Chopped Up Provinces - Little Lessons

July 14 - 2009

So I'm in a meeting today with the Ministry of Health in downtown Kabul. His Excellency is telling us that the most valuable thing we can offer them as a project that covers the entire country - vs. the way things are now.

To my shock (and I don't know why I should be so shocked given the bizarre revelations each day) the country of Afghanistan has been chopped up into quadrants of coverage by donors. There are 34 countries and over twenty international donors offering help with health in Afghanistan. For example USAID covers thirteen provinces and has the largest portfolio. The World Bank covers X provinces and the EC covers X provinces. None of the donors are coordinating efforts. How in the world is this poor Ministry of Health supposed to develop a basic package of health services and products when so many ad visors are giving different directions? On my team alone there are two Australian economists, One Scottish public health specialist, a Sri Lankan monitoring & evaluation specialist, a Dutch behavior change specialist and three Americans who specialize in maternal child health, pharmaceutical management and social marketing. Even our team has it's divisions on how to solve things.

So what to do.

I think the best thing I can do now is to facilitate dialogue between team members and reach out to the donors on a coordination effort.

The social marketing efforts here so far have been excellent. But there is so much more to do.

Our team has grown to 10 ex-pats. Three women arrived last night. They seem to have some turf issues - that are a bit of a side show. Today they insisted we all wait for the driver outside the compound of the Ministry of Health - in the middle of rush hour traffic ... all of them un-covered and laughing about how dangerous it was to be out there. I'm learning an interesting thing about myself - which is to trust my instincts. This kind of behavior is very dangerous and I have nothing to prove now. I don't want to make a statement about anything. I just want to do this work safely. So I will simply wait for my bodyguard and a car and let these women do their own thing. If they want to wear sexy clothes and stand in the streets of Kabul - fine. I just want to do this work in a manner that is respectful to the cultural norms, doesn't put the body guards, the drivers, the translators and the colleagues at risk - and I want to feel calm. So in a strange way, these little challenges all day long are a learning experience.

Oh .. also I am taking a kind of yoga calisthenics class each morning. Our security manager is a former general in the Indian Special Forces. Each morning he does a 1 hour class. It has done wonders for me. Now my clothes are all too loose!