Islamabad: At a time when HIV is spreading rapidly across Pakistan and fresh outbreaks are being reported from different parts of the country, serious questions have been raised over the governance of the national HIV response after an unauthorised official of the Common Management Unit issued a notification assigning the charge of the HIV and AIDS programme to a section officer of the federal health ministry.
Officials said the notification was not issued by the competent authority in the Ministry of National Health Services, Regulation and Coordination and was instead signed by a non-government employee working with the CMU, a foreign-funded entity responsible for coordinating HIV, tuberculosis and malaria programmes. The CMU official, they said, had no legal or administrative authority to issue such a notification.
The development has triggered concern within public health circles, particularly as it comes at a time when Pakistan is witnessing a sharp rise in HIV infections. Official figures show that more than 13,000 new HIV cases were reported across the country last year, while national and international estimates suggest the actual number of new infections could be between 48,000 and 50,000 annually, as a large proportion of cases remain undiagnosed due to limited testing and weak surveillance.
Senior officials familiar with the matter said assigning a technically complex national programme through an unauthorised notification not only violates basic administrative rules but also reflects deeper governance problems within the CMU. They said such decisions should rest with the federal government through proper channels, particularly for programmes dealing with epidemics of national importance.
At present, the overall charge of the CMU for HIV, tuberculosis and malaria formally rests with Additional Secretary Laiq Ahmed of the federal health ministry, who has been holding the additional responsibility for around a year now. However, officials acknowledged that the HIV, TB and malaria programmes continue to operate without regular, dedicated and technically competent leadership, leaving key decisions to interim arrangements and non-technical personnel.
Public health experts warn that such administrative instability is unfolding alongside a worsening disease burden. Pakistan remains among the highest tuberculosis burden countries globally, including a growing number of drug-resistant TB cases, while gaps in programme leadership and oversight have affected early detection, treatment adherence and contact tracing.
Malaria has also emerged as a growing public health concern, particularly in Sindh and Balochistan following floods, population displacement and weak vector control. Experts say delays in programme interventions and shortages of trained staff have limited the impact of donor-funded malaria control efforts.
Health experts argue that running disease control programmes through junior or non-technical officials increases the risk of mismanagement and inefficient use of resources. “These programmes require public health expertise, continuity and clear authority. Ad hoc arrangements weaken accountability and outcomes,” a senior official said.
The issue has surfaced as a high-level delegation of the Global Fund is currently visiting Pakistan. Officials said the delegation has held meetings with government officials and representatives of the World Health Organization, during which concerns were raised over the functioning of the CMU, wastage of resources and the rising prevalence of HIV, tuberculosis and malaria despite years of substantial funding.
Pakistan has received millions of dollars in grants from the Global Fund over the past several years to control the three diseases. However, health experts say recurring outbreaks, rising infection numbers and administrative lapses point to serious flaws in governance, planning and oversight.
They warn that unless authority within the CMU is regularised, unauthorised decision-making halted and technically competent leadership put in place, Pakistan risks undermining both its disease control efforts and the confidence of international partners at a critical moment