'We didn't understand SHA deal': Why teachers are crying foul over Mwalimu cover

The Ministry of Health maintains that teachers through their respective unions were consulted during the onboarding to Social Health authority (SHA).

 Teachers Service Commission (TSC) was also engaged in the process.

 This is despite claims by a section of teachers and respective unions that teachers and their representatives were forcefully on boarded onto the Mwalimu Cover under SHA.

 Health Cabinet Secretary (CS) Aden Duale insists that the formulation of the SHA benefit packages underwent rigorous statutory public participation involving TSC.

 Police and prison officers were also engaged, Duale has emphasised.

 “Teachers were consulted. SHA working closely with the Ministry of Health has continously engaged providers, employees including TSC,” Duale told The Standard in an interview.

 To air their medical cover grievances, teachers are planning to paralyse learning across the country, a push that seemingly beats logics, as they were expected to share their expectations, during formation of the benefit package, if the ministry’s sentiments is true.

 Several interviews with unions by The Standard established that majority of teachers do not understand the contract they got into, nor do they have a copy of what they say was signed.

 Teachers were transitioned to the SHA scheme on December 1, 2025, under the Mwalimu Cover, marking the end of the long-standing Medical Administrators (K) Limited (MAKL) arrangement.

 Prior to signing of the package under Mwalimu Cover, thousands of teachers including union officials from KNUT and KUPPET visited State House in Nairobi, where they were allegedly asked to support a shift from Minet cover to SHA.

 During signing of the Mwalimu Cover, a section of teachers also complained of not having been engaged by the union, during signing of the document.

 About four months later, teachers have continuous complained of services offered under SHA, saying they were duped by their employer- TSC.

 Under Mwalimu Cover, a teacher is allowed to include one spouse and up to five children aged below 21 years, or up to 25 years if they are still in school.

 The package, includes both inpatient and outpatient services, chronic illness management, maternity care, as well as optical and dental services.

 Teachers are also entitled to access care at more than 9,000 SHA-accredited facilities across the country.

 Additional benefits include inpatient cover of up to Sh3 million annually, outpatient limits ranging between Sh150,000 and Sh450,000, maternity cover of Sh10,000 for normal delivery and up to Sh30,000 for caesarean section, as well as overseas treatment capped at Sh2 million.

 Currently, the scheme covers at least 413,577 teachers and 807,426 dependants.

 Despite accusing TSC, the unions admit to not having proposed, neither signed some of their current demands like group life cover.

 In a recent interview,  KUPPET Secretary General Akello Misori said that Group life cover is important when a teacher has lost a relative.

 “SHA, did not include Group life cover in the agreement we had. TSC did not include it in SHA. We did not negotiate to have it because we had an issue with SHA CEO,” said Misori.

 His sentiments on the cover are contradictory, as teachers continue to push for the cover, that was not aligned to the scheme.

 Misori further claims that Duale directed teachers to negotiate Group Life cover with The National Treasury for allocation of the funds.

 “Duale told us he doesn’t have money,” said the union official.

 In a separate interview SHA CEO Dr Mercy Mwangangi also explained to The Standard that negotiation on package granted under SHA is negotiated by the employer.

 In this case, TSC, and National Police Service Commission (NPSC) for the police and prison officers already on boarded to the scheme.

 “The official position already communicated by the Ministry is that teachers, police and prison staff have historically been served through employer-managed arrangements administered with benefits shaped by negotiated contractual terms,” said Mwangangi.

 Mwangangi noted that teachers are entitled to negotiated healthcare benefits under the applicable Public Officers Medical Scheme Fund (POMSF) arrangements, anchored within the broader SHA framework.

 

These include access to outpatient and inpatient care, diagnostics, maternity services, surgery, emergency services, chronic disease management, oncology, mental health services, last expense, overseas treatment, and critical care support within the approved benefit structure and referral pathway.

 

Mwangangi dismissed claims that police and prison officers had been granted a better package udner SHA.

 

“This is not a question of one group being placed on a “better SHA” package, but of different employment-based administrative arrangements that may have distinct benefit designs,” explained the CEO.

 In an interview with The Standard, Duale acknowledged concerns raised by teachers saying they are being actively addressed by the ministry.

 The issues currently being experienced by teachers according to Health CS are largely operational and transitional as the new scheme settles, rather than structural defects.

 To stabilise service delivery, he said SHA is aggressively implementing a number of interventions for example provider engagement and enforcement o ensure strict adherence to agreed tariffs and benefit terms.

 “We are taking firm action against any facility charging unauthorised out-of-pocket fees,” said Duale, warning hospitals that are allegedly charging teachers for services.

 The authority is additionally resolving configuration gaps and refining digital workflows to better align benefits with clinical pathways and drastically improve claims turn around.

Additional resources are also being directed to high-pressure areas such as outpatient and chronic care to ensure continuity and consistency for all beneficiaries.

 Prior to being onboarded to SHA, teachers were being served by Minet, but they still complained of delayed pre-authorisation.

 Teachers through their employer further told parliamentary Education and Health committees that the private cover was also not providing them with specialised doctors.

 But in a quick turn of events, teachers claim Minet was better than SHA, and that what was offered at the private insurer was lifted to SHA.

 The Rural and Urban Private Hospitals Association (RUPHA) however notes that teachers are complaining simply because they are not receiving enhanced cover.

 RUPHA chairman Dr Brian Lishenga, explained that enhanced cover expected by teachers is getting treatment without out-of-pocket expenditure, with limited exclusion.

 

Limited exclusion includes incidences where they get to hospital, have medical checks done like laboratory works, CT Scan and MRI, services were a number of teachers complain not getting, despite having been promised during onboarding.

 “Teachers are experiencing out of pocket expenditure and paying for tests, this is becaue SHA doesn’t have an enhanced, nor comprehensive cover,” said Dr Lishenga.

 SHA, the official explained only provides basic cover, that is accessed by any Kenyans who is a member of the social scheme, paying premiums of 2.75 percent.

 Teachers are being deducted 2.75 percent of their income, in addition to medical allowances averaging Sh4,000, money that is given to SHA to provide enhanced cover.

 Initially, teachers through their unions and employer according to Lishenga were to source for a better medical provider, for care, and not onboard on SHA that lacks provision of comprehensive cover.

 “On paper, teachers have comprehensive cover, but Social Health Insurance Act 2023, does not have such a provision. Teachers want to go to hospital, get special rooms, but they are treated like anyone else paying their monthly premiums,” observed Lishenga.

 “On and appointed day, the Fund shall not provide enhanced benefits schemes and packages,” reads Section 5 (1) of the SHI Act.

 Additionally, Lishenga says during onboarding of teachers to SHA, services were limited because a number of hospitals had numerous rejections of claims, as a result of verification gaps.

 A number of hospitals contracted by SHA were also not able to treat patients because they were unable to purchase commodities due to cumulated unpaid debts.

 “Teachers are used to seeking care in private hospitals, because of readily available amenities and private consultation rooms, which are not available in most public hospitals. SHA was designed to provide basic care,” added Lishenga.

 Teachers’ union admits to not having understood SHA benefit package and limitations.

 “TSC should have informed teachers about quality of service and contract, and contracted facilities, under SHA,” said Misori.

 He added, “Teachers are not happy with SHA, for example, they go to some hospitals, and are turned away simply because those hospitals do not have contract”.

 SHA has contracted at least 9,000 hospitals across the country ranging from private, public and faith based were contracted to serve teachers.