LAHORE: A ‘tussle’ between the two federal ministries over the post-devolution health issues has deprived Pakistan of $100 million potential grant of the Global Alliance for Vaccines & Immunization (GAVI) that was supposed to be utilised for Immunization System Strengthening (ISS) and Health System Strengthening (HSS).

A complete utilisation of the balance HSS grant (US$3.5 million) was a conditionality to access and apply for the next GAVI HSS grant of $100 million for the next five years. An approval to the PC-1 was required for the utilisation of the $3.5 million HSS grant.

According to documents (a copy of which is available with Dawn), the Planning & Development division said the provinces should develop PC-1s for the utilisation of the grant through their respective provincial development working parties (PDWPs).

While the National Health Services, Regulations and Coordination (NHSR&C) insisted that a revised PC-1 was submitted to the P&D division for approval after taking onboard the stakeholders, including the Planning Commission.

The health ministry had developed first PC1 for utilisation of GAVI HSS and submitted to the P&D division for its approval in 2010.

However, the two-year correspondence between the two ministries on the issue brought no relief to the nation which was in dire need of the grant to overcome communicable and non communicable diseases.

Pakistan’s health system has been simultaneously challenged by the communicable and non-communicable diseases. The geographical location, topography and other environmental factors also place Pakistan among ‘disaster prone countries’.

The documents said GAVI has been providing global support for improvement in immunisation coverage and outcomes since 2000. There are different windows available for GAVI eligible countries to get the grant, including New Vaccines Support (NVS), ISS HSS.

Pakistan is the largest recipient of all these grants, with approximately $850 million allocated for the country till 2015.

In January, 2009 GAVI introduced Transparency and Accountability Policy (TAP) for all the countries receiving cash fund for ISS and HSS under which they had to go through a Financial Management Assessment (FMA).

Pakistan underwent FMA in October 2009 which recommended that further release of GAVI grants would be subject to GFR and approval of PC-1 by P&D division.

Pakistan received $16.898 million as first tranche of HSS grant in Aug 2008; of which the health ministry component as per FMA recommendation, was required to be developed and approved as HSS PC1 ($3.5m) to enable utilisation of GAVI HSS grant.

Keeping in view the sensitivity of the issue and inordinate delay in approval of the PC-1, an emergent meeting with GAVI/WHO Joint Mission was called at P&D division on Dec 14, 2012. The minutes of the meeting were later approved by the P&D secretary on January 1, 2013.

According to the minutes of the meeting (a copy available with Dawn) an overview on the HSS and ISS support and the reasons for the delay were highlighted in the meeting by the mission members, including Dr Irtaza Chaudhry, Ms Anne Cronin and Dr Mounir Farag.

They informed the meeting that at present approximately $10 million were available under GAVI-HSS support for Pakistan. Out of this amount approximately $3.5m were lying with the State Bank of Pakistan while approximately $6.6m were with GAVI secretariat.

The mission further shared with the meeting that the additional GAVI-ISS support for Pakistan that was approximately $10m for HSS/ISS was with GAVI secretariat which would be disbursed after successful utilisation of the grant available with Pakistan government.

However, out of this $10m, an amount of Rs477m (equivalent approximately $5m) has been recently allocated to the National EPI under its extended PC1. The mission requested for early process of PC-1 for GAVI/HSS so that the grant could be utilised without further delay.

According to the meeting minutes, the P&D division informed the mission that it has been decided by the competent authority that the Inter-Provincial Coordination (IPC) ministry will coordinate with GAVI and Global Fund for components being supported by these donor agencies.

“After detailed deliberations on expediting the implementation of HSS programme and utilisation of the available GAVI-HSS grant, the joint meeting decided that a PC-1 of GAVI-HSS worth approximately $3.5m will be prepared by IPC and submitted to P&D division”, the minutes of the meeting said.

After three-year delay, the NHSR&C revised it in 2013 and resubmitted to the P&D division for approval.

This time the revised PC-I was developed after devolution in consultation with all stakeholders and as per direction of P&D division. But, the division again raised some objection to the PC-1 which were addressed and responded accordingly by the NHSR&C in February, 2014.

The division intimated to the NHSR&C that after devolution of health service delivery the provincial governments should prepare their own PC-Is for the purpose.

“Although it is a fact that after devolution of health services delivery to the provinces, the provincial governments shall prepare their PC-1s for the purpose, the PC-1 in question was prepared on the directions of the planning commission in a meeting held with the GAVI-WHO Joint Mission on 14th December 2012. As per Aide Memoir signed with GAVI money can only be released after approval of PC-I”, the NHSR&C wrote to the P&D division in a letter on Feb 4, 2014.

However, the ministry could not impress the senior officials of the P&D division and the PC-I is pending for approval since then.

Published in Dawn, July 8th , 2014