Competing to deliver? Political workers and service delivery in Pakistan

Why do some citizens receive better municipal services than others? Comparative political economy is deeply concerned with this question, but most answers so far suggest that unequal access to these services is determined by either class or partisan voting. Our research in Pakistan found that the unequal provision of functional municipal services is a particular challenge in the central neighbourhoods of megacities in emerging democracies. What explains this trend? The difference in urban citizens’ access to services in Lahore appears to be linked to the density of party worker networks at the local level, and to levels of electoral competition faced by political representatives. This is an important finding for policy purposes because it establishes the intrinsic value of multiparty competition, which, in and of itself, can make politicians more responsive to citizens’ demands for the provision of services, even when institutions are weak. These findings suggest that improvements to service delivery will require institutional reforms that strengthen channels of political accountability at the local level.DFIDUSAIDSidaOmidyar Networ

Women's Political Participation in a Pakistani Metropolis: Navigating Gendered Household and Political Spaces

The male–female gap in voter turnout in the 2018 Pakistani general elections stood at 9.1 per cent, with 11 million fewer women exercising their right to vote than men. This report shows that the largest city in each of Pakistan’s four provinces did much worse in terms of gender inequality in voter turnout in compared to the remaining constituencies of each province. The report argues that it would not be possible to forge an effective agenda of action to address the gender inequality in participation in big cities without recognising that it is a product of a complex dynamic between women, social attitudes in households and the gendered nature of political space and political engagement. The main aim of the report is to provide an understanding of this complex dynamic by unpacking the constraints women face in exercising political agency. It is led by a simple question – why does a gender gap in political participation exist in a big city context? We answer this question by using evidence from qualitative interviews and focus group discussions with close to 250 women and men and an original baseline citizen survey of 2,500 randomly selected households across 7 of Lahore’s 14 national assembly constituencies and one third of the city’s local government electoral wards. Within each household, one man and one woman member were randomly selected and interviewed, providing us with a total sample of 5,000 respondents. We also draw on an original turnout survey that validated the turnout of women and men in Election 2018 by observing indelible ink marks on the thumbs of the respondents within two days of the elections

The Empty Promise of Urbanisation: Women’s Political Participation in Pakistan

Do big cities enable or hinder women’s electoral participation? What are the determinants of women’s participation in big cities and how are they different from those in rural areas? We use the Election Commission of Pakistan’s novel gender-disaggregated constituency level data set for the 2018 elections to answer these questions in the context of Pakistan, a country that has seen rapid urbanisation and today hosts 14 big cities with populations of over half a million people. Contrary to expectations, we find that women’s electoral participation is 8.5 per cent lower in big cities compared to rural areas and this is mirrored by a higher gender gap in participation in this context. In big cities we do not find support for theories that suggest women’s increased political participation is linked to a fall in the burden of care work, an increase in women’s intra-household bargaining power, and their entry into the paid labour force. The gender gap in political participation is higher in big cities even though city women do much better on all these indicators compared to their rural counterparts. We do, however, find a positive association between education and women’s political participation in big cities. We use data from the Herald-SDPI national opinion poll conducted in the run up to the 2018 elections to show that women’s lower electoral participation in cities is mirrored by more tenuous linkages between them and political parties compared to linkages in rural areas. This evidence suggests that weak engagement between political parties and women voters may be an important channel explaining women’s lower electoral participation in cities. We also find that women’s political participation is lower in big cities with greater exposure to political violence.Foreign, Commonwealth & Development Offic

Documenting clinical performance problems among medical students: feedback for learner remediation and curriculum enhancement

Introduction: We operationalized the taxonomy developed by Hauer and colleagues describing common clinical performance problems. Faculty raters pilot tested the resulting worksheet by observing recordings of problematic simulated clinical encounters involving third-year medical students. This approach provided a framework for structured feedback to guide learner improvement and curricular enhancement. Methods: Eighty-two problematic clinical encounters from M3 students who failed their clinical competency examination were independently rated by paired clinical faculty members to identify common problems related to the medical interview, physical examination, and professionalism. Results: Eleven out of 26 target performance problems were present in 25% or more encounters. Overall, 37% had unsatisfactory medical interviews, with ‘inadequate history to rule out other diagnoses’ most prevalent (60%). Seventy percent failed because of physical examination deficiencies, with missing elements (69%) and inadequate data gathering (69%) most common. One-third of the students did not introduce themselves to their patients. Among students failing based on standardized patient (SP) ratings, 93% also failed to demonstrate competency based on the faculty ratings. Conclusions: Our review form allowed clinical faculty to validate pass/fail decisions based on standardized patient ratings. Detailed information about performance problems contributes to learner feedback and curricular enhancement to guide remediation planning and faculty development