Global Health: USAID Programs and
Appropriations from FY2001 through FY2010
Tiaji Salaam-Blyther
Specialist in Global Health
August 13, 2009
Congressional Research Service
7-5700
www.crs.gov
RS22913
CRS Report for Congress
P
repared for Members and Committees of Congress

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

Summary
A number of U.S. agencies and departments implement U.S. government global health
interventions. Overall, U.S. global health assistance is not always coordinated. Exceptions to this
include U.S. international responses to key infectious diseases—for example, U.S. programs to
address HIV/AIDS through the President’s Emergency Plan for AIDS Relief (PEPFAR), malaria
through the President’s Malaria Initiative (PMI), and avian and pandemic influenza through the
Avian Flu Task Force. Although a number of U.S. agencies and departments implement global
health programs, this report focuses on funding for global health programs conducted by the U.S.
Agency for International Development (USAID), a key recipient of U.S. global health funding.
Congress appropriates funds to USAID for global health activities through five main budget lines:
Child Survival and Maternal Health (CS/MH), Vulnerable Children (VC), HIV/AIDS, Other
Infectious Diseases (OID), and Family Planning and Reproductive Health (FP/RH). From
FY2001 through FY2009, Congress appropriated about $16.1 billion to USAID for global health
programs (excluding contributions to the United Nations’ Children’s Fund [UNICEF] and the
Global Fund to Fight AIDS, Malaria, and Tuberculosis [Global Fund]). Much of the growth in
global health spending by USAID from FY2001 through FY2009 targeted three diseases:
HIV/AIDS, malaria, and avian and pandemic influenza. During this period, Congress supported
President Bush’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 PMI (FY2006-FY2010). Congress also endorsed the President’s
Pandemic Influenza Plan to address avian influenza and prepare for any pandemic influenza that
might arise.
Since PEPFAR was launched in 2004, the United States has apportioned the bulk of its global
health spending on the plan. In light of the dominant role that PEPFAR has played in shaping
U.S. global health assistance, analysis about funding for USAID’s global health programs in this
report is organized to reflect changes that occurred before and after PEPFAR authorization.
President Barack Obama has indicated early in his Administration that global health is a priority
and that his Administration would continue to focus global health efforts on addressing
HIV/AIDS. When releasing his FY2010 budget request, President Obama indicated that his
Administration would increase investments in global health programs and, through his Global
Health Initiative, improve the coordination of all global health programs. The President requested
that Congress approve $9.1 billion for all global health programs, including $2.6 billion for
USAID. See CRS Report R40740, U.S. Global Health Assistance: Background, Priorities, and
Issues for the 111th Congress, for more information on all U.S. global health funding.
There is a growing consensus that U.S. global health assistance needs to become more efficient
and effective. There is some debate, however, on the best strategies. This report explains the role
USAID plays in U.S. global health assistance, highlights how much the agency has spent on
global health efforts from FY2001 to FY2010, discusses how funding to each of its programs has
changed during this period, and raises some related policy questions.
Congressional Research Service

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

Contents
Introduction ................................................................................................................................ 1
USAID Global Health Programs: FY2001-FY2003 ..................................................................... 1
USAID Global Health Programs: FY2004-FY2008 ..................................................................... 4
HIV/AIDS ............................................................................................................................ 4
Malaria ................................................................................................................................. 6
H5N1 Avian Influenza...........................................................................................................7
Tuberculosis.......................................................................................................................... 8
USAID Global Health Programs: FY2009-FY2010 ..................................................................... 8
Pandemic Influenza............................................................................................................... 8
USAID Global Health Programs: FY2009 Appropriations ................................................... 11
USAID Global Health Programs: FY2010 Appropriations ................................................... 11
Key Provisions in House-Passed FY2010 Foreign Operations Appropriations ............... 12
Key Provisions in Senate Appropriations Committee-Passed FY2010 Foreign
Operations Appropriations.......................................................................................... 12
Administration Priorities ..................................................................................................... 12
Related Policy Issues ................................................................................................................ 13
Does USAID Effectively Monitor and Evaluate Its Health Programs? ................................. 14
What Should USAID’s Role Be in Leading U.S. Global Health Assistance? ........................ 15

Figures
Figure 1. USAID Global Health Programs: FY2001-FY2003 ...................................................... 3

Tables
Table 1. USAID Global Health Programs: FY2001-FY2003........................................................ 2
Table 2. U.S. Spending on Global HIV/AIDS Programs and the Global Fund: FY2001-
FY2003.................................................................................................................................... 3
Table 3. USAID Global Health Programs: FY2004-FY2008........................................................ 5
Table 4. Actual U.S. Funding for Global HIV/AIDS, TB, and Malaria: FY2004-FY2008............. 6
Table 5. U.S. Assistance for International H1N1 Responses, FY2009 ........................................ 10
Table 6. USAID Global Health Programs: FY2009-FY2010...................................................... 10

Contacts
Author Contact Information ...................................................................................................... 17

Congressional Research Service

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

Introduction
Congress appropriates funds for USAID’s global health programs through five main budget lines:
Child Survival and Maternal Health (CS/MH), Vulnerable Children (VC), HIV/AIDS, Other
Infectious Diseases (OID), and Family Planning and Reproductive Health (FP/RH).1 From
FY2001 through FY2009, Congress appropriated about $16.1 billion to USAID for global health
programs (excluding contributions to the United Nations’ Children’s Fund [UNICEF] and the
Global Fund to Fight AIDS, Malaria, and Tuberculosis [Global Fund]).2 Increased global health
spending by USAID occurred most precipitously from FY2004 to FY2009, after the launching of
the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative
(PMI).
President Barack Obama has indicated early in his Administration that global health is a priority.
On May 5, 2009, he announced his new Global Health Initiative, a six-year plan to spend $63
billion using an integrated approach to fight the spread of infectious diseases while addressing
other global health challenges.3 For the first year of this plan, the President has requested some
$8.6 billion for global health programs funded through the recently established Global Health and
Child Survival account (GHCS)—which combines funding for USAID global health programs,
HIV/AIDS programs managed by the Department of State under the Global HIV/AIDS Initiative
(GHAI), and a contribution to the Global Fund—and other accounts.4 Although the President has
indicated that his global health initiative would “adopt a more integrated approach to fighting
diseases, improving health, and strengthening health systems,” about 70% of the funds requested
through the GHCS account is targeted at HIV/AIDS interventions.
On July 9, 2009, the House voted to exceed the President’s request and passed the FY2010
Foreign Operations Appropriations (H.R. 3081), which included $8.8 billion dollars for global
health programs. The Senate version (S. 1434) included about $100 million more than the
President requested for global health programs, about $8.7 billion.
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). The bulk of this growth was generated by increases in funding for

1 Other CRS reports provide background information and analysis on these and other programs. For example, see CRS
Report RL34586, Child Survival and Maternal Health: U.S. Agency for International Development Programs, FY2001-
FY2008, by Tiaji Salaam-Blyther; CRS Report RL34569, PEPFAR Reauthorization: Key Policy Debates and Changes
to U.S. International HIV/AIDS, Tuberculosis, and Malaria Programs and Funding, by Kellie Moss; CRS Report
RL34246, Tuberculosis: International Efforts and Issues for Congress, by Tiaji Salaam-Blyther; and CRS Report
RL33250, International Population Assistance and Family Planning Programs: Issues for Congress, by Luisa
Blanchfield.
2 For background information on U.S. Contributions to the Global Fund, see CRS Report RL33396, The Global Fund
to Fight AIDS, Tuberculosis, and Malaria: Progress Report and Issues for Congress, by Tiaji Salaam-Blyther.
3 The White House, “Statement by the President on Global Health Initiative,” press release, May 5, 2009,
http://www.whitehouse.gov/the_press_office/Statement-by-the-President-on-Global-Health-Initiative/.
4 USAID global health programs are funded through the GHCS account, as well as other accounts, which may include
Assistance to Europe, Eurasia, and Central Asia (AEECA), Development Assistance (DA), and Economic Support
Fund (ESF).
Congressional Research Service
1

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

programs to address HIV/AIDS and other infectious diseases (Figure 1). Spending on global
HIV/AIDS programs, however, far outpaced that amount. From FY2001 through FY2003,
Congress provided $2.4 billion for U.S. global HIV/AIDS efforts (implemented by five agencies
and departments) and $622.5 million for U.S. contributions to the Global Fund (Table 2). During
this time period, Congress authorized agencies and departments other than USAID to implement
HIV/AIDS programs through the LIFE Initiative (launched under the Clinton Administration) and
expanded access to treatments to prevent the transmission of HIV/AIDS from mother to child
through the International Mother and Child HIV Prevention Initiative (instituted under the Bush
Administration).5
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
7.9%
Vulnerable
Children
(VC)
36.7 32.3 34.3 -6.5%
HIV/AIDS
318.0 424.0 523.8 64.7%
Other Infectious Diseases (OID)
140.2
182.0
173.1
23.7%
Family Planning/Reproductive Health (FP/RH)
425.0
425.0
443.6
4.4%
United Nations Children’s Fund (UNICEF)
109.8 120.0 119.2 8.6%
Grant
Global Fund
$100.0
$50.0
$248.4
148.4%
Total
1,490.8 1,625.0 1,932.1 29.6%
Source: Compiled by CRS from appropriations legislation and correspondence with Robbin Boyer, USAID
Budget Office.

5 For more on these initiatives, 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.
Congressional Research Service
2

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

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 Robbin Boyer, USAID
Budget Office.

Table 2. U.S. Spending on Global HIV/AIDS Programs and the Global Fund: FY2001-
FY2003
(current U.S. $ millions)
Agency, Department, or Program
FY2001
FY2002
FY2003
USAID 318.0
424.0
523.8
CDC 104.5
143.7
182.6
NIH Global HIV/AIDS Research
160.1
218.2
278.5
DOD 10.0
14.0
7.0
DOL 10.0
10.0
9.9
Global Fund
100.0
175.0
347.8
Total 702.6
984.9
1,349.6
Source: Compiled by CRS from appropriations legislation and correspondence with Robbin Boyer, USAID
Budget Office.
Acronyms: Centers for Disease Control and Prevention (CDC); National Institutes of Health (NIH);
Department of Defense (DOD); and Department of Labor (DOL).
Congressional Research Service
3

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

USAID Global Health Programs: FY2004-FY2008
Since Congress authorized PEPFAR through the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 (P.L. 108-25) and the plan was launched in FY2004,
debate on how funds for USAID’s global health programs should be apportioned has focused
mostly on efforts to respond to four infectious disease threats: HIV/AIDS, malaria, pandemic
influenza, and tuberculosis.
HIV/AIDS
Appropriations to HIV/AIDS programs and discussions about which interventions those funds
should support have dominated debate about the appropriate level of funding for USAID’s global
health programs. In the first four years of PEPFAR implementation, some observers contended
that support for PEPFAR was diverting some of the funds that might have been otherwise spent
on other critical global health programs, such as child survival and maternal health, to those
focused exclusively on HIV/AIDS. While some Members applauded the Administration’s focus
on HIV/AIDS, particularly through PEPFAR,6 they chided the Administration for requesting less
for other global health efforts, particularly those related to child survival, maternal health, family
planning, and reproductive health (Table 3).7 Other Members questioned the ability of recipient
countries to absorb burgeoning HIV/AIDS funds because of overtaxed health systems. Some
Members urged the Administration to better integrate HIV/AIDS programs with other health
programs, particularly those related to TB and nutrition.
Although average appropriations for USAID’s bilateral HIV/AIDS programs fell between
FY2004 and FY2008, debate focused on total HIV/AIDS spending, because USAID receives
most of the funds that Congress provides to the State Department for the Global HIV/AIDS
Initiative (GHAI).8 From FY2004 through FY2008, Congress made available $15.3 billion for
global HIV/AIDS programs (Table 4). During that same time period, Congress provided $4.6
billion for USAID’s child survival and maternal health, vulnerable children, and family planning
and reproductive health initiatives.


6 For more information on PEPFAR, see CRS Report RL34569, PEPFAR Reauthorization: Key Policy Debates and
Changes to U.S. International HIV/AIDS, Tuberculosis, and Malaria Programs and Funding, by Kellie Moss.
7 For example, at a hearing held by the House Foreign Operations subcommittee on April 26, 2006 on USAID’s
FY2007 budget request, Representative Nita Lowey questioned the effectiveness of raising spending on PEPFAR,
while proposing a reduction or no change in spending for other development assistance and non-AIDS programs.
8 The Office of the Global AIDS Coordinator (OGAC) at the State Department is responsible for coordinating and
overseeing U.S. global HIV/AIDS funds. The bulk of the funds are spent on the Global HIV/AIDS Initiative (which
mostly funds HIV/AIDS activities in 15 countries). Through GHAI, OGAC transfers funds to implementing agencies.
USAID receives the greatest portion of these funds. For background on this process and actual funds transferred from
FY2004 through FY2008, see CRS Report RL33771, Trends in U.S. Global AIDS Spending: FY2000-FY2008, by Tiaji
Salaam-Blyther.
Congressional Research Service
4

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

Table 3. USAID Global Health Programs: FY2004-FY2008
(current U.S. $ millions)
%Change:
FY2004
FY2005
FY2006
FY2007
FY2008
FY2004-
FY2004-
Program
Actual
Actual
Actual
Actual
Actual
FY2008 Total
FY2008
CS/MH
442.9 451.7 447.8 427.9 521.9
2,292.2
17.8%
VC
36.0 35.3 29.7 19.6 20.5
141.1 -43.0%
HIV/AIDS
555.5 384.7 373.8 345.9 371.1
2,031.0
-33.2%
OID
200.5 215.8 445.1 586.4 707.9
2,155.7
253.1%
TB
85.1 92.0 91.5 162.2 94.9
525.7
90.6%
Malaria
79.9 90.8 102.0 349.6 248.0
870.3
337.5%
Avian/Pandemic Flu
n/a 16.3 161.5 115.0 161.5
454.3
605.5%c
Other
35.5 16.7 90.1 82.0 81.1
305.4 128.5%
FP/RH
429.5 437.0 435.0 435.6 457.2
2,194.3
6.5%
Global Fund
397.6 248.0 247.5 247.5 0.0b 1,140.6
n/ad
Total
w/
Global
Fund
2,062.0 1,772.5 1,978.9 2,062.9 2,078.6
9,954.9
0.8%
Total w/o Global Funda 1,664.4 1,524.5 1,731.4 1,815.4 2,078.6
8,814.3
24.9%
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 the State Department since
FY2004.
Figures for all fiscal years include funding through all accounts, which in addition to the Global Health and Child Survival account, may include
Assistance to Europe, Eurasia, and Central Asia (AEECA), Development Assistance (DA) and Economic Support Fund (ESF).
Abbreviations: CS/MH—Child Survival/Maternal Health; VC—Vulnerable Children; OID—Other Infectious Diseases; FP/RH—Family
Planning/Reproductive Health.
a. The final row reflects appropriations to USAID’s global health programs excluding U.S. contributions to the Global Fund.
b. In FY2008, Congress provided the ful U.S. contribution to the Global Fund from Foreign Operations Appropriations to GHAI.
c. Because Congress began funding global avian flu interventions in FY2005, this percentage reflects changes in appropriations from FY2005
through FY2008.
d. Changes in U.S. contributions to the Global Fund from FY2004-FY2008 are not calculated, because: Congress stopped channeling support
for the Global Fund through USAID in FY2008. Also, in prior fiscal years, Congress provided funds to USAID and the Department of State
for U.S. contributions to the Global Fund, as wel as to NIH through Labor/HHS Appropriations. Thus, U.S. contributions to the Global
Fund channeled through USAID represent only a portion of the total U.S. contribution to the Fund. Since FY2008, al U.S. contributions to
the Global Fund through Foreign Operations Appropriations have been provided to the U.S. Department of State. Congress continues to
channel additional support to the Global Fund through Labor/HHS Appropriations. For background on this process, see CRS Report
RL33396, The Global Fund to Fight AIDS, Tuberculosis, and Malaria: Progress Report and Issues for Congress, by Tiaji Salaam-Blyther.



Congressional Research Service
5

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

Table 4. Actual U.S. Funding for Global HIV/AIDS, TB, and Malaria: FY2004-FY2008
(current U.S. $ millions)
FY2004-
% Change
Program, Agency, or Department
FY2004
FY2005
FY2006
FY2007
FY2008
Actual
Actual
Actual
Actual
Actual
FY2008
FY2004-
Total
FY2008
USAID HIV/AIDS
555.5
384.7
373.8
345.9
371.1
2,031.0
-33.2%
State GHAI
488.1
1373.9
1777.1
2869.0
4116.4
10,624.5
743.4%
Foreign Military Financing
1.5
2.0
2.0
1.6
1.0
8.1
-33.3%
CDC Global AIDS Program
266.9
123.8
122.6
121.0
118.9
753.2
-55.5%
NIH International HIV Researcha 317.2
369.5
373.0
361.7
411.7
1,833.1
29.8%
DOL AIDS Initiative
9.9
1.9
0.0
0.0
0.0
11.8
-100.0%
DOD HIV/AIDS
4.3
7.5
5.2
0.0
8.0
25.0
86.0%
HIV/AIDS Subtotal
1,643.4
2,263.3
2,653.7
3,699.2
5,027.1
15,286.7
205.9%
USAID
Tuberculosis
85.1 92.0 91.5 94.9 162.2 525.7 90.6%
CDC Tuberculosisb 2.0
2.3
2.2
1.9
1.6
10.0
-20.0%
Tuberculosis Subtotal
87.1
94.3
93.7
96.8
163.8
535.7
88.1%
USAID
Malaria
79.9 90.8 102.0 248.0 349.6 870.3 337.5%
CDC Malaria
9.2
9.1
9.0
8.9
8.7
44.9
-5.4%
Malaria Subtotal
89.1
99.9
111.0
256.9
358.3
915.2
302.1%
U.S. Contributions to the Global Fund
458.9
435.0
544.5
724.0
840.3
3,002.7
83.1%
Total 2,287.5
2,905.7
3,402.9
4,776.9
6,389.5
19,740.3
180.4%
Source: Compiled by CRS from congressional budget justifications and correspondence with agency officials.
a. NIH does not request funding for international HIV research. The figures represent the estimated value of the grants NIH
anticipates awarding each fiscal year.
b. CDC does not receive appropriations specifically for global TB activities but rather spends part of its TB control appropriation on
global TB efforts.
Malaria
Those concerned about the impact of malaria on the health on the world’s poorest, particularly in
Africa, contended that USAID did not allocate enough of its malaria funding on treating those
sickened by malaria in Africa. From FY2001 through FY2005, Congress provided $414 million
to fight malaria globally. During this time period, some Members of Congress and health experts
maintained that U.S. bilateral malaria interventions—which were mostly implemented by
USAID—yielded little tangible results, because a relatively small proportion of the funds were
spent on medicines to cure malaria and prevent its transmission from mother to child. Instead, the
programs focused more on preventative measures such as information-raising campaigns and
distributing insecticide-treated bed nets, and less on other highly effective strategies like indoor
residual spraying (IRS) and malaria treatments.
Shortly after PEPFAR was authorized and implemented, the President announced the President’s
Malaria Initiative (PMI), a coordinated U.S. government response to malaria in 15 sub-Saharan
Congressional Research Service
6

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

African countries.9 Launched in FY2006, PMI is led by USAID and implemented in conjunction
with CDC. The initiative is part of a broader change in USAID’s malaria policies, which since
PMI’s launching has focused on concentrating resources in fewer countries to increase program
effectiveness and devoting greater resources to procure malaria commodities, such as drugs that
treat or prevent malaria, and instituting IRS. U.S. spending on malaria commodities has increased
from 8% of the FY2004 USAID malaria budget to 46% of the FY2008 USAID malaria budget.
From FY2006 through FY2008, Congress provided $726.2 million for U.S. malaria programs.
H5N1 Avian Influenza
Concerns about a possible influenza pandemic also prompted increased appropriations to
USAID’s global health programs between FY2004 and FY2008. In FY2005, Congress began
providing emergency supplemental funds for U.S. technical assistance efforts related to global
pandemic influenza preparedness and response. Those funds have been used to train health
workers in foreign countries to prepare for and respond to a pandemic that might occur from any
influenza virus, including H5N1 avian flu and the newly emergent influenza virus, H1N1 “swine
flu,” which was characterized as a pandemic by the World Health Organization (WHO) on June
11, 2009 (discussed below).10
Influenza A/H5N1 is one of many strains of avian influenza that can cause illness in poultry and
has killed about 60% of the people who have contracted the virus. Bird (or avian) flu outbreaks
have occurred at various times around the world. Until 1997, there were no known human H5N1
cases. That year, 18 people in Hong Kong contracted the virus, including 6 who died. To contain
the virus, 1.5 million birds were killed. Since 2003, when the virus resurfaced and killed four
people, scientists have closely monitored resurgent H5N1 outbreaks. As of July 30, 2009, the last
human H5N1 case was reported to WHO on July 1, 2009, with a total of 436 people having
contracted the virus, of whom 262 died.11
The State Department announced in October 2008 that the United States has pledged nearly $950
million to international avian and pandemic influenza efforts, accounting for 30.9% of overall
international donor pledges of $3.07 billion since 2005.12 The funds have been used to support
international efforts in more than 100 nations and jurisdictions. The assistance focused on three
areas: preparedness and communication, surveillance and detection, and response and
containment.13

9 For background on PMI, see CRS Report R40494, The President’s Malaria Initiative and Other U.S. Global Efforts
to Combat Malaria: Background, Issues for Congress, and Resources, by Kellie Moss.
10 For more information on the 2009 influenza pandemic, see CRS Report R40588, The 2009 Influenza Pandemic: U.S.
Responses to Global Human Cases , by Tiaji Salaam-Blyther, and CRS Report R40554, The 2009 Influenza Pandemic:
An Overview, by Sarah A. Lister and C. Stephen Redhead.
11 For up to date information on human cases of H5N1 avian flu, see WHO, Cumulative Number of Confirmed Human
Cases of Avian Influenza A/(H5N1) Reported to WHO, http://www.who.int/csr/disease/avian_influenza/country/en/. For
up to date information on human cases of H1N1, see WHO, Situation Updates – Pandemic (H1N1) 2009,
http://www.who.int/csr/disease/swineflu/updates/en/index.html.
12 Correspondence with Jeffrey Lutz, Avian Influenza Task Force, U.S. Department of State, April 28, 2009 and U.S.
Department of State press release, “U.S. International Avian and Pandemic Influenza Assistance Approaches $950
Million,” October 25, 2008 at http://2001-2009.state.gov/r/pa/prs/ps/2008/oct/111241.htm.
13 In addition to these funds, other U.S. agencies and departments conduct pandemic and avian influenza activities,
which in many cases serve both domestic and international objectives (i.e., quarantine, rapid-testing, etc.). For example,
DOD-Global Emerging Infections System (GEIS) and the National Institutes of Health (NIH) conduct avian influenza
(continued...)
Congressional Research Service
7

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

Tuberculosis
WHO estimates that someone contracts TB every second and that about one-third of all people in
the world carry TB; most of these cases, however, are latent. Appropriations for USAID’s global
TB programs remained mostly level from FY2004 through FY2007, hovering between $90
million and $95 million. Some believe that congressional support for boosting funding for global
TB programs rose in response to a 2007 incident when a man carrying XDR-TB entered the
United States.14 In FY2008, Congress made available $162.2 million to USAID for global TB
efforts (some $67 million above FY2007 levels) and directed OGAC to apply at least $150
million of GHAI appropriations to TB/HIV co-infection programs.15 Unlike in the cases of the
other three diseases (HIV/AIDS, malaria, and avian flu), Congress has not authorized the creation
of a coordinating mechanism for overseeing U.S. support for international TB programs.
USAID Global Health Programs: FY2009-FY2010
After Congress authorized the extension of PEPFAR through the Tom Lantos and Henry J. Hyde
United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization
Acct of 2008 (Lantos-Hyde Act, P.L. 110-293), debate related to USAID’s global health programs
began to focus on how to integrate PEPFAR programs with pre-existing global health
interventions. The Act authorized $48 billion for U.S. international HIV/AIDS, tuberculosis, and
malaria programs from FY2009 through FY2013. The Act authorized a number of changes to
U.S. international HIV/AIDS, tuberculosis, and malaria programs, including higher funding
levels for programs targeted at the three diseases, the establishment of the U.S. Global Malaria
Coordinator within USAID, and strategies to promote sustainability of health care systems in
affected countries.
In FY2009, Congress and the Administration also became concerned about other health
emergencies, such as the impact of global food shortages on vulnerable populations and a new
influenza virus. The emergence of these issues has prompted more vigorous debate on how to
improve the coordination and integration of existing health programs and how to strengthen
health systems in poor countries to the extent that they can respond to whatever health crisis
might develop.
Pandemic Influenza
In April 2009, an influenza virus that had never circulated among humans before began to spread
around the world. The virus is called Influenza A/HIN1. There are many unknown factors about
the disease, including its origin. It is, however, mostly treatable, and less than 1% of those who

(...continued)
research activities.
14 Two months after Andrew Speaker entered the United States carrying XDR-TB, Congress held a special hearing on
U.S. efforts to contain and combat TB domestically and globally. See, U.S. Congress, Senate Committee on
Appropriations, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, Cracks in the
system: An examination of one tuberculosis patient’s international public health threat, 110th Cong., 1st sess., June 6,
2007, S.Hrg.110-359.
15 For background information on U.S. funding for global TB programs, see CRS Report RL34246, Tuberculosis:
International Efforts and Issues for Congress, by Tiaji Salaam-Blyther.
Congressional Research Service
8

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

have contracted the virus have died. By June 2009, WHO declared that the virus had spread so
pervasively that it had become a pandemic. The characterization was based on the reach of the
virus, not its virulence. As of July 30, 2009, WHO has confirmed nearly 135,000 human H1N1
cases, including 816 deaths. About 87% of those fatalities occurred in the Americas. It is
important to note that many more people may have contracted H5N1 and H1N1; the number of
cases reflects only those reported to WHO by health authorities.
On May 1, 2009, USAID established the Pandemic Influenza Response Management Team—
composed of its Bureaus of Global Health and Democracy, Conflict, and Humanitarian
Assistance—to coordinate all U.S. humanitarian responses to H1N1 outbreaks.16 As of May 18,
2009, the United States has provided more than $16 million to assist countries in Latin America
and the Caribbean respond to the H1N1 pandemic (Table 5). These funds are used for H1N1
responses specifically, and build on influenza pandemic preparedness efforts that began in earnest
after the 2003 severe acute respiratory syndrome (SARS) outbreak and were expanded at the peak
of H5N1 outbreaks. U.S. international responses to the H1N1 pandemic are conducted mostly by
CDC and USAID, though the Department of Defense (DOD) has also provided support. Foreign
assistance efforts largely focus on commodity delivery and disease detection and surveillance.
In addition to the support listed in Table 4, USAID announced on May 27, 2009, that it had
donated “4,000 personal protection equipment (PPE) kits to Vietnam and 100 boxes of
biodegradable powder—enough to produce over 20,000 liters of disinfectant to help animal
health workers respond quickly to potential new outbreaks of avian or H1N1 influenza.”17 The
kits—valued at over $57,000—can be used in response to H5N1 bird flu or H1N1 outbreaks.









16 USAID, Global—Influenza A/H1N1, Fact Sheet # 3, May 18, 2009, p. 1, http://www.usaid.gov/our_work/
humanitarian_assistance/disaster_assistance/countries/pandemic_influenza/template/fs_sr/
pandemic_influenza_fs03_05-18-2009.pdf.
17 USAID, “United States Donates Protective Suits and Disinfectant for Avian Influenza Response Preparedness,”
press release, May 27, 2009, http://vietnam.usembassy.gov/pr052709.html.
Congressional Research Service
9

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

Table 5. U.S. Assistance for International H1N1 Responses, FY2009
(U.S. $ thousands)
Agency/Implementing Partner
Activity
Location
Amount
HHS/Government of Mexico
Health Mexico
10,000.0
USAID/Government of Mexico
Emergency Relief Supplies
Mexico
875.0
USAID/Pan American Health Organization (PAHO) Emergency Relief Supplies
Panama
262.0
USAID/PAHO Health
Central
America
2,500.0
USAID/World Health Organization
Health
Central America
2,500.0
USAID Administrative
Support
Mexico
100.0
USAID Total


6,237.0
DOD/Ministries of Health
Emergency Relief Supplies
Central America
234.7
Total U.S. Assistance


16,471.7
Source: USAID, Global—Influenza A/H1N1, Fact Sheet # 3, May 18, 2009.
In addition to the funds that Congress provided specifically for responses to the H1N1 pandemic,
Congress also provided funds to help countries respond to avian influenza outbreaks and prepare
for any other influenza virus that might cause a pandemic. Through FY2008 Supplemental
Appropriations (P.L. 110-252), Congress mandated that $75 million be provided to USAID for
avian flu interventions in FY2009 (Table 6). Congress provided USAID an additional $50 million
for international pandemic preparedness efforts through FY2009 Supplemental Appropriations
(P.L. 111-32). These funds were provided in addition to the $140 million included in FY2009
Omnibus Appropriations (P.L. 111-8) for avian and pandemic influenza preparedness efforts.
Table 6. USAID Global Health Programs: FY2009-FY2010
(current U.S. $ millions)
%Change:
FY2009
FY2010
FY2009-FY2010
FY2010
FY2010
Program
Estimate
Request
Request
Houseb
Senateb
CS/MH 628.3
666.3
6.1%
669.3
666.3
VC 32.9
18.9
-42.6%
15.0
18.9
HIV/AIDS 350.0
350.0
0.0% 350.0
350.0
OID 914.5
1,029.8
19.1%
1,026.4
974.0
Tuberculosis 176.6
191.4
8.4% 266.3
201.0
Malaria 385.0
585.0
51.9%
585.0
585.0
Avian/Pandemic Flu
265.0
125.0
-52.8%
75.0
100.0
Other 87.9
128.4
46.1%
50.0
88.0
FP/RH 515.0
543.5
5.5%
648.5
628.5
Global Fund (GF)
100.0
0.0
-100.0%
0.0
0.0
Total with GF
2,540.7a 2,608.5 2.7%
2,709.2
2,637.7
Total without GF
2,440.7
2,608.5
6.9%
2,709.2
2,637.7
Source: Appropriations legislation and correspondence with USAID Budget Office.
Congressional Research Service
10

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

a. FY2009 estimate includes $75 million provided to USAID through FY2008 Supplemental Appropriations (P.L.
110-252), which mandated that the funds be used for international H5N1 avian flu interventions in FY2009; $50
million provided through FY2009 Supplemental Appropriations (P.L. 111-32) for international pandemic
preparedness efforts and $100 million for a U.S. contribution to the Global Fund.
b. FY2010 House and Senate figures are drawn from FY2010 House State-Foreign Operations Appropriations
Report (H.Rept. 111-187) and FY2010 Senate State-Foreign Operations Appropriations Report (S.Rept. 111-44),
respectively. House CS/MH $669.3 million includes $528 million from the GHCS account, $127.5 million from
ESF, and $13.9 million from AEECA. The House reports that it has met the Administration’s request for
pandemic flu preparedness and response activities, given the $50 million for such activities provided through the
FY2009 Supplemental Appropriations. House TB $266.3 million includes $252 million from the GHCS account
and $14.3 million from other accounts. House FP/RH $648.5 million includes $520 from the GHCS account,
$58.8 million from ESF, and $60 million to be provided to the United Nations Population Fund (UNFPA)
through the State Department. According to the Senate Appropriations Committee, if the Senate Report does
not indicate that additional funds have been made available for USAID global health programs through other
accounts, the Committee recommends that funds be provided through al accounts at requested levels.
USAID Global Health Programs: FY2009 Appropriations
In the first session of the 111th Congress, a number of congressional briefings have been held to
raise awareness about various issues related to global health, including maternal and child health,
family planning and reproductive health, and strengthening global health systems. Some
Members advocated for sustained funding for polio eradication efforts and higher spending on
family planning interventions. Others supported the enactment of H.R. 1410, the Newborn, Child,
and Mother Act of 2009, which seeks to increase spending on international maternal and child
health interventions.
In FY2009, Congress provided more funds to all USAID global health programs than it did in
FY2008, with the exception of HIV/AIDS. Support for child survival and maternal health
activities, as well as efforts to support vulnerable children, rose the most: 16.5% and 31.7%,
respectively. In the accompanying explanatory statement to the FY2009 Omnibus Appropriations
Act (P.L. 111-8), the Appropriations Committee indicated its support for strengthening health
systems, when it directed USAID within 180 days of enactment to:
[P]rovide a report to the Committees on Appropriations not later than 180 days after
enactment of this Act on current efforts to strengthen health systems, including spending by
program, and progress made. The report should include a summary of OGAC’s plans to
implement the World Health Organization task shifting guidelines and a summary of the
health care infrastructure that will be built with HIV/AIDS funding in this Act.
Increased support in FY2009 for non-HIV/AIDS global health programs in general, and health
systems in particular, seemed to indicate that Congress took into consideration the concerns that
some health experts raised about the impact of other health issues on global mortality rates.
USAID Global Health Programs: FY2010 Appropriations
On June 23, 2009, the House Appropriations Committee reported out (H.Rept. 111-187) its
version of the FY2010 Foreign Operations Appropriations bill, which included about $2.7 billion
for global health programs at USAID and an additional $5.4 billion for global HIV/AIDS
programs managed by OGAC at the State Department, including $750 million for a U.S.
contribution to the Global Fund. On July 9, 2009, the House passed the FY2010 Foreign
Operations Appropriations (H.R. 3081). The House-passed version includes an amendment that
Congressional Research Service
11

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

transfers $10 million from the State Department to USAID for maternal health programs
(H.Amdt. 306).
On July 9, 2009, the Senate Appropriations Committee reported out (S.Rept. 111-44) its version
of the FY2010 Foreign Operations Appropriations (S. 1434), which included slightly lower
funding levels for USAID global health programs, $2.6 billion, and an additional $5.4 billion for
OGAC-managed global HIV/AIDS programs, including $700 million for a U.S. contribution to
the Global Fund.
Both House and Senate Appropriations Committees emphasized the importance of improving the
integration, coordination, monitoring, and evaluation of U.S. global health programs. They also
underscored the importance of improving overall health systems. The House, however, attached
more directives to the funds and included reporting requirements.
Key Provisions in House-Passed FY2010 Foreign Operations Appropriations
As passed by the House, the FY2010 House Foreign Operations Appropriations directs the
Secretary of State to issue a report to the Appropriations Committees no later than 180 days after
enactment that describes and examines all ongoing global health programs by country funded
through Foreign Operations and other appropriations; discusses the impact, outcomes, and
effectiveness of the programs; provides specific information about complementary work by other
private and public donors; and recommends changes to such programs to improve results and
enhance effectiveness. The committee also directed that $130 million of GHAI resources be used
to support food security efforts; $43 million for a contribution to UNAIDS, and $160 million for
TB/HIV co-infection programs.
Key Provisions in Senate Appropriations Committee-Passed FY2010 Foreign
Operations Appropriations
Provisions for USAID global health, GHAI, and Global Fund contributions, as reported out of the
Senate Appropriations Committee, are about $250 million less than the House version. The
Senate Committee report calls for instituting a more integrated and sustainable approach to
fighting disease, improving basic health care, and strengthening health systems. It also endorses
the President’s Global Health Initiative and describes it as an opportunity to create a
comprehensive and sustainable global health strategy that identifies specific initiatives,
quantitative goals, and appropriate funding levels for global health. The Senate committee report
directs that 50% of microenterprise development funds be provided for microfinance service
providers who work with people infected with HIV/AIDS.
Administration Priorities
Global health has emerged as a key foreign policy goal early in the Obama Administration. When
releasing his FY2010 budget request, President Obama indicated that his Administration would
increase investments in global health programs.18 The President requested that Congress approve

18 Office of Management and Budget, A New Era of Responsibility: Renewing America’s Promise, FY2010 Budget,
February 26, 2009, p. 32, http://www.whitehouse.gov/omb/assets/fy2010_new_era/
A_New_Era_of_Responsibility2.pdf.
Congressional Research Service
12

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

his FY2010 budget request of $8.6 billion for the recently established Global Health and Child
Survival Account, which combines funding for USAID global health programs, HIV/AIDS
programs managed by the Department of State under the Global HIV/AIDS Initiative (GHAI),
and a contribution to the Global Fund. He also requested that Congress provide $1.5 billion in
emergency funds to support U.S. domestic and international responses to H1N1.19 He did not
indicate, however, how much of the funds would be spent on international efforts.
On May 5, 2009, President Obama announced his new Global Health Initiative, a six-year plan to
spend $63 billion using an integrated approach to fight the spread of infectious diseases while
addressing other global health challenges.20 In announcing the initiative, the President stated that
[i]n the 21st century, disease flows freely across borders and oceans, and, in recent days, the
2009 H1N1 virus has reminded us of the urgent need for action. We cannot wall ourselves
off from the world and hope for the best, nor ignore the public health challenges beyond our
borders. An outbreak in Indonesia can reach Indiana within days, and public health crises
abroad can cause widespread suffering, conflict, and economic contraction. We cannot
simply confront individual preventable illnesses in isolation. The world is interconnected,
and that demands an integrated approach to global health.
Although the President indicated that his global health initiative would “adopt a more integrated
approach to fighting diseases, improving health, and strengthening health systems,” about 70% of
the funds requested under GHCS is targeted at HIV/AIDS interventions. In addition, President
Obama requested some $490 million for other global health efforts to be conducted by CDC and
DOD.
Related Policy Issues
From FY2001 through FY2009, USAID’s spending on global health has increased by 84%. At the
same time, the number of U.S. agencies and departments engaged in global health and their scope
of work has grown considerably. In addition, there has been a precipitous increase in other types
of organizations engaged in global health work, including non-governmental organizations,
philanthropic foundations, corporate foundations, and online services that allow individuals to
provide funds directly to global health causes abroad.
Although a number of advancements have been made in improving global health, some health
experts have raised a number of questions about USAID’s capacity to meet future related
challenges. Some of the concerns relate to broader questions about USAID’s workforce levels and
reliance on contractors in the field, including on global health projects. Recent budget requests
and legislation have included workforce increases (for more information, see CRS Report
R40693, State, Foreign Operations, and Related Programs: FY2010 Budget and Appropriations,
by Susan B. Epstein, Kennon H. Nakamura, and Marian Leonardo Lawson). Other concerns
targeting the health sector include USAID’s capacity to monitor and evaluate health programs,
and what role USAID should play in light of the growing number of global health initiatives.

19 The White House, “Letter from the President to the Speaker of the House,” press release, April 30, 2009,
http://www.whitehouse.gov/the_press_office/Letter-from-the-President-to-the-Speaker-of-the-House-of-
Representatives/.
20 The White House, “Statement by the President on Global Health Initiative,” press release, May 5, 2009,
http://www.whitehouse.gov/the_press_office/Statement-by-the-President-on-Global-Health-Initiative/.
Congressional Research Service
13

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

Does USAID Effectively Monitor and Evaluate Its Health
Programs?
USAID’s ability to effectively monitor and evaluate its health programs has become an area of
concern for some Members of Congress and some health experts. In April 2007, GAO released a
report detailing research it conducted on USAID’s monitoring and evaluation practices of its
Child Survival and Maternal Health (CS/MH) account during FY2004 and FY2005. GAO
concluded that it could not identify how much was actually spent on child survival and maternal
health programs in FY2004 and FY2005 because the Office of the Administrator did not require
its missions and bureaus to report their obligations and expenditures of CS/MH allocations and
because USAID did not centrally track its missions’ and bureaus’ CS/MH obligations and
expenditures during that time period. It also concluded that program managers did not have
sufficient data to determine whether they were meeting their agencies’ strategic and annual
performance plans and their goals for accountability for the effective and efficient use of
resources.21 Furthermore, GAO found that the Office of the Administrator had a limited ability to
verify that the allocated CS/MH funds were used for their intended purposes, including
addressing congressional directives.
After having received a draft of the GAO report, USAID officials reportedly told GAO in
February 2007 that they had modified their accounting system to enable the agency to record and
trace future maternal and child health obligations and expenditures and verify that CS/MH funds
are being used for their allocated purposes.22 The system is not intended to function retroactively,
however, and will not be able to trace accounting data prior to FY2007.
USAID reportedly revised its accounting system so that its financial data could correlate with the
Foreign Assistance Framework that former Secretary Condoleeza Rice instituted and that the data
could be compatible with the State Department’s new planning system, which records budget
allocation information. GAO found, however, that the two systems are not integrated (though
USAID officials report that it can trace information between the two systems). USAID officials
reported to GAO that expenditure information reflecting the accounting changes would not be
available until FY2008 or FY2009. GAO has not yet released a follow-up report on this issue.
In this same report, GAO applauded the wide variety of methods that USAID used to disseminate
information on health care innovations and best practices that could be used to improve maternal
and child health programs in the field. GAO found, however, that USAID had not evaluated the
effectiveness of its methods. Failure to assess the effectiveness and impact of its information
sharing system meant that some of the health programs were operating under older methods that
were not as effective as new methods and that the innovative health strategies were not uniformly
applied.
The House Appropriations Committee Report (H.Rept. 111-187) to the FY2010 House Foreign
Operations Appropriations expressed concern about whether U.S. global health funds were being
efficiently and effectively used. The House directed the Secretary of State to issue a report to the

21 GAO, USAID Supported a Wide Range of Child and Maternal Health Activities, but Lacked Detailed Spending Data
and a Proven Method for Sharing Best Practices, p.4, GAO Report 07-486, http://www.gao.gov/new.items/d07486.pdf.
22 GAO, USAID Supported a Wide Range of Child and Maternal Health Activities, but Lacked Detailed Spending Data
and a Proven Method for Sharing Best Practices, pp. 3 and 4, GAO Report 07-486, http://www.gao.gov/new.items/
d07486.pdf.
Congressional Research Service
14

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

Appropriations Committees no later than 180 days after enactment that describes and examines
all ongoing global health programs by country that are funded through Foreign Operations and
other appropriations; discusses the impact, outcomes, and effectiveness of the programs; provides
specific information about complementary work by other private and public donors; and
recommends changes to such programs to improve results and enhance effectiveness.
The Senate Appropriations Committee also included reporting requirement language in the Senate
FY2010 Foreign Operations Appropriations bill. The committee directed the USAID
Administrator to submit a report to the Appropriations and Foreign Affairs Committees no later
than 180 days after enactment that outlines USAID’s program review and impact evaluation
processes. The report is to include “the number of evaluations conducted over the previous fiscal
year, the office or bureau that conducted the evaluation, the titles of those evaluations, the criteria
used to choose subjects for evaluation, the methodologies used, and how the results of such
evaluations are disseminated to USAID’s staff.” The committee indicated that “without an
analysis of what works and why, the Committee does not have confidence that assistance funds
are achieving their intended development objectives.”
What Should USAID’s Role Be in Leading U.S. Global Health
Assistance?
Some health experts have asserted that USAID’s ability to shape and guide its own
policies are being eroded by a number of factors, including congressional earmarks,
increased emphasis on short-term projects, decreased investments in research and
innovative long-term efforts, and the expanding role of the State Department in the
oversight and coordination of global health programs.

At an April 2009 Senate hearing, Georgetown University Professor and former USAID Deputy
Administrator Carol Lancaster testified that “USAID has become little more than an
implementing agency for programs decided in the Department of State.”23 She also maintained
that during the Bush Administration, most of the policy and budgetary expertise in USAID was
relocated to the F Bureau at the State Department, which depleted significantly the ability of
USAID to analyze and develop U.S. development policies and link budgets to policies. GAO
indicated in its report on CS/MH monitoring and evaluation that USAID officials told the Office
that, “the majority of the Program and Policy Coordination (PPC) Bureau’s functions had been
transferred to the State Department’s Office of Foreign Assistance, which now oversees the
budgetary administration of the Child Survival and Health account.”24
Others assert that the Administration’s decision to place the leadership of PEPFAR at the State
Department and the creation of the Millennium Challenge Corporation (MCC) has further
weakened USAID. Although PEPFAR is led by the State Department, the bulk of the funds that

23 Senate Foreign Relations Committee hearing, USAID in the 21st Century, Official Testimony, Carol Lancaster, April
1, 2009.
24 The Child Survival and Health (CSH) account is now incorporated into the Global Health and Child Survival
account, which combines the accounts of CSH, Global HIV/AIDS Initiative (GHAI)—managed by the Department of
State, and the portion of the Global Fund contribution provided through the Foreign Operations Appropriations. GAO,
USAID Supported a Wide Range of Child and Maternal Health Activities, but Lacked Detailed Spending Data and a
Proven Method for Sharing Best Practices, p. 15, GAO Report 07-486, http://www.gao.gov/new.items/d07486.pdf.
Congressional Research Service
15

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

the State Department transfers to implementing agencies goes to USAID. Similarly, the Avian Flu
Task Force, which is responsible for coordinating U.S. funding for global pandemic preparedness
efforts and for representing the United States at global meetings on the phenomenon, is led by the
State Department. Nonetheless, USAID coordinates the humanitarian responses to avian and
pandemic flu in the field.
There is some debate, however, about whether the recent increased involvement of the State
Department in global health programs threatens the ability of USAID to conduct its work.
Supporters of State Department participation in global health assert that PEPFAR has been
successful, in part, because the U.S. Global AIDS Coordinator was appointed as an Ambassador.
Proponents contend that this elevated status helped to engender partnerships and commitments
from foreign governments that other global health programs have yet to secure. While there is
little question that PEPFAR has been one of the United States’ most successful public diplomacy
initiatives, some health experts have concerns about the political implications of expanding the
State Department’s participation in global development and health programs. Some argue that
further integrating global health programs into the State Department might lead to a level of
politicization that health programs, in particular, have been largely protected from under the
current structure. Furthermore, some critics are concerned that further integration might result in
diplomatic concerns outweighing global health concerns or the use of health assistance as a
political tool.
Some observers maintain that USAID should become completely independent from the State
Department. Former USAID Administrator Andrew Natsios supports this idea, in large part
because development and diplomacy have different emphases. In a prepared statement for the
Senate hearing on USAID in the 21st Century, Mr. Natsios asserted that “the current gradual
absorption of USAID by stealth into the State Department through the merging of the agency’s
budgeting system, procurement, electronic mail system, its logistics, office space, motor pool,
reduction in USAID field presence, and warehousing capability in the field, is gradually eroding
the Agency’s capacity to carry out its mission.”25
In addition to making USAID more independent, some advocate expanding USAID’s authority to
include oversight over PEPFAR, the Millennium Challenge Corporation, and U.S. activities
related to multilateral lending institutions (which are currently led by the U.S. Treasury
Department). Others suggest empowering USAID by giving it a seat on the National Security
Council.26 One opponent to this idea maintains that USAID needs to be better funded and staffed
before it could assume greater leadership.27


25 Senate Foreign Relations Committee hearing, USAID in the 21st Century, Official Testimony, Carol Lancaster, April
1, 2009
26 In addition to the witnesses at the April 2009 Senate Foreign Relations Committee hearing on USAID, Sheila
Herring of the Center for Global Development proposed that the USAID Administrator be added to the National
Security Council, see http://blogs.cgdev.org/globaldevelopment/2009/03/dear-general-jones-add-the-usaid-
administrator-to-the-national-security-council.php.
27 See Amy Frumin, “Diagnosing USAID,” Foreign Affairs, March/April 2009, Volume 4, Number 88,
http://www.foreignaffairs.com/articles/64663/amy-b-frumin/diagnosing-usaid.
Congressional Research Service
16

---

Global Health: USAID Programs and Appropriations from FY2001 through FY2010

Author Contact Information

Tiaji Salaam-Blyther

Specialist in Global Health
tsalaam@crs.loc.gov, 7-7677




Congressional Research Service
17

---