Teachers in Embu County have raised serious concerns over the implementation of the Social Health Authority (SHA) scheme, warning that emerging gaps in service delivery are compromising access to quality healthcare for educators.
In a joint communication to the Chief Executive Officer (CEO) of the Social Health Authority, the Embu branches of the Kenya National Union of Teachers (KNUT) and the Kenya Union of Post Primary Education Teachers (KUPPET) expressed dissatisfaction with what they termed as systemic challenges under the new health insurance arrangement.
The letter was signed by KNUT Embu Executive Secretary Josphat Kathumi and his KUPPET counterpart Jacob Karurua.
The unions singled out the introduction of a Ksh 2,500 daily capitation for outpatient services as one of the most pressing concerns.
According to the teachers’ representatives, the capitation is inadequate, particularly for members living with chronic and critical illnesses who require continuous medication and specialized care.
They argue that the amount cannot sufficiently cover monthly treatment needs, forcing many teachers to dig deeper into their own pockets.
Further, the unions cited technical challenges within the SHA system, including what they described as “double coding” limitations.
They noted that the system is currently unable to generate two Medical Care Vouchers (MCVs) to facilitate treatment for two patients under one cover, a situation that has significantly slowed down service delivery.
The delays, they said, are especially worrying at a time when cases of communicable diseases remain a concern.
The educators also lamented the exclusion of several key medical procedures that were previously covered under the comprehensive scheme.
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Among the services reportedly removed are IVF treatment, OGD and colonoscopy, endoscopy, CT angiogram, physiotherapy, echocardiogram, immunoglobulin injections, tru-cut biopsy for breast masses and other essential procedures.
The unions argue that the removal of these services has left many teachers stranded and unable to access critical interventions.
In addition, the letter highlights delayed claim disbursements to approved health facilities, a problem the unions say has strained hospital operations.
They warn that prolonged delays in payments leave hospitals without sufficient funds to sustain basic services, ultimately affecting the quality of care extended to teachers.
To address the situation, the unions have proposed the reinstatement of the Chronic Disease Management (CDM) programme to allow affected teachers to utilize inpatient services rather than being restricted by daily outpatient caps.
They have also called for comprehensive training of hospital staff on SHA systems to reduce claim rejections and streamline authorization processes.
Further, the unions are demanding the inclusion of previously covered procedures back into the scheme, faster and more efficient management of funeral expense benefits, and the reintroduction of “last expense” and group life cover to safeguard families of teachers who die while in service.
The Embu teachers have urged the relevant authorities to treat the matter with urgency, emphasizing that educators play a critical role in national development and deserve reliable, accessible and comprehensive healthcare.
The Social Health Authority had not issued a response by the time of publication.
By Kithinji Njeru
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