Provider absence in schools and health clinics

Abstract

This paper presents comparable national estimates of provider absence at primary schools and primary health centers in six countries. It relies on new data drawn from nationally representative samples of facilities using a common survey instrument and methodology, with providers counted as absent when they were not present in the facility at the time of an unannounced visit. Absence ranges from 11 to 27 percent among primary-school teachers, and from 23 to 40 percent among medical personnel. Absence rates are generally higher in poorer countries and states, with an additional $1000 in per-capita income (PPP-adjusted) reducing predicted absence by 2.7 percentage points. Absence generally does not appear to be concentrated among a small number of frequently absent providers, but instead is spread out over most providers, suggesting a general culture of tolerance for absence. Correlates of teacher absence include poor school infrastructure, which suggests that working conditions matter for absence, and distance from the nearest Ministry of Education office, which suggests that administrative monitoring may also be important. By contrast, proxies for salary levels, intensity of community monitoring, and intrinsic motivation levels are not robust predictors of absence.