Absent providers are a major problem both for public health facilities and primary schools in many developing countries. The paper by Chaudhury and others in this issue provides new and systematic evidence on the rates of absenteeism based on surveys of absence rates of teachers and health workers in several developing countries. For example, in India, absence rates for teachers are over 24 percent, and for health providers they are over 40 percent.
Efforts to improve attendance are therefore crucial to making public services play their designated role in the lives of the poor. Initiatives to reduce absence rates in schools range from hiring more teachers on short contracts and instituting school committees to decentralizing of education to local government. Unfortunately, it is rarely clear whether initiatives to fight absence are having their desired effect. Imagine, for example, that a new headmaster arrives at a school, full of enthusiasm and new ideas and wants to fight teacher absence. He gets parents involved by setting up a parents’ committee. Word spreads that the new headmaster is good, and some children transfer into the school from other local schools. Teachers start showing up more regularly. How can one disentangle the effects of the parents’ committee, the impact of the headmaster’s enthusiasm on other teachers in school and the effect of the influx of new students, who might be more motivated than average?
This paper discusses evidence on a number of innovative strategies to reduce absenteeism in government and nongovernment organization-run schools and health facilities that have been implemented in Kenya and India over the past few years and that have all been evaluated using the randomized evaluation methodology. These strategies have involved alternative levers to fight absence. Some have 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 base their strategies on the idea that the providers are discouraged by the lack of interest among the potential beneficiaries in what they are being offered and have tried to increase 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.