TSC, SHA clash over teachers' health cover amid limited access to services

All teachers in the country are eligible for coverage under the Social Health Authority (SHA), just like other Kenyan workers, contributing 2.75 per cent of their salaries or income, the government has confirmed.

SHA clarified that teachers are entitled to the social health benefits package under three key funds: the Primary Healthcare Fund, the Social Health Insurance Fund (SHIF), and the Emergency, Critical and Chronic Illness Fund.

“All teachers and their dependants are eligible for SHA benefits under these three funds,” the Authority stated in a recent announcement.

Teachers do not receive any special treatment compared to other civil servants or informal sector workers, except for their choice of service providers. Teachers, through the Teachers Service Commission (TSC), have contracted a consortium of insurers via insurance broker Minet to provide superior coverage.

However, like other employees, teachers contribute 2.75 per cent of their salaries towards SHA. “In line with public service norms, TSC deducts SHIF contributions and remits them. Instead of paying teachers a medical allowance, they procure private medical cover through Minet,” explained a SHA official.

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This private cover is expected to offer teachers superior benefits beyond those available under the SHA scheme.

TSC awarded the insurance contract to Minet, which in turn contracted Medical Administrator Kenya Limited (MAKL) to manage the scheme. Teachers forfeit their medical allowance, which is added to their monthly deductions to purchase a superior cover, financed through their medical allowance and statutory deductions under the public officers’ medical scheme.

SHA’s clarification follows claims by TSC Chief Executive Nancy Macharia, who recently stated that SHA had been reluctant to include teachers in its scheme. She told the National Assembly’s Education Committee that efforts to onboard teachers onto SHA had failed due to insufficient structures and a demand for Sh37 billion, which she considered too high given the Sh20 billion allocated to the health scheme.

Despite these setbacks, TSC continues to work with Minet, contracted in 2015, though concerns persist over delays in payments and high pre-authorisation requirements in hospitals. Teachers seeking services under the private scheme are sometimes turned away.

Dr Brian Lishenga, chairperson of the Rural-Urban and Private Hospitals Association (RUPHA), confirmed that RUPHA hospitals have suspended services for MAKL holders, including teachers, and are only offering services to SHA members.

SHA has stated that while TSC can provide complementary insurance for additional benefits, it does not manage the TSC’s private medical cover.