ISSUE 182 : Jul/Aug - 2010 - Australian Defence Force Journal

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In addition, with recent trends to ‘sub-specialisation’ in medicine, many military doctors havelimited experience in obstetric emergencies, paediatrics or in treating patients with a range ofdiseases attributable to pre-existing chronic conditions. These are not the services normallyrequired of a healthy military population. However, they may be required by a host populationor the diverse demographic of contractors and aid workers in the deployed environment.Military planners must decide if this capability gap is to be met by further training of militarypersonnel or by reserve specialists or contract civilian professionals and, if the latter, how theywill be integrated into existing military structures.Rise of private military companiesPrivate military companies (PMCs) represent a pragmatic solution to military shortfallsoccurring not only in the health area. PMCs have been employed to provide many supportingand logistic functions in recent operations, such as aviation, communications, bulk cargo,accommodation, close personal protection, waste, maintenance and engineering. Despite theearly controversy surrounding security-focused companies, such as Blackwater Inc, PMCs arenow recognised as a vital component to achieving overall mission success, particularly in ‘lowlevel’or peace-keeping environments. 6The use of privately contracted services is well accepted by the ADF and was used extensivelyduring operations in East Timor, as well as the continuing and successful operations in theSolomon Islands. However, the use of PMCs to provide health care in military settings raisesa number of issues. Among these, training, credentialing and governance requirements,ongoing management of the scope of work, integration issues for hybrid forces, planning andmanagement of contracted services, and relationships between the ‘customer’ and contractormust be defined.Increasingly, the international community is looking towards contracted health solutions inoperational areas. In 2007, Joint Contracting Command-Iraq asked whether private healthcare providers might be interested in establishing ‘medical treatment facilities at forwardoperating bases throughout Iraq that would provide medical treatment to contractors workingwith the coalition forces’. 8 But while the use of contracted health support in benign militaryenvironments has been well tested, the implications for manoeuvre environments and in hightempo operations have not been clarified, particularly in relation to force protection andsecurity. In addition, any health support needs to be flexible and agile enough to adequatelyrespond to ‘surge’ requirements.Why consider using PMCs in the operational health care space?The provision of health care in operational environments is complex, expensive and carriessignificant training and governance obligations. While some health capabilities clearly must bemaintained by national militaries, notably combat health support, the use of PMCs to deliverother forms of operational health care is appealing.18
Contracted solutions in less hostile areas or on enduring operations may allow uniformedhealth components to be available to project their capability forward in the ‘battlespace’ andthereby achieve more immediate and significant policy objectives. The consequent reductionin the operational footprint of the military force adds to its flexibility (one of the principlesof war), including the ability to be withdrawn and re-deployed elsewhere or to meet ‘surge’requirements. This was evidenced in the ADF health deployments to Pakistan and Aceh.Contractor support to the Solomon Islands and Timor-Leste similarly allowed ‘non-committed’ADF health assets freedom to respond and deploy elsewhere.The challenges of operational health care extend beyond personnel issues and include facilities,equipment, pharmaceuticals and consumables required to support the mission. Privatecontractors are not constrained by (often cumbersome) military procedures and structuresand may be better positioned to offer greater flexibility, ‘just in time’ solutions and acceptgreater business risks, resulting in more cost effective service delivery capabilities. PMCs arealso not constrained by the national defence procurement processes which may give theman advantage in terms of employing the latest ‘off the shelf ’ technologies and consumables.An example of this is the provision of tele-radiology and remote imaging reporting from theSolomon Islands at a time when the ADF had no similar capability.A further potential advantage of contracted support is the ability to ‘close down’ therequirement at times of low operational tempo. Large ‘war stocks’ contingency holdings arecomplex and expensive to manage, particularly in the field of pharmaceuticals, due to shelf lifeand currency limitations, and the scope and range of the formulary needed for the supportedpopulation. PMCs may have greater flexibility in their procurement and disposal processes,making it easier to absorb or dispose of no-longer-required equipment and pharmaceuticals.Equally, when the requirement for contracted support ends, so does the contract, therebylimiting the ongoing maintenance and training liability to the ADF.Under a ‘whole of government’ construct, reconstructing health assets and supporting the hostnation’s ability to provide its own health care are of paramount concern. This is an area thathas traditionally been difficult for militaries to manage, resulting in friction between military,non-government organisations (NGOs) and other providers. 9 PMCs on the other hand are lessconstrained by strategic policy directives and may show a greater willingness to engage locals,either as independent providers or in a supporting role.The perceived impartiality of PMCs may also provide access to otherwise denied populationsand provide a natural progression through ‘military’ to ‘policing’ to civilian assets.This supports the restoration and confidence building mandate of the overall mission andfacilitates disengagement. There are also areas where, as part of the national objectives, anon-uniformed solution may offer a better diplomatic outcome in relation to service provisionto civilian casualties or areas of national focus—such as indigenous health—and may addresslegitimate concerns about cooperation with military forces, thereby extending strategiccapability.Two basic models of PMC-supported operational health care can be considered, namely‘sequenced’ (military/contracted) and ‘hybrid’.19
Page 3 and 4: Australian Defence ForceCONTENTSISS
Page 5 and 6: asics of the ADF’s approach to wa
Page 7 and 8: Oceanography and Force 2030: harnes
Page 9 and 10: The warm, relatively fresh waters o
Page 11 and 12: In a further example, the Australia
Page 13 and 14: Direct threats include maritime ter
Page 15 and 16: Commodore Rod Nairn is a career hyd
Page 17 and 18: Institute of Marine Science, $80m i
Page 19: The nature of casualties presenting
Page 23 and 24: Planning implications of increased
Page 25 and 26: When a nation is at war, it is acce
Page 27 and 28: NOTES1. Doug Brooks, ‘Role of pri
Page 29 and 30: the further from Stanley the landin
Page 34 and 35: 20. Comisión de Análisis y Evalua
Page 36 and 37: Coral Sea neighbours - then and now
Page 38 and 39: sources. In contrast, such trade be
Page 40 and 41: New Caledonia’s significance toda
Page 42 and 43: years, it was often perceived—by
Page 44 and 45: NOTES1. K. Mushakoji quoted in R. A
Page 46 and 47: Lasers or Longbows? A Paradox of Mi
Page 48 and 49: Military complexityAs military capa
Page 50 and 51: accounts for 93 per cent of the pro
Page 52 and 53: The paradox of military technology
Page 54 and 55: fleet is massive, with sustainment
Page 56 and 57: NOTES1. Benjamin Franklin, Poor Ric
Page 58 and 59: 30. D. Korowicz, ‘Things Fall Apa
Page 60 and 61: This new capability provides techni
Page 62 and 63: ‘Reaching back’ for information
Page 64 and 65: Figure 2. Chart summarising an exam
Page 66 and 67: Fast OR typically uses established
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of findings if very short time-scal
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Dr Tim McKay is Head of the DSTO Op
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strategic documents signed by the U
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• Strategic Command (STRATCOM), t
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Geographic Combatant Commands in th
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8. This evolution and expansion can
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27. In particular, in contrast to t
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Nevertheless, it can be argued that
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Proposed conceptThe proposed networ
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organisations could deploy at short
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The PacificHugh AmbroseText Publish
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Bloody Victory: the sacrifice on th
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Somme as critical to the forging of
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Command and Control: the sociotechn
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Human Factors Issues in Combat Iden
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The Canadian paper on CAS (Chapter
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The Ashgate Research Companion to M
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The authors’ chief vulnerability
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Books of this genre are intended to
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The ninth chapter is entitled ‘To
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Many members of the ADF may honestl
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GUIDANCE FOR AUTHORSThe Australian
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ISSUE 182 : Jul/Aug - 2010 - Australian Defence Force Journal

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