Union of Kenya Civil Servants Secretary General Tom Odege addressing journalists in Nairobi on September 3, 2024.
Civil servants have warned of a strike beginning March 18 if the government fails to address their grievances on the new medical scheme run by the Social Health Authority (SHA).
Representatives of civil servants and medics have told MPs their members in national and county governments are now being forced to fundraise to meet their medical needs because the state-run scheme is not working.
This despite having their monthly pay deducted twice to finance the Social Health Insurance Fund (SHIF) and the forfeiture of their medical allowance to the Public Officers Medical Fund (POMF).
This comes as hospitals across the country decided not to treat patients under the POMF scheme over the non-payment of bills incurred by civil servants running into billions of shillings. The decision by the hospitals to deny the public servants treatment has seen the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) and the Union of Kenya Civil Servants (UKCS) threaten industrial action.
In a document tabled before the Health committee of the National Assembly last week, KMPDU Secretary-General Davji Atellah and his UKCS counterpart Tom Odege warned that public servants will boycott work unless the matter is addressed.
Kenya Medical Practitioners Pharmacists and Dentists Union (KMPDU) Secretary General Dr Davji Bhimji Atellah.
“We are giving the government two weeks to resolve this issue once and for all. Failure to do so, we will call on all civil servants in both national and county governments to join a series of demonstrations starting March 18, 2025,” states the March 4 document.
“Civil servants across the country are wasting valuable time chasing medical services while simultaneously being subjected to cash payment demands for the same,” said Mr Odege.
KMPDU and UKCS are planning to escalate the matter to a national strike within 30 days “to demand a functional comprehensive medical insurance scheme”.
“Frustrating civil servants by denying them their entitlements will not be tolerated,” the unions said.
A notice issued by Dr Brian Lishenga, the Chairman, Rural and Urban Private Hospitals Association of Kenya (Rupha), towards the end of last month stated that “patients seeking care under SHA will need to make cash payments at private and faith-based hospitals”.
“This is not a decision we wanted to make but it has become unavoidable to safeguard patient care and hospital sustainability,” Dr Lishenga said.
However, Rupha last week lifted the suspension of SHA after President Ruto directed partial payment of debts owed by government to the facilities.
But faith-based healthcare providers also issued a 14-day ultimatum to the government to settle the Sh10 billion debt owed to them or they will require patients to pay cash for services.
The Rural Private Hospitals Association of Kenya chairman Brian Lishenga.
The government has been providing a comprehensive insurance cover for public officers that includes medical (Sh5.4 billion), group life (sh3.6 billion), group personal accident (Sh1.1 billion) and Work Injury Benefit Act (Wiba) at Sh1.1 billion.
The cover was under the National Health Insurance Fund (NHIF), jointly with private insurance companies, but expired on April 31, 2024. NHIF has since ceased operations and replaced with SHA.
This has left civil servants exposed and on their own. This means that civil servants who get sick, injured from occupational exposure or die while in the course of duty, are not being paid their benefits.
The Public Service Superannuation Scheme Act of 2012 states that death in service and disability for all pensionable public servants should be paid at five years basic pay—pensionable emolument—and Wiba.
The comprehensive medical cover for the public servants was established in 2012 when the government employees forfeited their medical allowance for a medical insurance scheme, which was captured in the collective bargaining agreement for all civil servants.
The scheme would later evolve from co-payment and capitation to a fee-for-service model and was widely accepted by civil servants and their dependants.
However, the policy was terminated with the enactment of the Social Health Act,.
In November last year, an agreement was signed introducing the POMF to be managed by SHA, which KMPDU and UKCS say “now seems to be falling short of expectations”.
“The public servants are now back to fundraising for their medical needs despite being deducted for SHIF and the forfeiture of their medical allowance to POMF,” the document before the Health committee reads.
Now, unless a public servant has private medical insurance, they may be exposed to increased out-of-pocket expenditures to settle medical bills, especially for those with chronic illnesses.
The public workforce may also experience worse health outcomes due to decreased access to necessary treatments and preventive care, exposing them to public hospitals that are not sufficiently equipped to handle the range of services the members need.
The risk of increased patient load in private hospitals due to underfunding in public hospitals may lead to an influx of patients who cannot afford care, “leading to overcrowding and longer waiting periods hence compromising quality”.
“A healthy worker is a productive worker and as a union, we will not tolerate any attempts to drag us into unnecessary industrial disputes caused by deliberate efforts to undermine our members’ medical insurance coverage,” the document states.
Kitutu Chache South MP Anthony Kibagendi, a member of the National Assembly’s Health committee, said that the government’s lack of a proper financing mechanism for public servants’ medical insurance schemes poses serious risks for the healthcare providers, insurance companies, public health, and vulnerable groups.
“A reduction in health insurance coverage may lead to a rise in the number of uninsured individuals, placing additional pressure on emergency services and public health systems,” said Mr Kibagendi.
Further, the MP noted that the implication of “this reduction” is poor health workers’ productivity, which can have broader economic repercussions. Increased healthcare costs can also strain government resources and budgets.
“The government may need to explore alternative funding mechanisms, such as public-private partnerships or increased taxes to mitigate the negative effects of budget cuts,” he said.
