Teachers face health cover blow as SHA excludes crucial benefits

Teachers across the country have been dealt a major blow after details emerged that unions may have signed off on weaker benefits for their members.

It has now emerged that Group Life Cover and Work Injury Benefits Act (WIBA) provisions are not available for teachers under the Social Health Authority (SHA).

This means teachers who are injured at work may not have their medical bills covered by the government insurance plan.

The revelation was communicated to the Kenya Union of Post-Primary Education Teachers (Kuppet) on Tuesday during a meeting with officials from the Ministry of Health and the SHA.

The meeting was convened to deliberate reforms to the teachers’ medical scheme under the Public Officers Medical Scheme Fund (POMSF).

The tripartite meeting brought together Health Cabinet Secretary Aden Duale, TSC Acting Chief Executive Officer Eveleen Mitei and KUPPET Secretary General Akelo Misori.

In a joint communiqué released after the meeting, the parties said the Last Expense Benefit for teachers will be operationalised under SHA, while a seamless claims process will be established to support bereaved families.

However, the statement clarified that other critical benefits fall outside the authority’s mandate.

“We wish to categorically clarify that the Group Life Cover and Work Injury Benefits Act (WIBA) provisions are not administered under SHA,” the statement read.

The revelation has dimmed hopes for a comprehensive last-resort cover, an issue that recently gained urgency after two teachers died in a tragic matatu accident during Kuppet grassroots elections in Nairobi.

Many teachers say the clarification has left them wondering whether their welfare is being adequately protected.

“It seems we are being tossed around by those we mandated to stand in the gap and fight for our rights. What are we left with as teachers in these deals?” questioned Kelvin Mahasi, a teacher from Kakamega, reflecting the frustrations felt by many tutors.

For years, Kenya’s teachers have quietly carried the responsibility of educating the nation while contributing to medical schemes that promised security for them and their families.

But the shift from the long-running Minet medical cover to the new SHA system has been anything but smooth.

Although reforms announced by the government include the expansion of services under the Mwalimu Cover, automation of beneficiary registration and integration of TSC and SHA systems to prevent data delays, many teachers say the transition mirrors the frustrations experienced when the medical scheme was moved from AOI Minet to SHA in December 2025.

Initially, the shift was presented as a major improvement to teachers’ health cover.

“We are working towards a seamless transition of our teachers to the new medical scheme,” said Mitei during the rollout.

The development means TSC must now seek a separate budgetary allocation from the National Treasury to cater for the benefits, raising fresh anxiety among educators over the future of their welfare and medical protections.

However, Misori assured teachers that the new arrangement would significantly improve access to health care.

“This is a comprehensive cover that exclusively covers teachers, especially for services beyond treatment in dispensaries and sub-county hospitals and can even facilitate treatment abroad,” said Misori.

Dr Mercy Mwangangi, Chief Executive Officer of the Social Health Authority (SHA), also said the scheme would expand access to healthcare facilities across the country.

“There will be no prequalification as happens in the private sector. We are expanding the list to Level Six, Level Four, Level Three A and V, and Level Two hospitals,” she said.

“In terms of ownership, public, private and faith-based, the offering for teachers will be greatly improved and expanded, including access to care for chronic conditions.”

The revamped scheme was expected to allow teachers to access nearly 9,600 healthcare facilities nationwide while also expanding benefits to more dependents.

Despite these assurances, the reality on the ground has been far different.

Teachers across several counties report being turned away from private hospitals that previously treated them without difficulty.

Others say they have been forced to pay cash for treatment because facilities claim the SHA system has not yet approved or cleared their services. In some cases, teachers have reportedly been detained in hospitals over unpaid bills. 

The situation has angered unions, which accuse the government of failing to ensure a smooth transition.

“We are deeply disturbed that the health cover under SHA is not working at all. It is not giving our teachers the comfort we anticipated,” said Omboko Milemba, Emuhaya MP and KUPPET national chairman.

He criticised the continued deductions from teachers’ salaries despite the challenges they face in accessing treatment.

Reports from across the country indicate that some hospitals have declined to admit teachers until payments are guaranteed.

KUPPET has now called on the Ministry of Health to fast-track the accreditation of hospitals under SHA so teachers can access treatment without disruptions.

Misori urged the government to deploy a multi-agency team to address the emerging crisis. “We have hospitals that have refused to take some teachers, which is very regrettable,” he said.

“We are asking the Health minister to work closely with the Education minister and TSC to ensure that, during this difficult time for our teachers, all hospitals are put on alert to treat them.”

Even as the government moves to address the operational gaps, skepticism remains high among teachers who feel their concerns were ignored during the transition.

Primary school heads have also criticised the process, arguing that the new arrangement was rushed without adequate consultation.

“This thing was rushed because there was no discussion laid out and we did not take part as teachers. We see it as part of the oppression,” one head teacher said.

Still, union leaders insist there are safeguards within the new arrangement.

KNUT Secretary General Collins Oyuu said the scheme includes a cancellation clause that allows teachers to withdraw if it fails to deliver.

“We assure our members that this scheme has a very clear cancellation clause. Let’s not get worried,” said Oyuu.

But in the joint meeting, the government has introduced additional measures to stabilise the system.

Forty-seven County Joint Committees have been established to address operational challenges and improve communication between teachers, unions and healthcare providers.

The committees, chaired by TSC County Directors, will include representatives from SHA and teachers’ unions.

Their role will be to address complaints from teachers, review the performance of the medical scheme and propose solutions to emerging problems.

Quarterly tripartite assessments will also be conducted to monitor how teachers are accessing healthcare services.

In addition, an Ex-Gratia Management Framework has been introduced to assist teachers facing catastrophic medical expenses.

Under the arrangement, TSC will vet and finance requests while SHA will process and pay approved claims.

According to CS Duale, the new system is already benefiting a large number of teachers.

“In the last three months, over 227,000 teachers and 807,426 dependants have benefited under the Mwalimu Comprehensive Medical Cover,” he said.