The Union Labour Ministry’s announcement of free annual health check-ups for workers aged 40 years and above, to be implemented through the Employees’ State Insurance Corporation under provisions of the new Labour Codes, represents a significant if long-overdue step toward formal occupational health protection for India’s large organised sector workforce. The programme builds on an existing provision in the Occupational Safety, Health and Working Conditions Code 2020, one of four new Labour Codes that consolidated 29 central labour laws, and is to be financed through the well-endowed ESI fund.
However, the announcement raises as many questions as it answers. Only approximately 31 crore out of India’s 94 crore workers are registered on the e-Shram portal, and the integration of e-Shram with ESIC remains incomplete in many states. Women workers in the informal economy, construction workers, domestic workers, waste pickers, and sanitation workers, who face the highest occupational health risks, are largely outside the ESIC coverage net. The programme’s focus on non-communicable diseases like diabetes and hypertension, while excluding heat-related illnesses and prioritising non-communicable diseases over the infectious disease risks faced by informal sector workers, reveals the limitations of a scheme designed primarily around organised sector parameters.
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For UPSC aspirants, this topic engages GS-II content on welfare schemes, labour policy, healthcare access, and the challenges of extending social security to India’s predominantly informal workforce. It also touches on GS-III themes of industrial policy, labour market reform, and the implementation challenges of the new Labour Codes framework.
Background: The Labour Codes Reform and the OSH Code
Five Important Key Points
- The four new Labour Codes, the Code on Wages 2019, the Industrial Relations Code 2020, the Social Security Code 2020, and the Occupational Safety Health and Working Conditions Code 2020, consolidated 29 central labour laws and are intended to simplify compliance, extend coverage, and modernise India’s labour regulatory framework, but most states have not yet finalised the rules required for implementation.
- Only approximately 31 crore of India’s 94 crore workers are registered on the e-Shram portal, which was launched in 2021 as a national database of unorganised workers, and the portal’s integration with ESIC, the National Career Service portal, and other social security systems remains incomplete.
- Health check-ups will be mandatory for workers in hazardous conditions such as those handling toxic chemicals or operating heavy machinery, with free treatment at ESIC hospitals and dispensaries if illness is detected, but the government is still expanding the number of beds and doctors available, partly by empanelling PMJAY facilities.
- The programme does not adequately address heat-related illnesses, which are not explicitly recognised as occupational diseases under the ESI Act, despite construction and agriculture workers being at the highest risk from extreme heat, which is becoming an increasingly severe occupational hazard in India’s warming climate.
- The opportunity costs of accessing healthcare, including lost wages for daily wage workers who must take time off to attend check-up camps, remain unaddressed in the current design, as does the absence of provisions for mobile occupational health units that can conduct check-ups at workplaces as stipulated under the OSH Code 2020 for organised workers.
The Institutional Framework: ESIC and Its Coverage
The Employees’ State Insurance Corporation is a statutory body under the Ministry of Labour and Employment, established by the ESI Act 1948. It provides a comprehensive social security net for workers earning below a specified wage threshold, currently Rs 21,000 per month, covering medical care, sickness benefits, maternity benefits, disablement benefits, and dependents’ benefits. ESIC currently covers approximately 14 crore employees and their family members, making it one of the largest integrated social security schemes in the world.
The ESI fund has historically been well-endowed, with collections consistently exceeding expenditure, but the quality and accessibility of ESIC hospitals and dispensaries vary significantly across states. Urban ESIC facilities in major industrial centres tend to be better equipped and staffed, while facilities in smaller towns and industrial areas distant from metropolitan centres often suffer from doctor shortages, equipment deficiencies, and administrative inefficiencies. The plan to supplement ESIC infrastructure by empanelling facilities under the Pradhan Mantri Jan Arogya Yojana, the insurance component of Ayushman Bharat, is a pragmatic recognition of these limitations but introduces coordination challenges between two very different delivery systems.
Gender Dimensions: Women Workers and Occupational Health
The announcement by Labour Minister Mansukh Mandaviya did not address how women working in the informal economy, including domestic workers, garment home unit workers, and informal food processing workers, would access the extended maternity leave provisions of the new Labour Codes or the annual health check-up programme. This is a fundamental gap because the most vulnerable female workers are precisely those who have no formal employer-employee relationship and therefore cannot access employer-linked social security benefits.
Women workers in formal factories are covered by ESIC and would benefit from the annual health check-up programme. However, even for these workers, the programme must account for specific health needs including gynaecological examinations, breast and cervical cancer screening, and anaemia detection, which are particularly prevalent among Indian women workers but require different medical staff, equipment, and protocols from the general health check-ups that will be the norm in ESIC camps dominated by male workers.
Hazardous Work and the Recognition Gap
The announcement specifically mentions mandatory check-ups for workers in hazardous conditions such as handling toxic chemicals or operating heavy machinery. This is important but inadequate. India has a large population of workers in highly hazardous informal occupations, including manual scavenging, which despite legal prohibition continues under various guises; unorganised construction work; artisanal gold mining; ship-breaking at Alang in Gujarat; and agate and quartz stone cutting in Khambhat. These workers face severe occupational disease risks including silicosis, asbestosis, lead poisoning, and chronic respiratory conditions, but most are outside ESIC coverage.
Heat stress represents a growing and inadequately addressed occupational hazard. India’s temperatures have been rising consistently due to climate change, and outdoor workers in agriculture, construction, and informal transport experience sustained heat exposure that causes both acute conditions like heat stroke and chronic conditions including kidney disease associated with chronic dehydration. The failure to explicitly recognise heat-related illness as an occupational disease under the ESI Act and to mandate heat stress monitoring and cooling measures as part of occupational health check-ups is a significant policy gap.
The Opportunity Cost Problem and the Mobile Health Unit Solution
Perhaps the most fundamental implementation challenge is that daily wage workers, who constitute the majority of India’s organised sector informal-formal boundary workers, cannot afford to lose a day’s wages to attend health check-ups. The programme as announced does not include any provision for wage compensation during health check-up attendance, making it effectively inaccessible for the most economically vulnerable workers it purports to serve.
The OSH Code 2020 stipulates that occupational health services should be provided at workplaces for organised sector workers. The most effective implementation of the annual health check-up programme would be through mobile occupational health units that visit factories, construction sites, and other large workplaces, conducting check-ups during working hours with the employer obligated to provide the time without wage deduction. This approach eliminates the opportunity cost barrier and ensures high uptake rates. Several countries including Germany and Japan have successfully implemented workplace-based occupational health surveillance systems that India could adapt.
Way Forward
The government must issue clear operational guidelines specifying how the check-up programme will reach workers in small enterprises with fewer than ten employees, who constitute a large share of the formal sector workforce but often fall below the threshold for effective labour law enforcement. Mobile health units must be deployed to reach workers at construction sites, industrial areas, and agricultural settlements. The ESI Act must be amended to explicitly recognise heat-related illness, mental health conditions, and musculoskeletal disorders as occupational diseases. Wage compensation for time spent in mandatory health check-ups must be mandated, with the cost shared between government and employers above a certain size threshold. And the e-Shram portal must be urgently integrated with ESIC to enable extending at least basic occupational health benefits to the informal workforce.
Relevance for UPSC and SSC Examinations
UPSC Paper: GS-II (Government Policies and Interventions; Social Justice; Health; Welfare Schemes); GS-III (Labour Market; Industrial Policy)
SSC Topics: Government Schemes; Labour Laws; Social Security; Public Health
Key Terms: ESI Act 1948, ESIC, OSH Code 2020, Labour Codes, e-Shram portal, Ayushman Bharat, PMJAY, occupational disease, hazardous work, manual scavenging, heat stress, mobile health units, TReDS, informal workforce.