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.