Monday, March 30, 2009

Pause to reflect

I forgot to mention, unbelievably, that I saw a report that two US military nurses were in an armed attack in Afghanistan. Unfortunately one has died. I do not have permission to release names ( the families know by now) but am saddened by this report.

While my blog tends to be academic and long-winded, my heart and soul recognizes the human aspects of what we are engaged in. Sinews, bones and blood, tears and sweat. Us, the Iraqis, the Afghans, our coalition partners, and even Hamas, Hezbollah, and what's left of the FARC.

We each strive to create a world of our imagining and in doing so we create a world we cannot imagine.

Legitimacy part II

I've been away for a couple of weeks, partly due to taking Command and General Staff College on the weekends, and partly because I'm writing a paper for submission to a peer-reviewed journal. The topic of the paper is the topic of tonight's post on Legitimacy, part II.

I've been doing a lot of reading about legitimacy in the political science literature because counterinsurgency doctrine demands legitimizing the established government as a method of opposing the insurgents. Democracy is founded on the idea of 'legitimate' representation. So, I began to wonder what exactly is "legitimacy"?

As it turns out there are several theoretical models of legitimacy which are usually presented in lit reviews, beginning with Max Weber. I'm not going to go through all the models, here, at least not now. The models are useful and intriguing, and describe how legitimacy is essentially a relationship between a population and a government. Legitimacy of the government can be produced via coercion, on the "less legitimate/more unstable" side of the scale, or via consent on the "very legitimate/very stable" side of the scale. So first of all, in a counterinsurgency, we want popular consent--or at least we want the slider on the scale to rest more toward the "consent" side and less toward the "coercion" side. So far so good. Nothing revelatory.

Here's what I found, though, that I think is revelatory. In a journal article from March 1990, "Legitimacy, Religion, and Nationalism in the Middle East" author G. Hossein Razi makes the case that legitimacy is actually a 2-part construct. He doesn't exactly say this--this is my summarization. First, he says there are two basic meanings: 1) that legitimacy means the set of norms and values relating to politics which are sufficiently shared so that a political system becomes possible; and 2) that legitimacy deals with meanings of the purpose of the government, the rights and obligations of the government and the governed and the methods of selection, change and accountability of the government personnel. We normally use legitimacy with the second meaning.

And here comes my 'Ah Ha' moment. The second part of the legitimacy construct is "performance."

Razi says: "...there has been insufficient grasp of the difference between the nature and sources of legitimacy and those of performance (i.e., the production of goods and services and generation of organized instruments of physical compulsion)."(pg 71). He points out that "Success in performance areas... does not necessarily result in an increase in legitimacy....the simultaneous existence of a problem in legitimacy and a problem in performance "characterizes most of the 'crises'" of the Third World...."(pg 72)
(cite:G. Hossein Razi, Legitimacy, Religion , and Nationalism in the Middle East. The American Political Science Review. Vol 84, No. 1, March 1990. pp. 69-91)

To explain what this means in concrete terms: I was recently culling through poll data from the Asia Foundation on Afghanistan (available here: . Although the government has performed well in health and education development, and the public recognizes the performance, the overall optimism about the way the country is going is declining. In fact, in spite of recognized gains, the public opinion about the performance of the central government has decreased from 80% positive in 2007 to 67% in 2008. (pg. 53). One would expect performance to be legitimizing by way of producing positive benefit to the people, and the people expressing satisfaction with that benefit. But this apparently not the case in Afghanistan.

It seems to me that a partial explanation is that perhaps the people of Afghanistan do not expect the central government to provide health care. First, there hasn't ever been a real central government for any meaningful stretch of time, and next, no quasi governmental agency ever provided health care. And the fact that the new government does provide health care is nice, but does not change their overall view of the government. It seems from the poll data that economic benefit is expected the most.

A second idea I had was that Afghanistan is a clientelistic political system with patrons collecting resources to dole out to their clients. Because Afghanistan has never had a health system (hence the name "reconstruction" is a fallacy), trading health benefits might not yet be widely perceived to be a useful trading tool. If it becomes a useful trading tool, then there might be commensurate importance placed on government performance in this area.

The problem here is that the use of medicine for counter insurgency and stability operations seems to not be functioning, at least this year. We know so little about legitimacy, that it is hard to posit a time frame for when development activities would actually "legitimize" the government. In fact I suspect that it's probably unique to the culture we are working with. We also don't understand the other variables in the system--I suspect that we don't even know what they are more less their relationships to each other. As with most other important questions of the day, I can say I conclude that "more research is needed."

I read another interesting journal article about health development in Guatemala that sums up everything pretty well, I think:

"Development strategies that attempt to make improvements in the lives of the rural poor without addressing the underlying structural causes of poverty serve to deflect attention away from the real needs of impoverished communities. Though the underlying ideology is that local people should have a voice in solving their own problems, the definitions of the problems and the determination of priorities are usually the prerogative of the outside agencies."

(Cite: Green, Linda Buckley. Consensus and Coercion: Primary Health Care and the Guatemalan State. Medical Anthropology Quarterly, New Series, Vol 3, No. 3, The Political Economy of Primary Health Care in Costa Rica, Guatemala, Nicaragua, and El Salvador (Sept 1989). pp 246-257.)

Wednesday, March 18, 2009

Who was Thomas Tackaberry? And other (provocative) Counterinsurgency questions

"Today [1968] the problem of war has dwarfed all others. Science and technology have created a situation which is unique in the history of mankind....In the last 5,500 years there have been 14,531 wars, for an average of 3.18 per year; and in the last twenty years the frequency has increased to 5.2 wars a year. With these statistics, one can safely extrapolate that wars will continue.
Since achievement of the supreme objective of preventing war looks dim, statesmen are fervently pursuing the goal of keeping hostilities at the lowest possible level of intensity.... Since employment of United States military forces in the classical sense is not appropriate, or required, other components of military counterinsurgency must be used. These include psychological operations, unconventional warfare, civic action and military aid, advice, and training. These capabilities have become the primary components of counterinsurgency. Furthermore, successful counterinsurgency is as much dependent on political, social, economic, and psychological factors as upon purely military factors and sometimes more so....
Whether one is concerned with programs to alleviate political, social, or economic sources of discontent [in a counterinsurgency], with techniques of indirect influence, or with the social and political environment in which actions occur, the kind of underlying knowledge required is the understanding and prediction of human behavior at the individual, political, and social group levels....
There has been much discussion about counterinsurgency, but very little directed toward an understanding of the art of insurgency or conspiracy.... Knowledge of how to prevent internal strife is a paramount need. An essential question that must be answered is: What should be the division of effort between repression or conciliation of dissident elements in a prerevolutionary situation? To what extent should one follow a hard or soft line, or a combination of the two, and in what ways and under what conditions...?
The military might of the United States can defeat the military symptoms of insurgency: the big challenge is to insure free, stable nations. In the final analysis, this is a fight for peoples' minds."

~Thomas H. Tackaberry; American Journal of Economics and Sociology; vol 27, No 1. January , 1968. p 1-8 (available on JSTOR). (LTG Thomas Tackaberry received a Distinguished Service Cross for his service in Korea and two more for service in Vietnam. He commanded the XVIII Airborne Corps.)

How is it that this was written 40 years ago and we haven't answered some of the basic questions posed? Tackaberry suggests that the military needed research to answer the basic questions of how people view themselves within their culture, how they decided to become 'revolutionaries', and what the military could do in a counterinsurgency.

I have been thinking about Tackaberry's final assessment that the US military can defeat the "military symptoms" of a counterinsurgency, but that it was going to take a lot more than the military's conventional armament. That's old news that we have recently re-discovered.

I am drawn to consider other options than a purely military response. For example, in this "whole of government" era, where the agencies must seek ways to work together, I am left wondering what is the Department of State's counterinsurgency doctrine or strategy, exactly? And, does the USAID realize that it is joined, whether willingly is another question, to the counterinsurgencies in Iraq and Afghanistan? Or, what about HHS, mentioned in the Iraq SOFA framework~ when DoD withdraws at the end of 2010, what counterinsurgency and stability actions will it take?

While these questions are certainly provocative, they are stimulated by the disturbing fact that LTG Tackaberry asked some of the same ones more than 50 years ago. Although he was interested primarily in providing the military with answers, he also recognized that more than the military was needed as a counterinsurgency response. I am just taking the logic to the appropriate conclusion.

Giving the Department of State more money is certainly a first step. But then we need a real strategy with real priorities. I understand that the DoS is ramping up its staff in Afghanistan and will make a plan. That sounds pretty good: I'm sure the Afghan desk is busy at the DoS and I know the one in DoD is swamped.

But really what I want to know is this: where is the Al Qeada desk?

Tuesday, March 17, 2009

Down with "Roles and Responsibilities"

I'll just get it right out: the endless discussions we are having in the government about "roles and responsibilities" of the various agencies are fantasies. I agree with Michele Flournoy in the Armed Forces Journal (In search of harmony: Orchestrating 'The Interagency' for the long war, available here: She basically says that what we need are a new breed of national security professionals who are "development-diplomats" and "defense-development" experts and so forth (those are my terms, tho), and who are trained at a national security institute--like the National Defense University.

What I would like to see are 'functional' experts who understand global public health across the security domains of defense, development and diplomacy. I'd like to know that the government has a team of experts who sit next to each other and understand how the bad guys are using health as a commodity against the U.S., and what strategies the U.S. is using against them in return. And I'm not just talking about biosecurity either. How about an expert who understands how to reach out to other countries like China in order to partner and do good around the world?

Instead, we seem to be locked in a do-loop of discourse about how the DoD should not be working in the "humanitarian space", for example, because we make the world dangerous. And how USAID's problem is that it can't leave the FOB. And how the Department of State is so weak it couldn't lead its way to the bathroom down the hall. And then the NGO staff stand up at meetings and talk as if ALL NGOs were all working with the same pure motivation and intent, born from a "human rights" perspective that is shared world wide. And the message from all of this is that if only we all knew our roles and responsibilities, and would climb back in to those boxes, then life would be much less frustrating, our actions much more legitimate (see my previous post about legitimacy), and the world an all around better place. And it's the fault of the "other guys" that the world is not 'better' already. Unfortunately, that's just way too easy.

Call me a pragmatist, darn it, but the world is what it is, and what we need is a way to deal with it. A flexible, responsive and initiating way of dealing with it. That is going to take a new breed of national securitists who are sophisticated and smart.

The discourse must change: we need to stop with the "roles and responsibilities". We are all in this together--the "humanitarian space" is populated by NGOs, DoD, USAID, DoS, USDA, private security firms, IGOs and more. It's a cacophony. And there you have it. What we need are good rules for working together, and good processes to at least share knowledge of our often conflicting actions. We must understand that there are differing purposes for being in the humanitarian space, and therefore take different actions. The most reasonable thing we can do is figure out how to best deconflict those actions. It makes sense to have a USG strategy, coordinated across agencies for initiating action and for responding to changes, and "Roles and Responsibilities" is not going to get us there.

The USAID is sponosoring a 90-day assessment in Afghanistan of all USG health development work. I hope it talks about processes, coordination, and methods to at least communicate actions. I look forward to the result.

Sunday, March 15, 2009

Health diplomacy explored

Funny how you run across things on the internet. Here's an important document from the Nuffield Trust about health and foreign policy: authored in 2005 by David Fidler.

On Legitimacy

I was recently reminded of the vitriol between humanitarian NGOs and DoD. The basic argument is that DoD's actions "in the humanitarian space" cause violence, danger to the humanitarian workers and are generally viewed as illegitimate.

This is too easy of an argument to make, and it mires the discussion in the patterns established after WWII where the military does defense, the Dept of State does diplomacy, and where USAID does development and somehow all of those actions are conducted in distinct "lanes". I find this thinking to be old-fashioned and perhaps no longer useful.

I am doing reading about 'legitimacy' in order to understand the word and the practice-implications. My thoughts are very much influenced by Patrick Chabal and Jean-Pascal Daloz's book "Culture Troubles; Politics and the Interpretation of Meaning." (Available on Amazon. com). They posit that culture is a system of meanings, and not of values. By taking this view, they assert that descriptions of culture no longer, therefore would require "an explicit definition, in terms of norms, beliefs and values." (p 23). They quote Geertz "Culture, here, is not cults and customs, but the structures of meaning through which men give shape to their experience; and politics is not coups and constitutions, but one of the principal arenas in which such structures publicly unfold." (p 25).

So, where am I going here? Well, legitimacy of governments is one of the fundamentals of "stability" and therefore a tenet of US National Security Strategy and DoD's counter insurgency doctrine. Ideas of legitimacy are most likely created by cultures as shared meanings and understandings about governance and the relationship between the government and the individual in that culture. So I am looking for an understanding of "legitimacy" of systems outside our own Western view. For example, Afghanistan is a clientelistic society-- what does that mean for governance? What does that mean for the health of their people? I doubt that the people of Afghanistan have the same understanding and ideation of governance as I and my neighbors. Their expectations are different, meaning that development must fit in to their schema, rather than mine. Do the people of Afghanistan expect the central government to supply a health system? I would suspect they do not. We, in America, have the same debate at this very time over the lack of coverage of nearly 50 million people and what should be done. Most people do not expect the government to provide health care to the population. Working with the Minister of Public Health in Afghanistan to build the health system is admirable work, but is it legitimizing the government? Does it de-ligitimize the coalition efforts to be involved? Should only NGOs do this work? All these questions depend upon the cultural ideation of legitimacy and health institutions, I think.

I have not found clear writing on this topic yet, but will keep looking. Meanwhile, there are several thoughts about legitimacy that I read in an essay by Robert Grafstein "The Legitimacy of Political Institutions", Polity, Vol 14, No 1, 1981 p 51-69.

1. "A legitimate regime is more likely to be the stable ceteris paribus than an illegitimate one." (p 51)

2. "Legitimacy, in effect, is a highly efficient way to secure obedience and thus is conducive to stability." (p 51)

3. Legitimacy involves the correspondence "between the overall state of the legitimate political system (for example, stability based on conformity) and the citizens' evaluation of the system (for example, belief in its legitimacy). " (p 57)

4. Compliance is a "necessary feature". (p 57) And compliance involves persuasion on a scale from coercion all the way to appealing to self-interest or tradition.

The essay is primarily focused on Western ways of governance, and discusses liberal democracies, which Afghanistan is not. Nonetheless, I found these few points clarifying. More to follow.

Monday, March 2, 2009

Public Health and Afghanistan

I was perusing my book shelf for information about the formation of our own Public Health system in order to inform my thoughts about Afghanistan. I have an interesting publication from Pfizer called Milestones in Public Health. Reading through this history of the U.S. Public Health system, I was reminded of the Essential Public Health Functions:

1. Monitor health status to identify community health problems. This would mean that Afgh needs labs. And skilled workers.

2. Diagnose and investigate health problems and health hazards in the community. This means some kind of skilled and mobile health work force.

3. Inform, educate and empower people about health issues. Some kind of communication technique/vehicle.

4. Mobilize community partnerships to identify and solve health problems. Maybe more private sector engagement in Afgh as opposed to NGOs? Don't know.

5. Develop policies and plans that support individual and community health efforts. Two levels of analysis and planning.

6. Enforce laws and regulations that protect health and ensure safety. Hard in de-centralized, tribal territories, but something to keep in mind.

7. Link people to needed personal health services and assure the provision of health care when it is otherwise unavailable. This seems to be the primary focus at the moment.

8. Assure a competent public health and personal healthcare workforce. Goes with first three points and a big problem in Afgh.

9. Evaluate the effectiveness, accessibility, and quality of personal and population-based health services. This point should have gone before point #5 in my mind. But in any case, this would take MoPH resources.

10. Research new insights and innovative solutions to health problems. Same thoughts as for #9.

I like this list because these are what the military calls "lines of effort" and imply tasks like human capacity building. Lab building. Bringing in new partners. It provides a framework for considering how to build a health system, without prescribing the steps.