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Swasthya Suraksha Missing in ‘e-Shram’

Jose Vattakuzhy Jose Vattakuzhy
04 Oct 2021

On 26th August, in the name of e-Shram, (<https://eshram.gov.in/>), a web portal was started by the Union Ministry of Labour and Employment. It intends to create a National Database of Unorganized Workers (NDUW). Being the first initiative in the history of India, the Government claims this database aims to optimize unorganized workers' employability and make sure that they would get for them the benefits of social security schemes. 

However, the much-needed health social security scheme or Universal Health Coverage-UHC (Swasthya Suraksha Yojana) is lost in this platform. Many families around the world are under threat as a result of the COVID-19 economic crisis. The financial catastrophe has been indicated in the form of loss of jobs and income, returning migrants, unemployment, etc. Pew Research has cited that 75 million people moved back into poverty in India. This has been damaging the social fabric of communities across India. Recently the report of the standing committee on Labour, in the context of the COVID 19 crisis, recommended extension of social security schemes for informal workers -- particularly health security or Swasthya Suraksha.

In line with this, many schemes have been formulated. Some of them are: Unorganised Sector Workers Social Security Scheme 2004; Universal Health Insurance Scheme 2004; Janani Suraksha Yojana (JSY) 2005; Health Insurance scheme for weavers (HISW) 2005; Aam Admi Bima Yojana 2007; Rashtriya Swasthya Bima Yojana (RSBY) 2007; National Program for the Health Care of the Elderly - NPHCE: 2011; Pradhan Mantri Suraksha Bima Yojana (PMSBY) 2015; and Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) 2018. The latest Shram 2021 came into a reality without any new program for universal health coverage. It means albeit in the e-Shram platform, the UHC concept remains indefinable aim, and the health system stays to be branded by substantial deficiencies relating to the unorganized workforce with lack of availability and infrastructure for quality health service.

e-Shram’s  Health, Social Security  Schemes

Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) of 2018 is one of the health and social security schemes which comes under e-shram. The eligibility for the scheme's benefit is determined based on deficiency criteria measured in the 2011 Socio-Economic Caste Census. Therefore e-Shram web portal cited that the family with no adult/male/earning member within the age group of 16-59 years could be enrolled; families living in one room with Kuccha walls and roof are eligible; households without a healthy adult member and one differently-abled member or manual scavenger families or landless households earning a major part of their family income from, manual labour would come under the AB-PMJAY. 

Pradhan Mantri Suraksha Bima Yojana (PMSBY) was started in 2015. It has benefits of Rs.2 lakh and Rs. 1 lakh respectively for accidental death and fractional incapacity in life. The enrolment in the scheme would be done by debiting from the bank account on consent.

'Health Insurance Scheme' for Weavers (HISW) was introduced in 2005.  The eligibility to get benefits is that at least 50 per cent of his/her income should come from handloom weaving. The available provisions of the scheme are reimbursement of Rs.15,000  against the treatment of both pre-existing and new diseases, Rs.2500 maternity benefits per child for the first two, Rs. 4,000 for domiciliary or hospitalization, Rs. 4,000 for hospitalization, including Ayurveda/Unani/Homeopathic/Siddha, Rs.500  for baby care, and 7,500 for  OPD treatment per illness. 

UHC Abolishes Poverty   

As per National Commission for Enterprises of the Unorganized Sector, among the social security divisions, health insecurity has a close link to workers and their income creation. It affects the financial growth and progress of society. Healthy workers have better output; labour supply improves as if the morbidity and mortality rates of people are lower. That means the major reason for poverty is lack of health social security.

In the social lives of people, sociologists say that there are two circles -- the circle of poverty and the circle of development or vicious and virtuous. The circle of poverty starts from the stage of no capacity for treatment at health risk of persons; this phase is a state of loss of working days which means there is no income. In addition, there is no chance to make good living condition; and there are no opportunities to avail good education and food for their children that would lead them to end up with malnutrition. Finally, the circle of these people's lives will reach again into poverty from poverty due to deficiency of facilities for the decent treatment. 

At the same time in the circle of development, all these moves would happen in reverse mode. The development stage means there will be the economic capacity to face hospitalization risk because of that there is no regular income stoppage; this would also help them to have savings, good living conditions, and fine educational facilities for their children with nutritious food. These stages could promote healthy and productive generation for the development of the society.    

The gap between circles of poverty and development is very much broadened in India during the pandemic and lockdown. The devastations of people during pandemic and lockdown indicated that all measures like social security and the steps taken by the Government seem quite inadequate. This reality has shown through the rise of inequality in society.

Many studies have observed that due to informalities among workers in semi-industrialized countries like India, the working class has been destined to be at the bottom level of the society. The COVID 19 impact intensified the great divide between the rich and the poor who mainly belong to unorganized sectors. This great divide was clear in the mode of functioning of workers in India. 

During Covid 19 and lockdown seasons, while people lost daily work, especially those who were engaged in contract employment, for example, daily earners, street vendors, domestic workers, shop employees, workers in restaurants, hospitality, travel, and tourism fields, the so-called white-collar and blue-collar workers were setting jobs in home (work from home-WFH) and protecting income (Report of Google format survey during August 1 to 15, 2021). They could make this season as opportunities of the best way of savings as if a time of less chance of expense.  

This trend could also be clear from the stock market trends of India. It was thriving with indices at record highs despite the rigorous season of last year; the profits of listed companies as a share of GDP hit a ten-year high of 2.6 per cent and the number of billionaires in the country went up from 102 to 140. One of the MPs said in Parliament that the success of oxygen call response rate was only 2-3 per cent in India during the second COVID season that indicates the situation of 'working poor' due to lack of health social security.

To avoid the fall-back from financial stability in the life of people due to incidents like pandemic, it has intensely recommended a universal health social security system by many committees and commissions on labour. Therefore, India needs a right-based or legalized universal health social security like ESIS and CGHS for all informal workers or 'working poor' families. 

Studies point out that once social health security becomes the right of a citizen, all people would be entitled to a quality life, level of well-being, and access to basic social service supported by either State or employer. Thus the social health security system would be institutionalized through the process of implementation without any discriminations and disparities. It is hoped that universal health security coverage, especially for unorganized workers, would be added in e-Shram without delay.  

(The writer is the founder Director of Workers’ India Federation (WIF). Email: josevattakuzhy2017@gmail.com)

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