Informal workers constitute 93% of the Indian workforce. Women are the poorest of the workers in our country and are at least 50% of the informal workforce. The Self-Employed Women’s Association, SEWA organizes women workers for full employment, including social security, thus helping them to move out of poverty and towards self reliance.

Given their significant contribution to India’s economy and to society, these workers are entitled to basic health security. Yet most still do not have access to low cost health care, both preventive and curative.

Informal workers live without basic amenities like water and sanitation. Hence they are often sick. The high cost of health care often prevents informal sector workers from seeking treatment, resulting in the worsening of their state of health. Poor health, resulting in loss of wages and/or health care expenditures, leads to indebtedness, loss of assets and further poverty. In addition, workers have very little access to preventive health information and education.

Starting from 1970s, over the years, we learned that sickness is the major and recurring crisis in women’s lives. A study done by SEWA Bank in 1977, of women who were not re-paying their loans regularly revealed that the major cause was sickness of the woman or her family members.

In the early 1980s, SEWA negotiated with the Government of India for helping to distribute maternity benefits to poor women. The main thrust of SEWA’s health program was to provide simple, life-saving health information with a focus on disease prevention and promotion of well-being. In addition, SEWA’s health team continued to provide a wide range of primary health care services. Another important goal was capacity-building among local women, especially traditional midwives (dais), so that they become the barefoot doctors of their communities. These women provide services like health education to women and their families.

The health team of SEWA developed into a registered state-level health cooperative in 1990: The Shri Gujarat Mahila Lok Swasthya SEWA Sahakari Mandali Ltd. The primary objectives of the cooperative are to provide life-saving, preventive health information/education and to provide low cost, appropriate curative services at women’s doorsteps. It also helps women and their families get access to referral care.


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