The Political Economy of Public Sector Absence: Experimental Evidence from Pakistan

Public sector absenteeism undermines service delivery in many developing countries. We report results from an at-scale randomized control evaluation in Punjab, Pakistan of a reform designed to address this problem. The reform affects healthcare for 100 million citizens across 297 political constituencies. It equips government inspectors with a smartphone monitoring system and leads to a 76% increase in inspections. However, the surge in inspections does not always translate into increased doctor attendance. The scale of the experiment permits an investigation into the mechanisms underlying this result. We find that experimentally increasing the salience of doctor absence when communicating inspection reports to senior policymakers improves subsequent doctor attendance. Next, we find that both the reform and the communication of information to senior officials are more impactful in politically competitive constituencies. Our results suggest that interactions between politicians and bureaucrats might play a critical role in shaping the success or failure of reforms.