Africa-Press – Kenya. Teachers, the Social Health Authority (SHA), and the Ministry of Health have signed a crucial agreement aimed at resolving long-standing medical scheme challenges and averting a looming nationwide teachers’ strike.
The deal, reached after high-level talks involving the ministry, SHA, and the Kenya National Union of Teachers (KNUT) on Tuesday, April 28, seeks to address operational bottlenecks that had disrupted the 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, announcing a raft of binding resolutions designed to restore seamless access to medical services across the country.
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, this year.
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.
“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.
As part of ensuring sustainability, SHA will undertake a nationwide tariff negotiation exercise targeting over 3,500 private and faith-based health facilities. The process, expected to run for four weeks, aims to standardise costs while ensuring quality healthcare delivery.
