Govt sets measures to improve healthcare access for civil servants under POMSF
Nairobi, Kenya - - Cabinet Secretary for Health, Hon. Aden Duale, chaired the signing of a Joint Communiqué outlining agreed measures to improve the delivery of healthcare services for civil servants under the Public Officers Medical Scheme Fund.
The agreement provides for the immediate removal of the tariff locking mechanism within the Social Health Authority system to ease access challenges at the point of care. In the interim, all facilities offering services under the scheme are prohibited from charging any out-of-pocket fees, in line with existing contractual obligations. Provisions on strict tariff application will remain suspended pending the conclusion of ongoing nationwide tariff negotiations.
A Joint Rapid Response Desk will be established immediately, bringing together the Social Health Authority, the State Department for Public Service, and the Union of Kenya Civil Servants to address urgent cases, including the release of detained patients and review of unauthorised charges for refunds.
Nationwide tariff negotiations for private and faith-based Level 3 to Level 6 facilities will commence on and are expected to conclude within four weeks, with the aim of delivering a harmonised, evidence-based reimbursement framework.
Under the revised framework, the “walk-in, walk-out” principle will apply strictly, with no co-payments permitted. Only contracted facilities within the Social Health Authority network will provide services, with enforcement action, including de-contracting, for facilities found to be in breach of agreed terms.
The Social Health Authority will maintain and regularly update a public list of approved facilities, while strengthening accountability through claims audits, utilisation reviews, fraud detection systems, and continuous monitoring of facility performance.
The parties also underscored the importance of clear and timely communication to beneficiaries, including updates on system changes. The Social Health Authority will enhance stakeholder engagement, expand regional sensitisation efforts, and publish an updated scheme manual to improve access to information.
The meeting was attended by Principal Secretary for Medical Services Dr Ouma Oluga, Union of Kenya Civil Servants Secretary General Lawrence Nyaguti, Social Health Authority Chief Executive Officer Dr Mercy Mwangangi, Digital Health Agency Chief Executive Officer Eng. Anthony Lenayara, and officials from the Ministry of Health and the Union.