Policy Update
Gargi Bisht
Background
Around 2.35 lakh workers migrate to Kerala from various parts of the country annually. The total number of migrant workers in the state has crossed over 25 lakh (Starhealth). Despite the state’s comparatively developed public healthcare system, migrant workers faced barriers to accessing healthcare arising from precarious living conditions, limited awareness of welfare entitlement and inadequate institutional outreach. These constraints indicate that the availability of public health infrastructure did not necessarily translate into equitable access for migrant workers.
Evidence from Kerala Institute of Labour and Employment’s study on interstate migrant workers highlights the material conditions underlying these vulnerabilities. The study documents inadequate sanitation and drinking water facilities among migrant sections, exposing workers to preventable health risks (KILE, 2020). Kerala Interstate Migrant Workers Welfare Scheme, introduced in 2010, already provided certain medical and social security benefits; however, weak registration, limited awareness and poor implementation undermined its reach. The central challenge therefore, was not the absence of welfare provisions, but gap between policy design and effective coverage.
It was in this light that the AAWAZ scheme was introduced in 2017, to address this gap through free healthcare insurance and accident coverage for migrant workers. It was an attempt at extending formal protection to the vulnerable workforce while recognising that insurance alone could not eliminate barriers associated with healthcare accessibility, administrative exclusion and affordability of treatment.
Functioning
The Awaaz Health Insurance Scheme was launched by the Kerala Government in 2017 to cover the accidents and medical expenses of state migrant workers. The scheme is administered by Kerala’s Department of Labour and Skills through the Labour Commissionerate, which oversees the scheme’s implementation and beneficiary registration. Unlike the contributory insurance schemes, AAWAZ is financed by the state government. Kerala’s Annual Plan 2024-25 earmarked Rs. 125 lakh (1.25 crore) for AAWAZ covering health, accidental death and disability insurance benefits alongside facilitation of activities for guest workers (Kerala State Planning Board, 2024). The scheme operates through an assurance model, under which claims are managed by the Department of Labour and Skill.
Under the original provisions of the scheme, individuals between 18 and 60 years can claim a sum insured of ₹15,000 to cover their medical expenses. Apart from that, beneficiaries can also avail of a ₹2 Lakh death benefit and ₹1 Lakh disability compensation under this scheme (Department Of Labour and Skills, Kerala). Kerala Calling (2025) reports that the medical cover is now ₹25,000, with ₹1 lakh for disability and maternity care included. Enrolment involves collecting workers’ identification and biometric details, following which they receive an AAWAZ identity card.
This card facilitates their identification as registered beneficiaries and access to the scheme’s benefits. These medical benefits could be accessed at government hospitals and designated private hospitals, subject to the scheme’s conditions. By providing insurance without requiring a contribution from workers, AAWAZ sought to make healthcare financing more accessible to a population that may otherwise postpone treatment or depend on personal savings and employer assistance. A government order from the Labour Commissionerate in 2023, routes Awaz benefits through Athidhi, which makes the portal the single entry point. In practice, a worker who registers on Athidhi is enrolled in Awaz automatically.
However, the provision of insurance does not automatically ensure access to healthcare. The scheme’s effectiveness depends on workers being aware of its benefits, completing registration and being able to access empanelled hospitals. Therefore, AAWAZ should be assessed not only in terms of the insurance coverage it promises but also by examining its actual reach, utilisation and ability to reduce out of pocket expenditure.
Performance
The evidence from KILE, government linked research and migrant welfare in Kerala suggests a persistent gap between the scheme’s formal coverage and its practical accessibility. Administrative data indicate substantial initial reach with a total of approximately 5 lakh migrant workers enrolled by January 2021. Kerala Development Report 2026 subsequently reported that more than 5.2 lakh workers were covered under the AAWAZ ( Government of Kerala, 2026).
However, these figures must be considered against the estimated 3.5 million interstate migrants in Kerala in 2018 (Peter et al, 2020), although the authors acknowledge uncertainty in estimating the migrant population. More importantly, cumulative enrollment does not establish how many workers retained active coverage or could access treatment when required. The KILE survey found that only 34.7% of the workers knew about the scheme’s benefits and 33.5% were aware of its treatment facilities.
Treatment utilisation raises further concerns. The Population Research Centre 2022, reported that only 299 people had accessed treatment benefits up to 2020-21, against approximately five lakh registrations by January 2021. Medical benefit expenditure stood at 17.25 lakhs, while Rs 36 lakh was disbursed to the families of 18 workers under accidental benefits. (Population Research Centre, 2022) Low utilisation on its own does not prove that the scheme has failed.
It could be because of healthcare needs or because of eligibility conditions and access barriers. Yet, the Population Research Centre in 2022 also found that 46 percent of workers who went to the hospital paid for it themselves. Not all of these costs would have been covered by AAWAZ. The finding shows that financial protection was not complete, and that the scheme has not shown that it has reduced out-of-pocket expenses enough.
AAWAZ’s performance was constrained by the distance between its administrative processes and migrant workers’ circumstances. Frequent movement between worksites, informal employment and limited awareness can complicate registration and benefit utilisation. Peter et al. (2020) identify broader implementation and outreach weaknesses in Kerala’s migrant-welfare programmes. Consistent with these concerns, only 4.3% of KILE respondents reported approaching the Labour Department regarding their AAWAZ card. This points to limited institutional engagement, although the available evidence does not establish whether documentation, registration procedures or hospital access contributed most to unused benefits. Claim-level data would be necessary to identify the principal bottlenecks.
The scheme’s continuity has also come under scrutiny. The New Indian Express reported in September 2025 that registrations had closed in 2022 and cited researchers questioning whether AAWAZ remained functional (The New Indian Express, 2025). These reports raise concerns about continuity but do not independently establish the status of every existing beneficiary. The contrast between reported cumulative coverage and uncertainty over continued registration highlights the need for transparent administrative data.
The state should publish annual figures on active beneficiaries, renewals, claims submitted and settled, rejection rates, treatment expenditure and district-wise utilisation. Multilingual outreach through employers, labour contractors and local institutions could improve awareness, but its success should be measured through actual healthcare access and reduced out-of-pocket spending.
Emerging Issues
AAWAZ’s central challenge is the gap between formal insurance coverage and effective access to healthcare. The Population Research Centre (2022) recorded approximately five lakh registrations by January 2021, but only 299 beneficiaries had accessed treatment benefits up to 2020–21. Meanwhile, KILE’s survey found that just 34.7% of respondents knew about the scheme’s benefits, while 53.9% were unregistered (Kerala Institute of Labour and Employment). Together, these findings suggest that weak awareness and limited enrolment undermined the scheme’s potential to reduce financial vulnerability. However, low claims alone cannot establish the scheme’s overall impact without data on eligible treatment needs, rejected claims and active beneficiaries.
A second challenge concerns institutional continuity. In September 2025, The New Indian Express reported that AAWAZ registrations had closed in 2022 and cited researchers who questioned the scheme’s continued functioning. The report also highlighted uncertainty among officials about the number of workers insured through AAWAZ and the newer Athidhi portal (The New Indian Express, 2025). Yet the Economic Review 2025 records 516,320 workers under AAWAZ registration as of August 2022 and 431,975 registrations through Athidhi Portal as of November 20, 2025 (Government of Kerala, State Planning Board, 2026). These are different registration datasets, not evidence of active insurance coverage. The discrepancy highlights the need to distinguish worker identification from valid insurance enrolment and actual benefit utilisation.
Way forward
First, Kerala should integrate AAWAZ insurance records with Athidhi registration while maintaining a clear distinction between worker registration and active insurance. The Economic Review 2025 identifies Athidhi as a centralised registration system, creating an opportunity to improve beneficiary identification and coordination across welfare programmes (Government of Kerala, State Planning Board, 2026). The government should publish annual data on active policies, renewals, claims filed and settled, treatment expenditure and district-wise utilisation. This would make it possible to identify whether low utilisation reflects limited awareness, administrative barriers or gaps in hospital access.
Second, implementation must move beyond digital registration towards direct outreach. KILE’s findings on low awareness and limited engagement with the Labour Department support enrolment drives at construction sites, factories and migrant-worker settlements. Information should be provided in workers’ languages, with designated facilitators assisting with registration, hospital referrals and claims. The 2025 report on language barriers and restrictive work schedules also highlights the need to explore health services and flexible outreach arrangements (The New Indian Express, 2025).
Third, the state should strengthen accountability for protection.The government notification, G.O. (P) No. 82/2024/LBR, S.R.O. No. 1077/2024, replaced the requirement to use the specifically named Advanced Information Interface System (AIIS) with the provision to use any web-based application through the Labour Commissionerate, retaining Aadhaar-based biometric authentication (Government of Kerala, 2024). However, administrative changes must lead to results. Beneficiaries should get their benefits on time. Independent evaluations should be done regularly to check if people get the treatment they are entitled to without paying much out of their own pockets. Claims should be settled quickly with no delays.
Ultimately, AAWAZ’s impact depends on converting formal coverage into accessible, reliable protection. Its performance should be measured by the proportion of eligible workers insured, their ability to obtain treatment and the reduction in financial hardship – not merely by registration totals.
Reference
- AAWAZ – Insurance programme for guest workers. http://61.0.248.124/
- Aswin Asok Kumar. (2025, September 26). Only 9.8% of migrant workers in Kerala have health coverage. The New Indian Express. https://www.newindianexpress.com/states/kerala/2025/Sep/26/only-98-of-migrant-workers-in-kerala-have-health-coverage-finds-mahatma-gandhi-university-study
- Government of Kerala, State Planning Board. (2026). Economic Review 2025 (Volume 2).https://spb.kerala.gov.in/sites/default/files/2026-01/ER%202025%20Volume%202%20Eng%20final.pdf
- Kerala Institute of Labour and Employment. Interstate migrant workers in Kerala: A study on their work and life. https://kile.kerala.gov.in/wp-content/uploads/2024/09/ISM-Coffe-table_compressed-1-1.pdf?
- Interstate migrant workers and healthcare system in Kerala, India: Critical examination of social and institutional inclusiveness. (2023). Indian Journal of Politics and International Relations. https://www.researchgate.net/publication/380433415_Interstate_Migrant_Workers_and_Healthcare_System_in_Kerala_India_Critical_Examination_of_Social_and_Institutional_Inclusiveness
- Peter, B., Sanghvi, S., & Narendran, V. (2020). Inclusion of interstate migrant workers in Kerala and lessons for India. Indian Journal of Labour Economics (Vol. 63, Issue 4, pp. 1065 – 1086). https://doi.org/10.1007/s41027-020-00292-9
- Government of Kerala. (2024, November 25). Notification No. 3746: S.R.O. No. 1077/2024, G.O. (P) No. 82/2024/LBR. Labour and Skills (E) Department, Kerala Gazette Extraordinary. https://document.kerala.gov.in/documents/notifications/notification3011202417%3A45%3A52.pdf
About the Contributor
Gargi Bisht is a history postgraduate from Miranda House, specializing in medieval history. Her interest lies at the intersection of history, research, and public policy, exploring issues related to governance, society, development, and international relations.
Acknowledgement
The author would like to express sincere gratitude to the IMPRI team for providing this valuable opportunity and for facilitating a platform to engage in and contribute to research and policy discourse, and also the reviewers Divya and Aditi
Disclaimer
All views expressed in the article belong solely to the author and not necessarily to the organisation.
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