Sick teachers: Half a million tutors’ medical covers in limbo as Treasury delays Sh17.6 billion

Collins Oyuu

Knut Secretary General Collins Oyuu (left) with Deputy Secretary General Hesbon Otieno after addressing journalists at their headquarters in Nairobi on February 6, 2024.

Photo credit: Lucy Wanjiru | Nation Media Group

What you need to know:

  • Out of the Sh316.7 billion allocated to TSC in the current financial year, Sh 17.6 billion was appropriated for medical cover for the teachers.
  • Teachers are covered by Minet Brokers Limited, which subcontracted a consortium of eight other insurance companies under Medical Administration Kenya Limited to provide services across the 47 counties.

When Ronald Mitei, a teacher at Mogindo Primary School in Bomet County, took his 10-year-old child to AGC Tenwek Hospital for treatment last Wednesday, he did not expect to pay cash for the services.

"Like any other teacher employed by the Teachers Service Commission (TSC), and having a Minet Insurance cover, I expected my child, who is covered as a beneficiary, to be treated without a hitch," Mr Mitei told Nation.Africa.

However, he was shocked when he was told he had to pay for the service in cash because Minet had not cleared the payments for his child's treatment due to "financial and technical issues."

"I tried to log on using my wife’s cover, who is also a teacher, but the results were the same – preauthorization had not been approved. We then opted to use the National Hospital Insurance Cover (NHIF) and topped up Sh710 to access medication and drugs at the hospital," Mr Mitei revealed.

"It was not the first time I was experiencing challenges using the Minet cover at the hospital. A year ago, I was equally turned away, along with other teachers, while seeking medication after services were suspended for alleged nonpayment of capitation by the insurer,” he added.

Hundreds of teachers have been turned away from hospitals due to non-authorisation by the Minet for treatment, attributed to the failure of the National Treasury to release funds for the medical scheme.

The National Treasury has been blamed for delaying the release of Sh17.6 billion to the TSC for the annual medical scheme, leaving 406,635 teachers and tutors without access to necessary healthcare services.

Treasury has only disbursed Sh5.1 billion for the first quarter of the 2023/2024 financial year, leaving Sh12.5 billion outstanding, with the shortfall leading to numerous teachers being turned away from hospitals.

Representatives from TSC, the Kenya National Union of Teachers (Knut), and the Kenya Union of Post Primary Education Teachers (Kuppet) criticized the Treasury for the delays during a Senate Committee on Health session chaired by Uasin Gishu Senator Jackson Mandago earlier this week.

Out of the Sh316.7 billion allocated to TSC in the current financial year, Sh 17.6 billion was appropriated for medical cover for the teachers.

“The commission depends on the funds released from the National Treasury for onward payment to Minet that in turn releases the money to the consortium under MAKL that then pays the hospitals the bills that are due,” said Ayabei Chumo, representing TSC CEO Nancy Macharia.

Teachers are covered by Minet Brokers Limited, which subcontracted a consortium of eight other insurance companies under Medical Administration Kenya Limited (MAKL) to provide services across the 47 counties.

The companies include - 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. 

“TSC signed a three-year contract for the service with Minet Broker Limited for the medical insurance cover for teachers serving in public schools and employed by the commission, but excluding the 46,000 serving on contract as interns,” Mr Chumo told the committee.

The contract runs from December 1, 2022, to November 31, 2025, and was awarded to Minet after a competitive bidding process.

“The contract covers all teachers employed by TSC, one spouse, four dependants up to 18 years and 25 years for those who can prove they are in school or in college,” Mr Chumo told the Senators.

The contract provides up to Sh2 million for treatment in international hospitals and Sh2 million for travel costs for the patient and one accompanying family member.

Knut and Kuppet urged the Treasury to expedite the release of funds to save teachers from suffering and humiliation while seeking medical attention.

The cover includes outpatient, in-patient, dental, optical, maternity, psychiatric, and counselling services, as well as road and air evacuation and funeral benefits.

“It is important for the National Treasury to release on time the outstanding funds and what is periodically due to TSC to pay for the insurance cover. This will bring to an end the perennial challenges that have dogged the programme for several years,” Knut Secretary General Collins Oyuu said. 

Mr Oyuu, flanked by first national vice chairman Malel Langat, Deputy Secretary General Hesbon Otieno and second national Woman Representative Mercy Ndung’u, said the award of the tender by TSC to the providers under the capitation financing model instead of full insurance should be changed in the future.

Kuppet Secretary General Akello Misori also weighed in on the matter, saying: "The review of cover limits, particularly concerning maternity expenses, should be conducted on a need basis 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 regarding the medical cover 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).

Before 2012, medical allowance was included in teachers’ pay slips, but the responsibility has since shifted to the TSC to engage a medical insurer.

In Primary and Secondary schools, 1,288,395 members are under insurance coverage, with 361,000 teachers as Principal Members with 233,568 spouses, 353,767 sons and 339,967 daughters, according to available statistics.

There are 800 medical and health care service providers in the 47 counties – that comprises levels two to six, managed by the government, faith-based and private companies – have been cleared to offer treatment to teachers in the country under the scheme.

Available documents show that initially, 416 health facilities had been cleared, but it currently stands at 829 hospitals - a total of 71 public, county and government referral hospitals were listed in the tender list, but the numbers have since risen to 146.

Mission and Faith-based hospitals in the tender list were originally 29 but rose to 133, while privately managed facilities were 316 but have since risen to 550.

Under the medical cover, the benefiting teachers and their family members registered as dependents are entitled to outpatient, in-patient, dental, optical, maternity, psychiatric and counselling services, road and air evacuation, funeral benefits, international referrals, and travel allocation benefits.