Addressing Absence

Abstract

Absent providers are a major problem both for public health facilities and primary schools in many developing countries. For example, in India, absence rates for teachers are over 24 percent, and for health providers they are over 40 percent. This paper presents evidence on a number of innovative strategies to reduce absenteeism in government– and nongovernmental organization–run schools and health facilities. These strategies were implemented in Kenya and India over the past few years and have been evaluated using the randomized evaluation methodology. The strategies involved alternative levers to fight absence. Some tried to improve incentives for providers, either through rewards and punishments implemented by external monitors, or through facilitating a more active involvement of those who expect to benefit from the service. Others are based on the idea that the providers are discouraged by the lack of interest among the potential beneficiaries in what they are being offered; these strategies aim at increasing the demand for the services as a way of putting more pressure on the providers. The results of these efforts, taken together, shed light not only on ways to address the problem of absence in the public sector, but also on the underlying reasons for this phenomenon.