Confusion over new Sh26bn teachers’ SHA medical scheme

By Newsflash Writer

Uncertainty continues to cloud the proposed Sh26 billion medical insurance for teachers under the Social Health Authority (SHA), as internal documents raise concerns over the overall cost and the specific services to be provided.

The plan—set to cost taxpayers an additional Sh11 billion to cover roughly 400,000 tutors—has split the education sector, with critics accusing decision-makers of pushing the transition without meaningful consultation.

Union leaders and the Teachers Service Commission (TSC) have insisted that teachers will not face extra deductions under the SHA arrangement, saying the government will shoulder the additional Sh11 billion needed to sustain the new scheme. However, private discussions among union officials indicate unease, with some warning that the authority’s mounting debt to hospitals could eventually affect access to healthcare for teachers.

Fears over tests, delays and the transition process

Delayed payments under the SHA have already caused some health facilities to turn away patients unable to rely on private insurance or pay out of pocket. A senior union official, who requested anonymity to discuss the matter candidly, said colleagues who initially endorsed the deal are increasingly worried that unresolved hospital debts could spill over and disrupt services for teachers once the transition begins.

The unions have also cautioned that if teething problems persist after rollout, they will invoke a clause allowing them to cancel the agreement within 30 days. The transition is guided by the Public Officers Medical Scheme Fund Regulations No. 195 of 2024, which created the Public Officers Medical Scheme Fund (POMSF) to administer health benefits for government employees.

A TSC brief to unions revealed that teachers may be required to personally pay for certain high-cost diagnostic tests meant to detect conditions such as cancer, sepsis and severe pneumonia when seeking outpatient services. While the TSC insists all current benefits offered under the Minet-led scheme will be carried over and improved, the documentation suggests that some advanced laboratory tests will only be covered under inpatient care. This is a departure from the outgoing scheme, which includes many of these diagnostics under outpatient services.

TSC acting CEO Eleveen Mitei defended the transition, saying teachers’ benefits will not be watered down. She emphasised that the government has significantly expanded funding—moving from the previous Sh9 billion medical allowance to a Sh26 billion comprehensive scheme. Teachers will continue contributing as before, with the only change being the shift from Minet to SHA management. Mitei also stated that educators will still draw from the Social Health Insurance Fund (SHIF) while enjoying enhanced benefits under POMSF.

Under the Social Health Insurance Act of 2023, the system is anchored on three funds: the Primary Healthcare Fund, SHIF and the Emergency, Chronic and Critical Illness Fund. Teachers will continue remitting to SHIF, while POMSF provides additional, tailor-made coverage.

Union leaders have echoed the message that teacher contributions will not increase. Kenya National Union of Teachers Deputy Secretary-General Hesbon Otieno said the scheme remains the same, only under a new administrator. Kenya Union of Post Primary Education Teachers Deputy Secretary-General Moses Nthurima, while acknowledging ongoing concerns, urged teachers to wait for the final contract. He argued that the law only outlines a general framework, leaving the contractual parties to fill in coverage details.

Expanded benefits and larger hospital network

Documents shared with unions outline coverage for various job groups. Teachers in Job Group B will enjoy unlimited inpatient and outpatient services, with specified benefits for dental (Sh45,000), optical (Sh60,000) and maternity (Sh120,000). They will also receive Sh300,000 for funeral expenses and Sh2 million for overseas treatment, including Sh200,000 for travel.

Teachers in job groups C1 to C5 will retain unlimited inpatient and outpatient coverage for lower cadres, with limits rising to between Sh1.5 million and Sh1.8 million for higher categories. Their benefits include dental, optical, maternity, evacuation support, funeral cover and international treatment where applicable.

Senior teachers in job groups D1 to D5 will receive the highest coverage caps ranging from Sh2 million to Sh3 million.

The SHA scheme will cover teachers, their spouses and up to five children. Those with larger families will receive guidance on additional coverage options. The package is exclusive to teachers and will not be merged with other public service schemes. One of the most significant improvements is the expansion of accredited facilities—from 800 to 9,600 nationwide—covering levels two to six across public, private and faith-based hospitals.

Teachers will also access overseas treatment, including air travel, while chronic disease management will be streamlined to allow direct treatment in private facilities without pre-approval hurdles. Faster approval timelines and dedicated support officers have been introduced to ease the transition from the outgoing scheme.