Gov't dismisses claims teachers are being denied treatment under SHA

Health Cabinet Secretary Aden Duale said the Public Officers Medical Scheme Fund (POMSF) administered by the Social Health Authority (SHA) is performing well and continues to provide uninterrupted services to teachers and their dependents.

His statement came after the Kenya Union of Post-Primary Education Teachers (KUPPET) on Thursday announced plans to pull out of the new medical scheme, arguing that the system has been failing teachers seeking treatment.

The union cited frequent system breakdowns, a limited number of hospitals accepting the scheme, and what it called inadequate funding allocations, particularly for accident and emergency services.

KUPPET, while issuing a seven-day strike notice, also said several teachers have been denied treatment, while others have reportedly been detained in hospitals over unpaid medical bills.

Duale, however, dismissed the claims that teachers are being denied care, saying data from the Ministry of Health shows widespread uptake and use of the cover since its rollout.

According to the ministry, more than 249,000 teachers and their dependents have already received treatment under the scheme, with claims exceeding Ksh.3.5 billion processed so far.

CS Duale said teachers have accessed healthcare services in 2,823 facilities across the country, both in public and private institutions.

He revealed that Nairobi County has recorded the highest number of claims at 30,766 cases worth Ksh.527.7 million, followed by Uasin Gishu with 29,212 claims valued at Ksh.463.2 million.

Other counties that reported high utilization include Meru, which he said registered 34,189 claims amounting to Ksh.243.8 million, and Bungoma with 29,743 claims worth Ksh.237.6 million.

The ministry further said additional high-usage counties include Kisii, Kisumu, Nakuru, Kiambu, Trans Nzoia and Kericho.

Duale argued that the new arrangement represents a major shift from the previous private insurance-based model used to cover teachers’ healthcare needs.

“We must contextualize this transition. For years, teachers were placed under private insurance arrangements that were plagued by opaque administrative limits, highly inflated premium costs, and restricted access that often left them stranded at the hour of need. The POMSF under SHA represents a fundamental shift,” said the Health CS.

“We have eliminated the profit-driven middlemen. This new framework ensures that every shilling allocated by the government goes directly into purchasing quality healthcare for the teacher and their dependents, rather than funding administrative overheads and inflated private margins. The current scheme is comprehensive, equitable, and offers a much wider, unhindered network of access.”

Duale added that the government is monitoring the performance of the new medical scheme for public officers in collaboration with the Teachers Service Commission (TSC) and the Social Health Authority (SHA).

He acknowledged that the transition may have experienced isolated operational challenges, but said such issues are being addressed in real time to ensure there is no disruption to service delivery.

CS Duale urged teachers to continue using SHA-contracted health facilities nationwide, reaffirming the government’s commitment to safeguarding the health and welfare of educators.