The International Donor Agency Global Fund has agreed to conduct a “clinical audit” and a “third-party evaluation” of approximately $44 million it provided to a private organization in Pakistan for the prevention of HIV among People Who Inject Drugs (PWID) over the last ten years after Sindh health officials expressed serious reservations about the performance of private organizations working for HIV prevention, officials said on Tuesday.
“On the concerns and request of the Sindh government, the Global Fund hired the Dutch firm Mainline last month to conduct a rapid assessment and response study of the performance of two of its grant recipients in Pakistan, including Nai Zindagi Trust (NZT) and Bridge Consultant Foundation (BCF) in Sindh, which received millions of US dollars from the Global Fund for HIV Prevention and Control in the province,” Dr. Ershad Kazmi, Additional Director of the Communicable Diseases Programmed, said.
Since 2003, the Global Fund to Fight AIDS, Tuberculosis, and Malaria has invested US$697 million in Pakistan, making it the country’s largest contributor to HIV/AIDS and tuberculosis (TB). Dr. Ershad Kazmi stated that the Global Fund has provided over $44 million to a private organization, Nai Zindagi Trust, for the control and prevention of HIV among people who inject drugs. However, the prevalence of HIV among drug users is alarmingly increasing and now stands at 38.4% in the country.
“In 2005, just 10.8 percent of injectable drug users were HIV positive, but currently roughly 38.4 percent of injectable drug users in the country, particularly in Sindh province, are HIV positive. ” Our main concern in this regard is that, despite the supply of infinite resources totaling millions of dollars over the previous 11 years, new infections, HIV prevalence, and fatalities among PWIDs have been steadily increasing with little impact or value for money,” Dr. Ershad Kazmi stated.
He said that the performance of the main and sub-recipients of Global Fund grants, such as the Nai Zindagi Trust and the Bridge Consultant Foundation (BSF), has never been audited in the last ten years by anyone, including the provincial government and the donor agency.
“A few weeks ago, the directorate of CDC HIV/AIDS Sindh wrote to the Global Fund Country Team in Geneva and conveyed serious concerns of the provincial government about the manner in which the Global Fund PWID (People Who Inject Drugs) Grant was being managed,” he explained, adding that at the request of Sindh health authorities, the Global Fund agreed to conduct an audit and third-party evaluation of both organisations’ performance.
However, the audit firm selected by the Global Fund for third-party examination and auditing surprised the Sindh health officials. Dr. Ershad Kazmi argued that Mainline is also a partner of Nai Zindagi Trust and questioned how an organisation could audit and evaluate the performance of its own partner. “We have also expressed our concern in this respect to the Global Fund in Geneva and requested an impartial probe and audit since people in Sindh are suffering as a result of mismanagement and lack of transparency in the use of global funds,” he added.
Dr. Ershad Kazmi stated that the Bridge Consultant Foundation, which is a sub-recipient of the Global Fund award, lacks trained and certified experts, and that as a result of its poor performance, no influence on the front of HIV prevention and control was evident in the province. “For example, they hired Dr. Rafiq Khanani, a pathologist, even though he didn’t have much experience, to train people on HIV prevention and control.”
Dr. Kazmi insisted that he had brought the entire situation to the attention of Sindh health minister Dr. Azra Pechuho and that, on her orders, his directorate had called the Global Fund to look into the matter and correct the problems with HIV control and prevention. However, they have begun negative propaganda against me and my team since we raised this issue and began questioning the performance of these private companies. ” Unverified reports of fresh HIV outbreaks are being propagated on social and local media, but we are not afraid of these techniques,” he said.
Officials in the National Health Services, Regulations and Coordination (NHS,R&C) Common Management Unit (CMU), which deals with HIV, TB, and malaria, said they were also closely monitoring the situation and gathering data to request similar audits and third-party evaluations in other provinces and federally controlled areas, including Islamabad, AJK, and Gilgit-Baltistan.
