http://www.globalconsultants.us/iraq_tour/index.php Copyright 2012, David Newberry David Newberry en-US SPHPBLOG 0.5.1 http://www.globalconsultants.us/iraq_tour/index.php?entry=entry090218-064840 Iraq Provincial Reconstruction Team
Analysis and Recommendations

Marion David Newberry
FOB Marez, Ninewa Province, Iraq
18 February 2009

Executive Summary

This report includes professional experiences, observations, analyses, and recommendations for the reconstruction or rehabilitation of Iraq through the Provincial Reconstruction Teams (PRT) structure. My experience was with the PRT in Mosul City, Ninewa Province, Iraq. I was assigned as the Section Leader for Health and Education to the PRT and answered to the Department of State PRT Team Leader.

My career experience (45 years) includes developing refugee resettlement health screening program components, international health program assessments, development of health assessment procedures and evaluation manuals for international partners, training in epidemiology and health program development, as well as my participation in the eradication of smallpox, guinea worm and polio.

My intention is not to condemn all of the DOS employees in Iraq, but an attempt to better illustrate how the results can improve dramatically, once personal career ambitions become secondary to the mission of reconstruction. Ordained achievements were largely political and directed from the Bagdad Office of Provincial Authority (OPA). The idea that a successful reconstruction model furthers one’s career apparently was never entertained. My overall observation is that Iraq Provincial Reconstruction effort in its current iteration under the Department of State (DOS) is woefully lacking in direction, coordination, leadership, accountability, imagination, external supervision, and effectiveness. There are continued failures to consult and plan with our Iraqi counterparts, develop and conduct needs assessments, evaluate options, and develop infrastructure, of which I was originally assigned to help accomplish.

The DOS is not the agency to perform these functions. It is more appropriately the job of its sister agency, the United States Agency for International Development (USAID). For DOS to perform the job of reconstruction in Iraq is like sending in the Coast Guard to accomplish the mission better handled by an armored infantry division.

USAID demonstrated leadership during the Office of Foreign Disaster Assistance (OFDA) activity during the 2003 period. Assigned USAID officials are among the most capable partners at the PRT level. USAID works at the community level and provides collaboration that improves achievements levels. It is recognized that there are limitations in terms of both funding and flexibility in use of AID funds.

The final major recommendations are as follows: 1) PRT members should be assigned a minimum of 24 months; 2) PRTs should be led by former local (county/city-level) managers experienced in managing diverse government operations; 3) PRTs need to be USAID-led and supervised by technical experts that are skilled in local administration management.



Background

My first tour of duty began in 2003 when I worked with CARE Australia through USAID’s OFDA. I consider this a highly competent organization, and would recommend them for any related project. As far as rehabilitation is concerned, USAID/OFDA proved to be the most effective of any agency that I have worked for in my 45-year career.

Unlike my experience with USAID/OFDA, my second tour (beginning in late 2007) was an utter failure. The reason for this is due to the crippling leadership tactics the DOS employs on its PRT. I left Iraq discouraged by my inability to obtain funding support through the team leader of the PRT. This funding would have provided for innovative opportunities, both practical and effective, to bring a measure of joint ownership between the PRT and my valued Iraqi counterparts in various healthcare and educational programs. The proposed project involved the Ninewa Province educational system, allowing access to clean water for school children and their families, as well as providing solar-powered lighting for their schools. I was left with feelings of technical inadequacy, perhaps a result of my inability to bridge the abyss between what can be done and what I was allowed to do.

There is a great divide at Forward Operating Base (FOB) Marez, where I was stationed. The chasm exists between the Iraqi people (those outside the barb wire of this camp) and the PRT staff. Although I cannot speculate too much about its inception, it is certainly enabled and maintained through the faulty organization the DOS and OPA provide.

This report serves in lieu of my Exit Interview. The report is solely a consequence of the fact that my PRT Team Leader chose not to conduct the interview, as well as choosing not say farewell to me after nearly 11 months serving as a team member of the PRT for Ninewa Province. Instead of the proper formalities, I received only a standard certificate of appreciation through the mail some months later. I am grateful for that document.

This document is intended to be analytical in approach and constructive in response to major issues identified. In the final analysis it has been difficult—at times impossible— to be completely objective, especially when reporting my actual experiences and observations.

Introduction

This document is based on personal and professional experience gained while serving two tours in Iraq as a health and education specialist. The first tour was under CARE Australia, August through October 2003, in Baghdad. This tour was devoted to reconstruction and funded through USAID/OFDA.

The second tour was from the first of December 2007 through the end of October 2008. I functioned as the Section Chief of the Health and Education Unit with PRT in Ninewa Province, Iraq. This second tour in Mosul City PRT was under the authority of the DOS and funding was based on the approval of the PRT Leader and his diplomacy officer. I worked under a Department of Defense (DOD) contract awarded to All Native Systems, Inc. Any errors in this document are my own and based on personal observations and actual experience of two localized assignments. Upon completion of my tour, the DOS team leader sought to eliminate the Health and Education Unit in Ninewa Province and the OPA chief in Baghdad has never considered the need to seek input from provincial Iraq officials regarding either health or education as tools for empowering the Iraqi people. The DOS PRT Leadership in Mosul City actually refused to support very basic projects related to health and education in spite of proposals and requests made by the Directorate Generals for Health and Education.

Unlike USAID, the DOS leadership lacks a clear mission and vision, and comprehensible objectives that are time-phased and measurable. Furthermore, the DOS PRT team leaders demonstrated a lack of expertise, understanding, and the ability to differentiate between rehabilitation and diplomacy. They have allowed their own professional and personal limitations to adversely affect the mission, the task requirements, and the Iraqi people as a whole. The DOS Team Leader and his Diplomatic Officer have the authority to affect local policy and program direction, but not the requisite knowledgeor background to be able to initiate meaningful change. And all too often this authority is misused and/or misdirected, repeatedly exercised without regard to (or even blatant disregard of) the technical advice of the experts on their team. Hence, economic recovery and agricultural progress were seriously compromised, as were healthcare and educational support projects.

Unfortunately, the choice to use DOS officials in structuring and providing guidance and professional leadership to attain the goals of Iraqi rehabilitation and to improve local capacity was wrong. DOS team leadership has failed to appropriately define the role of the US Military, resulting in a failure of its proper utilization. This became apparent in the poor coordination between the PRT DOS personnel and the military. Here, the military has a clearer understanding of the Iraqi situation than their DOS counterparts. This also affected the ability of the PRT members to accomplish the mission assigned them. The PRT technical experts have a stronger, more realistic understanding of network-building with their Iraqi counterparts. They demonstrate more suitable use of tools, resources, and overall pace at which they tackle issues, than the DOS staff. More pertinent is the triangular competition between the DOS, DOD (civil affairs), and the military. Each of these "partners" trust their technical experts in uneven measures. The military has found a successful protocol through training its own Civil Affairs Teams/Units and assigning tasks based on this, providing widespread impact on expertise, task completion, accountability, and related fiscal aspects.

While the OFDA oversight mechanisms were amazingly devoted to Iraqi management and ownership, the PRT DOS functions to empower inexperienced, highly career-motivated DOS staff to produce results they neither understand nor appreciate. They possess authority, exercised with or without the participation of the PRT Team. From the moment Paul Bremer decided to operate rehabilitation as a diplomatic exercise in the absence of civil security, yet presence of increased insurgent activity, the PRT DOS was destined to fail. The following mission failures ensued: the mission to prevent loss-of-life; to develop local Iraqi capacity via increased local, regional, and national skills; to generally empower the people through on-the-job training, and resource management capacity-building. One may argue that insecurity and insurgency are the greatest problems, but the true solution can only be rooted in local ownership.

The OFDA mechanism for rehabilitation was local supervision and ownership. Neighborhood health clinics, schools, and safe drinking water were assessed for reconstruction needs and requirements through neighborhood leaders and inhabitants. These requirements were reviewed and local contractors working directly for local residents, through humanitarian agencies, completed repairs with funds allocated through OFDA-sourced funding. Accountability was generally well-vested in the OFDA, humanitarian aid agencies, NGOs with local groups, and contractors. While it is true that during the 2003 era, insurgency, insecurity, and corruption presented minor problems compared to later activities, the mechanism for meaningful rehabilitation was operational and well-defined in terms of local resident populations through direct accountability and quality control. Was this process perfect? Perhaps not, but it resulted in the reopening of every school and the rehabilitation of hundreds of local neighborhood health clinics.

Basic Analysis

The strategy of providing PRTs through the auspices of the DOS for the rehabilitation of Iraq is analogous to serving liquor to a group of alcoholics and expecting each one to drink with moderation. Or perhaps it is more like calling on the Coast Guard to accomplish what is obviously a mission for the infantry. Diplomats that may prove themselves competent and useful in situational interactions do not prove the same for rehabilitation efforts. USAID has a strong track record utilizing local aspirations by implementing programs that are culturally acceptable, even culturally inclusive, to the local population. The fact that USAID’s expertise has not been called on to shoulder the reconstruction effort is absolutely perplexing.

During my tenure in the Ninewa Province PRT, there were two DOS Team Leaders, each having a vastly different approach. In each case there was minimal success in creating infrastructure, improving local capacity, assuring economic development, and improving food shortages during a three-year drought. The team also failed to help citizens attain the skills necessary to establish and maintain successful governance on their own. As a result, our team missed an opportunity to provide the 660,000 school children of Ninewa hope for a better future.

In terms of personality and perspective, each team leader seemed to be the polar opposite of the other. However, the results were quite similar given the absence of security from the violence of insurgents. The outcomes were further limited by the individuals perceived to be best suited for governing, chosen by the DOS. This resulted in higher-echelon contact, diplomatic discourse, and socialization with only those individuals perceived to be Iraqi leadership. Meanwhile, Iraqi officials who dared cooperate with the US were earmarked for death. One of the Team Leaders explained to me that he based his decision-making for the PRT on his readings of important historical tomes on Iraq and the Middle East Region. He had no understanding of the culture, local history, or how the government at the local level had operated successfully in the past. The full extent that a PRT Team Leader can be held responsible for rehabilitation achievements is unknown, but it is most certainly a topic that should be explored.

The major quandary with the PRT leaders is they hire DOD and other technical contractors while they themselves are less-than-qualified to accomplish the task at hand. These contract individuals, regarded as skilled experts, are tasked with providing technical recommendations and advice on matters related to reconstruction and capacity building. Because each team leader is coming from a DOS mindset that is completely different from that of the experts hired to assist them, and would not accept the technical experts’ recommendations and often refused to support programs developed in collaboration between the PRT technical experts and their Iraqi colleagues. The Health and Education Sector expertise was severely compromised by the PRT leadership under the guise of the Team Leader's chief Advisor who was assigned as a diplomacy officer. Many of the technical team developed excellent rapport and networked very well with our province-level Iraqi colleagues. The end result was often crisis management.

Expertise in national rehabilitation and community-level understanding of the Iraqi culture and its importance in reconstruction was never a consideration of DOS staff. The Ninewa USAID Office staff had a much better understanding and functional relationship with Iraqi officials. The major flawed concept is that “brick-and-mortar” projects representing ideas such as team-based reconstruction are associated with career-advancement opportunities for any DOS employee who is brave enough to head to Iraq. My intention is not to denigrate the service of a whole host of DOS professionals, but rather an attempt to illustrate what can be done better if the mission of reconstruction is the leadership’s primary concern, not career ambitions. Ordained achievements were largely political and directed from Bagdad OPA, and the leadership never attained the idea that a successful reconstruction model can actually serve as proof, which itself can further ones career. Simple things can add up to larger achievements. For example, by adding a cultural advisor to assist Iraqi families who experience a death via coalition forces (vs. those killed by insurgents), would reduce the likelihood that surviving relatives retaliate against US or Iraqi personnel decreases. Simple solutions such as this can add up to a decrease in loss-of-life, and help stabilize the foundations to create a stronger Iraq.

Overall Observations

Leadership

The extremely flawed selection of DOS assignees to PRT leader positions typically falls into one of the following categories: 1) those that will go based on DOS employee career status; 2) those that must go for career enhancement and to save their jobs; 3) those that just happen to be available through the DOS HR system. Too often this results in selecting individuals who are focused on their next assignment, rather than the current task of reconstructing and rehabilitating Iraq.

The DOS assignees tour is only one year rather than two or three years. It usually takes at least one year to learn the environment and how to do business. The second year is spent building lasting programs and training locals to manage their programs, and a third year in which to begin turning the operation over to local successors and program managers. This format is true for the Iraqi military and police forces on a shorter time scale.

A lack of defined goals and objectives with measureable, time-phased achievements means there is little or no accountability. Ergo, there is no consistency of mission between predecessor and successor team leaders. This may be argued but when examined from the Iraqi perspective it stands true.

The mission itself was often changed by different team leaders, with little or no team discussion, many times without informing the rest of the team. Leadership tends to be autocratic, oppressive, and fickle, as well as authoritative and hypocritical. It does not represent the democracy we wish to model for the Iraqi nation as it rebuilds itself.

Team leaders felt their position meant they were to schmooze with the local politicians rather than ensure that their team members developed productive relationships and networks with their Iraqi counterparts and build sustainable programs. The potential for unintended consequence is wide open under this rationale.

There was a very serious lack of coordination between the DOS PRT, the DOD, and the military. This resulted in the actual building of schools where there were few students, even on land not even owned by the Iraqi government. This occurred with no Iraqi input or building standards adherence. This is terribly frustrating for the Provincial Iraqi Ministry of Education, and similar incidences occur in health sector projects.

The DOS team leaders neither appreciate nor attract concepts conducive to effective teamwork such as interactivity, innovation, or productivity. The brick-and-mortar mentality hampers opportunities to address ongoing problems. It also prevents us from addressing future concerns in Iraq including hunger, sanitation, clean water, employment, electricity, sanitation, and heat in schools. This is a truly undesired result because I have interacted with so many fellow Americans, as colleagues in Iraq as well as friends and family back home, and they elicit generosity and desire to help the Iraqi people at the community level.

Program Operations

All projects and budgets must be approved by the DOS team leader, while the technical advisors were given little-to-no flexibility or leeway on budgets to initiate pilot or study projects. This seems to indicate that the presence of such technical professionals has become obsolete, and that the team leaders fail to use these experts as the resources they are intended to be.

Safe drinking water, using school children as change agents in initiating individual household low-cost water purification, water sampling, and solar purification studies are critically needed, in conjunction with the Director Generals of the Provincial Ministries of Health and Education. One simple water purification proposal could have been provided at a total cost under $12,000. This proposal and others like it were vetoed by DOS PRT team leader.

The Director General of Health and the Iraqi Red Crescent Organization initiated a joint project for the assembly and eventual manufacture of quality wheelchairs for handicapped children born or maimed during years of conflict. The long term prospects for the development of sustained production appear to be very promising. This project has been funded by USAID and foreign donors. Results: Delivery of the first 600 (of 1,200) wheelchairs to the Iraqi Red Crescent Organization and assigned accordingly through the Ninewa Province GD Health (Ministry of Health) in February 2009.

In conjunction with the Director Generals of the Provincial Ministries of Health and Education, a proposal using school children as home change agents by printing and distributing 1000,000 pamphlets with cholera warnings and prevention messages prior to the cholera season was completed. When PRT funding was approved. Results: No cases of cholera in Ninewa Province or Mosul City while other Iraq provinces had cholera outbreaks and continuing such demonstration health projects involving Ninewa Province school children: Vetoed by the PRT.

In difficult collaboration with the Director General of Health, the Health Sector of the PRT sought to initiate a study to develop a cadre of Village Health Workers who would be trained to provide village-based basic health services, including immunizations and oral rehydration services for diarrhea, and screening with referral to primary health care facilities (via Pakistan’s Community Health Care Worker system). A proposal for conducting two pilot projects in different ethnic areas was never approved by the DG Health or supported by the PRT Leadership. The Iraqi national health leadership must take the lead in establishing and improving community-based secondary and tertiary health care and disease prevention.

Education needs

The current DG Education is a dedicated professional and the only woman serving at that provincial level of responsibility. She is dedicated and knowledgeable about both the needs of education in Ninewa Province as well as leading a remarkable professional staff. The problems she faces are daunting and among many others include:


• No means to locally print quality, easily distributable education products.

• Severe teacher shortages within the province. A lack of ongoing teacher training and upgrading of curricula.

• Most schools are still without water and electricity for, lighting, sanitation or heat. Most schools lack supplies, desks, white boards, and teacher training aids.

• A 70% unemployment rate prevents parents from providing basic needs, much less purchasing school supplies and food for their school-aged children.

• Lack of an incentive program to attract dropout children to continue their education. The DG submitted a proposal for returning students to their classrooms. This demonstration project includes a school-based food distribution, and a small stipend (about $2.25 per day) for school attendance while maintaining a passing grade average. These dropout children have been targeted by insurgent recruiters to plant IEDs or to throw grenades.

• Lack of transportation to move supplies and equipment.

• Lack of trained school nurses to provide surveillance, hands-on treatment, and disease prevention services.

• Lack of school-based maintenance and repair staff to cover 1,850 school facilities in Ninewa Province. This includes a complete absence of fully equipped mobile units or materials needed to operate any scope of activity.

Healthcare needs

The following problems plague the Iraqi healthcare system—as well as overall infrastructure—and were discussed at length with the Director General of Health in Ninewa Province and Mosul City:



• There has been a heavy loss of health facilities, laboratory staff and equipment, and infrastructure especially over the past decade.

• There is an absolute need for a timely, universal, sensitive, and specific surveillance and response system to detect, measure, and respond to communicable disease outbreaks.

• A system for procuring, dispensing, and monitoring pharmaceuticals is non-existent or not enforced through accountability.

• Losses of more than 22,000 physicians to other countries because of security concerns, lack of a viable economy, and the threat of death by insurgents (2,200 physicians murdered). Together these factors have crippled quality healthcare in Iraq.

• There are severe shortages of local medical treatment, community health workers, local disease prevention capacity, triage mechanisms, referral systems, and complete lack of encouraging proactive health behaviors for locals to seek medical treatment.

• Universal shortage of basic medical care services and well-placed trained personnel in rural areas. There are multiple data and reports on health problems, diseases and other significant problems. WHO, UNICEF and the UN agencies may be accurate in their estimation and assertions about those statistics, but either way the significance of these numbers is absolutely astounding: 80% of Iraqis lack access to adequate sanitation, 46% lack access to clean water, and only 60% have access to the public food distribution system.

• There is a serious lack of capacity to respond to diarrhea and acute respiratory infections, which is worsened by increased levels of malnutrition, tainted water, traditional personal hygiene practices, and inadequate sanitation. These factors account for about two-thirds of all deaths among children under five due to dehydration associated with diarrhea. At the same time, stunting (chronic child malnutrition) is estimated at 21% (WHO and UNICEF reports).

• There is a serious need for an Integrated Management of Childhood Illness (IMCI) or Community Management of Childhood Illness (CMCI) health care component. According to WHO and other agencies, CMCI was initiated in 1996 as a strategy to improve child health at the community level, and has proven successful in preventing deaths. As the program developed it became obvious that although children attending primary health facilities and clinics were clinically assessed, deaths at the household level continued because about 60% of child deaths occurred in the community.

• Need for collection of Tuberculosis incidence and prevalence data, and ensuing treatment program based in the high-risk communities.

• Anemia assessments, particularly among women. Iron-deficiency problems and research can reveal whether or not tea, which serves as an iron uptake inhibitor, has a strong negative impact.

• Need for school-based and adult response program to survey the community and assess the impact of intestinal parasites.

• Need for nutrition assessment for infants, children and pregnant women, including measuring household food intake. This is in light of the province being in the grip of a three-year drought.

• Lack of Perinatal and Neonatal-outcome surveys, including essential newborn care, particularly with “baby-warming” techniques.

• Lack of maternal and infant mortality reduction programs through ANC, perinatal care, and child survival interventions.
• Serious need for essential micronutrients assessment and distribution program to pregnant women and infants.

• Need for adequate community-based Anti-Natal Care (ANC) and obstetric support with a strong referral system, including a need for training and hiring women to serve as obstetric counselors at the community level (i.e., widows, educated women, and respected ladies of the community are excellent candidates).

• Lack of community and district-based epidemiologists and properly trained local disease-prevention sanitarians.

• Critical need for school-based health education courses and public health nurse training, including disease prevention and treatment options.

Recommendations and Rationale

Leadership

PRTs function and authority should fall under the full jurisdiction and authority of USAID/OFDA because:


1. USAID has a long range development mission and a great deal of experience. USAID/OFDA supports a variety of approaches world-wide and programs based on needs assessment. This agency studies both the impact and potential impact of a crisis before, during, and after an event with the design of programs and projects focused on measures to save lives first, and then establish a long-range plan for development. USAID also evaluates the capacity of local populations to cope with crisis. Capacity-building and humanitarian aids are offered to high-risk population with the goal of creating local independence.

2. USAID/OFDA is experienced in programming a complex series of variables ranging from social and political and gender roles through disaster response mechanisms in any situation. USAID has operated in humanitarian emergencies involving highly relevant circumstances including wars and many other forms of civil and political strife.

3. USAID has experience and success in responses, which establishes mechanisms and activities that people engage in to survive a crisis including heightened survival coping measures and survival or development behaviors.

4. USAID also utilizes indicators and measurable outcomes, which monitor progress that will demonstrate positive or negative changes toward established goals. This concept includes a focus on reducing vulnerability, reduce the loss of life, improved livelihoods and applications related to property - i.e. international Millennium Development Goals (MDG).
5. USAID has the experience and familiarity in programming that coincides with the military in most instances of insecurity including insurgency situations. USAID works at the community/local level with the same populations that the military does. Their common objectives are to reduce the loss of life (human and livestock) and negative economic impact by strengthening local population capacity and infrastructure to survive.

6. USAID/OFDA has years of experience, trained staff and organizational capacity to function through multiple disciplines needed to establish a fully functional Iraqi infrastructure capable of forming an operational nation. USAID's experience covers cradle to grave parameters through long and short term projects designated to assist people from birth through death. Child survival projects, agriculture, education, health, political stability and programs designed to deal with gender and local people empowerment have been successful globally. USAID exercises heightened cultural awareness and sensitivity.

With USAID/OFDA as the PRT lead technical contracts/contractors responsible for each team function such as health and education, agriculture, etc., one possibility is to assign a person or a team on a two to three-year basis. Alternatively, this could be accomplished through a single sector, three-person rotation, with a six-month duration for each cycle. This enables technical experts to be on rotation while the basic project components and targeted objectives are not. The networking relationships with our Iraqi partners would have more potential for continuity and satisfactory outcomes with duel ownership in place. USAID could recruit experienced county and city managers with proven track records in directing multifaceted agencies and programs.

Each sector of the PRT, including Agriculture, Health and Education, and Engineering should have an established budget for projects under $75,000. This would enable rapid development and implementation of many of the projects that are quickly becoming missed opportunities under the current PRT iteration.

Health

All the following recommendations include the caveat that all assessment, planning, and implementation activities MUST be carried out in conjunction with and the support of the affected Iraqi Ministries. We must be partners if the impact of these activities is to be lasting.

It was recommended that the MOH could initiate an IMCI program implementation pilot project with three components:


1. Empowering health workers and improving the performance and clinical proficiency of trained workers in providing health care to children less than 5 years in age.

2. Enhanced skills and improved practices for the care of children at the household and community level.

3. Training in clinical life saving skills, community obstetric awareness, and routine in-service care and referral to the nearest health care service facility.

IMCI can work seamlessly when close collaboration and supervision within the healthcare infrastructure is prepared to provide equitable and sustainable solutions to illness problems and available pharmaceuticals in a pipeline sequence. CHWs could also be provided with solar charged cell phones and a panel of clinical experts available on a 24-hour basis. The initial project would target a known population base of about 30,000 where local primary health clinics are overburdened. It would require the support of local officials and traditional leaders following the initial approval of the Ninewa Provincial Director General for Health. It was recommended that a trial project be initiated in the Tel Afar area with a review of achievements, lessons learned, and achievements. A comprehensive one year review meeting would be conducted with detailed findings analyzed and published. If successful the Ninewa Province DG Health could expand the Community Health Worker to a province-wide scope.

Health problems in Ninewa Province obviously need additional study, programmatic assessment, remedy and/or control, and include:


1. Establish a surveillance program and train local personnel to perform disease surveillance activities and establish Response Protocols.

2. Assess Tuberculosis incidence and prevalence. Assess Anemia particularly among women for assess iron deficiency problems and the potential negative impact of tea - tea serves as an iron uptake inhibitor.

3. Assess the prevalence of intestinal parasites in children and establish response programs as indicated. Assess nutrition levels for infants, children and pregnant women—measure household food intake—particularly since the province is in the grip of a three-year drought.

4. Conduct Perinatal and neonatal outcome surveys, including essential newborn care. Assess Maternal and infant mortality surveys and pilot reduction programs through ANC and perinatal care.

5. Develop an essential micronutrients distribution system for pregnant women and infants with assessments both pre- and post-distribution and a feasability study for establishing a distribution system and assured pipeline capacity. Initiate a community-based Anti-Natal Care (ANC) and obstetric pilot project with a strong referral system to assess community capacity to support needed training and hiring of women to serve as obstetric counselors at the community level (widows, educated women, respected ladies of the community).

6. Design and pilot test a community and district-based cadre of trained epidemiologists and disease prevention sanitarians.
.
Education

All the following recommendations include the caveat that all planning and implementation activities MUST be carried out in conjunction with and the support of the affected Iraqi Ministries. We must be partners if the impact of these activities is to be lasting.

The Iraqi education system was once considered to be one of the best education systems in Middle East. Neglect and civil conflict has reduced it to a state where it cannot meet the basic needs of it children, the future of Iraq. Therefore, assistance is needed to help the Director General of Education to implement her functional Five-Year Development plan and use it to improve education conditions in Ninewa Province. The following measures will greatly assist this goal:

1. Provide a printing press to print quality products that can be distributed easily.

2. Provide an assistance and incentives pilot project to recruit and train elementary school teachers. Assist the DG Education in developing and upgrading teacher training and curricula.

3. Coordinate with the DG Education resources available through the Military, DOD Civil Affairs, and donor agencies the provision of safe water, sanitation, and electricity in approved school buildings.

4. Develop a list of critically needed school supplies, desks, white boards, and teacher training aids and coordinate elicitation and provision of these supplies through donor agencies, NGOs, and PVO activities.

5. Establish a pilot incentive program to attract dropout children, especially aimed at recruiting female students and other school age kids to return to their education, and providing a means for a large number of students to graduate from primary, secondary and vocational schools. This effort should include school-based food distribution, and a stipend for school attendance while maintaining a passing grade average.

6. Provide transport vehicles for distribution of supplies and equipment with and eventual GOI provision of new vehicles, maintenance, and petrol.

7. Establish a school nurse pilot program to ensure screening for health problems, surveillance of disease, treatment, and disease prevention activities. Establish a protocol for school maintenance, list of personnel and training needs, supplies and equipment and establish a pilot project for gradual assumption by the Education Ministry.
Remaining Issues of Concern

The united goal of all participants must be personal security, free elections, economic development, a functional Iraqi judicial system, subsidized agricultural programming, clear land ownership, restored education and health systems. Each of these goals shares a common thread, they must be based on Iraqi ownership. PRT leaders must be given specific tasks as predefined by a well-thought-out strategy, rather than allowing them to develop and designate approaches based on flawed ideology—employing unrealistic perspectives and ignorant disregard oftrue Iraqi participation and contribution. Security must become a basic goal, fully operational as an Iraqi government function, and (relatively speaking) free of bribery and corruption.

Marion David Newberry, CEO
Global Consultants, Inc
2927 Harcourt Drive
Decatur, Georgia 30033
404-321-1032
]]> 2009 http://www.globalconsultants.us/iraq_tour/index.php?entry=entry090218-064840 David Newberry Wed, 18 Feb 2009 14:48:40 GMT http://www.globalconsultants.us/iraq_tour/comments.php?y=09&m=02&entry=entry090218-064840 http://www.globalconsultants.us/iraq_tour/index.php?entry=entry081106-061703
Exit Review for David Newberry, Chief

Health and Education Section

Provincial Reconstruction Team

Nine Province, FOB Marez, Iraq

As my tour in Iraq nears completion I remain both awed by the willingness and determination of the Iraqi people to reestablish a “normal” life of providing a living for their families, education for their children, and a healthy future for their grandchildren, and frustrated by the inadequacy of the system that our government has designed to address the problems of reconstruction. My situation is illustrious of this conundrum. I leave with feelings gratitude for the wonderful young men and women with whom I had the honor of working and who guarded my life with theirs, courage of some members of the Iraqi government who continued to come to work to rebuild their country while under a threat of death by those who wish to continue the chaos of jihad, and the wonderful and infinite curiosity of the children who long for and example to which they can attach their destiny. I leave, too, with a lingering sense of failure from my inability to obtain funding through the Provincial Reconstruction Team leader for easy, effective, and innovative opportunities to bring a measure of involvement between the PRT and my Iraqi counterparts through programs to involve school children providing clean water for their families and light in their schools. I also leave with feelings of technical inadequacy in my inability to bridge the abyss between what can be done and what I was allowed to do. And finally, I am saddened by the great divide between the Iraqi people outside the barb wire of this camp and the rest PRT staff as organized under the Department of State (DOS) and Office of Provincial Authority (OPA). This report serves as my Exit Report in lieu of the fact that my PRT Team Leader chose not to either conduct such an interview or say farewell to me after nearly 11 full months serving as a team member of the PRT, Ninewa Province.
Realistically, in December 2007, I expected to find a reconstruction situation and operation similar to the one I left in Iraq October 2003. This has proved to be even more of a fable than one could have written into a movie plot or even imagine. Our DOS training included numerous DOS role playing, problem analysis, solutions with infrastructure development and capacity building. Various funds were designated as available to bridge the gap between current problems with funding solutions or to create capacity for Iraqi joint ownership and fiscal support as available.
I want to make it clear that I am neither a diplomat nor am I strategic command person. I do have expertise and skills in health programmatic development and experience in education management and development. The culture, language, and intellect of Iraqis and history of this nation are such that we – Americans - should be taking notes from our colleagues here. We should be sitting in their classrooms making lists of things to do in collaboration with our partners and most importantly, when we say we are going to do something - then keep our word and do it without politics or policy development created by DOS PRT leadership and absolute control by the US Department of State officials who lack the skills, knowledge and the common sense to implement and support programmatic efforts needed to reconstruct Iraq. If they were not here to play that role, what role are they to play? It did not appear to me that they had much interest in, nor a relationship to, the title of their team.
Our partners, the Iraqi people have been made so many promises that were never kept – such that we could pave the road all the way to Egypt with them. What makes the situation even more curious is the implementing structure at the provincial level. Here, there four types of professionals: those who are Department of State (DOS) career seeking individuals and many of them will be rewarded because the DOS system has no H R mechanism for anything better or worse – if one serves in Iraq one can go pass “Go” in terms of career enhancement. It does not appear to be related to the “Mission” I was lead to believe I was coming to Iraq to help accomplish. So a DOS person or FSO comes out to Iraq and he/she spends one year (or more) during which time there little professional accountability and success is measured in terms of what was or what was not accomplished (numbers), but more importunely measures developed on DOS a measurement standard – which is often founded on a lack of accountability and for what was not accomplished. But, regardless, there were no “waves” created. The DOS RULES either way. The second major “player” group then is the military heroes and heroines who fought to win the military war and are presently stuck trying to keep doing “good things” like building and rebuilding schools, repairing hospitals, and other brick and mortar projects. It seems to me that we should go shoulder-to-shoulder with the Iraqis to take on whatever tasks they prioritize and become partners with their efforts. This must be accomplished within the normal cost, without corruption and with a financial fluidity that keeps the Iraqi’s in charge and to reduce cost in ways that will reduce corruption and assure quality control. This means taking responsibility with our Iraqi partners, in developing capacity to perform, even low cost Brick and mortar tasks with ethical concerns regarding the impact on the present and future generation.
Currently the US Government builds schools in Ninewa Province without consulting the Directorate General for Education regarding location, land ownership, appropriate structure, and cost or education staffing requirements. Schools may be built using Iraqi money or US dollars. This problem has become less obvious through a few mechanisms established by the military. Some of these school buildings are located where there are too few school age children to justify a building or worse these schools are inferior in construction and not coordinated with the entire provincial plan or priority needs. In some situations these schools were not even built on Iraqi Government property. The coordination issues need protocols and some structure.
Meanwhile the military are frustrated generally trying to do good while the PRT is playing whatever game the DOS wants to play. The USA military, Civil Affairs staff (CAs) try to work at the lowest and most important levels of the country while the PRT leadership meanders around the country-side hobnobbing with the elate Iraqi societal leadership with menus for women rights, governance, and whatever other USA based programmatic issues are considered as politically expedient. This is not to say that these kinds or programs are not important but it is important to state that we should be seeking the Iraqi prioritization of issues and programs for saving lives and reconstruction support. At the PRT level we have seen a succession of leadership and authority that alternates between autocratic leadership and/or weak individuals who wouldn’t know or even guess what the Iraqi people really want. Worse, such leadership really does not care and will have no clue how to help rebuild a nation that has never experienced a government by the people, and for the people. Good leadership and a team builder is one who must take the wide range of experts into a strong force for rebuilding Iraq. The individual Iraqi is the one the needs the opportunity to forge a future that is structured in his or her lifetime with a sense of ownership and in such a way that insurgents and others can not take it away from them.
Expertise needs to be harnessed to improve the education, health and welfare of every Iraqi. We have initiated studies and made recommendations to improve the maturation of the Iraqi children while saving lives. We recommended a specific water sampling study coupled with a water purification component using solar and ultraviolet light. We wanted to sample fifty sampling points along the Tigris River that are used by household members as a drinking water source. The proposal was scheduled to include testing for organisms in matched samples exposed to the sun and non-exposed samples. The cost was $11,645. It was turned down by the PRT leader because the Iraqi people could purchase (with money they do not have because they are unemployed) iodine tablets or add Clorox to their drinking water. Is tiring to work seven days a week as a technical person and have some poorly informed and selective listening diplomat make decisions that guarantee failure in terms of creating infrastructure, improving capacity or even creating real employment for the Iraqi people. The Iraqi people don’t have jobs, lack food, and have lost hope that Americans will help solve the problem. In addition, the civil situation is such that the Governor has had 11 staff members assassinated and those who work for the Americans are likewise at risk. In January 2008 the Mosul City Chief of police was killed by a suicide bomber in broad daylight. I wonder how many Americans would go to work if they and their families were at risk of being murdered.
The second type of person assigned to a Provincial Reconstruction Team (PRT) is usually a technical expert in a field of law, economics, construction, water, electricity, public health or education. Obviously the technical experts must have free access to our Iraqi partners and listen to what they say and analyze each situation to better determine a remedial course of action that is basically owned by the Iraqi people. Technical staff should be given adequate funds to make commitments and to keep them at all times. When our Iraqi partners make commitments we should honor those statements and support their prioritized programs. Iraqi “buy in” should be on their terms rather than some DOS professional who does not understand how the culture works nor interested in understanding it. To many of them a tour in Iraq is something to be endured as a means of career enhancement based not on what they accomplished or it quality of their effort. Actual performance just doesn’t seem to matter. A couple of examples come to mind for health and education. These may be redundant but pertinent. UNICEC reports that about one third of the children less than five years in age die from dehydration and diarrhea related diseases. I recommended that we support a high school science contest using the sun and photoelectric cells to provide lighting and heating in schools; the second prize would be awarded to the student who shows how simple household drinking water could be purified through solar exposure to heat and ultraviolet light.
Two 1.5 liter samples were to be taken properly labeled and one sample kept out of the sun while the second would be placed on a black plastic bag and exposed to solar ultraviolet and heat. Temperatures were to be recorded while the water was exposed for 6 hours or more. Temperatures were to be recorded hourly. Then both samples were to be collected and taken to the Mosul City Water Laboratory for testing. The lab would report all specific organisms found in both samples. We would then have a baseline of waterborne organisms found in both samples. If the action of solar heat and ultraviolet light were significant, those samples would be purified enough to drink safely. A second study would or could be initiated based on findings from the first study results. We would recommend expansion of the study to include a greater number of sampling points and extend the time of solar ultraviolet light and heat exposure to assure coverage during the colder months of winter. It is our intent to use the D G Health to compose health related materials based on the water study and to use the 660,000 school children to transmit that information on the basis of children as behavior change agents.
Technical experts are assigned to the PRT without fiscal funding or the ability to make policy. As different Team Leaders take the assignment they have about one year to make their “mark” within the PRT mechanism. DOS usually recruits from the assigned POS staff to further their reputations at the least risk. The current PRT Team Leader has empowered his Diplomatic Officer in two ways; she controls the approval process of the QRF and other funding mechanisms and secondly she “protects” the Team Leader from negative consequence related to funds, policy, public affair functions, and meeting the high profile targets of the DOS menu such as gender issues and related social targets. Civilian staff has been discharged for various and often petty reasons, creating an atmosphere of fear and trepidation among team members. This is especially true when the team leader’s management style is autocratic.
The DOS priorities for programming are politically orientated and not appropriately selected based on the needs of the Iraqi people. It is apparent that the Ninewa Team Leader’s decisions are based on his supervisor’s priorities and not the needs of the situation on the ground. Needs dictate that decisions be based on helping provide families with food, jobs, education and most importantly security against insurgents. This is key in reducing the power of the insurgents in Mosul City and Ninewa Province. The PRT’s mission is to reconstruct the province and prepare the population for a self sufficient, functional government. This requires extensive economic, social, education, health and USAID functions. All this is accomplished through collaboration with all our Iraqi colleagues and the US military. One obvious and creative approach to improved networking could be accomplished through contract with a proven contractor who provides a team of three experts who rotate every four to six months. This approach would solve the problem of continuity in programming based on Iraqi priorities and programs. Capacity building, establishing infrastructure, and continuity in programming would all be accomplished.
While the actual number of accomplishments was limited under the DOS leadership in Ninewa Province, the Health and Education Sector did obtain enough pediatric wheel chairs for 1300 children, established a new high school science contest, printed 100,000 anti cholera and diarrhea prevention pamphlets circulated by 40,000 school age children. We prevented cholera from infecting Ninewa Province. We obtained three vehicles for the Directorate General Education’s use in the transportation of school materials. The Japanese Government funded these vehicles. We were denied funding for a school week long project to encourage Art, Music and Theatre. A water project was denied approval. We developed a return to School project designed to return 15,000 school dropouts and recruited females to attend school for a stipend of $2.25 per day based on attendance and grades. Another proposal was designed to provide a school lunch program. Both these project were to be forward funded through the Iraqi budgetary system. We also worked on establishing an Iraqi vision for a quality national wheelchair factory, a national Rehabilitation Center in Ninewa Province and a prosthetic limb production center in collaboration with the Iraqi Red Crescent Organization and the Ministry of Health.
At the conclusion of my assignment the USAID, Chief, the local PRT staff, the Commanding Officer of the 86th CAH Hospital and the various medical officers of the 3rd ACR Regiment and the Division Surgeon honored me with their kind comments and offering their best wishes for my future. As the oldest member of the Ninewa Province PRT – at 75 years in age I thank God for giving me the opportunity and blessings of good health to complete this assignment
]]> November http://www.globalconsultants.us/iraq_tour/index.php?entry=entry081106-061703 David Newberry Thu, 06 Nov 2008 14:17:03 GMT http://www.globalconsultants.us/iraq_tour/comments.php?y=08&m=11&entry=entry081106-061703 http://www.globalconsultants.us/iraq_tour/index.php?entry=entry080926-063856
Iraq and its people have been driven from the top down so long that it is nearly impossible for most public officials to practice “a government of the people and by the people”. We should learn from our past failures here and use both, large support components, which operate on “buy in” terms according to priorities based on the creation of jobs, and establishing security, educating the children, and providing both curative and preventive health care service. We can start with simple health and education projects that create Iraqi interest and ownership. My biggest failures include: a non-funded, simple water sampling of 50 household drinking water sampling sites starting just below the Mosul Dam and extending to a village well below the city of Mosul. This survey would involve a very simple design that would involve a person collecting pared 1.5 liters of household sourced drinking water. Both samples would be well marked and labeled. One sample would be stored in the house while the second would be placed on a black plastic bag and exposed to the sun for six or more hours. Both samples would then be taken to the water testing laboratory for complete testing. Identify all organisms found in both samples and these would be recorded and the results shared with both DGs for Health and Education. The health sector could extend this type of survey and measure the solar purification process or conduct additional research as needed. The department of education would look to the health sector to write education materials about home prevention and treatment of diarrhea, which the 660,000 students of Ninewa Province could take these messages home to mothers and fathers for improved water sanitation and awareness of water-borne diarrhea illnesses. The project would cost about $11,600. It was turned down for funding because the people can buy iodine tablets and local Clorox to add to their drinking water. We ignore that fact that 37% of the deaths of Iraqi childreen less than 5 years of age are attributable to diarrhea and dehydration!

I feel guilty because it just doesn’t make sense to me and now my feelings are mixed because even complaining here seems like sour grapes and perhaps it is just that. It is clear to me that the proposal to initiate a trial school feeding program, or to initiate a project to get “drop out” students back into the classrooms is not likely to happen nor is the provincial education printing press. Will our wheel chair factory become a reality? I will not be replaced: so a DOS staff person already here will take on these duties. Am I bitter – yeah I think so! Why? Because the things that make me weep doesn’t seem to affect DOS people so career minded they just don’t get it. What makes me cry? Many things in life: holding a small child until it falls asleep. It is being at the bedside of a loved one as they breathe their last. It is sitting beside the bodies of two of your children, powerless to change their fate. Holding the person I love most and wishing she could know how very much I love her after 50 years. It is seeing a family break up because of mistakes and sensitivity between two people who should understand that being selfish and being hurt empties one of love and the capacity to sacrifice for your children. My tears are for the innocent Iraq children as I see them on the street, war-torn, hungry, without hope, tired and in danger. It is for those who are hungry - because there are no jobs and little likelihood this economic situation will change in any near future. My tears are for those officials who are trying to do the right thing and at the same time do things right. They are for the poor and those suffering from illnesses that could be prevented and lastly these tears are for the DOS folks who just don’t get it but - know it all after two or three months being here.

Taken from the book “The Spirituality of Imperfection” by Ernst Kurtz and Katherine Ketcham (page172 and 173) – “Reuter suggests three layers of attachment that need to be peeled back sequentially, like an onion. First, we need to become detached from material gain, second from self-importance, and third from the urge to dominate others. It is only through this process of stripping away these attachments, she writes, that we can lay claim to spiritual progress.” This week I am committed to working on all three! It is a constant challenge to try and keep away from sour grapes. May God help me!

Ecclesiastes 3:1-11 says it so much better than I can. It states: “There is an appointed time for everything, and a time for everything under the heavens. A time to be born and a time to die: a time to plant and a time to uproot the plant. A time to kill and a time to heal: a time to tear down and a time to build. A time to weep, and a time to laugh; a time to mourn, and a time to dance. A time to scatter stones and a time to gather them: a time to embrace and a time, and a time to be far from embraces. A time to seek, and a time to lose; a time to keep and a time to cast away. A time to rend and a time to sew; a time to be silent, and a time to speak. A time to love and a time to hate; a time of war and a time of peace.

]]> September http://www.globalconsultants.us/iraq_tour/index.php?entry=entry080926-063856 David Newberry Fri, 26 Sep 2008 13:38:56 GMT http://www.globalconsultants.us/iraq_tour/comments.php?y=08&m=09&entry=entry080926-063856 http://www.globalconsultants.us/iraq_tour/index.php?entry=entry080922-065008 On the good news side we were successful in getting $80K from the Japanese Grassroots fund to purchase three vehicles for the DG Education. It is a project I have been working on since January 2008. The US Army Captain who set it in motion back in February deserves the major credit. At the same time other PRT projects are refused funding for reasons unrelated to the proposal itself. Back in April and May I anticipated another cholera season in Iraq. I went to the WHO folks to obtain their Arabic cholera and diarrhea prevention pamphlets and posters. They didn't have any available but I was able to obtain their PDF files and we paid a printing company to arm us with 100,000 pamphlets and 10,000 all weather posters. We used 40,000 children to distribute these materials and to explain their content. Cholera did appear early this month but so far we have been spared. Hopefully the early prevention work paid off. Other PRTs are trying to catch up so I shared our PDF files with a distributor who can hopefully take appropriate action.

This brings me up to the general question of water and one of our simple projects that continues to be rejected for one reason or another. What we propose is a simple collection of 50 water samples collected from family drinking water sites ranging from just below the Mosul Dam to a small village at the edge of Ninewa Provincial border. The project is a simple one: each agent would collect two 1.5. Liter water samples from normal drinking water sources, label both samples carefully and accurately. One sample is to be stored in the house while the second is placed on a black plastic bag and placed in the sun for more than 6 hours. The ultraviolet light and solar heat should kill most bacteria, virus, or protozoan organisms. Both samples would be submitted to the local water testing laboratory and tested for organisms, chemicals with a final report, which we would analyze and develop a water-borne mapping of organisms found in the fifty sites and the solar effect on purification. The cost for this survey is less than $13K. So far funding has been refused.
As my tenure draws closer to an end it amazes me to know that these PRTs are staffed with technical persons with a mission to empower, enhance, create capacity and to help build Iraqi infrastructure and yet the DOS has full power to make decisions based on their own definitions. The water project has the blessing of both directors for education and health. Oh well, we will keep trying to meet our mission and provide some assistance where we can. I doubt that my position will be filled after I leave. So another major factor for failure is technical PRT continuity. Unless we realize that winning this war, from my perspective, is to raise up this current generation of Iraqi children in schools and with functional and modern curriculum, and with fully equipped science laboratories, arts, music and theater wherewithal, with water, electricity, heating and school health programs – we have lost it. Unless we assist the Iraqi educators in getting school dropouts back to classes with some incentive for both attendance and passing grades and possibly food supplement the insurgents are going to continue recruiting them to throw grenades, and to plant IEDs. What’s more we will help rise up a generation illiterate and unemployable – all because we screwed up the later possibility to help win this war. Meanwhile the unemployment rate is estimated as high as 70% in Mosul City and there is no single solution. Our leadership talks about Iraqi “buy in as measured in dollars” but I measure it in terms of empowerment, safe drinking water, reduction of preventable child mortality related to diarrhea and dehydration, pneumonia, vaccine preventable disease and maternal mortality due to a lack of adequate ANC care during pregnancy. The DOS structure reminds me of that old fable “The Emperor’s New Clothes”, by Hans Christian Anderson.
]]> September http://www.globalconsultants.us/iraq_tour/index.php?entry=entry080922-065008 David Newberry Mon, 22 Sep 2008 13:50:08 GMT http://www.globalconsultants.us/iraq_tour/comments.php?y=08&m=09&entry=entry080922-065008 http://www.globalconsultants.us/iraq_tour/index.php?entry=entry080914-163719 Bluntly Miranda said that the "Department of State and the Foreign Service is not competent to do the job. These folks are hard working, intelligent and capable in many settings. They cannot successfully lead the civilian surge or to manage our civilian surge." They are not trained or prepared to do the job. Their careers will be enhanced as the result of being here but they are not able to do the job. Miranda's tour began one year ago in February 2007 and mine began December 2007 so we have about a combined 18 months experience in Iraq. Our task was to create a level of Iraqi independence, infrastructure development and to conduct just plain capacity building. Here I’ll quote directly from the Miranda document: “In particular, neither the State Department nor its Foreign Service is competent to manage and lead personnel whom have been hired and brought to Iraq as experts, or to synchronize expertise, funds, and programs to support the GOI (Government of Iraq). As managers, the Embassy’s leaders do not have the leadership profiles or management experience required by the nation’s high sacrifice of blood and treasure.”
My tenure is winding down and in a few short weeks I’ll be home. Upon reflection of what I’ve experienced verifies what Manual Miranda wrote about. I have spent months getting to know our Directorate Generals for Education and Health. I am not a super expert in education but I do something about international public health. I can certainly tell you more about what doesn’t work rather than what does work. So, I’ve invested months in getting to know the DGs and about their short and long term plans. Very simply put, their goals and plans have become my dreams as well. I have no direct access to funds, nor do I have the authority to enforce activities that I see would empower, or create infrastructure and build capacity. Together the DG Health and I share a vision for this province as the national handicapped center for rehabilitation and the location for a quality wheel chair factory capable of supplying all of Iraq. We see the possibility for collaboration with the Iraq Red Crescent Organization to produce prosthetic limbs. Eventually I aspire to see a program for training community health workers and to train women as antenatal care workers but these are a long way off. We see a 500 unit per day capacity blood bank to serve the two million people in this immediate area. There is action to complete a project that would increase capacity in one main hospital to conduct cardiac surgery. In four weeks my continuity will be interrupted and probably some FSO will take over. Without a replacement to hand over these projects and networking ties my guess is they will not go far. If we were given a set budget to work with we could start projects and programs to strengthen the capacity of our Iraqi partners and the next technical expert could do “relief pitching” until their projects are developed.
The Director General (DG) for Education has my special admiration and apprecitation. She is a remarkable woman in a man's world. She just might be the Sarah Palin of Iraq. Her vision is to win the children of our province by providing top quality education and exercise innovative means for achieving these goals. She knows that children are at great risk to insurgent violence and kidnapping. She tells about visiting a school to find one child taking a test and finding the child crying. SO, she asks the child why she is crying – the child answers, because she is hungry! So we have developed a school lunch program that will cost $6 million for the start-up year. She has budgeted for subsequent years. Is the any hope of us funding that project? There is no means for that possibility to even be considered. I try three other donors and hope one of them comes through. We envision a Return to School program where we take a 15000 student cohort and recruit them to return to classes. There are about 250,000 such kids’ age 12 to 17 on the streets. We would pay a $2.25 per day stipend and provide some food supplement contingent upon both attendance and maintaining passing grades. Again she has budgeted for future years but needs to get the start-up year money. Again I’ll look around to see what I can find as a new source or a new donor. I could go on for hours about this sort of plans for enriching these children through education for both academic and vocational schools.
The inclination here is to forget these projects and transform the PRT into a US Consulate staffed by diplomats, who will produce the “inability to respond to the urgency of America’s presence in Iraq, and the inclination to make excuses and blame the Embassy’s failures on others” – another quote from the Miranda Memorandum. I’ve got to quit this meandering because it is too complex an issue to really try and cover in one setting. Perhaps I’ll try again next week but it is midnight and time to sleep.
]]> September http://www.globalconsultants.us/iraq_tour/index.php?entry=entry080914-163719 David Newberry Sun, 14 Sep 2008 23:37:19 GMT http://www.globalconsultants.us/iraq_tour/comments.php?y=08&m=09&entry=entry080914-163719 http://www.globalconsultants.us/iraq_tour/index.php?entry=entry080907-185715
Working in Health and Education in Iraq, really capacity building and infrastructure development for an Iraqi future through the children and a healthy population. The challenges are greater in the health sector because 20,000 doctors have fled the country while another 2,200 were murdered by insurgents.

It is a repeated refrain from me to state that the insurgents want to prevent the people from being safe from death, access to safe water, electricity, food, jobs, free communications, participation in education, and most importantly of all – participation in a democratic government. Who is Iraq? Seventy five percent of the population is Arab, Kurds, dwelling in the highlands of Iraq make up 15-20 percent of the population. The rest include smaller groups of Turkmen, Jews, Armenians, Chaldeans (Iraq Catholics) and Assyrians. The majority of Kurds are Sunni Muslim but there are also Shi’a and Christian Kurds. Most Kurds are moderates toward religion. Sunni Islam represents the largest institutional branch of Islam – they represent about 85% of all Muslims. Their main belief is that Muhammad died without a successor, therefore it was decided that the leadership role should pass on to the most qualified person. Shi’s Islam differ from the Sunni belief in that they believe that the only legitimate leadership of the Muslim people can come from a descendent of Muhammad’s family.

Sorry to include all this background information but it is pertinent because there folks here who believe that we are on the verge of a destructive civil war between these ethnic and divergent Islamic groups. I hope and pray they are wrong. I’ve come to love these people, their culture and unbelievable suffering extending back many, many years not just because of this war.

Education is free in Iraq. In Ninewa many children do not attend school. Six years of compulsory and instruction is in Arabic except for the Kurdish areas. It is estimated that the literacy rate for 15 years or older is 40%. Health standards are poor to very poor. Unfortunately, there is a huge gap in both available health care and prevention of premature death. There is no discernable program for the prevention of endemic diseases. I have visited many small Primary Health Care Centers and reviewed their problems. There are myriad problems observed. Shrinking pharmaceuticals supply, inadequate laboratory equipment, incredible numbers of outpatients and no prevention capacity. In one clinic staff expect to treat several hundred patients. I saw their treatment book which showed staff expects to treat 10 cases of typhoid fever per day, unfortunately, no prevention capacity exists. Life expectancy is about the same as for Naïve American reservation and that is 47 to 55 years. The infant mortality rate is not accurate and varies but is estimated at 55 per 1000 live births. Unfortunately, the health and medical service sectors are understaffed, threatened by insurgents and supplied with too few treatment drugs. There is no support for Community Health Workers (CHW) to be trained to serve the community by treating simple illnesses, conducting health education, conducting disease prevention practices, conducting triage services to get the seriously ill to the nearest health care facility. In the most effective CHW programs they work under a loose supervision of the nearest health facility physician. The most effective CHW workers connect with that facility and their staff through a quarterly one day in-service training experience. Such a program would revolutionize health care in Iraq and save many lives every day! There is more and greater interest in establishing both health care and community-based health care services.

Education in Ninewa Province is in the most capable hands in the country. We are supporting a high school science contest on harnessing the sun for heat and lighting and simple water purification through the solar heat and ultraviolet light. We hope to assist the DG Education in establishing province-wide Arts, Music and Theatre talent search. We have used 40,000 students to teach the people how to prevent diarrhea and especially cholera. We want to assist in establishing a pilot project for returning 15,000 12 year olds to 17 to return to or begin to attend school. The plan is to provide a small daily stipend of $2.25 to attend school. Attaining a passing grade standard would have to be met. Results from this cohort will be closely examined and analyzed scrupulously with the findings utilized to expand the program and refine it better. There are about 250,000 of the kids on the streets looking for jogs, money and food for themselves and their families. We need $6 million dollars to operate for one year. We calculate it will cost about $405 dollars per child. The DG Education has already added this program to here future budget. So, we are out beating the bushes looking for donors, and different sources of funds through US and Iraqi channels.

Well, that was the week that was and there is plenty more to do. We are still short-staffed as there are only two of us in my section – my Iraqi Interpreter and myself. Oh, well if it were easy they wouldn’t use me. That sounds too pontificating doesn't it? Off the record I am participating in this years’ Ramadan by fasting. While working in Northern Nigeria, I joined my working colleagues by fasting for two Ramadan’s. It is an interesting experience.
]]> September http://www.globalconsultants.us/iraq_tour/index.php?entry=entry080907-185715 David Newberry Mon, 08 Sep 2008 01:57:15 GMT http://www.globalconsultants.us/iraq_tour/comments.php?y=08&m=09&entry=entry080907-185715 http://www.globalconsultants.us/iraq_tour/index.php?entry=entry080902-101024
The function of the PRT has begun to change its design and structure. We see many visitors and it is difficult not to analyze and draw conclusions about or from these visitors. The PRT goal is to empower, to create functional infrastructure leading to some form of operational democracy is fast fading from my perspective. I remember back in 2003 when I first came to Iraq there was such high hopes that we could transition to a country operating as a government of the people, by the people and for the people. The insurgents rapidly figured it out. They acted to keep the people at high personal risk of personal injury or death. To keep the electricity turned off. Let unhealthy drinking water prevail. Reduce any possibility for economic growth or even the creation of jobs for the evolution of a middle class structure. They painted the whole country with the brush of fear, with sectarianism, with religious fanaticism and finally a severe blend of ethnic anarchy. Then we moved in with high-roller-fashion solutions, based on Department of State diplomacy, which cast every problem with a solution based in money. It is a corporate world here and everything has its price. The military are the true assets of patriotism. Their role in Iraq peace is still being defined. Back in 2003 we treated recovery as Disaster Assistance Project and made headway until a serious lack of communication with the people permitted the politicians to snatch defeat from the possible jaws of victory.

We then invited the big agencies to help, which appeared again as the correct thing to do. So it appeared to be the best thing to do. This was a serious mistake on both the problem and the solution. As soon as Sérgio Vieira de Mello was killed the UN pulled out and insecurity took over. Once again the overarching paradigm will focus on many agencies and dependence on the Iraqi Army and police force. I don't think they are ready to take over. We still need to focus on the kids, food, jobs, security, health, personal participation in government and the creation of a middle class. We need to spend full time letting the various ethnic groups solve or resolve their problems. It was pretty much done in Nigeria and while that country is not a model for Iraq there are sectarian similarities. My recommendation is to keep American politics out and help Iraqis develop infrastructure! Any how that is my opinion and I've been wrong before.

]]> September http://www.globalconsultants.us/iraq_tour/index.php?entry=entry080902-101024 David Newberry Tue, 02 Sep 2008 17:10:24 GMT http://www.globalconsultants.us/iraq_tour/comments.php?y=08&m=09&entry=entry080902-101024 http://www.globalconsultants.us/iraq_tour/index.php?entry=entry080824-094157
In the sectors of education and health Ninewa Province will do very well in the long term. The vision for a healthy people and an active educated youth generation are the most important and significant movements that can possibly be achieved by the surge and the PRT. There are very good USA-based examples for failure in the empowerment of people in problem solving through planning, budgeting, impact measurement and programmatic execution in our great country. President Johnson’s “Great Society” is a sad example of spending huge amounts of money to solve problems and even the creation of an entire entitlement system, which proved to a massive failure in solving societal problems. Poverty, welfare dependence and driving males out of families for money purposes resulted in high rates of fatherless children.

Another example is the Indian Health Service (IHS), which has been responsible for Native American health programs and budgets for 150 years. Result: "The average life expectancy for Native Americans is 55, which is lower than for residents of Bangladesh," (June 2, 2002 Miami News-Record). Lack of public health infrastructure and services contribute to the inadequate health care of many Native Americans living on reservations. "The federal government spends half as much on health programs per tribal member as it does on health programs for other Americans," (June 23, 2002, Great Falls Tribune).

"Just 68% of American Indian households have telephones, compared to 95% for the nation as a whole. The legislature deplored the fact that there are 90,000 homeless or under housed Indian families, and that 30% of Indian housing is overcrowded and less than 50% of it is connected to a public sewer"
(March 10, 2004, Indian Country Today).

But the Indian Health Service, run by the Department of Health and Human Services, is funded at less than $2,000 per Indian each year, half of what federal prisoners receive. This year, Congress rejected legislation to increase its budget. The administration redirected Indian Health Service funding to homeland security and the Iraq war.
Various news reports show the following findings.
In Pine Ridge, people are not joking when they say someone practically has to be dying to receive emergency room care; Indian Health Service hospitals operate under a "life or limb" policy. For lesser ailments, people write off a day of their lives in a clinic waiting room. Often, they just give up and go home.
Deferred health problems take their toll. Life expectancy on the reservation is 47 to 56 years, the nation’s lowest. Infant mortality is twice the rate of the rest of the country. Diabetes afflicts about half the population, and people here talk about their blood sugar levels the way other Americans mention their cholesterol counts. Alcoholism is rampant on every reservation with associated high rates of death due to related physical and behavior events such as accidents, intended and unintended injuries, etc...
When one considers the plight of the Iraqi people waiting for their government to improve local health care and health services – it is easy to review the above history in regards to American government response to empowerment and to extend the life expectancy of American Indians and know why most Americans arriving here in Iraq have very little understanding of creating infrastructure or developing capacity. The sad part is that we just don’t learn from our mistakes even as we move forward here. How many Americans would even think of going to work under a death threat? Here it takes months to develop relationships with Iraqi officials for many reasons. Then we rotate back home and someone else starts all over again.

Some of these mistakes go back to 2003 when we made lots of reconstruction and infrastructure mistakes. These have been analyzed to death and beyond. Unfortunately we have failed to employ community level answers to fully overcome these mistakes. Instead we have created a civil service approach that may or may not create infrastructure that works and is owned by the people. We do not intend to review that part of of the Iraqi reconstruction history.

The most important reconstruction action that we can take is to ask the Iraqi folks what are their goals and how can we help them, as partners, reach those targets while serving as tools of assistance and change. The big question is how we can use our resources and expertise to help the Iraqi people develop programs that work when needed and how to encourage the formation of a participatory and responsible government that functions to improve the life and well-being of all Iraqi citizens. Is that too ambitious? Well, perhaps by next week we will find something that is not complicated to achieve.
]]> August http://www.globalconsultants.us/iraq_tour/index.php?entry=entry080824-094157 David Newberry Sun, 24 Aug 2008 16:41:57 GMT http://www.globalconsultants.us/iraq_tour/comments.php?y=08&m=08&entry=entry080824-094157 http://www.globalconsultants.us/iraq_tour/index.php?entry=entry080815-133856 The city lacks electricity, potable water, but it does possess infrastructure at the mayoral and Governor's levels. The departments of education and health are functional and staffed by dedicated professionals. Their vision and goals are consistent with education and health professionals anywhere in the world. As the Wizard of Oz would say is ..."All you lack is an organized budget and an “accountable" system for achieving all your wonderful goals and aspirations, therefore, I am giving you self-help book on One-Day-At-a-Time budgeting and planning execution in a democracy"! The Iraqi people and government has nearly always been a top-down controlled society. The rise of the political party system and the use of Islamic law have been to obtain and retain total power and to control the money. This is the geographic area where the cradle of civilization was born. It began and was based on an agrarian society and culture. After 3000 or 4000 years society became more complicated and political and religious cultures replaced the more simplistic farmer life-style. The emergence of ethnic groups and strong leaders also contributed to power struggles that shifted powers.
In the end, the Iraq war left a giant vacuum created by the loss of formal and traditional leadership and power. Democratization was initially confusing and especially in face of the US attempts to spend money to solve all problems. A huge lack of quality control became a source of corruption and theft. In the end problems remained or multiplied while accountability diminished. The looting of 2003 was a sample of the Iraqi frustration and a sign of unorganized resistance and backlash to the Saddam regime. Following that initial open resistance and as resistance became organized along political and religious lines the early advantage was lost. Frustration became the major tool of insurgents while corruption led the way to organized destruction and mass murder. The West was focused on establishing a government of the people and by the people while the insurgents were sowing economic, social, rule of law disintegration. This resulted in a loss of electrical power along with a reduction in access to water and food availability. Anarchy and societal disintegration took over while the West began to intervene with money, power and politics. It is not clear who is to blame even if one wanted to play the blame game.
The total disintegration of a poorly working system took about one year. Starting in 2004 the gains made early on in 2003 were lost. The political will was frustrated while the corruption cycle became more intense. The search for weapons of mass destruction should have focused on the presence of massive weapons of personnel destruction, the attempt to democratize Iraq has both intended and unintended consequences. Simple supply and demand concepts became lost in unaccountability often resulting in theft and shortages in essential supplies such as fuel, pharmaceuticals and even food. Agriculture, animal husbandry and access to water have all lagged behind their potential. Economic development has been in "locked down" position because of problems related to investment cash shortages, banking problems and land disputes. Overarching all these is the lack of security. Many of our partners are marked for death and the insurgents are mad with application of the power of fear. Americans fail to really understand the heroic performance of most of the Iraqis we work with every day. Whether it is health education, reconstruction, economic development or just water and agriculture ventures - there is every possibility of death from the insurgents. The enemy doesn't want Iraqi society to operate successfully. The insurgents want the people to basically fear every effort to produce any good or to supply water, electricity, medical care or even to conduct education in schools. So, they kill maim and commit suicide to influence by fear.
The next big issue is that of large budget and a controlling central government conducted without accountability or ownership at lower levels. Planning and budgeting is a hindsight activity that is in a constant state of flux. Even textbooks for education must be printed in Baghdad and transported to the periphery. School exams conducted in Ninewa Province must be transported to Baghdad Ministry of education offices for grading. Results have to be reported back up the line to Mosul City DG Education. The shortage of medical doctors has made it difficult to provide basic health care at the Primary Health Care center, in local hospitals and even larger hospitals because these are often targeted by insurgents. On the other side of that equation are some of the bravest people I have ever met. One doctor informed me that insurgents had murdered his son, injured his wife and killed his best friend's wife - who was also a medical doctor because he refused to abandon his patients. He informed me that "they will have to kill me to stop me from seeing patients." Wow, how many Americans could or would make such a declaration? Most health care workers and educators are deeply committed to their duties. Unfortunately, too many impediments exist in simple areas of supply and demand and technical enhancements. Curriculum development is several years behind but we are working on helping to offset these shortages. High Science class laboratories contain equipment last supplied back in 1960. Teachers are well prepared to teach as professional educators but there are still shortages of approved positions for teachers. That permission comes out of the Ministry of Education. Approval requires time and money to implement!
Supervision and support for professionals employed by the Government of Iraq are difficult to perceive. Sometimes these are slow and at other times they just can't be tracked. The persistence of Iraqis' locked in battle again every possible advisory makes me love and admire them even more. There difficulties are just unimaginable, their courage unbelievable and their persistence is totally admirable. I am motivated and honored to be a part of their effort every day. As they seek to build a government of the people and by the people I understand that takes time, energy, education, effort and patience. It is my wish that those of us who have been here may never forget the opportunity to learn from our Iraqi colleagues and to share even a small amount of their society and culture in exchange for our "Top Down" and heavy handed attempts to develop by control. I hope the Iraqis will forgive our need for "instant solutions" and especially our crass focus on money.
Last Tuesday, August 12th 2008, the government of Iraq approved the federal budget law of $46.4 billion, with 18% increase over 2007. They increased the money devoted to investment projects to $13 billion and another $11.8 billion for reconstruction and development. Final approval will be referred to Parliament for study and approval.
There is no way that I can even comment on the impact of de-Baathification effect on any aspect of health and education systems in Ninewa Province. Perhaps this is a subject for a future blog. The role of PRTs is a mixed bag and is also a topic for the next blog.
]]> August http://www.globalconsultants.us/iraq_tour/index.php?entry=entry080815-133856 David Newberry Fri, 15 Aug 2008 20:38:56 GMT http://www.globalconsultants.us/iraq_tour/comments.php?y=08&m=08&entry=entry080815-133856 http://www.globalconsultants.us/iraq_tour/index.php?entry=entry080808-130516
The DG Education program here is among the best in all of Iraq. This program sees final victory in the education of the youth here in the Ninewa Province. It has 1850 schools, a student population of about 660,000 kids and is committed to their education amid many difficulties. The PRT Health and Education Sections are engaged in helping it through initiative and creative activities. We are supporting a high school science contest focused on students harnessing the sun and photoelectric cells to provide their over-crowded schools with light and heat. We are also are supporting a Province-wide talent competition with prizes to restore Arts, Music and Theatre achievements of long ago. Concurrently we are trying to raise funds for a province-wide school lunch program. We need to help finance a one year start-up program because many of the students that attend school do so with too little food to really energize them for academic or vocational education sessions. This program also needs a printing press to print its school materials and needs vehicles to transport all school materials as well as curriculum development assistance. Many families have school age children not attending school because there is a lack of money at the household level. In addition, many of these children do not have enough food.

These children are on the streets looking for money and/or food. The insurgents then recruit them for throwing grenades or planting IEDs. The DG Education wants to jump-start a program to return these kids to their classrooms. We are trying to assist it by finding funds to pay each of these children a small school stipend for attending classes. We think for about $2.25 per day and some food we can get these kids back into school. In Mosul City and the Ninewa Province security is still a serious issue but it is getting better. Now the big problem is simply two-fold. First is how can the PRT can provide or facilitate finding a fairly large amount of money for such start-up programs and second is how to assist the DG Education program to develop the capacity to plan, budget and obtain long-term Iraqi funds to continue these programs?

I am a 74 year old Korean War veteran who has worked in and around public health since 1964. I've worked at the Centers for Disease Control and prevention during the fight to eradicate Smallpox as well as for seven years towards the eradication of polio. I also worked at CARE for 13 years and as part of that effort I came to Baghdad in August, September and October of 2003. I am a huge fan of CARE’s CEO, Helene Gayle, and want you all to know she exercises excellent judgment. I hope to learn more about her successes in the future.

]]> August http://www.globalconsultants.us/iraq_tour/index.php?entry=entry080808-130516 David Newberry Fri, 08 Aug 2008 20:05:16 GMT http://www.globalconsultants.us/iraq_tour/comments.php?y=08&m=08&entry=entry080808-130516