Teachers have received a rude shock after a revelation that health facilities listed under the Social Health Authority (SHA) have now capped outpatient expenditure at maximum of sh 2,500 per visit.
Hospitals have already informed teachers of these changes which have disrupted routine hospital visits especially for teachers with chronic ailments.
This is despite TSC getting an allocation of sh 24.2 billion in the supplementary budget to cover salary shortfalls and teachers SHA contributions and an additional sh 3 billion for TSC pending bills for teachers medical cover.
“The amount is intended to cover basic treatment services only, including general consultation, essential medications, and limited laboratory tests,” said medical health facilities.
However hospitals have distanced themselves from the changes saying its a government directive and not a policy determined by the hospitals.
Getting admission for inpatient services is also an uphill task as the government has put strict requirements before one is admitted.
Below is a statement by medical health facilities listed under SHA that has sparked outrage among teachers.
Dear Teachers,
We wish to inform you that SHA has introduced revised tariffs for outpatient (OP) treatment and to clarify what this means for you when accessing care.
Under the new structure:
- A fixed amount of KES 2,500 per outpatient visit has been set.
- This amount is intended to cover basic treatment services only, including general consultation, essential medications, and limited laboratory tests.
As a result, please note the following limitations under outpatient care:
- Specialist clinics and consultant services are not covered
- Medication coverage is limited to basic and essential drugs
- Only basic laboratory investigations are included; advanced tests and procedures are not covered
Due to these limitations, some conditions may not be adequately managed under outpatient care alone.
It is therefore important to communicate openly with the attending healthcare provider, especially if symptoms persist or worsen, so that appropriate clinical decisions can be made.
Kindly note that SHA cover is more comprehensive during inpatient care (admission), where there is provision for broader treatment, additional investigations, and closer medical monitoring when clinically necessary.
Admission, however, is determined strictly based on medical assessment and necessity.
Please note that this is a government directive and not a policy determined by the hospital. We are therefore required to adhere strictly to these guidelines.
Hospital remains fully committed to providing you with quality healthcare and supporting you within the SHA framework.
