The first booklet in the series, Informalisation of Work: A Regional Overview covers the trends in informalisation of employment in the public healthcare sector in India, Nepal and Sri Lanka. This overview reveals that the expansion of the private sector in the provision of health-care services and the penetration and normalisation of non-standard forms of employment in the public heath care facilities follow a parallel path of development. It comes out clearly that in Sri Lanka, where the health system remains dominated by the public sector, informalisation is least entrenched. While in Nepal, where the private sector domination is been established for the longest time, non-standard employment is the norm across institutions and across job categories, including clinical jobs. In India, the picture varies across States as both health-care and labour are legislated by the State administration. In addition, the progression of non-standard employment is also influenced by the level of financial constraint faced by the specific administration in charge of a set of facilities, thus the facilities under the Central ministries are less affected by informalisation than those under the State and Municipal administrations. Yet, the general trend seems to remain consistent in India as well.
While the initial argument for introducing non-standard form of employment were of the nature that this would allow ensuring that services remain uninterrupted, or that cutting costs would ensure the efficiency and strengthening of existing services, it appears instead that informalisation of employment is but one more piece in the process of weakening of public health-care institutions and therefore of the role of the public sector in a country’s health system.
Overall, we hope that the booklets published under the series will provide a window into the issues of interest of Public Services International, South Asia and areas of possible collaboration with existing and future allies in the struggle for Health for All with Decent Work around the world.