Pain, suffering and fury as hospitals deny teachers, police officers medical care

Teachers and police officers are suffering in silence as crisis hits their medical insurance covers. 

The health of more than one million teachers, police officers and their dependents is at risk as hospitals deny them services due to delayed capitation. 

For seven months, hospitals have gone without payments under the state-sponsored medical covers, forcing some facilities to turn away patients who cannot pay in cash.

The contracted hospitals are owed Sh11 billion for teachers cover, which has left 403,522 tutors and 969,638 dependents at a loss. 

Similarly, the schemes for over 110,000 police officers and their dependents under the National Police Service (NPS) and Kenya Prisons Service are dysfunctional.

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At least six hospitals have suspended services to teachers under the Teachers Service Commission (TSC) medical scheme. A notice from Tenwek Hospital in Bomet County, for example, stated that it stopped offering medical services on credit effective February 1. Other affected hospitals include Kisii Referral Hospital and Reale Hospital in Uasin Gishu County.

Hospitals blame the situation on the non-payment by the defunct National Hospital Insurance Fund, its successor Social Health Authority and Medical Administrators Kenya Limited, which administers the teachers' medical scheme through Minet Kenya. 

Some teachers disclosed that some facilities are denying them treatment even though they have not issued official notices.Under contract terms, hospitals must give a seven-day notice before suspending services.

Minet runs about 600 medical providers across the country, but more hospitals may follow suit if the issue remains unresolved.

On Tuesday, Minet Kenya Chief Executive Officer, Sammy Muthui, said they were working with the government to ensure the balance is settled.

“It is an issue touching on all sectors due to cash flow issues in the country. There is quite a substantive pending balance, but some good progress has been made by TSC in negotiations to offset the balance,” he said

Similarly, police officers under APA Insurance, which took over their medical scheme from CIC Insurance in April last year, have reported worsening conditions. 

“I have a chronic condition that requires constant monitoring. The last time I was at Nairobi West, I was told to wait another two weeks before I could get another consultation. How do you tell a sick person to wait 14 days? Does illness wait?” said an officer who sought anonymity.

The situation is even worse for officers in remote areas. “My wife was unwell and had to be rushed to a hospital, but the insurance provider refused to approve treatment. I was hundreds of kilometers away, unable to help, and they had to pay out of pocket,” said an officer stationed in Lamu.

Both Kenya National Union of Teachers and Kenya Union of Post Primary Education Teachers have warned that the crisis could disrupt learning.

“What is happening in the teaching fraternity is unacceptable. We demand immediate intervention from Treasury Cabinet Secretary John Mbadi to resolve this crisis,” said Moses Nthurima, the union acting secretary general.

Knut Secretary-General Collins Oyuu said the situation was robbing teachers of their dignity, noting that those living with chronic illnesses were the most affected. 

“We will not sit back and watch as our teachers suffer. We need a clear outline of how the government plans to offset the pending balance to hospitals and also to have a conversation with the hospitals so that teachers get the services they deserve,” he said.

For police officers, the frustrations have reached a boiling point, leading to fears of a potential go-slow. 

A video that circulated widely online last week captured an intense exchange between a junior and a senior officer during a meeting to discuss the insurance issue. 

The junior officer accused the administration of ignoring their plight, highlighting a case of a colleague whose wife was denied treatment while he was away on duty. 

His colleagues in the room appeared to cheer in support, a rare display of open defiance in the disciplined forces.

Despite repeated complaints, police officers say all they get are vague assurances that "the issue is being worked on".

Many are now calling for the removal of third-party brokers from the medical cover arrangement, insisting that direct hospital-insurer relationships worked better.

The teachers’ medical scheme, introduced in 2015, replaced a direct medical allowance previously provided to teachers.

Teachers and their dependents are entitled to outpatient, inpatient, maternity, dental, optical, psychiatric, and counselling services, as well as air and road evacuation, funeral benefits, international referrals and travel allowances.

However, due to the government’s failure to remit payments, hospitals have refused to offer these services, leaving teachers stranded.

The teachers' unions and police are demanding immediate action from the Treasury, warning that continued delays could have dire consequences.

“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,” said Nthurima.