Maharashtra’s sugarcane cutters become ‘doctor tai’ in fields far from healthcare

Waghmare is among the women trained under ‘Arogya Sathi’, a pilot initiative launched by the Beed district administration in partnership with the Mahila Ustod Kamgar Sanghatana to provide basic healthcare support to migrant sugarcane workers at remote worksites.

A sugarcane cutter is bandaging the wound of a cane cutter worker in the field. (Express)

Under the programme, one woman volunteer was selected for every 100 sugarcane workers through gram panchayats and linked to Primary Health Centres (PHCs) for training and referral support.
District officials said 923 women sugarcane cutters were identified under the initiative.
Waghmare said the training equipped women workers to handle injuries and illnesses directly in the fields where access to doctors is limited.

“If someone gets injured, we were taught to first clean the wound with iodine solution or Dettol using cotton, apply antiseptic lotion and then bandage it properly. If the injury is severe, we use a larger bandage and immediately take the person to the nearest PHC. For fever, cold, cough, throat infection, diarrhoea and vomiting, we know which basic medicines to give. During menstruation, women face many difficulties while working in the fields, so we were also taught about maintaining hygiene by using clean cloth pads and demanding access to clean water,” she said.

The initiative emerged from years of documentation by grassroots organisations working with migrant sugarcane workers from drought-prone districts such as Beed and Hingoli, who migrate annually to western Maharashtra and Karnataka for cane cutting.
Workers often live in temporary settlements lacking drinking water, sanitation, toilets and healthcare facilities.

The original ‘Arogya Sakhi’ model was conceptualised nearly three years ago by the Mahila Ustod Kamgar Sanghatana with support from MAKAAM, Society for Promoting Participative Ecosystem Management and SATHI-Anusandhan Trust before it was proposed to the government.
Manisha Tokle, chairperson of the Farmers’, Sugarcane Harvesters’, and Other Unorganised Women Workers’ Forum, Maharashtra, said the grassroots experiment was designed to reduce workers’ dependence on private clinics and medical shops.

A sugarcane cutter is bandaging the wound of a cane cutter worker in the field. (Express)

“For even minor ailments, workers are frequently forced to depend on private clinics or local medical shops, pushing already indebted families into further financial distress. To address this gap, grassroots organisations launched the Arogya Sakhi experiment which the government calls Arogya Sathi, training women sugarcane workers themselves to provide basic healthcare support within labour camps and sugarcane-cutting groups,” Tokle said.

Jithin Rahman, Chief Executive Officer of Beed Zilla Parishad, said the administration designed the government pilot after identifying recurring illnesses among migrant labourers.
“We identified the most common health issues faced by sugarcane workers, including skin infections, recurring fever, body pain and accidental injuries, and designed the training module accordingly. The women were taught how to manage first-aid, dress wounds, and approach the nearest PHC during emergencies. The administration also distributed first-aid kits carrying the Zilla Parishad logo,” Rahman said.

Seema Kulkarni, senior fellow at SOPPECOM and national facilitation team member of MAKAAM, said the original pilot showed measurable impact.

“According to records maintained by 12 trained Arogya Sakhis, between November 2023 and March 2024 they treated 349 patients through 855 interventions for illnesses and injuries ranging from fever and dehydration to wounds and menstrual health issues,” Kulkarni said.
The organisations estimated that the intervention helped workers save nearly Rs 4.27 lakh in healthcare expenses.

However, activists and workers alleged that the government rollout suffered from rushed implementation, inadequate training and poor follow-up.

Kulkarni said, “Government trainings were often wrapped up within an hour or two. The core principle of the original model was that the Arogya Sakhis themselves had to be migrant sugarcane labourers. But during the scale-up process, local power structures influenced selections.”
Tokle alleged that in several villages gram panchayat heads selected women from influential families instead of actual sugarcane workers.

“We repeatedly told officials that the programme would only work if the selected women were actual migrant labourers. Only a small number of women previously trained through grassroots programmes received complete medical kits during the official launch. Around 750 other women only got medicines for eight to ten days in plastic carry bags. There was no refill medicines provided later,” Tokle said.

Waghmare too said the medicines distributed under the programme were exhausted within days because entire labour groups depended on a single kit.

Kulkarni said menstrual and reproductive health formed a central part of the original model because many women continue strenuous labour despite chronic pain and illness.

“One important aspect was discouraging women from immediately opting for hysterectomies. This was precisely why the model required institutional support and recognition through the public health system. Sugar companies should also come forward and make sure that the loss of days wages does not happen because that prevents them from getting treated,” she said.
Dr Ulhas Gandal, District Health Officer, Beed, said the administration plans to review gaps in the pilot before expanding it further.

“We are going to sit with the women who have returned from sugarcane work and understand the gaps and issues they faced during the implementation of the programme. We have also requested additional funds from the district administration,” Gandal said.