Teachers, the Social Health Authority (SHA), and the Ministry of Health have formalised a key agreement to address persistent medical scheme issues and prevent a potential nationwide teachers’ strike.

The pact, finalised after high-level discussions on Tuesday, April 28, 2026, between the ministry, SHA, and the Kenya National Union of Teachers (KNUT), focuses on resolving operational challenges that had hindered the smooth transition of the Mwalimu Cover to the Public Officers Medical Scheme Fund (POMSF).

In a joint communiqué, the three parties reaffirmed their commitment to safeguarding the health and welfare of teachers and announced a raft of binding resolutions to restore seamless access to medical services nationwide.

Among the key resolutions is the full restoration of the Last Expense Benefit, with a streamlined claims process now in place. The benefit has been set at Ksh300,000, with 160 pending claims already processed and payments to beneficiaries scheduled for release from April 29, 2026.

“To ensure health systems serve and do not frustrate teachers, SHA will immediately withdraw the tariff locking currently configured in the system. Locked tariffs shall only be implemented after comprehensive negotiations and are concluded, and exclusively with healthcare providers,” the communiqué read in part.

At the same time, the agreement also formalises an Ex-Gratia Management Framework to support teachers facing medical expenses beyond standard cover limits.

Under this arrangement, the Teachers Service Commission (TSC) will process requests, while the SHA will facilitate payment of approved compassionate claims.

Additionally, the scheme has now been expanded to include overseas treatment, with several specialised hospitals in countries such as India, Turkey, and Saudi Arabia now contracted.  

Teachers will also benefit from enhanced reproductive health services, with the inclusion of In Vitro Fertilization (IVF) treatment at designated facilities, in a bid to make the coverage more comprehensive and responsive to diverse health needs.

In a major policy shift, SHA has agreed to immediately withdraw tariff locking within the system, a move that had previously drawn sharp criticism from teachers.

During the interim period, all contracted health facilities have been directed not to charge teachers any out-of-pocket fees.

“Key issues included overseas treatment, in vitro fertilisation (IVF) services, management of chronic conditions and concerns around benefit capping under SHA. We also addressed emerging implementation gaps, with a shared commitment to improving quality and access to healthcare, “Health Cabinet Secretary Aden Duale wrote on X.

“We are rolling out a decentralised National Ambulance Service under SHA to strengthen emergency response and referral systems. Quarterly engagements have been agreed upon to sustain coordination and resolve emerging issues.”

To support long-term sustainability, SHA plans to conduct a nationwide tariff negotiation involving more than 3,500 private and faith-based health facilities.

Scheduled to take place over four weeks, the initiative seeks to harmonise pricing structures while maintaining high standards of healthcare delivery.