Garment worker Mira breathed a sigh of relief when she learnt last November that she would no longer have to bear her healthcare bills.

Paying an annual premium of Tk 100, the worker of Millennium Textiles (Southern) and Fashion House Ltd in Ashulia became the holder of a healthcare insurance policy.

The policy would cover her inpatient medical bills amounting to Tk 12,000 and outpatient bills, including medicine, of Tk 3,000 for the year.

Within three months of enlisting in the scheme, she fell ill with abdominal pains and nausea. Without much fanfare, she headed on over to the company designated hospital -- Centre for Woman and Child Health in Ashulia -- and was quickly treated by the doctors and handed over medicine worth Tk 1,000. The scheme took care of the bills.

“I had never heard about an insurance policy before,” she told The Daily Star, sitting with her co-workers at the factory. “Otherwise, I would have to wait till I got my next month's wages before I could go see a doctor.”

“I did not ignore my health from then on.”

A total of 10,000 workers from five factories in Savar, Ashulia and Gazipur have enlisted in the insurance scheme.

Of the yearly premium of Tk 575 per worker, Tk 375 comes from Carrefour Foundation, a non-profit organisation working against exclusion. The remainder is divided between the workers and factory owners.

Of the 2,200 employed at Millennium Textiles, 1,600 have already enrolled in the scheme. It is mostly the women who have enrolled to address their gynaecological issues, said Basu Dev, its assistant general manager.

According to a study by the Institute of Health Economics, Dhaka University, published earlier this year, the factories experienced fewer work absenteeism since this scheme was rolled out.

Workers are less reluctant to switch jobs as well, said Syed Abdul Hamid, the institute's director.  

Encouraged by the study results, Hamid suggested initiating a life insurance policy for the workers.

Millennium Textiles adopted the life insurance policy recently, where the workers will receive Tk 30,000 in the case of death in addition to the health insurance.

“I will be paying Tk 150 this month as annual premium that will include both health and life insurance,” said Mira.

Under the project 'Working With Women II', the SNV Netherlands Development Organisation has been providing technical support to cover the cost of health care services for garment workers and create awareness among them on health insurance.

Farhtheeba Rahat Khan, team leader of Working With Women II, said, “In 2015-16, we piloted the Health Insurance Plus in three factories and after the initial positive responses, we are now scaling it up for adoption across the garment sector.”

The Carrefour Foundation will fund the project till 2019. The 'Working With Women II' will extend financial support till 2021.

Siddiqur Rahman, president of Bangladesh Garment Manufacturers and Exporters Association, said donations given by the foundation would phase out at a point. It was not possible to include 40 lakh apparel workers in the health insurance scheme, he added.

The BGMEA and the labour and employment ministry have a welfare fund for the garment workers. The trade body disburses the fund according to the needs of a worker, if he/she applies for it, he added.

Moreover, the BGMEA provides group insurance for workplace injuries or death.

Babul Akhter, a labour leader, said if a worker becomes paralysed or suffers from an injury, he/she can apply to the welfare fund.

However, to receive the funds, the worker has to go through a lot of paper work that passes through the board meetings, which make it a lengthy process.

The health insurance policy by SNV ensures primary health care, which is an important part; but it should be made legally binding by the government, he said.

Apparel workers are subject to a variety of diseases due to long working hours, lack of sanitation and a nutritious diet. Workers mostly suffer from tonsillitis, influenza, common colds, diarrhoea, headaches, sleep disorders and acute bronchitis, said Col MD Shahjahan [Rtd], a consultant medicine doctor at the Centre for Woman and Child Health.

Tuberculosis is also an epidemic among the garment workers, he added.

According to the Labour Act (amended), 2006, it is compulsory to have 'group insurance' for workers if an establishment has more than 100 permanent employees.

Health insurance initiatives will be more successful if all stakeholders -- the government, owners, international brands, buyers and workers come forward to contribute, said Abdul Alim, lead trainer of Social Accountability International -- a New York-based not for profit organisation for human rights at work.

Though health insurance is not compulsory by law, it should be introduced for the betterment of factories since it boosts productivity, reduces workers' absence and encourages less migration, said Syful Alam Mallick, regional compliance manager at Auchan Retail International.