Order Code RS22913
July 8, 2008
Global Health: Appropriations to USAID
Programs from FY2001 through FY2008
Tiaji Salaam-Blyther
Specialist in Global Health
Foreign Affairs, Defense, and Trade Division
Summary
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.1 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 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.
1 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.

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USAID Global Health Programs: FY2001-FY2003
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.2 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 appropriated $100 million to USAID for
the initiative in FY2002 supplemental appropriations (P.L. 107-206); $100 million to
USAID and $40 million to Centers for Disease Control and Prevention (CDC) for the
initiative in FY2003 (P.L. 108-7); and $150 million to CDC the for the initiative in
FY2004 (P.L. 108-199). Conferees for the FY2004 measure also expressed an
expectation that an additional $150 million would be made available for the initiative
from the newly established Global HIV/AIDS Initiative (GHAI). Since FY2004, when
the initiative expired, Congress has continued to include funds for programs that prevent
the transmission of HIV from mother to child (PMTCT) in the GHAI account (Figure 1).
Table 1. USAID Global Health Programs: FY2001-FY2003
(current U.S.$ millions)
% Change:
FY2001
FY2002
FY2003
FY2001-
Program
Enacted
Enacted
Enacted
FY2003
Child Survival/Maternal Health (CS/MH)
361.1
391.7
389.7
0.079
Vulnerable Children (VC)
36.7
32.3
34.3
-0.065
HIV/AIDS
318
424
523.8
0.647
Other Infectious Diseases (OID)
140.2
182
173.1
0.237
Family Planning/Reproductive Health
425
425
443.6
0.044
(FP/RH)
United Nations Children’s Fund (UNICEF)
109.8
120
119.2
8.6%
Grant
Global Fund
$119.7
$200.0
$250.0
108.9%
Total
1510.5
1775
1933.7
28.0%
Source: Compiled by CRS from appropriations legislation and correspondence with USAID’s Budget
Office.
2 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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Figure 1. USAID Global Health Programs: FY2001-FY2003
(current U.S. $ millions)
600
500
400
300
200
100
0
FY2001
FY2002
FY2003
CS/MH
VC
HIV/AIDS
OID
FP/RH
UNICEF Grant
Global Fund
Source: Compiled by CRS from appropriations legislation and correspondence with USAID’s Budget
Office.
USAID Global Health Programs: FY2004-FY2008
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),3 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.4 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.
Still, appropriations for HIV/AIDS, TB, and malaria programs far outpaced support
for USAID’s other health programs. From FY2004 through FY2008, Congress provided
3 For more information on PEPFAR, see CRS Report RL33771, Trends in Global AIDS
Spending: FY2000-FY2008, and CRS Report RL34192, PEPFAR: From Emergency to
Sustainability, by Tiaji Salaam-Blyther.
4 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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$4.6 billion for USAID’s child survival and maternal health, vulnerable children, and
family planning and reproductive health initiatives (Table 2). During that same time
period, Congress appropriated $19.7 billion for global HIV/AIDS, TB, and malaria
programs (Table 3).
Table 2. USAID Global Health Programs: FY2004-FY2008
(current U.S.$ millions)
% Change:
FY2004-
Program
FY2004 FY2005
FY2006
FY2007
FY2008
FY2008
CS/MH
442.9
451.7
447.8
427.9
521.9
17.8%
VC
36.0
35.3
29.7
19.6
20.5
-44.3%
HIV/AIDS
555.5
384.7
373.8
345.9
371.1
-33.2%
OID
200.5
215.8
445.1
586.4
707.9
253.1%
TB
[85.1]
[92.0]
[91.5]
[94.9]
[162.2]
[90.6%]
Malaria
[79.9]
[90.8]
[102.0]
[94.9]
[349.6]
[337.5%]
H5N1 (Avian Flu)
n/a
[16.3]
[161.5]
[248.0]
[115.0]
[605.5%]a
Other
[35.5]
[16.7]
[90.1]
[161.5]
[81.1]
[128.5%]
FP/RH
429.5
437.0
435.0
435.6
457.2
6.5%
c
Global Fund (GF)
397.6
248.0
247.5
247.5
0.0b
Total with GF
2,062.0
1,772.5
1,978.9
2,062.9
2,078.6
0.8%
Total without GF
1,664.4
1,524.5
1,731.4
1,815.4
2,078.6
24.9%d
Source: Compiled by CRS from appropriations legislation and correspondence with USAID’s Budget
Office.
Notes: Contributions to UNICEF are not included in this table because Congress has appropriated those
funds to GHAI since FY2004.
Abbreviations: CS/MH — Child Survival/Maternal Health; VC — Vulnerable Children; OID — Other
Infectious Diseases; FP/RH — Family Planning/Reproductive Health.
a. Because Congress began funding global avian flu interventions in FY2005, this percentage reflects
changes in appropriations from FY2005 through FY2008.
b. In FY2008, Congress provided the full U.S. contribution to the Global Fund from Foreign Operations
Appropriations to GHAI.
c. CRS did not calculate changes in appropriations to the Global Fund, because the Global Fund is not a
bilateral program that the United States controls or through which the United States provides direct
assistance.
d. The final row reflects appropriations to USAID’s global health programs without considering U.S.
contributions to the Global Fund.

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Changes in USAID Global Health Appropriations Since
PEPFAR Authorization
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 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.
Figure 2. USAID Global Health Programs:
FY2004-FY2008
(current U.S. $ millions)
Source: Compiled by CRS from appropriations language and correspondence with USAID’s Budget Office.

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Table 3. U.S. Spending on Global HIV/AIDS, TB, and Malaria:
FY2004-FY2008
(current U.S.$ millions)
FY2004-
FY2004
FY2005 FY2006 FY2007 FY2008
FY2008
PROGRAM
Actual
Actual
Actual
CR
Estimate TOTAL
1.
USAID HIV/AIDS (excluding Global Fund)
555.5
384.7
373.8
345.9
371.1
2,031.0
2.
USAID Tuberculosis
85.1
92.0
91.5
94.9
162.2
525.7
3.
USAID Malariaa
79.9
90.8
102.0
248.0
349.6 870.3
4.
USAID Global Fund Contribution
397.6
248.0
247.5
247.5
0.0
1,140.6
5.
FY2004 Global Fund Carryoverb
(87.8)
87.8
n/a
n/a
n/a
0.0
6.
State Department Global HIV/AIDS Initiative (GHAI)
488.1
1,373.5
1,777.0
2,869.0
4,116.4
10,624.0
7.
GHAI Global Fund Contribution
0.0
0.0
198.0
377.5
545.5
1,121.0
8.
Foreign Military Financingc
1.5
1.9
1.9
1.6
—
6.9
9. Subtotal, Foreign Operations Appropriations
1,519.9
2,278.7
2,791.7
4,184.4
5,544.8
16,319.5
10. CDC HIV/AIDSd
291.6
123.8
122.6
121.0
118.7
777.7
11. CDC Tuberculosis
2.0
2.0
2.0
2.0
2.0
10.0
12. CDC Malaria
9.0
9.0
9.0
8.9
8.7
44.6
13. CDC International Research
9.0
14.0
0.0
0.0
0.0
23.0
14. National Institutes of Health (NIH) AIDS Researche
317.2
370.0
373.0
372.0
363.6 1,795.8
15. NIH Global Fund contribution
149.1
99.2
99.0
99.0
294.8
741.1
16. Department of Labor (DOL) HIV/AIDS
9.9
1.9
0.0
0.0
0.0
11.8
17. Subtotal, Labor/HHS Appropriations
787.8
619.9
605.6
602.9
787.8
3,404.0
18. Department of Defense (DoD) HIV/AIDS
4.3
7.5
5.2
0.0
8.0
25.0
19. Total HIV/AIDS and Global Fund
2,136.0
2712.3
3,198.0
4,433.5
5,818.1
18,297.9
20. GRAND TOTAL
2,312.0
2,906.1
3,402.5
4,787.3
6,340.6
19,748.5
Sources: Prepared by CRS from appropriations bill figures and interviews with officials from CDC, NIH, and the Office
of the Global AIDS Coordinator (OGAC).
Notes: Agencies and departments might obligate more funds to global HIV/AIDS, TB, and malaria efforts than were
appropriated. The figures for FY2008 are at appropriated levels and include rescissions. Division G, Section 528 of the
FY2008 Consolidated Appropriations Act, rescinds 1.75% of all FY2008 Labor/HHS appropriations and Division J, Section
699P of that Act rescinds 0.81% of all FY2008 State/Foreign Operations appropriations.
a. The Administration asserts operations for PMI began in FY2006; Congress did not appropriate funds to the initiative,
however, until FY2007 when Congress provided $250.9 million for global malaria programs, including $149.0 million
to expand PMI.
b. In FY2004, $87.8 million of U.S. contributions to the Global Fund was withheld per legislative provisions that prohibit
U.S. contributions to the Fund to exceed 33% of all contributions. The FY2005 Consolidated Appropriations Act
released these funds to the Global Fund, subject to the 33% proviso.
c. Appropriations for Foreign Military Financing are used to purchase equipment for DOD HIV/AIDS programs.
d. Lower spending levels after FY2004 reflect the shift of funds initially reserved for the International Mother and Child
HIV Prevention Initiative to GHAI. When the initiative expired in FY2004, these changes were made permanent and
were applied to subsequent fiscal years.
e. Although appropriations bills do not specify funding for NIH’s international HIV research initiatives, sufficient funds are
provided to the Office of AIDS Research (OAR) to undertake such efforts. Data was reported to CRS by OAR.

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