Nairobi, Kenya, April 24 – Access to healthcare crisis affecting over 360,000 teachers and their dependents under the Teachers Service Commission (TSC) medical scheme remains unresolved, after the Social Health Authority (SHA) declined to integrate them due to inadequate capacity and high cost implications.
Speaking before the National Assembly’s Education Committee, TSC Chief Executive Officer Nancy Macharia revealed that although the government allocated Sh20 billion for the teachers’ medical cover, SHA indicated it would require Sh37 billion to absorb the beneficiaries.
“This funding gap also affected the former National Health Insurance Fund (NHIF), which led us to renew our contract with Minet Insurance,” Macharia said.
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The Commission signed a three-year deal with Minet, running from December 1, 2022, to November 2025.
“Last year, when there were challenges with Minet, our intention was to transition our teachers to SHA. We’ve always wanted our teachers to benefit from the national insurer, even during NHIF’s time,” she added.
“However, SHA told us they lacked the necessary infrastructure and needed Sh37 billion to take over the scheme, which we currently run on Sh20 billion. That’s where we hit a wall.”
The Minet-administered scheme has drawn sharp criticism from lawmakers, who labeled it a “mongrel system” that fails to deliver timely and efficient healthcare services to teachers and their families.
Igembe North MP Julius Taitum questioned the integrity of the tendering process, suggesting that the lack of competing bidders might be a strategy to maintain a monopoly.
“You mentioned that no other insurance companies submit bids during tendering. Is this because the current handlers are mismanaging the scheme to discourage competition? Are they sabotaging the process to remain unchallenged?” he asked.
Teso South MP Mary Emase delivered a passionate plea, recounting real-life examples of teachers facing long delays or outright denial of care due to slow approvals.
“I know of a teacher whose approval from Minet was delayed until we had to intervene through agents. In Bungoma, teachers are left waiting for hours in hospital lobbies. Some are even accused of faking illness just to access care,” Emase lamented.
Committee Chair Julius Melly echoed the frustrations, calling the medical scheme dysfunctional and structurally flawed. He cited a case where a teacher was detained in a hospital for three months due to delayed payments, with Minet only settling the bill after sustained pressure.
“We’ve had cases where teachers are held in hospitals for months because the school isn’t listed as a service provider. That’s unacceptable,” Melly said.
He urged the TSC to abandon the current consortium-based model and explore decentralized, competitive alternatives.
“You should divide teachers among several reputable insurers. What you have now is a headless system it’s chaotic and ineffective,” he said.
Luanda MP Dick Maungu criticized the centralized approval model, blaming it for chronic delays. He proposed a cluster-based approach to streamline service delivery and reduce the burden on central administrators.
“With Bliss Healthcare handling approvals for all teachers, it’s no wonder delays are rampant. Why not break them into smaller, manageable groups?” Maungu suggested.
Baringo North MP John Makilap warned that unless significant changes are made before the contract expires in November 2025, teachers will continue to suffer under the current arrangement.
“This scheme is vague and poorly structured. If we don’t restructure iteither by dividing teachers into cohorts or transitioning them to SHA it will keep failing them,” he said.
Taitum called for a thorough investigation into the consortium’s operations, arguing that it was working against the interests of teachers.
“This setup is denying justice to our teachers. It’s a cartel of insurers acting together, and we need a full-day session to interrogate them and find a way forward,” he stated.
However, TSC Director of Legal Services Cavin Anyour defended the existing model, arguing that it represents the best available option in the private sector.
“At the time of tendering, Minet came in with a consortium of eight top medical insurers. They’re the country’s leading providers and each plays a specific role. They absorbed all capable firms, leaving out the smaller players who lacked capacity,” Anyour explained.
