Fiscal decentralization for poverty reduction in Asia: opportunities, challenges and policy issues

The increasing popularity of decentralization has been due to political imperatives and the economic rationale of improving the efficiency of the allocation of resources and the responsiveness of policymaking to local needs and preferences. There are various forms of decentralization, but this paper is focused mainly on fiscal decentralization. The paper analyses the challenges and policy issues of decentralization with respect to experiences of countries in Asia. It examines the benefits and advantages of decentralization, as well as the various costs. The financial and human resources costs can be quite large, especially in the early phases of decentralization. It is essential to conduct a careful cost-benefit evaluation before making a decision on the process of fiscal decentralization. The paper concludes with some suggestions for measures and policy options that could maximize the benefits and minimize the risks of the fiscal decentralization process and make it conducive to poverty reduction.

Wadhwa, Charan D. and MukulG. Asher (eds.). ASEAN-SOUTH ASIA Economic Relations. Singapore: Institute of Southeast Asian Studies. 1985. ix+384pp.

The need to enhance their economic relations with each other has long been felt by developing countries. However, their efforts in this regard have met with limited success. One of the reasons for this could be that not much serious work has been done to understand the complexities and possibilities of economic relations of developing countries. The complementarities which exist among the economies of these countries remain relatively unexplored. There is a lack of concrete policy proposals which developing countries may follow to achieve their often proclaimed objective of collective self-reliance. All this needs serious and rigorous research efforts. In this perspective, the present study can be considered as a step in the right direction. It examines trade and other economic relations of developing countries of two regions of Asia-South Asian countries and member countries of the Association of Southeast Asian Nations (ASEAN). The study also explores ways and means to improve economic relations among these countrie

Some New Evidence on the Incidence of Poverty in Pakistan

A number of studies have been done in the past to measure the level of poverty in Pakistan. These studies include Naseem (1973, 1977), Alauddin (1975), Mujahid (1979), Irfan and Amjad (1983), Kruijk and Leeuwen (1985) and Cheema (1985). The time periods covered by these studies are not the same. Moreover, in some cases the methodologies and results of these studies also differ. The present study covers the most recent data made available in the Household Income and Expenditure Survey (HIES) for 1984-85. Some selected previous Survey years have also been included in the study to see changes in poverty levels over time. The incidence of poverty is measured on the basis of both households and population. To determine the location of the poor, poverty levels have been estimated for rural and urban areas of the country

Consumption and Employment Effects of Income Redistribution in Pakistan

The argument that growth and equality are two opposite objectives and the conviction that if the former is preferred in the short run, the latter will automatically follow in the long run, though very popular in the past, have become somewhat controversial in recent years. Available evidence from the developing countries does not seem to support the 'trickle down' theory. It is being increasingly felt that the solution to the problem of poverty does not lie in mere maximization of the GNP. Economists have now started stressing the need for 'direct attack on poverty' (6, pp.42- 44] and for specific policies with growth implications for different groups in the Society (2, p. xiii] . Redistribution of income among different groups is therefore emerging as an important policy objective in many developing countries, including Pakistan

EFFICACY OF ORAL ZINC SULPHATE VERSUS TOPICAL APPLICATION OF SALICYLIC ACID (16.7%) & LACTIC ACID (16.7%) COMBINATION IN THE TREATMENT OF PLANTAR WARTS

Background; Warts are common epidermal growths caused by human papillomavirus that often cause significant discomfort and embarrassment. Current treatment options include topical therapies, cryotherapy, laser vaporization, and surgical excision. Objective: To compare the efficacy of oral zinc sulphate versus topical application of salicylic acid (16.7%) & lactic acid (16.7%) combination in the treatment of plantar warts. Material and Methods; Group A, having 78 patients, was given oral zinc sulphate (10 mg/kg/day) in 2 or 3 divided doses. In group B, 78 patients were advised to apply a combination of salicylic (16.7%) & lactic acid (16.7%) once at night daily. In group A, using oral zinc sulphate, the treatment was given for two months and follow up continued for next 1 month. In group B, the topical preparation was also continued for 2 months or till the complete removal of warts. Results; Of these 156 study cases, 94 (60.3 %) were male patients while 62 (39.7 %) were female patients. Mean age of our study cases was 34.42 ± 9.87 years. Monthly family income up to Rs. 30000 was noted in 68 (43.6%) while 88 (56.4%) had monthly family income more than Rs. 30000. Mean weight of our study cases was 61.96 ± 10.29 kilograms. Mean height of our study cases 161.24 ± 12.23 centimeters. Mean BMI of our study cases was 26.52± 1.87 kg/m2 and obesity was present in 31 (19.9%) of our study cases. Mean no. of lesions was noted to be 5.30 ± 2.45 lesions (with minimum no. of lesions was 4 and maximum no. of lesions was 10) and 131 (84%) had up to 5 lesions. Mean duration of disease was 4.69 ± 1.61 months and 112 (71.8 %) had disease duration up to 6 months. Efficacy was noted in 110 (70.5 %). Efficacy in group A was noted to be 83.3 % and in group B was 57.7 % (p= 0.001). Conclusion; Our study results support the use of oral Zinc Sulphate in the treatment of plantar warts as compared to the salicylic acid (16.7%) and lactic acid (16.7%) combination. Efficacy of Zinc Sulphate was significantly higher when compared with combination therapy and it was found to be safe and reliable mode of treatment having no side effects were observed in our study. Use of Zinc Sulphate can help to reduce chance of recurrence and disease morbidity. Being cost effective, it provides cheaper mode of treatment as compared with cryotherapy which is quite expensive which will provide economic relief to our large poor population. Early treatment can help patients to maintain routine daily lives and physical activities such as sports without any pain and side effects. Keywords; Plantar warts, Zinc Sulphate, Salicylic acid, lactic acid

FREQUENCY OF MICROALBUMINURIA IN PATIENTS WITH TYPE-2 DIABETES MELLITUS HAVING DIABETIC RETINOPATHY

Objective; To determine the frequency of microalbuminuria in patients with type 2 diabetes mellitus with retinopathy. Methodology:- This descriptive study was carried out in the Out Patient Department Nishtar Hospital Multan from June 2017 to December 2018. Sample size of 296 was calculated according to formula. Results:- Of these 300 study cases, 179 (59.7%) were male while 121 (40.3%) were female patients. Mean age of our study cases was 52.10 ± 5.65 years (with minimum age was 42 years while maximum age was 60 years).  Majority of our study cases had low educational level such as illiterate i.e. 60 (20%), primary education in 71 (23.7%) secondary education53% while only 3 % had bachelors degree or above. Mean duration of diabetes was 14.18 ± 2.73 years (with minimum duration of disease 10 years and 19 years was maximum duration of the disease). Among these patients Grade III diabetic retinopathy was more prevalent i.e. 149 (49.7%) followed by grade IV retinopathy i.e. 100 (33.3%) and grade11 retinopathy (17%). Diabetes was controlled (HbA1c<7%) in only 81 (27%) of our study cases and obesity(BMI>30kg/m2) was present in 101 (33.7%) of our study cases. Microalbuminuria was present in 121(40.3% of our study cases.  Conclusion:- Very high frequency of microalbuminuria was noted in patients with diabetic retinopathy in our study. Keywords; Microalbuminuria, Diabetic Retinopathy, Frequency

Supervised Learning Based Classification of Cardiovascular Diseases

Detecting cardiovascular disease (CVD) in the early stage is a difficult and crucial process. The objective of this study is to test the capability of machine learning (ML) methods for accurately diagnosing the CVD outcomes. For this study, the efficiency and effectiveness of four well renowned ML classifiers, i.e., support vector machine (SVM), logistics regression (LR), naive Bayes (NB), and decision tree (J48), are measured in terms of precision, sensitivity, specificity, accuracy, Matthews correlation coefficient (MCC), correctly and incorrectly classified instances, and model building time. These ML classifiers are applied on publically available CVD dataset. In accordance with the measured result, J48 performs better than its competitor classifiers, providing significant assistance to the cardiologists

Term Back / Detention Policy Revision Measures in Academic Medical and Allied Institutions of Pakistan in the COVID-19 Epidemic for the Session 2019-2020

The Pakistan Medical and Dental Council (PM&DC) is the body concerned for the medical and dental education in Pakistan.1 The council was dissolved by an order of the President of Pakistan in October 2019, 2 but the order was revoked by the decision of the High Court of Pakistan.3 According to the PM&DC return/detention policy, a medical student has two chances of exam for his promotion in the next academic class and if one of the students could not pass the two chances provided in at least one of his subjects, the student must pass the exam in 3rd attempt with loss of his / her academic year and must pursue medical studies with the junior class. If one of these students could not pass this or these subjects by exceeding the 3rd chance, the conceded institution offers the 4th and last opportunity to the student.1 If the student still cannot pass the subject in 4th and last opportunity, he is expelled from the establishment with the cancellation of his admission, and the dreams of such a student to become a doctor are fulfilled until he will only be readmitted upon reappearing in the PM&DC competitive entrance test. But due to the sudden and unexpected outbreak of Covid-19, the medical community was the most affected. In some countries, more death rates have been reported among physicians who performed Covid-19 patient care tasks.4 Due to the lockdown policy of Govt. of Pakistan across the country, academic medical institutions were closed as a result of academic months of medical and dental students have also been wasted like other academic fields. The lockdown has been continued and we expect further academic waste from these students. The Pakistan Higher Education Commission has asked for conducting online courses for these students, but the clinical subjects of medical students cannot be taught online as they require direct clinical exposure to patients for the transmission of learning. required. Therefore, as a result of Covid-19, there is expected to be a waste of courses from almost all students across the country. However, in such circumstances, detained / term-back students will suffer a greater and irreparable waste of time as there may be many other technical difficulties regarding the continuation of medical education and the examinations of these students due to the Covid-19 disaster. Therefore, it may be good to revise the Term-Back / Detain policy for these medical, dental, and related students. The authors made the following suggestions for the PM&DC and the institutions to consider this review.         1) To Revise once the Term-Back / detention policy for the period 2019-2020 by allowing students to continue academic promotion during the next academic year with a unique relaxation in the policy.   2) Students who have not passed four chances and who are expelled from the establishment can be relaxed to have an additional chance to continue their medical studies, applicable for the year 2019-2020.   3) Relaxations are similar to those mentioned in the serial number. 1 and 2 for other courses such as Pharm-D, Bachelor of Nursing, etc.   Health workers are the main force in the fight against Covid-19 in the exercise of their functions to manage the patients of Covid-19. Mortality rates among healthcare providers have also been reported due to high viral load. There may be a shortage of health care providers around the world. Therefore, facilitation attempts are necessary to help the bona fide medical profession maintain their numbers and needs in the health sectors and to meet the future needs of the world for these health workers. Consequently, in implementing the suggestions of the authors, hundreds to thousands of health professionals and paramedical services will be able to save and secure their future in the service of the sacred mission of saving and serving the sick community