[DOCID: f:sr192.110]
From the Senate Reports Online via GPO Access
[wais.access.gpo.gov]
Calendar No. 414
110th Congress Report
SENATE
1st Session 110-192
======================================================================
AFRICAN HEALTH CAPACITY INVESTMENT ACT OF 2007
_______
October 9, 2007.--Ordered to be printed
Filed under the authority of the order of the Senate of October 4, 2007
Mr. Biden, from the Committee on Foreign Relations,
submitted the following
R E P O R T
[To accompany S. 805]
The Committee on Foreign Relations, having had under
consideration S. 805, a bill to amend the Foreign Assistance
Act of 1961 to assist countries in sub-Saharan Africa in the
effort to achieve internationally recognized goals in the
treatment and prevention of HIV/AIDS and other major diseases
and the reduction of maternal and child mortality by improving
human health care capacity and improving retention of medical
health professionals in sub-Saharan Africa, and for other
purposes, reports favorably thereon and recommends that the
bill do pass.
CONTENTS
Page
I. Purpose..........................................................1
II. Committee Action.................................................1
III. Discussion.......................................................2
IV. Cost Estimate....................................................2
V. Evaluation of Regulatory Impact..................................4
VI. Changes in Existing Law..........................................4
I. PURPOSE
The purpose of S. 805 is to assist countries in sub-Saharan
Africa in the effort to achieve better outcomes in the fight
against HIV/AIDS and other health challenges through the
recruitment, training, and retention of health workers;
improvements in infrastructure; and reforms in management and
health systems.
II. COMMITTEE ACTION
S. 805 was introduced by Senators Durbin, Coleman,
Feingold, Dodd, Kerry, and Bingaman on March 7, 2007. An
additional 21 members cosponsored the legislation. On September
11, 2007, the committee ordered the bill, with amendments,
reported favorably by voice vote.
III. DISCUSSION
As reports by the World Health Organization and others have
demonstrated, the single greatest obstacle in the fight against
HIV/AIDS and other major global health challenges is the
shortage of health care professionals and managers. The dearth
of such professionals in sub-Saharan Africa is particularly
acute. The lack of personnel in Africa has been aggravated by
the HIV/AIDS pandemic and by the "brain drain" of health
professionals to wealthier countries. Countries in Africa also
lack adequate health systems, in terms of both infrastructure
and management.
S. 805 seeks to help the nations of sub-Saharan Africa
address these critical shortages of trained personnel and
shortfalls in health systems by authorizing a variety of
activities to promote the recruiting, training, retention, and
proper deployment of health workers and to improve health
systems. Specific tools include assistance to address systemic
issues by strengthening national health plans; improving
fiscal, personnel, and data management; and reducing
corruption. In order to improve the training and retention of
health workers, including community health workers, the bill
authorizes assistance to promote workplace safety and to
enhance training, educational, and career development
opportunities and retention incentives. It authorizes
assistance for basic infrastructural improvements, especially
in rural and other underserved areas, and to create a global
clearinghouse to share knowledge and best practices in health
capacity development.
This legislation requires the President to establish a
monitoring and evaluation system to measure the effectiveness
of these undertakings and to transmit to Congress a strategy
for coordinating, implementing, and monitoring United States
assistance programs for human health care capacity in sub-
Saharan Africa. This strategy is to include a description of
coordination among U.S. agencies and with other bilateral and
multilateral donors as well as with the African Union and
individual African governments. It also requires an analysis of
how international financial institutions can most effectively
assist countries in their efforts to increase investments in
the health and education sectors while maintaining prudent
fiscal balance. One year after submission of the strategy, the
President is required to provide Congress with a report on the
implementation of the strategy and a document assessing best
practices to be shared with governments of developing countries
and others seeking to promote health capacity. A final report
on implementation is required not later than three years after
submission of the strategy.
S. 805 authorizes the appropriation of $150,000,000 for
fiscal year 2008, $200,000,000 for fiscal year 2009, and
$250,000,000 for fiscal year 2010 to support activities to
promote health capacity in sub-Saharan Africa.
IV. COST ESTIMATE
In accordance with Rule XXVI, paragraph 11(a) of the
Standing Rules of the Senate, the committee provides this
estimate of the costs of this legislation prepared by the
Congressional Budget Office.
United States Congress,
Congressional Budget Office,
Washington, DC, September 19, 2007.
Hon. Joseph R. Biden, Jr.,
Chairman, Committee on Foreign Relations,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 1678, the Torture
Victims Relief Reauthorization Act of 2007.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sunita
D'Monte.
Sincerely,
Peter R. Orszag.
------
Congressional Budget Office Cost Estimate
September 20, 2007.
S. 805 would authorize the appropriation of $150 million in
2008 and $600 million over the 2008-2010 period for foreign
assistance programs to develop and improve the local capacity
to provide health care in countries of sub-Saharan Africa. The
bill would require the President to monitor and evaluate the
effectiveness of such assistance and to coordinate assistance
with other donors.
As shown in the following table, CBO estimates that
implementing the bill would cost $23 million in 2008 and $523
million over the 2008-2012 period, assuming that the authorized
amounts are appropriated and that outlays will follow
historical spending patterns for similar programs. The costs of
this legislation fall within budget function 150 (international
affairs ). Enacting the bill would not affect direct spending
or revenues.
ESTIMATED BUDGETARY IMPACT OF S. 805
By Fiscal Year, in Millions of Dollars
----------------------------------------------------------------------------------------------------------------
2008 2009 2010 2011 2012
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Authorization Level...................................... 150 200 250 0 0
Estimated Outlays........................................ 23 90 155 165 90
----------------------------------------------------------------------------------------------------------------
The bill would authorize financial and technical
assistance, including aid provided through international or
nongovernmental organizations, to develop and improve the
health care sectors of sub-Saharan African economies by:
Developing and implementing workforce plans, fiscal and
personnel management systems, and computerized
workforce databases,
Recruiting and training health care workers,
Improving health care facilities and infrastructure,
especially in rural and under-served areas, and
Establishing a global clearinghouse to share knowledge
regarding human resources for health care.
S. 805 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would not affect the budgets of state, local, or tribal
governments.
The CBO staff contact for this estimate is Sunita D'Monte.
This estimate was approved by Peter H. Fontaine, Assistant
Director for Budget Analysis.
V. Evaluation of Regulatory Impact
Pursuant to Rule XXVI, paragraph 11(b) of the Standing
Rules of the Senate, the committee has determined that there is
no regulatory impact as a result of this legislation.
VI. Changes in Existing Law
In compliance with Rule XXVI, paragraph 12 of the Standing
Rules of the Senate, changes in existing law made by the bill,
as reported, are shown as follows (existing law proposed to be
omitted is enclosed in black brackets, new matter is printed in
italic, existing law in which no change is proposed is shown in
roman).
The Foreign Assistance Act of 1961
* * * * * * *
PART I
Chapter 1--Policy; Development Assistance Authorizations
* * * * * * *
SEC. [135.] 136. ASSISTANCE TO PROVIDE SAFE WATER AND SANITATION.
* * * * * * *
SEC. 137. ASSISTANCE TO INCREASE HUMAN CAPACITY IN THE HEALTH SECTOR IN
SUB-SAHARAN AFRICA.
(a) Assistance.--
(1) Authority.--The President is authorized to
provide assistance, including providing assistance
through international or nongovernmental organizations,
for programs in sub-Saharan Africa to improve human
health care capacity.
(2) Types of assistance.--Such programs should
include assistance--
(A) to provide financial and technical
assistance to sub-Saharan African countries in
developing and implementing new or strengthened
comprehensive national health workforce plans;
(B) to build and improve national and local
capacities and sustainable health systems
management in sub-Saharan African countries,
including financial, strategic, and technical
assistance for--
(i) fiscal and health personnel
management;
(ii) health worker recruitment
systems;
(iii) the creation or improvement of
computerized health workforce databases
and other human resource information
systems;
(iv) implementation of measures to
reduce corruption in the health sector;
and
(v) monitoring, evaluation, and
quality assurance in the health field,
including the utilization of national
and district-level mapping of health
care systems to determine capacity to
deliver health services;
(C) to train and retain sufficient numbers of
health workers, including paraprofessionals and
community health workers, to provide essential
health services in sub-Saharan African
countries, including financing, strategic
technical assistance for--
(i) health worker safety and health
care, including HIV/AIDS prevention and
off-site testing and treatment programs
for health workers;
(ii) increased capacity for training
health professionals and
paraprofessionals in such subjects as
human resources planning and
management, health program management,
and quality improvement;
(iii) expanded access to secondary
level math and science education;
(iv) expanded capacity for nursing
and medical schools in sub-Saharan
Africa, with particular attention to
incentives or mechanisms to encourage
graduates to work in the health sector
in their country of residence;
(v) incentives and policies to
increase retention, including salary
incentives;
(vi) modern quality improvement
processes and practices;
(vii) continuing education, distance
education, and career development
opportunities for health workers;
(viii) mechanisms to promote
productivity within existing and
expanding health workforces; and
(ix) achievement of minimum
infrastructure requirements for health
facilities, such as access to clean
water;
(D) to support sub-Saharan African countries
with financing, technical support, and
personnel, including paraprofessionals and
community-based caregivers, to better meet the
health needs of rural and other underserved
populations by providing incentives to serve in
these areas, and to more equitably distribute
health professionals and paraprofessionals;
(E) to support efforts to improve public
health capacities in sub-Saharan Africa through
education, leadership development, and other
mechanisms;
(F) to provide technical assistance,
equipment, training, and supplies to assist in
the improvement of health infrastructure in
sub-Saharan Africa;
(G) to promote efforts to improve
systematically human resource management and
development as a critical health and
development issue in coordination with specific
disease control programs for sub-Saharan
Africa; and
(H) to establish a global clearinghouse or
similar mechanism for knowledge sharing
regarding human resources for health, in
consultation, if helpful, with the Global
Health Workforce Alliance.
(3) Monitoring and evaluation.--
(A) In general.--The President shall
establish a monitoring and evaluation system to
measure the effectiveness of assistance by the
United States to improve human health care
capacity in sub-Saharan Africa in order to
maximize the sustainable development impact of
assistance authorized under this section and
pursuant to the strategy required under
subsection (b).
(B) Requirements.--The monitoring and
evaluation system shall--
(i) establish performance goals for
assistance provided under this section;
(ii) establish performance indicators
to be used in measuring or assessing
the achievement of performance goals;
(iii) provide a basis for
recommendations for adjustments to the
assistance to enhance the impact of the
assistance; and
(iv) to the extent feasible, utilize
and support national monitoring and
evaluation systems, with the objective
of improved data collection without the
imposition of unnecessary new burdens.
(b) Strategy of the United States.--
(1) Requirement for strategy.--Not later than 180
days after the date of the enactment of this Act, the
President shall develop and transmit to the appropriate
congressional committees a strategy for coordinating,
implementing, and monitoring assistance programs for
human health care capacity in sub-Saharan Africa.
(2) Content.--The strategy required by paragraph (1)
shall include--
(A) a description of a coordinated strategy,
including coordination among agencies and
departments of the Federal Government with
other bilateral and multilateral donors, to
provide the assistance authorized in subsection
(a);
(B) a description of a coordinated strategy
to consult with sub-Saharan African countries
and the African Union on how best to advance
the goals of this Act; and
(C) an analysis of how international
financial institutions can most effectively
assist countries in their efforts to expand and
better direct public spending in the health and
education sectors in tandem with the
anticipated scale up of international
assistance to combat HIV/AIDS and other health
challenges, while simultaneously helping these
countries maintain prudent fiscal balance.
(3) Focus of analysis.--The analysis described in
paragraph (2)(C) should focus on 2 or 3 selected
countries in sub-Saharan Africa, including, if
practical, 1 focus country as designated under the
President's Emergency Plan for AIDS Relief (authorized
by the United States Leadership Against Global HIV/
AIDS, Tuberculosis, and Malaria Act of 2003 (Public Law
108-25)) and 1 country without such a designation.
(4) Consultation.--The President is encouraged to
develop the strategy required under paragraph (1) in
consultation with the Secretary of State, the
Administrator for the United States Agency for
International Development, including employees of its
field missions, the Global HIV/AIDS Coordinator, the
Chief Executive Officer of the Millennium Challenge
Corporation, the Secretary of the Treasury, the
Director of the Bureau of Citizenship and Immigration
Services, the Director of the Centers for Disease
Control and Prevention, and other relevant agencies to
ensure coordination within the Federal Government.
(5) Coordination.--
(A) Development of strategy.--To ensure
coordination with national strategies and
objectives and other international efforts, the
President should develop the strategy described
in paragraph (1) by consulting appropriate
officials of the United States Government and
by coordinating with the following:
(i) Other donors.
(ii) Implementers.
(iii) International agencies.
(iv) Nongovernmental organizations
working to increase human health
capacity in sub-Saharan Africa.
(v) The World Bank.
(vi) The International Monetary Fund.
(vii) The Global Fund to Fight AIDS,
Tuberculosis, and Malaria.
(viii) The World Health Organization.
(ix) The International Labour
Organization.
(x) The United Nations Development
Programme.
(xi) The United Nations Programme on
HIV/AIDS.
(xii) The European Union.
(xiii) The African Union.
(B) Assessment and compilation.--The
President should make the assessments and
compilations required by subsection
(a)(3)(B)(v), in coordination with the entities
listed in subparagraph (A).
(c) Report.--
(1) In general.--Not later than 1 year after the date
on which the President submits the strategy required in
subsection (b), the President shall submit to the
appropriate congressional committees a report on the
implementation of this section.
(2) Assessment of mechanisms for knowledge sharing.--
The report described in paragraph (1) shall be
accompanied by a document assessing best practices and
other mechanisms for knowledge sharing about human
resources for health and capacity building efforts to
be shared with governments of developing countries and
others seeking to promote improvements in human
resources for health and capacity building.
(3) Follow-up report.--Not later than 3 years after
the date on which the President submits the strategy
required in subsection (b), the president shall submit
to the appropriate congressional committees a further
report on the implementation of this section.
(d) Definitions.--In this section:
(1) Appropriate congressional committees.--The term
``appropriate congressional committees'' means the
Committee on Foreign Relations and the Committee on
Appropriations of the Senate and the Committee on
International Relations and the Committee on
Appropriations of the House of Representatives.
(2) Brain drain.--The term ``brain drain'' means the
emigration of a significant proportion of a country's
professionals working in the health field to wealthier
countries, with a resulting loss of personnel and often
a loss in investment in education and training for the
countries experiencing the emigration.
(3) Health professional.--The term ``health
professional'' means a person whose occupation or
training helps to identify, prevent, or treat illness
or disability.
(4) HIV/AIDS.--The term ``HIV/AIDS'' has the meaning
given such term in section 104A(g) of the Foreign
Assistance Act of 1961 (22 U.S.C. 2151b-2(g)).
(5) Paraprofessional.--The term ``paraprofessional''
means an individual who is trained and employed as a
health agent for the provision of basic assistance in
the identification, prevention, or treatment of illness
or disability.
(6) Community health workers.--The term ``community
health worker'' means a community based caregiver who
has received instruction and is employed to provide
basic health services in specific catchment areas, most
often the areas where they themselves live.
(e) Authorization of Appropriations.--
(1) In general.--There are authorized to be
appropriated to the President to carry out the
provisions of this section--
(A) $150,000,000 for fiscal year 2008;
(B) $200,000,000 for fiscal year 2009; and
(C) $250,000,000 for fiscal year 2010.
(2) Availability of funds.--Amounts made available
under paragraph (1) are authorized to remain available
until expended and are in addition to amounts otherwise
made available for the purpose of carrying out this
section.
<all>