The TSC Medical Scheme Crisis Continues Since the SHA Refuses to Include Teachers
The Social Health Authority (SHA) refused to take in the over 360,000 teachers and their families covered by the Teachers Service Commission (TSC) medical program, citing excessive costs and a lack of capacity, leaving their future uncertain.
TSC CEO Nancy Macharia, speaking before the Education Committee of the National Assembly, disclosed that SHA needed Sh37 billion to onboard the instructors, even if the government set aside Sh20 billion for the initiative. This shortfall also prevented the now-defunct National Health Insurance Fund (NHIF) from enrolling them.
The budget deficit has been a persistent challenge, according to Macharia. “They told us they lacked the necessary infrastructure and needed Sh37 billion even last year, when we considered transitioning to SHA. We now operate the plan with Sh20 billion.”
Consequently, in December 2022, TSC extended its three-year deal with Minet Insurance, which will last until November 2025.
Lawmakers have harshly condemned the Minet-administered plan, calling it a “mongrel system” that is plagued with inefficiencies, delays, and a lack of compassion.
Julius Taitum, the MP for Igembe North, questioned the absence of competition in the tendering process and suggested the possibility of a monopoly. “Is it that other insurers avoid applying because they know it’s being handled haphazardly, to the detriment of teachers?” he wondered.
The plight of teachers who have been waiting for hours or refused care due to clearance delays was described by Teso South MP Mary Emase in a moving manner. Teachers at Bungoma Life Care have been waiting endlessly for approval,” she said. “Some are told they are pretending to be sick.”
Citing instances like a teacher being held in a Nairobi hospital for 90 days due to late pay, committee chair Julius Melly described the program as ineffective. “This scheme has no head or tail. It must be overhauled,” he said.
Many of the issues were blamed on delayed government payments by Macharia, who claimed that suppliers occasionally halt services when payments are late.
“Teachers would need comprehensive insurance coverage in order to receive the finest medical treatment.” Due to budgetary restrictions, this is no longer the case, she stated.
A full reorganization of the program was demanded by lawmakers. To decentralize services and increase efficiency, Melly suggested that teachers be divided into groups that are managed by several insurers.
Luanda MP Dick Maungu stated, “Approval procedures are overwhelmed with Bliss Healthcare as the master capitator. Why not break it down into clusters for better management?”
According to John Makilap, a member of parliament for Baringo North, teachers will continue to suffer unless significant changes are made before the contract’s expiration in 2025. He said, “This amorphous setup won’t work. We must divide them into cohorts or transition to SHA.”
The consortium operating the scheme needs to be thoroughly investigated, according to Taitum. “Teachers won’t get justice from this setup. The service provider must be questioned for the entire day.
TSC Director of Legal Services Cavin Anyour defended the current model by stating that the consortium consists of high-end insurers. “Minet leads a group of eight top providers. Those who were left out lacked the capacity to deliver,” he said.