National Treasury leads negotiation for teachers health scheme

The National Treasury, it has emerged, is now leading the negotiation process on how teachers would be moved to the new medical scheme.

Teachers Service Commission (TSC) and Social Health Authority (SHA) are part of the negotiation team.

But there has been complaints on inefficiencies in the medical scheme for teachers, with the majority of teachers disadvantaged as they are not able to access healthcare in private hospitals with Minet.

Some of the hospitals accredited to provide cover for teachers also do not have specialised health professionals.

The challenges, according to insiders at SHA, led to the ongoing negotiations to help place teachers  on a social health scheme to guarantee their quality care, when sick.

“Ongoing negotiations are chaired by The National Treasury, to onboard teachers under the Public Medical Scheme Fund,” said a senior insider at SHA.

Public Medical Scheme Fund is preferred for teachers because there is no special package, or cover under SHA as it were under defunct National Health Insurance Fund (NHIF).

The Social Health Insurance Act 2023, scrapped comprehensive cover that was highly enjoyed by civil servants, a package Kenya Kwanza administration maintain was discriminatory.

“Teachers have been suggesting to be put on comprehensive cover, but they cannot be on boarded as it is not in law,” added the insider.

Even with this, teachers shall still pay 2.75 percent as statutory, under essential package within SHA, as stipulated under Social Health Insurance Act, 2023, like anyone else.

However, according to the source, teachers have an option of buying a private medical cover, away from the Public Medical Scheme Fund, that covers all civil servants employed by the Public Service Commission (PSC).

The SHA oversees Public Medical Scheme Fund, whereas deductions for teachers are done by TSC and remitted to The National Treasury, that then gives the money to the service provider.

In this case, Public Medical Scheme Fund shall contract hospitals, that will cover teachers.

Civil scheme is however encouraged as it is cheaper, as compared to commercial that is expensive. 

“Private health insurers are expensive, but it is upon teachers to decide on whether to pick private, on that serving other civil servants,” emphasised the source.

Previously, teachers used to enjoy civil servants package, but they opted out in 2016, after procuring Minet.

“For Civil servants, PSC negotiated for them. It is upon TSC to negotiate, for teachers, the best option. Police officers are already onboarded through their employer-National Police Service Commission (NPSC)”.

After negotiation, The National Treasury is expected to give way forward on the matter.

Teachers will be entitled to Universal Health Coverage (UHC) scheme/essential benefit package, if exhaust the cover (Fund).

SHA has two schemes according to the Act, namely UHC benefit, where all Kenyans are enrolled, with a deduction of 2.75 percent of earnings, but those who wants complimentary cover are at liberty to buy from commercial or would use the fund.

Appearing before the National Assembly Committee on Education in April this year, the then TSC Chief Executive Officer (CEO) Nancy Macharia, said efforts by the commission to onboard teachers into the health scheme failed due to lack of sufficient structures.

Macharia said push by TSC to enrol teachers into social health scheme are yet to bear fruits.

During the committee probe, the committee wanted the insurer’s contract to be terminated, terming the contract as amorphous structure.

The private insurer however faced with operation challenges, hindering access of healthcare by teachers.

Macharia told the committee that TSC approached SHA for the provision of a medical scheme to teachers but was informed of inefficient structures to onboard teachers, and further demanded Sh37 billion.

Macharia maintained the demand of Sh37 billion, she said, was much higher, against the Sh20 billion allocated to health scheme.

She maintained that last year, TSC had a meeting with SHA, but the authority claimed not to have structures to undertake the scheme.

This year, she said the authority is also not ready to onboard teachers.

Macharia informed the committee that TSC contracted Minet in 2015, and has been tendering it up to date.

However, she revealed that plans to terminate the contract is being sought because of numerous complaints by teachers over delays in payment approvals and prohibitive pre-authorisation requirement in hospitals.

Some teachers seeking service with the private contractor, she said, are also turned away.

But even with plans to onboard teachers to the Fund, it remains unclear if they will get quality care, as the employer is yet to remit debt owed to private hospitals.

Early this week, Rural and Urban Private Hospitals Association of Kenya (Rupha)  noted that the reintroduction of teachers and police scheme to SHA, is a move being adopted by the government for survival of SHA.

The association demanded to have TSC and NPSC pay a total of Sh30 billion owed to hospitals across the country before being onboarded under special SHA scheme as planned.

The money, they said, should be paid before change of schemes.

"Kenyan people, police and teachers need to understand that if migration is made to SHA before liabilities by Minet and Medical Administrators Kenya Limited is sorted, guarantee of them not receiving services will deepen," said the association in a statement.

According to the association, Kenyan people, police and teachers need to understand that if migration is made to SHA before liabilities by Minet and Medical Administrators Kenya Limited is sorted, guarantee of them not receiving services will deepen.

“When they move teachers and police to, they left NHIF with debts, those two schemes owe NHIF money, a big fraction of NHIF debt was left by teachers and police medical schemes when they were transferred back to private hospital,” RUPHA added.