Memorandum submitted by Medicins du Monde
MEDECINS DU
MONDE
1. Médecins du Monde UK—(MDM
UK) is part of Medecins du Monde France (MDM), an international
medical humanitarian organisation whose volunteers provide healthcare
to vulnerable populations in both developed and developing countries.
Our aim is to provide healthcare for people in situations of crisis
or social exclusion around the world. In order to be effective
in the long term, Médecins du Monde's work goes
beyond providing healthcare. Based on the information and testimonies
collected through our medical practice, we identify and highlight
violations of human rights, particularly with regard to accessing
healthcare.
2. MDM has been present in Afghanistan
since 1992 and currently operates medical clinics in Kabul and
Herat. Based upon our experience, we provide the following response
to the questions posed by the Committee in its call for evidence.
THE OBJECTIVES
OF DFID'S
PROGRAMME IN
AFGHANISTAN
3. MDM shares DFID's view that it is vital
to support the Afghan people in a way that enables them to help
themselves. But where monitoring and evaluation shows particularly
poor performance on the part of the government, itself the recipient
of funds, more must be done to understand and address the reasons
for the same.
4. Where the failure is on the part of those
who were meant to provide technical assistance to the government,
this must be addressed as well.
5. Where there were budgetary disbursements
without any activities to justify them, this must be addressed.
6. The obstacles and barriers to achievement
in Afghanistan are well known, but progress is possible. Where
progress is not being made, there must be a measure of accountability.
The absence of accountability can unwittingly send a message that
progress is neither possible nor expected.
7. In order to ensure that local NGOs are
adequately supported, DFID may wish to consider providing running
costs in advance. This would help ensure stability by introducing
a measure of predictability.
THE TRADE-OFF
BETWEEN SHORT-TERM
GAINS AND
LONG-TERM
TRANSFORMATION
8. Establishing small scale experimental
programs can provide a kick-start for short-term gains by: a)
meeting immediate needs; b) demonstrating results with data collected—in
order to build credibility with the government and other stakeholders
and; c) laying the groundwork for scaling up and replicating the
project elsewhere in the country by maintaining a particular focus
on the training of trainers and the adaptability of project design.
The programs thus provide a foundation for longer term transformation.
THE ROLE
OF NGOS
9. In addition to providing direct services
and building the capacity of local actors, NGOs are uniquely positioned
to advocate for beneficiaries by gathering evidence of the situation
on the ground in order to support the government in understanding
the problem as well as pressuring it to make progress toward its
resolution. NGOs have the combined expertise and autonomy necessary
to do this effectively.
HARMONISATION AND
CO -ORDINATION
OF THE DONOR
RESPONSE
10. Although a mechanism exists to improve
donor co-ordination, there is still waste which results from duplicative
programming. There is likewise room to improve the efficiency
of programs by improving the exchange of best practices, as well
as lessons learned. Although this is emphasised by the international
community in its interactions with the government and civil society,
the international community does not itself provide a healthy
model for the same. Given the inadequate funding, as measured
against the urgency of need in Afghanistan, this is especially
poignant.
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