Teachers’ Medical Insurance Crisis: SHA Tycoon Jayesh Umesh Saini Link to Sh55 Billion MAKL and Bliss Deal.
Jayesh Umesh Saini has been identified as the beneficial owner of Medical Administrators (K) Ltd (MAKL) and Bliss Healthcare (K) Ltd, two firms at the core of the Sh55 billion teachers’ medical insurance scheme controversy.
The companies, linked to the United Arab Emirates, play a central role in the administration of this scheme, which has faced setbacks following the withdrawal of services by some hospitals due to unpaid arrears.
The insurance cover is managed by a consortium led by Minet Kenya Insurance Brokers Limited. Within this arrangement, MAKL functions as the medical administrator, contracting hospitals and overseeing payment of bills, while Bliss Healthcare acts as the master capitator, operating 63 clinics nationwide.
Where Bliss Healthcare lacks presence, it forms third-party agreements through MAKL to ensure service delivery.
MAKL was established on December 7, 2018, with Bliss Healthcare (K) Ltd owning all its 1,000 shares. Madni Ali Asif Ansari is its only listed director, while Lenah Chelangat serves as the company secretary.
Bliss Healthcare (K) Ltd itself was incorporated on December 6, 2019, under the ownership of UAE-registered Bliss Healthcare and Administrators LLC, which also holds 1,000 shares. Ansari remains the sole director of this UAE-based entity.
During legal proceedings in France against activist Nelson Amenya, Saini reportedly described himself as the owner of Bliss Healthcare, managing over 60 clinics across Kenya, and Dinlas Pharma, the firm responsible for importing the Russian Covid-19 vaccine Sputnik V.
The teachers’ medical cover is underwritten by six insurance companies: Old Mutual Kenya, Britam, CIC Insurance, Pioneer Insurance, Star Discover General Insurance, and Star Life Insurance.
However, the scheme’s sustainability has been threatened by the National Treasury’s failure to remit Sh9 billion in premiums since September 2024, jeopardizing healthcare access for teachers. Several hospitals contracted by MAKL have ceased providing services, leaving affected teachers to seek alternatives where available.
Links to the Digital Health Platform
Saini has also been associated with a consortium involved in the Sh104.8 billion digital platform project supplied by Safaricom PLC under the Social Health Authority (SHA). Other participants in this consortium include Apeiro Ltd, a UAE royal family-owned firm, and Kenya’s Konvergenz Network Solutions.
Rufus Marundu Maina, a director in other companies linked to Saini, including Lifecare Hospitals, holds similar roles in two firms established by Apeiro for the project.
These companies—Apeiro Kenya Technologies Ltd and SIH Africa Ltd—are connected, with SIH Africa owning all shares in Apeiro Kenya Technologies Ltd. Despite being directors, Maina, Inder Deep Singh Virdi, Judy Mwende Gatabaki, and Aswanth Bindhu Lambodaran hold no shares in Apeiro.
SIH Africa’s shareholding structure includes Nishant Mishra and Lambodaran, each holding 500 shares in trust. Maina remains a director without equity in the company.
Both SIH Africa and Apeiro operate as subsidiaries of Sirius International Holding, an Abu Dhabi-based investment firm under IHC, incorporated on July 5, 2024.
Teachers’ Struggles and Complaints
Over a million teachers and their dependents are facing uncertainty as hospitals begin denying medical services due to delayed capitation fund disbursements for medical coverage. For the past six months, hospitals have gone without payments for teachers’ health insurance, forcing some facilities to either refuse treatment or demand upfront cash payments.
The situation affects a total population of 1,373,160 individuals, including 403,522 teachers and 969,638 dependents. The Standard has established that hospitals are owed Sh11 billion, which has accumulated over the past six months.
Several hospitals have already begun suspending services due to the financial strain. Tenwek Hospital in Bomet County issued a public notice stating that, effective February 1, it would no longer provide services on credit to members under Medical Administrator Kenya Limited (MAKL).
Despite this, the medical scheme provider claimed on Tuesday that they had not been informed of any teachers being denied services.
Meanwhile, frustration among teachers is growing, as many already struggle financially and are now forced to cover their medical expenses out of pocket.
The Teachers Service Commission (TSC) and the National Treasury have remained silent on the crisis, offering no communication on the growing concerns.
The Kenya Union of Post-Primary Education Teachers (KUPPET) has sounded the alarm, calling for the immediate release of Sh11 billion to cover teachers’ medical expenses. The union reported that several hospitals had already begun turning teachers away or requiring cash payments upfront.
KUPPET Acting Secretary General Moses Nthurima highlighted that Tenwek Hospital had issued an official withdrawal notice, while other hospitals had opted to deny teachers services without any formal communication. The union is now demanding urgent intervention by the Treasury to prevent further distress.
The Impact on Teachers’ Well-being
Teachers depend on a comprehensive medical insurance scheme managed by a private underwriter, introduced to replace direct medical allowances.
The scheme covers inpatient and outpatient services; however, due to the lack of government disbursements, many healthcare providers have ceased offering services, leaving teachers stranded.
Nthurima emphasized that teachers’ health is crucial and delaying their access to medical care violates their right to healthcare and human dignity. He stated that sick teachers cannot be productive in the classroom, underscoring the urgent need for action.
Teachers from various regions have shared their struggles with accessing medical care. A teacher from Kisii County reported being turned away from a private hospital when she sought treatment because her medical cover was no longer accepted due to unpaid dues. She expressed frustration over having to pay out-of-pocket despite her already strained salary.
Another teacher from Machakos, who lives with a chronic illness, revealed that she was forced to pay cash for her medication after being informed that her insurance card was no longer valid. She stated that when she went to refill her ulcer medication, the hospital required her to make a direct payment due to the outstanding debts owed to healthcare providers.
KUPPET has reiterated its demand for the Treasury to release the funds immediately, noting that the money is deducted directly from teachers’ salaries. Nthurima pointed out that these funds are part of teachers’ earnings, redirected from their previous medical allowances.
The union has also urged accredited hospitals to continue offering medical services despite the financial challenges. They called on healthcare providers to uphold their service commitments and ensure that teachers receive the necessary medical care.
Delisting of Hospitals Raises Further Concerns
KUPPET has also criticized the decision by medical scheme operators to delist 17 hospitals as primary healthcare providers. These hospitals are now only available for referral services, meaning teachers can only access them upon recommendation from another facility.
Edward Obwocha, KUPPET’s National Secretary for Secondary Schools, argued that this move has stripped teachers of access to quality healthcare, leaving them dependent on poorly equipped medical institutions.
Neither the Treasury nor the TSC has issued a public response to KUPPET’s demands. The teachers’ medical scheme, introduced in 2015, replaced the previous medical allowance system. However, the current crisis raises concerns about its effectiveness in ensuring reliable healthcare access for educators and their families.
The The Kenya National Union of Teachers (KNUT) has urged the government and the Teachers Service Commission (TSC) to promptly remit medical allowances to hospitals, ensuring teachers can access their entitlements.
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David Bore, the union’s branch executive secretary, urged the government to release the withheld funds so hospitals could receive timely payments.
Bore also proposed that teachers should have the option to select their preferred medical schemes and receive refunds of their deductions if the current provider cannot meet its obligations.
Teachers’ Medical Insurance Crisis: SHA Tycoon Jayesh Umesh Saini Link to Sh55 Billion MAKL and Bliss Deal.
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