Udaipur is the Rajasthan district where Seva Mandir tested a time-clock scheme intended to improve nurses’ attendance at government health facilities. Its brief initial success, followed by local officials’ deliberate obstruction, makes the district a concrete example of the book’s argument that development interventions cannot reliably change outcomes while the institutions that produce them remain untouched.

Setting and Health-Care Problem

Government health care in India was formally available at low cost, and its personnel were generally qualified. Yet even poor residents often chose more expensive private providers, sometimes of deficient quality, because government facilities were frequently closed and staff absent. The problem in Udaipur was therefore not simply a lack of a plausible monitoring technique: patients could be unable to enter a facility or find nurses there at all.

Seva Mandir’s Attendance Scheme

In 2006, Seva Mandir worked with a group of economists to encourage nurses in Udaipur district to attend work. The intervention introduced time clocks that stamped the date and time, with nurses expected to record their attendance three times a day to show that they arrived, remained at the facility, and left on time. The scheme was deliberately straightforward: if monitoring and incentives could improve attendance, the experiment might demonstrate that a practical intervention could raise the quantity and quality of health care.

Administrative Resistance and Reversal

Attendance rose sharply soon after the scheme began, but the improvement lasted only briefly. In a little more than a year, the local health administration undermined the program. Absenteeism returned to its usual level, while officially sanctioned “exempt days” increased, allowing nurses to be absent without the absence counting against them. The time clocks also developed a growing number of “machine problems.” Seva Mandir could not replace the broken clocks because local health ministers would not cooperate.

The account attributes the sabotage to complicity between health administrators and nurses: officials did not want a system that compelled attendance or reduced nurses’ pay when they failed to appear. The episode thus distinguishes a technical obstacle from an institutional one. The clocks offered a way to monitor attendance, but those with authority over the scheme could neutralize that monitoring and prevent its repair.

Significance

Udaipur’s experiment illustrates the limits of treating development problems as isolated failures of incentives. A mechanism that initially improved attendance could not endure when local administrators and nurses had reasons to preserve absenteeism and the authorities could obstruct enforcement. The case supports the book’s broader claim that institutional arrangements shape incentives and determine whether reforms can take hold: efforts to engineer better services are unlikely to succeed if they leave the political and administrative structures behind the failure intact.