The Panchdeep project of the Employees' State Insurance Corporation to provide health and social security services to millions of contributor-members through a national digital network from July 1 is a laudable initiative. Workers have been waiting for some measure that ensures they do not lose their welfare benefits simply because they have to relocate. Happily, they will now be able to use their identity cards to access the services in any networked institution. Achieving such scale is no easy task, considering that the membership base of the ESIC stands at 56 million, and the number of hospitals, dispensaries, and offices is 2,220. Networking will also bring about another significant advance: the families of the insured can get health care without the insured member having to accompany them. These are overdue measures, and they lend belated impetus to India's efforts to provide low-cost health insurance and welfare support to workers. Over the decades, the agenda has made only fitful progress. Often, the huge cash reserves with the ESIC have contrasted sadly with the less-than-average quality of its services. Against this backdrop, the 2010 amendment to the Employees' State Insurance Act, 1948 to widen its reach was welcome. The new provisions enabled extension of coverage to any institution with a manufacturing process, and employing 10 or more people, irrespective of the use of power.
Impressive as the networking achievement is, the ESI system now has to turn its focus on strengthening its core purpose — to safeguard employee health. There are acknowledged problems starting with the sheer demand for facilities, inefficiency, official indifference, corruption, and a lack of accountability. Improving medical infrastructure is a key priority, as is an administrative revamp. A legitimate question is whether the Hospital Development Committees constituted by the ESIC have brought about any perceptible change. Policy concerns at the State level also remain. For example, a liberal approach would facilitate the inclusion of more shops and establishments. The Centre has been appealing to the States to invoke the powers under the Act and lower the threshold for coverage from 20 employees to 10. But not all States have acted. Labour Minister Mallikarjun Kharge told Parliament recently that only Bihar, Punjab, Rajasthan, and West Bengal had issued the necessary notifications. The decision of the ESIC to start 18 medical colleges “in phases” to provide the human resources for its expanding hospital operations is a step forward. At a time of rising costs and debilitating out-of-pocket health expenditure, it is vital that governments widen social security.