Teachers are now seeking medical assistance from pharmacies or paying for their medical care after being turned away from private hospitals claiming they have not been paid by the government.
Tutors’ medical insurance scheme is sponsored by the Teachers Service Commission (TSC). The teachers now report that their cover is no longer being accepted, leaving them with limited options for healthcare.
Some teachers told the Business Daily that they have been forced to endure long waits in overcrowded public hospitals or resort to buying medicine over-the-counter without a proper diagnosis or prescription from a doctor.
“I’m a teacher under TSC. I happened to be sick last month. I went to Plainview hospital Ruiru n they informed me they aren’t treating teachers with minet. I then went to Nairobi West Ruiru Branch,same thing. I resorted to going to Gatundu Level Five Hospital where I used cash to be treated because even SHA doesn't allow outpatient. Yesterday I was in the same hospital and I’m using cash to be treated yet I have two insurance covers. Pathetic and painful,” said one teacher in Nairobi.
Trizah has been a teacher for 10 years now. She has two chronic illnesses—epilepsy and high blood pressure and she visits the hospital frequently.
She has to get drugs on a daily basis. She has never had any issues with her medical cove—AoN brokered by Minet under the Medical Administrators Kenya Limited. She recently started to have a fatty mass growing on her face, so she went to hospital to seek medical attention.
“I first went to a nearby private hospital near my neighbourhood and the doctors advised that the needs had to be removed,” she said. Trizah was denied service in the first private hospital. She then went to another bigger private hospital.
“They told me that they are not treating teachers who have Minet, that’s the same experience that I had when I went to the first hospital,” she says.
Since her condition was not getting any better, she went to a Level Five public hospital where there is some progress but she is paying the medical bills out-of-pocket.
“I am using cash yet I have SHA and Minet. It is pathetic and painful,” she says.
Triza is due for a surgery and she will have to pay at most Sh20, 000.
“Maybe SHA will cover the surgery, I am not sure, but I have paid for consultation and a CT scan,” she says.
Maria*, a teacher registered by the Teachers Service Commission and pays for the teachers’ backed medical insurance, also went to another private hospital in Nairobi and was denied service.
“I have been sick for some time so I have been going to this particular hospital to see a specific physician. It has always been seamless. This time, I was told that I won’t be treated because they are solving an impasse between the hospital and the insurer, so I had to wait,” she narrates.
After waiting for hours, she left after learning that the issue was not going to be resolved.
“I went to a different hospital and saw a general doctor. I followed up after two weeks, and after a month but to this day I can’t go back to see the physician that was handling my case in the previous hospital,” she adds.
Another teacher from Western Kenya took his son to hospital.
“I saw the medical officer on duty and even got a prescription for his drugs. When I got to the pharmacy, we were not given drugs. I was not the only one. I wonder why we pay yet we still have to buy drugs elsewhere,” says the teacher.
Rural and Urban Private Hospitals Association (Rupha) Chairperson Dr Brian Lishenga told Nation that more than 600 of their facilities is owed about X million that has not been remitted to their facilities since May last year. It is only last month that they received payments from April last year.
“They’ve owed liabilities for almost a year now, we suspended services because, frankly, how do you deliver without resources? It’s like telling the Principal Secretary in charge of medical services that he won’t get his salary for a year, then threatening to deport him when he refuses to work. Does that make sense?” he asked.
According to Kenya Union of Post Primary Education Teachers (Kuppet), the Sh22 billion Teachers’ Medical Scheme is on the brink of collapse, with private and rural mission hospitals suspending services due to mounting unpaid bills owed by the scheme’s underwriter.
According to the teachers' union, the Sh22 billion Teachers’ Medical Scheme is on the brink of collapse, with private and rural mission hospitals suspending services due to mounting unpaid bills owed by the scheme’s underwriter.
“Only public hospitals – of which there are very few across Kenya – are currently offering services to teachers. Some little money of the Medical capitation funds were last released in September 2024 following the return-to-work formula/court consent signed between Kuppet and the TSCeachers are now forced to que in to end the industrial action by Kuppet over the scheme. Regrettably, the funds released in September went to off-setting arrears for the previous two quarters – implying that hospitals have not been paid for services rendered since September 2024,” said Moses Nthurima, Acting Secretary General.
The tussle between teachers and the TSC over the Minet-administered medical scheme has intensified, despite a return-to-work formula signed in August 2024 to end industrial action. The agreement mandated the timely release of medical capitation funds to restore healthcare services for teachers, but the government has yet to remit over Sh11 billion.
“The teachers medical cover is not working. Government is not paying service providers hence teachers are not getting services because the service providers are reluctant to provide services,” said Edward Obwocha
However while appearing before the Education Committee, the Teachers Service Commission (TSC) CEO highlighted that sh4.9 billion has been allocated towards teachers' medical health insurance for the Financial Year 2024/25. However, a shortfall of sh9.3 billion remains, jeopardising comprehensive coverage.
“By not properly funding the scheme, the TSC is in contempt of the consent order which obligated it to fully restore medical services to teachers. The National Treasury is equally at fault for not remitting funds that have been duly appropriated by Parliament for teachers’ medical scheme,” he said.
“Teachers are falling ill and are now forced to queue in overcrowded public hospitals because private hospitals have withdrawn their services due to unpaid bills. As a result, sick teachers are being turned away — and when they’re unwell, they simply can’t deliver quality education in schools,” he added.
