ESI ki Baat 2026: Strengthening ESIC from within
Safe in India Foundation’s new report, ESI ki Baat 2026, takes a 360-degree look at India’s Employees’ State Insurance Corporation (ESIC), its growth, benefits, healthcare delivery, processes, governance and finances, and examines what it will take to strengthen the system for the millions of workers who depend on it.
The report draws on nearly a decade of SII’s experience supporting more than 15,000 injured and vulnerable workers in three states, ESIC’s own data and the insights of independent experts.
A key driver of this report is SII’s belief, now enshrined in the Economic Survey 24-25, that without improving working conditions and social security for Indian workers, Indian Labor productivity (133rd) and Indian MSME productivity (half of emerging markets, relative to large companies) will not improve.
The report was released on 3 September 2026 at the India International Centre, New Delhi, by Shri Ashok Kumar Singh, IAS, Director General, ESIC, followed by a workers' Panel on the topic “ESIC ki Baat, IP ki Awaaz” and an expert panel on the topic “Reforming ESI Services: Evidence, Gaps, Opportunities.”
The expert panel included Shri A.K. Sahu, Insurance Commissioner, ESIC; Dr Indranil Mukhopadhyay, Professor, O.P. Jindal Global University; Dr T. Sundararaman, public health researcher and former Dean, TISS; and Shri S.P. Tiwari, National General Secretary, TUCC.
Dr. Ravi Srivastava, Institute for Human Development and Dr. Abhay Shukla, SATHI/Jan Swasthya Abhiyan, also provided their expert inputs.
Release of ESI ki Baat 2026: Conversations on ESIC reforms, expert perspectives and workers’ experiences
Release and Keynote Address:
“I am very glad to hear about this effort which Safe In India has taken. We have carried out a lot of reforms with the help of SII, and the second series of reforms is awaited; we will carry it out."
“We now have a Reform Cell which has been institutionalized in ESIC, and through this Reform Cell, we have decided to talk to all the stakeholders. Whatever good ideas come, whatever is implementable, we will do it.”
Shri Ashok Kumar Singh, IAS, DG, ESIC, while releasing the report and delivering the keynote address.
Opening Address:
“Looking at the international evidence, any wholesale privatisation of the insurance function of social insurance is likely to be counterproductive for workers and, in many cases, for businesses. That doesn’t mean the private sector has no role. Private healthcare, technology and specialist expertise can contribute to better delivery.
Sandeep Sachdeva, Co-Founder & CEO, SII, while delivering the Opening Address
Expert Panel on “Reforming ESI Services: Evidence, Gaps, Opportunities” and Other Expert Inputs:
The expert panel examined the strengths and shortcomings of ESIC as a comprehensive social security system, focusing on gaps in access and implementation, employer dependence, healthcare delivery, worker participation and the risks of privatisation. The discussion emphasised strengthening ESIC’s public character while making it more accountable and responsive to workers.
"The government has come up with the new idea of the Inspector-cum-Facilitator, so that there is no harassment of the employer; they should have ease of doing business. At the same time, we must have proper inspections so that compliance is proper.”
Shri A.K. Sahu, Insurance Commissioner, ESIC.
“There is a gap between being formally insured and actually being aware of and able to enjoy your entitlements.”
Dr T. Sudararaman, public health researcher and former Dean, TISS
“When you go to the private sector, the expenditure per person is considerably higher compared to when care is delivered through the public system.”
Dr. Indranil, Professor, O.P. Jindal Global University.
“ESI and EPFO are the world’s most unique schemes. There is no better scheme in any country. But the issue is: this is such a good scheme, yet its benefits are not reaching people.”
Shri S.P. Tiwari, National General Secretary, TUCC.
“Privatisation is not a solution to fulfilling the five pillars of social security that ESIC looks after”
Prof. Ravi Srivastava, Institute for Human Development
"Privatisation is not a good idea. It has not worked. And the reverse, which we saw in Hyderabad in the ESI hospital, was that between 2016 and 2019, an almost defunct hospital was converted into a very well-functioning hospital when referrals to private hospitals were minimised and the ESI hospital itself was reactivated.”
Dr. Abhay Shukla, SATHI/Jan Swasthya Abhiyan.
Workers’ Panel on “ESIC ki Baat, IP ki Awaaz”:
The worker panel brought issues faced by IPs to life through first-hand experiences of accessing ESIC benefits, showing both the value of cash and medical benefits and the considerable hardship caused by repeated visits, documentation gaps and delays.
Workers also made a clear case for improving and strengthening the government-run ESIC system rather than privatising it.
" टाइम लगा लेकिन काम हुआ। अच्छा हो गया। अब मेरी पेंशन भी आ रही है। और सब ठीक है। (It took time, but the work was done. Now my pension is being received, and everything is fine.) " - Moj Lal Sahni, ESIC IP injured in the auto sector supply chain
" सबसे बड़ी समस्या यह है कि भागदौड़ करते हैं बार-बार। एक बार काम नहीं करते। ये लोग चार बार बुलाते हैं तब काम करते हैं। (The biggest problem is that we have to keep running around. They call us multiple times before they do the work) " - Jyoti, ESIC IP injured in the auto sector supply chain
"हमारा मानना है कि ईएसआई सरकारी होना चाहिए क्योंकि अभी तो है ईएसआई में कि थोड़ा सा उनको डर रहता है चेकिंग आजाएगा तो उसके हिसाब से काम सही हो रहा है लेकिन बाद में प्राइवेट सही नहीं रहेगा। (Our view is that ESIC should remain government-run. Right now, employers have some fear that inspections will happen, so they follow the rules. But if it becomes private, that may not remain the case.)" - Nibha Kumari, ESIC IP injured in the auto sector supply chain
ESI ki Baat 2026: first of its kind independent report on ESIC using bottom-up evidence from 15,000 workers
For nearly ten years, Safe in India Foundation has worked directly with more than 15,000 injured and other vulnerable workers across three states, helping them access ESIC healthcare and compensation.
The data, analysis, and recommendations in the report are grounded in workers’ real experience of the system as well as policy documents and ESIC’s own data. The problems identified in the report are systemic problems that have accumulated over the decades.
I appreciate Safe In India Foundation’s sustained engagement with ESIC and its efforts to bring workers’ experience into the policy and administrative discourse. I hope this report will contribute constructively to the continuing evolution and strengthening of the ESI system.
Shri Ashok Kumar Singh, IAS Director General, ESIC
“ESI ki Baat 2026 is a truly monumental and comprehensive report on the ESIC. The report draws on case studies, many of which have been carried out by partners of SII, and secondary literature to present a 360-degree picture of the ESIC. This picture extends from the micro to the macro issues. Each benefit given by ESIC is examined at length, and process issues which can ramp up the efficiency of ESIC are elaborated. At the macro level, two issues are examined in depth. These include ESIC's compatibility and adjustment to the Code on Social Security, 2020, and a comparison of ESIC to private insurance and delivery. The final chapter sums up strategic recommendations. All in all, this report is momentous and extremely comprehensive. Hope it gets the attention it deserves.”
Dr Ravi S. Srivastava Professor and Director, Centre for Employment Studies, Institute for Human Development, New Delhi; Former Full-Time Member, National Commission for Enterprises in the Unorganized Sector (NCEUS), Government of India.
“This report makes the case for why and how ESI must be saved, revitalized and expanded, and why it must be recognised as an integral part of the struggle to achieve the right to health in India. Given the strong lobbies which push for privatisation in the name of reform, this report also highlights the urgent need to build a public understanding of ESIC and the need for public action to save this institution before it is too late.” - Dr T. Sundararaman, Former Executive Director, National Health Systems Resource Centre (NHSRC), MoHFW; Former Dean, School of Health Systems Studies, TISS.
ESI ki Baat 2026 – Some Key Findings:
The report spans 23 chapters, covering ESIC's growth trajectory, analysis of the delivery of key benefits (disability, maternity, sickness, and medical reimbursements), medical infrastructure, governance, finances, and the debate around privatisation, including international and Indian evidence.
The report analyses 15-year trends based on secondary data, including ESIC Annual Reports.
Insured Persons (IPs) up 2.7× in 15 years to 3.84 crore; Insured Women (IWs) grow faster - 3.2× to 0.83 crore
Real per-IP spend increased across Medical Benefits and Cash Benefits
After the 2019 contribution-rate cut from 6% to 4%, the gap between benefits and contributions narrowed creating new financial pressure; ESIC continues to deliver comparable or greater value per IP than private insurance.
The following findings draw on primary evidence from workers assisted by SII (so biased but representative of reality) and employers, capturing their experiences of ESIC benefits, services and access.
70% of IPs waited More than 6 Months from Accident to Receiving TDB; 78% of IPs waited More than 12 Months from Accident to Receiving PDB
73% of IWs assisted by SII have received Maternity Benefit payments after 6 months; 37% of IPs received Sickness Benefit payments after 6 months
ReEngineering Opportunity Example: The Medical Board application spans nine steps and typically six in-person trips. The number of steps (for the IP) can be reduced from 9 to 2. The number of visits by the IP can be reduced from 6 to 2
16% of the injured IPs are Post-Accident Registration (PAR) cases; ~63% IPs receive an e-Pehchaan card only post-accident; 25% of workers injured in the last six months had no accident report filed.
Next steps:
This report has been discussed with ESIC for the past three months over six meetings with ESIC’s top management. Next step is to work through 15 strategic/policy recommendations and 150+ tactical process improvement recommendations through a series of workshops that have been agreed.
The first such workshop has already been concluded to standardise maternity benefit checklist (one of the relatively simpler but important recommendations). This is expected to halve the number of documents being asked from workers and improve turnaround times.
Develop partnerships with social security experts, unions, social sector, academics, etc and conduct a series of seminars to develop the ideas in this report for wider debate and implementation.
Please check out the full report for additional data and graphs here – ESI ki Baat 2026.
We would love to hear your thoughts and suggestions. Team@safeinindia.org
Report and this blog authored by Dhanraj B, Senior Manager, Research & Advocacy, SII
Stay safe and spread the word to your automobile sector and government contacts and please send us any feedback you have to help us do our job better at team@safeinindia.org.
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