THEME: PROTECTING THE VULNERABLE

Providing Social welfare to Informal sector workers

SHRAMIK SURAKSHA YOJNA

Medical cum Life Insurance scheme

Kushagra Tiwari Pratyush Pandey Anshuman Tripathi Saurabh Biyani Alok Ratre

INDIAN INSTITUTE OF TECHNOLOGY, ROORKEE

UNORGANISED SECTOR Characteristics about the Unorganized sector: Contributions to National Product and Net Domestic Product: • 92 % of the total work force

in the country are employed in the unorganized sector.

• 370 million form the workforce of the unorganized sector.

• Over 60 % share as per current price in NDP.

• Contribute significantly to national product.

Contribution to savings and capital formation: • Sharing of only household

sector in total gross domestic saving mainly unorganized sector is about three-fourth.

• More than 30 % of the national income comes from unorganized sector.

What can be done for this sector: • Government has formed national

commission to address peculiar issues of this sector.

• Mainly working on Social Security-recently approved 1000 cr. for this.

• Adopted a concept of growth pole to link this sector with organized sector.

• Availability of capital for this sector. • Introduction of Health Insurance

AIM:

To propose an umbrella legislation for workers in the unorganised sector that will assure at least a minimum protection and welfare to workers in the unorganised sector.

Causes of problem: • There is a total lack of job security and social

security benefits.

• The areas of exploitation are high, resulting in long hours, unsatisfactory work conditions, and occupational health hazards.

• They are Daily wage earners, piece-rate workers who are engaged in a variety of occupations or employments, victims of invisibility, themselves are un- conscious of the laws, risking of finance capital by self migrants.

• NO effective means to implement, monitor and provide quick redress.

0

50

100

150Organized vs Unorganized

Sector

Unorganized Sector Organized Sector

1

Scheme for Rag Picker

Over 5 million people in India engaged in waste collection

• Waste picking • Sorting • Recycling • Door to door collection

DIRTY PICTURE Rag pickers are individuals with no rights. They have a difficult life, working hard to clean the cities. They recycle wastes that they collect. They are mostly ignored by the government and are harassed by the police, even being put into jail for no reason.

REASON FOR SELECTING THIS SECTION • We must recognize the useful

role played by the scrap collectors both in helping recycling activities as well as in maintaining Civic hygiene.

• Most of the employed workers are women and children .

• It is, therefore, essential that they should be protected from insecurity of various forms.

RAG PICKERS (50 LAKH) 2

INNOVATIVE SOLUTION

Providing medical cum life insurance against the occupational hazards, associated with work (lets start with ragpickers).

Medical cum life insurance.

Implementation model

Advantage over existing system

• Low cost insurance. • Covers occupational diseases stated by the National Institute Of Occupational

Health (NIOH). • Money transferred to account connected with smart card.

• Beneficiaries are identified by Municipal Corporation. • Biometric enabled smart card issued by the Post Office. • Nodal body of the scheme is National Association for Enterprises in unorganized

Sector. • Empanelment of hospitals as decided by nodal body and insurance company. • Claim settlement by the insurance company delivered by Post Office.

• Nothing substantial existing before the scheme. • Use of technology to ensure easy, fast and transparent

transfer of benefits. 3

PUBLIC-PRIVATE PARTNERSHIP

VALUE PROPOSITON

ACCESS

TECHNOLOGY PLATFORM

State Nodal Agencies (SNAs) facilitate the implementation and

monitoring of scheme

The insurance company provides

provides the outpatient benefits

Providers are empanelled according

to Geographical area to ascertain their

accessibility

Development of the outpatient specific

software that works online or offline mode

Government platform with specific tasks being managed by

private parties

Risk pooling is through health

insurance for outpatient care

Beneficiaries can exercise choice to visit any of the empanelled

hospital or medical shops

For authentication and verification of the

enrolled Smart card to enable cashless treatments

Implementation of the solution

4

Basic Features of Scheme

Identification Enrolment

Utilisation of Services

Claim settlement

By municipal corporation by issuing certificate/bonafide.

Issue biometric enabled smart card by post office by conducting camps and collecting fee.

• By utilising the participating hospitals and receive medical aid upon diagnosis.

• Annual health care checkup.

Life insurance claim could be collected through post office upon production of death certificate and submission of smart card.

Stakeholders

4

Government NAEUS Municipal Corporation

Post Office Insurance Company

Healthcare Providers

Rationale for choosing the group

• Basic Funding Agency

• Nodal agency

• Occupation Data

• Ward level worker

• Large network

• Experience • Postman

can help deliver message

• Provides health cover bearing risks.

• Network of hospitals

• Group of hospitals, dispensaries and medical shops.

Work • Provide funds

• Manage data bank

• Overall functionality

• Issue certificate/bonafide to identify

• Issue smart card

• Deals with money transactions

• Provide Insurance product

• Bear risk and claims

Provide health care facility.

Benefits to players

• Achieves goal of social security

• Gets data

• Creates data bank and gets actual number of workers, trends of shifts in jobs

• Additional funding to run offices, as revenues are already crunched

• Additional funding

• Rejuvenates postal bank services suffering from onset of LPG

• Profit making

• Revenue • Job

satisfaction

5

Insurance Company

State Nodal Agency

Health Care Providers

MUNICIPAL CORP.

Beneficiaries

Government of India

POST OFFICE

4. Selection through tendering

7. In

form

ation

an

d c

erification

12. Submission of data and bill

13. Payment to Insurer

6

13

. L

ife

In

su

ran

ce

Cla

im P

roce

ss

Organisation Flow Chart

Awareness Health Camps

8. Enrollment

14. Life Insurance Claim

3. Assistance

Call Center

DATA

Setting Up of Nodal Agency

– Develop a full time team for State Nodal Agency with some experts in Data Analysis ,IT etc

– Strengthen capacity of Post Office and Municipal corp. by training

– Hire District Coordinators eg. NGOs

– Establishing Grievances Redressal system

Primary Stage Role of Nodal Agency

• Setting of State Server require for storing data

• Get the data of eligible candidates from Census and related agencies

• Provide Training to the field officers involved in the process.

• Receive data of other eligible categories from field-officers and NGOs

• Process and analyse Data .

Basic Role of Nodal Agency

• Empanelment of Insurance Agency

• Receive enrolment data from Insurer and OPD data directly from the Health Providers

• Analyse this data on a regular basis

• Prepare monthly report based on data analysis.

• Monitoring- Fraud Detection and Control

Empanelment of

Insurance Agency

– Selection Through Competitive Bidding

– Strengthen capacity of Post Office and Municipal corp. by training

– Hire District Coordinators eg. NGOs

Primary Stage Role of Insurance Agency

Empanel the Healthcare Providers (hospitals, clinics and medical shops) and sign MoUs

Upload their details and providing them with necessary hardware

Train all providers with the new software

Basic Role of Insurance Agency

• Organise Awareness Campaign

• Receive data directly from the Health Providers and provide claim

• Provide Call Center Fascility

• Monitoring- Fraud Detection and Control

Required Resources

7

• The scheme would be envisaged as 70:30 funding partnership between Center-State government

• Additional funding could be achieved through incorporating Philanthrophists, foundations etc

Funding

8

TOTA

L FU

ND

ING

REQ

UIR

ED

ORGANISATIONAL COST

TECHNOLOGY COST

• Chief Controller • Central Teams • Regional Teams • Training Cost

• IT Hardware cost • IT Software cost • Communication expense

OTHER COST

• External Review Report • Logistics cost

INR 5 CR.

INR 2 CR.

INR 20 CR.

Measurement

Quantitative and Qualitative study covering all stake holder involved in process.

Inviting reputed organisations/agencies having experience of preparing evaluation studies for government schemes. Responsibility of Research Agency: • Developing Research instruments, after

consulting with nodal agency • Selection of experienced field workers. • Providing adequate training to its field

workers by providing complete background ,topic areas, protocols.

• Data collection and Data Management • Quality Assurance data monitoring on

daily basis on field and during compilation of raw data.

• Data analysis and Report Writing

Impact of solution Scalability

Total Number of Beneficiaries is 50 lakh. Additional 20 lakh if labourers in scrap establishments and reprocessing units included PHASE 1: PUNE (5,000) PHASE 2: DELHI (1,50,000) PHASE 3: Pan India (50,00,000)

Sustainability • These preventive health care measures can

reduce the possibility of disease and lead to fewer future medication.

• Gradually including the people of upper strata in this segment(kabadis,thailawala) risk pooling can be greatly increased to make the system sustainable.

• Another alternative is to offer lifelong insurance coverage, so inter-temporal risk pooling would take place thereby, low incidences of diseases at a young age would be offset by high incidences at an older age.

Monitoring and Fraud Detection - Control

State Nodal Agency • Analyse the data on a regular basis • Visit to the hospitals based on data

analysis • Provide support to the Insurance

Company as and when needed for this purpose

Insurance Company • Daily transaction data from hospitals

should be monitored very closely to identify patterns/ trends

• Triggers/ filters etc. shall be built into software for early detection

• Strict action should be taken against errant hospitals however, good hospitals should be nurtured

• Steps to be taken after de-empanelment are defined in revised advisory for de-empanelment

• SNA should be kept in confidence for actions against hospitals

9

Action area • Provider

activation

• Technology

• Awareness

• Availability and cost of drugs

• Reviews • Claims and

Reimbursement

Issues and Challenges o Lack of co-ordination among the local authorities o not actively claiming public facilities; inadequate

provider density

o Evaluating technology platform to make it user-friendly for smooth functioning

o Ocurrence of technology issues eg. Compatibility of softwares

o Misconception among beneficiaries

o Addressing the high incidence of cost for drugs prescribed

o Need for improving communication between various partners

o Challenges in settlement with providers

Implementing Steps

Extensive field visits to gain first-hand understanding of the ground realities and identification of gaps

Meetings held with the nodal agency

Regular upgrades required based on the feedback Troubleshooting support ( reinstallation of software

and ensuring it is operational) Hands-on training on the software

Interaction held with beneficiaries/community

through participation sector-level meetings Other activities for generating mass awareness

Supply and storage of Janaushadhi medicines Field teams trying to encourage prescription of

Janaushadhi medicines

Follow up visits undertaken to share developments and issues for resolution

Better documentation of terms and conditions Providers directed to deduct tax at source

Challenges and Risks

10

• Report of National Commission on Labour 2(Chapter 7 unorganised sector Part A)

• National Commission on Self-Employed Women, 1988 under the Chairpersonship of Smt. Ela R. Bhatt, included in their terms of reference, the women workers in the unorganised sector SHRAMSHAKTI REPORT):

• NCAER-SEWA (National Council for Applied Economic Research and Self-Employed Women’s Association) workshop March-April 1997

• Brazilian ragpickers by M C da Silva, A G Fassa, C E Siqueira, D Kriebel , Federal University of Pelotas, Brazil

• Report on Child Rag-pickers by NGO PRATHAM

References