Crisis for Teachers: Medical Coverage for Half a Million Teachers in Jeopardy as Treasury Delays Sh17.6 Billion
When Ronald Mitei, a dedicated teacher at Mogindo Primary School in Bomet County, took his 10-year-old child to AGC Tenwek Hospital last Wednesday, he expected to use his Minet Insurance cover. Like any other teacher employed by the Teachers Service Commission (TSC), Mitei believed his child, a beneficiary of his insurance, would receive treatment seamlessly.
To his dismay, Mitei received information that he had to pay in cash because Minet had not cleared the payments due to “financial and technical issues.” Despite attempts to use his wife’s insurance cover, who is also a teacher, they faced the same problem—preauthorization had not been approved. Ultimately, they resorted to using the National Hospital Insurance Fund (NHIF) and paid an additional Sh710 for medication and services.
This situation is not unique to Mitei. Numerous teachers have been turned away from hospitals due to non-authorization by Minet, attributed to the National Treasury’s delay in releasing Sh17.6 billion allocated for the annual medical scheme. This delay has left 406,635 teachers without access to essential healthcare services.
Funding Delays and Their Impact
The National Treasury has disbursed only Sh5.1 billion for the first quarter of the 2023/2024 financial year, leaving a significant shortfall of Sh12.5 billion. This gap has led to widespread disruptions in medical services for teachers, causing frustration and hardship.
During a Senate Committee on Health session chaired by Uasin Gishu Senator Jackson Mandago, representatives from TSC, the Kenya National Union of Teachers (Knut), and the Kenya Union of Post Primary Education Teachers (Kuppet) expressed their concerns over the delays. They criticized the Treasury for its failure to release the necessary funds promptly, emphasizing the detrimental effects on teachers’ access to healthcare.
Out of the Sh316.7 billion allocation to TSC for the current financial year, Sh17.6 billion was earmarked for medical cover for teachers. Ayabei Chumo, representing TSC CEO Nancy Macharia, explained that the commission relies on funds from the National Treasury to pay Minet, which then distributes the money to a consortium of eight insurance companies under Medical Administration Kenya Limited (MAKL). These companies are responsible for paying hospitals for the services provided to teachers.
The insurance consortium includes Bliss Healthcare Limited, Medical Administrators Kenya Limited, Old Mutual General Insurance Kenya Limited, Britam General Insurance Company (K) Limited, Star Discovery Insurance Limited, Pioneer Assurance Company Limited, and Star Discover Life Insurance Limited. The TSC signed a three-year contract with Minet Brokers Limited for the medical insurance cover, which runs from December 1, 2022, to November 31, 2025.
Coverage Details and Challenges
The contract covers all teachers employed by TSC, including one spouse and up to four dependents up to 18 years of age, extendable to 25 years for those in school or college. It provides up to Sh2 million for treatment in international hospitals and an additional Sh2 million for travel costs for the patient and one accompanying family member. The insurance plan includes outpatient, inpatient, dental, optical, maternity, psychiatric, counseling services, road and air evacuation, and funeral benefits.
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Despite these comprehensive benefits, the delay in releasing funds has caused significant challenges. Knut and Kuppet have urged the Treasury to expedite the release of funds to prevent further suffering and humiliation for teachers seeking medical attention. Knut Secretary General Collins Oyuu emphasized the need for timely fund disbursement to resolve the ongoing issues that have plagued the program for years.
Oyuu, along with other union leaders, suggested reconsidering the capitation financing model for awarding the tender. Kuppet Secretary General Akello Misori also highlighted the need to review cover limits, particularly for maternity expenses, to ensure equitable support for all teachers, regardless of their job group.
Senator Mandago and other committee members expressed concern over the complaints from teachers and called for a resolution. The medical scheme initially covered 416 health facilities, which has since expanded to 829, including public, faith-based, and private hospitals licensed by the Kenya Medical, Pharmacists, and Dentists Council (KMPDC).
Historical Context and Current Coverage
Before 2012, medical allowances were included in teachers’ pay slips, but the responsibility has since shifted to TSC to engage a medical insurer. The current scheme covers 1,288,395 members, including 361,000 principal members, 233,568 spouses, 353,767 sons, and 339,967 daughters. There are 800 medical and healthcare service providers in the 47 counties, including government, faith-based, and private facilities.
Initially, 416 health facilities received clearance to offer treatment under the scheme, but this number has grown to 829. Public, county, and government referral hospitals have increased from 71 to 146, mission and faith-based hospitals from 29 to 133, and privately managed facilities from 316 to 550.
In conclusion, the ongoing delay in releasing Sh17.6 billion by the National Treasury has put the medical coverage for over 400,000 teachers in jeopardy. The situation underscores the critical need for timely fund disbursement to ensure that teachers and their families can access essential healthcare services without interruption. As stakeholders continue to push for solutions, it remains imperative that the government addresses these issues promptly to prevent further hardship for the nation’s educators.
Crisis for Teachers: Medical Coverage for Half a Million Teachers in Jeopardy as Treasury Delays Sh17.6 Billion.
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