|Outside ESI hospital in Naroda, Ahmedabad|
Vyavsayik Svashthya Suraksha Mandal (VSSM), the apex body of NGOs working on occupational health issues in Gujarat, has taken strong objection to the Government of India seeking to raise the cut off salary for receiving Employees’ State Insurance (ESI) health facility from Rs.15,000 to Rs.21,000, saying this would put huge burden on ESI hospitals, which are already in poor state.
In a strongly-worded letter to the Ministry of Labour and Employment, Government of India, VSSM’s Jagdish Patel has said that this would mean that the total number of those enrolled in ESI would go up from 2.5 crore across the country to 10 crore, suggesting how the state-sponsored ESI hospitals would be burdened.
Referring to the draft notification of the Employees’ State Insurance (Central) Amendment Rules, 2016, dated October 6, 2016, Patel says, “In most cases the services rendered by the ESI scheme in various states is too poor”, adding, the situation would become precarious, as it is the responsibility of state governments to provide ESI medical benefits.
“ESI schemes do not run adequate dispensaries”, says Patel, adding, “For these 9.67 lakh insured persons (IPs) enrolled in Gujarat and their family members (around 40 lakh in total) there are 103 dispensaries which come to 9388 IPs per dispensary.”
“As per ESI Act & Rules, for every 5,000 IPs there should be one dispensary”, says Patel, adding, this would mean, in Gujarat, “100 more dispensaries need to be opened to provide services promised by law.”
“Existing dispensaries, in most cases are run in rental buildings which are of poor quality, many are situated on first floor which are difficult to access by children, pregnant women, old people, sick patients visiting dispensary, injured workers and their family members and differently able persons”, says Patel.
“Dispensaries have large vacancies of medical officers, nurses, pharmacists, clerks and other staff which affect the services”, Patel points out, adding, “At present 40% of sanctioned posts of medical officers are vacant” which “should be filled immediately.”
Things become worse because the state government applied “austerity measures like 20% cut in new appointments which badly affect services”, forgetting that “IPs pay insurance premium and they have to be given the services assured in the Act.”
Referring to how CAG Report referred to ESI hospitals in Gujarat having “deficient management of hospitals and dispensaries” resulting in “under-utilisation of beds, idling of equipment, injudicious purchase of medicines and procurement of sub-standard drugs”, Patel says, “On and off experts like orthopedic, psychiatrists, physiotherapist, gynecologist, radiologists etc. are not available at all or for part time only.”
“Patients are routinely referred to general hospitals which are always crowded”, Patel says, adding, “Patients are not referred to the tied-up private hospitals when required.”
Given this framework, says Patel, there is no justification for the proposed amendment. “Citizens do not know how many more workers would be covered or affected as a result of this change, what will be estimated income the corporation by way of contribution from employers and employees, burden over the services and how that will be dealt with by the state health departments.”
“ESI is not very popular, which can be seen from the average daily OPD in certain areas (e.g. Surat in Gujarat)”, Patel says, adding, then there are areas where ESIS services are not available – “in villages like Kahanwadi, Mogar, Adas, Vadod from where large numbers of workers work in Nandesari industrial area.”
“Unless, the medical services are improved, the amendment should not be enforced”, Patel concludes, demanding the withdrawal of the draft notification.