Page 136 - Journal of Special Operations Medicine - Summer 2015

phasing is secondary. The primary objective must be to nation had never been written into the coalition plan
build the capacity at a pace that allows the partner na- as a component of the casualty evacuation plan (even
tion to internalize the capacity and take ownership in an though small). The SOCAF leadership was comfortable
environment that will foster proficiency, reliability, and with adding Niger’s participation in Flintlock 14 as a
sustainability. The titles of the phases do not reflect the force capability provider because the Niger military had
administrative planning, coordinating, and accounting successfully met several key milestones/metrics. On the
activities that took place before, during, and after every part of the US agency, the follow-on phase annotates a
mission. spike in activity/focus related to the capacity. This spike
might be to advocate for the partner nation to supply the
The time frame allotted for this mission (9 months) capacity to regional efforts (ie, United Nations peace-
was relatively short compared to the 2 to 5 years rec- keeping operations) or might be represented by medical
ommended by the RAND report. A lesson learned dur- advisors being dispatched to support program growth.
ing this mission was that two additional phases should The addition of a partner nation’s leadership effort line
be added to the framework concept recommended by is intended to capture the absolute necessity for support
Thaler et al. Figure 4 represents a modified version of and involvement of leadership at the strategic and op-
1
the RAND Conceptual Framework. Reflected in the erational levels. Partner nation leadership interest, sup-
modified framework is the addition of the two phases port, and effort must go beyond merely saying yes to the
and a depiction of desired effort on the part of partner entry of the training team in the country. The leadership
nation leadership. The first additional phase is the ad- must be available to the training team as needed, willing
vocacy phase. The advocacy phase starts with the TSOC to invest resources and develop the necessary guidance
at the strategic level but continues into mission tasking to direct their forces if the capacity is to have any chance
at the operational and tactical level. The advocacy phase of being sustained or growing.
permits for a transition from the theoretical agreements
of principle at the strategic level to the practical impli- As this article incorporates the theory of the report with
cations of policy development and institutional change actual experience, a recommendation for an additional
needed within the partner nation at the operational and phase is the starting point. The new phase is rooted in
tactical level. In the case of the Niger program, the criti- what was the actual focus of SOCAF Surgeon’s office
cal operational need was the development of a national immediately following COA selection, which was the
policy that would make the program more likely to be advocacy, education, resourcing, and consulting activi-
sustained well into the future. ties. This is a leadership-centric phase that leads to a
tasking and sets the parameters for success. Many tradi-
Figure 4 Adaptation of RAND TR1201-4.1: framework for tional Special Operations Warriors scoffed at the idea of
an actual BPC-H training program. With permission. a multiyear program to build the capacity of a partner’s
health system. Many staffers blew a gasket at the men-
tion that this increase in capacity might be the lifesav-
ing tool for an injured US military member operating in
the theater. These staffers and several Operators held
tight to the idea that only American assets (or Western
partner nations) should be trusted with saving American
lives. It was only through bold advocacy, consistent edu-
cation, and sheer perseverance that the SOCAF Surgeon
and other visionary leaders were able to turn the tide
and not only get to “Yes” in a staff meeting but also to
persuade staff partners to help find the funding and help
with assessing the locations for the greatest potential
for mutual benefit and synergistic effect in the area of
operation. The consulting in this phase focused on the
The second additional phase incorporated into the Ni- strategic level of the host country. SOCAF Surgeon con-
ger program was a follow-on phase with a programmed ducted interviews with not only the US country teams
real world support requirement. This finishing phase but also with the senior leadership of the militaries of
not only allows US agencies to turn over ownership of potential partner countries to determine the level of
the program but also demonstrates a clear progression need for effort and support for bringing the program to
in status of the partner nation to that of a trusted part- a host country. This effort married up with the report’s
ner and capable agent, which fosters long-term goodwill Metrics 1 and 2 [Metric 1: Level of need for effort, Met-
and demonstrates new independent capability to US and ric 2: Level of broad endorsement from superiors and
other regional allies. Prior to Flintlock 13, an African important audiences]. In a broad sense, the need for that

126 Journal of Special Operations Medicine Volume 15, Edition 2/Summer 2015