After midnight in sprawling Karachi, the person most likely to hand a transgender person an HIV test is not a doctor or a health worker. It is an outreach worker from a community organisation, often transgender themselves, who knows which streets to walk and which doors to knock.
The people they reach – transgender persons, people who inject drugs and sex workers – live at the far edge of Pakistan’s health system, turned away from hospitals, harassed by police, disowned by their families. They will not walk into a clinic, but they will open the door to someone from their own community.
That outreach worker did not appear on their own. Under the UNDP’s HIV Response, community organisations are not merely hired to deliver someone else’s design; one serves as a co-recipient of the donor’s grant, standing alongside UNDP rather than beneath it. That simple encounter on a Karachi street sits at the centre of one of development’s oldest debates.
For decades, practitioners and academics have contended with a fundamental question: does donor funding strengthen civil society, or transform it into a professionalised, elite-driven enterprise offering technical solutions to problems that are inherently political?
The criticism is familiar. Time-sensitive programming can make civil society organisations more accountable to donors than to the communities they serve. Genuine grassroots organisations, it is claimed, are either excluded for failing compliance requirements, or made to turn organic, community-focused approaches into managerial models centred on short-term outputs. The result, critics contend, is a class of technically proficient interlocutors who occupy an exclusive space within donor circles, adapting to shifting donor priorities rather than local needs.
These criticisms are neither new nor unfounded. They have gained renewed attention amid a global aid crunch, as blended financing gains ground and an “efficient” private sector is presented as a substitute for traditional development actors. Yet none of this erases the scene in Karachi. The worker knocking on that door is there because of the donor architecture that critics question, not in spite of it.
The debate therefore requires a more nuanced reading, one that recognises the limitations of donor-driven approaches while acknowledging how profoundly they have enabled civil society to expand access to essential services, bring marginalised communities into decision-making, and introduce more locally informed practices.
In Pakistan, civil society extends far beyond registered NGOs. It is visible in village organisations, women’s savings groups, disability rights collectives, youth networks and local welfare groups that people often turn to before approaching a formal institution. These are legitimate, deeply rooted forms of civic organisations, often better positioned than the state to understand and reach their own communities.
Donor support does not create this social capital; at its best it strengthens it, acting as seed funding to help organise and empower women, youth, persons with disabilities, and ethnic, religious and gender minorities who, facing marginalisation, stigma and discrimination, need sustained support to strengthen their voice and agency.
The same dynamic holds in Pakistan’s wider public service landscape. The Benazir Income Support Programme (BISP) shows both the scale of social protection and the importance of last-mile trust. In November 2025, it launched the pilot phase of its Social Protection Wallet across 41 districts, targeting 10.6 million beneficiaries. For women who are poor, rural, less literate, or socially constrained, navigating official messages, SIM collection, payment points and banking channels requires trust as much as technology. Local civic organisations often provide the support that makes formal systems accessible in practice.
My experience working in Pakistan and across South Asia has reinforced how these partnerships diversify development programming while strengthening democratic governance. They enable communities not only to receive services but also shape the policies that affect their lives, making public institutions more responsive to local needs.
‘Professionalisation’ need not imply elite capture. At their best, technically proficient NGOs serve as an interface between governments, donors and local communities, enabling vulnerable groups to access resources that would otherwise remain out of reach. This intermediary role has allowed governments and development partners to expand support in areas often considered politically or operationally difficult, such as HIV prevention, gender equality, human rights, climate change, disaster response, health and education and political participation. Many of these issues remain on the public agenda because of sustained NGO-led advocacy and would otherwise receive far less attention in resource-constrained settings.
The importance of this interface becomes clearest during crises. During the 2025 monsoon floods, which affected more than six million people and displaced around 2.5 million, humanitarian actors depended heavily on local knowledge: which families were cut off, where women could not safely reach camps, who lost identity documents and which households were being overlooked. This is why community-rooted actors often prove essential to making humanitarian response more accurate, dignified and responsive.
Development partners, including UNDP, increasingly recognise that compliance requirements often discourage grassroots organisations from participating. A community collective that keeps its books in a handwritten register, whose treasurer holds a matric certificate rather than a professional accounting qualification, and cannot survive three months waiting for reimbursement is unlikely to satisfy standard procurement requirements. This is why partners are shifting towards modalities that build capacity in financial, human resource and results-based management, meeting organisations where they are rather than where the paperwork assumes they should be.
Greater attention should also go to long-term sustainability and local accountability. In Pakistan, this means frameworks through which credible, community-rooted organisations can draw on government partnerships, domestic philanthropy, community contributions, social enterprise and responsible private sector collaboration. Just as importantly, these organisations should be accountable to the communities and local institutions they serve as much as they are to development partners.
The central policy challenge, therefore, is not whether civil society should be supported, but how. Between the idea and the reality lies a process of negotiation, adaptation, and institutional learning, a process that also shapes the relationship between the state and its citizens. Moving beyond simplistic binaries requires investing in models that strengthen trust between communities, civil society, and public institutions while preserving the independence and legitimacy that make civic organisations effective in the first place.
The outreach worker on that Karachi street is not waiting for this debate to be resolved. Tonight, thanks to that worker, someone the state has never counted will know their HIV status by morning. The ultimate measure of success is not whether civil society permanently substitutes for the state, but whether it helps build a state that is capable of reaching those it once left behind.
The writer is the deputy resident representative of UNDP Pakistan.
