Medical Insurance

A deepening financial crisis in Kenya’s public healthcare sector has left thousands of teachers, police officers, and prison staff stranded without medical care. Over 452,635 teachers and an estimated 150,000 police personnel are being turned away from hospitals after their insurer, Medical Administrative Kenya Limited (MAKL), failed to settle billions in pending claims. The standoff, linked to delayed capitation funds from the National Treasury, has exposed systemic flaws in the country’s health financing model and raised urgent questions about the welfare of essential workers.

Background: From NHIF to SHA – A Rocky Transition

Kenya’s healthcare system has undergone significant reforms in recent years, including the phasing out of the National Hospital Insurance Fund (NHIF) in favor of the Social Health Authority (SHA) under the Social Health Insurance Act 2023. The SHA was designed to universalize coverage and address inequities, but its rollout has been marred by bureaucratic delays and funding shortfalls. Meanwhile, MAKL, a private insurer contracted by the Treasury since 2021 to manage medical cover for police and teachers, owes hospitals over Sh1.2 billion in unpaid claims, according to AGC Tenwek Hospital’s chairman, Dr. Robert Langat.

The Treasury’s Sh29 billion contract with MAKL was intended to streamline services for public servants. However, delayed disbursements from the Teachers Service Commission (TSC), National Police Service (NPS), and Kenya Prisons Service (KPS) have left hospitals unpaid since July 2024. Rural and Urban Private Hospitals Association (Rupha) Chairman Dr. Brian Lishenga confirmed that at least 30 facilities, including major referral centers like Tenwek and Kisii Teaching and Referral Hospital, have suspended services for affected groups.

The Human Toll: “We Are Treated Like Beggars”

Teachers and police officers shared harrowing accounts with the Nation. Emily Cherono, a primary school teacher in Bomet, described being denied dialysis at Tenwek Hospital despite a life-threatening condition. “I’ve served this country for 15 years. Now I’m told to pay Sh15,000 per session or go home to die,” she said. Similarly, Police Constable John Mwangi in Nairobi recounted how his pregnant wife was turned away from a clinic: “Even those of us guarding VIPs aren’t spared.”

The crisis extends beyond individuals. Families of officers and teachers, who rely on the same insurance, are also impacted. “My asthmatic son was refused admission at Reale Hospital. Where do we go?” asked teacher Margaret Atieno from Kisumu.

Institutional Fallout: Hospitals on the Brink

Faith-based and private hospitals, which handle 40% of Kenya’s healthcare needs, are bearing the brunt. Tenwek Hospital, a mission facility renowned for its cardiothoracic center, is owed Sh560 million by NHIF and Sh120 million by SHA, crippling its operations. Smaller clinics face closure. “We can’t buy drugs or pay staff. This is unsustainable,” said Dr. Lishenga.

Public hospitals, already strained by underfunding and strikes, are overwhelmed. Moi Teaching and Referral Hospital reported a 30% surge in patients, exacerbating wait times and shortages. “The system is collapsing,” warned Dr. Evans Kiprotich, a Nairobi-based health economist.

Unions Sound Alarm: “Education and Security at Risk”

Teachers’ unions have threatened nationwide strikes if the issue isn’t resolved. Kenya Union of Post Primary Education Teachers (KUPPET) Chairman Omboko Milemba warned, “Sick teachers can’t teach. If TSC and Treasury don’t act, schools will shut down.” Kenya National Union of Teachers (KNUT) Secretary-General Collins Oyuu criticized the Treasury for “abandoning” educators, noting that even maternity coverage—critical for female teachers—has lapsed.

Police unions remain quieter due to protocol but privately express fury. “How can officers protect others when their families are suffering?” a senior officer anonymously told the Nation.

Government Response: Promises Amid Silence

While Health CS Susan Nakhumicha acknowledged “challenges in the transition to SHA,” the Treasury, led by CS John Mbadi, has yet to address the payment delays. A Treasury insider cited “cash flow problems” due to Kenya’s Sh10.1 trillion public debt, which consumes 63% of revenue. Critics, however, blame mismanagement. “Why contract MAKL if funds aren’t allocated?” asked MP Ndindi Nyoro, chair of the Budget Committee.

MAKL CEO Dr. James Kamau shifted responsibility to the Treasury: “We can’t pay hospitals without funds from the government.”

Broader Implications: A Failing System

This crisis underscores chronic issues in Kenya’s health financing. Despite constitutional guarantees to healthcare, underfunding persists—only 4.6% of the 2024/25 budget went to health, far below the 15% Abuja Declaration target. Dr. Githinji Gitahi, CEO of Amref Health Africa, warns, “Without urgent reforms, universal coverage will remain a dream.”

The debacle also risks eroding trust in public institutions. “Teachers and police are pillars of stability. Neglecting them invites social unrest,” said governance expert Nerima Wako.

Pathways to Resolution

1. Emergency Funding: Parliamentarians urge the Treasury to prioritize payments from the Contingencies Fund.

2. Audit MAKL Contract: Transparency advocates demand a review of MAKL’s performance and pricing.

3. Accelerate SHA Reforms: Fast-tracking SHA’s rollout could centralize payments and reduce bottlenecks.

4. Public-Private Dialogue: Stakeholders propose a summit involving hospitals, unions, and insurers to renegotiate terms.

Conclusion: A Nation at a Crossroads

Kenya’s treatment of its essential workers reflects broader governance failures. As hospitals turn away those who educate and protect the nation, the urgency for systemic overhaul has never been clearer. The coming weeks will test the government’s commitment to its workforce—and its vision for a healthier Kenya.