Inside the deal that teachers signed with MoH, TSC over medical cover with SHA

The Ministry of Health (MoH), the Social Health Authority (SHA), the Teachers Service Commission (TSC) and the Kenya Nationa Union of  Teachers  (KNUT) recently signed a joint communiqué aimed at enhancing and streamlining the Teachers Medical Scheme under the Public Officers Medical Scheme Fund (POMSF).

The agreement, signed on March 12, 2026, follows extensive tripartite deliberations and reaffirms the government’s commitment to safeguarding the health, dignity and well-being of Kenyan teachers and their dependants.

The parties agreed on a clear framework of responsibility and accountability to ensure that the health financing model serves the teaching fraternity transparently and efficiently.

Under the new measures, the institutions will formally publish and widely disseminate a comprehensive list of accredited healthcare providers and clearly outline the benefits structure under the mwalimu cover.

The move is intended to eliminate confusion and ensure teachers fully understand the scope of services available to them.

The partners also agreed to operationalize the Last Expense Benefit through SHA, guaranteeing a seamless claims process with payouts within 48 hours.

However, it was clarified that Group Life Cover and Work Injury Benefits Act (WIBA) provisions are not administered under SHA.

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The TSC is actively pursuing a separate budgetary allocation to cover these provisions, with the Ministry of Health committing to follow up with the National Treasury to fast-track the process.

In a firm directive to healthcare providers under POMSF, including those serving under the Mwalimu Cover, the communiqué states that co-payments and cash demands are strictly prohibited, and any provider found demanding payment from teachers will be deemed in breach of contract and compelled to issue a full refund.

The agreement further guarantees comprehensive maternity services within the applicable limits, urging teachers to report any denial of services directly to SHA for immediate intervention.

Access to specialized treatment has also been expanded to include advanced cancer care, complex surgical procedures, in vitro fertilization (IVF) and other fertility treatments.

The scheme now formally includes overseas treatment benefits and road evacuation services, while the Kenya Medical Practitioners and Dentists Council (KMPDC) will support strict accreditation of facilities offering specialized care.

To address previous challenges related to missing biodata and unregistered dependants, SHA and TSC have committed to accelerating automation of data exchange and system integration.

The integration is expected to enable real-time updates of the Mwalimu Cover beneficiary register and prevent denial of care due to data synchronization delays.

At the grassroots level, 47 County Joint Committees have been activated to enhance inclusive participation and responsive service delivery.

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The committees, chaired by TSC County Heads and comprising SHA County Managers and KNUT representatives, will convene quarterly to address emerging operational issues and strengthen communication with beneficiaries.

The communiqué also introduces stronger transparency and accountability measures, including mandatory quarterly utilization assessments and regular consultative forums to review scheme performance.

SHA has pledged to publish periodic reports detailing fund utilization, coverage statistics and service availability to ensure independent oversight.

Additionally, the Ministry of Health has guaranteed active worker representation on the SHA Board to safeguard contributors’ interests.

Currently, the Central Organization of Trade Unions (COTU) represents Kenyan workers at the board level.

To support teachers facing catastrophic health costs, a structured Ex-Gratia Management Framework has been formalized.

Under the arrangement, TSC will finance, receive, vet and route ex-gratia requests while SHA will process and pay approved claims.

SHA has also operationalized a dedicated 24-hour toll-free line, 0800 720 601 and shortcode 147, exclusively for teachers experiencing emergencies or administrative bottlenecks at the point of care.

The four institutions further committed to rolling out a continuous nationwide member education campaign to equip teachers with accurate information on their benefits, patient portal navigation, rights and responsibilities.

The communiqué was signed by Cabinet Secretary for Health Aden Duale, SHA Chief Executive Officer Dr. Mercy Mwangangi, TSC Acting Commission Secretary/CEO Evaleen Mitei, and KNUT Secretary General Collins Oyuu, marking what stakeholders described as a significant step toward restoring confidence in the teachers’ medical scheme.

By Our reporter