REQUEST INL APPROVAL FOR CONTRACT TO CONSTRUCT ATS

UNCLAS VIENTIANE 000806 SIPDIS SIPDIS DEPT FOR INL/RM-BARRY DEPT ALSO FOR INL/C-BROWNE DEPT ALSO FOR INL/AAE-BOULDIN FRANKFURT FOR RPSO E.O. 12958: N/A TAGS: SNAR ASUP LA SUBJECT: REQUEST INL APPROVAL FOR CONTRACT TO CONSTRUCT ATS DRUG TREATMENT CLINIC IN VIENTIANE PROVINCE REF: NAS VIENTIANE FY-2007 DRUG DEMAND REDUCTION PROJECT ADVANCED ACQUISITION PLAN ¶1. (U) Summary and Action Requested (see also para 9): This message requests INL/RM approval for NAS Vientiane to authorize RPSO Frankfurt to contract for design and construction of a drug abuse treatment clinic in Vientiane Province, Laos, specializing in treatment of addiction to amphetamine-type stimulants (ATS). NAS proposes to employ components of a standard GOL design that has been used in three other provinces. Unlike those earlier projects, however, NAS is recommending that this facility be constructed only to the more limited patient capacity (probably initially 20-30 patients) that Vientiane province can demonstrably support, in terms of both operating funds and trained personnel. NAS Vientiane also requests INL/C concurrence to use any remaining FY 2006 demand reduction funds to address continuing deficiencies in the habitability of the Vientiane Municipal treatment facility at Somsagna. End Summary. ¶2. (U) Background: Sale and abuse of ATS has been identified in the INCSR, by UNODC, and by the GOL as a significant and increasing concern that has now reached virtually all socio-economic levels and geographic regions in Laos. The response of the Government of Laos continues to be impaired by a shortage of treatment facilities, lack of trained treatment personnel, and insufficient operating resources. ¶3. (U) Several international donors have already responded to this problem: UNODC, Japan, Singapore, the USG, and others have assisted the Somsagna drug abuse treatment center in Vientiane Municipality, which is the de facto national treatment and training facility. The Government of Thailand built a 100-bed center in Champassak Province in 2005. The USG funded construction of a center using similar plans in Savannakhet Province that opened in 2006. China has built a facility following the Champassak/Savannakhet plan in Udomxai Province, which opened in 2007. In addition to these three built to relatively standard designs, Brunei constructed two small clinics in Xaignabouri Province during 2006 that are not yet functional. Bokeo Province operates a small clinic of its own in the village of Nam Chuam, and UNODC donated its former headquarters in Boun Neua, Phongsaly Province, for use as a clinic. With the exception of Udomxai, the Embassy plans to provide limited assistance to all of these facilities in FY 2008, especially with regard to building staff competence and expanding vocational training. ¶4. (U) Unfortunately, even with these existing facilities, the Government of Laos (GOL) lacks the capacity to treat even a fraction of its addict population. Total annual patient throughput, were all facilities operating at capacity, would not exceed 2000 patients per year. The GOL estimates the number of ATS addicts nationally at 40,000 (and growing); NAS Vientiane estimates that there may be as many as 200,000 ATS users of all types in Laos. Unfortunately, all of the treatment facilities, save Somsagna, are operating well below their physical capacities, for want of both trained staff and adequate funding. Consequently, Somsagna, the only major facility with competent personnel, is operating well over capacity, routinely handling patient loads of 600-700 in a center that could reasonably accommodate perhaps 400. Somsagna, for the reasons detailed above, is the current default for addicts from Vientiane Province. NAS Vientiane believes that construction of a center in Vientiane Province (which is a separate administrative entity from Vientiane Municipality) could help to mitigate some of the overcrowding at Somsagna, as the proposed site for the new center is 70 kilometers north of the city, in an area currently without a treatment center. ¶5. (U) Vientiane Province Center. To avoid some of the problems that have plagued other facilities, Vientiane Province officials have agreed to establish an operating budget for the center in advance, and to construct only the treatment capacity that the province can support. This decision in principle followed Embassy-funded travel by provincial officials to existing treatment centers where they were able to see for themselves the problems intrinsic to building large but operationally expensive facilities. The Lao National Commission for Drug Control and Supervision (LCDC) informed the NAS that Vientiane Province has established an annual operating budget of US$20,000. NAS Vientiane estimates that US$20,000 per annum could potentially support the operations in Laos of an ATS treatment center with up to 55 beds. The GOL claims that patient expenses, primarily food and medication, run approximately US$0.75-0.80 per day in existing centers, and has told the NAS that staff salaries are paid by provincial governments separately from the operating budget. Using one dollar per patient-day as a conservative figure in Laos, US$20,000 could in theory support an annual throughput of 110 patients (meaning, since the GOL uses a 180-day treatment cycle, capacity of 55 patients at a time). ¶6. (U) However, NAS intends to urge that the new facility be initially constructed on an even smaller scale, considering that a well-equipped center with a more modest patient capacity is the best option for Vientiane Province until Laos can correct its current deficiencies in staff training. Drawing on plans developed for the existing centers in Champassak, Savannakhet and Udomxai, the Vientiane Province center could be designed to accommodate further expansion in the future, when the province is better able to provide additional staffing and financial support. For that reason, NAS would urge construction of a Vientiane Province facility with an initial target capacity of 20-30 in-patients. We consider this preferable to building another larger facility that would be underutilized because of limits on professional staff and patient support funding. ¶7. Somsagna Facility. (U) The amount of FY 2006 demand reduction funds provided by INL/C that would be used for the smaller Vientiane Province center would thus be somewhat less than the total now available. NAS Vientiane would therefore also propose to use any remaining FY 2006 provided by INL/C, above what is necessary to construct the Vientiane Province center, to renovate portions of the existing men's rehabilitation facility at Somsagna, along lines similar to the renovation of the women's facility now being completed. As noted above, Somsagna, as the only fully functional treatment facility in Laos with an effective staff, is heavily overcrowded and suffers severe habitability problems. Though intended only to care for addicts from the capital, it has assumed the role of a national treatment center because families will not entrust their troubled youth to the semi-trained staffs in the provincial centers. (Note: The Director of Somsagna recently told the NAS that 60 percent or more of the patients are committed by their families. End note.) NAS Vientiane believes that the savings from a reduced scope Vientiane provincial center could best be utilized in Somsagna, where 500-600 young men are crammed into dormitories that can reasonably house half that number. ¶8. (U) Timing: The rainy season should be ending in Vientiane Province shortly, and construction of the Vientiane Province center, and renovation work at Somsagna, could begin at any time after that. NAS understands demands upon RPSO, but hopes that if NAS can secure quotations for a small initial design contract, RPSO would be able to place this order promptly to enable advertising and evaluation of actual construction bids and a start of construction with as much of the dry season as possible left to complete it. ¶9. (U) Action Requested: NAS Vientiane requests INL/RM approval for the NAS to authorize RPSO Frankfurt to contract for the design and construction of a drug treatment center in Vientiane Province. The NAS also requests INL/C/CJ concurrence to utilize any remaining FY 2006 demand reduction funds not subobligated for the Vientiane provincial project on habitability enhancements at the Somsagna drug treatment center in the Municipality of Vientiane. ¶10. (U) Post again thanks INL/C/CJ for its strong support of drug demand reduction programs in Laos. HUSO