Report | May 19, 2014

U.S. Military and Coalition Efforts to Develop Effective and Sustainable Healthcare in Support of the Afghan National Police

DODIG-2014-072

Objective

The overall purpose of this project was to assess the progress of U.S. and Coalition efforts to develop effective and sustainable healthcare in support of the Afghan National Police (ANP).  Specifically, we assessed whether the plans to develop effective and sustainable healthcare services for the ANP were comprehensive and implemented to meet the transition timeline.  Additionally, we determined whether advisory resources were sufficient and appropriate to support the medical needs of the ANP.  Finally, we assessed whether developmental efforts were on schedule and effective in ensuring there was adequate medical capability, including logistics, to provide proper medical support to ANP personnel from the point of injury to the next required level of care.

Observations

The Afghan Air Force is developing the casualty evacuation capabilities utilizing fixed and rotary wing aircraft, C-208 and Mi-17’s respectively.  We found that significant progress was made by the Afghan Air Force in conducting casualty evacuation this past year with an increased number of casualty evacuations and improved response times.

We found examples of improved cooperation among Government of the Islamic Republic of Afghanistan  organizations which have had a positive effect on the development of the Afghan National Security Forces  healthcare system and direct medical support to the ANP.  Examples include the General Officer Steering Council and cooperation among the ministries regarding the medical care provided to ANP casualties.

However, we found that U.S. and Coalition plans and advisory efforts were not consistently focused on developing the ANP medical capability to provide effective point-of-injury and en route care for combat casualties.  Additionally, we found that medical advisory resources were not sufficient or, in some cases, not skilled and trained to aid in the development of ANP medical capability.

We also found that the ANP did not have sufficient medics, nor the necessary medical equipment and supplies, to properly care for injured police personnel.  Furthermore, ANP ambulances were not stocked with necessary equipment and supplies and not properly utilized to transport casualties to the next level of care.  Additionally, the ANP had not been providing sufficient basic medic training and did not have training programs to develop first-aid training to adequately prepare non-medical police personnel to render effective first aid.

Additional development assistance was needed by the ANP Office of the Surgeon General to provide effective oversight and management of medical activities within the Ministry of Interior.  Priority focus on the shortages of medical personnel at the ANP Hospital was needed to support the increasing number of ANP casualties and to ensure there were sufficient pharmacists to provide effective pharmacy operations.  Additionally, we found that the ANP medical logistics system was marginally effective and required significant improvement to ensure that medical supplies, including pharmaceuticals, were available as needed for patient care.

Recommendations

International Security Assistance Force Joint Command (IJC), North Atlantic Treaty Organization Training Mission–Afghanistan (NTM-A), and Combined Security Transition Command–Afghanistan (CSTC-A) advise and assist the MoI to:

  • ensure there are sufficient medics available to provide effective medical support to ANP personnel;
  • ensure that ANP have adequate equipment and medical supplies, including first-aid kits, medic first-aid bags, and equipped ambulances, to properly care for the combat injured;
  • develop effective and sustainable training programs to produce ANP medics and provide additional first-aid training, including combat lifesaver skills, to non-medical police personnel;
  • ensure there are sufficient medical personnel, including pharmacists, at the ANP Hospital to provide effective medical support and well-managed pharmacy operations;
  • understand the healthcare limitations at the ANP Hospital and develop patient protocols to identify and transfer those patients whose healthcare needs may require a higher level of care;
  • evaluate and improve the medical logistics process for the receipt and distribution of medical supplies; and
  • update the Office of the Surgeon General Organization and Functions Manual.

NTM-A/CSTC-A, in coordination with IJC, conduct key leader engagements with Ministry of Interior to ensure that the Surgeon General is provided authority to discharge his responsibilities for the oversight of healthcare services provided to the ANP and for the manning, equipping, and training of ANP medical personnel.

International Security Assistance Force, in coordination with IJC and NTM-A:

  • update and distribute medical development plans, and ensure the development of ANP point-of-injury care and patient evacuation remains a top priority; and
  • continue to conduct key leader engagements with Ministry of Interior, Ministry of Defense, and Ministry of Public Health to encourage improved relationships and sharing of healthcare resources.

U.S. Central Command (USCENTCOM), in coordination with NTM-A, ensure that medical logistics advisor positions are filled with qualified personnel with the requisite medical logistics experience.

Management Comments and Our Response

USCENTCOM, IJC, and NTM-A provided comments to this report.  Management concurred with all but one recommendation; however, their responses did not include what actions they have taken or plan to take to accomplish the recommendations.  We request that these commands provide additional comments to the final report specifying any progress made with the recommendations. 

USCENTCOM provided a response to Recommendation 8.a explaining that it was critical that the sourcing service and those monitoring personnel assignments pay close attention to the special remarks and job descriptions listed in the Joint Manning or the Request for Forces documents to ensure that Individual Augmentees/service members tasked to these billets have the appropriate skillset to provide guidance to their mentees.  Furthermore, USCENTCOM explained that using just the Military Occupational Specialty/Air Force Specialty Code/Naval Officer Billet Classification does not always guarantee that the tasked officer has the required skillset.  This recommendation was revised to address USCENTCOM’s comments and now includes coordination with the sourcing service to ensure that the ANP medical logistics advisor position is filled with qualified personnel with medical logistics experience. 

We did not receive a written response from International Security Assistance Force prior to the publication of the final report and request that they provide their response to Recommendations 6.a and 7.a for the final report.