Public sector absenteeism undermines service delivery in many developing countries. We report results from an at-scale randomized control evaluation in Punjab, Pakistan of a reform designed to address this problem. The reform affects healthcare for 100 million citizens across 297 political constituencies. It equips government inspectors with a smartphone monitoring system and leads to a 76% increase in inspections. However, the surge in inspections does not always translate into increased doctor attendance. The scale of the experiment permits an investigation into the mechanisms underlying this result. We find that experimentally increasing the salience of doctor absence when communicating inspection reports to senior policymakers improves subsequent doctor attendance. Next, we find that both the reform and the communication of information to senior officials are more impactful in politically competitive constituencies. Our results suggest that interactions between politicians and bureaucrats might play a critical role in shaping the success or failure of reforms.

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We evaluate a program in Pakistan that equips government health inspectors with a smartphone app which channels data on rural clinics to senior policy makers. The system led to rural clinics being inspected 104% more often after 6 months, but only 43.8% more often after a year, with the latter estimate not attaining significance at conventional levels. There is also no clear evidence that the increase in inspections led to increases in general staff attendance. In addition, we test whether senior officials act on the information provided by the system. Focusing only on districts where the app is deployed, we find that highlighting poorly performing facilities on a dashboard viewed by supervisors raises doctor attendance by 75%. Our results indicate that technology may be able to mobilize data to useful effect, even in low capacity settings

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