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Pakistan hastens to sign $255 million grant agreement after warning from Global Fund

By Shahina Maqbool
January 28, 2016


The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) has cautioned Pakistan that if it does not sign, by mid-February 2016, the framework agreement for allocation of a US$255 million grant in support of the country’s national programmes for AIDS, TB, and Malaria, the GFATM will not be able to allocate funds to the country due to its own obligations, ‘The News’ learnt on good authority here Wednesday.

The Global Fund felt constrained to convey its stance to the Ministry of Health in the wake of unwarranted delay on part of Pakistan to sign the framework agreement, which is a generic document signed by all recipient countries.

The delay was caused by misinterpretation of and technical objections to some clauses of the agreement by some line ministries that were part of the consultations. And even though the Global Fund made amendments to the agreement in the light of these observations, Pakistan still delayed furnishing an official response on the agreement to the Global Fund.

Only on Tuesday, Secretary Health Muhammad Ayub Sheikh intervened yet again, as he had been doing for the past several months, by convening a meeting with his counterparts in the Ministry of Foreign Affairs and the Economic Affairs Division (EAD). He recognised that Pakistan was on the verge of losing the grant in support of AIDS, TB, and Malaria — diseases that are purely funded by GFATM. The meeting concluded with development of consensus to the effect that Pakistan would sign the agreement on February 7, 2016. It is pertinent to mention that the Pakistan government’s own contribution to the prevention and control of these three diseases is a mere pittance.

Meanwhile, a four-member team from GFATM, led by Urban Weber, who currently heads the High Impact Asia department of the Fund (covering Bangladesh, China, India, Indonesia, Myanmar, Pakistan, and the Philippines), is also in town these days to develop clarity on the issue and to hold discussions on future grant-making.

The GFATM has been providing grants to Pakistan for AIDS, TB and Malaria right from its second round. During the current cycle of Rounds 9 and 10 of the grant, GFATM introduced a New Funding Model (NFM) and tailored its framework agreement in consonance with it. Pakistan’s share under the agreement comes to US$255 million (TB: US$170.168, Malaria: US$50.686, HIV/AIDS; US$27.756 and Health Systems Strengthening: US$6.39million) for three years (January 2015-December 2017).

Under the NFM, the Global Fund has formulated strict guidelines wherein a country cannot access grants without first signing the framework agreement. It is, therefore, extremely crucial that the agreement be signed at the earliest to ensure uninterrupted flow of funds for activities to control and prevent the three diseases. While the concept notes for TB and Malaria have long been approved, that of HIV/AIDS has only recently been approved.

The Global Fund shared the agreement with Pakistan in August 2015. Thereafter, on December 4, 2015, the secretaries of health and EAD co-chaired a meeting to deliberate on the framework agreement in the presence of representatives of all public and private sector Principal Recipients (PRs) of the grant. The meeting noted that since Pakistan’s grant is drying up, the agreement should be signed at the earliest. More so, because the Global Fund will not continue the grant after June 30, 2016, as Pakistan is already on extension of the pervious grant.

The meeting agreed to the need for a detailed discussion on clauses on which reservations were expressed by various line ministries. These clauses pertained to tax exemption, anti-money laundering and countering of terrorist financing, access to information, and human rights. The PRs requested for more time to study the document and agreed to provide feedback in two weeks’ time. The private sector PRs generally showed satisfaction over the new mechanism since it does not have any direct impact on them. Recommendations received by the participants were forwarded to EAD on January 22, 2015.

Meanwhile, a revised framework agreement, after incorporation of comments from the government of Pakistan, was received from GFATM’s Fund portfolio manager for Pakistan. This response was also forwarded to EAD. Yet, no sincere effort was made to expedite signing of the contract, much to the annoyance of GFATM, which minced no words in conveying that if the contract is not signed by mid-February, Pakistan will not get a single penny of the grant.

Confirming all the above details, which led to inordinate delay in signing of the contract by Pakistan, the national manager of the AIDS Control Programme Dr. Baseer Achakzai said, “More than 350,000 HIV patients are in dire need of continuity of treatment in Pakistan. It is, therefore, a matter of immense satisfaction that all concerned have arrived at an understanding that the signing of the framework agreement is the need of the day. Moreover, it will also reflect the government of Pakistan’s commitment to the cause, being a high-burden country in the region for these three diseases.”