Union threatens SHA exit as teachers cry foul over care delays

When the government rolled out the Social Health Authority (SHA) in December 2024, it was presented as a bold leap toward universal healthcare, one that would finally replace fragmented insurance systems with a unified, digital, and more equitable model.

Teachers were told they were stepping into a new era of healthcare, one that promised broader coverage, faster approvals, and protection against catastrophic illness.

Sixteen months later, that promise is increasingly being questioned, with union leaders now threatening to pull members out, calling the transition a betrayal.

Tutors are voicing frustration, with union leaders now warning of possible withdrawal from the scheme. What was once hailed as reform is increasingly being described as a breakdown in trust between educators and the state.

Kenya Union of Post-Primary Education Teachers (KUPPET) Chairman Omboko Milemba has led the criticism, calling the transition from the Minet medical cover to SHA a “policy betrayal.”

“We supported reforms in principle, but what we have now is a downgrade in service. Teachers are being turned away from hospitals or forced to top up for services that were previously fully covered,” Milemba said.

The growing discontent has escalated into threats of industrial action, with union leaders warning that they may advise members to opt out of SHA contributions altogether, a move that could disrupt the broader universal health coverage agenda.

The shift from the now-defunct Minet medical scheme to SHA was anchored on the Social Health Insurance Act 2023, which replaced the National Hospital Insurance Fund framework and introduced a three-tier system: the Primary Healthcare Fund, the Social Health Insurance Fund, and the Emergency, Chronic and Critical Illness Fund.

Teachers were also placed under a supplementary arrangement through the Public Officers Medical Scheme Fund (POMSF), intended to top up benefits.

For teachers, the arrangement was further reinforced by the Public Officers Medical Scheme Fund (POMSF), designed to “top up” benefits once SHA limits are exhausted.
Teachers Service Commission (TSC) officials assured educators that the new system would expand coverage and eliminate inefficiencies that had long plagued the Minet scheme.

“We are moving teachers into a more sustainable and universal system that guarantees access to essential and specialised care,” said TSC CEO Evaleen Mitei in late 2024.

SHA leadership also defended the reforms. SHA CEO Mercy Mwangangi described the system as a foundation for equity in healthcare.

“This reform is about equity and efficiency. Every Kenyan, including teachers, will access a standardised package of care with government support,” she said.

But ground reality, KUPPET Secretary General Akelo Misori says, tells a different story.

“The Minet scheme had challenges, yes, but you knew what you were entitled to. With SHA, there is confusion, delays, and in some cases outright denial of services,” Misori said. Teachers report delays in approvals, unclear benefit limits, and frequent hospital rejections over pre-authorisation requirements. What was promised as a fast, digital system has, for many, become a bureaucratic maze.

“You go to the hospital and are told your service is under a different fund, or your limit is exhausted. It is frustrating and sometimes life-threatening,” said Nairobi teacher Paul Mwangi.

Union branches are now openly discussing industrial action, including advising members to opt out of contributions entirely, a move that could destabilise the broader universal healthcare rollout.

Beyond delays, teachers also point to confusion caused by SHA’s multi-layered structure. Basic outpatient care is handled under one fund, inpatient services under another, and critical illnesses under a separate emergency pool.

While designed to spread risk, Kuppet Secondary Schools Secretary Edward Obwocha says it has created uncertainty at the point of care.

“Instead of simplifying healthcare, it has complicated it. Teachers are not sure what is covered and what is not,” said Obwocha.

The Ministry of Health has defended the transition, arguing that SHA offers long-term sustainability compared to private schemes like Minet.

“The previous systems were costly and not always equitable. SHA ensures a unified, government-backed system for all public officers,” a ministry official said.

Despite criticism, the government insists reforms are still stabilising.

Speaking on Sunday at African Gospel Church in Nairobi, President William Ruto defended the health overhaul, saying digitisation has eliminated fraud and inefficiencies.

“The situation then was different from what we have today. We have not only transformed health infrastructure, but also digitised it. There is no more paper left to be manipulated,” Ruto said.

He announced that the government will release Sh13 billion through SHA to hospitals for monthly reimbursements.

“That is what used to be collected in almost six months under NHIF. Now we are paying it in one month,” he said.

Ruto urged patience, insisting healthcare reforms are meant to guarantee universal access. “We are making health a right for all citizens, not a privilege for those who can afford it,” he added.

But for teachers on the ground, the debate is far from settled. Between policy promises and hospital realities lies a widening gap, one that union leaders warn could soon turn into a full-blown standoff over the future of Kenya’s healthcare system.