M. Waqar Bhatti
Believe it or not, Pakistan’s federal health ministry is in a far deeper crisis than is visible on the surface. Behind official meetings, press releases and repeated promises of reform lie vacant leadership posts, cancelled recruitments, collapsed regulatory structures, dysfunctional hospitals, and national health programmes operating without the staff and direction they need.
The federal health ministry itself is operating like a hospital without a doctor in charge. Although it is not necessary for the federal health minister to be a physician, a ministry responsible for public health, hospitals, medicines, immunisation and disease control cannot be left without stable, competent and technically credible leadership at its most critical institutions.
The warning signs are everywhere: 14 newborns dead in a PIMS nursery fire; no permanent DG Health for nearly four years; NIH without a permanent chief executive and executive directors for ages; a broken and compromised Islamabad healthcare regulator; stalled DRAP recruitment ahead of a crucial WHO assessment; and HIV, TB, malaria, hepatitis C and immunisation programmes struggling without competent technical heads and experts.
Since Syed Mustafa Kamal assumed charge as federal health minister in March 2025, five secretaries and special secretaries have been removed, transferred or pushed out of the ministry’s top administrative structure: Nadeem Mahboob, Mirza Nasiruddin Mashhood Ahmad, Waqar ul Hassan, Hamid Yaqoob and, most recently, Muhammad Aslam Ghauri.
Aslam Ghauri’s removal came after the PIMS nursery fire. But the issue is much wider than one official or one catastrophe. How can a ministry formulate policy, supervise hospitals, regulate medicines and manage national health programmes when its top administrative leadership keeps changing? Five upheavals in about 18 months are not reform. They are institutional instability.
The Directorate General Health has remained without a permanent, appropriately qualified technical head since the removal of Dr Rana Muhammad Safdar nearly four years ago. It is currently headed by Dr Muhammad Zaeem Zia, an officer on deputation from Gilgit-Baltistan, who replaced Dr Wali of the Federal Government Polyclinic.
The DG Health office should lead preparedness for outbreaks, disease surveillance, immunisation, health emergencies and public-health policy. Instead, this critical post has become another temporary arrangement, as if a country of more than 240 million people can manage public health through deputations and additional charges.
e National Institutes of Health is in similar disarray. NIH, the country’s premier institution for public-health laboratories, research, surveillance and biologicals, remains without a permanent CEO and permanent executive directors for its key institutes.
A new NIH board headed by Prof Dr Zulfiqar Bhutta was expected to restore order. But the process to appoint executive directors has stalled after questions arose over whether rules had been followed in recommending candidates. The process is reportedly being redone, meaning more delay for an institution that should be strengthening national preparedness.
Acting NIH CEO Dr Muhammad Salman is a respected laboratory professional, but NIH needs a full-time chief executive with the authority to manage a large national institution. Instead, he has also been handed additional charge of PIMS after the removal of its executive director following the deaths of 14 newborns. One person cannot effectively lead both NIH and PIMS. This is not efficiency. It is administrative desperation.
The Islamabad Healthcare Regulatory Authority has also descended into crisis. Created to enforce standards in hospitals and laboratories, IHRA faced serious questions over conflicts of interest as board members associated with private healthcare establishments sat on a body meant to regulate them. Its controversial chairman, Dr Riaz Shahbaz Janjua, has resigned along with most board members.
The regulator is now being run by a junior officer with limited apparent authority to confront powerful hospital and laboratory interests in Islamabad. A regulator that cannot regulate the influential is merely protecting the status quo.
PIMS, the Federal Government Polyclinic, CDA Hospital and other public facilities are struggling with weak governance, divided command, staffing disputes and entrenched employee interests.
Meanwhile, hospitals and primary-care facilities built with billions of rupees in Islamabad’s peripheries remain non-functional or underused because recruitment has not been completed. Buildings and equipment are there. Patients are there. The staff are missing.
DRAP’s recruitment has reportedly been cancelled for the third time, leaving it short of directors, inspectors and other technical staff ahead of a critical WHO Maturity Level 3 assessment. HIV, TB and malaria programmes lack essential personnel, while the hepatitis C elimination drive has failed to gain the expected momentum. Immunisation, too, is being run through deputed leadership instead of transparent, merit-based public-health appointments.
The repeated upheaval in the Common Management Unit, which is responsible for coordinating Global Fund-supported HIV, TB and malaria programmes, is another example of this instability. The Office of the Inspector General of the Global Fund found that the CMU’s national coordinator was changed 10 times and its deputy national coordinator for HIV four times during the three-year grant cycle it reviewed.
Separately, the Auditor General of Pakistan found that more than Rs122 billion in Global Fund assistance for HIV, TB and malaria between 2015 and 2023 was lost, missed or severely underutilised because of weak oversight and administrative failures.
The ministry does not need another reshuffle or another committee after the next tragedy. It needs permanent, competent and independent leadership. Until then, every vacancy will remain a public-health risk, and every avoidable death a reminder of a system that failed before the emergency began.