The political economy of public sector absence

•Politicians routinely interfere with bureaucrats who would like to increase attendance.•Doctors work less (in public facilities) where politics is not competitive, and especially when they share connections with politicians. This is consistent with a view that low levels of competition mark constituencies in a patronage equilibrium where doctor postings provide political currency.•We find that the increase in inspections driven by the new technology only raised doctor attendance for doctors in competitive constituencies who were not politically connected. Again, this points toward a system where doctors do not feel a need to respond to more regular visits by an inspector.•Senior bureaucrats can reduce absence when monitoring information is presented to them in an actionable format. However, their ability to make a difference is similarly limited to areas of high political competition and to doctors unconnected with politicians. Once again, this suggests that politically-connected doctors, working in uncompetitive constituencies do not respond when bureaucrat managers learn about their 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.