Islamabad: Pakistani health authorities failed to utilise more than Rs122 billion in Global Fund assistance provided for HIV, tuberculosis (TB) and malaria control programmes due to administrative lapses, weak oversight and poor implementation while another Rs34.5 billion remained tied up in delayed procurement and stalled projects, a latest audit report of the Auditor General of Pakistan (AGP) says.
The audit, which reviewed Global Fund-supported programmes implemented through the Common Management Unit (CMU) for AIDS, TB and Malaria under the Ministry of National Health Services, Regulations and Coordination (NHSR&C) from 2015 to 2023, identified financial losses, missed funding opportunities, delayed infrastructure projects, procurement irregularities and failure to achieve programme targets.
According to the report, the cumulative financial impact of these shortcomings exceeded Rs156 billion.
Among the major observations, the AGP said Pakistan failed to secure an additional US$22.9 million in Global Fund support after officials did not submit the required Integrated Funding Request for catalytic funding.
The auditors also reported discrepancies of US$11.476 million in in-kind disbursement records, losses of US$2.442 million linked to prohibited practices by a private Principal Recipient and weak oversight by the Country Coordinating Mechanism (CCM), and expiry of donor-funded medicines worth US$2.197 million, or around Rs468 million.
The report said underperformance in tuberculosis control resulted in Pakistan losing US$336.84 million in Global Fund support because agreed TB testing and treatment targets were not achieved. Another US$3.68 million allocated for tuberculosis programme targets also remained unutilised.
The audit also highlighted delays in installation of health infrastructure procured through Global Fund grants. According to the report, the United Nations Development Programme (UNDP) failed to install and commission 36 Pressure Swing Adsorption (PSA) oxygen plants, delaying projects worth Rs10.78 billion (US$48.644 million), while the United Nations Office for Project Services (UNOPS) did not install nine medical waste incinerators valued at Rs553.46 million (US$1.977 million).
Auditors further noted that Rs2.4 billion remained parked in unauthorised bank accounts instead of being utilised for programme activities.
The report also identified losses due to theft and weak inventory management. It said 368,200 insecticide-treated mosquito nets worth about US$824,768 (around Rs230 million) were stolen, while the Common Management Unit (CMU) for AIDS, TB and Malaria accepted medicines with short remaining shelf life valued at Rs41.5 million, increasing the risk of expiry and wastage.
According to the audit, Pakistan’s HIV programme also failed to meet diagnostic and treatment targets despite the availability of donor funding, resulting in a funding gap of US$24.85 million. The auditors further questioned payments of US$39.395 million made as salaries to employees of sub-recipients, stating that attendance records had not been verified before the payments were released.
The AGP also pointed to several other irregularities, including distribution of 604 laptops worth Rs149.18 million to an unrelated organisation, procurement of solar systems without transparency and laboratory equipment worth Rs24.27 million remaining unused in warehouses for five to twelve years.
The auditors observed that weaknesses in programme management and oversight resulted in Pakistan’s Global Fund programme being placed under the donor’s Additional Safeguard Policy (ASP), under which the Global Fund exercises enhanced control over financial management and procurement.
To improve governance of donor-funded programmes, the Auditor General recommended including the AGP in the financial oversight mechanism of the Country Coordinating Mechanism, ensuring timely submission of statutory audit reports, establishing a robust internal audit system within the Ministry of National Health Services for Global Fund grants, making merit-based appointments of national and deputy national coordinators, strengthening supply chain and inventory management systems, and strictly enforcing procurement rules to prevent financial losses and wastage.
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