Global Health Assistance

U.S. funding for global health activities has grown significantly over the past decade. Much of the growth in U.S. global health spending has been motivated by infectious disease outbreaks, including human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), severe acute respiratory syndrome (SARS), H5N1 avian influenza (avian flu), extremely drug-resistant tuberculosis (XDR-TB), and the 2009 influenza pandemic. Congress also provides funds to the Centers for Disease Control and Prevention (CDC) for global health activities. In addition to funds Congress provides directly to U.S. agencies and departments for global health efforts, U.S. agencies and departments also use portions of their budgets for global health programs. For example, CDC regularly allots a part of its tuberculosis budget for international interventions, though Congress does not specify that the funds should be used for those purposes. USAID Global Health Programs

Through Foreign Operations Appropriations, Congress specifies support for five key USAID global health programs: 
child survival and maternal health , aimed at, among other things, reducing morbidity and mortality from key diseases such as polio, measles, and diarrhea, providing vaccines and immunizations, supporting safe delivery, and addressing malnutrition; vulnerable children , aimed at providing services to vulnerable children and orphans, particularly those affected by blindness and war (support for children made vulnerable by HIV/AIDS is provided through HIV/AIDS funds); HIV/AIDS , aimed at preventing and treating HIV/AIDS, particularly among vulnerable populations such as women, girls, and orphans, through voluntary counseling and testing, awareness campaigns, and antiretroviral medicines; other infectious diseases , aimed at addressing a number of diseases and resultant outbreaks, such as those related to pandemic and avian influenza, malaria, tuberculosis (TB), and neglected diseases; and family planning and reproductive health , aimed at increasing access to related services, such as reproductive health education to improve awareness about birth spacing, contraception, and sexually transmitted diseases. Although Congress does not appropriate funds to CDC specifically for global tuberculosis and pandemic influenza preparedness and response efforts, CDC allots a portion of its overall TB and pandemic preparedness funds for international assistance. In addition, through the FY2001 Consolidated Appropriations Act ( P.L. In FY2008, Congress created a new account that combined appropriations for USAID global health activities funded through the CSH account with appropriations to OGAC for the Global HIV/AIDS Initiative and a U.S. contribution to the Global Fund. From FY2006 through FY2009, Congress provided more than $1.5 million for U.S. malaria programs. The Act made more than $8 billion available for global health programs, including about $5.4 billion for HIV/AIDS programs managed by OGAC, including a $750 million contribution to the Global Fund; an additional $300 million for a contribution to the Global Fund through NIH; some $2.4 billion for USAID; an estimated $328 million for CDC; and $10 million for HIV/AIDS programs conducted by DOD. The President requested that Congress approve his FY2010 budget request of $8.6 billion for the recently established Global Health and Child Survival Account. On May 5, 2009, President Obama announced his new Global Health Initiative (GHI), a six-year, $63 billion from FY2009 to FY2014 to better coordinate the U.S. government's approach to global health programs. The United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 ( P.L. Another popular reform proposal would create a cabinet-level international development agency with authority over all global health and development programs. U.S. Department of State 
At the U.S. Department of State, a number of activities may be related to global health and are conducted by the Office of the Director of Foreign Assistance (F Bureau); the Offices of the Global AIDS Coordinator (OGAC or S/GAC) and Global Women's Issues (S/GWI), which report directly to the Secretary of State; and five bureaus or offices within the purview of the Under Secretary for Democracy and Global Affairs (G).
U.S. funding for global health activities has grown significantly over the past decade, from $1.8 billion in FY2001 to $8.5 billion in FY2010. During this time period, Congress has significantly increased funding for responses against infectious disease outbreaks, including the 2009 influenza pandemic (H1N1), H5N1 avian influenza (avian flu), human immunodeficiency/acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis (TB), and malaria. U.S. agencies and departments also supplement funds that Congress appropriates for these purposes with funds from their discretionary budgets.
Through FY2009 Supplemental Appropriations (P.L. 111-32), Congress appropriated $100 million to the U.S. Agency for International Development (USAID) for an additional contribution to the Multilateral Global Fund to Fight AIDS, Tuberculosis and Malaria and $50 million for international pandemic preparedness and response efforts. The Act also provided $200 million for domestic and global pandemic preparedness response programs conducted by the U.S. Centers for Disease Control and Prevention (CDC), though it did not specify how the funds should be apportioned.
President Barack Obama sent Congress a FY2010 budget request of $9.1 billion for global health initiatives. Of those funds, he proposed that $7.6 billion be funded through the Global Health and Child Survival Account (GHCS), which is funded through Foreign Operations Appropriations and supports USAID global health programs, global HIV/AIDS programs managed by the Office of the Global AIDS Coordinator (OGAC) at the Department of State and a U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund). The President asked that Congress support his new Global Health Initiative that would provide $63 billion over six years "to shape a new, comprehensive global health strategy" that would focus on "broader global health challenges, including child and maternal health, family planning, and neglected tropical diseases, with cost effective intervention." He also requested $1.5 billion in emergency funds to support U.S. domestic and international responses to the 2009 influenza pandemic and more than $319 million for CDC global health programs. Through the FY2010 Consolidated Appropriations Act (P.L. 111-117), Congress provided more than $8 billion for global health activities.
Foreign assistance reform, including global health aid, has emerged as a key issue in the 111th Congress. This report discusses some of the policy questions Congress may face as it considers proposals to improve U.S. global health aid, including defining U.S. global health aid, identifying the scope of U.S. global health spending, determining oversight and leadership roles, and coordinating global health and development programs.