Officials with a State Department agency scrapped plans to renovate a failing Pakistani hospital after a political promise from then-Secretary of State Hillary Clinton forced the agency to build an entirely new facility instead, according to USAID’s watchdog.
The resulting hospital, which cost the U.S. $17 million, was so poorly planned that it faces the risk of falling into the same state of disrepair as the crumbling facility USAID declined to rehabilitate, the inspector general said in a report made public Jan. 29.
But an agency official told the Washington Examiner that USAID only abandoned plans to revamp the hospital in Jacobabad — an impoverished, crime-ridden city 300 miles north of Karachi — after finding its conditions so deplorable that building an entirely new facility emerged as the more economic option.
“The U.S. government made a commitment to renovate the hospital in Jacobabad in July 2010. However, after an assessment of the condition of the existing hospital, our engineers determined that it was in such poor condition that it would be more cost effective and practical to build a new hospital instead,” said the USAID official spoke to the Examiner on condition they would not be named.
Under pressure “to fulfill a commitment that a senior Department of State official made in 2010,” USAID initially ignored the fact that the institute would one day depend on faulty infrastructure and would struggle to attract qualified staff due to its remote location, the inspector general’s report said. The document did not identify the senior official, but a USAID spokesman confirmed it was Clinton.
The Pakistani government and USAID “focused instead on building the institute” because the agency “felt compelled to fulfill that commitment,” the report said.
“Details other than facility design and construction, including funding, were ironed out piecemeal,” the report continued.
In remarks at the U.S.-Pakistan Strategic Dialogue in July 2010, Clinton announced she was “pleased to announce we will either renovate or build three medical facilities” in the country. She also mentioned the ultimately foregone plans to renovate the hospital in Jacobabad.
Water and sewage systems in Jacobabad are “substandard,” yet the new facility, the Jacobabad Institute of Medical Sciences, must rely on them to operate. The water supply there is so unclean that it must be treated for “biological impurities” before it can be used, and the district doesn’t even have a functioning sewage system.
USAID is funding an effort to improve the water systems there, but the watchdog said the project isn’t slated for completion until this September — a full year after construction on the institute ended.
Among other problems was the fact that “excessive political influence” has threatened to derail the hiring of competent staff.
What’s more, Pakistani operators were incapable of running the backup solar power systems USAID purchased because the technology was unfamiliar and, even if they did have the ability to maintain the systems, the country’s atmosphere is too “dusty” to allow efficient use of solar energy. The need for a backup system is made dire by the widespread and prolonged power outages that plague the district.
“The institute may struggle to remain financially and operationally viable and may devolve into the same condition as the Jacobabad hospital,” the watchdog said.
USAID officials called conditions at that hospital “horrific” in a 2011 report.
The inspector general’s findings raised questions as to why USAID would abandon a struggling hospital in order to build a new one that could soon devolve into the same conditions as the first.
“If the institute degenerates into a facility that cannot provide the quality of health care planned, the U.S. Government’s image will be damaged, and a large U.S. Government investment will be wasted,” the watchdog said in its report.
The Jacobabad construction project was part of a $180.5 million five-year contract to build schools and healthcare facilities in Pakistan’s earthquake zones, although the medical facilities discussed in the watchdog report had no earthquake damage.
