In many developing countries, public sector absence is both common and resistant to reform. One explanation for this is that politicians provide public jobs with limited work requirements as patronage. We test this patronage hypothesis in Pakistan using: (i) a randomized controlled evaluation of a novel smartphone absence monitoring technology; (ii) data on election outcomes in the 240 constituencies where the experiment took place; (iii) attendance recorded during unannounced visits and; (iv) surveys of connections between local politicians and health staff. Four results support this view. First, while doctors are present at 42 percent of clinics in competitive constituencies, they are present at only 13 percent of clinics in uncompetitive constituencies. Second, doctors who know their local parliamentarian personally are present at an average of 0.727 of three unannounced visits, while doctors without this connection are present at 1.3 of the three visits. Third, the effect of the smartphone monitoring technology, which almost doubled inspection rates, is highly localized to competitive constituencies. Last, we find evidence that program impact is in part due to the transmission of information to senior officers. We test this by manipulating the salience of staff absence in data presented to officials using an online dashboard. These effects are also largest in politically competitive constituencies. Our results have implications for the study of bureaucratic incentives in fragile states and are potentially actionable for policymakers trying to build state capacity.