Non clinical services in Karnataka's 165 secondary hospitals are in a deplorable state. Delayed release of funds to the contractors by the government and lower payments due to cut throat competition amongst the contractors are mainly responsible for this state of affairs. The contracts are given by the Directorate of Health and Family Welfare, government of Karnataka. The department has been contracting out non-clinical secondary hospital services for better maintenance in a cost-effective way for some time. Started as a pilot initiative under the Rs. 595-crore World Bank supported Karnataka Health Systems Development Project (KHSDP) in 1997, these services have been extended to 165 taluk and district level hospitals in the State.

The KHSDP officials told Pharmabiz.com that non-clinical services which included cleaning of buildings and maintenance and waste management were being contracted out to private parties after a competitive biddings process on a monthly payments basis and on satisfactory performance. The services offered by these contractors used to be encouraging to the department and the level of cleanliness had improved.

However, services started declining after the KHSDP officials handed over the contracting work of these services to the Directorate of Health and Family Welfare in April 2002. The quality of these services is extremely poor now in many hospitals. Maintenance of corridors, wards and toilets were being neglected in many of the secondary hospitals due to delay in contracting out the services by the Directorate of Health and Family Welfare officials said. Even the Lok Ayukta, which is Vigilance cell of the government of Karnataka, has received complaints from patients and doctors regarding improper management of non-clinical services in hospitals, said Dr. H Sudarshan, former chairperson, of the erstwhile Karnataka Task Force on Health and Family Welfare.

Carelessness of the health department and even stoppage of payments to contractors were the main reasons for poor sustainability of services, he pointed out. Dr. G Murugendrappa, director, department of health and family welfare admitted that services were not properly managed during the settling period from April to September but a few days back an order was issued to release funds and contract out these services, he said. After contracting out the non-clinical services the government had stopped recruitment of Class IV employees who were earlier engaged in these services. The existing Class IV staff had been transferred to the other hospitals or retained as ambulance or operation theatre assistants.

Nonetheless the contract payments were less than the salary previously paid to staff to perform the same tasks, informed KSHDP officials. Apart from the lack of cooperation from doctors, the services started declining as they had been contracted out at lower rates. In the beginning, the services were contracted for more than Rs. 20,000 a month, but presently, the same services were contracted out for Rs. 12,000 due to competition among bidders. "If the price is too low, then the service will never be up to the mark whether it is in-house or contracted out," informed KSHDP officials. There have been some problems reported with some catering services contracts at hospitals in the health system development projects in other states, where the quality and quantity of food have been reported to be worse after they were contracted out.

The World Bank report too had taken cognizance of the poor performance of the non-clinical services in Karnataka in areas requiring technical competence such as waste management, larger financial inputs which involves provisions of material such as linen, soap, service accessories and decorations, maintenance of safety standards and display of information. The report has recommended the provision for training to those working in areas of waste management, informed Dr. Murugendrappa.