Teachers cry foul as SHA glitches leave many with huge bills to pay

Zena Makokha Wesonga expected to welcome her baby on February 19, but the child arrived three weeks earlier, plunging the family into an emotional and financial crisis that has since exposed growing challenges with the teachers’ medical insurance scheme under the Social Health Authority (SHA).

The premature birth immediately triggered medical complications and an urgent rush to hospital. Zena, a teacher in Job Group C2, had to hire a private ambulance after going into labour, paying Sh7,500 out of pocket because SHA does not cover ambulance services.

She was admitted to St Francis Community Hospital where her maternity bill totalled Sh135,137. SHA paid Sh120,000, leaving the family to clear the remaining Sh15,000.

The biggest challenge, however, emerged after the baby was admitted to the Newborn Unit (NBU) due to the early delivery. The infant’s treatment and stay in the unit pushed the medical bill to Sh133,185, which SHA declined to settle despite the child being eligible for cover.

A hospital–client discharge agreement form seen by The Standard shows the family was forced to sign a payment arrangement after failing to clear the amount.

The document states that the patient had received medical services from the hospital and had incurred a bill totaling Sh133,185 as at February 12, 2026, which remained unpaid.

Under the agreement, the family committed to settling the bill later while depositing a land title deed as security.

The document states that the balance must be cleared in full by May 12, 2026 and indicates that the guarantor deposited a title deed belonging to Asha Auma Otini.

Speaking to The Standard, Zena said the family attempted to register the newborn under SHA immediately after delivery, but delays in the system prevented the process from going through on time.

“The application only went through on Wednesday, three days later and the hospital told us that SHA will not cater for the balance so we have to pay it ourselves,” she said, adding:

“So my mum had to come with our title deed. We deposited the title with an agreement to pay.”

Documents seen by The Standard indicate that the delay in registering the newborn on the SHA portal may have contributed to the insurer declining to settle the infant’s bill. 

In a letter dated March 2, 2026, the Kenya Union of Post Primary Education Teachers (Kuppet), Nairobi County Branch wrote to Social Health Insurance chief executive officer Mercy Mwangangi seeking intervention over the outstanding amount.

According to the union, the problem arose because the newborn was not declared and updated in the SHA system within the 24-hour window required under the policy for teachers’ comprehensive medical cover.

Zena had delivered a premature baby who required nursery care for at least a week, but the teacher had not been properly informed about the requirement to update the infant’s details on the SHA platform immediately after birth.

“The teacher did not have the correct information regarding the 24-hour policy of updating the newborn infant in the SHA system,” KUPPET Nairobi County branch executive secretary Isaac Masenge wrote in the letter.

The union further noted that the hospital did not adequately guide the teacher on the registration process, resulting in the newborn being added to the system four days later.

By the time the update was completed, the delay had already complicated the processing of the claim, leaving the family with the full hospital bill and forcing them to deposit a title deed as collateral to secure the baby’s discharge.

One month after leaving the hospital, the family says SHA has yet to clarify whether the bill will eventually be settled, leaving them living in fear of losing their home if they fail to raise the money before the deadline stipulated in the agreement.

Zena’s case is not isolated.

Gladys Alphael, another teacher, says she was also forced to meet medical expenses out of pocket despite being enrolled under SHA. Gladys, who is currently on maternity leave, sustained serious burns after a gas explosion at her home and was rushed to hospital where she was admitted to a private ward for six days.

Upon discharge, however, the hospital demanded that the family pays for the bed before she could be formally registered under the SHA system.

“SHA has a cap on what they can cover for bed but the hospital refused to register me, and we had to pay Sh28,000 out of pocket,” she told The Standard.

The experiences of the two teachers reflect wider challenges emerging three months after the government transferred the Sh20 billion teachers’ medical insurance scheme from a private provider to the Social Health Authority.

The transition was meant to widen the network of healthcare facilities available to teachers, but unions say the shift has instead exposed educators to additional financial strain.

Kuppet Chairman Omboko Milemba says while teachers are still receiving treatment, the system has experienced significant operational challenges.

“One of the major issues that the SHA cover was meant to address was out of pocket cost. But increasingly, we are seeing teachers struggle with the burden of paying extra costs after treatment,” Milemba said.

He said under the previous Minet insurance arrangement, once a teacher exhausted their medical cover, the Teachers Service Commission (TSC) would clear the remaining hospital bill and later recover the amount from the teacher’s salary through an agreed payment plan.

The arrangement has changed under the new system, Milemba says.

“This is leaving teachers with a heavy burden. Teachers are now struggling with medical contributions to cover the hospital bills,” Milemba, who also doubles as the Emuhaya Member of Parliament, told The Standard. 

Milemba says he will be seeking Parliament’s intervention on the matter.

“I will present the matter before the floor of the House this week for intervention,” he said.

According to the union, teachers across the country have reported difficulties accessing treatment under the SHA platform. There are cases where hospitals decline to admit them or demand payments before offering services.