On March 11, the House Appropriations Subcommittee on State, Foreign Operations, and Related Programs held a hearing on HIV/AIDS and global health programs. The president’s proposed FY2009 budget includes $1.58 billion for the Child Survival and Health (CSH) account within the U.S. Agency for International Development (USAID), a reduction from the $1.8 billion enacted in FY2008. Of the request, $385 million would fund the President’s Malaria Initiative, $370 million would fund child survival and maternal health (CS/MH), $302 million would fund voluntary family planning, $85 million would combat tuberculosis (TB), and $25 million would fund the initiative.
Chair Nita Lowey (D-NY) said, “Congress took the first step towards a more integrated and comprehensive health strategy when we consolidated all health funding into one account the Global Health and Child Survival Account. I was disappointed to see that the administration did not embrace this approach and once again requested funding in stove-piped accounts that inhibit integrated assistance strategies…Congress provided a $356 million increase for maternal and child health, family planning, and infectious diseases programs in the FY2008 omnibus [appropriations bill] [P.L. 110-161]. Yet the president’s FY2009 budget request cuts funding for these programs by $251 million, including a $57 million decrease for TB, $65 million for avian-flu readiness, $77 million for maternal and child health, and $90 million for family planning. I am concerned that many health programs in Africa, Asia, and the Western Hemisphere will be forced to shut down or greatly reduce operations under the president’s request.”
U.S. Global Aids Coordinator Ambassador Mark Dybul testified, “PEPFAR [The President’s Emergency Plan for AIDS Relief, P.L. 108-25] has supported antiretroviral prophylaxis in more than 827,000 pregnancies, preventing an estimated 157,000 infant HIV infections. In fact, five of the [14 current] focus countries have greater than 50 percent coverage of pregnant women, the goal of the president’s International Mother and Child Prevention Initiative…and Botswana has achieved a four percent national mother-to child transmission rate, which approximates that of the U.S. and Europe.”
Dr. Kent Hill, assistant administrator for global health at USAID, said that USAID would focus its CS/MH funds on about 30 countries that represent about half of maternal and child deaths worldwide. “By 2013, we aim to achieve an average 25 percent reduction of maternal and under-five mortality in these 30 priority countries, as well as an average 15 percent reduction of child malnutrition in at least 10 of these countries.” He added, “USAID’s family planning program is designed to expand access to and use of high-quality, voluntary family planning services…with the objective of reducing unintended pregnancy, decreasing abortion, and improving maternal and child health and survival.”
During questions, Rep. Betty McCollum (D-MN) said, “Eighty percent of our global health investments are for HIV/AIDS. That doesn’t reflect the global disease burden or mortality rates. I am concerned about the lack of investment in child health, maternal health and family planning…Every year, as many children around the world die from diarrhea as all people die of AIDS. It costs six cents to cure a child of diarrhea. Every $100 million invested in attacking common causes of child death like diarrhea saves between 113,000 and 200,000 children. Every $100 million invested in maternal health provides care for 4 million women. And every $100 million invested in family planning prevents 825,000 abortions. Yet this year’s budget request cuts Child Survival and Health by $251 million.”
In response, Ambassador Dybul said that there had been large drops in childhood deaths in many PEPFAR focus countries, because antiretroviral drugs had kept many parents alive to care for their children. “There is a threefold increase in kids dying if their parents die,” he said, referring to PEPFAR focus countries. There has been a reduction in childhood mortality in Botswana because of a “reduction in HIV incidence,” he said, adding, “You can pour [a lot of] money into education, but if all your teachers are dying, you’re not going to be able to educate.”