USAID and Watchdog Continue Sparring Over Afghan Health Clinics

In another volley over measuring results of a $210 million U.S.-funded health care program run by the Afghan government, an inspector general has again challenged the mapping methodology used by the U.S. Agency for International Development.

In June, John Sopko, special inspector general for Afghanistan reconstruction, had sent the development agency a scathing letter criticizing its oversight of a vital health program for war-torn Afghanistan, asserting that 80 percent of the program’s putative health clinics were wrongly located on maps due to faulty coordinates.

A USAID official defended the work, but agreed to revise some maps and provide an updated list. But in an Aug. 18 letter released Monday, Sopko renewed his concerns, citing “inconsistent data” on geospatial coordinates locating clinics in the Ministry of Public Health’s program. “We found new irregularities that led us to believe that the updated list may contain errors,” he said while praising USAID for meeting with his team to make improvements.

“For example, we found that 60 facilities did not have geospatial data in either list and that the updated list does not provide any new coordinates for 115 of the facility locations which we expressed concern about in our June 2015 letter. Moreover, the updated list provided new coordinates for 513 facilities; however, our analysis showed that these new locations were an average of 55 kilometers away from the original coordinates, with some locations hundreds of kilometers away.”

SIGAR worked to verify the USAID data using an independent Afghan nonprofit, Sopko said. “While we agree with, and commend, USAID for implementing a multi-tiered monitoring approach, doing so does not negate the need for data indicating the specific geospatial coordinates of a facility receiving USAID support," he said. "In fact, using a multi-tiered monitoring approach in an unstable environment demands such data.”

USAID officials on Friday continued to disagree. The clinics program, Larry Sampler, assistant to the administrator in the Office of Afghanistan and Pakistan Affairs, said in an email to Government Executive, “is not a construction project, it’s about delivering quality health care. USAID is able to locate and monitor the clinics in the PCH program. When we send monitoring teams to these clinics they are checking to see if the clinics are staffed, if they have medicine and supplies, if people are using health services, if the facility is clean, among other indicators.”

He added: “The most important thing is ensuring these villages have access to quality health care. Having accurate GPS coordinates can be helpful, but the lack of such data does not inhibit our ability to deliver quality health services or to monitor this program."