LAHORE (BLOOMBERG) - Above the pristine lobby of a new hepatitis prevention and treatment clinic in Lahore, the capital of Pakistan's Punjab province, a portrait of Chief Minister Shehbaz Sharif smiles down on the waiting patients.

This is the Punjab that Sharif's ruling party wants Pakistanis to see: a gleaming new building of white tiles and anti-bacterial paint, where doctors in crisp, white uniforms work in orderly offices. It's part of a soaring infrastructure budget that could win votes ahead of next year's election as Sharif's Pakistan Muslim League-Nawaz (PML-N) party tries to hold onto power after his brother Nawaz Sharif was barred from being prime minister after a corruption investigation into his finances.

The scandal raises the likelihood of a close election campaign that could fuel anti-US sentiment and accelerate a pivot toward China, which is investing billions in the country. Shehbaz Sharif in August called for an end to American assistance after US President Donald Trump said Pakistan continues to harbour terrorists and asked arch-rival India to play a larger role in his new strategy for Afghanistan.

Yet, if Sharif's PML-N party were to lose power or be forced into a coalition government, then the ties between the US and the world's only Muslim nuclear-armed nation could unravel even faster.

The key to victory is Punjab. Home to 110 million people, more than half the country's population, it sends more lawmakers to the National Assembly than the other four provinces combined. No party has ever taken full control of Parliament without winning in Punjab.

So when Nawaz Sharif was barred from office in July following an anti-graft probe into his finances, sparked by revelations in the Panama Papers, the ruling party had to make a choice: replace Nawaz with his brother - the natural choice for a family dynasty that's been running the country on and off since 1990 - or keep him in Lahore.

They kept him in Lahore.

"The PML-N's decision to keep Shehbaz in Punjab and not have him run for Nawaz's seat is about retaining the party's grasp," said Shailesh Kumar, an Asia analyst with Eurasia Group. "Shehbaz is far more valuable by staying in Punjab."

So Shahid Khaqan Abbasi became caretaker premier until the election and left Shehbaz, 65, to get on with shoring up support in the province.

Over the past two years, 5,500km of new highways, including "farm-to-market" roads, have been laid down, taking the administration's presence into the villages of Pakistan's breadbasket. The administration has built a modern bus network in Lahore and is constructing a metro railway.

And the pace of building is accelerating. The annual provincial budget for infrastructure jumped 37 per cent to 635 billion rupees (S$8 billion) for 2017-2018, from 465 billion rupees the previous year, according to Mujahid Sherdil, chief executive officer of the Infrastructure Development Authority Punjab (IDAP), a special agency set up last year to oversee the projects.

"The chief minister realised that government departments weren't capable," Sherdil said. "IDAP is just one example of what the chief minister is trying to do. And that's why I think his infrastructure projects are delivering."

IDAP has helped free up other government departments to plow ahead building roads, bridges and 10,000 classrooms.

The scale of the task can be seen at Lahore's Jinnah Hospital, across town from IDAP's new showcase clinic.

As she walks through the corridors of the 23-year-old building, Myra Ali, IDAP's US-trained general manager for architecture and planning, points to cots of writhing patients near the reception, mould on the ceiling and air-conditioning units leaking water down stained walls. The hallways are filled with occupied stretchers, ageing medical equipment and family members eating food as their relatives wait for treatment.

"I don't want you to get sick," Ali says as a janitor wrings his mop out of the window.

Still, the state's new roads, schools and medical facilities may not sway an electorate accustomed to political promises and pre-election largesse unless Sharif can also make a dent in the nation's most crippling infrastructure headache: electricity.

Even in major cities like Lahore, Karachi and the capital Islamabad, blackouts remain a daily reality in Pakistan. The government has pledged to end the cuts by next year, and in Punjab the Sharif administration has been building plants across the province, such as the giant Quaid-e-Azam solar park in Bahawalpur and an LNG-fueled station in Bhikki.

The hardest part of providing stable power is the transmission network and despite government investment to revamp the grid, a series of failures this summer cast doubts over how soon the network will be able to handle demand that is rising at 7 per cent a year.

The factor that may tip the balance is China, which is pouring money into roads, power stations, transmission lines and ports as part of the US$50 billion (S$66.9 billion) China-Pakistan Economic Corridor.

China has directly invested US$2.8 billion in Pakistan in the past four fiscal years, compared with US$533 million from the US, according to Pakistan's central bank. With China's yuan, Pakistan's government and military don't need to worry so much about appeasing US interests and politicians can tap anti-US sentiment to try to win votes.

With China's investment, about 7,000 to 9,000 megawatts of power will be added to the national grid by March 2018, Shehbaz said in a June interview.

Keeping Shehbaz in Lahore may make it difficult for Pakistan's opposition, including anti-corruption crusader Imran Khan. Khan, leader of the second-largest opposition party, Pakistan Tehreek-e-Insaf, or Movement for Justice, said in an interview in August that he would try to use Nawaz's disqualification to win over disaffected PML-N lawmakers.

Khan, a former cricket star, has campaigned hard on an anti-graft stance and brought about the case that barred Nawaz Sharif from office.

But in Pakistan, corruption and construction are only part of the political story. With eight major ethnic groups and more than a dozen regional languages, where you come from matters.

The Sharif brothers are sons of late industrialist Mian Muhammad Sharif whose family emigrated to Lahore from Amritsar during partition, which split Punjab in two. They entered politics in the 1980s and have rotated power since 1990 with the Pakistan People's Party controlled by the Bhutto political dynasty from Sindh province.

"It's a family vote to us," said Zeeshan Manzoor, a 28-year old clerk at the Edhi volunteer ambulance service in Lahore. "Whether or not Nawaz remains on the seat doesn't matter, as Shehbaz Sharif is still there." Manzoor said he voted for Sharif's party in the last election and will do so again in line with his family elders.

Still, the corruption allegations against Shehbaz's family may reduce his party's number of seats nationally, forcing it into a coalition, said Hasan Askari Rizvi, a Lahore-based political analyst.

"At the moment, the PML-N continues to be the leading party in Punjab," Rizvi said. "The decisive question will be how he deals with electricity."