Sewamandir

Seva Mandir is an NGO whose 2006 collaboration with economists in Rajasthan tested whether a straightforward attendance-monitoring scheme could improve public health care. Its intervention briefly increased nurses’ attendance, then was deliberately undermined by local administrators. The episode serves as a concrete example of the organization’s efforts—and of the institutional obstacles that can defeat a well-designed development program.

The Service Problem in Rajasthan

Government health care in India was, in principle, widely available and inexpensive, and its staff were generally qualified. Yet even poor patients often chose more expensive, unregulated private providers. The account attributes that choice not to irrational preference but to the failure of public facilities: absenteeism left clinics without nurses, and buildings were often closed when patients arrived.

The problem therefore looked amenable to a practical intervention. If staff could be made to attend reliably, the existing public system might provide care that people could actually use. But the scheme’s later failure showed that staff absence was not simply a gap in monitoring that a new device could close.

The Time-Clock Scheme

In 2006, Seva Mandir and a group of economists designed an incentive program in the Udaipur district of Rajasthan. The NGO introduced time clocks that recorded the date and time of nurses’ attendance. Nurses were expected to stamp their time cards three times each day, documenting arrival, presence during the working day, and departure.

The scheme made attendance visible and sought to link the record of presence to incentives. Its logic was deliberately direct: a reliable record could encourage nurses to show up and, if the scheme worked as intended, improve the amount and quality of care. The early results seemed promising, with attendance rising sharply shortly after implementation.

Administrative Resistance and Failure

The improvement did not last. In a little more than a year, the local health administration deliberately weakened the program, and absenteeism returned to its customary level. At the same time, officially sanctioned “exempt days” increased: nurses were recorded as excused even though they were not present. Reports of “machine problems” also rose as the clocks broke, while local health ministers would not cooperate with Seva Mandir to replace them.

These were not merely technical glitches. The account emphasizes that clock-based attendance monitoring was already a familiar practice, including in Indian industry, making ignorance of the method an inadequate explanation for its absence from the health system. Administrators and nurses were described as acting in concert to preserve endemic absenteeism; they did not want a system that compelled attendance or reduced pay for absence. Their response turned an initially effective monitoring device into a procedure that could be bypassed and obstructed.

What the Episode Shows

The case exposes the limits of treating poor service delivery as a collection of isolated market failures. A time clock could change the record of attendance, but it could not by itself change the interests of administrators and staff who benefited from, or were complicit in, the existing arrangement. When local officials sanctioned absences and blocked replacement equipment, implementation failed at the very level meant to make the intervention work.

Seva Mandir’s experience is presented as a small-scale illustration of a broader institutional problem: the structures that produce a failure can also prevent efforts to correct it. Advice and incentives aimed at a visible symptom may achieve a brief improvement, only to be neutralized by actors with the capacity and motive to preserve the status quo. The episode therefore cautions against attempts to engineer prosperity through narrow technical fixes while leaving the institutional and political causes of poor public services untouched.