Pakistan Failed to Use Rs. 122 billion in Global Health Aid: Report

The Auditor General of Pakistan has flagged major failures in the management of Global Fund assistance, revealing that more than Rs. 122 billion in international health funding was lost, missed, or severely underutilized due to weak oversight and administrative failures.

According to the latest audit report, the Ministry of National Health Services managed Global Fund assistance worth a combined Rs. 156.5 billion between 2015 and 2023 for programs targeting HIV, tuberculosis, and malaria. Of that amount, over Rs. 122 billion was lost, missed, or remained underutilized, while another Rs. 34.5 billion was tied up in stalled procurement, delayed infrastructure, and other structural inefficiencies.

One of the largest setbacks identified by auditors was the failure to secure additional funding worth $22.9 million after officials did not submit an Integrated Funding Request for Catalytic Funds. The audit also recorded $11.476 million in discrepancies involving in-kind disbursements, $2.442 million lost due to prohibited practices by a private principal recipient, and $2.197 million worth of donor-funded medicines that expired before they could be used.

The report also highlighted serious implementation failures in the tuberculosis program, including $336.84 million in missed opportunities due to underperformance in TB testing and treatment, along with another $3.68 million in unutilized funds allocated for TB targets.

Auditors found that 36 Pressure Swing Adsorption oxygen plants worth Rs. 10.78 billion were never installed by the United Nations Development Program, while the United Nations Office for Project Services failed to install nine medical waste incinerators valued at Rs. 553.46 million.

The audit further identified Rs. 2.4 billion parked in unauthorized bank accounts, theft of insecticide-treated mosquito nets worth around Rs. 230 million, medicines with short shelf lives worth Rs. 41.5 million accepted by program managers, and laboratory equipment valued at Rs. 24.27 million lying unused in warehouses for up to 12 years.

In addition, the report found that HIV diagnosis and treatment targets were missed despite available funding, resulting in a funding deficit of $24.85 million. Auditors also questioned $39.395 million in salary payments made to sub-recipient employees without attendance verification.

The Auditor General attributed the findings to systemic management failures and weak oversight within the Ministry of National Health Services. The report noted that these shortcomings resulted in Pakistan’s Global Fund program being placed under the donor’s Additional Safeguard Policy.

To improve governance, the Auditor General recommended strengthening internal audit mechanisms, integrating supply chain management systems, enforcing procurement rules, ensuring merit-based appointments, and including the Auditor General in the Country Coordinating Mechanism responsible for financial oversight of Global Fund grants.