TY - JOUR
T1 - The political economy of public sector absence
AU - Callen, Michael
AU - Gulzar, Saad
AU - Hasanain, Ali
AU - Khan, Muhammad Yasir
AU - Rezaee, Arman
N1 - Funding Information:
Authors’ Note: We thank Farasat Iqbal for championing and implementing the project and Asim Fayaz and Zubair Bhatti for designing the smartphone monitoring program. Support is generously provided by the International Growth Centre (IGC) political economy program, the IGC Pakistan Country Office, and the University of California Office of the President Lab Fees Research Program Grant #235855. Callen was supported by grant #FA9550-09-1-0314 from the Air Force Office of Scientific Research. We thank Erlend Berg, Eli Berman, Leonardo Bursztyn, Ali Cheema, Melissa Dell, Ruben Enikolopov, Barbara Geddes, Naved Hamid, Gordon Hanson, Michael Kremer, Asim Ijaz Khwaja, Craig McIntosh, Ijaz Nabi, Aprajit Mahajan, Monica Martinez-Bravo, Benjamin A. Olken, Gerard Padro-́i-Miquel, Karthik Muralidharan, Rohini Pande, Daniel N. Posner, Ronald Rogowski, Jacob N. Shapiro, Christopher Woodruff, Oliver Vanden Eynde, David Yanagizawa-Drott, Ekaterina Zhuravskaya and various seminar participants for insightful comments. Excellent research assistance was provided by Muhammad Zia Mehmood and Haseeb Ali. We thank Ali Cheema and Farooq Naseer for kindly sharing their data on election outcomes.
Publisher Copyright:
© 2022 The Author(s)
PY - 2023/2
Y1 - 2023/2
N2 - 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.
AB - 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.
KW - Absenteeism
KW - Health sector reforms
KW - Information Communication Technology
UR - http://www.scopus.com/inward/record.url?scp=85145824213&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85145824213&partnerID=8YFLogxK
U2 - 10.1016/j.jpubeco.2022.104787
DO - 10.1016/j.jpubeco.2022.104787
M3 - Article
AN - SCOPUS:85145824213
SN - 0047-2727
VL - 218
JO - Journal of Public Economics
JF - Journal of Public Economics
M1 - 104787
ER -