THIRUVANANTHAPURAM: While the state government claims to have made significant strides in the welfare of interstate migrant workers, their access to health facilities remains poor, according to a recent study.
Researchers from the Mahatma Gandhi University (MGU), Kottayam, found that only 9.8 per cent of migrant workers in the state are covered by health insurance. Moreover, 87.7 per cent are not even aware of central and state health policies designed for their welfare. The study raises key questions about the effectiveness of government schemes in providing insurance coverage to these workers.
Earlier in the year, a report published by the Centre for Migration and Inclusive Development (CMID) found that at least 690-700 migrant labourers die every year in Kerala. “Around two migrant labourers die every day, of which one death is linked to workplace accidents,” said CMID executive director Benoy Peter. He added that there is no record of migrant worker deaths in the state.
The principal investigator of the MGU study, Dr Bijulal M V, said that a key reason for poor health insurance coverage is the involvement of middlemen. “No principal employer hires labourers directly. They do it through contractors. With multiple levels of contracts and sub-contracts, legal provisions get undermined, as the sole aim becomes labour arrangement,” he told TNIE.
Close to 50 per cent of migrant workers said that they are overworked in hazardous conditions, which vary from sector to sector — high risk in construction and manufacturing, and low risk in restaurants, salons, etc. Nearly 57 per cent said they work 9-12 hours a day. In certain places, workers mentioned that they were not allowed to sleep for more than six hours, despite 12-14 hours of work with an hour’s rest in between.
The Awaz Health Insurance Scheme (AHIS), a state government initiative to provide health and accidental death coverage to migrant workers, was introduced in 2017. Although a 2021 study funded by the State Planning Board found that close to 13 per cent of the migrant population benefited from it, registration was closed in 2022. The Athidhi portal, an interface for registration and welfare of migrant workers, was introduced in 2023 and has registered a total of 4,19,570 people, as of September 15.
While officials with the labour commissionerate mention that those registered on the portal will have access to health insurance coverage, as in Awaz, they do not have a clear picture of the total number of people who have been insured through the portal and AHIS.
“From what we understand through right to information (RTI) applications, the Awaz scheme has been largely non-functional since 2019,” said Navas M Khader, a project associate of the study.
According to co-investigator Dr Noushad P P, “Even though the study found that digital penetration among migrant workers is fairly high (85.5 per cent), poor registration on government portals like Athidhi calls for a change in approach.”
While reiterating the need for grassroots-level interventions, he stressed that specialised drives are needed to avoid stereotyping them. Migrant workers limit their access to health facilities due to language barriers and work timings. Many of them consult doctors over the phone or prefer self-treatment, according to researchers. Only 2-3 per cent of migrants seek real-time medical aid from qualified doctors, Bijulal said.
Deployment of mobile health clinics with flexible timings should be considered by the government, he added. “Similar practices were earlier implemented in certain parts of the state by CMID and found to be effective,” he said. The appointment of labour ambassadors, who can converse in both Malayalam and the migrants’ mother tongues, should be considered, as proper communication is essential in health matters, Bijulal opined.