Congressional Priorities

During the Clinton, Bush, and Obama administrations, successive Congresses have demonstrated strong support for global health programs and have, for the most part, appropriated funds for global health in excess of presidential requests. Although some Members of Congress contend that cuts to these programs could yield important savings, others contend that such reductions would have little impact on the federal deficit but could significantly imperil the lives of vulnerable populations reliant on U.S. assistance. This includes global health programs implemented by USAID and CDC as well as interagency presidential global health initiatives including the President's Emergency Plan for AIDS Relief (PEPFAR), the President's Malaria Initiative (PMI), the Neglected Tropical Disease Program (NTD Program), and the Global Health Initiative. The Global Health Initiative

In May 2009, President Obama announced the Global Health Initiative, a six-year plan projected to cost $63 billion. GHI attempts to provide a comprehensive U.S. global health strategy for existing U.S. global health programs, including many of the programs and initiatives outlined above. FY2012 Funding

On December 23, 2011, the President signed the Consolidated Appropriations Act, 2012 ( P.L. 112-74 ). FY2013 Budget Request

The President's FY2013 budget request includes $8.5 billion for global health activities under the GHI, including $7.9 billion through the GHP account. Early action and debate within both the House and the Senate on FY2013 appropriations indicate that Congress may not support proposed reductions in funding for many global health programs. Likewise, some advocates argue that given advances in global health research and development, increased funding is critical for scaling up the use of new—and potentially very successful—tools to prevent and treat diseases, including HIV/AIDS and malaria. Finally, some global health experts contend that a decline or leveling off of global health spending could threaten U.S. efforts to develop multi-year agreements with governments that call for recipient countries to increasingly assume responsibility over the programs (see " Enhancing Country Ownership "). Over the last decade, Congress has frequently debated the appropriate balance between bilateral and multilateral assistance. On the other hand, supporters of higher multilateral spending argue U.S. participation in multilateral responses to global health offers distinct advantages, including the ability to
pool and leverage limited resources in the face of global challenges such as global health; capitalize on efficiencies in global health programming; coordinate assistance with a range of donors; and provide aid that better aligns with the priorities of the recipient countries. The compact specifically calls on
international organizations and bilateral donors to use national health plans as the basis for funding and planning health aid, ensure efforts to address particular diseases are funded and implemented as part of a broader effort to improve health systems, and be accountable for health aid by annually evaluating, monitoring, and reporting on results; governments to use national health plans to guide development of health systems, work with all stakeholders (including civil society and international organizations) and ensure that budgets reflect common vision for the health sector, tackle misappropriation of funds, strengthen health and financial management systems, and be accountable to the citizenry and funders through reports on results; and other donors to use their resources to advance coordinated multilateral approaches to strengthening health systems, continue to invest in learning and evaluation mechanisms to identify best practices, and be accountable and hold organizations receiving support accountable for measuring impact and directing funding to proven successes. Along with debating issues related to U.S. global health assistance, Congress may also wish to consider its own role in determining how U.S. global health programs are implemented.
U.S. funding for global health has grown significantly over the last decade, from approximately $1.7 billion in FY2001 to $8.8 billion in FY2012. During the George W. Bush Administration, Congress provided unprecedented increases in global health resources, especially in support of multi-agency initiatives targeting infectious diseases, such as the President's Emergency Plan for AIDS Relief (PEPFAR) and the President's Malaria Initiative (PMI). As support for global health increased, the 110th and 111th Congresses began to emphasize better coordination of all global health programs and efforts to strengthen health systems in recipient countries. In 2009, the Obama Administration announced the Global Health Initiative (GHI), proposed as a six-year, $63 billion effort to integrate existing global health programs and provide a comprehensive U.S. global health strategy.
Funding for FY2012 was signed into law on December 23, 2011 (P.L. 112-74). FY2012 appropriations for global health programs remained similar to FY2011, although these amounts were agreed to after prolonged debate over potential budget reductions. The 112th Congress is currently debating FY2013 funding for global health activities. The Administration's FY2013 budget request includes reduced funding for global health for the first time in over a decade. However, early debate and action on FY2013 appropriations by both the House and Senate suggests that Congress may not support these reductions.
While some policymakers and health experts argue that reductions in global health may be possible due to newly identified efficiencies in programming that could yield important savings, others have raised concerns about the impact of potential cuts on current U.S. global health activities and stated targets. Some groups contend that lower levels of U.S. assistance could
limit U.S. agencies' ability to integrate their activities and implement innovative approaches to global health, as emphasized by GHI; threaten advances in eradicating diseases like polio and guinea worm and reverse progress made in preventing and treating diseases like HIV/AIDS, tuberculosis, and malaria; compel recipient countries to decrease spending on health issues that disproportionately affect the poor, like neglected tropical diseases and limit access to basic health services such as midwifery care, nutritional support, and vaccinations; and weaken U.S. efforts to encourage greater country ownership through multi-year funding plans.
This report provides a broad overview of U.S. global health assistance, including global health programs and global health initiatives, and analyzes some of the policy questions that the 112th Congress may consider as it oversees and debates funding for global health programs. For more detail on specific diseases and global health challenges, see related reports at http://www.crs.gov.