TSC Medical Scheme Crisis Continues as SHA Refuses to Onboard Educators
The situation for over 360,000 educators and their dependents under the Teachers Service Commission (TSC) medical scheme remains uncertain after the Social Health Authority (SHA) refused to include them, citing limited capacity and excessive costs.
During a session with the National Assembly’s Education Committee, TSC CEO Nancy Macharia disclosed that although Sh20 billion was allocated by the government for the scheme, SHA needed Sh37 billion to onboard the educators—a gap that also prevented the now-defunct National Health Insurance Fund (NHIF) from accepting them.
“This financial shortfall has been a recurring challenge,” Macharia stated. “Even last year, when we contemplated moving to SHA, they indicated they lacked the required infrastructure and needed Sh37 billion. We are currently managing the scheme with Sh20 billion. ”
Consequently, TSC renewed a three-year agreement with Minet Insurance in December 2022, which extends until November 2025.
The Minet-managed scheme has faced strong criticism from legislators, who characterized it as a “mongrel system” plagued by inefficiencies, delays, and a lack of empathy.
Igembe North MP Julius Taitum raised concerns about the absence of competition in the bidding process, suggesting a potential monopoly. “Is it that other insurers refrain from bidding because they realize it’s being mismanaged, harming the educators? ” he inquired.
Teso South MP Mary Emase shared a heartfelt account of teachers left waiting for hours or denied care due to delays in approvals. “Some are accused of feigning illness. Educators at Bungoma Life Care have been waiting indefinitely for authorization,” she remarked.
Committee Chair Julius Melly labeled the scheme as dysfunctional, referencing incidents such as a teacher being held at a Nairobi hospital for 90 days due to late payments. “This scheme is directionless. It needs a complete overhaul,” he stated.
Macharia attributed many of the problems to delayed government funding, indicating that providers sometimes withdraw services when payments are late.
“If our teachers were to receive the best medical treatment, they would require comprehensive insurance coverage. Unfortunately, this is not the case now due to budget limitations,” she explained.
Legislators advocated for a total restructuring of the scheme. Melly suggested segmenting teachers into clusters managed by different insurers to decentralize services and enhance efficiency.
“With Bliss Healthcare as the primary capitator, the approval processes are overwhelmed,” remarked Luanda MP Dick Maungu. “Why not divide it into clusters for improved management? ”
Baringo North MP John Makilap cautioned that unless significant changes occur before the contract concludes in 2025, educators will continue to face difficulties. “This unclear structure is ineffective. We must separate them into groups or transition to SHA,” he declared.
Taitum called for a comprehensive investigation into the consortium managing the scheme. “Teachers will not receive justice from this arrangement. We require a full-day examination of the service provider. ”
In defense of the existing model, TSC Director of Legal Services Cavin Anyour stated that the consortium consists of top-tier insurers. “Minet leads a coalition of eight leading providers. Those left out did not possess the capacity to deliver,” he asserted.
