understanding the health needs of migrants in gurgaon city in haryana state of the national capital...

Understanding the health needs of migrants in Gurgaon, Haryana, India

Society for Labour and Development (SLD)

Understanding the health needs of migrants in Gurgaon city in Haryana State of the National Capital Region (NCR) in India

A Report of Gurgaon Migrants Health Study on behalf of the Society for Labour and Development (SLD)


Acknowledgements

The preparation of this report was project-‐led by a Consultant, hired by Society for Labour and Development (SLD). The work is the product of the Society for Labour and Development, a non-‐government NGO working for migrant and human rights in the National Capital Region of Gurgaon.

The report brings together data on the health needs of migrants in Gurgaon city in Haryana taken from a range of publicly available sources and from findings of an original health-‐related field study among migrant workers’ communities.

Interviews were undertaken by a lead consultant and co-‐lead consultant. Unless otherwise stated the report is written by the consultant, who also edited all the contents, contributed to the discussion sections and summarised all the public health recommendations.

We gratefully acknowledge all those who contributed to this report, including staff from Society for Labour and Development (SLD). We also acknowledge the help, support and contributions of all the colleagues within the SLD, including the board members and administrative staff who contributed in many ways to make this report a success.


Acronyms

AIDS Acquired Immune Deficiency Syndrome

BBV Blood borne Viruses

CSWs Commercial Sex Workers

CWG Common Wealth Games

ESI Employers State Insurance Corporation

FGD Focus Group Discussion

FSWs Female Sex Workers

GP General Practitioner

GPCs Good Practice Centres

HSACS Haryana State AIDS Control Society

HBV Hepatitis B Virus

HCV Hepatitis C Virus

HRG High Risk Population

HIV Human Immunodeficiency Virus

IHC Integrated Health Centre

IDUs Injecting Drug Users

KI Key Informants

NCR National Capital Region

NACO National AIDS Control Organisation

NSV No-‐Scalpel Vasectonomy

PHC Primary Health Care

SLD Society for Labour and Development

STI Sexually Transmitted Infections

SI Skin Infection

TB Tuberculosis


Table of Contents

Executive Summary……………………………………………………………………………………………………………………………....5

Background and Introduction………………………………………………………………………………………………………………….5

Methodology and Limitations………………………………………………………………………………………………………………….9

Objectives……………………………………………………………………………………………………………………………………………..10

Methodological approach……………………………………………………………………………………………………………………..10

Tools for data collection………………………………………………………………………………………………………………………..11

Sample selection……………………………………………………………………………………………………………………………........13

Data analysis……………………………………………………………………………………………………………………………….………..14

Findings………..............................................................................................................................................15

Barriers to service…………………………………………………………………………………………………………………………..….…32

Conclusions and Recommendation…………………………………………………………………………………….………………..33

References……………………………………………………………………………………………………………………........................35

Annexure A (Health need assessment tool for male migrant workers)....................................................36

Annexure B (Health need assessment tool for women and spouses)……………………………………………………37

Annexure C (Health need assessment tool for service providers)…………………….……………….…………………39

Annexure D (Health need assessment tool for field staff).....………………………………………….………………..…40

Annexure E (Administrative setup)….......................................................................................................41

Annexure F (Health department in Gurgaon)...……………………………………………………………........................42

Annexure G (List of NGOs working in the district)……………………………………………………………………………….45

Annexure H (List of hospitals under ESIC)………………………………………….………………………………………………..47

Annexure I (Employers State Insurance benefits)………………………………………………………………..….……….….48


Executive Summary

The Society for Labour and Development (SLD) commissioned this report to inform private and public health care service providers in the region about the health needs of migrants, and to recommend ways to meet identified needs. This report has been written by a consultant, in collaboration with the field staff of SLD. Stakeholders, including those participating in the study from January – March 2012. It will be published as an e-‐publication to facilitate easy and wide dissemination, in order to increase its impact and accessibility to the broadest range of stakeholders and service providers in the country.

Migration has always played an important part in the economic, cultural, social and educational life of India. Migration is affected by geopolitical and economic factors. Migrants are a diverse and dynamic group and for this reason, have variable and varying health needs. Migrants can be those seeking employment or education, or they can be refugees, family members coming to join established relatives. They can be migrating through legal or irregular channels and be documented or undocumented. By far the most important groups in the region under study are economic migrants, and those who have then followed to join their family members.

Background and Introduction:

Migration is an important feature of human civilization. It reflects human endeavor to survive in the most testing conditions, both natural and man-‐made. Migration in India has always been in existence but in the context of neo-‐liberal globalization, assumes special significance for civil society.

Migration in India is mostly influenced by social structures and methods of development. The development policies by Indian government since Independence have accelerated the process of migration. Uneven and extractive development is the main cause of migration. Added to it, are the disparities between regions and different socio-‐economic classes. The landless poor who mostly belong to lower castes, indigenous communities and economically backward regions constitute the major portion of migrants. In the very large tribal regions of India intrusion of outsiders, displacement of local tribal people and deforestation have also played a major role in migration -‐ (Sudershan Rao Sarde et al, Regional Representative, IMF – SERO, New Delhi, ‘Migration in India’ Oct 2008).

The Indian daily Hindustan Times on 14thOctober 2007, revealed that according to a study by a Government Institute (National Skills Development Corporation (NSDC)), 77% of the population i.e. nearly 840 million Indians live on less than Rs. 20 (40 cents) a day. Indian agriculture became non-‐remunerative, taking the lives of 100,000 peasants during the period from 1996 to 2003, i.e. a suicide of an Indian peasant every 45 minutes. Hence, rural people from the


downtrodden and impoverished communities and regions such as Bihar, Orissa, Uttar Pradesh travel to far distances seeking employment at the lowest rungs in construction of roads, irrigation projects, commercial and residential complexes -‐-‐ in short, in building “Shining” India.

The pull factors of higher wages also caused outward migration to the Middle East countries by skilled and semiskilled workers. Migration of professionals such as engineers, medical practitioners, teachers and managers to such countries constitutes a fraction of the total migrants.

According to a study on ‘Migration in India’ Oct 2008, by Sudershan Rao Sarde, in India migration is predominantly short distance with around 60% of migrants changing their residences within their district of birth and 20% within their state (province), while the rest move across the state boundaries. The total migrants as per the census of 1971 were 167 million persons, as per the 1981 census 213 million, as per the 1991 census 232 million and as per the 2001 census 315 millions. As per the census of the year 1991, nearly 20 million people migrated to other states seeking livelihood. Within a decade, the number of interstate migration doubled to 41,166,265 persons as per the census figures of 2001. It is estimated that, the present strength of interstate migrants is around 80 million persons of which, 40 million are in the construction industry, 20 million are domestic workers, 2 million are sex workers, 5 million are call girls and somewhere from half a million to 12 million are in the illegal mines otherwise called as “small scale mines”.

There is an increase of women migrant workers. They travel long distances for employment without any assurance or prospect. They end up working in inhumane conditions and become victims of sexual abuse and harassment. Women form more than half of the interstate migrant workforce. The division of labour is gendered. Masonry is a male-‐dominated skill as are carpentry and other skilled jobs. Women carry head loads of brick, sand, stone, cement and water to the masons, and also sift sand. Their wages are less as compared to men. – Sudershan Rao Sarde et al, Regional Representative, IMF, SEARO, New Delhi

The Government of India made an enactment in 1979 in the name of “Inter-‐state Migrant Workmen (Regulation of Employment and Conditions of Service) Act 1979”. Though the Act covers only inter-‐state migrants, it lays down that contractors must pay timely wages equal or higher than the minimum wage, provide suitable residential accommodation, prescribed medical facilities, protective clothing, and notify accidents and causalities to specified authorities and kin. The Act provides the right to raise Industrial Disputes in the provincial jurisdiction where they work or in their home province. The Act sets penalties including imprisonment for non-‐compliance. At the same time the Act provides an escape route to principal employers if they can show that transgressions were committed without their knowledge. Needless to say, that the Act remains only on the paper. Records of prosecutions or


dispute settlement are almost non-‐existent. The migrant labourers face additional problems and constraints as they are both labourers and migrants. -‐ (B. K. Sahu et al, Insurance Commissioner, ESI Corporation, India)

In Gurgaon, for most of the 8-‐10 lakh migrant workers, discrimination on the basis of place of birth is common. It was evident in the days leading up to the Commonwealth Games, when nearly 1.5 lakh migrant workers were forced by the police department to leave the city, contrary to Article 15 of the Fundamental Rights of the Constitution of India which prohibits discrimination on grounds of religion, race, caste, sex or place of birth as well as Article 19(1) (e) which assures freedom to reside and settle anywhere in the territory of India. -‐ The Times of India, May 2011, Gurgaon’s 8 Lakh migrant workers live and work like animals

Nevertheless, discrimination is evident when it comes to, applying for new ration cards. The applicants are asked questions like, “where are you from?” These questions and the implicit derision are obvious as it is mandatory to produce documents giving proof of address when applying for ration cards.

It is this kind of treatment that keeps migrant workers and their families invisible. They do not have birth certificates, ration cards, residence proofs or voter IDs. They make up more than 30 per cent of Gurgaon’s population and have contributed to the large-‐scale boom in the economy by working in factories and construction sites or by working in the homes of people occupying the high-‐rises but their own identity hang on a thread with the persistent question, “Where are you from?”-‐ Times of India report, 7th May 2011

But the struggle does not end there. Some migrant workers have ration cards, which does not guarantee food grain. Nearly 25% of all migrant workers are women. For them, ration cards and food security, especially in the face of sky-‐rocketing prices are the highest priority. Yet, in the last one year, the government of Haryana has not made grain available for many card holders.1 This speaks volumes of the attitude of the administration in refusing to acknowledge the presence and needs of the many migrant workers, who come here, live on very unstable incomes and have absolutely no work security.

Residence proof is very difficult to acquire. Most migrant workers take up a room in blocks of rooms that have sprung up all over Gurgaon. Here, they either share a room with other workers or live with their families. The house owner usually owns the whole block of rooms and refuses to give any rent receipts or rent agreements. Not only this, they also do not permit any of the neighbours to vouch for the fact that the person is indeed living there.

1 Source: Reports on workers’ rights in Gurgaon, South Asia Citizens Web


In some cases, migrant workers, face eviction because they dared to buy groceries from a shop other than the one owned by their house owners. Such is the domination that the migrants are forced to not only rely on insecure housing arrangements but they are also coerced into buying products higher than the actual market price from the shops of the house owners. Thus, the spiral of invisibility and exploitation continues.

In addition, the government of India has introduced various BPL schemes (self-‐employment, housing, food, free education health insurance and small value individual schemes) for people who are under below poverty line, to bring them above the poverty line, including migrants and citizens. But most of the migrant families or people who fall under this category are not aware of the schemes and have no knowledge and information on how to approach the state governments for enrolment and registration. Furthermore, migrant labourers constitute a major “bridge” population comprising people from various states. Through close proximity to high risk groups they are at risk of contracting HIV and other concomitant illnesses. Quite often they are clients or partners of male and female sex workers. They are a critical group because of their ‘mobility with HIV’. Their living and working conditions, sexually active age and separation from regular partners for extended periods of time predispose them to paid sex or sex with non-‐regular partners. Further, inadequate access to treatment for sexually transmitted infections aggravates the risk of contracting and transmitting the virus.

Presently, the only intervention under the National AIDS Control Organisation (NACO) for migrants is focussed on 8.64 million temporary migrant workers. The migrants are of particular significance to the HIV epidemic because of their regular movement between source and destination areas. In order to reach out to this bridge population with interventions, NGOs identify active volunteers among the community and train them in disseminating preventive messages among their fellow workers. Factory owners, construction companies and other employers engaging the services of these migrants are also motivated to undertake preventive HIV education activities among the migrant community.

According to the Haryana State AIDS Control Society (HSACS), seven new TI (Targeted Intervention) projects that include five for migrants will be implemented at Panipat, Faridabad Jhajjar and Gurgaon. The interventions would be functional in the current fiscal (2012– 2013) which will assist in reducing the prevalence of HIV among the high risk groups. This was disclosed by the state health secretary, at the 12th meeting of the Executive Committee of Haryana State AIDS Control Society (HSACS) at Panchkula on 2nd June 2012. Presently Haryana state is covered by 32 TI NGOs in order to cover the high risk population like FSWs, IDUs, core composite and Migrants. All these NGOs are supported by the HSACS.


Access to regular health services in government and public health facilities is always a challenge for migrant workers as most of them do not have identity or residential proof. Some of them who are long-‐term workers in companies have smart cards, which allow them to access free health services through the ESI hospital in Gurgaon. But, the vast majority and especially those who have freshly joined, temporary workers and daily wagers, have no identity proof or any health cards for accessing treatment services from ESI hospitals. Hence, they are compelled to go to private facilities or local clinics and pharmacies, and have to pay for the doctor’s consultation and medication, which majority of them cannot afford due to poor financial and economic condition. -‐ (Targeted Intervention for Migrants, 2007, NACO)

Methodology The research methodology used to compile this report has included a detailed literature review, identifying and interrogating data sources, and interviews and discussions with health care service providers, clinics, hospitals and individuals involved in providing health care services among the migrants in the region. A key finding of this process is the extreme inadequacy of available data resources for identifying the population of interest, their experiences of health and disease, or their use of health services. A comprehensive report exploring the strengths and weakness of these data sources is provided as an Appendix to this report.

Limitations

• The study design was based on the assumption that only qualitative data is “ideal” standard to assess the health needs of migrant workers. To compensate for the possibility that the research might not be able to find the most-‐needed specific services we developed open-‐ended questions in the interviews and FGDs;

• The study has only managed to capture the qualitative data through the statements made by the respondents but not the quantitative ones for analytical reports;

• It was only possible to conduct the study questionnaire with migrant workers, who are linked directly or indirectly with the SLD – those that SLD has not reached at all were not interviewed;

• Data collection tools were in English and the data collectors are well versed in English and the local language (Hindi). If the study participant did not know English, then they had to rely on translations and ‘back translations’, which marginally affected the quality of the data to some degree;

• As most of the migrants work under extremely stressful conditions with little personal time, they were not available in time or were not able to participate for FGDs and


interviews during the week days, which delayed the study process as they were only available for a short while during Sundays, which is the only holiday for the workers;

• The study did not focus on numeric data in order to obtain information about the variables, as would be the case in quantitative research.

The health needs assessment study that was conducted, targeted individual migrants including groups of migrants and their spouses, hospitals (government and private) and, private clinics (quacks) and other health related facilities in Gurgaon region, of Haryana state in India. The study also targeted people and service providers working with migrants to contribute positively to the process of identifying health issues in particular. The results of the study are drawn from a range of both government and private health care service providers across a wide geographical spread in Gurgaon region. The limitations of the study results and methods used in the report are discussed, but this work should provide a useful ‘baseline’ of current knowledge against which future strategies and plans on health care services for migrants can be designed.

Objectives

This health needs assessment study was conducted with the following objectives:

1. To assess the factors associated with health related issue of migrant workers in Gurgaon region;

2. To understand the performance levels of the health care service providers in the region; 3. To assess the facilities available and accessible for migrants in the existing health care

centers; and 4. To provide recommendation for improving the performance of the health services; Methodological Approach To achieve these objectives a combination of following methodological approaches were used in the health needs assessment study. 1) Review of existing (secondary) data: This comprised a review of the existing facilities, private and government hospitals and clinics and reports of migrants’ health care services in the region. 2) Collection and Analysis of Primary data:

i. Using largely qualitative interview methods, FGDs, where the consultant along with the field staff of SLD, collected data on-‐field, among various levels of migrant workers


and health care service providers and functionaries of government/private hospitals and clinics:

• Migrants workers; • Spouses of migrant workers; • Service providers (i.e. Hospital staff, Doctors and Compounders); and, • Health care workers and field staff of SLD.

Tools for Data Collection For primary data collection a set of semi-‐structured questionnaires were drafted, specific for each category interviewed. After development, the questionnaire was subjected to peer-‐review and after discussion among the various stakeholders the questionnaires were finalised. The report provides information on the population of migrants in Gurgaon region, recorded using current data systems. It also provides information on existing health services (government and private) available to migrant workers and their families and whether the community is aware about these services. The study also identifies the gaps in knowledge and the knowledge level of migrant workers related to health services in this particular region. All this data reveals the nature of the migrant population and their distribution throughout the area. It also highlights localities where health and social care providers may find the meeting of needs of migrants to be a significant challenge. While the full questionnaires for various categories of respondents have been added as annexures, a brief outline of questionnaires for all categories of respondents is as follows: Category Areas covered in the questionnaire Migrant workers (Men)

• Perception of government and private health facilities; • Preference of services; • Type of health services received through government and private

facilities; • Services that are not available for the community; • Attitude of service providers towards migrant workers; • Knowledge of HIV/AIDS; • Major health problems and illnesses; • Community awareness and knowledge on existing health care

facilities; • Relationship between employer and migrants;


• Health care services that are most needed among the community; • Drugs and alcohol related issues in the community.

Women/Spouses of Migrant workers

• Basic needs for survival; • Health services for women; • Problems women face in the community; • Biggest fears among women; • Safety and security; • Work and employment issues; • Children support and education; • Relationship and marriage; • Sexual and reproductive related health issues; • Women’s’ rights to negotiate sex; • Availability of contraceptive methods; • Knowledge of HIV/AIDs and STIs; • Alcohol and drug related issues; • Gender violence; • Specific health services for women.

Service Providers (Doctors, Nurses, Govt. & Pvt. Hospitals, Clinics & Field Staff)

• Available health facilities ; • Fee structure; • Major health issues; • Referral services; • Timings of service delivery; • Knowledge on HIV status among the migrants; • Alcohol and drugs related issues; • National/State health policies for migrants; • Health related issues to be addressed;

Regarding various areas of migrant’s population, the respondents were asked to share common problems encountered in accessing health care services and the gaps. It must be noted that the basic component for data collection was the individuals and group of migrant workers, their spouses, doctors, and nurses of clinics and hospitals providing health care services. Thus in the above mentioned categories of respondents, specifically hospitals and private clinics, the individuals and persons in charge of the health care facilities, who take the lead and are likely to be most informed about migrants’ health issues were asked to respond to the questionnaires.


Additionally the scope of the study extended to specific areas of Gurgaon, where the migrant workers are situated. Thus, all attempts to singularly identify a particular area or a single health care facility have been deliberately avoided. All the responses have been analysed and findings have been presented in such a way that discourages disclosing the identity of the respondents. Sample Selection For the above methods of data collection, attempt was made to choose a sample that was as representative as possible. It was ensured – to the extent possible – that specific geographical areas in Gurgaon region are proportionately represented, since it was assumed that different groups and areas in the region have different views related to their health issues. Hence, different sets of questions were used for different categories for qualitative analysis. However since there is a large number of migrant workers in NCR region, around 97 migrants workers were selected for the FGDs and the following approach was adopted to select the sample.

• In areas where majority of migrant workers are situated, minimum 10 – 15 migrants were chosen for the FGDs;

• In areas where there is less number of migrant workers, minimum 10 – 12 migrants were chosen;

• In areas where majority of migrant families are situated, minimum 10 – 15 spouses of migrants were chosen for the FGDs;

• In regards to the health care facilities and services, 3 government and 3 private hospitals/clinics were chosen for the interviews;

• In regards to organisations that are working for migrants issues, minimum 8 – 10 field staff of were chosen for the FGD;

Thus, approximately about 117 migrant workers, including women and spouses, 10 health service providers and 10 field staff of SLD were involved in the FGDs and interviews. Among these chosen people, almost all were approached and focus group discussions were held by the lead consultant using qualitative data analysis tools. The basis for selection of sites for field visit was both – representative factor in terms of geographical area, burden of health issues as well as logistical considerations.


Data Analysis Once the data collection was over, data was triangulated, and analysed using largely qualitative data analysis techniques. However, all the data was qualitative in nature. This data was entered in the data-‐entry formats, triangulated and thus analysed to summarise the common findings. The findings were used for formulating the conclusion and recommendations. Since the methodology adopted allowed collection of data from multiple sources, it provides an opportunity to triangulate the data so obtained. Specifically, regarding problems and gaps in health services among the migrant workers in various areas, data was obtained from migrants themselves, women and spouses of migrant workers and the service providers. Similarly, migrant workers were asked to identify specific gaps and factors that influence access to health services for the migrant’s community. Finally, all three types of respondents: migrant workers (men), women and spouses of migrant workers, and services providers (doctors, nurses, government and private hospitals, clinics and field staff) – were asked their opinion on ways to improve access to health services in the region. All these data were compared grouped according to various topics and have been summarized in findings below.


Findings

Response rate The following table presents the response rate across various categories of respondents. Sl No Category of

respondents Areas covered No. of individuals and organisations from

whom responses could be obtained on-‐field (through interviews/FGDs)

1 Migrant workers (Men)

Dundahera, Kapasera, Manesar, Mohammadpur, Naharpur, Sarhol,

72

2 Women/Spouses of migrant workers

Kapasera, Mohammadpur -‐ Nalapaar

25

3 Service providers (Doctors, Nurses, Government/Private Hospitals & Clinics and Field staff)

Kapasera, Nalapaar, Gurgaon, Udyog Vihar

20

Thus, we were able to obtain responses from a large majority of the respondents. In case of women and spouses of migrant workers however, despite best efforts, within the stipulated duration of data collection, responses could be obtained from about 25. In case of health care service provider responses could be obtained only from 20 service providers. This section on findings has been organised as follows. Initially responses obtained from each category of respondents have been summarised. Finally, common issues arising out of triangulation of data collected from various sources has been presented. Most of the responses are through FGDs with male migrant workers and their spouses who are directly in contact with SLD’s field staff and are working in private factories under exploitative


conditions. The areas that are covered during the study are Kapasera, Dundahera, Manesar, Mohammadpur Khandsa, Mohammadpur Nalapaar, Naharpur Manesar and Sarhol in Guragon.2 The following chart shows the total response rate of four types of categories of respondents, who were approached for Focus Group Discussion and interviews.

1. Migrant workers (Men)

# Perception of government and private health facilities: Focus Group Discussions (FGDs) were conducted at 6 different locations in Gurgaon region with 72 male migrant workers, who responded that they prefer to go to private hospitals and clinics, as the treatment is good, staff is efficient and they are satisfied with the services. In government facilities the staff attitude is not good and the patients have to wait for long hours in queues. Sometimes the doctors are not available in time of need. Majority of migrant workers expressed dissatisfaction with the ESI hospital exemplified with statements such as -‐ “If we do not have a smart card, we cannot access services from the ESI hospital and smart cards are only provided to the permanent workers of the companies.” “I don’t have a card so I have to go to a private clinic and pay for my treatment and health checkup, which is quite difficult for me as I get a very small amount of money.”

2 Most of the responses obtained on field as mentioned on the above table and are the statements made during the FGDs


There are three government hospitals (including 2 ESI hospitals) with all the facilities in Gurgaon but some of the migrant workers from the community have a different perception about government facilities such as -‐

• The treatment is not satisfactory as the doctors do not give much time to the patients; • Behaviour and attitude of government hospital staff are not good but a few staff, who

are from various other districts or states and not from Gurgaon or Haryana are more polite and well behaved;

• Services are not accessible in the time of need as doctors have restricted timings for seeing patients;

• The facility is far from the locality; • Transportation is a problem for most of the migrant workers, as they have to spend

money to transport patients during emergencies; • Long waiting hours in queues; • A few staff who handles the queue and numbering, take money from patients to

advance them to the front of the queue; • Treatment is almost free but difficult to access due to the crowds; • ESI hospital is the best with all the facilities where treatment is free of cost but is only

accessible to people who possess a smart card; • For those, who do not have smart cards issued by their employers, they could not access

treatment services in ESI facilities and hence they have to go to private clinics for treatment, which is expensive.

A statement of one of the respondent is – “In government hospital, I have to wait in a queue for a long time for my turn to come and when my turn comes the doctor, who sees me does not listen to my problems carefully and takes very little time to see.” “I am not satisfied with the diagnosis.”

Community perception about private hospitals and clinics -‐

• The treatment facilities in private hospitals are good; • Staff attitude and behavior is better; • Treatment services are provided in time; • Doctors attend to the patients carefully; • Services are accessible to all, and during emergencies as well; • Treatment is expensive as compared to government facilities;


• Patients are satisfied with the treatment.

# Preference of services: The following chart shows that out of 97 male and female migrants from 6 different areas in the region, the majority of the migrant population i.e. 62% prefer to go to private facilities, 26% prefer government facilities and the rest 12% prefer to access services from ESI hospitals. # Type of health services received through government and private facilities: Health services that are offered free of cost by the government hospital in Gurgaon for all BPL are –

• A 24 x 7 emergency (OPD & indoor) – first 24 hours, free for all; • Ante-‐natal checkup, delivery & caesarian facility, free for all; • Surgery package programme for all surgeries, on minimum fixed rates which is free for

BPL and ‘notified slums’ i.e. slums that are recognized by the Union government under the ‘Slum Act’ or recognized by the Municipal Corporations (MCs);

• Indoor package programme: indoor facility at Rs. 100 per day with free medications which is free for BPL and notified slums;

• Referral transport 102 (transportation to carry patients to other health facilities) which is free for BPL and notified slums, newborn, delivery, road side accidents and freedom fighters;

• Family planning surgery – No-‐Scalpel Vasectonomy (NSV) and tubectommy on a daily basis;

• Immunisation between Monday – Fridays; • A 24 x 7 Blood bank service;


• Investigation including Lab, X-‐ray, Ultrasound, MRI on fixed rates and free for BPL and notified slums;

• Free Cataract surgery for all; • Neurologist, Neurosurgery, Clinical Psychologist on selected days; • De-‐addiction Consultation and Counselling; • ICTC, Suraksha Clinic Facility; • Six bedded burn unit; • A 24 x 7 ICU and Special Neonatal Care Unit; • Special Facilities for Handicapped people.

In the government hospital, the first time patients need to register themselves with a nominal amount of Rs 5/-‐ only after which they receive a registration number and a card for availing the health services. During the FGDs it was learned that the migrant workers find it difficult to access services due to long queues, waiting time (especially given their employers’ refusal to grant them leave and their fear of job loss) and lack of identity proofs. The health services that are offered by the Private Hospitals in Gurgaon are similar to the above mentioned services but the patient needs to pay more for the treatment and investigation which is unaffordable for a migrant worker due to his meager income. Apart from this, there is a government mobile clinic that comes to a particular area on every alternate day and provides services, like health checkups and free medication for all the BPL and slums dwellers. The migrant workers community can also access the mobile clinic. The mobile clinic charges Rs 20/-‐ for checkups and medication. The ESI hospitals are the better option for the migrant workers who have smart cards issued by their companies and those who haven’t do not have any choice but to pay money and access small local private clinics and pharmacies run by less qualified and inexperienced doctors from other states. In the absence of service providers in the neighborhood, the only choice is some small clinics. The charges are Rs. 50 – 100 for each consultation and services. Some of the respondent statements are such as -‐ “I am working as a daily wager in a garment manufacturing company, and I have not received any smart card from the employer, so I cannot go to ESI for treatment”. ”When I am sick, I go to the local doctors and pharmacies, which are running clinics in my locality and pay consultation fee of Rs.50 -‐ 100”. The facilities that are offered by local clinics and doctors are only health checkup and prescribed medications for which the migrant workers have to pay extra money. The doctors and nurses are not experienced and are less qualified. In case of serious illnesses and


complications they are referred to government and private hospitals in Gurgaon and New Delhi for further examination and treatment. # Services that are not available for the migrants’ community:

• In the opinion of migrant workers, emergency services for accidents and fractures are difficult to obtain as there is no adequate facility in their locality for transportation and treatment;

• In government hospitals, they cannot access emergency services when needed, as the doctors have particular timings for examining patients;

• During emergency delivery cases they have difficulties in getting medical assistance; • Ambulance services for emergency cases are not available in time of need; • According to the respondents, there are no NGOs or private health care service

providers in the region who are specifically providing health care services for the migrant community except for NGOs working for skill building and human rights based issues.

One of the respondents stated – “During my wife’s delivery, I had to call a local midwife (Dai) to do the delivery at home. Many delivery cases in our locality are mainly done by the midwives as people do not like to take risk in taking their wives to government hospitals during emergency deliveries”. # Attitude of service providers towards migrant workers:

• During the FGDs, the respondents mentioned that the attitude of the staff of government service providers, hospitals and clinics are not so good;

• However the respondents stated that the staffs of private hospitals and clinics are better and are polite and concerned about the patients.

# Knowledge of HIV/AIDS:

• Most of the migrant workers (90%) have no knowledge of HIV/AIDS. They have heard about HIV infection but lack information and awareness. Only two out of 97 respondents had some knowledge through media, TV and radio advertisements on HIV and its routes of transmission;

• A few of them have heard about HIV/AIDS through TV, Radio and advertisements; • There are no specific NGOs or service providers working for HIV/AIDS awareness in the

locality; • The Haryana State AIDS Control Society under the guidance of NACO and MoH has only

TI programmes for migrant workers community for prevention of HIV/AIDS in various states in India. Unfortunately there is no programme for migrants, presently in Gurgaon region;


• However, the Haryana State government has plans to implement such TIs for migrant workers in collaboration with NGOS, sometimes during this year 2012.

# Major health problems and illnesses:

• During the focus group discussion, most of the respondents expressed that they are not aware of any major health problems but have come across a few cases of TB, lung infections and liver problems in their community. Majority of them mentioned that they are not much aware of major health problems as such in their community;

• Some stated that the people have oral thrush and mouth ulcers due to chewing of tobacco and tobacco products;

• Skin rashes among the children due to unhygienic conditions and unclean water; • Malnutrition due to loss of iron and other proteins among the migrant workers children; • One of the migrant worker mentioned that he had some lung infection, where he had to

go to the private doctor for his treatment and medication as he does not have a smart card. He was satisfied with the treatment and services that were rendered by the private doctor. But he had to spend a lot of money there;

• However, in most cases the migrant workers who have smart cards prefer to go to ESI hospital as the treatment and services are provided free of cost

• Occupational health hazards and safety is another area where majority of the migrant workers lack awareness or information on how to prevent themselves from the danger. A structured approach is needed for identification of the risks in the working places. Hence, awareness of occupational health hazards and information on preventive measures is crucial, as most of the migrant workers are working in unhealthy working conditions. The employers also need to be made aware and accountable for providing appropriate safety and health measures.

# Community awareness and knowledge of existing health care facilities;

• The migrant community is aware of the existing government and private treatment services that are available in the locality. The migrant workers who are working in the industries and possess smart cards can access services from the ESI hospital but those who do not have a card cannot and are compelled to go to private clinics for treatment where the services require payment;

• The migrants also access services from private hospitals which do not have all the facilities and charge more money for health checkups and treatment.

# Relationship between employer and migrant workers and their attitude towards them:

• There is significant tension in the relationship between the migrant workers and their employers. It is a minimally functional relationship as the employers are not concerned


about the health issues of their workers but are mainly interested in getting their work done within a specific time frame;

• The factory owners and employers violate labour laws and the workers do not voice their grievances to any authorities as they fear losing their jobs or being threatened and harassed by the employers or contractors;

• The employers have no interest in the social well being of the workers and majority of the workers are not being given any contract or appointment letter and most are denied social security, PF and ESI during their employment period;

• There is little attempt by the State government to check the violations of basic labour laws and human rights in the corporate sector or manufacturing industries that are employing these migrant workers with little regard for their rights.

One of the respondent statement is – “When I get sick during my working hours, the contractor gives me some medicine and asks me to continue working without any leave, which is quite hectic sometimes and if I take leave they cut my wages and keep some other person on my job” # Health care services that are most needed among the community: According to the respondents the services that are most needed are –

• Medical assistance and timely services for delivery cases; • Home based care in order to provide treatment, care and support for sick migrant

workers and their family members at home through an outreach team consisting of a trained doctor, nurse and a health care worker;

• Mobile health clinics specially for migrant families; • Provision of free medication;

# Drugs and alcohol related issues in the community:

• During the study, it was learned that majority of the migrant workers are habitual drinkers. They have no idea or awareness of any drug/alcohol treatment centres;

• The drugs that are commonly used are marijuana and charas/hashish. Majority of the workers prefer drinking alcohol and they have no idea about anyone using other pharmaceutical or opioids.

• There are many workers who are habitual and dependent on alcohol and some of them start drinking since morning.

2. Women/Spouses of Migrant workers


During the study, FGDs were conducted at 3 different areas in Gurgaon region with 25 women and spouses of migrant workers to understand the perspective of women specific issues related to health and problems they face in the community. The specific areas that were covered are as follows.

# Basic needs for survival:

• Under this particular area during the interaction it was learned that the women and spouses of migrant workers have many difficulties, for even basic needs for survival. The most difficult part for them is to pay their monthly rent as their husbands earn very little. Some stated “We cannot have even proper food, clothing, health checkups, education for children, etc. as our basic needs for living”. “We are all compelled to live this way due to our financial status”.

• Some of the women stated that they have minimum basic needs for survival as they have limitations. Even if they wish to have something additional, they cannot afford as their husbands earn very little. They stay in rented houses and most of the time cannot afford to pay their rent in time. Most of the migrant families manage their daily expenses with what they receive on a monthly basis, which is bare minimum.

# Health services for women:

• As expected, there are no women specific health services in the community. They have

only a few local private health clinics, run by unqualified doctors, where they never do a proper health examination and for consultations they have to pay more money. As they have no choice, they go to these clinics when they are sick and have some health problems. A few women and spouses stated “Sometimes when we don’t have enough money, we prefer to go for cheaper treatment to local pharmacies and clinics as they charge Rs.50 – 100 per visit. “ However, it was learned during the interaction that the physicians and doctors in these local clinics and pharmacies are all untrained and the women and spouses are compelled to visit these facilities due to their poor financial status, even if they are not willing. The government hospitals in the vicinity, mostly refers them to other hospitals for treatment and checkup. It was learned that, presently there are no private NGOs or any other services providers who are working specifically for the women and spouses of the migrant worker in the community.

# Problems women face in the community:

• This area highlighted the main problems of women and spouses’ of migrant workers that they are facing in the community. Some of them stated they face difficulty in paying their rents in time, as husbands don’t pay or they stop working as they lose their jobs


and have no income and some don’t go to work due to their alcohol problem hence cannot support their families. A few of them stated that their husbands force them to work and they sit at home which in turn compels the women to search for jobs in order to support her children and family.

• With regard to government hospitals, they mentioned that the attitude of hospital staff is not good and some of them ask for money to register their names;

• In some cases of educated women, they find it difficult to get a job in the government or private sector as they have no proper ID proofs and nobody to give guarantee as authority in support of this person.

• Most of them stated that they are constantly harassed by their landlords for rent money and pressurized into purchasing groceries from their shops, at higher rates.;

• As majority of them do not have ration cards or voter IDs on their name, they cannot register themselves as residents. The landlords also do not provide any rent agreement as proof of residence. They cannot move around freely in the evenings and nights as they are stalked or followed by some local men. Their main problem is the hardship in running their families with a small amount of money that they receive;

• Majority of the families cannot afford to send their children to good schools, as they earn very little money.

# Biggest fears among women:

• According to the respondents during the study, most of the women and spouses of migrants revealed that their biggest fear is police vehicles, as they come anytime and harass them for personal records and identity proof for no reasons. Some of them stated they are also scared of their husbands, who might be violent after drinking or due to some mental stress. Majority of the women and spouses mentioned that their biggest fear is of losing their jobs and wages or being fired by their employers at any point without being given a reason. One of the women respondents stated “I don’t know how I will manage my house expenses if I am out of job”.

# Safety and security:

• It was found from all the FGDs that the women and spouses of migrant workers never feel secure in their community as they are often stalked by local men. This is especially true for working women, who are active in public spaces. The landlords harass them for rent payment and force them to stay, even if they may not want to. Most of them cannot afford to stay in the rented rooms as their husband’s wages are very small. One


of them stated “It becomes more difficult for me, when my husband leaves his job and doesn’t do any work”.

• In addition, it came out through discussion that most of the women feel unsafe in the community, as they are not the local residents and belong to other states. They are scared of being stalked and followed by some local men, especially when their husbands are not at home. Some of them are also scared of their houses being robbed by the local people in their absence. They also do not feel safe on the streets at night for fear of being stalked.

# Work and employment issues:

• According to the majority of the respondents, some women and spouses of migrant workers are working in private companies or small units in their neighborhood. They usually are employed with garment factories for knitting and stitching jobs. The employer does not pay them well and fires them anytime they want due to no reasons and they have to work for long hours. According to some of the respondents, most of the women who are working in garment factories receive only Rs 4,600/-‐ per month, which is not enough to support their families.

# Children’s services and education:

• According to the respondents during FGDs, some children attend government schools where education is free and some children attend private schools, where they have to pay tuition fee which most of them cannot afford due to their poor financial status.

• In addition, they also stated, that one private school charges INR 2,500 per month as tuition fee, which is unaffordable for majority of the migrant families. Most of the migrant children who attend private schools, attend one where the fee is Rs 180 per month.

• There are a significant number of children who do not go to school due to various problems unique to migrant situations.

# Relationship and marriage:

• According to the majority of respondents in the FGD, the women in villages get married at a very early age (between 13 – 14 years). They have a tradition of “Gauna”, meaning ‘selection of a bride or an advanced engagement at a very young age’ but the bride goes to her husband’s place after she attains the age of 17 or 18 years. However, presently


the trend is changing where the women, being better informed and educated, are not getting married before reaching the age of 17 or 18 years.

# Sexual reproductive health issues:

• According to the majority of the participants and key informants, the migrant women have no knowledge about their reproductive health. They feel shy to share these reproductive health problems with others and hence they never go for treatment. Most of the participants stated that if there is an opportunity, they would be interested in learning more about sexual and reproductive health issues;

• According to some participants of the FGDs, migrant women experience a lot of bleeding during their menstruation cycle and some stated that white discharge and lower abdominal pain is very common among the migrant women which they assume to be a normal phenomenon. They usually never share these women-‐specific concerns or sexual and health related issues with any other person and never bother to consult a doctor due to wariness. A few participants added that even if they go to government hospitals for treatment of such issues they have to wait for a long period of time and have to pay for their turn to come. One of the participant stated “If you pay money you are treated well in government hospitals”;

• In case of any health problem, they go to government hospital for treatment and during crisis they visit local doctors and clinics where they have to pay for their treatment and medication that is most of the times difficult to afford. However, some of the participants stated that they prefer to go to private clinics, if they have money as the behavior of the staff of government hospitals are not good and most of the time the attendants of government hospitals ask for extra money for treatment and registration.

# Women’s rights to negotiate sex:

• It was found from the FGDs that majority of the migrant women and spouses have difficulties in negotiating sex with their husband. One of the participants stated “Yes! At some occasions I manage to negotiate sex, especially when I am not feeling well or in a mood to have sex”. But most stated that they have problems in negotiating sex with their husbands as they never listen and force, especially when they are under the influence of alcohol. According to the majority, the women usually have no rights to negotiate, as in their cases; the husband is always the decision maker.

# Availability of contraceptive methods:

• According to the participants from the FGDs the contraceptive methods that are known are condoms, copper – Ts and Mala -‐ Ts, which are easily available in pharmacies.


Majority of the women never negotiate condom use, as they find it difficult to convince their partners. In case husbands also wish to avoid pregnancy, they use copper-‐ T and in few cases the husband uses Nirodh. However, condom use is rare among the male migrant community especially when they are under the influence of alcohol and some due to religious restrictions.

# Knowledge of HIV/AIDs and STIs:

• It was apparent from the FGDs that women and spouses have no awareness and information related to HIV/AIDS and STIs but a few of them have little information through media and advertisements on one or two of the routes of transmission HIV and STI;

• However upon stressing, it was learned that most of the women experienced lower abdominal pain and white discharges, which they take as common and never seek any medical assistance or advice unless it is serious.

# Alcohol and drug related issues:

• During the FGDS it was learned that majority of them have no idea about drug use related issues in their community but a few stated that some men use ganja (marijuana) and cannabis. They only have knowledge about alcohol use among men as most of the males are habitual drinkers. Some of them stated that drinking alcohol is a very common phenomenon among the men, especially in the evenings when they return home after their work. Almost all their husbands use alcohol, and some are alcoholics and beat their wives at home, when they are drunk;

# Gender violence and commercial sex:

• It was highlighted during the FGDs that a few women are CSWs within the community. They usually engage in this profession in order to support their family and children, as their husbands either stop working or lose their jobs or become alcoholics and force their wives to earn money. Some stated that these types of women are few and they usually sell sex among the migrant workers who are alone or have no families. But, majority of the women work in garment factories to earn more money to meet their household expenses. Some of the participants, stated that their partners are faithful but when they visit their parents in their hometown, the husbands mostly go to CSWs;

• With regard to gender violence, some of the participants stated that there are a few men, who are violent and beat their wives when they come home drunk and those women who are tortured, have no courage to seek any kind of support or assistance due to fear of their husbands. Some stated that they have small arguments and fights in


their families but not physical. The FGDs reveal that women usually tend to hide their family problems.

• It was also highlighted that as there are no services or support from any NGOs in the locality, related to violence against woman, they prefer to go to their parent’s house in their hometown, if they are beaten or tortured.

# Women specific health service:

• According to the participants from FGDs, majority stated that they need support and assistance during deliveries, childbirth and emergencies. It was highlighted that the women and spouses face many difficulties during delivery. When they go to government hospitals, the doctors never examine properly. In the government hospitals, for each delivery cases they have to pay Rs 3,000/-‐ and in private clinics, they charge Rs 2,000 for the same. A few participants stated that during emergencies they have to go to the government hospital in Gurgaon, which is quite far from their places of residence.

• Upon asking, majority of the women and spouses stated that a proper Health Care Centre with a provision of a doctor and nurse for regular health checkup and treatment is required, as they don’t trust the local clinics, pharmacies and doctors, who are only there to make money from their patients. Apart from that, all of them stated that they are not really satisfied with the government hospitals as there is always a long waiting period and is also a bit far in case of emergencies;

3. Service providers (Doctors, Nurses, Govt./Pvt. Hospitals/Clinics and Field

staff) : During the study, interviews and FGDs were also conducted at 6 different sites in the region with 20 service providers from various hospitals, clinics and organisation to understand the perspectives on health related issues and problems of the migrant community. The specific areas that were covered are as follows.

# Available health facilities:

• According to the participants from the interviews and FGDs, government hospitals provide all the health care facilities including emergency service. One of the participants stated there are mobile clinics operating on every alternate day in the region to provide health checkups and free medication for the BPL and slum dwellers, which includes the migrants. The government hospitals are regularly accessed by migrant workers for various health checkups and treatment. Those who have smart cards issued by their


employers can access free services from the government hospitals e.g. ESI facility. In case of some major complicated surgeries or TB cases, the patients are directly referred to big institutions and reputed government hospitals in Delhi. But, according to the FGDs with the migrant workers, majority of them stated that they have difficulties in accessing services from the government facilities due to staff outlook, identity proof issues, and unsatisfactory treatment.

# Fee structure:

• As per the findings from interviews of key informants, the government hospitals are usually free of cost. The first time patients have to register themselves and obtain a treatment registration card with a nominal fee of Rs 5/-‐ for BPL and slum dwellers. The patients with smart cards are not charged any money for their treatment in ESI hospitals. However, in private clinics and hospitals the patients have to pay between Rs 50 – 250 for doctor’s consultation and treatment and extra charges for in patient admission. If they are referred to other big health institutions in Delhi for further treatment, the middle man there makes big money for admission and major operation cases, which varies from Rs 20,000 to 30,000 per case depending upon the nature of treatment and services required.

# Major health issues: During one of the interviews with a government service provider, the following major health issues were highlighted.

• Anemia due to lack of protein and vitamins among the children and women; • Skin infections due to unhygienic water-‐related conditions among the children; • Lung infections among the male migrants due to smoking and chewing tobacco (Gutka); • Tuberculosis; • Infections like diarrhea, stomach aches, indigestion, due to unclean water and poor

hygiene ; • Mouth ulcers, soars and cancer due to chewing of tobacco products among the male

migrants. One of the common and major health issues that were highlighted by the service providers is lung and liver infections as well pleurisy due to unhygienic food, living and working conditions. # Referral services:


• According to the key informants, the patients are only referred to big health institutions

in Gurgaon and Delhi when their hospitals or clinics do not have the specific treatment services e.g. TB and HIV cases where specialized treatment is required. Some patients are referred to other institutions, in case of major surgeries and if a particular specialist is not available.

# Timings of service delivery:

• Interviews and discussion with the service providers reveal that government hospitals and clinics specify the timings of doctor’s visit as 09.00 AM – 05.00 PM. Emergency services in bigger hospitals are available 24 x 7 with ambulance on call. They also have a hotline for emergency cases. The private institutions and clinics are accessible at any hour, including their emergency services, where the patients are charged for any kind of services. But in government institutions it is free of cost. Some of the respondents mentioned that ESI hospital has no emergency services but according to the doctor of ESI hospital, it exists.

# Knowledge on HIV status among the migrants:

• According to the findings the majority of the service providers have no knowledge or very little information on HIV/AIDS related issues specifically related to the migrants community in the region.

# Alcohol and drugs related issues:

• According to the key informants majority of the migrant workers consume alcohol and tobacco but the service providers have no knowledge on drug related issues.

# National/State health policies for migrants;

• As per the findings, the State AIDS Control Society under NACO and MoH, have a policy on HIV/AIDS prevention programme among the migrants population. However, specifically in Gurgaon region, the implementation has not been done due to various reasons but the government has future plans to identify NGOs to implement the project in two sites.

• Under Revised National Tuberculosis Control Programme (RNTCP) which has five components (e.g. political and administrative commitment, good quality diagnosis, good


quality drugs with an uninterrupted supply, supervised treatment to ensure the right treatment and systematic monitoring and accountability) of stop TB strategy is implemented in India for all including migrants. This is a comprehensive package for TB control.

• Rashtria Swasthya Bima Yojna (RSBY) National Health Insurance Scheme has been launched by Ministry of Labour and Employment, Government of India to provide health insurance coverage for Below Poverty Line (BPL) families. The objective of RSBY is to provide protection to BPL households from financial liabilities arising out of health shocks that involve hospitalization. Beneficiaries under RSBY are entitled to hospitalization coverage up to Rs. 30,000/-‐ for most of the diseases that require hospitalization. Government has even fixed the package rates for the hospitals for a large number of interventions. Pre-‐existing conditions are covered from day one and there is no age limit. Coverage extends to five members of the family including the head of household, spouse and up to three dependents. Beneficiaries need to pay only Rs. 30/-‐ as registration fee while Central and State Government pay the premium to the insurer selected by the State Government on the basis of a competitive bidding.

# Health related issues to be addressed:

• According to the respondents of health services, majority stated that there should be proper linkage and cooperation among the government and private service providers. Government should introduce additional mobile health clinics to address the health needs. The awareness level on health related issues should be strengthened among the community. Private NGOs and service providers should implement health interventions and awareness programmes for the community. Some stated that periodical health camps for this marginalized community should be in place. Home based care and support should be introduced for pregnant women and in case of emergencies. One of the respondents stated “There should be an emergency vehicle with attendant to transport patients to hospitals”.”If some NGO can provide this will be a boon for the migrant’s community”.


Barriers to services • Barriers found from the respondents, key informants and migrant workers FGDs were

that many members of the migrant community are not accessing health services because they do not feel comfortable using the available government services or because they think that the services are inadequate and not able to cover their specific needs due to the attitude and behavior of staff in public health settings.

• Lack of finance and poor economic condition are deterrents for seeking services. • Women with sexual and reproductive health issues are shy and burdened with poverty

and household responsibilities, resulting in their not seeking health services they need. • Another barrier is stigma and discrimination faced from government hospital identified

through the FGDs and interviews; • It was mentioned that many migrant workers including women and spouses do not feel

comfortable with government facilities as they are not satisfied with the services that are offered by them. They are mostly comfortable with private facilities and clinics as the staff in private facilities is polite and treat them well, where they are satisfied with the doctor’s examination and treatment. But, it was learned that majority of the migrants have difficulties in accessing private facilities, as the treatment is unaffordable for most of the migrant workers.


Conclusion and Recommendations Methodological issues The study was conducted as a cross sectional, survey mainly qualitative in nature. Any temptation to evaluate the actual performance of the public health services for the migrant workers was deliberately avoided as the study has not tried to underestimate the services and staff performance of the Public Health Services (PHSs) like government and private hospitals; instead the information was gathered from individual migrant workers and their spouses through FGDs. Thus the data falls in the category of self-‐report and must be seen with all the potential caveats of such an approach in mind. However, the self-‐report by the respondents gets credibility by the consistency of most of the responses in various geographical areas in Gurgaon. It must also be noted that the responses were obtained through a healthy mix of qualitative questionnaires, interviews and FGDs conducted by an external lead consultant and a co-‐lead interviewer from SLD. In spite of these variations consistency of responses was largely maintained, enhancing the credibility of these responses. The study attempted to explore almost all the areas of health related issues and performance of the existing government and private health facilities as well as various other aspects which could influence the same. Thus, though the study was exclusively qualitative in nature, an unstructured free-‐flow of thoughts and opinions was intentionally avoided. This helped in collecting data on specific issues and minimised the complexities involved in grouping and categorising the responses, typically associated with qualitative studies.

Crucial factors influencing migrant health service As per the findings of the study the following can be grouped as factors influencing health service for the migrant workers in the region.

• Level of awareness about existing health services among the migrants is not adequate; • Emergency health services, specifically during pregnancies are not in place; • Lack of general medical services for women; • Level of awareness about HIV/AIDS related issues, especially related to prevention

strategies is inadequate; • Lack of trust in government facilities; • Poor socio-‐economic and financial status of the community; • Stigma and discrimination among the health care service providers towards migrants;


• Inadequate coverage of migrants for health services; • Absence of NGOs and private organisations addressing the health needs of migrants; • Poor networking and linkages among the government and private health service

providers; • Unhygienic conditions and lack of support from the society; • Myths and misconceptions among the migrants related to health issues; • Fear and insecurity among the migrants community;

Recommendations In order to address the above mentioned healthcare needs the following recommendations are given. • Setting up of a Primary health Care (PHC) Centre with a clinic which is easily accessible in

the migrant community to address the health concerns, with the provision of doctor’s service, nurses and trained community health care workers for outreach for providing free medical assistance and medications;

• Strengthening referral and networking systems with other hospitals and clinics in the region that are providing health care services including government and private health care facilities;

• Conducting periodical health camps with information and knowledge sharing for the community;

• Formation and strengthening of Community Support Groups to address the health related issues through outreach service;

• Raise awareness among the migrant community concerning their increased risk of HIV Transmission;

• Conducting periodical awareness and prevention programmes on HIV/AIDS, STIs and Drugs related issues;

• Dissemination of information, education and communication materials among the community;

• Providing knowledge and information related to existing health care services and facilities in the region;

• Service providers need to foster discussion about healthy sexual behaviours among the women and spouses of migrant workers and address gender norms in sexual decision making in heterosexual partnerships. This can be helpful to empower women and to raise their ability to convince their partners to use contraceptives;

• Increase awareness and knowledge levels among the women on STIs (symptoms);


• Involvement of migrant workers and their spouses in planning and development of health services among the community;

• Organising and conducting regular advocacy events for the wider community in order to reduce stigma, discrimination, harassment and extend support and cooperation;

• Advocacy and awareness programmes with staff of medical services (especially in governmental hospitals) in order to increase accessibility of these services for migrant workers and their families;

• Advocacy and awareness programmes with police personnel, house owners and employers in order to create and enabling environment for the community;

• Promotion of health education materials and information through street plays and flyers as well as providing primary health education to the community;

• Development of Best Practice Model Centre for referral, collaboration, partnering and service agreements to provide comprehensive services to the migrants in the region.

• Initiating primary level education and positive entertainment events for the children of migrant workers;

• Developing vocational training and income generation schemes for the migrant women and spouses in the community;

• Facilitating networking meeting among the migrant workers in order to address the socio-‐economical and legal problems;

References:

1. Employment State Insurance Corporation, Sub Regional Office, Gurgaon, Haryana http://esigurgaon.in/index2.php?event=Medical;

2. Employees state insurance corporation super specialty hospital; 3. Hospitals, in Gurgaon, Haryana, webindia123.com/dpy/Haryana/gurgaon/hospital/1/

http://www.webindia123.com/dpy/Haryana/gurgaon/hospital/1/; 4. Haryana government web portal, www.haryana.gov.in. 5. National AIDS Control Organisation program report 2011, www.nacoonline.co.in 6. Haryana State AIDS Control Society,

http://www.haryanahealth.nic.in/userfiles/file/pdf/AIDS/Advertisement Aids_24022012.pdf 7. Targeted intervention for Migrant worker, 2007, NACO guidelines for service providers; 8. et al Sudershan Rao Shinde, Regional Representative, IMF – SERO, New Delhi, ‘Migration in

India’ Oct 2008; 9. Articles.timesofindia.indiatimes.com/collections/Gurgaon; 10. http://haryanahealth.nic.in/menudesc.aspx?Page=15.


Annexure A Health Need Assessment Tool

Questionnaires used for male Migrant workers

Explore the perception of the community about government facilities available in the area and that is provided through private hospitals and clinics.

1. Do you have a preference for one of these service providers? If yes, for which provider and why?

2. Do you receive health services from the private clinic/NGOs/government? If so, what are they? In your opinion are there any services that Migrants workers need but are not available through government and private clinics? What is your opinion about the

a) accessibility of the services, (delivery points, timings, distances, etc); b) attitudes of the staff; c) quality of facilities provided by the government and private centres?

3. Do you think you have adequate information on HIV to protect yourself from getting infected? If yes, what has been the source(s) of this information?

4. Have you had any major health problems or illnesses in the last six months? If yes, where did you receive treatment for it and were you satisfied with the quality of services for the same?

5. What is your opinion on community awareness about various government and private treatment services that are available in the area? Do you think that all those who need health care services/treatment are actually accessing services? If not, what are the possible reasons for the same?

6. How has the power relations (employers/stakeholders/general community) changed over the last 1 year? Has there been any change in the way the employers view or treat the Migrant community?

7. Has there been any drug use in your area? (Type of drug used, new initiation to drug use)? If yes, what types of drugs are being commonly used by the community? What is the age group, etc? Are there any treatment facilities for drug/alcohol dependents?

8. For Spouse/partner of Migrant workers – What are the health services that you think spouse/partner of Migrant worker’s needs? Which of these services are available in the area through government or private facilities? What is your opinion on the adequacy, accessibility and acceptability of these services to the intended beneficiaries? How can the services be improved?


Annexure B Health Need Assessment Tool

Questionnaires used for Women & Spouses of Migrant workers Introduction:

I am interested in learning about some of the health needs of Women/Children living in your community. I would like to ask your permission to ask you questions about health care and other issues related to health care. You are not required to answer any questions. However, your answers will be confidential. The information will help us to learn more about the health and wellbeing of women/children people in the community and to advocate for improved services and assistance. I expect our conversation to last about 45 minutes to an hour.

I want to ask you a question about your general well being

1. Do you have everything you need for basic survival (food, water, shelter, clothing and medical care)?

2. What are the main problems women are facing in your community today? 3. What are the biggest fears among women in your community today? 4. Do you feel safe in your community? If not, why not? 5. Do you work or know young people who work? What kinds of work do they do? 6. What activities are available for your children? What are the kinds of things that you do in your

free time? Are you a member of a local club or committee/group? Now, I want to ask some questions about relationships and marriage

7. What age do people usually marry? Has this changed for people who have been displaced from their homes?

8. Is there a traditional marriage ceremony? What is it? Has this changed since people have been displaced?

Now, I have some questions about health and sexuality 9. What particular health concerns do women have? Has this changed for women who have been

migrated from other states? 10. If you had a health problem, what would you do first? Would you have a doctor to go to? Who

else would you see? 11. Are there any health services/centers that are just for women? Have you ever visited a health

center that is specifically targeted for women? If yes, what attracts you to the center? 12. What if the problem concerned your sexual or reproductive health? What would you do?

Would you go to see someone? Who would it be? Would there be people you could talk to about it? Who?

13. Are women in your community having rights to negotiate sex? If so, how? Has this changed for women, who have been migrated from other states/places?

14. Are condoms available to people who are having sex? If so, from where? Are people using them? Do women use them? Do men/husbands use them? If not, why not?

15. If a couple is having sex and does not want the women to become pregnant what does s/he do? 16. What are the ways one can avoid getting pregnant? What are the modern ways? Are there

traditional ways? Where would you go to get contraceptives? Anyplace else? Do you have to


buy them? Is it difficult or easy to get contraceptives? Why? Do you think that most of your women folks in your community are protecting themselves/their partners from becoming pregnant?

Now I want to talk about STIs and HIV/AIDS 17. Have you heard of HIV/AIDS? Do you believe it exists? 18. Tell me all of the ways in which you believe a person can get HIV? 19. Are women/men worried about getting HIV? Do you think the women are at risk of getting HIV

virus? 20. Do you know of anyone who is HIV +ve? Do you know anyone who died of HIV infection? 21. What can be done to prevent HIV? 22. Do you know of any infections one can get through sexual intercourse? What kinds? (HIV/AIDS,

Gonorrhea, Syphilis, Chancroid, Chlamydia, Genital warts, herpes C, Hepatitits B, Vaginitis, Other?)

23. Is there anything women/men can do to avoid getting STIs? What? 24. Can you tell by looking that another person has a STI or HIV? 25. What do women/men do if they think they have an STI? Do they see a health worker? 26. Is there a drug problem in your community? Which drugs? Oral/Intravenous? Alcohol abuse -‐

Other? What can people do if they have a problem? Are there community resources for them? I would also like to ask some questions about gender based violence

27. Do you know of women who have sex for money, protection or food? With whom do they have sex? What do you know and think about this kind of situation? Has this changed for women who have migrated from other states/places?

28. Do you think that any of your partners’ have frequented a commercial sex worker? If yes, a few, many, mostly all, of your partners’?

29. Do you know of any women who were forced to have sex? Has this changed for women who have migrated from other states/places?

30. Do you know about husbands who are violent with their wives (e.g., beat or torture)? Has this increased or decreased since the time of migration? Do women look for help when this happens to them? If not, why not? Where and/or who will they go to for help?

31. What services are available if women have been beaten and tortured? One last question….

32. Is there any health services that you would like to have that is not available to you? What are they? Which are the most important services that your think should be available for women in the community?


Annexure C Health Need Assessment Tool

Questionnaires used for Service Provider (Doctors, Nurses, Government/Private Hospital & Clinics and field staff)

1. What are the health facilities you have in your hospital/clinic? 2. What is the fee structure? 3. In your opinion, what are the major health problems among the migrant workers? What

could be the reason? 4. In case of serious health problems, where would you like to refer your patient? 5. What are the timings of your hospital/clinic? 6. What is your information on HIV status among the migrants? 7. In your opinion, are there any alcohol/drug related cases among the migrant

community? 8. In your opinion, what type of health related services you think should be available for

the migrants’ community? Are they available and accessible? If, not what could be the reason? What else?

9. Is there any National Health Policy for migrant workers to provide services at state, district and township level?


Annexure D

Health Need Assessment Tool Questionnaires used for field staff

1. How long you are working in this township as Organizers?

2. What are the activities undertaken for Migrant workers in Gurgaon? What specific

services you provide?

3. Do you think there are Health related problems among the Migrant workers? If yes, what type of health problems they have? Where do they go for treatment? Is it easily accessible? If not, what are the barriers? What is the cost of the treatment?

4. If you are health care service provider, what health related issues would you like to be addressed among the migrant community?

5. Do you have any idea about migrant workers using drugs for recreational purposes? If yes, what type of drugs they use? What about alcohol use? If yes, how often people use alcohol and is there any alcohol related problems in the family/community? If yes, what are they?


Annexure E

ADMINISTRATIVE SETUP

The Deputy Commissioner is the Chief District Officer of the Administration. He is assisted by Sub Divisional Magistrate heading a sub division. The Additional Deputy Commissioner is in-‐charge of District Rural Development Agency (DRDA) for development of the district. Sectorial development is looked after by the district head of each development department such as agriculture, animal husbandry, health, education etc. Administrative Structure:

Sub Divisions ( 3) Gurgaon (North, South &Pataudi)

Tehsils ( 5 ) Gurgaon, Sohna, Pataudi, Farukh Nagar, Manesar

Blocks ( 4 ) Gurgaon, Sohna, Farukh Nagar , Pataudi

Municipal Committees (4) Sohna, Pataudi, HailyMandi

Population as on Census 2001 8,70,539

Panchayati Raj Institution: 3 Tier Setup Total Villages : 291 Village Level : Panchayat Block Level : PanchayatSamiti District Level : ZilaParishad

Block No. of Panchayats as on July-‐2010

Gurgaon 34

Sohna 57

Pataudi 71

F.Nagar 48

TOTAL 210


Annexure F

Health Department in Gurgaon

The General Hospital of District Gurgaon is located in the heart of Gurgaon city and it is near to Bus stand Gurgaon.

List of Govt. Health Institutions

SNo. Name of Institutions No. of Beds

(A) GENERAL HOSPITALS (03 ):-‐

1. G.H Gurgaon 120

2. G.H. Sohna 039

3. G.H Hailymandi 025

(B) COMMUNITY HEALTH CENTERS (CHCs=03) :

1. CHC Farukh Nagar 30

2. CHC Pataudi 30

3. CHC Ghangola 30

(C) PRIMARY HEALTH CENTERS (PHCs=12):

1. PHC F. Nagar 04

2. PHC Wazirabad 04

3. PHC GarhiHarsaru 04

4. PHC Gurgaon Village 04

5. PHC Pataudi 04

6. PHC Kasan 04

7. PHC MandPura 04

8. PHC Bhangrola 04

9. PHC Bhorakalan 04

10. PHC Ghangola 04

11. PHC BadshahPur 04

12. PHC Bhondasi 04


List of private health Institutions

SNo. Name of Institution No. of Beds

1. Nagina Hospital 15

2. Bhatnagar Maternity & N. Home 15

3. Nagpal Nursing Home 07

4. Gupta Hospital 07

5. Malik Nursing Home 06

6. Kalyani Hospital 60

7. Pushpanjali Hospital 45

8. Parashar Hospital 06

9. Mathur Maternity & Child Care 15

10. Vasudeva Polyclinic &ChughN.Home 05

11. Rama Hospital 20

12. Pahwa Nursing Home 05

13. Lall Nursing Home 20

14. Arora Mother & Child Care 15

15. Chiranjiv Maternity & Nursing Home 15

16. Mahajam Nursing Home 10

17. Swastik Maternity & Nursing Home 07

18. Kamal Memorial Hospital 10

19. Kanshi Ram Medical Hospital 07

20. Jyoti Hospital 15

21. Jain Hospital 07

22. Uma Sanjivini Health Center 20

23. Goel Nursing Home 07

24. Saraswati Hospital 25

27. East & West Hospital 35

28. Alboda Hospital 15

45. Kharbanda Nursing Home 13


47. Sethi Nursing Home 20

50. Aryan Hospital 40

Total 487

Population Percentage(based on 1991 census)

SNo Statistics Haryana India Gurgaon 1. Urban Population Percentage 24.63 25.73 11.7 2. Density of Population 372 274 591 3. Sex Ratio 865 927 882

Decennial Population Growth

Territory Haryana Gurgaon Year 1981 1991 1981 1991 Growth 28.75 27.41 24.66 23.85

Vital Rates of Haryana State (1998 SRS)

Rates Rural Urban Combined Gurgaon Birth Rate 28.8 23.3 27.6 31.1 Death Rate 8.6 6.9 8.2 7.7 Infant mortality rate 72 59 70 51.8

Projected Expectation of Life (1991-‐96) in %

Statistics Haryana India Gurgaon Male 65.2 60.6 60 Female 64.2 61.7 40


Annexure G

LIST OF NGOs WORKING IN THE DISTRICT

SNO NAME OF THE NGO ADDRESS PHONE NO.

1. Indian Red Cross Society, Distt. Branch , Gurgaon

Behind ITI, Delhi Mehrauli Road, Gurgaon

2320468

2. District Council for Child Welfare BalUdyan,Civil Lines, Gurgaon 2328288

3. Haryana Welfare Society for Hearing and Speech Handicapped,Gurgaon Branch

Mehrauli Road, Near I.T.I. Gurgaon

2320698

4. Rotary Club,Gurgaon 98-‐L,New Colony, Gurgaon 2327015 2327212

5. Rotary Club,DLFQutab Enclave G-‐11/8 D.L.F. QutabEnclave,Phase-‐I, Gurgaon

2350529

6. Lions Club, Gurgaon city 99, Sector-‐15, Part-‐I, Gurgaon 2321695

7. Lioness Club, Sukarma DLF Qutab Enclave

K-‐19/4, Phase-‐II, QutabEnclve City, Gurgaon

2350262 2351235

8. Lions Club, Sohna Town Bharat T.V. Centre Near Bus Stand, Sohna

2362169

9. Lions Club, Taoru Town Vijay Chowk, Taoru 72242

10. All India Confederation of Blind, Gurgaon Branch

Village Behrampur, Distt. Gurgaon

11. National Association for Blind 168-‐B, New Colony, Gurgaon 2321156

12. All India Crime Prevention Society 606, Street No.-‐8, MadanPuri, Gurgaon

2330245

13. Youth Welfare and Culture Association House No.-‐152, Sector-‐4, Gurgaon

2325665

14. India Medical Association, Gurgaon Kashiram Medical Services 344/4, Jacobpura, Gurgaon

2325011 2323377

15. Khushboo Welfare Society, Gurgaon 4B,Friends Colony,JharsaRoad,Gurgaon

2321243

16. Haryana Social Welfare Society, Gurgaon

17. Sadbhawna Charitable Trust S.C.O. No-‐11, Sector-‐4, Gurgaon

2322938 2341060


18. Vinayak Charitable Trust 35, PurviMarg D.L.F. City, Phase-‐II Gurgaon

2352741 2352600

19. Joint Assistance Centre G-‐17/3, D.L.F. Qutab Enclave, Phase-‐I, Gurgaon

2352741 2353833

20. Bharat VikasParishad H No.-‐2047, Sector-‐4, Gurgaon 2321864 2329451

21. SanyuktKalyanParishad 90-‐T, New Colony, Gurgaon 2320961 2305092

22. Vijay JyotiSangh 8, Bank Colony, New Colony, Gurgaon

2302752

23. Mahavir International 2355530

24. Samved 743, Sector-‐4, Gurgaon 2331044 2331958

25. SanatanDharamSabha 2322206

26. AryaKendriaSabha, Gurgaon 1088, Sector-‐4, Gurgaon 2322388 2329622

27. Digamber Jain Sabha Civil Lines, Gurgaon 2325460

28. Gurudwara Singh Sabha Gurudwara Road, Gurgaon 2320583

29. AggrawalSabha 2322864

30. AdarshBrahamanSabha 1539, MarutiVihar, Chakkarpur 2352131

31. Mahavir Dal, Gurgaon 2320459

32. Resident Welfare Association, Sector 14-‐17, Gurgaon

2322836 2322124

33. Resident Welfare Association, Sector 4-‐7, Gurgaon

2051, Sector-‐4, Gurgaon 2320522

34. Gurgaon Chamber of Commerce and Industries

P.O. No.-‐2, Khandsa Road, Gurgaon

2370303 2370404

35. Gurgaon Distributors Association Chandna Sales Agency, Main Jacobpura Road, Opp. Kulwant Studio

2324851 2322320 2324851

36. Gurgaon Udyog Association 785, Phase-‐IV, UdyogVihar, Gurgaon

2340634

37. Gurgaon Industrial Association G.I.A. House, Industrial Development Colony, Mehrauli Road, Gurgaon

2320746


Annexure H

LIST OF HOSPITALS UNDER ESIC

EMPANELMENT OF METRO HOSPITALS

Sr. No Place/Address Tel. No. 1. ESCORTS HOSPITAL

RESEARCH CENTRE, FARIDABAD 0129-‐2466216 / 2466779

2. METRO HEART INSTITUTE, FARIDABAD

0129-‐4277777

3. SARVODYA HOSPITAL FARIDABAD

0129-‐4284444

4. PARAS HOSPITAL GURGAON

0124-‐4585555

5. ARTEMIS HEALTH INSTITUTE, GURGAON

0124-‐67679999

6. PUSHPANJALI HOSPITAL GURGAON

0129-‐4284444

7. MODERN DIAGNOSTIC & RESEARCH CENTRE GURGAON

0124-‐4104002

8. Dr. PREM HOSPITAL LTD. PANIPAT

0180-‐4008431

9. ALCHEMIST HOSPITAL LTD PANCHKULA

0172-‐4500000

10. JINDAL INSTITUTE OF MEDICAL SCIENCE HISSAR

01662-‐220476

11. UMKAL HEALTHCARE Pvt. Ltd. GURGAON

0124-‐4777000

12. QRG CENTRAL HOSPITAL & RESEARCH CENTRE FARIDABAD

0129-‐4090300

13. PRIVAT HOSPITAL DLF QUTUB ENCLAVE PHASE-‐II, M.G. ROAD, GURGAON

0124-‐2351162 Fax-‐ 0124-‐2353794

14. Dr. N.K.PANDEY CHAIRMAN M.D. ASIAN INSTITUTE OF MEDICAL SCIENCES, BADKHAL FLYOVER ROAD, SECTOR 21-‐A, FARIDABAD

0129-‐4253000

15. Dr. NARESH TREHAN CHAIRMAN & MANAGING DIRECTOR MEDANTA-‐ THE MEDICITY SEC-‐38, GURGAON

0124-‐4141414 Fax-‐ 0124-‐4834111


Annexure I

EMPLOYERS STATE INSURANCE BENEFITS

The section 46 of the Act envisages following six social security benefits:-‐

(a) Medical Benefit: Full medical care is provided to an Insured person and his family members from the day he enters insurable employment. There is no ceiling on expenditure on the treatment of an Insured Person or his family member. Medical care is also provided to retired and permanently disabled insured persons and their spouses on payment of a token annual premium of Rs.120/-‐ .

(b) Sickness Benefits (SB): Sickness Benefit in the form of cash compensation at the rate of 70 per cent of wages is payable to insured workers during the periods of certified sickness for a maximum of 91 days in a year. In order to qualify for sickness benefit the insured worker is required to contribute for 78 days in a contribution period of 6 months.

Extended Sickness Benefits (ESB): SB extendable up to two years in the case of 34 malignant and long-‐term diseases at an enhanced rate of 80 per cent of wages.

Enhanced sickness Benefit: Enhanced Sickness Benefit equal to full wage is payable to insured persons undergoing sterilization for 7 days/14 days for male and female workers respectively.

(c) Maternity Benefits (MB): Maternity Benefit for confinement/pregnancy is payable for three months, which is extendable by further one month on medical advice at the rate of full wage subject to contribution for 70 days in the preceding year

(d) Disablement Benefit: -‐

Temporary Disablement Benefit (TDB): From day one of entering insurable employment & irrespective of having paid any contribution in case of employment injury. Temporary Disablement Benefit at the rate of 90% of wage is payable so long as disability continues.

Permanent Disablement Benefit (PDB): The benefit is paid at the rate of 90% of wage in the form of monthly payment depending upon the extent of loss of earning capacity as certified by a Medical Board

(e) Dependent’s Benefit (DB): DB paid at the rate of 90% of wage in the form of monthly payment to the dependents of a deceased Insured person in cases where death occurs due to employment injury or occupational hazards.

(f) Other Benefits:


Funeral Expenses: An amount of Rs.10, 000/-‐ is payable to the dependents or to the person who performs last rites from day one of entering insurable employment.

Confinement Expenses: An Insured Women or an I.P.in respect of his wife in case confinement occurs at a place where necessary medical facilities under ESI Scheme are not available.

In addition, the scheme also provides some other need based benefits to insured workers.

Vocational Rehabilitation: To permanently disabled Insured Person for undergoing VR Training at VRS.

Physical Rehabilitation: In case of physical disablement due to employment injury.

Old Age Medical Care: For Insured Person retiring on attaining the age of superannuation or under VRS/ERS and person having to leave service due to permanent disability insured person & spouse on payment of Rs. 120/-‐ per annum.

Rajiv Gandhi Shramik Kalyan Yojana: This scheme of Unemployment allowance was introduced w.e.f. 01-‐04-‐2005. An Insured Person who become unemployed after being insured three or more years, due to closure of factory/establishment, retrenchment or permanent invalidity are entitled to :-‐

• Unemployment Allowance equal to 50% of wage for a maximum period of up to one year;

• Medical care for self and family from ESI Hospitals/Dispensaries during the period IP receives unemployment allowance;

• Vocational Training provided for upgrading skills -‐ Expenditure on fee/travelling allowance borne by ESIC.

An interesting feature of the ESI Scheme is that the contributions are related to the paying capacity as a fixed percentage of the workers’ wages, whereas, they are provided social security benefits according to individual needs without distinction.

Cash Benefits are disbursed by the Corporation through its Branch Offices (BOs) / Pay Offices (POs), subject to certain contributory conditions.

Medical

Insured persons and their dependants are entitled to full medical care from day one of taking up employment in any factory or establishment covered under the ESI Act 1948. The comprehensive package includes primary medical care, specialists and diagnostic services, in-‐patient care with provision for all super-‐specialty treatments.

The scheme provides full range of Medical care, namely –


• Out-‐Patient services; • Diagnostic services; • Specialists services; • Hospital service through a network of ESI dispensaries & Panel clinics, diagnostic

centers and ESI Hospitals; etc. The package covers all aspects of health care from primary to super-‐specialist facilities as detailed below:-‐

• Outpatient treatment; • Domiciliary treatment; • Super-‐specialty treatment; • Specialist consultation and diagnostic facilities In-‐Patient treatment; • Free supply of drugs and dressings; • X-‐ray and laboratory investigations; • Vaccination and preventive inoculations; • Ante-‐natal care, confinement and post natal care; • Ambulance Service or conveyance charges for going to hospitals, diagnostic

centers, etc. wherever admissible; • Free diet during admission in hospitals; • Free supply of artificial limbs, aids and appliances for physical rehabilitation; • Family welfare services and other national health programme services; • Medical certification; • Special provisions including super-‐specialty treatment.

For super-‐specialty treatment such as –

Open Heart Surgery, Neuro Surgery, Bone Marrow Transplant, Kidney Transplant or specialized investigations like CAT scan, MRI, and Angiography etc.

Referral arrangements have been made with the reputed, premier hospitals of the country. The total cost of such treatment, diagnostic facilities or surgical intervention is borne by the ESI Scheme.

Though medical care is provided, by and large, to the beneficiaries in modern system of medicine (Allopathic), facilities in indigenous systems such as (i) Ayurveda (ii) Unani (iii) Homoeopathy & Siddha are also being provided to the insured persons, on demand in many areas

Extension of medical cover to the Retired and Disabled Insured Persons and their spouses (Rule 60 & 61 of ESI Central Rules -‐ 1950) -‐


The scheme also provides for a comprehensive medical cover to the retired and disabled insured persons and their spouses on pre-‐payment of a nominal contribution of Rs.120/-‐ per annum, per couple, provided that the insured person was in continuous insurable employment for at least 5 years before retirement. The scheme, thus, offers total medical cover to the retired and disabled employees without any upper ceiling on expenditure at a very low premium when compared with medical cover schemes introduced by some other insurance agencies in the business of medical insurance.

understanding the health needs of migrants in gurgaon city in haryana state of the national capital...

Government & Nonprofit