Outcomes-based financing: Possibility and promise in global health


Outcomes-based financing: Possibility and promise in global health



Winter in Afghanistan

Philip H. Gordon
Philip H. Gordon Former Brookings Expert, Mary and David Boies Senior Fellow in U.S. Foreign Policy - Council on Foreign Relations

March 1, 2006

Originally published with the title: American Pie

I hadn’t planned on spending the night in a tent with Italian
soldiers 30 miles from the Iranian border, but that’s the way it
turned out. And the reasons I ended up getting stranded with the
Italian contingent in the dusty western Afghan city of Herat can
tell us as much about the promise and limits of US-European
cooperation as any of the political or military briefings on the
subject I have received in Washington.

While friends were off skiing or whatever, I spent part of my
winter break on a trip — with a group of Western
‘opinion leaders’ — to Afghanistan, to get a
sense of the challenges facing the US and
European troops over there. Since
August 2003, a NATO force of 9,000
mostly European troops has been
supplementing the 20,000-strong
US force that is fighting Taliban
remnants and terrorists in the
southern part of the country.
Late last year, the alliance decided
to deploy 6,000 more troops,
including some to the dangerous
south, a mission about which
some European governments are
now having second thoughts.

They should realise that what NATO
is doing in Afghanistan is really important.
‘Provincial Reconstruction Teams’ (PRT)
throughout the country provide security and
help with jobs like the construction of schools
and hospitals and the digging of wells.
Seeing troops from 37 different
countries working together on the
ground to try to bring some stability
and development to this dirt-poor
country impresses even the most
cynical observer. At least in the north
and the west of the country, where
European peacekeepers drive around in
white vans marked ISAF (International
Security Assistance Force), they are greeted
with smiles and waves from young and old. Said
to be deeply sceptical of foreigners, the Afghans
seem to welcome the Western effort to help bring them peace
after 30 years of war and destruction.

Now back to getting stuck with the Italians and what it tells us
about the limits of NATO’s commitment. Our visit to Herat was
supposed to be a day-trip, to get a sense of how several hundred,
mostly Italian and Spanish soldiers, were getting on with their
PRT. The day’s briefings and tour of the city — apparently one of the country’s richest, a fact not particularly apparent from the
oxen seen ploughing the barren fields and the rag-tag goods
available in the markets — went fine. But when the time came to
fly back to Kabul, the lack of resources plaguing NATO’s mission
became painfully apparent. ISAF’s main transport plane, a Dutch
C-130, was grounded by propeller trouble, and its other, Danish
plane, was undergoing maintenance. A German aircraft based in
Termez, Uzbekistan was apparently available, but the Germans
are one of the many contributing countries whose forces labour
under restrictive national ‘caveats’, which forbid them
from doing things like flying at night or picking
up foreigners — so again there was no plane. I
agree that stranding a group of Western
pundits in Herat is no big deal, but what
if NATO actually had to quickly move
troops to do something important —
like quell a rebellion or deliver
emergency supplies?

On the very day when our generous
Italian hosts escorted us to the
airport (enduring our complaints
about the uncomfortable body
armour they made us wear), they
were attacked by a suicide car bomb,
which injured three of them and killed
three passers-by. The attack was not an
isolated incident but part of a trend
whereby Taliban remnants and
their Al-Qaeda supporters are
copying the methods of the
insurgency in Iraq and trying
to undermine support for the
NATO mission. Indeed, of the
nearly 30 suicide attacks that
have taken place in Afghanistan
since the start of the NATO
mission, almost two-thirds have
taken place since last summer.

NATO’s unprecedented effort to help
provide the new Afghan government with
enough stability to get off the ground — and to begin to
deal with the enormous problems of underdevelopment,
drug-running, corruption and warlordism — deserves wholehearted
support. As NATO expands its mission — assuming
European governments muster up the courage to fulfil their
pledges to do so — its staying power will surely be tested by
more suicide bombers and roadside explosives. But make no
mistake: the West has a huge stake in success in Afghanistan,
lest that country again become a global exporter of terrorism,
migrants and drugs.