The Marketization of HIV/AIDS Governance: Public–Private Partnerships and Bureaucratic Culture in Pakistan

The World Bank-financed ‘Enhanced HIV and AIDS Control Program’ tried to reorganized HIV/AIDS governance in Pakistan by pushing a neoliberal agenda of marketizing the provision of publicly-funded HIV prevention services. NGOs and the private sector competed for contracts with the government to provide services to the quasi-legal population of sex workers, drug users, transgendered people and homosexuals who were deemed ‘high risk’ groups for HIV. With contractualisation emerged a new bureaucratic field that emphasized ‘flexible organization’ and ‘efficiency’ in getting things done, in place of the traditional bureaucratic proceduralism which has been characteristic of the Pakistani civil service. This new corporate-style bureaucratic culture and the ambiguities of a hastily contracted (and ‘efficiently’ rolled out) Enhanced Program gave occasion to public funds ending up in the pockets of a few powerful actors. Instead of generating more efficiency, the marketisation of services dispossessed the intended beneficiaries of the World Bank loan.