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Outsourcing of non-clinical services, Punjab
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Subject Area="Public / private partnership (including NGOs)." Objective="Improved hospital services."
Details for Reform Option "Outsourcing of non-clinical services, Punjab"

Background: Due to a shortage of manpower in hospitals, many non-clinical services (eg cleaning) were not being carried out, leading to an inefficient delivery of health services. Action: Punjab Health System Cooperation (PHSC), which runs health services in Punjab, decided to outsource non-clinical services to ensure efficient and smooth functioning of its hospitals round- the-clock. (i) Ambulance services: 147 drivers are hired on a contract basis. Among these 133 drivers were selected by PHSC with the remaining 36 drivers being provided by the Punjab Ex Serviceman Corporation (PESCO).(ii) Sanitary services: In addition to the permanent staff, sanitary staff are hired on contract basis in 56 health facilities. (iii) Electric and plumbing services: Hospitals which have user charge collections of more than INR 25,000 per month are allowed to hire an electrician and plumber. Monthly retention charges on these services are decided according to the bed strength of the hospital. Functional bed capacity Maximum monthly retention charge Electrician Plumbers 200 beds and above INR 1500 INR 1500 100 –200 beds INR 1000 INR 1000 Less than 100 beds INR 750 INR 750 However, electricity expenses, water expenses and other statutory expenses cannot be paid for from user charges. Results: (a) Total annual expenditure on permanent staff- INR 34139067 . Total annual expenditure on contractual staff- INR 18137756. (b) Total sanitation staff - 1104 Permanent sanitation staff- 399 Contractual sanitation staff- 705

Cost No additional cost as the reform and running costs come from user fees.
Place 154 hospitals in Punjab, including Community Health Centres, Sub divisional hospitals and District hospitals.
Time Frame Approximately one year.

Hygienic health facilities: Regular availability of sanitation staff in the hospital and accountability of the cleanliness of the facility in the contract provides hygienic health facilities. Availability of ambulance round the clock: Availability of drivers round-the-clock ensures emergency transport services for patients.


None perceived.


Government Order.

Who needs to be consulted

State government.



Sustainable as the cost of the outsourced services comes from user charges.

Chances of Replication

Many states have outsourced non-clinical services and found it to be a successful solution.


Outsourcing has become one of the management strategies to deal with routine problems encountered in the smooth functioning of health facilities. Outsourcing of services has the potential to deliver the assigned jobs with accountability.


Submitted By

Dr. Anuradha Davey, Research Consultant, National Institute of Medical Statistics, September, 2005.

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