Health Cabinet Secretary Aden Duale has announced sweeping reforms to the teachers’ medical scheme following a high-level meeting with teachers’ unions and the Social Health Authority (SHA), aimed at improving access, efficiency and accountability in healthcare delivery for educators.
Duale said the government oversaw the signing of a binding agreement after engagements with the Kenya Union of Post Primary Education Teachers (KUPPET), the Kenya National Union of Teachers (KNUT) and SHA, under the Public Officers Medical Scheme Fund (POMSF).
The agreement introduces a coordinated framework designed to streamline service delivery and eliminate delays in accessing medical care for teachers across the country.
According to Duale, the scheme now confirms a Last Expense Benefit of KES 300,000 for deceased principal members, with all verified claims to be processed and payments released.
He also announced the institutionalisation of an Ex-Gratia Management Framework to support teachers facing catastrophic medical costs beyond standard coverage.
On specialised treatment, Duale said arrangements for overseas medical care have been finalised, with contracted facilities in Turkey, India and Saudi Arabia now operational.
He added that implementation has already begun, with the first patient scheduled to travel.
The reforms also extend to In Vitro Fertilisation (IVF) services, which will now be fully covered under the scheme through approved providers.
To enhance efficiency, the government has withdrawn the tariff locking mechanism. During the transition, health facilities will not be allowed to impose out-of-pocket charges or co-payments, in line with existing contracts.
A four-week nationwide tariff negotiation process will now harmonise pricing across Level 3 to Level 6 facilities before the rollout of a “walk-in, walk-out” model.
Duale further noted that new governance structures, including national and county-level forums, will strengthen oversight and stakeholder engagement in service delivery.
The meeting was attended by senior officials including Principal Secretary for Medical Services Dr Ouma Oluga, KUPPET Secretary General Akelo Misori, Chairperson Omboko Milemba, SHA CEO Dr Mercy Mwangangi and DHA CEO Eng. Anthony Lenayara.