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Public Policy Update: News from Washington, D.C.



December | November | July | June | May | April | March | February | January
Table of Contents
December, 2009
Both Senate and House Pass FY10 Consolidated Appropriations Bill
December 15, 2009

The U.S. Congress passed the final conference report for the FY2010 Consolidated Appropriations Bill (HR 3288) the week of December 7, 2009. The bill, as summarized by the conference report, included 6 of the 7 FY10 appropriations bills still waiting to be passed including the Transportation, Housing and Urban Development, and Related Agencies Appropriations bill; Commerce, Justice, Science, and Related Agencies; Financial Services and General Government; Labor, Health and Human Services, Education, and Related Agencies; Military Construction, Veterans Affairs, and Related Agencies; and State, Foreign Operations, and Related Programs.

State/Foreign Operations Bill
The State, Foreign Operations and related agencies bill totaled $48.76 billion. Of that amount, $7.779 billion was allocated to Global Health and Child Survival (GHCS) programs, which is $440 million more than the total enacted in 2009 and $184 million more than the President's FY 2010 budget request. Overall, the GHCS account saw an increase of $6 million above the Senate level, but a decrease of $15 million below the House approved level.

Funding Levels

HIV/AIDS (USAID + State), FY10 Enacted: $5.709 billion
+$100 million above FY10 President's request
+$200 above FY09 Enacted

Above HIV/AIDS number includes the following for the Global Fund:
Global Fund, FY10 Enacted: $750 million
+$150 million above FY10 President's request
+$150 million above FY09 Enacted
Malaria, FY10 Enacted (USAID): $585 million
Same as FY10 President's request
+ $200 million above FY09 Enacted

Tuberculosis, FY10 Enacted (USAID): $225 million
+ $52 million above FY10 President's request
+ $62 million above FY09 Enacted

Maternal & Child Health, FY10 Enacted (USAID): $549 million
+ $25 million above FY10 President's request
+ $54 million above FY09 Enacted

Family Planning, FY10 Enacted (USAID, UNFPA, Other): $ 648.5 million
+ $55 million above FY10 President's request
+ $103 million above FY09 Enacted

Neglected Tropical Diseases, FY10 Enacted (USAID): $65 million
- $5 million below FY10 President's request
+ $40 above FY09 Enacted

Differences between original House and Senate bills:
The bill worked out a few differences in funding between the House and Senate. Among the changes worked out in conference were:

Tuberculosis, FY10 Enacted: $225 million
+ $24 million above FY10 Senate Appropriations Committee recommendation
- $27 million below FY10 Full House recommendation

Maternal & Child Health, FY10 Enacted: $549 million
- $6 million below FY10 Senate Appropriations Committee recommendation
+ $11 million above FY10 Full House recommendation

Family Planning, FY10 Enacted: $648.5 million
Here, the conference report maintained the higher overall allocation supported by the House, but changed the composition slightly. USAID Family Planning received $525 million (as compared to $520 million in the final house and senate versions). UNFPA received $55 million (as compared to $60 million in the final house version and $50 million in the Senate). Other accounts received $68.5 million (same as the house and as compared to $58.5 million in the Senate)

Policy Changes:
In addition to funding increases, the FY10 omnibus included a number of policy changes of importance to the global health community. The bill does not include the Senate committee-approved Lautenberg amendment, which would have permanently repealed the Global Gag rule. While the bill does include language supporting the Obama Administration's decision to restore U.S. contributions to UNFPA, it does not repeal a variety of restrictions that govern U.S. UNFPA funding including a restriction on funding of abortion and funding for China. Other policy changes or implications include the endorsement of the HIV/AIDS prevention reporting requirement proposed by the House, endorsement of the research and development reporting requirement as proposed by the Senate and does not include a provision proposed by both the House and Senate regarding funds to monitor certain global health programs.

Labor HHS Bill
The FY 2010 consolidated appropriations bill also includes Labor Health and Human Services. This bill includes global health funding through the Center for Disease Control and Priorities. Funding levels are as follows:

Funding Levels

CDC Global Immunization Program, FY10 Enacted: $153.6 million
+ $1.6 million above FY10 President's request
+ $11.6 million above FY09 Enacted levels

CDC Global AIDS Program, FY10 Enacted: $119 million
Same as FY10 President's request
Same as FY09 Enacted

CDC Malaria Program, FY10 Enacted: $9.4 million
Same as FY10 President's request
Same as FY09 Enacted

NIH Contributions to the Global Fund, FY10 Enacted: $300 million
Same as FY10 President's request
Same as FY09 Enacted

Policy Changes:
In addition, the bill removes the federal funding ban on syringe exchange and eliminates the 1000 foot restriction in earlier versions of the bill. Next, the bill will go to the President's desk for a signature and be enacted into law.

For more information on funding for specific global health accounts, please view GHC's funding chart.

For more details regarding specific accounts of policy changes please view the report, committee press release and accompanying summary.

Written by Chris Bennett, Legislative Associate, Global Health Council Back to Top

Senate Foreign Relations Committee Holds Confirmation Hearing
for USAID Administrator Nominee Dr. Rajiv Shah
December 2, 2009

On December 1, President Obama's nominee for head of the United States Agency for International Development (USAID), Dr. Rajiv Shah, testified before the Senate Foreign Relations Committee. Currently the Undersecretary for Research, Education and Economics at the Department of Agriculture, Dr. Shah outlined his vision for the agency and fielded questions from the Senators who attended the confirmation hearing.

In their opening statements, Chairman John Kerry (D-MA) and Ranking Member Richard Lugar (R-IN) both stressed the importance of U.S. development assistance and the vital role that USAID plays in U.S. foreign policy. After providing a summary of the the ongoing foreign aid reform efforts within the Administration and in Congress, Chairman Kerry praised the nominee, "Dr. Shah, you are being given an opportunity to enact a bold and far-reaching reform agenda. It is encouraging that you come from an institutional culture that rewards the innovation and risk taking that this moment requires."

In his testimony, Shah pledged to crafting and implementing a development strategy that "delivers on the President's and the Secretary's vision of USAID as the world's premiere development agency" in consultation with the Senate Foreign Relations Committee and the broader development community. Shah committed himself to restoring AID's effectiveness and outlined what he believes are a set of core principles for USAID that "will require significant changes in the way the Agency does business":
  • Instead of designing policy in Washington and dictating it abroad, we work in partnership with nations to ensure our efforts support country-led plans and priorities and build the local capacity for transformational change.
  • Instead of tackling a large number of worthy but unrelated projects, we narrow our strategic focus to key areas that we can address comprehensively and for maximum impact.
  • Instead of taking on complex issues by ourselves, we coordinate with a cross-section of stakeholders-governments, foundations, civil society, and the private sector- and better coordinate with other donors to ensure our collective efforts are mutually reinforcing.
  • Instead of engaging only in a bilateral manner, we understand and leverage the resources and reach of multilateral organizations.
  • Finally, it means sustained commitment to achieving long term results. This type of "focus-for-decades" approach has led to many of the breakthroughs we have seen in vaccinations, agricultural productivity, democratic governance, inclusive economic growth, and other aspects of human development. Development is a discipline - and in many ways these principles reflect the best practices of that discipline.
During the question and answer session, Ranking Member Lugar expressed his dismay at the current state of USAID, "Even as the important role of foreign assistance has come into sharper focus, policy makers have under-resourced USAID to such an extent that other agencies have stepped in to fill the gap." Other Senators such as Senators Robert Menendez (D-NJ), Ben Cardin (D-MD) and Johnny Isakson (R-GA) struck a similar theme emphasizing the need for a strong USAID and expressing the support that the administrator would receive from the congress.

In response to a number of questions from Senator Feingold (D-WI), Dr. Shah expressed his support for the Global Health Initiative as an integrated approach to global health assistance and identified integration and the importance of strengthening health systems as two ways to help make U.S. aid efforts both sustainable and effective. He also emphasized the importance of measuring and evaluating the U.S.' development efforts which he said requires quick, effective and timely date collection as well as the importance of integrating evaluation in design of USAID programs.

Another consistent theme throughout the hearing was the need for USAID to be more effective in getting the word out about their successes and the difference that USAID is making in the world. Chairman Kerry stressed that "people don't know about the successes of USAID" whether in country or here in the U.S. domestically. "I think it is important to be quantitative, specific and accountable to the American people," Dr. Shah responded.

Senators were given till the end of the day on Tuesday to submit any final questions for Dr. Shah to answer in writing. The committee is expected to vote on Dr. Shah's confirmation as early as next week which will set up a full senate vote sometime shortly thereafter.

View Shah's testimony.

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The State of the World Population 2009 Report Released
November 18, 2009

The State of the World Population 2009, a report by the United Nations Population Fund (UNFPA), was released on November 18, highlighting the central role of women in combating climate change. "Climate change is about people", the report simply states, and those people who live in the developing countries least responsible for climate change will be the hardest hit by its ill effects. The poor, especially women, are most vulnerable to the effects of climate change because they tend to live agricultural lifestyles, and they live in marginalized areas that are especially susceptible to floods, rising seas, or other climate events.

UNFPA Executive Director, Thoraya Ahmed Obaid, stated in her forward to the report that "climate change is more than an issue of energy efficiency or industrial carbon emissions; it is also an issue of population dynamics, poverty and gender equity."

Women and population have long been absent from literature on climate change and have been neglected in international conferences and agreements. Thoraya Ahmed Obaid states that meaningful action on climate change will require "taking a broader, more nuanced approach to climate change that factors in gender and population".

According to the report, men will be affected differently by climate change, and "gender blind policies" are bound to be both less effective in dealing with climate change and harmful to women. For example, studies indicate that women are more likely to die in extreme weather events like heat waves or tsunamis than are men.

The report also discusses that women are in a unique position to combat climate change as they have significant roles in food production and land-use and in reproduction and child-raising. Both of these areas present potential sites for intervention by building women's capacity to influence them.

The report does not call for new funding. Rather, it calls for policies and programs that empower women such as family planning and education. It also calls on governments to honor commitments made at the 1994 International Conference on Population and Development and to the Millennium Development Goals.

View full report.

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November, 2009
Third Edition of State of the World's Vaccines and Immunization (SOWVI) Released
November 17, 2009

On October 21, 2009, the World Health Organization (WHO), the United Children's Fund (UNICEF), and the World Bank held in an event in Washington, D.C., to launch the third edition of the State of the World's Vaccines and Immunization (SOWVI). Presenters at the event included: Daisy Mafubelu, Assistant Director-General of Family and Community Health for WHO; Saad Houry, Deputy Executive Director for UNICEF; Joy Phumaphi, Vice President for Human Development for the World Bank Group; and Dr. Fred Were, National Chairman of the Kenya Pediatric Association. The last SOWVI report was released in 2002.

The report evaluates the Global Immunization Vision and Strategy (GIVS) established in 2005 by WHO and UNICEF to expand global vaccine coverage and development through the integration of immunization with other health systems, global interdependence and new technologies. Among the successes identified in the report was the immunization of 106 million infants in 2008, which is more than ever before. However, the report reveals a funding gap that needs to be addressed in order to immunize a remaining 24 million children.

The report is broken down into two parts. The first part of the document assesses human development, childhood vaccine growth, improvements in vaccine quality, safety and efficacy and the Millennium Development Goal 4 (MDG4). The second part of the document reviews twenty vaccine-preventable diseases and the efforts made towards achieving greater coverage in developing countries since 2000. Some of the interesting aspects of the report include:
  • In 2008, 88% of 33 measles vaccination campaigns were integrated with at least one other intervention, playing a critical role in the 74% drop in measles deaths between 2000 and 2007.
  • The vaccine industry has tripled since 2000, contributing over US$ 17 billion in global revenue by mid-2008.
  • New initiatives such as, Reaching Every District (RED), assist in identifying implementation problems, organizing delivery services and encouraging community participation in immunization efforts at the district level.
  • Immunization expenditures have continued to increase since the 1980s with the average cost of immunizing a child expected to reach US$ 18.00 per live birth by 2010. In 2008, WHO-UNICEF calculated that US$ 76 billion is needed between 2006 and 2015 to meet the GIVS goals in 117 WHO low- and lower-middle-income Member States.
  • The International Finance Facility for Immunization (IFFIm) raised US$1.2 billion for the GAVI Alliance through the issuing and selling of bonds in international capital markets in 2008.
  • Advance Market Commitment (AMC) contributed $US 1.5 billion to the development and manufacturing of the pneumococcal vaccine in 2005.
View the executive summary | view the entire report.

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Dodd, Durbin and Corker Introduce a Global Child Survival Bill
November 16

On October 28, Senator Chris Dodd (D-CT) introduced S. 1966, The Global Child Survival Act of 2009, with lead cosponsors Senator Richard Durbin (D-IL) and Senator Bob Corker (R-TN). With this bill, the senators aim to reduce mortality and morbidity rates of newborns and children in developing countries.

The bill requires the Obama Administration to develop and implement a strategy to improve the health of newborns and children globally. A major component of this strategy will include utilizing cheap, proven effective treatments for child health issues such as micronutrient deficiencies, diarrhea, malaria and other preventable diseases. It will also implement newly developed treatment technologies and include support programs for vulnerable and orphaned children. The Global Child Survival Act supports efforts to improve the health of mothers by promoting educational programs, increasing obstetric care, and combating female genital cutting. Additionally, an Interagency Task Force on Child Survival in Developing Countries will assess, monitor, and evaluate progress in achieving the fourth Millennium Development Goal of reducing child mortality.

Between 1960 and 1990, there has been a 60 percent reduction in child mortality worldwide. However, 8.8 million children still die every year, and one out of every 22 women die from childbirth. Senator Dodd believes the United States can do more to prevent mother and child deaths, citing the mere 54 cent price tag of oral rehydration therapy and 71 cent treatments for child respiratory infections. Senator Corker also pointed to the inherent element of smart power in the new bill, stating that reducing poverty and disease in other parts of the world supports global stability, and, ultimately United States security interests both domestically and internationally.

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2009 WHO Report Highlights Women's Health Needs
November 16

On November 9, 2009, The World Health Organization (WHO) released a report entitled, Women and health: Today's evidence, Tomorrow's agenda. The report illustrates the need to make women's health a global priority by highlighting current information on the health of women, identifying opportunities for growth and exploring areas that need greater attention at all levels. Using a life-course approach, the report moves beyond sexual and reproductive needs and examines how the various stages of life, gender inequality, limited access to care, and the interaction between biological and social determinants affect women's health and the health of subsequent generations. In addition, attention is given to the consequences and costs of not addressing the risk factors specific to women that result in future chronic diseases. Since women contribute to health as a consumer and a provider, it is essential that the design, management and delivery of health services engage women as active participants in future reform.

In addition to highlighting the lead causes of death for women such as HIV/AIDS and complications of pregnancy and childbirth, the report also calls for greater attention to chronic diseases and mental ill-health. The report identifies suicide to be the leading cause of death from women between 20 and 59 years of age globally.

In order to improve women's health, health systems need to remove the financial barriers to accessing health care and increase female representation in executive and management-level positions within the health systems. While much progress was been made in increasing access to education for girls, more improvements can be made in reducing the male-female gap in secondary education and increasing the access and protection for women in the workplace. The report concludes by developing four areas of reform for women's health policy:
  1. Fostering strong leadership and developing a collaborative agenda between international organizations and governments for immediate response to women's health issues.
  2. Strengthening health systems in a manner that improves women's access to care, extends level of coverage, reduces the equity gap, and offers financial protection.
  3. Leveraging for a fundamental change in public policies that influence access to care and risk exposure, an intersectoral collaboration to address issues not within the health sector, and broader strategies from a gender equality and rights-based approach.
  4. Reducing the gaps in knowledge and understanding of women's health issues and needs by strengthening the foundations of data collection and measuring the progress of key interventions, public policies, and health system performance.
View Full Report | Executive Summary

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July, 2009
Senate Committee on Foreign Relations Releases Foreign Aid Reform Bill
July 29, 2009

On July 28, Senate Foreign Relations Committee Chairman John Kerry (D-MA), Ranking Member Richard Lugar (R-IN) and Sens. Robert Menendez (D-NJ) and Bob Corker (R-TN) introduced The Foreign Assistance Revitalization and Accountability Act of 2009 (S1524).

The legislation is designed to be an important first step in foreign aid reform for the Senate as both the House and the administration took up the issue earlier this year. The bill will focus on "increasing the capacity" of the United States Agency for International Development (USAID) to "deliver effective and accountable programs and the broader capacity of all our foreign aid programs."

The legislation plans on strengthening USAID by doing the following:
  • Restoring strategic thinking by reestablishing a bureau for policy and strategic planning.
  • Strengthen coordination of U.S. foreign aid in the filed under the guidance of USAID.
  • Increase accountability and transparency of U.S. foreign aid programs by establishing the Council on Research and Evaluation of Foreign Assistance (CORE) to objectively evaluate the effectiveness of all foreign aid programs undertaken by the US Government.
  • Finally, improving the personnel at USAID by mandating a comprehensive review of all aspects of human resources and establishing a high-level task force to advise on personnel issues.
View the press release on Chairman Kerry's website.

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House, Senate Mark up FY10 Labor, HHS and Education Bills; Souder Amendment Defeated
July 29, 2009

On July 24, the House passed its FY10 Appropriations bill for Labor, Health and Human Services, and Education (HR3293), by a vote of 264-153. The bill provides $730.5 billion for Labor, HHS and Education Departments and is $1.9 billion above the administration's request and $58.9 billion above the FY09 enacted level.

With in the $730.5 billion bill, the House allocated $73.3 billion for the Health and Human Services Department which funds both the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), both of which include some funding for global health programs. In the NIH budget and consistent with past years, $300 million was allocated for the Global Fund to Fight HIV/AIDS, TB and Malaria. The CDC Global Health budget which totals $323.1 million includes $119 for CDC Global AIDS program; $101.6 million for the CDC Polio Program; $52 million for CDC Measles Vaccine Program and $9.4 million for CDC Malaria research. In addition, the HHS budget includes $153.5 million for the Global Immunization program and $70.78 million for the John E. Fogarty International Center.
Several amendments, which sought to cut portions of the budget, such as Mike Pence's (R-IN) amendment to cut funding for Planned Parenthood and Rob Wittman's (R-VA) attempt to cut $803 million from the total bill, were defeated. The Mark Souder (R-IN) amendment which sought to strip language that would lift the prohibition on federal funding for needle exchange programs was also defeated by a vote of 211-218. However, the Republicans were able to successfully pass one amendment, submitted by Darrel Issa (R-CA), which stripped $5 million in funding for three National Institutes of Health grants to study increased HIV risks of alcohol and substance use among prostitutes in Thailand and China and among hospitalized Russian alcoholics.

Moving the FY10 appropriations process forward, the Senate Appropriations Labor, Health and Human Services, and Education subcommittee completed markup of its FY10 appropriations bill. Scheduled for a full committee markup on Thursday, the bill includes $30.8 billion for the National Institutes of Health, $300 million of which is for the Global Fund. In addition, within the CDC budget, the subcommittee allocated $333 million for global health activities, which is $24 million above the FY09 enacted level.

On July 30, details of the Senate bill and any differences between the House and Senate bills will be available after the full committee completes it mark up, and the Global Health Council's policy analysis will then be updated to reflect these developments.

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Senate Foreign Relations Committee Holds Hearing on Foreign Aid Reform
July 24, 2009

On July 22, the U.S. Senate Committee on Foreign Relations held a hearing on foreign aid reform which included testimony by three expert witnesses: Peter McPherson, President, The Association of Public and Land Grant Universities; Jeffrey Sachs, Director, The Earth Institute; and David Beckmann, President, Bread for the World. The hearing focused on the upcoming Kerry-Lugar bill which is expected to address the need for foreign aid reform and the strengthening of USAID. The bill comes on the heels of Secretary of State Hillary Clinton's recent announcement that the department will undergo a quadrennial review of its diplomacy and development policies and the recently introduced Initiating Foreign Assistance Reform Act of 2009 (HR 2139) by Congressmen Howard Berman which seeks both aid reform and a rewrite of the Foreign Assistance Act of 1961.

Leading off the hearing, Chairman John Kerry read his opening statement reiterating his commitment to foreign aid reform and addressing the momentum that foreign aid reform is receiving in Washington; "We are here today to continue an ongoing conversation on foreign aid reform. For the last six months, the administration has been busy laying the groundwork for a new development agenda…While there is some debate on what form foreign aid reform should take, there is a broad consensus in the development community about why reform matters."

In his opening statement Ranking Member Richard Lugar emphasized the bipartisan support for foreign aid reform and indicated the important role that USAID will play in the process, "The basic question with respect to development is how we can best strengthen the capacity of USAID to run effective foreign assistance programs."

During their opening statements, all three witnesses who had received copies of the bill, praised the senate's bill and seemed to agree about the central role that USAID should play in any aid reform. There was also consensus that USAID needed to receive significantly more resources in order to be a successful development agency, which according to the witnesses, includes the ability to adequately assess which development efforts work and which do not. "Any agency that can't learn from its mistakes is ineffective and eventually becomes sterile," McPherson said.

Jeffrey Sachs followed McPherson's testimony by identifying 10 recommendations for foreign aid reform to the committee and emphasizing the 6 key focus areas that he felt were important for successful development: health, education, business development, infrastructure, sustainability and agriculture. Sachs also stressed his desire for the US to explicitly adopt the UN MDG goals in order to leverage US power and influence in support of economic development.

Finally, David Beckmann, from Bread for the World emphasized the bipartisan desire to have an effective foreign aid regime, "All people, whether liberal or conservative want us to use our money well."

While the hearing mostly touched on the importance of foreign aid reform and the necessity for the US to have a clear, development strategy, the issue of global health was clearly on the radar. Sachs praised both PEPFAR and PMI as two initiatives that "have clear goals" and cited the Global Fund to Fight HIV/AIDS, TB, and Malaria and the Global Alliance for Vaccines and Immunization (GAVI) as two examples of effective development funding programs that were targeted and worthy of replication.

Before questioning the witnesses, Senator Bob Menendez reiterated the importance of global health in development policy, "If we want to meet the challenges of global health, where disease knows no borders, then we must work on foreign aid reform."

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Both House and Senate Complete Major Action
on FY10 State, Foreign Operations Appropriations Bills
July 15, 2009

Both House and Senate complete major action on FY10 State, Foreign Operations Appropriations Bills.

Thursday, July 9 proved to be a busy day in the congressional appropriations process with both chambers working on appropriations bills that directly affect global health funding. In the evening, the U.S. House passed their FY10 State, Foreign Operations bill, while earlier in the afternoon the Senate Committee on Appropriations met to mark up their FY10 State, Foreign Operations bill.

By a margin of 318 to106, the House voted to allocate $48.8 billion to the State, Foreign Operations account, which included $7.79 billion for global health programs. Of concern to the global health community were a couple of amendments that sought to cut portions of global health funding from the bill. Reps. Steve Buyer, R-IN, Cliff Stearns, R-FL, and John Culberson, R-TX, all offered amendments that would have cut portions of the global health budget, however all of these amendments were defeated in votes on the floor. In addition, a manager's amendment sponsored by Rep. Rita Lowey, D-NY, added $10 million to maternal health programs and passed by a vote of 261 - 168.

Earlier in the day the Senate Committee on Appropriations passed its FY10 State, Foreign Operations bill totaling $48.7 billion with roughly $7.77 billion going towards global health programs. While the total State, Foreign Operations bill was below the administration's request, according to the committee the portion going to global health programs was $178 million above the administration's request and $434 million above enacted FY09 levels. Consistent with the House Appropriations Committee's allocations, most global health programs received increases above the administration's request and FY09 enacted levels.

Child survival and maternal health received $555 million which, in addition to being above both the administration's request and the FY09 enacted, exceeded the House's allocation by $27 million. Neglected tropical diseases also got a boost from the Senate, receiving $70 million as compared to the House allocation of only $50 million.

Among those that received less than the amount allocated by the House were tuberculosis (USAID) and family planning (USAID, plus other accounts). The committee allocated $201 million to TB, which was $51 million, less than House's allocation, but higher than the President's request. Likewise, while the House allocated $648.5 million for family planning programs, the Senate provided $628.5 million which was $35 million above the Administration's total family planning request, but $20 million less than the House's allocation.
Next up, the Senate will have to bring the bill to the floor and subject it to debate and possible amendments. Once the Senate bill has passed the floor vote, both bills will go to conference where any differences will have to be reconciled.

View the details of the:
House FY10 State, Foreign Operations bill | Senate FY10 State, Foreign Operations bill

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UN Releases 2009 Report on Millennium Development Goals by 2015
July 13, 2009

On July 6, the United Nations released the 2009 report on the Millennium Development Goals detailing the successes and challenges in achieving the goals by 2015. In the report Secretary General Ban Ki-Moon emphasized that efforts to restore economic growth must utilize policies and actions backed by adequate funding and strong political commitment. The report describes the great achievements in the reduction of extreme poverty worldwide over the past nine years since these quantitative benchmarks were set, but also acknowledges the recent declines due in large part to the global economic downturn. This includes improvement in reductions in child mortality. Mortality of children under the age of five has dropped in developing countries from 103 per 1000 in 1990 to 74 per 1000 in 2007.

However the report notes that progress has yet to be made in a number of areas. Less than half of all pregnant women in developing countries have access to adequate prenatal care with trend data indicating that maternal deaths have only decreased from 480 per 100,000 in 1990 to 430 per 100,000 in 2005. According to the report, deaths from AIDS around the world have peaked in 2005 at 2.2 million per year, but there are still 33 million people living with HIV and another 2.7 million newly infected each year. Great strides have been made in the fight against Malaria as well, but almost one million people, mostly young people die from Malaria each year.

View a copy of the full report.

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Congresswomen Learn of Effects of Global Economic Crisis on Women, Children
June 23, 2009

On June 18, three members of the Democratic Women's Working Group learned of the importance of providing more resources to protect the health and save the lives of mothers, infants and children during a time of economic hardship at a meeting organized and chaired by the Global Health Council. Congresswomen Gwen Moore, D-WI, Lois Capps, D-CA, and Lynn Woosley, D-CA, who together requested the meeting, were present. Global Health Council President and CEO Jeffrey L. Sturchio chaired the event.

Dr. Tore Godal, a special advisor on global health issues to the Prime Minister of Norway, briefed the congresswomen on the report, Leading by Example, Protecting the Most Vulnerable During the Economic Crisis, which was released on June 15 by Secretary General Ban Ki-moon and Norwegian Foreign Minister Jonas Gahr Støre at the United Nations headquarters in New York. The report was published by the Global Campaign for the Health Millennium Development Goals (MDGs).

In the report, a prestigious group of global leaders urged other countries to increase, not decrease, measures to protect women and children from the economic downturn. The leaders contributing to the report included 15 heads of state from such countries as Australia, Brazil, France, Germany, Italy, Japan, Liberia, Mozambique, Tanzania and the United Kingdom, and the heads of all the UN agencies working on health issues.

View report | view press release.

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June, 2009
House Appropriations Committee Approves $48.8 billion for FY10
State and Foreign Operations Budget
June 29, 2009

On Tuesday June 23, the House Appropriations Committee began its full committee markup of the FY10 State and Foreign Operations budget. Consistent with the subcommittee markup, the bill authorized $48.843 billion for FY10 State and Foreign Operations. This was a $3.2 billion or 6% decrease from the President's request of $52.044 billion and 2.3% less than the total FY09 spending of $50 billion including supplemental.

Overall, the committee authorized $7.784 billion for FY10 global health programs, which is $190 million above the President's request and $670 million above 2009 enacted levels. The Global Health and Child Survival account, which is the primary fund used to fund global health expenditures, saw increases for HIV/AIDS, maternal and child health, malaria, TB and family planning over both the president's FY10 request and the FY09 levels.

Of the total, $5.759 billion was allocated for global HIV/AIDS programs with $5.359 billion going to the State Department's Office of the Global AIDS Coordinator (OGAC); a $100 million increase above the administration's request. In addition, $350 million was allocated to USAID's HIV/AIDS programs.

Another winner of the house markup process was Tuberculosis, which received an increase of $50 million in a manager's amendment and an additional $29 million in USAID funding; bringing total bilateral funding for TB to $252 million. The Global Alliance for Vaccines and Immunization (GAVI) received a boost from the committee, with a budget increase of $18.5 million. Also receiving an increase was the Global Fund which saw $50 million added to its budget during the mark up process, bringing total Global Fund money in the State and Foreign Operations budget to $750 million. In addition, there is another $300 million of Global Fund money that is funded through the Health and Human Services budget. The rest of the global health numbers remain the same from the subcommittee markup as noted in the included chart.

Next up, the bill will go to the floor of the house where we are anticipating a number of floor amendments that will attempt to cut the International Affairs Budget. After the house floor markup sometime in July, the appropriations process will begin in the Senate. In the coming days, the Global Health Council will be sending out an analysis of the bill's language with a detailed breakdown of the numbers.

For more information regarding the breakdown of the Foreign Operations subcommittee markup, please see the House Appropriations website.

View the Council's funding chart.

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Nomination of Dr. Eric Goosby: U.S. Global AIDS Coordinator
June 11, 2009

On June 9, 2009 the Senate Committee on Foreign Relations held a confirmation hearing on the nomination of Dr. Eric Goosby to the position of U.S. Global AIDS Coordinator. Senators Russ Feingold, D-WI, and Richard Lugar, R-IN, presided over the hearing.

The confirmation hearing began with Sen. Feingold's opening statement in which he pointed out the United States' "historic and unprecedented" leadership in recent years to address global health and especially HIV/AIDS. He continued by highlighting three important areas that the United States needs to improve its programs and approach in addressing HIV/AIDS. First, the exploration of new prevention strategies to limit the spread of HIV; second, the integration of all U.S. global health programs; and third, ensuring that U.S. programs support strong local health systems and health-care professionals. Feingold concluded his opening statement with support for President Obama's Global Health Initiative and commended Dr. Goosby's experience and expertise.

In his opening remarks, Sen. Lugar voiced his satisfaction that the Committee was moving forward in Goosby's nomination and emphasized "the importance of maintaining the momentum of our global HIV/AIDS programs." He continued, mentioning the progress that has been made under the President's Emergency Plan for AIDS Relief (PEPFAR); substantial increases to the number of people on treatment, targeted prevention of 12 million new HIV infections and efforts to ensure that HIV positive mothers give birth to HIV negative babies. Lugar concluded his statement saying, "I am optimistic that the Administration and Congress will continue to work together to ensure that the U.S. lives up to our commitments and funds the program at a level that allows us to meet and possibly exceed the goals Congress set forth last year."

Goosby discussed his experience as a physician, CEO and chief medical officer of the Pangaea Global AIDS Foundation, service as deputy director of the White House National AIDS Policy Office and director of the Office of HIV/AIDS Policy of the Department of Health and Human Services. He praised the "enormous" accomplishments of PEPFAR, specifically that its aggressive prevention programs have reduced HIV transmission, but noted that there is still much work to be done. Goosby indicated that, if confirmed, he would work to build strong partnerships with government, utilize existing health structures and strategies and engage healthcare providers and community-based peer educators. According to Goosby, the work should be guided by four major themes: intensifying the focus on prevention, entering into strong country-driven partnerships, supporting health systems strengthening and taking effective interventions to scale to achieve population-level health outcomes.

A brief question and answer session followed the three opening statements. Questions from Sens. Feingold and Lugar addressed the training and retention of 140,000 new health professionals, leveraging PEPFAR to increase health workforce capacity, priority areas under prevention of HIV and support for orphans and vulnerable children. Goosby highlighted the need to expand the function of midlevel health professionals in the short-term and in the long-term address health workforce capacity through partnerships with medical schools in PEPFAR countries. He emphasized the importance of ongoing and coordinated combination prevention, especially for women and children, linked with treatment efforts. Goosby drew attention to PEPFAR's partnerships with NGOs that support orphans through nutrition programs, medical evaluation and in some instances testing for HIV and other STDs. The question and answer session concluded with Goosby stressing the necessity of tracking and follow up, especially in relation to health workforce capacity building.

View opening statements, testimonies and video from the hearing:
Senator Russ Feingold | Senator Richard Lugar | Dr. Eric Goosby | See the video

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House Appropriators Approve $50.7 billion for International Affairs Account
June 10, 2009

On June 9th, The House Appropriations Committee announced the approved, binding FY10 302 (b) allocations for the 12 appropriations subcommittees. The committee allocated approximately $50.7 billion for the International Affairs Budget, which is a 6% decrease from the Administrations request of $53.9 billion, but consistent with the $51 billion requested in the Joint Budget Resolution. Of this $50.7 billion, it is expected that approximately $7.6 billion will go towards global health issues. The committee also released a schedule of the mark up process with a goal to pass all of the bills before the August recess.

Known as a 302 (b) allocation, the $50.7 billion for International Affairs is comprised of three parts: $48.8 billion for State, Foreign Operations and Related Programs, $1.9 billion for international food aid programs and $100 million for International Trade and Foreign Claims Settlement Commissions. The $48.8 billion for State, Foreign Operations is $3.2 billion or 7% less than the Obama administration's request, however according to the committee this represents a $12.2 billion increase over the FY09 allocations.

While the overall budget allocations from the house were $8.9 billion less than the administration requested, most of the cuts – over $ 7 billion – came from the Defense, State-Foreign Operations and Energy-Water portions of the budget. The next step in the House allocations process will begin when the State, Foreign Operations subcommittee begins mark up of its bill on June 17 followed by a floor vote tentatively scheduled for July 9.

On the Senate side, Appropriations Committee Chairman Daniel Inouye is expected to announce the Senate 302(b) allocations sometime later this month. Ultimately, the final allocations will be determined later this year when the two chambers bring the bills to conference and reconcile the differences.

Also important to Global Health funding is the FY09 war supplemental which is expected to include an additional $10 billion for the FY09 International Affairs Budget. The supplemental however, is still in conference deliberations where there are a number of differences between the Senate and House versions that must be worked out. Of importance to the Global Health community is the difference between the $100 million in the Senate bill and the $50 million in House bill for the Global Fund.

To see the tentative House Appropriations Committee markup schedule, click here.

To see the breakdown for all 12 subcommittees, click here.

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IOM Report Webcast - U.S. Commitment to Global Health:
Recommendations for the Public and Private Sectors
June 9, 2009

On May 20, the Institute of Medicine (IOM) released its report on the U.S. Commitment to Global Health: Recommendations for the Public and Private Sectors. The report concludes a 14-month expert study organized by the IOM to explore global health more broadly and inclusively than its 1997 study, America's Vital Interest in Global Health. Following the report's release, the Kaiser Family Foundation Broadcast Studio in Washington, DC hosted a live, interactive question and answer webcast on the IOM's final report. The panelists were:
  • Maria Freire, president, The Albert and Mary Lasker Foundation, and member, IOM committee on U.S. Commitment to Global Health
  • Jeffrey Koplan, vice president, Global Health and director, Global Health Institute, Emory University, and member, IOM committee on U.S. Commitment to Global Health
  • Ruth Levine, vice president and senior fellow, Center for Global Development, and member, IOM committee on U.S. Commitment to Global Health
Moderator: Jen Kates, vice president, Kaiser Family Foundation

The conversation covered numerous components of the IOM report recommendations in light of the Obama administration's recent announcement of the Global Health Initiative. Jen Kates opened with a question addressing the big picture of the report; why it was done now, what its main findings were and how it related to the report submitted to the Obama Administration in December 0f 2008. According to Ruth Levine the report addresses, "some priority areas in which the US really needs to make some key contributions to better health around the world" more specifically the following five key messages:
  1. To fulfill prior commitments and invest in scale up in areas where we are far from achieving the Millennium Development Goals.
  2. Recognition of the U.S. assets (knowledge generation, scientific research, and impact evaluation) that can effect global health around the world.
  3. The importance of long-term U.S. commitments to institutional development and human resources in developing countries.
  4. A call to increase US global health funding to $ 15 Billion by 2012
  5. Respectful U.S. Government engagement with developing countries, particularly with regard to their national health plans.
Next, Jeff Koplan discussed how the committee defined global health in the study, as an aspiration and goal, but also as a field of study in pursuit of achieving health equity. He later highlighted the importance of global health as an element of diplomacy, security and economic development. He went on to emphasize the need for global health to be placed at the cabinet level or higher, giving it close proximity to key leaders in NIH and CDC as well as access to the National Security Council (NSC). Interagency coordination and communication is thus essential in avoiding the duplication of work.

Maria Freire discussed the need for country level representation especially in a global health climate much different than that of 10 years ago. In a globalized world with greater philanthropic engagement and product partnerships, she stressed the importance of streamlining the reporting process to enable efficient delivery of services.

The group spent a significant amount of time discussing various issues pertaining to the increased funding of $15 billion by 2012, a number that they called a "placeholder" derived from international norms and practices. Equally important, the group noted that the call for increased funding does not include funding for research, a key component to generating knowledge. All of the panelists underscored the importance of balancing the portfolio for all areas of global health including water and sanitation and placing great emphasis on health systems. They further recognized the value of the World Health Organization (WHO), but called for greater support as it is spread thinly across a number or priorities. Freire noted that if there was not a WHO, they would have recommended that one be created.

See the video.

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Community Letter Calls on President Obama to Present Detailed Plan to
Address MDGs 4, 5 At G8 Summit
June 2, 2009

On May 21, twenty-two organizations that take part in the Global Health Council's Family Health Roundtable sent a letter to President Obama requesting that the United States present a detailed plan to accelerate progress toward the United Nations Millennium Development Goal 4 (reducing child mortality) and MDG 5 (improving maternal health and achieving universal access to reproductive health). The letter requests that the plan "lay out a trajectory of increased resources that, wisely invested, will yield dramatic gains in maternal, child and reproductive health."

The letter applauds President Obama's Global Health Initiative, which includes a heightened commitment to maternal and child health and family planning. According to the letter, releasing a plan aimed at MDG 4 and 5 at the G8 would "reassert United States leadership and reinforce the efforts of other nations, such as the United Kingdom and Norway, now campaigning vigorously for the health of women, children and families."

View the full letter.

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May, 2009
Key Agencies Testify before House Foreign Operations Subcommittee on the FY 2010 International Affairs Budget Request
May 25, 2009

On May 20, the House State and Foreign Operations Appropriations Subcommittee held hearings with key agencies on the FY10 State and Foreign Operations budget. While the hearings covered a variety of development issues, global health was high on the agenda.

The first hearing featured Alonzo L. Fulgham, the Acting Administrator of USAID, who testified on USAID's President's FY10 Foreign Operations Budget Request and fielded question from various members of the subcommittee. In his opening remarks, Mr. Fulgham highlighted the administration's request of $36.7 billion for foreign operations (including food aid) and the administration's plan to double U.S. foreign assistance by 2015; while at the same time addressing capacity issues by doubling the number of USAID Foreign Service Officers over the next several years. He also highlighted the President's global health initiative request of $7.6 billion for the Global Health and Child Survival account which is a first step in the Administration's six year plan to create a new, integrated approach for global health. Mr. Fulgham mentioned USAID's plans to scale up efforts to reduce mortality rates of children under five, help mothers avert unintended pregnancies and the desire to eliminate neglected tropical disease (NTDs).

In response to a question in which Representative Betty McCollum (D-MN) expressed disappointment at the budget for child survival, Mr. Fulgham reiterated the administration's dedication to global health issues--emphasizing the $63 billion over five years as being a "huge number" and that "one year doesn't make a story". He added "we have heard from Chairwoman Lowey on this issue." Other global health issues that were brought up included the need for skilled healthcare professionals, the importance of safe drinking water and the awarding of global health related USAID contracts to minority businesses.

Later that morning the Acting U.S. Global AIDS Coordinator, Thomas J. Walsh discussed the Administration's FY10 budget request and global HIV/AIDS strategy. In his opening statement, Walsh emphasized the President's FY2010 budget request which includes $6.66 billion for bilateral HIV/AIDS and TB programs and US contributions to the Global Fund and UNAIDS. "This is of $165 million, or 2.5 percent increase compared to the FY2009 enacted level…In a time of tightening budgets and economic constraints, the FY2010 budget request demonstrates this Administrations commitment to placing the global fight against HIV/AIDS as a critical piece of its global health agenda."

In her opening statement, Chair of the Subcommittee, Representative Lowey praised the Office of the U.S. Global AIDS Coordinator (OGAC) for their hard work and impressive results in the past few years highlighting the $58.3 million people benefiting from PEPFAR's HIV/AIDS prevention and education programs. However, she balanced her praise with concern for the problems that lay ahead in particular the high transmission rates between mothers and children and the pandemic's "disproportionate impact on women". Ranking Member Kay Granger (R-TX) questioned Mr. Walsh about a perceived $250 million shortfall for the Global Fund. Mr. Walsh replied that "right now, there are$265 million in grants that were approved for which we do not have cash in hand," but emphasized that the cash will be available later this year and that OGAC has been working to ensure that there will be "no gap in services".

Also, prevalent in the questioning was the issue of global health integration. The Global Health Council has actively sought to address the issue of integration and linkages because of the importance of integrating health solutions over a variety of diseases to ensure efficiency and a comprehensive approach to global health. Mr. Walsh made a point of emphasizing the OGAC's commitment to integration saying, "We need to do a better job with linkages and integration."

Other global health issues brought up at the hearing included pediatric issues, nutrition, the need for skilled health professionals and the importance of dealing with transmission.

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U.S. Malaria Community Applauds Obama's FY 2010 Budget
May 14, 2009

On May 7, the Obama Administration released the details of its proposed Fiscal Year 2010 budget which includes a 53% increase (to $585 million) in the malaria budget of the U.S. Agency for International Development (USAID) as part of a larger global health initiative. The U.S. malaria community commends both the policy shift towards a comprehensive, integrated global health initiative and the president's dedication to combating malaria.

"President Obama's strong leadership and unwavering commitment is what malaria needs right now as global control efforts reach a critical juncture, both in implementation and in the funding necessary to sustain the progress we've made," said Professor Awa Coll-Seck, Executive Director of the Roll Back Malaria Partnership.

These funds will fully support the President's Malaria Initiative (PMI), led by USAID and implemented with the U.S. Centers for Disease Control and Prevention (CDC). PMI represents an historic $1.2 billion, five-year commitment of U.S. government resources to reduce malaria-related deaths by 50 percent in 15 malaria endemic countries in Africa. PMI has helped to expand dramatically effective malaria prevention and treatment interventions in some of the poorest countries in the world. In the past year, PMI has reached more than 32 million people.

The continued support - both politically and financially - of PMI is pertinent given the economic burden that malaria places on families, communities and entire countries. The mosquito-borne disease claims about one million lives around the world each year. In Africa alone, malaria is estimated to cost over $12 billion per year in terms of health expenditures and lost productivity costs, while currently consuming as much as 40 percent of sub-Saharan African public health expenditures. At the household level, the cost of fighting malaria places a huge burden on a family's finances, accounting for more than 10% of its annual spending.

"The U.S. Government's commitment to fight malaria is a key component of our foreign assistance strategy and has been strongly endorsed by President Obama and his Administration," said Admiral Tim Ziemer, U.S. Malaria Coordinator. "We have enjoyed strong bipartisan support from both the House and Senate. Under the Hyde-Lantos Act of 2008, Congress reauthorized the President's Emergency Plan for AIDS Relief (PEPFAR) and institutionalized the malaria initiative, keeping our nation boldly at the forefront of efforts to reduce poverty and enhance the lives of people around the world for years to come."

The malaria community looks forward to working with the Obama Administration toward the goal of ending malaria mortality by 2015.

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President Obama Releases Detailed FY 2010 Global Health Budget Request
May 5, 2009

President Barack Obama released details of the FY 2010 budget request for international affairs today, including specific requests for global health programs. In his first budget request, President Obama proposes an overall increase of nearly $500 million over the FY 09 enacted level. Details are as follows:
  • USAID Maternal and Child Health: $523.5 m (FY09: $495 m)
  • USAID Family Planning: $475 (FY 09: $455 m) ($491-all accounts)
  • Malaria: $585 m (FY 09: $383 m)
  • Tuberculosis: $173 m (FY 09: $163 m)
  • Neglected, Tropical Diseases: $70 m (FY 09: $25 m)
  • Global HIV/AIDS: $6.028 b total ($5.009 bilateral; $935 m Global Fund, $119 CDC)

  • UNFPA: $50 m
  • UNICEF: $128 m
On Tuesday, May 5, the Administration announced the Global Health Initiative, which is expected to increase funding for global health programs including research and development to up to $63 billion over six years. For more information on the initiative, please go to the White House Website.

View details on the budget.

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Council Looks for Details on President Obama's Global Health Budget
May 6, 2009

The Global Health Council welcomes President Obama's request for a global health initiative that includes an integrated and comprehensive global health strategy but has concerns about how the commitments made by the Obama Administration can be achieved by the budget proposals outlined by the White House on Tuesday.

The White House on May 5, 2009, released a statement asking Congress to approve the president's request for $8.6 billion in fiscal year 2010 and $63 billion over six years for a comprehensive U.S. global health initiative. According to the White House, the president's proposed FY 2010 budget for global health programs of $8.645 billion would be a $459 million increase from fiscal year 2009. The Council looks forward to hearing from the Obama Administration how they plan to achieve the non-partisan Institute of Medicine's recommendation that the United States double global health spending to $15 billion annually by fiscal year 2012, as well as how the budget projections for global health would be an integral part of the President Obama's stated goal of doubling U.S. foreign assistance by 2012.

"It is not clear how the Obama Administration can get to the stated goal of $63 billion in global health funding by 2014 with an increase of less than $500 million from the current fiscal year," Maurice Middleberg, Executive Vice President of the Global Health Council, said.

"A panel of some of the world's top public health experts concluded in the Institute of Medicine report that it is critical to American foreign policy and security that the U.S. double global health investments, and the president's statement eloquently talked of the need for an integrated approach to global health in today's interconnected world. The Council is concerned that these budget figures will not be enough to meet these goals."

The Council's top recommendation to President Obama's transition team was to create a comprehensive global health strategy, and the Council has been working with the global health community to call for robust investments to carry out the strategy.

The Council welcomes the Administration's call to scale up U.S. global health funding and looks forward to working with the Administration to address the critical health challenges facing the developing world.

President Obama's statement and a White House Fact Sheet on the proposed Global Health Initiative are available on the White House Website.

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House Subcommittee on Africa and Global Health Examines Foreign Aid Reform
May 1, 2009

On April 23, the House Subcommittee on Africa and Global Health held a hearing on "U.S. Assistance to Africa: A Call for Foreign Aid Reform". The witnesses were:
  • Mr. Earl Gast, Senior Deputy Assistant Administrator, Bureau for Africa, United States Agency for International Development
  • Ousmane Badiane, PhD, Africa Director, International Food Policy Research Institute
  • Steven Radelet, PhD, Senior Fellow, Center for Global Development
  • Meredeth Turshen, D. Phil, Professor, Edward J. Bloustein School of Planning and Public Policy, Rutgers University
  • Mr. Bill O'Keefe, Senior Director of Policy and Advocacy, Catholic Relief Services
According to Chairman Donald Payne (D-NJ), the first hearing of the 111th Congress's Subcommittee on Africa and Global Health was held to examine the effectiveness of US assistance to African countries. Payne stated, "I feel that we must carefully assess what our assistance is actually contributing in terms of long term, sustainable development and not simply rest on our laurels". The Chairman's sentiments were echoed by Ranking Member Chris Smith (R-NJ) who emphasized his interest in seeing a focus on microfinance, better coordination and accountability for development funding.

All witnesses shared varied perspectives about foreign aid reform assistance. The hearing began with testimony by Mr. Gast who provided an overview of US assistance to Africa through USAID. It was then followed by broader discussions about the need for a more coherent and country driven foreign aid structure. Topics of discussion included examination of agriculture and food security assistance, HIV/AIDS and the Millennium Challenge Corporation.

To view opening statements and testimonies, please click here:

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April, 2009
Secretary Clinton Testifies before House Committee on Foreign Affairs on Foreign Policy Priorities
April 29, 2009

On April 22, the House Committee on Foreign Affairs held its first hearing with Secretary of State Hillary Clinton to address the foreign policy priorities of the Obama Administration. Chairman Howard Berman (D-CA) opened the hearing by explaining that he had asked the Secretary "to testify today on the Administration's overall foreign policy agenda and to discuss the broad outlines of the budget request". He went on to commend the Secretary and her team for taking immediate action to review the United States' diplomatic and development capabilities and ensuring that they are adequately funded by the International Affairs Budget.

In her opening statement Secretary of State Hillary Clinton touched upon a number of key issues, including the importance of addressing poverty and disease as "one of the existing and emerging challenges that will define our century". She made it clear that the challenges of today cannot be dealt with by the United States alone and stressed the importance of strengthening our alliances with our democratic partners in Europe, Asia, Africa, and Latin America.

During the question and answer session, Secretary Clinton reaffirmed her and the Administration's support for women's health issues, including a strong commitment to reproductive health issues.

Secretary of State Clinton concluded by calling special attention to the need for effective support of the United States' diplomatic efforts around the world to strengthen civil society, protect human rights and advance education and healthcare.

View the testimony.

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House-Senate Budget Conference Committee Approves $51 Billion for
FY10 International Affairs Budget
April 29, 2009

On Monday, April 27, the House-Senate Budget Conference Committee formally approved the FY10 Concurrent Budget Resolution recommending $51 billion for the FY10 International Affairs Budget. This figure includes contributions to international food aid. This recommendation represents an increase of $1.2 billion or 2.5 percent above the total FY09 spending of $49.8 billion. The conference committee's request is $2.5 billion or 5.1 percent increase over the House-approved funding level of $48.5 billion and a $2.8 billion or 5.2 percent reduction below the Senate and Administration request of $53.8 billion.

Even though the conference committee's resolution is non-binding, the $51 billion recommendation serves as an important marker for the Appropriations Committees, as each subcommittee establishes the binding 302(b) allocations. While House Appropriations Committee Chairman David Obey (D-WI) is not expected to formally announce the binding 302(b) allocations for the 12 subcommittees until early June, many of the subcommittees are already moving forward with their appropriations bills.

Once Congress completes the FY10 Concurrent Budget Resolution this week, their attention will then turn to the Administration's $83.4 billion FY09 Emergency Supplemental request, which includes $7.1 billion for the International Affairs Budget.

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Council Welcomes White House's Announcement of Intent to
Nominate Dr. Eric Goosby for U.S. Global AIDS Coordinator
April 28, 2009

The Global Health Council welcomes President Obama's announcement that he intends to nominate of Dr. Eric Goosby to the position of Global AIDS Coordinator with ambassadorial rank. Dr. Goosby is a Professor of Clinical Medicine at the University of California-San Francisco and Chief Executive Officer and Chief Medical Officer of the Pangaea Global AIDS Foundation. During the Clinton administration, Dr. Goosby served as Deputy Director of the White House National AIDS Policy Office and Director of the Office of HIV/AIDS Policy of the Department of Health and Human Services. He has worked on HIV/AIDS issues for more than 25 years.

The Council encourages the leadership of the Office of the Global AIDS Coordinator (OGAC) to support development of a comprehensive HIV prevention strategy for the President's Emergency Plan for AIDS Relief (PEPFAR). The Council encourages Dr. Goosby and OGAC to work with all key Obama Administration officials on a global health strategy that effectively coordinates effective global health programs on the full range of issues.

The Council calls on the Senate to quickly act on Dr. Goosby's nomination and for the Obama Administration to quickly fill the other vacant positions critical for U.S. leadership on global health. The Council has urged President Obama to fill the posts of USAID administrator, assistant USAID administrator for global health, director of the Centers for Disease Control, director of the National Institutes of Health, and director of the Health and Human Services Office of Global Health Affairs. The Council calls on the Senate and the White House quickly act to fill the OGAC Coordinator position and for the Obama Administration to respond positively to the Institute of Medicine's recommendation for a deputy assistant to the president for global health at the National Security Council.

View the Council's letter to President Obama on global health appointments.

View the Global Health Council's November 2008 recommendations to the Obama transition team.

View the November 2008 Global AIDS Roundtable recommendations to the Obama transition team.

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Global Health Council Calls for Obama Administration To Fill Global Health Posts
April 20, 2009

Now three months into the new Administration, the Global Health Council and its partners in global health and development are calling on President Barack Obama to nominate candidates for U.S. government positions that are critical for implementation and leadership of global health programs.

The Council has urged the U.S. president to fill the posts of USAID administrator, assistant USAID administrator for global health, director of the Centers for Disease Control, director of the National Institutes of Health, and director of the Health and Human Services Office of Global Health Affairs. In addition, the Council also has recommended that the Obama Administration respond positively to the Institute of Medicine's recommendation for a deputy assistant to the president for global health at the National Security Council.

View the Council's letter to President Obama.

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Senate Approves Amendment Restoring
President Obama's FY 2010 Budget Request for International Affairs
April 2, 2009

The Global Health Council and its partners throughout the global health, development and international affairs communities applaud the U.S. Senate's approval of an amendment to the Senate budget resolution restoring President Obama's fiscal year 2010 request of $53.8 billion for international affairs programs. The international affairs budget includes allocations for the majority of global health programs.

The U.S. Senate on Wednesday, April 1, 2009, by unanimous consent approved an amendment to the chamber's fiscal year 2010 budget resolution that would recommend international affairs programs be funded at President Obama's request of $53.8 billion.

Both the House and Senate budget resolutions originally called for lower allocations to international affairs than the President outlined in February. The House Budget Committee resolution – which will not be allowed to be amended – recommends $48.5 billion for international affairs – a $5.3 billion cut from President Obama's request. The Senate Budget Committee recommended $49.8 billion for the international affairs budget, a $4 billion cut. However, the Senate allowed amendments to its resolution on the floor. Sens. John Kerry, D-MA, and Richard Lugar, R-IN, the chair and ranking member, respectively, of the Senate Foreign Relations Committee, offered an amendment that restores the President's $53.8 billion request for international affairs in the Senate's resolution.

The Global Health Council encouraged passage of the amendment. The Council and its partners call upon Congress to preserve the President's request for International Affairs funding when House and Senate conferees meet to reconcile differences in the budget resolution.

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March, 2009
State Department Announces U.S. Will Resume Contributions
to U.N. Population Fund
March 26, 2009

The Global Health Council applauds the U.S. State Department's announcement on March 24, 2009, that the United States will contribute the $50 million to the United Nations Population Fund (UNFPA) in 2009 – the first contributions the U.S. has made to UNFPA since 2002.

UNFPA promotes voluntary family planning and HIV prevention in 150 countries. Acting State Department spokesperson Robert Wood said the contribution reflects the Obama Admnistration's "strong commitment to international family planning, women's health and global development." UNFPA Executive Director Thoraya Ahmed Obaid said the organization is "delighted that the United States will, once again, take a leading role in championing women's reproductive health and rights, alongside all other countries and partners that have supported UNFPA over the years."

The $50 million contribution was authorized in the fiscal year 2009 omnibus appropriations bill passed by Congress and signed by President Obama in February. During the presidential transition, the Global Health Council called on the Obama Administration to restore UNFPA funding.

UNFPA's statement is available on its website.

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February, 2009
Administration Releases FY 10 Blueprint Budget
February 26, 2009

On February 26, the Administration released a blueprint budget for FY 2010 which outlines the top line asks for each issue area. The total international affairs budget ask is $51.4 b, $4 billion above the 09 enacted level. The 09 enacted level of $47 billion combines the base level of $36 b plus the 08 and anticipated 09 war supplementals. While some of the increase between FY 09 and FY 10 may be due to a transfer of supplemental funding into the base, the budget does not give enough information to verify that.

The following is the paragraph on global health programs:

Increases funding for Global health Programs.
The Administration will continue to build on its commitment to save lives through increasing investments in global health programs, including areas such as maternal and child health, family planning and other core health programs, while also emphasizing a commitment to HIV/AIDS, malaria, and tuberculosis through successful programs, such as the President's Emergency Plan for AIDS relief and the Malaria Initiative. Together with our multilateral partners, the United States will continue to provide global leadership to improve the health status of the world's poorest populations.

Click here for International Affairs section of the budget brief.

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Congress Poised to Pass FY 09 Omnibus Appropriations Bill
February 26, 2009

On February 23, 2009, the U.S. Congress released the FY09 Omnibus Appropriations bill, including funding levels for global health programs. The bill increases funding for all core global health programs. President Bush's last budget request proposed decreases to core global health programs such as maternal and child health. The bill reverses these proposed cuts.

The breakdown is as follows:
  • Maternal and Child Health: $495 m
  • Family Planning: $545 all accounts including $50 m contribution to UNFPA
  • Malaria: $382.5 m
  • TB: $162.5 m
  • NTDs: $25 m
  • HIV/AIDS: $5.838 b
  • Bilateral: $4.469 b for focus countries. $350 m for USAID non-focus countries
  • Global Fund: $900 m ($600 for ops, $300 HHS)
  • CDC Global AIDS: $119 m
Within the total HIV/AIDS funding, there is an earmark of $100 m for food and nutrition activities and $150 m for TB/HIV programs. Under microenterprise, $20 m is earmarked for HIV/microenterprise programs.

In addition to the funding through Child Survival and Health account, the joint explanatory statement also states that an additional $122 m is allocated for global health under Global Programs which also includes $70 m for child survival programs and $19 m for infectious diseases. Regional programs also include additional allocations for child survival of $9 m.

CDC Global Health:
$309 m including $9 m for global malaria and inclusive of the CDC global AIDS

Policy Language
The bill includes specific policy language on global health issues. Under maternal and child health, the Committee directs USAID to report on maternal health funding country by country. Under malaria, the Committee calls for malaria funding to be coordinated with country strategic plans. Under health workforce, the Committee calls for a report on US spending on health systems and directs OGAC a plan to implement WHO's task shifting guidelines.The Committee also includes language on family planning including an amendment to the Kemp-Kasten restriction that would allow US funds to be provided to UNFPA, not withstanding a negative Kemp-Kasten determination - directing this assistance only to designated activities such as safe childbirth and emergency obstetric care and contraceptives and other activities.

The House and Senate are expected to consider the omnibus appropriations bill on the floor this week.

Please view chart for further details. | Download in PDF format (390k).

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Senator Feingold Calls for Comprehensive U.S. Global Health Strategy
February 23, 2009

The Global Health Council applauds Sen. Russ Feingold's, D-WI, remarks on the Senate floor on Monday Feb. 23, 2009, in which the Senator called on President Obama to put in place an "all inclusive and robust" strategy for global health. Feingold – Chair of the Senate Foreign Relations Subcommittee on African Affairs – said in tough economic times, it is vitally important for the United States to lead in global health with a strategy that is "all inclusive, integrated and sustainable."

Feingold calls for the Obama Administration to continue of U.S. leadership to fight HIV/AIDS, to build upon President Bush's Malaria Initiative, to address tuberculosis and neglected tropical diseases, and to develop a plan to address the basic child and maternal health issues as the foundation of U.S. global health policy. In addition, Feingold calls for the removal of funding restrictions that hinder evidence-based responses to health issues or limits flexibility to balance prevention and treatment programs. Feingold said that family planning and reproductive health is integral to many global health programs, and that integration of U.S. global health programs would create great efficiency and contribution to stronger health systems. According to Feingold, the great challenge facing the global health community is the addressing weaknesses in health infrastructure. The senator said he plans to continue his work to address the issue of health systems and health care workforces in the 111th Congress.

Feingold said the health challenges facing the world demand strong and sustained U.S. engagement because of global health's national security, economic and diplomatic implications. The senator cited a National Intelligence assessment released in January about the imperatives for global health investments for U.S. security and diplomacy. He said that implementing a comprehensive global health strategy can help ensure the quality of investments made by the U.S. taxpayers and maximize the results for the world's sick and vulnerable.

Sen. Feingold's remarks for the Congressional Record are available on his Web site.

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January, 2009
President Obama Repeals Global Gag Rule, Calls for Resumed Funding To UNFPA
January 27, 2009

On Jan. 23, 2009, President Obama issued an executive order that repealed restrictions put in place by the Bush administration on funding to international family-planning organizations. According to executive order, the restrictions – known as the "Global Gag Rule" or the "Mexico City Policy" – expanded the ban on U.S. funds for abortion-related services in the 1961 Foreign Assistance Act by also banning funding to any international organization that engages in a wide variety of activities, including "providing advice, counseling, or information regarding abortion, or lobbying a foreign government to legalize or make abortion available."

The Global Gag Rule – which was first instituted by former President Reagan in 1984, repealed by former President Clinton and reinstituted by former President Bush in 2001 – has severely hindered the work of international family planning organizations. In a written statement President Obama said, "It is clear that the provisions of the Mexico City Policy are unnecessarily broad and unwarranted under current law, and for the past eight years, they have undermined efforts to promote safe and effective voluntary family planning in developing countries."

In recommendations sent to President Obama in November 2008 and in subsequent meetings with his Presidential Transition Team in December, the Global Health Council called on President Obama to "immediately repeal the Global Gag Rule, allowing for greater access to family planning and HIV prevention services around the world and saving countless lives." The Council also has called on Congress and the Obama Administration to work together on a long-term, bipartisan legislative solution to this issue to halt the decades-old conflict over the Global Gag Rule.

President Obama in his statement also called for the restoration of U.S. contributions to the United Nations Population Fund (UNFPA) and for a "fresh conversation on family planning, working to find areas of common ground to best meet the needs of women and families at home and around the world." Currently, the U.S. does not contribute to UNFPA's work to promote voluntary family planning and HIV prevention in 150 countries. The Council echoes President Obama's call to restore UNFPA funding.

The text of President Obama's executive order and his written statement is available online on the White House Web site at: http://www.whitehouse.gov/the_press_office/MexicoCityPolicy-VoluntaryPopulationPlanning/
http://www.whitehouse.gov/statement-released-after-the-president-rescinds/

The recommendations the Global Health Council presented to President Obama's Transition Team, as well as the recommendations of the roundtables convened by the Council also are available online by clicking here.

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Senate Considers President Obama's Nominations for HHS Secretary, Secretary of State, OMB Director, Ambassador to U.N.
January 23, 2009

The Senate opened the 111th session of Congress with confirmation hearings and votes on several Obama administration Cabinet-level nominees, including several impacting global health issues: Secretary of State, Secretary of Health and Human Services, Director of the Office of Management and Budget (OMB) and the United States Ambassador to the United Nations.

Senate committees have approved the nominations of former Senator Tom Daschle for Secretary of Health and Human Services and Susan Rice for U.S. Ambassador to the United Nations. On Jan. 20, the Senate approved by voice vote Peter Orzsag as the new OMB Director, and confirmed former Sen. Hillary Rodham Clinton as the 67th Secretary of State by a vote of 94-2 on Jan. 21.

The series of confirmation hearings began with now-Secretary Daschle's testimony. The secretary focused on the importance of inter-agency cooperation to coordinate improving health efforts. In his opening statement, Secretary Daschle noted the need to "revitalize CDC [Center for Disease Control and Prevention] and strengthen its ability to detect and investigate health problems; conduct research to enhance prevention; develop and advocate sound public health policies; implement prevention strategies; promote health behaviors; and foster safe and healthful environments." He also highlighted the importance of the enhancing the public health workforce.

Secretary Daschle's testimony was followed by that of now-Secretary Clinton, who testified before the Senate Foreign Relations Committee with Sen. John Kerry, D-MA, presiding as chair. In her testimony, Secretary Clinton promoted the need for fully funding the State Department and USAID in order to increase the efficiency of their efforts. She also highlighted the need to focus on improving rights of women and girls globally. SFRC Ranking Member, Sen. Richard Lugar, R-IN, and other Republicans on the committee asked Secretary Clinton about the activities of her husband's organization, the Clinton Foundation.

Peter Orszag, nominated for the Office of Management and Budget director, testified in front of the Senate Homeland Security and Governmental Affairs Committee. The committee asked Orszag how he planned to improve government performance and retain and recruit federal workers. Senators also asked Orszag about procurement issues. The director stressed the importance of transparency and accountability.

Finally, the SFRC approved the nomination of Susan Rice as the next U.S. Ambassador to the U.N. In her testimony, Ambassador Rice addressed the challenges facing her -- including climate change, global disease, nuclear weapons proliferation and refugee crises related to Iraq and the Darfur region of Sudan. Rice spoke passionately about the need to do more to address the crisis in Darfur.

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PEPFAR Releases Annual Report To Congress
Annual PEPFAR Report To Congress Highlights Progress During First Five Years, Sets New Targets
January 12, 2009

On January 12, 2009, the Office of the U.S. Global AIDS Coordinator in collaboration with several U.S. government agencies released its annual report to Congress on the status of the President's Emergency Plan for AIDS Relief. According to the report, titled "Celebrating Life: Fifth Annual Report to Congress on PEPFAR (2009)," the program from its inception in 2003 through September 2008 has used the $18.8 billion invested in the program to support programs that have provided:
  • Antiretroviral treatment for 2.1 million HIV-positive people;
  • Sexual HIV prevention messages to 58.3 million people in fiscal year 2008;
  • Care for more than 10.1 million people, including nearly 4 million orphans and vulnerable children in PEPFAR's 15 focus countries;
  • Mother-to-child HIV prevention services (PMTCT) form nearly 16 million pregnancies from fiscal year 2004 through FY 2008, including provision of antiretrovirals to more than 1.2 million HIV-positive women, allowing 240,000 infants to be born HIV-negative;
  • Provision of 2.2 billion condoms from 2004 through Dec. 20, 2008.
The report also outlines goals for FY 2009 through FY 2012, which will be guided by the Lantos-Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008 (PL 110-293). The Lantos-Hyde Act, enacted in July 2008, authorizes $48 billion over the next five years to fight HIV/AIDS, TB and malaria worldwide. According to the report PEPFAR plans to work with developing countries and partners to support:
  • Prevention of 12 million new HIV infections;
  • Treatment for at least 3 million people;
  • Care for 12 million people, including 5 million orphans and vulnerable children;
  • Training of at least 140,000 new health care workers in HIV/AIDS prevention, treatment and care.
The report, a fact sheet and a highlights brochure are available on PEPFAR's Web site.

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