Broken promises? MPs grill firms behind teachers’ health cover over delays, limited access to care

Members of Parliament have raised alarm over persistent failures in the teachers’ medical scheme, grilling service providers over delays, poor treatment, and limited access to care, especially in rural areas.

The National Assembly's Departmental Committee on Education on Wednesday questioned officials from Medical Administrators Kenya Ltd and Bliss Healthcare after teachers reported widespread service complaints under a cover that supports over 300,000 teachers and their dependents.

Facing the Committee were Medical Administrators Kenya Ltd's Chief Operating Officer Parmanand Mishra, Bliss Healthcare CEO Dr. Felix Wanjala, and James Njuguna, GM Operations at MAKL.

They appeared to respond to rising complaints from teachers under a scheme that covers over 300,000 teachers and their dependents.

“As you are aware, the Teachers Service Commission in Kenya has partnered with Aon Minet and Bliss Healthcare to offer a comprehensive healthcare package,” said Committee Chair Julius Melly.

“However, over the years, numerous challenges have emerged, affecting access and quality of healthcare for our educators."

The scheme, running from 2022 to 2025, is managed by a consortium led by Minet Kenya under a hybrid model that combines capitation and insurance.

The consortium includes Bliss GVS Healthcare, Medical Administrators Kenya Ltd, Old Mutual, CIC, Britam, Pioneer Assurance, and Star Discover.

MPs raised concerns about long wait times, the quality of medication, poor coverage in rural areas, and facilities allegedly turning teachers away due to unpaid bills.

“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 Melly, questioning whether quality standards were being upheld.

Bliss CEO Dr Felix Wanjala dismissed the drug quality claims, saying no formal complaints had been made.

“We are always responding to our clients, and any complaint raised is always addressed in terms of service. If an MP has anyone with a case, we will address it,” he said.

“I do not want us to mix quality and generic. Let me pick an example of Panadol. It is the simplest thing 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, which is called generic,” he added.

Wanjala also claimed that “all acute outpatient visits are handled directly without pre-authorisation, and over 96 per cent of inpatient admissions are approved within 30 to 45 minutes.”

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• Broken promises? MPs grill firms behind teachers’ health cover over delays
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He said emergency cases are attended to immediately and that regular staff training helps reduce approval delays.

But Vice Chair Eve Obara challenged this, asking, “What measures are in place to expedite the approval process for specialised and overseas treatments?”

Other MPs echoed similar frustrations. Nabii Nabwera questioned the lack of accessible care in remote areas.

“Some of your facilities are very far from the teachers. What strategies are being implemented to decongest urban hospitals and improve rural access?” he asked.

Documents presented to the Committee showed that while Minet operates 47 facilities and Bliss runs 35, the full network includes 763 accredited providers across all 47 counties. Yet members said rural coverage remains inadequate.

Medical Administrators Kenya COO Parmanand Mishra said the scheme had removed the need for pre-authorisation for acute outpatient visits and insisted most admissions were processed within 45 minutes.

He admitted some cases flagged for review could take longer.

“This measure is essential in safeguarding members’ benefits and protecting public funds from misuse or fraudulent claims,” Mishra said.

He also confirmed delays in settling claims due to late funding from Treasury, adding that while 36 hospitals had temporarily suspended services, “over 95 per cent of the 763 contracted providers continue to serve members.”

Mishra said funds were received last week and that processing was underway to ensure all providers are paid by next week. “We are working closely with service providers to ensure prompt settlements and resolve any backlogs,” he said.

MP Mary Emaase and her counterpart, Phylis Bartoo, demanded clarity on oversight and enforcement of service quality.

“We’re receiving complaints about poor services and the use of low-quality generic drugs,” said Emaase.

Bartoo questioned the process for holding defaulting hospitals accountable. MP Julius Taitumu stressed the need for transparency.

“Teachers need to be fully informed about their benefits and the procedures for accessing care,” he said.

The Committee directed MAKL to submit a detailed report on the status of its facilities within seven days.

“Our teachers deserve better, and we will hold each player accountable until they get the healthcare they are entitled to,” Melly said.