefficiencies and delays.

Committee Chair Julius Melly dismissed the system as dysfunctional, sharing a shocking case of a teacher 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 highlighted cases of teachers being denied treatment or subjected to long waits 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 raised concerns over the lack of competition in the procurement process, suggesting that the deal might have discouraged other insurers from bidding.

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

Luanda MP Dick Maungu proposed breaking down the scheme by job group or region to enhance efficiency.

Other Topics To Read

• Headlines
• Education
• Education
• TSC
• SHA
• Nancy Macharia
• TSC: Over 360
• 000 teachers face healthcare uncertainty as SHA declines onboarding

“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 backed calls to split the scheme into cohorts, warning that without drastic 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 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.

TSC Director of Legal Services Cavin Anyour defended the current arrangement, saying the Minet-led consortium was composed of top-tier insurers.

“Minet leads a group of eight top providers. Those who were left out lacked the capacity to deliver,” Anyour told the committee.

Macharia, however, maintained that budget constraints and delayed government disbursements continue to hinder the scheme’s efficiency.

“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.

Legislators have now urged the government to urgently restructure the scheme and explore feasible options to ensure teachers receive the medical care they deserve.