Reaching the unreached migrants in unorganised workforce with health services

Shobha Shukla (CNS)
Contd from last Saturday
“Engaging the local contractor who hires labour workforce is also very important,” points out Jogendra.
GAP organised over 15 meetings of all those who had a role to play in helping support the initiative to reach the unreached informal sector workers.
“First step was to survey over 1,200 people from labour workforce for a range of vulnerability-related factors,” said Pankaj. “20% of them reported to have multiple sexual partners. We could also connect with few who reported to be gay men and other men who have sex with men or female sex workers. These were hidden communities," rightly says Pankaj and Jogendra of GAP as these people were not able to benefit from the existing interventions for migrants.
Four-Fifths did not go to health centre so as not to lose their daily wage
“Our survey shows that 78% of these persons did not go to the health centres of integrated counselling and testing centres of the government as they did not want to lose their daily wages – and rather preferred if such a service was available at their workplace,” said Jogendra.
“That is why, all programmes of GAP are done at the workplace of workers,” emphasised Jogendra.
Community-based HIV and TB screening, community-based HIV testing, linkage to HIV and TB care services, and a range of comprehensive support services are key elements which makes GAP’s intervention at workplaces of migrant workers so successful.
Game: Ladder signifies Do’s – and Snakes signify Don’ts
GAP not only uses flipcharts for raising awareness, but also uses the widely popular ‘snakes and ladders’ board game, but with a difference: ladder is for those who give the right answer (they move upwards in the game), and snake is for those who give a wrong one (they go downwards in the game).
Games help us engage people more and convey important messages related to HIV (and STIs, TB, hepatitis) prevention, testing and treatment in a more effective way, says Jogendra.
Agrees Afsar of ILO: “I have seen how GAP volunteers use ‘snakes and ladders’ game to engage people at workplaces. If you give the right answer, you go upwards, and if you give the wrong answer, you go downwards. These are inter-educational approaches that need to be leveraged upon to enhance health seeking behaviour.”
GAP’s impact
In a span of three years, GAP (via its community-based intervention), has screened almost 40,000 migrant workers for HIV and TB at the workplace of informal or unorganised workforce in few districts of Gujarat. Out of those screened and tested, 87% were first-time testers for HIV in their lifetime, informed Jogendra.
Thanks to GAP’s important work in bridging the divide between the reached and unreached with services, 116 people were diagnosed with HIV and 37 with active TB disease (and one worker with drug-resistant form of TB, HIV and cervical cancer) - and all of them were linked to the nearest government-run treatment and care services.
"It is important to note that 96% of those diagnosed with HIV were asymptomatic – they had no symptom. Worksite interventions help find people early and link them with public care services,” said Jogendra.
Once found positive for HIV (or active TB disease), every person is linked to the government-run programmes without any delay. We link those with HIV to the nearest centre which provides antiretroviral treatment, and those with active TB disease to the district TB programme, said Jogendra.
“In addition, we also help them avail of the benefits from government-run social protection schemes, such as e-Shram Card (for labour and employment) and Ayushman Bharat Card (for health coverage),” said Jogendra. ((To be contd)