U.S.-built hospitals in Afghanistan unsustainable after pullout, watchdog warns

Hospitals that Americans are building to serve local populations in Afghanistan may not be sustainable after U.S. troops leave the country in 2014, the chief U.S. watchdog for Afghan recontruction bluntly warns.

The two hospitals the U.S. is currently building in Gardez and Khair Khot “have estimated operation and maintenance costs that are considerably higher than the associated costs of the hospitals they are replacing,” said a report by the Special Inspector General for Afghanistan Reconstruction, or SIGAR.

The U.S. Agency for International Development dropped $18.5 million on the new structures, but didn’t get the advice of the Afghanistan Ministry of Public Health until a year after construction began, the inspector general alleged.

SIGAR, headed by Inspector General John Sopko, is concerned the Afghan government won’t have the resources to maintain the hospitals.  The medical center in Gardez, located in eastern Afghanistan, is more than 12 times larger than the facility it is replacing.  And operating expenses have skyrocketed too.  The current hospital costs $611,000 to operate, but estimates for the new hospital places the upkeep tab at $3.2 million, more than five times as much as the old hospital cost to run.

Likewise, the current hospital in Khair Khot, also in eastern Afghanistan, has a current maintenance cost of $98,000.  Upkeep for the new hospital is expected to run as high as $587,000, investigators said.

But USAID officials said the report completely misses the mark.  Afghanistan health officials were involved in the planning process from day one, they said.  SIGAR’s statement that the Ministry of Public Health was only contacted a year after construction began actually refers to the approval of the final design plans, USAID officials said.  Ministry officials looked at initial plans and drafts before construction began.

And USAID said the Afghan government has assured the U.S. they can run the hospital once American assistance stops.

“USAID takes sustainability of our projects very seriously,” said a letter from S. Ken Yamashita, USAID’s Afghanistan Mission Director.  “The Government of the Islamic Republic of Afghanistan, with the support of the international community, is focusing its attention on operations and maintenance.”

The hospitals are part of a marked improvement in Afghan health, Yamashita said.

“The improved health statistics in Afghanistan reflect some of the most striking development advancements in the last 25 years in any single country,” he said.

An Afghan official told the inspector general that much of the extra costs were from extra fuel for a new and complex heating system.  SIGAR suggested that more sustainable heating systems might need to be used instead.

“Better design planning for Gardez and Khair Khot would have produced more economical and practical hospitals and allowed for better use of U.S. appropriated funds,” SIGAR said.

In addition to the money, SIGAR officials found several USAID-funded hospitals are lacking certain positions for the planned medical procedures.

“Three of the five hospitals had no anesthesiologist, one had no pediatrician and two had no obstetrician/gynecologist,” the inspector general said.

USAID said the inspector general’s report didn’t take into account charities and other non-governmental organizations that are helping to supply medical staff to the region.  The Afghan government is already taking action to get all hospitals fully staffed, it said.

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