In many developing countries, public sector absence is both common and resistant to reform. One explanation is that politicians preferentially provide public jobs with limited work requirements as patronage. We test this patronage hypothesis in Pakistan using: (i) a randomized evaluation of a novel smartphone absence monitoring technology; (ii) data on election outcomes in the 240 constituencies where the experiment took place; (iii) attendance recorded during unannounced visits; (iv) surveys of connections between politicians and health staff; and (v) a survey of the universe of health supervisors. Four sets of results are consistent with this view. First, 36 percent of health officers report interference by a politician in the previous year when sanctioning an employee and report this twice as often in uncompetitive constituencies. Second, doctors are 21 percentage points less likely to be present if they know their politician, 32 percentage points less likely to be present if they work in an uncompetitive constituency, and are only at work during 10 percent of normal reporting hours if both conditions are true. Third, the effect of the smartphone monitoring technology, which almost doubled inspection rates, is highly localized to competitive constituencies and to monitored employees who do not know their politician. Last, we find evidence that program impact is in part due to the transmission of information to senior officers. We test this by manipulating the salience of staff absence in data presented to senior officials using an online dashboard. Highlighting absence leads to larger subsequent improvements in attendance for facilities located in a competitive constituencies.
September 9, 2014