On March 31, the House Appropriations Subcommittee on State, Foreign Operations, and Related Programs held a hearing on global health and HIV/AIDS programs.
While expressing her support for the goals of the Global Health Initiative (GHI), Chair Kay Granger (R-TX) raised several concerns with the FY2012 budget and authorization for such programs: “If the GHI will achieve better health for adults and children in the developing world and provide a long-term plan for delivery of health services led by the countries themselves, then I can support the administration’s efforts. However, given that there is no authorization for this program and no clear goals, I must admit that I am skeptical…I also have concerns about the operations of the Global Fund to fight AIDS, [tuberculosis], and malaria, specifically the administration’s large multiyear commitment – something that, if fulfilled, would most likely have to come from offsets to your bilateral HIV/AIDS program. I know this is not your intention, Ambassador [Eric] Goosby, but it could well be the reality of today’s budget climate.” Rep. Granger added, “In the current fiscal environment, our government will have to deliver services more efficiently, without destructive competition between agencies and with open books to ensure ample auditing and transparency.”
Ranking Member Nita Lowey (D-NY) said, “Over the past six years, this committee has made global health a top priority, providing over $38 billion for innovative programs to prevent the spread of disease, treat the sick, and strengthen local health systems to sustain advances. We have had impressive results: HIV/AIDS treatment for more than 4 million people, bed nets to prevent malaria for over 19 million families, and voluntary family planning services for 19 million women. Along with saving lives, these programs help to free developing countries from the burden of disease, allowing economic growth and increased stability as more children can attend school and more adults can maintain jobs and care for their families. The $8.7 billion request for the Global Health Initiative supports a whole-of-government approach, helping partner countries improve health outcomes with a particular focus on women, newborns, and children by addressing infectious disease, nutrition, maternal and child health, and family planning. I am pleased the budget request focuses on better coordination of our efforts and look forward to hearing how U.S. government-supported health programs will become more effective and efficient in target countries.”
Ambassador Eric Goosby, U.S. Global AIDS Coordinator at the State Department, described how “smart investments” have led to improvements in global health, even during a “difficult economic environment.” With regard to the prevention of mother-to-child transmission (PMTCT) of HIV/AIDS, Ambassador Goosby said, “Vertical transmission is a significant cause of new HIV infections worldwide – causing one in every seven new infections. Yet PMTCT interventions are extraordinarily effective. Without PMTCT, 25-40 percent of babies of HIV-positive mothers will be born infected; with PMTCT that number can be reduced to below five percent. PMTCT has a triple life-saving benefit: saving the life of the woman, protecting her newborn from HIV infection, and protecting the family from orphanhood. Because it works so well and touches so many lives, PMTCT is a smart investment for PEPFAR [President’s Emergency Plan for AIDS Relief] – high-impact and cost-effective. In FY2010 alone: PEPFAR directly supported HIV counseling and testing for nearly 8.4 million pregnant women; [m]ore than 600,000 HIV-positive pregnant women received antiretroviral prophylaxis to prevent mother-to-child transmission; and [t]hrough these PMTCT efforts in 2010, more than 114,000 children are estimated to have been born HIV-free (adding to the nearly 340,000 from earlier years of PEPFAR). We are leading the global effort on PMTCT, and I’m proud to note these are the highest PMTCT results of any year in PEPFAR’s seven-year history. We are working to ensure that every partner country affected by the HIV epidemic has at least 80 percent coverage of testing for pregnant women at the national level, and 85 percent coverage of antiretroviral drug prophylaxis and treatment, as indicated, of women found to be HIV-infected.” Dr. Goosby added, “In 2010, PEPFAR established ‘PMTCT Acceleration Plans’ for six countries with high burdens of vertical transmission. PMTCT Acceleration Plans provided $100 million in additional FY2010 PEPFAR funding – above the more than $956 million spent on PMTCT from FY2004-2009 – to fund plans targeting bottlenecks to expanding services. Based on the encouraging early results of this effort, PEPFAR has continued this funding in FY2011. With the help of Congress, I was proud to oversee the ‘virtual elimination’ of pediatric AIDS here in America during my tenure at HHS [Health and Human Services], and I believe PEPFAR can be instrumental in helping to end pediatric AIDS worldwide and ensuring new generations are born HIV-free. These PMTCT efforts have benefits for overall health care for women. Linking HIV testing with antenatal care helps to identify women who are in need of care. In addition, counseling and testing can help women who are HIV-negative remain HIV-free. The availability of these additional services also provides an incentive for women to seek antenatal care. In Kenya, Uganda, South Africa, and other countries, strong linkages among PMTCT, maternal and child health and other programs dramatically increased program coverage, allowing programs to focus on the needs of each woman and family in a more holistic way.”
Dr. Goosby also testified that “Across all programs, PEPFAR recognizes that gender inequalities fuel the spread of HIV and supports programs that respond to this challenge. Gender-based violence (GBV), in particular, limits women’s ability to negotiate sexual practices, disclose HIV status, and access medical services and counseling. We have intensified our focus on GBV with a $30 million commitment that builds on PEPFAR platforms in all countries, with a particular focus on Mozambique, Tanzania, and the Democratic Republic of Congo – and with strong governmental and civil society engagement in all three countries. We have also created a Gender Challenge Fund to stimulate our country teams to identify and seize new opportunities. As part of a strong and growing portfolio of innovative partnerships with the private sector, PEPFAR also joined the Together for Girls public-private partnership to work with countries to inform and implement a coordinated approach to surveillance, policy and programs for ending sexual violence against girls.”
Amie Batson, deputy assistant administrator for Global Health at the United States Agency for International Development (USAID), described in detail the administration’s FY2012 request for global health and child survival programs at USAID. “The FY2012 request of $3.074 billion includes $846 million for Maternal and Child Health, $150 million for Nutrition, $691 million for Malaria, $626 million for Family Planning and Reproductive Health, $350 million for HIV/AIDS, $236 million for Tuberculosis, $100 million for Neglected Tropical Diseases, $60 million for Pandemic Influenza within Other Public Health Threats, and $15 million for Vulnerable Children. With this funding USAID will also support activities crucial to achieving our targets in a sustainable way, such as health systems strengthening, integration, building partnerships, research, and innovation.” Ms. Batson continued, “For most American women, access to hospitals or trained health professionals during a birth is a given. But for women in developing countries, where access to hospitals and medical care is limited or non-existent, giving birth can be a potentially life-threatening process for mother and baby. While the proportion of births attended by a skilled attendant has increased globally, fewer than half the births in Africa and Southeast Asia have a skilled attendant present. USAID welcomed the publication of new international estimates which reported a 34 percent decline in the number of maternal deaths from the levels of 1990. With these gains in mind, USAID is focusing on key interventions to improve maternal care during pregnancy, childbirth, and the postpartum period, including new approaches to the control of postpartum hemorrhage (the leading cause of maternal mortality in the developing world). Key programs to reduce morbidity will include fistula prevention and rehabilitation. With FY2012 funding USAID will accelerate action on a set of highly-effective interventions targeting specific high-mortality complications of pregnancy and birth – hemorrhage, hypertension, infections, anemia, and prolonged labor. Together, these complications account for two-thirds of maternal mortality. Hemorrhage alone accounts for almost one-third, and USAID has been in the forefront of promoting ‘active management of the third stage of labor’ (AMSTL), a highly-effective technique for preventing postpartum hemorrhage. To ensure women have access to quality care and information, USAID will train and equip skilled midwives to manage obstetric emergencies, and programs to prepare community health workers who then educate mothers on preparing for birth and proper infant care.”
Ms. Batson also discussed funding for family planning, saying, “An estimated 215 million women in the developing world either want to space their next birth or have no more children, and yet are not using family planning. Family planning is a key health intervention, contributing to improved maternal and child health outcomes through healthy timing and spacing of pregnancy and by preventing unintended pregnancies and associated health risks. Greater access to family planning also reduces abortion. In addition to its health impacts, family planning improves women’s economic opportunities, family well-being, and country stability. USAID has sharpened its focus in 24 countries where the majority of maternal deaths, [children] under-five deaths, and unintended pregnancies occur, designing and supporting programs that match local needs. Additionally, USAID is graduating countries with mature programs. Between 2008 and 2012 eight countries will have graduated from family planning assistance. Activities will support the key elements of successful FP [family planning] programs, including commodity supply and logistics; provider and supervisory training; behavior change communication; policy analysis and planning; biomedical, social science, and program research; knowledge management; and monitoring and evaluation. Priority areas include contraceptive security, community-based approaches for family planning and other health services, expanding access to different methods, integration of FP into MCH [maternal and child health] and HIV programs, promoting healthy birth spacing; and cross-cutting issues including gender and equity.”
