Skip to main content

'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.
---
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

Comments

TRENDING

Manufacturing, services: India's low-skill, middle-skill labour remains underemployed

By Francis Kuriakose* The Indian economy was in a state of deceleration well before Covid-19 made its impact in early 2020. This can be inferred from the declining trends of four important macroeconomic variables that indicate the health of the economy in the last quarter of 2019.

Incarceration of Prof Saibaba 'revives' the question: What is crime, who is criminal?

By Kunal Pant* In 2016, a Supreme Court Judge asked the state of Maharashtra, “Do you want to extract a pound of flesh?” The statement was directed against the state for contesting the bail plea of Delhi University Professor GN Saibaba. Saibaba was arrested in 2014, a justification for which was to prevent him from committing what the police called “anti-national activities.”

Food security? Gujarat govt puts more than 5 lakh ration cards in the 'silent' category

By Pankti Jog* A new statistical report uploaded by the Gujarat government on the national food security portal shows that ensuring food security for the marginalized community is still not a priority of the state. The statistical report, uploaded on December 24, highlights many weaknesses in implementing the National Food Security Act (NFSA) in state.

Why Indo-Pak relations have been on 'knife’s edge' , hostilities may remain for long

By Utkarsh Bajpai*  The past few decades have seen strides being made in all aspects of life – from sticks and stones to weaponry. The extreme case of this phenomenon has been nuclear weapons. The menace caused by nuclear weapons in the past is unforgettable. Images of Hiroshima and Nagasaki from 1945 come to mind, after the United States dropped two atomic bombs on the cities.

The soundtrack of resistance: How 'Sada Sada Ya Nabi' is fueling the Iran war

​ By Syed Ali Mujtaba*  ​The Persian track “ Sada Sada Ya Nabi ye ” by Hossein Sotoodeh has taken the world by storm. This viral media has cut across linguistic barriers to achieve cult status, reaching over 10 million views. The electrifying music and passionate rendition by the Iranian singer have resonated across the globe, particularly as the high-intensity military conflict involving Iran entered its second month in March 2026.

Modi’s Israel visit strengthened Pakistan’s hand in US–Iran truce: Ex-Indian diplomat

By Jag Jivan   M. K. Bhadrakumar , a career diplomat with three decades of service in postings across the former Soviet Union, Pakistan, Iran, Afghanistan, South Korea, Sri Lanka, Germany, and Turkey, has warned that the current truce in the US–Iran war is “fragile and ridden with contradictions.” Writing in his blog India Punchline , Bhadrakumar argues that while Pakistan has emerged as a surprising broker of dialogue, the durability of the ceasefire remains uncertain.

Lata Mangeshkar, a Dalit from Devdasi family, 'refused to sing a song' about Ambedkar

By Pramod Ranjan*  An artist is known and respected for her art. But she is equally, or even more so known and respected for her social concerns. An artist's social concerns or in other words, her worldview, give a direction and purpose to her art. History remembers only such artists whose social concerns are deep, reasoned and of durable importance. Lata Mangeshkar (28 September 1929 – 6 February 2022) was a celebrated playback singer of the Hindi film industry. She was the uncrowned queen of Indian music for over seven decades. Her popularity was unmatched. Her songs were heard and admired not only in India but also in Pakistan, Bangladesh and many other South Asian countries. In this article, we will focus on her social concerns. Lata lived for 92 long years. Music ran in her blood. Her father also belonged to the world of music. Her two sisters, Asha Bhonsle and Usha Mangeshkar, are well-known singers. Lata might have been born in Indore but the blood of a famous Devdasi family...

'Batteries now cheap enough for solar to meet India's 90% demand': Expert quotes Ember study

By A Representative   Shankar Sharma, Power & Climate Policy Analyst, has urged India’s top policymakers to reconsider the financial and ecological implications of the country’s energy transition strategy in light of recent global developments. In a letter dated April 10, 2026, addressed to the Union Ministers of Finance, Power, New & Renewable Energy, Environment, Forest & Climate Change, and the Vice Chair of NITI Aayog, with a copy to the Prime Minister, Sharma highlighted concerns over India’s ambitious plans for coal gasification and the Prototype Fast Breeder Reactor (PFBR).

Labour unrest in Manesar trigger tensions: Recently enacted labour codes blamed

By A Representative   A civil rights coalition has expressed concern over recent developments in the industrial hub of Manesar in Haryana, where a series of labour actions and police responses have drawn attention. A statement, released by the Campaign Against State Repression (CASR), said it stood in solidarity with workers in IMT Manesar and other parts of the country, while also alleging instances of police excess during ongoing unrest.