Submission ID 118215
| Issue/Objective | The progressive reduction and cessation of donor health aid from organizations including USAID, UKHSA, WHO, and CDC has disrupted Pakistan's health sector, particularly in disease surveillance, immunization, and vertical programs. While often viewed as a blow to public health, this evolving shift presents an opportunity for health system transformation, public sector leadership, and locally led solutions. This study examines whether donor withdrawal can catalyze sustainable domestic financing and greater national ownership in LMICs, with Pakistan as a case study. |
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| Methodology/Approach | A policy and systems analysis was conducted using the WHO Health System Building Blocks framework. This included a desk review of OECD iLibrary, Global Health Expenditure Database, USAID and GAVI reports, and Pakistan's national health accounts from 2015-2024. [Preliminary interviews with government and development stakeholders revealed that public health, unlike curative care, was largely donor-driven, requiring urgent institutional strengthening post-withdrawal. Another noted concern was the potential disruption to International Health Regulations (IHR) implementation in countries like Pakistan due to resource gaps |
| Results | Between 2010 and 2020, Pakistan received over $2.5 billion in USAID health funding. Programs like FELTP, GPEI-supported polio eradication, and EPI (via UNICEF, JICA) were heavily donor-dependent. The drawdown post-2022 triggered operational disruptions across surveillance and immunization. However, it also prompted early reforms: domestic budget reallocations, increased provincial accountability, and exploration of a national health emergency fund. UKHSA's maturity model enabled a structured transition of the IDSR system to national leadership-a rare instance of embedded capacity and sustainable handover |
| Discussion/Conclusion | Donor dependency entrenched external agenda-setting and passive governance. Its retreat now compels Pakistan to take proactive steps toward building internal capacity and planning mechanisms. Early signs suggest that donor exit can be seen as a policy window for health financing reform, if strategically supported. Structured transition models like UKHSA's maturity framework may offer replicable strategies for LMICs navigating similar post-donor shifts. The findings may inform other countries facing aid transitions, particularly in sustaining surveillance systems and health security commitments amid global funding contractions |
| Presenters and affiliations | Muhammad Asif Khan UK Health Security Agency Muhammad Asif Khan United Kingdom Health Security Agency Muhammad Sartaj UK Health Security Agency Maimoona Junaid UK Health Security Agency |
