Labour Investigation Committee (1946)||
With regard to the provision of medical facilities, the most important question of principle involved is the extent to which employers can be made responsible for financing medical facilities. It is no doubt true that employers have a duty towards the workers in mitigating their physical suffering- in so far as this is directly due to industrial employment. On the other hand, society as a whole must share the responsibility for industrial employment with all its attendant evils and to that extent must be regarded as liable to bear a part of the cost of medical facilities specially meant for hazardous or physically uncomfortable employment. In India the provision of hospitals and dispensaries has been undertaken mainly by the State, including municipalities and local boards, but a large number of industrial concerns have their own medical institutions. Such medical institutions provided by employers, however, must be regarded as ex-gratia although one can readily agree with the view expressed by the Royal Commission (Report, p. 258), that "those employers who have taken a more humanitarian view have found that their action has had valuable effects on the efficiency of their establishments" and that "many of the medical organisations in industrial compounds are worthy of great praise and are clearly responsible for a considerable increase in the health and happiness of the workers and their families". Generally speaking, however, the medical organisation of the country as a whole is extremely inadequate and correspondingly the special medical facilities provided by employers are also insufficient from both the quantitative and qualitative standards. It is to be hoped that as a result of the recommendations of the Health Survey and Development Committee, the medical organisation- for the entire population including industrial workers will be made more comprehensive and also more adequate than it is at present. However, it may as well be recognised that the specially hazardous nature of industrial employment requires that the State should give somewhat preferential treatment to industrial and urban areas where health conditions are less satisfactory than in rural areas owing to congestion and insanitary environments. At the same time, as admitted, earlier, it is the responsibility of the employer partly, and perhaps even of the worker, to help in the provision of medical facilities. Accordingly, we are inclined to the view that provision of medical facilities though primarily the responsibility of the State should also be supported by employers and workers themselves. The Unified Scheme of Social Insurance, providing for factory workers medical care in respect of the three contingencies of sickness, employment, injury and childbirth, which is envisaged by the Labour Department of the Government of India is a step in the right direction.
At the same time, we feel that there is a residue of medical amenities which can be rightly regarded as the sole responsibility of the employer, In particular, the provision of First Aid in the event of sudden sickness or an accident is undoubtedly the responsibility of the employer. Likewise, provision of ambulance, maintenance of standards of industrial hygiene etc., may also be regarded as primarily matters to be dealt with by employers. In western countries, the Factory Doctor has become an indispensable feature of large-scale enterprise. The factory Doctor is
rightly regarded as the connecting link between the factory and the public hospital. Unfortunately in India the law imposes upon the employer only the provision of first-aid facilities. Under the Factories Act (Section 32), Provincial Governments are empowered to make rules "requiring the managers of factories to maintain stores of first-aid appliances and provide for their proper custody" But practical investigation conducted by the Committee, which is also corroborated by the experience of the Factory Inspection staff, reveals that in a number of cases the contents of these first-aid boxes are not renewed even after they are used up. Secondly, there is no certainty that the first-aid boxes are ever used at all by the employers in the event of accident or sudden sickness. In most places, there is no one trained in first-aid, with the result that when an accident occurs, no relief can be administered on the spot, and the worker is just removed to some public dispensary or hospital nearby. We may, however, mention that a very large proportion of employees in the Madras Port Trust have received such training. The absence of any obligation of the employers to maintain a person trained in first-aid has thus practically nullified this provision of the law. In view of this, we strongly feel that the precise legal responsibilities of the employer in regard to provision of medical facilities within or near the factory should be clearly demarcated and prescribed under the law, the rest being left to be dealt with by either hospitals and dispensaries set up for the general public or for industrial workers under a scheme of social insurance.
It may be useful here to give a rough picture of the type of medical facilities actually provided by employers. These are, of course, of various types and grades ranging from mere first-aid to hospitals of first-class type. Thus, many employers have dispensaries, but there are not enough drugs and appliances, nor a qualified full-time medical man to administer them. Some factories employ a part-time doctor who visits the factory premises once or twice a fortnight, or more often, just for an hour or so, and the workers are required to consult him while he is available. Sometimes factories arrange to send their workers to private practitioners under an agreement. Sometimes the doctors employed for looking after workers are more busy attending upon the employers and officials, as well as their families, than upon the workers. However, at the other end, we have some cases of really first-rate medical facilities. Thus, for example, the Tata Iron and Steel Co. maintain a large well-equipped hospital with 168 beds, 29 medical officers, 38 nurses, and other staff; and also 6 out-door dispensaries. Treatment is free to employees of the Company but nominal fees are charged to non-employees; The Delhi Cloth Mills maintain a hospital which is fully equipped with X-ray apparatus and other modern appliances, and which gives free medical aid to both mill workers and their families and free food to indoor patients. The hospital at the Kolar Gold Field is a model of its kind, but while hospital treatment is free to European and Anglo-Indian staff and their families, in the case of Indian workers, families are excluded, moreover, the wards for the latter are separate from those for the former and also the equipment considerably inferior. The Buckingham and Carnatic Mills of Madras and the three important groups of employers of Cawnpore (viz; Begg Sutherland, British India Corporation, and J. K. Industries), the Assam Oil Co., at Digboi and many other employers have also provided adequate medical facilities which for want of space cannot be described here. In all Class I railways in British India there are medical departments under the control of chief medical and health officers with divisional medical officers assisted by a number of assistants. At most of the branches
all facilities are provided free of charge for indoor and outdoor patients including the dependants of the employees. A diet charge is realised if the income of the indoor patient is above a certain specified minimum. However, complaints from the workers showed that there was hardly any provision for T. B, patients and that the number of lady doctors was very inadequate. In the Assam tea gardens, medical aid is provided by a network of dispensaries run by assistant medical officers. Hospital accommodation, however, is exceedingly inadequate and uninviting. Indoor patients are fed free of cost but out-patients are given only half hazira and that too by a few gardens if there is nobody to support them. Arrangements for medical aid in South Indian tea gardens vary from the provision of a few common drugs dispensed by clerks to hospitalisation and specialist attention. An attractive feature of the medical facilities provided in these plantations is the system of Central or Group hospitals catering for groups of estates. The Kannan Devan Hills Produce Company has an efficient system of medical aid. The Company runs a general hospital with well-equipped X-ray, opthalmic and dental departments. The C.P. Manganese Ore Co. Ltd., maintains dispensaries at most of its mines. Maternity treatment including post-natal treatment is also provided at some of the bigger mines. As mentioned elsewhere, the Assam tea planters have done a valuable service to the planting population by adopting anti-malarial measures with a great degree of success.
The position in regard to the provision of maternity and child welfare centres is much less satisfactory than that of ordinary medical facilities. The Royal Commission recommended that women should be appointed to public health staffs, particularly in the more industrialised provinces, and that every hospital of any size should have a woman doctor on its staff who should be in charge of all work connected with the health and welfare of women and children. Very few Provincial Governments and employers have implemented this recommendation. The Madras Government have appointed a lady as an Assistant Director of Health. The Tata Iron and Steel Co., Parry and Co. of Madras (at their Nellikuppam Sugar Factory), the Empress Mills of Nagpur and some others nave organised systems' of maternity and child welfare. Only in some cases, Lady Doctors who are employed to supervise and guide this work, nurses and dais attend to pre-natal and post-natal cases, at the dispensary as well as at the homes of workers; children are treated and in some cases they are given a bath, and milk free of cost. In some cases, their weight are regularly recorded and proper steps taken to remedy deficiencies. In the coal mines, the Jharia and Asansol Mines Boards of Health have in recent years done very valuable work in the field of maternity and child welfare, by providing welfare centres for this work in selected areas in the Bihar and Bengal coalfields.