Infection risks, long hours, mental stress: Why is there no law for the safety of health workers?

The unpreparedness of healthcare establishments to protect workers from occupational hazards came into sharp focus during the Covid-19 pandemic. Nurses and sanitation workers drew attention to the lack of basic facilities like gloves, drinking water, and access to toilets.

The pandemic shed light on the challenges that healthcare workers routinely face- long working hours, high workloads, exposure to infectious diseases, hazardous chemicals, mental and physical strain. Adding to this are the psychosocial hazards such as fatigue, occupational burnout, distress or declining mental health, which affect the health and quality of work of healthcare workers.

Approximately 1,800 doctors died from Covid-19, the Indian Medical Association has estimated. As of September 22, data from the Union Ministry of Health and Family Welfare, indicates that 974 health workers had died from the virus.

But despite the significant risks that healthcare workers face there is no specific legislation to protect their occupational health and safety – apart from one narrowly applicable law in the context of HIV, the human immunodeficiency virus that causes AIDS, or acquired immunodeficiency syndrome.

The Occupational Safety, Health and Working Conditions Code, 2020, is the overarching legal framework that determines work standards in India. It addresses the health and safety concerns of factory and mine workers but fails to provide recourse to healthcare workers from hazards specific to their occupation. The code falls short in scope by not explicitly covering healthcare establishments within the meanings of ‘establishments’ or ’employer’.

Even health-specific laws like the Clinical Establishments Act, 2010, and state legislations and rules do not have potent clauses that ensure occupational safety. It is only the HIV & AIDS Act, 2017, that obliges healthcare establishments of more than 20 people where there is a significant risk of exposure to HIV to ensure a safe working environment.

Occupational health and safety is addressed only to a limited extent in the Bio-Medical Waste Management Rules, 2016, which govern the collection, segregation, processing, treatment and disposal mechanisms of biomedical waste produced by healthcare-related entities.

While legal frameworks are weak, policy has been pointing towards the right direction. Initially, policy frameworks were less than rigorous in articulating the need for occupational safety for healthcare workers. The National Health Policy, 2017, focused on improving the quality of education and human resources in the healthcare sector but gave little guidance on occupational safety.

The revised Indian Public Health Standards, 2022, focus on planning service delivery and standards for training human resources to enhance the quality of care in public healthcare institutions. They briefly lay down minimum performance standards for specialists and healthcare staff without touching on ancillary occupational safety issues.

Yet, there have also been some positive developments. The National Guidelines for Infection Prevention & Control in Healthcare Facilities, 2020, prescribe safe work practices and an occupational health programme for the safety of healthcare workers. Most recently, in August, the health ministry issued draft guidelines to improve the working conditions of nurses in healthcare institutions, although the status of their implementation is unknown. These are long overdue but commendable steps.

However, they are not located within actionable frameworks such as legislation but only in policy documents, which do not necessarily provide legal recourse in case of violations. These policies need teeth for effective implementation, impact, and accountability.

Moving an explicit law on occupational safety for healthcare workers is not only a legal obligation but also upholds the principle that all work has inherent dignity, making it imperative to ensure that nurses, doctors and others are protected from occupational hazards.

Anmol Mathur is a lawyer and Programme Associate at the Centre for Health Equity, Law & Policy, ILS Pune.