TSC Medical Scheme Crisis Continues as SHA Refuses to Onboard Teachers
The future of over 360,000 teachers and their dependents covered by the Teachers Service Commission (TSC) medical scheme remains uncertain after the Social Health Authority (SHA) opted not to include them, citing a lack of sufficient capacity and unaffordable costs.
During an appearance before the National Assembly’s Education Committee, TSC CEO Nancy Macharia disclosed that while the government allocated Sh20 billion to the scheme, SHA needed Sh37 billion to onboard the teachers—an issue that also prevented the now-defunct National Health Insurance Fund (NHIF) from taking them on.
“This budget shortfall has been a persistent challenge,” stated Macharia. “Even last year, when we looked at moving to SHA, they informed us they lacked the required infrastructure and required Sh37 billion. We are currently operating the scheme with Sh20 billion. ”
Consequently, TSC extended a three-year agreement with Minet Insurance in December 2022, which is set to continue until November 2025.
The Minet-managed scheme has faced significant backlash from lawmakers, who labeled it a “mongrel system” plagued with inefficiencies, delays, and a lack of compassion.
Igembe North MP Julius Taitum questioned the absence of competition in the bidding process, suggesting a potential monopoly. “Is it that other insurers refrain from applying because they understand it’s being managed poorly, to the detriment of teachers? ” he inquired.
Teso South MP Mary Emase shared a heartfelt account of teachers who are left waiting for hours or are denied care due to approval delays. “Some are told they’re feigning illness. Teachers at Bungoma Life Care have waited endlessly for approval,” she explained.
Committee Chair Julius Melly described the scheme as dysfunctional, referencing instances such as a teacher being held at a Nairobi hospital for 90 days due to late payments. “This scheme lacks coherence. It needs a complete overhaul,” he remarked.
Macharia attributed many of the problems to delayed government payments, stating that providers sometimes withdraw services when funds are late.
“If our teachers were to receive the best medical care, they would require full insurance coverage. That’s not the situation currently due to budget limitations,” she noted.
Lawmakers called for a total restructuring of the scheme. Melly suggested segmenting teachers into clusters managed by different insurers to decentralize services and enhance efficiency.
“With Bliss Healthcare as the main capitator, approval processes are inundated,” stated Luanda MP Dick Maungu. “Why not break it down into clusters for improved management? ”
Baringo North MP John Makilap warned that unless significant modifications occur before the contract concludes in 2025, teachers will continue to endure hardships. “This vague structure won’t suffice. We must divide them into cohorts or shift to SHA,” he asserted.
Taitum demanded a thorough investigation into the consortium managing the scheme. “Teachers won’t receive justice from this arrangement. We need a full-day interrogation of the service provider. ”
In defense of the existing model, TSC Director of Legal Services Cavin Anyour affirmed that the consortium comprises top-tier insurers. “Minet heads a group of eight elite providers. Those who were excluded did not possess the capacity to deliver,” he explained.