Rs156.5 billion Global Fund health grants lost, missed or stalled, AGP report says

Global Fund assistance worth Rs156.5 billion for HIV, tuberculosis and malaria programmes was lost, missed, underutilised or held up due to administrative failures under the Ministry of National Health Services, Regulations and Coordination, according to the latest audit by the Auditor General of Pakistan.

The audit reviewed international healthcare grants from 2015 to 2023 and said more than Rs122 billion was lost, missed or severely underutilised, while another Rs34.5 billion remained tied up in stalled procurement and structural inefficiencies.

One of the major observations was the non-receipt of $22.900 million in additional funding after officials failed to submit an Integrated Funding Request for Catalytic Funds.

The audit also recorded $11.476 million in discrepancies in in-kind disbursement records, $2.442 million in losses due to prohibited practices by a private Principal Recipient and weak oversight by the Country Coordinating Mechanism, and $2.197 million, or around Rs468 million, in losses due to expiry of donor-funded medicines.

The report said underperformance in TB testing and treatment coverage under the Global Fund Pakistan Programme resulted in losses of $336.840 million. Another $3.680 million allocated for TB targets remained unutilised.

The audit also flagged stalled health infrastructure projects. It said the United Nations Development Programme failed to install and commission 36 Pressure Swing Adsorption plants, affecting projects worth Rs 10.780 billion, or $48.644 million.

Similarly, the United Nations Office for Project Services failed to install nine incinerators worth Rs553.462 million, or $1.977 million.

The audit identified Rs 2.400 billion lying unutilised in unauthorised bank accounts.

It also recorded losses of $824,768, or around Rs230 million, after the theft of 368,200 insecticide-treated nets.

The Common Management Unit was cited for negligence after accepting medicines with short shelf lives worth Rs41.504 million.

The audit said the programme failed to achieve HIV diagnostic and treatment targets despite available funding, resulting in a deficit of $24.850 million.

It also found that $39.395 million was paid in irregular salaries to Sub-Recipient employees without verification of attendance.

Other irregularities included the distribution of 604 laptops worth Rs149.188 million to an unrelated organisation, non-transparent procurement of solar systems, and laboratory equipment worth Rs24.267 million lying idle in warehouses for five to 12 years.

Auditors cited systemic deterioration in management and lack of oversight by the Ministry of NHSRC. The report said the Pakistan Programme was placed under the Global Fund’s Additional Safeguard Policy due to these shortcomings.

The Auditor General recommended mandatory inclusion of the Auditor General of Pakistan in CCM financial oversight, timely submission of statutory audit reports, and establishment of a stronger internal audit and oversight mechanism within the Ministry of NHSRC for all Global Fund grants.