Emphasizing Health Insurance as Social Security System of Unorganized Sector in Maharashtra: The Case of the Ragpickers

The Indian economy is categorized into two sectors, namely: organized and unorganized sectors. The unorganized sector consists of a pivotal part of the Indian economy. Ragpickers are that class of employees who can be considered as an organized-unorganized labor class. Ragpicking business entails collecting, sorting, and selling various waste materials, mainly plastics or metals. After doing all this work, they sell recyclable material to the junkyard dealers at very petty prices, making them economically poor. Ragpickers are a major contributor to the Indian economy, as they are involved in recycling. Ragpickers mostly work without being equipped with any protective gear and are exposed to many health hazards while doing their role. They suffer from occupational risks and are often found hospitalized paying their bills from their pockets. There are times when they even do not go to hospitals because of hospital expenses. The paper primarily focuses on analyzing the different health insurance schemes, which are provided as social security by the Maharashtra Government and tries to find out the possible loopholes in health insurance policies because of which the ragpickers are not able to utilize or avail the benefits of the policies for which they are eligible. For developing a better understanding of the subject, the researcher has conducted an empirical survey on the ragpickers of Pune. Based on this, the researcher has recommended some policy changes, which can prove beneficial for the welfare of the Ragpickers.


Introduction
Indian economy consists of approximately 10% of the organized sector.In contrast, the unorganized sector or informal sector constitutes a pivotal part of the Indian economy, i.e., more than 90% of people are working in the unorganized sector of the country (NCEUS 2007).Most workers in this sector neither receive many facilities or benefits from the government nor have any fixed employee-employer relationship.The workers in this sector can be seen doing risky and unhygienic jobs, which leads to infections, contaminations, and bad health conditions [1].Due to these conditions, they spend their daily wages in hospitals, which generally brings them poverty and economic vulnerability.However, to overcome this problem, Social protection is provided by the government; one such social protection is by offering various insurances.
Ragpickers are the unorganized sector workers who collect rags or recyclable materials that can be sold for money.Ragpicking entails collecting, sorting, and selling various waste materials, mainly plastic and metals [2].
Ragpickers are broadly divided into three categories: • Itinerant rag pickers, who mainly pick up recyclables from streets, dump sites, and businesses, but not residences; • Fixed Rag pickers, who have been formally integrated into the door-to-door waste collection programmed to run by municipalities; and, • Itinerant Buyers purchase recyclables from the waste pickers and resell them up the chain for an added value.

Socio-Economic Condition of the Rag Pickers
Ragpickers are the poor class of the society, and their earnings depend upon the rag or the material they collect.Different materials have different rates per kilogram; their earnings depend on how much they collect daily or what material they find, or what type of waste they collect.According to the study conducted by Bose & Bhattacharya (2017), it is seen that ragpickers earn Rs. 175-200 per day, i.e., after working for long hours and walking miles; they earn Rs. 200 per day [3].The Environment Minister also stated that Ragpickers of India collects nearly 22-28% of wastes in India, which is processed and recycled.Ragpicking occupation is mainly adopted by the population that is dislocated or migrated from rural to urban.There are 40 lakh ragpickers in India, out of which five lakhs are in Delhi alone.Females mainly adopt this profession, and 73% of women work in the waste picking sector.About 90% of the ragpickers are found illiterate, and their children are mostly engaged in the same occupation [4].

Health Hazards
There is a reason why rag-picking is considered the worst form of labor.The risks related to health, unexpected incidents, and accidents make rag picking an adverse occupation.

Ergonomic and Biological Hazards
Ragpickers start their work at dawn and work till dusk, while some of the ragpickers work from dusk to dawn; Ragpickers often get contacted with the used bandages, disposable diapers, toilet paper, sanitary napkins, disposable needles or syringes, and used condoms on the dumpsites or while collecting the rags [5].Besides these, the wastes from small clinics, pharmacies, labs, and even hospital wastes, may also be mixed with residential trash, carrying micro-organisms responsible for causing more serious diseases.Ragpickers often walk a long-distance or pull heavy carts or bicycles loaded with rags on them, which causes musculoskeletal problems.Micro-organisms found on the dumpsites can cause skin diseases or other harmful diseases, including Gastro Tract Infections (GITs).The smoke on the dumpsites is mainly caused due to burning of tires or plastics can also cause Respiratory Tract Infections [6].

Safety Hazards
Ragpickers often get bitten by the dogs, pigs, or other insects on the dumpsites or the streets.
Further, in rainy seasons the open dumpsites or dumping grounds are the breeding grounds for the disease vectors, such as flies, mosquitoes, and other pests, which can cause many seriously.
Ragpickers sometimes work bare feet or collect rags with bare hands, which cause them to receive cuts on their hands or feet by broken glass or other sharp objects or contact other microbial infectious organisms, which can cause festering wounds or serious harm to them [7].

Other Hazards
Ragpickers are involved in sexual activities and sometimes work as the pimp or go to the prostitutes to get involved in sexual activities.Child ragpickers are also involved in homosexual sex and visit prostitutes.Further, the ragpickers are involved in consuming alcohol, tobacco, smoking, drugs, or gambling (The International Labor Organization International Program on the Elimination of Child Labor, 2001).Most child ragpickers also suffer from malnourishment, which reduces the resistance capacity for various diseases Bhaskar Majumdar (2017).

COVID-19 Hazards
More than 2,925,337 people are infected by the Novel Virus pandemic and have taken more than 55,174 deaths all over India.Coronaviruses, which are also identified as COVID-19, entered India in February, resulting in the nationwide lockdown in March, which periodically extended till further notice.The nationwide lockdown resulted in shutting industries and all other sectors resulting in unemployment to many workers.Ragpickers are one of the workers who are prevented from going out and work.However, the prevention is only limited to the self-employed ragpickers and not to the workers working for municipalities [8].Ragpickers who are working under the municipalities are working on the field, like other frontline corona warriors.Ragpickers already have unexpected high risks in their occupation.There is an addition of the coronavirus; the virus the signs and symptoms of which are very similar to the occupational hazards of the ragpickers, which they usually ignore.
Ragpickers working on the field do not have any protective gear to protect themselves from the novel virus-like other frontline warriors.Ragpickers who work on the field have to deal with the household wastes or the medical wastes or the other wastes thrown on the dump yards, including the medical wastes used by the corona infected person or the suspected patients.Working in such conditions without proper protective gear can cause serious health issues to the ragpickers [9].
Ragpickers are handling unmarked medical waste emerging from homes, where COVID-19 patients are quarantined.They are dealing with discarded masks, gloves, and tissues, which could be highly contagious, revealed Chaitanya Mallapur.The article also reveals that the guidelines were issued by the Central Pollution Control Board (CPCB) on March 18, 2020, under which the COVID-19 waste should be marked separately by the Hospitals and should only be handled by authorized staff.However, such guidelines are only for the hospitals and not for the quarantine camps or the homecare suspected patients.
CORONAVIRUS CRISIS (n.d.) Reveals that 90% of the sanitation workers do not have health insurance even amid the coronavirus crisis, the article also reveals that there is no training or any safety instructions given to the sanitation workers.The study also reveals that 93% of the workers were not given any instruction for health checkups and 96.5% of the female workers reported no special arrangements made for them at work [10].
Ragpickers affiliated with the SWACH are carrying a silent protest against Pune Municipal Corporation (PMC) regarding their demand for extra money to tide them from current financial emergency, the life insurance coverage of Rs. 2 lakh in line with the government provisioning for those who died of COVID-19, and the PPE kit for on-field ragpickers, reveals Prachee Kulkarni.

Importance of Ragpickers in the Indian Economy
Ragpickers pickers play an important role in the recycling value chain.They are the primary providers of raw material to the industry.By doing so, the ragpickers reduce the cost of the municipality and the industries.Ragpickers handle a significant portion of the waste and protect the environment by doing their work.Ragpickers add a greater value to the plastic and save the municipality a significant amount of money.According to the report (Second National Labor Commission Report, 2002), it is estimated that nearly 50 lakh Indians earned their livelihood as waste pickers in the country after excluding those working in the recycling industry.Ragpickers clean up a significant proportion of the 62 million tons of waste generated annually in India Bose & Bhattacharya (2017) [11].

Social Security
Social security provides social protection to a certain class of people in society irrespective of their employment sector.The state extends the protections in any relevant contingencies, such as health, retirement, death, life accident, or any other conditions beyond the control of the individual member of the society.The government makes different schemes or policies to offer social security to its beneficiaries in terms of social security.Each scheme or policy has different beneficiaries, which are carried and funded by the government.Insurance is one way to offer social protection to the beneficiaries in monetary terms.They can be secured and protected against any future contingency (IRDAI, n.d.).Providing insurance will benefit the ragpickers in a very efficient way, as most of the ragpickers hail from economically backward sections and are not much educated [12].It is common for them to ignore small-time health problems, like fever, cold, body pain, etc., leading to prolonged diseases.Therefore, providing social security to ragpickers in terms of insurance can be a very efficient way to help ragpickers, and spreading awareness of such services should be the major concern of the government.

Health Insurance Schemes
Recognizing the health hazards of the ragpickers and the importance of ragpickers, the government has offered social security schemes in health insurance to the ragpickers; the following are the major health insurance schemes currently active in the state of Maharashtra [13].

Pradhan Mantri Jan Arogya Yojana (PMJAY)
PMJAY (n.d.) suggests that the Hon'ble Prime Minister of India, Shri Narendra Modi, launched the policy in 2018.The policy is also known as the largest health assurance scheme in the world.It aims to provide coverage of Rs. 5 lakhs per year; the policy covers secondary and tertiary care across public and private empanelled hospitals in India and covers nearly Rs. 10.74 crores, low-income families.The beneficiaries are included based on the deprivation and occupational criteria of socio-economic care census 2011.The policy was also known as the National Health Protection scheme earlier [14].The policy also covers the families that are covered by RSBY policy as PMJAY subsumes the RSBY policy.The government and cost fully fund the policy are shared between the center and state, respectively.The policy provides cashless access to health care and covers pre-and post-hospitalization expenses.The policy does not restrict any person based on age, gender, or family and covers pre-existing diseases [15].

Drawback:
The state should choose to implement the scheme or not.The SECC data also includes those who do not come to BPL now or those who do not need the free health insurance benefits.The scheme has a lot of terms and conditions for availing of the benefits.If a person can benefit from one category, he can get rejected because of falling into other conditions.

Rashtriya Swasthya Bima Yojana (RSBY)
RSBY (n.d.) suggests that the policy was introduced in 2008 by the Ministry of Labor and employment for unorganized workers.The object was to provide health care services and social security to the families below the poverty line and marginally above the poverty line.The scheme can get the best medical facilities in health hazards due to old age, maternity, disability, and general ailments [16].The beneficiaries are eligible for hospitalization coverage of up to Rs. 30,000, for which they have to pay Rs. 30 as registration fee.The expenses and the premiums of the policy are paid directly by the center and the state government.The policy covers the entire family of up to five members in the family.It provides complete medical coverage without providing any restriction 6.5.Jan Arogya Policy IRDAI (n.d.) suggests that Kagad Kach Patra Kashtakari Panchayat (KKPKP) is the holder of this policy; the policy is provided by the New India Assurance Company (NIA) since January 2003.
Pune Municipal Corporation bears the premium expenses of this policy.The policy is offered to the economically backward society, and the insurer is eligible to receive an amount of Rs. 5,000 [22].
The policy covers the family members and the individuals.It covers only the person who is above 18 years of age and below 70 years of age.Treatment can be admissible in registered private and public hospitals and covers only hospitalization expenses.
Drawbacks: Medical checkup benefits are not included in the scheme.Outpatient procedures are not covered.Pregnancy and childbirth expenses are not covered under the scheme.

Shahari Gareeb Vaidyakeeya Sahayya Yojana (Urban Poor Health Scheme)
Urban Poor Health Scheme (n.d.) suggests that citizens living in the jurisdiction of Pune Municipal Corporation can avail the benefits from this scheme, especially waste-pickers (special inclusion), through a General Body Resolution in February 2015.It covers the ragpicker's immediate family members [23].The Solid Waste Management Department of Pune Municipal Corporation pays Rs. 200/-, which is the total amount of membership registration fees for the Members of KKPKP.The scheme covers the hospital expenditure up to Rs. 1 lakhs, where the bill is to be shared in a 9:1 ratio, i.e., 90 % of the bill is shared by the PMC and 10% is to be paid by the patient [24].

Drawbacks:
The schemes are only limited to the empanelled hospitals, mostly public hospitals, where a yellow ration card will get free treatment.The applicant's name should be on the ration card.

Objective of Study
To analyze the need for health insurance and analyze the problems relating to accessing health insurance schemes.

Specific Objective
• To examine the issues of the need for health insurance to the rag pickers.
• To inquire the problem relating to access to the health insurance schemes provided by the government.

Research Question
• What are the possible needs of health insurance schemes for the ragpickers?
• What are the problems relating to accessing the health insurance schemes provided by the government?
• What are the possible loopholes in the government health insurance schemes?

Empirical Study
A field study has been conducted in Pune city, mainly Prabhat Road, Yerwada, Lohgaon, and Vadgaon localities.Pune is one of the cleanest cities in India is supposed to serve as exemplars to other municipal corporations [25].Here, the attempt was made to assess and analyze the community's difficulties and predicaments engaged in the rag-picking occupation.The present study involves a descriptive study conducted by face-to-face interviews, a total of 10 ragpickers who are above 18 years of age [26].Figure 1 indicates the rag-picking occupation is majorly done by the people above 50 years of age and 30% by the people above 30 years of age.The remaining 30% from 18 to 30 years of age group makes rag picking a mixed occupation, which any age group can do [27].We conclude that more than 70% of the ragpickers are more than 30 years of age from the above data.

What are Your Wages?
Figure 3 shows 50% of rag pickers earned up to Rs. 300/-per day, while the other 20% earned up to Rs. 500/-, and the remaining 30% earned above Rs.500/-in the rag-picking occupation.The above data shows the economic condition of the ragpickers by their daily wages.
Ragpickers are the poor workers in the unorganized sector.The data shows that 50% of the ragpickers hardly earn up to Rs. 300 a day, which hardly adds up to Rs. 9,000 per month, which is the amount with which they must fulfill their daily needs.However, considering the working hours and the physical work in which the ragpickers are engaged, the wages they get are very low, making ragpickers a poor class of society [30].The Figure 4 shows 50% of the rag pickers were self-employed, 30% worked for the SWaCH organization, and the remaining 20% ragpickers were involved in rag picking business part-time workers.The analysis reveals that the ragpickers choose to work separately rather than to work under any association.They are eligible to get a monthly salary and bonuses as the organized sector workers.However, the self-employed ragpickers do not have any such benefits as organized ragpickers and are unaware of their eligibility benefits.The ragpickers who are self-employed are dependent on the amount and quality of the rag they collect.In contrast, the ragpickers who work for any association get paid monthly.This survey has also found out that self-employed ragpickers work for the junkyard dealers, who help them if in need.A study made by WIEGO Policy Brief, 2012, reveals that most ragpickers are self-employed, and some other workers are also involved in a part-time rag picking business.The survey also reveals that KKPKP plans to provide Identity Cards to each rag picker in Pune.The researcher completely validates the survey done by the WIEGO and agrees to it [31].

Are You Aware of any of These Health Insurance Schemes Provided by the Government?
Figure 5 shows 60% of the rag pickers responded to this question negatively, as they are not aware of the health insurance schemes provided by the government.In comparison, 40% of them knew about the health insurance schemes.The data shows that ragpickers are not aware of the health insurance schemes.
The above data see that the majority of the ragpickers are not aware of the social security schemes.The survey also helped the researcher understand that the ragpickers working under any organization know the health insurance schemes.However, the ragpickers who are self-employed are unaware of such social security schemes.Many surveys have found out that the ragpickers are often Figure 6 shows the 60% of rag pickers responded negatively to this question.They were unaware of any of the health insurance schemes, which were suggested to them.The remaining 40% of the ragpickers were aware of two schemes.The two schemes which they were aware of where the during the survey, where ragpickers mostly complained about the documentation problems for availing the benefits or the excuses, which the hospital staff gives for not providing them the benefits.
The researcher completely agrees with the research and confirms the loopholes in the social security schemes and the reasons for not utilizing the health insurance scheme [33].

What Problems do you Face when you Visit the Hospitals?
The researcher's motive to keep this question open-ended was to understand the ragpickers' problems to help the researcher develop suggestions for them and learn the drawbacks of the social security scheme at the ground level.
All ragpickers complained that public hospitals have very long procedures and fixed timing for everything.The long procedure included that when they first visit the hospital, they must pay the hospital fees and takes a prescription slip before visiting any doctor.After that, they can go to the respective rooms, where the specialty doctor is available.In complying with both procedures, they must stand in long queues before the diagnosis.If some tests have to be done, then the doctor prescribed some tests for which initially they have to pay the prescribed test fees, for which they again have to stand in queues and then must go to the prescribed test labs.They have to wait for the reports and take that to the specialty doctor, who will prescribe medicines.Sometimes during this procedure, OPD time gets over, and they have to come the next day for the remaining procedures.
This long procedure often cost the ragpickers their work hours and must take work off.60% of the ragpickers revealed that they have to pay for the tests, and 80% of the ragpickers also revealed that if they are eligible for any social security benefits, they have to show the qualifying document for the required scheme.However, such required documents are not readily available with the ragpickers, so even if they are eligible for the social security benefits, they cannot benefit from the scheme.40% of the ragpickers also revealed that they face discrimination from the hospital staff during diagnosis, examination, or the general public.
The data reveals that the hospitals' main problems are poor services, long queues, unnecessary procedures, and documentation to avail the social security benefits and discrimination faced by the hospital staff.

What are the Health Hazards in Your Daily Activities?
Every ragpicker revealed that they often cut themselves by the glass or steel or any other sharp objects.40% of the ragpickers revealed the problems of inhaling the harmful gases, which cause them breathing problems.Dogs or any other stray animals bite 80% of the ragpickers.Common cold or cough is a very common problem.Every ragpicker suffers from a musculoskeletal problem.
They must take long walks or must carry or push the long carts, which causes many problems.60% of the ragpickers revealed the problems of skin diseases or gastro tract infections.40% of them revealed the problems of respiratory tract infections or eye problems.Every ragpicker has a habit of substance abuse, and 80% of the ragpickers revealed the problems of water-borne diseases, including kidney stones or typhoid.50% of the ragpickers also revealed that sorting sheds are not well equipped with sanitation facilities, clean drinking water, first aid kits, or sanitary pads.These are the daily health hazards that ragpickers face.
Ragpickers are more engaged in unhygienic occupations and are always exposed to such diseases, but this is because they do not have any protective gear to protect themselves from such

Figure 1 -
Figure 1 -Shows the Age Group

Figure
Figure 4 -Organization

Figure
Figure 6 -Health Insurance Figure8shows 80% of the rag pickers spend Rs. 1,000-5,000 at the hospital and 20% of them spend up to Rs. 1,000 at the hospital.The data reveals that the ragpickers, who merely earn their bread, spend much money on the hospital bills[35].

Figure
Figure 8 -Expenses