Massive Losses in Global Fund Assistance Revealed by Audit
The Auditor General of Pakistan has uncovered severe mismanagement of Global Fund assistance, with over Rs. 122 billion in international health funding either lost, unutilized, or left underutilized due to weak oversight and administrative failures. The audit report covers the period from 2015 to 2023, during which the Ministry of National Health Services managed Global Fund support worth Rs. 156.5 billion for HIV, tuberculosis, and malaria control programmes.
Of this total, more than Rs. 122 billion was lost, unutilized, or not effectively absorbed, while an additional Rs. 34.5 billion remained blocked due to procurement delays, stalled projects, and systemic inefficiencies. The audit highlighted multiple financial and operational irregularities that contributed to these losses.
Specific Irregularities and Missed Opportunities
The audit detailed several specific failures, including the failure to secure $22.9 million in catalytic funding after officials did not submit an Integrated Funding Request. It further noted discrepancies of $11.476 million in in-kind disbursements, $2.442 million lost due to prohibited practices by a private principal recipient, and $2.197 million worth of medicines that expired unused.
Significant shortcomings were also observed in the tuberculosis programme, where $336.84 million in funding opportunities were missed due to underperformance in testing and treatment targets, alongside $3.68 million in unutilized allocations. The HIV programme also missed targets despite available funding, creating a $24.85 million funding gap.
Infrastructure and Procurement Projects Left Incomplete
The report revealed that major infrastructure and procurement projects remained incomplete. These included 36 Pressure Swing Adsorption oxygen plants worth Rs. 10.78 billion that were never installed by the United Nations Development Programme, and nine medical waste incinerators valued at Rs. 553.46 million that were not set up by the United Nations Office for Project Services.
Other irregularities included Rs. 2.4 billion parked in unauthorized bank accounts, theft of mosquito nets worth around Rs. 230 million, acceptance of short-shelf-life medicines worth Rs. 41.5 million, and laboratory equipment worth Rs. 24.27 million lying unused in warehouses for up to 12 years.
Systemic Governance Weaknesses and Donor Sanctions
The Auditor General attributed these issues to systemic governance weaknesses and poor oversight within the Ministry of National Health Services. These failures resulted in Pakistan’s Global Fund programme being placed under the donor’s Additional Safeguard Policy. The audit also questioned $39.395 million in salary payments made to sub-recipient staff without verified attendance records.
To address the issues, the report recommended strengthening internal audit systems, integrating supply chain management, enforcing procurement rules, ensuring merit-based appointments, and including the Auditor General in the Country Coordinating Mechanism overseeing Global Fund grants.
