MOST PEOPLE IN THE DEVELOPED WORLD TAKE FOR GRANTED ACCESS TO BASIC HEALTH SERVICES AND THE EXISTENCE OF A FUNCTIONING HEALTH SYSTEM. THE SITUATION IS DIFFERENT IN IRAQ BECAUSE OF FUNDAMENTAL LIMITATIONS IN FUNDING, STAFFING, TRAINING, AND OTHER ELEMENTS OF ESSENTIAL INFRASTRUCTURE.


worked for MoD, and the director of health affairs, who worked for MoI, and their staffs on health care policy, preventive medicine, medical training, medical logistics, and facility planning. The health affairs medical logistics sec- tion played a crucial role in the initial distribution of Class VIII (medical mate- riel) supplies; in the design, development, and equipping of medical infrastructure and logistics systems; and in enabling the ISF to become capable and ready as it moves toward self-sufficiency.


THE BIG PICTURE The ISF faces discouraging challenges in its efforts to rebuild the shattered Iraqi medical infrastructure. These challenges can be attributed to excessive bureau- cracy, a lack of health care professionals, widespread illiteracy, and lack of access to pharmaceuticals and medical equipment.


The shortage of health care personnel in Iraq is the direct result of


its three


wars since 1980 and years of ethnic per- secutions. After June 2003, there was a massive exodus of health care profession- als to neighboring nations. This created a huge void in access to care. The Ministry of Health (MoH) adopted an aggressive employment strategy that included a safe work environment, higher salaries, and


an excellent retirement package. The SGIJF was forced to match, and in most cases exceed, MoH benefits in an effort to recruit more clinicians into the ranks.


This prompted extraordinary SGIJF out- reach efforts, from recruiting campaigns over the radio to bonuses for highly trained personnel. This endeavor has benefited both MoD and MoI in health care. Trained and proficient


human


capital is the most important aspect of ensuring that the Iraqis are able to attain true self-sustainment.


The Iraqi Form 101 was meant to streamline the requisition process; how- ever, it still required SGIJF’s signature for approval. Such action by itself could take months at a time, thus hindering local commanders’ and their surgeons’ efforts to replenish their Sets, Kits and Outfits. A complex hierarchy and administrative processes bound by red tape put severe limitations on the ISF’s ability to direct, control, and achieve the objectives and requirements from its requesting units and support agencies. Bureaucracy seemed to be the rule for day-to-day operations.


The MoD acknowledged its inability to spend its annual budgets. FY09 budget


expenditures for the SGIJF office did not reach 30 percent of annual funds by the end of the second quarter. In fact, this is one reason MoD provided its Command- er’s Emergency Relief Program funds to MNSTC-I, so that MNSTC-I could spend MoD money.


Kimadia, the state company managing the importation and distribution of drugs and medical equipment, is the main drug supplier of Iraq. It operates a distribution network of specialized central, governor- ate, and district warehouses. Kimadia also is the sole legally authorized source for management, planning, selection, quantification,


procurement, storage,


and distribution of medicines and medi- cal equipment. This restricts the SGIJF and the MoI health affairs director from selecting their own sources of supply at home and abroad.


LAYING A FOUNDATION Most people in the developed world take for granted access to basic health services and the existence of a functioning health system. The situation is different in Iraq because of fundamental limitations in funding, staffing, training, and other ele- ments of essential infrastructure. It took a joint effort of MNSTC-I, SGIJF, and the MoH to ensure partnering, coordination,


ASC.ARMY.MIL 51


LOGISTICS


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