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Global Health Initiatives and Universal Health Coverage in Pakistan-Aligned for the Future?

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|November 19, 2025
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Global Health Initiatives (GHIs) in Pakistan show weak alignment with universal health coverage (UHC) goals, creating inefficiencies. Addressing power imbalances and integrating aid with national health systems is crucial for sustainable development and reduced aid dependence.

Keywords:
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Area of Science:

  • Global Health
  • Health Systems Strengthening
  • Health Economics

Background:

  • Global Health Initiatives (GHIs) play a significant role in international health aid.
  • Alignment of GHIs with Universal Health Coverage (UHC) is increasingly critical, especially with declining global aid.
  • Tensions exist between national health systems and GHI assistance, impacting UHC goals.

Purpose of the Study:

  • To identify challenges and leverage points for aligning GHI assistance with UHC-focused health systems in Pakistan.
  • To analyze the political economy of national aid architecture and stakeholder interests regarding GHI reforms.
  • To understand country stakeholders' perspectives on GHI ecosystem strengths, weaknesses, and future reforms.

Main Methods:

  • A political economy approach was employed to analyze Pakistan's national aid architecture.
  • Key informant interviews were conducted with stakeholders in federal and provincial health systems.
  • A desk review of health financing data and policy-programmatic documents supplemented the interviews.

Main Results:

  • GHIs in Pakistan have an expanding mandate but weak alignment with national primary health care (PHC) budgeting and planning.
  • Off-budget grant models, multiple intermediaries, and selective support lead to inefficiencies, duplication, and poor sustainability.
  • Competing interests between federal and provincial governments, and disease-specific programs versus PHC, weaken national stewardship of GHI assistance.

Conclusions:

  • Addressing power imbalances is central to paradigm shifts in GHI country assistance.
  • Integration with national PHC reforms, fewer intermediaries, on-budget incentives, and PFM technical assistance are key for efficient and sustainable alignment.
  • Urgent action is needed to build local capacity for reduced GHI dependence while protecting disease outcome gains.