The political economy of public sector absence

The paper examines how politics relates to public sector absenteeism, a chronic and intractable public service delivery problem in many developing countries. In Punjab, Pakistan, we document that political interference routinely protects doctors from bureaucratic sanction, while personal connections between doctors and politicians and a lack of political competition are associated with more doctor absence. We then examine how politics impacts the success of an at-scale policy reform to combat absenteeism. We find that the reform was more effective at increasing doctor attendance in politically competitive constituencies, both through increased monitoring and through senior health officials being able to respond more effectively to the data gathered on poor performing clinics. Our results demonstrate that politics can block the success of reform; instead of lifting poor performers up, the reform only improved places that had already been performing better. The evidence collectively points to the fundamental importance of accounting for political incentives in policy design and implementation.