The USAID vs SIGAR Pissing Contest

Reuters has a riveting exclusive today in which they have been given a treasure trove of documents from which they have reported on documentation that a contractor involved in USAID highway construction in Afghanistan is employing a subcontractor who is a member of the Haqqani network:

Much of the evidence against Zadran is classified, but the cache of documents given to Reuters by U.S. officials on condition of anonymity show that he has close business ties with the Haqqani network’s leader, Sirajuddin Haqqani.

The Haqqanis, Islamist insurgents who operate on both sides of the Afghanistan-Pakistan border, are believed to have introduced suicide bombing into Afghanistan.

The links between Zadran and the insurgency include him teaming up with Saadullah Khan and Brothers Engineering and Construction Company (SKB), believed to be one of Sirajuddin Haqqani’s companies.

Together they won a $15 million contract to help build a road between the towns of Gardez and Khost in Afghanistan’s east for the U.S. Agency for International Development (USAID) in 2011.

“The owners of these companies are facilitators and commanders of the Haqqani Network,” one U.S. government memorandum says.

This problem fits into the overall work that SIGAR has been doing recently in which they comment on the lack of control and auditing on funds once they are turned over from USAID and other agencies to the Afghan government for disbursement. And huge amounts of money are involved:

The inability over many years to stop firms believed to be supporting the insurgency from winning multi-million-dollar contracts exposes the lack of control that donors have over cash once it is handed over to the Afghan government.

Those transfers make up an increasing proportion of aid. U.S. federal agencies want more than $10.7 billion for reconstruction programs in 2014, SIGAR says, and the government has promised at least half will be granted directly to Afghan institutions to spend as they see fit.

SIGAR has clearly upset a number of folks with their work on this front. Back on October 10, the Atlantic carried a hit piece against SIGAR (I owe Marcy a huge thank you for alerting me to the article) in which we are supposed to believe that USAID has built a public health system in Afghanistan that in just a few years has added 20 years to life expectancy while dropping child mortality by half. And the article would have us believe that this wonderful new system is at risk of being shut down because of SIGAR’s campaign against funds being disbursed by the Afghan government without an audit trail:

John Sopko is the U.S. government’s chief auditor for Afghanistan and a former prosecutor with years of experience on Capitol Hill. In September, Sopko’s office—the Special Inspector General for Afghanistan Reconstruction, or SIGAR—issued a report calling for the suspension of USAID’s $236 million in aid for basic health care in Afghanistan.

Why shut down such a successful program? The short answer is that SIGAR’s is a peculiar concept of caution.

Strikingly, the auditors’ report calling for the funding freeze for the health program doesn’t claim any evidence of serious fraud or waste. Instead, it raises hypothetical concerns about the Afghan government’s ability to manage aid money well, including evidence that some salaries were paid in cash, as well as the absence of double entry bookkeeping.

There is a huge problem with the underlying premise of “such a successful program”, though. It is fabricated bullshit. Here is how the hit piece frames their argument on the successes:

While the U.S. military can win wars with overwhelming firepower, the conventional wisdom is that the U.S. lacks effective civilian tools to win the peace. Afghanistan’s public health care system provides a powerful counterpoint: financed largely by American foreign aid, it has produced the most rapid increase in life expectancy observed anywhere on the planet. What went right? And why do American auditors and Congressional overseers suddenly want to pull the plug?

In late 2011, the U.S. Agency for International Development announced some astonishing news about progress in health and mortality in Afghanistan. The new findings came from the release of the 2010 Afghanistan Mortality Survey, the largest survey of its kind ever undertaken in Afghanistan. The survey showed that from 2004 to 2010, life expectancy had risen from just 42 years—the second lowest rate in the world—to 62 years, driven by a sharp decline in child mortality. As a result, nearly 100,000 Afghan children per year who previously would have died now don’t.

What is this magic elixir of life that has added nearly 50% to life expectancy in Afghanistan in only a six year time period? Hint: it involves fruit. Specifically, it involves apples and oranges, because to get this life expectancy increase, USAID is comparing separate studies with differing methodology. The study carried out by USAID only addressed mortality at one time point, 2010. The study can be found here (pdf). Clearly, USAID has enabled those in the press who wish to embellish USAID’s accomplishments on the public health front. While the Atlantic hit piece would have us believe that the life expectancy of 42 in 2006 and 62 in 2010 both come from the USAID study, when the study was first released, the Guardian at least provided hints that other studies must be relied on for developing an idea of how life expectancy has changed:

Conducted by the Afghan health ministry in 2010, the survey was sponsored and funded by international organisations such as Unicef, the World Health Organisation, the US government and the British Department for International Development. It was the most comprehensive to date in Afghanistan, despite the exclusion of some rural areas in the south where international forces are fighting insurgents.

It showed that estimated life expectancy is up to between 62 and 64 years for both men and women. That compares with previous studies showing life expectancy from 47 to 50 – the latter figure reported by the WHO in 2009.

As for the claims of cutting child mortality in half, the graph presented in the Atlantic is not supported even within the USAID study. It seems to come from an “independent” assessment of the effectiveness of USAID’s work on Afghanistan’s public health system carried out by Johns Hopkins, although the article doesn’t directly state it. The graph suggests that the death rate before age 5 per 1000 children was in the 160-190 range between 2002 and 2004 and then magically dropped to 90-100 in 2005 and 2006. The USAID study itself developed an estimate (see Table 5.1.1 on page 91 of the study) of 80 deaths per 1000 in 1996-2000, 72 in 2001-2005 and 71 in 2006-2010. It appears that child mortality rate estimates in Afghanistan vary over a huge range. This article cites a UNICEF study from 2008 that puts the death rate at an astonishing 257 per 1000 in 2008. But the chart here plots a steady decrease in mortality rate from 373 per 1000 in 1960 to 101 in 2011, with remarkably few bends in the curve given the periodic upheavals in Afghanistan over that time period.

The bottom line is that the Atlantic article clearly has been very selective in presenting what it claims to be data supporting the most remarkable progress the world has ever seen in life expectancy. The claims are so outlandish and laughable that they completely distract from the point the author was trying to make regarding denying funding to public health efforts in Afghanistan. Sadly, though, SIGAR’s response has been to try a somewhat similar approach by funneling a pile of documents to a select group of journalists, putting their message on the perils of lack of accountability in disbursing funds at risk of also being overlooked. SIGAR would have been better served to merely carry out their standard analysis of documents they post publicly to point out the flow of USAID funds to the Haqqani network. Engaging in a public pissing contest is not advisable, especially in a desert country.

Many years ago, Jim got a BA in Radiation Biophysics from the University of Kansas. He then got a PhD in Molecular Biology from UCLA and did postdoctoral research in yeast genetics at UC Berkeley and mouse retroviruses at Stanford. He joined biosys in Palo Alto, producing insect parasitic nematodes for pest control. In the early 1990’s, he moved to Gainesville, FL and founded a company that eventually became Entomos. He left the firm as it reorganized into Pasteuria Biosciences and chose not to found a new firm due a clash of values with venture capital investors, who generally lack all values. Upon leaving, he chose to be a stay at home dad, gentleman farmer, cook and horse wrangler. He discovered the online world through commenting at Glenn Greenwald’s blog in the Salon days and was involved in the briefly successful Chris Dodd move to block the bill to renew FISA. He then went on to blog at Firedoglake and served a brief stint as evening editor there. When the Emptywheel blog moved out of Firedoglake back to standalone status, Jim tagged along and blogged on anthrax, viruses, John Galt, Pakistan and Afghanistan. He is now a mostly lapsed blogger looking for a work-around to the depressing realization that pointing out the details of government malfeasance and elite immunity has approximately zero effect.
15 replies
  1. orionATL says:

    this strikes me as very wobbly, smart-aleck reporting.

    yes, there is a conflict between a u.s. ig and the u.s. aid (a part of the state department). so what!

    the u.s. military and the state department have been fighting with each other over the “right” way to “victory” in afghanistan since the u.s. became involved there.

    increases in health and well-being of afghanis should not be sneered at nor “definitively” evaluated in the process of reporting on this bureaucratic snipering.

    here is what the press release with pdf that the j. hopkins school of public health put out on its 2007 study:

    http://www.jhsph.edu/news/news-releases/2007/burnham-afghanistan.html

    the fact is that large increases in life expectancy can be achieved very rapidly where public health work is focusing on prenatal-, postnatal-, wellbaby- care, systematic vaccination, and clean water. that seems to have been the case here. true, these increases are a function of the epidemiological formulas used to measure life-expectancy, but that’s true world-wide.

    my view is that any country-wide improvements in health of afghanis during 10+ years of war is to be admired. that it would have occurred with the corruption that always accompanies war is to be expected. just what u.s. activities in afghanistan have not occurred with corruption in our 10+ years of invasion and occupation.

    i would suggest conversations with mothers and families as an anecdotal antidote to this bloodless reporting of a bureaucratic battle.

    i also note that the initial upsetness at the beginning of this column seem to focus on the fact that a taliban (or quasi-drug taliban) construction company was working with the afghanis to build a road. again, so what. it’s their country and government. if we try to buy them off with aid (recall the bags of cia cash that were delivered to president karzhai’s office?) that ends up “misused”, that’s our initiative.

  2. Jim White says:

    @orionATL: Yeah, I was snarky in the post. Sue me.

    But believe me, if four years of field work in the middle of a war really did cut child mortality in half and add 20 years to life expectancy, the people involved would all be in Stockholm collecting their joint Nobel prizes for Peace and Medicine. Maybe these guys are doing good work, but the main point of my post is that making claims that are outlandish enough to be Baghdad Bob-worthy buys nothing for credibility.

    The Hopkins study you linked to is more or less a customer satisfaction survey. It has no data on child mortality.

  3. orionATL says:

    the sigar audit of usaid’s (sigar audit 13-17) is presented in pdf format which is great for reading but impossible to highlite and paste for discussions in text.

    here is a text version of audit 13-17:
    SIGAR

    Special Inspector General for
    Afghanistan Reconstruction

    SIGAR Audit 13-17

    Health Services in Afghanistan: USAID Continues
    Providing Millions of Dollars to the Ministry of Public
    Health despite the Risk of Misuse of Funds

    SEPTEMBER

    2013
    SIGAR Audit 13-17/Health Services in Afghanistan

    SIGAR

    September 2013

    Health Services in Afghanistan: USAID Continues Providing Millions of
    Dollars to the Ministry of Public Health despite the Risk of Misuse of Funds

    note the phrase “despite risk of misuse”.

    hmmm. is that all just “risk”.

    is there ANY us gov undertaking in afghanistan that isn’t at the risk of fraud?

    so what did sigar find about a program apparently aimed mostly at pregnant women and infants:

    “… WHAT SIGAR REVIEWED

    Despite financial management deficiencies at the Afghan Ministry of Public
    Health (MoPH), the U.S. Agency for International Development (USAID)
    continues to provide millions of U.S. taxpayer dollars in direct assistance with little assurance that the MoPH is using these funds as intended.

    Specifically, USAID’s April 2012 assessment of the MoPH’s financial management capability identified significant internal control deficiencies

    that put U.S. funds provided under the Partnership Contracts for Health (PCH) program at risk of waste, fraud, and abuse. For example, the assessment found deficiencies in the MoPH’s internal audit, budget, accounting, and procurement functions.

    USAID officials stated that they have not verified what, if any, actions the
    MoPH has taken to address these deficiencies. Rather, a USAID official told
    SIGAR that USAID has no obligation to address the deficiencies identified or to verify any corrective actions that the MoPH may have implemented for the
    ongoing PCH program. In SIGAR’s view, USAID’s decision to continue
    disbursing funds to the MoPH with little to no assurance that these funds are safeguarded from waste, fraud, and abuse raises serious concerns about the integrity of the PCH program.

    In July 2008, USAID and the MoPH
    signed an implementation letter
    establishing the $236 million PCH
    program. The program, which began in
    November 2009, supports the MoPH in
    its delivery of health services to local
    Afghan clinics and hospitals. The MoPH
    uses USAID provided funds to contract
    with nongovernmental organizations to
    provide basic health care in 13
    provinces and hospital services in 5
    provinces.
    The objectives of this audit were to
    determine the extent to which (1)
    USAID assessed the financial
    management capability of the MoPH
    and (2) cost estimates for the PCH
    program were developed appropriately.
    To accomplish these objectives, SIGAR
    reviewed USAID policies, including
    USAID and third party assessments of
    the MoPH; interviewed USAID and
    MoPH officials; and examined
    documentation on funds obligated and
    disbursed for the PCH program.

    WHAT SIGAR FOUND

    USAID provided $236 million for the PCH program based on a cost estimate
    that the MoPH developed, but which USAID did not independently validate.
    Specifically, USAID did not prepare a comprehensive analysis of the actual
    cost for the PCH program using key factors such as, among other things,
    patient load, population statistics, existing infrastructure, and security.

    USAID officials stated that the estimate was based on historical data, but they could not provide documentation showing how the estimate was calculated. More than $190 million of the $236 million provided for the PCH program has been obligated. However, SIGAR’s review found that about $127 million has actually been spent, resulting in potential excess obligations of about $63
    million.

    WHAT SIGAR RECOMMENDS
    SIGAR recommends that the USAID Mission Director (1) provide no further funding to the PCH program until program cost estimates are validated as legitimate; (2) develop, in coordination with the MoPH, a comprehensive action plan to address deficiencies identified in the April 2012 ministry capability assessment, establish key milestones to monitor progress in
    executing this action plan, and make additional funding for the PCH program contingent upon the successful completion of
    established milestones; and (3) and validate the funds obligated and expended under the PCH program since its inception
    and de-obligate any excess funds and return the funds to the U.S. Treasury or put these funds to better use.

    SIGAR received comments on a draft of this report from USAID non-concurring with the first recommendation, partially concurring with the second recommendation, and concurring with the third recommendation. USAID stated that the safeguards it has put in place within MoPH protect taxpayer funds from misuse. However, strong evidence exists that funds provided to MoPH are at risk of misuse. In particular, both USAID and third party assessments of the MoPH have concluded that MoPH’s systems, operations, and internal controls to manage donors’ funds cannot be relied upon without substantial corrective measures being taken….”

    For more information, contact SIGAR Public Affairs at (703) 545-5974 or [email protected].

  4. orionATL says:

    “..The Hopkins study you linked to is more or less a customer satisfaction survey. It has no data on child mortality…”

    you’re being very literal.

    here is what the press release says:

    “…According to the 2006 assessment, more female patients than male patients used outpatient services, and the poor were more likely to use public sector services than the non-poor, which is in line with the Ministry of Public Health’s stated goal for equitable health care. Additionally, household surveys implemented by researchers from Johns Hopkins and the Indian Institute of Health Management Research in late 2006 estimated that of every 1,000 children born in Afghanistan, on average 129 die in the first year of life (infant mortality rate) and 191 die before reaching the age of five years (under 5 mortality rate). The surveys covered more than 8,200 households in rural areas in 29 of Afghanistan’s 34 provinces. Previous estimates from UNICEF for the year 2000 place the infant mortality rate in Afghanistan at 165 per one thousand live births and the under 5 mortality rate at 257 per one thousand live births.

    The percentage of women in rural Afghanistan receiving antenatal care during pregnancy from a skilled provider increased from an estimated 4.6 in 2003 to 32.2 in 2006. Over the same time period, the percentage of women in rural Afghanistan who had a doctor, nurse or midwife assist with their last delivery increased from 6.0 to 18.9.

    More children are receiving vital childhood immunizations, according to the assessments. The percentage of children 12-23 months of age in rural Afghanistan who received the BCG vaccine to protect against tuberculosis increased from an estimated 56.5 in 2003 to 70.2 in 2006. The percentage of children 12-23 months of age in rural Afghanistan who received the full dosage of oral polio vaccine increased to 69.7 in 2006, from 29.9 in 2003…”

    those are the health activities if consistently applied that would drive a rapid increase in life expectancy.

    you write:

    “.. if four years of field work in the middle of a war really did cut child mortality in half and add 20 years to life expectancy …”

    it wasn’t “field work”. it was creation/improvement of a health care management system focusing apparently on women, infants, and young children.

    the question is how widely applied and how persistent was the effort? i don’t know that. do you?

    finally, this whole sigar episode involving establishment of a health maintenance system ends with sigar stating u.s. funds were “at risk”.

    this is just fuccuping stupidly banal.

    to repeat, what u.s. funds in afghanistan aren’t at risk of fraud and waste?

  5. orionATL says:

    bottom line:

    reduction of mortality among children 5 and younger can drive a very rapid rise in life-expectancy.

    so, from a wikipedia article on health in afghanistan:

    “… Maternal and child health care

    Further information: Afghanistan Midwifery Project

    Mothers and infants receiving health care at a hospital in Kabul.
    An improvement in child health services in 500 – 600 health facilities was noted in 2006; the improvement correlates with the presence of clinical guidelines and the frequency of supervision of health care providers.[31] A 2008 study by Future Health Systems and the Johns Hopkins Bloomberg School of Public Health indicated that only 13% of respondents had used skilled birth attendants.[32] By 2010, the maternal mortality rate per 100,000 births for Afghanistan was 1,400. The under 5 mortality rate, per 1,000 births was 201 and the neonatal mortality as a percentage of under 5’s mortality was 27. The aim of this report was to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal death.[33]
    In June 2011, the United Nations Population Fund released a report, which contained new data on the midwifery workforce and policies relating to newborn and maternal mortality for 58 countries.[34] Afghanistan has more than 3,000 midwives with an additional 300 to 400 being trained each year. According to Afghanistan’s Ministry of Health about 1 in 50 women die while giving birth and the number of children who died before the age of 5 is about 1 in 10. According to Sima Ayubi, a maternity doctor in Kabul who advocates hospital births, explains: “Now pregnant women have more information about health. This mortality rate is still a problem. There’s just a decrease. The problem is not completely eliminated or under control.”[14]
    According to a 2012 report by Save the Children, improved healthcare and the rise of females attending school have made Afghanistan climb up from its position as the worst place on earth to be a mother.”More mothers are surviving and fewer children are dying and this is something we need to be celebrating,” said Rachel Maranto, Advocacy and Mobilisation senior Manager at Save the Children in Kabul. Despite the better healthcare, about 275 children die every day in the country of 30 million.[35]…”

    sigar audit 13-17 does not indicate a concern in whether infants and children or pregnant women or mothers women are at risk,

    only a concern that u.s. funds are “at risk”.

  6. Jim White says:

    @orionATL: Okay. Last response from me on this. Again, if you click through the press release you linked and look at the actual study, it’s lots and lots of pages on analysis of the services provided.

    The one-off number quoted here that is said to come from the analysis is a mortality rate for children under 5 of 191 per thousand for the year 2006. And, just as in the Guardian piece, they have to go to a completely different study by another group to say this compares favorably to the rate of 257 for the year 2000.

    But as I pointed out in the post, the numbers for child mortality in Afghanistan are all over the map. I still haven’t found the report the graph in the Atlantic came from, but remember it said 2006 was the great year with a mortality rate just below 100 per thousand by age 5, which is half the rate in the press release. Which is it? 191 or 90-something? That’s a lot of mortality difference and is pretty much the basis of the claim of adding so many years to life expectancy.

  7. orionATL says:

    @Jim White:

    whether you respond or not is a matter of indifference to me, but clearly not to you. don’t pretend you’re doing me some favor when you are defending your column.

    my interest was to raise questions in readers’ about some of this column and about sigar’s motives. i hope i’ve done that.

    the questions i have raised are not dependent on whether you find infant mortality figures in the j. hopkins report or not.

    i have repeated my central point several times – it is well known in epidemiology that vigorously attacking infant mortality of children 5 and under can lead to a remarkably large increase in life expectancy in a very short period.

    did this happen. i’ve said i don’t know. it certainly could have.

    i’ve also said i don’t think you know either, and it is your column.

    and i’ve demonstrated that focus on specific named health programs that can lead to rapidly reduced child mortality exists in afghanistan.

    as for the atlantic article, it seems harmless and may actually be substantially true. neither of us knows enough to say.

    that it is a hit piece on sigar is silly. was it encouraged/planted by usaid? very likely.

    are dod (sigar) and state department (usaid) continuing their war on each other begun years ago? very likely.

    should a report on aid monies spent on health programs be the subject of a sigar report citing only “risk” of mismanagement of u.s. monies. it’s a free country and sigar surely knows it can’t just focus solely on the big fraud in afghanistan – dod, cia – without consequences.

    i will add one last irritant associated with your column:

    the j. hopkins school of public health report on additive non-combat deaths in iraq was widely praised, except in government circles.

    was this j. hopkns study on health systems in afghanistan a less competent whitewash for a client, rather than another carefully done study?

  8. Don Bacon says:

    This riveting exposure by Reuters on highways is merely an extension of the corruption in Afghanistan fomented by the US favorite contractor Louis Berger and his facilitators, in this case the Zadran tribe and company. It was all covered by the NYTimes in May 2011 “Costly Afghanistan Road Project Is Marred by Unsavory Alliances” which covers Louis Berger (Marcy’s encyclopedic mind knows LB) and Zadran. The article reports that in November [2010], the Louis Berger Group paid one of the highest fines ever in a wartime contracting case to the federal government for overbilling.
    http://www.nytimes.com/2011/05/01/world/asia/01road.html?pagewanted=all&_r=0

    Louis Berger has been bad but — shocking news — it is still doing fine. The latest contract award to LB was reported Friday:
    Louis Berger Aircraft Services Inc., Greenville, S.C., was awarded a $14,959,823 modification (P00021) to previously awarded contract HTC711-10-C-S002 to exercise the option for air terminal and ground handling services for fiscal year 2014.

  9. orionATL says:

    @Don Bacon:

    thanks for this insight.

    so louis berger and kalil zadran are, precisely, two sides of the same coin.

    this is too much to be mere coincidence.

    http://mobile.bloomberg.com/news/2010-11-05/louis-berger-group-charged-with-fraud-over-contracts-in-iraq-afghanistan.html

    so when coincidence fails, what is left to explain the inexplicable that’s going on?

    why, cia.

    or, congressional “approval” :)

    oh, the record includes a “deferred prosecution” agreement between doj and the louis bacon firm:

    http://www.reuters.com/article/2010/11/05/louisberger-settlement-idUSN0510112220101105

    hmmm. time in the penalty box, then back on the ice to steal again.

    sweet!

  10. Don Bacon says:

    Louis Berger ties into DiFi’s hubby’s extensive business interests which include war profiteering in the construction biz, as I recall, dating (at least) back to when Senator Feinstein was chairperson and ranking member of the Military Construction Appropriations subcommittee (MILCON) from 2001 through the end of 2005.

    Richard Blum also ties into the FDIC and other covered-up government shenanigans. In 2009 it was reported that Blum’s wife Sen. Dianne Feinstein introduced legislation to provide $25 billion in taxpayer money to the Federal Deposit Insurance Corp, a government agency that had recently awarded her husband’s real estate firm, CB Richard Ellis, what the Washington Times called “a lucrative contract to sell foreclosed properties at compensation rates higher than the industry norms.”

  11. Don Bacon says:

    The US is totally corrupt, but it’s not reported except in rare instances.

    Sep 18, 2013

    U.S. Attorney Preet Bharara Testifies at the Public Hearing of the Moreland Commission to Investigate Public Corruption

    “Fighting public corruption has been a top priority for my office for a long while, as it has been for my friends Loretta Lynch and Cy Vance.

    “The diversity of the officials caught up in our probes reflects not only the level of our commitment but also the depth of the problem in our state. Public corruption, based on all the evidence, appears rampant. And the ranks of those convicted in office have swelled to absolutely unacceptable levels.

    “We have had to prosecute State Senators as well as State Assemblymen; elected officials as well as party leaders; city council members as well as town mayors; Democrats as well as Republicans.

    “In an age often decried for increasingly bitter partisanship, we can say that public corruption in New York is truly a bipartisan affair.”

    http://www.justice.gov/usao/nys/pressspeeches/2013/MorelandCommTestimony.php

    The corruption problem is not confined to New York.

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