As published on standardmedia.co.ke on April 8th 2024
Section 34 of the Employment Act 2007 requires employers to ensure they provide the means through which employees under them can access, enjoy and utilize medical services while under employment.
This is in agreement with the 1998 International Labour Organisation declaration on fundamental principles and rights, the Occupational Safety and Health Convention’ 1981 (No. 155) and the Promotional Framework for Occupational Safety and Health Convention, 2006 (No. 187).
All these conventions and other relevant laws are in consonance with Article 43 (1) (a) of our Constitution, which provides that every person has the right to the highest attainable standard of health, which includes the right to healthcare services, including reproductive health care.
The Teachers Service Commission, after immense pressure from Kenya National Union of Teachers (Knut), succumbed to demands in 2017 to have teachers provided with a health insurance that would cater for their health needs commensurate with their status in the society. Teachers had become a laughing stock due to their inability to foot medical bills. Fundraisers were the order of the day. Many teachers died in very pathetic situations and their relatives were left with hefty bills after burials, which made them poorer.
The coming of teachers medical cover under AON-MINET in 2017 saved face for the tutors. Today teachers and their families have a medical cover even though challenges persist in its management.
These include lack of well-equipped medical facilities to serve teachers especially in rural and far-flung areas, long distances to and from these facilities and long pre-authorization processes. However, there is evidence that teachers are happier now than before.
The Knut is always on the look out to address challenges, both at the national and county level. National and county governing councils have been formed. These governance councils consist of health facility owners, employers, teachers, government and insurance representatives. The main mandate of the councils is to accredit facilities, present and discuss challenges faced by teachers and find lasting solutions then report back to teachers. This intervention still does not meet the teachers’ expectations.
In 2019, owing to the complaints raised by teachers over time with the insurer, AON-MINET, now MINET, sub contracted the management bit of the insurer’s funds to Medical Administrators Kenya Limited (MAKL) to try and minimize the many challenges that had been identified by both the insurer and teachers.
Founded in 2018, MAKL handles government regulated and managed medical schemes administrative functions on behalf of private health insurance companies in Kenya. It is a digital third party administrator covering over four million clients in the country, most of whom are teachers and members of police service and their families. Accordingly, MAKL brings in creative solutions to healthcare systems, customer cares services, insurance carriers and specialized healthcare benefits. These administrators aim to curb medical billing fraud cases as they bridge direct relationships among insurance providers, healthcare providers and scheme members.
So, the journey of MAKL started in 2019 with the aim of addressing their vision and mission. The question we must start asking ourselves is whether the administrators’ existence in this cover has been felt in terms of efficiency and effectiveness in service delivery.
The answer is yes. Fraudulent activities in claims have commendably reduced, turn-around time on pre-authorization especially for specialized treatment has drastically reduced and there are several channels of addressing challenges.
This is however not enough. The union’s opinion is that MAKL must work harder and ensure it collaborates with investors so that medical infrastructure can be expanded to far-flung areas to benefit teachers. For instance, counties like Elgeyo Marakwet, with only one facility and others like Isiolo, Samburu and West Pokot have very few facilities to serve many teachers there. This is a real challenge in terms of access.
MAKL should also loop in the public health sector to serve teachers. Public hospitals have the best facilities but with an unfortunate low drugs supply and a demotivated work force. This should be top on their agenda so that funds collected from public servants can be ploughed back to public institutions. MAKL should also begin thinking towards supporting sector plans to motivate health workers both in public and private hospitals.
The administrators should also begin thinking of how to enhance several specialised services across the country through collaborations. As it is, specialised treatment such as optical, dental, psychiatric and counselling services, among other services, are only populated in major towns and cities. These services need to be taken down to all areas where accredited facilities exist.
When all these will have been done, MAKL will be rightfully felt in its administrative functions to the teachers’ medical insurance.
