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831. Health Financing and Health Outcomes in the Eastern Mediterranean Region

Author:
Marwa Farag
Publication Date:
11-2009
Content Type:
Working Paper
Institution:
Belfer Center for Science and International Affairs, Harvard University
Abstract:
This paper presents an overview of health spending and health outcomes in the WHO Eastern Mediterranean region over the time period 1995-2006, using cross-country and over-time comparisons. Overall, the region experienced improvements in health outcomes measured in terms of reductions in infant, under-5 child mortality and maternal mortality. However, there are notable exceptions to this trend of declining mortality in countries such as Afghanistan. In addition to providing an overview of changes in health outcomes and health spending over the 12-year period, the paper examines the following two issues: 1) The responsiveness of health care spending to changes in a country's income, and 2) The impact of spending on health care services on health outcomes. The methodological approach adopted in this paper is multivariate regression analysis. I employ random effects models with year dummies, which are appropriate for panel data analysis. I also use double-log formulas for econometric necessity and ease of interpreting the results. The findings indicate that a 1 percent increase in GDP per capita is associated with 0.89 percent increase in health spending in the region and that income growth does not explain all the variation in health spending, indicating that other factors, such as the organization of the health care system, influence health care spending levels. This is an important finding because it suggests that on the one hand cost-containment and on the other mobilizing more funds for the health care sector are possible with appropriate interventions. The findings on the importance of spending on health care for achieving better health outcomes demonstrate that investing in health care matters; a 1 percent increase in health spending is associated with 0.11 percent reduction in infant mortality and 0.14 percent reduction in under-5 child mortality. These results are likely to be underestimating the effect of health spending because of the inclusion of a country's income in the models. Gender parity in secondary school education also had a significant impact on reducing infant and child mortality. Government effectiveness had a strong and significant effect on reducing maternal mortality. The results contradict the notion that increases in income through better nutrition and living conditions alone are responsible for improvements in health outcomes. The results of this analysis clearly indicate that investing in health care also matters.
Topic:
Health
Political Geography:
Afghanistan, Europe, Middle East, and Arabia

832. Military-humanitarian integration: The promise and the peril

Author:
Denis Kennedy
Publication Date:
08-2009
Content Type:
Policy Brief
Institution:
Finnish Institute of International Affairs
Abstract:
Finland is currently drafting a comprehensive national crisis management strategy (CNCM). This briefing paper puts this exercise in conversation with the increase in violence directed at aid workers in crisis situations, with special reference to Afghanistan. On a policy level, Finnish decision makers should take into consideration the changing security environment and the mosaic of actors involved in crisis management. It is argued that increased integration and coordination has complicated aid agencies' attempts to maintain neutrality in the field. Neutrality, together with impartiality and independence, functions to create a "humanitarian space" in conflict zones. It is precisely this space that is most at risk when humanitarian actors are coupled with military and state apparatuses. The aim of integration and coordination is to improve the responsiveness, effectiveness, and efficiency of humanitarian relief and crisis response. It involves coordination and cooperation in the planning and use of military and civil defense assets in humanitarian operations. Despite the potential for efficiency gains, integration remains a controversial topic. In particular, it forces tough questions on aid agencies who find their ability to remain neutral, impartial, and independent severely curtailed. There is concern in the humanitarian sector that coherence and integration mean subordinating principles to politics and that this has made aid agencies targets of violence. In Afghanistan and elsewhere, rising violence testifies to an environment in which aid agencies are now perceived as taking sides in conflict. The increase in violence in crisis situations calls attention in drafting the CNCM to the fragility of humanitarian space and the need for open, public debate. Given Finland's experiences with neutrality during the Cold War and in light of contemporary debates over Afghanistan, there is the opportunity to bring deeper understandings to bear in the field of crisis management.
Topic:
Conflict Resolution, Security, Human Rights, Human Welfare, Humanitarian Aid, and War
Political Geography:
Afghanistan and Finland

833. Afghanistan's hard summer: The impact on European troop contributing nations

Author:
Timo Behr, Matthieu Chillaud, Toby Archer, Charly Salonius-Pasternak, Valtteri Vuorisalo, and Barbara Zanchetta
Publication Date:
09-2009
Content Type:
Policy Brief
Institution:
Finnish Institute of International Affairs
Abstract:
The increase in fighting in the summer of 2009 has led to renewed debate in many of the countries contributing troops to the international mission in Afghanistan. In the UK the heavy loss of life amongst British soldiers has been central to the discussion on Britain's continued contribution. In Germany the debate has more focused on the increasingly offensive actions that the Bundeswehr is undertaking. France's contribution to the Afghanistan mission is less politically controversial than in other European countries because of the president's power over foreign and security policy. For many years Italy's Afghanistan contribution was less politically sensitive compared to the Italian presence in Iraq, but this is changing with the increase in violence in Afghanistan. In Sweden the annual parliamentary approval process and the increased expeditionary focus of the armed forces have lead to a strong consensus on the need to participate in Afghanistan. The debate in Finland is sporadic and reactive as there is not an annual parliamentary debate as is the case in Sweden and Germany. Nevertheless Finland's contribution is centrally linked to the decision made in those countries.
Topic:
Political Violence, Terrorism, and War
Political Geography:
Britain, Afghanistan, Iraq, United Kingdom, Europe, Finland, Germany, Italy, and Sweden

834. Unity of Effort: Key to Success in Afghanistan

Author:
Christopher J. Lamb and Martin Cinnamond
Publication Date:
10-2009
Content Type:
Working Paper
Abstract:
The Barack Obama administration is debating alternatives to the population-centric counterinsurgency strategy in Afghanistan that it unveiled in March 2009. The reevaluation is prompted by the recent submission of supporting civil and military campaign plans that indicate substantial additional resources are required for success. The resource issue is important, but as General Stanley McChrystal, USA, the new commander of U.S. and North Atlantic Treaty Organization (NATO) forces in Afghanistan, argues, the need to pursue an “indirect” strategy that is sustainable for the Afghans and implemented with unified purpose is more important. Lack of progress in Afghanistan to date is due more to international donors and forces working at cross purposes, and unilaterally instead of with Afghans, than to insufficient resources.
Topic:
Defense Policy, NATO, and War
Political Geography:
Afghanistan and North Atlantic

835. Establishing Leadership on Civilian Assistance to Afghanistan

Author:
J Alexander Thier and William B. Taylor
Publication Date:
12-2009
Content Type:
Policy Brief
Institution:
United States Institute of Peace
Abstract:
By all accounts, the civilian role in creating a stable Afghanistan, capable of protecting its citizens and providing essential services, is at least as important as the military operation.
Topic:
Security, Civil Society, and War
Political Geography:
Afghanistan

836. Obama's surge: The United States, Australia and the Second War for Afghanistan

Author:
Anthony Bubalo
Publication Date:
12-2009
Content Type:
Policy Brief
Institution:
Lowy Institute for International Policy
Abstract:
President Obama's announcement of a troop surge and the planned withdrawal of the Netherlands as lead nation in Oruzgan province in mid-2010, where the bulk of Australia's military contribution operates, raise a number of issues for Australia's role in Afghanistan. In particular: the potential and perhaps unintended impact of any new lead nation on the relative improvements in security that have been achieved in Oruzgan province a possible demand for more Australian troops and greater flexibility in the way they are used in Afghanistan as the result of changes in US strategy; and the effectiveness of Australia's small but growing number of civilian and police personnel in Afghanistan.
Topic:
Conflict Resolution, Arms Control and Proliferation, and War
Political Geography:
Afghanistan, United States, and Australia

837. Caught in the crossfire: the Pashtun tribes of Southeast Afghanistan

Author:
Tom Gregg
Publication Date:
10-2009
Content Type:
Policy Brief
Institution:
Lowy Institute for International Policy
Abstract:
There is increased recognition of the importance of engaging tribes in Afghanistan, but the government of Afghanistan and the international community are yet to come up with a coherent and coordinated approach. While more effective tribal engagement won't work everywhere, there is an opportunity to engage more fully with Pashtun tribes in Afghanistan's southeast. A meaningful and well resourced tribal policy would help improve stability in this strategically important region and also help avoid any mismanagement that could make things worse.
Topic:
Conflict Resolution, War, and Fragile/Failed State
Political Geography:
Afghanistan

838. The Forgotten Front

Author:
Christopher S. Bond and Lewis M. Simons
Publication Date:
11-2009
Content Type:
Journal Article
Journal:
Foreign Affairs
Institution:
Council on Foreign Relations
Abstract:
Barack Obama's planned visit to Indonesia this November is not only a sentimental journey to his childhood home. It also represents a long-overdue recognition that to recapture the admiration and respect of the world's Muslims, Washington should focus neither on the stalemated chessboard of the Middle East nor on the chaotic Afghan-Pakistani frontier. Rather, it should concentrate its efforts in Southeast Asia, an increasingly democratic and peaceful region that is also beginning to face the threat of Islamic fundamentalism. The last time Americans took a sober look at Southeast Asia, military helicopters were snatching the last U.S. officials off Saigon rooftops as Vietcong soldiers marched on the panicked capital. Soon after the fall of Saigon, in 1975, Cambodia and Laos were toppled by their own domestic communist movements. Thailand trembled with the fear of North Vietnamese tanks churning across the Mekong River, and the other so-called dominoes shook, too. But the dreaded threat failed to materialize. More than three decades later, Americans no longer concern themselves with this corner of the world. One day, the United States' future seemed inextricably bound to Southeast Asia's; the next, Southeast Asia was forgotten. This is an all-too-familiar pattern: Washington ignores a country or region until it blows up; then, it belatedly discovers such nations and obsesses clumsily over them; and finally, it relapses into a self-imposed torpor, allowing new threats to emerge. This was the case in Afghanistan during the 1990s after it ceased to be useful as a bulwark against Soviet expansion, and it may also prove true of Southeast Asia today if Washington does not awaken to the region's growing importance. Southeast Asia is home to 250 million Muslims, concentrated in Indonesia, Malaysia, the Philippines, Singapore, and Thailand -- the supposed dominoes of the Vietnam era. Indonesia has the world's single largest Muslim population: 220 million -- three times as large as that of Egypt, the most populous Arab nation. Yet Indonesia remains truly unknown to most Americans.
Political Geography:
Pakistan, Afghanistan, America, Middle East, and Southeast Asia

839. Russia Reborn

Author:
Dmitri V. Trenin
Publication Date:
11-2009
Content Type:
Journal Article
Journal:
Foreign Affairs
Institution:
Council on Foreign Relations
Abstract:
Two decades after the withdrawal of Soviet troops from Afghanistan and the fall of the Berlin Wall, and nearly 20 years after the breakup of the Soviet Union, Russia has shed communism and lost its historical empire. But it has not yet found a new role. Instead, it sits uncomfortably on the periphery of both Europe and Asia while apprehensively rubbing shoulders with the Muslim world. Throughout the 1990s, Moscow attempted to integrate into, and then with, the West. These efforts failed, both because the West lacked the will to adopt Russia as one of its own and because Russian elites chose to embrace a corporatist and conservative policy agenda at home and abroad. As a result, in the second presidential term of Vladimir Putin, Russia abandoned its goal of joining the West and returned to its default option of behaving as an independent great power. It redefined its objectives: soft dominance in its immediate neighborhood; equality with the world's principal power centers, China, the European Union, and the United States; and membership in a global multipolar order. Half a decade later, this policy course has revealed its failures and flaws. Most are rooted in the Russian government's inability and unwillingness to reform the country's energy-dependent economy, the noncompetitive nature of Russian politics, and a trend toward nationalism and isolationism. In terms of foreign policy, Russia's leaders have failed to close the book on the lost Soviet empire. It is as if they exited the twentieth century through two doors at the same time: one leading to the globalized market of the twenty-first century and the other opening onto the Great Game of the nineteenth century. As the current global economic crisis has demonstrated, the model that Russia's contemporary leaders have chosen -- growth without development, capitalism without democracy, and great-power policies without international appeal -- cannot hold forever. Not only will Russia fail to achieve its principal foreign policy objectives, it will fall further behind in a world increasingly defined by instant communication and open borders, leading to dangers not merely to its status but also to its existence. Russia's foreign policy needs more than a reset: it requires a new strategy and new policy instruments and mechanisms to implement it.
Political Geography:
Afghanistan, Russia, United States, and Soviet Union

840. Fixing Bagram: Strengthening Detention Reforms to Align with U.S. Strategic Priorities

Author:
Sahr MuhammedAlly
Publication Date:
11-2009
Content Type:
Working Paper
Institution:
Human Rights First
Abstract:
Eight years after launching Operation Enduring Freedom (OEF) in Afghanistan—with a mission to kill and capture “high-value” al Qaeda and Taliban members and destroy the safe havens from which al Qaeda planned and directed the 9/11 attacks—the United States government has announced several significant detention reforms in Afghanistan. Human Rights First has closely monitored U.S. detention policies and practices since September 11, 2001. In this paper, we analyze the new detention reforms announced in September 2009 and make recommendations for further improvement in U.S. detention practices in line with U.S. policy interests and legal obligations. We base our recommendations on an analysis of the applicable humanitarian and human rights law and field visits to Afghanistan.
Topic:
Political Violence, Human Rights, Terrorism, War, and Prisons/Penal Systems
Political Geography:
Afghanistan, United States, and Taliban