Exclusive: How TSC Teachers were neglected by SHA executives

Exclusive: How educators were neglected by SHA executives

The Social Health Authority (SHA) rejected a proposal to insure approximately 400,000 educators, stating that it lacked sufficient structures, according to the Teachers Service Commission (TSC).

MPs were informed that the SHA system would have billed the TSC Sh37 billion.

SHA was explicit that even if the commission had provided that payment, it would have required one year to finalize implementation, TSC chief executive Nancy Macharia conveyed to the legislators.

Similar to SHA, Macharia mentioned that teachers were also not covered under the now-defunct NHIF, as it also cited substantial figures that the TSC was unable to afford.

No infrastructure

Macharia was addressing an inquiry from Mandera South MP Abdul Haro, who questioned why the TSC had not transitioned teachers to SHA.

Macharia stated: “When we faced challenges with Minet last year, we considered transferring our teachers to SHA, so we convened a meeting with SHA and were informed that SHA lacked adequate structures for this. ”

She continued: “We did meet with them, and aside from stating they did not have structures, they requested Sh37 billion to onboard teachers, and even then, they indicated they were not prepared to onboard them this year. Our [Minet] program operates on a budget of about Sh20 billion. ”

Macharia appeared before the Education Committee, led by Tinderet MP Julius Melly, to answer inquiries regarding teachers’ health insurance.

While the Minet coverage – extended for a three-year duration, expiring on November 30 – has its issues, she noted, the TSC has been unable to secure another insurance provider to accommodate the large number of teachers.

Macharia clarified that the TSC had issued a tender but no insurance companies had put forth a bid to provide insurance services.

Government payment delays

Even though the TSC had completely settled the contract for the second-year policy concluding on November 30, 2024, she stated that government payment delays meant that it had not yet provided payment for the first and second quarters of the third-year policy, which commenced on December 1, 2024, and March 1, with the total obligation at Sh11. 2 billion.

The TSC, she noted, will be unable to offer group life insurance for teachers starting in November, when it expires, as the agency needs Sh1. 5 billion for it.

Through the Minet plan, teachers receive inpatient and outpatient services ranging from Sh1 million to Sh2. 5 million, dental coverage of Sh45,000, optical of Sh60,000, maternity ranging from Sh120,000 to Sh300,000, evacuation funds, international and travel referral allocations of Sh2 million and Sh200,000 respectively, and funeral costs for primary members along with transportation for immediate family members up to 10 people at Sh300,000.

However, MPs dismissed the teachers’ insurance program, asserting that it had failed educators and calling on the TSC to create a more effective coverage plan.

Several MPs shared personal anecdotes about needing to assist teachers hospitalized when the insurance scheme failed to pay their bills.
Lawmakers identified flaws in the program, stating it had left teachers to struggle on their own.

They mentioned late approvals for treatment, delays in the approval of authorization and pre-authorization forms, patients being refused entry at hospitals, and the failure to pay final benefits for teachers who have passed away.

Melly stated he needed to consult with Minet representatives after a patient was reportedly held at Upper Hill Hospital for over 90 days because the scheme failed to cover the expenses.

Melly expressed: “We need a reliable insurance scheme for teachers. You must either categorize these teachers into groups and provide them with a suitable scheme or offer us a solution, because what you are doing is not acceptable. “The current scheme is merely a mix of insurance providers, which is quite a ridiculous scheme. ”

Amorphous scheme

Joseph Makilap (Baringo North) described the scheme as amorphous and unhelpful for teachers. “As TSC, you have indicated you are experiencing budget cuts and it is evident that teachers will keep suffering due to this group of insurance companies.

We are advising you as TSC to meet and organize teachers to determine how they can benefit. If not, let us enroll all teachers into SHA and from there we request divine assistance. ”

Julius Taitum (Igembe North) wanted to know why the disbursement of final benefits was delayed: “Currently, teachers are not receiving their funds to handle the affairs of their deceased loved ones. What is occurring? ”

Dick Maungu (Luanda) remarked that it was taking too long to process treatment requests from teachers.

He noted: “This insurance situation is a complex matter. It is an issue that began in 2015 and cannot be resolved instantaneously. Let TSC go and figure out how to group the teachers so that they can be insured differently. Otherwise, this is a coalition of ambiguous firms that is simply nonsensical, it is not an insurance company at all. ”

Jerusha Momanyi (Nyamira woman rep) asserted that teachers were expressing distress over the inadequate services provided by SHA, while Peter Orero (Kibra) inquired why teachers were only treated at hospitals without receiving medications. “When teachers visit hospitals … they are treated but not given medicines. They are compelled to purchase medication. ”

Mary Emase (Teso South) mentioned she also had to help teachers out of hospitals after their current scheme refused to pay their bills. “There are issues with this scheme. Our teachers are in distress. If you want our teachers to remain in class, please resolve these matters. ”

Emase recounted how she was compelled to assist teachers hospitalized as the scheme would not cover their bills, saying they are forced to pay for their medications.

She stated: “There are issues with this scheme, our teachers are suffering. If you want our teachers to remain in class please resolve these matters. ”