Sustainability of international aid and development – hospitals
By Tim Foxley
Summary: More evidence of poorly planned, un-sustainable and wasteful international reconstruction activity in Afghanistan
I have documented a few examples of where the construction, development and aid have been spent poorly in Afghanistan over the 12 years since 2001. In essence, money has been thrown into the country with apparently little understanding of the longer-term sustainability of such projects, which include, roads, schools and, now, hospitals. Although such projects look good and feel good, after international attention moves on, the projects start to look precarious – too expensive, not suited to the needs of local Afghans, high maintenance costs or no planning for maintenance requirements, and corruption and contractors both skimming off huge chunks of the value of the project.
I mentioned Canadian overall efforts in southern Afghanistan here (“All the projects have failed. None of them have been successful,”)
A new report has arrived from the US Special Inspector General for Afghanistan Reconstruction (SIGAR) – who
“…provides independent and objective oversight of more than $89.5 billion provided to implement reconstruction programs in Afghanistan. SIGAR’s core value of excellence, independence, and integrity guide its audits, investigations, and inspections.”
SIGAR is becoming adapt at spotting the longer-term problems with reconstruction work – has now focused on the construction by USAID of two hospitals. Their website is worth a look. The report, sub-headed: “Health Services in Afghanistan: Two New USAID-Funded Hospitals May Not Be Sustainable and Existing Hospitals Are Facing Shortages in Some Key Medical Positions”, looks damning:
Gardez in Paktiya province and Khair Khot in Paktika province—currently being built with USAID funds. USAID’s $18.5 million investment in these new hospitals may not be the most economical and practical use of these funds. First, USAID did not fully assess MOPH’s ability to operate and maintain these new facilities once completed. Second, construction began on the new hospitals about 1 year before USAID coordinated the final design plans with MOPH. USAID’s late coordination resulted in the construction of facilities that are larger—Gardez hospital is 12 times larger than the facility being replaced—than can be sustained, and increased estimated operating costs for the new facilities that are disproportionate to current costs…
…maintenance costs could be over five times more than the annual operating costs for the hospitals they are replacing…neither USAID nor MOPH has committed to provide funding to cover the additional operating costs of the new hospitals. SIGAR also found that some provincial hospitals are experiencing staffing shortages for certain key medical positions. Specifically, four of the five provincial hospitals that SIGAR reviewed to determine whether they met medical staffing standards reported persistent vacancies, some lasting several years…”
Analysis and Outlook
The Time article that carried the hospital story plausibly suggests a major cause of the problem. In the last 10 years, in the context of Afghanistan and Iraq, USAID had a 30% staff cut combined with a massive increased allocation of funding for development. The result was that money had to be spent via contractors with little oversight applied. Doubtless more of these stories will continue to emerge. Over 12 years there ought to have been plenty of opportunity for lessons to be identified, learnt and applied. I can’t help worrying about the Afghan army which is expected to carry the burden of holding the state together for the next decade – how much of the billions invested there have been thrown in without real thought to sustainability in the long-term?