Teachers need a reliable medical scheme to access quality treatment

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This month, Kenya joined other countries in celebrating the World Teachers’ Day. The highlights were the ongoing curriculum reforms, digital literacy, competency-based learning among other milestones in our education system. However, teachers’ health as a crucial factor influencing learning outcomes in our schools should have been accorded equal attention.

A healthy and productive teaching force is the cornerstone of a vibrant education sector. Besides fair remuneration, teachers also deserve benefits like medical insurance for them to perform their duties diligently and effectively. A teacher’s mental, physical and emotional well-being is reflected in students’ performance.

Teachers, therefore, deserve access to quality and affordable health care to remain productive throughout their career. Frequent illness results in reduced productivity and absenteeism thus disrupting learning. Teachers are exposed to a lot of stress significantly affecting their mental health.

This underlines the need for a robust medical insurance scheme offering both inpatient and outpatient care. However, providing health insurance to the over 300,000 teachers in Kenya’s public schools and their spouses and dependents requires a firm(s) with a strong national presence.

Recently, the Teachers Service Commission (TSC) advertised a tender for the teachers’ medical cover for the period 2019-2022, with bidders required to forward proposals based on four options, namely, fully insured scheme, hybrid financing (inpatient self-fund), hybrid financing (inpatient fully insured), and capitation financing.

Under the fully insured scheme, the tutors will enjoy 100 percent cover. They do not have to pay for any inpatient and outpatient services up to the cover limit which is currently capped at Ksh700,000 but which TSC has proposed to increase to Ksh 1 million. Under the hybrid financing scheme, the patient pays for either their inpatient or outpatient treatment. On the other hand, capitation involves a fixed sum of money being allocated by TSC for a certain period to a hospital or other health provider to offer services to teachers.

There are reports that certain players are pushing for a capitation scheme. Previous experience shows that capitation schemes are fraught with many risks. For example, since the cash is normally paid upfront to the health provider for the entire contract period, there is a real risk of the quality of service being compromised as a result of the contracted provider cutting costs to maximize profits.

In addition, services under a capitation scheme may be restricted to one provider who may not have the capacity to service the large population of teachers spread across the country. Worse, where the selected provider does not own hospitals, teachers may not access inpatient services forcing them to dig deeper into their pockets to access treatment.

With the escalating cost of health care and rising incidence of serious ailments like cancer, teachers will be exposed to financial risk and poverty, disrupting learning in schools and resulting in poor performance in our schools. Moreover, the ongoing implementation of competency-based learning will be severely undermined where teachers are absent from school for prolonged periods seeking treatment. This has a negative impact on the well-being of future generations.

In any case, what will stop a sole provider with constrained capacity from diverting money from the scheme to expand their facilities in a bid to cope with the huge demand for services? How will TSC track the cash to ascertain it is only being used to provide the contracted services?

These are just some of the concerns TSC should address for the scheme to achieve the desired results. It should further insulate the process from political influence and put in place the necessary checks and balances by ensuring the scheme is not awarded to only one company. Best practice requires such a scheme has an administrator who is separate from the health provider(s).

In a nutshell, TSC should only pick providers with the requisite technical and financial competence, as well as a strong track record in service delivery. They selected providers must guarantee access to health services in all corners of the country both in public and private hospitals and offer comprehensive inpatient and outpatient services.

In awarding the tender for the scheme, the commission should conduct a detailed appraisal of the technical and financial capability of each bidder. They should have no previous history of financial impropriety involving public funds.

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