Islamabad: HIV deaths in Pakistan have jumped by an alarming 400 percent and new infections have surged by 64 percent in just five years — a catastrophic failure linked to gross mismanagement, chronic delays, and collapsing oversight under Pakistan’s national health response, a damning Global Fund audit has revealed.
Despite receiving over US$1.1 billion in aid since 2003, including nearly half a billion dollars in the last grant cycle alone, Pakistan’s efforts to combat HIV, tuberculosis, and malaria are being crippled by dysfunctional governance, weak procurement systems, and poor financial accountability, according to the Office of the Inspector General (OIG) of the Global Fund.
Covering the period between January 2021 and December 2023, the audit slams Pakistan’s grant governance as “ineffective,” exposing a broken system where political instability, lack of strategic direction, and frequent leadership changes have paralyzed implementation of life-saving programs.
At the heart of the crisis is the Common Management Unit (CMU) — a body embedded within the Ministry of National Health Services — which has failed to deliver on its mandate despite receiving over US$16.7 million in Global Fund support.
New HIV infections rose from 7,741 in 2018 to 12,731 in 2023, while AIDS-related deaths skyrocketed from 2,200 to 11,000 in the same period. For tuberculosis, nearly 70 percent of drug-resistant TB cases went undetected in 2023. The report also points to stagnation in TB incidence — with 277 cases per 100,000 population, the highest since 2010 — despite the Global Fund injecting US$165 million into TB control efforts during the last grant cycle.
Procurement and supply chain systems, which account for nearly 60 percent of the grant budget, remain fragmented and weak. The audit highlights widespread stock-outs of HIV test kits at 64 percent of sites, expired HIV diagnostic products sent to provinces, and nearly 369,000 malaria bed nets — worth US$0.9 million — that have simply gone missing. Local procurements worth US$4.3 million faced average delays of nearly two years, stalling diagnostic and treatment efforts and causing massive waste.
The CMU’s internal dysfunction is laid bare: in just three years, it saw 10 changes in national coordinators, five in TB deputies, and four in HIV deputies. Key positions like procurement managers remained vacant throughout the audit period, while biometric attendance records show employees being paid for hundreds of days they did not work.
Pakistan also failed to meet its co-financing obligations under Global Fund agreements, falling short by US$116 million. Only five percent of allocated federal funds for HIV, TB, and malaria were utilized between 2022 and 2025. Weak tracking systems, data inaccuracies, and lack of coordination between federal and provincial governments contributed to the crisis, the audit notes.
While principal recipients such as Mercy Corps and Indus Hospital maintained robust financial controls, the audit uncovers widespread non-transparent hiring, with nearly a third of staff recruited without interviews or proper shortlisting. Payroll and procurement irregularities have been flagged, and millions wasted on non-competitive contracts, including US$3.7 million spent without market surveys or tenders.
Despite these alarming revelations, the Global Fund Secretariat declined to formalize new corrective actions for many of the report’s findings, although it promised to work with Pakistani authorities to improve governance, develop sputum transport plans for TB, and revise oversight mechanisms.
With Pakistan’s disease burden rising and donor confidence shaken, the OIG report serves as a stark warning: unless urgent and systemic reforms are undertaken, the country risks squandering global support and plunging deeper into a public health disaster.
On the other hand, experts said while the Common Management Unit (CMU) was not the Principal Recipient for the HIV grant during Grant Cycle 6 (2021–2023), oversight and coordination failures still plagued the national HIV response.
The HIV grants were managed by two Principal Recipients — the United Nations Development Programme (UNDP) and Nai Zindagi Trust — under the Global Fund’s Additional Safeguard Policy. However, the CMU, which hosts the national HIV program, retained a critical role in setting strategic direction and coordinating implementation with provincial governments.
The audit found that despite this role, CMU failed to lead effectively, with persistent gaps in leadership, planning, and accountability contributing to delays in key HIV activities and a deteriorating epidemic.
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