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Policies, principles, and the ‘reality on the ground’.

By Willem van de Put
on April 13, 2023

The reality on the ground” is an expression that refers to the state of things as they are or appear to be, rather than as one might wish them to be. Policies and principles are  guidelines and rules to help bring about a ‘wanted’ reality  – how things “ought” to be (at least from the point of view of decision makers). One of the eternal struggles is then to get policy into practice – and this is also true for policy making beyond the health sector.

In international politics, one of the tensions for decision makers is to find the balance between domestic politics and international relations. This week, for example, there was commotion about the Afghanistan Taliban government’s ban on women working for the UN.  After the Taliban take-over in August 2021, women were banned from working for non-governmental organisations, from universities, and on April 4 this ban was extended to UN offices across the country. The international outcry has been vast, for obvious reasons. The UN mission in Afghanistan said on 11 April that “the Taliban de facto authorities seek to force the United Nations into having to make an appalling choice between staying and delivering in support of the Afghan people and standing by the norms and principles we are duty-bound to uphold.” That seemed a diplomatically worded threat to leave the country.

So here we have the norms and principles of the UN pitted against the norms and principles of the Taliban. Oops, that is dangerous ground. Time to shift the focus from the halls of power to the muddy waters on the ground. A shift from ‘what’ (no women) to ‘how’ (really?). This is also known in management techniques, where they call it the actualisation gap – the gap between the ones behind a plan, and the actual people who will need to implement it ‘on the ground.’

So what is going on, “on the ground”?

In health, considerable progress was made in the two decades before the Taliban takeover in 2021. Afghanistan increased the coverage of health services and improved some important health indicators such as maternal mortality. Health services in Afghanistan are today still defined by the Basic Package of Health Services (BPHS) and the Essential Package of Hospital Services (EPHS), funded by the Afghanistan Reconstruction Trust Fund (ARTF). The biggest problem after the Taliban takeover, at least when we focus on health services, was the discontinuation of this funding. Afghan central bank reserves ($3.5 billion) were frozen by the United States and were  released only in September last year. These ‘humanitarian funds’ are still far from the regular funding needed to keep services up at the former level.

Taliban rules are a disgrace according to 21st century international standards. But ‘the Taliban’ – a fragile government facing  internal power struggles and (other) terrorist threats – are also balancing between international isolation and domestic policies. Against that background, it is thus not very surprising that hard-liners put (ever more) bans on women, whereas other factions in the government do not feel inclined to do much on ‘actualization’. In more remote areas, local leaders and NGOs negotiate as always, and local rulers allow many women to continue work – although it is getting more and more difficult. The way to ease the stress, it seems to me, is to apply ‘soft power’: get over the loss of the military endeavor, and start supporting health and education in a decent way again. Then perhaps even the ‘reality on the ground’ might change for the better again.

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