Global Health Policy Update

We would like to update you on some important policy discussions and decisions happening in Washington.

As we indicated in our last policy update, the House Appropriations Subcommittee on State, Foreign Operations, and Related Programs (SFOPS) released its FY2012 appropriations bill last week. This budget contains a majority of global health program funding and overall funding levels for USAID and the State Department. The bill also includes “Overseas Contingency Operations” (OCO) funding, which finances supplemental programs in Afghanistan, Pakistan, and Iraq. The Subcommittee marked up the bill on July 27th, and the full Committee is expected to consider the legislation on August 3rd.

The total budget approved by the Committee is $39.6 billion—$8.6 billion (18%) below the enacted FY2011 budget. As expected, there were deep cuts in development programs, with global health programs hit particularly hard. The bill cuts overall global health funding by 9% compared to FY2011 levels and 18% below the President’s request. In comparison, security assistance programs and OCO funding received little or no cuts.

Several policy provisions were also included in the bill that will significantly impact global health programs:

  • Statutory reinstatement of the Global Gag Rule, which prohibits US funds going to organizations that “promote or perform abortion, except in cases of rape or incest or when the life of the mother would be endangered if the fetus were carried to term.”
  • Prohibition on funding for the United Nations Population Fund (UNFPA).
  • Prohibition on funding in FY2012 or prior fiscal years to “carry out any program of distributing sterile needles or syringes for the hypodermic injection of any illegal drug.”
  • Withholding of 20% of funds for the Global Fund until the Secretary of State makes certain certifications about the independence and transparency of the work of the Fund’s Inspector General.

Unlike previous years, the bill provides an overall funding level for global health but does not specify funding for specific programs, thereby giving broad discretion to the Administration to determine funding levels. However, the bill does contain language, albeit non-binding, that gives the Administration guidance on Congress’s priorities. Among this year’s priorities are maternal and child health programs, which the Committee indicates should not receive less than FY2011 funding levels. The Committee also indicated support for programs targeting malaria, tuberculosis, and neglected tropical diseases – although no funding levels were specified.

The bill includes several provisions to increase oversight of taxpayer dollars and places specific restrictions on the Administration in areas such as direct government assistance, UN funding, and multi-year funding commitments. It also increases oversight by funding Inspectors General, reduces the period of availability of funds, and requires more accurate reporting of how and when funds are spent.

House Appropriations Chairman Hal Rogers (R-KY) praised the bill, claiming, “This bill provides essential support to secure and stabilize some of the most critical areas of the world—including Iraq and Afghanistan.” Echoing Rogers’ support for the bill, SFOPS Chairwoman Kay Granger (R-TX) stated, “This bill reforms and refocuses the way we spend our foreign aid… In this difficult geopolitical and economic climate, the American people deserve policies that are based on our principles.”

House Democrats, meanwhile, voiced strong disappointment with the bill’s steep funding cuts. Congresswoman Nita Lowey (D-NY), the ranking Democrat on the SFOPS Subcommittee, issued a statement criticizing the inclusion of “divisive and partisan policy riders that are counter-productive to effective diplomacy and development,” and claimed that inadequate funding levels threaten the government’s leadership in areas such as global health, development, and disaster relief. Her statement also made specific reference to the Global Gag Rule, claiming that it “prohibits recipients of U.S. health assistance from providing the most truthful and comprehensive health care possible to women in need” and that cutting funding for family planning and UNFPA denies critical health care to millions of women worldwide. House Appropriations Committee Ranking Democratic member Norm Dicks (D-WA) voiced similar disapproval, calling the subcommittee allocation “irresponsibly low” and claiming that the bill is “loaded down with short-sighted and ideologically driven riders.”

The full Appropriations Committee is scheduled to mark up the bill on Wednesday, August 3rd, but that mark-up may be postponed until the fall when Congress returns from its August recess. And despite an outcry from State Department officials and relief agencies, there is speculation that some Republican members may offer amendments during full committee consideration to further reduce funding levels in the bill.

Global Health and Development Assistance Funding, FY2012 House Subcommittee Mark
($US, millions)

FY2011 Enacted FY2012 Request FY2012 House
Global Health/Child Survival $7,783 $7,845 $8,716 $7,114
USAID $2,424 $2,500 $3,074
Department of State $5,359 $5,345 $5,642


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