BMC’s move towards PPP amid 40% Class-IV vacancies lambasted

MUMBAI: As the BMC moves to partially privatise Borivali’s Bhagwati Hospital under the Public-Private Partnership (PPP) model, its own hospitals are grappling with a crippling staff crisis with four in every ten Class IV roles lying vacant, alleged the Municipal Mazdoor Union.

The civic-run hospitals’ employees have slammed the decision, warning that over 40 percent of essential Class IV positions—comprising ayahs, ward boys, sweepers, sanitation workers and lab attendants—remain vacant across major municipal hospitals, compromising basic patient care. “Instead of strengthening public health infrastructure and hiring staff to fill these critical vacancies, the BMC is prioritising privatisation. This could severely affect the quality and affordability of care,” Pradeep Narkar, secretary of Municipal Mazdoor Union.

According to internal data, KEM Hospital has 1,991 sanctioned Class IV posts, of which only 1,110 are filled—leaving 881 posts vacant (44%). LTMG (Sion) Hospital shows a similar gap, with 1,725 sanctioned posts and 719 vacancies (42%). BYL Nair Hospital has the highest shortage, with only 679 of its 1,454 posts filled, leaving 775 posts vacant (53%).

Additional municipal commissioner Dr Vipin Sharma did not respond to the messages sent to him by Hindustan Times.

These gaps, the union says, directly impact patient care. “We often have to work overtime to cover duties because there just aren’t enough workers for basic cleaning and patient support,” said a sweeper from KEM Hospital on condition of anonymity. “It affects not only us but also the quality of care patients receive.”

The civic body has already spent ₹500 crore on the construction of the new Bhagwati Hospital. According to a recently released government resolution (GR), the hospital will have 480 beds, of which 148 will be managed by the BMC and offered at civic hospital rates. The remaining beds will be managed by private operators. Patients on these private beds will be eligible for treatment under the Ayushman Bharat Scheme and other available health schemes.

However, the union warns that partial privatisation could result in increased costs for patients not covered under the scheme and create disparities in care. “The BMC is trying to hand over newly constructed hospitals under the PPP model even though our 16 peripheral hospitals and four main civic hospitals are already reeling under severe staff shortages,” said the union member. “Instead of outsourcing services, the corporation should focus on recruiting staff and ensuring that existing hospitals function efficiently.”

In the BMC budget announced in February, municipal commissioner Bhushan Gagrani announced plans to adopt the PPP model in hospitals to reduce operational costs and ease patient expenses. However, workers argue that without addressing chronic staffing shortages, especially in Class IV roles, such models risk failing on the ground. They have urged the civic body to prioritise filling vacancies before involving private players in public healthcare.

“PPP models may work on paper, but in practice, if hospitals lack sufficient nurses, ward staff and sanitation workers, the quality of care will inevitably suffer,” said Dr Amar Jesani, public health expert. “Healthcare is not just about infrastructure or technology—it’s about people. Without investing in human resources, even the best partnerships will fall short of delivering equitable care.”