Pakistan to face growing health risk as international funding to health sector continues to decline: report

ISLAMABAD: As international funding to Pakistan’s health sector continues to decline and major foreign donors are set to completely suspend grants by 2030, the country faces serious health risks unless urgent steps are taken by the government, it emerged on Tuesday.

These are the findings of a report published last week, titled “Beyond Dependence: Understanding the Impact of ODA Cuts on Pakistan’s Health System”. The report, prepared by think tank Tabadlab, is authored by Behzad Taimur, Shahab Siddiqi and Syeda Farwa Qamar Jaffri and discusses the impact of declining Official Development Assistance (ODA) on Pakistan.

ODA refers to grants and concessional loans provided by governments and international agencies to support economic development and welfare in low- and middle-income countries.

The report finds that shrinking foreign assistance can threaten disease control programmes, immunisation efforts, and institutional capacity across the country. Once funding stops, it may significantly affect district-level monitoring, community outreach interventions, diagnostic testing capacity, and workforce training programmes.

According to the report, global ODA flows have been declining since 2019, with a sharper decline in recent years. Total global ODA dropped from $215 billion in 2024 to $174.3bn in 2025 — a decrease of 23 per cent — and may further decline in coming years.

The report warns that reductions in global health financing can have devastating consequences worldwide. Estimates suggest aid cuts may contribute to approximately 22.6m additional deaths globally by 2030, including 5.4m children under the age of five.

Country burdened by weak health indicators

The report paints a bleak picture of Pakistan’s health outcomes, describing the country as burdened by both communicable and non-communicable diseases.

Tuberculosis, diabetes, cardiovascular illnesses, malaria, HIV-AIDS and child health complications continue to strain the healthcare system. Despite modest gains in life expectancy, Pakistan still lags behind regional countries on several key indicators, it said.

Life expectancy in Pakistan stands at 68 years, nearly four years below the South Asian average. Infant mortality remains among the highest in the region at 50.1 deaths per 1,000 live births — more than double the rates observed in Bangladesh and Nepal.

Low public health spending

One of the report’s central findings is that Pakistan continues to under-invest in public healthcare despite rising health demands. Total health expenditure amounts to only 2.9pc of GDP, far below international benchmarks and lower than the South Asian average of 4pc. Public sector spending accounts for just 0.9pc of GDP, significantly below the levels recommended for achieving universal health coverage.

Although federal and provincial health budgets increased from Rs530.8bn in FY2019-20 to Rs1.4tr in FY2025-26, the report notes that inflation has sharply reduced the real value of those increases. After adjusting for inflation, health spending increased by only 25pc over six years. It argues that this rise remains insufficient to close longstanding gaps in healthcare infrastructure and service delivery.

The report points out that there are also disparities in per capita investments in different provinces. It notes that in Punjab, Rs2,043 ($12) are spent on each person every year; in Balochistan, Rs2,680 ($16); in Khyber Pakhtunkhwa, Rs3,136 ($18); and the most is spent in Sindh, at Rs3,203 ($19) per capita.

Increasing reliance on loans instead of grants

The report notes that Pakistan has received an average of $4.9bn annually in ODA between FY2016-17 and FY2024-25, equivalent to approximately 1.7pc of the GDP during the period. However, the composition of aid has changed significantly over time. Grant-based assistance has declined by 59pc, falling from $512m to $211m, while concessional loans now make up 96pc of all external assistance to Pakistan.

The report links this shift to broader global trends emphasising “shared responsibility” and “country ownership”, where donor agencies increasingly expect developing countries to finance development projects through debt, co-financing arrangements, and blended finance mechanisms rather than grants.

Global health initiatives face risks

The report also focuses heavily on Global Health Initiatives (GHIs), particularly institutions such as The Global Fund and Gavi, which finance critical public health programmes in Pakistan. Researchers argue that these initiatives play a system-critical role because they support vaccine procurement, supply chains, diagnostic infrastructure, disease surveillance, and service delivery programmes, according to the findings.

It also refers to recent cuts linked to USAID and UN agencies as examples of how donor withdrawal can trigger immediate disruptions. According to the analysis, aid contraction affects Pakistan through three main channels: abrupt bilateral donor withdrawals, reductions in multilateral pooled financing, and indirect spillover effects from weakening regional health systems.

Technical capacity and disease surveillance

Beyond direct financial losses, the report warns that shrinking ODA threatens Pakistan’s technical and institutional capacity.

It said that international partners such as the World Health Organisation, Unicef and the World Food Programme provide “advisory expertise, outbreak response coordination, disease surveillance support, and specialised technical assistance”. Cuts to these programmes could weaken Pakistan’s ability to respond to epidemics and cross-border disease threats, it highlighted.

The report highlights risks associated with trans-boundary transmission of tuberculosis, malaria, typhoid and polio, particularly from Afghanistan.

“Researchers warn that weakening surveillance systems could place enormous strain on local health infrastructure,” it said, adding that health management information systems, laboratory networks, diagnostics, and programme monitoring mechanisms are also expected to suffer if technical assistance contracts further.

Fund cuts already impacting Pakistan

The report identifies recent funding reductions by the Global Fund as an early warning sign of future disruptions.

It noted that in July 2025, Pakistan’s health ministry was informed of a $27.2m reduction under the Global Fund’s grant. Most of the cuts targeted tuberculosis control programmes, although HIV-AIDS programmes managed by the National AIDS Control Programme and UNDP Pakistan also faced reductions exceeding $4m.

The report states that once implemented, these cuts could “significantly affect district-level monitoring, community outreach interventions, diagnostic testing capacity, and workforce training programmes” in Punjab and KP.

Call for structural reforms

The report concludes that Pakistan must urgently reduce its dependence on external health financing and strengthen domestic systems before global aid contractions deepen further. It warns that declining ODA could sharply increase disease burdens, worsen mortality outcomes, and weaken long-term human capital development if measures are not taken quickly.

To address these challenges, the report recommends the establishment of a National Health Financing Forum to coordinate federal and provincial responses.

Other recommendations include creating a national ODA registry, introducing a health financing risk matrix, strengthening forecasting and integrated financial planning systems, improving domestic resource mobilisation, enhancing technical capacity, and reforming governance structures within the healthcare sector.

Last month, Federal Minister for Health Mustafa Kamal lashed out at The Global Fund for allegedly giving over 90pc of its funds to non-government organisations (NGOs) to combat HIV.

He said that NGOs were not answerable to the government and they did not share any data with the ministry under the pretext of confidentiality. Meanwhile, the government had received only $3.9 million from the fund.

Earlier in April, speakers at a national symposium on primary healthcare in Karachi underscored the need for promoting health across sectors, improving access and service quality, enhancing government-private collaboration and reducing reliance on external aid.