U.S. Foreign Assistance to Sub-Saharan Africa: The FY2012 Request

Contents

• Overview: U.S. Policy Priorities in Africa and the FY2012 Aid Request
• The FY2012 Request by the Numbers
• Recent Trends and the Debate Over Foreign Aid
• Selected Issues for Congress
• Africa and the President's Global Foreign Assistance Initiatives
• The Global Health Initiative
• Feed the Future
• The Global Climate Change Initiative
• Congress and the Initiatives
• Other Selected Program Areas
• Democracy and Governance
• Economic Growth
• Security Assistance
• The MCC and Africa

Summary

Sub-Saharan Africa, the world's poorest region, receives over a quarter of all U.S. bilateral foreign assistance. Aid to Africa more than quadrupled over the past decade, primarily due to sizable increases in global health spending during the Bush Administration and more measured increases in development, economic, and security assistance. The Obama Administration's FY2012 bilateral Africa aid budget request, at $7.8 billion, represents an increase of roughly 10% compared to FY2010, albeit at a more restrained growth rate than in previous years (see "The FY2012 Request by the Numbers"). FY2011 enacted levels are not yet available by region. The proposed increases are concentrated in the areas of health, governance, and agriculture.

Significant aid increases since 2001 reflect, in part, changing perceptions of Africa's importance to U.S. national interests and security. They also reflect strong bipartisan support for global health assistance, which has dominated U.S. aid to Africa in recent years. Africa bears the brunt of the world's global health challenges, notably with regard to HIV/AIDS and malaria, and African governments generally lack sufficient capacity to confront the burden of disease on their own. U.S. health efforts in Africa, as elsewhere, have been underpinned by humanitarian concerns, but they have also been motivated by concerns over potential threats to global security. Nearly 70% of proposed FY2012 bilateral aid for African countries (not including Millennium Challenge Corporation funding) would go toward implementing President Obama's Global Health Initiative, which incorporates significant HIV/AIDS, malaria, and tropical disease programs initiated during the Bush Administration. (See "Africa and the President's Global Foreign Assistance Initiatives.")

The Obama Administration has identified a number of other policy objectives in Africa, including food security, democracy, economic growth, conflict prevention and mitigation, and addressing transnational threats. This range of objectives reflects the continent's size and diversity. It also challenges policy makers to balance foreign aid priorities and achieve strategic focus. While health programs represent the bulk of U.S. bilateral spending, other types of assistance, such as democracy promotion and security cooperation, may be more powerful in defining U.S. bilateral relations with African countries and in achieving U.S. diplomatic leverage. Given the inability of many African countries to meet basic development and governance criteria, policy makers often debate whether poor performance justifies terminating or, rather, continuing aid.

Analysts, practitioners, and aid advocates have long debated the value and design of aid programs in Africa. Critics allege that aid has done little to improve socioeconomic outcomes in Africa, and that in some cases it may serve to prolong conflicts or empower undemocratic regimes or rebel groups. Aid advocates counter that programs should be reformed or scaled up, not terminated, and that seeking to improve the welfare of impoverished populations abroad is both a humanitarian imperative and in the U.S. national interest. The methods and metrics for evaluating the effectiveness and impact of aid programs are also a topic of debate.

Congress authorizes, appropriates funding for, and oversees aid programs in Africa. U.S. assistance is also subject to a number of legislative restrictions imposed by Congress, including some which directly or indirectly pertain to African countries. (See "Selected Issues for Congress.")

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U.S. Foreign Assistance to Sub-Saharan Africa: The FY2012 Request

Overview: U.S. Policy Priorities in Africa and the FY2012 Aid Request

Figure 1. The FY2012 Bilateral Aid Request for Africa by Program Area $ Millions

Source: FY2012 Congressional Budget Justification for Foreign Operations Notes: Does not reflect aid funding administered by agencies other than the State Department and USAID. Does not include humanitarian aid, most of which is not requested on a bilateral basis and is allocated during the year according to need.

The Obama Administration has requested $7.8 billion in bilateral foreign assistance for Africa in FY2012, which is designed to meet a number of objectives (see Figure 1). The Administration has identified five U.S. policy priorities in Africa that broadly correspond to long-standing U.S. engagement on the continent:

• to strengthen democratic institutions;
• to foster broad-based and sustainable economic growth;
• to combat disease and improve public health;
• to prevent, mitigate, and resolve armed conflict; and
• to help to address transnational threats and challenges.¹

At the same time, over three-quarters ($6 billion) of the Administration's FY2012 foreign assistance budget request for the continent is allocated toward implementing three global aid initiatives launched over the past two years:

• the Global Health Initiative, which incorporates significant pre-existing HIV/AIDS, malaria, and tropical disease initiatives;
• Feed the Future; and
• the Global Climate Change Initiative.²

(These initiatives and other bilateral and regional assistance program areas are discussed below.) The wide range of U.S. policy objectives with regard to Africa reflects the continent's size and diversity. It also reflects a central tension of foreign aid policy: aid aims to enable other countries to achieve a certain level of prosperity and governance capacity for their own sake, but it is also a tool for the United States to advance its national and strategic interests.³ Bilateral aid packages thus ostensibly advance U.S. interests, while seeking to meet recipient countries' assessed needs and perceived ability to benefit from U.S. programs. There is additional tension between aid as a tool to achieve specific development outcomes (such as increasing economic growth, extending life expectancy, improving government service delivery, or contributing to the settlement of conflicts) and its potential usefulness in obtaining diplomatic leverage.

The design of U.S. aid to Africa therefore represents a challenge to U.S. policy makers in terms of balancing priorities and achieving strategic focus. Given the inability of many African countries to meet basic development and governance criteria—as a region, Africa is not on track to meet the U.N. Millennium Development Goals⁴—policy makers often debate whether poor performance on the part of recipient governments justifies terminating or continuing aid. Some policy makers may argue that governance concerns justify cutting aid, while others might contend that aid is designed to improve areas of poor performance, and that maintaining programs may give the United States leverage to change poor or ineffective policies pursued by recipient governments. Others debate whether security assistance programs strengthen undemocratic regimes in Africa, and whether they serve the national security interests of the United States (and at what cost). At the same time, security assistance programs sometimes aim to improve the professionalism and human rights record of African military and police forces.

A breakdown of U.S. aid to Africa by program area shows a strong emphasis on health assistance (largely categorized as Investing in People by the State Department), which represents nearly three-quarters of total bilateral aid to the continent. President Obama's Administration and recent Congresses have provided strong support for global health assistance, building on the sharp increase in U.S. global health commitments initiated by the Administration of former President George W. Bush. At the same time, Administration policy statements reference various other policy priorities in Africa, which are not necessarily matched with equally robust aid allocations.

The FY2012 Request by the Numbers

The proposed FY2012 budget represents an increase of roughly 10% compared to FY2010 enacted levels for Africa ($7.1 billion; actual aid reached $8.1 billion with emergency humanitarian aid included), albeit at a more restrained growth rate than in previous years. (FY2011 enacted levels by region and program area are not yet available.) The proposed increases are concentrated in the areas of health, governance, and agriculture. When compared to FY2010 by broad program area,⁵ the FY2012 request would increase Governing Justly and Democratically assistance by 19%, Investing in People assistance (which includes health and education) by 12%, and Economic Growth assistance by 14%. Peace and Security assistance would decrease by 1%. The Administration has also requested $24 million ($6 million less than FY2010) for the African Development Foundation, an independent U.S. agency established by Congress to support grass-roots development solutions.⁶

The proposed budget would provide bilateral aid to 46 African countries, ranging from a total of $751.4 million (Kenya) to $25,000 (Guinea-Bissau). The top 10 aid recipients would be Kenya, Nigeria ($660.5 million), Ethiopia ($608.3 million), Tanzania ($571.9 million), South Africa ($561.9 million), Uganda ($527.8 million), Sudan ($518.3 million), Mozambique ($424.6 million), Zambia ($400.8 million), and the Democratic Republic of Congo (DRC, $261.9 million). Each country's aid package includes different programming, reflecting country-specific assistance and policy priorities. Together, these 10 countries represent about $5.29 billion, or about 68% of the total Africa bilateral aid request.

A number of countries would receive significant increases in their total bilateral aid packages under the proposed FY2012 budget. For example, Cameroon, DRC, Ghana, Malawi, Mali, Sudan, Swaziland, Tanzania, and Zimbabwe would receive increases of 20% or more, compared to FY2010. At the same time, the budget would eliminate certain types of assistance in some African countries, and would reduce the levels of aid given to others. For example, previously small allocations of existing Development Assistance funds would be eliminated in at least eight countries (Benin, Cameroon, Chad, Madagascar, Mauritania, Mauritius, Niger, and Togo) and would be cut by over half in several others (including Burundi, Djibouti, and Guinea). Angola's total aid package would be cut by 13.5% and Sierra Leone's by 27%. Aid to the African Union (AU) would decrease from $1.5 million to $1 million. At the same time, funding devoted to several regional assistance (i.e., non-country-specific) allocations would significantly increase. Regional allocations, which provide funding for specific countries during the year according to identified needs, enable more flexible decision making, but they represent a potential trade-off in terms of planning and transparency.⁷

In addition to country-specific aid programs, the proposed FY2012 budget would fund the continuation of a number of State Department-led regional security and rule-of-law initiatives, such as the Trans-Sahara Counter-Terrorism Partnership (an interagency program administered jointly by the State Department, the Defense Department, and USAID), the Partnership for Regional East Africa Counter-Terrorism (formerly known as the East Africa Regional Strategic Initiative), the Africa Maritime Security Initiative, the Africa Conflict Stabilization and Border Security program, the Women's Justice and Empowerment Initiative, and programs to stem human trafficking and the regional trade in "conflict minerals." The State Department is also requesting $14.7 million to support a new program, the West Africa Regional Security Initiative (WARSI), which "seeks to enhance the ability of West African states to respond to the threat of transnational crime."⁸ The FY2012 budget would also fund USAID regional initiatives on areas such as food security and environmental conservation.

The proposed FY2012 bilateral aid budget for Africa represents roughly 27% of the Administration's FY2012 global bilateral aid request of $29.1 billion. (This includes Africa-specific and global funding allocated for GHCS, ESF, DA, and State Department-administered security assistance; it does not include food aid or multilateral aid.⁹) Africa-specific aid represents about 62% of the proposed global budget for the GHCS account, 40% of the DA account, 10% of the ESF account, and 4% of the State Department-administered security assistance budget.¹⁰

Bilateral or country-to-country aid, also known as direct assistance, is implemented by non-governmental organizations (NGOs), private and voluntary organizations, contractors, or African government ministries and agencies. Multilateral aid, or indirect assistance, is provided to inter-governmental bodies, notably United Nations entities and international financial institutions—such as the World Bank, African Development Bank (AfDB), and International Monetary Fund—which, in turn, decide on country and program allocations (with U.S. participation). The Administration's FY2012 budget request includes $195 million for the African Development Fund, the concessional wing of the AfDB,¹¹ and $1.6 billion to support assessed contributions to U.N. peacekeeping operations in Africa, which are appropriated to the State Department's Contributions to International Peacekeeping Activities (CIPA) account.¹² The United States also contributes to international debt relief efforts for poor countries through funding administered by the Department of Treasury, as authorized by Congress with certain restrictive provisions.¹³

Recent Trends and the Debate Over Foreign Aid

Figure 2. Bilateral Foreign Assistance to Africa, Selected Accounts: FY2002-FY2012 (appropriations, millions of constant 2010 dollars)

Source: Congressional Budget Justification for Foreign Operations, FY2004-FY2012. FY2012 figures are presented as-is, not adjusted for projected inflation. Notes: (1) Does not include humanitarian aid, most of which is not requested on a bilateral basis. (2) Does not reflect assistance administered by agencies other than the State Department and USAID. (3) Prior to FY2008, GHCS (USAID) figures refer to the Child Survival and Health (CHS) account, and GHCS (State) figures refer to the Global HIV/AIDS Initiative (GHAI) account. (4) State Department-administered security assistance includes the following accounts: INCLE, PKO, NADR, IMET, and FMF. (5) Enacted figures for FY2011 are not available.

U.S. bilateral aid to African countries, adjusted for inflation, more than quadrupled over the past decade, from $1.4 billion in FY2002 to $8.1 billion in FY2010.¹⁴ The biggest increases occurred under the Bush Administration and were largely due to growth in global health spending—particularly focused on HIV/AIDS—with more moderate increases in economic and development aid and some security assistance programs (Figure 2). As noted above, FY2011 levels by region and program area are not yet available.

Foreign assistance funding is widely viewed as vulnerable in federal budget debates. The Obama Administration has expressed strong support for foreign aid, which it has elevated as a pillar of foreign policy through its Quadrennial Diplomacy and Development Review (QDDR) and defended as "vital to U.S. national security" and "a strategic, economic, and moral imperative."¹⁵ Yet, the Administration released its FY2012 Congressional Budget Justification (CBJ) for Foreign Operations in March 2011 amid an ongoing congressional debate over the value, design, and appropriate funding levels of foreign aid programs worldwide. Some aspects of the debate are tied to long-standing discussions over ways to improve USAID, coordination among implementing agencies, and aid effectiveness.¹⁶ Other aspects relate to concerns over the U.S. federal budget deficit and related attempts to restrain government spending. Secretary of State Hillary Clinton has defended the FY2012 global foreign aid request as "a lean budget for lean times."¹⁷ While some Members support this view and contend that the sustainment of foreign assistance is crucial to U.S. policy priorities, others have strongly criticized the Administration's proposed foreign aid budget as expensive, ineffective, and based on "misplaced priorities."¹⁸ House leaders have proposed significant cuts to appropriations for the International Affairs (150) account, which includes Foreign Operations and other allocations.¹⁹

The Administration's proposed FY2011 foreign aid budget, released in early 2010, included increases in some types of foreign aid to Africa and decreases in others. Congress appropriated funds for foreign operations for the first half of FY2011, however, through a series of continuing resolutions that, until April 15, 2011, broadly maintained global foreign assistance at FY2010 enacted levels, while giving little guidance on the allocation of assistance by region and program. H.R. 1473 (enacted as P.L. 112-10 on April 15, 2011), which appropriated funding for the remainder of FY2011, directed rescissions and cuts to various global foreign aid accounts. Pending further consultation between the executive branch and Congress, the regional, country-specific, and programmatic effects of these directives have not been determined.

Analysts, development practitioners, and aid advocates have also long debated the value and design of aid programs in Africa. In the 1990s, as the Cold War drew to a close, a number of critics contended that foreign assistance on the continent had achieved little; indeed, development indicators in many African countries had declined since decolonization. Some further alleged that humanitarian aid in Africa had served to prolong conflicts and had empowered undemocratic regimes and rebel groups.²⁰ Aid advocates countered that aid should be better designed or scaled up, not terminated, in order to achieve desired objectives, and that aid to Africa is a humanitarian imperative and in the U.S. national interest.²¹ After the terrorist attacks of September 11, 2001, and subsequent increasing concern over so-called "failed states," some policy makers justified funding increases for Africa (and elsewhere) as integral to U.S. national security prerogatives. By President George W. Bush's second term, the view that U.S. interests in Africa were significant, and therefore justified a sizable aid budget, appeared to have achieved some level of bipartisan support.²² Critics continue to analyze purportedly neo-colonial aspects of aid programs in Africa and to emphasize potential negative effects, contending that programs are designed with little input from local populations, or that aid has inadvertently spurred corruption and dependency.²³ Methods and metrics for evaluating aid's effectiveness and impact are also a topic of debate.

Selected Issues for Congress

Congress authorizes, appropriates funding for, and oversees U.S. foreign assistance programs. Potential issues for Congress include the following broad areas of consideration. Country-specific references are provided as examples and are not intended to emphasize one country at the expense of another.

• Balance and prioritization. To what extent is foreign assistance to Africa a U.S. policy and budgetary priority? Does the FY2012 Africa aid budget accurately reflect U.S. strategic objectives? For example, is the overwhelming focus on global health programming in Africa justified? Do the order of recipient countries and the breakdown of aid per country reflect U.S. policy priorities? For example, Ethiopia is identified as a priority country (see below) for its role in "advancing regional security and economic growth," but the overwhelming majority of aid to Ethiopia is related to health and economic growth—is this allocation justified? What areas and countries are other donors focusing on, and is donor coordination sufficient to maximize impact and prevent duplication?
• Impact of proposed cuts and increases. What is the potential impact of proposed aid cuts on development outcomes and on bilateral relationships? What is the potential impact of decreases in democracy and governance aid to several West African countries (such as Guinea, Mauritania, Niger, and Chad)? Conversely, do countries targeted for aid increases have the capacity to absorb new programming? For example, can the Democratic Republic of Congo, a fragile post-conflict state, absorb a proposed 32.2% increase in bilateral aid?
• Transparency. Does the Administration, in its aid budget request for Africa, provide sufficient information and insight into planned programs and activities? Do the aid funding and implementation processes allow for sufficient consultation with, and oversight by, Congress?
• Country ownership. To what extent are African countries addressing problems of socioeconomic development, security, and governance themselves? Do U.S. aid programs and policies enable greater involvement and responsibility from recipient governments? What does the professed U.S. goal of "country ownership" mean in the African context, where available resources and capacity are often very low?
• Aid effectiveness. What aid programs are most effective? What metrics—if any—are used to evaluate effectiveness? Should the balance of foreign assistance programs be based primarily on effectiveness, or on other criteria, such as policy objectives? To what extent are criticisms of U.S. assistance programs in Africa merited (see "Recent Trends and the Debate Over Foreign Aid"), and what steps can be taken to counter such criticisms?
• Unintended consequences. What are the potential unintended consequences of aid programs in Africa? Does aid contribute to corruption, market distortions, health system disparities, or the strengthening of undemocratic regimes or non-state actors? Does the design of aid for some countries jeopardize U.S. policy goals in other areas? For example, does security assistance for Uganda inhibit U.S. leverage on democracy and governance concerns with the Ugandan government?²⁴ What is the impact of security assistance programs in countries with records of serious human rights abuses?
• Donor coordination. The United States is the largest bilateral donor to Africa. Still, a range of other bilateral and multilateral donors also administer substantial assistance programs on the continent. For example, combined bilateral official development assistance to Africa from other industrialized countries participating in the Organization for Economic Cooperation and Development's (OECD's) Development Assistance Committee totaled roughly $13.8 billion in 2009, excluding grants, or nearly double the U.S. share.²⁵ Development aid funding for Africa administered by European Union institutions totaled an additional $4.6 billion.²⁶ Are U.S. policy makers effectively coordinating with other donors to achieve maximum impact and to eliminate duplication?

More broadly, Congress influences U.S. foreign policy when it authorizes and funds foreign assistance programs, and these foreign policy positions can have a significant impact on aid to Africa. Measures in both annual appropriations and long-standing authorization requirements to curtail or deny aid because of a failure of the recipient state to meet standards in human rights, weapons proliferation, anti-terrorism, illicit narcotics trafficking, religious freedom, and trafficking in persons can weigh heavily on U.S. bilateral aid to Africa.

The current foreign operations appropriations act, for example, restricts aid to any government that rose to power by militarily overthrowing a democratic regime, does not comply with budget transparency requirements, supports international terrorism, or is in arrears in paying its external debt. The act requires the President to notify Congress in advance of security assistance being made available to select countries (including Angola, Cameroon, Central African Republic, Chad, Côte d'Ivoire, Equatorial Guinea, Ethiopia, Rwanda, Guinea, Somalia, and Zimbabwe). It requires certain conditions are met before foreign aid can be made available to the governments of Sudan or Zimbabwe. Similarly, it states that Peacekeeping Operations (PKO) assistance for Chad, Sudan, Somalia, and the Democratic Republic of Congo "should not be used to support any military training or operations that include child soldiers."²⁷

Congress has initiated and reinforced these restrictions and conditions on foreign aid in authorization acts. The Foreign Assistance Act of 1961, for example, requires the President to take into account a prospective recipient's record on expropriation, human rights, narcotics trafficking, debt arrearage or default, support of international terrorism, aid to other terrorist states, and proliferation.²⁸ Congress has also required the President and the U.S. foreign aid agencies to deny aid to those engaged in trafficking in persons, denying religious freedom, or recruiting child soldiers.²⁹ And as individual countries—most notably Sudan³⁰ and Zimbabwe³¹—have experienced significant political and social turmoil, Congress has led U.S. foreign policy, particularly through asserting its views regarding the best use of foreign aid.

Africa and the President's Global Foreign Assistance Initiatives

Figure 3. The FY2012 Bilateral Aid Request for Africa by Initiative $ Billions

Source: State Department and USAID briefing for congressional staff, March 18, 2011 Note: Does not reflect cross-regional assistance programs, aid administered by agencies other than the State Department and USAID, or multilateral assistance to Africa.

Over three-quarters of the Administration's FY2012 bilateral aid request for African countries (not including MCC funding) would be allocated toward implementing three presidential global foreign aid initiatives focused on health, food security, and mitigation of the impacts of global climate change. The remaining "non-initiative" funding amounts to $1.8 billion, or 23% of the total bilateral aid request for African countries (see Figure 3). (Other aid priorities are discussed below, in "Other Selected .")

The Global Health Initiative

The Administration has advocated increased funding for health programs both globally and within Africa (see Figure 4). President Obama created the Global Health Initiative (GHI) in 2009 to better coordinate and integrate the implementation of three global health initiatives launched during the George W. Bush Administration—the President's Emergency Plan for AIDS Relief (PEPFAR), the President's Malaria Initiative (PMI), and the Neglected Tropical Diseases (NTD) Program—as well as other ongoing bilateral health efforts conducted by the State Department, USAID, and the U.S. Centers for Disease Control and Prevention (CDC).³² President Obama delegated the State Department to head the GHI until September 2012, when leadership will be transferred to USAID if certain benchmarks are achieved.³³ The GHI is projected to cost $63 billion globally from FY2009 through FY2013.

In creating the GHI, President Obama also indicated his intention to increase investments in areas that he deemed underfunded, namely maternal and child health, neglected tropical diseases, and family planning and reproductive health. Although the GHI calls for higher spending in these areas, the Obama Administration has maintained support for health priorities previously set by the Bush Administration, particularly assistance to confront HIV/AIDS and malaria. This means that requests to raise spending on the above cited areas are made in proportion to other budgetary increases and do not radically alter how GHCS funds are distributed.

Figure 4. U.S. Funding for Bilateral Global Health Programs (GHCS) (billions of historical dollars)

Source: Congressional Budget Justification for Foreign Operations, FY2010-FY2012. Notes: Africa receives a share of some GHCS funding allocated for functional (non-region-specific) purposes. Figure does not reflect funding administered through other foreign assistance accounts, or multilateral assistance. It does not include allocations for FY2011, as enacted levels are not yet available.

The GHI's emphasis on creating a more cohesive and efficient approach to global health is rooted in long-standing recommendations by bipartisan policy makers and advocates. The GHI also aims to strengthen domestic health systems in developing countries, and to support "country ownership" of U.S.-funded health assistance programs. Critics of GHI argue that its goals are overly vague and do not fundamentally shift the nature, implementation, or impact of U.S. global health programs. Some skeptics also question whether the GHI's interagency approach may slow the implementation of global health programs. Some, including Members of Congress, have expressed concern that the GHI's emphasis on increasing funding for certain areas (including maternal and child health, nutrition, and family planning/reproductive health) could shift attention and resources away from PEPFAR and jeopardize the gains made in the global fight against HIV/AIDS. Finally, some Members contend that greater transparency and consultation with Congress is needed on GHI implementation.

The proportionally high allocation of global health funds for Africa (Figure 4) reflects, in part, the heavy socioeconomic burden of disease on African populations and the relative lack of capacity of many African governments to respond. Africa bears the brunt of the world's global health challenges, accounting for close to 24% of the global "burden" of disease (as calculated by the World Health Organization)³⁴ and grappling with some of the world's highest rates of malnutrition, infant mortality, and poor maternal and child health. The continent is home to approximately 90% of global malaria deaths, two-thirds of all people living with HIV, and one-third of all tuberculosis (TB) cases.³⁵ Worldwide, more than 7 out of every 10 child deaths worldwide occur in Africa.³⁶ Along with the humanitarian impact of these challenges, disease and poor health in Africa pose what many believe to be critical obstacles to economic development. Moreover, many health advocates have expressed concern that decreasing budgets for health assistance programs could result in the termination of HIV/AIDS treatment programs for some patients, potentially resulting in growing viral resistance to existing medications as well as greater numbers of deaths.

African countries are also among the least equipped to withstand and confront endemic health problems. Many countries in the region have chronically under-resourced public health sectors, including inadequate health facilities, poor health information systems, and insufficient numbers of trained health workers. Although African countries as a whole have increased their commitments to health, these investments have not been commensurate with the challenge. Advocates of health assistance in Africa argue that this necessitates greater international commitments to helping African countries confront the burdens of disease, whereas critics contend that African countries themselves should be responsible for shouldering an increasing share of the cost of responding. Some critics also contend that international donors such as the United States have overemphasized health at the expense of other aid priorities.

Congress funds global health assistance through three annual appropriations: State, Foreign Operations and Related Programs; Labor, Health and Human Services, and Education; and Defense. The majority of U.S. global health funding is provided through the Global Health and Child Survival (GHCS) account in Foreign Operations appropriations, which is jointly managed by the Department of State and USAID. Congress also makes funds available for global health through other foreign assistance accounts, including the DA and the ESF accounts. Appropriators do not, however, specify how much should be made available for global health through these accounts. The analysis below focuses only on the GHCS account.

The Administration has requested $5.4 billion in GHCS funding for global health programs in Africa in FY2012. This represents a 12.5% increase over the $4.8 billion provided in FY2010. The proposed increase in funding for Africa is proportional to overall GHCS funding increases and would not significantly increase Africa's share of global GHCS funds: in FY2010, GHCS allocations for Africa amounted to roughly 61% of global GHCS funds, and in FY2012, proposed GHCS funding for Africa would make up just under 62% of the global request.

Comparing FY2012 with FY2010, the largest requested program area increases in Africa are related to nutrition (+186.1%), maternal and child health (+134.2%), and family planning and reproductive health (+39.7%). The FY2012 budget also calls for slightly higher funding for HIV/AIDS (+3.8%), TB (+23.4%), and malaria (+9.7%) programs in Africa. Along with these increases, the FY2012 budget calls for several shifts in the relative allocation of global funds for combating certain diseases. For example, the budget request calls for increasing the share of global TB funds spent in Africa in FY2012 compared to FY2010 levels, while decreasing Africa's share of global malaria funds.

Feed the Future³⁷

In June 2009, at the G8 Summit in L'Aquila, Italy, President Obama pledged $3.5 billion over three years (FY2010 to FY2012) to a global initiative to address hunger and poverty worldwide. The U.S. commitment is part of a global pledge, by the G-20 countries and others, of over $22 billion. In May 2010, the State Department launched Feed the Future (FtF) as the Administration's global hunger and food security initiative.³⁸ The State Department led in developing the FtF strategy; USAID is the primary agency responsible for coordinating its implementation.³⁹ The two primary objectives of the initiative are (1) to accelerate inclusive agricultural sector growth, including by improving agricultural productivity, expanding markets and trade, and increasing the economic resilience of vulnerable rural communities, and (2) to improve the nutritional status in developing countries, particularly of women and children, including by preventing undernutrition through community-based programs, improving diet quality and diversity, and improving the delivery of nutrition services by health systems linked to community-based programs. Nutrition-related programming will be coordinated with the Global Health Initiative.⁴⁰ Feed the Future builds on the five principles for sustainable food security first articulated at L'Aquila and endorsed at the 2009 World Summit on Food Security in Rome: support comprehensive strategies, invest in country-owned plans, improve stronger coordination among donors, leverage effective multilateral institutions, and deliver on sustained and accountable commitments.⁴¹

For FY2010, the Administration allocated about $1.31 billion to FtF from existing resources.⁴² FtF is funded primarily through USAID's DA account, but also from the ESF; Assistance for Europe, Eurasia, and Central Asia (AEECA); and GHCS accounts. The FY2011 budget request included $1.84 billion for FtF-related activities, and was the first instance in which the Administration requested funds specifically to implement FtF.⁴³ The final FY2011 continuing resolution (P.L. 112-10) specified allocations to the USAID budget accounts that fund global food security activities, specifically DA, ESF, AEECA, GHCS, and International Disaster Assistance (IDA), but did not provide specific allocations to the FtF initiative. The implications of P.L. 112-10 on the overall funding levels of the FtF initiative remain uncertain. For FY2012, the Administration has requested $1.56 billion for FtF, with about one-third allocated for Africa.⁴⁴

The initiative has selected 20 focus countries, of which 12 are in Africa: Ethiopia, Ghana, Kenya, Liberia, Mali, Malawi, Mozambique, Rwanda, Senegal, Tanzania, Uganda, and Zambia. FtF activities are also planned in Nigeria, which is considered a "Strategic Partner" country because of its regional economic importance. The proportionally high number of African focus countries reflects, in part, a conclusion by some policy makers and researchers that agricultural development is key to Africa's broader socioeconomic development. This is due to a confluence of factors, including the socioeconomic burden of food insecurity in Africa, in terms of health outcomes and lost productivity; the centrality of agriculture to African economies; and African farmers' relatively low level of access to widely used technology that could boost productivity. Agriculture represents 26.2% of Africa's gross domestic product (GDP), the largest share of any world region, compared to 9.5% in developing countries on average.⁴⁸ Africa also has the highest proportion of rural residents as a percentage of the total population, compared to other developing regions, and the highest proportion of agriculture workers as a percentage of the total labor force.⁴⁹ Yet arable land in Africa receives, on average, fewer key inputs—such as fertilizer, farming machinery, and irrigation—than in other developing regions.⁵⁰ The cycle of poverty in Africa is thought to be strongly linked to food insecurity, and vice-versa; Africa has the lowest per-person food consumption of any world region, and the highest average amount of food aid received. High population growth is expected to exacerbate these issues. Five of the top 10 country recipients of international food aid worldwide are in Africa.⁵¹

The Global Climate Change Initiative

Africa is widely viewed as among the global regions most likely to experience significant social and environmental effects attributable to global climate change. The Global Climate Change Initiative (GCCI) seeks to

• build social resilience and adaptation in developing countries to extreme weather and climate events to reduce associated risk of damage, loss of life, and instability;
• promote clean energy technologies, supportive regulatory environments, and low-emission development strategies in selected countries; and
• support environmental conservation and sustainable land use in order to reduce carbon emissions, preserve flora and fauna species, ensure future biodiversity, and sustainably manage the use of forests.

The FY2012 budget request asserts that failure to lead in these areas would "undermine U.S. standing and influence around the world."⁵² The FY2012 budget request would allocate $650.6 million for the GCCI, of which the largest share ($452 million) would come from the DA account. The budget does not provide country-level GCCI program plans, but it does allocate $126 million in DA funding for Africa—27.8% of global GCCI DA funding, the equivalent of 19.4% of total global GCCI funding. FY2012 funding would provide $53 million (42% of the Africa total) for adaptation programs; $25 million (20%) for clean energy technology and low-emission development; and $48 million (38%) for "sustainable landscapes."

Congress and the Initiatives

The Administration's focus of aid resources on global health, food security, and global climate change responds, in part, to congressional directives. In authorization legislation and annual appropriations bills, Congress has directed the executive branch to allocate significant sums of money toward these three areas. For example, the FY2010 Consolidated Appropriations Act (P.L. 111-117, Division F, Title VII, Sec. 7081) provided "up to" $1.26 billion in foreign assistance funding for programs and activities to (1) reduce, mitigate, and sequester greenhouse gases that contribute to global climate change; (2) support climate change adaptation; (3) protect forests and other critical landscapes; and (4) protect biodiversity, subject to various further provisions. The act (Division F, Title III, Development Assistance) also provided "not less than" $1.17 billion for food security and agricultural development programs. These directives indicated global funding levels, and were not Africa specific.

Beginning in 2004, Congress significantly increased support for foreign aid programs to tackle the escalating global HIV/AIDS crisis. Higher funding levels followed calls by President Bush to wage an aggressive battle against HIV/AIDS through PEPFAR, with an emphasis on providing life-saving treatment to those in need. These efforts spurred newly robust engagement on a range of other health issues in Africa, including support for anti-tuberculosis efforts, the President's Malaria Initiative, and the neglected tropical diseases initiative. President Obama announced the Global Health Initiative to better coordinate these efforts and to bolster support for other critical health efforts, especially those related to women's health (maternal and child health, family planning, and reproductive health), and for countries' domestic health systems.

These efforts have been underpinned by humanitarian concerns, but they have also been motivated by concerns over the potential security threats posed by emergent infectious diseases and epidemics. President Obama and former President George W. Bush have both highlighted potential links between the capacity of development countries to respond to disease outbreaks, these countries' levels of socioeconomic development, and international security, and have argued that improving global health can have strategic value for the United States. Likewise, global health programs have been progressively recognized as diplomatic tools, with the potential to facilitate trust and improve relations between the United States and recipient countries. Some Members of Congress have echoed these sentiments in hearings, legislation, and other activities.

In the Tom Lantos and Henry J. Hyde U.S. Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (P.L. 110-293), Congress authorized $48 billion to be spent from FY2009 through FY2013 on global HIV/AIDS, tuberculosis, and malaria programs, including $4 billion for U.S. bilateral TB programs and $5 billion for bilateral malaria efforts. In FY2009 and FY2010, Congress provided $14.5 billion to combat the three diseases, from GHCS and several other accounts. The GHCS provisions included the following:

• HIV/AIDS: $5.6 billion (FY2009) and $5.7 billion (FY2010), including GHCS contributions to the Global Fund.
• TB: $162.5 million (FY2009) and $225.0 million (FY2010).
• Malaria: $382.5 million (FY2009) and $585.0 million (FY2010).

Current spending trends suggest that the authorized levels may not be met unless increases in funding for global HIV/AIDS, TB, and malaria are appropriated in FY2012 and FY2013. In FY2012, the Obama Administration has requested $6.0 billion for HIV/AIDS (including GHCS contributions to the Global Fund), $236 million for TB, and $691 million for malaria.

Other Selected Program Areas

The Administration has identified 13 priority African countries for non-initiative aid programming:

• 1. Sudan, Liberia, the Democratic Republic of Congo (DRC), Kenya, Zimbabwe, and Somalia are "facing major humanitarian problems, or recovering or suffering from serious conflict."
• 2. Ethiopia, Nigeria, and South Africa play "important roles … in advancing regional security and economic growth."
• 3. Ghana, Mali, Mozambique, and Tanzania are "relatively well-performing" but are seen as requiring assistance to support "democratic consolidation."⁵³

Proposed FY2012 aid to these 13 countries totals $5.14 billion, or just under 66% of the total Africa aid request. The decision to designate priority countries reflects an attempt to strategically focus foreign aid resources; the designations, however, do not necessarily correspond to overall aid levels, in part because the prioritization refers to non-initiative aid allocations. In other words, some countries receive higher overall funding than some priority countries, potentially because of large costs in health, food assistance, or climate change programs. For example, Uganda ($527.8 million), Zambia ($400.8 million), and Rwanda ($241.4 million) are among the top 13 aid beneficiaries in the FY2012 budget, but are not designated among the 13 priority countries.⁵⁴ Neither is Angola, which is one of three African countries (along with Nigeria and South Africa) with which the United States has initiated a bilateral strategic partnership dialogue.⁵⁵

Democracy and Governance

The Administration has identified support for Governing Justly and Democratically (GJD) programs as its top foreign assistance priority in Africa, after funding for the three global aid initiatives discussed above.⁵⁷ This reflects growing concerns among policy makers and advocacy groups that many African countries have experienced a downward trend with regard to democracy and good governance in the past five years.⁵⁸ GJD assistance cover a wide range of activities, from strengthening government institutions to supporting civil society, political party development, and independent media. The Administration has requested $371 million in FY2012 funding for GJD programs in Africa, compared to $312 million in FY2010. The FY2012 request represents a 19.1% increase over FY2010 levels, the highest proportional increase for any broad program area. However, GJD programs represent only roughly 5% of the total FY2012 request for Africa, or about 20% of the $1.8 billion identified as non-initiative Africa aid funding.

The FY2012 budget request would increase GJD funding in several key countries compared to FY2010, while decreasing it in others. Notably, the Administration proposes increases in GJD funding for Tanzania (+202%), Ghana (+150%), Mali (+82%), and Mozambique (+57%), which the Administration has identified as priority countries for democracy support. Increases are also proposed for Uganda (+67%), Kenya (+42.3%), Rwanda (+32%), DRC (+31%), Nigeria (+30%), Sudan (+18%), Senegal (+14%), and Liberia (+10%). At least four of these countries—Kenya, DRC, Senegal, and Liberia—are expected to hold national elections during FY2012. However, the budget would eliminate existing low levels of GJD funding in several countries (such as Cameroon, Chad, Mauritania, and Niger) and would significantly decrease it in others, compared to FY2010, including Angola (-89%), Djibouti (-61%), Burkina Faso (-54%), Guinea (-31%), Zambia (-30%), and Somalia (-23%).⁵⁹ Several of these countries have extremely troubled democracy and governance records. The proposed decreases for Niger and Guinea, for example, are striking, as both countries initiated fragile transitions from military rule to civilian-led, elected governments in the past year. The State Department and USAID may, however, choose to adjust bilateral allocations during the year based on conditions.

Economic Growth

Proposed FY2012 funding for Economic Growth programs, at $1.14 billion, constitutes the second-largest programmatic share of proposed bilateral aid to Africa, after Investing in People (which includes health assistance). Africa has the highest poverty rate, on average, of any world region, although the continent has experienced relatively strong economic growth (on average) over the past 15 years, averaging 6.5% per year between 2002 and 2007 according to the International Monetary Fund (IMF). Although African economies were negatively affected by the 2008-2009 global economic recession, they appear to be recovering from the crisis with the potential to significantly increase growth rates in the coming years.⁶⁰ Still, this growth record masks significant disparities among countries and sub-regions.

The largest shares of proposed FY2012 economic growth funding are allocated for agricultural development ($671.7 million, a 19.1% increase over 2010) and environmental assistance ($193.6 million, a 35.8% increase over FY2010). These allocations are linked to the implementation of the Feed the Future and Global Climate Change initiatives. Funding for infrastructure constitutes the third-largest sectoral allocation in the FY2012 request, at $82.7 million; however, this represents a 35.4% decrease compared to FY2010. The decrease largely reflects the reallocation of funds for Southern Sudan, in order to focus on other areas in what is expected to be the immediate aftermath of independence from the North.⁶¹

Security Assistance

The Obama Administration has requested approximately $431 million for programs related to "Peace and Security," representing just under a quarter of non-initiative aid to Africa and a slight decrease (-1.2%) from FY2010.⁶² This funding focuses on promoting of military professionalization; mitigating armed conflict; building national and regional capacity to counter terrorism and narcotics trafficking, to ensure maritime security, and to participate in multilateral peacekeeping operations. Such aid also supports programs to promote respect for human rights among African security forces.

Many African countries also receive assistance through the African Contingency Operations and Training Assistance (ACOTA) program, which supports African troops deploying under international peacekeeping missions, and is part of the Global Peacekeeping Operations Initiative (GPOI). (Funding for ACOTA, because it is in support of a global program, is not requested on a bilateral basis or as part of the Africa regional security assistance allocation.) U.S. assessed contributions to U.N. peacekeeping costs—appropriated to the State Department's CIPA account—also contribute to stabilizing African countries and may indirectly provide assistance to African troops participating in such missions. African countries may potentially benefit from stabilization-focused aid administered through USAID's Complex Crises Fund, established by the 111th Congress to support programs and activities responding to emerging or unforeseen complex crises abroad. The Administration has requested $75 million for this fund for FY2012.⁶³

The FY2012 request features a substantial increase in INCLE funding for Africa, which supports rule of law and counternarcotics programs, from $34.5 million in FY2010 to a requested $91.7 million.⁶⁴ This includes a significant increase in funding to support the development of the police service in Southern Sudan, which is expected to become an independent country in July 2011 (see text box, above). The two other countries targeted for the largest amounts of INCLE funding are Liberia and DRC. Decreased funding for counterterrorism programs partly reflects proposed cuts to the NADR account (-17%), which has funded anti-terrorism training programs in several African countries. The largest intended NADR recipients in FY2012 are Kenya, Sudan, Somalia, and Mozambique. The PKO account request would also decline (-18%), which partly reflects the United Nations assuming the logistical support of the AU peacekeeping mission in Somalia. PKO funding is also the primary vehicle for several major security sector reform initiatives in Africa, as reflected in the large amounts requested for Sudan, Somalia, the DRC, and Liberia.

A significant amount of "Peace and Security" assistance, roughly $57.9 million, is requested to fund the State Department's "Africa Regional" allocation. According to the State Department, African countries participating in the Trans-Sahara Counter-Terrorism Partnership (TSCTP) would receive at least $16.3 million in regional PKO funds, the Partnership for Regional East Africa Counterterrorism (PREACT) would receive $21.3 million, and the Africa Conflict Stabilization and Border Security (ACSBS) program—which has funded a range of initiatives, including U.S. support for regional military operations against the Lord's Resistance Army in central Africa—would receive $7.2 million. USAID's "West Africa Regional" allocation also includes $12 million for TSCTP-related activities focused on countering extremist ideologies. It is difficult to compare funding levels for these programs to previous years, as allocations for certain components of TSCTP and other regional programs are not broken out by country in the annual Congressional Budget Justification. Participant countries may also receive related assistance funded by the Defense Department and other agencies.

The MCC and Africa

The Millennium Challenge Corporation (MCC) was established in 2004 to introduce a new approach to foreign economic assistance. A number of key elements differentiate it from previous aid efforts and from the ongoing work of USAID. Its purpose—reducing poverty through economic growth—is not characterized by the multiple objectives legislated for USAID or with similar legislative restrictions. It was conceived to work with only a relative handful of nations that are viewed as most likely to succeed. Recipients must score above the median in relation to other countries in their income brackets in performance indicators that measure their commitment to "ruling justly," "investing in people," and "economic freedom." In the most radical departure from previous aid efforts, recipient countries are expected to "own" their projects, with responsibility to formulate, propose, and implement them.

The MCC maintains two types of programs—compacts and threshold agreements. Compacts are large-scale grants, most lasting five years, that contain two or three project elements focusing on different sectors. Most projects have emphasized infrastructure, especially roads and irrigation, but many also include a component aimed at land titling, financial sector reform, health, water, education, tourism, or artisan crafts. Of the 23 compacts signed to date, 12 have been with African countries. Of the roughly $8.3 billion in compact funding provided, about $4.8 billion (58%) is committed to African countries.

The MCC also has supported two-year threshold programs designed to assist promising candidate countries in addressing shortcomings in one or more of their qualifying performance indicators. Nearly all of these threshold programs focus on corruption concerns, a performance measure that must be passed in order to achieve compact-eligible status. Of the 21 countries that have received threshold funding to date, 10 are in Africa. Of the $495 million in threshold program funding, Africa represents $161 million (33%).

In FY2011, the MCC is funding a first compact for Malawi and plans to fund a first compact for Zambia and a second compact for Cape Verde. The Malawi compact was signed on April 7, 2011. Valued at $351 million, it will focus entirely on the electricity sector. The envisaged $350 million Zambia compact is expected to focus on tourism and clean water supply. The Cape Verde compact is expected to address problems in water sanitation and property rights. The Administration's FY2012 request would cover funding for a second compact with Ghana. A project proposal has not yet been fully developed.

Appendix A. Aid to Africa: Selected Charts

Appendix A.

Appendix B. Map

Figure B-1. Map Showing Sub-Saharan African Countries

Source: CRS graphics. Borders do not necessarily indicate international agreement.

Author Contact Information

Footnotes

1.	Johnnie Carson (U.S. Assistant Secretary of State for African Affairs), "U.S. Priorities on Sub-Saharan Africa," Remarks for the Diplomacy Briefing Series Conference on Sub-Saharan Africa, June 14, 2010, at http://www.state.gov/p/af/rls/rm/2010/143144.htm.
2.	State Department and USAID briefing to congressional staff, March 18, 2011.
3.	The Obama Administration's Quadrennial Diplomacy and Development Review (QDDR) emphasizes a national-interests-oriented justification for foreign aid through its use of the term "civilian power" (applied to both diplomacy and development aid) as a tool for "advancing the interests of the American people." The QDDR also emphasizes a "need to elevate civilian power alongside military power as equal pillars of U.S. foreign policy." At the same time, development practitioners often argue that development assistance should be carried out according humanitarian prerogatives, not because programs necessarily support U.S. objectives. See U.S. State Department and USAID, Leading Through Civilian Power: The First Quadrennial Diplomacy and Development Review, 2010, available at http://www.state.gov/documents/organization/153635.pdf.
4.	The UN Summit on the Millennium Development Goals concluded with the adoption of a global action plan to achieve eight anti-poverty goals by 2015. See CRS Report R41410, The Millennium Development Goals: The September 2010 U.N. High-level Meeting, by [author name scrubbed] and Marian Leonardo Lawson.
5.	The 2006 Foreign Assistance Framework organizes bilateral U.S. foreign aid—or at least that portion of it that is managed by the State Department and/or USAID—around five strategic objectives (or program areas), each of which includes a number of program elements, also known as sectors. The five objectives are Peace and Security, Investing in People, Governing Justly and Democratically, Economic Growth, and Humanitarian Assistance. Generally, these objectives and sectors do not correspond to any one particular budget account in appropriations bills. See CRS Report R40213, Foreign Aid: An Introduction to U.S. Programs and Policy, by [author name scrubbed] and Marian Leonardo Lawson.
6.	More information is at http://www.adf.gov/about.html.
7.	The annual Congressional Budget Justification for Foreign Operations is publicly available (http://www.state.gov/s/d/rm/rls/statecbj/) and states the Administration's intentions before appropriations are enacted or notifications of intended obligation are made to congressional committees. Proposed allocations of regional funding during the year are communicated directly to specific committees through the congressional notification process.
8.	State Department, FY2012 Congressional Budget Justification for Foreign Operations.
9.	State Department-administered bilateral security assistance is funded from the following accounts: INCLE, PKO, NADR, IMET, and FMF. These figures do not reflect non-region-specific security assistance or "Section 1206" assistance, which is administered by the Defense Department with State Department sign-off (see CRS Report RS22855, Security Assistance Reform: "Section 1206" Background and Issues for Congress, by [author name scrubbed]).
10.	CRS calculations based on the State Department's Congressional Budget Justification: Foreign Assistance Summary Tables, FY2012, available at http://www.state.gov/documents/organization/158269.pdf.
11.	The Obama Administration is also requesting Congress to authorize and appropriate U.S. contributions in support of a doubling of the capital base of the AfDB. CRS Report R41672, Multilateral Development Banks: General Capital Increases, by [author name scrubbed].
12.	CIPA allocations are not categorized as "Foreign Operations," but rather, "Department of State Operations." See CRS Report RL33700, United Nations Peacekeeping: Issues for Congress, by [author name scrubbed]. For further background on U.S. contributions to the U.N. system, see CRS Report RL33611, United Nations System Funding: Congressional Issues, by [author name scrubbed].
13.	Authorization for the President to "implement multilateral official debt relief" for poor countries was provided in the FY2010 Consolidated Appropriations Act, 2010 (Division F, Title VII, Sec. 7033), with certain restrictions, and was carried over in subsequent continuing resolutions that have appropriated funding for FY2011.
14.	These figures refer to actual aid allocations, which differ slightly from enacted figures. For example, as noted above, enacted aid funding for Africa in FY2010 was $7.1 billion, but actual aid reached $8.1 billion with emergency humanitarian aid included.
15.	Obama Administration, "Fact Sheet: U.S. Global Development Policy," September 2010.
16.	See CRS Report R40102, Foreign Aid Reform: Studies and Recommendations, by [author name scrubbed] and [author name scrubbed], Foreign Aid Reform: Studies and Recommendations.
17.	Senate Foreign Relations Committee Hearing on the Proposed Fiscal 2012 Budget for the Department of State and Related Activities and Programs, March 2, 2011; transcript via Congressional Quarterly (CQ).
18.	See, e.g., House Foreign Affairs Committee Hearing on the Fiscal 2012 Proposed Budget Requests for the U.S. Agency for International Development and Millennium Challenge Corporation, March 16, 2011; and House Foreign Affairs Committee Hearing on U.S. Foreign Policy Priorities, March 1, 2011. In the March 1 hearing, Committee Chairwoman Ileana Ros-Lehtinen used the phrase "misplaced priorities" to refer to "massive increases in global health and climate change programs" in Africa at the perceived expense of security assistance and counter-terrorism programs on the continent. (Transcript via CQ.)
19.	See H.Con.Res. 34 (Ryan), and House Committee on Appropriations, "Chairman Rogers Announces Schedule and Subcommittee Spending Limits To Complete Appropriations Bills 'On Time and On Budget,'" May 11, 2011, at http://appropriations.house.gov/index.cfm?FuseAction=PressReleases.Detail&PressRelease_id=298.
20.	See Alex de Waal, Famine Crimes: Politics & The Disaster Relief Industry in Africa, Indiana University Press: 1997.
21.	See, e.g., Jeffrey D. Sachs, The End of Poverty, New York, Penguin Press: 2005.
22.	See Princeton N. Lyman and Patricia Lee Dorff, Eds., Beyond Humanitarianism: What You Need to Know About Africa and Why It Matters, Washington D.C.: Council on Foreign Relations Press, September 2007.
23.	See, e.g., William Easterly, The White Man's Burden: Why the West's Efforts to Aid the Rest Have Done So Much Ill and So Little Good, 2006: Penguin Press; and Dambisa Moyo, Dead Aid: Why Aid Is Not Working and How There Is A Better Way for Africa, Farrar, Straus and Giroux: 2009.
24.	Uganda benefits from substantial levels of regionally allocated security assistance that are not reflected in the bilateral budget request. See CRS Report CRS Report R41473, Countering Terrorism in East Africa: The U.S. Response, by Lauren Ploch.
25.	OECD statistics, at http://stats.oecd.org/index.aspx. Official development assistance (ODA) does not include security assistance, which is otherwise included in aid statistics cited in this report. Development Assistance Committee countries, in addition to the United States, are: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Republic of Korea, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, and the United Kingdom.
26.	OECD statistics, op. cit.
27.	Restrictions on appropriations for these and other concerns are generally enacted as part of the general provisions title of annual appropriations (most recently, title VII of division F of P.L. 111-117, as continued and amended by P.L. 112-10).
28.	Foreign Assistance Act of 1961 (P.L. 87-195; 22 U.S.C. 2151), see, particularly secs. 116, 481, 502B, and 620 (22 U.S.C. 2151n, 2291, 2304, 2370).
29.	Trafficking Victims Protection Act of 2000 (P.L. 106-386; 22 U.S.C. 7101 et seq.); International Religious Freedom Act of 1998 (P.L. 105-292; 22 U.S.C. 6401 et seq.); and Child Soldiers Prevention Act of 2008 (Title IV of P.L. 110-457; 22 U.S.C. 2370c).
30.	Sudan Peace Act (P.L. 107-245); Comprehensive Peace in Sudan Act of 2004 (P.L. 108-497); Darfur Peace and Accountability Act of 2006 (P.L. 109-344); and Sudan Accountability and Divestment Act of 2007 (P.L. 110-174)—all codified as notes to 50 U.S.C. 1701. See also, CRS Report RL32606, Sudan: Economic Sanctions, by [author name scrubbed].
31.	Zimbabwe Democracy and Economic Recovery Act of 2001 (P.L. 107-99; 22 U.S.C. 2151 note). See also, CRS Report RL34509, Zimbabwe: The Transitional Government and Implications for U.S. Policy, by Lauren Ploch.
32.	For more on PEPFAR, see CRS Report R41645, U.S. Response to the Global Threat of HIV/AIDS: Basic Facts, by [author name scrubbed], and CRS Report RL34569, PEPFAR Reauthorization: Key Policy Debates and Changes to U.S. International HIV/AIDS, Tuberculosis, and Malaria Programs and Funding, by [author name scrubbed]. For more on PMI, see CRS Report R41644, U.S. Response to the Global Threat of Malaria: Basic Facts, by [author name scrubbed], and CRS Report R40494, The President's Malaria Initiative and Other U.S. Global Efforts to Combat Malaria: Background, Issues for Congress, and Resources. For more on the NTD Program, see CRS Report R41607, Neglected Tropical Diseases: Background, Responses, and Issues for Congress. For more on TB, see CRS Report R41643, U.S. Response to the Global Threat of Tuberculosis: Basic Facts.
33.	QDDR, p. 217.
34.	World Health Organization (WHO), The World Health Report 2006 - Working Together for Health, at http://www.who.int/whr/2006/whr06_en.pdf, p. 8. The WHO global burden of disease (GBD) uses the disability-adjusted life year (DALY) as a proxy metric. This time-based measure combines years of life lost due to premature mortality and years of life lost due to time lived in states of less than full health. The DALY metric was developed in the original GBD 1990 study to assess the burden of disease consistently across diseases, risk factors and regions. (See http://www.who.int/topics/global_burden_of_disease/en/.)
35.	See WHO, World Malaria Report, 2010, at http://wholibdoc.who.int/publications/2010/9789241564106_eng.pdf; UNAIDS, Report on the Global AIDS Epidemic, 2010, at http://www.unaids.org/globalreport/Global_report.htm; and WHO, Global Tuberculosis Control, 2010, at http://whqlibdoc.who.int/publications/2010/9789241564069_eng.pdf.
36.	WHO, Global Burden of Disease: 2004 Update, 2008, http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf, p. 16.
37.	See also CRS Report R41612, The Obama Administration's Feed the Future Initiative, by [author name scrubbed] and [author name scrubbed].
38.	See the Feed the Future website, http://www.feedthefuture.gov, especially pp. 9-14.
39.	This is one of the outcomes of the Quadrennial Diplomacy and Development Review report, which was released in December 2010. See http://www.state.gov/s/drrr/qddr/#.
40.	See Feed the Future guide, http://www.feedthefuture.gov/guide.html.
41.	FAO, World Summit on Food Security, Declaration of the World Summit on Food Security, November 16-18, 2009.
42.	FY2010 allocations to FtF are based on USAID's 653(a) Supplementary Tables. (After the annual foreign operations appropriations bill has been enacted, USAID is required to submit a statement to Congress known as a Section 653(a) Report to show how USAID plans to allocate the appropriated budget.)
43.	See FY2011 Congressional Budget Request for Foreign Operations.
44.	This estimated allocation to Africa includes bilateral and regional programming.
45.	Authority for traditional food aid programs has historically resided in the House and Senate Agricultural Committees and appropriations are made through the Subcommittee on Agriculture, Rural Development, and Food and Drug Administration of the House and Senate Appropriations Committees. See CRS Report CRS Report R41072, International Food Aid Programs: Background and Issues, by [author name scrubbed] and [author name scrubbed].
46.	The FtF initiative includes funding for multilateral initiatives, such as the World Bank Global Agriculture and Food Security Program (GAFSP) Trust Fund, to which the United States contributes through appropriations to the U.S. Treasury. Financial commitments to the GAFSP, which was officially launched in April 2010 with contributions from the United States, Canada, Spain, South Korea, and the Bill & Melinda Gates Foundation, totaled $925.2 million as of January 2011. The primary objective of the fund is to improve the food security and livelihoods of the poor in developing countries through more effective public and private sector investment in the agricultural and rural sectors. The GAFSP trust fund has awarded eight countries a total of $337 million, including $248 million for five African states, Ethiopia, Niger, Rwanda, Sierra Leone, and Togo.
47.	For more info about the McGovern-Dole program, see http://www.fas.usda.gov/excredits/FoodAid/FFE/FFE.asp.
48.	U.N. Food and Agriculture Organization (FAO), "Summary of World Food and Agriculture Statistics," 2009, available at http://www.fao.org. Note: figures on the value of agriculture relative to Africa's GDP vary. According to the World Bank, agriculture represents 32% of GDP growth in Sub-Saharan Africa. (World Bank, World Development Report 2008: Agriculture for Development, October 19, 2007.
49.	FAO statistics, op. cit.
50.	ONE, "Sparking Agricultural Development in Africa," June 2009.
51.	FAO statistics, op. cit.
52.	State Department, FY2012 Congressional Budget Justification for Foreign Operations, Vol. 2.
53.	USAID and State Department, "Notes on the Africa Bureau FY2012 Non-Initiative Request," distributed to congressional staff on March 18, 2011.
54.	As previously noted, these figures do not include funding allocations from regional programs or from accounts administered by other U.S. agencies and departments. Uganda, for example, benefits from several State Department-administered regional security assistance programs that are not reflected in the bilateral aid request.
55.	See State Department, Office of the Spokesman, "U.S. and Angola Hold Strategic Partnership Dialogue Meetings," November 12, 2009.
56.	In its FY2012 Congressional Budget Justification for Department of State Operations, the Administration requests $6.1 million to expand the U.S. "diplomatic platform" in three African locations, including Juba. (The other two are Kano in Northern Nigeria and Goma in DRC.)
57.	USAID and State Department congressional staff briefing, March 18, 2011.
58.	For example, Freedom House's 2010 edition of its annual Freedom in the World survey noted that of the world regions, "Sub-Saharan Africa suffered the largest setbacks, with 15 countries registering declines and 4 securing gains." See Arch Puddington, "Freedom in the World 2010: Erosion of Freedom Intensifies," at http://www.freedomhouse.org/template.cfm?page=130&year=2010.
59.	Percentages are drawn from State Department, Office of the Director for Foreign Assistance, "Analysis of Non-Initiative Changes from FY2010 to FY2012 Request," distributed to congressional staff on March 18, 2011. In some cases, FY2010 actual aid levels were high due to one-time allocations of regional funds, so FY2012 proposed decreases may reflect a return to average levels rather than a drastic shift in resources.
60.	See CRS Report CRS Report R40778, The Global Economic Crisis: Impact on Sub-Saharan Africa and Global Policy Responses, by [author name scrubbed], [author name scrubbed], and [author name scrubbed]. The IMF predicts that growth in Africa in 2011 will average 5.5%, and 6% in 2012; see IMF, Regional Economic Outlook: Sub-Saharan Africa, April 2011.
61.	USAID written response to CRS, May 2011.
62.	Funding for "Peace and Security" does not necessarily correspond perfectly to funding for State Department-administered "international security assistance" accounts (INCLE, IMET, FMF, NADR, and PKO). This is because some assistance categorized as "Peace and Security" is funded through other accounts, such as DA and ESF, while some INCLE funding is categorized as "Governing Justly and Democratically" because it promotes human rights and the rule of law. Thus, while "Peace and Security" funding for Africa is set to decrease in FY2012, total funding for "security assistance" accounts is set to increase slightly.
63.	See CRS Report RL32862, Peacekeeping/Stabilization and Conflict Transitions: Background and Congressional Action on the Civilian Response/Reserve Corps and other Civilian Stabilization and Reconstruction Capabilities, by [author name scrubbed].
64.	INCLE funding is categorized as security assistance; however, of this total for Africa, $25.5 million is allocated toward the program area "Governing Justly and Democratically," with the remainder categorized as "Peace and Security."