This archive report was first published on 23 November 2021.
Kenya's Largest Medical Insurance Scheme Under Fire ¶
Financed by the Teachers Service Commission (TSC), the scheme has been running for six years, covering 334,531 teachers and their 734,372 dependants as of July this year.
The commission collects more than Sh6 billion from teachers in premiums and gets Sh3 billion more from the government towards the scheme.
However, teachers have expressed dissatisfaction with the scheme, citing poor service, inaccessibility, bureaucracy, corruption, and failing to solve problems it was meant to.
Some service providers have spoken of strained relations with Minet Kenya, the insurance brokers who administer the scheme.
"We are experiencing a strained relationship with teachers because there is a limit to which private business can bend backwards to accommodate debt. In the case of teachers, there is non-payment and breach of contractual terms," said private health care service providers lobby chairperson Kenneth Maguta.
Mr Maguta, who runs The Virgin Hospital in Murang'a, said unless the insurance scheme managers revisit the contractual commitments, many hospitals will be forced to require teachers to pay for treatment.
He added that key among the complaints is the scheme refusing to honour payments, discriminating beneficiaries, and failing to engage providers to address the conflict.
"As things stand now, we are contemplating going to court so that we can have our pending bills paid and seek judicial consideration that we be absolved of blame should we turn away teachers seeking treatment on the strength of the health scheme since it amounts to obtaining services by false pretence," he said.
Teachers in various counties have expressed similar dissatisfaction with the scheme, citing issues such as limited hospital options, poor quality of services, and long referral processes.
"Using this scheme has been frustrating and humiliating," said a secondary school teacher from Molo sub-county who only gave his name as John for fear of reprisal.
He criticised the one visit per week rule for out-patient treatment and said some hospitals inflate bills, leading to letters from the National Hospital Insurance Fund (NHIF) and TSC to explain why the bills are so high.
Teachers in western and Nyanza regions also expressed disappointment with the quality of medical services at designated facilities.
"Our teachers are suffering because of the capitation, which limits how much they can spend per visit," said Mr Harrison Otota, the executive secretary of Kuppet in Kakamega County.
He called for the scrapping of the Sh1,200 and Sh1,500 fee teachers pay per visit when seeking outpatient services.
Minet Kenya did not respond to an email seeking a comment.
Reporting by Mwangi Muiruri, David Muchui, Regina Kinogu, Francis Mureithi, Benson Amadala, George Odiwuor, Elizabeth Ojina, and Geoffrey Ondieki.
