Teachers' SHA upgrade clouded by delays, fraud fears and legal risks

Whether the government will deliver an improved medical cover for teachers lies at the centre of mounting concern among thousands of tutors who have long relied on the multi-billion-shilling health scheme.

Delays in payments to medical facilities, reports of fraud in claims processing and fears that a hurried rollout could expose the new arrangement to legal challenges are among the major issues troubling teachers.

Further fuelling anxiety are the teething problems reported under the Social Health Authority (SHA) cover—issues publicly acknowledged by President William Ruto and Health Cabinet Secretary Aden Duale, who have said the insurer is experiencing initial difficulties.

Despite these concerns, the shift from the Minet-managed medical scheme to the SHA cover is scheduled to take effect on December 1. The transition will introduce sweeping changes to financial allocations and benefits for teachers, even as uncertainty persists over how effectively the system will be implemented.

Investigations by The Sunday Standard reveal that teachers stand to receive substantially improved benefits under the proposed cover. The package was adopted by teachers’ unions on November 10, although reservations remain regarding the government’s commitment to delivering on the promises made.

Kenya Union of Post-Primary Education Teachers (KUPPET) chairman Omboko Milemba has warned that implementation, not policy design, will determine the scheme’s success.

“On paper, it is a better deal than Minet. There have been a lot of improvements, so we said let’s take it and see how it goes. But I am more concerned about whether the government will honour the pledges,” Milemba told The Standard.

Some teachers fear that hospitals may deny them services during the transition. Kenya National Union of Teachers (KNUT) Secretary General Collins Oyuu cautioned that delays in remitting funds to health facilities could cripple the scheme.

“If disbursement of funds to hospitals is delayed, then the SHA cover can face the same fate that plagued Minet. Delayed payments saw teachers denied services. This must be corrected under SHA,” he said.

Nonetheless, an analysis by The Standard shows that teachers will receive expanded benefits and access to more health facilities. The cost of the new medical cover will rise from Sh15 billion to Sh21 billion. The number of approved health facilities will increase dramatically from 816 to 9,016—a growth of 8,200 facilities—greatly improving access across the country.

Teachers will also enjoy enhanced medical packages. The lowest-earning teachers will receive an additional Sh50,000 for outpatient care, while the highest earners will get an extra Sh75,000. Under the proposed changes, those in Job Group B5 will now have an outpatient limit of Sh150,000, up from Sh100,000 under the Minet scheme. The highest earners will access up to Sh450,000, compared to the current Sh375,000.

Inpatient cover has also been improved. The lowest-earning teachers will see their limit rise from Sh750,000 to Sh1 million, while top earners will have access to Sh3 million, up from Sh2.5 million.

Dental cover will rise from Sh35,000 to Sh45,000, while maternity benefits will increase by Sh20,000—raising the limit from Sh100,000 to Sh120,000. Optical care will also improve, with teachers receiving an additional Sh15,000, bringing the total to Sh60,000.

The last expense benefit has been increased from Sh200,000 to Sh300,000. The most significant boost, however, is in overseas treatment. Teachers will now receive up to Sh2.2 million for treatment abroad, more than double the current Sh1 million limit.

Additionally, teachers will be allowed to insure up to five children under the new cover, up from the current limit of four. Those with more children may extend cover to additional dependants through a top-up arrangement.

The SHA proposal also removes the Sh50 co-payment required for outpatient visits under Minet. Payment to hospitals will similarly change: instead of receiving a fixed capitation amount per teacher, facilities will now be reimbursed based on actual utilisation, which the government argues will improve efficiency and accountability.

Teachers living with chronic illnesses are set to benefit from a new Emergency, Chronic and Critical Illness Fund (ECCIF). This fund will allow patients to continue receiving care even after exhausting their inpatient limit—a departure from the Minet cover, which funded chronic care solely under inpatient benefits.

According to the Teachers Service Commission (TSC), the new scheme will improve access to high-quality medicines, with teachers allowed to seek treatment from a considerably wider range of facilities. The TSC also claims the SHA cover will automate pre-authorisation processes, reducing approval times from an hour to just two minutes—addressing a longstanding complaint under Minet.

However, the decision to transition to SHA could encounter serious legal obstacles. Insiders claim that key procurement requirements—including competitive tendering and public participation—were bypassed.

A senior KNUT official told The Standard: “No advertisement was done for SHA, nor were other competitors invited to bid. Remember how Minet came to be? It was an open contract where bidders competed openly. Why was it single-sourced this time?”

Constitutional lawyers have echoed these concerns, warning that the opaque process could trigger court challenges that may suspend the scheme. Advocate Ken Echesa noted that public participation is a constitutional requirement. “If there was no public participation, then this will be a major ground for a court battle,” he said.

Echesa added that although single-sourcing is permitted under specific circumstances, it is subject to strict limitations. “Direct procurement is not meant to be abused. At the very least, union national officials should have consulted teachers through branch leadership before settling on this decision.”

He cautioned that while teachers faced challenges under Minet, moving them to SHA without thorough due diligence is risky—particularly given questions raised in Parliament about the financial sustainability and operational preparedness of the government-run insurer.

As the country approaches the December 1 implementation date, teachers remain torn between optimism over the enhanced benefits and fear that systemic weaknesses could undermine the long-awaited improvements.