http://www.law360.com/articles/43723...ainable-report
US-Funded Afghan Hospitals May Not Be Sustainable: Report
US-Funded Afghan Hospitals May Not Be Sustainable: Report
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Law360, New York (April 30, 2013, 5:54 PM ET) -- The Special Inspector General For Afghanistan Reconstruction reported Tuesday that two new U.S.-funded hospitals costing $18.5 million may be too large and expensive for the Afghan government to operate and staff after U.S. forces leave.
Law360, New York (April 30, 2013, 5:54 PM ET) -- The Special Inspector General For Afghanistan Reconstruction reported Tuesday that two new U.S.-funded hospitals costing $18.5 million may be too large and expensive for the Afghan government to operate and staff after U.S. forces leave.
Sustainability has long been a concern for rebuilding projects in Iraq and Afghanistan. The Wartime Contracting Commission reported in 2011 that U.S.-contracted projects could come to nothing if host governments cannot or will not commit the funds, staff and expertise to operate and maintain them, and the recently closed office of the
Special Inspector General for Iraq Reconstruction has advocated for a new federal agency to better coordinate rebuilding contracts with the U.S. Departments of Defense and State and the U.S.
Agency for International Development.
SIGAR's Tuesday report found that USAID began contracts to build the two hospitals, Gardez in Paktia province and Khair Khot in Paktika province, before design plans were finalized with the Afghan Ministry of Public Health, leading to the creation of larger facilities than the local government can sustain.
“USAID’s $18.5 million investment in these new hospitals may not be the most economical and practical use of these funds,” the report said. “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.”
The annual operating costs of the new hospitals, including costs to staff, heat and fuel the facilities, could be five times more than the annual operating costs for the hospitals they are replacing, SIGAR said. While the existing Gardez hospital costs $611,000 annually, USAID estimates that annual fuel costs alone for the new hospital could be as much as $3.2 million, the report found.
The inspector general also found that the provincial hospitals were having difficulty recruiting and retaining key medical positions, a problem that extends to three other facilities reviews by SIGAR. Only one of the five provincial hospitals has met the minimum staffing standards for the five key positions reviewed, and none of the hospitals met the advised staffing standards, except for the general practitioner and pediatrician positions. Three of the five hospitals had no anesthesiologist, one had no pediatrician and two had no ob-gyns, according to SIGAR.
“Ministry of Public Health contracts require [nongovernmental organizations partnering with USAID] to implement the full range of health care services — including staffing — at hospitals during the life of the contract,” SIGAR found.
“However, NGO officials stated that the limited availability of doctors in Afghanistan, combined with the low pay for doctors, makes it difficult for them to staff key positions at provincial hospitals.”
USAID defended its work, saying its contributions had helped modernize Afghanistan's health system and drive a 20-year increase in the life expectancy in Afghanistan over the past decade. The agency disagreed with the SIGAR report, which it said was too narrowly focused, inaccurate and misleading in its characterization of the coordination between USAID and the Ministry of Public Health.
"The primary finding, that these two hospitals are unsustainable, is incorrect. MOPH has provided written assurance it will provide funding for the hospitals," USAID said in comments to SIGAR. “USAID takes [the] sustainability of our projects very seriously and [operation and maintenance] planning is built into our projects.
USAID pointed out that the Ministry of Public Health is eligible get additional funding from the Afghanistan Reconstruction Trust Fund, which provides $1.5 in matching funds for every dollar spent by the Afghan government for eligible projects. But SIGAR said that those funds were far from assured.
“MOPH is simply one of many Afghan ministries eligible to apply for such funding and there is no guarantee that any such funding will be provided to MOPH programs,” SIGAR said.
Many in Congress have grown more vocal in their opposition to funding rebuilding projects, and sustainability is a key concern for some, including Senator Claire McCaskill, D-Mo., who chairs the Senate Subcommittee on Financial and Contracting Oversight. McCaskill offered an amendment to Senate's March budget resolution currently under consideration that would strip funding for large-scale infrastructure projects in Afghanistan and redirect those resources for use in construction of roads and bridges in the U.S.
"We're borrowing money to build projects halfway around the world in Afghanistan — projects that can't be secured or maintained," McCaskill said on March 22. "We should take this money and put it into construction and repair of roads and bridges right here at home."
--Editing by Elizabeth Bowen.
SIGAR's Tuesday report found that USAID began contracts to build the two hospitals, Gardez in Paktia province and Khair Khot in Paktika province, before design plans were finalized with the Afghan Ministry of Public Health, leading to the creation of larger facilities than the local government can sustain.
“USAID’s $18.5 million investment in these new hospitals may not be the most economical and practical use of these funds,” the report said. “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.”
The annual operating costs of the new hospitals, including costs to staff, heat and fuel the facilities, could be five times more than the annual operating costs for the hospitals they are replacing, SIGAR said. While the existing Gardez hospital costs $611,000 annually, USAID estimates that annual fuel costs alone for the new hospital could be as much as $3.2 million, the report found.
The inspector general also found that the provincial hospitals were having difficulty recruiting and retaining key medical positions, a problem that extends to three other facilities reviews by SIGAR. Only one of the five provincial hospitals has met the minimum staffing standards for the five key positions reviewed, and none of the hospitals met the advised staffing standards, except for the general practitioner and pediatrician positions. Three of the five hospitals had no anesthesiologist, one had no pediatrician and two had no ob-gyns, according to SIGAR.
“Ministry of Public Health contracts require [nongovernmental organizations partnering with USAID] to implement the full range of health care services — including staffing — at hospitals during the life of the contract,” SIGAR found.
“However, NGO officials stated that the limited availability of doctors in Afghanistan, combined with the low pay for doctors, makes it difficult for them to staff key positions at provincial hospitals.”
USAID defended its work, saying its contributions had helped modernize Afghanistan's health system and drive a 20-year increase in the life expectancy in Afghanistan over the past decade. The agency disagreed with the SIGAR report, which it said was too narrowly focused, inaccurate and misleading in its characterization of the coordination between USAID and the Ministry of Public Health.
"The primary finding, that these two hospitals are unsustainable, is incorrect. MOPH has provided written assurance it will provide funding for the hospitals," USAID said in comments to SIGAR. “USAID takes [the] sustainability of our projects very seriously and [operation and maintenance] planning is built into our projects.
USAID pointed out that the Ministry of Public Health is eligible get additional funding from the Afghanistan Reconstruction Trust Fund, which provides $1.5 in matching funds for every dollar spent by the Afghan government for eligible projects. But SIGAR said that those funds were far from assured.
“MOPH is simply one of many Afghan ministries eligible to apply for such funding and there is no guarantee that any such funding will be provided to MOPH programs,” SIGAR said.
Many in Congress have grown more vocal in their opposition to funding rebuilding projects, and sustainability is a key concern for some, including Senator Claire McCaskill, D-Mo., who chairs the Senate Subcommittee on Financial and Contracting Oversight. McCaskill offered an amendment to Senate's March budget resolution currently under consideration that would strip funding for large-scale infrastructure projects in Afghanistan and redirect those resources for use in construction of roads and bridges in the U.S.
"We're borrowing money to build projects halfway around the world in Afghanistan — projects that can't be secured or maintained," McCaskill said on March 22. "We should take this money and put it into construction and repair of roads and bridges right here at home."
--Editing by Elizabeth Bowen.

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