Over a million teachers and their dependents face uncertainty as hospitals begin to deny medical services due to delays in the release of capitation funds for medical cover.
For six months, hospitals have gone without payments for teacher’s health insurance, forcing some facilities to turn away patients or demand cash up front.
Hospitals are owed Sh11 billion, accrued over the past six months.
The effects will see a total population of 1,373,160 at risk with 403,522 teachers and 969,638 dependents affected by the delays.
A notice to the public seen by from Tenwek hospital in Bomet County indicates the facility has paused medical services on credit effective February 1.
“AGC Tenwek Hospital wishes to inform all stakeholders that effective 1st February 2025, the hospital will no longer provide services to members under Medical Administrator Kenya Limited (MAKL),” the notice dated January 29 reads.
However, the medical scheme provider on 11th February said they are not aware of any teacher turned away from seeking services.
The Teachers Service Commission (TSC) and the National Treasury equally remain silent on the crisis, with neither addressing the growing concerns.
Meanwhile, frustration is mounting as teachers, whose salaries are already stretched, are forced to dig into their pockets to access healthcare services.
Recently, the Kenya Union of Post-Primary Education Teachers (KUPPET) sounded the alarm, demanding the immediate release of Sh11 billion for teachers’ medical cover by the National Treasury to avert a crisis.
In response, KUPPET acting Secretary General Moses Nthurima said some hospitals have begun withholding services and demanding funds before remitting funds.
“We have seen a letter from Tenwek hospital notifying teachers it is withdrawing services due to unpaid capitation. Other hospitals are not providing official communication but are turning the teachers away on arrival or demanding out-of-pocket payments before attending to teachers,” Nthurima said.
The union now demands that the treasury release the funds to avert a crisis.
Teachers rely on a comprehensive medical insurance scheme managed by a private underwriter, which was introduced to replace direct medical allowances.
The scheme covers inpatient and outpatient services, but without government disbursements, healthcare providers have refused to offer services, leaving teachers stranded.
“Teachers’ health is paramount. Delaying their access to medical care is a violation of their right to healthcare and flies in the face of the right to human dignity. A sick teacher cannot be productive in the classroom,” Nthurima said.
A teacher in Kisii County, who spoke on condition of anonymity, said she was recently turned away from a private hospital when she sought treatment.
“The receptionist told me they no longer accept my medical cover because payments have not been made for months. I had to dig into my own pocket, yet my salary is already stretched thin,” she lamented.
Another teacher from Machakos living with chronic illness said she was asked to pay cash for the medication.
“The insurance card is useless right now. I went for a refill of my ulcer meds but was forced to either pay in cash,” she said.
KUPPET has now called on the Treasury to release the funds without further delay, noting that the money is deducted directly from teachers’ salaries.
“These funds are a component of teachers’ salaries—hived off from their previous medical allowances,” Nthurima said.
The union also urged accredited hospitals to continue offering services despite the challenges.
“We urge hospitals to maintain the integrity of their services and ensure that teachers receive high-quality medical care,” he said.
At the same time, the union has faulted a decision by the medical scheme operators to delist 17 hospitals as primary health providers.
The 17 hospitals have now been limited for referral services, meaning a teacher can only get their services once recommended by another medical facility.
Edward Obwocha, KUPPET National Secretary for Secondary Schools said the decision has stripped teachers of good medical facilities leaving them at the mercy of medical institutions that are poorly resourced.
Neither the Treasury nor the TSC has responded publicly to KUPPET’s demands.
The teachers’ medical scheme came into force in 2015, ending a medical allowance that was provided to teachers prior to the scheme.
