Kerala’s AAWAZ health insurance for migrant labourers benefited only a handful

December is the follow-up month at TNM where we go back to headlines of the past for a status update. In this series, we strive to bring focus back to promises made by governments, revisit official investigations that should have been completed by now and exhume issues of public interest that lost steam over time.

Five years have passed since the Kerala government introduced Aawaaz, a free medical insurance scheme for migrant labourers, who are officially referred to as guest workers in the state. The scheme promised them free medical treatment worth Rs 15,000 per year and insurance coverage of Rs two lakh for accident deaths.

A 2013 study estimated the migrant labour population in Kerala at around 25 lakh but a projection by the State Planning Board says the state will be home to nearly 60 lakh migrant workers by 2030. The insurance scheme for migrant labourers was introduced in the backdrop. According to information available on the Labour Department web page for Aawaz, 5.16 lakh migrant workers have registered under the scheme and have got the biometric cards.

However, there are numerous complaints by migrant labourers regarding the scheme including not receiving the promised benefits. Arshad from Murshidabad of West Bengal has been working in Ernakulam for the past 12 years and says that he never received the benefit though he was admitted in hospitals multiple times. “We waited in lines for days to register and get the card. After that there were no benefits at all. Even in government hospitals though the treatment was free, many times we had to spend thousands for scanning, medicine and so on. If it's in a private hospital, all expenses we have to bear. We don’t even understand what is the use of the card,” he said.

There were similar complaints from many of the AAWAZ card holders TNM spoke to. “My friend was admitted to a private hospital after he fell at our construction worksite. He was shifted to a government hospital after five days. Even after being an inpatient in a government hospital there were extra expenses. In total we collected Rs 25,000 to pay his medical expenses. We have no idea how many times we went to offices seeking the promised insurance amount,” says Sonu, an Odia native from Thiruvananthapuram.

George Mathew, an activist based in Ernakulam who works among migrant workers said, “when this scheme was introduced all labour officers were given targets for registrations. Workers waited in long queues and got the biometric cards. Many of them still have no clue that these cards can be used for health insurance. They considered it as a mandatory identity card to work in Kerala.”

As per the data provided by the Labour Commissionerate in Thiruvananthapuram, from 2018 to 2022 there were 374 beneficiaries to whom the government released Rs 24,18,583. Under the accident death claim scheme of AAWAZ, there were 30 beneficiaries from 2018 to 2022, who have been sanctioned Rs 58,50,000.

The data shows that less than one percent (0.07%) of the registered members have received benefits under the scheme. “These numbers are quite small,” says George, adding that migrant labourers seek treatment for injuries, some of them serious, and ailments regularly. “ A person from West Bengal has been admitted to Little Flower hospital, Angamaly following a cobra bite. Around Rs two lakh is needed for his treatment. How can a daily wage worker like him afford it?” asks George.

Ernakulam District Labour officer Vinod Kumar attributes the low number of beneficiaries to lack of awareness on the usage of AAWAZ card use and the exodus of migrant labourers to the native places during the pandemic. ‘Many card holders don’t know which hospitals have been empanelled under the scheme,” he said. The majority of the cards were given before the start of COVID-19 pandemic, the official said.

“We provide the list of empanelled hospitals to their employers. But more than 60% of the labourers are scattered and they have no clue on why the card is used for. We had limitations to find them all and give awareness due to language issues. Many of them do not understand Hindi. So from 2023 January we will restart the AAWAZ insurance drive and will provide details in many Indian languages. Any labourer who gets admitted through Out Patient department in the empanelled hospitals are eligible for the insurance,” the officer said.

He also pointed out that the government had entrusted an external agency to enrol migrant workers for the insurance scheme. The period of agreement has ended but the department has plans to renew it, the officer said.