“Trust takes years to build, seconds to break, and forever to repair.”
Anonymous

THIS observation aptly describes Pakistan’s relationship with one of its most important international health partners.

Since 2003, the Global Fund to Fight AIDS, Tu­­berculosis and Malaria has disbursed more than $1.1 billion to Pakistan’s HIV, tuberculosis and malaria programmes. In August 2020, however, it invoked its Additional Safeguard Policy (ASP) on Pakistan.

Behind this bureaucratic terminology lies an extraordinary decision: the Global Fund no longer had sufficient confidence in the country’s arrangements for managing its gra­nts and implementing disease-control programmes.

More than six years later, this decision deserves serious public scrutiny.

Established in 2002, the Global Fund is one of the most successful innovations in international health financing. It mobilises resources to support countries fighting these three diseases and has helped save an estimated 72 million lives globally. Pakistan has been a significant beneficiary.

The Global Fund normally operates through a partnership model in which national stakeholders identify priorities, nominate implementing organisations and oversee grants through a Country Coordinating Mechanism (CCM). The underlying philosophy is country ownership: international resources should strengthen national institutions, not substitute for them.

The Global Fund’s observations point to serious weaknesses in governance & institutional accountability.

In 2004, the Global Fund Board adopted ASP to address situations where normal funding arrangements could not adequately protect its investments. It permits oversight and direct involvement in........

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