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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.
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?
This week, Congress passed the African Growth and Opportunity Act and Millennium Challenge Act Modernization Act (H.R. 3445). Once signed, it will give MCC the long-awaited authority needed to pursue regional programming more effectively.
One of the biggest questions donors grapple with is how to balance implementing specific projects with building local capacity to execute similar programming in the future. Indeed, this question is central to the conversation—now active at USAID—about how donors can “work themselves out of a job.” One good example of how this can look comes from the Millennium Challenge Corporation’s (MCC) 2005-2010 partnership with Honduras. In this story, a key part of MCC’s legacy is not about what the agency funded but how it funded it.