Report warns aid cuts are putting Pakistan’s health system under growing strain

ISLAMABAD: Reductions in development assistance are placing Pakistan’s health sector under serious pressure and threatening the functioning of key programmes, according to a new report released by think tank Tabadlab.

In a press release issued on Tuesday, the organisation said its report warned that Pakistan’s health system was facing the risk of breakdown in critical areas as Official Development Assistance (ODA) continued to shrink, adding that higher budget allocations alone would not be enough to address the problem.

The report, titled Beyond Dependence: Understanding the Impact of ODA Cuts on Pakistan’s Health System, was published last week. It was authored by Shahab Siddiqi, Behzad Taimur and Syeda Farwa Qamar Jaffri.

Key functions affected

According to the press release, the study documented how recent cuts by donors were disrupting specific parts of the health system that domestic funding only partly supports. These include procurement of commodities, diagnostic services, supply chain operations and specialist staffing.

Tabadlab said the report was based on interviews with dozens of development practitioners and public health officials working across federal and provincial governments, along with an analysis of budgetary and ODA data.

"The evidence is already visible. USAID's suspension closed over 60 facilities, disrupting care for 1.7 million people. A $27.2m global fund reduction halved TB monitoring in Punjab and Khyber-Pakhtunkhwa, cut diagnostic kit financing and placed treatment for tens of thousands of HIV-positive patients at risk. These disruptions will only intensify if the government does not develop effective transition plans as ODA continues to contract," he said.

Budget limits and structural concerns

Shahab Siddiqi, Tabadlab’s director for human capital, said the issue went beyond the size of public spending.

"This is a functional problem, not just a fiscal one. Pakistan's public budgets finance salaries and facilities. ODA finances vaccines, medicines, diagnostics, and supply chains. When ODA contracts, services retain staff but lose the operational core that makes programmes work," he said.

The press release said the strain was being worsened by what it described as Pakistan’s chronically low health spending, which it put at 0.9% of GDP. It said this was far below the World Health Organisation’s recommended minimum of 5%.

It further stated that grant-based assistance to Pakistan had fallen by 59% since 2017, while projections by the OECD pointed to another 5.9% drop in global ODA in 2026, indicating what the think tank described as a longer-term structural change rather than a short-lived disruption.

Recommendations in the report

According to the press release, the report proposed a structured transition framework to manage the impact of declining external support.

Its immediate recommendations include setting up a national health financing forum, creating a national ODA registry and preparing a risk matrix to classify health functions according to substitutability and criticality.

For the medium term, the report called for time-bound transition plans for tuberculosis, HIV-AIDS and immunisation programmes, along with regulatory changes to allow more flexible procurement and hiring. It also recommended increasing public health expenditure towards 3% of GDP.

The press release said the report’s longer-term proposals focused on strengthening technical capacity and gradually integrating vertical programmes into primary healthcare.