Understanding the health needs of migrants in Gurgaon city in Haryana State of the National Capital Region (NCR) in India Society for Labour and Development http://www.sldindia.org/

1.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
1
Society
for
Labour
and
Development
(SLD)
Understanding
the
health
needs
of
migrants
in
Gurgaon
city
in
Haryana
State
of
the
National
Capital
Region
(NCR)
in
India
A
Report
of
Gurgaon
Migrants
Health
Study
on
behalf
of
the
Society
for
Labour
and
Development
(SLD)

2.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
2
Acknowledgements
The
preparation
of
this
report
was
project-­‐led
by
a
Consultant,
hired
by
Society
for
Labour
and
Development
(SLD).
The
work
is
the
product
of
the
Society
for
Labour
and
Development,
a
non-­‐
government
NGO
working
for
migrant
and
human
rights
in
the
National
Capital
Region
of
Gurgaon.
The
report
brings
together
data
on
the
health
needs
of
migrants
in
Gurgaon
city
in
Haryana
taken
from
a
range
of
publicly
available
sources
and
from
findings
of
an
original
health-­‐related
field
study
among
migrant
workers’
communities.
Interviews
were
undertaken
by
a
lead
consultant
and
co-­‐lead
consultant.
Unless
otherwise
stated
the
report
is
written
by
the
consultant,
who
also
edited
all
the
contents,
contributed
to
the
discussion
sections
and
summarised
all
the
public
health
recommendations.
We
gratefully
acknowledge
all
those
who
contributed
to
this
report,
including
staff
from
Society
for
Labour
and
Development
(SLD).
We
also
acknowledge
the
help,
support
and
contributions
of
all
the
colleagues
within
the
SLD,
including
the
board
members
and
administrative
staff
who
contributed
in
many
ways
to
make
this
report
a
success.

3.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
3
Acronyms
AIDS
Acquired
Immune
Deficiency
Syndrome
BBV
Blood
borne
Viruses
CSWs
Commercial
Sex
Workers
CWG
Common
Wealth
Games
ESI
Employers
State
Insurance
Corporation
FGD
Focus
Group
Discussion
FSWs
Female
Sex
Workers
GP
General
Practitioner
GPCs
Good
Practice
Centres
HSACS
Haryana
State
AIDS
Control
Society
HBV
Hepatitis
B
Virus
HCV
Hepatitis
C
Virus
HRG
High
Risk
Population
HIV
Human
Immunodeficiency
Virus
IHC
Integrated
Health
Centre
IDUs
Injecting
Drug
Users
KI
Key
Informants
NCR
National
Capital
Region
NACO
National
AIDS
Control
Organisation
NSV
No-­‐Scalpel
Vasectonomy
PHC
Primary
Health
Care
SLD
Society
for
Labour
and
Development
STI
Sexually
Transmitted
Infections
SI
Skin
Infection
TB
Tuberculosis

4.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
4
Table
of
Contents
Executive
Summary……………………………………………………………………………………………………………………………....5
Background
and
Introduction………………………………………………………………………………………………………………….5
Methodology
and
Limitations………………………………………………………………………………………………………………….9
Objectives……………………………………………………………………………………………………………………………………………..10
Methodological
approach……………………………………………………………………………………………………………………..10
Tools
for
data
collection………………………………………………………………………………………………………………………..11
Sample
selection……………………………………………………………………………………………………………………………........13
Data
analysis……………………………………………………………………………………………………………………………….………..14
Findings………..............................................................................................................................................15
Barriers
to
service…………………………………………………………………………………………………………………………..….…32
Conclusions
and
Recommendation…………………………………………………………………………………….………………..33
References……………………………………………………………………………………………………………………........................35
Annexure
A
(Health
need
assessment
tool
for
male
migrant
workers)....................................................36
Annexure
B
(Health
need
assessment
tool
for
women
and
spouses)……………………………………………………37
Annexure
C
(Health
need
assessment
tool
for
service
providers)…………………….……………….…………………39
Annexure
D
(Health
need
assessment
tool
for
field
staff).....………………………………………….………………..…40
Annexure
E
(Administrative
setup)….......................................................................................................41
Annexure
F
(Health
department
in
Gurgaon)...……………………………………………………………........................42
Annexure
G
(List
of
NGOs
working
in
the
district)……………………………………………………………………………….45
Annexure
H
(List
of
hospitals
under
ESIC)………………………………………….………………………………………………..47
Annexure
I
(Employers
State
Insurance
benefits)………………………………………………………………..….……….….48

5.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
5
Executive
Summary
The
Society
for
Labour
and
Development
(SLD)
commissioned
this
report
to
inform
private
and
public
health
care
service
providers
in
the
region
about
the
health
needs
of
migrants,
and
to
recommend
ways
to
meet
identified
needs.
This
report
has
been
written
by
a
consultant,
in
collaboration
with
the
field
staff
of
SLD.
Stakeholders,
including
those
participating
in
the
study
from
January
–
March
2012.
It
will
be
published
as
an
e-­‐publication
to
facilitate
easy
and
wide
dissemination,
in
order
to
increase
its
impact
and
accessibility
to
the
broadest
range
of
stakeholders
and
service
providers
in
the
country.
Migration
has
always
played
an
important
part
in
the
economic,
cultural,
social
and
educational
life
of
India.
Migration
is
affected
by
geopolitical
and
economic
factors.
Migrants
are
a
diverse
and
dynamic
group
and
for
this
reason,
have
variable
and
varying
health
needs.
Migrants
can
be
those
seeking
employment
or
education,
or
they
can
be
refugees,
family
members
coming
to
join
established
relatives.
They
can
be
migrating
through
legal
or
irregular
channels
and
be
documented
or
undocumented.
By
far
the
most
important
groups
in
the
region
under
study
are
economic
migrants,
and
those
who
have
then
followed
to
join
their
family
members.
Background
and
Introduction:
Migration
is
an
important
feature
of
human
civilization.
It
reflects
human
endeavor
to
survive
in
the
most
testing
conditions,
both
natural
and
man-­‐made.
Migration
in
India
has
always
been
in
existence
but
in
the
context
of
neo-­‐liberal
globalization,
assumes
special
significance
for
civil
society.
Migration
in
India
is
mostly
influenced
by
social
structures
and
methods
of
development.
The
development
policies
by
Indian
government
since
Independence
have
accelerated
the
process
of
migration.
Uneven
and
extractive
development
is
the
main
cause
of
migration.
Added
to
it,
are
the
disparities
between
regions
and
different
socio-­‐economic
classes.
The
landless
poor
who
mostly
belong
to
lower
castes,
indigenous
communities
and
economically
backward
regions
constitute
the
major
portion
of
migrants.
In
the
very
large
tribal
regions
of
India
intrusion
of
outsiders,
displacement
of
local
tribal
people
and
deforestation
have
also
played
a
major
role
in
migration
-­‐
(Sudershan
Rao
Sarde
et
al,
Regional
Representative,
IMF
–
SERO,
New
Delhi,
‘Migration
in
India’
Oct
2008).
The
Indian
daily
Hindustan
Times
on
14th
October
2007,
revealed
that
according
to
a
study
by
a
Government
Institute
(National
Skills
Development
Corporation
(NSDC)),
77%
of
the
population
i.e.
nearly
840
million
Indians
live
on
less
than
Rs.
20
(40
cents)
a
day.
Indian
agriculture
became
non-­‐remunerative,
taking
the
lives
of
100,000
peasants
during
the
period
from
1996
to
2003,
i.e.
a
suicide
of
an
Indian
peasant
every
45
minutes.
Hence,
rural
people
from
the

6.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
6
downtrodden
and
impoverished
communities
and
regions
such
as
Bihar,
Orissa,
Uttar
Pradesh
travel
to
far
distances
seeking
employment
at
the
lowest
rungs
in
construction
of
roads,
irrigation
projects,
commercial
and
residential
complexes
-­‐-­‐
in
short,
in
building
“Shining”
India.
The
pull
factors
of
higher
wages
also
caused
outward
migration
to
the
Middle
East
countries
by
skilled
and
semiskilled
workers.
Migration
of
professionals
such
as
engineers,
medical
practitioners,
teachers
and
managers
to
such
countries
constitutes
a
fraction
of
the
total
migrants.
According
to
a
study
on
‘Migration
in
India’
Oct
2008,
by
Sudershan
Rao
Sarde,
in
India
migration
is
predominantly
short
distance
with
around
60%
of
migrants
changing
their
residences
within
their
district
of
birth
and
20%
within
their
state
(province),
while
the
rest
move
across
the
state
boundaries.
The
total
migrants
as
per
the
census
of
1971
were
167
million
persons,
as
per
the
1981
census
213
million,
as
per
the
1991
census
232
million
and
as
per
the
2001
census
315
millions.
As
per
the
census
of
the
year
1991,
nearly
20
million
people
migrated
to
other
states
seeking
livelihood.
Within
a
decade,
the
number
of
interstate
migration
doubled
to
41,166,265
persons
as
per
the
census
figures
of
2001.
It
is
estimated
that,
the
present
strength
of
interstate
migrants
is
around
80
million
persons
of
which,
40
million
are
in
the
construction
industry,
20
million
are
domestic
workers,
2
million
are
sex
workers,
5
million
are
call
girls
and
somewhere
from
half
a
million
to
12
million
are
in
the
illegal
mines
otherwise
called
as
“small
scale
mines”.
There
is
an
increase
of
women
migrant
workers.
They
travel
long
distances
for
employment
without
any
assurance
or
prospect.
They
end
up
working
in
inhumane
conditions
and
become
victims
of
sexual
abuse
and
harassment.
Women
form
more
than
half
of
the
interstate
migrant
workforce.
The
division
of
labour
is
gendered.
Masonry
is
a
male-­‐dominated
skill
as
are
carpentry
and
other
skilled
jobs.
Women
carry
head
loads
of
brick,
sand,
stone,
cement
and
water
to
the
masons,
and
also
sift
sand.
Their
wages
are
less
as
compared
to
men.
–
Sudershan
Rao
Sarde
et
al,
Regional
Representative,
IMF,
SEARO,
New
Delhi
The
Government
of
India
made
an
enactment
in
1979
in
the
name
of
“Inter-­‐state
Migrant
Workmen
(Regulation
of
Employment
and
Conditions
of
Service)
Act
1979”.
Though
the
Act
covers
only
inter-­‐state
migrants,
it
lays
down
that
contractors
must
pay
timely
wages
equal
or
higher
than
the
minimum
wage,
provide
suitable
residential
accommodation,
prescribed
medical
facilities,
protective
clothing,
and
notify
accidents
and
causalities
to
specified
authorities
and
kin.
The
Act
provides
the
right
to
raise
Industrial
Disputes
in
the
provincial
jurisdiction
where
they
work
or
in
their
home
province.
The
Act
sets
penalties
including
imprisonment
for
non-­‐compliance.
At
the
same
time
the
Act
provides
an
escape
route
to
principal
employers
if
they
can
show
that
transgressions
were
committed
without
their
knowledge.
Needless
to
say,
that
the
Act
remains
only
on
the
paper.
Records
of
prosecutions
or

7.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
7
dispute
settlement
are
almost
non-­‐existent.
The
migrant
labourers
face
additional
problems
and
constraints
as
they
are
both
labourers
and
migrants.
-­‐
(B.
K.
Sahu
et
al,
Insurance
Commissioner,
ESI
Corporation,
India)
In
Gurgaon,
for
most
of
the
8-­‐10
lakh
migrant
workers,
discrimination
on
the
basis
of
place
of
birth
is
common.
It
was
evident
in
the
days
leading
up
to
the
Commonwealth
Games,
when
nearly
1.5
lakh
migrant
workers
were
forced
by
the
police
department
to
leave
the
city,
contrary
to
Article
15
of
the
Fundamental
Rights
of
the
Constitution
of
India
which
prohibits
discrimination
on
grounds
of
religion,
race,
caste,
sex
or
place
of
birth
as
well
as
Article
19(1)
(e)
which
assures
freedom
to
reside
and
settle
anywhere
in
the
territory
of
India.
-­‐
The
Times
of
India,
May
2011,
Gurgaon’s
8
Lakh
migrant
workers
live
and
work
like
animals
Nevertheless,
discrimination
is
evident
when
it
comes
to,
applying
for
new
ration
cards.
The
applicants
are
asked
questions
like,
“where
are
you
from?”
These
questions
and
the
implicit
derision
are
obvious
as
it
is
mandatory
to
produce
documents
giving
proof
of
address
when
applying
for
ration
cards.
It
is
this
kind
of
treatment
that
keeps
migrant
workers
and
their
families
invisible.
They
do
not
have
birth
certificates,
ration
cards,
residence
proofs
or
voter
IDs.
They
make
up
more
than
30
per
cent
of
Gurgaon’s
population
and
have
contributed
to
the
large-­‐scale
boom
in
the
economy
by
working
in
factories
and
construction
sites
or
by
working
in
the
homes
of
people
occupying
the
high-­‐rises
but
their
own
identity
hang
on
a
thread
with
the
persistent
question,
“Where
are
you
from?”-­‐
Times
of
India
report,
7
th
May
2011
But
the
struggle
does
not
end
there.
Some
migrant
workers
have
ration
cards,
which
does
not
guarantee
food
grain.
Nearly
25%
of
all
migrant
workers
are
women.
For
them,
ration
cards
and
food
security,
especially
in
the
face
of
sky-­‐rocketing
prices
are
the
highest
priority.
Yet,
in
the
last
one
year,
the
government
of
Haryana
has
not
made
grain
available
for
many
card
holders.1
This
speaks
volumes
of
the
attitude
of
the
administration
in
refusing
to
acknowledge
the
presence
and
needs
of
the
many
migrant
workers,
who
come
here,
live
on
very
unstable
incomes
and
have
absolutely
no
work
security.
Residence
proof
is
very
difficult
to
acquire.
Most
migrant
workers
take
up
a
room
in
blocks
of
rooms
that
have
sprung
up
all
over
Gurgaon.
Here,
they
either
share
a
room
with
other
workers
or
live
with
their
families.
The
house
owner
usually
owns
the
whole
block
of
rooms
and
refuses
to
give
any
rent
receipts
or
rent
agreements.
Not
only
this,
they
also
do
not
permit
any
of
the
neighbours
to
vouch
for
the
fact
that
the
person
is
indeed
living
there.
1
Source:
Reports
on
workers’
rights
in
Gurgaon,
South
Asia
Citizens
Web

8.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
8
In
some
cases,
migrant
workers,
face
eviction
because
they
dared
to
buy
groceries
from
a
shop
other
than
the
one
owned
by
their
house
owners.
Such
is
the
domination
that
the
migrants
are
forced
to
not
only
rely
on
insecure
housing
arrangements
but
they
are
also
coerced
into
buying
products
higher
than
the
actual
market
price
from
the
shops
of
the
house
owners.
Thus,
the
spiral
of
invisibility
and
exploitation
continues.
In
addition,
the
government
of
India
has
introduced
various
BPL
schemes
(self-­‐employment,
housing,
food,
free
education
health
insurance
and
small
value
individual
schemes)
for
people
who
are
under
below
poverty
line,
to
bring
them
above
the
poverty
line,
including
migrants
and
citizens.
But
most
of
the
migrant
families
or
people
who
fall
under
this
category
are
not
aware
of
the
schemes
and
have
no
knowledge
and
information
on
how
to
approach
the
state
governments
for
enrolment
and
registration.
Furthermore,
migrant
labourers
constitute
a
major
“bridge”
population
comprising
people
from
various
states.
Through
close
proximity
to
high
risk
groups
they
are
at
risk
of
contracting
HIV
and
other
concomitant
illnesses.
Quite
often
they
are
clients
or
partners
of
male
and
female
sex
workers.
They
are
a
critical
group
because
of
their
‘mobility
with
HIV’.
Their
living
and
working
conditions,
sexually
active
age
and
separation
from
regular
partners
for
extended
periods
of
time
predispose
them
to
paid
sex
or
sex
with
non-­‐regular
partners.
Further,
inadequate
access
to
treatment
for
sexually
transmitted
infections
aggravates
the
risk
of
contracting
and
transmitting
the
virus.
Presently,
the
only
intervention
under
the
National
AIDS
Control
Organisation
(NACO)
for
migrants
is
focussed
on
8.64
million
temporary
migrant
workers.
The
migrants
are
of
particular
significance
to
the
HIV
epidemic
because
of
their
regular
movement
between
source
and
destination
areas.
In
order
to
reach
out
to
this
bridge
population
with
interventions,
NGOs
identify
active
volunteers
among
the
community
and
train
them
in
disseminating
preventive
messages
among
their
fellow
workers.
Factory
owners,
construction
companies
and
other
employers
engaging
the
services
of
these
migrants
are
also
motivated
to
undertake
preventive
HIV
education
activities
among
the
migrant
community.
According
to
the
Haryana
State
AIDS
Control
Society
(HSACS),
seven
new
TI
(Targeted
Intervention)
projects
that
include
five
for
migrants
will
be
implemented
at
Panipat,
Faridabad
Jhajjar
and
Gurgaon.
The
interventions
would
be
functional
in
the
current
fiscal
(2012–
2013)
which
will
assist
in
reducing
the
prevalence
of
HIV
among
the
high
risk
groups.
This
was
disclosed
by
the
state
health
secretary,
at
the
12th
meeting
of
the
Executive
Committee
of
Haryana
State
AIDS
Control
Society
(HSACS)
at
Panchkula
on
2nd
June
2012.
Presently
Haryana
state
is
covered
by
32
TI
NGOs
in
order
to
cover
the
high
risk
population
like
FSWs,
IDUs,
core
composite
and
Migrants.
All
these
NGOs
are
supported
by
the
HSACS.

9.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
9
Access
to
regular
health
services
in
government
and
public
health
facilities
is
always
a
challenge
for
migrant
workers
as
most
of
them
do
not
have
identity
or
residential
proof.
Some
of
them
who
are
long-­‐term
workers
in
companies
have
smart
cards,
which
allow
them
to
access
free
health
services
through
the
ESI
hospital
in
Gurgaon.
But,
the
vast
majority
and
especially
those
who
have
freshly
joined,
temporary
workers
and
daily
wagers,
have
no
identity
proof
or
any
health
cards
for
accessing
treatment
services
from
ESI
hospitals.
Hence,
they
are
compelled
to
go
to
private
facilities
or
local
clinics
and
pharmacies,
and
have
to
pay
for
the
doctor’s
consultation
and
medication,
which
majority
of
them
cannot
afford
due
to
poor
financial
and
economic
condition.
-­‐
(Targeted
Intervention
for
Migrants,
2007,
NACO)
Methodology
The
research
methodology
used
to
compile
this
report
has
included
a
detailed
literature
review,
identifying
and
interrogating
data
sources,
and
interviews
and
discussions
with
health
care
service
providers,
clinics,
hospitals
and
individuals
involved
in
providing
health
care
services
among
the
migrants
in
the
region.
A
key
finding
of
this
process
is
the
extreme
inadequacy
of
available
data
resources
for
identifying
the
population
of
interest,
their
experiences
of
health
and
disease,
or
their
use
of
health
services.
A
comprehensive
report
exploring
the
strengths
and
weakness
of
these
data
sources
is
provided
as
an
Appendix
to
this
report.
Limitations
• The
study
design
was
based
on
the
assumption
that
only
qualitative
data
is
“ideal”
standard
to
assess
the
health
needs
of
migrant
workers.
To
compensate
for
the
possibility
that
the
research
might
not
be
able
to
find
the
most-­‐needed
specific
services
we
developed
open-­‐ended
questions
in
the
interviews
and
FGDs;
• The
study
has
only
managed
to
capture
the
qualitative
data
through
the
statements
made
by
the
respondents
but
not
the
quantitative
ones
for
analytical
reports;
• It
was
only
possible
to
conduct
the
study
questionnaire
with
migrant
workers,
who
are
linked
directly
or
indirectly
with
the
SLD
–
those
that
SLD
has
not
reached
at
all
were
not
interviewed;
• Data
collection
tools
were
in
English
and
the
data
collectors
are
well
versed
in
English
and
the
local
language
(Hindi).
If
the
study
participant
did
not
know
English,
then
they
had
to
rely
on
translations
and
‘back
translations’,
which
marginally
affected
the
quality
of
the
data
to
some
degree;
• As
most
of
the
migrants
work
under
extremely
stressful
conditions
with
little
personal
time,
they
were
not
available
in
time
or
were
not
able
to
participate
for
FGDs
and

10.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
10
interviews
during
the
week
days,
which
delayed
the
study
process
as
they
were
only
available
for
a
short
while
during
Sundays,
which
is
the
only
holiday
for
the
workers;
• The
study
did
not
focus
on
numeric
data
in
order
to
obtain
information
about
the
variables,
as
would
be
the
case
in
quantitative
research.
The
health
needs
assessment
study
that
was
conducted,
targeted
individual
migrants
including
groups
of
migrants
and
their
spouses,
hospitals
(government
and
private)
and,
private
clinics
(quacks)
and
other
health
related
facilities
in
Gurgaon
region,
of
Haryana
state
in
India.
The
study
also
targeted
people
and
service
providers
working
with
migrants
to
contribute
positively
to
the
process
of
identifying
health
issues
in
particular.
The
results
of
the
study
are
drawn
from
a
range
of
both
government
and
private
health
care
service
providers
across
a
wide
geographical
spread
in
Gurgaon
region.
The
limitations
of
the
study
results
and
methods
used
in
the
report
are
discussed,
but
this
work
should
provide
a
useful
‘baseline’
of
current
knowledge
against
which
future
strategies
and
plans
on
health
care
services
for
migrants
can
be
designed.
Objectives
This
health
needs
assessment
study
was
conducted
with
the
following
objectives:
1. To
assess
the
factors
associated
with
health
related
issue
of
migrant
workers
in
Gurgaon
region;
2. To
understand
the
performance
levels
of
the
health
care
service
providers
in
the
region;
3. To
assess
the
facilities
available
and
accessible
for
migrants
in
the
existing
health
care
centers;
and
4. To
provide
recommendation
for
improving
the
performance
of
the
health
services;
Methodological
Approach
To
achieve
these
objectives
a
combination
of
following
methodological
approaches
were
used
in
the
health
needs
assessment
study.
1)
Review
of
existing
(secondary)
data:
This
comprised
a
review
of
the
existing
facilities,
private
and
government
hospitals
and
clinics
and
reports
of
migrants’
health
care
services
in
the
region.
2)
Collection
and
Analysis
of
Primary
data:
i.
Using
largely
qualitative
interview
methods,
FGDs,
where
the
consultant
along
with
the
field
staff
of
SLD,
collected
data
on-­‐field,
among
various
levels
of
migrant
workers

11.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
11
and
health
care
service
providers
and
functionaries
of
government/private
hospitals
and
clinics:
• Migrants
workers;
• Spouses
of
migrant
workers;
• Service
providers
(i.e.
Hospital
staff,
Doctors
and
Compounders);
and,
• Health
care
workers
and
field
staff
of
SLD.
Tools
for
Data
Collection
For
primary
data
collection
a
set
of
semi-­‐structured
questionnaires
were
drafted,
specific
for
each
category
interviewed.
After
development,
the
questionnaire
was
subjected
to
peer-­‐review
and
after
discussion
among
the
various
stakeholders
the
questionnaires
were
finalised.
The
report
provides
information
on
the
population
of
migrants
in
Gurgaon
region,
recorded
using
current
data
systems.
It
also
provides
information
on
existing
health
services
(government
and
private)
available
to
migrant
workers
and
their
families
and
whether
the
community
is
aware
about
these
services.
The
study
also
identifies
the
gaps
in
knowledge
and
the
knowledge
level
of
migrant
workers
related
to
health
services
in
this
particular
region.
All
this
data
reveals
the
nature
of
the
migrant
population
and
their
distribution
throughout
the
area.
It
also
highlights
localities
where
health
and
social
care
providers
may
find
the
meeting
of
needs
of
migrants
to
be
a
significant
challenge.
While
the
full
questionnaires
for
various
categories
of
respondents
have
been
added
as
annexures,
a
brief
outline
of
questionnaires
for
all
categories
of
respondents
is
as
follows:
Category
Areas
covered
in
the
questionnaire
Migrant
workers
(Men)
• Perception
of
government
and
private
health
facilities;
• Preference
of
services;
• Type
of
health
services
received
through
government
and
private
facilities;
• Services
that
are
not
available
for
the
community;
• Attitude
of
service
providers
towards
migrant
workers;
• Knowledge
of
HIV/AIDS;
• Major
health
problems
and
illnesses;
• Community
awareness
and
knowledge
on
existing
health
care
facilities;
• Relationship
between
employer
and
migrants;

12.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
12
• Health
care
services
that
are
most
needed
among
the
community;
• Drugs
and
alcohol
related
issues
in
the
community.
Women/Spouses
of
Migrant
workers
• Basic
needs
for
survival;
• Health
services
for
women;
• Problems
women
face
in
the
community;
• Biggest
fears
among
women;
• Safety
and
security;
• Work
and
employment
issues;
• Children
support
and
education;
• Relationship
and
marriage;
• Sexual
and
reproductive
related
health
issues;
• Women’s’
rights
to
negotiate
sex;
• Availability
of
contraceptive
methods;
• Knowledge
of
HIV/AIDs
and
STIs;
• Alcohol
and
drug
related
issues;
• Gender
violence;
• Specific
health
services
for
women.
Service
Providers
(Doctors,
Nurses,
Govt.
&
Pvt.
Hospitals,
Clinics
&
Field
Staff)
• Available
health
facilities
;
• Fee
structure;
• Major
health
issues;
• Referral
services;
• Timings
of
service
delivery;
• Knowledge
on
HIV
status
among
the
migrants;
• Alcohol
and
drugs
related
issues;
• National/State
health
policies
for
migrants;
• Health
related
issues
to
be
addressed;
Regarding
various
areas
of
migrant’s
population,
the
respondents
were
asked
to
share
common
problems
encountered
in
accessing
health
care
services
and
the
gaps.
It
must
be
noted
that
the
basic
component
for
data
collection
was
the
individuals
and
group
of
migrant
workers,
their
spouses,
doctors,
and
nurses
of
clinics
and
hospitals
providing
health
care
services.
Thus
in
the
above
mentioned
categories
of
respondents,
specifically
hospitals
and
private
clinics,
the
individuals
and
persons
in
charge
of
the
health
care
facilities,
who
take
the
lead
and
are
likely
to
be
most
informed
about
migrants’
health
issues
were
asked
to
respond
to
the
questionnaires.

13.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
13
Additionally
the
scope
of
the
study
extended
to
specific
areas
of
Gurgaon,
where
the
migrant
workers
are
situated.
Thus,
all
attempts
to
singularly
identify
a
particular
area
or
a
single
health
care
facility
have
been
deliberately
avoided.
All
the
responses
have
been
analysed
and
findings
have
been
presented
in
such
a
way
that
discourages
disclosing
the
identity
of
the
respondents.
Sample
Selection
For
the
above
methods
of
data
collection,
attempt
was
made
to
choose
a
sample
that
was
as
representative
as
possible.
It
was
ensured
–
to
the
extent
possible
–
that
specific
geographical
areas
in
Gurgaon
region
are
proportionately
represented,
since
it
was
assumed
that
different
groups
and
areas
in
the
region
have
different
views
related
to
their
health
issues.
Hence,
different
sets
of
questions
were
used
for
different
categories
for
qualitative
analysis.
However
since
there
is
a
large
number
of
migrant
workers
in
NCR
region,
around
97
migrants
workers
were
selected
for
the
FGDs
and
the
following
approach
was
adopted
to
select
the
sample.
• In
areas
where
majority
of
migrant
workers
are
situated,
minimum
10
–
15
migrants
were
chosen
for
the
FGDs;
• In
areas
where
there
is
less
number
of
migrant
workers,
minimum
10
–
12
migrants
were
chosen;
• In
areas
where
majority
of
migrant
families
are
situated,
minimum
10
–
15
spouses
of
migrants
were
chosen
for
the
FGDs;
• In
regards
to
the
health
care
facilities
and
services,
3
government
and
3
private
hospitals/clinics
were
chosen
for
the
interviews;
• In
regards
to
organisations
that
are
working
for
migrants
issues,
minimum
8
–
10
field
staff
of
were
chosen
for
the
FGD;
Thus,
approximately
about
117
migrant
workers,
including
women
and
spouses,
10
health
service
providers
and
10
field
staff
of
SLD
were
involved
in
the
FGDs
and
interviews.
Among
these
chosen
people,
almost
all
were
approached
and
focus
group
discussions
were
held
by
the
lead
consultant
using
qualitative
data
analysis
tools.
The
basis
for
selection
of
sites
for
field
visit
was
both
–
representative
factor
in
terms
of
geographical
area,
burden
of
health
issues
as
well
as
logistical
considerations.

14.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
14
Data
Analysis
Once
the
data
collection
was
over,
data
was
triangulated,
and
analysed
using
largely
qualitative
data
analysis
techniques.
However,
all
the
data
was
qualitative
in
nature.
This
data
was
entered
in
the
data-­‐entry
formats,
triangulated
and
thus
analysed
to
summarise
the
common
findings.
The
findings
were
used
for
formulating
the
conclusion
and
recommendations.
Since
the
methodology
adopted
allowed
collection
of
data
from
multiple
sources,
it
provides
an
opportunity
to
triangulate
the
data
so
obtained.
Specifically,
regarding
problems
and
gaps
in
health
services
among
the
migrant
workers
in
various
areas,
data
was
obtained
from
migrants
themselves,
women
and
spouses
of
migrant
workers
and
the
service
providers.
Similarly,
migrant
workers
were
asked
to
identify
specific
gaps
and
factors
that
influence
access
to
health
services
for
the
migrant’s
community.
Finally,
all
three
types
of
respondents:
migrant
workers
(men),
women
and
spouses
of
migrant
workers,
and
services
providers
(doctors,
nurses,
government
and
private
hospitals,
clinics
and
field
staff)
–
were
asked
their
opinion
on
ways
to
improve
access
to
health
services
in
the
region.
All
these
data
were
compared
grouped
according
to
various
topics
and
have
been
summarized
in
findings
below.

15.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
15
Findings
Response
rate
The
following
table
presents
the
response
rate
across
various
categories
of
respondents.
Sl
No
Category
of
respondents
Areas
covered
No.
of
individuals
and
organisations
from
whom
responses
could
be
obtained
on-­‐
field
(through
interviews/FGDs)
1
Migrant
workers
(Men)
Dundahera,
Kapasera,
Manesar,
Mohammadpur,
Naharpur,
Sarhol,
72
2
Women/Spouses
of
migrant
workers
Kapasera,
Mohammadpur
-­‐
Nalapaar
25
3
Service
providers
(Doctors,
Nurses,
Government/Private
Hospitals
&
Clinics
and
Field
staff)
Kapasera,
Nalapaar,
Gurgaon,
Udyog
Vihar
20
Thus,
we
were
able
to
obtain
responses
from
a
large
majority
of
the
respondents.
In
case
of
women
and
spouses
of
migrant
workers
however,
despite
best
efforts,
within
the
stipulated
duration
of
data
collection,
responses
could
be
obtained
from
about
25.
In
case
of
health
care
service
provider
responses
could
be
obtained
only
from
20
service
providers.
This
section
on
findings
has
been
organised
as
follows.
Initially
responses
obtained
from
each
category
of
respondents
have
been
summarised.
Finally,
common
issues
arising
out
of
triangulation
of
data
collected
from
various
sources
has
been
presented.
Most
of
the
responses
are
through
FGDs
with
male
migrant
workers
and
their
spouses
who
are
directly
in
contact
with
SLD’s
field
staff
and
are
working
in
private
factories
under
exploitative

16.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
16
conditions.
The
areas
that
are
covered
during
the
study
are
Kapasera,
Dundahera,
Manesar,
Mohammadpur
Khandsa,
Mohammadpur
Nalapaar,
Naharpur
Manesar
and
Sarhol
in
Guragon.2
The
following
chart
shows
the
total
response
rate
of
four
types
of
categories
of
respondents,
who
were
approached
for
Focus
Group
Discussion
and
interviews.
1. Migrant
workers
(Men)
#
Perception
of
government
and
private
health
facilities:
Focus
Group
Discussions
(FGDs)
were
conducted
at
6
different
locations
in
Gurgaon
region
with
72
male
migrant
workers,
who
responded
that
they
prefer
to
go
to
private
hospitals
and
clinics,
as
the
treatment
is
good,
staff
is
efficient
and
they
are
satisfied
with
the
services.
In
government
facilities
the
staff
attitude
is
not
good
and
the
patients
have
to
wait
for
long
hours
in
queues.
Sometimes
the
doctors
are
not
available
in
time
of
need.
Majority
of
migrant
workers
expressed
dissatisfaction
with
the
ESI
hospital
exemplified
with
statements
such
as
-­‐
“If
we
do
not
have
a
smart
card,
we
cannot
access
services
from
the
ESI
hospital
and
smart
cards
are
only
provided
to
the
permanent
workers
of
the
companies.”
“I
don’t
have
a
card
so
I
have
to
go
to
a
private
clinic
and
pay
for
my
treatment
and
health
checkup,
which
is
quite
difficult
for
me
as
I
get
a
very
small
amount
of
money.”
2
Most
of
the
responses
obtained
on
field
as
mentioned
on
the
above
table
and
are
the
statements
made
during
the
FGDs

17.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
17
There
are
three
government
hospitals
(including
2
ESI
hospitals)
with
all
the
facilities
in
Gurgaon
but
some
of
the
migrant
workers
from
the
community
have
a
different
perception
about
government
facilities
such
as
-­‐
• The
treatment
is
not
satisfactory
as
the
doctors
do
not
give
much
time
to
the
patients;
• Behaviour
and
attitude
of
government
hospital
staff
are
not
good
but
a
few
staff,
who
are
from
various
other
districts
or
states
and
not
from
Gurgaon
or
Haryana
are
more
polite
and
well
behaved;
• Services
are
not
accessible
in
the
time
of
need
as
doctors
have
restricted
timings
for
seeing
patients;
• The
facility
is
far
from
the
locality;
• Transportation
is
a
problem
for
most
of
the
migrant
workers,
as
they
have
to
spend
money
to
transport
patients
during
emergencies;
• Long
waiting
hours
in
queues;
• A
few
staff
who
handles
the
queue
and
numbering,
take
money
from
patients
to
advance
them
to
the
front
of
the
queue;
• Treatment
is
almost
free
but
difficult
to
access
due
to
the
crowds;
• ESI
hospital
is
the
best
with
all
the
facilities
where
treatment
is
free
of
cost
but
is
only
accessible
to
people
who
possess
a
smart
card;
• For
those,
who
do
not
have
smart
cards
issued
by
their
employers,
they
could
not
access
treatment
services
in
ESI
facilities
and
hence
they
have
to
go
to
private
clinics
for
treatment,
which
is
expensive.
A
statement
of
one
of
the
respondent
is
–
“In
government
hospital,
I
have
to
wait
in
a
queue
for
a
long
time
for
my
turn
to
come
and
when
my
turn
comes
the
doctor,
who
sees
me
does
not
listen
to
my
problems
carefully
and
takes
very
little
time
to
see.”
“I
am
not
satisfied
with
the
diagnosis.”
Community
perception
about
private
hospitals
and
clinics
-­‐
• The
treatment
facilities
in
private
hospitals
are
good;
• Staff
attitude
and
behavior
is
better;
• Treatment
services
are
provided
in
time;
• Doctors
attend
to
the
patients
carefully;
• Services
are
accessible
to
all,
and
during
emergencies
as
well;
• Treatment
is
expensive
as
compared
to
government
facilities;

18.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
18
• Patients
are
satisfied
with
the
treatment.
#
Preference
of
services:
The
following
chart
shows
that
out
of
97
male
and
female
migrants
from
6
different
areas
in
the
region,
the
majority
of
the
migrant
population
i.e.
62%
prefer
to
go
to
private
facilities,
26%
prefer
government
facilities
and
the
rest
12%
prefer
to
access
services
from
ESI
hospitals.
#
Type
of
health
services
received
through
government
and
private
facilities:
Health
services
that
are
offered
free
of
cost
by
the
government
hospital
in
Gurgaon
for
all
BPL
are
–
• A
24
x
7
emergency
(OPD
&
indoor)
–
first
24
hours,
free
for
all;
• Ante-­‐natal
checkup,
delivery
&
caesarian
facility,
free
for
all;
• Surgery
package
programme
for
all
surgeries,
on
minimum
fixed
rates
which
is
free
for
BPL
and
‘notified
slums’
i.e.
slums
that
are
recognized
by
the
Union
government
under
the
‘Slum
Act’
or
recognized
by
the
Municipal
Corporations
(MCs);
• Indoor
package
programme:
indoor
facility
at
Rs.
100
per
day
with
free
medications
which
is
free
for
BPL
and
notified
slums;
• Referral
transport
102
(transportation
to
carry
patients
to
other
health
facilities)
which
is
free
for
BPL
and
notified
slums,
newborn,
delivery,
road
side
accidents
and
freedom
fighters;
• Family
planning
surgery
–
No-­‐Scalpel
Vasectonomy
(NSV)
and
tubectommy
on
a
daily
basis;
• Immunisation
between
Monday
–
Fridays;
• A
24
x
7
Blood
bank
service;

19.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
19
• Investigation
including
Lab,
X-­‐ray,
Ultrasound,
MRI
on
fixed
rates
and
free
for
BPL
and
notified
slums;
• Free
Cataract
surgery
for
all;
• Neurologist,
Neurosurgery,
Clinical
Psychologist
on
selected
days;
• De-­‐addiction
Consultation
and
Counselling;
• ICTC,
Suraksha
Clinic
Facility;
• Six
bedded
burn
unit;
• A
24
x
7
ICU
and
Special
Neonatal
Care
Unit;
• Special
Facilities
for
Handicapped
people.
In
the
government
hospital,
the
first
time
patients
need
to
register
themselves
with
a
nominal
amount
of
Rs
5/-­‐
only
after
which
they
receive
a
registration
number
and
a
card
for
availing
the
health
services.
During
the
FGDs
it
was
learned
that
the
migrant
workers
find
it
difficult
to
access
services
due
to
long
queues,
waiting
time
(especially
given
their
employers’
refusal
to
grant
them
leave
and
their
fear
of
job
loss)
and
lack
of
identity
proofs.
The
health
services
that
are
offered
by
the
Private
Hospitals
in
Gurgaon
are
similar
to
the
above
mentioned
services
but
the
patient
needs
to
pay
more
for
the
treatment
and
investigation
which
is
unaffordable
for
a
migrant
worker
due
to
his
meager
income.
Apart
from
this,
there
is
a
government
mobile
clinic
that
comes
to
a
particular
area
on
every
alternate
day
and
provides
services,
like
health
checkups
and
free
medication
for
all
the
BPL
and
slums
dwellers.
The
migrant
workers
community
can
also
access
the
mobile
clinic.
The
mobile
clinic
charges
Rs
20/-­‐
for
checkups
and
medication.
The
ESI
hospitals
are
the
better
option
for
the
migrant
workers
who
have
smart
cards
issued
by
their
companies
and
those
who
haven’t
do
not
have
any
choice
but
to
pay
money
and
access
small
local
private
clinics
and
pharmacies
run
by
less
qualified
and
inexperienced
doctors
from
other
states.
In
the
absence
of
service
providers
in
the
neighborhood,
the
only
choice
is
some
small
clinics.
The
charges
are
Rs.
50
–
100
for
each
consultation
and
services.
Some
of
the
respondent
statements
are
such
as
-­‐
“I
am
working
as
a
daily
wager
in
a
garment
manufacturing
company,
and
I
have
not
received
any
smart
card
from
the
employer,
so
I
cannot
go
to
ESI
for
treatment”.
”When
I
am
sick,
I
go
to
the
local
doctors
and
pharmacies,
which
are
running
clinics
in
my
locality
and
pay
consultation
fee
of
Rs.50
-­‐
100”.
The
facilities
that
are
offered
by
local
clinics
and
doctors
are
only
health
checkup
and
prescribed
medications
for
which
the
migrant
workers
have
to
pay
extra
money.
The
doctors
and
nurses
are
not
experienced
and
are
less
qualified.
In
case
of
serious
illnesses
and

20.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
20
complications
they
are
referred
to
government
and
private
hospitals
in
Gurgaon
and
New
Delhi
for
further
examination
and
treatment.
#
Services
that
are
not
available
for
the
migrants’
community:
• In
the
opinion
of
migrant
workers,
emergency
services
for
accidents
and
fractures
are
difficult
to
obtain
as
there
is
no
adequate
facility
in
their
locality
for
transportation
and
treatment;
• In
government
hospitals,
they
cannot
access
emergency
services
when
needed,
as
the
doctors
have
particular
timings
for
examining
patients;
• During
emergency
delivery
cases
they
have
difficulties
in
getting
medical
assistance;
• Ambulance
services
for
emergency
cases
are
not
available
in
time
of
need;
• According
to
the
respondents,
there
are
no
NGOs
or
private
health
care
service
providers
in
the
region
who
are
specifically
providing
health
care
services
for
the
migrant
community
except
for
NGOs
working
for
skill
building
and
human
rights
based
issues.
One
of
the
respondents
stated
–
“During
my
wife’s
delivery,
I
had
to
call
a
local
midwife
(Dai)
to
do
the
delivery
at
home.
Many
delivery
cases
in
our
locality
are
mainly
done
by
the
midwives
as
people
do
not
like
to
take
risk
in
taking
their
wives
to
government
hospitals
during
emergency
deliveries”.
#
Attitude
of
service
providers
towards
migrant
workers:
• During
the
FGDs,
the
respondents
mentioned
that
the
attitude
of
the
staff
of
government
service
providers,
hospitals
and
clinics
are
not
so
good;
• However
the
respondents
stated
that
the
staffs
of
private
hospitals
and
clinics
are
better
and
are
polite
and
concerned
about
the
patients.
#
Knowledge
of
HIV/AIDS:
• Most
of
the
migrant
workers
(90%)
have
no
knowledge
of
HIV/AIDS.
They
have
heard
about
HIV
infection
but
lack
information
and
awareness.
Only
two
out
of
97
respondents
had
some
knowledge
through
media,
TV
and
radio
advertisements
on
HIV
and
its
routes
of
transmission;
• A
few
of
them
have
heard
about
HIV/AIDS
through
TV,
Radio
and
advertisements;
• There
are
no
specific
NGOs
or
service
providers
working
for
HIV/AIDS
awareness
in
the
locality;
• The
Haryana
State
AIDS
Control
Society
under
the
guidance
of
NACO
and
MoH
has
only
TI
programmes
for
migrant
workers
community
for
prevention
of
HIV/AIDS
in
various
states
in
India.
Unfortunately
there
is
no
programme
for
migrants,
presently
in
Gurgaon
region;

21.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
21
• However,
the
Haryana
State
government
has
plans
to
implement
such
TIs
for
migrant
workers
in
collaboration
with
NGOS,
sometimes
during
this
year
2012.
#
Major
health
problems
and
illnesses:
• During
the
focus
group
discussion,
most
of
the
respondents
expressed
that
they
are
not
aware
of
any
major
health
problems
but
have
come
across
a
few
cases
of
TB,
lung
infections
and
liver
problems
in
their
community.
Majority
of
them
mentioned
that
they
are
not
much
aware
of
major
health
problems
as
such
in
their
community;
• Some
stated
that
the
people
have
oral
thrush
and
mouth
ulcers
due
to
chewing
of
tobacco
and
tobacco
products;
• Skin
rashes
among
the
children
due
to
unhygienic
conditions
and
unclean
water;
• Malnutrition
due
to
loss
of
iron
and
other
proteins
among
the
migrant
workers
children;
• One
of
the
migrant
worker
mentioned
that
he
had
some
lung
infection,
where
he
had
to
go
to
the
private
doctor
for
his
treatment
and
medication
as
he
does
not
have
a
smart
card.
He
was
satisfied
with
the
treatment
and
services
that
were
rendered
by
the
private
doctor.
But
he
had
to
spend
a
lot
of
money
there;
• However,
in
most
cases
the
migrant
workers
who
have
smart
cards
prefer
to
go
to
ESI
hospital
as
the
treatment
and
services
are
provided
free
of
cost
• Occupational
health
hazards
and
safety
is
another
area
where
majority
of
the
migrant
workers
lack
awareness
or
information
on
how
to
prevent
themselves
from
the
danger.
A
structured
approach
is
needed
for
identification
of
the
risks
in
the
working
places.
Hence,
awareness
of
occupational
health
hazards
and
information
on
preventive
measures
is
crucial,
as
most
of
the
migrant
workers
are
working
in
unhealthy
working
conditions.
The
employers
also
need
to
be
made
aware
and
accountable
for
providing
appropriate
safety
and
health
measures.
#
Community
awareness
and
knowledge
of
existing
health
care
facilities;
• The
migrant
community
is
aware
of
the
existing
government
and
private
treatment
services
that
are
available
in
the
locality.
The
migrant
workers
who
are
working
in
the
industries
and
possess
smart
cards
can
access
services
from
the
ESI
hospital
but
those
who
do
not
have
a
card
cannot
and
are
compelled
to
go
to
private
clinics
for
treatment
where
the
services
require
payment;
• The
migrants
also
access
services
from
private
hospitals
which
do
not
have
all
the
facilities
and
charge
more
money
for
health
checkups
and
treatment.
#
Relationship
between
employer
and
migrant
workers
and
their
attitude
towards
them:
• There
is
significant
tension
in
the
relationship
between
the
migrant
workers
and
their
employers.
It
is
a
minimally
functional
relationship
as
the
employers
are
not
concerned

22.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
22
about
the
health
issues
of
their
workers
but
are
mainly
interested
in
getting
their
work
done
within
a
specific
time
frame;
• The
factory
owners
and
employers
violate
labour
laws
and
the
workers
do
not
voice
their
grievances
to
any
authorities
as
they
fear
losing
their
jobs
or
being
threatened
and
harassed
by
the
employers
or
contractors;
• The
employers
have
no
interest
in
the
social
well
being
of
the
workers
and
majority
of
the
workers
are
not
being
given
any
contract
or
appointment
letter
and
most
are
denied
social
security,
PF
and
ESI
during
their
employment
period;
• There
is
little
attempt
by
the
State
government
to
check
the
violations
of
basic
labour
laws
and
human
rights
in
the
corporate
sector
or
manufacturing
industries
that
are
employing
these
migrant
workers
with
little
regard
for
their
rights.
One
of
the
respondent
statement
is
–
“When
I
get
sick
during
my
working
hours,
the
contractor
gives
me
some
medicine
and
asks
me
to
continue
working
without
any
leave,
which
is
quite
hectic
sometimes
and
if
I
take
leave
they
cut
my
wages
and
keep
some
other
person
on
my
job”
#
Health
care
services
that
are
most
needed
among
the
community:
According
to
the
respondents
the
services
that
are
most
needed
are
–
• Medical
assistance
and
timely
services
for
delivery
cases;
• Home
based
care
in
order
to
provide
treatment,
care
and
support
for
sick
migrant
workers
and
their
family
members
at
home
through
an
outreach
team
consisting
of
a
trained
doctor,
nurse
and
a
health
care
worker;
• Mobile
health
clinics
specially
for
migrant
families;
• Provision
of
free
medication;
#
Drugs
and
alcohol
related
issues
in
the
community:
• During
the
study,
it
was
learned
that
majority
of
the
migrant
workers
are
habitual
drinkers.
They
have
no
idea
or
awareness
of
any
drug/alcohol
treatment
centres;
• The
drugs
that
are
commonly
used
are
marijuana
and
charas/hashish.
Majority
of
the
workers
prefer
drinking
alcohol
and
they
have
no
idea
about
anyone
using
other
pharmaceutical
or
opioids.
• There
are
many
workers
who
are
habitual
and
dependent
on
alcohol
and
some
of
them
start
drinking
since
morning.
2. Women/Spouses
of
Migrant
workers

23.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
23
During
the
study,
FGDs
were
conducted
at
3
different
areas
in
Gurgaon
region
with
25
women
and
spouses
of
migrant
workers
to
understand
the
perspective
of
women
specific
issues
related
to
health
and
problems
they
face
in
the
community.
The
specific
areas
that
were
covered
are
as
follows.
#
Basic
needs
for
survival:
• Under
this
particular
area
during
the
interaction
it
was
learned
that
the
women
and
spouses
of
migrant
workers
have
many
difficulties,
for
even
basic
needs
for
survival.
The
most
difficult
part
for
them
is
to
pay
their
monthly
rent
as
their
husbands
earn
very
little.
Some
stated
“We
cannot
have
even
proper
food,
clothing,
health
checkups,
education
for
children,
etc.
as
our
basic
needs
for
living”.
“We
are
all
compelled
to
live
this
way
due
to
our
financial
status”.
• Some
of
the
women
stated
that
they
have
minimum
basic
needs
for
survival
as
they
have
limitations.
Even
if
they
wish
to
have
something
additional,
they
cannot
afford
as
their
husbands
earn
very
little.
They
stay
in
rented
houses
and
most
of
the
time
cannot
afford
to
pay
their
rent
in
time.
Most
of
the
migrant
families
manage
their
daily
expenses
with
what
they
receive
on
a
monthly
basis,
which
is
bare
minimum.
#
Health
services
for
women:
• As
expected,
there
are
no
women
specific
health
services
in
the
community.
They
have
only
a
few
local
private
health
clinics,
run
by
unqualified
doctors,
where
they
never
do
a
proper
health
examination
and
for
consultations
they
have
to
pay
more
money.
As
they
have
no
choice,
they
go
to
these
clinics
when
they
are
sick
and
have
some
health
problems.
A
few
women
and
spouses
stated
“Sometimes
when
we
don’t
have
enough
money,
we
prefer
to
go
for
cheaper
treatment
to
local
pharmacies
and
clinics
as
they
charge
Rs.50
–
100
per
visit.
“
However,
it
was
learned
during
the
interaction
that
the
physicians
and
doctors
in
these
local
clinics
and
pharmacies
are
all
untrained
and
the
women
and
spouses
are
compelled
to
visit
these
facilities
due
to
their
poor
financial
status,
even
if
they
are
not
willing.
The
government
hospitals
in
the
vicinity,
mostly
refers
them
to
other
hospitals
for
treatment
and
checkup.
It
was
learned
that,
presently
there
are
no
private
NGOs
or
any
other
services
providers
who
are
working
specifically
for
the
women
and
spouses
of
the
migrant
worker
in
the
community.
#
Problems
women
face
in
the
community:
• This
area
highlighted
the
main
problems
of
women
and
spouses’
of
migrant
workers
that
they
are
facing
in
the
community.
Some
of
them
stated
they
face
difficulty
in
paying
their
rents
in
time,
as
husbands
don’t
pay
or
they
stop
working
as
they
lose
their
jobs

24.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
24
and
have
no
income
and
some
don’t
go
to
work
due
to
their
alcohol
problem
hence
cannot
support
their
families.
A
few
of
them
stated
that
their
husbands
force
them
to
work
and
they
sit
at
home
which
in
turn
compels
the
women
to
search
for
jobs
in
order
to
support
her
children
and
family.
• With
regard
to
government
hospitals,
they
mentioned
that
the
attitude
of
hospital
staff
is
not
good
and
some
of
them
ask
for
money
to
register
their
names;
• In
some
cases
of
educated
women,
they
find
it
difficult
to
get
a
job
in
the
government
or
private
sector
as
they
have
no
proper
ID
proofs
and
nobody
to
give
guarantee
as
authority
in
support
of
this
person.
• Most
of
them
stated
that
they
are
constantly
harassed
by
their
landlords
for
rent
money
and
pressurized
into
purchasing
groceries
from
their
shops,
at
higher
rates.;
• As
majority
of
them
do
not
have
ration
cards
or
voter
IDs
on
their
name,
they
cannot
register
themselves
as
residents.
The
landlords
also
do
not
provide
any
rent
agreement
as
proof
of
residence.
They
cannot
move
around
freely
in
the
evenings
and
nights
as
they
are
stalked
or
followed
by
some
local
men.
Their
main
problem
is
the
hardship
in
running
their
families
with
a
small
amount
of
money
that
they
receive;
• Majority
of
the
families
cannot
afford
to
send
their
children
to
good
schools,
as
they
earn
very
little
money.
#
Biggest
fears
among
women:
• According
to
the
respondents
during
the
study,
most
of
the
women
and
spouses
of
migrants
revealed
that
their
biggest
fear
is
police
vehicles,
as
they
come
anytime
and
harass
them
for
personal
records
and
identity
proof
for
no
reasons.
Some
of
them
stated
they
are
also
scared
of
their
husbands,
who
might
be
violent
after
drinking
or
due
to
some
mental
stress.
Majority
of
the
women
and
spouses
mentioned
that
their
biggest
fear
is
of
losing
their
jobs
and
wages
or
being
fired
by
their
employers
at
any
point
without
being
given
a
reason.
One
of
the
women
respondents
stated
“I
don’t
know
how
I
will
manage
my
house
expenses
if
I
am
out
of
job”.
#
Safety
and
security:
• It
was
found
from
all
the
FGDs
that
the
women
and
spouses
of
migrant
workers
never
feel
secure
in
their
community
as
they
are
often
stalked
by
local
men.
This
is
especially
true
for
working
women,
who
are
active
in
public
spaces.
The
landlords
harass
them
for
rent
payment
and
force
them
to
stay,
even
if
they
may
not
want
to.
Most
of
them
cannot
afford
to
stay
in
the
rented
rooms
as
their
husband’s
wages
are
very
small.
One

25.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
25
of
them
stated
“It
becomes
more
difficult
for
me,
when
my
husband
leaves
his
job
and
doesn’t
do
any
work”.
• In
addition,
it
came
out
through
discussion
that
most
of
the
women
feel
unsafe
in
the
community,
as
they
are
not
the
local
residents
and
belong
to
other
states.
They
are
scared
of
being
stalked
and
followed
by
some
local
men,
especially
when
their
husbands
are
not
at
home.
Some
of
them
are
also
scared
of
their
houses
being
robbed
by
the
local
people
in
their
absence.
They
also
do
not
feel
safe
on
the
streets
at
night
for
fear
of
being
stalked.
#
Work
and
employment
issues:
• According
to
the
majority
of
the
respondents,
some
women
and
spouses
of
migrant
workers
are
working
in
private
companies
or
small
units
in
their
neighborhood.
They
usually
are
employed
with
garment
factories
for
knitting
and
stitching
jobs.
The
employer
does
not
pay
them
well
and
fires
them
anytime
they
want
due
to
no
reasons
and
they
have
to
work
for
long
hours.
According
to
some
of
the
respondents,
most
of
the
women
who
are
working
in
garment
factories
receive
only
Rs
4,600/-­‐
per
month,
which
is
not
enough
to
support
their
families.
#
Children’s
services
and
education:
• According
to
the
respondents
during
FGDs,
some
children
attend
government
schools
where
education
is
free
and
some
children
attend
private
schools,
where
they
have
to
pay
tuition
fee
which
most
of
them
cannot
afford
due
to
their
poor
financial
status.
• In
addition,
they
also
stated,
that
one
private
school
charges
INR
2,500
per
month
as
tuition
fee,
which
is
unaffordable
for
majority
of
the
migrant
families.
Most
of
the
migrant
children
who
attend
private
schools,
attend
one
where
the
fee
is
Rs
180
per
month.
• There
are
a
significant
number
of
children
who
do
not
go
to
school
due
to
various
problems
unique
to
migrant
situations.
#
Relationship
and
marriage:
• According
to
the
majority
of
respondents
in
the
FGD,
the
women
in
villages
get
married
at
a
very
early
age
(between
13
–
14
years).
They
have
a
tradition
of
“Gauna”,
meaning
‘selection
of
a
bride
or
an
advanced
engagement
at
a
very
young
age’
but
the
bride
goes
to
her
husband’s
place
after
she
attains
the
age
of
17
or
18
years.
However,
presently

26.
Understanding
the
health
needs
of
migrants
in
Gurgaon,
Haryana,
India
Page
26
the
trend
is
changing
where
the
women,
being
better
informed
and
educated,
are
not
getting
married
before
reaching
the
age
of
17
or
18
years.
#
Sexual
reproductive
health
issues:
• According
to
the
majority
of
the
participants
and
key
informants,
the
migrant
women
have
no
knowledge
about
their
reproductive
health.
They
feel
shy
to
share
these
reproductive
health
problems
with
others
and
hence
they
never
go
for
treatment.
Most
of
the
participants
stated
that
if
there
is
an
opportunity,
they
would
be
interested
in
learning
more
about
sexual
and
reproductive
health
issues;
• According
to
some
participants
of
the
FGDs,
migrant
women
experience
a
lot
of
bleeding
during
their
menstruation
cycle
and
some
stated
that
white
discharge
and
lower
abdominal
pain
is
very
common
among
the
migrant
women
which
they
assume
to
be
a
normal
phenomenon.
They
usually
never
share
these
women-­‐specific
concerns
or
sexual
and
health
related
issues
with
any
other
person
and
never
bother
to
consult
a
doctor
due
to
wariness.
A
few
participants
added
that
even
if
they
go
to
government
hospitals
for
treatment
of
such
issues
they
have
to
wait
for
a
long
period
of
time
and
have
to
pay
for
their
turn
to
come.
One
of
the
participant
stated
“If
you
pay
money
you
are
treated
well
in
government
hospitals”;
• In
case
of
any
health
problem,
they
go
to
government
hospital
for
treatment
and
during
crisis
they
visit
local
doctors
and
clinics
where
they
have
to
pay
for
their
treatment
and
medication
that
is
most
of
the
times
difficult
to
afford.
However,
some
of
the
participants
stated
that
they
prefer
to
go
to
private
clinics,
if
they
have
money
as
the
behavior
of
the
staff
of
government
hospitals
are
not
good
and
most
of
the
time
the
attendants
of
government
hospitals
ask
for
extra
money
for
treatment
and
registration.
#
Women’s
rights
to
negotiate
sex:
• It
was
found
from
the
FGDs
that
majority
of
the
migrant
women
and
spouses
have
difficulties
in
negotiating
sex
with
their
husband.
One
of
the
participants
stated
“Yes!
At
some
occasions
I
manage
to
negotiate
sex,
especially
when
I
am
not
feeling
well
or
in
a
mood
to
have
sex”.
But
most
stated
that
they
have
problems
in
negotiating
sex
with
their
husbands
as
they
never
listen
and
force,
especially
when
they
are
under
the
influence
of
alcohol.
According
to
the
majority,
the
women
usually
have
no
rights
to
negotiate,
as
in
their
cases;
the
husband
is
always
the
decision
maker.
#
Availability
of
contraceptive
methods:
• According
to
the
participants
from
the
FGDs
the
contraceptive
methods
that
are
known
are
condoms,
copper
–
Ts
and
Mala
-­‐
Ts,
which
are
easily
available
in
pharmacies.