THE interior minister of Pakistan had said the other day that whether “we admit it or not, this system has collapsed” and that “this system has to be reset”.
The healthcare system of Pakistan is sadly a clear illustration of what the minister said, and the spread of HIV and hepatitis C symbolise this collapse. The latest reported figure of small children infected with HIV in the country due to reused syringes and transfusion of unscreened blood is 7,500, minus cases in 2026 from Punjab, which has reportedly not bothered to share its data with the federal government. The total number of deaths due to HIV is reported to be 25,000. The number of children’s deaths is not available. As for the case of hepatitis C, we have the world’s largest infected population, ie around 10 million. The current estimated prevalence of hepatitis C in Pakistan is 7.5 per cent, which is also the highest in the world. Twenty per cent of the global burden of hepatitis C is in Pakistan alone. HIV and hepatitis C share the same modes of transmission.
Imagine a mother who takes her child to a health facility for a minor ailment — cough, fever or diarrhoea. The child is given an injection through a syringe which has been used on other patients drawing from the same multi-dose vial, or through a cannula that has also been reused or an IV drip. After a few days of this “treatment” the child starts losing weight and falls sick again and again. Every visit to the health facility brings the same “treatment”. Eventually someone suspects immune deficiency and tests the child for HIV and s/he turns out to be positive.
The HIV epidemic is part of a prevailing public health crisis in Pakistan.
This generic story is being repeated day in and day out in Pakistan. Children are being infected with HIV not through mother-to-child transmission, not through sexual contact, but through the very healthcare system meant to treat them. Most children, across the country, are never suspected and remain undiagnosed. This is why it is the tip of the iceberg.
Those who are diagnosed have to be on daily treatment for the rest of their lives. If they are caught late, a child can slide into ‘advanced disease’ requiring intensive care. Even children who survive this stage may carry lasting effects on their body systems: slower growth, delayed brain and motor development, and problems affecting the heart and kidneys. Every six months, children on treatment are supposed to have their viral load tested — the single indicator of whether medicine is working or the child is sliding into advanced disease. Reportedly, this testing has been interrupted in Sindh since December last year. The monitoring chain in Punjab and other provinces is also unclear.
Working backwards from health facility level where our children are being infected with HIV, there are issues of system failure, governance failure and moral failure on the part of all those responsible, going up to the top-most level of policymakers.
The government of Pakistan runs prevention and treatment of HIV on grants from the Global Fund to Fight AIDS and Malaria — thanks to the Fund. In the last five years, more than 90pc funding for this disease and TB and malaria has come from the Global Fund. Out of this funding between 2013 and 2015, according to the 2025 Auditor-General of Pakistan report, Rs122 billion have remained unspent. Despite availability of money, many key positions in federal and provincial AIDS programmes remain vacant, and so on. And there is zero accountability for all this.
If this is not a system collapse, then what is it? The consequence of this collapse is 7,500 children infected with HIV, and the number is growing.
The unfolding HIV epidemic in Pakistan is gradually moving towards becoming a generalised epidemic from a concentrated epidemic limited to high-risk populations.
But the HIV epidemic is part of a prevailing public health crisis in Pakistan. We don’t pay attention to it because the elite classes take care of their health through super specialists in their expensive private clinics. The bulk of the population in smaller towns and villages suffers at the hands of an extremely unsafe public health system and suboptimal and minimally regulated private practitioners and outright quacks.
It is no coincidence, hence, that Pakistan has the second highest neonatal mortality in the world; 49pc of our women in reproductive age suffer from iron deficiency anaemia and they give birth to underweight children, 40pc of whom become stunted, physically and mentally; we along with Afghanistan are not able to eradicate polio whereas 192 countries have done it, including those poorer than us and those who have been chronically in emergency situations like Somalia, Haiti, Yemen and Syria; every third Pakistani above the age of 18 years is suffering from type II diabetes, 34.5m of them, which is the largest population in the world; every fourth Pakistani above the age of 40 years has high blood pressure; every fourth mother undergoes postnatal depression and every fifth child in our schools is suffering from emotional or behavioural disorders. These are those lucky children who go to school whereas there are more than 25m children who are out of school ie more than two crore and 25 lakh children — imagine!
We have very high inequity in healthcare. One figure says it all: government health expenditure per capita in Lahore is around $70.8, the same figure for district Rajanpur in southern Punjab $4.2. This is according to a government report. The Pakistan government is among the lowest spenders on health.
These are the consequences of the collapse. The accumulative effect of all the above is that an average Pakistani’s life expectancy at birth is eight to nine years less than an Iranian and a Sri Lankan.
There is a collapse, and there are consequences. After the outburst of the interior minister, Pakistan has started asking important questions about itself. Indeed, smaller administrative units are essential, but they are not sufficient as a solution. A much more comprehensive and deeper introspection and reform process is needed, and a precondition for that is a political consensus between all the main stakeholders in Pakistan. I hope we would not lose this opportunity. Otherwise, innocent children would continue to be infected with HIV, and much more.
The writer is a former SAPM on health with ministerial status, adjunct professor of health systems and president of the Pakistan Association of Lifestyle Medicine.
Published in Dawn, August 7th, 2026
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