Not just in letter, in spirit too

Sex workers and ragpickers were hit the hardest by government apathy during the pandemic

On 2 July 2012, the-then Maharashtra Government launched the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) in eight districts of Maharashtra (Phase 1). It later introduced it to remaining 28 districts of Maharashtra in Phase 2. This scheme was renamed as Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) from 1 April 2017 under which people in the state could avail the benefits of free and cashless health insurance.

In order to apply for the scheme, applicants needed to essentially furbish documents such as ration card and domicilecertificate. In order to enable benefits reach out to state government, semi-government employees and white ration card holders too, the government signed a MoU with the General Insurance Public Sector Association (GIPSA) for treatment of Covid-19 patients at private hospitals in Pune and Mumbai. Different packages would be designed to standardise treatment fees at all hospitals. In order to prohibit hospitals from charging exorbitant fees, the Maharashtra government capped the fees of Covid 19 treatment too in private hospitals.

At the Centre, the Pradhan Mantri Jan Arogya Yojna or PM-JAY as is popularly known was launched on 23 September 2018 in Ranchi, Jharkhand by Prime Minister Narendra Modi. Plugged as the largest health assurance scheme in the world, it provides a health cover of ₹ 5 lakhs per family per year for secondary and tertiary care hospitalization to approximately 50 crore poor and vulnerable persons that formed the bottom 40 percent of the Indian population. The households included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively. PM-JAY was earlier known as the National Health Protection Scheme (NHPS) before being rechristened.

What the State and Centre overlooked was, in order to avail the treatment, the prerequisite paperwork that had to be processed was simply beyond the reach for most. Pune’s Budhwar Peth zone’s sex-workers were hit the hardest by the state’s apathy rather than the Covid-19 pandemic itself. Thousands of female sex-workers and transgenders even moved out of Pune back to native places in Maharashtra and Karnataka in order to dodge punitive State action during the lockdowns.

After being tested for the Covid-19 virus with RT-PCR tests, the civic authorities would simply classify the girls as either being ‘positive’ or ‘negative’ without producing even a single physical test result, felt few. The process, they said, was created to strike fear in the hearts of thesex-workers who would often pay up only to be let off. Or else, the authorities would force the girls into undertaking institutional treatment. “And, all of this without producing a test result, ”says a sex-worker without revealing her identity. "We were charged for tests as high as ₹ 10,000 and ‘Covid-19 treatment’ all at the whim of private centres, she adds.

Completely oblivious of the schemes available, the sexworkers in Pune, caught in the eye of the storm of the second wave, simply couldn’t afford the costs incurred during treatment. On paper they could avail free treatment, in reality, they were provided no relief. Given a choice, most of the sex-workers would opt for private facilities who would, in turn, fleece them by charging them arbitrarily rather than avail a government-provided treatment. That it would be for free and fast was only on paper. There were practical hurdles in their way. So, among the 3,000-odd sex-workers in the zone, most of them lost all their savings and incurred a lot of debt during the COVID pandemic. There were also those from other states like Karnataka who got admitted in a government facility but simply couldn’t avail any benefits because they didn’t have any papers or documents needed to do the same.

As of March 31, 2021, a total of 28,12,980 Covid infections were recorded in the Maharashtra, with 54,649 Covid deaths. Between April 1, 2020 and March 31, 2021, 5,07,188 Covid patients have benefitted from the Mahatma Jyotiba Phule Jan Arogya Yojana in Maharashtra. Pune district, which had the highest number of infections in the state, saw 34,045 claims settled till then. On the other hand, Mumbai, which had 4,23,419 infections and 11,708 deaths on April 1, 2021, saw 29,664 claims settled. The highest number of claims settled was in Ahmednagar, at 34,867 where 95,000 infections and 1,221 deaths were recorded. A total of 34,574 in claims were settled in Kolhapur.

The government had declared that holders of all types of ration cards eligible under the scheme, at grassroots, yet families were known to shell out a fortune for COVID treatment. Hospitals had forced citizens to pay up hefty bills and simply refused to implement the scheme leading to state government’s action across Maharashtra’s hospitals. Despite the insurance policies in place, Maharashtra government had to literally take over hospitals during this period even ensure checks in prices and rates for procedures to provide medical relief.

Pune Shivajinagar ragpickers faced the worst time of their lives in March this year when their entire families contracted Covid-19. Pune’s Kagad Kach Patra Kashtakari Panchayat co-founder Poornima Chikarmane offers, “Despite being essential workers, the ragpickers simply could not avail the benefits of the schemes as, at the time, they were applicable only in certain hospitals. Only later, the Jumbo Covid facilities came up to provide aid. Sadly, private entities made a fortune in the period especially when there was a shortage of beds.” Even in government hospitals, at that time, several medicines such as Remdesivir, were not included in these schemes. The patients were left with little option but to pay a fortune for them. A huge black market was created owing to this, leaving the poor and marginalized to the whim and fancy of private players.

“Those who were admitted too, in Covid Centres, and had got the tests done were not given the reports in hand. They would simply be told that they were either Covid positive or negative. Even the death certificate would not reveal Covid-19 as the “cause of death,”leaving little to show by way of proof for redress. Unable to show a correlation of COVID-19 with death would ensure that the kin do not avail any benefit,” added Ms Chikarmane. “Covid Warriors have been assured insurance on death and several applications remained pending with the Pune Municipal Corporation, but nothing came out of it,” she maintains.