HEALTHCARE IN AFGHANISTAN
Naomi Klein’s May 2 “Lookout” column contains a mind-blowing statement: “In Afghanistan, where the World Bank also administers the country’s aid through a trust fund, it has already managed to privatize healthcare by refusing to give funds to the Ministry of Health to build hospitals. Instead it funnels money directly to nongovernmental organizations, which are running their own private health clinics on three-year contracts.” Klein obviously thinks building hospitals would be preferable to providing primary healthcare. Building hospitals to serve the urban elite rather than primary healthcare facilities to serve the rural poor was an early fault of the World Bank and other aid agencies. Now that the bank is finally addressing needs of the rural poor, Klein wants to see money diverted to hospitals to serve the rich and powerful. This casts doubt on the validity of her entire column.
TIMOTHY D. BAKER
Professor, international health, Johns Hopkins University
The question of how Afghanistan spends its national healthcare budget should not be up to Timothy Baker, me or any other foreigner; it should be up to a sovereign and accountable Afghan government. Instead, the government of Hamid Karzai–already heavily shaped and influenced by foreign forces–is virtually shut out of all major reconstruction decisions. The Financial Times reports that two-thirds of the national budget goes directly from foreign donors into the hands of NGOs and private contractors, bypassing the Afghan government entirely. The real question is not whether aid dollars will be spent on rural clinics or urban hospitals; it is whether any healthcare system will be left behind when the contracts are up and the private contractors leave Afghanistan. The NGOs themselves admit that the current situation is one of total dependence: Acbar, a group presenting eighty large NGOs in Afghanistan, recently said that if foreign contractors were shut out of government reconstruction contracts “all national development programs, including those that focus on health and education, would collapse.” Which raises the question: Is Afghanistan really being reconstructed, or is it just a place for foreigners to collect lucrative short-term contracts? The great fear, as articulated by President Karzai’s spokesman, Jawed Ludin, is that the billions spent on aid will be “like an iceberg that melts away and leaves nothing.”