Aids fight in Pakistan suffers from bureaucratic inefficiency

Approximately 98,000 people are HIV positive in Pakistan, according to the World Health Organisation (WHO), with some reports putting the figure at over 100,000. The epidemic is spreading from a ‘concentrated’ one, where the disease is limited to a certain vulnerable group, to a ‘generalised’ one where more than one per cent of the population is HIV positive. In Pakistan, as with most of Asia, the most vulnerable groups are injecting drug users (IDUs), transgender and female sex workers and as the global standards for measuring epidemics go, the disease is now spreading from these groups to the general public. Talking to The Express Tribune Dr Quaid Saeed, head of the WHO Blood Safety and Hepatitis Programme, Pakistan is transitioning through a very crucial stage in the control of HIV epidemic where there is a window of opportunity that can be availed. The disease can be stopped from further spread in high risk groups by providing them efficient harm reduction services. However, as the disease escalates in the country, the government’s strategies to counter it are falling victim to bureaucratic mismanagement. The National Aids Control Programme (NACP) has been unable to organize a lot of its activities due to severe paucity of funds. The programme, which runs on government funding, was broken down into provincial and federal units after the devolution of the Ministry of Health under the 18 Amendment in June 2011. Most functions of the NACP were passed on to the provinces but without proper planning causing bureaucratic confusion.

At the federal level, the programme is supposed to be the recipient for international funding, to prepare proposals for and liaise with international agencies for partnerships and importantly, provide technical and material resources to the provinces which could control the disease and conduct close surveillance. However, since the devolution no awareness campaigns or sessions have been organised by the federal NACP. The programme has also been unable to pay salaries to its 30 odd employees since June. On October 4, a store-keeper with the NACP Mohammad Razaq, tried to set himself on fire in protest. Razzaq, 43, who is diabetic, has been an employee of the NACP for 22 years.

Given this status of the main Aids fighting body, Pakistan’s ability to achieve the Millennium Development Goal to limit the spread of the disease by 2015 seems like a tall order. The Planning and Development Division (P&D), responsible for disbursing government funds to the NACP, has been delaying the release of funds, as according to it the necessary paperwork is incomplete. International donors like the World Bank and Department for International Development (DFID) withdrew their support for the NACP in 2010 after the floods, in what is described as a major setback for the programme. Dr Saeed said the services provided by the NACP for high risk groups have seen a marked reduction in the last few years because of diminishing resources, devolution of the health ministry and lack of capacity in the provinces. “It is time that we take control of this situation and give due attention to this impending threat to our nation before it is too late,” he said. Dr Saeed went on to state that because of NACP’s inability to manage the Aids programme efficiently there is a poor record keeping of those affected with Aids, their location and status.