Healthcare facilities and access for tea garden Laboure's in Kerala



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The tea business in India has been one of the India’s leading private sector employments. Nearly one-fifth of the workforce of Kerala, India's southernmost state is engaged inside the plantation industry, which provides housing, sanitation, health care, and education, among other necessities, for plantation workers. Local farmers refused to cooperate on estates, and as a result British firms forced their way into India's central along with the southern states, bringing with them the poor, landless as well as indigenous (Panwar, 2017, George et al. 2018) (Adivasi or other types of Indigenous) inhabitants of the lower caste (Scheduled tribes or untouchable caste). India's tea business has been one of the country's oldest. Assam,

West Bengal, Kerala, as well as Tamil Nadu are indeed the four primary tea-producing places in India. According to statistics given by the Tea Board, Kerala has 161 tea estates with a total size of 8.09 acres. These plantations cover a total of 31984 hectares of tea-growing land. Additionally, there are 89 big tea firms, 163 large estates, among 3956 small producers in Kerala, according to statistics (, 2022).

The Plantation Labour Act (PLA) was enacted to formalise this exploitative aspect of plantation labour (Panwar, 2017). The net impact has been even after: as in the Spanish colonization, tea estates continue to dominate the livelihoods of their workers under a parallel government framework, with minimal active engagement by the State. Landless and  landlocked workers have faced various sorts of marginalisation for decades (Panwar, 2017).

Access to medical care is one of the fundamental elements of health services usage and for guaranteeing universal health insurance.  GBD (Global Burden of Disease) estimates the healthcare specialty access to high - quality index (HAQ) for 195 nations, with Iceland scoring the best (97.1 out of 100) and Central African Republic scoring the lowest (18.6). India came up the 145th place out of 195 countries with a score of 41. In India, Kerala, a southeast state earned the lowest rating (34.0), showing a larger amount of difference across the Indian states (Peter, Sanghvi & Narendran, 2020, 2022).

This paper will direct the types of healthcare facilities and accessibilities which are imposed to the tea labourers who are working in the states of Kerala, South India. In 2009, the state's department of health was prompted to act after learning of Kerala's high rate of maternal mortality (237 every 100,000 live births compared to 130 every 1000 births nationwide) (, 2022).

 In spite of this, argument line can be given to the general lack of awareness of the circumstances and rights of women labourers – their socioeconomic status, terms of employment, access to healthcare and education – the Social Determinants of Health (SDH). Assessing the realities, requirements, and perspectives of women employees in terms of their health along with the well was the goal of this study (George et al. 2018).

It is well known that far more over half of the workers on plantation farms are women since it is thought that "tiny fingers and nimble hands of women" are best suited for harvesting tea leaves (, 2022). The prevalence of severe anaemia, early marriage, and high parity among women in plantations estates has also been linked to this essay.


The Union Ministry of Labor did the right thing by increasing the ESI (Employee Service Scheme) wage ceiling from Rs.15,000 to Rs.25,000. In South India here less than 3% of the workforce has access to essential services, this is a meagre measure of relief (, 2022). There has been an emphasis on expanding ESI's reach across a variety of industries and geographic locations throughout its history. When the applicable 1948 Factories Act first came into effect, it only classified into non businesses that worked 10 or more people (Rajbangshi & Namibiar, 2020).

Over the years, it has expanded its scope to include transportation companies, hospitals, newspapers, the hotel industry, and educational organisations. The age limit for dependents of workers was increased to 25 years in 2010 (Raj, 2020). Even employees in the informal sector, those who do not contribute to the present employer-employee system, would be eligible for medical benefits under the ESI. Expanding the reach of medical services in an economy where the vast majority of workers remain in the informal sector cannot be stressed.

In addition, India's out-of-pocket health expenditures, which accounts for 67 percent of the country's overall health spending, is the largest in the world (George et al., 2018). Consumer spending might benefit from lower medical costs, even if critics of the most recent ESI coverage changes aren't aware of it.

A short-term solution to the problem of medical care in a mostly impoverished country is, of course, possible. As of now, the Union government is committed to increasing its health-related spending to 2.5% of GDP through both planned and unplanned means. From here on, India must implement the High Level Expert Group's recommendation of fully tax-funded and paperless implementation of universal healthcare (George et al., 2018).

This study, which came out in 2011, calls for a more holistic approach to patient care that goes beyond the usual ways of responding to disease and the insurance schemes that channel enormous resources to expensive medical assistance. For the most part the focus is on preventing and addressing issues like basic sanitation, potable water that is safe to drink, minimum wage and elementary school. The HLEG's suggestions include merging the National Rural Health Mission and the Rashtriya Swasthya Bima Yojana into the UHC in order to better achieve their social goals.

To achieve the goal of making India a global economic superpower, a stable environment is essential. UHC is far more than a means to an end, though. The lack of women's voices in tea labour unions was also observed (George et al., 2018). Workers' union membership and leadership among women from governmental plantations were not reported.

Workers at a Kerala's commercial plantation, meantime, reported the formation of a new organization with 17 males and four women participants, according to reports. Some female Union members voiced doubt about the feasibility of a woman becoming Union President since they were inexperienced with the procedures surrounding this position (George et al., 2018).

Even if they were equal providers to the household's income, several women indicated that they were unable to express their views at home or in social dialogues. Several women also stated that while they are involved in home decision-making, they do not occupy that position.

In the majority of cases, women agreed that they couldn't do it without their spouses' consent or permission (George et al., 2018). According to reports, their husbands made even the most basic decisions, including whether or not they work or even how to work. Women tea pickers in Kerala's more than 800 tea estates have a difficult job. They are paid Rs 275 per day to pick 15 kg of green tea, which is their daily allotment. Depression, emotional problems, severe anxiety, and PTSD are all on the rise as a result of the epidemic.

These women, on the other hand, have no access to mental health care (, 2022). Healthcare professionals in Kerala have been lauded across the world and often touted as an inspirational figure. Although morale has dropped in the two-year battle against Covid, they have worked tirelessly to keep the state's government healthcare equipment in peak condition (, 2022). Coming back home after days of exhausting work, enter the building through a completely separate door,

separating in a set aside to pay room, keeping away from close family members which include children, all the whilst also fearing regarding getting infected (Ashbin et al., 2017, George et al. 2018). This has always been the daily task of most physicians and health care consultants for the past two decades and through three consecutive Covid waves. 

Psychological state of tea pluckers seems to be an area that usually remains ignored. Most of the tea estates workers do not have  access to psychologists or even general practitioners, and if one wanted to contact them she would also have to travel vast distances for getting both treatment and diagnosis. "Adivashis" and locals make up most of the labour force in tea plantations.

These workers are among the worst abused in the tea plantations (Ashbin et al., 2017, George et al, 2018). Most of them are employed on a seasonal basis, either as full- or part-time labourers, depending on output and demand. This group's employees also work in other types of workplaces including factories and offices. Both sexes are equally represented in the workforce among working-age adults. In certain rural gardens, children are engaged in harvesting, weeding, harrowing, including nursery work, despite the fact that child labour also isn't widely practised (Raj, 2020).

Compared to other organised sector workers, tea workers are paid the poorest salaries. When business is brisk, tea gardens hire seasonal help for rates that are well below the legal minimum. Most of them are employed as manual labourers on a daily basis. 

Workers in large tea gardens receive bonuses during festivals and additional compensation if their productivity exceeds expectations. Firewood was collected during the week by women who had no paid employment on Sundays, so they conducted unpaid domestic chores like this (Ashbin et al., 2017, Ganesan & Saravanabavan, 2018). As part for their household duties, all women performed a variety of jobs.

Most women's labour began about 4 a.m. and lasted until 10 p.m., after they got into bed. Each day, they would get up at four in the morning and do domestic tasks until seven thirty in the morning, after which they would report to school at eight. They were given a one-hour break for lunch from 1pm to 2pm at labor, which they often disregarded in order to reach their daily plucking goals, working until 4pm.

They'd make dinner, get water, and serve their family once they got there. They would retire to bed around 9 and 10 p.m. following eating and cleaning the kitchen. Regardless of the sort of plantation or contract, ladies followed this regimen.

Several ladies joked that they only experience pain in the bodies when they lie down to sleep at the conclusion of the day. It has been  mentioned that they had been accustomed to working nonstop and couldn't relax at home. When it comes to labourers, overcrowding and unsanitary housing conditions are among the most common issues they confront. Most of these workers are illiterate and live in squalid living circumstances (George et al. 2018).

There are several illnesses and health issues plaguing the working class, many of which may be traced back to factors such as poor personal and family cleanliness, inadequate sanitation, and substandard living conditions. Insect bites, for example, were frequently cited as an employment danger by women. In one plantation, a female worker was discovered unconscious after being stung by bees. A native emollient consisting of mustard oil, lemon, and tobacco leaves was also found to be used by women on the fields to defend themselves from pest attacks.

Due to the absence of protective clothing, such as gloves and boots, such tactics were employed. In isolated rural regions, tea production is characterised by high labour intensity, with women accounting for half of the entire workforce (Raj, 2020). Low salaries, poor hygienic and health conditions, and a lack of worker voice and representation describe the working circumstances of tea pickers as a whole. There are still problems with market prices, competitiveness, reduced employee earnings, and terrible living circumstances for employees (George et al. 2018).

As a result of the rising costs of combating climate change in the region, social amenities on tea plantations have begun to suffer, prompting severe socio-economic concerns about working conditions, particularly safety and security.

The tea industry has been plagued by a number of issues, including poor living as well as working circumstances, a lack of clean water, sanitation, and bad health. Workers in the tea industry face a number of potentially lethal jobs, including harvesting, trimming, and applying pesticides to the plants; as well as working with antiquated technology in the tea factory (Oxfam, 2019).

Typhoid, jaundice, eye discomfort, asthma, coughing, and allergic responses to dust and odours are all water-borne disorders. Pesticides can also induce dehydration, temperature, and other illnesses in women, who are more vulnerable to their effects. Spiders, scorpions, and snakes all pose a health risk in tea plants. While addressing their labor practices, women employees also voiced a need for better childcare (Oxfam, 2019).

Day-care facilities were meant to be offered on every plantation estate, but there was only one commercial plantation that maintained a fully equipped crèche for the children of regular employment. A bamboo shack (without a wall) with no amenities had been selected as the only crèche on two additional plantation estates. Even though non-permanent employees were not entitled to housing amenities, some did that because their spouse or another member of their family worked as a permanent employee. There are specified places inside the plantation sector estates for employees to live in, known as labour lines.

The lack of housing was highlighted by women on all of the plantations. "No matter where we move, this is our home," said a long-term employee. For centuries, our family has lived on the plantation. A few other type of non-permanent employees who had been evicted from the plantation's workforce and were now residing in the nearby communities felt the same way.

In a government farm, a few women said that they didn't have electricity or water in their apartments. Despite the fact that the structures were almost decades old, almost all of the ladies interviewed said they had complained about the need for repairs and renovations but had received no response. They remarked that all continuous workers were not given quarters during the discussion on housing. The goal of this initiative is to ensure the health and safety of all plantation employees (Raj 2019, Lama 2022). The immediate goals of South India element are to produce and disseminate knowledge to enhance the health & wellbeing of tea workers.

The health and safety risks of agricultural workers in India is promoted and protected by national and local agencies (Oxfam, 2019). Initiatives to improve the health & wellbeing of Indian employees, particularly women, are being established or bolstered. Plantation workers in Kerala, South India would benefit from the initiative by learning about the challenges they face and potential solutions to these problems (Raj 2019, Lama 2022).

Improve the safety and security of agricultural workers in India through strengthening national and local organizations. Workers in landholdings and women inside the tea plantation business in India should be better represented (including their 'voice') in workforce and industry policies and activities to enhance health and safety of employees.

Other determinants may include the institutional capacity, social discourse, and the implementation of OSH legislation, basic agreements, and other global labor protections will be strengthened through this initiative. The degrees of intervention will range from businesses or workspaces to the sector as a whole to regional and comment thread organisations, procedures, and processes (Raj, 2020). Treatments will be made in both structured tea estates and much more in formalized tea plantations.

Additionally, efforts will be made to avoid and mitigate the COVID-19 crisis (Raman 2020). Project partners and stakeholders will be guided by International Labor Organization (ILO) recommendations for gender mainstreaming in OSH, with the ultimate objective of enhancing health and safety at work for both male and female employees (Raj 2019, Lama 2022). Department of Labour and Welfare are the operational stakeholders of this project. Tea Board of India,

Central Employers' Organizations and its affiliates by the names of EFI, AIEO, CIE, CII and FICCI, Central Trade Unions and the Indian Tea Association are the intended beneficiaries (ITA). Additionally, the State Government's Labor & Welfare Department; various Line Government agencies, including the Department of Health and the Department of Rural Development;

the Regional Labour Institute in Shilling (DGFASLI); the Confederation of Small Growers Association; the Kerala Branch of the Indian Tea Association (ABITA); the North Eastern Tea Association (NETA); the Kerala Tea Planters' Association; the All Bodoland Small Tea Growers Association; the Organic Small Tea Growers Association of Nohkal are also included (Ashbin et al., 2017, Ganesan & Saravanabavan, 2018).

The component's goal is to organise South Indian small tea producers through the establishment of SHGs, FPOs, also FPCs, and to provide them with assistance, education, and paperwork in order to get various certifications, among other things. It is necessary to give financial and technical assistance for organic tea growing in order to get certification of organic farm inputs as well as organic tea (Ashbin et al., 2017, Ganesan & Saravanabavan, 2018).

Random checks will be made to ensure that samples are collected and analysed in accordance with the international quality standards. According to the plan, distinct brand creation and promotion for Kerala as well as other North Eastern areas are included. Exporters of teas from the ICD Amingaon will indeed be given incentives to increase the region's export opportunities. It is necessary to give financial and technical assistance for organic tea growing in order to get certification of organic farm inputs as well as organic tea (Ganesan & Saravanabavan, 2018).

Random checks will be made to ensure that samples are collected and analysed in accordance with national and international quality standards. In order to take advantage of Kerala's and other North Eastern country's geographic significance, the plan provides for independent brand creation and marketing. Exporters of teas from the concerns of ICD Amingaon would be given incentives to increase the region's export opportunities. Since the 19th century,

British businesses coerced low class (Dalits or any other untouchable caste), welfare dependency, dispossessed, and various other tribal (Adivasi or Indigenous) communities from central along with southern India to labour on the estates (Raj 2019, Lama 2022). In addition to supporting households and caring for children, women played an essential role in doing specific jobs (such as plucking) with improved quality in the operation.


In the framework of social protection, although permanent women employees were eligible to get about three month's maternity benefit, non-permanent employees had to quit work. Nevertheless, even during the phase of maternity leave, regular workers also weren't given complete salary and 1/2 of their working wage was removed. While elementary school was sponsored for kids of individuals working on the tea plantation, lack of care and support for schooling further than this stage led to several failures youngsters to not finishing school and entering the plantation job to boost their parent’s wages. Many tea estates continue to govern the lives for their employees notwithstanding their country's independence from British colonial rule. Workers are still deprived of land and marginalised in the modern economy. The health and quite well of female agricultural labourers in Kerala has been the subject of several research, although little is known about their situations. This study underlined the benefits of health professionals for all male and female workers who really are working on the tea estates.


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Ganesan, J., & Saravanabavan, V. (2018). Nutritional problems of anaemia disorders among the tea plantation labourers in nilgiris district–a geo medical study. International Journal of Research Studies in Science, Engineering and Technology4(4), 360-1366. 

George, M., Ramesh, N., Gopal, S., Mohan, V., & Fathima, F. N. (2018). Diabetes and hypertension–a comprehensive assessment among workers in selected tea plantations, South India. Int J Med Sci Public Health7(12), 1005-11. 


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