	Introduction

The U.S. Agency for International Development (USAID) plays a central role in shaping and implementing U.S. global health policy. The agency is one of three agencies tasked with leading the Global Health Initiative (GHI), an initiative created by the Obama Administration to coordinate ongoing presidential health initiatives and raise investments in other health areas, including maternal and child health, neglected tropical diseases, and family planning and reproductive health ( Figure 1 ). The agency leads the implementation of the President's Malaria Initiative (PMI) and the Neglected Tropical Diseases (NTD) Program, and is an implementing partner of the President's Emergency Plan for AIDS Relief (PEPFAR), which is coordinated by the State Department. This report highlights the health-related activities conducted by USAID worldwide, outlines how much the agency has spent on such efforts from FY2001 to FY2011, and highlights FY2012 proposed funding levels. Through this vehicle, Congress appropriates funds directly to USAID through the Global Health and Child Survival (GHCS) account and USAID uses additional funds from other accounts within State-Foreign Operations, including the Development Assistance and the Economic Support Fund accounts, to support its global health programs. In 2009, President Barack Obama announced the Global Health Initiative to increase investments in health areas that he deemed underfunded, bolster the health systems of weak and impoverished states, and improve the coordination of presidential health initiatives established during the Bush Administration (PEPFAR, PMI, and the NTD Program) as well as other USAID and Centers for Disease Control and Prevention (CDC) bilateral health programs. In FY2010, for example, nearly 81% of all U.S. global health spending was aimed at these initiatives. GHI aims to develop a comprehensive U.S. global health strategy for existing U.S. global health programs, including the programs and initiatives outlined above. Leadership of GHI is expected to transition from the State Department to USAID in FY2012, should USAID meet a set of benchmarks related to management capacity, outlined in the Quadrennial Diplomacy and Development Review. FY2012 Budget and Issues

The Obama Administration requests an estimated $3.1 billion in support of USAID's global health efforts through the GHCS account for FY2012. After PEPFAR was launched, U.S. efforts to address HIV/AIDS dominated congressional discussions and appropriations for global health. The vast majority of USAID's global health programs are funded through the Global Health and Child Survival account. The Obama Administration requests that in FY2012, Congress provide approximately 25% more for USAID's global health activities funded through the GHCS account than in FY2010. USAID is reportedly responding to concerns over aid effectiveness.
A number of U.S. agencies and departments implement U.S. government global health interventions. The U.S. Agency for International Development (USAID) plays a particularly central role. The agency is responsible for coordinating two important presidential health initiatives—the President's Malaria Initiative (PMI) and the Neglected Tropical Diseases (NTD) Program. USAID serves as an implementing agency of the largest U.S. global health program—the President's Emergency Plan for AIDS Relief (PEPFAR)—and is set to assume leadership over the Global Health Initiative (GHI) in September 2012 (presuming it meets a set of benchmarks related to management capacity, as outlined in the Quadrennial Diplomacy and Development Review). In addition, Congress appropriates the most funds to USAID for global health efforts, excluding provisions for presidential health initiatives, which are carried out by several agencies, including USAID.
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 FY2010, Congress appropriated nearly $20 billion to USAID for global health programs, including contributions to the United Nations' Children's Fund (UNICEF) and the Global Fund to Fight AIDS, Malaria, and Tuberculosis (Global Fund). From FY2001 through FY2010, the greatest budgetary growth was aimed at fighting infectious diseases, mainly malaria, tuberculosis (TB), and pandemic influenza.
President Barack Obama 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 FY2012 budget request, President Obama indicated that his Administration would increase investments in global health programs and, through the Global Health Initiative, improve the coordination of all global health programs. The President requested that in FY2012, Congress provide $3.8 billion for USAID's global health programs funded through the Global Health and Child Survival (GHCS) account.
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 FY2012, discusses how funding to each of its programs has changed during this period, and raises some related policy questions. For more information on all U.S. global health assistance, see CRS Report R41851, U.S. Global Health Assistance: Background and Issues for the 112th Congress, by [author name scrubbed] and [author name scrubbed].