USAID slammed over bad location data on Afghan health care facilities

The U.S. Agency for International Development has done a poor job of keeping accurate location data and documenting operating conditions in health facilities it funds in Western Afghanistan.

In a letter issued last week, John Sopko, the Special Inspector General for Afghan Reconstruction said “substantial inaccuracies” in geospatial coordinates are hindering oversight of the System Enhancement for Health Action in Transition (SEHAT) program — a World Bank-administered health program to which USAID contributes $238 million.

The data, Sopko says, is vital to make sure the facilities are actually serving the local communities the health services are designed to benefit.

Of the 23 facilities SIGAR examined in Herat province, seven were found to to be more than five kilometers distant from the coordinates provided by USAID. Of those seven, four were further than 10 kilometers from the coordinates.

For 40 other facilities attached to the program that SIGAR was tasked with examining, USAID provided only two to four photos for each facility, none of which had any geospatial data. From the photos, SIGAR could only determine that 19 of the 40 clinics actually existed.

“None of the USAID files included any site visit reports or other supporting documentation,” the report read. “As a result, we could not determine the basic operation of any of these clinics based on the USAID data.”

SIGAR also took issue with the conditions of some of the facilities their inspection teams visited, noting that four of the 23 clinics lack water or power, which is needed to refrigerate some pharmaceuticals and vaccines. Teams also found at least 16 facilities disposing of medical waste in open-air kilns, some of which were publicly accessible.

“This method of unsecured disposal does not adhere to best practices and raises the risk that patients seeking treatment—or children we observed playing outside at several facilities—could be accidentally exposed to contaminated waste,” the report reads.

The office did not visit 39 of the remaining unidentified 40 due to “security conditions” that prevented the group from performing a site inspection.

“The documentation provided by USAID to identify the location and existence of the remaining clinics in Herat was generally quite poor,” the report concluded. “We encourage USAID to require its monitoring teams and partners to use cameras that are capable of producing photos with embedded geospatial data and conduct more robust site inspections that include descriptions of facility condition and operations.”

Sopko also mentions how important accurate data flaws can be, referring to the controversial bombing of a Doctors Without Borders hospital in Kunduz earlier this month that was believed to be under Taliban control.

The SIGAR letter states that, while it’s unclear exactly what role geospatial data might have played in the Kunduz bombing, it illustrates how important GPS data is to the government.

Sopko called on USAID to confirm and update the coordinates for the 23 clinics his office visite, particularly those facilities that were more than five kilometers away than what was reported, and share that information with the World Bank.

USAID had no immediate response to the letter Wednesday evening.