The American aid was part of an expansion in U.S. spending in Pakistan to help stabilize the country, reduce anti-Americanism and steer it away from Islamist militancy. The U.S. aid effort in general has been criticized for failing to achieve its objectives, inefficiency and lack of coordination.
There have been a few reported incidents of people missing out on the money, or local politicians trying to direct its distribution. But the system that has been put in place makes it very hard for systematic abuse and those who feel they have missed out can, and do, appeal, said opposition politicians, diplomats, analysts and those working on the scheme.
"I really think that in comparison to what came before it, this program has done significantly better," said Shazna Khan, a development consultant who has studied the scheme. "But there is always room for improvement."
Kaiser Bengali, the economist who designed the initial program but is no longer affiliated with it, said it was so hard to steal from that some "shameless" local lawmakers "came and told me you have left nothing for us."
Since taking office, Zardari has used every opportunity to play up his association with Bhutto, the daughter of an iconic Pakistani prime minister who founded the party he inherited on her death. Naming the program after Bhutto, and having her image featured prominently around the program, including on the debit cards, is an attempt to win votes on the back of the program.
Farzana Raja, the head of the program, a close friend of Bhutto and a member of Zardari's Pakistan's People's Party, said like any government anywhere in the world, it wanted credit for its achievements. But she said the money was not being used to get votes in elections, which are likely to take place this year or early next.
"We have not, and we will not, use these funds for political reasons. That is crystal clear," said Raja. "Transparency is why donors are attracted. We are doing everything according to international standards."
Many of the recipients had to get identity cards for the first time to claim the money, meaning they are now eligible to vote. Women voters are believed to be more inclined to vote PPP, so the party is expected to pick up some support from them.
Still, Ayaz Amir, an opposition legislator whose constituency includes the Punjabi town of Kallar Kahar, said neither he nor any of his colleagues had concerns about the program.
"Some of the recipients might be more inclined to vote PPP, but it will not have much of an impact on the electoral dynamics," he said.
Most of the criticism in Pakistan mirrors that of similar projects elsewhere in the world, namely that it's better to give training, work opportunities or tools to the poor rather than cash handouts, which some say encourage a "beggar mentality." But Raja said that reasoning ignores the fact that for many the money is a life saver, and there is no evidence it has been a disincentive to work.
Looking ahead, there are concerns the government will not have enough money to keep up the payments and cover the continuous testing to ensure targeting is accurate. The scheme is also branching out into other areas, including microfinance and health insurance, raising the possibility that it might lose focus.
Those concerns mean little to Khulsoom Bibi, who lives in a one-room, dirt-floored shack with her eight children in a Kallar Kahar slum. She, along with others in the district, is a grateful recipient of the funds. She pays about $10 a month in rent, and her husband's wages as an occasional fruit picker are not enough to feed her family.
"We don't even have flour some of the time," she said as a child played at her feet, chewing on a filthy broken toothbrush. "I will give my vote to Benazir's party. She has made us happy."
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