Govt Announces SHA Changes for TSC Teachers in Kenya

The government has announced sweeping reforms to fix challenges affecting teachers under the medical scheme managed by the Social Health Authority (SHA). The changes follow a high-level consultative meeting that brought together key stakeholders.

In a joint communiqué, representatives from the Ministry of Health, SHA, and the Kenya Union of Post-Primary Education Teachers outlined binding resolutions to restore efficiency and protect teachers’ welfare.

“We met to address the urgent operational challenges surrounding the transition of the Mwalimu Cover to the Public Officers Medical Scheme Fund (POMSF),” they said.

“Our unwavering commitment to the health, dignity, and well-being of the Kenyan teacher,” they reaffirmed.

Benefit Issues Resolved

First, the parties moved to fix benefit administration challenges that had disrupted services.

• The Last Expense Benefit: Officials said that a prompt and seamless claims process has been established. The benefit stands at KES 300,000. They added that the initial 160 claims received have been fully processed and payments will be released on Wednesday, April 29, 2026.
• Ex-Gratia Framework: In addition, the Ex-Gratia Management Framework has been fully institutionalized. Teachers can now submit written requests through TSC for support in extreme medical cases. SHA will handle payments for approved claims.
• Overseas Treatment: At the same time, SHA has finalized the contracting of overseas facilities to provide specialized, life-saving interventions for teachers. Hospitals in Turkey, India, and Saudi Arabia have already been onboarded. The communiqué added that the first patient is leaving tonight for overseas treatment.
• IVF Services: Furthermore, officials confirmed that the scheme covers and guarantees access to In Vitro Fertilization (IVF) services.

Also Read: TSC Moves to Avert Teachers’ Strike as Govt Revises SHA Scheme

Tariff Locking Withdrawn

Next, SHA addressed system restrictions. The authority stated, “SHA will immediately withdraw the tariff locking currently configured in the system.”

As a result, teachers will not face extra charges during this transition period. The communiqué clearly states that all health facilities offering POMSF services are strictly prohibited from charging any teacher any out-of-pocket fees or co-payment.

Meanwhile, SHA will roll out a four-week nationwide tariff negotiation exercise targeting 3,566 facilities. The process starts on Tuesday, April 28, 2026.

The exercise will cover all regions and counties, with exact facility numbers outlined below:

• Central Region – 130 facilities

Kirinyaga (60)

Murang’a (31)

Nyandarua (11)

Nyeri (28)

• Coast Region – 229 facilities

Kilifi (54)

Kwale (23)

Lamu (14)

Mombasa (82)

Taita Taveta (18)

Tana River (38)

• Eastern Region – 244 facilities

Embu (51)

Isiolo (26)

Kitui (50)

Marsabit (27)

Meru (75)

Tharaka Nithi (15)

• Nairobi Region – 853 facilities

Kajiado (95)

Kiambu (163)

Machakos (69)

Makueni (28)

Nairobi (498)

• North Eastern Region – 850 facilities

Garissa (112)

Mandera (463)

Wajir (275)

• North Rift Valley – 191 facilities

Baringo (27)

Elgeyo Marakwet (5)

Nandi (27)

Trans Nzoia (36)

Turkana (26)

Uasin Gishu (57)

West Pokot (13)

• Nyanza Region – 566 facilities

Homabay (102)

Kisii (127)

Kisumu (112)

Migori (95)

Nyamira (73)

Siaya (57)

• South Rift Valley – 257 facilities

Bomet (16)

Kericho (32)

Laikipia (34)

Nakuru (123)

Narok (41)

Samburu (11)

• Western Region – 246 facilities

Bungoma (78)

Busia (50)

Kakamega (88)

Vihiga (30)

In addition, stakeholders will validate the outcomes at county level. These forums will include KUPPET, KNUT, KUSNET, and other stakeholders.

Also Read: CS Duale Names Five Counties as Hotspots in SHA, NHIF Fraud Crackdown

Zero Co-Payment Policy

After negotiations, SHA will sign contracts with vetted facilities. These facilities must follow a strict rule. They must offer a “walk-in, walk-out” service to all teachers, with absolutely zero co-payments.

At the same time, the government plans to improve engagement. TSC and SHA will convene a joint NEC meeting within two weeks.

Moreover, officials have reactivated county structures. According to the communiqué,

“County-level committees will initiate and hold their first meetings within the next one (1) week,” the communiqué stated. This step will help resolve issues locally.

Transparency and Cost Control

Finally, SHA aims to boost transparency and accountability. The authority will continuously publish and update the comprehensive list of all contracted POMSF facilities.

It will also enforce regular claims audits, quarterly reviews, and network optimization to protect public funds.

Overall, the reforms signal a decisive push by the government to stabilize the teachers’ medical scheme. They also aim to restore trust and ensure smooth healthcare access for teachers across all counties.

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Delegates drawn from Social Health Authority and Teachers Service Commission in Mombasa during the discussion of incorporating teachers into SHA. PHOTO/ SHA