OFFICE OF THE SPECIAL INSPECTOR GENERAL FOR IRAQ RECONSTRUCTION

CONSTRUCTION OF PRIMARY

HEALTHCARE CENTERS REPORTED

ESSENTIALLY COMPLETE, BUT

OPERATIONAL ISSUES REMAIN

SIGIR--09--015

AAPPRRIILL2299,,22000099
 

 

April 29, 2009

CONSTRUCTION OF PRIMARY HEALTHCARE CENTERS 

REPORTED ESSENTIALLY COMPLETE, BUT 

OPERATIONAL ISSUES REMAIN

What SIGIR Found

GRD has completed construction of most of the PHCs despite poor security 

conditions that led to incidents such as bombing of some facilities. GRD

awarded follow-on construction contracts to Iraqi contractors to complete the 

PHCs partially constructed under the Parsons design-build contract and now 

reports that most construction is complete. GRD estimates the completed 

facilities will provide outpatient treatment for over 4 million Iraqis annually. 

However, the program has cost substantially more than planned, taken much 

longer to complete, and produced fewer facilities. Specifically:

The program has cost about $345 million or about $102 million more 

than the $243 million estimate when the Parsons’ contract was 

terminated. 

PHCs have been transferred to the MoH years later than planned.

The original 150 PHCs were reduced to 142 during the Parsons 

contract and 9 additional sites were removed, leaving 133.

Management problems significantly burdened the program. GRD did not draft 

its program management plan until about 6 months after most contracts to 

complete the partially constructed PHCs were awarded and failed to finalize it. 

The program had six different managers in three years. ITAO, which had key 

oversight and coordination responsibilities with MoH, did not have adequate 

resources to meet these responsibilities. 

Although GRD now reports that 133 PHCs have been completed and 

transferred to the MoH, not all of these PHCs are complete and open to the 

public. Further, GRD and ITAO experienced problems in transferring PHCs 

to the MoH, and they do not have accurate data on the number of PHCs 

actually open and operating. Furthermore, both are aware of operational and 

sustainability issues at the PHCs, and MoH officials also stated that 

construction and equipment issues exist with the transferred PHCs. SIGIR’s 

inspections of four open and operating PHCs identified significant uncorrected 

construction deficiencies and non-operating medical equipment.

In May 2008, a contract was awarded for sustainment of health projects that 

includes assessing equipment and systems at selected facilities. The contract 

amount is limited to the $16.5 million of available funds and will not provide 

for an assessment of all PHCs. GRD reports 6 detailed assessments under 

review and 28 preliminary assessments completed. GRD and ITAO officials

state there are no plans or funds for further action to assess PHCs. GRD 

further noted that such assessments were not its responsibility. 

Conclusions

GRD and ITAO have not provided sufficient accountability and transparency 

on the status of the PHC program as it nears completion. Millions of dollars 

were spent on the program; however, available data indicates that the 

construction, the installation of equipment, and the needed training were not 

completed for a significant number of PHCs. Without sufficient 

accountability and transparency on current PHC program status, the U.S. 

government does not have the information essential for a policy determination 

as to whether any further U.S. management attention is needed to prevent 

some or all of its PHC investment from being wasted.

Special Inspector General for Iraq Reconstruction

For more information, contact SIGIR Public Affairs 

at (703) 428-1100 or PublicAffairs@sigir.mil

Summary of Report: SIGIR-09-015

Why SIGIR Did This Study

In March 2004, the U.S. Army issued a 

contract to Parsons Delaware, Inc. 

Subsequent task orders under the contract 

provided for the design and construction of 

150 primary healthcare centers (PHCs). Two 

years later, the U.S. government terminated 

the PHC task orders; the PHCs throughout 

Iraq were in various construction phases. In 

our report, Management of the Primary 

Healthcare Centers Construction Projects

(SIGIR-06-011, 4/29/2006), we reported on 

the need for a strong management team, in 

cooperation with the Iraq Ministry of Health 

(MoH), to complete the partially constructed 

PHCs. The U.S. Army Corps of Engineers’ 

Gulf Region Division (GRD) and the U.S. 

Embassy’s Iraq Transition Assistance Office 

(ITAO) managed the program to complete the 

PHCs. The objectives of this report are to 

show the costs and outcomes of efforts to 

complete the PHCs, the extent to which 

completed PHCs have been transferred to the 

MoH, and the operational status of the PHCs.

What SIGIR Recommends

SIGIR recommends that the U.S. Ambassador 

and the Commanding General, Multi-National 

Forces-Iraq, jointly direct a U.S. government 

study—obtaining the Government of Iraq’s 

participation and/or input to the extent 

possible—to (1) provide transparency on the 

current status of PHCs and assess the cost and 

benefits of potential actions to address 

identified PHC operational and sustainability 

problems and (2) identify actions the U.S. 

government could undertake to help ensure 

that the benefits expected from the PHC 

program are realized and the investment will 

not be wasted. 

Management Comments

In commenting on a draft of this report, the 

Embassy concurred with the 

recommendations and stated that it was 

working to accomplish them. GRD did not 

address the recommendations, but disagreed 

with numerous statements in the report. The 

comments are addressed where applicable in 

the report.

Special Inspector General for IRAQ Reconstruction

SIGIR
April 29, 2009

MEMORANDUM FOR U.S. SECRETARY OF DEFENSE

U.S. AMBASSADOR TO IRAQ

DIRECTOR, IRAQ TRANSITION ASSISTANCE OFFICE

COMMANDING GENERAL, MULTI-NATIONAL FORCEIRAQ

COORDINATOR, OFFICE OF PROVINCIAL AFFAIRS

COMMANDING GENERAL, GULF REGION DIVISION, U.S. 

ARMY CORPS OF ENGINEERS

COMMANDER, JOINT CONTRACTING COMMANDIRAQ/AFGHANISTAN

SUBJECT: Construction of Primary Healthcare Centers Reported Essentially 

Complete, but Operational Issues Remain (SIGIR-09-015)

This report is provided for your information and use. It includes the results of the Special 

Inspector General for Iraq Reconstruction (SIGIR) audit of costs and outcomes of the 

U.S.-funded effort to complete the partially completed primary healthcare centers (PHCs). 

These PHCs remained after the termination of task orders with Parsons Delaware, Inc. in 

March 2006. Our review was done as SIGIR Project No. 9001.

We considered written comments from the Director, Iraq Transition Assistance Office,

and the U.S. Army Corps of Engineers, Gulf Region Division, when preparing this report. 

The comments are addressed in the report, where applicable, and copies of the comments 

are included in the Management Comments section of the report.

We appreciate the courtesies extended to our staff. For additional information on this 

report, please contact Mr. Glenn Furbish (glenn.furbish@sigir.mil/703-428-1058) or Ms. 

Nancee Needham at (nancee.needham@iraq.centcom.mil)/703-343-9275). 

Stuart W. Bowen, Jr.

Inspector General
Table of Contents

Executive Summary i

Introduction 1

Lack of Progress Leads to Termination 1

Prior SIGIR Reports 2

Responsible Organizations 3

Construction Is Essentially Complete, but Cost, Schedule, and 

Management Problems Occurred 5

Increased Costs and Schedule Delays in PHC Program 5

Nine PHCs Not Completed Because of Security Issues 9

Management Issues Continued to Impact Program 13

Transfer and Sustainability Issues Place Program Investment at Risk 18

Difficulties in Transfers to MoH 18

Conflicting Reports on Number of PHCs Open and Operational 19

Operations and Sustainability Uncertain 20

No Plans for Continued U.S. Government Role and Responsibilities 

for PHC Program 22

Conclusions and Recommendations 24

Conclusions 24

Recommendations 24

Management Comments and Audit Response 24

Appendices

A. Scope and Methodology 26

B. Total Construction Cost of PHCs 29

C. Reported Dates of Transfer to MoH and Dates PHCs Opened 34

D. Acronyms 39

E. Audit Team Members 40

F. Management Comments 41
i

Construction of Primary Healthcare Centers Reported

Essentially Complete, but Operational Issues Remain

SIGIR-09-015 April 29, 2009

Executive Summary

In March 2004, the U.S. Army issued a design-build contract to Parsons Delaware, Inc. 

Subsequent task orders under the contract provided for the design and construction of 150 

primary healthcare centers (PHCs) in Iraq. In addition, the task orders provided for the delivery 

and installation of medical and dental equipment at the PHCs. Two years later, the U.S. 

government terminated the task orders; the 142 PHCs remaining in the program were in various 

phases of construction. The Special Inspector General for Iraq Reconstruction (SIGIR), in

Management of the Primary Healthcare Centers Construction Projects (SIGIR-06-011, 

4/29/2006), reported on the need for a strong management team, in cooperation with the Iraq 

Ministry of Health (MoH), to complete the partially constructed PHCs. In addition to our report 

on the construction projects, we issued 3 audit reports on concerns related to equipment for the 

PHCs. The U.S. Army Corps of Engineers’ Gulf Region Division (GRD) and the U.S. 

Embassy’s Iraq Transition Assistance Office (ITAO) managed the program to complete the 

PHCs. 

The objectives of this report are to show the costs and outcomes of U.S.-funded efforts to 

complete the PHCs, the extent to which completed PHCs have been transferred to the MoH, and 

the operational status of the PHCs.

Results

GRD completed construction of PHCs despite very poor security, which included the bombing of 

PHC facilities. After the termination of the Parsons’ task orders in March 2006, GRD awarded 

direct construction contracts to Iraqi contractors to complete the partially constructed PHCs. 

GRD reports most construction is now complete and estimates the facilities will provide 

outpatient treatment for over 4 million Iraqis annually. However, the program has cost 

substantially more than planned, taken much longer to complete, and produced fewer facilities

than originally planned. Specifically:

The program has cost about $345 million or about $102 million more than the $243 

million estimate of the Parsons contract. The increase came from $57 million for followon construction contracts and $56 million for delivering and installing medical equipment 

and providing training.

Many PHCs have been transferred to the MoH years later than planned. Under the 

Parsons contract, all of the PHCs were originally to be completed by December 2005. 

Under a September 2006 GRD plan, most PHCs were to be completed by early 2007. 

However, most were reported completed in the last quarter of 2007 and 2008. GRD even 
ii

awarded contracts to complete construction of the six PHCs considered complete when 

the Parsons contract was terminated in March 2006

During the Parsons contract, the originally slated 150 PHCs were reduced to 142, and 9 

additional sites have been removed, leaving 133. Security issues, which were major 

factors in the cost increases and schedule delays, caused the removal of the nine PHCs. 

Six of the nine PHCs were not completed because explosives destroyed part or all of the 

facilities. About $5.18 million was spent on the construction of these nine PHCs. 

Management problems have long burdened the program. GRD, which had program management 

responsibilities, did not draft its program management plan for the follow-on contracts until 

about 6 months after most contracts to complete the partially constructed PHCs were awarded 

and never finalized it. It also had six different program managers in three years. Moreover, 

GRD’s award of firm-fixed-price contracts to Iraq contractors for completing construction 

required assessment of the partially constructed facilities and development of independent 

government estimates before award of the contracts. However, because GRD did not locate 

requested project assessments, SIGIR was unable to verify the extent of any site assessments that 

were made. Also, the data from the Iraq Reconstruction Management System that GRD used for 

program management was inaccurate and incomplete. ITAO, which had key responsibilities for 

oversight and coordination with MoH, did not have resources to meet its responsibilities. 

GRD reports that 133 of the PHCs have been constructed and transferred to the GOI, but not all 

of these PHCs are complete and open to the public. In addition, GRD and ITAO experienced 

problems in transferring PHCs to the MoH. Officials said that, in some cases, they were ready to 

transfer a facility, but MoH officials were not yet ready to accept the facility because of limited 

availability of facility protection service personnel and insufficient number of trained and 

available staff. In 14 cases, GRD transferred facilities to MoH that were incomplete, with plans 

for continued construction work at just two. (The 14 incomplete PHCs that were transferred 

included the 9 sites removed from the program after the Parsons termination.) The other 

incomplete PHCs had no completion plans. In addition to the transfer of incomplete facilities, 

GRD transferred five PHCs unilaterally, without MoH acceptance. GRD reports that 115 PHCs 

are open and operational, but MoH reports just 101. 

Even more significant than discrepancies in the number of open PHCs is the operational and 

sustainability status of the PHCs that are open. GRD, ITAO, and the MoH all expressed 

concerns about operation and maintenance issues at PHCs. The issues include whether PHCs 

have basic services—such as electricity, water, and sewage—and, whether medical equipment 

has been provided, installed, and is operating. Health Attaché officials stated that neither the 

construction nor the materials met expected standards and the facilities did not make a good 

presentation of a U.S.-funded and managed construction project. MoH officials stated that the 

PHCs had construction, electrical, mechanical, and equipment deficiencies that will require 

reconstruction and rehabilitation. SIGIR’s inspections have identified operation and 

maintenance issues at four open PHCs.

Although all parties have concern over PHC operation and maintenance issues, the U.S. 

government does not have accurate visibility into the overall status of the PHCs. In May 2008, 

GRD and ITAO contracted with Stanley Baker Hill for the sustainment of health projects funded 
iii

by the U.S. government. The scope of work included assessing equipment and system at 

selected facilities. The contract amount is limited to the $16.5 million of available funds and will 

not provide assessment of all PHCs. GRD reports 6 detailed assessments under review and 28 

preliminary assessments completed; however, the number of assessments to be completed is 

unknown. Also, because GRD failed to provide the requested assessments, SIGIR has not 

reviewed these documents. Finally, based on discussions with GRD and ITAO officials, the U.S. 

government does not plan for future U.S. government roles/responsibilities with regard to the 

PHCs. Neither organization has any plans or funds for a further effort.

Conclusions

U.S. funds and GRD’s and ITAO’s management have furnished the Iraq MoH with PHCs that 

are expected to provide medical care to more than 4 million Iraqis throughout the country. This 

has been accomplished despite serious security conditions, such as the bombing of facilities. 

However, GRD and ITAO have not provided sufficient accountability and transparency on 

current PHC program status. Reports showing that 133 PHCs having been completed and 

transferred are not complete and accurate. Questions about the completeness of the PHCs relate 

to far more than those few transferred ―as is.‖ 

Millions of dollars were spent to finish construction, deliver and install medical and office 

equipment and consumables, and train Iraqis on PHC equipment. However, some or all of these 

actions were not completed for a significant number of PHCs. The limited contract effort to 

assess PHC status is based on funds available, not the amount needed. Further, neither has

identified plans and/or funds for additional assessments and/or completion work for PHCs. 

The U.S. government’s future role regarding the PHCs in Iraq requires a policy decision; 

however, the U.S. government has not developed the information essential for making that 

decision. A lack of further management attention by the U.S. government and the Government 

of Iraq to address the PHCs’ operation, maintenance, and sustainability issues places a 

substantial portion of the U.S. investment in the program at risk of being wasted. 

Recommendations

SIGIR recommends that the U.S. Ambassador and the Commanding General, Multi-National 

Forces-Iraq, jointly direct a U.S. government study—obtaining the Government of Iraq’s 

participation and/or input to the extent possible—to:

1. Provide transparency on the current status of PHCs and assess the cost and benefits of 

potential actions to address identified PHC operational and sustainability problems.

2. Identify actions the U.S. government could undertake to help ensure that the benefits 

expected from the PHC program are realized and the investment will not be wasted. 

Management Comments and Audit Response

In preparing this report, SIGIR considered written comments from ITAO and GRD. Their 

complete comments are included in Appendix F.
iv

The Director of ITAO, on April 17, 2009, commented that the Embassy concurs with the 

recommendations and is working to implement them. ITAO states that the ongoing contract with 

Stanley Baker Hill will help to identify, prioritize, correct, report, track, and manage facility and 

equipment deficiencies. ITAO states that its goal is not to assume a long term role in or 

responsibility for the assets provided to the Government of Iraq. To that end, it notes the shift 

from reconstruction to boosting the capacity of Iraqis to exercise ownership, control, and 

operations of the assets-based infrastructure the U.S. government has contributed. It further 

comments that assessments of near half of the PHC will provide transparency on the status of the 

facilities and equipment and the information needed to calculate potential operational and 

sustainability concerns.

We agree that ongoing assessments will help. However, questions remain as to the number of 

PHCs that will be assessed under the existing contract. ITAO noted that, according to GRD, 42 

PHCs have been assessed and funding on the contract will permit an additional 20 PHCs to be 

assessed. During our audit work, GRD provided different numbers for PHCs that had been and 

would be assessed, but did not provide documentation on completed assessments or on additional 

assessments that could be completed with the existing funds. We plan follow up to further verify 

the number of PHCs that has been and will be assessed under the existing contract. However, 

assessments of about 50% of the PHCs would be a significant step toward providing 

accountability and transparency to PHC program status. 

The Commanding General sent GRD’s comment on April 20, 2009. GRD’s comments did not 

address the recommendations but stated a disagreement with the ―basic assumption that GRD 

and ITAO failed.‖ In addition, GRD stated that the draft report did not fully highlight the 

difference in responsibilities between GRD, ITAO, and the Health Attaché. GRD also disagreed 

with other statements in the report and provided 31 specific comments on the draft report. A 

number of these comments related to a clarification of GRD’s responsibilities with regard to the 

PHC program. GRD emphasized that it is only responsible for tracking the construction 

management of the projects through physical completion, local turnover to the MoH, and 

financial and contractual closeout.

GRD’s comments regarding its responsibilities highlight the lack of an integrated management 

structure for contingency reconstruction programs, such as the PHCs, and serve to reinforce our 

overall conclusion regarding the need for additional program integration and overall 

accountability.

We believe the information in the draft report is accurate. However, we have revised or deleted 

some statements based on GRD’s comments to improve final report accuracy. Regarding GRD’s

overall comment, SIGIR did not conclude that GRD and ITAO failed. The first sentence of the 

Results in the Executive Summary states that ―GRD completed construction of PHCs despite 

very poor security, which included bombing of facilities‖ and note that the facilities will provide 

outpatient treatments to over 4 million Iraqis annually. Further, the draft report addressed the 

responsibilities of GRD, ITAO, and the Health Attaché in the Introduction section and in various 

subsequent sections when relevant to the subject discussed. For example in the section on MoH 

transfers, we noted that the GRD management plan stated that the opening and operation of the 

facilities as well as sustainability were outside the scope of the GRD program. However, we 

have added GRD’s language as appropriate to clarify its stated responsibilities.
v

SIGIR’s responses to GRD’s individual comments are presented on a comment by comment 

basis in Appendix F of the report. These comments identify the changes SIGIR made in 

finalizing this report.
1

Introduction

In March 2004, the U.S. Army awarded a design-build contract (W914NS-04-D-0006) to 

Parsons Delaware, Inc., Pasadena, California, to provide design and construction services in the 

building, housing, and health care sector in Iraq. The contract had a ceiling of $500 million. The 

government later issued 14 task orders under the contract, including 3 for the design and 

construction of 150 primary healthcare centers (PHC) located throughout Iraq and to provide 

equipment for the centers. In March 2006, after concerns arose about a lack of progress on the 

contract, the government terminated it. In April and July 2006, the Special Inspector General for 

Iraq Reconstruction (SIGIR) issued three reports expressing concern about the management of 

the PHC program. Agencies responsible for the management of the PHC program are the U.S. 

Army Corps of Engineers Gulf Region Division (GRD), the Iraq Transition Assistance Office 

(ITAO), and the Joint Contracting Command-Iraq/Afghanistan (JCC-I/A).

Lack of Progress Leads to Termination

The PHC task orders provided for the design and construction of 150 PHCs (41 PHCs in the 

central region of Iraq, 49 PHCs in the north region, and 60 PHCs in the south region) at a 

definitized cost of about $88.47 million. Parsons was to provide three standard healthcare center 

designs: a model center (Type A, about 1,324 square meters), a model center with teaching 

facilities (Type B, about 1,400 square meters), and a model center with emergency and labor 

facilities (Type C, about 2,126 square meters). In addition, the three task orders provided for the 

delivery and installation of medical and dental equipment at each center. The medical equipment 

to be installed included x-ray equipment, hematology analyzers, examination tables, patient beds, 

defibrillators, electroencephalography equipment, ventilators, and incubators. The dental 

equipment to be installed included dental chairs, lights, cabinets, instruments, and supplies. The 

total definitized cost of the equipment for the 150 PHCs was about $69.12 million.

In June 2005, JCC-I/A, which administered the Parsons contract, began notifying Parsons of 

concerns about the design and construction of the PHCs. In September 2005, in consultation 

with Iraq’s Ministry of Health (MoH), a decision was made to remove from the requirements for 

―lack of progress‖ nine PHCs that were reported to be in the initial stages of construction. One

PHC removed from the contract was continued through a direct contract. As of March 2006, 

about $186 million had been spent on the PHCs over two years, but only six centers had been 

accepted as completed.

In March 2006, JCC-I/A terminated for convenience the PHC task orders and reduced the scope 

of work by 121 PHCs. At this time, Parsons was to deliver, by April 3, 2006, 20 PHCs, 

including 14 that were incomplete and 6 that were considered complete. However, in April 

2006, the JCC-I/A decided to accept the 14 PHCs ―as is‖ rather than require completion by 

Parsons. 

Table 1 includes the key dates and summarizes the contract actions for the PHC program under 

the Parsons’ contract. 
2

Table 1—Key Dates and Actions for Contract W914NS-04-D-0022 with Parsons

Date Contract Action

March 25, 2004 Contract awarded to Parsons, and task order directs mobilization and 

commencement of work. 

May 11, 2004 Notice to proceed issued for task orders to construct 150 PHCs.

October 20, 2004 Task orders to design and construct PHCs are definitized. 

June 11, 2005 Stop work order issued for 20 PHCs without agreement between 

Parsons and U.S. government. 

July 18, 2005 Letter of concern issued to the contractor regarding PHC task orders. 

July 23, 2005 Stop work order is lifted on 12 PHCs. 

September 8, 2005 Bilateral modifications reduce number of PHCs by 9, leaving 141 as a 

contractual requirement. One PHC is to be completed with a direct 

contract, leaving a total of 142 in the program. 

March 3, 2006 Partial terminations for convenience issued for PHC task orders. Six 

PHCs are considered complete, and the U.S. government expects 

Parsons to complete 14 additional PHCs by April 2006. The 

remaining 122 are to be completed by Iraqi contractors. 

April 30, 2006 Fourteen PHCs are accepted “as is,” and 142 PHCs require 

completion: 141 from Parsons (including 6 that are essentially 

complete) plus the one previously removed for completion under a 

direct contract. 

Source: SIGIR analysis of prior reports and updated data from GRD.

Prior SIGIR Reports 

In 2006, SIGIR issued three reports related to the management of PHC construction and 

concerns about equipment purchased for PHCs. In a report, Management of the Primary 

Healthcare Centers Construction Projects (SIGIR-06-011, 4/29/2006), SIGIR reported that 

overall management of the PHC construction projects could have been better executed. Because 

of the strong commitment by the Iraqi and U.S. governments to complete the partially 

constructed centers, we recommended the development of a strong management team to ensure 

completion of the PHCs that were in various phases of construction.

In addition to our report on the construction projects, we issued two audit reports on concerns 

related to equipment for the PHCs. In April 2006, we issued Interim Audit Report on the Review 

of Equipment Purchased for Primary Healthcare Centers Associated with Parsons Global 

Services, Contract Number W914NS-04-D-0006 (SIGIR-06-016, 4/4/2006) to alert responsible 

U.S. government agencies of our concerns about (1) the lack of written plans for the acceptance, 

storage, and use of medical equipment that exceeded the current PHC needs as a result of 

reduced numbers; (2) the need to ensure U.S. government accountability of the equipment upon 

delivery; and (3) the U.S. government’s inability to ensure proper protection and accountability 

of equipment. In July 2006, we issued Review of the Medical Equipment Purchased for the 

Primary Healthcare Centers Associated with Parsons Global Services, Inc., Contract Number 

W914NS-04-D-0006 (SIGIR-06-025, 7/28/2006). This report noted that the U.S. government 

had decided not to store any equipment at the Iraqi MoH warehouse but rather to deliver extra 
3

equipment sets to the U.S. government-controlled warehouse. While this decision alleviated our 

concern over the security of equipment stored in an Iraqi warehouse, we reported additional 

concerns, including (1) the lack of appropriate actions to ensure that medical equipment 

delivered to the warehouse was properly accepted, inspected, and inventoried; (2) visible damage 

to a large number of the equipment shipping crates; and (3) a question about whether the 12-

month warranty provided as part of the basic equipment purchase contract would continue to

apply given delayed delivery and installation. 

A third report, Status of Medical Equipment and Other Non-construction Items Purchased for 

Primary Healthcare Centers (SIGIR-06-030, 1/30/2007), updated the status of the medical 

equipment and discussed controls over and use of medical consumables and other 

nonconstruction purchases for the PHC project. GRD had arranged to have the medical 

equipment sets, furniture, and consumables delivered to storage facilities, thus reducing an 

extremely high risk of pilferage and susceptibility to damage. 

Responsible Organizations

Three U.S. government organizations have primary responsibility for the PHC completion 

program: GRD, ITAO, and JCC-I/A. In addition, Berger/URS provided program management 

support to GRD until the fourth quarter of 2007, at which time Stanley Baker Hill, assumed that 

role. The Iraq MoH is the end user and owner of the facilities. 

GRD

GRD provides engineering services to the Multi-National Force-Iraq. These services include

planning, design, and construction management support for military and civil infrastructure 

construction. It is a major subordinate command of the Multi-National Force-Iraq. For the PHC 

program, GRD has management responsibility to deliver complete, ready-to-operate centers to 

the MoH. GRD stated that it is only responsible for executing the program funded by its 

customer, which in the case of the PHC program was ITAO. GRD receives a fee for performing 

project construction management and contractor quality assurance compliance services. In the 

case of the follow-on contracts for completing construction of the PHCs, GRD received a fee of 

6.5% of the contract costs. 

ITAO

ITAO was created by Executive Order on May 9, 2007, as the successor organization to the Iraq 

Reconstruction Management Office. National Security Presidential Directive 36, ―United States 

Government Operations in Iraq,‖ May 11, 2004, established the Office within the Department of 

State and directed that it facilitate the transition in Iraq. ITAO reports to the U.S. Ambassador to 

Iraq. For the PHC program, ITAO is to provide funding, direct program scope and objectives, 

and coordinate with the MoH. Working with ITAO on the PHC program, but not reporting 

directly to ITAO, is the Health Attaché, who provides advice to the U.S. Ambassador and others 

and coordinates the health program with the Iraq MoH. 

JCC-I/A

JCC-I/A, the head contracting activity, is responsible for administering contracts. JCC-I/A,

established in 2004 to consolidate contracting activities, reports through the Deputy Assistant 
4

Secretary of the Army (Policy and Procurement) to the Assistant Secretary of the Army for 

Acquisition, Logistics, and Technology. JCC-I/A is responsible for awarding the contracts for 

medical equipment, training, office equipment and furniture, consumables, and site electrical 

work. One contactor was responsible for all of the site electrical work at the PHCs. 

Objectives

The objectives of this report are to show the costs and outcomes of U.S.-funded efforts to 

complete the PHCs, the extent to which completed PHCs have been transferred to the MoH, and 

the operational status of the PHCs.

For a discussion of the audit scope and methodology, see Appendix A. For a detailed list of the 

PHCs; their status as of March 2006; and the total construction costs, see Appendix B. Appendix 

C provides the reported dates that PHCs were transferred to MoH and the reported dates they 

were opened. For a list of acronyms used in this report, see Appendix D. For a list of the audit 

team members, see Appendix E. Appendix F is the management comments received for this 

report.
5

Construction Is Essentially Complete, but Cost, 

Schedule, and Management Problems Occurred

In March 2006, after the termination of the Parsons contract, GRD undertook a program to 

complete and transfer PHCs to Iraq’s MoH. GRD awarded firm-fixed-price construction 

contracts to Iraqi contractors to complete the partially constructed PHCs, and it now reports that 

construction is essentially complete. This construction has been accomplished despite serious 

security conditions such as the bombing of facilities. Security conditions have affected all

aspects of the program, including assessing sites, awarding contracts, and inspecting work done. 

GRD estimates the facilities will provide outpatient treatment for over 4 million Iraqis 

annually—a significant accomplishment. However, the final program results, when compared to 

early plans (1) cost substantially more, (2) took longer to complete, and (3) produced fewer 

facilities. Specifically:

The program has cost about $102 million more than the $243 million estimate when the 

Parsons’ contract was terminated. 

PHCs have been transferred to the MoH months and years later than planned.

The original 150 PHCs were reduced to 142 during the Parsons contract, and 9 additional 

sites have been removed, leaving 133 constructed.

GRD did not have a timely and finalized management plan and had six different program 

managers, and ITAO’s resources for management and coordination of the program were limited. 

Increased Costs and Schedule Delays in PHC Program

Under its contract, Parsons had three task orders that required the design and construction of 150 

PHCs. As of March 2006, the total definitized cost of the PHC task orders was $104 million. 

Parsons was also to procure, deliver, install, and commission medical and dental equipment and 

provide training to MoH staff. The definitized cost for the equipment was $69 million. The 

contract also had an administrative task order for the indirect costs of projects under the contract, 

and we estimate that $70 million of these indirect costs were related to the PHC program. 

As shown in Table 2, the total estimated cost of the PHC program has increased by about $102

million—from $243 million at Parsons’ termination in March 2006 to $345 million in March 

2009—while the number of PHCs to be completed has been reduced from 150 to 133. Although 

Parsons’ construction costs decreased by about $20 million, the costs of follow-on construction 

contracts added $57 million to program cost. Also, because the PHCs were not complete, 

Parsons’ purchased equipment was delivered to a warehouse instead of PHCs. This resulted in 

the need for contracts to deliver and install the equipment and provide the planned training. 

These contracts added another $56 million to program costs.
6

Table 2—Increase in Estimated Cost of PHC Program from March 2006 to March 

2009 ($ millions)

Cost Element March 2006 March 2009

Increase

(Decrease)

Parsons’ Construction $104 $84 ($20)

Parsons’ Purchased Equipment $69 $75 $6 

Parsons’ Administrative Costs including 

Security and Life Support $70 $73 $3

Follow-on Construction Contracts - $57 $57

Delivering and Installing Equipment and 

Training - $56 $56

Total $243 $345 $102

Source: SIGIR report, GRD data, and Corps of Engineers Financial Management System data as of March 2009.

Costs for Follow-on Construction Contracts

After Parsons’ termination, GRD had program management responsibility to deliver PHCs that 

were complete and ready-to-operate. According to GRD, in carrying out this responsibility, it 

was to assess the partially completed PHCs, develop government estimates of the cost to 

complete construction, and award firm-fixed-price contracts between April and August 2006 to 

Iraqi contractors to complete construction of the PHCs. GRD awarded firm-fixed-price contracts 

to Iraqi contractors to complete construction of each of the 142 PHCs. Appendix B shows, by 

type of PHC, the percentage of PHCs’ completion as of the March 2006 termination, Parsons’ 

construction cost, and the additional cost for construction by Iraqi contractors. As shown, GRD 

awarded construction contracts for all 142 PHCs, even for those identified as complete under the 

Parsons contract. These additional contracts for about $57 million added to the $84 million spent 

on construction prior to the Parsons’ termination, brings the total cost of construction to $141

million. 

Our analysis shows that GRD awarded 128 different contracts to 65 different contractors to 

complete construction of the PHCs. Accordingly, some contracts were for completions of more 

than one PHC, and some contractors received more than one contract. For 18 PHCs, more than 

one contractor was involved in completing construction. This occurred primarily because at least 

17 of the follow-on contracts were terminated either for convenience or for default. 

Figure 1 shows a completed Type A clinic. PHCs similar to the one shown in Figure 1 have 

been constructed throughout Iraq and are reported to have the capacity to provide outpatient 

medical care to more than 4 million Iraqis annually. 
7

Figure 1—Photograph of Completed Type A Clinic in Basrah

Source: GRD photograph.

Costs of Nonconstruction Contracts

In addition to contracts to complete PHC construction, contracts were awarded for tasks that 

were necessary to complete the facilities and make them operational. As shown in Table 3, these 

contracts included tasks to provide the PHCs with needed generators and transformers, deliver 

and install medical equipment and furniture that had been procured under the Parsons’ contract, 

and provide needed training on medical and other equipment. 
8

Table 3—Nonconstruction Contracts for Tasks Needed to Make PHCs Operational 

($ millions)

Contract Number

Total

Obligated 

Completion 

Date Work Under Contract

W27P4B-05-C-0015 $24.58 October 2008 Procure and install generators/transformers at

PHCs and provide training

W27P4B-05-C-0015 $6.78 October 2008 Electrical work at PHC sites

W27P4B-05-C-0016 $14.38 June 2006 Deliver and install furniture at PHCs 

W91GET-06-A-5005 $2.93 March 2009 Install medical equipment and provide training 

on its use

W91GET-06-A-5006 $2.93 March 2009

Install medical equipment and provide training 

on its use

W91GET-06-A-5024 $1.40 April 2008 Procure, deliver, and install equipment and 

provide training

Other contracts $3.03 Various Deliver equipment and consumables and

other tasks

Total $56.03

Source: GRD and Corps of Engineers Financial Management System data as of March 2009.

In addition to program costs identified above, SIGIR reported in March 2006 that the U.S. 

government cost for managing and administering the PHC program was $7.4 million; we 

estimate that this cost now would be about $11 million. For example, to recover costs involved 

in contract supervision and administrative services, GRD charges a fee of 6.5% of the 

construction contract amount.

Planned Completion Significantly Delayed 

In addition to increased costs, completion of the PHCs was significantly delayed from plans 

under the Parsons’ contract and from GRD’s September 2006 revised plan. Under the Parsons’ 

contract, all PHCs were to be completed by December 2005. However, no PHCs were 

completed in 2005, and only two were completed in 2006. In September 2006, GRD developed 

a projected completion schedule based on the construction contracts awarded in the summer of 

2006. Figure 2 compares that schedule with the reported completion dates of the PHCs. GRD’s 

plan was that about half the PHCs would be completed in 2006 and most of the remainder would 

be completed in early 2007. Figure 2 shows that the completion dates for PHCs slipped 

significantly from the GRD schedule, as 64 PHCs were reported as complete in the last quarter 

of 2007 and 2008. 
9

Figure 2—Comparison of GRD Planned Completion with Reported Completion

Source: GRD data.

Nine PHCs Not Completed Because of Security Issues

GRD reported that 9 of the 142 PHCs to be completed were removed from the program. A total 

of about $5.18 million was spent on the construction of these 9 PHCs. Figure 3 shows the 

location of the 142 PHCs in Iraq and the location of the PHCs removed from the program. 

Thirty of the PHCs were in Baghdad, with one of those removed from the program. The 

remaining 112 PHCs are shown in Provinces and 8 of those were removed from the program. 
10

Figure 3—Location of 142 PHCs 

Source: GRD February 2009 briefing slide.

Security issues were the major factors in the cost increases and schedule delays in the PHC 

program, both before and after the March 2006 Parsons’ termination, and were the major reasons 

for removal of the nine PHCs. Six of the nine PHCs were not completed because explosives 

destroyed portions or all of the buildings during construction. Table 4 identifies the six PHCs 

removed from the program because of explosives and the amount of funds expended on their 

construction. The other three were removed for general concerns about security at the locations.
11

Table 4—PHCs Not Completed Because of Explosives ($ thousands)

Healthcare Center Site Identification 

Number and Location

% Physical 

Completion as 

of March 2006

Construction Cost

Parsons Additional Total

NA06-Hai Al Intisar, Ninewa 48% $506 $250 $756

DY04-Al Tahrir, Diyala 38% $87 $39 $126

AN06-Al Jazeera/Albo Ubeid, Anbar 70% $367 $0 $367

AN01-Al Hukum Al Mahalli, Anbar 51% $365 $256 $621

BK10-Al Jami'a, Baghdad 27% $73 $84 $157

DY08-Bani Sa'ad, Diyala 97% $43 $888 $931

Total $1,441 $1,517 $2,958

Source: IRMS and GRD data.

Insurgents bombed the Al Tahrir PHC before a contract to complete construction was awarded in 

July 2006. Because of the bombing, the contractor was reluctant to sign a contract but was 

assured that the contract would be amended to include any additional work. In an August 2006 

visit, GRD representatives identified substantial damage but reported that the site was 

salvageable. The next day, three improvised explosive devices detonated in the PHC caused 

additional damage. This time, the extent of damage was unknown because the area was very 

volatile and the contractor could not assess the damage.

In October 2006, the contractor notified GRD that he was unable to negotiate with the local 

sheiks and would be unable to continue at the site. GRD requested that the contractor remain on 

the site to provide security for materials valued at around $80,000. The contractor agreed and 

was paid for security services. In April 2007, the contract was terminated for convenience and 

the PHC was removed from the program. A June 2007 GRD memorandum notes that all 

measures to identify a point of contact to transfer the PHC to an Iraqi official has been exhausted 

and that no further actions will be required to close out the project.

The completion contract for the Hai Al Intisar PHC was awarded in July 2006, and, according to 

GRD, the contractor ―worked slowly, but steadily,‖ up to November 15, 2006, when insurgents

used explosives to seriously damage the structure, as shown in Figures 4 and 5.
12

Figure 4-Left Side of Bombed Hai Al Intisar PHC

Figure 5-Right Side of Bombed Hai Al Intisar PHC

Source of Figures 4 and 5: GRD contract files.

GRD was initially uncertain as to whether the PHC would be completed, but for security and 

other reasons terminated the contract for convenience. In processing the termination, GRD 

notified the contractor that based on the $278,430 paid, the contractor should have completed 

45% of the construction, but the government determined that only 13% had been completed and 

the contractor therefore owed the government $173,277. This overpayment indicates that the 
13

government was not adequately assessing physical progress as it was making performance 

payments. Additionally, the government has been unable to recover the overpayment. 

According to GRD, attempts to locate the contractor have proved unsuccessful.

Table 5 provides information about the three additional PHCs that GRD identified as being 

removed from the program for security reasons. 

Table 5—Additional PHCs Removed from the Program ($ thousands)

Healthcare Center Site Identification 

Number, Location

% Physical 

Completion as 

of March 2006

Construction Cost

Parsons Additional Total

MN04-Qadha Al Majar Al Kabeer, Missan 51% $345 $294 $639

BA05-Abdalla Hashim/Qadha' Al Madina, 

Basrah 55% $1,069 $0 $1,069

BA08-Janeena, Basrah 65% $287 $229 $516

Total $1,701 $523 $2,224

Source: GRD data.

On the PHC at Abdalla Hashim/Qadha' Al Madina (BA05), a follow-on construction contract 

was awarded in June 2006; however, the contractor was prevented access to the site by a 

previous subcontractor under the Parsons contract. The subcontractor, believing it was owed for 

work performed, threatened to attack anyone approaching the site. According to project data, 

GRD terminated the follow-on contract in March 2008 and removed the PHC from the program. 

Management Issues Continued to Impact Program

SIGIR’s earlier report1on the PHC program identified inadequate U.S. government management 

as a factor in the failure to complete PHCs as planned and addressed the need for a strong 

program management team to complete the partially constructed PHCs. Management issues 

have continued in that 

GRD drafted a management plan for the program about 6 months after critical actions 

such as assessing sites and awarding construction contracts were taken, but did not 

finalize it. 

With six program mangers in a three-year period, the program lacked management 

continuity.

Documentation of project assessments were not provided

ITAO did not have resources to fulfill oversight and coordination responsibilities.

Inaccurate program management data created questions. 

 

1 Management of the Primary Healthcare Centers Construction Projects (SIGIR-06-011, 4/29/2006)
14

Management Plan Drafted Late and Not Finalized 

GRD drafted a management plan in December 2006 to outline its progress and establish a way 

forward for the successful completion of the PHC program. The document includes a 

description of the program, its status, and an execution plan. It also identifies potential risks and 

presents risk mitigation measures. The plan describes various reporting mechanisms for the 

management of the program, including a detailed list of both internal and external reporting on 

the program. Reporting included a monthly summary on the cost to complete the program, a list 

of the 10 most critical PHCs in terms of being behind schedule, and other reports to identify 

PHCs steadily making progress and those with problems requiring resolutions. 

The December 2006 management plan was drafted after completion of some of the most critical 

early program activities, such as assessing PHCs’ status and awarding construction contracts. 

We asked GRD officials if a management plan existed prior to the December draft and whether 

the draft plan was officially implemented. GRD officials stated that their archives contained 

neither a plan drafted before December 2006 nor an officially implemented plan. GRD’s 

management of the PHCs did include some of the reporting mechanisms described in the plan, 

but some of the reports were discontinued during GRD’s construction. For instance, according 

to a GRD official, the top 10 list of PHCs in jeopardy of being behind schedule was discontinued 

after the January 6, 2007, report, but at that time, only two PHCs had been turned over to the 

Iraqi government. 

Turnover of Program Managers

In addition, the PHC program had a significant turnover of the PHC Program Manager, an 

obviously critical position of the program. In the draft plan, the Program Manager was assigned 

responsbility for overall program scope, schedule and budget, and control over changes in the 

entire program, including construction and nonconstruction aspects of the program. The 

Program Manager was also responsible for coordination with other U.S. government offices and 

consulting with and seeking support from the MoH. The plan notes that the Program Manager 

has the ―ultimate responsibility to complete the program and deliver functional and equipped 

facilites to MOH.‖ 

GRD officials informed us that the postion of Program Manager had been held by six different 

individuals. The first manager left the position in May 2006, and the next manager held the 

position for about 15 months until August 2007. Since that time, the program has had four 

managers; the latest took the position in February 2009. Although GRD officials did not 

comment on any management issues or problems related to this turnover, such turnover in a 

critical position would likely present significant continuity challenges and issues throughout the 

program.

Documentation of Assessments Not Provided

According to GRD officials, their district engineers, in accordance with contracting procedures, 

conducted site visits in the spring of 2006 to assess the extent of additional construction needed 

and to develop independent government estimates before award of construction contracts. In 

response to our request for selected site assessments, GRD officials stated that the assessments 

could not be located, and they provided no documentation on the assessments. Earlier, when 
15

SIGIR inspected selected PHCs2 and requested assessments for the sites, GRD was unable to 

provide them. Moreover, during the inspections, GRD officials had stated that those assessments 

were to be performed by the contractors. Since GRD has not provided any site assessments, we 

are unable to verify the extent to which site assessments were done and who did them. 

One contract file we examined demonstrates the importance of government assessments and 

independent government estimates. The contract for the PHC at Al Wihda/Talla'afer, Ninewa

(NA07) had been awarded for about $565,000, which seemed like a low price since the 

independent government estimate was about $100,000 more. However, contract file documents 

show that (1) the estimate was calculated with limited information and (2) the security situation 

did not allow time for a full evaluation of the work remaining. The issues surfaced at a 

preconstruction meeting when GRD discovered that the contractor had visited and bid on the 

wrong PHC. Through a series of e-mails, the contractor and the government revised and 

reviewed proposals, and a new proposal of about $881,000 was determined to be fair and 

reasonable. The new independent government estimate was about $929,000. 

For several facilities, two additional contracts were awarded to complete construction. For the 

PHC at Al Thalith, Baghdad (BR04), Parsons was paid about $387,000 for construction, and 

GRD considered the PHC 100% complete when the Parsons contract was terminated. GRD 

awarded a follow-on construction contract for $50,000 in April 2006 to complete the PHC, and 

the contract was reported complete in May 2006. However, in September 2006, another contract 

for about $30,000 was awarded. In response to our questions as to why two contracts totaling 

about $80,000 were awarded on a 100% complete PHC, GRD officials stated that both were to 

complete punch list items. However, GRD provided no assessment reports to document why the 

Parsons constructed PHC, which had been accepted as 100% complete, required additional work 

or why a second contract was needed after the first follow-on contract for about $50,000. We 

discuss similar situations in a subsequent section of this report.

ITAO Resource Shortages Limited Oversight and Coordination 

ITAO officials stated that they did not have the capacity to visit all the facilities for which they 

were responsible, including the PHCs. According to the Director, ITAO relies on GRD to 

provide status updates, and ITAO may request that the Provincial Reconstruction Teams or 

military units visit facilities if they will be in the area. ITAO and GRD held regular meetings,

including a weekly strategic-level meeting and a weekly program-level meeting, but these 

meetings covered all GRD reconstruction projects and were not specific to the PHCs or the 

health sector. ITAO officials stated that GRD did not always have readily available information 

on the current status of projects like PHCs because it relied on field personnel to provide updates 

on projects’ status. If GRD’s personnel could not easily check on the status of projects, detailed 

information was not readily available. ITAO officials said that they primarily coordinate through 

monthly cost-to-complete briefings provided by GRD, but again, the scope of these briefings 

encompasses all programs and issues. ITAO also relies on the Embassy’s Health Attaché to 

provide subject matter expertise regarding the health sector. 

 

2Heet Primary Healthcare Center Sustainment Assessment (SIGIR PA 08-133, 1/23/2009) and Haditha Primary 

Healthcare Center Sustainment Assessment (SIGIR PA 08-134, 1/28/2009).
16

GRD and ITAO officials said that they also rely on the Health Attaché for insight into the 

operational status of many of the PHCs because the office serves as the primary U.S. government 

contact with the MoH. According to the Health Attaché, however, he relies extensively on GRD 

and ITAO for information on the status of the PHCs because his office has only three people. 

The Health Attaché stated that, despite regular meetings regarding the health sector, coordinating 

with officials about work needed for the PHC program is difficult. 

In commenting on a draft of this report, GRD stated that it held weekly teleconferences with the 

District Project Managers specific to the Health program to ensure GRD had visibility over the 

status of the program and possible issues. GRD also stated it participated in teleconferences 

specific to PHCs, held by the Districts, and distributed a weekly Health Sector Update to ITAO 

and the DoS Health Attaché.

Management Data Is Inaccurate and Incomplete

One key factor in the PHC program is determining the percentage of PHCs’ completion at the 

time of contract termination and when subsequent contracts are awarded. Percentage completion 

data is contained in the Iraq Reconstruction Management System (IRMS), which was developed 

to support the Iraq reconstruction program. In a July 2008 SIGIR report3, we noted that this 

IRMS data is entered manually and does not always contain accurate and up-to-date information. 

In responding to that report, GRD officials acknowledged that IRMS is known to contain 

inconsistent and incomplete data in several areas. GRD officials also stated that the percentage 

of completion displayed in IRMS could be incorrect for several reasons, including incorrect 

estimates, typographical errors, and entries of 100% complete to indicate contract termination 

rather than actual completion. Furthermore, the draft PHC management plan noted that GRD is 

required to report ―IRMS data even though in most cases the data is suspect.‖ 

Our analyses of the percentages of PHC completions and their costs support questions about data

accuracy. For example, IRMS records for the PHC at Khaleej Al Arabi, Basrah (BA02) show 

two different percentage completions (26% and 85%) in two different records on the project. In 

discussing this discrepancy with GRD officials, they stated that they had considered the project 

57% complete after about $201,000 had been spent under the Parsons’ contract. After GRD had 

paid a follow-on contractor about $312,000 to complete the PHC, it terminated the contract for 

default. After this termination, a third contract was awarded for about $338,000, and IRMS data 

shows the project as 0% complete. Without accurate figures on the percentage of PHC 

completion, the reasonableness of the dollar amount of follow-on contracts cannot be assessed. 

A similar situation was identified with the PHC at Hai Al Hussien, Basrah (BA11), and the same 

two contractors were involved. One IRMS record identifies the Parsons project as 36% complete 

and the second identifies the Parsons project as 75% complete. For the third contract, IRMS 

identified the prior project as 0% complete. 

Our analysis of data for the completion of the PHCs identified other indicators of IRMS data 

issues, inadequate assessments, and/or construction management issues. For example, 17 PHCs 

were identified as being either 100% or 99% complete at termination in March 2006, but 

significant construction contracts totaling about $1.90 million were awarded for completing these 

 

3 Comprehensive Plan Needed to Guide the Future of the Iraq Reconstruction Management System (SIGIR-08-021, 

7/26/2008). 
17

PHCs. For 11 of the PHCs, two separate contracts were awarded to complete the PHCs. For 

example, GRD data shows that Parsons spent about $407,000 on the PHC at Al Huriya, Baghdad

(BK06) and that it was 100% complete. However, two contracts were awarded to complete 

construction of the PHC: one for about $43,000 in April 2006 and one for about $33,000 in 

August 2006. For another PHC, GRD data shows that Parsons completed 99% of the 

construction for about $319,000; however, two follow-on contracts were awarded—the first for 

about $56,000 and the second for about $208,000. Such data indicates significant assessment 

and/or construction issues.

PHCs that had a lower percentage rate of completion had similar discrepancies. For example, 

the PHC at Al Armooshiya, Salah Al-Din (SD02) was identified as 90% complete with about 

$707,000 expended. The completion contract was for about $567,000; much more than the 

$70,000 or so that might be expected. Another example is the PHC at Sarawan, Erbil (AR01), 

which was identified as 69% complete with about $359,000 expended, but about $435,000 was 

the amount of the completion contract. As noted earlier, without project assessments, we were 

unable to determine the reasons for apparent discrepancies between completion percentages and 

follow-on construction costs. 

 Validity of Geographic Data

SIGIR’s attempt to validate the location and conditions of selected PHCs highlights another 

potential IRMS data deficiency. To identify the project’s geographic location, IRMS captures 

the project’s longitude and latitude. We used these IRMS identified coordinates for satellite 

photographs to validate the location and completeness of 10 randomly selected PHCs. The 

imagery showed 4 of the 10 selected sites were empty fields. We have referred this data to GRD 

to further resolve whether the coordinates are incorrect or more serious issues exist.
18

Transfer and Sustainability Issues Place Program 

Investment at Risk

While GRD faced security and management challenges in completing construction of PHCs, it 

and ITAO faced additional challenges in transferring PHCs to the MoH. Furthermore, GRD and 

ITAO do not have accurate and complete oversight data on the number of PHCs that are open 

and operating. They and MoH are aware of operational and sustainability issues at open PHCs,

and a contract effort was undertaken in May 2008 to identify and address issues at selected 

PHCs. SIGIR’s inspection reports on four PHCs in 2008 identify significant construction and 

operational issues. GRD and ITAO officials state that they have no future plans and/or funds for 

additional U.S. government actions related to the PHCs. Difficulties in PHC transfers, 

incomplete oversight data on unopened PHCs, recognized operational and sustainability issues,

and a lack of plans or funds to address these issues leave the overall U.S. investment at risk and 

subject to waste.

Difficulties in Transfers to MoH

Although progress has been made in completing construction of the PHCs, the lack of 

coordination about the program among the U.S. government organizations and the MoH has 

affected the transfer of PHCs to the MoH. According to the Health Attaché and MoH officials, 

coordination issues about the selection of sites and contractors began early in the program. The 

Health Attaché stated that many contracts were awarded with great speed and little consultation

with the Iraqi government. (GRD, in its comment on the draft report, noted that archived 

correspondence and reports do not support this statement.) For example, he noted that the Iraqi 

Regional Director for Health was consulted about the locations of several PHCs built north of 

Baghdad, but was not consulted about whether new or rehabilitated facilities were preferred.

According to GRD officials, coordination issues hampered the transfer of some sites to the Iraqi 

government. GRD said that the transfer of PHCs to the Iraqi government involves two letters:

one signed at the local level and one signed at the national level. The local-level transfer letter is 

GRD’s responsibility, and the national-level letter is ITAO’s responsibility. GRD officials said 

that in some cases, they were ready to transfer a facility, but MoH officials were not yet ready to 

accept the facility because of limited available trained staff. According to GRD, at times, the 

MoH was unable to obtain protection service to secure the site, and as a result, GRD had to 

arrange for security at the site and the transfer was delayed. Without effective transfer, there are 

no assurances that the PHCs will be used, maintained and sustained by the MoH. SIGIR has 

issued several reports on difficulties in transfers of facilities and the latest report was issued in 

April 2009.4 SIGIR reports that unless flawed policies, plans, procedures, and accounting for the 

status of completed and turned over assets is improved, U.S. funded infrastructure projects will 

remain highly vulnerable to become wasted.

 

4 Asset-transfer Process for Iraq Reconstruction Projects Lacks Unity and Accountability (SIGIR-09-016, 

4/26/2009). 
19

GRD’s 2006 draft management plan recognizes that MoH is the end user and owner of the PHCs 

and that a smooth transfer was the key to a successful program. It states that the opening and 

operation of the facilities as well as sustainability were outside the scope of the GRD program. 

GRD states that it is only responsible for tracking the construction management of the projects 

through physical completion, local turnover to the MoH, financial and contractual closeout. 

GRD states that it is not responsible for tracking when the MoH staffs the PHC or opens it to the 

public and relies on the U.S. Embassy – Baghdad for that information.

GRD’s plan highlights the need for regular consultation with MoH officials on all aspects of the 

program and notes that the MoH at each of the Governates is responsible for accepting and 

staffing the facilities and is to be engaged throughout the projects. In our audit, MoH officials 

stated that GRD did not consult with them in designing the facilities, in selecting construction 

contractors, or in overseeing contractors during construction. As a result, they were dissatisfied 

with many facilities. MoH officials said that they would likely accept any U.S.-funded facilities, 

even if dissatisfied with the construction outcomes. 

In some cases, GRD transferred to MoH some facilities that were incomplete. GRD officials 

told us that 14 facilities—identified in Appendix C—were transferred ―as is.‖ (These 14 

facilities include 9 sites that were removed from the program after the Parsons termination.) 

They noted that construction work continued for two of the ―as is‖ facilities after transfer based 

on an agreement with MoH. For example, the Al-Atheem PHC in Diyala (DY06) was 

transferred ―as is‖ to the MoH in October 2008; however, work continued on the facility until 

February 2009. GRD officials said that they had no completion plans for the other incomplete 

PHCs transferred to the MoH and that the facilities were accepted with deficiencies. 

In addition to the transfer of incomplete facilities, GRD officials stated that five PHCs—

identified in Appendix C—were transferred to MoH unilaterally without MoH acceptance. For 

example, the transfer letter for the Al Badeer, Qadissiya PHC (DI03) states that GRD’s south 

division completed final inspection of the facility with the Diwaniyah Department of Health and 

accepted the completed facility from the contractor with intent to transfer it to the local MoH 

representative. According to the letter, GRD south made three unsuccessful attempts to obtain a 

signature from the Diwaniyah Director General of Health before writing a letter of unilateral 

transfer. 

To verify transfer data reported by GRD, SIGIR requested local and national transfer letters for 

12 selected PHCs reported as transferred. GRD was able to provide only two local transfer 

letters, while ITAO provided seven local transfer letters but did not provide any national transfer 

letters. In some cases, the letters provided conflicted with information in IRMS, GRD 

statements and reports, and ITAO status information. 

Conflicting Reports on Number of PHCs Open and Operational 

GRD and MoH have reported conflicting numbers of open and operational PHCs. A GRD 

internal report shows that 115 PHCs were open to the public as of late February 2009, with 18 

facilities turned over but not yet open to the public. However, GRD officials stated that they do 

not have visibility over the operational status of the PHCs and that the opening dates listed in 

their report are based on various sources, including communication from the MoH, news reports, 

and reports from field staff. Appendix C provides, to the extent data was available, the month 
20

and year a PHC was transferred to MoH, whether GRD identified the transfer as unilateral or as 

is, and the month and year the MoH opened the PHC. 

In response to our request, the Deputy Inspector General for the MoH stated that only 101 PHCs 

had been opened and 27 facilities had been transferred without yet being opened to the public.

Based on this report, the total number to be opened is 5 less that the 133 reported by GRD, and 

the number open to the public is 14 less than GRD reported. The Iraq Ministry of Planning

provided information on the number of transferred and opened PHCs that closely matches the

GRD numbers. 

Operations and Sustainability Uncertain

Even more significant than discrepancies in the number of PHCs opened is the status of 

operations and sustainability at the open PHCs. GRD, ITAO, and the MoH have expressed 

concerns about operational and maintenance issues at PHCs. Specifically, they question whether 

the PHCs have basic services such as electricity, water, and sewage and whether planned medical 

equipment has been provided, installed, and is operating. SIGIR’s inspections have identified 

operational and maintenance issues at four open PHCs. While all parties are concerned about

PHC operational and maintenance issues, the U.S. government does not have visibility of the 

PHCs’ status.

ITAO and GRD Contracted for Operation and Maintenance Support for PHCs 

In May 2008, GRD and ITAO contracted with Stanley Baker Hill to implement a PHC 

maintenance and operations program that can be transferred to the MoH to assist in its operating

and maintaining these facilities. The initial contract was for $7 million, but it was modified in 

September 2008 to increase the contract amount to $16.5 million. According to the statement of 

work for the contract, as PHCs were completed and turned over, it became apparent that all 

facilities were already beginning to have operational and maintenance issues. The document 

further notes that a number of the facilities have been operational for over 2 years without 

maintenance and repair contracts. According to the document, GRD saw an obvious need to 

develop a means to replace and/or repair medical and mechanical equipment that was vital to the 

effective and safe operation of the facilities. The statement of work notes that structural and/or 

construction deficiencies can be corrected by the government of Iraq in time, but the immediate 

need is for operational equipment, preventative maintenance, and capacity building in all of the 

133 U.S.-funded PHCs. 

Work under the contract includes identification, prioritization, correction, reporting, tracking, 

and management of facility and equipment deficiencies with a final report due in June 2009. 

According to GRD, as of February 2009, detailed assessments of 6 PHCs were under review, 

preliminary assessments were complete for 28, and another 16 were identified for future 

assessments. However, the number of assessments that can be completed with the available 

funds is unknown. ITAO, in its April 17, 2009, written response to our draft, stated that GRD 

reports 42 PHCs have been assessed and an additional 20 PHCs could be assessed with available 

funds. GRD has not provided us with requested documentation on the assessments that have

been completed or on plans for additional assessments. We will follow-up in an attempt to 

further verify the number of PHCs to be assessed under the existing contract
21

According to a GRD briefing chart, the preliminary assessment findings were that facilities have 

substantial issues, including a lack of critical utilities, untrained staff, and missing equipment that 

was never installed or was transferred to other sites. In addition to conducting assessments, 

GRD reported that some repair work was ongoing, including repairing water delivery systems;

electrical generators; and heating, ventilation, and air conditioning systems. Ongoing challenges 

include inadequate utility support that precluded the use of medical equipment and delivery of 

health services.

We requested documents from GRD related to the contract with Stanley Baker Hill. The 

requested documents include the complete contract, assessments of the PHCs that are ongoing, 

and lists of reported infrastructure deficiencies since transfer of facilities. At the time we 

completed our work, GRD had provided only a general statement of work for the contract and no 

other documentation. In response to our draft report, GRD provided the contract and 

modifications. 

The U.S. funded effort to address the deficiencies in the PHCs will not be sufficient to identify 

and address all the PHCs deficiencies, according to ITAO and GRD officials in March 2009. 

According to the Director of ITAO, the current contract value is not enough to complete full 

assessments of all facilities. The contract amount was not based on an assessment of PHC needs, 

but was the amount of funds available. In addition, according to the Director of ITAO and GRD 

officials, no funds or plans are available for further PHC efforts. 

MoH Reports Construction, Electrical, Mechanical, and Equipment Deficiencies 

In response to our request, the MoH stated in March 2009 that PHCs had construction, electrical, 

mechanical, and equipment deficiencies that will require reconstruction and rehabilitation. For 

example, MoH reported that roofs need to be resurfaced on all PHCs accepted, several PHCs 

have rooms or hallways with major and minor wall cracks and many fire alarm detectors do not 

work properly. They further reported that for some facilities, the generators have malfunctioned

due to extensive use during construction and that generator fuel containers were plastic and 

began to crack in harsh weather conditions. They also reported that most of the laboratory test 

tubes and x-ray film development equipment have expired and cannot be used. In addition to 

deficiencies in the construction and equipping of PHCs, MoH reports that security remains the 

main challenge for the health sector and that the sector also lacks qualified medical practitioners.

Health Attaché Identifies Operational and Maintenance Issues

Current and former Health Attaché officials said that during visits to selected PHCs over the past 

18 months, they had identified construction and equipment deficiencies. During all visits, they

identified issues with the construction materials used and contractors’ performance. They also 

reported that equipment was not installed or not operating and that in some cases, electricity, 

water, and/or sewage were not connected. In general, they stated that neither the construction 

nor the materials were to the standards expected and that the facilities did not make a good 

presentation of a U.S.-funded and managed construction project.

In relation to electricity at the PHCs, ITAO reported, as of March 2008, that 76 facilities were 

receiving power off the grid, 4 were awaiting connection, 31 were operating off generators, and 

24 were either under construction or the status was unknown. While we did not identify any 
22

later status report, a November 2008 ITAO memorandum states that connecting the PHCs to the 

grid remains the biggest challenge. In planning for PHC completion, the Health Attaché, GRD,

and the MoH agreed that GRD would be responsible for extending electrical, water, and sewer 

connections no further than 25 meters from the PHC and that the MoH would be responsible for 

coordinating, funding, installing, and connecting the remainder. According to the ITAO 

memorandum, the MoH has not consistently been able to arrange for its portion with Iraq’s 

Ministry of Electricity. In comments about a visit to a Baghdad PHC, the Health Attaché said

that although the PHC was in an area with electricity, it was not connected to the grid and was 

operating with generators provided for emergency use.

SIGIR Inspection Reports Identify Construction and Equipment Deficiencies 

SIGIR recently reported on its inspections of four PHCs5—Heet (AN05), Haditha (AN07), 

Shiqaq Hai Musalla (KE02), and Hai Tiseen (KE03)— and noted such problems as lack of 

documentation on required GRD inspections and identified deficiencies that contractors had not 

corrected before turnover of the PHCs to the MoH. These deficiencies included damaged airconditioning units, interior water leaks, poorly insulated duct work, and problems with plumbing. 

According to one turnover document, the final inspection by GRD noted that it found ―no new 

deficiencies‖ from the pre-final inspection and that all previously identified deficiencies had 

been corrected. However, SIGIRs inspection disputed this statement. 

Further, during site visits, SIGIR determined that some medical equipment delivered to the PHCs 

as early as February 2008 was either not connected or not operating. For example, the Heet PHC 

reverse osmosis unit was still in a crate outside the facility and the dental chair was not 

connected in the dental room. The Haditha PHC x-ray equipment for the medical and dental 

units was not connected due to inadequate electrical connections, and the PHC did not have a 

reverse osmosis unit. Both of these PHCs were connected to the national grid and back-up 

generators were installed. However, the Heet and Haditha PHCs’ automatic transfer switch for 

the large generator did not work. 

SIGIR identified other construction deficiencies, such as damaged heating, ventilation, and air 

conditioning units; plumbing problems in the bathrooms and the sewer system; non-functioning 

hot-water heaters; exterior surface cracks; and low-quality door hardware and windows. GRD 

recognized that, in many cases, the companies awarded the contract to complete the PHCs did 

not properly install the medical equipment or train the PHC personnel on the use of the 

equipment. In addition, once the U.S. government turned over the facilities to the Iraqi 

ministries, little preventive maintenance was performed for items such as generators. 

Consequently, the facilities and equipment were failing at a rate much faster than expected if 

preventive maintenance was being performed. 

 

5Heet Primary Healthcare Center Sustainment Assessment (SIGIR PA 08-133, 1/23/2009); Haditha Primary 

Healthcare Center Sustainment Assessment (SIGIR PA 08-134, 1/28/2009); Shiqaq Hai Musalla Primary 

Healthcare Sustainment Assessment (SIGIR PA 08-157, 4/13/2009); Hai Tiseen Primary Healthcare Center 

Sustainment Assessment (SIGIR PA 08-158, 4/16/2009).
23

No Plans for Continued U.S. Government Role and Responsibilities 

for PHC Program 

Both GRD and ITAO have expressed concerns and taken some action to address PHC 

operational and sustainability issues; however, officials of both organizations state that they have

no plans or funds for further involvement with the PHCs. GRD officials informed us that they 

have no responsibility for a PHC once it is transferred to the MoH. GRD stated that it is only 

responsible for executing the program funded by its customer, in this case, ITAO. It added that 

recommendations had been made to ITAO toward the obligation of additional funding to support 

further assessments, training, and operations and maintenance services. 
24

Conclusions and Recommendations

Conclusions

U.S. funds and GRD’s and ITAO’s management have furnished the Iraq MoH with PHCs that 

are expected to provide medical care to more than 4 million Iraqis throughout the country. This 

has been accomplished despite serious security conditions such as the bombing of facilities. 

However, GRD and ITAO have not provided sufficient accountability and transparency on 

current PHC program status. Reports showing 133 PHCs having been completed and transferred 

are not complete and accurate. Questions about the completeness of the PHCs relate to far more 

than those few transferred ―as is.‖ 

Millions of dollars were spent to (1) finish construction, (2) deliver and install medical and office 

equipment and consumables, and (3) train Iraqis on PHC equipment. However, some or all of 

these actions were not completed for a significant number of PHCs. ITAO’s and GRD’s limited 

contract effort to assess PHC status is based on funds available, not the amount needed. Further, 

neither has identified plans and/or funds for additional assessments and/or completion work for 

PHCs. 

The U.S. government’s future role regarding the PHCs in Iraq requires a policy decision; 

however, the U.S. government has not developed the information essential for making that 

decision. A lack of further management attention by the U.S. government and the Government 

of Iraq to address the PHCs’ sustainability, operation, and maintenance issues places a 

substantial portion of the U.S. investment in the program at risk of being wasted. 

Recommendations

SIGIR recommends that the U.S. Ambassador and the Commanding General, Multi-National 

Forces-Iraq, jointly direct a U.S. government study—obtaining the Government of Iraq’s 

participation and/or input to the extent possible—to:

1. Provide transparency on the current status of PHCs and assess the cost and benefits of 

potential actions to address identified PHC operational and sustainability problems.

2. Identify actions the U.S. government could undertake to help ensure that the benefits 

expected from the PHC program are realized and the investment will not be wasted. 

Management Comments and Audit Response

In preparing this report, SIGIR considered written comments from ITAO and GRD. Their 

complete comments are included in Appendix F.

The Director of ITAO, on April 17, 2009, commented that the Embassy concurs with the 

recommendations and is working to implement them. ITAO states that the ongoing contract with 

Stanley Baker Hill will help to identify, prioritize, correct, report, track, and manage facility and 

equipment deficiencies. ITAO states that its goal is not to assume a long term role in or 
25

responsibility for the assets provided to the Government of Iraq. To that end, it notes the shift 

from reconstruction to boosting the capacity of Iraqis to exercise ownership, control, and 

operations of the assets-based infrastructure the U.S. government has contributed. It further 

comments that assessments of near half of the PHC will provide transparency on the status of the 

facilities and equipment and the information needed to calculate potential operational and 

sustainability concerns.

We agree that ongoing assessments will help. However, questions remain as to the number of 

PHCs that will be assessed under the existing contract. ITAO noted that, according to GRD, 42 

PHCs have been assessed and funding on the contract will permit an additional 20 PHCs to be 

assessed. During our audit work, GRD provided different numbers for PHCs that had been and 

would be assessed, but did not provide documentation on completed assessments or on additional 

assessments that could be completed with the existing funds. We plan follow up to further verify 

the number of PHCs that has been and will be assessed under the existing contract. However, 

assessments of about 50% of the PHCs would be a significant step toward providing 

accountability and transparency to PHC program status. 

The Commanding General sent GRD’s comments on April 20, 2009. GRD’s comments did not 

address the recommendations but stated a disagreement with the ―basic assumption that GRD 

and ITAO failed.‖ In addition, GRD stated that the draft report did not fully highlight the 

difference in responsibilities between GRD, ITAO, and the Health Attaché. GRD also disagreed 

with other statements in the report and provided 31 specific comments on the draft report. A 

number of these comments related to a clarification of GRD’s responsibilities with regard to the 

PHC program. GRD emphasized that it is only responsible for tracking the construction 

management of the projects through physical completion, local turnover to the MoH, and 

financial and contractual closeout.

GRD’s comments regarding its responsibilities highlight the lack of an integrated management 

structure for contingency reconstruction programs, such as the PHCs, and serve to reinforce our 

overall conclusion regarding the need for additional program integration and overall 

accountability.

We believe the information in the draft report is accurate. However, we have revised or deleted 

some statements based on GRD’s comments to improve final report accuracy. Regarding GRD’s 

overall comment, SIGIR did not conclude that GRD and ITAO failed. The first sentence of the 

Results in the Executive Summary states that ―GRD completed construction of PHCs despite 

very poor security, which included bombing of facilities‖ and note that the facilities will provide 

outpatient treatments to over 4 million Iraqis annually. Further, the draft report addressed the 

responsibilities of GRD, ITAO, and the Health Attaché in the Introduction section and in various 

subsequent sections when relevant to the subject discussed. For example in the section on MoH 

transfers, we noted that the GRD management plan stated that the opening and operation of the 

facilities as well as sustainability were outside the scope of the GRD program. However, we 

have added GRD’s language as appropriate to clarify its stated responsibilities.

SIGIR’s responses to GRD’s individual comments are presented on a comment by comment 

basis in Appendix F of the report. These comments identify the changes SIGIR made in 

finalizing this report.
26

Appendix A—Scope and Methodology

To determine the costs and outcomes of U.S.-funded efforts to complete the partially constructed 

PHCs, we contacted officials from GRD, ITAO, and MoH. We discussed and obtained 

documentation and data about the plans, programs, and activities involved in completing the 

PHC program. Also, we collected contract and financial data from several databases, including 

the Iraq Reconstruction Management System (IRMS) and the U.S. Army Corps of Engineers’

Financial Management System (CEFMS). 

IRMS is the reporting database for reconstruction projects by U.S. agencies operating in 

Iraq. Although it provides the most complete data available on projects, both SIGIR and 

GRD have previously expressed concerns about the accuracy and completeness of its 

data.

CEFMS is an automated financial management system that is intended to provide timely, 

accurate, and comprehensive financial information for all levels of management, 

especially at the program and project management level, through interface with other 

information system programs. 

SIGIR had direct access to data in IRMS and CEFMS and used this access to identify obligation, 

expenditure, and completion data on PHC construction projects. If significant differences in data 

between the systems were identified, we followed up with GRD officials to reconcile the 

differences. Differences that could not be explained are identified in the report. 

After we obtained basic data on the partially constructed PHCs, we judgmentally selected 

individual PHCs for further review if available data indicated that a PHC encountered potential 

problems in completion, such as a high total construction cost, terminations of contracts, and 

more than one contractor to complete a project. Because many of GRD’s project files were 

located throughout Iraq and not easily accessible, the number of project files SIGIR selected for 

review and obtained from GRD was limited. We requested contract files on 7 PHCs from GRD 

and received partial files on 3 of those selected projects. During our work, we obtained data 

from a few PHC contract files that SIGIR had obtained during other audits. Also, GRD provided 

partial files on other PHCs. 

SIGIR performed this audit under the authority of Public Law 108-106, as amended, which 

incorporates the duties and responsibilities of inspectors general under the Inspector General Act

of 1978, as amended. The audit was conducted between December 2008 and April 2009 in 

accordance with generally accepted government auditing standards. Those standards require that 

SIGIR plan and perform the audit to obtain sufficient, appropriate evidence to provide a 

reasonable basis for our findings and conclusions based on our audit objectives. SIGIR believes 

that the evidence obtained provides a reasonable basis for our findings and conclusions based on 

our audit objectives. 
27

Use of Computer-Processed Data

To perform this audit, SIGIR used data taken from IRMS and CEFMS. We examined computerprocessed data contained in these databases to identify, verify, and crosscheck information on the 

PHC projects. As noted in this and in previous SIGIR reports, issues have been identified about 

the completeness and accuracy of IRMS data. For purposes of this review, we relied greatly on 

the IRMS data system because it contained the most complete data on PHC projects. However, 

to the extent possible, this data was crosschecked with CEFMS data and financial and 

management information from individual project and contract files. The report fully discusses 

the limitations we noted with the data from these systems. We believe these steps provide 

assurances that the data presented in this report is reasonable for the purposes for which it is 

used. 

Internal Controls

We reviewed the specific controls used in managing and administering the PHC program. 

Specifically, we reviewed the plans established for the program and the management controls 

related to contract award, contract oversight, installation of PHC equipment, and the turnover of 

completed PHCs to the MoH. Since constructing and equipping the PHCs was largely complete 

at the time of our audit, we did not monitor progress on these activities. Further, we did not 

observe the completed PHCs. We also identified various instances where specific records and 

documents related to the completion and transfer of PHCs were not available. Thus, we relied on 

available reports, site photographs, transfer documents, and discussions with government 

officials for insight on the completion of PHCs.

Prior Coverage

We reviewed the following reports and relied on them in conducting this audit:

Iraq Reconstruction Project Terminations Represent a Range of Actions

(SIGIR-09-004, 10/27/2008)

Comprehensive Plan Needed to Guide the Future of the Iraq Reconstruction 

Management System (SIGIR-08-021, 7/26/2008)

Review of Outcome, Cost, and Oversight of Iraq Reconstruction Contract, W914NS-04-

D-006 (SIGIR-08-010, 1/28/2008)

Status of Medical Equipment and Other Non-construction Items Purchased for Primary 

Healthcare Centers (SIGIR-06-030, 1/30/2007)

Review of the Medical Equipment Purchased for the Primary Healthcare Centers 

Associated with Parsons Global Services, Inc., Contract Number W914NS-04-D-0006

(SIGIR-06-025, 7/28/2006) 

Management of the Primary Healthcare Centers Construction Projects 

(SIGIR-06-011, 4/29/2006)
28

Interim Audit Report on the Review of Equipment Purchased for Primary Healthcare 

Centers Associated with Parsons Global Services, Contract Number 

W914NS-04-D-0006 (SIGIR-06-016, 4/4/2006) 
29

Appendix B—Total Construction Cost of PHCs 

($ thousands)

Healthcare Center Site Identification 

Number, Location, and Province

% Physical 

Completion as 

of March 2006

Construction Cost

Parsons Additional Total

103 TYPE A (MODEL CENTER)

BK06-Al Huriya, Baghdad 100% $407 $76 $483

BR08-Al Mashtal, Baghdad 100% $211 $74 $285

BR04-Al Thalith, Madinat Al Sadr, Sector 46, 

Baghdad 100% $387 $80 $467

BR05-Al Guyara Sector 56, Baghdad 99% $281 $52 $333

BR10-Al Husseniya, Baghdad 99% $256 $37 $293

BK11-Al Rasheed, Baghdad 99% $260 $129 $389

BK08-Al Tahaddi, Baghdad 99% $296 $30 $326

SD08-Al Tooz, Salah Al-Din 99% $673 $64 $737

NA05-Al Nahrawan, Ninawa 99% $825 $99 $924

SD05-Tikrit, Salah Al-Din 99% $823 $119 $942

BK14-Al Noor, Baghdad 99% $319 $264 $583

BR14-Al Sha'ab 1, Baghdad 99% $245 $129 $374

BR13-Hai Babil, Baghdad 99% $312 $180 $492

WA07-Qadha' Al Aziziya, Wassit 99% $628 $21 $649

BK09-Al Salam, Baghdad 99% $319 $154 $473

BR02-14 Tammooz, Baghdad 99% $302 $165 $467

AN02-Al Falluja/Al Hfefi, Anbar 96% $175 $65 $240

DY10-Nahrawan, Diyala 90% $363 $127 $490

SD03-Al Razi/Tikrit, Salah Al-Din 90% $697 $168 $865

SD02-Al Armooshiya, Salah Al-Din 90% $707 $567 $1,274

SD01-Ibn Rushid, Salah Al-Din 89% $754 $162 $916

BK03-Al Mahmoudiya, Baghdad 87% $260 $114 $374

BK02-Al I'lam, Baghdad 87% $381 $316 $697

BR03-Al Ameen, Baghdad 85% $255 $159 $414

SD07-Beji, Salah Al-Din 85% $649 $191 $840

SD06-Al Sharqat / Hajeel Al Kabeer, Salah AlDin 85% $571 $392 $963

BR11-Al Thani, Madinat Al Sadr Sector 29, 

Baghdad 85% $408 $179 $587

BA02-Al Khaleej Al Arabi, Basrah 85% $201 $650 $851

NF01-Hai Kinda, Najaf 83% $557 $166 $723

BR17-Al Sha'ab 2, Baghdad 82% $333 $246 $579
30

Healthcare Center Site Identification 

Number, Location, and Province

% Physical 

Completion as 

of March 2006

Construction Cost

Parsons Additional Total

NF06-Hai Al Jam'Ia (Near Uroba), Najaf 82% $484 $141 $625

BK01-Al Hadhar, Baghdad 81% $121 $27 $148

NA09-Hai Nablus, Ninewa 81% $618 $392 $1,010

BB02-Hai Al Imam, Babylon 78% $420 $202 $622

BR16-Hai Ur, Baghdad 76% $382 $150 $532

NA10-Al Mahallabiya, Ninewa 76% $785 $426 $1,211

DK02-Bahdeenan, Dahuk 75% $926 $304 $1,230

BA11-Hai Al Hussien, Basrah 75% $258 $590 $848

KE02-Shiqaq Hai Musalla, Tameem 70% $315 $303 $618

SU05-Halabjay Taza, Sulaymaniyah 70% $597 $400 $997

AN06-Al Jazeera/Albo Ubeid, Anbar 70% $367 $0 $367

AR01-Sarawran, Erbil 69% $359 $435 $794

SU04-Khormal, Sulaymaniyah 68% $554 $385 $939

SU06-Ashti Koyseneeq, Sulamaniyah 68% $357 $414 $771

SU02-Qalawa, Sulaymaniyah 68% $567 $421 $988

BK15-Al Washhash, Baghdad 67% $237 $377 $614

KE01-Hai Alhajjaj, Tameem 67% $320 $374 $694

AR04-Ainkawa, Erbil 66% $513 $486 $999

KR01-Al Haidariya (Hai Al Askari), Kerbala 65% $808 $265 $1,073

WA01-Hai Al Shuhada', Wassit 65% $679 $291 $970

WA06-Hai Al Jamaheer, Wassit 65% $614 $308 $922

SU03-Cham Chamal, Sulaymaniyah 65% $554 $453 $1,007

BA08-Janeena, Basrah 65% $287 $229 $516

BR01-Al Sadis Sector 72, Baghdad 64% $306 $463 $769

KE05-Hai Alasra Wa Al Mafqoodeen, Tameem 64% $299 $454 $753

WA03-Al Kut (Zayn Al Qaws), Wassit 63% $669 $301 $970

KE04-Hai Al Wasity, Tameem 63% $256 $331 $587

BB06-Al Hadi, Babylon 62% $381 $250 $631

AR06-Qaraqejeen, Erbil 62% $466 $463 $929

AR05-Hanjeerok, Erbil 62% $557 $508 $1,065

AN05-Heet/Hai Al Bakr, Anbar 60% $198 $412 $610

BA10-Al Mishraq, Basrah 59% $206 $331 $537

BB04-Al Midhatiya, Babylon 58% $391 $317 $708

AR07-Harem, Erbil 58% $581 $546 $1,127

KR06-Hai Al Asra, Kerbala 57% $412 $302 $714

BA01-Al Aqeel/Qadha' Al Zubair, Basrah 56% $231 $421 $652

BA09-Hai Al Muhandiseen, Basrah 56% $234 $356 $590
31

Healthcare Center Site Identification 

Number, Location, and Province

% Physical 

Completion as 

of March 2006

Construction Cost

Parsons Additional Total

BA03-Al Qurna, Basrah 56% $529 $523 $1,052

BR19-Al Sabi', Madinat Al Sadr Sector 15, 

Baghdad 55% $371 $438 $809

DY02-Al Khalis, Diyala 55% $59 $532 $591

BR07-Al Karrada Al Awal, Baghdad 55% $285 $363 $648

BA07-Al Risala, Basrah 55% $266 $454 $720

WA02-Qadha' Badra, Wassit 54% $459 $317 $776

BB03-Al Qasim, Babylon 52% $329 $295 $624

MN04-Qadha' Al Majar Al Kabeer, Missan 51% $345 $294 $639

KR07-Ayn Tamr, Kerbala 50% $397 $350 $747

AN04-Qadha'rama, Anbar 50% $214 $502 $716

SD09-Al Door, Salah Al-Din 49% $683 $539 $1,222

NA06-Hai Al Intisar, Ninewa 48% $506 $250 $756

MN02-Hai Al Nida', Missan 48% $459 $337 $796

BB07-Al Kifil, Babylon 47% $394 $377 $771

MU03-Qadha' Al Khidhir, Muthanna 46% $575 $389 $964

BB05-Al Mahaweel, Babylon 45% $429 $386 $815

BA06-Al Zahrawi/Nahiat Um Qasr, Basrah 44% $322 $504 $826

NF02-Hai Al Meelad, Najaf 42% $267 $352 $619

KR05-Qadha'Al Hinidiya Sayid Husseon Al 

Janib Al Kabeer, Kerbala 42% $571 $425 $996

BR06-Al Awal Al Mad'in, Baghdad 40% $158 $844 $1,002

AN07-Hadeetha, Anbar 40% $117 $538 $655

KR03-Qadha' Al Hindiya, Kerbala 38% $613 $460 $1,073

DY04-Al Tahrir, Diyala 38% $87 $39 $126

NF05-Hai Al Askari Near Al Wafa', Najaf 36% $221 $459 $680

DI05-Hai Al Wihda, Qadissiya 36% $487 $431 $918

TQ03-Qal'at Sukkar, Thi-Qar 34% $304 $403 $707

DI04-Al Shannafiya, Al Qadissiya 33% $452 $451 $903

DY03-Jalowla', Diyala 30% $73 $790 $863

TQ06-Al Rifa'ee, Thi-Qar 28% $262 $448 $710

TQ08-Al Nasr, Thi-Qar 27% $393 $508 $901

TQ01-Suq Al Shyookh/Al Zahra, Thi-Qar 27% $335 $405 $740

TQ05-Al Duwaya, Thi-Qar 26% $195 $438 $633

TQ04-Al Gharraf, Thi-Qar 24% $289 $508 $797

TQ02-Sayyid Dakheel Al Moosawi, Thi-Qar 24% $182 $515 $697

NA08-Hai Mansoor, Ninewa 23% $670 $818 $1,488

NA07-Al Wihda/Talla'afer, Ninewa 17% $475 $1,069 $1,544
32

Healthcare Center Site Identification 

Number, Location, and Province

% Physical 

Completion as 

of March 2006

Construction Cost

Parsons Additional Total

20 TYPE B (MODEL CENTER with TEACHING FACILITIES)

BK05-Al Hibna, Baghdad 99% $317 $227 $544

BR18-Shaikh Omar, Baghdad 85% $161 $275 $436

DK03-Barzan, Dahuk 75% $806 $341 $1,147

AR03-Brayeti, Erbil 72% $489 $413 $902

BB01-Hai Al Asatiha, Babylon 71% $492 $217 $709

WA04-Al Haidariya, Wassit 71% $883 $119 $1,002

NA02-17 Tammooz, Ninewa 65% $660 $486 $1,146

KR02-Hai Al Wafa', Kerbala 58% $610 $346 $956

BR12-Family Medicine, Al Thubbat, Baghdad 57% $305 $721 $1,026

BA04-Mawkee Kul Yat Al Tib Al Kadema, 

Basrah 56% $240 $482 $722

KE03-Hai Tiseen, Tameem 54% $280 $463 $743

AN01-Al Hukum Al Mahalli, Anbar 51% $365 $256 $621

MN01-Door Al Naft, Missan 44% $469 $362 $831

MU01-Hai Al Husein, Al Muthanna 39% $329 $427 $756

NF04-Hai Al Adala, (New Per DG), Najaf 38% $283 $454 $737

DI02-Al Jadida, Qadissiya 38% $592 $476 $1,068

BK10-Al Jami'a/Family Medicine, Baghdad 27% $73 $84 $157

TQ07-Somer, Thi-Qar 17% $153 $719 $872

DY07-Hai Al Mustafa, Diyala 12% $152 $510 $662

SU07-Sirchanar, Sulaymaniyah ??? $592 $797 $1,389

19 TYPE C (MODEL CENTERS with EMERGENCY AND LABOR FACILITIES)

DY08-Bani Sa'ad, Diyala 97% $43 $888 $931

NA03-Zummar, Ninewa 92% $1,288 $486 $1,774

NA01-Al Qosh, Ninewa 77% $578 $442 $1,020

DK01-Sameel, Dahuk 71% $1,146 $432 $1,578

BR09-Jisir Diyala, Baghdad 67% $386 $509 $895

AR02-Bnaslawa, Erbil 61% $734 $862 $1,596

BA05-Abdalla Hashim/Qadha' Al Madina, 

Basrah 55% $1,069 $0 $1,069

KR04-Qadha'al Hindiya Al Khayrat, Kerbala 52% $988 $595 $1,583

AN03-Al Falluja/Al Karma, Anbar 50% $428 $766 $1,194

DY09-Al Mansooriya, Diyala 44% $313 $836 $1,149

BK04-Khan Dhari, Baghdad 40% $381 $483 $864

MN03-Qadha' Ali Al Sharji, Missan 32% $922 $690 $1,612

DI03-Al Badeer, Qadissiya 30% $816 $592 $1,408
33

Healthcare Center Site Identification 

Number, Location, and Province

% Physical 

Completion as 

of March 2006

Construction Cost

Parsons Additional Total

WA05-Sheikh Sa'ad, Wassit 30% $507 $569 $1,076

DI01-Ghammas, Qadissiya 26% $786 $572 $1,358

MU02-Al Warka', Muthanna 19% $319 $1,133 $1,452

NF03-Suq Sha'alan, Najaf 17% $484 $868 $1,352

DY05-Al Wajihiya, Diyala 15% $0 $1,217 $1,217

DY06-Al Atheem, Diyala 9% $89 $1,691 $1,780

Total Construction Costs $60,8596

$56,809 $117,668

Source: Physical completion data is from IRMS and construction cost data was provided by GRD. The additional construction 

cost was validated against contract data in CEFMS, and if significant differences existed between the GRD provided data and the 

CEFMS data, we report the official accounting data from CEFMS.

 

6 Although the Parsons construction cost provided by GRD for each of the 142 PHCs adds to $61 million, the 

financial records in CEFMS shows that $84 million is obligated for Parsons’ PHC construction task order as of 

March 2009. We use this more reliable financial data for total Parsons construction cost. 
34

Appendix C—Reported Dates of Transfer to MoH and 

Dates PHCs Opened7

Healthcare Center Site Identification 

Number, Location, and Province

Month and Year 

Transferred to 

MoH

Identified as a

Unilateral or

As Is Transfer

Month and 

Year Opened

103 TYPE A (MODEL CENTER)

BK06-Al Huriya, Baghdad Unknown Unknown

BR08-Al Mashtal, Baghdad Unknown Unknown

BR04-Al Thalith, Madinat Al Sadr, Sector 46, 

Baghdad May 2006

BR05-Al Guyara Sector 56, Baghdad Unknown Unknown

BR10-Al Husseniya, Baghdad Unknown Unknown

BK11-Al Rasheed, Baghdad Dec 2007 Not open

BK08-Al Tahaddi, Baghdad Oct 2008 Unknown

SD08-Al Tooz, Salah Al-Din Dec 2006 Unknown

NA05-Al Nahrawan, Ninewa Sep 2007 Unknown

SD05-Tikrit, Salah Al-Din Feb 2007 Unknown

BK14-Al Noor, Baghdad May 2007 Mar 2008

BR14-Al Sha'ab 1, Baghdad May 2007 Unilateral Feb 2008

BR13-Hai Babil, Baghdad May 2007 Unknown

WA07-Qadha' Al Aziziya, Wassit Sep 2006 Unknown

BK09-Al Salam, Baghdad Aug 2008 Aug 2008

BR02-14 Tammooz, Baghdad May 2007 Jul 2008

AN02-Al Falluja/Al JghefiI, Anbar Jul 2007 Unknown

DY10-Nahrawan, Diyala Mar 2007 Apr 2008

SD03-Al Razi/Tikrit, Salah Al-Din Mar 2008 Unknown

SD01-Ibn Rushid, Salah Al-Din Mar 2008 Unknown

BK03-Al Mahmoudiya, Baghdad May 2007 Mar 2008

BK02-Al I'lam, Baghdad Jul 2008 Jul 2008

BR03-Al Ameen, Baghdad Jul 2007 Unknown

SD07-Beji, Salah Al-Din May 2007 Sep 2007

SD06-Al Sharqat / Hajeel Al Kabeer, Salah AlDin Oct 2008 Oct 2008

BR11-Al Thani, Madinat Al Sadr Sector 29, 

Baghdad Dec 2007 Feb 2008

BA02-Al Khaleej Al Arabi, Basrah Oct 2008 Oct 2008

 

7 GRD provides the dates and other data in this Appendix and in most cases, the dates and data were not verified 

against source documents, as noted in the report. 
35

Healthcare Center Site Identification 

Number, Location, and Province

Month and Year 

Transferred to 

MoH

Identified as a

Unilateral or

As Is Transfer

Month and 

Year Opened

NF01-Hai Kinda, Najaf Jan 2007 Unknown

BR17-Al Sha'ab 2, Baghdad Sep 2007 Feb 2008

NF06-Hai Al Jam'Ia (Near Uroba), Najaf Jan 2007 Unknown

BK01-Al Hadhar, Baghdad Not Completed As Is Not open

NA09-Hai Nablus, Ninewa Apr 2007 Feb 2008

SD02-Al Armooshiya, Salah Al-Din Sep 2008 Not open

BB02-Hai Al Imam, Babylon Apr 2008 Feb 2008

BR16-Hai Ur, Baghdad May 2007 Unknown

NA10-Al Mahallabiya, Ninewa Apr 2007 Not open

DK02-Bahdeenan, Dahuk Jul 2007 Oct 2007

BA11-Hai Al Hussien, Basrah Sep 2008 Nov 2008

KE02-Shiqaq Hai Musalla, Tameem Jul 2007 Unknown

SU05-Halabjay Taza, Sulaymaniyah Jun 2007 Nov 2007

AN06-Al Jazeera/Albo Ubeid, Anbar Not Completed/

Destroyed As Is

AR01-Sarawran, Erbil Sep 2007 Oct 2007

SU04-Khormal, Sulaymaniyah Aug 2007 Dec 2007

SU06-Ashti Koyseneeq, Sulaymaniyah Jul 2007 Dec 2007

SU02-Qalawa, Sulaymaniyah Nov 2007 Mar 2008

BK15-Al Washhash, Baghdad May 2007 Mar 2008

KE01-Hai Alhajjaj, Tameem Aug 2007 Jan 2008

AR04-Ainkawa, Erbil Sep 2007 Feb 2008

KR01-Al Haidariya (Hai Al Askari), Kerbala May 2008 Jul 2008

WA01-Hai Al Shuhada', Wassit Jul 2007 Mar 2008

WA06-Hai Al Jamaheer, Wassit Sep 2008 Sep 2008

SU03-Cham Chamal, Sulaymaniyah May 2007 Feb 2008

BA08-Janeena, Basrah Not Completed/

Mar 2008 As Is

BR01-Al Sadis Sector 72, Baghdad Oct 2007 Unknown

KE05-Hai Alasra Wa Al Mafqoodeen, Tameem Jul 2007 Jan 2008

WA03-Al Kut (Zayn Al Qaws), Wassit Jul 2007 Mar 2008

KE04-Hai Al Wasity, Tameem Jul 2007 Unknown

BB06-Al Hadi, Babylon Nov 2007 Dec 2007

AR06-Qaraqejeen, Erbil Sep 2007 Feb 2008

AR05-Hanjeerok, Erbil Sep 2007 Oct 2007

AN05-Heet/Hai Al Bakr, Anbar Jul 2008 Aug 2008

BA10-Al Mishraq, Basrah Aug 2007 Sep 2007

BB04-Al Midhatiya, Babylon May 2008 Sep 2008
36

Healthcare Center Site Identification 

Number, Location, and Province

Month and Year 

Transferred to 

MoH

Identified as a

Unilateral or

As Is Transfer

Month and 

Year Opened

AR07-Harem, Erbil Sep 2007 Feb 2008

KR06-Hai Al Asra, Kerbala May 2007 Jan 2008

BA01-Al Aqeel/Qadha' Al Zubair, Basrah Jun 2007 Sep 2007

BA09-Hai Al Muhandiseen, Basrah Jun 2008 Jul 2008

BA03-Al Qurna, Basrah Jun 2007 Jun 2008

BR19-Al Sabi', Madinat Al Sadr Sector 15, 

Baghdad Nov 2007 Feb 2008

DY02-Al Khalis, Dahuk Jun 2008 Nov 2008

BR07-Al Karrada Al Awal, Baghdad Oct 2007 Dec 2007

BA07-Al Risala, Basrah Jul 2007 Dec 2007

WA02-Qadha' Badra, Wassit Nov 2007 Mar 2008

BB03-Al Qasim, Babylon Jan 2008 Jul 2008

MN04-Qadha' Al Majar Al Kabeer, Missan Not Completed As Is

KR07-Ayn Tamr, Kerbala Jun 2008 Jul 2008

AN04-Qadha'rama, Anbar Not Completed 

Sep 2008 Not open

SD09-Al Door, Salah Al-Din Feb 2008 Jul 2008

NA06-Hai Al Intisar, Ninewa

Not Completed/

Destroyed

Jul 2008

As Is

MN02-Hai Al Nida', Missan Jul 2007 Mar 2008

BB07-Al Kifil, Babylon Jul 2008 Oct 2008

MU03-Qadha' Al Khidhir, Muthanna Aug 2007 Mar 2008

BB05-Al Mahaweel, Babylon Jan 2008 Jan 2008

BA06-Al Zahrawi/Nahiat Um Qasr, Basrah Sep 2008 Not open

NF02-Hai Al Meelad, Najaf Jan 2008 Jan 2008

KR05-Qadha'Al Hinidiya Sayid Husseon Al 

Janib Al Kabeer, Kerbala Jul 2008 Jul 2008

BR06-Al Awal Al Mad'in, Baghdad May 2008 Sep 2008

AN07-Hadeetha, Anbar Jul 2008 Jul 2008

KR03-Qadha' Al Hindiya, Kerbala Jul 2008 Aug 2008

DY04-Al Tahrir, Diyala

Not Completed/

Destroyed

Jun 2007

As Is

NF05-Hai Al Askari Near Al Wafa', Najaf Nov 2007 Feb 2008

DI05-Hai Al Wihda, Qadissiya May 2008 Unilateral Jun 2008

TQ03-Qal'at Sukkar, Thi Qar Feb 2008 Aug 2008

DI04-Al Shannafiya, Qadissiya Jun 2008 Unilateral Jul 2008

DY03-Jalowla', Diyala Jan 2008 Not open
37

Healthcare Center Site Identification 

Number, Location, and Province

Month and Year 

Transferred to 

MoH

Identified as a

Unilateral or

As Is Transfer

Month and 

Year Opened

TQ06-Al Rifa'ee, Thi-Qar Aug 2008 As Is Not open

TQ08-Al Nasr, Thi-Qar Sep 2008 Not open

TQ01-Suq Al Shyookh/Al Zahra, Thi-Qar Feb 2008 Aug 2008

TQ05-Al Duwaya, Thi-Qar Aug 2008 As Is Not open

TQ04-Al Gharraf, Thi-Qar Sep 2008 Not open

TQ02-Sayyid Dakheel Al Moosawi, Thi-Qar Sep 2008 Not open

NA08-Hai Mansoor, Ninewa Apr 2008 Oct 2008

NA07-Al Wihda/Talla'afer, Ninewa Jun 2008 Not open

20 TYPE B (MODEL CENTER with TEACHING FACILITIES)

BK05-Al Hibna, Baghdad Jun 2007 Unknown

BR18-Shaikh Omar, Baghdad Sep 2007 Feb 2008

DK03-Barzan, Dahuk Jul 2007 Nov 2007

AR03-Brayeti, Erbil Sep 2007 Nov 2008

BB01-Hai Al Asatiha, Babylon Mar 2008 April 2008

WA04-Al Haidariya, Wassit Apr 2007 Unknown

NA02-17 Tammooz, Ninewa Jul 2007 Mar 2008

KR02-Hai Al Wafa', Kerbala Jul 2008 Jul 2008

BR12-Family Medicine, Al Thubbat, Baghdad Nov 2007 Dec 2007

BA04-Mawkee Kul Yat Al Tib Al Kadema, 

Basrah Jul 2007 Feb 2008

KE03-Hai Tiseen, Tameem Jul 2007 Unknown

AN01-Al Hukum Al Mahalli, Anbar Not Completed/

Destroyed As Is

MN01-Door Al Naft, Missan Jul 2007 Mar 2008

MU01-Hai Al Husein, Muthanna Aug 2007 Mar 2008

NF04-Hai Al Adala, (New Per DG), Najaf Nov 2007 Feb 2008

DI02-Al Jadida, Qadissiya May 2008 Unilateral May 2008

BK10-Al Jami'a/Family Medicine, Baghdad

Not Completed/

Destroyed 

Nov 2007

As Is

TQ07-Somer, Thi-Qar Feb 2008 Aug 2008

DY07-Hai Al Mustafa, Diyala Jun 2008 Aug 2008

SU07-Sirchanar, Sulaymaniyah Feb 2008 Mar 2008
38

19 TYPE C (MODEL CENTERS with EMERGENCY AND LABOR FACILITIES)

DY08-Bani Sa'ad, Diyala

Not Completed/

Destroyed

Feb 2008

As Is

NA03-Zummar, Ninewa Sep 2007 Unknown

NA01-Al Qosh, Ninewa Jun 2007 Apr 2008

DK01-Sameel, Dahuk Sep 2007 Nov 2007

BR09-Jisir Diyala, Baghdad Nov 2007 Feb 2008

AR02-Bnaslawa, Erbil Sep 2007 Feb 2008

BA05-Abdalla Hashim/Qadha' Al Madina, 

Basrah

Not Completed

Mar 2008 As Is

KR04-Qadha'al Hindiya Al Khayrat, Kerbala Apr 2008 Jun 2008

AN03-Al Falluja/Al Karma, Anbar Apr 2008 Not open

DY09-Al Mansooriya, Diyala Jan 2008 Not open

BK04-Khan Dhari, Baghdad Feb 2008 Jul 2008

MN03-Qadha' Ali Al Sharji, Missan Sep 2007 May 2008

DI03-Al Badeer, Qadissiya Jun 2008 Unilateral Jun 2008

WA05-Sheikh Sa'ad, Wassit Feb 2008 Feb 2008

DI01-Ghammas, Qadissiya Jul 2008 Sep 2008

MU02-Al Warka', Muthanna Mar 2008 Not open

NF03-Suq Sha'alan, Najaf Jul 2008 Sep 2008

DY05-Al Wajihiya, Diyala Oct 2008 As Is Not open

DY06-Al Atheem, Diyala Oct 2008 As Is Not open

Source: GRD provided data as of March 2009
39

Appendix D—Acronyms

Acronym Description

CEFMS U.S. Army Corps of Engineers Financial Management System

GRD Gulf Region Division

IRMS Iraq Reconstruction Management System

ITAO Iraq Transition Assistance Office 

JCC-I/A Joint Contracting Command-Iraq/Afghanistan

MoH Ministry of Health

PHC primary healthcare center

SIGIR Special Inspector General for Iraq Reconstruction
40

Appendix E—Audit Team Members

This report was prepared and the review was conducted under the direction of David R. Warren, 

Assistant Inspector General for Audit, Office of the Special Inspector General for Iraq 

Reconstruction.

The staff members who conducted the audit and contributed to the report include: 

Ziad Buhaissi

David Childress

Whitney Miller

Richard McVay
41

Appendix F—Management Comments

Iraq Transition Assistance Office
42
43
44

Management Comments

U.S. Army Corps of Engineers - GRD 
45

GULF REGION DIVISION

COMMAND REPLY

to

SIGIR Draft Audit Report – Construction of Primary Healthcare Centers Reported 

Essentially Complete, but Operational Issues Remain 

SIGIR Report Number 09-015

(SIGIR Project 9001)

Overall Comment. GRD does not agree with the basic assumption that GRD and ITAO failed. 

Although both organizations could have done a few things better, the protracted nature of the 

Iraqi insurgency, poor performance by contractors, and lack of responsibility taken by the

Ministry of Health are significant factors that the report failed to address and explore.

In addition, the draft report does not fully highlight the difference in responsibilities between 

GRD, ITAO and the Health Attaché.

GRD disagrees with some statements in the report as discussed in our comments.

SIGIR Response. SIGIR did not conclude that GRD and ITAO failed. The first sentence of the 

Results in the Executive Summary states that “GRD completed construction of PHCs despite 

very poor security, which included bombing of facilities” and notes that the facilities will 

provide outpatient treatments to over 4 million Iraqis annually.

The draft report addressed the responsibilities of GRD, ITAO, and the Health Attaché in the 

Introduction section of the report and various subsequent sections such as the section on 

transfers to the MoH where we note that the GRD management plan states that the opening and 

operation of the facilities as well as sustainability were outside the scope of the GRD program. 

We believe the report clearly discusses the responsibilities of GRD, ITAO, and the Health 

Attaché.

Overall SIGIR believes the information provided in the draft report is accurate. However, we 

agree that certain statements could be revised or deleted to improve the final report accuracy 

and have done so where appropriate. SIGIR specific responses to the individual GRD comments 

are presented below in italics on a comment by comment basis.

1. Draft Report, summary page, third paragraph. Further, GRD and ITAO experienced 

problems in transferring PHCs to the MoH, and they do not have accurate data on the number of 

PHCs actually open and operating.

Command Comment. GRD is responsible for tracking the construction management of the 

projects through physical completion, local turnover to the MoH, and financial and contractual 

closeout. GRD is not responsible for tracking when the MoH staffs the PHC or opens it to the 

public. Problems experienced by GRD and ITAO during turnover were related to MoH staffing 

shortages.
46

SIGIR Response. GRD notes that is it not responsible for tracking the staffing and opening of 

PHCs. As noted above, this was discussed in the body of the draft report. Also, the section on 

transfers in the report includes GRDs comments about MoH staffing shortages creating 

difficulties in transfer of facilities. However, the report also notes that GRD did have internal 

reporting on the number of PHCs and the limitations GRD identified with the reported data. 

2. Draft Report, summary page, fourth paragraph. In May 2008, a contract was awarded to 

assess equipment and systems at selected facilities. 

Command Comment. The scope of this contract is not limited to assessments. The scope of 

work includes the following primary objectives: (1) Implement an Effective Facilities 

Management & Operations Program at USG-Funded Healthcare Facilities; (2) Develop a 

Comprehensive Maintenance Management Plan; (3) Implement a Maintenance Management 

Program at USG-Funded Healthcare Facilities; (4) Establish a Centralized Maintenance Data 

Collection Capability; and (5) Enhance Operational and Life-Cycle Facilities Management 

Capabilities; which includes completing assessments at the selected facilities.

SIGIR Response. We have added information to the final report’s summary page and executive 

summary to clarify the contract was awarded for sustainment of health projects and includes 

assessing equipment and systems. The additional details about the contract’s scope were

included in the text of the draft report.

3. Draft Report, summary page, fifth paragraph. GRD and ITAO have not provided 

sufficient accountability and transparency on the status of the PHC program as it nears 

completion. 

Command Comment. GRD is unclear what SIGIR means by this statement or if it fully 

understands GRD program responsibilities. SIGIR implies that GRD has information that it has 

not provided. Some SIGIR information requests did not follow the prescribed process to permit 

a proper response or allow a reasonable response time. All 133 IRRF funded PHCs have been 

completed and transferred to the Government of Iraq. In addition, GRD provided contact 

information related to achieved records shipped to the United States.

SIGIR Response. SIGIR concluded that more information is needed about the status and 

condition of the PHCs. The additional information is needed to more fully detail the status of 

PHCs than is provided by a summary statement that 133 PHCs have been completed and 

transferred to the Government of Iraq. We believe the additional information includes the 

number of PHCs (1) open and serving the public, (2) with construction deficiencies, (3) without 

basic services, (4) without required equipment, and (5) without training staff to operate 

equipment. We believe such additional information will provide sufficient accountability and 

transparency on the PHCs.

As discussed in response to the overall comment above, the draft report discussed GRD’s 

responsibilities. In the Introduction section of the report, we state that GRD has management 

responsibility to deliver complete, ready-to-operate centers to the MoH.
47

4. Draft Report, page i, second bullet in results section. GRD even awarded contracts to 

complete construction of the 6 PHCs considered complete when the Parsons contract was 

terminated in March 2006.

Command Comment. The source of this information is unknown, as GRD did not provide it as 

part of their response to information requests.

SIGIR Response. In December 2008, we requested a listing of the contractors and contracts for 

each PHC, showing award date, completion date, and cost. GRD provided this data in midJanuary, as part of SIGIR’s requests for data on all 142 PHCs remaining in the program after 

Parsons termination. The data provided on the 142 included the 6 considered complete.

5. Draft Report, page ii, first paragraph. Management problems have long burdened the 

program. GRD, which had program management responsibilities, did not draft its program 

management plan for the follow-on contracts until about 6 months after contracts to complete the 

partially constructed PHCs were awarded and never finalized it. It also had six different program 

managers in three years. Moreover, GRD’s award of firm-fixed-price contracts to Iraq 

contractors for completing construction required assessment of the partially constructed facilities 

and development of independent government estimates before award of the contracts. However, 

because GRD failed to provide the assessments, we are unable to verify the extent of any site 

assessments that were made. 

Command Comment. This paragraph contains misleading statements. For example:

For the period of May 06 to February 09, GRD averaged one contractor Program Manager per 

year. The only exception has been one short-term Program Manager who supported the program 

for one month. For the last two years, Feb 07 to March 09, while the program was nearing 

completion and closeout, there was only one GRD Programs Directorate Department of the 

Army Civilian assigned as the government lead of the program.

It is not unusual for the program management plan to be drafted after contract award. GRD 

could not locate signed copies in the three year old project file; thus, it is unconfirmed the plan 

was never finalized.

GRD could not locate copies of the assessments in its project files.

SIGIR Response. GRD, in a written response to a SIGIR request, provided the names of the 

PHC program managers and the dates they served. That is the data included in the draft report. 

The GRD statement about a GRD Programs Directorate Department of the Army Civilian 

appears to be referring to someone other than the individuals GRD had previously identified as 

“PHC Program Manager.”

GRD states that it is not unusual for a program management plan to be drafted after contract 

award. SIGIR’s point is that this practice created risk since drafting a plan after completion of 

some of the most critical program actions—assessing PHCs construction status and awarding 
48

firm-fixed-priced contracts for construction completion—were completed without the benefit of a 

management plan.

During our audit, we were not told that the assessment files could not be located. However, 

based on this GRD statement, we have revised the final report language to reflect GRD’s 

position. It should be noted that this statement conflicts with GRD comment number 17 which 

states that “GRD informed SIGIR that the assessments were archived and that GRD 

recommended an alternate contact to obtain the requested information.

6. Draft Report, page ii, second paragraph. In 14 cases, GRD transferred facilities to MoH 

that were incomplete, with plans for continued construction work at just two.

Command Comment. This paragraph misleadingly suggests all 14 were part of the 133 PHCs 

completed and turned over to MoH. In reality, nine of the 14 referenced cases were 

deprogrammed from the original 142 PHCs under the Parsons contract. A deprogrammed PHC 

is a PHC that ITAO and GRD collectively determined are no longer beneficial to complete from 

a cost perspective. Both base this determination on cost to complete, scope, schedule, or other 

risk factors. GRD then cancels or terminates any contracts for work on that site and removes it 

from the program.

SIGIR Response. We have included the suggested wording in the final report. We also note 

that Appendix B of the draft report provided the information about the 14 incomplete PHCs. 

7. Draft Report, page ii, second paragraph, last sentence. GRD reports that 115 PHCs are 

open and operational, but MoH reports just 101. 

Command Comment. GRD is not responsible for tracking when the MoH staffs the PHC or 

opens it to the public. GRD does not report the ―open‖ or ―operational‖ status of PHCs.

SIGIR Response. As stated above in response to GRD’s overall comment, the report states that 

GRD’s management plan states that GRD is not responsible for tracking opening and operation 

of facilities. However, GRD’s internal reports did show that 115 PHCs were open and 

operational. Our reports further notes that GRD officials have no visibility on the operational 

status.

8. Draft Report, page iii, top of page. Also, because GRD failed to provide the requested 

assessments, SIGIR has not reviewed these documents.

Command Comment. GRD has no record of a data request for assessments. 

SIGIR Response. We requested details about the Stanley Baker Hill contract in our initial 

questions to GRD in December 2008 and continued to pursue such data throughout the audit. 

On March 12 an e-mail was sent to GRD specifically requesting any assessments available and 

other related data. We received no response.
49

9. Draft Report, page iii, second paragraph. Reports showing 133 PHCs having been 

completed and transferred are not complete and accurate.

Command Comment. GRD provided SIGIR a table showing all 133 IRRF funded PHCs were 

completed and transferred.

SIGIR Response. This is a SIGIR conclusion. As noted above in response to GRD’s comment 3, 

we believe that accurate and complete reporting would provide additional information on PHCs, 

including the number (1) open and serving the public, (2) with construction deficiencies, (3) 

without basic services, (4) without required equipment, and (5) without training staff to operate 

equipment.

10. Draft Report, page iii, third paragraph. Millions of dollars were spent to (1) finish 

construction, (2) deliver and install medical and office equipment and consumables, and (3) train 

Iraqis on PHC equipment. However, some or all of these actions were not completed for a 

significant number of PHCs. ITAO’s and GRD’s limited contract effort to assess PHC status is 

based on funds available, not the amount needed.

Command Comment. This paragraph begins by addressing the original IRRF program goals

and then tries to associate the intent of the follow-on O&M program of Task Order 36. This 

approach leaves a false and negative impression of the intent and a limited view of the scope of 

the O&M program.

SIGIR Response. Again the cited statement is a part of SIGIR’s conclusions. We are noting 

that despite the expenditure of millions of dollars, the job is not complete and the ongoing 

contract effort will not fully address questions about what is not complete. These SIGIR 

conclusions lead to the recommendation for further study to provide transparency to the current 

status of PHCs.

11. Draft Report, page iii, third paragraph, last sentence. Further, neither has identified plans 

and/or funds for additional assessments and/or completion work for PHCs.

Command Comment. The SIGIR statement is misleading. GRD is only responsible for 

executing the program funded by its customer, in this case, ITAO. GRD has made 

recommendations to ITAO towards the obligation of additional funding to support further 

assessments, training, and operations & maintenance services.

SIGIR Response. This statement is based on information obtained during our audit. To clarify 

the point we added information to reflect GRD’s position. However, we do note that GRD’s 

comment regarding the recommendations it made to ITAO indicates GRD had some interest in 

this issue.
50

12. Draft Report, page 3, third paragraph. In addition, Stanley Baker Hill, a contractor, 

provides management support to GRD for the program.

Command Comment. Berger/URS provided program management support for GRD until the 

fourth quarter of 2007 at which time SBH transitioned into the role.

SIGIR Response. We have added the suggested language to the final report.

13. Draft Report, page 3, fourth paragraph. GRD provides engineering services to the MultiNational Force-Iraq and the Iraqi government. 

Command Comment. The SIGIR statement is misleading because GRD does not provide 

engineering services to the Iraqi government.

SIGIR Response. We deleted the reference to the Iraqi government from the final report.

14. Draft Report, page 5, fourth paragraph. As shown in Table 2, the total estimated cost of 

the PHC program has increased by about $98 million—from $243 million at Parsons’ 

termination in March 2006 to $341 million in March 2009—while the number of PHCs to be 

completed has been reduced from 150 to 133. 

Command Comment. This statement is misleading as it suggests the estimate to complete the 

program in March 2006, at the time of Parson’s termination was $243 million. In reality, it was 

the original, $67.1M (IRRF) & $0.7M (CERP) definitized construction cost for the program,

under Parson’s as reported by GRD. In addition, the PHC count had reduced to 142 by 

termination in 2006 rather than 150 as represented in this report.

SIGIR Response. We clearly state that we are comparing the expected cost under the Parsons 

contract at the time of termination, to the current cost. Likewise, we are also comparing the 

original 150 planned PHCs to the current number. In our final report, we have updated the 

amount of obligations for construction under the Parsons’ contract to March 2009 and the 

increase is reported at $102 million—from $243 million to $345 million.

15. Draft Report, page 8, first paragraph. For the nonconstruction costs that were awarded 

by JCC-I/A, the GRD fee for contract administrative services is 4% of the contract amount.

Command Comment. This statement is inaccurate since GRD did not provide it in response to 

a data request. In addition, JCC-I is not aware of any occasion where GRD receives an 

administrative fee on procurement contracts. GRD does not know the source of this inaccurate 

information.

SIGIR Response. We have deleted the statement from the final report. Also, the final report 

shows the estimated government cost of managing and administering the PHC program as $11 

million.
51

16. Draft Report, pages 11 - 13. The completion contract for the Hai Al Intisar PHC was 

awarded in July 2006, and, according to GRD, the contractor ―worked slowly, but steadily,‖ up 

to November 15, 2006, when insurgents used explosives to seriously damage the structure, as 

shown in Figures 4 and 5. GRD was initially uncertain as to whether the PHC would be 

completed, but for security and other reasons terminated the contract for convenience. In 

processing the termination, GRD notified the contractor that based on the $278,430 paid, the 

contractor should have completed 45% of the construction, but the government determined that 

only 13% had been completed and the contractor therefore owed the government $173,277. This 

overpayment indicates that the government was not adequately assessing physical progress as it 

was making performance payments. Additionally, financial records do not indicate that the 

government has recovered the overpayment. In our follow-up to determine whether the funds 

were recovered, a GRD official said that they were still seeking information about the potential 

refund.

Command Comment. The pictures show the kinetic activity associated with this PHC. The 

Gulf Region North district office notified the contractor by email in 2007 of the overpayment. 

The district did not receive a response from the contractor and could not locate the contractor. 

Subsequent attempts to contact the contractor proved unsuccessful. The total amount involved is 

less than one percent of the PHC program.

SIGIR Response. We added to the final report GRD’s statement that its attempts to contact the 

contractor proved unsuccessful.

17. Draft Report, page 14, last paragraph. GRD provided no documentation in response to 

our request for selected site assessments. 

Command Comment. While this statement is true, it fails to indicate that GRD informed 

SIGIR that the assessments were archived and that GRD recommended an alternate contact to 

obtain the requested information.

SIGIR Response. We were not informed during our audit work that the assessments were 

archived. This statement also seems to conflict with GRD’s statement in comment number 5 that 

the assessments could not be located in its files.

18. Draft Report, page 15, first paragraph. Moreover, GRD had stated that those assessments 

were to be performed by the contractor, not by the district engineers.

Command Comment. GRD did not make this statement response to a request for information; 

the source is unknown. GRD and its Districts practice standard USACE procedures. GRD 

district engineers, in accordance with contracting procedures, conducted site visits in the spring 

of 2006 to assess the extent of additional construction needed and to develop independent 

government estimates before award of construction contracts. 

SIGIR Response. The statement is from SIGIR inspection reports on PHCs that were issued in 

January 2009. The final report reflects the source of this information.
52

19. Draft Report, page 15, third paragraph. For several facilities, two additional contracts 

were awarded to complete construction. For the PHC at Al Thalith, Baghdad (BR04), Parsons 

was paid about $387,000 for construction, and GRD considered the PHC 100% complete when 

the Parsons contract was terminated. GRD awarded a follow-on construction contract for 

$50,000 in April 2006 to complete the PHC, and the contract was reported complete in May 

2006. However, in September 2006, another contract for about $30,000 was awarded. When we 

asked GRD why two contracts totaling about $80,000 were awarded on a 100% complete PHC, 

they responded that one was to complete construction, and the other was to complete a punch 

list. 

Command Comment. GRD’s response to this question, both verbally and in writing, was that 

both follow-on contracts were to complete punch list items. Based upon its thorough review of 

all RMS and IRMS data, GRD determined that contract W917BG-06-D-0005 was not terminated 

as previously reported in its response to a SIGIR data request.

SIGIR Response. While the cited information was provided to us during the audit, we have 

revised the final report based on GRD’s current statements. SIGIR’s data on contracts show 

that the cited contract was not terminated.

20. Draft Report, page 15, last paragraph. ITAO officials stated that GRD did not always 

have readily available information on the current status of projects like PHCs because it relied on 

field personnel to provide updates on projects’ status. If GRD’s personnel could not easily check 

on the status of projects, detailed information was not readily available.

Command Comment. The SIGIR statement is misleading. GRD held weekly teleconferences 

with the District Project Managers specific to the Health program to ensure GRD had visibility 

over the status of the program and possible issues. GRD also participated in teleconferences 

specific to PHCs, held by the Districts, and distributed a weekly Health Sector Update to ITAO 

and the DoS Health Attaché.

SIGIR Response. This cited statement was made by ITAO officials. While GRD cites various 

efforts to have program details, the comments by ITAO officials was that GRD did not always 

have readily available data on project status. GRD comments were added to the report.

21. Draft Report, page 16, first paragraph. GRD and ITAO officials said that they also rely 

on the Health Attaché for insight into the operational status of many of the PHCs because the 

office serves as the primary U.S. government contact with the MoH. According to the Health 

Attaché, however, he relies extensively on GRD and ITAO for information on the status of the 

PHCs because his office has only three people.

Command Comment. Again, GRD is only responsible for tracking the construction 

management of the projects through physical completion, local turnover to the MoH, and 

financial and contractual closeout. For related information, GRD would be the appropriate 

resource. GRD is not responsible for tracking when the MoH staffs the PHC or opens it to the 

public, and relies on the U.S. Embassy – Baghdad for that information.
53

SIGIR Response. SIGIR statement is that GRD and ITAO officials stated that they rely on the 

Health Attaché. It neither states nor implies that GRD is responsible for tracking when the PHC 

is open. As noted in a number of earlier comments, the draft report stated that GRD does not 

track when the MoH staffs or opens the PHCs.

22. Draft Report, page 16, second paragraph. Furthermore, the draft PHC management plan 

noted that GRD is required to report ―IRMS data even though in most cases the data is suspect.

Command Comment. The referenced management plan was written in 2006. Integrity of the 

IRMS data is a command priority, has improved significantly, and GRD continually scrubs it for 

discrepancies. The majority of the IRMS data involving PHCs is District construction 

management data reported in the USACE Resident Management System (RMS) which is 

imported into IRMS.

SIGIR Response. We agree with GRD points and also note that IRMS data problems are not 

limited to 2006 data. In the same paragraph cited by GRD, the draft report noted that GRD 

officials, in response to a July 2008 SIGIR report, stated that IRMS is known to contain 

inconsistent and incomplete data in several areas. 

23. Draft Report, page 16, third paragraph. Our analyses of the percentages of PHC 

completions and their costs support questions about data accuracy. For example, IRMS records 

for the PHC at Khaleej Al Arabi, Al Basrah (BA02) show two different percentage completions 

(26% and 85%) in two different records on the project.

Command Comment. The report does not identify the date or name of the IRMS report 

allegedly containing this data. GRD continually scrubs data accuracy and could not find the 

situation described.

SIGIR Response. The cited percentages were taken from project tracking data for the URIs in 

March 2009.

24. Draft Report, page 16, fourth paragraph. Our analysis of data for the completion of the 

PHCs identified other indicators of IRMS data issues, inadequate assessments, and/or 

construction management issues. For example, 17 PHCs were identified as being either 100% or 

99% complete at termination in March 2006, but significant construction contracts totaling about 

$1.90 million were awarded for completing these PHCs. For 11 of the PHCs, two separate 

contracts were awarded to complete the PHCs. 

Command Comment. The 17 sites were not part of any information requests for this audit. 

Depending on the data field selected, either the 100% or 99% data could accurately reflect the 

termination of the project. The re-award for completion is an entirely separate record. Again, 

the situation is unknown. Of note, the punch list contracts targeted ten PHCs. In addition, based 

upon its thorough review of all RMS and IRMS data, GRD determined that contract 

W917BG-06-D-0005 was not terminated as previously reported in its response to a SIGIR data 

request.
54

SIGIR Response. In December 2008, we requested a listing of the contractors and contracts for 

each PHC, showing award date, completion date, and cost. GRD provided this data in midJanuary, including data on the 17 PHCs. Appendix B of the draft report shows percentage 

completion and construction costs for each of the 142 PHCs and is based on the GRD provided 

data.

25. Draft Report, page 18, first paragraph. Furthermore, GRD and ITAO do not have 

accurate and complete oversight data on the number of PHCs that are open and operating.

Command Comment. Again, GRD is only responsible for tracking the construction 

management of the projects through physical completion, local turnover to the MoH, financial 

and contractual closeout. GRD is not responsible for tracking when the MoH staffs the PHC or 

opens it to the public and relies on the U.S. Embassy – Baghdad for that information.

SIGIR Response. The GRD language has been inserted in the final report and the GRD 

comment has been addressed in a number of previous comments.

26. Draft Report, page 18, second paragraph. The Health Attaché stated that many contracts 

were awarded with great speed and little consultation with the Iraqi government.

Command Comment. Archived correspondence and reports do not support this statement. On 

the contrary, documentation indicates active MoH-PCO discussion specific to site selection, type 

(new construction/rehabilitation), and priority via written and in-person communication. 

SIGIR Response. The statement is attributed to the Health Attaché. Also, included in the draft 

report were comments by MoH officials that GRD did not consult with them in designing 

facilities, in selecting construction contractors, or in overseeing contractors and that this 

resulted in dissatisfaction with many facilities. We have added GRDs comment to the final 

report but without the GRD documents, SIGIR cannot verify the validity of the statements.

27. Draft Report, page 19, second paragraph. GRD officials told us that 14 facilities—

identified in Appendix C—were transferred ―as is.‖ They noted that construction work continued 

for two of the ―as is‖ facilities after transfer based on an agreement with MoH.

Command Comment. Nine of the 14 sites were those deprogrammed from the 142 PHC 

program. GRD an ITAO deprogrammed one when insurgent activity severely damaged it. The 

Iraqi government used another to complete the facility and GRD delivered GFE to a MoH 

warehouse for installation. The medical equipment went to the warehouse instead of the site 

because MoH did not yet have available staff or security dedicated for the location (BK01). Two 

other facilities were still on-going at the time of turnover (DY05 & DY06). Two were near 

complete when they were terminated (TQ05 & TQ06) and MoH agreed to accept the sites and 

complete construction themselves.

SIGIR Response. We have added to the final report the statement that 9 of the 14 facilities 

transferred “as is” were removed from the PHC program. As cited in the draft report, Appendix 

C identified the 14 facilities and provides additional information.
55

28. Draft Report, page 19, fourth paragraph. To verify transfer data reported by GRD, 

SIGIR requested local and national transfer letters for 12 selected PHCs reported as transferred.

Command Comment. All local letters requested from GRD were located and delivered to 

SIGIR. ITAO is responsible for executing and tracking national transfer letters.

SIGIR Response. We requested 12 local transfer letters from GRD. GRD provided us with 2 

letters as stated in the report. We did not receive transfer letters from GRD for the other 10 

PHCs. However, ITAO provided us some of the local transfer letters, but no national transfer 

letters.

29. Draft Report, page 22, third paragraph. GRD recognized that, in many cases, the 

companies awarded the contract to complete the PHCs did not properly install the medical 

equipment or train the PHC personnel on the use of the equipment.

Command Comment. GRD did not make this statement in response to any information 

requests. The source is unknown.

SIGIR Response. This statement comes from the SIGIR inspection reports on PHCs issued in 

January 2009 and is included in a section where the results of the inspections are being 

discussed. 

30. Draft Report, page 22, last paragraph. Both GRD and ITAO have expressed concerns and 

taken some action to address PHC operational and sustainability issues; however, officials of 

both organizations state that they have no plans or funds for further involvement with the PHCs. 

Command Comment. GRD only executes the program funded by its customer, in this case, 

ITAO. GRD does not formulate plans unless it receives a statement of requirements from its 

customer, also in this case, ITAO.

SIGIR Response. As noted in response to comment number 11, this statement is based on 

information obtained during our audit. To clarify the point we added information to reflect 

GRD’s position. However, we do note that GRD’s comment regarding the recommendations it 

made to ITAO indicates GRD had some interest in this issue.
56

31. Draft Report, page 22, last paragraph, last sentence. GRD officials informed us that they 

have no responsibility for a PHC once it is transferred to the MoH.

Command Comment. GRD is responsible for tracking the construction management of the 

projects through physical completion, local turnover to the MoH, and financial and contractual 

closeout. GRD is not responsible for tracking when the MoH staffs the PHC or opens it to the 

public and relies on the U.S. Embassy – Baghdad for that information.

SIGIR Response. As noted in response to comment 25, this GRD language has been inserted 

into the report.
57

SIGIR’s Mission Regarding the U.S. reconstruction plans, programs, and 

operations in Iraq, the Special Inspector General for Iraq 

Reconstruction provides independent and objective:

oversight and review through comprehensive audits, 

inspections, and investigations

advice and recommendations on policies to promote 

economy, efficiency, and effectiveness

deterrence of malfeasance through the prevention and 

detection of fraud, waste, and abuse

information and analysis to the Secretary of State, the 

Secretary of Defense, the Congress, and the American 

people through Quarterly Reports

Obtaining Copies of SIGIR 

Reports and Testimonies

To obtain copies of SIGIR documents at no cost, go to 

SIGIR’s Web site (www.sigir.mil).

To Report Fraud, Waste, and 

Abuse in Iraq Relief and 

Reconstruction Programs

Help prevent fraud, waste, and abuse by reporting 

suspicious or illegal activities to the SIGIR Hotline:

Web: www.sigir.mil/submit_fraud.html

Phone: 703-602-4063

Toll Free: 866-301-2003

Congressional Affairs Hillel Weinberg

Assistant Inspector General for Congressional

 Affairs

Mail: Office of the Special Inspector General

 for Iraq Reconstruction

 400 Army Navy Drive

 Arlington, VA 22202-4704

Phone: 703-428-1059

Email: hillel.weinberg@sigir.mil

Public Affairs Danny Kopp

Office of Public Affairs

Mail: Office of the Special Inspector General

 for Iraq Reconstruction

 400 Army Navy Drive

 Arlington, VA 22202-4704

Phone: 703-428-1217

Fax: 703-428-0818

Email: PublicAffairs@sigir.mil