The US Agency for International Development, known as USAID, has spent around $260 million on health clinics in Afghanistan — but many of those facilities lack electricity, adequate medical supplies, and sanitary waste disposal systems. And while each clinic is supposed to be tagged with a GPS identifier, many cannot be located using the official coordinates provided by the US government.
A January 5 letter by John Sopko, the Special Inspector General for Afghanistan Reconstruction (SIGAR) who audits spending in the country, reveals that of 32 such clinics in Kabul province 11 were more than three miles away from coordinates provided by USAID and the Afghan Ministry of Health. He worried that the lack of accurate location data could hamper efforts to regularly inspect the facilities and ensure they are up to standard.
"As SIGAR has stressed previously, robust program oversight requires specific knowledge of the location where the service is provided, " Sopko wrote in a public letter to USAID Administrator Gayle Smith. "Accurate location-specific information is critical to ensure that the local population is receiving the intended services."
Over the summer, SIGAR asked USAID for geospatial tags on the more than 641 health clinics that the US government has helped to build in Afghanistan through the Partnership Contracts for Health program. The initiative officially ended in 2015, and is now administered by the World Bank.
Much of the data USAID handed over to SIGAR was useless or severely limited. Sopko noted that "13 coordinates were not located within Afghanistan," while another 13 of the locations were duplicates of other sites; 189 locations did not correspond to any health structures within 400 feet of the geotag. One set of coordinates that USAID provided to SIGAR actually pointed to a spot in the middle of the Mediterranean Sea.
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At the time, USAID explained that locating health centers by coordinates was not a priority for healthcare providers in Afghanistan.
"GPS coordinates are not the first line in monitoring a health facility," said Larry Sampler, an assistant in USAID's Afghanistan and Pakistan affairs department, in a public statement. "It has been a common practice for Afghan ministries to use the location of a village center as the coordinates for a facility, particularly when there was limited access to GPS technology."
Over the past six months, SIGAR has sent representatives to Afghanistan to audit the facilities in Kabul provinces. Investigators found that USAID data still was inadequate — 22 of the 32 clinics SIGAR visited in Kabul were constructed within a kilometer of their purported location. Another 10 clinics were too dangerous for SIGAR inspectors to visit, and nine of them were tagged with incorrect GPS data.
SIGAR released a similar report in October highlighting the inaccuracy of geospatial data in the province of Herat. Out of 23 USAID-funded clinics there, 11 were located more than a kilometer from their official coordinates. When inspectors found their way to the sites in Kabul, they spoke with Afghans who reported the clinics to be in "good working order." But the watchdog identified some troubling deficiencies: "Five facilities did not have running water, three appeared not to have electricity, and eight may not have adequate or consistent power required for proper lighting and to refrigerate some pharmaceuticals and vaccines."
Upon speaking to medical staff, SIGAR reported that at least six facilities might lack adequate medical supplies.
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Tamra Halmrast-Sanchez, the acting mission director of USAID in Afghanistan, said she "welcomed the feedback," and that the maintenance concerns will be brought to the Afghan Ministry of Health and the World Bank. VICE News reached out to the ministry and to the World Bank for comment and has yet to receive a response.
This is not the first time USAID, which has devoted some $14.4 billion to Afghan reconstruction, has come under scrutiny for poor oversight. Many of its projects, from the construction of schools, prisons, and dams, have turned out to only exist on paper. While the ongoing SIGAR inspection of health facilities indicates that USAID project is up and running, Sopko has noted that the basic structural deficiencies in many of the clinics raises questions about whether taxpayer money "is indeed reaching the facilities."
Follow Avi Asher-Schapiro on Twitter: @AASchapiro