Free Health Check-ups for Workers, A Commendable Step That Misses the Real Barriers
The Union Labour Ministry has announced a new initiative: free annual health check-ups for workers aged 40 years or more, implemented through the Employees’ State Insurance Corporation (ESIC). The programme follows an existing provision in the new Labour Codes and will be financed through the well-endowed ESI fund. For workers in hazardous conditions—such as those handling toxic chemicals or operating heavy machinery—check-ups are mandatory. If illness is detected, ESIC hospitals and dispensaries will provide free treatment. On paper, this is a significant expansion of health coverage for India’s vast workforce. But operational evidence and historical experience suggest that the programme’s success is far from guaranteed.
India already has a few workers’ health obligations on paper, including under the Factories Act of 1948 (which applies only within factories), the ESI Act of 1948, and the Occupational Safety, Health and Working Conditions (OSH) Code of 2020. The problem has never been the absence of laws. The problem has been the absence of implementation. The new programme, commendable though it is, risks repeating the same pattern. The government is still shoring up the number of beds and doctors available via PMJAY-empanelled facilities. At this time, insured workers will be the main beneficiaries. The vast majority of informal workers, who make up over 90 per cent of India’s workforce, may find the scheme as inaccessible as its predecessors.
One of the most glaring gaps is the integration of the e-Shram portal with ESIC. At present, only around 31 crore of 94 crore workers are registered on the e-Shram portal. Integration with ESIC is still in its early stages in many states. Without seamless data sharing, workers cannot be identified, tracked, or referred. A worker who is not on the portal cannot access the scheme. This is not a minor technical issue; it is a fundamental barrier.
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.” This is not a niche concern. Millions of women work in precisely such informal, unregulated settings. They have no written contract, no fixed hours, and no identifiable employer. The law, as currently structured, does not reach them. The new health check-up scheme, by extension, may also fail to reach them.
Annual check-ups for women also warrant specific medical staff needs. Many ESIC camps are crowded and dominated by men. A woman who needs a gynaecological examination or a breast cancer screening may find the environment unwelcoming or may not find a female doctor at all. This is not a matter of entitlement; it is a matter of design. A scheme that does not account for the specific health needs of women will not serve them well.
As with many of its predecessors, the programme does not address the opportunity costs of accessing health care. A worker who takes time off to visit an ESIC facility loses a day’s wages. For a daily wage worker, that is not a minor inconvenience; it is the difference between feeding the family and going hungry. Even if the check-up is free, the cost of lost wages is prohibitive. The scheme offers no compensation for this loss. So workers will not come. The programme could have provided tokens or cash transfers to compensate workers for their time. It does not.
An ESIC facility may also refer a worker to another centre if it lacks the resources for specific tests. This leads to repeat visits, added time, and added cost. For a worker who has already lost a day’s wages for the first visit, a second visit is a second loss. Many workers will simply not return. The scheme’s design assumes that workers have the time and resources to navigate a fragmented system. They do not.
The new programme focuses predominantly on non-communicable diseases such as diabetes and hypertension. These are important, but they are not the only health risks workers face. Heat-related illnesses, for example, are not explicitly recognised as occupational diseases under the ESI Act. Construction and agriculture workers, who are most at risk of heat stress, will not be covered for these conditions. Waste-pickers and sanitation workers face greater risk of infectious diseases such as hepatitis and leptospirosis. The scheme offers screening but does not mandate proactive vaccination. A hepatitis vaccine costs a fraction of what treating the disease costs. But the scheme does not provide it.
The government must meet workers where they are. This means deploying mobile occupational health units that can travel to industrial clusters, construction sites, and agricultural fields. It means, as the OSH Code 2020 stipulates for organised workers, conducting check-ups at their places of work, not at distant ESIC facilities. It means providing tokens or cash transfers to compensate workers for time spent on check-ups. It means integrating the e-Shram portal with ESIC as a matter of urgency. It means training more female medical staff and creating women-friendly spaces in ESIC camps. It means expanding the list of covered conditions to include heat-related illnesses and infectious diseases. It means mandating vaccination for preventable diseases, not just screening.
Otherwise, any scheme of this nature will not improve upon the already deficient system. The government has announced a commendable goal. But a goal without a plan is just a wish. The plan must address the real barriers workers face: lost wages, fragmented services, lack of integration, and a one-size-fits-all approach that does not account for gender, occupation, or geography. If the government can address these barriers, the scheme could be transformative. If not, it will join the long list of well-intentioned but poorly implemented policies that India’s workers have learned to ignore.
The ESI fund is well-endowed. The government has the resources. The question is whether it has the will. The workers of India will be watching.
Questions and Answers
Q1: What is the new programme announced by the Union Labour Ministry?
A1: The Union Labour Ministry has announced free annual health check-ups for workers aged 40 years or more, implemented through the Employees’ State Insurance Corporation (ESIC). The programme follows an existing provision in the new Labour Codes and will be financed through the ESI fund.
Q2: What is the current status of integration between the e-Shram portal and ESIC?
A2: Only around 31 crore of 94 crore workers are registered on the e-Shram portal, and integration with ESIC is still in its early stages in many states. Without seamless data sharing, workers cannot be identified, tracked, or referred.
Q3: What specific concern does the article raise about women workers accessing the scheme?
A3: The article notes that annual check-ups for women require specific medical staff, but many ESIC camps are crowded and dominated by men. Women needing gynaecological examinations or breast cancer screening may find the environment unwelcoming or may not find a female doctor at all.
Q4: What is the “opportunity cost” of accessing health care that the scheme does not address?
A4: The article highlights that a worker who takes time off to visit an ESIC facility loses a day’s wages. For a daily wage worker, even a free check-up is prohibitive because of lost wages. The scheme offers no compensation for this loss.
Q5: What specific occupational health risks does the article identify that are not explicitly recognised under the ESI Act?
A5: The article notes that heat-related illnesses (affecting construction and agriculture workers) are not explicitly recognised as occupational diseases under the ESI Act. Additionally, waste-pickers and sanitation workers face greater risk of infectious diseases such as hepatitis and leptospirosis, but the scheme offers screening without mandating proactive vaccination.
