Thursday, July 16, 2009

U.S. studies Afghan health successes

WASHINGTON — Seeking to overhaul the failure-plagued Afghanistan reconstruction program, U.S. development officials are taking lessons from one of the few bright spots: the health sector, where more than $1 billion in international aid since 2002 has produced measurable results.
Though Afghanistan's health statistics remain some of the worst in the world, they have improved markedly over the past seven years, according to annual assessments by the Bloomberg School of Public Health at Johns Hopkins University. Infant mortality has dropped 21%, while tuberculosis treatment has expanded from 15% to 97% of cases, according to the Johns Hopkins surveys and World Health Organization data.

"Here's a place where it works," said James Bever, who directs the Afghanistan-Pakistan task force at the U.S. Agency for International Development, which has spent $535 million on Afghan health programs since 2002. It works, Bever said, because the Afghan Health Ministry worked with big donors to create a list of basic services, determined a common way to build clinics and then divided the country among them. "We're trying to learn some lessons from that," he said.

In 2002, 9% of Afghans had access to basic health services, and now 85% do, Afghan Health Minister Sayed Fatimie said in an interview. "It is a tremendous achievement," he said, "because the national health system of Afghanistan had collapsed."

Since Afghan government ministries are weak and corruption-plagued, most international aid to the country has been sent through private contractors and relief groups that operate on their own. That has led to poor coordination, high overhead and spotty performance, say critics, including the relief group Oxfam.

In February, USA TODAY reported that of six audits of Afghan aid programs conducted in the last year by USAID's inspector general, only one found a program working largely as it was supposed to.

Most health care aid goes through the Afghan Health Ministry, where the main donors — USAID, the World Bank and the European Union— have not encountered the problems seen elsewhere in the government, said Julie McLaughlin, the World Bank's South Asia health manager. The ministry operates health clinics through non-governmental organizations, but most of the contractors are non-profits — often small Afghan groups, she said.

USAID has built more than 700 health clinics. Although there were initial glitches, a 2006 inspector general's audit found the program had eventually delivered most of what it promised.

"The idea that we're pouring resources down a rodent hole — at least in the health sector, that is definitely not true," said Gilbert Burnham, a physician who co-directs the Center for Refugee and Disaster Response at Johns Hopkins and has supervised reviews of the Afghan system.

There are limits. The aid has yet to change Afghanistan's status as one of the world's most dangerous places for women to have babies. The maternal death rate is among the world's highest. About 26,000 Afghan women died in childbirth in 2005, according to WHO.

Obama warns racial barriers persist

NEW YORK — President Obama on Thursday traced his historic rise to power to the vigor and valor of black civil rights leaders, telling the NAACP that the sacrifice of others "began the journey that has led me here." The nation's first black president bluntly warned, though, that racial barriers persist.
"Make no mistake: The pain of discrimination is still felt in America," the president said in honoring the organization's 100th convention.

Painting himself as the beneficiary of the NAACP's work, Obama cited historical figures from W.E.B. DuBois to Thurgood Marshall to explain how the path to the presidency was cleared by visionaries.

Obama's remarks, steeped in his personal biography as the son of a white mother from Kansas and black father from Kenya, challenged the audience — those in the room and those beyond — to take greater responsibility for their own future. He told parents to take a more active role and residents to pay better attention to their schools.

Rousing up a friendly crowd, Obama made his first speech so directly linked with race since he took office; the White House says he worked on it for about two weeks. Implicit in his appearance: He is seeking the backing of the powerful NAACP and its members for his ambitious domestic agenda.

The president said that in the current down economy, blacks are suffering high unemployment and are afflicted with more diseases but are less likely to own health insurance. He said that the African-American child is about five times as likely as a white child to be sent to jail.

Obama touted education as essential to improving the lives of all children. He said the state of schools is an American problem, not an African-American one.

"You know what I'm talking about. There's a reason the story of the civil rights movement was written in our schools. There's a reason Thurgood Marshall took up the cause of Linda Brown. There's a reason the Little Rock Nine defied a governor and a mob," Obama said. "It's because there is no stronger weapon against inequality and no better path to opportunity than an education that can unlock a child's God-given potential."

"We have to say to our children, 'Yes, if you're African-American, the odds of growing up amid crime and gangs are higher. Yes, if you live in a poor neighborhood, you will face challenges that someone in a wealthy suburb does not,'" Obama said, returning to his tough-love message familiar from his two-year presidential campaign.

"But that's not a reason to get bad grades, that's not a reason to cut class, that's not a reason to give up on your education and drop out of school," he said. "No one has written your destiny for you. Your destiny is in your hands and don't you forget that."

Obama expanded his message of equal rights beyond the black communities. He said many Americans still face discrimination.

Racism, he said, is felt "by African-American women paid less for doing the same work as colleagues of a different color and gender. By Latinos made to feel unwelcome in their own country. By Muslim Americans viewed with suspicion for simply kneeling down to pray. By our gay brothers and sisters, still taunted, still attacked, still denied their rights."

Obama also pressed for NAACP members to encourage their young people to find new role models beyond sports or music.

"I want them aspiring to be scientists and engineers, doctors and teachers, not just ballers and rappers," Obama said. "I want them aspiring to be a Supreme Court justice. I want them aspiring to be president of the United States."

To bolster his argument that it's within their reach, he cited his own biography, growing up with a single mother.

"I don't come from a lot of wealth. I got into my share of trouble as a kid. My life could easily have taken a turn for the worse. But that mother of mine gave me love; she pushed me, and cared about my education; she took no lip and taught me right from wrong," Obama said. "Because of her, I had a chance to make the most of my abilities. I had the chance to make the most of my opportunities. I had the chance to make the most of life."


Supreme Court nominee Sonia Sotomayor revealed only what she wanted to, and nothing more, during two days of grilling by the Senate Judiciary Committee.
The 55-year-old New York native showed her human side; at one point, pivoting in her chair to whisper to her 82-year-old mother, Celina, ''Thanks, Mom.'' She flexed her prosecutorial muscle, speaking of her time in the district attorney's office. She stayed calm, praised precedent and respectfully cited conservative justices.

Though the confirmation hearing continues Thursday with further questioning of Sotomayor and testimony by witnesses, including some antagonistic toward the nominee, senators from both parties know now how the hearing will turn out.

''She's handled herself very well,'' conceded Sen. Jeff Sessions of Alabama, the committee's senior Republican member. ``She's not rushed.''

So far, Sotomayor has stayed completely in control even as the Judiciary Committee's 19 members alternately tried to shake and support her.

Nowhere has her self-command been more evident than in her refusal -- despite repeated efforts by Republicans and Democrats alike -- to offer hints about her thinking on the nation's most politically sensitive disputes.

On abortion, Second Amendment rights, voting rights and more, Sotomayor consistently has steered clear of hinting how she might rule. In part, she refuses to pre-judge a specific case she might see again. In part, she is showcasing her stated intention to ''bring an open mind to every case'' that comes before her.

''And by an open mind I mean a judge who looks at the facts of each case, listens, and understands the arguments of the parties, and applies the law as the law commands,'' Sotomayor said.

``It's a refrain I keep repeating because that is my philosophy of judging: applying the law to the facts at hand.''

Physically, too, Sotomayor has held her ground, despite a cast on her right leg and a lifelong diabetic condition, which requires her to keep a glass of sugary Sprite by her side.

Her body language has been commanding. She gestures freely, occasionally touching senators like Republican Sen. Lindsey Graham of South Carolina while in casual conversation.

Hoping to dislodge her, Republicans have repeatedly tried asking the same question in different ways. Sotomayor's comments about a ''wise Latina'' have prompted at least 15 questions, with her answers hardly varying.


Sotomayor's ruling with the 2nd U.S. Circuit Court of Appeals to uphold New York state's ban on the joined-sticks weapon called nunchucks, likewise, drew question after question about whether she thinks the Second Amendment applies to states. She frustrated them all, insisting the state issue might yet come before the high court.

On abortion, Sen. John Cornyn, R-Texas, noted that the White House reportedly was offering vague assurances to abortion rights groups in May that Sotomayor would be sympathetic to their views.

How would they know that? Cornyn wondered. Sotomayor said she didn't know.

''You just have to look at my record to know that in the cases that I addressed on all issues, I follow the law,'' Sotomayor said.

The focus throughout has been extremely tight. Though Sotomayor has participated in more than 3,000 decisions during her 17-year tenure on the federal bench, Senate Judiciary Committee Democrats noted that during two days of questioning, Republicans asked her about a grand total of eight cases.

The Senate Democratic Communications Center said that, ''Judge Sotomayor has answered more questions more in depth than any nominee in recent history.'' More pointedly, though, the Democrats noted that Sotomayor was hardly less forthcoming than Republican nominees, including John G. Roberts and Samuel Alito.

''I think I should stay away from discussions of particular issues that are likely to come before the court again,'' Roberts said during his 2005 confirmation hearing, in words that Sotomayor might have quoted directly.


Philosophically, Sotomayor stressed her respect for precedent and her intention to judge every dispute on a case-by-case basis.

Put another way, she was assuring senators that she's no ``judicial activist.''

''I can only talk about what the court said in the context of that particular case,'' Sotomayor said, when asked about a high-profile property rights case.

''It's entitled to stare decisis and deference,'' she said, using a Latin term meaning ''Let the decision stand,'' a doctrine requiring that judges apply the same reasoning to lawsuits that has been used in previous cases.

``But the extent of that has to await the next cases.''