[DOCID: f:sr282.110]
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Calendar No. 633
110th Congress Report
SENATE
2d Session 110-282
======================================================================
UNITED STATES COMMITMENT TO GLOBAL CHILD SURVIVAL ACT
_______
April 9, 2008.--Ordered to be printed
Mr. Biden, from the Committee on Foreign Relations,
submitted the following
REPORT
[To accompany S. 1418]
The Committee on Foreign Relations, having had under
consideration the bill (S. 1418), to provide assistance to
improve the health of newborns, children, and mothers in
developing countries, and for other purposes, reports favorably
thereon with an amendment in the nature of a substitute, and
recommends that the bill, as amended, 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. 1418 is to reduce the mortality rate of
children and mothers in the developing world through the
development and implementation of an integrated child and
maternal health strategy; the creation of an interagency child
and maternal health task force to achieve health goals; and the
authorization of increased funding for child and maternal
health interventions.
II. COMMITTEE ACTION
S. 1418 was introduced by Senators Dodd, Smith, Leahy, and
Brown on May 15, 2007. An additional 19 members cosponsored the
legislation. On February 13, 2008, the committee ordered the
bill, with an amendment in the nature of a substitute, reported
favorably by voice vote.
III. DISCUSSION
Every year, nearly 10.5 million children under age 5 die
from highly preventable and treatable causes, while more than
500,000 mothers die from causes related to pregnancy and
childbirth. Nearly 40 percent of under-5 childhood deaths occur
during the first 4 weeks of life. To combat this public health
crisis, in 2000 the United States joined the international
community in committing to achieve Millennium Development Goals
(MGDs) 4 and 5, which aim to reduce the mortality rate of
children under the age of 5 by two-thirds and the maternal
mortality rate by three-fourths in the developing world,
respectively.
S. 1418 seeks to support these goals and to improve child
and maternal health in the developing world by increasing
funding for and delivery of proven low-cost, life saving health
interventions. The bill requires the President to develop a
holistic strategy which will include an identification of not
less than 60 countries with priority needs in maternal and
child health, a detailed analysis of those needs, and
prescriptions for interventions designed to improve health
outcomes in each country. The President will transmit to
Congress a report on this strategy 180 days after the enactment
of this bill.
In implementing this strategy, the President is authorized
to provide assistance for a wide range of activities including
immunization interventions; vitamin and micronutrient
supplementation; oral rehydration therapy; essential newborn
care; improved sanitation and drinking water; childhood illness
treatment; promotion of breast-feeding; training of clinicians,
nurses, technicians, and other persons integral to health care
delivery; and support health information management systems in
host countries.
This legislation creates an interagency task force to
assess, monitor, and evaluate the progress and contributions of
relevant U.S. departments and agencies in achieving child and
maternal health goals. The task force will consult outside
experts in child and maternal health, including members of
academic institutions, nongovernmental organizations, and
international organizations such as the World Bank. The task
force is required to transmit to the President an annual
report, for 4 years, on the implementation of this new
strategy.
S. 1418 authorizes the appropriation of up to $600 million
for fiscal year 2008, up to $900 million for fiscal year 2009,
up to $1.2 billion for fiscal year 2010, and up to $1.6 billion
for fiscal years 2011 and 2012 to support activities to expand
child and maternal health interventions.
IV. COST ESTIMATE
Pursuant to Rule XXVI, paragraph 11(a) of the Standing
Rules of the Senate, the following cost estimate has been
provided by the Congressional Budget Office.
U.S. Congress,
Congressional Budget Office,
Washington, DC, April 3, 2008.
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 S. 1418, the United
States Commitment to Global Child Survival Act of 2007.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Michelle S.
Patterson.
Sincerely,
Robert A. Sunshine
(For Peter R. Orszag, Director).
Enclosure.
S. 1418--United States Commitment to Global Child Survival Act of 2007
Summary: S. 1418 would require the President to develop a
comprehensive strategy to improve the health of newborns,
children, and mothers in developing countries and to furnish
assistance to accomplish those goals. For those purposes, the
bill would authorize the appropriation of $5.9 billion over a
5-year period. CBO estimates that implementing S. 1418 would
cost about $30 million in 2008 and $4.9 billion over the 2008-
2013 period, assuming appropriation of the authorized amounts.
Enacting the bill would not affect direct spending or receipts.
S. 1418 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would not affect the budgets of state, local, or tribal
governments.
Estimated cost to the Federal Government: The estimated
budgetary impact of S. 1418 is shown in the following table.
The costs of this legislation fall within budget function 150
(international affairs).
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------------------------------
2008 2009 2010 2011 2012 2013
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Authorization Level........................... 600 900 1,200 1,600 1,600 0
Estimated Outlays............................. 30 510 787 1,081 1,367 1,171
----------------------------------------------------------------------------------------------------------------
Basis of estimate: S. 1418 would require the United States
Agency for International Development (USAID) to expand several
existing programs focused on improving the health of newborns,
children, and mothers in developing countries. The bill would
double to 60 the number of countries in which USAID operates
those programs and require an interagency task force to assess
the effectiveness of the aid and activities.
For those purposes, S. 1418 would authorize the
appropriation of up to $600 million in 2008, $900 million in
2009, $1.2 billion in 2010, and $1.6 billion for each of years
2011 and 2012. To date, the Congress has provided USAID with
$450 million to fund its current children's and mothers' health
programs in fiscal year 2008.
For the estimate CBO assumes that S. 1418 will be enacted
by early summer, that the maximum authorized amounts are
appropriated each year, and that outlays will follow historical
patterns for existing programs. (Funding for 2008 would have to
be provided in a supplemental appropriation act; most of any
such 2008 supplemental would be spent in later years.)
Based on information from USAID, CBO estimates that the
amount authorized to be appropriated is sufficient to fund the
expanded requirements and that implementing S. 1418 would cost
about $4.9 billion over the 2008-2013 period. Most of the
remaining amount from the authorized funding would be spent by
2018.
Intergovernmental and private-sector impact: S. 1418
contains no intergovernmental or private-sector mandates as
defined in UMRA and would not affect the budgets of state,
local, or tribal governments.
Estimate prepared by: Federal Costs: Michelle S. Patterson;
Impact on State, Local, and Tribal Governments: Neil Hood;
Impact on the Private Sector: Jacob Kuipers.
Estimate 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
Pursuant to 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 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
Public Law 87-195 [S. 1983], 75 Stat. 424, approved
September 4, 1961, as amended
* * * * * * *
PART I
* * * * * * *
Sec. 104. Population and Health.--(a) * * *
* * * * * * *
(c) Assistance for Health and Disease Prevention.--(1) In
order to contribute to improvements in the health of the
greatest number of poor people in developing countries, the
President is authorized to furnish assistance, on such terms
and conditions as he may determine, for health programs.
Assistance under this subsection shall be used primarily for
basic integrated health services, safe water and sanitation,
disease prevention and control, and related health planning and
research. The assistance shall emphasize self-sustaining
community-based health programs by means such as training of
health auxiliary and other appropriate personnel, support for
the establishment and evaluation of projects that can be
replicated on a broader scale, measures to improve management
of health programs, and other services and suppliers to support
health and disease prevention programs.
[(2)(A) In carrying out the purposes of this subsection,
the President shall promote, encourage, and undertake
activities designed to deal directly with the special health
needs of children and mothers. Such activities should utilize
simple, available technologies which can significantly reduce
childhood mortality, such as improved and expanded immunization
programs, oral rehydration to combat diarrhoeal diseases, and
education programs aimed at improving nutrition and sanitation
and at promoting child spacing. In carrying out this paragraph,
guidance shall be sought from knowledgeable health
professionals from outside the agency primarily responsible for
administering this part. In addition to government-to-
government programs, activities pursuant to this paragraph
should include support for appropriate activities of the types
described in this paragraph which are carried out by
international organizations (which may include international
organizations receiving funds under chapter 3 of this part) and
by private and voluntary organizations, and should include
encouragement to other donors to support such types of
activities.
[(B) In addition to amounts otherwise available for such
purpose, there are authorized to be appropriated to the
President $25,000,000 for fiscal year 1986 and $75,000,000 for
fiscal year 1987 for use in carrying out this paragraph.
Amounts appropriated under this subparagraph are authorized to
remain available until expended.
[(C) Appropriations pursuant to subparagraph (B) may be
referred to as the ``Child Survival Fund.''
[(3) The Congress recognizes that the promotion of primary
health care is a major objective of the foreign assistance
program. The Congress further recognizes that simple,
relatively low-cost means already exist to reduce incidence of
communicable diseases among children, mothers, and infants. The
promotion of vaccines for immunization, and salts for oral
rehydration, therefore, is an essential feature of the health
assistance program. To this end, the Congress expects the
agency primarily responsible for administering this part to set
as a goal the protection of not less than 80 percent of all
children, in those countries in which such agency has
established development programs, from immunizable diseases by
January 1, 1991. Of the aggregate amounts made available for
fiscal year 1987 to carry out paragraph (2) of this subsection
(relating to the Child Survival Fund) and to carry out
subsection (c) (relating to development assistance for health),
$50,000,000 shall be used to carry out this paragraph.]
[(4)] (2) Relationship to other laws.--Assistance made
available under this subsection and sections 104A, 104B, [and
104C] 104C, and 104D, and assistance made available under
chapter 4 of part II to carry out the purposes of this
subsection and the provisions cited in this paragraph, may be
made available notwithstanding any other provision of law that
restricts assistance to foreign countries, except for the
provisions of this subsection, the provisions of law cited in
this paragraph, subsection (f), section 634A of this Act, and
provisions of law that limit assistance to organizations that
support or participate in a program of coercive abortion or
involuntary sterilization included under the Child Survival and
Health Programs Fund heading in the Consolidated Appropriations
Resolution, 2003 (Public Law 108-7).
* * * * * * *
SEC. 104A. ASSISTANCE TO COMBAT HIV/AIDS.
* * * * * * *
(c) Authorization.--
(1) In general.--Consistent with section 104(c) and
section 104D, the President is authorized to furnish
assistance, on such terms and conditions as the
President may determine, for HIV/AIDS, including to
prevent, treat, and monitor HIV/AIDS, and carry out
related activities, in countries in sub-Saharan Africa,
the Caribbean, and other countries and areas.
* * * * * * *
(f) Funding Limitation.--Of the funds made available to
carryout this section in any fiscal year, not more than 7
percent may be used for the administrative expenses of the
United States Agency for International Development in support
of activities described in [section 104(c), this section,
section 104B, and section 104C] section 104(c), this section,
section 104B, section 104C, and section 104D. Such amount shall
be in addition to other amounts otherwise available for such
purposes.
* * * * * * *
SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS.
* * * * * * *
(c) Authorization.--To carry out this section and
consistent with section 104(c) and section 104D, the President
is authorized to furnish assistance, on such terms and
conditions as the President may determine, for the prevention,
treatment, control, and elimination of tuberculosis.
* * * * * * *
SEC. 104C. ASSISTANCE TO COMBAT MALARIA.
* * * * * * *
(c) Authorization.--To carry out this section and
consistent with section 104(c) and section 104D, the President
is authorized to furnish assistance, on such terms and
conditions as the President may determine, for the prevention,
treatment, control, and elimination of malaria
* * * * * * *
(c) Funding Level.--For fiscal year 1987, not less than
$2,500,000 of the funds available to carry out this part
(excluding funds made available to carry out [section
104(c)(2), relating to the Child Survival Fund] section 104D)
shall be allocated for assistance pursuant to subsection (b)
for activities which were not funded prior to fiscal year 1987.
In addition, the Agency for International Development shall, to
the fullest extent possible, continue and increase assistance
pursuant to subsection (b) for activities for which assistance
was provided in fiscal years prior to fiscal year 1987.
SEC. 104D. ASSISTANCE TO REDUCE MORTALITY AND IMPROVE THE HEALTH OF
NEWBORNS, CHILDREN, AND MOTHERS.
(a) Authorization.--Consistent with section 104(c), the
President is authorized to furnish assistance, on such terms
and conditions as the President may determine, to reduce
mortality and improve the health of newborns, children, and
mothers in developing countries.
(b) Activities Supported.--Assistance provided under
subsection (a) shall, to the maximum extent practicable,
include
(1) activities to improve newborn care and treatment;
(2) activities to treat childhood illness, including
increasing access to appropriate treatment for
diarrhea, pneumonia, and other life-threatening
childhood illnesses;
(3) activities to improve child and maternal
nutrition, including the delivery of iron, zinc, vita-
min A, iodine, and other key micronutrients and the
promotion of breast feeding;
(4) activities to strengthen the delivery of
immunization services, including efforts to eliminate
polio;
(5) activities to improve birth preparedness and
maternity services;
(6) activities to improve the recognition and
treatment of obstetric complications and disabilities;
(7) activities to improve household-level behavior
related to safe water, hygiene, exposure to indoor
smoke, and environmental toxins such as lead;
(8) activities to improve capacity for health
governance, health finance, and the health work-force,
including support for training clinicians, nurses,
technicians, sanitation and public health workers,
community-based health workers, midwives, birth
attendants, peer educators, volunteers, and private
sector enterprises;
(9) activities to address antimicrobial resistance in
child and maternal health;
(10) activities to establish and support the
management information systems of host country
institutions and the development and use of tools and
models to collect, analyze, and disseminate information
related to newborn, child, and maternal health;
(11) activities to develop and conduct needs
assessments, baseline studies, targeted evaluations, or
other information-gathering efforts for the design,
monitoring, and evaluation of newborn, child, and
maternal health efforts; and
(12) activities to integrate and coordinate
assistance provided under this section with existing
health programs for--
(A) the prevention of the transmission of HIV
from mother-to-child and other HIV/AIDS
counseling, care, and treatment activities;
(B) malaria;
(C) tuberculosis; and
(D) child spacing.
(c) Guidelines.--To the maximum extent practicable,
programs, projects, and activities carried out using assistance
provided under this section shall be--
(1) carried out through private and voluntary
organizations, including faith-based organizations, and
relevant international and multilateral organizations,
including the GAVI Alliance and UNICEF, that
demonstrate effectiveness and commitment to improving
the health of newborns, children, and mothers;
(2) carried out with input by host countries,
including civil society and local communities, as well
as other donors and multilateral organizations;
(3) carried out with input by beneficiaries and other
directly affected populations, especially women and
marginalized communities; and
(4) designed to build the capacity of host country
governments and civil society organizations.
(d) Annual Report.--Not later than January 31, 2009, and
annually thereafter for 4 years, the President shall transmit
to Congress a report on the implementation of this section for
the prior fiscal year. The report shall include the most recent
report submitted to the President by the Interagency Task Force
on Child Survival and Maternal Health in Developing Countries
under section 5(f) of the United States Commitment to Global
Child Survival Act of 2007.
(e) Definitions.--In this section:
(1) AIDS.--The term ``AIDS'' has the meaning given
the term in section 104A(g) (1) of this Act.
(2) HIV.--The term ``HIV'' has the meaning given the
term in section 104A(g) (2) of this Act.
(3) HIV/AIDS.--The term ``HIV/AIDS'' has the meaning
given the term in section 104A(g) (3) of this Act.
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