Teachers, the Social Health Authority (SHA), and the Ministry of Health have stroke truce to tackle ongoing medical scheme challenges and avert a potential nationwide teachers’ strike.
Finalized on April 28, 2026, following high-level discussions between the ministry, SHA, and the Kenya National Union of Teachers (KNUT), this pact targets the operational difficulties that have obstructed the transition of the Mwalimu Cover to the Public Officers Medical Scheme Fund (POMSF).
In a joint communiqué, the three parties emphasized their dedication to ensuring teachers’ health and welfare and announced several binding resolutions aimed at restoring seamless access to medical services across the country.
A central resolution includes the complete restoration of the Last Expense Benefit, now set at Ksh300,000, with a revamped claims process. The SHA has already processed 160 pending claims, with payments to beneficiaries beginning on April 29, 2026.
“To enhance the health system’s efficacy for teachers, SHA will promptly eliminate the tariff locking currently in place. Locked tariffs will only be reinstated after thorough negotiations with healthcare providers,” the communiqué stated.
Additionally, the agreement introduces an Ex-Gratia Management Framework to support teachers facing medical expenses that exceed standard coverage limits. The Teachers Service Commission (TSC) will handle requests, while SHA will oversee the payment of approved compassionate claims.
The scheme now extends to include overseas treatment, contracting specialized hospitals in countries like India, Turkey, and Saudi Arabia.
Teachers will also gain access to improved reproductive health services, including In Vitro Fertilization (IVF) treatment at designated facilities, enhancing the coverage’s comprehensiveness and responsiveness to varied health needs.
In a notable policy shift, SHA has committed to withdrawing tariff locking, a move that previously faced significant backlash from teachers. During this interim phase, all contracted health facilities must refrain from charging teachers out-of-pocket fees.
“Key issues such as overseas treatment, IVF services, chronic condition management, and concerns about benefit capping have been addressed. We also identified implementation gaps, pledging to enhance healthcare quality and access,” stated Health Cabinet Secretary Aden Duale on X.
SHA plans to roll out a decentralized National Ambulance Service to strengthen emergency response and referral systems. The parties agreed to quarterly meetings to ensure ongoing coordination and address emerging issues.
To ensure long-term sustainability, SHA will conduct a nationwide tariff negotiation involving over 3,500 private and faith-based health facilities. This initiative, scheduled for four weeks, aims to harmonize pricing structures while upholding high healthcare delivery standards.
