An audit by the Auditor General of Pakistan has uncovered Rs156.5 billion in financial irregularities, underutilised funding, and operational failures in Global Fund-supported health programmes managed by the Ministry of National Health Services, Regulations and Coordination (NHSRC).

The audit, covering the 2015-2023 period, found that over Rs122 billion in funding was lost, missed, or significantly underutilised, while another Rs34.5 billion remained tied up in stalled procurement and implementation delays.

Among the major findings, Pakistan failed to secure USD22.9 million in additional Global Fund assistance after authorities did not submit the required Integrated Funding Request. The report also identified USD11.48 million in discrepancies in in-kind disbursement records, USD2.44 million lost due to prohibited practices by a private Principal Recipient, and USD2.2 million worth of donor-funded medicines that expired before use.

The audit further highlighted a USD336.84 million shortfall linked to underperformance in tuberculosis testing and treatment programmes, along with USD3.68 million in unutilised TB-related funds.

Significant implementation failures were also identified, including the non-installation of 36 PSA oxygen plants worth Rs10.78 billion by UNDP, failure by UNOPS to install nine medical incinerators valued at Rs553.46 million, and Rs2.4 billion remaining idle in unauthorised bank accounts.

Additional observations included the theft of 368,200 insecticide-treated mosquito nets, acceptance of short shelf-life medicines worth Rs41.5 million, a USD24.85 million gap in HIV diagnostic and treatment targets, and USD39.4 million in irregular salary payments made without attendance verification.

The audit also cited the distribution of 604 laptops worth Rs149.19 million to an unrelated organisation, non-transparent procurement of solar systems, and laboratory equipment worth Rs24.27 million remaining unused in warehouses for up to 12 years.

Auditors attributed the shortcomings to weak governance, poor financial controls, and inadequate oversight by the Ministry of NHSRC, noting that these deficiencies led to Pakistan's placement under the Global Fund's Additional Safeguard Policy (ASP).

The Auditor General recommended strengthening financial oversight, introducing robust internal audit mechanisms, ensuring merit-based appointments, improving inventory and supply chain management, enforcing procurement rules, and including the Auditor General in the Country Coordinating Mechanism's financial oversight to enhance accountability and prevent future losses.