Islamabad: In a clear vote of no confidence, the Pandemic Fund has bypassed Pakistani government institutions and handed a US$18.7 million grant to FAO, WHO, and ADB, citing growing mistrust in Islamabad’s ability to manage donor funds transparently.
The unprecedented decision came following a damning audit by the Office of the Inspector General (OIG) of the Global Fund exposed massive mismanagement and misuse of international aid meant for controlling HIV, TB, and malaria.
According to the OIG audit, HIV-related deaths in Pakistan rose by an alarming 400% in just five years, while nearly 70% of drug-resistant TB cases went undetected in 2023, despite Pakistan receiving more than US$1.1 billion in grants since 2003.
That audit painted a devastating picture of the health sector’s crumbling infrastructure and financial opacity: diagnostic kits missing, expired test materials sent to provinces, procurement delays of up to two years, and tens of millions of dollars spent without basic tendering processes. One key government body—the Common Management Unit (CMU)—saw 10 national coordinator changes in just three years, leaving essential programs in disarray and foreign donors alarmed.
Amid this growing credibility crisis, the Pandemic Fund, backed by the World Bank and G20 partners, allocated US$18.7 million to Pakistan to enhance its capacity to prevent, detect, and respond to future pandemics under the One Health framework.
However, in a telling move, the grant will not be routed through the Ministry of National Health Services or the National Institute of Health (NIH)—the very institutions tasked with public health in Pakistan.
Instead, three global bodies—the Food and Agriculture Organization (FAO), World Health Organization (WHO), and the Asian Development Bank (ADB)—will implement the project directly. In a further blow to local confidence, the NIH, which initially conceptualized the project, has reportedly been sidelined during implementation, despite its mandate and technical capabilities.
The project’s stated objectives include establishing national and provincial One Health coordination units, expanding human and animal disease surveillance to all 170 districts, and developing biosafety laboratories in each province.
It will also build diagnostic capacity at NIH and other national labs, train epidemiologists and veterinarians, and enhance outbreak investigation and community-level disease response. However, all of this will be overseen by the international agencies, not the Pakistani state.
The exclusion of national institutions is not merely symbolic—it’s an indictment. According to officials familiar with the matter, the decision to bypass the Pakistani government stems from widespread concerns over its repeated failure to meet co-financing commitments and its poor record on accountability.
Between 2022 and 2025, only 5% of the federal funds allocated for HIV, TB, and malaria programs were actually utilized, the Global Fund audit revealed.
The contrast is stark. While principal recipients like Mercy Corps and Indus Hospital maintained strong financial controls under the Global Fund grants, government-run entities struggled with corruption, ghost employees, and contract awards lacking competitive bidding. Nearly US$4 million in contracts were handed out without market surveys or tenders. In one instance, 369,000 mosquito nets worth nearly a million dollars went missing without a trace.
This rising tide of donor mistrust is now reshaping the way international agencies operate in Pakistan. The Pandemic Fund project, which also draws over US$50 million in co-financing and investment, includes a wide range of partners—from the CDC and UNICEF to local NGOs like the Alkhidmat Foundation—but the control firmly rests in foreign hands.
Public health experts say the move sets a dangerous precedent and reflects a deepening disconnect between global institutions and Pakistan’s public health leadership. “This is no longer just about corruption. It’s about the total erosion of institutional credibility,” one former NIH official said. “Donors are willing to fund our problems, but not our institutions.”
With the burden of disease rising and new threats like zoonotic outbreaks and climate-linked epidemics looming large, experts warn that unless Pakistan undertakes urgent systemic reforms, it risks further alienating donors—and, more crucially, endangering the health of millions.
As the Pandemic Fund rolls out its ambitious blueprint for preparedness, the absence of trust in Pakistan’s own health machinery looms as the most damning diagnosis of all.
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