The Auditor General of Pakistan has flagged serious irregularities and weak oversight in the management of Global Fund assistance, revealing that more than Rs. 122 billion in international health financing was either lost, missed or remained severely underutilized between 2015 and 2023.
According to the latest audit report, the Ministry of National Health Services managed Global Fund assistance worth a combined Rs. 156.5 billion for programmes aimed at tackling HIV, tuberculosis and malaria. Of this amount, over Rs. 122 billion was either not fully utilised or lost because of administrative lapses, while another Rs. 34.5 billion was tied up in delayed procurement, stalled infrastructure and other structural bottlenecks.
The audit identified one of the biggest setbacks as the failure to secure additional financing of $22.9 million after officials did not submit an Integrated Funding Request for Catalytic Funds. It also pointed to $11.476 million in discrepancies in 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 use.
The report highlighted major implementation failures in the tuberculosis programme, including $336.84 million in missed opportunities caused by underperformance in TB testing and treatment, along with another $3.68 million in unutilised funds allocated for TB targets.
Auditors also found that 36 Pressure Swing Adsorption oxygen plants worth Rs. 10.78 billion were not installed by the United Nations Development Programme, while the United Nations Office for Project Services failed to install nine medical waste incinerators valued at Rs. 553.46 million.
Further irregularities included Rs. 2.4 billion parked in unauthorised bank accounts, theft of insecticide-treated mosquito nets worth around Rs. 230 million, medicines worth Rs. 41.5 million with short shelf lives accepted by programme managers, and laboratory equipment valued at Rs. 24.27 million lying unused in warehouses for up to 12 years.
The audit also found that HIV diagnosis and treatment targets were missed despite the availability of funds, resulting in a funding deficit of $24.85 million. In addition, auditors questioned $39.395 million in salary payments made to sub-recipient employees without attendance verification.
The Auditor General attributed the findings to systemic management weaknesses and poor oversight within the Ministry of National Health Services. It said these failures had led to Pakistan’s Global Fund programme being placed under the donor’s Additional Safeguard Policy.
To address the shortcomings, the audit 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.
