The Social Health Authority (SHA) turned down an offer to insure about 400,000 teachers on the grounds that it did not have adequate structures, the Teachers Service Commission (TSC) has said.

The SHA system, MPs heard, would have charged the TSC Sh37 billion.

SHA was categorical that even if the commission had paid that money, it would have taken one year to operationalise it, TSC chief executive Nancy Macharia told MPs.

As with SHA, Macharia said, teachers were not insured under the defunct NHIF either, because the latter also quoted enormous figures that the TSC was unable to pay.

‘No structures’

Macharia was responding to a question from Mandera South MP Abdul Haro, who sought to know why the TSC had not moved teachers to SHA.

Said Macharia: “When last year we had issues with Minet, we wanted to move our teachers to SHA, so we had a meeting with SHA and we were advised that SHA did not have adequate structures for this.”

She added: “We did have a meeting with them and apart from saying they do not have structures, they asked us for Sh37 billion to onboard teachers, and even then, they told us that they were not ready to onboard them this year. Our [Minet] scheme runs on a budget of about Sh20 billion.”

Macharia appeared before the Education Committee, chaired by Tinderet MP Julius Melly, to respond to questions about teachers’ health insurance.

While the Minet cover – offered for a three-year term, which expires on November 30 – has problems, she said, the TSC has been unable to find another insurance company to cover the large number of teachers.

Macharia explained that the TSC had floated a tender but no insurance firms had submitted a bid to offer insurance services.

Exchequer delays

Though the TSC had fully paid the contract for the second-year policy ending on November 30, 2024, she said, exchequer delays meant that it had yet to pay for the first and second quarters of the third-year policy, which started on December 1, 2024 and March 1, with the bill at Sh11.2 billion.

The TSC, she added, will not be able to provide group life insurance for teachers beginning November, when it expires, as the agency requires Sh1.5 billion for it.

Under the Minet scheme, teachers are offered inpatient and outpatient services ranging between Sh1 million and Sh2.5 million, dental cover amounting of Sh45,000, optical of Sh60 000, maternity of Sh120,000-300,000, evacuation allocation, international and travel referral allocation amounting to Sh2 million and Sh200,000 respectively, and funeral expenses for principal members and transport for immediate family members up to a maximum of 10 people of Sh300,000

But MPs rubbished the teachers’ insurance scheme, saying it had failed teachers and asking the TSC to come up with a better cover.

Some MPs shared personal stories about having to bail out teachers being treated at hospitals after the insurance scheme failed to settle their bills.

Lawmakers poked holes in the scheme, saying it had left teachers to suffer on their own.

They cited late approvals for treatment, delays in approving authorisation and pre-authorisation forms, patients being turned away from hospitals, and failure to pay last benefits for teachers who have died.

Melly said he had to speak with Minet representatives after a patient was allegedly detained at Upper Hill Hospital for more than 90 days because the scheme failed to the the bills.

Said Melly: “We want a credible insurance scheme for teachers. You either divide these teachers in groups and give them a good scheme or give us a way forward, because what you are doing is not right. “The current scheme is just a mongrel of insurance providers, which is a very funny scheme.”

‘Amorphous’ scheme

Joseph Makilap (Baringo North) called the scheme amorphous and unhelpful to teachers. “As TSC, you said you are suffering from budget cuts and it is clear that teachers will continue to suffer due to this conglomerate of insurance firms. We are telling you as TSC you sit down and cluster teachers and see how they can benefit. If not, let us onboard all teachers into SHA and from there we say God help us.”

Julius Taitum (Igembe North) sought to know why the payment of last benefits was delayed: “Today, teachers are not getting their money to dispose of their loved ones. What is happening?”

Dick Maungu (Luanda) said it was taking too long to approve treatment requests from teachers.

He said: “This insurance issue is a matter that is difficult to deal with. It is a matter that started in 2015 and cannot be solved at once. Let TSC go and see how to cluster the teachers so that they can be insured differently. Otherwise this is a consortium of amorphous firms that is just crazy, it is not an insurance company at all.”

Jerusha Momanyi (Nyamira woman rep) claimed teachers were crying out over poor services offered by SHA, while Peter Orero (Kibra) sought to know why teachers were only treated at hospitals but not given medicines. “When teachers go to hospitals … they are treated and not given medicines. They are forced to buy medicine.”

Mary Emase (Teso South) said she too had to bail out teachers from hospitals after their current scheme decline to settle their bills. “There are problems in this scheme. Our teachers are suffering. If you want our teachers to be in class, please address these issues.

Emase narrated how she was forced to also bail out teachers admitted in hospitals as the scheme decline settle their bills, saying they are forced to buy medicine.

She said: “There are problems in this scheme, our teachers are suffering. If you want our teachers to be in class please address these issues.”