standard of living of its people and the improvement of public health as among its primary duties and, in particular, the state shall endeavour to bring about prohibition of the consumption except for medicinal purposes of intoxicating drinks and of drugs which are injurious to health.

Similarly at the global level ICESCR mandates right to social security and health through Article 9 and Article 12 of the covenant:

Article 9 The states parties to the present covenant recognise the right of everyone to social security, including social insurance. Article 12 1 The states parties to the present covenant recognise the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. 2 The steps to be taken by the states parties to the present covenant to achieve the full realisation of this right shall include those necessary for:

Also Articles 7 and 11 include health provisions:

The states parties...recognise the right of everyone to...just and favourable conditions of work which ensure...safe and healthy working conditions;...the right to...an adequate standard of living.

India ratified the ICESCR on April 10, 1979 making it obligatory to honour the provisions of the covenant. The social security legislations in India are thus not in line with the above provisions.

Social Health Insurance3

The total employment in India today is estimated at nearly 400 million but of this only 28 million is in what is called the organised or formal sector,4 which is covered by comprehensive social security legislation, including social health insurance. The largest of this is the ESIS which covers 8 million employees, and including family members provides health security to 33 million persons. In 2002-03 the ESIS Corporation spent Rs 12 billion on healthcare for its member beneficiaries averaging Rs 365 per beneficiary. This effectively covers a mere 3.2 per cent of the population. Another about half per cent of the population is covered by the CGHS. In the same year the CGHS spent Rs 2 billion averaging Rs 450 per beneficiary. While these social health insurance plans have been around for a long time, their credibility is at stake and large scale outsourcing to the private sector is taking place. ESIS has private panel doctors in large cities who provide ambulatory care to those covered under ESIS whereas their own doctors in dispensaries and hospitals run by ESIS are increasingly idling. Similarly under CGHS, those covered are being given “choice” to access private healthcare by being given reimbursements which for instance for a by-pass surgery could go upto Rs 1,50,000 for a senior bureaucrat.

Further, other government employees like the railways, defence services and the P and T department have healthcare services and/or reimbursements for their employees which amounts to a significant Rs 1,600 crore per annum and this averaged a large Rs 1,150 per beneficiary. Also, welfare funds have been created by acts of Parliament and state assemblies for specific occupational groups, including those in selected unorganised sector groups, like beedi workers, plantation workers, mine workers, building/construction workers, head load workers to meet social security benefits like healthcare, education, recreation, water supply, housing, etc. In 2002-03 these funds expended Rs 35 on healthcare, which was about half the expenditure of the welfare funds.

From the rest of the organised sector, largely the middle and upper middle classes, about 30 million persons are provided healthcare protection from employers through reimbursements and/or employer provision. This is estimated at about Rs 2,400 crore per year, averaging Rs 3,000 per employee per annum. Thus about 10 per cent of the country’s population has some form of social insurance cover for health through their employment.

From time to time, the government has also introduced social security schemes, including health cover for various groups of population, especially the poor or below poverty line groups, in the unorganised sector, like the Krishi Shramik Samajik Sanstha Yojana, National Social Assistance Programme, National Family Benefit Scheme, National Maternity Benefit Scheme, handloom workers thrift, health and group insurance, agricultural workers central schemes, Janashree Bima Yojana, state government welfare funds, national illness assistance fund and state illness funds, etc. But these schemes are not run on a regular basis, that is if a person gets a benefit once there is no guarantee that she will continue to have access to that scheme on a regular basis. No firm figures of their coverage are available because most such schemes, like the latest universal health insurance scheme in the 2004-05 budget, are populist announcements to lend social credibility to the budget and when the next budget comes the scheme gets quietly archived.

The above brief analysis of social health insurance is a clear pointer towards the failure of a segmented approach to social security and hence it is futile to pursue the same trajectory as the commission does.

Way Forward

The commission is aware of the segmentation it is further contributing to but it uses the logic of “lets start with something”. This mindset of being well meaning adds to the existing distortions within the social security framework. Instead of endeavouring to bring the unorganised sector into the organised sector realm the commission takes it further away. Why does it not venture into the territory of the organised sector and demand the inclusion of the entire unorganised sector within the folds of the mainstream legislations covering the organised sector?

Today even the organised sector is threatened with a curtailment of rights under the neoliberal economic framework and it therefore makes perfect sense to seek refuge in large numbers to subvert plans of reducing access to social security. Thus, the commission should have seized the opportunity and dovetailed the unorganised sector into the existing social security mechanisms governing the organised sector by demanding extension of these laws to the entire workforce of the country on a compulsory basis. This is the only route for universalising social security.

The history of social security in India provides clear evidence that social security mechanisms designed for the organised sector workforce have worked well and provided reasonable security to them but all other schemes designed for occupational groups under the numerous welfare funds have failed miserably.

If we believe in the principles of nondiscrimination and equity then not only