The Making of Benazir Income Support Program

The Benazir Income Support Program (BISP), introduced in 2008-09, is a unique cash support scheme for economically stressed families. Its uniqueness arises from several facets. The cash transfers are provided only to women aged over 18 years and have been ever married. It is unconditional and aimed at supplementing income as opposed to alleviating poverty. It was politically neutral, given that the facility to identify potential beneficiaries was extended to all parliamentarians, irrespective of party affiliation. A set of filters, applied electronically, ensured objectivity in beneficiary selection. Disbursement mechanism was automated to ensure minimal leakage. This paper outlines the process of the preparatory work that went into designing BISP – the conceptual debates, the beneficiary identification and disbursement procedures, etc. – involving a combination of high quality research with political decision making. It also addresses the debates surrounding BISP, cites independent empirical studies that show that the parliamentarian-based beneficiary selection mechanism was efficient and equitable and did indeed cover the deserving, and also responds to the variety of criticisms. ______

Two to Nine Year Review of Breast Conservation Therapy Bct for Breast Carcinoma: Clinico-Pathological Features and Survival in a Single Centre in East Africa

Introduction: Breast conservation therapy compares to mastectomy in terms of overall survival and disease free survival. However it’s utilization in most parts of the sub-Sahara Africa is minimal with various factors cited: patient preference, provider preference and adverse effects of or limited access to radiation therapy. The aim of this study was to determine the clinico-pathological profile and outcomes of breast cancer patients treated with breast conservation therapy or mastectomy at a single referral centre. Methods: The Aga khan university hospital is one of the institutions in East Africa, where breast conservation therapy is practiced. We retrospectively analysed the details of breast cancer patients who underwent breast conservation therapy from the year 2008 to 2015 and compared this with patients who had undergone mastectomy during the same period. Results: Ninety one patients who had breast conservation therapy and 187 patients who underwent mastectomy were included in this study. The following factors were correlated with the type of surgery: age <35, 35-50, >51 years, parity, grade, stage, histological subtype, receptor status, neo-adjuvant therapy, adjuvant therapy and re-excision rate. The majority of patients, 38.1% (n=106) had stage II breast cancer. Although there was no stage to stage comparison between the breast conservation group and the mastectomy group, patients who had breast conservation were likely to be younger, with tumour grade I or III and luminal A molecular subtype. There was no significant correlation with being nulliparous, grade II tumours, having received neoadjuvant chemotherapy or re-excision rates. Patients who had mastectomy were likely to be older with grade II breast cancer and had adjuvant chemotherapy. Conclusion: The present study concluded that with proper pre-operative patient selection, breast conservation therapy has comparable clinico-pathological characteristics and outcomes to mastectomy.