Friday, August 19, 2011

AMAZING collaboration between military, USAID, and not-for-profit

Wow! I recently heard a speech by Dr. William H. Foege, a world renowned epidemiologist who was key to the campaign that basically has eradicated smallpox (of course, with the exception of in Afghanistan and a few other war-torn areas), among other incredibly notable achievements. In his speech, Dr. Foege claimed that there would be an anti-malarial vaccine produced within the next 2-3 years, which is astonishing news from a very credible source.

This morning's news brings the announcement that the military, USAID and a not-for-profit called IDRI are collaborating to produce an anti-malarial vaccine. It's an incredible story, and if the effort is successful, the world will be changed. Here's the press release URL: http://m.prnewswire.com/news-releases/idri-usaid-strike-new-collaboration-for-malaria-vaccine-development-127868588.html.

I'm (slowly) writing a piece about the military's role in global health, and this kind of activity illustrates the real contributions that the U.S. government, writ large, can make. I hope it is successful!

Saturday, August 13, 2011

Louie Palu photos and essay

Photographer Louie Palau has a compelling piece on the Virginia Quarterly Review called "Total War" here at this URL:http://www.vqronline.org/articles/2010/spring/palu-total-war/, or click on this blog title. A Canadian doc tries to save an Afghan with a gut wound. His photos are evocative and powerful. I'd like to upload one to capture your attention, but I'm sure they are copyrighted.

Navy Corpsmen try to save an Afghan girl

I came across some compelling journalism from Afghanistan (where else?) by a young guy named Elliott D. Woods in the Virginia Quarterly Review. There's a particularly germane piece on how some Corpsmen tried to save a little Afghan girl who was blown up by an IED. It's called "Our Deepest Sympathy." Worth looking over, truly, as are the rest of his stories from "Assignment Afghanistan" at this URL: http://www.assignmentafghanistan.org or click on the title of this post.

Sunday, June 26, 2011

The Global Health Initiative

The President's Global Health Initiative is great--nested within his policy for Foreign Development it lays out a way forward for health development. Eight countries were selected for "fast track" focus: Bangladesh, Ethiopia, Guatemala, Kenya, Malawi, Mali, Nepal and Rwanda. (I would have loved to watch the political debate about which countries were selected.) The paper posted on the White House website (click on the title of this blog to go there) says the eight countries:

will receive additional technical and management support to quickly implement and learn from GHI’s approach, including integrated programs and investments across the health priorities, fostering greater country ownership and targeting health systems activities that deliver results. These countries will provide enhanced opportunities to build upon existing public health programs; improve program performance; and work in close collaboration with partner governments, across U.S. government agencies, and with global partners.


The GHI is a $63 billion program. It will be interesting to see how this, and the foreign development programs, perform. And, I wonder how the DoD is focused on these priority countries, if at all?

Monday, June 20, 2011

More on sustainability

Patricia McArdle wrote an oped descrying unsustainable development. She didn't point fingers at the military, this time, but did use the "s" word (sustainability) to advocate for solar and wind power. She apparently works for a solar cooker NGO. The punting around of the word sustainability is becoming almost comical, and I would laugh were I not so overwhelmingly wanting to bang my head against my desk when I read it.

CERP spending

A good report on CERP spending appeared in the PRISM magazine (from the National Defense University) from March. It's one of the more balanced and insightful discussions about CERP spending. The debate about CERP spending is unending because there is no theory or reliable research being done to support the theory and inform a strategy. So there are many opinions, stated firmly and provocatively, but only partially informed. Get two people together over a cup of coffee with opinions on CERP and you have an automatic debate. In the end they each might be using the words "CERP spending" but talking about completely different contexts, uses, goals and outcomes. However, it will sound like a cogent debate. That's why we need more study, and less polemics (refering to my 2-part complaint about the Congressional report on foreign assistance).

Sunday, June 19, 2011

Evaluating U.S. Foreign Assistance to Afghanistan-- A Two Part Complaint

So, I've read the report prepared by the Senate Foreign Affairs Committee on assistance in Afghanistan and it's completely bizarre, as I feared. Here's how it starts:

"...we believe the administration can be more effective in how it spends aid in Afghanistan. U.S. assistance should meet three basic conditions before money is spent: our projects should be necessary, achievable, and sustainable." (page 2).

I wonder who wrote those two sentences? They are classic. Let's pause for one moment and examine the thesis of this incredible piece of work.

First, it says the administration can be more effective in how it spends aid. What does that mean, exactly? That the money should get more 'bang' for each 'buck'? For example, for every dollar spent, Afghans should get 60 cents in actual assistance -- like meals, water, roads and so forth? Because one OXFAM report claims that something like 40% of foreign assistance is returned to the country of initiation in salaries and payments to project managers and monitors from that country. OR, does that sentence mean that for every dollar spent we should see a resulting decrease in violence in any given area? Or, does that mean that for every dollar spent, the Afghan markets grow by some proportional amount? Or, perhaps it means that for every dollar spent, we should be able to get out of there faster? Or maybe that we have quicker mechanisms for spending the money? Congress appropriates it one day, and it's spent within a week or two? or...? No clear acknowledgement or recognition that money is being spent in Afghanistan in an incredibly complicated context strikes me as irresponsible.

Next, it says that "U.S. assistance should meet three basic conditions before money is spent: our projects should be necessary, achievable, and sustainable." Should US assistance be necessary, achievable and sustainable? Or should projects be necessary achievable and sustainable? Those are two separate things. Here's why.

First, let's look at assistance. Let's say the authors are trying to say that assistance should be necessary, achievable and sustainable. That would imply that there would be clear goals, objectives and programmatic for spending aid money in Afghanistan, which I can tell you is not happening. So, for a project like the District Delivery Program (which I have first hand knowledge of and which was a project to build sub-national governance), before spending money, USAID should have established what the overarching goal was, what the intermediate objectives were, and then how to determine whether those goals were met and the timeline for taking those measurements. If they did this, it was in secret. And I'm pretty sure that although there is some programmatic language for the billions that are being spent in Afghanistan, measures are not really measuring effects. Dear reader, you and I could dream up a great-sounding programmatic justification for spending money in Afghanistan. Delivering the results is quite another monster all together. Who knows if the planned actions are achievable in a war zone being conducted in a fourth world nation. And CERTAINLY the assistance is not sustainable by the Afghan government because that's why it's called assistance. If the Afghan government had enough money to spend on all the development international donors are supporting, then we wouldn't need to assist. Right? Or am I missing something here. Hopefully we are not giving money to countries that don't need assistance.

Next, let's look at the assertion from the standpoint that it means that projects should be necessary, achievable and sustainable. In a fourth world country, where literacy is about 25%, and life expectancy is about 45 years old, any spending can be justified. Any at all. The Afghans need everything. And the more we give, the more they need. What are we trying to achieve by all this giving? Well, that depends. In a lot of cases, we give because it makes us feel good. Soldiers spend money because they are shocked by the conditions, or because a local village leader buttered up a Marine and next thing you know the market has some brand new toilet facilities. USAID spends money because they are told to do so. They are being goaded, prodded and pushed into 'supporting the military' as they say in country. So, let's say all the expenses over the past year in Helmand province were to a) make us feel good, and b) show USAID support to military actions. Did they succeed? Well, you could go there and ask around--ask soldiers and aid workers if they felt good, and ask the military if USAID is spending dollars in support of operations. I think you would find positive results. So, the spending could right away be called necessary and achievable just based on those two justifications--feel good-ism and supporting the military. Are projects sustainable? No, because they are foreign assistance. We just went over that. Are the projects that are being constructed achievable? Yes, most everything is achievable, and very little is not getting completed. From cell phone towers to market toilets to roads to water turbines, projects are being completed all across Afghanistan.

The thesis for this report is askew and politically motivated. The report goes on to make many other circular claims. Like this one, on page 2. Most of the assistance is being spent on short term stabilization programs (undefined, of course). Notice the words "short" and "term". One paragraph later it complains:

"The evidence that stabilization programs promote stability in Afghanistan is limited. Some research suggests the opposite, and development best practices question the efficacy of using aid as a stabilization tool over the long run."

Notice the conflation of applying "development best practices" and "stabilization over the long run". And refer back to the discussion about how most money is being used for stabilization in the short run. So, if it's being used for short term gains, then what's the problem and why is the next paragraph discussing "development best practices" as if that's what is going on?

Another example of circular logic is here:

"The administration is pursuing an assistance strategy based on counterinsurgency theories that deserve careful, ongoing scrutiny to see if they yield intended results."

There is a confusion of reasons for spending in Afghanistan. Not all reasons are mutually exclusive. We could be spending money in a kinetic environment to, say, get a village cleaned up and the men back to doing something productive. It might also start boosting the micro-economic environment as people have a bit to spend and a small market might open up. This may be short-term gain, but it also might not be harmful to long term prosperity. It's a crapshoot. But it seems to me that the development folks are wisely questioning spending in support of a counterinsurgency campaign, but they are unwisely not questioning long term development practices as well. Because to be completely honest, we just don't know what's what and how best to spend money when in a post-conflict environment. It's all unknown and conditional.

Here's the real issue:

"There must also be unity of effort across the U.S. Government and international community. If we conclude that a civilian program lacks achievable goals and needs to be scaled back, no other actors should take over the effort. Too often, when our civilians determine that a project is infeasible, we simply transfer the program
to other actors, such as the U.S. military or other donors."

The report is more bluster than utility. All hat and no cattle.