Social protection and the informal workers: a case study of the health (in) security of the Beedi workers in India

The growing informal employment, especially in developing countries, has put pressure on the state to provide social protection to a large number of workers. In India, informal employment accounts for more than 90 percent of the total employment without labour regulations and social security. One of the key challenges in ensuring social security for members of society is the growing informality around the world, especially in India. The higher level of informality in developing countries is associated with a greater prevalence of unsafe and unhealthy working conditions, lower productivity, irregular incomes, and vulnerability to shocks (Jha & Mishra, 2022). Thus, social protection is the most pressing need for this group. Realising the needs of the vast majority of the informal workers, the government of India has introduced a series of programs and policies to provide welfare benefits to the informal workers. However, these remain non-statutory in nature.
The health security of informal workers is crucial among various other forms of social security. Out- of-pocket healthcare expenditure is one of the major contributing factors to India's increasing vulnerability. Healthcare expenditure in India is a major factor pushing a large number of households below the poverty line each year. Nearly two-thirds of the total healthcare spending in India comes from out-of-pocket expenditures. The majority of the total health expenditure is contributed by individual households through out-of-pocket spending at the time of illness, which has been a major cause pushing households below the poverty line. Without health security, households face out-of- pocket expenses that perpetuate the cycle of poverty. As a significant shift in the healthcare regime, the government of India identified health insurance as a way to protect poor households against the risk of health spending leading to poverty. In the last decade, two major health insurance initiatives, namely RSBY and PM-JAY, have been introduced to reduce the financial burden on households through out-of-pocket expenditure on health.
Further, among the informal workers, I choose beedi workers as a case to investigate their access to health security as
beedi industry is a major small-scale industry in India, predominately unorganised; it employs a majority of women workers in the unorganised sector as
home-based workers.
health security is crucial for beedi workers due to their continuous exposure to
tobacco as an occupational health hazard. The
The beedi workers, as a category of informal workers, can access social security
based on their employment status through the beedi worker welfare fund and the welfare benefits of the government welfare programs through their poor citizen status. In the absence of these formal security measures, there is informal security for the beedi workers, which serves as a safety net in times of need. So far, little research has been conducted on the comprehensive analysis of the informal
workers' choices and experiences in dealing with welfare programs.
Thus, for this thesis, I conceptualise social security as a combination of formal and informal security, where formal security comprises the security available through employment status and citizenship status. In contrast, informal security is provided through social capital and informal security regimes. Thus, in this study, I aim to explore “how do the beedi workers deal with their health security needs?” Through this question, I explored the dynamics of the formal and informal security of the beedi workers and their choices and experiences in dealing with health security needs. To answer this research question, I employed qualitative methods such as semi-structured interviews, group
discussions, and non-participatory observation. To provide a holistic picture of the dynamics of access to health security programs, I conducted interviews with the experts engaged in the program implementation to identify the gaps and challenges in the program which could impact access by the workers, together with conducting interviews with the beedi workers to understand their choices and experiences in accessing the welfare programs. I analysed the data using thematic coding and
qualitative content analysis.
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The findings of the study provide an in-depth analysis of the dynamics of beedi workers' access to health security, the reasons behind non-access to health security, and the dynamics of informal security for beedi workers. The findings highlight the gaps in the implementation of health insurance programs that might impact beneficiaries' access to security. In addition to the gaps and challenges in the program implementation posing a barrier to access, other factors, such as unawareness of program features, gender, and village politics, among others, impact access to the benefits. In addition, program-specific barriers hinder the utilisation of the program benefits for beneficiaries despite enrolment and access to the health insurance program. Gender has been identified as a major barrier to access due to policy planning following the male head of the household model and the stricter social norms and patriarchal values. In addition, beedi workers choose informal security over formal security due to several factors, such as the low perceived value of the program benefits, a bad experience in the past and the uncertainty of formal security redefining the trust in the informal social network. Overall, the findings assert that the program’s outcome can be extended with better implementation initiatives.
Further, there is a need for targeted initiatives to ensure that the benefits reach the target population, especially women. In this direction, the self-help groups as a microfinance initiative have the potential to reap beneficial results in the financial and social empowerment of the workers, especially the women workers. Ultimately, these findings highlight the on-ground situation of the health insurance programs and call for immediate action to improve the distribution of workers' access to these programs.