Medical Providers Questioned Over Teachers’ Health Scheme Woes

The National Assembly Committee on Education has put medical service providers to task over ongoing problems in the Teachers’ Medical Insurance Scheme.

Top officials from the consortium managing the scheme appeared before the Committee to answer questions. They included MParmanand Mishra, Chief Operating Officer of Medical Administrators Kenya Ltd (MAKL); Dr. Felix Wanjala, CEO of Bliss Healthcare; and Mr. James Njuguna, GM Operations at MAKL.

The consortium, led by Minet Kenya, was awarded the contract to manage the scheme from 2022 to 2025.

It operates under a hybrid model that combines insurance and capitation.

Other members of the group include Bliss GVS Healthcare, Old Mutual, CIC, Britam, Pioneer Assurance, Star Discover, and Medical Administrators Kenya Ltd.

Lawmakers raised serious concerns about delays in treatment approvals, poor access to health services in rural areas, and claims of low-quality medication. The scheme currently covers more than 300,000 teachers and their dependents.

Committee Chair Julius Melly said teachers were suffering due to inefficiencies in the system.

“As you are aware, the Teachers Service Commission (TSC) in Kenya has partnered with Aon Minet and Bliss Healthcare to offer a comprehensive healthcare package. However, over the years, numerous challenges have emerged, affecting access and quality of healthcare for our educators,” said Melly.

Committee Vice Chair Eve Obara raised concerns over delays in authorizing specialized or overseas treatments. “What measures are in place to expedite the approval process for such cases?” she asked.

In response, Bliss Healthcare CEO Dr. Felix Wanjala said that 96 percent of inpatient cases are approved within 30 to 45 minutes and that emergency cases are handled immediately. He also noted that most outpatient visits do not require prior approval.

However, MPs remained unsatisfied. MP Nabii Nabwera noted that teachers in rural areas were forced to travel long distances to access healthcare.

“Some of your facilities are very far from the teachers. What strategies are being implemented to decongest urban hospitals and improve rural access?” he asked.

While documents presented to the Committee showed that Minet operates 47 facilities and Bliss runs 35, the total number of accredited facilities is 763. Still, MPs said coverage in rural areas is inadequate.

MP Mary Emaase also raised concerns about the alleged use of low-quality drugs. “We’re receiving complaints about poor services and the use of low-quality generic medication,” she said, calling for stronger regulation and quality control.

MP Phylis Bartoo questioned delays in paying hospitals under the scheme, which has led to some teachers being turned away. “What steps have been taken to ensure timely payments and how do you address cases of service denial?” she asked.

MAKL’s Mishra said they are working to speed up the reconciliation and payment process. “We are working closely with service providers to ensure prompt settlements and resolve any backlogs,” he assured the committee.

Hon. Julius Taitumu said there is a need to educate teachers on how to access healthcare under the scheme.

“Teachers need to be fully informed about their benefits and the procedures for accessing care,” he said.

Committee Chair Melly added, “Our teachers deserve better, and we will hold each player accountable until they get the healthcare they are entitled to.”

The Education Committee has now directed Medical Administrators Kenya Ltd to submit a detailed report on the status of its facilities within seven days.