Islamabad: The Common Management Unit (CMU) responsible for overseeing the country’s HIV, tuberculosis (TB), and malaria programs saw ten changes in its top leadership within just three years — a revolving door of national coordinators that severely crippled disease control efforts during the Global Fund’s sixth grant cycle (GC6), Office of the Inspector General (OIG) of the Global Fund has revealed.
The OIG report, released this week, provides a damning indictment of chronic mismanagement at Pakistan’s Ministry of National Health Services and exposes a systemic collapse in managerial continuity and strategic oversight at the CMU, where the position of National Coordinator was changed ten times between 2021 and 2023.
Over the same period, the Deputy National Coordinators (DNCs) for TB changed five times, HIV DNCs four times, and Malaria DNCs three times.
The chaos was compounded by prolonged vacancies in critical posts including the grant coordinator, TB advisor, procurement manager, and chief procurement officer — all of which remained unfilled throughout the grant cycle.
Alarmingly, one official — the warehouse manager — was found to be simultaneously holding the roles of procurement chief and manager, highlighting severe resource mismanagement.
As if the leadership instability wasn’t enough, the Ministry of Health has continued to make controversial appointments in violation of court orders and technical eligibility.
Most recently, it handed over the role of Deputy National Coordinator for Malaria to a non-medical officer, echoing an earlier move where a non-doctor, Ayaz Mustafa, was appointed as DNC for TB. These discretionary appointments, made on the basis of “additional charge” and without any transparent recruitment process, have triggered widespread concern among public health professionals and donor agencies.
“This is institutional sabotage,” a senior health official told The News, requesting anonymity. “Each program — HIV, TB, and malaria — demands continuity, technical expertise, and strong governance. What we’re seeing is the opposite: rapid-fire appointments, politicized postings, and disregard for court rulings.”
The OIG audit blames the health ministry’s instability and weak leadership for a massive rise in disease burden: HIV infections surged by 64% since 2018, while AIDS-related deaths rose by a staggering 400% between 2010 and 2023.
TB incidence stagnated due to poor diagnosis and a growing gap in treating drug-resistant cases. Meanwhile, the malaria program faltered with inadequate epidemiological data and massive delays in long-lasting insecticidal net (LLIN) campaigns.
The audit also slammed the health ministry for failing to provide strategic direction or implement key activities. The 2023–2026 HIV strategic plan was not approved, TB treatment guidelines remained undistributed, and a national supply chain strategy was never finalized.
Grant implementation suffered from glaring inefficiencies, with massive delays in procurements and local logistics, leading to expiries, product stock-outs, and financial losses worth millions of dollars.
Despite spending over US$16.7 million on CMU operations since 2021, the unit has failed to deliver measurable outcomes. The audit found that no performance evaluations were conducted for CMU leadership, and work plans with clear targets and milestones were lacking. Oversight mechanisms were either weak or non-existent, with no accountability for frequent staff reshuffles or stalled projects.
Adding to the dysfunction is the constant turnover in federal leadership: since 2020, the Ministry has cycled through four health ministers, six federal secretaries, and six Director Generals. This has rendered the CMU rudderless, incapable of enforcing programmatic discipline or securing long-term improvements.
The appointment of non-doctors to crucial leadership roles is emblematic of the rot. In the case of TB, Ayaz Mustafa — a PhD with no medical background — was appointed in defiance of Islamabad High Court orders that barred ad-hoc postings without merit-based recruitment.
A similar approach appears to have been taken with the Malaria program, where yet another non-clinical figure has been placed at the helm, despite the highly technical nature of the role.
Health experts warn that such politically influenced appointments risk alienating donor partners like the Global Fund, which has already shifted its HIV grant to the UNDP under its Additional Safeguard Policy due to concerns about government capacity and governance. Pakistan has received over US$1.1 billion from the Global Fund since 2003, with US$439 million disbursed in GC6 alone.
“The health ministry has become a revolving door of incompetence,” a development partner said. “Unless the government institutes serious reform and respects transparency and court rulings, we risk not only losing lives but also the confidence of the global health community.”
With GC7 already underway and fresh funds on the table, Pakistan now faces a stark choice: fix its broken management structure or watch its disease burden spiral further out of control. The first step, experts agree, is to stop appointing unqualified individuals to critical positions — and hold someone accountable for years of catastrophic misgovernance.
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