In this article, the author details how USAID has changed over the years and the agency's current focus. The five lessons discussed are a guide for donors to follow to assure dollars are well-spent.
Mine Action and Development
The focus of the 1997 Ottawa landmine conference was on advocating the implementation and ratification of the Convention,1 as well as increased levels of donor funding for such mine action activities as the cessation of stockpile production, removal of already planted mines and rehabilitative responses for people injured by these hidden killers.
A World Bank economist in attendance expressed his hope that a 2007 mine action retrospective conference would convene an entirely different set of participants including agronomists, economists, health-care specialists, industrial and regional planners, and other technical experts who would discuss how to accelerate the social and economic recovery of areas cleared by 2007.
This economist reflected the current thinking of many people working in the field of humanitarian mine action who now view their work in a broader context. They see the goal of HMA as going beyond mine clearance and victim assistance to support and increase the pace of social and economic development in communities and nations affected by conflict.
To achieve this goal, they are advocating a more holistic approach, one that realizes the importance of closely integrating mine action and reconstruction efforts. This approach begins with initial planning and runs through the execution of mine action activities to the long-term reconstruction and development of physical and social infrastructure.
Evidence shows that this approach works. For example, in Angola, demining operations made it possible to reestablish a water pumping station in Moxico province that brings potable water to more than 120,000 residents. Mine clearance also allowed the reconstruction of a surgery room in Huila province's Mavinga Hospital. These infrastructural changes will improve the health and productivity of Angola's people, which in turn will contribute to long-term economic gains and increased chances of political stability. The potential gains are great for many people in many sectors.
Whether or not mine clearance will have achieved its goals by 2007, it is increasingly important for those concerned about the lasting impacts of landmines and other explosive remnants of war to view their mine action activities within the framework of social and economic reconstruction and development strategies.
History of Foreign Assistance
Since 1961, when U.S. President John F. Kennedy signed the Foreign Assistance Act into law and created USAID, the agency has been the main U.S. government body responsible for promoting social change and economic development in the developing world—especially in post-conflict reconstruction. USAID's mission was premised on the Marshall Plan for the reconstruction of Europe after World War II and the Truman administration's Point Four program to provide technical skills and equipment to poorer nations.
Since its inception, USAID has been the principal U.S. agency assisting countries recovering from disaster, trying to escape poverty and engaging in democratic reforms. In recent years, many other U.S. departments and agencies have also become active in providing financial and technical assistance in this arena, including the Departments of State, Defense, Education and Homeland Security. In addition, there has been a tremendous increase in the number of traditional and nontraditional professional organizations around the world—including private companies, universities, and faith-based and other non-governmental organizations—that have become engaged in both humanitarian and development activities.
Responding to a Changing Global Scene
USAID's work supports long-term and equitable economic growth and advances U.S. foreign policy objectives by supporting the following:
- Economic growth, agriculture and trade
- Global health
- Democracy, conflict prevention and humanitarian assistance
It operates in four regions of the world: Sub-Saharan Africa, Asia and the Near East, Latin America and the Caribbean, and Europe and Eurasia.
Given the new state of relative "global disorder," the combined threats of terrorism and pandemic disease outbreaks and the continued devastation being wrought by HIV/AIDS, USAID and other partners involved in foreign assistance and foreign policy are engaged in serious reconsiderations of their priorities and strategies.
Within those considerations, and of pertinent interest to those engaged in humanitarian mine action, USAID has identified as a priority the need to recognize the potential disruption that fragile states (states that are considered to be failing, failed or are recovering from drastic failure, including conflict) pose to the rest of the world. To that end, the agency has developed a three-pronged strategy focusing on these states:
- Improve monitoring and analysis in fragile states
- Design programs appropriate to fragile states
- Streamline operational procedures for a rapid and effective response
Development Approach to Mine Action
Most people who have lost a limb can cope with the physical challenges placed before them. But they face more crippling obstacles: the loss of the means to earn a livelihood or the ability to gain an education or necessary job skills. These losses also have ripple effects that can mire the survivor's family in poverty for years. Even children can fall victim in such instances. They can be forced, for example, to leave school in order to care for the survivor or help earn money for their families, or be denied access to schools because of their own disability.
USAID finds the most effective approach to addressing the needs of landmine survivors is including them within the larger population of people living with disabilities, providing for their participation in national reconstruction efforts and giving them access to the opportunities national reconstruction provides. These opportunities relate directly to the objectives mentioned above, insofar as all members of mine-affected communities and countries need to regain the self-reliance and self-respect they have lost as a result of conflict. They also need to be able to take advantage of social and economic services that will help them be productive members of society. This requires access to meaningful education, skills training, appropriate health care and medical services, and opportunities that allow them to earn a livelihood.
A young rehabilitation patient. Photo courtesy of Mel Stills
For example, USAID's support in Cambodia began by meeting the physical rehabilitation needs of tens of thousands of people injured by mines and other unexploded ordnance. Several years later, one no longer saw amputees begging on the streets as they dragged themselves from restaurant to restaurant. Instead, they were begging on the streets while walking from restaurant to restaurant using their new prosthetic limbs. We learned that mere physical rehabilitation efforts did not address social and economic needs. As a result, orthopedic programs were quickly linked and networked with vocational rehabilitation programs and efforts to integrate children into the school system. Cambodians with disabilities are now increasingly seen in the workplace, participating in social and political life, and returning to the classrooms.
To these ends, meaningful humanitarian mine action programs should acknowledge that survivors of landmines and other explosive remnants of war who suffer from physical or other disabilities need to become engaged in the broader community and included in the planning and decisions that will affect their future livelihood.
USAID also encourages HMA planners and program managers to promote and complement the following initiatives:
- Creation of accessible and appropriate health care and medical services, including physical rehabilitation.
- Assurance of "barrier-free accessibility" to physical structures and electronic and telecommunications systems (where appropriate) that afford opportunities for formal education and skills training and information.
- Establishment of inclusive and accessible political, economic and social opportunities, and especially an open and competitive employment environment.
- Establishment of a political infrastructure where the rights of people with disabilities and of all minority and vulnerable populations are protected by the establishment and enforcement of the rule of law.
USAID's Recent Experience
Over the past 15 years, USAID has provided a broad range of financial and technical assistance in the area of orthopedic care in war-affected countries under the Leahy War Victims Fund.2 In Angola, Cambodia, Central America, Mozambique and Vietnam, to name just a few, the War Victims Fund has provided critical medical rehabilitation efforts coupled with training and access to meaningful employment opportunities. The Fund has also been able to increase the numbers of children returning to mainstream classrooms.
The Agency has learned important lessons from its experience that could serve to guide other donors and implementers who might be interested in pursuing activities in this area. Perhaps the five most important lessons we have learned are as follows:
- Think long-term and ensure quality. As much as (if not more than) other social services, prosthetic and orthopedic services need to be available on a sustained basis and must meet minimally acceptable standards of quality. Quick fixes such as one-time distributions and service delivery by inappropriately trained staff do not address the long-term needs of survivors and, in some instances, may do physical harm. USAID is addressing this issue through a grant to the International Society for Prosthetics and Orthotics.3 ISPO is providing hundreds of scholarships to local rehabilitation technicians that enable them to attend internationally accredited schools and facilities. When these technicians return to their home countries, ISPO tracks their progress and provides them with opportunities for additional education.
- Broaden the impacts of rehabilitation efforts. Investments in building service-delivery facilities must consider the downstream needs for both human and financial resources and ensure they are adequately addressed. Realistic strategies for maintaining financial, technical and managerial resources have to be addressed at the outset of humanitarian assistance activities. In addition, where and when possible, fee-for-service policies should be introduced. Fee-for-service programs give clients the right to demand better-quality care and also relieve some of the financial burdens on cash-strapped service providers. Cost-recovery programs are in place in USAID-supported projects in Laos, Cambodia and Nicaragua.
- Ensure commitment at all levels. International non-governmental organizations must begin with and maintain a commitment to establish and build the capacity of local service delivery entities, be they governmental or non-governmental. In addition, donors should ensure that government assumes a role that maximizes the effectiveness of its efforts, establishes standards, and ensures appropriate deployment of resources, without constraining the potential of non-governmental initiatives. In Angola, for instance, USAID has worked closely with the government to allocate staff and funds from the national budget to rehabilitation programs as international NGOs gradually phase out their projects.
- Leverage resources. Because external efforts cannot be sustained indefinitely, it is critical to leverage donor dollars and obtain host-country buy-in and participation from the outset. This is a significant challenge in countries that have recently emerged from conflict. In lieu of significant government investment, a number of USAID programs are working to engage the private sector in these efforts.
- Make providers accountable. Social-service organizations should identify what they do and ensure they do it well. International NGOs in particular need to hold themselves accountable for the integrity and quality of their programs, both at home and abroad.
Roque Ramirez, prosthetic technician (and an amputee himself) at the Walking Unidos Clinic in Leon, Nicaragua, fits a patient with a new leg.
Photo courtesy of Stephen Petegorsky.
In addition to the work that has been supported by the Leahy War Victims Fund, in 1997 the Agency issued a policy on the inclusion of people with disabilities. The aim of this policy is to remove the barriers that have prohibited people with disabilities from fully participating in USAID's development programs. In 2004, this policy was further strengthened when USAID's administrator launched a new initiative to ensure inclusion and accessibility for people with disabilities in all of USAID's operations and programs.
These initiatives address inclusive development from both the top down and the bottom up. At the agency level, new policies and procedures have been put into place to ensure that people with disabilities have equal access to USAID-funded programs; in addition, training is being provided to staff on ways in which they can better include people with disabilities in their programs. At a local level, capacity-building and institutional development are being provided to NGOs, especially those of and for people with disabilities. The Agency is also making efforts to provide additional small-grant opportunities to local organizations.
Resources are now being put in place to promote and assist grantees and contractors in responding to these guidelines and to strengthen the capacity of disabled people's organizations to effectively pursue changes in policy, laws, the physical environment and local attitudes with respect to people with disabilities.
USAID has long been committed to the inclusion of people with disabilities in its programs, and recent actions reaffirm this commitment. However, much work remains and USAID is steadfast in its promise to be as inclusive as possible in its development efforts around the world.
Information on USAID's development programs and strategies, the War Victims Fund, and USAID's disabilities policy can be found at http://www.usaid.gov.
Lloyd Feinberg currently serves as the coordinator for disability issues at the U.S. Agency for International Development and manages USAID's Leahy War Victims Fund. His primary responsibility is the oversight/management of a portfolio of three special funds that provide over $35 million (U.S.) annually in development assistance. Besides the War Victims Fund, this portfolio includes the Victims of Torture Fund and the Displaced Children and Orphans Fund.
- Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-Personnel Mines and on Their Destruction, Ottawa, Canada. Sept. 18, 1997; http://www.icbl.org/treaty/text. Accessed Oct. 21, 2005.
- The Leahy War Victims Fund works on behalf of civilian victims of war and people living with disabilities. See http://www.usaid.gov/our_work/humanitarian_assistance/the_funds/lwvf/index.html for more information. Last updated May 5, 2005. Accessed Oct. 21, 2005.
- Learn more about the United States International Society for Prosthetics and Orthotics at http://www.usispo.org/. Accessed Oct. 21, 2005.
Contact InformationLloyd Feinberg
Manager, Leahy War Victims Fund
Ronald Reagan Bldg., Rm 3.10.07
Washington, DC 20523-3100
Tel: +1 202 712 5725
Fax: +1 202 216 3231
Web site: http://www.usaid.gov