Addressing Absence Banerjee & Duflo (2006)

Addressing Absence Banerjee & Duflo (2006) MED06006 Rie Muraoka MED06007 Miki Kataoka MEP06049 Rafique Buriro

Overview 1. Introduction 2. External Control 3. Beneficiary Control over Service Providers 4. Demand-Side Intervention 5. Conclusion 6. Questions

1. Introduction • Absenteeism – Absence of service providers • Major issue in public health and education services • Common problem for all facilities Absences in the worst quartile of the health subcenters – 36% of overall absences Absences in the best quartile – 14% • Erratic patterns → Low utility in the public primary health centers and schools

1. Introduction (Cont.) • In India (Reported by Chaudhury and others) Absence rate for teachers – over 24% Absence rate for health service providers- over 40% • Surveys by authors in Udaipur district, the state of Rajasthan in India (2004) Absence rate in the primary health care facilities The larger centers – 36% Rural subcenters – 45% Absence rate for teachers – 36%

1. Introduction (Cont.) • Need efforts to improve attendance • Identify the effect of a reform on attendance – Use the randomized evaluation methodology • Major strategies 1.External Control 2.Beneficiary Control over Service Providers 3.Demand-Side Intervention

2. External Control • Improve incentives for providers through rewards and punishments implemented by external monitors • Set rules and monitor the attendance/ performance • Give rewards /punishment based on the attendance/ performance • Monitored with - Personal method (cf. monitored by the headmaster) - Impersonal method (cf. monitored by a camera) - Performance (cf. measured by student test scores)

2.External Control (Cont.)Impersonal monitoring by Camera • Case study in the rural Udaipur district in India - Absence rate for the education center – 44% ( August, 2003) - Selected 120 schools (picked 60 treatment schools and 60 the comparison schools) - Rewards – Rs 1,000 monthly if a teacher is present at least 21 days in a month – For each additional valid day, a bonus of Rs 50 – The maximum salary up to Rs 1,300 - Punishments – For each absence, Rs -50, relative to the 21-days benchmark - Monthly salary ranges from Rs 500 to Rs 1,300 per month - Monthly salary in the comparison school is Rs 1,000 - Teachers provided with cameras to take pictures at the beginning and end of the day

2.External Control (Cont.)Effect of Impersonal monitoring by Camera • Improvement in the treatment school - The absence rate: the treatment schools - 18% the comparison schools - 36% • More 88 children-days per month than in a comparison school • The average salary in the treatments school is almost same as that in the comparison schools • Simple program with impersonal monitoring is very effective

2.External Control (Cont.)Personal monitoring • Case study in Kenya, Kremer & Chen (2001) • Personal method – monitored by school headmasters • A prize (a bicycle) based on attendance • No impact on absence rate • The headmasters cheated - To avoid the unpleasantness of a personal confrontation - Compassion for the teachers • Strategy involved human judgment is easy to be perverted

2.External Control (Cont.)Rewards for Performance Rather than Presence • Case study in Kenya, (Glewwe, Ilias & Kremer, 2003) • Provide prizes to teachers based on the test scores of students • Improved test records but no effect on long term learning • No effect on teacher absence • Lesson: Rewards for attendance, rather than performance

3. Beneficiary Control over Service Providers Beneficiary Control • An alternative way to improve incentives of beneficiaries • Advocated by the World Bank (World Development Report in 2004 ) “ Service can work when poor people stand at the center of service provision” • If the poor avoid poor service providers, while rewarding good providers, then the service providers have incentives to serve the poor.

3. Beneficiary Control over Service Providers • Two necessary components for Beneficiary Control • Beneficiaries have a strong demand for the service. • Beneficiaries have a way to exert control over the providers. ex) Power to decide punishment against absence and delinquency of the providers

3. Beneficiary Control over Service Providers (Cont.) • Advantages of beneficiary control: 1. Less costly to monitor the providers 2. It reflects the degree of willingness for the beneficiaries to conduct the monitoring • But, no guarantee that beneficiary control will work even if there is demand for the service. Especially in many developing countries. Why?

3. Beneficiary Control over Service Providers (Cont.) Because in many developing countries, • Teachers or health care workers are likely to be social superior to the beneficiaries. • Government workers tend to have power to revenge the beneficiaries.

3. Beneficiary Control over Service Providers (Cont.) Empirical Study A. Local Monitoring • India case (Banerjee, et al,2004b) 143 health sub-centers for 12 months • Check the absence of the auxiliary nurse-midwife • Parallel check system : a. unannounced visit by a paid community member once a week on 143 sites in 12 months b. confirmed monthly visit by a member of survey team on 80 sites in the last four months • No rewards or punishment by monitoring outcome

3. Beneficiary Control over Service Providers (Cont.)Local Monitoring Findings: • Checks by both revealed the same absence rates 44% - by community member 42% - by survey team • Community monitoring itself fails to reduce the staff absence. • Community monitoring does not impact on improvement of attendance.

3. Beneficiary Control over Service Providers (Cont.) Empirical study B. Community Participation • Kenya(Kremer, et al, 2004) 36 schools out of 72 randomly selected School committee consisted of parents Assuring the authority of parents to : • allocate supplemental funds to teachers • monitor the performance Findings: • Not significant impact on teachers’ absence rate • No difference in children’s performance • Participation of community controlling over resource is not enough to reduce teacher’s absence.

4. Demand-side Interventions Target : to increase in people’s demand for public service since community does not value it much. a. Incentive to study India case(Kremer, et al. 2004) Providing scholarship for well-performing girls Finding: • Increase in attendance for both children & teachers. • The attendance and performance of girls as well as boys increased. • Teachers had higher motivation to work.

4. Demand-side Interventions (Cont.) b. Incentive to attend i) Mexico case (Schultz, 2000) Cash given to parents if they send children to school and for their health care. Finding: Increase in enrollment but not in student attendance. ii) Kenya case (Vermeersch and Kremer 2005) School breakfast for children and teachers. Finding: Children attendance increased by 30%, but no impact on local teachers’ absence.

5. Conclusion Indeterminate conclusions: • External impersonal monitoring along with extrinsic incentives reduces teachers’ absence, such as camera and rewards. • Beneficiary control by both community monitoring and participation does not affect on absence. • Increase in incentives for students to learn affects negatively on teachers’ absence. • Low demand of people for public service is one of critical issues. • Working / living circumstances and job descriptions of service providers are another critical factors.

6. Questions • Limited Samples (Udaipur in India and Kenya), is study universally applicable? • Extrinsic controls: are they sustainable in the long term? • Viability of Mechanical / Impersonal monitoring (How to make digital cameras work in villages with no electricity and how to transfer photographs taken without efficient internet connection?)

6. Questions (Cont.) • Why beneficiary control doesn’t work: Unsatisfactory explanation. Is community empowerment the answer? How about accountability and favoritism? • Study ignores critical factors for absenteeism: • Road and Access • Residence and Job • Origin of providers • Time of the year • Transport availability …

Arigato Very Much

Addressing Absence Banerjee & Duflo (2006)