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Bureau for Global Health
Please note: All linked documents are in PDF format
| Objective |
SO Nunber
| FY 2004 |
FY 2005 |
FY 2006 |
| Family Planning and Reproductive Health |
936-001 |
130,200 |
120,000 |
100,600 |
| Maternal Health |
936-002 |
14,000 |
14,600 |
14,600 |
| Child Health and Nutrition |
936-003 |
54,796 |
50,903 |
50,902 |
| AIDS Prevention and Control |
936-004 |
65,350 |
64,827 |
65,350 |
| Infectious Disease Program |
936-005 |
65,460 |
68,721 |
47,997 |
| Total (in thousands of dollars) |
329,806 |
319,051 |
279,449 |
Excludes P.L. 480. See Program Annex.
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The Development Challenge: The Bureau for Global Health (GH) is the pillar bureau charged with implementing central programs in support of the joint U.S. Department of State and USAID performance goal: "Improved global health, including child, maternal, and reproductive health, and the reduction of abortion and disease, especially HIV/AIDS, malaria, and tuberculosis." As a pillar bureau, GH's key functions are to support effective field operations, to conduct research and develop technical and program innovations, and to provide technical leadership in health on behalf of the Agency. Since the Agency reorganization in 2002, the Bureau has experienced an influx of new resources. New alliances have been forged and new U.S. Government (USG) agencies have become involved in global health programming. New strategies have emerged to adapt to these changes, as well as to the evolving understanding of health relative to national security and development.
The identification of Agency core goals has led to conceptualization of a flexible assistance life-cycle approach to country programming. The assistance life-cycle approach is based on the principle that countries in different development or relief circumstances need different approaches to support. Technical interventions are tailored to these circumstances, and programs and procurement have been adapted to address the range of health needs in countries, particularly those that have been identified by "U.S. Foreign Aid: Meeting the Challenges of the Twenty-first Century (the "White Paper")" as fragile states, those that are undergoing transformational development and advanced developing countries where there is a significant global issue or special concern.
New technical emphases for the Agency in health include: the health of the workforce, in addition to USAID's more traditional focus on family health; explicit focus on strengthening health systems, including logistics for life-saving drugs and responding to systems damaged by complex emergencies; and addressing non-communicable diseases, including injuries, accidents, and lifestyle diseases, as well as gender-based violence. GH will develop an updated strategic statement during FY 2005, which will identify which of these new foci will be included in GH programs and define GH participation. Any such additional programs complement the existing activities of the Bureau, which include:
- support for rapid start-up of health programs in Iraq, Afghanistan, southern Sudan, and Pakistan;
- implementation of the President's HIV/AIDS initiatives in the field;
- dramatic economies of scale in commodity procurements;
- addition of new partners with substantial field experience; and
- technical support to small missions and those with limited technical staff.
Effective programming in GH can also be attributed to greater mission involvement, consolidation of activities, strategic budgeting, strong country coordination teams, and limited personnel surge capacity. In addition, GH has strengthened support to the field by contributing both resources and technical expertise. The advantages to GH's field support mechanisms available to missions include: pre-positioned contracts and agreements; reduced burden for missions; increased access to world-class expertise; and improved ability to cope with surge needs, such as Hurricane Mitch, Afghanistan, Iraq, HIV/AIDS, and the Asia tsunami.
The growing recognition of the important link between health and economic development presents USAID with the opportunity for continued leadership in addressing critical problems that plague developing nations and, increasingly, the entire world. These efforts are also consistent with USAID's new strategic approaches, including the joint Department of State-USAID Strategic Plan, "Foreign Aid in the National Interest," and the "White Paper." Not surprisingly, many of the countries with the highest burdens of ill health, malnutrition, and mortality among their children are countries that are far from the governance and market goals of transformational development. However rapidly they move along this development pathway, their future effectiveness will be limited by their lack of basic investment in human capital. The assistance life-cycle approach has been developed to account for distinctions among countries in terms of their need, commitment, and performance in overall development, as well as the corresponding implications for health programming.
The health field enjoys unprecedented backing from both the Administration and Congress, as demonstrated by the President's $15 billion Emergency Plan for AIDS Relief (the "Emergency Plan"), including contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the "Global Fund"), and the President's Prevention of Mother-to-Child Transmission Initiative (PMTCT). USAID is well-positioned to use its expertise, experience and presence in global health to advance the President's agenda in HIV/AIDS and other infectious diseases, as well as in child survival and maternal and reproductive health. The top priorities include:
- under the leadership of the Global AIDS Coordinator, providing technical leadership and implementation for the USG's expanded AIDS programs, including the continuum of prevention to care and treatment;
- controlling the spread of re-emerging infectious diseases such as tuberculosis and malaria; and
- employing new approaches and improving full-scale access to family planning and reproductive health, child survival, and maternal health.
The USAID Program: To fulfill its mandate of improving global health, GH has identified three critical functions which provide the framework for each of the Bureau's programs:
1) Technical support to the field. GH follows a field-driven and field-centered approach to providing technical support to the field. The Bureau is a pioneer in results monitoring, and leads global efforts to develop program evaluation tools and analyze trends for global health. GH programs are flexible and can respond promptly to field needs, such as the rapid opening and closing of bilateral programs or emergencies such as tsunamis, earthquakes, and conflicts.
2) Research and innovation. GH is the Agency's repository for state-of-the-art thinking in biomedical, social science, and operational research for health. The focus is on priority-based research, evidence-based programming, research application, and the scaling-up of proven high-impact interventions.
3) Global leadership. GH has technical experts who manage a wide spectrum of diverse projects; increase understanding of programs with stakeholders, including the U.S. public and Congress; and nurture and galvanize stronger partnerships with the development community. By leveraging its funding, policies, and partners, GH is able to influence the worldwide health agenda.
GH applies these three functions to each of the five programs managed by GH.
1) Voluntary Family Planning. GH's first strategic objective is to advance and support voluntary family planning and reproductive health programs worldwide. These programs reduce unintended pregnancies and foster improved reproductive health practices.
GH supports the key components of effective family planning programs - service delivery, training, performance improvement, contraceptive availability and logistics, health communication, biomedical and social science research, policy analysis and planning, and monitoring and evaluation. Significant attention is being devoted to the health benefits of family planning, including birth spacing. Through better birth spacing, family planning can markedly improve maternal and child health. Family planning has also been demonstrated to reduce abortion, which further reduces maternal mortality.
Strategic priorities for family planning programs include: operationalizing family planning and HIV integration, demonstrating the contribution of family planning to improved maternal and child health, strengthening public-private partnerships, and working toward sustainability and graduation.
2) Maternal Health and Nutrition. GH's second strategic objective is to increase the use of key maternal health and nutrition interventions. These interventions are designed to prevent and treat life-threatening complications and long-term disabilities as a result of pregnancy. Priority is placed on: supporting field missions to promote community-based strategies; supporting skilled attendance at birth; targeting vulnerable populations; advancing evidence-based standards; and delivering compassionate, high-quality care to promote maternal and perinatal nutrition, health, and survival.
GH's strategy emphasizes improving key evidence-based interventions, such as:
- Birth preparation, including nutrition promotion and infection control;
- Safe delivery, postpartum and newborn care, including skilled birth attendance;
- Management of obstetric complications and treatment of obstetric disabilities, including fistula;
- Prevention of mother-to-child transmission of HIV; and
- Early exclusive breastfeeding and birth spacing.
Inequalities between the rich and the poor continue to affect maternal health programs. GH supports ongoing strategies to reach the poor. Women's health is also affected by complex emergencies caused by war and natural disasters. Nutritional deficiencies and loss of access to life-saving care make women and their newborns less likely to survive complications of pregnancy and childbirth. GH continues to make a concerted effort to address these problems in maternal health programming.
3) Child Health and Nutrition: GH's third strategic objective is to increase the use of key child health and nutrition interventions. These interventions are focused on targeting childhood killers and reducing the burden of disease, through interventions such as immunization, vaccination, prevention and treatment of pneumonia and diarrheal diseases, and improved nutrition including vitamin A, other micro-nutrients, and breastfeeding. Programs are designed to create sustainable approaches for systems development, including quality assurance and equitable health care financing. Innovative methodologies have been developed, including oral rehydration therapy and single-use syringes. The child health and nutrition programs have adapted to evolving needs, such as the focus on neonatal mortality and the introduction of new vaccines.
4) HIV/AIDS. GH's fourth strategic objective is to increase the use of improved, effective, and sustainable responses to reduce HIV transmission and to mitigate the impact of the HIV/AIDS pandemic. The fight against HIV/AIDS remains a top GH priority. USAID, with GH in a lead role, is a proud partner in the implementation of President Bush's Emergency Plan for AIDS Relief. GH will scale-up its assistance to both "focus countries" (the 15 countries in Africa, Asia, and the Caribbean) and "non-focus countries" (other bilateral country programs) to strengthen their ability to apply proven strategies and best practices to HIV/AIDS prevention, care, and treatment programs as part of that plan.
As a partner in the implementation of the President's Emergency Plan, USAID's strategy employs the following interrelated approaches:
- Preventing HIV transmission through a balanced approach to behavior change that will reduce HIV transmission, including the "ABC" model of abstinence, be faithful, and, as appropriate, correctly and consistently using condoms;
- Improving the lives of people living with HIV/AIDS (PLWHA) by employing a package of life- extending treatment (LET) interventions;
- Providing highly active anti-retroviral treatment (HAART) to infected individuals;
- Addressing the needs of children and orphans affected by HIV/AIDS;
- Providing palliative care and psychosocial support to individuals and communities affected by HIV/AIDS;
- Increasing capacity for surveillance, monitoring, and evaluation;
- Increasing the capacity of health systems to address HIV/AIDS, including increasing human resources and human resource capacity;
- Working in partnerships with the private sector, including faith and community based organizations as well as for profit, multilateral, and U.S. corporations;
- Providing technical leadership through research on key programmatic and technical issues such as changing behavior, providing treatment, and developing community-based care and support systems; and
- Creating a supportive environment for the scale-up of national HIV/AIDS prevention, care, and treatment programs.
5) Infectious Diseases. GH's fifth strategic objective is to increase the use of effective interventions to reduce the threat of infectious diseases of major public health importance. The infectious disease program is focused on improving the array and implementation of available proven interventions, and collaborating with other partners to establish synergies, leverage resources, and support expansion of interventions and treatment programs. GH's strategy concentrates on four areas:
- Scaling up and improving tuberculosis control programs;
- Scaling up and improving prevention and treatment efforts focused on malaria and other infectious diseases of major public health importance;
- Slowing the emergence and spread of antimicrobial resistance, with an emphasis on the principal microbial threats to all countries of pneumonia, diarrhea, sexually transmitted diseases, tuberculosis, and malaria; and
- Strengthening surveillance systems by enhancing detection capability, information systems, and data-based decision making and response capacity.
A key priority underlying all of GH's efforts in infectious disease programs is the strengthening of health systems and the building of local capacity to detect, respond, and manage interventions and programs that address infectious diseases. GH also works with missions to improve links between programs and Global Fund proposals and implementation. Global-level advocacy for the use of best practices is a fundamental component of the GH strategic approach for infectious diseases.
Program and Management Challenges: As GH advances new strategies and approaches, it must contend with programmatic and management challenges. For instance, the money managed and influenced by GH is much greater than the money appropriated to the Bureau. In addition to the $328 million in core funds appropriated to the Bureau in FY 2004, GH was also responsible for an additional $1.3 billion, including $547 million appropriated for the "Global Fund," $542 million in field support and modified acquisition and assistance request documents, $87 million in transfers from other USG agencies (excluding the Department of Health and Human Services contribution to the "Global Fund"), and $167 million in international partnerships. GH also exerts technical leadership which influences all the health sector funds appropriated to the Agency.
The Bureau also faces challenges when prioritizing AIDS focus-country support while continuing to support and care for non-focus countries. GH is working with other USG agencies, including the Office of the Global AIDS Coordinator (OGAC), Department of Health and Human Services (HHS), and the Millennium Challenge Corporation, to balance the appropriate levels of support on a global scale.
GH is interested in both increasing the scope and scale of health interventions and encouraging new partners to work with USAID. In order to encourage new partners, GH has removed obstacles in procurement and increased outreach efforts. GH must rely on both experienced partners and new partners as programs are scaled-up for national-level impact.
Deliberate efforts are being made to include new partners as GH works to meet the challenging goals of the President's Emergency Plan. In order to bring on new HIV/AIDS partners, including faith-based organizations, GH plans to establish a new USG partners fund using a portion of FY 2005 HIV/AIDS resources. By the end of Emergency Plan programming in FY 2008, the capacity and strength of such new partners will be greatly enhanced.
In addition to these challenges, the increase in funding for GH has not yet been accompanied by an increase in staff; recruitment is underway for several AIDS-related positions.
FY 2006 Program: The Administration is requesting $279 million for FY 2006 for GH programs. In addition to continuing activities under ongoing awards, GH will address new areas of concern in FY 2006. These include: building the capacity of health systems; phasing in (as funding permits) support for prevention of non-communicable conditions and injuries in countries where these represent a significant health burden; and using the assistance life-cycle approach to tailor health programming to countries in their respective transformational states. In voluntary family planning, efforts will be made to bring in new implementing partners from the private voluntary organization and non-governmental organization community and to identify promising public-private alliance opportunities. In maternal health and nutrition, the special initiative to prevent and treat postpartum hemorrhage will continue to be supported and programs to prevent and repair obstetric fistula will be expanded. In child health and nutrition, research in micronutrients, newborn survival, and links of newborn care to PMTCT will continue. Evaluation of zinc supplementation as a preventive intervention will be concluded and operations research on programming approaches for routine zinc supplementation will begin. The anticipated increases in HIV/AIDS resources will allow continued scaling up of interventions in prevention, treatment, and care in order to achieve USAID's contribution toward the 2008 goals set forth in the Emergency Plan's Five Year Global HIV/AIDS Strategy. Infectious disease programs in FY 2006 will be focused on: improving and implementing tuberculosis prevention and control programs; preventing and treating malaria; strengthening diseases surveillance systems; and slowing the emergence and spread of antimicrobial resistance.
Other Program Elements: In FY 2004, GH supported a number of public-private partnerships to expand public-private alliances and leverage funds from the private sector. GH's greatest investment in the private sector has been in commercial market development; health technologies, social marketing services, products, and materials; and workplace delivery of basic health services. GH has actively sought new ways of doing business with nongovernmental organizations and private sector organizations. The Bureau is scaling up Global Development Alliance programs and reaching out to faith-based organizations. Partnerships with Proctor & Gamble, the Jane Goodall Institute, Coca Cola, Exxon-Mobil, GlazoSmithKline, and other corporations, foundations, and universities demonstrate the GH's significant work with the private sector.
GH seeks to better integrate and balance immediate disease-driven interventions with capacity and systems-building interventions. Implementing the President's initiative on AIDS, with the additional funding and mandate provided under the Emergency Plan, USAID is working under the leadership of OGAC and in close collaboration with other U.S. Government agencies, particularly the Department of State and the Department of Health and Human Services (HHS).
GH has increased its involvement in complex global emergencies. GH has helped identify and control endemic and epidemic diseases, ensure adequate immunization coverage, prevent decline of nutritional status in vulnerable populations, and improve basic water and sanitation in these settings. GH has collaborated with: the Bureau for Democracy, Conflict and Humanitarian Assistance to create a joint work plan; the Bureau for Economic Growth, Agriculture, and Trade on the Presidential water initiative and biofortification, and regional bureaus on family planning graduation, malaria, and HIV/AIDS, and in such countries as Iraq, Afghanistan, Democratic Republic of Congo, Sudan, Mozambique, and South Africa.
By collaborating with other agencies and contributing to international partnerships, GH has sought to better integrate and balance immediate disease-driven interventions with capacity and systems building interventions. Working under the leadership and direction of the OGAC, USAID receives funding as one of the Emergency Plan's implementing partners. During FY 2004, USAID received $229 million in Global HIV/AIDS Initiative (GHAI) funding, including $79 million to GH, to support the fifteen focus countries and to implement central programs including Orphans and Vulnerable Children, Abstinence and Be Faithful, and Injection Safety.
In FY 2004, GH managed $167 million in contributions to international partnerships. Among the most notable are:
- A $60 million contribution to GAVI, which supports the 74 poorest countries of the world through: 1) the introduction of new vaccines; 2) performance based funding for supporting routine immunization systems, and 3) provision of auto disable syringes for use in the immunization program;
- A $26 million contribution to UNAIDS, which was used to scale up the global response to HIV/AIDS, with particular emphasis at the country level; and
- A $24 million contribution to IAVI, which was used for preclinical development of HIV vaccine candidates.
GH also oversaw an FY 2004 appropriation for the Global Fund of $398 million, plus transfers from HHS of $149 million (totaling $547 million), $459 million of which has been contributed. The Global Fund has leveraged increased resources to support prevention, care, and treatment programs in the fight against AIDS, tuberculosis, and malaria. As obligator of these funds, USAID will continue to use its resources to support the development and implementation of the Global Fund.
Other Donors: The United States is the leading bilateral donor for health and population, followed by the United Kingdom, Germany, Canada, and the Netherlands. In FY 2004, USAID collaborated with the United Kingdom to create a task force on HIV/AIDS. USAID also has collaborations with Japan, particularly in the areas of polio and health systems support. Additionally, USAID shares many priority interests with multilateral donors such as the World Bank and the Global Fund. For example, GH assumed a leadership position in the new inter-agency Child Survival Partnership, joining the United Nations Children's Fund (UNICEF), the World Health Organization, the World Bank, the Canadian International Development Agency, the Bill and Melinda Gates Foundation, and governments of developing countries themselves. In countries including Ethiopia and Cambodia, this Partnership carried out joint high-level visits that engaged political and religious leaders in the possibility of saving more children's lives from hunger and disease. In each partnership country, USAID programs are strengthening coordination with those of other partners to achieve maximum impact with available resources.
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