IslamabadPakistan spends 0.9% of GDP on public health.
The “donor graduation” label ends international grants by 2030 despite a South Asian average of 4%, the Tabadlab report found.
The Global Fund already cut $27.2m from tuberculosis programs in July 2025; HIV and polio face the same phase-out.
Sources: Dawn
WHAT GRADUATION MEANS
Donor graduation is the moment a country crosses an income or capacity threshold and is deemed ready to fund services that grants previously covered. The label is administrative — Gavi, the Global Fund, and the World Bank each set their own cutoffs — but the cash effect is real: programs built on external money must find domestic replacement or shrink.
THE SPENDING GAP
Pakistan's 0.9% of GDP on public health is roughly a quarter of the South Asian average and a fraction of the WHO's recommended 5% floor. The gap is not new — it has held for two decades across civilian and military governments alike.
WHY TB MATTERS HERE
Pakistan has the world's fifth-highest tuberculosis burden — roughly half a million new cases per year. TB is curable with a $40 six-month antibiotic course, but only if diagnosis, drug supply, and follow-up hold together. The Global Fund's $27.2m cut hits exactly that scaffolding: GeneXpert cartridges, contact tracing, and second-line drugs for resistant strains.
THE FISCAL CONSTRAINT
Pakistan's federal budget routes roughly 50% of revenue to debt service and another large share to defence. Health competes for what remains alongside subsidies and provincial transfers. Under the 18th Amendment (2010), health is a provincial subject — but the provinces depend on federal transfers that shrink whenever the IMF arrives.
THE DONOR GRADUATION PARADOX
Countries graduate based on average income, not health system capacity. A country can cross the GNI threshold while still lacking the institutions — tax collection, supply chains, trained staff — to convert taxes into delivered care. Sri Lanka graduated from Gavi in 2003 and saw vaccination coverage gaps emerge within a decade.
THE POLIO HOLDOUT
Pakistan is one of only two countries — with Afghanistan — where wild poliovirus still circulates. The eradication program is roughly 80% donor-funded, with the Gates Foundation, Rotary International, and the GPEI carrying most costs. Domestic replacement of that pipeline would require a line item Pakistan has never funded.