The Political Economy of Public Sector Absence

Authors: Michael Callen, Saad Gulzar, Ali Hasanain, Muhammad Yasir Khan, and Arman Rezaee

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Abstract

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 sanction in the health bureaucracy, 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 more effectively responding to data on poor performing health facilities. Our results demonstrate that politics can block the success of reform; instead of lifting the poor performers up, the reform improved places that were already performing better than others. The evidence collectively points to the fundamental importance of accounting for political incentives for policy design and implementation.