For workers in Kutch, October 1, 2026, marked an important change. After years of representations, official correspondence and a public interest litigation before the Gujarat high court, the district was finally brought under the Employees’ State Insurance (ESI) framework.A notification issued by the Union Ministry of Labour and Employment on September 25 appointed October 1 as the date from which contributions from employers and employees would become payable under section 29 of the Code on Social Security, 2020. It also provided for Employees’ State Insurance Corporation (ESIC) benefits under chapter IV across Kutch and 14 other previously non-implemented districts, as well as 16 partially implemented districts of Gujarat. The Gujarat high court subsequently disposed of the public interest litigation (PIL) on September 29, noting that the Social Security Code had been implemented across the entire state from October 1. The court also observed that if any grievance remained, the petitioners could approach it again. This is a significant achievement. But it should also raise a larger question: will the expansion of ESI coverage result in meaningful access to healthcare for workers, or will contributions begin before adequate medical services are in place?An industrial district without comprehensive social protectionThe demand for ESI coverage in Kutch was not new. On October 5, 2023, the ESI Adhikar Manch, a coalition of trade unions, civil society organisations, social workers, activists and lawyers wrote to the Union labour ministry, Gujarat government and ESIC authorities seeking notification of the entire district. The representation highlighted Kutch’s rapid industrialisation and the occupational risks faced by workers in ports, mining, chemicals, salt production, steel, cement, engineering and other industries. The issue became more urgent because Kutch’s industrial expansion had far outpaced the expansion of its social-security infrastructure. The district has major ports at Kandla and Mundra, large mineral-based industries, salt production, special economic zones, industrial estates and thousands of smaller industrial units. The high court, while hearing the PIL, recorded the petitioners’ submission that 944 factories were registered in Kutch, of which 857 were functional. The petition also identified 43 industries involving ports, chemicals, LPG, petroleum, salt, fertilisers, steel and pipelines as hazardous. For workers in such sectors, medical protection is not an optional welfare measure. Industrial accidents, occupational diseases, heat stress, chemical exposure and other workplace risks make access to affordable and timely healthcare particularly important.Yet, until now, Kutch remained outside full territorial implementation of the ESI scheme.From representation to the courtroomThe campaign for coverage continued through 2024. On August 1 that year, a letter was sent to the Union labour minister seeking his intervention to expedite notification of Kutch and other uncovered districts.When there was still no satisfactory progress, the issue moved to the Gujarat high court through a PIL (WPPIL No. 44 of 2025), filed by Shree Kutch General Mazdoor Sangh and another petitioner.The November 21, 2025, order of the court was an important turning point. The court recorded the petitioners’ arguments regarding Kutch’s industrialisation, hazardous workplaces and the absence of ESI coverage. It also directed the respondents to file separate affidavits explaining the efforts made by the ESIC, Gujarat government and Union government towards expanding ESI coverage, specifically in Kutch. The litigation also brought important information from within the ESIC system into the public domain.ESIC surveys had already identified thousands of workersThe affidavits filed by ESIC authorities showed that pre-implementation surveys had already been conducted in important industrial areas of Kutch. A survey of Gandhidham identified 13,675 employees in the establishments surveyed, of whom 10,300 were receiving gross wages below Rs 21,000. A separate survey of Mundra identified 16,943 employees, including 9,580 earning below Rs 21,000. The survey of Adani Port and SEZ/Mundra Port and SEZ identified another 10,575 employees, of whom 4,898 were receiving gross wages below Rs 21,000. These figures are significant. They show that the problem was not a lack of knowledge about Kutch’s industrial workforce. ESIC officials had already visited establishments, collected information and examined the potential coverage.The ESIC material also contained proposals for establishing an ESIC dispensary and branch office at Bhuj, two dispensaries at Mundra and an ESIC Dispensary-cum-Branch Office (DCBO) at Gandhidham. It proposed tie-ups with hospitals in Bhuj, Mundra and Gandhidham for secondary and tertiary care. Thus, the infrastructure question was already being considered.The notification changes the legal positionThe eventual notification came under the Code on Social Security, 2020 rather than the earlier ESI Act framework. The September 25 Gazette notification specifically included Kutch among the 15 non-implemented districts and stated that from October 1, contributions would be payable and ESIC benefits under chapter IV would be provided to employees of covered establishments. The court, in its September 29 order, therefore found no reason to keep the PIL pending. The court disposed of the matter but made it clear that the petitioners could return if grievances remained. Legally, the long-standing exclusion has ended. But implementation is only beginning.Contributions and healthcare must move togetherRecent reactions in Kutch underline the challenge ahead. A September 30 report in The Times of India reported that the expansion would bring additional workers and their families under the ESI net. It also reported that Gujarat had 103 ESIS dispensaries and 11 ESIC/ESIS hospitals, while 234 community and primary health centres had been empanelled. The state government said it would recommend new ESIC hospitals, including one at Gandhidham. At the same time, a report in Divya Bhaskar on October 2 highlighted concerns raised by the Federation of Kutch Industries Association (FOKIA) about the implementation of the scheme in Kutch, particularly the relationship between contributions and the availability of medical services. The newspaper estimated that contributions from workers and employers in Kutch could amount to around Rs 9 crore a month, based on its assumptions.The concern deserves serious consideration – but it should not be framed as a choice between industry and workers. ESI is a social-insurance mechanism. Workers and employers contribute because workers are entitled to protection against sickness, employment injury, maternity and other contingencies. For workers in hazardous industries, access to healthcare is central to that protection.At the same time, workers cannot be expected to travel long distances or depend on inadequate facilities to access benefits for which contributions are being deducted from their wages. The government must therefore ensure that the expansion of coverage is accompanied by a clear medical-care plan for Kutch. The next phase must focus on implementationThe immediate priorities should be straightforward. First, ESIC should publish a clear roadmap for medical infrastructure in Kutch, including the locations and timelines for dispensaries, branch offices and hospitals. Second, existing government and private hospitals should be empanelled wherever necessary so that workers do not have to wait for new buildings before receiving treatment. Third, information about eligibility, registration, benefits, hospitals and grievance mechanisms must reach workers in Gujarati and other languages used by migrant workers. Fourth, particular attention should be paid to contractual and migrant workers, who are often the least able to navigate complex administrative procedures. And finally, workers and their organisations should have a meaningful role in monitoring implementation.The journey from the first representation in 2023 to the notification in 2026 demonstrates the value of sustained worker advocacy, civil-society engagement and judicial scrutiny. But notification is not the same as social security.Kutch’s workers have helped build the district’s ports, factories, mines, industrial estates and supply chains. They have contributed to the economic transformation that has made Kutch one of Gujarat’s major industrial regions. They now deserve a social-protection system that matches that economic transformation.October 1 may have marked the end of Kutch’s exclusion from ESI coverage. It should also mark the beginning of a new accountability: ensuring that every rupee deducted in the name of social insurance results in real, accessible and timely protection for workers and their families.Aseem Mishra is an urban development practitioner and policy advocate working at the intersection of housing rights, social equity and climate-resilient cities. Since 2016, he has served as Programme Director of the Homes in the City initiative in Bhuj, Gujarat.