Independent study shows strong gains in Afghan health

The World Bank announced today that the preliminary findings of a Johns Hopkins University (JHU) household survey suggests that infant mortality rates dropped from 165 per 1,000 live births in 2001 to 135 per 1,000 live births in 2006 -- meaning that 40,000 fewer infants are dying each year now compared to when the Taliban were in power.

That's a lot of lives saved. And the number is significantly higher, since health care for adults has improved markedly as well. A parallel study assessing Afghanistan's health facilities, and observed a "25 percent improvement in overall quality of health services since  2004." The Hopkins assessment "surveyed more than 600 health facilities each year since 2004 and used a Balance Score Card (BSC) to measure different aspects  of quality of services (and) found improvements in virtually all aspects of care in almost every province."

Access to care also improved substantially: in its survey of 8,000+ households nationwide, Hopkins found that "the proportion of women receiving antenatal care increased from 5 percent in 2003 to 30 percent in  2006" and "the proportion  of pregnant women who received attendance by a skilled health worker increased 5 percent to nearly 19 percent." MORE

Oportunidades in Afghanistan?

Human Rights Watch and other organizations have documented how various problems -- security, poverty, and negative attitudes about education -- have undermined progress in ensuring education for Afghanistan's children.  School infrastructure has received a lot of attention but enrollment rates have plateaued -- especially among girls.

This story in today's NY Times suggested that Mexico has managed to simultaneously raise enrollment rates, reduce poverty, and improve health. The program provides cash payments to women on a contingent basis: "If the women and their children have kept all their medical appointments, and if their children have stayed in school, the money is theirs to use as they wish":

The program pays cash stipends mostly to mothers — about 97 percent of recipients are women — on the assumption that they will be more likely to spend the money on their children. To qualify, people must be in extreme poverty, roughly defined by officials here as living on less than the equivalent of $2 a day.

The article notes that "Since this program got its start in rural Mexico in 1997, it has been heralded by the World Bank and others as a powerful model for fighting chronic poverty." In a decade, Mexico's poverty rate has dropped by 17 percentage points. Over thirty countries have adopted versions of the program. Should Afghanistan become one of them?

Kabul hosts first agricultural fair

For the first time since 2001 Afghanistan is hosting an agricultural fair. The goal is to improve agricultural performance and draw investors. Over 86 companies are in attendance and -- encouragingly -- most  of them are local.

Bolstering Afghanistan's agricultural performance would have a huge impact on lives -- most of the country remains rural and dependent upon subsistence agriculture. Moreover, for a poor country, Afghanistan imports an astonishing amount of its food; something as simple as creating a domestic industry for poultry (most of which is currently imported from China) would go a long way to creating jobs and lowering prices for consumers.

Karzai-Musharraf to talk in Turkey

Musharraf said yesterday he hopes "the ground realities will be understood." Of course, some things have changed since the two last met, but tensions have hardly subsided: last week, fire was exchanged across the Afghan-Pakistani border.

Made in Iran

The US announced today that a shipment of Iranian-made arms (mortars and plastic explosives) were seized near Kandahar. It is unknown (or unstated) whether the shipment was officially authorized. A Guardian story notes that a senior Afghan general also claims his forces seized Iranian-made weapons. He says they were captured from insurgents last month in Farah province, and were channeled through drug smugglers in Iranian Baluchistan.

One note regarding the timing; the U.S. waited a year after its discover of Iranian weapons in Iraq and announcing them (see photo); this time it waited less than a month (the exact period was undisclosed). These announcements are typically timed strategically--but what's the strategy here? The language has been cautiously calibrated thus far, but the confrontation could reach an elevated pitch as each side toes the red line.

Some relevant quotes: MORE...

Dutch defend approach

Several readers took me to task for coming down too easy on the Dutch in my previous post. One Dutch reader who was recently in Uruzgan said "I’ve spent a lot of time traveling in these areas, and devoted quite a bit of effort to finding out exactly what the Dutch were up...I can find very little to praise in the attitude that the Dutch are taking...The terrain in Uruzgan is such that they have the luxury of avoiding the larger-scale clashes that are tying the Brits down in Helmand, but this doesn’t give them the right to preach in the way that they have been doing."

Rest assured, I don't (yet) endorse the Dutch model, but I do think it is a long-term strategy and must be evaluated on its own time-frame (In citing Musa Qala I was trying to illustrate that whether something  worked or not often depends on your time-frame.) MORE

WANTED: Seasoned Czar for War on Terror

Recently reports surfaced that a) for several weeks the White House has been seeking a 'Czar' to oversee wars in Iraq and Afghanistan; b) at least three of their top candidates have declined the position.

General Jack Sheehan, a former Marine, was particularly blunt in rejecting the offer: "The very fundamental issue is, they don't know where the hell they're going." Sheehan argued that the White House did not have a strategic vision and was dominated by hardliners instead of pragmatists looking for a way out of Iraq -- before penning a more diplomatic op-ed that was printed in today's Washington Post:

I concluded that the current Washington decision-making process lacks a linkage to a broader view of the region and how the parts fit together strategically. We got it right during the early days of Afghanistan-- and then lost focus. We have never gotten it right in Iraq. For these reasons, I asked not to be considered for this important White House position. These huge shortcomings are not going to be resolved by the assignment of an additional individual to the White House staff. They need to be addressed before an implementation manager is brought on board.

Others have suggested that no one wants a thankless job that will become a magnet for blame. Esteemed anchormen Jon Stewart and Stephen Colbert had a field day with this theme (click here to see their hilarious segments...)

This of course obscures the substance: is a failure to coordinate efforts in Iraq and Afghanistan a central issue, or just one of many things that have gone wrong? Is appointing a czar a good idea? Chime in...

 

Amb. Zahir Tanin at NYU

Last night I saw Zahir Tanin, Afghanistan's new Permanent Representative to the United Nations, speak at New York University (in conversation with scholar and journalist Alon Ben-Meir.)

Ambassador Tanin is clearly a learned man, but his comments were mostly pro-forma until the Q&A. But then things got interesting...MORE

Afghan journalists announce boycott to protest execution

AfghanWire has comprehensive coverage this week of Afghanistan's response to the murder of Ajmal Naqshbandi, the Afghan journalist beheaded by Taliban forces on Sunday. I found this phrase, from a pamphlet, particularly poignant: "The whole country is in mourning of this young man who travels to the south not to fight with any one; not to kill anyone but to guide a journalist, someone who is like a mirror to the world..."

Ajmal's execution strikes a nerve for Afghans, who in it see in it a microcosm of their national tragedy. Foreign powers get involved in Afghanistan and enlist the help of Afghan allies. But when things go wrong they'll pay any price to bail themselves out, leaving Afghans to pay the price. MORE

Photo: Ajmal Naqshbandi, the Afghan journalist who was executed by the Taliban Sunday. Source: Afghan Embassy.

The Dutch model, revisited

Last weekend the Times published an insightful piece ("Dutch Soldiers Stress Restraint in Afghanistan")

on the Dutch approach to counterinsurgency in Uruzgan, best summed up by commander Col. Hans van Griensven: “We’re not here to fight the Taliban...We’re here to make the Taliban irrelevant.”

The Dutch focus on finding secure areas, keeping them secure, and allowing development to spread outward like an "oil spot". Critics argue that this approach is driven not by vision but by risk-aversion, and that it allows the Taliban to bide their time and develop strongholds.

Today the Times published a second piece, a blow by blow account of a Taliban ambush of a Dutch patrol. (Alert readers will note that today's article documents a fight that took place on April 4th--two days before the first article ran...)

The fact that it's hard to imagine a US commander saying "we're not here to fight the Taliban" illustrates that each of the coalition forces in the south (Netherlands, US, UK, and Canada) is employing distinct strategies based not only upon local conditions but also upon their particular approaches to military affairs, their philosophy of insurgency, and their tolerance for risk. We are often and wisely reminded that the insurgency is multifaceted, but the efforts to fight it may be even more diverse!

Each coalition and NATO command, each PRT -- not to mention different Afghan commands -- has a different set of goals and caveats, and different perceptions of success. Far from the Pentagon's early and heavy handed approach, military forces in Afghanistan find themselves in a laboratory of ideas, of innovation by local commanders responding to conditions around them.

This should be a good thing. The problem is that each nation and each command has incentives to proclaim that its approach is uniquely effective, and there is very little in the way of objective evaluation of results. Moreover, the "right" strategy can often only be ascertained months or years in retrospect, since today's success may become tomorrow's model of failure, or vice versa. MORE