“THEY are getting away with murder,” says Khalid Masud, director of the Lady Reading Hospital in Peshawar, the largest in a province long racked by insurgency. Dr Khalid was not talking of the Pakistani Taliban or other extremist groups, but of his own doctors. Of the 45 senior consultants at the hospital, many pop in for no more than an hour a day if at all. Then they leave for their private clinics, taking with them those patients who can afford to pay. Patients without money can die before they see a specialist at the 1,750-bed facility. Such is the state of public health care for the 27m residents of Pakistan’s mountainous, troubled border region of Khyber Pakhtunkhwa.

Things may be changing, though. A recent law seeks to pin wayward doctors to their official place of work. Only a handful have reappeared at the notorious Lady Reading. But about 60 are back at work at another Peshawar hospital nearby.

That reform is possible in Khyber Pakhtunkhwa is down to improved security following the army’s anti-Taliban campaign in 2014. Better government has helped too. In elections in 2013 the Pakistan Tehreek-e-Insaf (PTI) party of Imran Khan gained control of the province after breaking the national stranglehold of the two traditional rivals, the Pakistan Muslim League-Nawaz (PML-N)—which is in power nationally under the prime minister, Nawaz Sharif—and the Pakistan Peoples Party (PPP), currently the opposition in Islamabad, the capital.

Ahead of an election due to be held in 2018, Pakistanis wonder how far the PTI has fulfilled its promise to do two unusual things: run a clean government, and transform hospitals and schools. The evidence is clear on corruption. Ministers no longer drive about arrogantly in motorcades a dozen vehicles long. The PTI’s term has seen little scandal. And the party has ended a free-for-all in which provincial assembly members could appoint friends and family to public-sector jobs (many of the 119,000 teachers could hardly read or write). Federal handouts to the provinces have increased, and in Khyber Pakhtunkhwa money is at last ending up where it is meant to.

The PTI now wants to see locals flocking to use public services. It has certainly made schools more appealing: the party has appointed 40,000 more teachers, rebuilt institutions blown up by the Taliban and furnished others with toilets and electricity. Teacher absenteeism has fallen. But the PTI’s claim that about 100,000 students have chosen to switch from private to public schools is based on dodgy data. There are other bones to pick. In 2013 the PTI allowed its coalition partner, the Jamaat-e-Islami, an Islamist group, to remove pictures in textbooks of women without a veil, among other measures.

The diagnosis is less mixed when it comes to health care. The PTI has employed many more medical staff, raising the ratio of doctors per 1,000 people from 0.16 to 0.24. It has also begun, albeit far from smoothly, to roll out a comprehensive health-insurance card for poor families. All this has had an effect. The number of operations in public hospitals has doubled since 2013; inpatient cases have risen by half as much again. Such change comes despite objections from special interests that lose out from reforms. Pharmacists broke the shelves of a new drug dispensary at one Peshawar hospital, so incensed were they by its offering medicine at the wholesale price.

Yet the PTI may struggle to win a second term in 2018. One problem is excessive promises. Mr Khan, who broke into politics after a stellar career as a cricketer, pledged a “tsunami” of change. But it took his inexperienced party two years to get a handle on government, and many of its reforms so far, according to Faisal Bari of LUMS university, need much longer to get entrenched. Some of its more notable improvements are hardly photogenic. It is one thing for people gleefully to take selfies in front of a new flyover in Peshawar, another to do the same in front of new toilets in a rural girls’ school.

That Mr Khan himself appears to have lost interest in the province does not help. He aspires to national office and spends much of his time heckling the prime minister, who is under investigation for corruption. The PTI is starting to look more like the established parties. Having long mocked rapid-transit bus lanes, a favourite pork-barrel project of such parties, as a costly distraction from public-sector reform, the PTI is now building one of its own in Peshawar. It is said to be the country’s most expensive, per kilometre, yet.