𝐄𝐃𝐔𝐂𝐀𝐓𝐈𝐎𝐍 𝐂𝐎𝐌𝐌𝐈𝐓𝐓𝐄𝐄 𝐏𝐑𝐎𝐁𝐄𝐒 𝐒𝐄𝐑𝐕𝐈𝐂𝐄 𝐏𝐑𝐎𝐕𝐈𝐃𝐄𝐑 𝐎𝐕𝐄𝐑 𝐓𝐄𝐀𝐂𝐇𝐄𝐑𝐒’ 𝐌𝐄𝐃𝐈𝐂𝐀𝐋 𝐈𝐍𝐒𝐔𝐑𝐀𝐍𝐂𝐄 𝐀𝐌𝐈𝐃 𝐂𝐎𝐍𝐂𝐄𝐑𝐍𝐒 𝐎𝐅 𝐏𝐎𝐎𝐑 𝐒𝐄𝐑𝐕𝐈𝐂𝐄 𝐀𝐍𝐃 𝐃𝐄𝐋𝐀𝐘𝐒

The National Assembly Committee on Education has put medical service providers on the spot over persistent challenges in the Teachers’ Medical Insurance Scheme.

Appearing before the Committee were Mr. Parmanand Mishra, Chief Operating Officer of Medical Administrators Kenya Ltd (MAKL), Dr. Felix Wanjala, CEO of Bliss Healthcare, and Mr. James Njuguna, GM Operations at MAKL.

The consortium, led by Minet Kenya, was awarded the tender for the 2022-2025 period under a hybrid model that combines capitation and insurance. Other consortium members include Bliss GVS Healthcare, Medical Administrators Kenya Limited, Old Mutual, CIC, Britam, Pioneer Assurance, and Star Discover

The representatives faced questions from Members of Parliament keen on addressing the plight of teachers particularly the delays in treatment approvals, limited access to quality care in rural areas, and complaints over the use of low-quality medication.

Committee Chair, Hon. Julius Melly raised concerns about the scope of the scheme, which covers over 300,000 teachers and their dependents across Kenya. “As you are aware, the Teachers Service Commission (TSC) in Kenya has partnered with Aon Minet and Bliss Healthcare to offer a comprehensive healthcare package,” said Hon. Melly. “However, over the years, numerous challenges have emerged, affecting access and quality of healthcare for our educators.”

Committee Vice Chair, Hon. Eve Obara questioned the lengthy wait times reported by teachers seeking critical care. “What measures are in place to expedite the approval process for specialized and overseas treatments?” she asked.

In response, Bliss CEO, Dr. Wanjala explained that “all acute outpatient visits are handled directly without pre-authorization, and over 96% of inpatient admissions are approved within 30 to 45 minutes.” He added that emergency cases are attended to immediately and that providers are regularly trained to reduce documentation errors that delay approvals.

However, Committee Members expressed dissatisfaction, citing continued bottlenecks. Hon. Nabii Nabwera raised concerns about teachers in rural areas travelling long distances to access care. “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 submitted to the Committee revealed that while Minet operates 47 facilities and Bliss runs 35, with the broader network comprising 763 accredited facilities. However the Committee noted that coverage rural areas remained inadequate.

Hon. Mary Emaase raised alarm over the alleged use of low-quality medication. “We’re receiving complaints about poor services and the use of low-quality generic drugs,” she noted, demanding stronger oversight and enforcement of medical standards.

The legislators also grilled the consortium over delayed payments to hospitals, with some providers reportedly turning away teachers due to unpaid bills. “What steps have been taken to ensure timely payments and how do you address cases of service denial?” asked Hon. Phylis Bartoo.

Mr. Mishra of MAKL assured the committee that reconciliation and payment timelines were being streamlined. “We are working closely with service providers to ensure prompt settlements and resolve any backlogs,” he said.

“Teachers need to be fully informed about their benefits and the procedures for accessing care,” said Hon. Julius Taitumu with Hon. Melly added that, “Our teachers deserve better, and we will hold each player accountable until they get the healthcare they are entitled to.”

Members noted that the consortium, led by Minet Kenya, was awarded the tender for the 2022-2025 period under a hybrid model that combines capitation and insurance. Other consortium members include Bliss GVS Healthcare, Medical Administrators Kenya Limited, Old Mutual, CIC, Britam, Pioneer Assurance, and Star Discover.

The Medical Administrators Kenya Ltd is expected to submitted a detailed reports on the status of its facilities before the Committee on Education within seven days.

TSC is ordered by SHA to discontinue Minet in favor of new teachers’ medical insurance.

The Social Health Authority (SHA) has recommended that the Teachers Service Commission (TSC) cancel its existing medical insurance agreement with Minet Kenya and enroll teachers in the Public Officers Medical Scheme Fund instead.

This audacious proposal comes just days after the TSC told the Parliament’s Education Committee that SHA was unable to incorporate more than 300,000 instructors from around the nation into its healthcare system.

In addition to this, Parliament has deemed the deal an “amorphous structure” and is now urging TSC to end its contract with Minet Insurance brokers and a consortium of underwriters that provide medical cover services to teachers.

According to Kibra MP Peter Orero, instructors have complained that they are not given medication when they go to the consortium-approved hospitals and that they are instead forced to pay for it out of their own pocket.

Alternatively, the majority of teachers in Orero were being refused treatment at healthcare institutions and told they were not registered under the medical system.

The Commission’s lawyer tried to explain that the agreement with the consortium would expire in November of this year and that the decision on whether teachers would be integrated into the “enhanced” SHA system would be made at that time, but these attempts were met with opposition and calls to end the contract sooner.

“What sort of insurance coverage is this?” It’s a mixed breed. It lacks a head or tail. You are acquiring an insurer, a capitator, and an administrator through a lead consortium. A really amusing kind of insurance. “You have to get out of this thing,” Melly stated.

“We cannot continue to conduct things the same way and expect different results. The consortium is an amorphous organization that doesn’t provide services,” stated Luanda MP Dick Maungu.

Joseph Makilap, the representative for Baringo North, advocated for teacher banding in order for them to have access to superior health care.

“As TSC terminates this contract in the next six months, teachers will suffer. I propose that we divide them in lots and get them good insurance covers or we bundle them to SHA and God help us all,” Makilap remarked.

All teachers and their dependents are eligible for the Social Health Authority (SHA) benefits package, which is administered by three main funds—the Primary Healthcare Fund (PHC), the Social Health Insurance Fund (SHIF), and the Emergency, Critical, and Chronic Illness Fund (ECCIF)—according to SHA. Nevertheless, the SHA stresses that companies like TSC may provide supplemental coverage for additional perks through reputable private underwriters.

At present, TSC offers medical coverage through Minet Kenya, a private insurance provider. SHA advised the commission to rethink its arrangement by switching to the Public Officers Medical Scheme Fund, explaining that it does not oversee the Minet cover. With this fund, TSC would be able to offer free benefits based on a government-managed budget as opposed to relying on private providers.

Currently, more than 21.6 million Kenyans have already registered with SHA, and about 50,000 new registrations are being added every day. To guarantee service availability, SHA has also established partnerships with more than 8,000 healthcare facilities across the country.

Concerns about the quality, accessibility, and administration of the current Minet medical plan continue to arise, fueling the discussion about teachers’ medical insurance. Teachers’ unions and other education stakeholders have often brought up problems with service delays, inadequate medications, and negative hospital experiences under the Minet scheme.

In the near future, if TSC follows SHA’s recommendation, teachers may see a major change in the way their health insurance is handled, which may enhance healthcare access and save the commission millions in insurance expenses each year.