health.mil

May 24, 2010

Media contact: Matt Pueschel | 703-681-3279 x157

The Department of Defense (DoD) has put in place a groundbreaking new policy that assigns responsibilities and instructions to specific department components for the military’s planning and provision of medical support in international stability operations.

Stability operations are humanitarian relief missions that the military conducts outside the U.S. in pre-conflict, conflict and post-conflict countries, disaster areas or underdeveloped nations, and in coordination with other federal agencies, allied governments and international organizations. Such missions can include reestablishing a safe environment and essential services, delivering aid, transporting personnel, providing direct health care to the population, mentoring host country military medical personnel and helping nations rebuild their health infrastructure.

Improving local medical capacity can in turn help stabilize governments and produce healthier populations. The new policy elevates the importance of such military health support in stability operations, called Medical Stability Operations (MSOs), to a DoD priority that is comparable with combat operations.

The International Health Division (IHD), within DoD’s Office of Force Health Protection & Readiness (FHP&R), crafted the new policy, which is referred to as DoD Instruction 6000.16 and was officially signed into department policy by Under Secretary of Defense for Personnel and Readiness Dr. Clifford L. Stanley on May 11. DoDI 6000.16 is available at http://www.dtic.mil/whs/directives/corres/pdf/600016p.pdf.

The instruction builds upon other recent department policies that required DoD medical personnel and capabilities to be prepared to meet military and civilian health requirements in stability operations. MSOs are now considered a core DoD mission that the Military Health System (MHS) must be prepared to conduct throughout all phases of conflict and non-combat environments. MSOs must be integrated across MHS’s doctrine, organization, planning and training activities.

The new instruction directs the MHS to prepare to establish and maintain the health sector capacity and capability of other countries when the local population, international or U.S. civilian agencies cannot do so, and to support and collaborate closely with other U.S. departments, foreign governments and security forces, nongovernmental and regional organizations.

“One of the keys for deployers coming back was looking into lessons learned, and trying to make the hand-off to NGOs (nongovernmental organizations) good if DoD has to do the care first,” advised CDR William J. Hughes IV, MSC, USN, IHD’s Program Director for Contingency Planning, who wrote the instruction.

The instruction also makes it incumbent upon DoD health care personnel to practice within their medical privileges and scope of practice when performing care on other populations. For instance, IHD officials said that when DoD physicians provide care in short-term medical assistance missions they should consider what sustainable sources of appropriate follow-up care are available to patients through local doctors or NGOs if further treatment may be needed, and make an effort to ensure those provisions are in place after they leave.

“Remember you have to first do no harm,” said IHD Director Dr. Warner Anderson. “It's up to us to prove that we're not going to be doing harm, and how we're impacting the health of the local population. If you can do things that have lasting impact, (it is better). We have to do it smart and talk to the local health department and NGOs in the area. We're here to make (them) look good, and (they can also) let us know if there is any threat (in the area if security needs to be enhanced).”

All patients’ identifiable information that is collected during the delivery of care will be safeguarded to the extent applicable. The instruction further outlines responsibilities for specific DoD components.

The Assistant Secretary of Defense for Health Affairs (ASD/HA) will be responsible for indentifying DoD-wide MSO capabilities and gaps and recommending priorities for the department to address them; ensuring MHS research and development programs address MSO capabilities and are integrated into DoD’s acquisition activities; establishing health standards of care and technical supervision for MSOs; collecting and examining MSO best practices to formulate further policy guidance; and developing measures of effectiveness to evaluate progress in achieving MSO goals.

For example, IHD officials said measuring how local medical capacity has grown or been improved over the long term such as through DoD’s provision of education and training to host country military medics and healthcare providers might have as much or more value as the number of patients treated or medications dispensed in humanitarian outreach missions. They also said it is important for DoD to carefully plan health facility construction projects by working closely with host country partners and civilian agency development experts to build from existing local infrastructure and capabilities, so that any new hospitals or clinics are sustainable.

The instruction also calls for each military service to appoint a senior medical department officer to champion MSO initiatives, and develop MSO capabilities by equipping and training the Services’ medical personnel to carry them out effectively.

The Chairman of the Joint Chiefs of Staff will develop joint and interagency MSO doctrine and support the ASD/HA and relevant U.S. government departments by participating in federal and multinational stability operations planning processes. DoD’s regional Geographic Combatant Commanders will identify gaps and incorporate MSOs and related training into their theater security cooperation plans and partnerships, as well as ensure unity of command and effort for health engagements in their areas.

Through the design and establishment of modeling and simulations aimed at identifying and testing innovative ideas, DoD’s Joint Forces Command will also explore new MSO concepts and capabilities for military-civilian teams to collaborate on and utilize in the field.

The International Health Division is a capability area within the Department of Defense Office of Force Health Protection & Readiness. The division advises the ASD/HA and develops MHS policies and tools for international stability, humanitarian assistance and disaster response missions. Its members participate in global health initiatives and collaborate with other federal agencies, NGOs, foreign governments and international organizations. For more information, please go to http://fhpr.osd.mil/intlhealth.

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