Exclusive: How educators were neglected by SHA executives
The Social Health Authority (SHA) declined an offer to insure approximately 400,000 educators, citing a lack of adequate structures, according to the Teachers Service Commission (TSC).
Members of Parliament were informed that the SHA system would have required the TSC to pay Sh37 billion.
SHA explicitly stated that even if the commission had provided that amount, it would have taken one year to implement the system, TSC Chief Executive Nancy Macharia reported to the MPs.
Macharia indicated that, similar to SHA, teachers were also not insured under the abolished NHIF, as that organization had similarly presented exorbitant figures that the TSC could not accommodate.
Lack of Structures
Macharia was addressing an inquiry from Mandera South MP Abdul Haro, who questioned why the TSC had not transitioned teachers to SHA.
Macharia stated: “Last year, when we encountered issues with Minet, we sought to transition our educators to SHA, resulting in a meeting with SHA wherein we were informed that SHA lacked adequate structures for this purpose. ”
She continued: “We did meet with them, and besides indicating their lack of structures, they requested Sh37 billion to onboard teachers, and even at that, they informed us that they were not prepared to onboard them this year. Our [Minet] scheme operates on a budget of approximately Sh20 billion. ”
Macharia appeared before the Education Committee, which is chaired by Tinderet MP Julius Melly, to address inquiries concerning teachers’ health insurance.
Despite the challenges associated with the Minet cover, a three-year arrangement set to expire on November 30, she mentioned that the TSC has been unsuccessful in locating another insurance provider to cover the extensive number of teachers.
Macharia elaborated that the TSC had issued a tender; however, no insurance companies had submitted bids to provide insurance services.
Delays in Exchequer Payments
While the TSC had fully paid the contract for the second-year policy set to conclude on November 30, 2024, she stated that exchequer delays have resulted in outstanding payments for the first and second quarters of the third-year policy, which commenced on December 1, 2024, and March 1, with an associated bill of Sh11. 2 billion.
Macharia noted that the TSC will not be able to offer group life insurance for educators starting in November, when the existing arrangement expires, as the agency requires Sh1. 5 billion for this purpose.
Within the Minet scheme, educators are provided inpatient and outpatient services ranging from Sh1 million to Sh2. 5 million, dental coverage of Sh45,000, optical coverage of Sh60,000, maternity coverage between Sh120,000 and Sh300,000, evacuation allocations, as well as international and travel referral allocations amounting to Sh2 million and Sh200,000, respectively, and funeral expenses for principal members and transportation for immediate family members up to a maximum of 10 individuals of Sh300,000.
However, MPs dismissed the teachers’ insurance initiative, asserting it has failed educators and urging the TSC to develop a more effective coverage solution.
Several MPs recounted personal experiences involving the need to assist teachers receiving hospital treatment after the insurance scheme failed to pay their bills.
Lawmakers identified significant flaws in the scheme, asserting that it has left teachers to fend for themselves.
They pointed to delays in the approval of treatment, holdups in the authorization and pre-authorization processes, instances where patients have been turned away from hospitals, and the failure to pay final benefits for teachers who have passed away.
Melly indicated that he had to engage with Minet representatives after it was reported that a patient was allegedly held at Upper Hill Hospital for over 90 days due to the scheme’s failure to cover the expenses.
Melly stated: “We desire a credible insurance scheme for teachers. You must either categorize these teachers into groups and provide them with a suitable scheme or present us with a viable solution because the current approach is unacceptable. “The existing scheme resembles a disorganized amalgamation of insurance providers, which is rather farcical. ”
Amorphous’scheme
Joseph Makilap (Baringo North) characterized the scheme as amorphous and ineffectual for teachers. “As TSC, you have indicated that you are constrained by budget cuts, and it is evident that teachers will continue to endure hardships due to this conglomerate of insurance companies.
We urge you as TSC to convene and organize teachers into clusters to determine how they can benefit. If that is not feasible, let us include all teachers in SHA and subsequently seek divine assistance. ”
Julius Taitum (Igembe North) inquired about the reasons for the delay in the disbursement of final benefits: “Currently, teachers are not receiving their funds to manage the affairs of their deceased loved ones. What is occurring? ”
Dick Maungu (Luanda) remarked that the approval of treatment requests from teachers was taking an inordinate amount of time.
He stated: “The issue regarding insurance is a matter that is complex. It is an issue that initiated in 2015 and cannot be resolved instantaneously. Let TSC explore options to group the teachers so that they can be insured in a different manner. Otherwise, this is merely a consortium of disorganized firms that is utterly nonsensical; it does not qualify as an insurance company. ”
Jerusha Momanyi (Nyamira woman rep) emphasized that teachers were expressing their distress over the inadequate services provided by SHA, while Peter Orero (Kibra) raised concerns regarding the treatment of teachers in hospitals without being provided with medications. “When teachers attend hospitals … they receive treatment but are not supplied with medications. They are compelled to purchase their own medicine. ”
Mary Emase (Teso South) indicated that she too had to assist teachers from hospitals after their current scheme refused to cover their expenses. “There are significant issues within this scheme. Our teachers are in distress. If you wish for our teachers to remain in the classroom, please rectify these matters. ”
Emase recounted her experience of having to assist teachers admitted to hospitals due to the scheme’s refusal to settle their bills, noting that they are compelled to buy medication.
She stated: “There are significant issues within this scheme; our teachers are in distress. If you wish for our teachers to remain in the classroom, please rectify these matters. ”