House Appropriations votes FY14 global health funding: adds PEPFAR requirements, tops Obama and Senate subcommittee TB number

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capitolfeaturedWith the President’s Emergency Plan for AIDS Relief  facing a drop from fiscal year 2012 funding, the House Appropriations Committee added language from Rep. Barbara Lee to the funding bill it voted on today, requiring indicators to ensure that “country ownership” is pursued effectively and appropriately.

The Committee proposed that three global health programs be funded at FY 2012 levels for FY 2014, including tuberculosis. The House bill slates $236 million for USAID’s tuberculosis program, more than the $225 proposed by the Senate yesterday, and still more than the President’s request of $191 million.

Malaria funding takes a hit in the House bill, however, as both the Senate and the President’s requests surpass the FY 2012 enacted level of $650 million for malaria programs, with the Senate proposing $667 million and the President requesting $670 million.

The committee bill continues the ban on funding for sterile syringe programs — a ban International AIDS Society president-elect Dr. Chris Beyrer in a recent Congressional briefing called “a retreat on the evidence of public health.”

In addition to spelling out funding numbers for key programs, the House bill requires government agencies to report on several key global health issues.

The Lee amendment directs the Office of the Global AIDS Coordinator to report to the Committee “on steps taken to develop performance indicators and clear milestones that will measure (1) a comparison of necessary funding for core interventions, as defined by the PEPFAR Blueprint for highest incidence countries, to actual funding levels in fiscal year 2013 from the United States and other sources, and (2) the level of readiness by each partner country to accept greater ownership of PEPFAR-supported programs in a way that addresses the needs of populations most acutely affected.”

The House bill also requires the Administrator of USAID to submit a report to the Appropriations Committee, in collaboration with the Global AIDS Coordinator, on the progress on increasing access to qualified health care workers in under-served areas in developing countries, noting that “front-line health workers, particularly in Africa and Asia, could save millions of at-risk families with proper training and support.”

The Committee also directs the Global AIDS Coordinator and USAID to provide a report on U.S. government resources committed to collaborations with the private sector and other institutional donors to leverage public and private investment in global health, calling these partnerships “instrumental in combating a number of health issues unique to the survival of women and mothers in sub-Saharan Africa.”

While praising PEPFAR’s significant achievement, the House report encourages the Office of the Global AIDS Coordinator to identify new tools to diagnose and safely treat children living with HIV.

The report goes on to acknowledge the benefits for HIV treatment for improving health while preventing new infections, and requires OGAC to consult with the Appropriations Committee on their efforts to reduce per-patient costs for treatment.  OGAC must report on per-patient costs for people on treatment as well as care costs for people not receiving treatment, provide a comparison for per-patient costs by programs not receiving funding from PEPFAR, and estimate per-patient costs across PEPFAR and for urban and rural treatment providers.  OGAC must also provide a report on the impact of capping administrative expenses at 10 percent, including a detailed list of efforts to lower administrative costs overseas and domestically.

It is unclear when this measure will move to the full House of Representatives for consideration.  Most insiders still believe that we are headed for a continuing resolution but these funding levels could influence global health funding in a final funding bill.

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