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'Unlocking' Covid policy gap? Just 10% Indians 'covered' under healthcare schemes

Counterview Desk
Among many “defining challenges” India’s top policy makers need to address midst Covid-type health emergency is overcoming huge gaps that exist between what India’s CityMakers need and what the government offers. A recent survey has revealed only one out of 10 respondents were covered under the Government of India’s flagship public health as well as life insurance schemes -- Ayushman Bharat, PM Jeevan Jyoti Bima and PM Suraksha Bima Yojna.
Conducted by the Delhi-based Impact and Policy Research Institute (IMPRI), the survey also found that about 65% of the surveyed respondents were aware of the Aarogya Setu app, propagated as the “health body guard” of each citizen, though among them only 62% reported to use it. Further, only 38% respondents were aware of state WhatsApp helplines.
Conducted by a group of IMPRI researchers -- Prof Balwant S Mehta, Dr Soumyadip Chattopadhyay, Dr Simi Mehta, Dr Indu Prakash Singh, Anshula Mehta, Ritika Gupta and Dr Arjun Kumar – while addressing livelihood issues, the survey also found that only 20-30% of respondents were aware of state e-coupon for ration, state e-pass or other different state apps.

An IMPRI note:

Symmetric to the global trends, Covid-19 has had multidimensional impacts on the economy and society of Indian cities. In the absence of any vaccine, prevention through containment and social distancing coupled with frequent handwashing appear to be the only viable strategies to fight against the novel coronavirus.
On March 24, 2020 the Prime Minister of India had announced the nation-wide lockdown to slow down the spread of Covid-19 and to reduce pressures on the inept health infrastructure of the country. In the days and months that followed, the policymakers and the administration faced enormous challenges in the trade-off between ensuring health and livelihood of the people.
Amidst rising concerns of lives and livelihood of the poorer sections of the population becoming jeopardised, the government announced seemingly bold economic packages. However, with few exceptions, lack of coordination in the official spheres at the ground level has had appalling consequences, especially the millions of ‘CityMakers’ who represent a significant share of the workforce and contribute in multiple ways to the economy.
Employed mostly in the unorganized sector and living in informal settlements in cities, they have borne most of the brunt of complete lockdown in India. They have no written job contracts, no regular work and are often employed casually and are without any social safety nets to support them and their families during exigencies.
Moreover, their livelihood opportunities are constrained by multiple barriers that include deplorable housing conditions, inadequacies of urban services, inbuilt socio-economic disparities relating to caste and gender and also the policies and practices of governments.
To understand the ground-realities of how the Covid-19 induced lockdown impacted the lives of the CityMakers, IMPRI conducted a ten-day country-wide telephonic-survey during between May 7 and 17, 2020 to evidence the challenges faced by the poorest sections of society including migrants in India, who have lost their daily wages and now are dependent on the government or non-government support for meeting their daily needs.
This study adds to the existing media literature by systematically evidencing through data from 3,121 CityMakers from over 50 cities of India.
The survey revealed that almost three-fourths of the respondents were engaged in informal employment, i.e. daily wage work, petty trades/business and temporary workers without any social security benefits. These respondents were vulnerable to economic and health shocks due to their irregular income, unstable jobs and lack of access to any social safety nets amid lockdown policies.
It was found that six out of 10 workers had lost their job during the lockdown, with unemployment being highest among the casual labourers and self-employed respondents; 74% of the casual labourers lost their jobs while 67% of the self-employed workers could not pursue their economic activities due to lockdown. When asked about their reasons for unemployment, quite a significant proportion of surveyed respondents cited their inability to visit workplaces and closure of places of works as pressing reasons.
Work from home was coined and advertised as the new mantra to ensure adherence to the diktat of social distancing. But this economic privilege was unavailable to the poorer workers, who had no other option but to remain confined within their houses without any work. They could neither realistically practice social distancing, nor could they afford it.
All these led to a massive shock to the livelihoods and wage earnings of these respondents and their families. For example, the inability to earn during the lockdown translated into 54% of people being unable to pay rent for their accommodations.
So, quite expectedly, most people wanted to return to work. When asked if the respondents and their family members would resume work after lockdown, almost three-fourths of respondents said that they would join the same work in which they were engaged prior to lockdown or they would look for new jobs.
Six out of 10 workers lost their jobs during lockdown, with unemployment being highest among casual labourers and self-employed
In other words, this loss of jobs or livelihood options can be considered as a temporary phenomenon. Importantly, the resumption of normal economic activities or absorption of the city makers in newer economic activities would significantly depend on the nature and type of government policies to jumpstart cities’ economy via providing boosts to local businesses and especially small and micro-enterprises that are hard hit amidst the lockdown.
Direct implications of job losses were revealed through inadequate access to public supply of water and had to rely on accessing water from private tankers which increased expenditure of the already cash-strapped households. The World Health Organization’s recommendations of frequent hand washing with soap, thus became a practical challenge.
Almost one third of the respondents reported improper drainage facilities, including absence of any garbage collection facility in their locality. Further, social distancing was not feasible for the CityMakers as they lived in congested spaces, with three to four people living in a single room within non-notified slums and unauthorized colonies. Such conditions provide ripe grounds for the possibilities of the rapid spread of Covid-19 and compromise the lives of the city makers, leaving them practically defenceless against the pandemic.
Loss of jobs had the spillover impacts on the education of their children, where most of the sent their children to government schools. In the prevailing new normal of online teaching methods and reliance on digital modes of learning, education has become a distant dream because they had no laptop or smart phone for accessing such education.
With 88% of the CityMakers depending on their household income or saving and/or borrowing or taking financial help from relatives, friends etc. for meeting their health related expenditure requirement, this temporary job loss has added to the anxieties that any kind of health emergency including Covid-19 would exacerbate their already weak financial position and make them more vulnerable.
A defining challenge for devising appropriate mitigating policies for the city makers is the lack of data about them both prior to, and during, any kind of emergencies. So, preparedness and early action by the communities are essential. 
To benefit from any central and state government relief measures -- both cash and non-cash to support the poor people during lockdown, people must possess government documents (ration card, aadhaar card), bank account, enrolment in different government welfare schemes and so on.
The survey revealed that coverage of and eligibility for the government support programme was a major concern as evident from the possession status of various important documents by the respondents.
About 23% of the respondents did not have ration card, 32% did not have zero-balance Jan Dhan bank accounts and on an average only one out of 10 respondents were covered under the Government of India’s flagship public health as well as life insurance schemes - Ayushman Bharat, PM Jeevan Jyoti Bima and PM Suraksha Bima Yojna. 
Almost one third of CityMakers reported improper drainage facilities, including absence of any garbage collection facility in their locality
About 65% of the surveyed respondents were aware of the Aarogya Setu app and among them only 62% reported to use the app. Only 38% respondents were aware of state WhatsApp helplines. For others app and e-initiatives, the awareness levels of the surveyed respondents are very poor.
Roughly about 20 to 30% of the respondents were aware of state e-coupon for ration, state e-pass or other different state apps and use of these apps among them turned out to be even more pathetic. Lack of access to smart phones and unstable internet connectivity were the major impediments in using the apps and portals.
Regarding their perception on eligibility of the government support programmes, only 37% of the respondents thought that they were eligible for benefits under Pradhan Mantri Gareeb Kalyan Yojana (having an outlay of Rs 20 lakh crore for the Covid19 response). However, only 34% of the respondents could avail benefits like cash transfers and free ration under this scheme.

Policy suggestions to tide over the crisis

In light of the above evidence, it is becomes extremely important to think of precise policy improvements to tide over the crisis. To start with, the stringent aadhaar-requirements for accessing different schemes must be relaxed for at least next six months. Another option could be a job assurance programme would give needy households livelihood security during the health crises.
Essentially, the Covid-19 crisis requires extremely localized and coordinated responses. So, city governments and their elected representatives should have decided on vigorous delivery of basic urban services that might be the most effective in their contexts. Financially empowered city governments with clear functional domain and adequate institutional capacity can respond rapidly and contain the outbreak of Covid-19.
It is equally important to improve and expand the coverage through the Public Distribution System (PDS). Bridging the awareness gap regarding available government support programs, especially the PDS, through timely and reliable information and expanding the coverage of such programs to needy but non-registered segments via certain temporary forms of authentication as alternatives can be very useful.
While the latest Economic Survey (2019-20) spoke of 'Thalinomics', which says that a good vegetarian and non-vegetarian platter costs a minimum of Rs 25 minimum and Rs 40, respectively, therefore, in order to ensure that the poorest sections of the population are able to fulfill their dietary requirements, each identified needy person must be provided with ‘a $ a day’ (around Rs 2000 per month).
Further, for everyone to be vigilant of the spread of Covid-19, digital literacy for children belonging to poor families, and smooth transfer of digital payment of welfare scheme, poor households should be provided an Android phone either for free or at a subsidised rates through PDS shops. 
In addition, the private sector (under the CSR component) should come forward and encourage for providing free sim and data coupon to the poor households by identifying through Below Poverty Line (BPL)/Antyodaya Anna Yojana (AAY) cards It is the most opportune time to ensure digital literacy among the people.
To ascertain the per person benefits from the PMGKY package, each person of the country would get Rs. 15,000. But in reality, we do not give poor people more than Rs 500 per month. Contrasted with developed countries, this meagre sum is spent only on a one-time meal.
In the United States, $300 to $400 are being given weekly to the unemployed as allowance. Therefore, to ensure dignified assistance to the poor, the Government of India can afford to give $1 (about Rs. 75) a day to each poor person of India.
If we give Rs 2,000 assistance to 12 crore people (the bottom quartile population in the urban economic ladder), it will translate to Rs 24,000 crore a month, and 72,000 crore for three months. Moreover, if we can give an Android phone in a graded manner to around five crore people (prioritizing elderly, women and children going to government schools) in the cities, it would amount to around Rs 30,000 crore (cost per handset around Rs 6,000).
Overall, this would amount to Rs 100,000 crore and would be crucial as India moves to the ‘Unlock’ phase. Such provisioning is certainly doable and would just need a reorientation of the Budget 2020-21 and to this the Rs 35 lakh crore worth of forex reserves could be rightly utilised to pay for the war against Covid-19, as it would help distribute the pain similar to the Keynesian tenets during the World War II and create a better society.
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For YouTube links, click here for release of the survey, here for webinar on the survey, and here for web policy talk on the survey

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