Teachers’ Health Cover Crisis Deepens as KUPPET Issues 30-Day Ultimatum.
The Kenya Union of Post Primary Education Teachers (KUPPET) has issued a 30-day ultimatum to the Social Health Authority (SHA), demanding immediate implementation of agreed reforms to the teachers’ medical scheme, warning that failure to address the outstanding issues will prompt the union to consider further action.
The union stated that the ultimatum follows what it described as SHA’s failure to implement commitments contained in two joint communiqués signed on March 10, 2026, and April 23, 2026, which were intended to resolve persistent challenges affecting teachers’ access to healthcare services.
KUPPET Secretary-General Akello Misori said the union had formally communicated its concerns to SHA and expected an urgent response within the stipulated period.
“Those 30 days are enough for us to study the operating environment and also to look at options which we can take,” Mr Misori said.
Medical Scheme Challenges Persist Despite Earlier Agreements
The ultimatum comes approximately three months after SHA and KUPPET reached agreements aimed at improving healthcare access for teachers following widespread complaints regarding delays in treatment and service delivery under the medical scheme.
According to KUPPET, the agreed reforms have not been implemented, with teachers continuing to experience delays in accessing healthcare services.
The union stated that teachers are still being subjected to prolonged pre-authorisation procedures for diagnostic tests, frequent system outages, and rationing of medical services at accredited healthcare facilities.
KUPPET further noted that many teachers continue to incur out-of-pocket expenses for diagnostic tests and treatment that should ordinarily be covered under the SHA benefits package.
“Additionally, many teachers are being compelled to pay out of pocket for diagnostic tests and treatment that should be covered under the SHA benefit package,” Mr Misori noted.
Failure to Implement Joint Communiqués
KUPPET attributed the ongoing challenges to SHA’s failure to implement commitments contained in the two joint communiqués that were developed following consultations convened by Health Cabinet Secretary Aden Duale.
The union stated that several key reforms remain outstanding despite the agreements.
Among the unresolved matters is the failure to publish the official benefits structure for the teachers’ medical scheme.
According to KUPPET, the absence of a publicly available benefits structure has resulted in teachers being subjected to daily treatment expenditure limits ranging between KSh1,200 and KSh2,000, which the union described as irregular.
Digital Platform and System Failures
KUPPET also raised concerns over the performance of the SHA digital platform, stating that it has become a major obstacle to service delivery rather than facilitating healthcare access.
The union cited frequent system failures that continue to affect admissions, claims processing and verification of beneficiaries.
According to KUPPET, recurring technical outages have resulted in Mondays effectively becoming a non-service day in many healthcare facilities across the country because medical providers are unable to process patient requests.
The union further stated that SHA has not fully automated data exchange between its systems and accredited hospitals, resulting in teachers being denied treatment because healthcare facilities cannot verify their eligibility.
County Committees Yet to Be Fully Established
KUPPET also expressed concern over delays in establishing county-level joint committees that were expected to handle complaints arising from implementation of the medical scheme.
The union stated that only a limited number of counties currently have operational committees despite earlier commitments.
In addition, KUPPET criticised customer service within SHA, alleging that some branch managers have declined to address complaints presented by union officials.
Fertility Treatment and Other Outstanding Benefits
The union further questioned the limited availability of fertility treatment services under the teachers’ medical scheme.
According to KUPPET, only the following healthcare facilities currently provide in-vitro fertilisation (IVF) services under the scheme:
- Nairobi West Hospital
- Fertility Point
KUPPET alleged that both facilities require teachers to pay as much as KSh250,000 in cash for diagnostic procedures before treatment can commence.
The union also stated that limited progress has been made in implementing:
- Ex gratia management framework for teachers.
- Group life insurance cover for teachers.
KUPPET said the delays have raised concerns regarding teachers’ ability to access benefits provided under the scheme.
Union Demands
As part of its demands, KUPPET called on the Social Health Authority to implement all outstanding commitments contained in the March 10 and April 23, 2026 joint communiqués.
The union specifically wants SHA to:
- Publish the official teachers’ medical scheme benefits structure.
- Eliminate irregular daily treatment expenditure caps.
- Resolve recurring system outages affecting healthcare delivery.
- Fully automate data exchange between SHA and accredited healthcare facilities.
- Operationalise county joint committees across all counties.
- Improve customer service by ensuring complaints are handled promptly.
- Expand accreditation of fertility treatment facilities.
- Finalise implementation of the ex gratia management framework and group life cover.
- Establish a dedicated toll-free customer care line exclusively for teachers.
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KUPPET argued that the current customer support system relies on a single telephone line serving all Social Health Authority beneficiaries nationwide, making it difficult for teachers to receive timely assistance.
The union stated that it expects the identified challenges to be addressed within the 30-day period, after which it will assess the operating environment and determine the appropriate course of action if the concerns remain unresolved.
Teachers’ Health Cover Crisis Deepens as KUPPET Issues 30-Day Ultimatum.
