Islamabad: Pakistani health authorities have stepped up efforts to secure the revocation of the Global Fund’s Additional Safeguard Policy (ASP), arguing that the measure is now unjustified and that the country has fulfilled all conditions required for its removal after nearly six years of extraordinary oversight.
The Additional Safeguard Policy was imposed by the Global Fund in August 2020 as an extraordinary risk management measure after it expressed concerns over Pakistan’s HIV and tuberculosis programmes, governance, financial oversight and implementation capacity.
In a letter to the then Special Assistant to the Prime Minister on Health, Dr Faisal Sultan in 2020, the Global Fund had cited stagnating tuberculosis notifications, rising HIV infections, weak leadership within the Common Management Unit (CMU), and concerns over programme implementation as reasons for invoking the policy.
Senior officials at the Ministry of National Health Services said Federal Health Minister Mustafa Kamal and Health Secretary Muhammad Aslam Ghauri have directed officials to complete an assessment of all remaining requirements within two weeks and submit a report to the ministry, after which Pakistan will formally initiate the process of seeking withdrawal of the policy from the Global Fund.
Officials acknowledged that the revocation process would involve extensive discussions and documentation with the Global Fund Secretariat in Geneva and was expected to take time.
A senior ministry official, requesting anonymity because he was not authorised to speak publicly, said the minister and secretary were dissatisfied that Global Fund-supported HIV grants continued to be channelled largely through the United Nations Development Programme (UNDP) and Nai Zindagi Trust, while the federal and provincial governments continued to face criticism over Pakistan’s worsening HIV situation.
“Mustafa Kamal has made it clear that Pakistan has met the conditions for revocation of the ASP and there is no justification for continuing an exceptional arrangement that undermines the government’s role,” the official said.
He praised Mustafa Kamal and Secretary Ghauri for what he described as “strong leadership” in pursuing the issue, saying they had taken decisions in Pakistan’s national interest and wanted the matter resolved without further delay.
In its letter issued in 2020, the Global Fund stated that the ASP would remain a temporary measure and would be reviewed after Pakistan met a series of conditions, including strengthening provincial programme implementation, ensuring the timely release of funds, reimbursing ineligible expenditures, demonstrating political commitment, establishing opioid substitution treatment services, implementing audit recommendations, strengthening oversight mechanisms, and mitigating identified risks.
According to ministry officials, Islamabad now believes every major condition has either been fulfilled or is in its final stage of implementation.
They said Pakistan has strengthened the Common Management Unit by appointing a qualified epidemiologist as National Coordinator, while recruitment for other key positions is under way.
Officials also said governance, procurement and programme monitoring mechanisms have been improved.
The official further said Pakistan has established an Opioid Agonist Maintenance Treatment (OAMT) centre at Jinnah Postgraduate Medical Centre (JPMC), Karachi, while another centre is expected to become operational in Lahore within days, fulfilling one of the Global Fund’s key conditions regarding treatment services for people who inject drugs.
The ministry also maintains that financial and administrative issues raised by the Global Fund have been addressed and that provincial governments are now playing a stronger role in programme implementation.
Officials argued that despite the extraordinary safeguards, Pakistan has continued to witness a significant rise in HIV infections, particularly among children, raising questions about whether the implementation arrangements introduced under the ASP have achieved their intended objectives.
The ministry official claimed that routing major HIV grants through UNDP and Nai Zindagi Trust had not succeeded in containing the epidemic and said governments continued to face public criticism despite having limited control over grant implementation under the current arrangements.
The official also alleged that Pakistan had previously accepted several personnel and structural changes sought by the Global Fund, yet the ASP remained in place.
He further claimed that the continued application of the policy had unfairly deprived government institutions of a greater role in managing international assistance.
“We are going to formally communicate to the Global Fund that Pakistan has met the required benchmarks and seek early withdrawal of the Additional Safeguard Policy, allowing future HIV grant implementation to proceed under normal country ownership arrangements,” the official added.
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