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CS Duale Disputes TSC’s Claim About 360,000 Teachers Excluded from SHA

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CS Duale Disputes TSC’s Claim About 360,000 Teachers Excluded from SHA

Following the Teachers Service Commission’s (TSC) announcement that many teachers across the country are unable to access medical services through the Social Health Authority (SHA), the Ministry of Health has clarified that all teachers are eligible for the government-supported medical program.

In a statement released on Saturday, April 27, Health Cabinet Secretary Aden Duale emphasized that teachers and their dependents can receive medical care through the Primary Healthcare Fund (PHC), the Social Health Insurance Fund (SHIF), and the Emergency, Critical, and Chronic Illness Fund (ECCIF).

“All teachers and their dependents qualify for the benefits package offered by the Social Health Authority (SHA) through these three funds—Primary Healthcare Fund (PHC), Social Health Insurance Fund (SHIF), and Emergency, Critical & Chronic Illness Fund (ECCIF)—just like any other registered and contributing Kenyan,” he stated.

Duale also noted that employers of teachers in the country have the option to provide additional medical insurance, which is not managed by the SHA.

He mentioned that the commission could choose to enroll its employees in the Public Officer Medical Scheme Fund, allowing them to determine supplementary benefits based on their budget.

“Employers like the Teachers Service Commission (TSC) can offer complementary insurance for their employees to provide extra benefits through a legitimate insurance underwriter,” he explained.

“The Social Health Authority does not oversee the TSC’s supplementary medical coverage, which is provided by a private insurance company,” he added.

Duale’s comments came just two days after Nancy Macharia, the CEO of the Teachers Service Commission (TSC), addressed the National Assembly on April 24, claiming that the Authority had refused to enroll over 360,000 teachers.

Macharia stated that the Authority cited a lack of adequate infrastructure nationwide to accommodate the teachers and indicated that Ksh 37 billion would be needed to establish the necessary facilities.

“Last year, when we faced issues with Minet, we aimed to transition our teachers to SHA. We have consistently sought to have our teachers under the national insurer, even during the NHIF era,” she remarked.

“We met with SHA before renewing our contract with Minet for this final year, and they informed us that they lacked sufficient infrastructure. They indicated that they would require Ksh 37 billion to enroll our teachers, but even then, they were not prepared to take them on this year,” she added.

SHA Responds to TSC After Disclosing That All Teachers Nationwide Were Locked Out

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SHA Responds to TSC After Disclosing That All Teachers Nationwide Were Locked Out

The Social Health Authority (SHA) has addressed allegations from the Teachers Service Commission (TSC) that it failed to enroll over 360,000 teachers because of insufficient nationwide infrastructure.

TSC CEO Nancy Macharia, while appearing before the National Assembly Education Committee, stated that attempts to integrate teachers into the SHA scheme were unsuccessful after they were informed that the Authority lacked adequate structures nationwide to support teachers.

She added that, although TSC has consistently aimed to enroll teachers in a public insurance scheme, achieving this has not been feasible so far.

“Last year, when we encountered issues with Minet, we sought to transition our teachers to SHA. We have always wanted our teachers to be under the national insurer, even during the NHIF days,” she stated.

However, according to SHA, all teachers and their dependents qualify for the Social Health Authority (SHA) benefits package through the three Funds.

These consist of the Primary Healthcare Fund (PHC), Social Health Insurance Fund (SHIF), and Emergency, Critical and Chronic Illness Fund (ECCIF), similar to any other Kenyan who is registered and contributing.

The authority noted that employers such as TSC can offer complementary insurance for their employees for extra benefits through a legitimate insurance underwriter.

SHA stressed that this additional coverage is managed independently from the services it offers.

“The Social Health Authority does not supervise the TSC supplementary medical cover which they obtained from a private insurance provider,” the statement read in part.

Nonetheless, SHA indicated that TSC can register its members in the public officers’ medical scheme fund, where they will assess the complementary benefits based on its budget.

Macharia States Authority Cited Ksh17 Billion Deficit
Nancy Macharia informed the National Assembly Education Committee that while the government had allocated Ksh20 billion for the medical scheme, SHA maintained it needed Ksh37 billion to accommodate the teachers.

“We convened a meeting with SHA prior to renewing our contract with Minet for this last year, and they communicated that they lacked sufficient structures. They indicated they would require Ksh. 37 billion to enroll our teachers, but even then, they were unprepared to accept them this year,” she told the committee.

Committee Chairperson Julius Melly recounted a concerning instance of a teacher who was placed in solitary confinement for three months for not clearing a hospital bill — despite being insured.

“What sort of insurance cover is this? It’s a mishmash; it has no coherence. You have an insurer, a leading consortium, an administrator, a capitator — it’s a very peculiar kind of insurance. You must extricate yourselves from this situation,” remarked Melly.

TSC renewed its three-year agreement with Minet Insurance in December 2022, which is scheduled to continue until November 2025.

Nonetheless, the Minet-administered scheme continues to receive criticism over inadequate service delivery, inefficiencies, and delays.

According to SHA, there are 21. 6 million Kenyans registered with SHA, and an average of 50,000 Kenyans register each day.

TSC CEO reveals Why SHA declined to enroll over 360,000 teachers for medical cover

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The Social Health Authority (SHA) has opted not to enroll over 360,000 teachers in health coverage due to insufficient nationwide infrastructure. Nancy Macharia, the CEO of the Teachers Service Commission (TSC), explained that their attempts to integrate teachers into SHA were unsuccessful because the insurer lacks the necessary structures to support them across the country.

During a session with the National Assembly Education Committee, Macharia expressed the TSC’s longstanding desire to include teachers in a public insurance scheme, which has yet to materialize.

“Last year, when we faced issues with Minet, we aimed to transition our teachers to SHA. Our goal has always been to have our teachers covered by the national insurer, even back in the NHIF days,” she stated.

She recounted a meeting with SHA prior to renewing the contract with Minet for the final year, where SHA indicated that they required Ksh.37 billion to enroll the teachers but were not prepared to take them on this year.

This discussion was prompted by numerous complaints from teachers nationwide who are struggling to access medical care, despite the Ksh.20 billion contract TSC has with Minet for educators’ health insurance.

Committee Chairperson Julius Melly highlighted a concerning incident involving a teacher who was placed in solitary confinement for three months due to unpaid hospital bills, despite having insurance.

“What kind of insurance is this? It’s a mess; it lacks coherence. You have an insurer, a lead consortium, an administrator, a capitator — it’s a confusing type of insurance. We need to move away from this,” Melly remarked.

Luanda MP Dick Maungu suggested that teachers be organized into clusters based on job group or region to expedite the approval process at health facilities, arguing that the current centralized system is inefficient.

“With Bliss Health Care as the primary capitator and given the large number of teachers, timely approvals are challenging, leading to delays. Why can’t we cluster teachers to streamline the process? The system is currently overwhelmed,” Maungu noted.

Macharia, however, pointed to insufficient funding as a significant obstacle to providing comprehensive medical insurance.

She urged the committee to allocate more resources, stating, “For our teachers to receive the best medical services, they need to be fully insured. Unfortunately, we cannot achieve this due to budget constraints. We also require timely funding to the consortium, as delays are common.”