The Marketization of HIV/AIDS Governance: Public-Private partnership and Bureaucratic Cultures in Pakistan

The World Bank-financed 'Enhanced HIV and AIDS Control Program' tried to reorganize HIV/AIDS governance in Pakistan by pushing a neoliberal agenda, marketizing the provision of publicly funded HIV prevention services. NGOs and the private sector competed for contracts with the government to provide services to sex workers, drug users, transgendered people and homosexuals who were deemed 'high risk' groups for HIV. With this contractualization emerged a new bureaucratic field that emphasized 'flexible organization' and 'efficiency' in getting things done in place of the traditional bureaucratic proceduralism 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 meant public funds ending up in the pockets of a few powerful actors. Instead of generating more efficiency, the marketization of services dispossessed the intended beneficiaries of the World Bank loan.