A standoff is building between civil servants and the Social Health Authority after new rules on medical cover triggered concerns over reduced outpatient benefits.
The Union of Kenyan Civil Servants on Wednesday, April 15, 2026, faulted the authority for introducing what it described as a restrictive cap of Sh2,500 per outpatient visit under the Public Officers Medical Scheme Fund.
Union Secretary General Lawrence Ochieng said the new ceiling does not match the cost of treatment and weakens the protection that civil servants rely on for routine healthcare.
“SHA has limited the outpatient scheme to Ksh2,500, which basically means that we as civil servants are not insured because Ksh2,500 is merely a consultation fee,” he said.
He said the union had not been adequately consulted before the changes were introduced and warned that legal action could follow if the situation is not addressed.
“We are warning SHA that we will take legal action against them if they continue acting without consultation. We are surprised that SHA has not differentiated between the universal health coverage and our scheme.”
The union is now calling for a return to the earlier medical benefits, arguing that the new structure departs from what had been agreed for public officers.
The concerns come days after SHA rolled out a revised tariff system for the Public Officers Medical Scheme Fund following talks with Level 5 and Level 6 hospitals.
The authority said the review was informed by a market assessment and negotiations with health facilities, with implementation expected within 21 days across all accredited centres.
The new framework will guide how patients access services, how claims are filed and reviewed, and how payments are made to hospitals.
“The Authority shall conduct a market analysis during the first three (3) months of the commencement of the POMSF Scheme and following negotiations with healthcare facilities, provide final tariffs subject to approval by the SHA Board,” the statement read.
The scheme covers civil servants, teachers, members of the disciplined services and their dependants, offering inpatient, outpatient and specialised care.
According to SHA, the revised tariffs are meant to align payments with the cost of care and ensure hospitals are fairly compensated under the scheme. Facilities that agreed to the terms will continue offering services within the defined benefit packages.
The authority has also opened discussions with Level 4 and Level 3 hospitals as it moves to expand the new tariff structure.
But union officials argue the outpatient cap fails to reflect actual medical needs, noting that most visits involve tests and medication that push costs well beyond consultation fees. They say the limit risks shifting the burden back to civil servants despite being under a medical scheme.