I

ABBREVIATIONS
AIMS ALL INDIA INSTITUTE OF MEDICAL SERVICE
ASC ARMY SERVICE CORPS
ASHA ACCREDITED SOCIAL HEALTH ACTIVIST
CE COMMON ERA
COVID CORONA VIRUS DISEASE
ERA EMPLOYMENT RIGHTS ACT
EU EUROPEAN UNION
FLSA FAIR LABOUR STANDARDS ACT
FPRW FUNDAMENTAL PRINCIPLES AND RIGHTS AT WORK
HASAW HEALTH AND SAFETY AT WORK
HASAWA HEALTH AND SAFETY AT WORK ACT
HCW HEALTH CARE WORKER
HEEG HIGHER EDUCATION ENTREPRENEURSHIP
HIV HUMAN IMMUNO VIRUS
HSW HEALTH AND SAFETY AT WORK
HSWA HEALTH AND SAFETY AT WORK ACT
GDP GROSS DOMESTIC PRODUCT
IGOT INTEGRATED GOVERNMENT ONLINE TRAINING
ILO INTERNATIONAL LABOUR ORGANISATION
ILS INTERNATIONAL LABOUR STANDARDS
IRPTC INTERNATIONAL REGISTER OF POTENTIALLY
TOXIC CHEMICALS
MOHFW MINISTRY OF HEALTH AND FAMILY WELFARE
NIF NATIONAL INNOVATION FOUNDATION
NIOSH NATIONAL INSTITUTE OF OCCUPATION
INTRODUCTION :- Labour Regulations in the Health Workforce are at the
centre of this paper's structure. We look at existing healthcare frameworks, the roles
that health personnel are assigned, and the labour regulations pertaining to them.
Earlier frameworks either ignore or treat health workers as one of several equally
important components. We situate the health worker at the core of the health system
because every function is either carried out by or mediated via the health worker. Our
methodology is beneficial for organising health workforce research and identifying
research challenges related to health workers. We address the various research topics
related to the health workforce; metrics to measure a health system's capacity to
deliver healthcare; international organisations' contributions to health workers in
meeting healthcare needs and demands; the appropriate size, composition, and
distribution of the health workforce; approaches to meeting health-worker
requirements; health workers' adoption and adaptation of treatments; and health
workers' training. We provide a framework for placing health workers at the centre of
the health system in this paper, and we utilise it to identify research issues related to
the health workforce. Existing health-system frameworks either ignore health workers
as a vital component of system operation or treat them as one of several equally
important components. The identification of research topics on the health workforce
becomes more obvious as a result of positioning health professionals at the core of the
health system. We'll go through several research areas vital for enhancing population
health and patient happiness in the following sections .size, character, and dispersion
of the health workforce must be assessed when evaluating the possibility of a health
system with health workers at its core. Other health-system frameworks, on the other
hand, may base their evaluation on financial criteria. In certain studies, health
spending per capita or the population density of hospital beds, for example, are
relevant measures for a health system's capacity. The amount of health personnel,
their education and training, and their geographic distribution will all be important in
our approach. Total health worker density, or the total number of health workers per
capita, is a straightforward metric to use. This demonstrates the health system's vast
ability to provide healthcare services. On the other hand, total health-worker density is
an overly simplistic measure because it ignores disparities in medical expertise and
the wide range of services that health professionals provide. Rather than general
health-worker density, physician density could be an alternative, limited to those with
specialised training. This metric may be preferred to aggregate health-worker density
if doctors are seen as the most important category of health worker, and other health
workers cannot easily replace them in extending healthcare services. However, a
weighted average of the many sorts of health workers, with the weights representing
each type's contribution to the health system's goals, may be required. Of course,
determining and estimating the relative contributions of various health workers is
required for such a set of weights. This metric may be preferred to aggregate health-
worker density if doctors are seen as the most important category of health worker,
and other health workers cannot easily replace them in extending healthcare services.
However, a weighted average of the many sorts of health workers, with the weights
representing each type's contribution to the health system's goals, may be required. Of
course, determining and estimating the relative contributions of various health
workers is required for such a set of weights. Health personnel, overall, meet the
requirements and desires of patients. Demands may or may not be founded on needs,
and needs may or may not be voiced. A range of demographic and health
circumstances, such as infancy, pregnancy, and illness, create needs. Governments in
most nations accept responsibility for meeting needs, but not always demands. In
general, we anticipate that the private sector of a healthcare system will fulfil demand
while the public sector will meet needs. The government is more likely to prioritise
satisfying healthcare needs than meeting healthcare desires. Health workers help to
meet healthcare needs by providing health services and assisting in the generation of
demand for unmet needs, for example, by teaching individuals about their objective
health conditions and risks. Individual and population health can benefit from such
supplier-induced demand. This should be distinguished from demand generated just
for the benefit of the supplier and not to meet demands. The majority of medical
treatment and drugs are delivered by private-sector health workers in many
developing nations. The contributions of public-sector health workers, on the other
hand, are more likely to be recognised than those of their private-sector colleagues.
The public sector has more information and is subject to more immediate and
thorough regulation than the private sector.

Workers' rights cover a wide range of human rights, including the right to decent
employment and freedom of association, as well as equal opportunity and
discrimination protection. In addition, four key labour laws were merged in the Code
on Wages, which was enacted in 2019. The four new Labour Codes were meant to
take effect on April 1, 2021, but due to an increase in COVID cases and the probable
impact of the new Codes on per-employee costs, the government has postponed their
implementation to a later date. The rules have yet to be announced by the federal and
state governments. Only after the new legal provisions have been notified will they
become effective.

Health workers in the public sector practise in facilities and use inputs that are
sponsored and monitored directly by the government. The extent of the treatments
they offer is well-known. For example, public-sector physicians in some hospitals are
unable to provide critical care because the facilities lack the requisite equipment and
wards. A variety of documents, including patient files, drug purchase volumes, and
hospital occupancy rates, provide information on actual therapy. In terms of
regulation, public-sector health workers are frequently expected to follow specific
criteria in their practice; however, physicians in the private sector are frequently
unrestricted. As a result, determining and measuring the contribution of private-sector
health personnel is more complex. On the other hand, the private sector may assist the
public sector in overcoming its limitations. A treatment that is not available in the
public sector, for example, may be available in the private sector. The extent to which
the government should plan and provide for the healthcare industry is a topic that has
yet to be investigated. To answer this question, we should first comprehend the
proportional contributions of public and private sector health workers in fulfilling the
health system's aims. This issue, in our opinion, has not been thoroughly investigated.

There are some limitations to our paper that should be acknowledged. First, while
focusing on health professionals is often beneficial for policy and practice since health
workers execute most of the tasks necessary to the health system's functioning,
alternate foci may be appropriate in some cases. A framework of financial flows in
the national health accounts may be better suited to tracking healthcare spending in
the health system than a structure focused on the health worker. Similarly, suppose we
want to know how patient preferences affect the structure and delivery of healthcare
services. In that case, a paradigm that puts patients first might be more informative
than one that puts health staff first. Patient satisfaction, on the other hand, is
determined by how patients engage with health care providers. As a result, if the goal
is to improve patient satisfaction, our health-worker-centred paradigm, as explained
above, can make a significant contribution. There is no comprehensive review of
health-worker research fields in our report. Such reviews are available for some
health-worker research issues, but others, such as the effectiveness of alternative
training models for health workers and the extent to which health workers impact
health outcomes, require them. In some ways, the goal of our study varies from that of
a systematic review. A systematic review's goal is to integrate the findings of all
studies undertaken on particular research subject to provide access to the evidence,
establish consistency and generalizability of findings, identify knowledge gaps, and
refine research hypotheses. Our research aims to focus health-system policy and
research on the health worker, allowing for the discovery of a broad range of research
concerns to increase health-system satisfaction.

It is impossible to turn a blind eye to those who appear to be working day in and day
out and being burned out in the process; healthcare personnel, in these times where
most of us are quiet bystanders of the world's horrific occurrences. It is also a moral
and legal obligation to protect healthcare workers from the infringement they are
facing. The violence experienced by our medical services workers is nothing new.
However, it appears that perception of excessive work hours, mental and physical
fatigue, and all the linked concerns that occur because of Covid-19's ongoing position
was anything but a big issue. “The pandemic has demonstrated how important it is to
protect health workers in order to maintain a functional health system and society.” It
is undeniable that Covid-19 has increased the health hazards for medical personnel
and their families. COVID-19 infections among health workers are significantly
higher than those among the general population, according to statistics from numerous
countries across WHO regions. The World Health Organization's charter, which was
released on World Patient Safety Day in 2020, clearly states that governments at both
the national and local levels must take five main steps to protect health workers from
violence, improve their mental health, protect them from physical and biological
hazards, advance national programmes for health worker safety, and connect health
and safety. The World Health Organization (WHO) urges all WHO member states
and key stakeholders to take action to implement the five guidelines they have
presented. In terms of labour laws, the guideline to protect health workers from
physical and biological hazards (ensuring adequate environmental services, such as
water and sanitation, and providing resources to prevent and treat injuries, harmful
radiations, and so on) and, most importantly, the guideline to develop and implement
national programmes for occupational health and safety of health workers. This
chapter will compare the Indian legislative framework for health workers in India to
the legal framework in the United States and determine whether these
recommendations are being followed in terms of occupational safety requirements for
health worker personnel in the two countries.

Social cohesion, human development, and inclusive economic growth require health
and decent jobs. In the health sector, decent employment is essential for sustaining
effective and robust health systems and addressing health workforce shortages, and
achieving the aim of equal access to high-quality health care. The health sector is
fundamentally about people; there can be no health care without health personnel.
Recent global policy initiatives have emphasised the importance of investing in health
and the health workforce in achieving sustainable development, emphasising the
integrative power of boosting the health sector while targeting many Sustainable
Development Goals at the same time. The Sustainable Development Goals
acknowledge that decent work is a critical component of achieving inclusive
economic growth and social progress. The pursuit of full and productive employment
for all women and men and decent work is a key component of the Sustainable
Development Goals, which also emphasises the preservation of workers' rights. In the
health sector, the Sustainable Development Goals link directly to the call to increase
health workforce recruitment, development, training, and retention as part of the
Sustainable Development Goals to guarantee that everyone lives a healthy life. In
2012, the
United Nations General Assembly supported the concept of Universal Health
Coverage (UHC). It urged states to invest in health to achieve universal access to
basic health care while safeguarding people from financial hardship.

The International Labour Organization (ILO) and the World Health Organization
(WHO) are two UN specialised bodies that are directly concerned with occupational
health and safety as a whole (WHO). The International Labour Organization stands
out among the United Nations' specialised agencies since it is a tripartite organisation
(i.e., its constituents are governments, employers, and workers). The ILO's standard-
setting operations are another feature (i.e., the International Labour Conference adopts
international Conventions and Recommendations). Because the working environment
is regarded to be an integral aspect of the human environment, the United Nations
Environment Programme (UNEP) is likewise concerned about the issue, particularly
in terms of chemicals. Within the International Program on Chemical Safety, its
International Register of Potentially Toxic Chemicals (IRPTC) works closely with the
ILO and the WHO (IPCS). The UN
Secretary-High-Level General's Commission on Health Employment and Economic
Growth (HEEG Commission), which was established in March 2016, determined in
its report that investments in the health workforce are required to achieve the SDGs.
The Commission identified the health industry as a key economic sector and job
creator, based on fresh research that suggests investments will pay off in increased
population health, economic growth, and health security. To solve existing and
expected future health workforce shortages, immediate action is required. The Ebola
outbreak in West Africa in 2014–15 revealed the devastating effects that inadequate
investments in public health systems and its staff may have on societies, economic
development, and international health security. Equal access to high-quality health
care is contingent on a sufficient number of properly trained health workers where
they are required. Various ILO papers have recognised their critical role in
safeguarding and promoting population health throughout time. Despite this, global
health workforce shortages and imbalances exist. Labour is a concurrent list issue
under the Indian Constitution. The Central and
State governments can pass legislation on it, subject to specific matters reserved for
the Central Government. The Indian Constitution enshrines precise protections
protecting citizens' (and other individuals') rights and the "Directive Principles of
State Policy," which states must follow in the country's governance. These Directive
Principles ensure the health of workers, both men, and women, by ensuring that
children are not abused at a young age; citizens are not forced by economic necessity
to enter vocations that are not suited to their age or strength; just and humane working
conditions and maternity leave are provided; and the government shall take steps, by
sui generis, to ensure that children are not abused at a young age. The Government of
India defines its objectives, goals, plans, and purpose using its power based on these
Directive Principles. It is committed to regulating all economic activities among states
and with foreign nations in order to manage occupational safety and health risks and
to provide measures for the protection of national assets, general welfare, and to
ensure, as far as possible, a safe and healthy working environment for every working
man and woman in the country in order to preserve human resources. Like most other
countries, India attempts to strengthen occupational health and safety (OHS) by
enacting legislation that governs the steps that businesses must take 1. These Acts
provide very basic minimum requirements in order to ensure a suitable level of OHS
throughout the country. Differences in the administration of the Act between states
can be minimised in this way. Another goal of these specific requirements is to
simplify the task of inspectors who must inspect factory working conditions if
inspectors have extensive knowledge of the issue. The government shall take
appropriate legislative or other measures to ensure employee participation in the
management of enterprises, establishments, or other organisations engaged in any
industry (Article 43A), and to ensure that no child under the age of 14 is employed in
any factory, mine, or other hazardous occupation (Article24) 2. The reality is that,
1 International, Governmental and Non-Governmental Safety and Health [Link],
[Link]
legal/internationalgovernmental-and-non-governmental-safety-and-health (last visited Aug 31, 2021)
2 , [Link] (last visited
Aug 31, 2021)
despite having over 44 separate labour laws, it is complicated, and there is no unique
legislation in India to safeguard the health workforce from the dangers they confront.
“The Epidemic Diseases (Amendment) Ordinance 2020 amends the Epidemic
Diseases Act, 1897 to make violence against healthcare professionals during an
epidemic a cognizable and non-bailable offence with heightened penalties.” 3. Despite
the fact that such instances constitute a systemic issue that remains outside of the
current conditions, the law only protects healthcare personnel from violence during
epidemics. Furthermore, the Ministry of Health and Family Welfare's D.O. No. Z-
20015/127/2019-ME. I (Pt. I), dated April 20, 2020, enumerates all of the measures
taken by the government to protect healthcare personnel during a pandemic, including
the Pradhan Mantri Garib Kalyan Package, which promises Accidental Insurance
cover of Rs. Fifty lakhs for 2212 lakh people. However, this is only for those
healthcare workers who have died as a result of being on covid duty. It is still unclear
what the rules are for reaping actual collateral benefits on the ground. Furthermore,
while guidelines and training programmes for health personnel to cope with various
scenarios are beneficial, gaps in the laws may be better addressed.

Additionally, the Indian government has taken steps to promote worker health and
safety. The laws governing occupational health and safety appeared to be all over the
place and a bit perplexing. As a result, in 2019, the Occupational Safety, Health, and
Working Conditions Code, 2019, was introduced in Parliament, bringing together 13
separate laws covering occupational health and safety in various industries. The Code
establishes a broad legal framework for workers' occupational health and safety in
every industry, trade, firm, production, or activity that employs ten or more people.
Under the Code, the central government shall define occupational safety standards for
diverse industries on the suggestion of the National Occupational Safety and Health
Board. In this sense, health workers will be included by inclusion. However, it is
unclear if this applies to healthcare facilities. The researcher believes that healthcare
establishments deserve unique regulation in terms of occupational safety and dangers

3 India’s healthcare workers are the most vulnerable, but there is no framework for their health The
Print, [Link]
their-health/459827/ (last visited Aug 31, 2021)
and minimum stipends, wages, and insurance coverage for various types of healthcare
staff. Different laws and plans, such as the Indian Public Health Standards and the
Clinical Establishments (Registration and Regulation) Act, 2010, that set out the
requirements for medical care foundations, should also be updated to reflect the
principles that have been discussed above in the form of guidelines proposed by the
World Health Organization. Under the Government of India Allocation of Business
Rules, Occupational Safety and Health is one of the subjects assigned to the Ministry
of Labour and Employment. The Ministry's Industrial Safety and Health division is in
charge of making policy choices and establishing criteria for legislative adoption.
National authorities do not formulate OHS and environmental policies, priorities, or
strategies on their own; they work with social partners, such as employees'
organisations, employers' organisations, autonomous and voluntary organisations, the
public, and others, to ensure that the set goals/objectives are met. The Indian
government is convinced that social justice cannot be accomplished without safe and
healthy working conditions and that achieving safety and health at work is critical to
economic progress.

The goal of universal health coverage necessitates an assessment of the number, kind,
and distribution of health workers needed to meet the population's healthcare needs.
The population demographics, including expected or predicted changes, have a role in
determining the ‘universal' health and well-being needs. Demography is the study of a
population's size, composition, age, and gender structure, as well as its dynamics. The
same research and its sound techniques can be applied to the demographics of the
health workforce. For example, a significant percentage of the workforce approaching
retirement will influence availability, a geographically mobile workforce will have an
impact on health coverage, and gender distribution in occupations will have an impact
on workforce acceptability and equity of opportunity. In a world where health
workers are in short supply and demand is expected to rise as a result of both
population expansion in the global south and population ageing in the global north,
studying and understanding workforce demographic characteristics can aid future
planning. This study analyses how demographic tools and methodologies might be
applied to the analysis of the health labour market and discusses the aspects of health
workers. As countries move toward universal health care coverage, the reduction of
disparities, and national development goals, a conceptual framework is given as a first
step toward applying demographic principles and approaches to health workforce
analysis and planning exercises.

Any wide identification of healthcare worker research topics necessitates a subset

selection. We've chosen issues that help the healthcare system achieve its objectives.
This does not limit the investigation of other relevant health policy and practise
issues. In this research, we propose a health-system paradigm centered on health
workers. We use our approach to suggest specific research topics for healthcare
workers. These include, among other things, measures to assess the health system's
ability to deliver healthcare, the contribution of public vs. private-sector health
professionals in achieving healthcare objectives, and the proper size, composition, and
distribution of the health workforce. The foundation of the health system, as we have
stated in this paper, is health workers. Every function of the health system is carried
out or mediated by the health professional. Health care professionals have an
important role in treatment selection, as well as curative and preventive care. Most
health-system funding is channeled to health workers (via wages and related
payments), and health workers make the majority of other spending decisions
(through prescriptions, referrals, and equipment purchases). The availability of care
for diverse populations is determined by the number of healthcare workers, their skill
composition, and their distribution. It would be impossible to achieve population
health and patient satisfaction goals without health personnel. As a result, our
paradigm prioritizes health workers as the foundation of the health system.

OBJECTIVE OF THE STUDY

Health workers, if a definition is to be extended, are all people engaged in actions

whose primary intent is to enhance health. This meaning extends from WHO’s
definition of the health system as comprising activities whose primary goal is to
improve health. This also includes those protectors of health who are unpaid.
However, in this dissertation paper, the focus will be on the health workers engaged in
paid activities, the risks they are involved in, the labour regulations pertaining to them
and the lacunas prevalent in these regulations. The role of health workers, especially
in times like these where ‘health is wealth’ is more than just a mere statement.
Millions of health workers risk their health on a daily basis, being the ones at the
highest risk.

The recent events of health workers strike and agitation, inclusive of the PIL filed
before the Honorable Supreme Court with regard to non-adherence of the standards
and guidelines by the WHO is a wakeup call to each of us. It is the first responsibility
of the state to protect its citizens from the pandemic and while so, protecting the
frontline workers, the Suraksha force should be of primary importance.

While the shortage of PPE has been highlighted and addressed to some extent in
recent times, it is the incidents of violence against healthcare workers that have
received the most attention, both from the public and central and state governments.
As a result, passed the Epidemic Diseases (Amendment) Ordinance 2020, amending
the Epidemic Diseases Act, 1897 to make violence against healthcare workers during
an epidemic a cognizable and non-bailable offence with enhanced punishment. While
this is a fair response, it does not address the issue of occupational safety of healthcare
workers in an overarching manner. The ordinance is not only inadequate in protecting
healthcare workers from the range of occupational hazards they face, but also does not
address the issue of violence structurally. The ordinance protects healthcare workers
from incidents of violence only during an epidemic, although these incidents are a
systemic problem that exist outside of the current situation. It also fails to recognise
that deterrence is not the solution to violence against healthcare workers, and that
more structural reforms are needed.

While some community health experts have suggested measures like infection control
audits across hospitals, they are only short-term measures. These instances in the
current public health crisis point towards a larger gap — the lack of a legal framework
to guarantee occupational health and safety of healthcare workers. Even though India
has more than 50 labour laws in place, there is an ambiguity and difference as to the
laws which are being applicable to health workers of different nature. Even though
these health workers are being subjected to the similar risks and issues, they are not
being given the same rights, which is a violation of Article 14 as there is no
reasonable classification in that regard.

The research will analyze the laws prevalent in India as of now in this regard and
compare the same with developed countries with specialized laws with regard to
health care workers and their labour rights. Further, it seeks to analyze the WHO
Protection of Healthcare workers guidelines along with other International
Instruments on this regard and verify if there are laws positively corresponding to the
same prevalent in India.

The objective of the research is as follows:

i. To identify the laws which are applicable to the health workers in India and
compare it with the laws on the same regard in other countries having specialized
laws and the corresponding international guidelines.

ii. To examine the role played by the labour laws which are applicable to the health
workers, and to examine whether the same is sufficient in protecting the labour rights
of these frontline workers.

iii. To suggest recommendations on the changes that can be made in the current legal
system with regard to the laws applicable to the protection of health workers in the
country.
Scope of the Study

The scope of this dissertation is to explore and critically examine the legal, structural,
and regulatory frameworks governing labour regulations in the healthcare workforce
in India, with a comparative analysis of legal frameworks from developed countries
and international standards. The research is multidisciplinary in nature, engaging with
the fields of labour law, public health law, constitutional law, and international human
rights law.

1. Examination of Domestic Legal Frameworks

The study investigates existing Indian labour legislations, including but not limited to:

The Code on Wages, 2019;

The Occupational Safety, Health and Working Conditions Code, 2020;

The Epidemic Diseases (Amendment) Ordinance, 2020;

The Minimum Wages Act, 1948;

The Payment of Gratuity Act, 1972;

State-specific laws and ordinances (e.g., Tamil Nadu Medicare Service Persons and
Medicare Service Institutions (Prevention of Violence and Damage or Loss to
Property) Act, 2008).

These statutes are analyzed in terms of their applicability to healthcare personnel,

especially in light of the pandemic-induced healthcare crisis[^1].
2. Focus on Occupational Health and Safety of Healthcare Workers

The dissertation places a strong emphasis on occupational health and safety (OHS)
issues faced by healthcare workers, particularly the risks aggravated by COVID-19.
The study examines the legal duties of employers and the State under constitutional
provisions (Articles 21, 39, 41, 42, and 47) and statutory obligations to ensure
workplace safety and welfare[^2]. The study analyses both public and private sector
implications in healthcare employment and the enforcement challenges therein.

3. International Law and Organizational Standards

The scope extends to:

WHO’s Charter on Health Worker Safety (2020);

ILO Conventions (C155, C161, C187, etc.);

Universal Declaration of Human Rights (UDHR);

International Covenant on Economic, Social and Cultural Rights (ICESCR);

Sustainable Development Goals (particularly SDG 3 and SDG 8).

These instruments are used to assess India’s compliance with international standards
and obligations in protecting the labour rights of its healthcare workforce[^3].

4. Comparative Jurisprudence and Best Practices

The dissertation undertakes a comparative legal analysis of labour protections for

healthcare workers in developed countries such as:

The United States (Fair Labor Standards Act, OSHA, and Affordable Care Act);

The United Kingdom (Health and Safety at Work Act, 1974 and NHS policies);
Canada (Canada Labour Code and Provincial Healthcare Laws);

New Zealand (Health and Safety at Work Act, 2015).

This analysis enables the identification of regulatory and institutional best practices
which can be localized or adapted to the Indian context[^4].

5. COVID-19 and the Shift in Healthcare Labour Discourse

The pandemic has exposed the fragility of India’s health system, particularly in terms
of health worker welfare. The study captures the legal response to crises such as PPE
shortages, lack of insurance coverage, mental health issues, contractualisation,
violence against doctors and nurses, and institutional neglect. It highlights relevant
case law (e.g., Jerryl Banait v. Union of India) and public interest litigation related to
health worker safety[^5].

6. Policy Recommendations

Based on the synthesis of domestic and international law, the study provides practical
recommendations, such as:

The enactment of a comprehensive national statute specifically tailored to health

worker rights and welfare;

Codification of occupational safety principles;

Recognition of psychosocial and mental health concerns;

Framework for wage parity and insurance;

Development of national protocols for emergency preparedness that protect frontline

healthcare workers.
Limitations of the Study

Despite its comprehensive structure and scholarly ambition, this study is subject to
certain academic and practical limitations, which are duly acknowledged:

1. Doctrinal and Non-Empirical Methodology

The dissertation follows a doctrinal research method. It relies extensively on legal

literature, statutes, international instruments, secondary reports, and judicial decisions.
Due to time and resource constraints, the study does not include:

Empirical data through interviews or surveys of health workers;

Quantitative data on health worker mortality, burnout, or mental health.

Thus, the study’s findings are legally and conceptually grounded, but not statistically
validated[^6].

2. Restricted Coverage of Health Worker Types

While the WHO broadly defines health workers to include informal and unpaid
caregivers, the scope of this study is limited to paid formal healthcare professionals—
doctors, nurses, paramedical staff, and hospital technicians. Informal caregivers,
ASHA workers, and community health volunteers are not covered in detail, although
their inclusion would offer further depth to occupational health research[^7].

3. Incompleteness in Legislative Review

India’s legal system comprises over 50 labour-related statutes and numerous state-
level laws. The study selectively focuses on those laws most relevant to the health
sector and does not provide a clause-by-clause examination of every applicable
legislation. Some contemporary bills, rules, and judicial precedents may have been
introduced after the research period[^8].

4. Temporal Limitations and Legal Fluidity

As of the writing of this dissertation (2021), many legal reforms (especially labour
codes) remain pending implementation in various states. The post-pandemic legal
landscape is still evolving, and new schemes or judicial pronouncements may impact
the findings or recommendations presented here[^9]

5. Geographical and Jurisdictional Limitations

The comparative study is limited to select developed countries. Jurisdictions such as

South Africa, Brazil, or Sri Lanka, which may share more contextual similarities with
India, were excluded due to limitations in access to primary sources and
translations[^10].

6. Absence of Systematic Literature Review

While an extensive literature review was undertaken, the study does not follow a
systematic review protocol used in public health research. The selection of literature
was guided by thematic relevance rather than meta-analytic standards[^11]
HYPOTHESIS OF THE STUDY

(i).The current laws in India pertaining to the protection and safeguard of health
workers do not adhere to the corresponding international standards

(ii).India is lacking sufficient laws with regard to the protection of the health
workforce in the country in comparison with other developed nations having a
specialized law in that regard.

METHODOLOGY OF THE STUDY

This dissertation employs a doctrinal (non-empirical) research methodology, focused

on a qualitative and analytical assessment of laws, legal principles, case law, and
international instruments related to labour regulations in the health workforce. The
study seeks to critically assess the existing legal framework in India, identify gaps,
and compare it with international standards and laws in developed jurisdictions.

1. Nature of Research

The study is doctrinal, analytical, and comparative in nature. It involves a structured

analysis of existing legal materials, supplemented with an evaluative approach to
suggest legal reforms.

2. Sources of Data

The study is grounded in:

Primary Sources:

Statutes and legislative texts (e.g., Code on Wages, Occupational Safety Code,
Epidemic Diseases Act)

Case laws and judicial pronouncements

International conventions and treaties (e.g., ILO Conventions, WHO Guidelines)

Secondary Sources:

Scholarly articles, journals, commentaries

Government reports and white papers

Reports from international organisations (ILO, WHO, UN)

News reports and expert commentaries

Books and academic publications on Public Health and Labour Law

3. Case Law Analysis

A critical analysis of landmark judicial decisions is undertaken to evaluate the

enforcement and interpretation of labour laws related to healthcare workers. This
includes:

Jerryl Banait v. Union of India, where the Supreme Court emphasized the need for
protective measures and adequate safety equipment for healthcare workers during the
COVID-19 pandemic.

Relevant High Court judgments interpreting labour protections in public healthcare

facilities.

Judicial responses to PILs and writs concerning workplace safety and minimum
standards of care in the medical profession.

These cases are used to highlight judicial activism (or the lack thereof), systemic
gaps, and the interpretive trends in safeguarding health workers’ rights.

4. Comparative Legal Analysis

The dissertation includes a comparative legal approach to understand how other
jurisdictions handle labour regulation in the healthcare sector. The selected
jurisdictions are:

United States

United Kingdom

Canada

New Zealand

The comparison focuses on:

Occupational safety laws

Legal safeguards against workplace violence

Compensation, insurance, and minimum working standards

Pandemic-related protective legal frameworks

The purpose of this analysis is to draw parallels, identify best practices, and assess the
feasibility of adopting or adapting similar laws in the Indian context.

5. Jurisprudential and Constitutional Framework

Constitutional provisions such as Article 14, Article 21, and relevant Directive
Principles of State Policy are studied to evaluate how fundamental rights apply to
health workforce protection.

The methodology includes a rights-based analysis, assessing whether existing Indian

laws meet the thresholds of equality, dignity, and occupational safety.

6. Thematic Structure
The research is organized thematically around:

Indian labour regulations specific to healthcare

International legal standards and organisations

Challenges and risks faced by health workers

Policy measures and administrative initiatives

Need for reform and harmonisation of legal provisions

7. Limitations

The research is limited to desk-based analysis and does not include fieldwork or
empirical surveys.

While unpaid care workers are acknowledged, the focus remains on those engaged in
paid health workforce activities.

The updated Methodology of the Study section has been drafted and added to the
canvas. You can review or edit it as needed. Let me know if you'd like help
integrating it into your dissertation or converting it into a formatted Word document.

LITERATURE REVIEW:- A tripartite step towards improving

employment and working conditions in the health services (2017) 4Since 1998, the
Tripartite Forum on Improving Employment and Working Conditions in the Health
Services was the first sectorial meeting of its kind on health services. According to the
plan, the purpose of the meeting was to discuss decent work strategies that effectively
address health workforce shortages as a prerequisite to providing equal access to
4 A tripartite step towards improving employment and working conditions in the health services
[Link], [Link]
towards-improvingemployment-and-working-conditions-in-the-health-services---?id=8241&lang=en
(last visited Aug 31, 2021)
health care for all in need, to adopt conclusions on future programme development
and inform policy-making on the selected topic at the international, regional, and
national levels. The meeting was attended by nearly forty governments, including
eight representatives representing the Employers' group. The Workers' group, which
included eight official delegates from six PSI organizations and two UNI Global
Union units, was led by Rosa Pavanelli, the PSI General Secretary. She emphasized
the importance of governments and employers respecting International Labour
Standards, discouraging non-standard forms of employment and precarity, safe and
effective health staffing, and fair and ethical health work to address these issues and
achieve "the goal of equal access to health for all and ensuring that we have the
required trained workforce needed to deliver this." Mme Habiba Kherrour, Premier
Secretaries of the Algerian Permanent Mission to Geneva, addressed the
Governments' group, stating that the meeting was crucial in light of the Sustainable
Development Goals. While several governments expressed that the global economic
slump has limited government support for public health, nearly every government
present agreed that health spending, including health employment, is an investment
rather than a cost. This echoes the findings of the United Nations High-Level
Commission on Health, Employment, and Economic Growth (CommHEEG). PSI
General Secretary Rosa Pavanelli served as a commissioner representing the labour
movement and public services. A side session was held, presided over by Guy Ryder,
Director-General of the International Labour Organization. Jim Campbell of the
World Health Organization led an intelligent debate on the ComHEEG's activities and
recommendations. It was pointed out that austerity measures will not assist issues,
based on the consensus that investing in the health workforce is of paramount
importance. We certainly believe that the dysfunctional taxation system, including tax
evasion, tax dodging, and tax loopholes, is a key cause of injustice around the world,
said Rosa Pavanelli, speaking on behalf of the Workers' Party. The Workers' Group
was also successful in reducing tripartite support for Public-Private Partnerships.
There is a solid case to be made that public-private partnerships are nothing more than
government money being utilized to subsidize corporate interests. While private
investments should not be disregarded, they must be appropriately regulated and
should not be disguised as a collaboration with public health, the foundation of
universal health care access. The importance of Occupational Safety and Health
(OSH) in the long-term delivery of high-quality health care was also emphasized. The
perilous situation health workers face in Liberia without personal protective
equipment at the onset of the Ebola outbreak was emphasised as a grisly example of
the dangers posed when OSH regimens fail. This is unforgivable. Workers who die as
a result of a lack of OSH safeguards are not heroes, according to Pavanelli. While
they live, they need to be treated with decency, and they deserve to be kept alive.

CHAPTERIZATION

Chapter-1: Introduction

Chapter-2: Regulations pertaining to the healthcare personnel in India

Chapter-3: The role of international organizations on Occupational health and safety

rights of healthcare personnel

Chapter-4: Comparative Study on labour regulations of healthcare in Developed

Countries

Chapter -5: Conclusion & Recommendations

CHAPTER-2
REGULATIONS PERTAINING TO THE HEALTHCARE
PERSONNEL IN INDIA

2.1. INTRODUCTION

In the present times where most of us are mute spectators of the horrendous events
transpiring in the world, it is impossible to turn a blind eye toward the ones that seem
to be working day in and day out and being burned out in the process; the healthcare
employees. Furthermore, it is an excellent and lawful obligation to shield the
healthcare workers from the infringement they are confronting. It's anything but new
that our medical services laborers are going through savagery. However, it seems like
it was anything but a significant issue to take perception of the long work hours, the
mental and physical burnout, and all the allied issues that arise due to the ongoing
situation of Covid-19. “The pandemic has highlighted the extent to which protecting
health workers is key to ensuring a functioning health system and a functioning
society.”5 It is a fact that Covid-19 had increased the health risks amongst the health
workers and their families. Although not representative, data from many countries
across WHO regions indicate that
COVID-19 infections among health workers are far greater than those in the general
population.6The charter released by the World Health Organization in 2020 on the
World Patient Safety Day requires the governments at the national as well as local
levels to take up five main actions to protect health workers from violence; to improve
their mental health; to protect them from physical and biological hazards; to advance
national programs for health worker safety, and to connect health worker safety
policies to existing patient safety policies. 7 The World Health Organization calls on
all the member states of the WHO and all the relevant stakeholders to fulfill the five
guidelines proposed by them.
5 Available at: [Link]
patients-safe-who . Last accessed on 20.06.2021.
6 Id.
7 Supra Note 1.
In terms of labour laws, the guideline to protect health workers from physical and
biological hazards (ensuring adequate environmental services inclusive of water,
sanitation, etc., providing resources to prevent and tend to injuries, harmful radiations,
etc.) and most importantly, the guideline to develop and implement national programs
for occupational health and safety of health workers. This chapter will enumerate the
Indian legal framework regarding the health workers in India compared to the U.S
legal framework and whether these guidelines are being followed regarding the
occupational safety standards of the health worker personnel in the respective
counties.

2.2. Regulations about healthcare personnel in India

It is to note that there is no specific law pertaining to the protection of healthcare

workers. The grim truth is that there is not enough care or protection extended to the
healthcare workers, often termed as ‘angels of the society.’ Mere clapping of hands or
utensils showing support to them is far from sufficient to protect them. The Ministry
of Health, Government of India, proposed the passing of the ‘Health Services
Personnel and Clinical Establishments (Prohibition of Violence and Damage of
Property) Bill,’ which had contemplated the imprisonment of up to 10 years and the
imposition of a fine of as much as Rs 10 lakh on those who assault healthcare
personnel. It had even attributed a reasonably broad definition to healthcare
personnel: doctors, dentists, nurses and paramedical staff, medical students,
diagnostic service providers in a health facility, and even ambulance drivers. 8 This
legislation was due to be introduced in parliament in its Winter Session of 2019.
However, the Ministry of Home Affairs gave its thumbs down to this proposed
legislation, reasoning that there could be no separate law to protect doctors. 9 The
Epidemic Diseases (Amendment) Ordinance, 2020, aimed at protecting healthcare
professionals against violence, has been promulgated in 2020, with the due consent of

8 Available at [Link] Last accessed on

20.05.2021.
9 Ibid.
President Ram Nath Kovind only deals with that particular aspect of protection of
health workers in terms of violence meted out against them, their property, including
their living and working premises, cognizable, non-bailable offenses. The ordinance
also provides for compensation for injury and damage to or loss of property in such
cases.10

Yet, there’s a lack of a specialized reform of legislation protecting healthcare workers.

The five guidelines proposed by the World Health Organization 11 are far from being
implemented, especially in the heath sector in India.

Having so many laws is not that there are too many, but that there aren't enough,
resulting in complete confusion. In India, medical regulations governing hospitals and
nursing homes are burdensome; currently, only two laws exist in Maharashtra and
Delhi.

A "significant number" of healthcare workers reported symptoms of anxiety, sadness,

insomnia, and discomfort, in addition to the occupational and safety challenges they
encounter. Women and nurses in Wuhan and frontline healthcare personnel who dealt
directly with COVID-19 patients were more likely to experience symptoms.

In India, there are various regulations governing workplace safety, employment

management, occupational environment, etc. The current government introduced the
Code of Wages, Industrial Relations, Social Security, and Occupational Safety,
Health, and Working Conditions, replacing 44 old labor laws. These laws weakened
and eliminated several long-standing legislative safeguards that protected workers'
rights and safety.

The problem with having so many laws in place is not the excess recourse but the lack
of proper alternative leading to absolute confusion. The medical laws governing
hospitals and nursing homes are difficult to find in India. At present, there are only
two legislations in force, in the states of Maharashtra and Delhi.

10 The Epidemic Diseases (Amendment) Ordinance, 2020.

11 Supra Note 1.
Apart from the occupational and safety struggles faced by the health workers, a
“considerable proportion” of healthcare workers reported symptoms of anxiety,
depression, insomnia, and distress. The symptoms were more common among women
and nurses in Wuhan and frontline healthcare workers dealing directly with COVID-
19 patients.

More than 634 participants reported symptoms of wretchedness, 560 showed tension-
related side effects, 427 highlighted sleep loss, and 899 specified problems during this
study.1213 The investigation also found that medical caregivers, women, and cutting-
edge medical care laborers and those transported to Wuhan, the underlying focal point
of the illness flare-up, had higher degrees of all psychological well-being side effects.
A considerable workload itself gives rise to other health-related pro

 In the western European countries, a doctor sees no more than five inpatients a
day.14
 Had they ever consulted more; they consider that as overworked.15

Indian doctors are overworked and have a lot of mental and physical issues due to the
same, which are not being regarded as issues at all.

It's also worth noting that the International Labour Organization (ILO) has at least 18
agreements dedicated to Occupational Safety and Health (OSH). Only three of these
treaties have been ratified by India thus far. Important conventions such as
Convention 155 on occupational safety and health and the working environment,
Convention 161 on occupational health services, Convention 167 on construction
safety and health, Convention 176 on safety and health in mines, Convention 184 on
12 Mamidipalli Sai Spoorthy, Sree Karthik Pratapa, and Supriya Mahant, Mental health problems
faced by healthcare workers due to the COVID-19 pandemic–A review Asian Journal of
Psychiatry,Volume 51,
13 , 102119, ISSN 1876-2018, Available at ttps://[Link]/10.1016/[Link].2020.102119. Last accessed on
19.06.2021.
14 OECD/EU (2018), Health at a Glance: Europe 2018: State of Health in the EU Cycle, OECD
Publishing, Paris. Available at [Link] Last accessed on
27.05.2021.
15 Id.
safety and health in agriculture, and Convention 187, the promotional framework for
occupational safety and health, have yet to be ratified by India.16

Even with the 44 legislations laid down for this purpose, it is clear that health workers
are not subjected to the same laws despite being exposed to similar risks and issues.
Some of the notable legislations applicable to the health workers in terms of labor
legislations include, but are not limited to;

The payment of gratuity act, 1972.

Gratuity is defined as a benefit given by the employer to the employee for rendering
services continuously for five years or more. It is a monetary reward that is generally
offered when an employee leaves or retires from an organization. However, several
requirements must be met for an employee to be eligible for gratuity. The
fundamental aim and notion of gratuity is to assist the worker after retirement,
regardless of whether the retirement is due to superannuation regulations, physical
infirmity, or impairment of a critical bodily component. Gratuity is an amount that is
not linked to any kind of compensation and should be viewed as something provided
free in exchange for an employee's service of more than five years to the company.

Sec 2 (e) of the Act defines “employee” to mean any person (other than an apprentice)
who is employed for wages, whether the terms of such employment are express or
implied, in any kind of work, manual or otherwise, in or in connection with the work
of a factory, mine, oilfield, plantation, port, railway company, shop or other
establishment, to which this Act applies, but does not include any such person who
holds a post under the Central Government or a State Government and is governed by
any other Act or by any rules providing for payment of gratuity.

• It is applicable for different kinds of workers in public and

private sectors. Every factory (as defined in Factories Act), mine, oilfield,
plantation, port, and railway.17
16 Pandita, Sanjiv, “Status of occupational safety and health in India,” Infochange Agenda. Available at
[Link]
india/ . Last accessed on 27.05.2021.
17 The payment of gratuity act, 1972.
 • Every shop or establishment to which Shops & Establishment
Act of a State applies in which ten or more persons are employed at any time
during the year-end.18
• Any establishment employing ten or more persons may be
notified by the Central Government.19
• Once Act applies, it continues to use even if employment
strength falls below 10.20

As for any other labour legislation in India, there is no blanket application to all types
of health workers in India. There is no specialised legislation for the same.

The Minimum Wages Act, 1948;

Section 2(h): “wages” means all remuneration, capable of being expressed in terms of
money, which would, if the terms of the contract of employment, express or implied,
were fulfilled, be payable to a person employed in respect of his employment21

Section 2(i): “employee” means any person who is employed for hire or reward to do
any work, skilled or unskilled, manual or clerical, in scheduled employment in respect
of which minimum rates of wages have been fixed; and includes an out-work22

This includes all types of employees in all spheres, inclusive of all kinds of health
workers.

It is to be noted that the researcher is refraining from mentioning all the acts and
giving a brief on the same as that would prove to be a futile exercise. The truth is that
there is no special legislation for the health workers in this term. Therefore, all labor
legislations that do not specifically exclude the health workers are applicable in this
context. However, the argument herein is that the health workforce needs special
legislation in this context to avoid immense confusion in such terms.

18 Ibid.
19 Supra n.16.
20 Supra n.16.
21 Minimum Wages Act, 1948.
22 Ibid.
2.2.1 Epidemic Diseases (Amendment) Ordinance, 2020

Amidst news reports of violence against healthcare workers during the spread of the
COVID-19 pandemic, the Epidemic Diseases (Amendment) Ordinance, 2020, was
promulgated on April 22, 2020. The Ordinance amends the Epidemic Diseases Act,
1897. The Act provides for the prevention of the spread of dangerous epidemic
diseases. The Ordinance amends the Act to include protections for healthcare
personnel combatting epidemic diseases and expands the powers of the central
government to prevent the spread of such diseases.

The Ordinance defines healthcare service personnel as persons at risk of contracting

the epidemic disease while carrying out duties related to the epidemic, such as caring
for patients. They include: (i) public and clinical healthcare providers such as doctors
and nurses, (ii) any person empowered under the Act to take measures to prevent the
outbreak of the disease, and (iii) other persons designated as such by the respective
state government.

An ‘act of violence’ includes any of the following acts committed against a healthcare
service personnel: (i) harassment impacting living or working conditions, (ii) harm,
injury, hurt, or danger to life, (iii) obstruction in the discharge of his duties, and (iv)
loss or damage to the property or documents of the healthcare service personnel.
Property is defined to include a: (i) clinical establishment, (ii) quarantine facility, (iii)
mobile medical unit, and (iv) other property in which a healthcare service personnel
has direct interest concerning the epidemic.

The Ordinance specifies that no person can: (i) participate in or commit an act of
violence against a healthcare service personnel, or (ii) participate in or cause damage
or loss to any property during an epidemic.23 A person committing these two offences
is punishable with imprisonment between three months and five years and a fine
between Rs 50,000 and two lakh rupees. However, for such offences, charges may be
dropped by the victim with the permission of the Court. Suppose an act of violence

23 Available at : [Link]
Last accessed on 15.04.2021.
against a healthcare service personnel causes grievous harm. In that case, the person
committing the offence will be punishable with imprisonment between six months
and seven years and a fine between one lakh rupees and five lakh rupees. All offences
under the Ordinance are cognizable (i.e., a police officer can arrest without a warrant)
and non-bailable.24

Persons convicted of offences under the Ordinance will be liable to pay compensation
to the healthcare service personnel they have hurt. The Court will determine such
compensation. In the case of damage or loss of property, the compensation payable to
the victim will be twice the amount of the fair market value of the damaged or lost
property, as determined by the Court.

The Indian Penal Code, 1860, provides for penalties for any harm caused to an
individual or any damage caused to property. The Code also prescribes penalties for
causing grievous hurt, i.e., permanent damage to another individual.

The Ministry of Health and Family Welfare had released a draft Bill to address
incidences of violence against healthcare professionals and damage to the property of
clinical establishments in September 2019. 25 The draft Bill prohibits any acts of
violence committed against healthcare service personnel, including doctors, nurses,
para medical workers, medical students, and ambulance drivers. It also prohibits any
damage caused to hospitals, clinics, and ambulances.26

Several states have passed special legislations to protect healthcare service personnel.
These states include Andhra Pradesh, Arunachal Pradesh, Assam, Bihar, Chhattisgarh,
Delhi, Gujarat, Haryana, Karnataka, Kerala, Maharashtra, Manipur, Odisha, Punjab,
Rajasthan, Tamil Nadu, Tripura, Uttarakhand, and West Bengal.

Most state Acts define healthcare service personnel as registered doctors, nurses,
medical and nursing students, and paramedical staff. Further, they define violence as

24 Ibid.
25 The Epidemic Diseases (Amendment) Ordinance, 2020.
26 Anurag Vaishnav and Saket Surya, “Explainer: The Code on Occupation Safety, Health and Working
Condition”. Available at [Link]
and-working-condition. Last accessed on 19.07.2021.
activities causing harm, injury, endangering life, intimidation, obstruction to the
ability of a healthcare service person to discharge their duty, and loss or damage to
property in a healthcare service institution.

All state Acts prohibit: “(i) any act of violence against healthcare service persons, or
(ii) damage to property in healthcare service institutions.” 27 If a person partakes in
these prohibited activities in most of these states, they are punishable with
imprisonment up to three years and a fine of fifty thousand rupees. However, in
certain states such as Tamil Nadu, the maximum prison sentence maybe ten years.

Even though the current administration has amended the Act, it still has to be
supported with robust law enforcement measures. Making an ordinance may not have
been difficult, but executing it will be a significant issue for the Indian government, as
has been the case when there has been a substantial gap in enforcing the law.28

2.3. Issues faced by health workers in India

Several publications from India's various states have highlighted mental health
personnel's risks when treating COVID-19 patients. These concerns can be attributed
to the disease's severity and clinics' lack of foresight in responding well to the
pandemic. Making separation wards and serious consideration offices, ventilators, and
other steady hardware, treatment and contamination control conventions, and
individual defensive gear for health personnel are a few critical angles for medical
clinic preparedness. In India, the provision of various sources of information has
differed across public and private clinics. In any case, the most fragile issue has been
that of the accessibility of PPEs – that incorporates sanitizers, veils, gloves, and
outfits – for wellbeing laborers. Deficiency in such fundamental defensive stuff has
influenced specialists, medical attendants, professionals, and sterile laborers in
emergency clinics and locally bleeding edge laborers.

27 Id.
28 Available at [Link]
to-protect-healthcare-workers-33398/ . Last accessed on 20.06.2021.
The general population and private emergency clinics have faced a lack of medical
services due to preparedness. Even at globally accredited tertiary private clinics in
Mumbai and Delhi, some medical attendants and experts have tested positive for
COVID-19. We didn't have the requisite gear for PPEs at the start of April 2020.
Therefore, we had to rely on China's inventory. The
PPEs delivered from China must be unloaded since they do not satisfy the required
requirements.

A substantial amount of time was spent getting the requisite quantity of PPEs due to
the reliance on imports for a range of clinical equipment.29

While specialists and attendants expressed concern about the deficiency, experts,
nursing orderlies, cleaning personnel, and security faculty in an emergency clinic
were also at risk of contracting the infection. The administration claims, however, that
the issue of accessibility has been addressed.

The overall health workers today are significantly enduring with respect to manager
soundness, wages, capabilities and benefits inferable from expansive
contractualisation in the public region. 30 The re-appropriated workers, attributable to
the transitory idea of their commitment, don't have a voice at the dynamic table and
their issue goes unheard. There is a significant difference and imbalance, which is an
unmistakable infringement of Article 14 of the constitution of India in such manner.
Since these wellbeing champions are on an understanding, the public power, i.e., the
public authority isn't answerable for their shortcomings and risk to COVID-19. This
scourge has included the harsh attitude of the public position and individuals overall
towards even the clinical overseers. Drawing out the National Disaster Management
Act suggests that all agents in facilities are constrained to work autonomous of the
risks and dangers introduced. Accordingly, a couple of private crisis centers shut
down when their health workers got the infection. The people who have the lower
rungs in the work reformist framework face additional risks – low wages, work
vulnerability, helpless safeguarding strategies, and extended frailty to infection. The
29 Available at [Link]
equipment-endangeringhealth-workers-worldwide. Last accessed on 15.04.2021.
30 Ibid.
social class level experts like ASHA workers deal with an equivalent issue. They are
given the endeavour of making care and recognizing potential COVID-19 cases
nonetheless are not being repaid enough for the risks that they need to look reliably.31

The COVID-19 pandemic has shown the requirement for reinforcing the health and
well-being laws. It is a chance for the Indian government to reconsider general
wellbeing by expanding speculations and to address a portion of the abnormalities that
have gotten settled in.36 The importance of Human Rights for well-being is an
important factor to consider. Contracting and other complicated corporate systems
have created divisions among the labour force, with one group gaining access to
government benefits while another struggles with weakness and inadequate salaries.
The concerns of medical care workers traveling throughout the progressive system
should be addressed with COVID 19 limitations, including lockdowns. 32 The new
situation where government medical workers in the public sphere, i.e., in the
government sector, didn't get their pay rates throughout the lockdown period
embodies the insensitivity of the public authority. The protest of the health workers in
the centre for non-payment of wages amongst other human rights concerns and the
PIL filed as Jerryl Banait v. Union of India (UOI) and Ors.33 The plight of the
workers was The Petitioner prays for issuing a direction to the Respondent, the AIMS
Hospital to ensure that guidelines issued by WHO and the guidelines issued by the
Ministry of Health and Family Welfare be implemented and Respondents be directed
to ensure availability of appropriate Personal Protective Equipment, including sterile
medical/Nitrile gloves, starch apparels, medical masks, goggles, face shield,
respirators (i.e., N95 Respirator Mask or Triple Layer Medical Mask or equivalent),
shoe covers, head covers and coveralls/gowns to all Health Workers including
Doctors, Nurses, Ward Boys, other medical and paramedical professionals actively
attending to, and treating patients suffering from COVID-19 in India, in Metro cities,
Tier-2 and Tier-3 cities. A direction had also sought for providing security to doctors

31 Available at [Link]
reforms-stalled-bybritish-colonial-rule/457234/?amp. Last accessed on 20.06.2021. 36 Ibid.
32 Supra note 32.
33 Writ Petition (Civil) Diary Nos. 10795, 10830, 10852/2020 (IA Nos. 48243, 48242 and
48249/2020). 39 Supra note 37.
and other paramedical professionals. It is extremely disgusting that the health
warriors, who the citizens were urged to clap for at the time of the lockdown, as a
gimmick has to go to such an extent, despite giving their lives to protect lives of
citizens. The Supreme Court bench consisting of Honourable justices Ashok Bhushan
and S. Ravindra Bhat, JJ. Held, while disposing off the petition that:

(i) It was the first responsibility of the State to protect its citizens from the
pandemic.39

(ii) The Petitioner had made out a case for issuing following interim
directions to theRespondents in this PIL:

(1) All health workers, including doctors, nurses, ward boys, and other
medical and paramedicalprofessionals, actively attending to, and treating patients
suffering from COVID-19 in India, in metro cities, Tier-2 and Tier-3 cities, were
directed to ensure the availability of appropriate Personal Protective Equipment,
according to Ministry of Health and Family Welfare guidelines.34

(2) Doctors and medical staff in hospitals and places where patients who
had been diagnosedwith COVID-19, patients suspected of COVID-19, or those
quarantined were housed were directed to have the necessary Police security provided
by the Government of India, respective States/Union Territories, and respective Police
authorities. Doctors and other medical personnel who visit areas to perform
screenings of individuals to find out symptoms of sickness should also be given the
necessary police protection.35

(3) The State will also take appropriate measures against anybody who
obstructs or commits anoffence in the discharge of responsibilities by doctors,
medical personnel, and other government officials tasked with limiting COVID-19. 36

34 Supra note 37.

35 Ibid.
36 Ibid.
 (4) The government will investigate all options, including permitting and
expanding localprotective clothes and equipment manufacturing for medical
professionals. This includes looking at alternative methods of producing such
garments (masks, suits, caps, gloves, and so on) as well as allowing raw materials to
flow freely. In addition, the government may impose export restrictions on such
materials to supplement inventories and domestic supply.37

The same was allowed by the Honourable Supreme Court, and direction was
appropriately given to the Government in this regard.

2.4. Conclusion

The fact is that despite having above 44 different legislations in terms of protecting
the workforce, it is confusing, and there is no special legislation to protect the hazards
faced by the health workforce in India. In terms of having legislation for their
protection, only the aspect of violence being meted out against them has been
addressed in the form of passing the Epidemic Diseases (Amendment) Ordinance
2020, amending the Epidemic Diseases Act, 1897 to make violence against healthcare
workers during an epidemic a cognizable and non-bailable offence with enhanced
punishment.38 The law solely protects healthcare professionals against assault during
epidemics, despite the fact that such occurrences represent a systemic issue that exists
outside of the current circumstances. Further, the D.O. No.Z-20015/127/2019-
ME.I(Pt. I) dated 20th April 2020 by the Ministry of Health and Family Welfare makes
it a point to enumerate all the measures that have been taken by the Government to
protect the healthcare personnel at the time of the pandemic, including the Pradhan
Mantri Gareeb Kalyan Package which promises Accidental Insurance cover of Rs. 50
Lakhs for 2212 Lakh healthcare workers who may be drafted for services for Covid-
19 patients. But then again, this is solely for those healthcare personnel who have lost
their lives due to being on covid duty. At the level of receiving actual collateral
37 Ibid.
38 Available at [Link]
framework-for-theirhealth/459827/ . Last accessed on 19.07.2021.
benefits at the ground level, it is still unsure what the procedures are in this regard.
Further, guidelines and training programs for health workers to deal with different
situations are helpful, yet, there are gaps in the legislation that could be addressed
better.

CHAPTER- 3
THE ROLE OF INTERNATIONAL ORGANIZATIONS
ON OCCUPATIONAL HEALTH AND SAFETY RIGHTS
OF HEALTHCARE PERSONNEL

3.1 INTRODUCTION

Any person's most valuable asset is their health and safety. Furthermore, health is
regarded as a key to prosperity, and safety provides the ability to provide a safe
atmosphere. Essentially, health, protection, wellbeing, and new working
circumstances or environments are critical for worker success as well as the world's
monetary development, as a strong workforce is increasingly profitable. Employees
are the foundation of any innovation strategy since they give its basic concept strength
and texture. Most of the rights offered to workers, as well as the obligations imposed
on the employer, are included in the health and safety of workers. 39. Occupational
health services are actions performed in workforce with aim of supporting and
enhancing individuals' safety, health, including well-being, along with improving
working conditions and workplace atmosphere. Occupational health experts deliver
these services as individuals, as part of particular service units within the
organization, or as specific tools. Occupational health practise encompasses more than
just the operations of welfare facilities. It is an interdisciplinary and holistic activity,
including work health & safety professionals, other professionals from within and
39 International Cooperation in Occupational Health: The Role of International Organizations
[Link], [Link]
structural-and-legal/internationalgovernmental-and-non-governmental-safety-and-health/item/
223-international-cooperation-in-occupational-healththe-role-of-international-organizations (last
visited Aug 24, 2021) 48 Ibid.
outside the organisation, and relevant authorities, employers, and workers'
representatives. A well-developed and possibly the best workplace framework is
required for such participation. All administrative, organisational, and operational
processes required to properly perform occupational health practice and assure its
orderly development and organizational improvement should be included in the
adequate resources48. Health personnel involved in pandemic response face a variety
of health and safety hazards on job. COVID-19 infection, disorder, and transmitting to
someone else; exhaustion from long hours as well as heavy workloads, sleep
disturbances or rest, overhydration, and nutritional deficiencies; cardiovascular injury
from patient handling and large items; continuous work while wearing protective
gear, which can cause thermal discomfort, skin as well as mucosal damage; workplace
violence as well as stereotyping. To operate safely and effectively, all health workers
must have the skills and knowledge to protect oneself and many others in the
occupational dangers they face.

The primary function of international organisations is to provide structured rules for

international collaboration. People have communicated experiences and information
in a variety of ways over the millennia. Occupational health services, which are
offered at work to meet health care needs of working populations, have also been
recognized as a major entity of public health approach. These services can also help
with other government goals, such as lowering health inequities, social isolation, and
sick leave. By supporting and enhancing the health of the working population,
occupational health services can help lessen the overall risk of illness. As the largest
single group of health care professionals involved in providing health care at work,
occupational health nurses have addressed these new issues.

3.2 WELLNESS AND OCCUPATIONAL HEALTH

Among the most significant issues of human concern are occupational health and
wellbeing. Its goal is to adapt the workplace environment to workers to promote and
maintain a high level of physical, mental, and societal standing in all jobs. The global
issue of occupational health and safety is currently adopting a new direction. The key
contributing elements to this idiosyncrasy appear to be the rapid industrial and
commercial development occurring in emerging countries and the introduction of new
products and market processes as a result of these developments. In many of these
countries' primary productive sectors, such as industrial, mining, and agriculture,
service mechanisation replaces manual labour. Therefore potential occupational
health consequences may be expected. In addition, these countries' unquenchable
thirst for technological improvement has resulted in the importation of advanced gear
and equipment, not just for industrial production but also for operations and trade 40.
This has always been linked to a shift in the labour force's overall structure, including
an increase in women's employment. The health concerns would change as well, as
one would expect. For example, in the services business, a greater focus on
ergonomics & occupational psychosocial variables is required. This would be a new
challenge for most Developing nations' occupational health and safety practices.

The tools and skills to deal with such issues are not currently as evolved as in
industrialised ones. Job injuries and infections kill an estimated 2-3 million people
each year worldwide, which is more than the global yearly number of malaria deaths.
Job-related ailments, such as cardiovascular disorders, cancer, hearing problems,
physical and reproductive disorders, mental and neurological illnesses, affect an
estimated 160 million people globally each year. In industrialised countries, an
increasing number of workers are complaining about mental trauma and work
overload41. Insomnia, sadness, exhaustion, and burn-out syndromes have all been
linked to these psychological effects, as well as an increased risk for heart disease.
With a few exceptions, only 5-12 percent of workers in underdeveloped nations and
20-70 percent of workers in industrial countries have access to effective occupational
health treatments. Even in sophisticated economies, many work locations are not
assessed for occupational safety on a regular basis.

40 [Link], [Link]
publication/ wcms_093550.pdf (last visited Aug 24, 2021)
41 Ibid.
Every country's workforce health has an immediate and obvious impact on its national
and global economies. The total economic losses incurred as a result of workplace
sickness and injuries are considerable. A productive, well-trained, and motivated
workforce enhances productivity and produces income, essential for the community's
overall health.

3.3 GLOBAL HEALTH AND INTERNATIONAL ORGANIZATIONS ON

RIGHTS OF HEALTH CARE PERSONNEL

Health-care personnel is defined as healthcare professionals and healthcare workers,"

including everyone who works in the health-care industry. “Health-care workers are
critical to the execution of health-care policies and the delivery of health-care
services. On the other hand, their rights are routinely ignored, and many HCWs
complain about terrible working conditions, long hours, and low pay. As a result,
many nurses, particularly in the public health sector, have chosen to leave.

The International Labour Organization is a United Nations specialised body that deals
with labour and social issues. Its Geneva offices are in charge of developing and
enforcing international labour rules. The International Labour Office is a group of
people who work around the world to conduct programs and projects 42. For labour
organization, employment policy, work schedules, pay, social welfare, immigrants,
and special categories of workers, International Labour Standards (ILS) have also
been developed. ‘Nevertheless, OSH is mentioned in more than half of the cases. ILS
Treaties, which are legally obligatory on nations that ratify them, and Suggestions,
which are nonbinding advice, are adopted and implemented on a tripartite basis at the
International Labour Conference. Aside from ILS, OSH-related issues are addressed
by Codes of Practice, which are usually developed on an ad hoc basis by a tripartite
panel of specialists to recognise specific sectors such as mining, agriculture, or

42 ,
[Link]
342946396_International_Organizations_as_Drivers_of_Change_in_Occu pational_Health (last visited
Aug 27, 2021)
hazards such as machinery, alcohol, and drugs, as well as the risks associated with
them at work43.

According to the ILO Constitution, workers must be guarded against sickness, illness,
and injury because of their work. However, the reality for thousands of workers is
extremely different. Every year, almost 2 million individuals die as a result of job
accidents and diseases. Job diseases affect an estimated 170 million individuals, and
2800 million fatalities and non-fatal job accidents occur each year. Injuries and
illnesses inflict immense hardship on workers and their families. According to the
International Labor Organization, occupational sickness and accidents cost the world's
economy 5% of its annual GDP. Health workers are essential for expanding health
care coverage and attaining the rights to the highest possible standard of wellness;
their existence, availability, acceptance, and quality are all dependent on them.
Building responsive and effective health care systems requires a strong health
workforce. Given the importance, it is still the weakest component of many nations'
health systems and a major impediment to reaching universal health care targets. One
of society's and the economy's most important industries is health care. Because of
seriousness of global health issues, no one country or organization can deal with them
alone. Several international organizations and agencies help in the creation of global
health policy, as well as funding, execution, and assessment of programs. Global
multinational organisations collaborate to enhance outcomes 44. The international labor
organization endorsed the essential concepts of the human right to healthcare and
personal protection. Individual & public health, economic growth, and development
benefit from social health protection and fair access to high-quality health care. This
industry is a large employer with significant job-creation potential 45. Nonetheless,
most countries face difficulties in providing affordable health care. Global scarcity
and disparity of competent health staff are a key impediment to universal health care

43 [Link], [Link]
[Link] (last visited Aug 27, 2021)
44 Health services sector [Link], [Link]
lang--en/ [Link] (last visited Aug 26, 2021)
45 Ibid.
access. Governments and healthcare executives are urged by WHO to deal with
regular dangers to health of healthcare personnel and patients.

“No country, hospital, or clinics can protect its patients unless its health personnel is
protected. The World Health Organization's Health Worker Safety Covenant is an
important prerequisite for ensuring that health care workers receive the workplace
safety, training, compensation, and recognition they deserve 46.” The pandemic has
also demonstrated how essential it’s essential to safeguard health workers to maintain
a functional health system and society. Art 23 of UDHR declares that the freedom to
work encompasses "just and beneficial working conditions" as a universal human
right. Since this pandemic, numerous significant global conventions, resolutions, and
instruments have called on governments and policymakers to provide safe, secure,
and supportive working environments for all workers, including 2030 Agenda for
Sustainable Development and its Sustainable Development Goals.

Given that women make up over 75% of the health care workforce globally, boosting
health worker safety directly contributes to eliminating unfair work practices and
female empowerment. On April 28, the annual World Day for Workplace Safety and
Health emphasizes the prevention of workplace accidents and illnesses around the
world. It's a public-awareness campaign aimed at drawing international attention to
the scope of the problem and how encouraging and fostering a health and safety
culture can help minimise the number of workplace injuries and deaths. Each of us is
accountable for preventing workplace deaths and injuries.

The Covenant, which was announced recently in honour of World Patient Safety Day,
asserts Governments and people responsible for local health systems to undertake five
steps to safeguard health workers in a better way. Steps to safeguard health workers
against violence, enhance the quality of life, shield them from physical and biological
hazards, promote national health worker safety programs, and link health worker
safety policies to existing patient safety regulations are among them. The employment
climate for health care employees is constantly changing as a result of comprehensive

46 [Link], [Link]
[Link]? sfvrsn=bcabd401_0 (last visited Aug 28, 2021)
health system reforms. The workers in the health-care industry have the right to form
trade unions. However, government-employed health care professionals are also
members of the general public service. As such, are within ambit of the same laws
and regulations that apply to the whole public sector. Workers of national agencies
and provincial administrations perform a number of public services, including health
care, as part of the public service. To deliver effective health care, health personnel
must do decent job. Workplaces in health care are distinct and complicated, with
inherent opportunities and challenges. Through sectoral labour standards and social
discourse, the ILO supports improvements in working conditions and labour relations
in the healthcare system and engages with WHO to foster supportive, facilitating, and
healthy workplace for health care workers. Early retirements, the loss of competent
employees, absenteeism, and expensive insurance premiums are all costs that
employers suffer as a result of job accidents and illnesses. However, many of these
deaths might be avoided if solid prevention, monitoring, and inspection methods were
used. Governments, companies, and workers can use ILO standards on occupational
safety and health to create such practices and ensure maximum workplace safety. In
2003, the International Labour Organization (ILO) announced a global strategy to
promote health and safety at work, including development and promotion of
applicable instruments and technical assistance47.

3.3.1 The rights of healthcare personnel are listed below-

In all applications & dealings with the government, the private sector, and others, to
equality and the benefit of the law. Family responsibilities, rural areas, historical
adversity, and other factors all play equal justice.

47 International Labour Standards on Occupational Safety and Health [Link],

[Link]
occupational-safety-andhealth/lang--en/[Link] (last visited Aug 25, 2021)
 Not to be treated unfairly by any patient, healthcare scheme, medical faculty or
school, government, employer, and other person or institution based on race, gender,
origin, or other factors. Healthcare personnel has a right to be free of harassment.

The right to life - includes the right not to be subjected to situations that are
disproportionately dangerous to one's life.

The right to personal security and freedom encompasses physical autonomy and the
right to be free against violence.

In terms of privacy, this encompasses safeguarding personal information,

connection, family, & property.

To freedom of movement and residence, including the right not to be subjected to

unjustified restrictions on where doctors are required to work and live.

To freedom of trade, vocation, and profession, including specialization options

when positions are available. This covers Healthcare personnel rights to participate in
commercial ventures.

To fair labour practices, such as the equitable distribution of overtime, leave, and
working conditions, as well as the right to have their complaints heard in suitable
channels. Healthcare personnel have the right to be supported in disciplinary
proceedings, present their case to an impartial chairperson, and have their side of the
story heard. Healthcare personnel have the right to labour in an atmosphere free of
discrimination based on gender, sexual orientation, or (supposed) race or ethnicity. In
circumstances of occupational HIV infection, doctors have the right to post-exposure
prophylactics48.

To property, which includes the right to fair compensation for services provided
and the right to have these and other property rights not infringed upon in any way.
Healthcare personnel has the right not to be taxed more or singled out for special
attention only because of their presumed financial level.

48 Supra note 7.
3.3.2 Art 23, 24, and 25 of the UDHR provide plenty of employment
rights.

As there aren't clear mechanisms for implementing OSH rights, one may argue that
there isn't any developed jurisprudence of right to protect life and health in workplace
except through stretched interpretations of major human rights treaties. “Article 3 of
the United Nations' Universal Declaration of Human Rights, for example, specifically
cites the need to preserve the right to life, liberty, and security of the person without
mentioning the environmental or occupational context in which such rights can or
should emerge”49.

Many nations' basic constitutional principles include safeguarding health rights.

Furthermore, there is an international agreement on essence of granting safe and
healthy employment, which is represented in several treaties, reiterating legal
concepts from several countries, such as domestic laws or constitutionally guaranteed
health security measures. In UDHR, there is a major group of rights dealing with
employment and “preferable working conditions50.” The concepts described in 3
successive articles of UDHR are a result of history, which is mirrored in previous
laws. From the aspect of OHS, there is one issue that UDHR is a highly prominent
and frequently accepted treaty, but it doesn’t accurately deal with issues of OSH51.

3.3.3 Interim recommendations from WHO 2020

The WHO issued interim recommendations in March 2020 titled Coronavirus disease

(COVID19) outbreak- rights, duties, and duties of health professionals, covering

critical issues for OSH. Given current and developing evidence, this edition offers
advice on occupational safety precautions for health workers and occupational health
services regarding COVID-19 pandemic. It also maintains health officials' rights and
49 Occupational health as a human right - Work Health and Survival Project Work Health and
Survival Project, [Link] (last visited Aug 25,
2021)
50 Ibid.
51 Supra note 2.
obligations for workplace health and safety in accordance with International Labour
Organization standards (ILO)52.

Important points:-

• With respect to COVID-19, health care workers must continue

to have right to adequate, healthy, & safe working conditions.

• Primary COVID-19 prevention amongst health workers must

be based on risk evaluation and the implementation of suitable strategies.

• Other occupational dangers exacerbated by COVID-19

epidemic should be addressed, such as violence, harassment, etc.

• All health workers must have access to health services, mental

health and psychological support, along with proper sanitation, cleanliness,
and rest facilities.

• Occupational health programmes, along with infection

prevention and control programmes, should be implemented in health-care
institutions.

• Employers are ultimately responsible for ensuring that all

essential preventive and protective measures are implemented to reduce risks
to health workers.

• Health care professionals are accountable for adhering to

specified guidelines to ensure their health and safety at work.

52 WHO releases COVID-19 occupational health and safety guidance for health workers - SHP - Health
and Safety News, Legislation, PPE, CPD and Resources SHP - Health and Safety News, Legislation, PPE,
CPD and Resources, [Link]
occupational-health-and-safety-guidancefor-health-workers/ (last visited Aug 29, 2021)
3.4 COMPONENTS OF THE RIGHT TO HEALTH THAT ARE
CRUCIAL

The right to health is a basic right available to all. The right to health is typically
associated with hospital construction and access to health care. This is true, but it goes
beyond that. It includes a wide set of factors that can help us in living a healthy
lifestyle53. These are referred to as the fundamental determinants of health by the
International Commissions for Economic, Sociological, and Cultural Rights, which
monitors the International Covenant on Economic growth, Social, and Cultural
Rights.

Facilitate cooperation between plans and practices relating to the safety of health care
workers and those relating to the safety of patients-

Patient and healthcare worker safety are intimately related problems in practice.
Patient safety concerns, patient harm, and poor patient outcomes can result from
hazards to health professionals' health and safety. At the system and point-of-care
levels, a shift in mindset is needed to relate health workers' rights to patient safety,
continuous improvement, and infectioncontrol programs 54. This tactical approach can
help patients and communities trust the healthcare system by offering safer care,
lowering expenditures due to attrition of health professionals, inadequate productivity,
and patient referrals to hospitals55.

Priority actions and interventions in this area include the need to: Develop links
between occupational health and safety, and patient safety-

• Infection prevention and control programmes, as well as quality

53 [Link], [Link] (last

visited Aug 29, 2021)
54 , [Link] (last visited Aug 27, 2021)
55 Keep health workers safe to keep patients safe: WHO [Link],
[Link]
(last visited Aug 28, 2021)
 • Include personal and patient safety skills in your health ,

• Health personnel at all levels should get education and training.

• Includes health-care worker and patient safety regulations.

• Develop integrated patient safety, health staff safety,

• Within health information systems, markers indicate care,

• Guidelines for licensure and accreditation in the field of health ,

• Align the monitoring and learning mechanisms for health staff

3.5 IN THE AFTERMATH OF THE COVID-19 OUTBREAK,

WORKERS SHOULD RECEIVE PSYCHOLOGICAL AND
SOCIAL SUPPORT.

Many problems are related to the Covid-19 pandemic, such as dread of illness, death,
or isolation, loss of a source of revenue, or social exclusion in the case of a Covid-19
infection, and these fears cause depression for employees. Thus mental health care
should be offered56. The first step in supporting workers' mental health, in addition to
psychological and sociological support for all types of workers, is to understand what
they feel and the reasons that affect them.
Remote workers, workers who have been temporarily suspended, and workers who
are remaining or returning to work at their customary workplace must all be
supported57. Governments must recognize and emphasize the vital role of personal
protective equipment along with infection control practices and water, sanitation, and
56 [Link],
[Link]
9_pandemic.pdf (last visited Aug 25, 2021)
57 Supra note 10.
cleanliness technologies. They must encourage and guide the development of large-
scale regional manufacturing. These initiatives must be reinforced by nationwide
buffer inventories of personal protective equipment large enough to offset any lacunae
in availability caused by substantial supply chain interruptions.

Furthermore, they must develop a detailed approach to PPE sourcing, going beyond
lowest cost to support the development of high-quality, unique Protection. WHO must
think over including ‘access for PPE as a crucial component of any future nation
assessment of readiness? It must also bring together regulators and standards
organisations to work on harmonizing medical Protection standards. The ILO also
emphasised the requirements of the most vulnerable employees and enterprises,
particularly those in the informal economy and migrant and domestic workers.
Safeguards to prevent these employees should include, among other things, education
and training on safe and healthy work practices, free PPE when needed, access to
health services, and alternatives livelihoods58.

Furthermore, it should define goal product attributes for PPE in order to guide future
innovations. Access to financing options and guidance from development banks and
banking operations is required to enable large-scale local production and testing
capability. Banking institutions could help to build a national supply chain, quality
management mechanisms for personal protective equipment. They also should make
it easier to invest in personal protective equipment. Industries must collaborate with
governments and public health stakeholders to facilitate this shift and engage actively
in technology to create inexpensive, safe, and elevated goods that fulfill the demands
of health workers.

3.6 RECOMMENDATIONS

For many months, healthcare systems around world may be running at or near
capacity.

58 Human rights and health [Link], [Link]

rights-and-health (last visited Aug 28, 2021)
However, healthcare employees can’t be made quickly or run higher capacity for
lengthy periods unlike ventilators and wards. Fear has gripped healthcare
professionals as a result of the worldwide crisis. Healthcare professionals are
concerned about their colleagues, family, friends, regions, and country. Although their
fears, they stand up and fight to carry out their duties while remaining in a constant
survival mode to preserve others around themselves. To win this war over COVID 19,
we must all facilitate those on the field of battle. While our healthcare personnel
continue fighting, we should assist them in combating any possible short or long-term
repercussions of this pandemic. It is critical that authorities view workers as human
beings rather than objects only to be used. The safety of healthcare professionals must
be assured as part of the worldwide approach. Adequate Equipment provision is only
the first move; additional practical steps, such as suspending non-essential functions
to prioritize resources, providing food, relaxation, and family support and mental
assistance, must also be addressed. Currently, healthcare employees are the most
valuable resource in every nation.

CHAPTER-4
COMPARATIVE STUDY ON LABOR
REGULATIONS OF HEALTH CARE IN
DEVELOPED COUNTRIES

4.1 INTRODUCTION
Labourers are the driving force of a country’s economy. This statement undoubtedly
needs no elaborate explanation as the same is known to almost everyone. Henceforth,
this is why a considerable emphasis is laid on effective labor laws in every country.
However, many countries have failed to keep up their labor laws in consonance with
the needs of the times. On the other side, there are some nations that have been
successful in securing the rights of the laborers, especially with respect to their health.
Health is undoubtedly an asset to not only a person but the nation as a whole. It has
rightfully been said that health is wealth. The reason is pretty simple the healthier a
man, the more is their efficiency to work and contribute to a country’s GDP. Also, the
right to health is a human right recognized under UDHR and has also been granted
constitutional legitimacy under several countries’ constitutions. Health care workers
need protection, and the same is indisputable, especially in times of Covid-19. We
shall now be discussing the labor regulations relating to health care workers in
developing nations to take a cue from them for our nation.

The regulation of labour in the healthcare sector has emerged as a subject of

significant legal, policy, and academic interest, particularly in the context of
contemporary challenges facing global health systems. As one of the most vital and
labour-intensive sectors in any economy, healthcare depends heavily on a skilled,
adequately protected, and well-regulated workforce. The nature of healthcare work—
characterised by long hours, high stress, exposure to occupational hazards, and moral
responsibility for human life—makes the regulation of labour conditions in this field
critically important. In developed countries, labour laws applicable to healthcare
professionals are shaped by a confluence of labour rights, public health imperatives,
economic policies, and social welfare objectives.

This dissertation undertakes a comparative analysis of labour regulations governing

healthcare workers in selected developed nations—namely, the United States, the
United Kingdom, Germany, Canada, and Australia. These countries represent a
diversity of healthcare models, from publicly funded and universally accessible
systems (such as the UK’s National Health Service and Canada’s Medicare) to
predominantly private and market-driven models (as in the U.S.). Despite their
differences, each of these countries has developed a complex legal and institutional
framework aimed at regulating employment conditions, occupational safety,
professional accountability, collective bargaining, and workforce mobility in the
healthcare sector. Understanding these frameworks in comparative perspective offers
valuable insights into how labour law interacts with healthcare delivery in advanced
economies.

The rationale for focusing on developed countries stems from their relatively mature
regulatory environments, robust enforcement mechanisms, and availability of detailed
legal and policy documentation. These jurisdictions often set international
benchmarks in labour protection and healthcare governance, and their approaches are
frequently referenced in global health policy discourse. Moreover, in the aftermath of
the COVID-19 pandemic, many developed countries have revisited and, in some
cases, reformed their labour regulations to address the vulnerabilities exposed during
the crisis. These include issues related to staff shortages, burnout, lack of mental
health support, inadequate occupational safety protocols, and the precarious
employment of temporary and migrant healthcare workers. As such, examining how
developed countries responded legislatively and institutionally to the pandemic
presents an opportunity to evaluate the resilience and adaptability of existing labour
[Link] central objective of this study is to critically examine the labour
regulations applicable to the health workforce in the selected countries, identify their
strengths and limitations, and highlight comparative lessons that can inform the
development of a robust regulatory framework in other jurisdictions, including
developing economies such as India. Key legal dimensions to be explored include:-

Employment law and contractual obligations: Nature of employment (permanent,

temporary, agency work), standard contracts, and termination rights.

Occupational health and safety: Legal protections against workplace hazards,

including biological, psychological, and ergonomic risks.

Working time regulations: Restrictions on working hours, overtime provisions, rest

periods, and shift patterns.

Unionisation and collective bargaining: Legal recognition of trade unions, scope of

collective agreements, and right to strike.

Gender equity and workforce diversity: Legal measures addressing discrimination,

maternity protection, and representation of minority groups.

Professional mobility and licensing: Cross-border recognition of qualifications and

regulation of migrant healthcare [Link] comparative study is grounded in the
analysis of national legislation, judicial decisions, policy documents, academic
commentary, and international instruments such as the conventions of the
International Labour Organization (ILO) and the World Health Organization (WHO)
Code of Practice on the International Recruitment of Health [Link] analysing
how developed countries structure and enforce labour regulations in healthcare, this
study aims to contribute to the broader discourse on health workforce governance,
propose evidence-based recommendations, and identify legal strategies for building a
more equitable and resilient global health workforce.

4.2 USA

There are several statutes in the USA which tend to protect the rights of Health care
workers. We shall now be discussing the same.

Fair Labor Standards Act 59

The FLSA establishes a federal minimum wage, overtime compensation, and child
labor safeguards. The legislation was approved by Congress because its features were
designed to safeguard employees while also stimulating the economy. It also
established the Wage and Hour Division (WHD) under the Department of Labor,
responsible for enforcing and administering the law. Employees and businesses
involved in interstate commerce are covered under the FLSA. A firm is insured if it
generates at least $500,000 in yearly sales or trade. The Act covers hospitals,
institutions primarily engaged in the care of the sick, elderly, mentally ill, or disabled
who reside on the premises, schools for children who are mentally or physically
disabled or gifted, etc.

The FLSA applies to majority of commercial and public sector employees, but not all.
Employers must pay covered, non-exempt employees at least $7.25 per hour under
Section 6 of the FLSA. The FLSA does, however, contain several subminimum pay
rates like disabled workers, etc. Employers can pay special minimum wages (SMWs)
to workers with disabilities u/s 14(c) of FLSA. The SMWs are designed to give

59 Wages and the Fair Labor Standards Act, US Department of Labor (August 30, 2021, 03:00 am)
[Link]
people with impairments a chance to work. A handicap can be either physical or
mental. It might be due to old age or an accident. The Patient Protection and
Affordable Care Act amended FLSA to include a new Section 7(r).

Employers must compensate workers who work overtime at least a half time under
Section 7 of the FLSA. The overtime obligations of Section 7 of the FLSA are
exempted in numerous ways under Section 13 of the FLSA. As a result, businesses
and workers exempt from overtime are not affected by the new Section 7(r).

Covered employers are required to offer nursing mothers break time under Section
7(r). For the first year following the child's birth, break time must be offered.
Employers must offer a place that is hidden from view and free from interference
from employees and general public, in addition to a restroom. Break periods to
express milk are only available to employees who have not been exempted from
FLSA's overtime compensation obligations. Employers with less than 50 workers are
exempt from the rule if complying would cause them undue hardship. Employers are
not obligated to compensate breastfeeding moms for pauses taken to express milk.

60
The Occupational Safety and Health Act
In 1970, the OSH Act was formulated in order to enhance workplace health
conditions. The OSH Act included provisions for a National Institute for Occupational
Safety and Health or NIOSH, to undertake research and provide guidance; an
Occupational Safety and Health Administration, or OSHA, to adopt and enforce
national occupational safety and health standards; and both OSHA and NIOSH to
provide consultative assistance to employers. Worker injury, sickness, and mortality
have declined since 1970, but not eradicated, from high levels at the turn of 20 th
century. The Occupational Safety and Health Act is enforced by the Occupational
Safety and Health Administration (OSHA). Despite the fact that the law provided
OSHA the power to develop industry-specific standards, it also included a "universal
responsibility" section that applies to all employers in all businesses. This phrase,

60 OSH Act of 1970, US Department of Labor (August 29, 2021, 02:00 pm)
[Link] 70 Supra 23.
officially Section 5(a)(1) of the act, acts as OSHA's mandate, requiring businesses to
create a safe working environment for their employees. The act says: "Each employee
shall comply with occupational safety and health standards and all rules, regulations,
and orders issued pursuant to this Act which is applicable to his actions and
conduct."70 In some areas of the country, an OSHA-approved state agency assists in
the development and enforcement of workplace safety regulations. However, these
requirements must be at least as rigorous as federal rules. Inspections of workplaces
and work locations are used by OSHA to enforce its laws and requirements. Penalties
and fines are imposed on violators, which are increased annually for inflation.

61
The Needlestick Safety and Prevention Act
On Nov 6, 2000, the Needlestick Safety and Prevention Act was enacted, revising
OSHA’s standard regulating occupational exposure to bloodborne pathogens. OSHA
issued its regulations reflecting the Act and its requirements in Federal Register. The
rules went into force on April 18, 2001. It aims to minimize healthcare employees'
exposure to bloodborne infections by putting extra sharps-related regulations on
employers, such as hospitals and ASCs. OSHA's rules :

(1) alter meaning of "engineering controls" and include meanings of

"sharps with engineered sharps injury prevention" and "needleless systems," in
accordance with the Act.

(2) When updating their "exposure control strategy," companies must

examine and integrate new technology.

(3) Employers are required to seek employee opinion on suitable

engineering controls, and

4.3 UNITED KINGDOM

61 NEEDLESTICK SAFETY AND PREVENTION ACT, Total Medical Compliance (August 30, 2021, 02:00
pm) [Link]
 62
Employment Rights Act (ERA) 1996
Many previous labor laws, like the Contracts of Employment Act 1963, the
Redundancy Payments Act 1965, Employment Protection Act 1975, and Wages Act
1986, were updated by Employment Rights Act (ERA) 1996. It is applied in the entire
UK. The rights of employees in instances like wrongful dismissal, maternity leave,
etc., are all discussed under ERA. The Labour govt proposed an amendment to it in
1997, which was later done so by Parliament, thereby increasing an employee's
authority to ask for not so stringent working hours. Among essential rights granted to
employees or enhanced by ERA are the following :

1. The right to be given employment particulars

The major agreements between employee and employer are to be documented

in written and communicated to employees before employment begins, according to
Sec 1(2) as modified by
Employment Rights (Employment Particulars and Paid Annual Leave)
(Amendment) Regulations 2018. An employment contract or a shorter "written
statement of particulars" might be the document. Between the employee and the
employer, signing creates an enforceable

[Link] and detriment

A company's secret or private information may not be disclosed to a third

party under the ERA 1999

3. Dismissal: notice and reason

Before a contract is ended, a "reasonable notice" u/s 86 is required. This is true

for both employees and employers. The employee's employment history determines
the duration of a reasonable notice period. If an employee has worked for above one
month, they are entitled to a one-week notice period before being fired. After two
years, the length of a reasonable notice period increases to 2 weeks. It rises from 1 to

62 The employment relationship, Institute of Employment Rights Journal Vol. 3, No. 1, Rolling out the
Manifesto for Labour Law (2020), pp. 62-72
3 weeks after three years, and so on, up to a maximum of 12 weeks. If an employee's
contract of employment mentions it, he can also give compensation in place of notice.

[Link] dismissal

The employee is protected against being fired unfairly under Section 94 of the
Act. The cause for employee's dismissal shall be specified by employer. Dismissals
connected to following are automatically deemed unjust: (a) health issues

(b) assertion of legal rights

(c) Seeking permission for not so stringent working

The following are valid (just) reasons for dismissing an employee as stated in
Section 98(2) :

(a) refers to the employee's capacity or qualifications to execute work of

the type he was hired bythe employer.

(b) pertains to the employee's actions.

(ba) is the employee's retirement.

(c) the employee was no longer needed, or

(d) employee couldn’t continuously work in stature he had without

violatinion obligation or limitation imposed by or under an enactment (either on
his own or on the part of his employer).

Furthermore, u/s 98 (1), employer has authority to terminate employee for any other
serious issue.

[Link] payments63

If an employee's employment gets outdated, they have the right to remuneration u/s
135. They have worked for the employer for a required period of time to become an

63 [Link]
redundancy/ redundancy_payments.html#:~:text=The%20statutory%20redundancy%20payment
%20is,One%20further %20week's%20pay
established employee. The employee must have worked for the same employer for
two years to be qualified for redundancy pay out (s 155). Redundancy payments are
not available to employees who have attained retirement age (s 156). By terminating
the employee for a different cause, such as misconduct or capacity, as indicated
above, the company might avoid paying the employee compensation. The length of
service and the employee's age are used to determine redundancy compensation. If the
employee is under the age of 21, each year will be compensated with half a week's
salary. If the employee is between the ages of 21 and 40, each year will be
compensated with one week's salary. If the employee is above 40, each year will be
compensated with one and a half weeks' salary. The redundancy payment's highest
level is about equivalent to the National Minimum Wage per week.

[Link] insolvency

In event that an employer goes bankrupt and there are zero finances left to pay,
Section 182 protects him or her. If the employer is bankrupt, the Secretary of State
will reimburse employee on behalf of the government from an NIF.
64
Health and Safety at Work, etc. Act 1974
The Health and Safety at Work etc. Act 1974, often called HSW, HSWA, HASAW
1974, or HASAWA, is an English statute that establishes foundation for regulating
workplace health and safeguards. The law specifies broad responsibilities of everyone
in most workplaces, from employers (sec 2) and workers (sec 7,8) through owners,
managers, and maintainers of work premises (and so on). In a nutshell, HASAWA
1974 mandates that employers provide:  Proper employee training to make sure that
health and safety measures are adhered to.

 Workplace welfare provisions.

 A safe working environment

64 Health and Safety at Work etc Act 1974, Health and Safety Executive (August 30, 2021)
[Link]
  Provision of necessary information, education, and monitoring in a
timed way

Employers with five or more workers are needed to keep a written record of
their health and safety policy and engage with employees on relevant policies.
65
Workplace (Health, Safety, and Welfare) Regulations 1992
The HSW rules include all aspects of the workplace and require employers to provide
an environment that is safe and acceptable for jobs done there. Everything from
comfort level and sanitation measures to provisions for acceptable working conditions
to workplace safety fall under this category.
66
Personal Protective Equipment Regulations (PPE) 2018
Some workplaces are harmful to employees' health and safety. In such cases,
employers have a responsibility to provide PPE to their employees to limit the risk of
injury after other measures have failed. Prior to delivering PPE, a thorough risk
assessment must be completed to guarantee that potential risk can't be mitigated
through other means.

The following are the most important aspects of PPE regulation:

 Suitable provision - Where PPE is necessary, it must be adequate for

job activity and associated risk and be CE registered in line with PPE Regulations
2002.

 Compatibility and efficacy - When more than one item of personal

protective equipment is necessary for an activity, the equipment must still be
functional when worn simultaneously. When one item is worn, the second item
should not be ill-fitting and ineffective, and vice versa.

 Maintenance and storage - PPE must be handled, stored, and

maintained appropriately. Reusable items must be cleaned properly and
maintained in good operating order. Replacement parts for disposable devices
must be compatible with original piece. It's also important to consider having
65 Ibid.
66 Supra 28.
 spare PPE on hand and appointing someone to oversee how and when items are
maintained.

 Use and training - It is the employer's obligation to ensure that workers

receive adequate training on how to use PPE, what degree of responsibility they
have for PPE maintenance, and that they are properly educated about the hazards
that the PPE is designed to protect them from. It is also the employer's obligation
to ensure that any PPE given is appropriately used.

 Employee responsibility - It is employee's obligation to utilize PPE in

line with instructions and training. Employees are also accountable for notifying
management of any equipment damage, defects, or loss.

It must be emphasized that when PPE is designated as a need of control procedure, it

has to be provided at zero cost to employees.

Management of Health and Safety at Work Regulations 1999

According to Management of Health and Safety at Work Regulations, an employer
shall analyze work-related activities and adopt any necessary controls to tackle
possible hazards to employees' health, safety, and welfare. 67 Employers have a
responsibility to:

 Provide staff with appropriate health and safeguarding training.

 Ascertain those appropriate processes are in place in emergency.

 Carry out an adequate evaluation of risks to workers' health, safety,

and

 Carry out particular risk assessments for the vulnerable individual that
have

 Appoint a qualified individual or persons to be in charge of the

workplace's

67 “How can occupational safety and health be managed?”, The ILO (August 30, 2021)
[Link]
guide-for-labourinspectors/how-can-osh-be-managed/lang--en/[Link]
4.4 CANADA

Because Canada is a federal state, law-making is divided among one federal, 10

provincial, and 3 territory administrations. The kind and location of an employer's
workplace determine the employer's obligations. The following legislation provide
workplace health and safety requirements:

» Canada Labour Code (R.S.C., 1985, c. L-2), Part II (Federal)

» Provincial health and safety legislation

» Canadian Criminal Code, R.S.C., 1985, c C-46

68
Canada Labour Code, Part II (Federal)
Like the Canadian provincial jurisdictions discussed below, the federal jurisdiction of
Canada compels every employer to guarantee that the health and safety of every
employee are safeguarded while at work. Whether a federally regulated Canadian
business may be held liable for failing to protect the health and safety of its Canadian
employees working overseas is contingent on the Canadian regulator's willingness to
extend its jurisdiction to acts outside of Canada. “Employers must take all precautions
feasible in the circumstances” when assessing risk and creating a program to keep
Canadian workers safe. As a result, no matter where an employer deploys personnel
globally, all companies should prepare ahead to limit the risk of Canadian authorities
exercising authority by making every effort, when reasonable, to practice and comply
with Canadian regulations.
79
Provincial Occupational Health and Safety Legislation
If a Canadian employer is not governed by the federal government, it is governed by
the province. As previously stated, Canada's ten provinces and three territories each

68 “Canada Labour Code, Part II: An Overview”, CCOHS (August 30, 2021)
[Link] 79 Supra 32.
have their own occupational health and safety regulations. This includes, but is not
limited to, the provincial industries listed below:

 Healthcare.

 Logistics and warehousing.

 Manufacturers, etc.

Employers subject to provincial regulation must also take all necessary steps to avoid
occupational injuries or accidents. Reasonable precautions, also known as reasonable
care, refer to the care, caution, or action that a reasonable person would take in
comparable circumstances. What is acceptable varies on the circumstances, but in
general, documented rules, practices, and processes are the first step. The policies
show and document that workplace audits were conducted and that hazardous
behaviors and circumstances were identified and remedied through worker training
and orientation. Supervisors must also be capable and well-trained to recognize and
handle hazards.69

While companies subject to provincial regulation may be held liable for failing to
protect the health and safety of their Canadian employees traveling or working
overseas, a recent interprovincial case is significant and instructive. In Ontario, the
Occupational Health and Safety Act 70 not only requires employers to take all
reasonable precautions for a worker's safety, but it also protects workers from
retaliation if they report a health and safety concern to the employer (also known as
"whistle-blower" protection).

In Diversified Transportation Ltd71., after bringing health and safety problems to his
employer's attention, a worker claimed to the Ontario Labour Relations Board
("OLRB") that he had been fired or reprimanded. The employer was located in
Ontario, Canada, while the employee was assigned to British Columbia, Canada.
Despite the employee's allegations about a workplace outside of the province, the

69 Supra 32.
70 R.S.O. 1990, CHAPTER O.1 [Act].
71 [2015] O.L.R.D. No. 2616.
OLRB decided it had jurisdiction to hear the case. The OLRB, on the other hand, was
careful to distinguish between an employer's basic need to take all reasonable
precautions in the circumstances and particular occupational health and safety norms
laid forth in provincial legislation.

4.5 NEW ZEALAND

New Zealand labor law sources are legislation (Acts of Parliament) and common law
(principles developed by Courts and Tribunals). The "minimum code" is a collection
of legislation that is commonly referred to as such. The minimal entitlements of New
Zealand employees are outlined in this set of legislation. The Employment Relations
Act of 2000, passed on October 2, 2000, is the most important legislation. The
Employment Contracts Act of 1991 was repealed by the ER Act. Because it took a
traditional contractual approach to the employment relationship and was founded on
the idea that employers and employees had equal negotiating power, the ECA drew a
lot of worldwide interest. It was implemented in 1991 and afterward. Although certain
sectors are split on the importance of the ER Act, the consensus is that it brings a far
more conventional and modest approach to labor market regulation. Several other
legislations that affects the working relationship and the labor market are
complemented by the ER Act.72

In New Zealand, the most significant legislation governing the labor market and the
employment relationship are:

The ER Act - Freedom of association, recognition, and operation of unions, etc. are all
covered.

The Bill of Rights Act 1990 establishes essential freedoms such as freedom of
association, peaceful assembly, and expression.

72 “Employment rights”, New Zealand Now (August 30, 2021)

[Link]
The Holidays Act 1981 establishes minimum entitlements to three weeks of paid
annual leave, five days of exceptional leave (for illness, bereavement, and other
reasons), and 11 days of public holidays each year for 12 months of work.

Minimum Wage Act 1983 - It establishes employee minimum salary rates.

Privacy Act 1993 lays forth a number of privacy rules, including those governing the
acquisition, use, and disclosure of personal data. Employee information is included in
the category of personal information.

The Equal Pay Act 1972 - It is a law that aims to eliminate and prohibit discrimination
in employee compensation rates depending on an employee's gender.

The Health and Safety in Employment Act 1992 - This Act mandates that both
employers and workers make efforts to provide a safe working environment. The
main goal of the Health and Safety Act is to protect employees, visitors, contractors,
and subcontractors from injury while they are on your premises. It does this by
placing a wide variety of legal obligations on both employers and employees. It aims
to do this in two ways. First, it recognizes that positive work connections lead to safe
and healthy workplaces. Those directly involved in the job (employers, workers, etc.)
are typically in the greatest position to decide on specific safety precautions for their
workplace. The only guaranteed method to do so is to handle all dangers in a
systematic manner.

Specific mechanisms are in place to promote these principles:73

Reiterate that the employer or other person in charge of the job has primary
responsibility.

 Recognize that workers, like everyone else, have duties to themselves

and

 Employers and workers must work together in good faith to bring

those two sets of obligations together.

73 Supra 37.
  Have the assumption that including employees in health and safety
concerns will bring readily accessible expertise to bear on the issues.

 Identification and Control of Hazards

 Information, Training, and Supervision

 Accident Investigation and Reporting

 Procedures in Case of an Emergency

The Accident Insurance Act 1998 - This Act establishes New Zealand's no-fault
system, under which employees who are injured at work are entitled to compensation
through a governmentfunded insurance plan. Employees cannot claim compensatory
damages for such injuries under common law as a result of this arrangement.

The Human Rights Act 1993 - Discrimination based on sex, color, family status,
political ideology, and other listed factors is specifically prohibited by this Act. These
restrictions are explicitly included in the work environment by the ER Act.

4.6 COMPARATIVE ANALYSIS

Depending upon innumerable factors, every country has its own set of requirements
and thus has different laws on every topic virtually. No two countries have or can
have the same approach to a particular issue. This is why comparative analysis helps
address common issues as it brings up unique and different solutions to a problem.

There is no doubt that developed countries have such labor laws that look after the
health and safety of their employees, and as a result of this, by use of term “health,” it
is meant both physical and mental health and not merely physical health. This is a
common factor among all the developed countries discussed hereby. The labor laws
look after the mental health also, though indirectly. As far as a special statute on the
health care sector is concerned, there is no explicit statute in at least the discussed
nations here. However, UK’s Personal Protective Equipment Regulations (PPE) 2018
fairs out on this aspect compared to other nations. Though enacted in 2018, its
relevance came to be realized much later in 2020 and 2021 when Covid-19 struck the
world, and PPE kits came to have a renewed level of importance. However, this does
not mean that other countries discussed lacked behind in looking after the safety of its
workforce in workplace. New Zealand has done the best job as far as combating
Covid-19 is concerned. Occupational Health and Safety has been taken by in an
equally serious manner in all developed nations.

However, the case of Canada seems to be a bit different. The reason is that the health
aspect is dealt with by the states and not the centre compared to other countries. This
makes things slightly different from province to province. With businesses and trade
no longer being limited to one particular country, let alone the question of one
particular province or city, this aspect is bound to give rise to several issues related to
jurisdiction when cases come up accordingly.

Regarding US, it is essential to appreciate the Needlestick Safety and Prevention Act,
which seems to be one of its kind. Virtually no other country discussed or even
otherwise before the pandemic of 2020 has a similar law that regulates exposure to
some viruses. This puts the US above other countries. Also, in developed nation like
discussed, there is a culture of sensitivity and national pride which lacks in developing
countries like India. Hence, the Indian govt must ensure to inculcate sensitivity
training in medical college syllabus.

Another essential point which the developing countries must learn from all
developing nations is governmental accountability. The corporations are responsible
for showcasing their efforts in protecting their workers' health annually to the
government. This undoubtedly has a positive impact.

As compared to developed nations, India lacks much behind them. The reason is
pretty simple laws are too old and redundant to keep up with the pace of today’s
times. Only after the current pandemic has health in the workplace taken up as an
issue. India has no special statute which on Occupational Health and safety, unlike the
countries discussed. Though there are provisions protecting workplace health in the
different labor laws, there is no single statute on this issue. This undoubtedly
decreases the level of seriousness with which OSH is understood and adhered to in
India. During the Covid 19 pandemic, it came to be realized that India has no law like
the Needlestick Safety and Prevention Act of USA, which is instrumental in
regulating exposure to bloodborne pathogens for everyone working in relevant
occupations and professions. India does punish intentionally exposing the public to
dangerous microorganisms, but it doesn’t have any regulations or strict guidelines.
The importance of the same was realized only much recently due to Covid 19. Unlike
the UK, India had no statute or regulation which dealt with supply of PPE kits. This
made it difficult to handle things during the initial days of a surge in number of
coronavirus cases. From the same, India must learn to enact a law that deals
specifically with the supply of necessary health equipment and its related aspects.

Another important point that is a must for being mentioned is the granting of
compensation in case of workplace mishaps. The statute has a limited scope and
unfortunately in our country, hardly anyone prefers litigation for seeking
compensation. Thus, there is less precedent in India in this regard. However, in
countries like UK and US, this is not the case. Common law remedy is often invoked
for compensation for workplace accidents, and even the statutory guidelines are much
clearer and, most importantly, wider in their ambit.

India can take a cue from Canada in order to implement its labor laws and make the
necessary changes. This is simply because OSH is more of the state’s responsibility in
Canada. With labor falling within The Constitution of India, 1950’s Concurrent List,
both state and Centre can make their relevant set of laws in this regard. However, this
would cause jurisdictional conflicts like in Canada. Still, the same will be of almost
negligible inconvenience if we consider the emphasis which would be laid on OSH in
such a case. States have a better idea of its peculiar issues. Hence since even health is
in State List, state laws can play an instrumental role. The states must take a cue from
Canada in this regard - how do states manage OSH, prevent jurisdictional conflicts,
etc.

Unlike New Zealand, India lacks any comprehensive statute on eradicating and
punishing workplace discrimination. The ambit of such discrimination is as wide as
possible in New Zealand, but the same is not the case in India. Discrimination is a
much-ignored topic when it comes to workplace issues. The Constitution protects us
from discrimination, which is undoubtedly true, but it doesn’t penalize the
wrongdoers. It just states the rights we have. It is important that India takes a lesson
from New Zealand in this regard.

CHAPTER-5 CONCLUSION

5.1 INTRODUCTON:- This paper is primarily focused on labor regulations in

the health workforce since health workers should be given utmost importance in this
era. Ignorance of health workers cannot be justified anymore. Health personnel meets
the overall requirements and desires of patients. Likewise, Governments are supposed
to take responsibility for meeting the needs of the health workforce. In most nations,
governments do so. But are they fulfilling the demands of the workforce? Health
workers have got rights too. These cover a wide range of human rights, including the
right to decent employment and freedom of association, as well as equal opportunity
and discrimination protection. In addition, four fundamental labour laws were merged
in the Code on Wages, which was enacted in 2019. The four new Labour Codes were
meant to take effect on April 1, 2021, but due to an increase in COVID cases and the
probable impact of the new Codes on per-employee costs, the government has
postponed their implementation to a later date. The health workforce is an integral
part of this covid situation, but due to covid rise, they are getting denied their rights.
This is not all acceptable.

n this horrific situation we have been facing for the past one, and a half years, if at all
we have strived, it is majorly because of the health workforce who work day and night
continuously. They are not working for their dear and near ones but ours. So, our
moral and legal obligation is to protect the health workers from the ill will they face.
Those who are most prone to get affected by the virus are the health workers. In a
way, they put themselves in danger to take care of others. We talk about the mental
health of people during the pandemic since most of the people lost their jobs and
everyone is going through a worse stage. It is high time we talk about the mental
health of the health workers who work tirelessly for more than their working hours,
ignoring physical fatigue. The World Health Organization's charter, which was
released on World Patient Safety Day in 2020, clearly states that governments at both
the national and local levels must take five main steps to protect health workers from
violence, improve their mental health, protect them from physical and biological
hazards, advance national programs for health worker safety, and connect health and
safety.

The health sector is fundamentally about people; there can be no health care without
health personnel. In 2012, the United Nations General Assembly supported the
concept of Universal Health Coverage (UHC). It urged states to invest in health to
achieve universal access to primary health care while safeguarding people from
financial hardship. The International Labour Organization (ILO) and the World
Health Organization (WHO) are two UN specialized bodies that are directly
concerned with occupational health and safety as a whole (WHO). Various ILO
papers have recognised their critical role in safeguarding and promoting population
health throughout time. Despite this, global health workforce shortages and
imbalances exist. Like most other countries, India attempts to strengthen occupational
health and safety (OHS) by enacting legislation that governs the steps that businesses
must take74.“The Epidemic Diseases (Amendment) Ordinance 2020 amends the
Epidemic Diseases Act, 1897 to make violence against healthcare professionals
during an epidemic a cognizable and non-bailable offence with heightened
penalties.”87. Healthcare establishments deserve unique regulation in terms of
occupational safety and dangers, as well as minimum stipends, wages, and insurance
coverage for various types of healthcare staff. Different laws and plans, such as the
74 International, Governmental and Non-Governmental Safety and Health [Link],
[Link]
legal/internationalgovernmental-and-non-governmental-safety-and-health (last visited Aug 31, 2021)
Indian Public Health Standards and the Clinical Establishments (Registration and
Regulation) Act, 2010, that set out the requirements for medical care foundations,
should also be updated to reflect the principles that have been discussed above in the
form of guidelines proposed by the World Health Organization. The Indian
government is convinced that social justice cannot be accomplished without safe and
healthy working conditions. Achieving safety and health at work is critical to
economic progress.

The guideline to protect health workers from physical and biological hazards ensuring
adequate environmental services inclusive of water, sanitation, etc., providing
resources to prevent and tend to injuries, harmful radiations, etc. and most
importantly, the guideline to develop and implement national programs for
occupational health and safety of health workers should be embedded in the labour
law.

5.2 INDIAN CONTEXT

During the first wave of covid, the central government asked us to clap utensils to
show support towards the health workers. Is this the way of supporting those people
who we call “angels”? The Ministry of Health, Government of India, proposed the
passing of the ‘Health Services Personnel and Clinical Establishments (Prohibition of
Violence and Damage of Property) Bill,’ which had contemplated the imprisonment
of up to 10 years and the imposition of a fine of as much as Rs 10 lakh on those who
assault healthcare personnel. The Epidemic Diseases (Amendment) Ordinance, 2020,
aimed at protecting healthcare professionals against violence, has been promulgated
in 2020, with the due consent of President Ram Nath Kovind only deals with that
particular aspect of protection of health workers in terms of violence meted out
against them, their property, including their living and working premises, cognizable,
non-bailable offences. As mentioned earlier, the five guidelines proposed by the
World Health Organization are far from being implemented, especially in the health
sector in India. Healthcare workers are more likely to show symptoms of anxiety,
sadness, insomnia, and discomfort, in addition to the occupational and safety
challenges they encounter. Unlike other countries, Indian doctors and

87
India’s healthcare workers are the most vulnerable, but there is no
framework for their health ThePrint, [Link]
workers-most-vulnerable-but-no-framework-for-their-health/459827/ (last visited
Aug 31, 2021)
nurses are overworked and have a lot of mental and physical issues due to the same,
which are not being regarded as issues at all. In India, there are various regulations
governing workplace safety, employment management, occupational environment,
and so on. Still, the problem with having so many laws in place is the lack of proper
recourse leading to absolute confusion. In terms of having legislation for their
protection, only the aspect of violence being meted out against them has been
addressed in the form of passing the Epidemic Diseases (Amendment) Ordinance
2020, amending the Epidemic Diseases Act, 1897 to make violence against healthcare
workers during an epidemic a cognizable and non-bailable offence with enhanced
punishment.75The Indian government has also made measures to improve workplace
health and safety. The legislation regarding health and safety at workplace seemed to
be all over the place and somewhat confusing. Thus, the Occupational Safety, Health,
and Working Conditions Code, 2019, was presented in Parliament in 2019 to bring
together 13 distinct laws governing occupational health and safety in several
industries.

The COVID-19 pandemic has shown the requirement for reinforcing the health and
well-being laws. It is a chance for the Indian government to reconsider general
wellbeing by expanding speculations and to address a portion of the abnormalities that
have gotten settled in. The new situation where government medical workers in the
public sphere, i.e., in the government sector, didn't get their pay rates throughout the
lockdown period embodies the insensitivity of the public authority.

75 Available at [Link]
framework-for-theirhealth/459827/ . Last accessed on 19.07.2021.
5.3 INTERNATIONAL PERSPECTIVE
The global issue of occupational health and safety is currently adopting a new
direction. The key contributing elements to this idiosyncrasy appear to be the rapid
industrial and commercial development occurring in emerging countries and the
introduction of new products and market processes resulting from these
developments. Every country's health workforce has an immediate and noticeable
impact on its national and global economies. Health-care workers are critical to the
execution of healthcare policies and the delivery of healthcare services. On the other
hand, their rights are routinely ignored, and many health care workers complain about
terrible working conditions, long hours, and low pay. As a result, many nurses,
particularly in the public health sector, have chosen to leave. The essential concepts of
the human right to healthcare and personal protection are endorsed by the
International Labour Organisation. The World Health Organization's Health Worker
Safety Covenant is an essential prerequisite for ensuring that health care workers
receive the workplace safety, training, compensation, and recognition they deserve76.

The pandemic has also demonstrated how essential it is essential to safeguard health
workers to maintain a functional health system and society. Art 23 of UDHR declares
that the freedom to work encompasses "just and beneficial working conditions" as a
universal human right. Through sectoral labour standards and social discourse, the
ILO supports improvements in working conditions and labour relations in the
healthcare system and engages with WHO to foster a supportive, facilitating, and
healthy workplace for health care workers. In 2003, the International Labour
Organization (ILO) announced a global strategy to promote health and safety at work,
which includes the development and promotion of applicable instruments and
technical assistance77. Art 23, 24, and 25 of the UDHR provide plenty of employment
rights. There is an international agreement on the essence of granting safe and healthy
employment, which is represented in several treaties, reiterating legal concepts from

76 [Link], [Link]
[Link]? sfvrsn=bcabd401_0 (last visited Aug 28, 2021)
77 International Labour Standards on Occupational Safety and Health [Link],
[Link]
occupational-safety-andhealth/lang--en/[Link] (last visited Aug 25, 2021)
several countries, such as domestic laws or constitutionally guaranteed health security
measures. In UDHR, there is a significant group of rights dealing with employment
and “preferable working conditions.”

The first step in supporting workers' mental health, in addition to psychological and
sociological support for all types of workers, is to understand what they feel and the
reasons that affect them. Governments must recognise and emphasize the vital role of
personal protective equipment along infection control practices and water, sanitation,
and cleanliness technologies. The ILO also emphasized the requirements of the most
vulnerable employees and enterprises, particularly those in the informal economy, as
well as migrant and domestic workers.

Healthcare professionals are concerned about their colleagues, family, friends,

regions, and country. We should assist them in combating any possible short or long-
term repercussions of this pandemic. It is critical that authorities view workers as
human beings rather than objects only to be used. The safety of healthcare
professionals must be assured as part of the worldwide approach. The right to health
is a human right recognized under UDHR and has also been granted constitutional
legitimacy under several countries’ constitutions.
The Fair Labor Standards Act (FLSA) of the United States establishes a federal
minimum wage, overtime compensation, and child labor safeguards. The Act covers
hospitals, institutions primarily engaged in the care of the sick, elderly, mentally ill, or
disabled who reside on the premises, schools for children who are mentally or
physically disabled or gifted, etc. The FLSA does, however, contain several
subminimum pay rates like disabled workers, etc. The Patient Protection and
Affordable Care Act amended FLSA to include a new Section under the Act. Covered
employers are required to offer nursing mothers break time

The Occupational Safety and Health Act of the United States was formulated in 1970
in order to enhance workplace health conditions. The Occupational Safety and Health
Act is enforced by the Occupational Safety and Health Administration (OSHA). The
Act says: "Each employee shall comply with occupational safety and health standards
and all rules, regulations, and orders issued pursuant to this Act which applies to his
actions and conduct." Penalties and fines are imposed on violators, which are
increased annually for inflation.

The Needlestick Safety and Prevention Act of the United States was enacted in 2000,
revising OSHA’s standard regulating occupational exposure to bloodborne pathogens.
OSHA issued its regulations reflecting the Act and its requirements in Federal
Register. The rules went into force on April 18, 2001. It aims to minimize healthcare
employees' exposure to bloodborne infections by putting extra sharps-related
regulations on employers, such as hospitals and ASCs.

The Employment Rights Act (ERA) 199678 of the United Kingdom updated many
previous labor laws, like the Contracts of Employment Act 1963 and the Redundancy
Payments Act 1965. The rights of employees in instances like wrongful dismissal,
maternity leave, etc., are all discussed under this Act. The Labour govt proposed an
amendment to it in 1997, which was later done so by Parliament, thereby increasing
an employee's authority to ask for not so stringent working hours. Several rights were
prescribed under the Act, including the Right to be given employment particulars,
right to get notice and reason for dismissal, right against unfair dismissal and right to
remuneration, etc.

Health and Safety at Work, etc. Act 1974 of the United Kingdom establishes
foundation for regulating workplace health and safeguards. The law specifies broad
responsibilities of everyone in most workplaces, from employers and workers through
owners, managers, and maintainers of work premises. The Act provides proper
employee training, workplace welfare provisions, a safe working environment,
necessary information, education, etc.

Workplace (Health, Safety, and Welfare) Regulations 1992 79 include all aspects of
workplace and require employers to provide an environment that is not just safe but
also acceptable for jobs done there. Everything from comfort level and sanitation
measures to provisions for acceptable working conditions to provisions for workplace
safety fall under this category.
78 The employment relationship, Institute of Employment Rights Journal Vol. 3, No. 1, Rolling out the
Manifesto for Labour Law (2020), pp. 62-72
79 Ibid.
Management of Health and Safety at Work Regulations 1999 states that an employer
shall analyze work-related activities and adopt any necessary controls to tackle
possible hazards to employees' health, safety, and welfare.

Personal Protective Equipment Regulations (PPE) 2018 poses a responsibility to

provide PPE to their employees to limit risk of injury after other measures have failed.
Prior to delivering PPE, a thorough risk assessment must be completed to guarantee
that potential risk can't be mitigated through other means.

In Canada, there is Canada Labour Code, Provincial health and safety legislation, and
Canadian Criminal Code for the protection of health workers. Canada's ten provinces
and three territories each have their occupational health and safety regulations. This
includes healthcare. In Ontario, the Occupational Health and Safety Act 80 not only
requires employers to take all reasonable precautions for a worker's safety, but it also
protects workers from retaliation if they report a health and safety concern to the
employer.

The Health and Safety in Employment Act 1992 of New Zealand Act mandates that
both employers and workers make efforts to provide a safe working environment. The
main goal of the Health and Safety Act is to protect employees, visitors, contractors,
and subcontractors from injury while they are on your premises.

5.4 CONCLUDING REMARKS AND SUGGESTIONS

The legislation regarding health and safety at workplace seemed to be all over the
place and rather confusing in India. Rather than having numerous laws regarding
health and safety at the workplace, it is necessary to have specific legislation that
clearly states the rights and protection granted specifically for the health workers.
Thus, the Occupational Safety, Health, and Working Conditions Code, 2019, was
presented in Parliament in 2019 to bring together 13 distinct laws governing
occupational health and safety in several industries. On the recommendation of the
National Occupational Safety and Health Board, the central government must set

80 R.S.O. 1990, CHAPTER O.1 [Act].

occupational safety standards for various industries under the Code. By inclusion,
health workers will also be included in this sense. Yet, it is not clear as to whether it
extends to healthcare establishments. Considering the case of nurses in India, it is a
known fact that they are underpaid. Why do nurses from India migrate to other
countries? The reason is evident. They get paid more for lesser working hours
compared to India. According to statistics, thousands of nurses fly to other countries,
not because they don’t want to serve the country but to improve their standard of
living. Nurses are the vital component of the health workforce. They deserve better
than what the country provides after being referred to as angels often. Not only wages
but also the physical and mental health of the health care personnel should be given
utmost importance since they are the reason we are able to strive through this
pandemic. Compared to developed nations, India lacks laws capable of providing
what is needed for the health workers. The reason is, laws are too old and redundant
to keep up with the pace of today’s times. It is only after the current pandemic that
health in workplace has been taken up as an issue. India has no special statute which
on Occupational Health and safety, unlike the countries discussed. Though there are
provisions protecting workplace health in the different labor laws, there is no single
statute on this issue. This undoubtedly decreases the level of seriousness with which
OSH is understood and adhered to in India. India can take a cue from Canada and
make the necessary changes because OSH is more of the state’s responsibility in
Canada. Discrimination is a much-ignored topic when it comes to workplace issues.
Unlike New Zealand, India lacks any comprehensive statute on eradicating and
punishing workplace discrimination. Constitutional provisions alone wouldn’t do the
work. The researcher strongly feels that healthcare establishments deserve special
legislation in terms of occupational safety and hazards and terms of minimum stipend,
wages, etc., for different kinds of healthcare personnel, in terms of insurance cover,
etc. For the effective execution of these norms, different laws and plans, which set out
the prerequisites for medical care foundations like the Indian Public Health Standards
and the Clinical Establishments (Registration and Regulation) Act, 2010, ought to
likewise be refreshed to mirror the principles that have been discussed above in the
form of guidelines proposed by the World Health Organization. However, hope that
the four new Labour Codes meant to take effect on April 1, 2021, will be
implemented soon.

BIBLIOGRAPHY

STATUTES AND LEGISLATIONS

(i) EPIDEMIC DISEASES ACT, 1897

(ii) THE OCCUPATIONAL SAFETY, HEALTH, AND WORKING
CONDITIONS CODE, 2019
(iii) THE INDIAN PUBLIC HEALTH STANDARDS AND THE CLINICAL
(iv) ESTABLISHMENTS (REGISTRATION AND REGULATION) ACT,
2010
(v) HEALTH SERVICES PERSONNEL AND CLINICAL
ESTABLISHMENTS
(vi) (PROHIBITION OF VIOLENCE AND DAMAGE OF PROPERTY)
BILL
(vii) THE EPIDEMIC DISEASES (AMENDMENT) ORDINANCE, 2020
(viii) THE CODE ON WAGES, 2019
(ix) THE PAYMENT OF GRATUITY ACT, 1972;
a. THE MINIMUM WAGES ACT, 1948;
(x) THE INDIAN PENAL CODE, 1860
(xi) THE WORKMEN’S COMPENSATION ACT
(xii) THE FACTORIES ACT 1948
(xiii) THE MATERNITY BENEFIT ACT 1961
(xiv) THE PAYMENT OF BONUS ACT 1965
(xv) FACTORIES ACT 1948
(xvi) EMPLOYEES PROVIDENT FUND ACT 1952
(xvii) DISASTER MANAGEMENT ACT 2005

FOREIGN LEGISLATIONS

(i) FAIR LABOR STANDARDS ACT

(ii) THE PATIENT PROTECTION AND AFFORDABLE CARE ACT
(iii) THE OCCUPATIONAL SAFETY AND HEALTH ACT
(iv) THE NEEDLE STICK SAFETY AND PREVENTION ACT
(v) EMPLOYMENT RIGHTS ACT (ERA) 1996
(vi) HEALTH AND SAFETY AT WORK, ETC ACT 1974
(vii) WORKPLACE (HEALTH, SAFETY AND WELFARE)
REGULATIONS 1992
(viii) PERSONAL PROTECTIVE EQUIPMENT REGULATIONS (PPE)
2018
(ix) MANAGEMENT OF HEALTH AND SAFETY AT WORK
REGULATIONS 1999
(x) CANADA LABOUR CODE (R.S.C., 1985, C. L-2), PART II
(FEDERAL)
(xi) PROVINCIAL HEALTH AND SAFETY LEGISLATION
(xii) CANADIAN CRIMINAL CODE, R.S.C., 1985, C C-46
(xiii) THE EMPLOYMENT RELATIONS ACT OF 2000
(xiv) THE EMPLOYMENT CONTRACTS ACT OF 1991
(xv) THE BILL OF RIGHTS ACT 1990
(xvi) THE HOLIDAYS ACT 1981
(xvii) MINIMUM WAGE ACT 1983
(xviii) PRIVACY ACT 1993
 (xix) THE EQUAL PAY ACT 1972
(xx) THE HEALTH AND SAFETY IN EMPLOYMENT ACT 1992
(xxi) THE ACCIDENT INSURANCE ACT 1998
(xxii) THE HUMAN RIGHTS ACT 1993

INTERNATIONAL CONVENTIONS & PROGRAMS

(xxiii) THE WORLD HEALTH ORGANIZATION'S CHARTER

(xxiv) UNIVERSAL HEALTH COVERAGE
(xxv) THE UNITED NATIONS ENVIRONMENT PROGRAMME (UNEP)
(xxvi) THE UNITED NATIONS HIGH-LEVEL COMMISSION ON
HEALTH, EMPLOYMENT, AND ECONOMIC GROWTH
(COMMHEEG)
(xxvii) GLOBAL STRATEGY TO PROMOTE HEALTH AND SAFETY AT
WORK
(xxviii) UNITED NATIONS' UNIVERSAL DECLARATION OF HUMAN
RIGHTS
(xxix) INTERIM RECOMMENDATIONS FROM WHO 2020
(xxx) THE INTERNATIONAL COVENANT ON VIVIL AND POLITICAL
RIGHTS (ICCPR)
(xxxi) THE INTERNATIONAL COVENENT ON ECONOMIC, SOCIAL
AND CULTURAL RIGHTS (ICESCR)
(xxxii) FORCED LABOUR CONVENTION 1930
(xxxiii) EQUAL REMUNERATION CONVENTION 1951
(xxxiv)ABOLITION OF FORCED LABOUR `1957
 CONSTITUTION

(xxxv) CONSTITUTION OF INDIA

(xxxvi)US CONSTITUTION
(xxxvii) CONSTITUTION OF CANADA

BOOKS

(i) KA PANDEY, BM GANDHI’S INDIAN PENAL CODE, 210 (EASTER

BOOK COMPANY, 2019)
(ii) KC JOSHI, INTERNATIONAL LAW AND HUMAN RIGHTS, 381-390,
EASTERN BOOK COMPANY, (2019).
(iii) MP JAIN, CONSTITUTIONAL LAW, (LEXIS NEXIS)
(iv) RATAN LAL &DHIRAJ LAL, CODE OF CRIMANLPROCEDURE,
202, (LEXIS NEXIS, 2013).
(v) RATAN LAL &DHIRAJ LAL, INDIAN PENALCODE,5, (WADHWA
PUBLICATION, 1992).
(vi) AUF DER HEIDE, DISASTER RESPONSE: PRINCIPLES OF
PREPAREDNESS AND COORDINATION, (MOSBY 1989)
(vii) HENK TEN HAVE, DISASTER, VULNERABILITY AND HUMAN
RIGHTS,
DISASTERS: CORE CONCEPTS AND ETHICAL THEORIES, 157-174,
(SPRINGER, 2018)