Union says “Dysfunctional” Medical Insurance Cover Assures Workers more of Death than Life
By Anchor Writers
The Kenya County Government Workers Union (KCGWU), Makueni County Branch, has issued a 48-hour ultimatum to the Makueni County Government, accusing it of presiding over a dysfunctional medical insurance scheme that has stripped workers of essential healthcare, violated constitutional guarantees, and exposed employees and their dependants to preventable suffering and death.
In a strongly worded complaint now in the hands of the county leadership, the Union says that although the County Government of Makueni has consistently contracted and remitted premiums for staff medical insurance since its establishment in 2013, the current medical cover represents a sharp regression from previous schemes. According to the Union, access to healthcare services was significantly better under earlier arrangements, while the existing cover is characterized by crippling limitations, exclusions, and restrictions that render it largely unusable.
The Union cites a 2014 circular issued by the Salaries and Remuneration Commission (SRC), which standardized healthcare benefits for public officers based on job groups and provided for outpatient, inpatient, dental, optical, and maternity services. It argues that the present medical cover falls far below these minimum standards. The insurer has accredited an unreasonably small number of healthcare facilities within and outside Makueni County, leaving many workers unable to access appropriate treatment when they need it most. Employees in lower job groups are particularly disadvantaged, with restrictions barring them from seeking care in Level 4 hospitals and above, even in cases requiring specialized or emergency intervention.
Beyond facility limitations, the Union says the scheme imposes service caps that are below SRC-recommended rates and enforces restrictive daily utilization limits per visit, forcing workers to either forego treatment or meet medical costs from their own pockets. More troubling, essential medical benefits — including outpatient, inpatient, dental, optical, and maternity services — have been excluded altogether from the cover, effectively hollowing out what is supposed to be a comprehensive staff medical insurance scheme.
The Union has taken particular issue with the inclusion of so-called “last respect expense” benefits, describing them as superficial and cynical. It says the provision appears designed to camouflage the withdrawal of critical healthcare services while doing nothing to protect workers from illness, disability, or long-term medical needs. In effect, the Union argues, the scheme offers more certainty in death than in life.
According to the Union, these omissions were not accidental. It believes the medical cover was deliberately structured to advance the interests of the insurance provider and/or procuring entities, to the direct detriment of county employees. As a result, workers have increasingly been compelled to finance their own medical care, with the Union reporting disturbing cases of loss of life that it attributes to delays, denials, and failures arising from the dysfunctional insurance cover.
The Union says the insurer has failed to provide services as stipulated in the contract, amounting to a gross violation of its obligations. It further contends that the situation constitutes a clear breach of Article 43 of the Constitution of Kenya, which guarantees every person the right to the highest attainable standard of health.
On the basis of these grievances, the Union has issued a formal demand for immediate corrective action, giving the county government forty-eight hours from receipt of the letter to act. It is demanding a comprehensive review and restructuring of the county staff medical insurance scheme to bring it into full compliance with SRC guidelines and constitutional requirements, the removal of discriminatory access restrictions based on job groups, and guaranteed access for all county staff to Level 4 hospitals and above both within and outside Makueni County.
The Union also wants an expanded list of accredited healthcare facilities, developed with the direct involvement of Union officials, to ensure services are adequate, reasonable, and geographically accessible. It is calling for a revision of medical service caps and daily utilization limits to reflect SRC recommendations and the prevailing cost of healthcare, as well as the immediate reinstatement of full outpatient, inpatient, dental, optical, and maternity cover.
Further, the Union is demanding full disclosure of the medical insurance contract, including benefit schedules and service obligations, to establish whether both the insurer and the procuring entity have complied with the law. It wants immediate remedial action taken against the insurance provider for failure to deliver contracted services, including consideration of termination for gross violation where applicable, and compensation for all workers who have incurred medical expenses from their own resources since the expiry of the last medical cover.
The letter, signed by Executive Branch Secretary-elect John Nzioka Sila, warns that failure to comply within the stipulated timeframe will compel the Union to initiate legal, industrial, and administrative action without further reference.
The complaint has been copied to Governor Mutula Kilonzo Jnr, Speaker Douglas Mbilu, the Secretary and Chief Executive Officer of the Makueni County Public Service Board, and all staff of the County Government, its municipalities, boards, and agencies.
In response, the Governor told The Anchor “The issue has been addressed . A meeting was called two days ago and the complete documents will be sent to Makueni tomorrow. It took long for the service provider to upload and or approve the hospitals that will give the services
Meanwhile, we have not signed the contract yet or paid the service provider.There is no reason for panic. A communication on the matter was issued last night to all workers”
The standoff could place renewed scrutiny on procurement decisions, percieved oversight failures, and whether county employees have indeed been quietly stripped of their constitutional right to healthcare under the guise of medical insurance.
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