SIGAR

SIGAR OVERSIGHT ACTIVITIES
Performance Audit Reports Published
SIGAR published one performance audit report this quarter. The audit
examined the quality of data USAID used to report progress in Afghanistan’s
health care sector.
Performance Audit 17-22-AR: Afghanistan’s Health Care Sector
USAID’s Use of Unreliable Data Presents Challenges in Assessing Program Performance
and the Extent of Progress
Since 2002, USAID has obligated nearly $1.5 billion in assistance to develop
Afghanistan’s health care sector and publicly cites numerous achievements
made in life expectancy, child and infant mortality, and maternal
mortality. However, SIGAR found that USAID did not disclose data quality
limitations. This lack of disclosure calls into question the extent of the
achievements claimed. Given the difficulties in collecting data, USAID’s
Automated Directive System allows USAID missions to choose the best
available evidence. However, missions are required to be transparent and
to communicate “any limitations in data quality so that achievements can
be honestly assessed.” In all cases SIGAR reviewed, USAID did not disclose
data limitations.
For example, for life expectancy, USAID publicly reported a 22-year
increase from 2002 to 2010. USAID did not disclose that the baseline data
came from a World Heath Organization report which cited that due to the
severe scarcity of information in countries like Afghanistan, indirect estimating
methods were used. In addition, a later World Health Organization
report only shows a six-year increase for males and an eight-year increase
for females in life expectancy between 2002 and 2010. For maternal mortality,
USAID’s public documents cite a decrease from 1,600 to 327 deaths
per 100,000 live births between 2002 and 2010. However, upon reviewing
USAID’s data, SIGAR found that the 2002 information was based on a survey
conducted in only four of Afghanistan’s then-360 districts. USAID’s own
internal documentation acknowledged the limitations.
USAID has also relied on data from the Ministry of Public Health’s
(MOPH) Health Management Information System (HMIS), which contains
information entered by Afghans working at clinics and hospitals throughout
the country. This includes information on the number of patients seen and
number of births that occurred at each facility. However, according to the
director general of the MOPH department that oversees the system, “The
data in HMIS [are] not 100% complete.” Furthermore, in 2014, the World
Bank found that although HMIS officials in Kabul require provincial officers
to verify the accuracy of reports collected in their provinces by visiting the
health facilities themselves, the officials indicated that “they rarely travelled
outside the provincial capital and rarely verified the reports.”
SIGAR found that USAID’s project evaluations and performance reports
were not linked to the broader health care assistance objectives included in
COMPLETED PERFORMANCE AUDITS
• Audit 16-22-AR: USAID’s Efforts to
Support and Improve Afghanistan’s
Health Sector
REPORT TO THE UNITED STATES CONGRESS I JANUARY 30, 2017
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