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Very interesting op-ed in Sunday’s WashPost on U.S. efforts to promote health care in Afghanistan that cuts to the heart of the debate over integrating development into U.S. foreign policy. The authors, two noted health experts, claim that American programs have done immediate good: up to 100,000 infants and children have been saved from early death this year alone. Perhaps more importantly for the long-term:

These initiatives have strengthened the foundations of a state that can serve its people. Rather than providing or contracting for services directly, USAID, the World Bank and the European Commission have strengthened the capacity of the Ministry of Public Health to develop and implement health policies, oversee programs, manage resources, engage communities and control the delivery of services.

But they warn:

Unfortunately, such work for Afghanistan's future is at risk. In an effort to win over populations in Taliban-controlled areas, the Obama administration is considering reducing overall funding for USAID health programs and concentrating development resources to support military operations. This means moving funds to certain geographic areas and emphasizing immediate results. Yet there is no evidence that expensive "quick impact" health projects that are not integrated into a larger strategy, or that do not actively engage locals, either contribute to security or wean populations from the enemy.

And the real kicker:

If the Obama administration is serious about supporting the emergence of a legitimate Afghan state and meeting the needs of people who have suffered for decades, it should not confuse health policy with military strategy.

This story encapsulates the current debate and all the underlying tensions over what to do with USAID (autonomous cabinet agency? More integrated into State? Subsumed into DoD?) My own view is that long-term “institution building” is always going to get crowded out by shorter-term security and diplomatic demands. It seems unrealistic to ever expect USAID to try to resist this or to be able to do both well, no matter what kind of beautiful restructuring we do or how much cover the White House thinks it can provide. To me, it would appear much better to recognize this and just have cleaner lines of responsibilities: let USAID do humanitarian, post-conflict, and other emergency assistance; State can handle counterterrorism, diplomatic bribery, etc.; and leave the long-term stuff that you want to insulate strictly to MCC and the multilaterals, especially the World Bank. Perhaps this is also too naïve?

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CGD blog posts reflect the views of the authors drawing on prior research and experience in their areas of expertise. CGD does not take institutional positions.