The Ministry of Health has announced a series of measures aimed at resolving operational challenges affecting healthcare delivery to civil servants under the Public Officers Medical Scheme Fund (POMSF). 

The changes, announced on Thursday, April 23, followed a consultative meeting involving representatives from the Ministry of Health, the Social Health Authority (SHA), and the Union of Kenya Civil Servants (UKCS). 

In a joint statement, the parties first moved to assure civil servants that their medical cover has not been reduced despite the ongoing disruptions.

“Parties confirm that the Government has not reduced the medical benefits for civil servants. The contractual limits, which exceed Ksh70,000 for outpatient care depending on job groups, alongside comprehensive optical and dental limits, remain fully intact for the 120,014 principal members and their dependents,” the statement read.

To address immediate challenges being experienced at hospitals, SHA announced changes to the system currently affecting service delivery.

“To alleviate the immediate friction at the point of care, SHA will immediately withdraw the tariff locking currently configured in the system,” the statement added.

With the removal of tariff restrictions, the government emphasized that civil servants should not incur any additional costs while seeking treatment.

“Crucially, in this interim period following the withdrawal of the locked tariffs, all health facilities offering POMS services are strictly prohibited from charging any civil servant or public officer any out-of-pocket fees,” the statement continued.

Officials further clarified that stricter tariff rules will remain on hold until ongoing discussions with healthcare providers are completed.

“Accordingly, the strict tariff applications contemplated under Clause 10.2(c) of the Addendum shall remain suspended and will only become active upon the successful conclusion of the nationwide negotiations,” the statement clarified.

To support affected individuals, the government announced the immediate establishment of a rapid response mechanism.

“To address the plight of affected civil servants, SHA, the State Department for Public Service, and UKCS will immediately establish a Joint Rapid Response Desk,” the statement noted.

The desk will intervene to secure the release of any civil servants detained in hospitals and will also review claims for refunds of unauthorized charges incurred during the disruption.

As part of long-term solutions, SHA will engage healthcare providers in fresh negotiations to streamline pricing and service delivery.

“SHA will immediately embark on comprehensive, nationwide tariff negotiations targeting Private and Faith-Based Level 3 to Level 6 health facilities,” the statement further read.

The negotiations are set to begin on April 28, and are expected to conclude within four weeks, establishing a standardized reimbursement framework.

The ministry reiterated that the scheme does not allow co-payments and that beneficiaries should receive seamless services once reforms are complete.

“Parties agree that absolutely no co-payments are permitted under the POMSF scheme. SHA will continuously sign contracts with vetted and negotiated facilities. Upon the conclusion of negotiations and once contracted, these facilities must strictly offer a “walk-in, walk-out” service,” the statement noted.

Further, the ministry warned healthcare providers against imposing unauthorized charges on civil servants.

“Any unauthorized charging of civil servants constitutes a material breach of contract and will attract swift enforcement action, including de-contracting,” the statement read.

Civil servants were also advised to only seek treatment from approved facilities within the scheme to avoid exploitation.

“To protect beneficiaries from exploitation, services must be accessed exclusively through health facilities that are formally contracted under the SHA POMSF network. Private doctors or clinics not contracted under the scheme are not covered. SHA will continuously publish and update the comprehensive list of all contracted POMSF facilities on its official website to guide civil servants,” the statement added.

Finally, the ministry emphasized stricter oversight measures to safeguard the sustainability of the fund.

“To protect the integrity of the medical fund, SHA will rigorously enforce approved cost-containment measures, including regular claims audits to detect fraud, quarterly utilization reviews, and continuous loss ratio monitoring. SHA will optimize the provider network, ensuring only facilities that adhere to clinical standards and negotiated pricing are contracted,” the statement concluded.