Civil servants across Kenya are set to benefit from sweeping reforms to their medical cover after the government moved to outlaw out-of-pocket charges and secure the release of patients detained in hospitals over unpaid bills.
In a joint communiqué issued on April 23, the Ministry of Health, the Social Health Authority (SHA) and the Union of Kenya Civil Servants (UKCS) announced immediate measures to restore access to healthcare under the Public Officers Medical Scheme Fund (POMSF), following weeks of disruptions and complaints.
At the centre of the agreement is a strict directive prohibiting hospitals from charging civil servants any additional fees beyond what is covered under the scheme.
“Absolutely no co-payments are permitted under the POMSF scheme,” the parties declared, adding that any facility found in violation risks being de-contracted.
The directive is accompanied by the immediate withdrawal of tariff locking — a system configuration that had been blamed for treatment delays and disputes at healthcare facilities.
“To alleviate the immediate friction at the point of care, SHA will immediately withdraw the tariff locking currently configured in the system,” the communiqué signed by Health Cabinet Secretary Aden Duale, SHA Chief Executive Officer Dr. Mercy Mwangangi, and UKCS Secretary General Lawrence Nyaguti Ochieng said.
In a significant humanitarian intervention, the government also ordered the unconditional release of civil servants currently detained in hospitals due to billing disputes.
“This desk is tasked with intervening today to secure the unconditional release of any civil servant currently detained in health facilities across the country,” the statement said, referring to a newly established Joint Rapid Response Desk.
The desk, comprising officials from SHA, the State Department for Public Service, and UKCS, will also process refunds for civil servants who incurred unauthorized out-of-pocket expenses during the disruption period.
The reforms come amid growing concern over the treatment of beneficiaries under the scheme, including reports of patients being held in medical facilities and denied services due to system inefficiencies and billing disagreements.
To address structural challenges, SHA announced that it will begin nationwide tariff negotiations with private and faith-based health facilities, targeting Level 3 to Level 6 hospitals.
The process is expected to take four weeks and aims to establish a unified and transparent reimbursement framework.
“These negotiations will establish a harmonized, evidence-based reimbursement structure,” the communiqué stated.
The government also reassured civil servants that their medical benefits remain unchanged, dismissing fears of reduced coverage.
“Parties confirm that the Government has not reduced the medical benefits for civil servants,” the statement said, noting that outpatient limits exceeding Sh70,000, along with optical and dental benefits, remain intact.
Further measures include restricting access to services strictly to contracted facilities, with SHA set to publish and regularly update a comprehensive list to guide beneficiaries.
Officials said this move is intended to protect civil servants from exploitation by unregistered providers and ensure accountability within the system.
To safeguard the sustainability of the scheme, SHA will implement stricter cost-control mechanisms, including routine audits, utilization reviews, and monitoring of claims to detect fraud and inefficiencies.