‘Had to borrow money’: Migrant workers struggle for healthcare during lockdown

Routinely excluded from urban healthcare systems, Indian migrant workers struggled to find medical help for Covid-19 and other illnesses during the second wave of the pandemic, according to a recent survey by the advocacy organization Aajeevika Bureau workers’ rights. They also struggled to access free Covid-19 vaccines.

Of the migrant workers surveyed in the first week of May 2021, 27% had Covid-19 or other illnesses during the second wave. Of these, 70% struggled to find treatment, 58% got no support from their employers and 62% were forced to borrow heavily to cover healthcare costs, Aajeevika’s phone survey shows with 195 migrant workers in Ahmedabad.

In a two-part series based on the survey, we explore the impact of sporadic state shutdowns on the lives of migrant workers who have chosen to stay in cities. The first part dealt with the loss of jobs and wages. In this final section, we examine the health impacts of the crisis and attribute them to the structural exclusion of migrants from urban health systems, the lack of support from employers and a deep distrust of the public health system.

32% of sick workers dismissed

Swati Saktavat, a community leader who works with tribal migrant workers in Ahmedabad, recounted the experience of Shamliben*, who caught a Covid-19 infection in April 2021 while in her village in Dahod district , in eastern Gujarat. Although she was diagnosed in Ahmedabad where she works, Shamliben chose to return to her village when her condition worsened because she did not trust the city’s public health facilities.

“Having spent more than Rs 25,000 for her hospitalization in the village, she struggled to repay her debt. A few days after being released, she was forced to return to town, during the second wave in the hope to find work at naka work,” Saktavat said.

Our survey also revealed a lack of support from employers. Up to 58% of workers with Covid-19 – or other illnesses – were not paid for the time they were sick; 32% were made redundant.

Choosing between security and subsistence

Rajanben Parmar, leader of a workers’ collective in Ahmedabad, says that unlike the 2020 Covid-19 outbreak, in April 2021 every building in her housing complex in Narol had a positive case and fear of infection was palpable. Aajeevika’s survey found that 73% of migrants feared contracting Covid-19 in the second wave as it would mean loss of income as well as heavy medical expenses.

She recounted the tragedy of a migrant household in her building where a mother and daughter spent an entire day looking for a hospital bed for a gravely ill relative who was also the only family member earning money. ‘silver. He eventually succumbed to the disease and with no support system in town, the family returned to their village.

In the absence of wage security, workers found themselves trading security for subsistence. “Ghar se aadmi naukri by ja rahe hai. Dar bhi lag raha tha. Ghar se nikle ya nahi? (My husband is going to work outside. I’m scared too. Should we get out of the house or not?),” Parmar said of the fears migrant families face.

READ ALSO: Crushed in the first wave, migrant workers have few jobs, still little support

Ayushman Bharat-Pradhan Mantri Jan Aroyga Yojana (PMJAY), the Centre’s flagship health insurance scheme which provides vulnerable families with free medical treatment up to Rs 5 lakh per year, has been extended to migrant workers for treatment Covid-19 in 2020. However, a survey conducted on June 16, 2021 by India Today found that in Gujarat, not a single Covid-19 patient had been able to benefit from this scheme.

Pankti Jog of Mahiti Adhikar Gujarat Pahel, a social activist, explained that Covid designated hospitals were not necessarily incorporated under PMJAY and Mukhyamantri Amrutam Yojana, Gujarat’s own health insurance scheme for poor families. And the hospitals hadn’t been given any guidance either to treat cardholders for either plan.

Many have questioned the effectiveness of the Ayushman Bharat program with its exclusive reliance on private healthcare infrastructure. Even government data from 2020 confirms this.

‘Had to borrow for processing

The second wave of the pandemic has strained the healthcare system in Ahmedabad, while increasing the vulnerability of workers to health shocks. According to our study, up to 68% reported excessive medical expenses and 62% said they borrowed for medical expenses and treatments. In interviews with authors, some workers revealed that during the second wave, private clinics and pharmacies began to charge 2 to 3 times more than the usual consultation fees, which increased their financial burdens.

Manju Meghwal*, a domestic worker in Ahmedabad, was infected by a family she cooked for. She received no help from the households that employed her and had to pay a medical bill of around 20,000 rupees, which she paid by borrowing from neighbours.

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Neglected by urban health networks

Residency requirements, language barriers, stigma and logistics prevented migrants from accessing the city’s local public healthcare systems. Outreach to migrant households by Accredited Social Health Activists (ASHAs) and other health workers is also irregular, as migrant settlements are not recognized by local authorities.

“Migrant workers facing health issues in the city cannot access government medical aid in Ahmedabad,” said Mahesh Gajera of Aajeevika center in Ahmedabad.

A pre-pandemic study on migrant access to the urban governance system conducted in 2020 found that 90% of respondents preferred private clinics, and this included consultations with quacks and pharmacists, to urban health centers ( small clinics that provide free primary health care) or public hospitals (for secondary treatment). They paid anywhere between Rs 100 and Rs 3 lakh out of their own pocket for these consultations.

Distrust of public health

Ranjanben Parmar added that during the second wave, government health workers started visiting migrant settlements in Narol every day, but migrants were reluctant to consult them due to mistrust and fear of forced confinement. in hospitals and the separation of families.

This mistrust can be attributed to weak public health systems in rural areas, Pavitra Mohan, co-founder of Basic Healthcare Services, a non-profit organization working in southern Rajasthan, pointed out in an interview with IndiaSpend. He added that this anxiety was compounded by stories of forced quarantine and coercive testing of migrants returning from cities last year.

Vaccine: exclusion and hesitation

With the onset of the second wave, attention has turned to accelerating mass vaccination in Gujarat. As of June 30, 19.8 million of the eligible population aged 18 and over in Gujarat have received the first dose, while in Ahmedabad up to 2.3 million people have been covered, according to government data.

At the time of the Aajeevika survey, the deployment for the 18-44 age group had just started and none of the migrant workers in this age group had taken the vaccine. Our survey revealed that 60% of them were willing to be vaccinated. However, even among those who wanted it, many expressed a lack of confidence in the vaccine.

“Now that the pandemic situation is improving, workers are more and more reluctant to get vaccinated saying that they are all healthy and there is no need for a vaccine,” says Mahesh Gajera.

Up to 40% of migrants said they were unwilling to get vaccinated, citing rumors of bad experiences among distant relatives and misconceptions about possible side effects. Surat also reported growing distrust of the vaccine among migrant workers.

The requirement for digital registration for vaccination has also been one of the biggest hurdles faced by workers wishing to get vaccinated. The Supreme Court’s directive to review this policy and the recently announced free vaccination campaign with on-site registration could change that.

However, limited time slots can create logistical hurdles for workers on 12-hour shifts. Additionally, up to 62% of workers said they would have to lose a day of work and pay to take the hit and recover from its potential side effects.

Workers will need to be incentivized with compensation for lost wages and targeted outreach, Gajera suggested. An example of an effective incentive is Odisha’s program for returning migrants which offered 2,000 rupees as compensation for a 14-day quarantine during the first lockdown.

*Names changed to protect identities

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