May 11, 2015
U.S. Global Health Assistance: The FY2016 Budget
Background
generation, and fighting other infectious diseases.
Significant progress has been made in each of these areas,
The President’s FY2016 budget request includes more than
though challenges remain.
$9 billion for global health assistance, including roughly $8
billion through State, Foreign Operations appropriation and
Maternal and Child Health
some $910 million through Department of Labor, Health
and Human Services (HHS), and Education appropriation.
International efforts to improve healthcare during
This report excludes emergency funding for Ebola
pregnancy and childbirth has resulted in a 45% reduction in
responses. For information on Emergency Ebola
maternal deaths from 1990, when 523,000 women died
Appropriations, see CRS Report R43807, FY2015 Funding
from complications in pregnancy and childbirth.
to Counter Ebola and the Islamic State (IS).
Nonetheless, in 2013, almost 800 women died a day from
complications in pregnancy and childbirth, amounting to
State Foreign Operations
289,000 deaths. Roughly one-third of these deaths occurred
Appropriations
in Nigeria and India. Human resource constraints continue
to complicate efforts to reduce maternal mortality. In many
Through the State, Foreign Operations appropriation,
developing countries, especially in sub-Saharan Africa,
Congress provides funds to support the President’s
pregnant women often deliver their babies without the
Emergency Plan for AIDS Relief (PEPFAR), the Global
assistance of trained health practitioners who can help to
Fund to Fight AIDS, Tuberculosis and Malaria, and global
avert deaths caused by hemorrhage. The World Health
health activities implemented by the U.S. Agency for
Organization (WHO) estimates that 27% of all maternal
International Development (USAID). The FY2016 budget
deaths are caused by severe bleeding. Pre-existing
request includes $5.4 billion in support of State-managed
conditions like HIV/AIDS and malaria are also key
HIV/AIDS programs and an additional $2.7 billion for
contributors to maternal mortality, accounting for roughly
USAID-managed global health programs (Figure 1).
28% of maternal deaths.
Figure 1. Foreign Operations Appropriations:
International efforts to improve child health have roughly
FY2014-FY2016
cut the number of child deaths in half from 12.7 million in
(current U.S. $ millions and percent)
1990 to 6.3 million in 2013. WHO estimates that more than
half of the 1,700 child deaths a day that occurred in 2013
FY2014 FY2015 FY2016 FY2015-
Agency/Program
could have been avoided through low-cost interventions,
Enacted Enacted Request FY2016
such as medicines to treat pneumonia, diarrhea, and
State HIV/AIDS
4,
020.0
4,
275.0
4,
319.0
1%
malaria, as well as tools that prevent the transmission of
Global Fund
1,
650.0
1,
350.0
1,
107.0
-18%
malaria and HIV/AIDS from mother to child. Other factors,
State-GHP Total
5,670.0
5,625.0
5,426.0
-4%
like inadequate access to nutritious food, also impact child
USAID HIV/AIDS
330.

0
3
30.0
330.

0
0%
health. WHO estimates that undernutrition contributes to
roughly 45% of all child deaths. The risk of a child dying is
Tuberculosis
236.

0
2
36.0
191.

0
-19%
at its highest within the first month of life, when 44% of all
Malaria
665.

0
6
69.5
674.

0
1%
child deaths occur. Children in sub-Saharan Africa are more
Maternal and Child Health
705.

0
7
15.0
770.

0
8%
than 15 times more likely to die before reaching age five
Nutrition
115.

0
1
15.0
101.

0
-12%
than their counterparts in developed countries.
Vulnerable Children

2
2.0
2
2.0
1
4.5
-34%
FP/RH
524.

0
5
24.0
538.

0
3%
In FY2016, USAID requests an 8% increase in funding for
NTDs
100.

0
1
00.0
8
6.5
-14%
maternal and child health programs. The Administration
Global Health Security

72.
5
7
2.5
5
0.0
-31%
requests that $235 million of these funds be provided to
USAID-GHP Total
2,769.5
2,784.0
2,755.0
-1%
Gavi, the Vaccine Alliance to meet the Administration’s
FOREIGN OPS TOTAL 8,439.5
8,409.0
8,181.0
-3%
four year $1 billion pledge to the multilateral effort, which
seeks to expand access to vaccines and introduce new ones.
Source: Created by CRS from FY2016 State, Foreign Operations
Congressional Budget Justification and explanatory notes of the
HIV/AIDS
FY2015 Consolidated Appropriations.
Notes: Excludes emergency appropriations for Ebola and global
In 2012, roughly 2.3 million people worldwide contracted
health funds provided through other USAID accounts, such as the
HIV, some 33% less than new infections in 2001. Some
International Disaster Assistance (IDA) account.
70% of new HIV cases occurred in sub-Saharan Africa.
While the number of new cases is declining, the number of
USAID groups its global health programs into three key
people living with HIV is rising. In 2012, more than 35
areas: saving mothers and children, creating an AIDS-Free
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U.S. Global Health Assistance: The FY2016 Budget
million people were living with HIV globally. Expanded
Despite the threat that infectious diseases pose to the world,
access to anti-retroviral treatments (ART) has decreased the
the FY2016 budget request cuts funding for all USAID
number of people dying from AIDS-related causes. In 2012,
infectious disease programs, except malaria.
1.6 million people died from HIV/AIDS, down from the
peak of 2.3 million in 2005.
Labor, HHS Appropriations
Figure 2. AIDS Deaths Worldwide: 1995-2012
The FY2016 budget includes an 8% increase for global
(millions)
health programs implemented by the Centers for Disease
Control and Prevention (CDC) and a 2% boost for
international HIV/AIDS research conducted by the National
Institutes of Health (NIH, Figure 3). Budgetary increases
were aimed at two key priorities for CDC: eradicating polio
and accelerating efforts to improve pandemic preparedness.
Figure 3. Labor-HHS Appropriations: FY2014-FY2016
(current U.S. $ mil ions and percent)

Source: Source: Adapted by CRS from the Joint United Nations
Program on AIDS (UNAIDS), 2013 Global Report, 2013.
The United States has contributed substantially to
improving global access to ART through PEPFAR and its
support for the Global Fund to Fight AIDS, Tuberculosis
and Malaria. In 2012, WHO estimated that 9.7 million
people in low- and middle-income countries were receiving
ART. At the end of FY2012, PEPFAR was supporting the

provision of ART to more than 5.1 million people, thereby
Source: Created by CRS from FY2016 State, Foreign Operations
supporting treatment for more than half of all HIV-positive
Congressional Budget Justification.
people in low- and middle-income countries. By the end of
Notes: Excludes appropriations for Ebola.
September 30, 2014, PEPFAR was supporting the provision
of ART to 7.7 million people. For FY2016, the
Eradicating Polio
Administration requests no change for PEPFAR funding
through USAID, but proposes a reduction in support to the
Expanded access to vaccines has contributed significantly
Global Fund.
to global declines in child deaths. According to the CDC,
80% of the world is now polio-free and polio cases have
Other Infectious Diseases
declined by more than 99% from 1998 levels. The disease
is endemic in only three countries: Afghanistan, Nigeria,
In recent years, a succession of new and reemerging
and Pakistan. Polio activities are part of broader efforts to
infectious diseases have caused outbreaks and pandemics
expand access to vaccine-preventable illnesses, such as
that have affected thousands of people worldwide: Severe
measles. Global vaccine efforts have reduced measles
Acute Respiratory Syndrome (SARS, 2003), Avian
deaths by 75% from 2000 levels.
Influenza H5N1 (2005), Pandemic Influenza H1N1 (2009),
Middle East Respiratory Syndrome coronavirus (MERS-
Pandemic Preparedness and Global Health
CoV, 2013), and the ongoing Ebola outbreak in West
Security
Africa. The incapacity of Guinea, Liberia, and Sierra Leone
to contain and end the ongoing Ebola epidemic has revealed
The largest budgetary increase in the global health request
the threat that weak health systems pose to the world. The
is for improving disease detection, surveillance, and control
United States plays a leading role in the Global Health
capacity worldwide. Based on recent trends, CDC
Security Agenda, a multilateral effort to improve the
anticipates the international community will seek its
capacity of countries worldwide to detect, prevent, and
expertise in responding to at least 100 disease outbreaks in
respond to diseases with pandemic potential.
2016. CDC reports it responded to 268 global disease
outbreaks in 2013 and provided assistance to over 145
At the same time that the world faces threats from new
humanitarian missions in 35 countries, including response
diseases, long-standing diseases like tuberculosis (TB)
to the Syrian Refugee crisis and Typhoon Haiyan in the
continue to pose a threat to global health security. Among
Philippines. Additional funds are also sought to deepen
infectious diseases, TB is the second most common cause
U.S. engagement in the Global Health Security Agenda. For
of death worldwide. Multi-drug resistant (MDR)-TB is of
more information on the Global Health Security Agenda,
growing concern, as it is more expensive and difficult to
see CRS In Focus IF10022, The Global Health Security
treat. Less than half of all MDR-TB patients survive. WHO
Agenda and International Health Regulations.
asserts that global funding for addressing MDR-TB is
insufficient and weaknesses in health systems complicate
Tiaji Salaam-Blyther, tsalaam@crs.loc.gov, 7-7677
efforts to treat the disease and prevent its further spread.
IF10131
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