Cost to access: On health check-up for workers
Union Labour Ministry has announced that it will provide a free annual health check-up to workers aged 40 years or more, following an existing provision in the new Labour Codes. The programme will be implemented through the Employees’ State Insurance Corporation (ESIC). For workers in hazardous conditions, such as handling toxic chemicals or operating heavy machinery, check-ups are mandatory; if illness is detected, ESIC hospitals and dispensaries will provide free treatment. India already has a few workers’ health obligations on paper, including under the Factories Act 1948 (only within factories), the ESI Act 1948, and the Occupational Safety, Health and Working Conditions (OSH) Code 2020. The new programme will be financed through the well-endowed ESI fund, although the government is still shoring up the number of beds and doctors available via PMJAY-empanelled facilities. At this time, operational evidence suggests that insured workers will be the main beneficiaries.
Commendable though the initiative is, its success is not guaranteed. At present, only around 31 crore of 94 crore workers are on the e-Shram portal, whose integration with ESIC is still in its early stages in many States. Labour Minister Mansukh Mandaviya also failed to address how a woman working in a garment home unit or as a domestic worker could access the longer maternity leave if she has no ‘employer’. Annual check-ups for women also warrant specific medical staff needs whereas many ESIC camps are crowded and dominated by men. As with many of its predecessors, the programme does not address the opportunity costs of accessing health care, forcing workers to continue contending with lost wages. An ESIC facility may also refer a worker to another centre if it lacks the resources for specific tests, leading to repeat visits and added time and cost. The new programme focuses predominantly on non-communicable diseases such as diabetes and hypertension. Heat-related illnesses are not explicitly recognised as occupational diseases under the ESI Act whereas construction and agriculture workers are most at risk of them. Waste-pickers and sanitation workers on the other hand face greater risk of infectious diseases such as hepatitis and leptospirosis. The scheme offers screening but does not mandate proactive vaccination. The government must meet workers where they are, through mobile occupational health units and — as the OSH Code 2020 stipulates for organised workers — at their places of work, and provide tokens to compensate them for time spent on check-ups. Otherwise, any scheme of this nature will not improve upon the already deficient system.
- 1The initiative aligns with India's constitutional commitment to a welfare state and the Directive Principles of State Policy (DPSP), particularly Articles 39(e), 42, and 47, which mandate the state to secure workers' health and provide just and humane conditions. However, the editorial highlights significant implementation gaps, especially concerning the vast informal sector and slow integration of the e-Shram portal with ESIC, hindering universal access. This underscores the persistent challenge of translating constitutional ideals into tangible benefits for all citizens, requiring robust administrative mechanisms and outreach strategies for equitable service access.
- 2India's domestic policy on labour welfare, exemplified by the new health check-up scheme under the Labour Codes, aims to enhance social security for its vast workforce. This initiative reflects a broader policy shift towards formalizing and safeguarding workers, particularly those over 40 years, in line with the objectives of the e-Shram portal launched in 2021 to create a national database of unorganised workers. Yet, the policy faces substantial hurdles in reaching the estimated 90% of workers in the informal sector, where issues like lack of a discernible 'employer' complicate access to benefits.
- 3The new health check-up programme stems from existing provisions in India's recently consolidated Labour Codes, specifically the Occupational Safety, Health and Working Conditions (OSH) Code 2020, which aims to modernize labour regulations. While the OSH Code mandates health provisions, including for organised workers at their workplaces, the editorial critiques the scheme's failure to explicitly recognise certain occupational diseases like heat-related illnesses under the ESI Act. This highlights a regulatory lacuna where the legal framework, despite replacing 29 central laws, still needs to adapt to evolving health risks and ensure comprehensive coverage, including proactive measures like mandatory vaccination, for all vulnerable worker groups.
- 4The scheme's success hinges on overcoming significant socio-economic barriers, particularly the opportunity costs faced by workers who lose wages to access healthcare, a critical concern for daily wage earners in India. Furthermore, the editorial points to gender disparities, noting that ESIC camps are often male-dominated and lack specific medical staff for women, hindering equitable access to health services for female workers. Addressing these issues requires a multi-pronged approach, including compensating workers for time off and deploying mobile health units to reach marginalized communities, ensuring economic constraints do not impede access to essential health benefits.