Putting a band-aid on a corpse, Banerjee, A. V., Duflo, E., & Glennerster, R. (2008) Flashcards
(13 cards)
📘 Core Problem and Motivation
Q1: What is the central problem examined in the paper?
A: The paper investigates nurse absenteeism in India’s rural public health centers and evaluates whether monitoring and financial incentives can reduce it.
Q2: Why is absenteeism a major obstacle in India’s public health system?
A: Despite wide coverage and low cost, over 60% of subcenters are closed when surveyed due to nurse absence, making the system ineffective, especially for the poor.
🧪 Methodology and Data
Q3: What kind of research design does the study use?
A: A randomized controlled trial (RCT) conducted in Udaipur District, Rajasthan, with treatment and control subcenters. The study evaluates the causal impact of monitoring and incentives on nurse attendance.
Q4: What data sources did the authors use?
Time-stamped register data from Seva Mandir’s monitoring (But a lot of the times the machines did not work, mysteriously).
Unannounced random checks by field officers to verify attendance
Historical baseline data from the 2003 Udaipur Health Survey covering 135 villages
Q5: How was nurse presence measured during the experiment?
Nurses stamped a tamper-proof register three times per day.
Presence was also validated by field visits with photos and timestamping.
Data distinguished between monitored and unmonitored days and excused vs. unexcused absences.
Q6: What was the main outcome variable in the evaluation?
A: The proportion of days the nurse was physically present in the subcenter during monitored hours.
Secondary outcomes included number of patients seen and use of excuses (e.g., exempt days, machine failure).
📊 Key Findings
Q7: What were the short-term effects of the incentive program?
A: In the first 6 months, attendance improved significantly in treatment centers. For example, Monday presence in single-ANM centers rose to ~60% from below 30%.
Q8: What happened after the initial success?
A: The local administration undermined the program by allowing an increasing number of “exempt days” and unverified excuses, rendering the incentives ineffective within a year.
Q9: Did patient visits increase in response to better attendance?
A: No. Despite increased presence initially, patient turnout did not change significantly, suggesting deep mistrust or habitual reliance on private providers.
💡 Critical Analysis and Interpretation
Q10: Why did the program eventually fail?
A: Because mid-level health administrators (PHCs) refused to enforce penalties. They allowed fake exemptions, ignored machine tampering, and refused to verify claims, disabling the incentive system.
Q11: What does the title “Putting a Band-Aid on a Corpse” signify?
A: It critiques the idea that technocratic fixes (like monitoring) can solve problems in a deeply dysfunctional system without broader political and institutional reform.
Q12: Why is there little political pressure for health reform?
A: Local politicians (MLAs) are not held accountable for healthcare. Constituents don’t expect effective public services, creating a low-demand, low-supply equilibrium.
Q13: What broader lesson does the paper offer about development interventions?
A: Even well-designed interventions can fail when institutions lack accountability. Reforms need top-level commitment and systemic change, not just isolated pilot programs.
