Drifmeyer Jeff, Llewellyn Craig
Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, USA.
Mil Med. 2003 Dec;168(12):975-80.
The U.S. Department of Defense (DoD) conducts humanitarian assistance missions under the Overseas Humanitarian Disaster and Civic Aid program for the statutory purposes of training military personnel, serving the political interests of the host nation and United States, and providing humanitarian relief to foreign civilians. These purposes are undertaken via the humanitarian assistance (HA), humanitarian and civic assistance, and excess property donation programs. DoD conducts over 200 such projects annually at a direct cost of approximately 27 million dollars in fiscal year 2001. Although varying by year and command, as many as one-half of these projects involve aspects of health care. These range from short-term patient care to donation of medical supplies and equipment excess to the needs of the DoD. Despite the considerable resources invested and importance of international actions, there is presently no formal evaluation system for these HA projects. Current administrative staffing of these programs by military personnel is often by individuals with many other duties and responsibilities. As a result, humanitarian projects are often inadequately coordinated with nongovernmental organizations, private volunteer organizations, or host-nation officials. Nonmedical military personnel sometimes plan health-related projects with little or no coordination with medical experts, military or civilian. After action reports (AARs) on these humanitarian projects are often subjective, lack quantitative details, and are devoid of measures of effectiveness. AARs are sometimes inconsistently completed, and there is no central repository of information for analysis of lessons learned. (The approximate 100 AARs used in the conduct of these studies are available for official use in the Learning Resources Center, Uniformed Services University of Health Sciences.) Feedback from past humanitarian projects is rare and with few exceptions; DoD-centric projects of a similar design are often repeated. Critical reviews to determine whether other kinds of projects might be more effective are rarely conducted. Recommendations for improving the effectiveness of DoD HA under Overseas Humanitarian Disaster and Civic Aid programs include: ensuring adequate staffing to meet the complex, dynamic nature of humanitarian missions and measuring the effectiveness of each project in mandatory, standardized AARs. For medical HA projects, application of public health strategies would compliment the patient care approach of the majority of medical projects to date. This offers possibilities for enhancing host nation infrastructure, allowing improvements beyond the short period of most military humanitarian projects.
美国国防部（DoD）根据海外人道主义灾难与公民援助计划执行人道主义援助任务，其法定目的包括训练军事人员、服务东道国和美国的政治利益以及向外国平民提供人道主义救济。这些目的通过人道主义援助（HA）、人道主义与公民援助以及多余财产捐赠计划来实现。2001财年，国防部每年开展200多个此类项目，直接成本约为2700万美元。尽管每年和各司令部情况有所不同，但这些项目中多达一半涉及医疗保健方面。范围从短期患者护理到捐赠国防部多余的医疗用品和设备。尽管投入了大量资源且国际行动很重要，但目前这些人道主义援助项目没有正式的评估系统。目前由军事人员对这些项目进行行政人员配备，往往是由承担许多其他职责的个人负责。因此，人道主义项目常常与非政府组织、私人志愿组织或东道国官员协调不足。非医疗军事人员有时在与军事或 civilian 医疗专家很少或没有协调的情况下就规划与健康相关的项目。关于这些人道主义项目的行动后报告（AARs）往往主观，缺乏定量细节，且没有效果衡量标准。AARs 有时填写不一致，也没有用于分析经验教训的信息中央存储库。（这些研究中使用的约100份AARs可在健康科学统一服务大学学习资源中心供官方使用。）过去人道主义项目的反馈很少，而且除少数例外；类似设计的以国防部为中心的项目经常重复进行。很少对是否其他类型的项目可能更有效进行批判性审查。关于提高国防部在海外人道主义灾难与公民援助计划下的人道主义援助有效性的建议包括：确保有足够的人员配备以应对人道主义任务的复杂、动态性质，并在强制性、标准化的AARs中衡量每个项目的有效性。对于医疗人道主义援助项目，应用公共卫生战略将补充迄今为止大多数医疗项目的患者护理方法。这为加强东道国基础设施提供了可能性，允许在大多数军事人道主义项目的短期之外进行改进。
