WikiLeaks Document Release
http://wikileaks.org/wiki/CRS-RS22913
February 2, 2009
Congressional Research Service
Report RS22913
Global Health: Appropriations to USAID Programs from
FY2001 through FY2008
Tiaji Salaam-Blyther, Foreign Affairs, Defense, and Trade Division
July 8, 2008
Abstract. Congressional awareness about and support for global health has grown considerably, particularly
during the tenure of President George W. Bush. From FY2001 through FY2008, Congress appropriated
about $15.2 billion to the U.S. Agency for International Development (USAID) for global health programs.
Appropriations supported five key programs: child survival and maternal health (CS/MH), vulnerable children
(VC), human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS), other infectious
diseases (OID), and family planning and reproductive health (FP/RH). Although a number of U.S. agencies
and departments implement global health programs, this report focuses on funding for global health programs
conducted by USAID. The role of other U.S. agencies and departments is discussed in the context of intergov-
ernmental partnerships, such as the President's Emergency Plan for AIDS Relief (PEPFAR).
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http://wikileaks.org/wiki/CRS-RS22913
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Prepared for Members and Committees of Congress
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Congressional awareness about and support for global health has grown considerably, particularly
during the tenure of President George W. Bush. From FY2001 through FY2008, Congress
appropriated about $15.2 billion to the U.S. Agency for International Development (USAID) for
global health programs. Appropriations supported five key programs: child survival and maternal
health (CS/MH), vulnerable children (VC), human immunodeficiency virus/ acquired
immunodeficiency syndrome (HIV/AIDS), other infectious diseases (OID), and family planning
and reproductive health (FP/RH). Although a number of U.S. agencies and departments
implement global health programs, this report focuses on funding for global health programs
conducted by USAID. (For further discussion of the structure of USAID's global health
programs, see CRS Report RL31433, U.S. Global Health Priorities: USAID's Global Health
FY2003 Budget, by Tiaji Salaam-Blyther.) The role of other U.S. agencies and departments is
discussed in the context of intergovernmental partnerships, such as the President's Emergency
Plan for AIDS Relief (PEPFAR).
From FY2001 through FY2008, much of the growth in global health spending targeted two
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diseases: HIV/AIDS and malaria. During this period, Congress supported the President's calls for
higher spending on these diseases through three key initiatives: The President's International
Mother and Child HIV Prevention Initiative (FY2002-FY2004), PEPFAR (FY2004-FY2008), and
the President's Malaria Initiative (FY2006-FY2010). PEPFAR has dominated much of overall
U.S. global health appropriations. Hence, this report analyzes funding for USAID's global health
before and after PEPFAR authorization. This report will not be updated and does not analyze
debates about PEPFAR reauthorization or discuss possible impacts of such reauthorization.
USAID Global Health Programs: FY2001-FY2003 ....................................................................... 1
USAID Global Health Programs: FY2004-FY2008 ....................................................................... 2
Changes in USAID Global Health Appropriations Since PEPFAR Authorization ......................... 4
Figure 1. USAID Global Health Programs: FY2001-FY2003 ........................................................ 2
Figure 2. USAID Global Health Programs: FY2004-FY2008(current U.S. $ millions) ................. 4
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Table 1. USAID Global Health Programs: FY2001-FY2003.......................................................... 1
Table 2. USAID Global Health Programs: FY2004-FY2008.......................................................... 3
Table 3. U.S. Spending on Global HIV/AIDS, TB, and Malaria: FY2004-FY2008 ....................... 5
Author Contact Information ............................................................................................................ 6
Overall support for USAID's global health programs grew from $1.5 billion in FY2001 to $1.9
billion in FY2003 (Table 1). Support grew in FY2002 and FY2003 only for HIV/AIDS
interventions, including U.S. contributions to the Global Fund to Fight HIV/AIDS, Tuberculosis,
and Malaria (Global Fund) (Figure 1). Support for child survival/maternal health programs
fluctuated during this period; appropriations did not reach FY2001 levels for vulnerable children
programs.
Increased funding for global HIV/AIDS programs was prompted in part by the International
Mother and Child HIV Prevention Initiative.1 In FY2002, President Bush submitted his first
budget request including $500 million for the initiative, which sought to prevent the transmission
of HIV from mothers to infants and to improve health care delivery in Africa and the Caribbean.
Congress provided that up to $100 million (excluding rescissions) be made available to USAID
for the initiative in FY2003. In FY2004, Congress provided $150 million (excluding rescissions)
to CDC for PMTCT programs. Conferees also expressed an expectation that $150 million would
be made available for the initiative from the newly established Global HIV/AIDS Initiative
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(GHAI; H.Rept. 108-401). Since the initiative expired in FY2004, Congress has included funds
for PMTCT programs in the GHAI account (Figure 1).
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1
For more on U.S. global HIV/AIDS policies, see CRS Report RL33771, Trends in U.S. Global AIDS Spending:
FY2000-FY2008, by Tiaji Salaam-Blyther. Also see The White House, "President Bush's International Mother and
Child Prevention Initiative," June 19, 2002, at http://www.whitehouse.gov/news/releases/2002/06/20020619-1.html.
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From FY2004 through FY2008, congressional debate increasingly focused on how to support the
global fight against HIV/AIDS, tuberculosis (TB), and malaria while maintaining support for
other global health programs. While some Members applauded the Administration's focus on
HIV/AIDS, particularly through the President's Emergency Plan for AIDS Relief (PEPFAR),2
they chided the Administration for requesting less for other global health interventions,
particularly those related to child survival, maternal health, family planning, and reproductive
health.3 Other Members questioned the ability of recipient countries to absorb burgeoning
HIV/AIDS funds because of overtaxed health infrastructures. Congress urged the Administration
to better integrate HIV/AIDS and other health programs, particularly those related to TB and
nutrition.
2
For more information on PEPFAR, see CRS Report RL33771, Trends in U.S. Global AIDS Spending: FY2000-
FY2008, by Tiaji Salaam-Blyther.
3
At a FY2007 House Foreign Operations Appropriations Subcommittee hearing on USAID's FY2007 budget request
on April 26, 2006, for example, Representative Nita Lowey questioned the effectiveness of increasing spending on the
Millennium Challenge Corporation (MCC) and PEPFAR, while proposing a reduction or no change in spending for
other development assistance and non-AIDS programs.
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$19.7 billion for global HIV/AIDS, TB, and malaria programs (Table 3).
reproductive health initiatives (Table 2). During that same time period, Congress appropriated
USAID's child survival and maternal health, vulnerable children, and family planning and
other health programs. From FY2004 through FY2008, Congress provided $4.6 billion for
Still, appropriations for HIV/AIDS, TB, and malaria programs far outpaced support for USAID's
£
While most health experts applaud increases in U.S. support for global HIV/AIDS interventions,
many are concerned that other low-cost life-saving interventions are overlooked and underfunded,
particularly those related to child survival and maternal health. Critics of how U.S. global health
funds are apportioned point out that child and maternal mortality rates remain dangerously high in
sub-Saharan Africa and that the continent is the only region in the world where those rates
continue to rise. In addition to these concerns, some global health analysts point out that despite
significant foreign investments in HIV/AIDS, many developing countries are ill-equipped to treat
the majority of patients suffering from non-infectious diseases and address basic health care.
Global health advocates urge Congress to provide more for health system strengthening, which
would enable governments to address any disease that might afflict its population. Supporters of
this idea assert that much of USAID's activities that are not related to PEPFAR operate in an
integrative fashion and simultaneously address a wide range of health challenges. Throughout the
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first term of PEPFAR (FY2004-FY2008), aggregated appropriations to USAID's global health
programs changed little (Figure 2). If FY2008 appropriations are excluded, support from
FY2004-FY2007 to three of USAID's five global health initiatives fell (CS/MH, VC, and
HIV/AIDS) and average funding increased only to FP/RH (by 1.4%) and OID (by 192.5%)--
which was driven largely by increases for malaria and avian influenza programs.
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tsalaam@crs.loc.gov, 7-7677
Specialist in Global Health
http://wikileaks.org/wiki/CRS-RS22913
Tiaji Salaam-Blyther
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