Every year on World Tuberculosis (TB) Day, the world reaffirms its commitment to eliminating the disease, which has plagued people for centuries. For Pakistan, TB is written in our history books. Access to timely TB care remains limited, though significant progress has been made, especially over the last 20 years, in increasing TB detection, strengthening diagnostic networks, and achieving high treatment success rates. However, donor funding continues to be a major underlier of Pakistan’s TB programme. According to local estimates, the Global Fund financed about 80 per cent of the TB programme between 2016 and 2023, with only 20 per cent sourced from domestic government spending.
Across the world, there has been a significant shift in donor priorities that is reshaping the landscape of global health financing. Geopolitical conflicts, economic pressures and competing domestic priorities in donor countries are leading to a contraction in development assistance.
These pressures are already affecting global health programmes. In early 2025, USAID terminated more than 5,300 grants and contracts worth approximately $27 billion, disrupting health programmes across several regions. It must be noted that the US is also the largest contributor to the Global Fund and accounts for more than half of international financing for tuberculosis control globally. In its most recent cycle of 2026-28, the Global Fund raised roughly $12.6 billion, falling significantly short of the fundraising target.
For Pakistan, the solution is undeniably complex. The broad direction of reform is widely understood: the provincial TB programmes need to take the lead for funding and oversight of their TB programmatic activities under the devolved health structure. However, moving from agreement to action remains a challenge.
Many low- and middle-income countries, such as the Philippines, Vietnam and India, have now transitioned to supporting 70 to 80 per cent of their national TB programmes financing through domestic resource mobilisation. Pakistan remains far behind this trajectory.
To reduce verticalisation and ensure greater sustainability, integrating TB services into national health programmes remains a key strategy. As an example, a TB care package can be introduced under the Sehat Sahulat Program, the flagship social health insurance programme in Pakistan, as in the Philippines, where the national health insurance program, PhilHealth, reimburses facilities for TB diagnosis and treatment, catalysing the shift to domestic financing.
Another key step towards greater national ownership and financing is reducing reliance on imported pharmaceutical products. At this point, amid geopolitical instability that has rattled the global order, supply chains are at increasing risk of disruption, and prices of medical commodities are expected to rise sharply. Particularly susceptible to these shocks are nations that rely significantly on imported medical technology, as is the case with TB in Pakistan.
Currently, TB medicines and diagnostics are procured through the Global Drug Facility, which accounts for an estimated 60 per cent of donor financing for TB in Pakistan. Consequently, a significant proportion of the funds is essentially retained at source, not moving through the domestic channels. Strengthening the country’s capacity to manufacture high-quality TB drugs that meet domestic and international regulatory standards could significantly lower the cost of treatment, pave the way for greater national control over programme resources, and potentially position Pakistan to generate foreign revenue through exports.
If Pakistan is to sustain the gains made against tuberculosis, the next phase of the fight must be built at home.
The writer is an assistant professor at the Department of Community Health Sciences, Aga Khan University.
