The Unsustainability of Afghanistan

Michael Yon, an independent journalist and author, has written a great article about Afghanistan and the work that one Provincial Reconstruction Team is doing there.

Here is the overall feeling of the article:

On one hand, we have a fraction of the troops we need, but on the other, increasing troop levels increases hostility toward us. Secretary Gates has made it clear to me that his biggest concern is that we will lose the goodwill of the people and they will turn against us. This happens to be my own biggest concern. The agony is in knowing we need more medicine and the medicine can be highly toxic here.

Yon also makes an interesting observation about the “dependency” that foreign aid can induce.  He gives two examples of such instances:

Unfortunately, these kids had already been taught the benefits of begging and this analogy extends directly to their parents. In Afghanistan, like Iraq, when we invest resources into installing a dieselgenerator for a neighborhood, the people will complain that we don’t supply the fuel. When the Indians paid for local broadcasting equipment in Chaghcharan, the station manager complained that the Indians didn’t make a new office, and there is often a tone that we need something or “give us or we will misbehave.”

While I do not have similiar experiences to Yon’s, the international development literature is full of practitioners worrying about just such a situation.  The solution is difficult: on the one hand, not providing the diesel might result in the locals not using the very expensive diesel system.  On the other hand, providing the diesel simply encourages the foreign aid dependence and kills any long term sustainability to the project.  Once international development organizations cease to provide the diesel, who will step in?

The same concern is echoed with regards to the health facilities in Afghanistan.  Yon speaks at length with a doctor in the Ghor Province, who is upset that the national government is mandating “free” health care when the existing system can barely handle those able to pay.  As Yon writes:

Dr. Yaqubi wants to show people that health care is not free, but he says that the parliament in Kabul thinks it should be free to all. The Afghan government can’t even drill a well for this provincial hospital, and all their machines and supplies were probably donated, yet they want “free” health care. The beggars of Kabul who refuse to drill a well for the Ghor Provincial Hospital want free health care for all!

I told Dr. Yaqubi that the same argument is raging in America, and I asked the Lithuanian doctor sitting beside me if this is an issue in Lithuania. She confirmed that it is. Dr. Yaqubi said that if treatment were completely free, the hospital would be overwhelmed. With about 750,000 people in Ghor Province, they’ve got 85 dirty beds here, and two smaller clinics elsewhere. Free health care? How about steady electricity to run the X-ray machine?

The comparison to the U.S. debate is a bit of a stretch, but the story serves as a good example of the sustainability problems international development organizations, and the Afghani government, face.  The national government is unwilling (unable?) to provide for the basic needs of the hospital but wants to mandate “free” health care without a source of funding.  While international development organizations maintain a presence, they can subsidize the bad policy and mute the negative impacts.  Once their term ends, however, what will the Afghani government do when faced with a dilapidated health care system that slowly deteriorates every year due to the inability of the hospitals to either, a) receive electricity, water or medicine and materials or b) cannot afford to stay open due to lack of revenue?