This article by Karen Jowers originally appeared on Military Times, the nation's largest independent newsroom dedicated to covering the military and veteran community.

Some troops and families are having to drive three hours to get routine medical care during pregnancy, or commuting 53 miles to work on a installations that are remote or isolated in the U.S., according to a new government report, highlighting the need for Defense officials to look at the full picture of support services for troops and their families at these bases.

DoD needs to gauge the risks of not providing those support services, and develop a strategy to meet those needs of troops and families, according to the report from the Government Accountability Office, which took a deep dive into life some of these U.S. installations.

Since 1989, 43 installations in the United States have been given that “remote or isolated” status for the purposes of morale, welfare and recreation, by either DoD or Congress, auditors said. Three of those were designated by DoD between 2011 and 2020 — Naval Support Activity, Crane, Ind.; Naval Air Weapons Station China Lake, Calif.; and Fort Hunter Liggett, Monterey, Calif. While there are more than 207 remote or isolated installations worldwide for MWR purposes, this congressionally-mandated report focused on those in the U.S.

For now, that designation matters when it comes to MWR programs. When these installations get that designation of “remote” or “isolated,” they may qualify for additional MWR funding for service members and families, under a process established by DoD. Some key MWR programs are child care and fitness centers, among others.

But there’s more to be considered than MWR, auditors said, and DoD’s current policies for housing, medical care and education don’t include a process for designating a base as remote or isolated for the purpose of extra resources for that particular support service. And without a system for assessing whether those support services are meeting the needs of service members and their families, DoD and the services may not be able to target funding to those needs.

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In their response to GAO, DoD officials agreed with the recommendations, and committed to review its policies and to look at the ways military families’ needs are met at these remote locations.

While DoD policies generally rely on communities near the installations to provide troops and families with the support services they need, those community services may not be available at the remote or isolated installations, auditors found. They may not even have a local community within close proximity.

Auditors examined the services available at four such remote installations: Dugway Proving Ground, Utah; Naval Air Station Key West, Fla.; Clear Air Force Station, Alaska (for unaccompanied personnel only); and Marine Corps Mountain Warfare Training Center, Calif.

Auditors said officials at the installations and service members surveyed described a number of financial effects experienced, such as increased commuting costs, higher costs of consumer goods, travel distance and time needed to reach grocery stores, and the high cost of off-base housing. Officials from two of the bases said that in some instances, young service members leave the military after being posted at a remote or isolated base.

Medical care: Service members at three of the locations faced commutes of an hour or more to reach health care providers within DoD’s Tricare network. For example, at Naval Air Station Key West, neither the on-base medical clinic nor the community outside the gate can provide certain types of specialty care, such as obstetric and gynecological care. Service members and their dependents must drive three hours to Miami to get this care. Officials at the installation told auditors that a policy that designates installations as remote or isolated for health care purposes would help them draw wider attention to that situation and boost their argument for more medical resources.

Defense Health Agency officials told auditors that requirements related to improving services in rural, remote and isolated areas of the U.S. are expected to be addressed in the next generation of Tricare contracts that are expected to being in 2023.

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Housing: At Marine Corps Mountain Warfare Training Center in Bridgeport, Calif., the privatized family housing community is located about 21 miles from the installation; but most of the service members live in a local community about 53 miles away. Officials at three of the installations GAO auditors visited identified the condition of base housing as a concern, too. A little more than half of the service members at the four remote installations who responded to a GAO survey said they were satisfied with the condition of their housing, whether it was located on or off the base. They cited problems such as mold in base housing and dormitories, inadequate air conditioning, and general disrepair.

GAO auditors note that the web-based survey size was small —– sent to 756 service members at those four installations, with 28 percent, or 212, responding. So the results can’t be generalized across all the remote or isolated installations, they said, but can be used to identify issues at those specific bases.

Auditors identified two key problems with housing — the lack of available, affordable housing and insufficient Basic Allowance for Housing. This has increasingly become an issue this year with service members, whether they live in remote areas or not, because of the hot housing market affecting both purchasers and renters.

Education: None of the bases examined have Department of Defense schools for children. The three installations with families rely on public schools to provide education for their children, as do most other military bases in the U.S. About 83 percent of the respondents to the GAO survey at the four installations said that their public schools met the needs of their school-aged children to a “moderate” extent. About 29 percent expressed dissatisfaction with the education options available for their children. Some cited lack of special education resources, athletic programs and extracurricular activities.

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MWR: While bases are designated as remote or isolated for MWR purposes, there’s dissatisfaction with some MWR programs among the troops.

Nearly half of the survey respondents at these four installations said they were “somewhat” or “very” dissatisfied with the availability of recreation programs and travel services at their installations; and nearly half also said they were dissatisfied with the quality of these programs.

Installation officials said their ability to provide MWR services is negatively affected by their difficulty in attracting and retaining civilian employees because of factors like low pay, commute time and cost of living.

DoD guidance states that the military services should provide comparable and consistent MWR support to all eligible personnel on DoD installations — to include the remote installations. While DoD expects many MWR programs to be self-sufficient, it provides flexibility for more funding for MWR programs at remote or isolated installations.

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