Pakistan is the first interim applicant in the transition phase of the new funding model (NFM) to be awarded money. On 3 May, the Global Fund Board approved funding in the amount of $8 million. This is the same amount that was identified for Pakistan when the interim applicants were announced (see GFO article).

In approving the money, the Board was acting on a recommendation from the Grant Approvals Committee (GAC).

The money will be used to replenish national, provincial and district buffer stocks to prevent treatment disruptions.

The $8 million will be added to an existing single-stream-of-funding (SSF) TB grant (PKS-T-NTP). The principal recipient is the National TB Control Programme. The PKS-T-NTP grant is a result of the consolidation of a recently approved Phase 2 of a Round 9 grant and an existing Round 8 grant. The total budget of the PKS-T-NTP grant is $121.2 million.

The GAC said that with support from the Global Fund (Rounds 2, 3, 6, 8 and 9) and other donors, Pakistan has achieved major increases in its capacity for TB control, and has reached treatment success rates that have been consistently above 90% since 2008. However, the GAC said, the case detection rate for all forms of TB, estimated at 64%, remains very low.

According to the GAC, Pakistan faces a major crisis in funding for TB first-line drugs (FLDs). In addition, TB control in Pakistan is facing new challenges associated with the devolution of health matters to the provinces and the dismantling of the Federal Ministry of Health in July 2012. The GAC said that FLD buffer stocks at all levels (national, provincial and district) have been completely depleted. This is due to substantial differences between allocations of stocks to the provinces and TB drug requirements,  and significant procurement delays on the government side. The GAC said that in the absence of buffer stocks, there is a very high risk of stockouts.

Editor’s Note: On 6 May, The International News, a Pakistani newspaper, reported that the national government has consolidated all key health institutions and health-related functions in Pakistan under a new agency, the “National Health Services, Regulations and Coordination Division.” The newspaper said that this decision is intended to “arrest the post-devolution fragmentation of health in Pakistan.”

The GAC said that the additional $8 million is also intended to pre-empt a situation where higher case notification – resulting from strengthened TB case finding in public and private health facilities – might lead to an unplanned rise of FLD consumption.

The buffer stock, which will comprise 268,304 courses of FLD, will be ordered in 2013. Half of the buffer will be stored at central warehouses, 25% in the five provinces, and the remaining 25% in the 134 districts.

Information for this article was taken from Board Decision B28-EDP-20 and from B28-ER-15, the Report of Secretariat Funding Recommendations and Decisions for April 2013. These documents are not available on the Global Fund website.