OUTSOURCING OF SERVICE PROVISIONING AND CHANGING EMPLOYMENT RELATIONSHIP IN PUBLIC SECTOR HOSPITALS OF WEST BENGAL Bijoya Roy* Since the 1990s, health sector reforms are changing the ways in which services are delivered and fnanced in public sector hospitals, which is also altering the workforce organisation. Casualisation has crept in among the support staff. This not only infuences the social consciousness, value system of the workers, and working conditions but also has a signifcant impact on the quality of care. With the selective outsourcing of non-clinical services, private contractors are delegating the responsibility of employing support staff. Thus, in a scenario of contracting out of services and increasing informalisation of jobs, this article delineates the relation between the nature of non-clinical service contracts and the organisation of the casual support staffs in a public sector hospital of Kolkata. It analyses the nature of service contracts, the working conditions of workers, and the job profle for providing non-clinical services. On the basis of this analysis, it tries to highlight the impact of contracting out of services on the staff members, their wages, and patient care. Healthcare is a labour- and capital-intensive sector, and human resource is its most valuable asset. In the provisioning of healthcare services, the use of technology alone cannot ensure the execution of any work, as technology itself requires service providers with skills. Healthcare providers constitute both an asset and an investment for healthcare delivery institutions. They comprise a wide range of medical, paramedical, and non-medical personnel with varied skills and functions, including those who directly oversee the clinical care of patients to those who deal with the supportive aspects concerning the patients and the administration. These workers range from doctors, nurses, laboratory technicians, community health workers, pharmacists, and dieticians, to stewards, ward boys, cleaners, and cooks. Globally, 67 per cent of the workforce in healthcare comprises doctors and nurses (WHO, 2006). Very few countries have data on the support workers even though globally, they constitute one-third of the total workforce in healthcare. In the high-income countries, support staff members outnumber the doctors and nurses while in the low and middle-income countries, the reverse holds true. The UK has a very high density of health management and support workers per a population of thousand, as compared to the physicians, nurses, and midwives, whereas in India, no formal account exists of the support staff members working in the healthcare sector (ibid.). The Indian Journal of Labour Economics, Vol. 53, No. 2, 2010 * Junior Fellow, Centre for Women’s Development Studies, New Delhi. e-mail: bijoyaroy@gmail.com.