Teachers and law enforcement officers are enduring hardships in silence as a crisis affects their medical insurance plans.
The well-being of over one million educators, police personnel, and their dependents is jeopardized as hospitals refuse to provide services due to delayed payments.
For the past seven months, medical facilities have not received payments from state-sponsored health insurance schemes, forcing some of them to refuse treatment to patients who are unable to pay out of pocket.
The hospitals contracted are owed Sh11 billion for the medical coverage for teachers, resulting in 403,522 educators and 969,638 dependents experiencing difficulties.
Likewise, the medical schemes for more than 110,000 police officers and their dependents under the National Police Service (NPS) and Kenya Prisons Service are non-functional.
At least six hospitals have halted services for teachers covered under the Teachers Service Commission (TSC) medical scheme. A notification from Tenwek Hospital in Bomet County, for instance, indicated that it ceased providing medical services on credit as of February 1. Other hospitals affected include Kisii Referral Hospital and Reale Hospital in Uasin Gishu County.
Hospitals attribute the predicament to non-payments by the now-defunct National Hospital Insurance Fund, its successor Social Health Authority, and Medical Administrators Kenya Limited, which manages the teachers’ medical plan through Minet Kenya.
Some educators have reported that certain facilities are refusing them treatment despite not issuing official notifications. According to the contract, hospitals are required to provide a seven-day notice prior to suspending services.
Minet oversees around 600 medical providers nationwide, but more hospitals may take similar actions if the situation is not remedied.
On Tuesday, Minet Kenya Chief Executive Officer, Sammy Muthui, stated they are collaborating with the government to ensure the outstanding balance is addressed.
“It is a matter impacting all sectors due to financial flow issues in the country. There is a significant outstanding balance, but some promising progress has been made by TSC in discussions to settle the debt,” he remarked.
In a similar vein, police officers under APA Insurance, which assumed control of their medical scheme from CIC Insurance in April of last year, have reported deteriorating conditions.
“I manage a chronic illness that requires regular check-ups. The last visit to Nairobi West resulted in being told to wait an additional two weeks for my next consultation. How can you ask a sick person to wait 14 days? Does sickness wait? ” expressed an officer who wished to remain anonymous.
The situation is even graver for officers stationed in remote locations. “My wife was ill and needed to be taken to a hospital, but the insurance provider denied approval for treatment. I was hundreds of kilometers away, unable to assist, and they had to pay out of their own pockets,” recounted an officer posted in Lamu.
Both the Kenya National Union of Teachers and the Kenya Union of Post Primary Education Teachers have cautioned that this crisis might disrupt educational processes.
“What is transpiring in the teaching profession is unacceptable. We demand immediate action from Treasury Cabinet Secretary John Mbadi to address this crisis,” stated Moses Nthurima, the acting secretary general of the union.
Knut Secretary-General Collins Oyuu expressed that the situation was stripping teachers of their dignity, pointing out that those with chronic illnesses were the most impacted.
“We will not remain passive while our teachers endure suffering. It is essential to have a detailed plan from the government on how it intends to settle the outstanding balances with hospitals and also to engage in discussions with the hospitals so that teachers receive the services they rightfully deserve,” he remarked.
For police officers, the frustrations have escalated to a critical point, resulting in concerns about a possible go-slow.
A video that spread widely online last week showed a heated argument between a junior officer and a senior officer during a meeting aimed at addressing the insurance issue.
The junior officer accused the administration of neglecting their struggles, emphasizing the case of a colleague whose wife was refused treatment while he was on duty.
His peers in the room seemed to cheer in support, a rare instance of open defiance within the disciplined forces.
Despite numerous complaints, police officers claim they receive only vague promises that “the issue is being addressed. ”
Many are now advocating for the elimination of third-party brokers from the medical coverage system, asserting that direct relationships between hospitals and insurers functioned more effectively.
The teachers’ medical scheme, established in 2015, replaced a direct medical allowance that had previously been given to teachers.
Teachers and their dependents have rights to outpatient, inpatient, maternity, dental, optical, psychiatric, and counseling services, along with air and road evacuation, funeral benefits, international referrals, and travel allowances.
However, as a result of the government’s failure to make payments, hospitals have refused to provide these services, leaving teachers in a difficult position.
The teachers’ unions and police are insisting on prompt action from the Treasury, cautioning that further delays could lead to severe consequences.
“Teachers’ health is crucial. Delaying their access to healthcare infringes on their right to healthcare and undermines the right to human dignity. A sick teacher cannot be effective in the classroom,” stated Nthurima.
Teachers still suffering.
Teachers in Kenya are encountering major difficulties in obtaining medical care due to problems with their health insurance coverage.
Those who depend on the medical insurance plan provided by the Teachers Service Commission (TSC) have reported that private hospitals are no longer accepting their insurance.
Consequently, many teachers are turning to pharmacies for medical help or paying for healthcare out of their own pockets, leading to both financial and emotional stress for those impacted.
The medical insurance program for teachers is generally funded and overseen by the Teachers Service Commission (TSC), which is responsible for hiring, training, and managing teachers in Kenya.
This situation is causing significant distress among teachers, who now have to either shoulder the financial burden of medical expenses or experience delays in receiving essential care.
Some teachers have mentioned that even basic medical check-ups or consultations have become challenging to access.