Security Assistance; and Logistics - Federation of American Scientists

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The Military Health System Strategic PlanThe DoD Military Health System (MHS) mission is “to provide optimal health servicesin support of our nation’s military mission - anytime, anywhere.” The MHS is a uniquepartnership of medical educators, medical researchers, and health care providers and theirsupport personnel worldwide. “The Military Health System Strategic Plan – A Roadmapfor Medical Transformation,” May 29, 2008, was developed to:[R]e-examine our fundamental purpose, our vision of the future, andstrategies to achieve that vision. We are refocusing our efforts on thecore business in which we are engaged - creating an integrated medicalteam that provides optimal health services in support of our nation'smilitary mission - anytime, anywhere. We are ready to go in harm'sway to meet our nation's challenges at home or abroad - to be a nationalleader in health education, training, research and technology. We buildbridges to peace through humanitarian support when and whereverneeded, across our nation and the globe, and we provide premier carefor our warriors and the military family.Joint Publication 4-02, Health Service Support, October 31, 2006According to Joint Publication 4-02, the purpose of health service support (HSS) is tomaintain the individual and group health needed to accomplish a military mission. Theintent is to effectively and efficiently use medical capabilities and individual healthfulpractices to prevent and/or correct any human condition that would impair or preclude thejoint force from achieving its objectives. Joint Publication 4-02 states that HSS is relatedto three joint functions: sustainment, movement and maneuver, and protection and adds:HSS promotes, improves, conserves, or restores health within a militarysystem. HSS capabilities are employed across the range of militaryoperations and include the ability to organize, train, and equippreceding deployment and enable the employment of physically fitpersonnel. These capabilities span the operational environment frompoint of injury/illness to the appropriate capability of care.Joint Publication 4-02 continues to state that foremost is the role of HSS in sustainment:the provision of medical support required to maintain health during prolonged operationsuntil successful accomplishment of the joint force objectives. Joint Publication 4-02 alsonotes that one of the HSS operational considerations is stability operations.Stability operations encompass various military missions, tasks, andactivities conducted outside the United States in coordination withother instruments of national power to maintain or reestablish a safeand secure environment, provide essential governmental services,emergency infrastructure reconstruction, and humanitarian relief.Stability operations objectives could include the restoration of servicessuch as water, sanitation, public health, and essential medical care. Thedesired military end state in the health sector should be an indigenouscapacity to provide vital health services.Providing for the Medical Needs of the Iraqi ArmyThe Iraqi Army could not provide for the in-garrison and operational health care needs ofits soldiers without significant Coalition medical support. MNF-I, MNSTC-I, and126
MNC—I had not fully identified the barriers to improving Iraqi Army medical care,devised a plan to address those barriers, or effectively advised and assisted MoD with astrategy to overcome them.Combat Casualty CareCombat casualty care was largely unavailable within the Iraqi Army health care system.For example, anecdotal reports of 115 patients transported to Baghdad after recentoperations in Basra indicated that no medical care was provided by the Iraqi Army beforeor during patient movement. Iraqi Army combat divisions had only 11 percent of the 588doctors authorized and 32 percent of the 7,410 allied health personnel authorized.MoD did not have its own functioning hospitals to care for soldiers. The Iraqi Army hadbasic and advanced clinics at all of its regional garrisons, though none of those clinicswere fully staffed. Garrison clinics had 31 percent of the 98 doctors authorized and 77percent of the 658 allied health personnel authorized. The U.S. was finishingconstruction on just one new Iraqi Army field hospital, funded through Foreign MilitarySales.All inpatient care for soldiers had to come from civilian hospitals operated by MoH, butpoor security within those facilities had allowed acts of uncontrolled sectarian violenceby militia units against soldiers, limiting their access to hospital care. Recently, MoDand MoH had created two short-term ad hoc partnerships in which MoD had providedsecurity for a hospital wing in a civilian hospital where soldiers were protected frommilitia violence. Those partnerships show potential for meeting the inpatient needs ofsoldiers nationwide if security conditions continue to improve.Recruiting and Retaining Medical PersonnelThe Iraqi Army was unable to recruit or retain sufficient medical staff. Physician staffingwas at 18 percent of requirements and was falling as physicians fled the country orresigned from the military to work in civilian hospitals. In addition to the exodus ofphysicians since 2003 due to the deteriorating security environment, military service wasseen as undesirable because military physicians were paid approximately half as much asMoH physicians and were often required to work in clinics distant from their families,rather than in hospitals near their homes.Dentists, nurses, combat medics, medical logistics, administrative, and allied healthsupport personnel were also staffed at critically low levels, far below those required, andfew junior officers, non-commissioned officers, and soldiers were in place. Nursestaffing was at 29 percent of requirements, and medics were at 46 percent.Iraqi Army Medical Education and TrainingInitial training, upgrade training, and continuing medical education for Iraqi Armymedical care personnel was lacking. Moreover, initial medical training classes at theIraqi Army Support and Services Institute were only about 30 percent filled because ofthe low value ascribed to training medical personnel by the Iraqi Army line leadership.127
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INSPECTOR GENERALDEPARTMENT OF DEFE
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Report No. SPO-2009-002 (Project No
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Report No. SPO-2009-002 (Project No
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Table of ContentsExecutive SummaryR
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IntroductionBackgroundThe DoD Offic
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Appendix A discusses the scope and
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letter to clarify that DoD Instruct
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USCENTCOM guidance for its area of
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1. Describe the mission, roles, and
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Status of Implementation of Recomme
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Management Comments to Recommendati
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. Performing a 10 percent sample in
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94 personnel). The proposed JMD als
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MiTTs. Between February 15 and Marc
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Part II - Arms, Ammunition, and Exp
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Observation 1. Assistance to the Mi
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5, March 25, 2008, 12 addresses DoD
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MNSTC-I personnel made on-the-spot
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1.a. We recommend that the Commande
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Observation 2. Assistance to the Mi
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and procedures for receipt, process
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MNSTC-I and Iraqi military personne
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captured weapons, or if it permanen
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SAO manning has increased approxima
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End-Use Monitoring Compliance PlanT
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Observation 4. Accountability of Ni
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• Corrective actions implemented
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Observation 5. Multi-National Secur
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Observation 6. Multi-National Secur
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elationships with ISF personnel. In
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Originally, personnel filling the n
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FMS shipments to Iraq will sharply
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Client CommentsThe Assistant Secret
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Ministry of Defense and Iraqi Army
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uild 3 rd and 4 th Line maintenance
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Page 104 and 105: The MoD provided an increased alloc
Page 106 and 107: Recommendations, Client Comments, a
Page 108 and 109: and KMTB used diesel generators exc
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Page 119 and 120: Observation 16. Undistributed ISFF-
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Page 132 and 133: investigate the practicality and lo
Page 134 and 135: developing the IAMP IT network to p
Page 137 and 138: Part V - Medical SustainabilityIntr
Page 139: Observation 19. Iraqi Army Heath Ca
Page 143 and 144: civilian patients. U.S. military me
Page 145 and 146: those deficiencies are many, but th
Page 147 and 148: two medical personnel who were alre
Page 149 and 150: Our ResponseCommander, MNSTC-I comm
Page 151 and 152: Observation 20. Multi-National Forc
Page 153 and 154: While some Iraqi Army mentoring and
Page 155 and 156: eporting. A Medical Operational Rea
Page 157 and 158: Client CommentsCommander, MNF-I con
Page 159 and 160: numbers of billets on the MNF-I JMD
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Page 164 and 165: The Military Health System Strategi
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Page 168 and 169: objective will also impact Iraqi ca
Page 170 and 171: 21.a.(2) We recommend that the Comm
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Page 174 and 175: Client Comments.This is a new recom
Page 176 and 177: FDA Shelf Life of Medical DevicesFo
Page 178 and 179: Client CommentsCommander, MNSTC-I c
Page 180 and 181: guidance on stability operations th
Page 182 and 183: standardized procedures to ASD(HA)
Page 184 and 185: The Arms and Ammunition Assessment
Page 187 and 188: Appendix B. Summary of Prior Covera
Page 189 and 190: Appendix C. GlossaryThis appendix p
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Foreign Military Sales Trust Fund -
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Small Arms are broadly categorized
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• Officials assigned to the U.S.
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Appendix E. Status of Recommendatio
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RecommendationNumberG-3-aG-3-bRecom
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RecommendationNumberL-2-aL-2-bFOLLO
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Appendix F. Organizations Supportin
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Joint Contracting Command-Iraq/Afgh
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DoD 5100.76-M. DoD 5100.76-M, “Ph
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DoD 5105.38-M states that:…[T]itl
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USD (AT&L) Value Stream Analysis, A
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leader in health education, trainin
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Appendix H. Notional Division and B
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6. Medical Logistics Status (Author
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Combatant CommandsCommander, U.S. C
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Final ReportReferenceDraftRecommend
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Final ReportReferenceIncorporated a
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Final ReportReferenceRecommendation
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Commander, Multi-National Force-Ira
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Final ReportReferenceClick to add J
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Final ReportReferenceRecommendation
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Final ReportReferenceDraftRecommend
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Commander, Multi-National SecurityT
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Final ReportReferenceRenumbered toR
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Team MembersUnder the guidance of t
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Security Assistance; and Logistics - Federation of American Scientists

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