Breaking Down the U.S. Global Health Budget by Program Area
This fact sheet provides an overview of U.S. funding for global health by program area. See our Budget Tracker for more detail on historical funding and our Budget Summaries for the latest on ongoing appropriations discussions.
U.S. Global Health Budget: Overview
The U.S. Government is the largest donor to global health in the world and includes support for both disease (HIV, tuberculosis, malaria, and neglected tropical diseases) and population (maternal and child health, nutrition, and family planning and reproductive health) specific activities as well as global health security. Most U.S. funding for global health is provided bilaterally (approximately 80%). Of the multilateral share, the majority is provided to The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). The U.S. investment in global health grew significantly in the early 2000s, largely due to the creation of new initiatives including the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI). However, over the last decade, U.S. funding for global health has remained relatively flat, with spikes in some years due to emergency supplemental funding for Ebola in FY 2015, Zika in FY 2016, and COVID-19 in FY 2020 and FY 2021. In FY 2023, funding for global health totaled $12.9 billion.
U.S. Global Health Funding: Figures
U.S. Global Health Funding: Table
U.S. Global Health Budget: Global HIV Funding, Including PEPFAR
The U.S. first provided funding to address the global HIV epidemic in 1986. U.S. efforts and funding increased slowly over time until the launch of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, which initiated a period of significant increases and is the largest effort devoted to a single disease in the world. The majority of U.S. global HIV funding is for PEPFAR bilateral efforts (89%) with additional funding for UNAIDS and international HIV research activities. As part of its global HIV response, the U.S. also provides funding to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) (see below for details). PEPFAR funding is specified by Congress in annual appropriations bills and is largely provided to the Department of State, which is responsible, through the Office of the Global AIDS Coordinator (OGAC), for coordinating all U.S. programs, activities, and funding for global HIV efforts. Other agencies that receive HIV funding under PEPFAR include the U.S. Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC), and Department of Defense (DoD). In addition, the National Institutes of Health (NIH) supports international HIV research activities, (funding which is not counted as part of PEPFAR). Global HIV funding through regular appropriations1 has historically accounted for the largest share of the U.S. global health budget (ranging from 42% to 50% from FY 2013 to FY 2023). In FY 2023, global HIV funding totaled $5.4 billion, of which $4.9 billion is for PEPFAR2 ($4.8 billion for bilateral HIV and $50 million for UNAIDS), and approximately $575 million is for international HIV research activities at NIH.
U.S. Global HIV Funding: Figures
U.S. Global HIV Funding: Table
U.S. Global Health Budget: Tuberculosis (TB)
Since 1998, when the U.S. Agency for International Development (USAID) began a global tuberculosis (TB) control program, U.S. involvement in global TB efforts has grown and it is now one of the largest donors to global TB control in the world. U.S. bilateral TB funding is provided through USAID and includes U.S. contributions to the TB Drug Facility (additional U.S. support for TB activities is provided through its contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria). U.S. funding for TB has grown over the past decade, with much of the increase occurring in more recent years. U.S. funding for TB rose from $233 million in FY 2013 to $406 million in FY 2023, and currently accounts for approximately 3% of the U.S. global health budget.
U.S. Global TB Funding: Figures
U.S. Global TB Funding: Table
U.S. Global Health Budget: Malaria/PMI
The U.S. government has been involved in global malaria activities since the 1950s and, today, is the second largest donor to global malaria efforts in the world (the largest is the Global Fund to Fight AIDS, Tuberculosis and Malaria). The U.S. response to malaria is driven by the President’s Malaria Initiative (PMI), an interagency initiative to address global malaria that is led by the U.S. Agency for International Development (USAID), and co-implemented together with the Centers for Disease Control and Prevention (CDC), with additional activities provided by the National Institutes of Health (NIH) and Department of Defense (DoD). (In addition to its bilateral programs, the U.S. also supports malaria programs through its contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria). U.S. bilateral funding for malaria increased over the past decade from $822 million in FY 2013 to approximately $1 billion in FY 2023; while funding increased over the period, it has been relatively flat in recent years. In FY 2023, malaria accounted for 8% of the U.S. global health budget.
U.S. Global Malaria Funding: Figures
U.S. Global Malaria Funding: Table
U.S. Global Health Budget: The Global Fund to Fight AIDS, Tuberculosis and Malaria
The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is an independent, public-private, multilateral institution which finances HIV, TB, and malaria programs in low- and middle-income countries. The Global Fund receives contributions from public and private donors and in turn provides funding to countries based on country-defined proposals. The U.S. provided the Global Fund with its founding contribution in 2001 and has since been its largest single donor (U.S. contributions to the Global Fund are counted as part of PEPFAR). The U.S. contribution to the Global Fund through regular appropriations has fluctuated over the past decade but reached its highest level to date ($2.0 billion) in FY 2023. In addition to regular appropriations, Congress provided $3.5 billion in emergency supplemental funding to the Global Fund to address the impacts of COVID-19 on HIV programs in FY 2021. Congress places a number of restrictions on U.S. contributions to the Global Fund, including total U.S. contributions must not exceed 33% of total contributions from all donors.
U.S. Funding for the Global Fund: Figures
U.S. Funding for the Global Fund: Table
U.S. Global Health Budget: Maternal & Child Health (MCH)
The U.S. has been involved in Maternal & Child Health (MCH) efforts since the 1960s (and is the largest donor government to MCH activities in the world). MCH funding, which includes funding for polio and U.S. contributions to Gavi, the Vaccine Alliance (GAVI) and the United Nations Children’s Fund (UNICEF), is provided through the U.S. Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC), and the State Department. U.S. funding for MCH increased from $1.04 billion in FY 2013 to $1.30 billion in FY 2023. This was primarily driven by increased funding to GAVI and polio during the period. In fact, when these are removed, bilateral MCH funding has remained relatively level for several years over the period. In FY 2023, MCH accounted for the third largest share of U.S. funding for global health (10%).
U.S. Global MCH Funding: Figures
U.S. Global MCH Funding: Table
U.S. Global Health Budget: Nutrition
The U.S. has a long history of supporting global efforts to improve nutrition and is the largest donor to nutrition efforts in the world. Historically, support for U.S. global nutrition activities was included as part of broader maternal and child health (MCH) funding; starting in 2010, Congress began to designate funding for nutrition activities, all of which is provided through the U.S. Agency for International Development (USAID). 3 U.S. funding for nutrition increased from $97 million in FY 2013 to $163 million in FY 2023 and has accounted for approximately 1% of the total U.S. global health budget over the period.
U.S. Global Nutrition Funding: Figures
U.S. Global Nutrition Funding: Table
U.S. Global Health Budget: Family Planning & Reproductive Health (FP/RH)
The U.S. has been involved in Family Planning & Reproductive Health (FP/RH) efforts since the 1960s and is currently the largest donor to global FP/RH in the world. The majority of U.S. FP/RH funding is provided through the U.S. Agency for International Development (USAID) for bilateral activities, with additional funding provided through the State Department for the U.S. contribution to the United Nations Population Fund (UNFPA).4 U.S. funding for FP/RH rose steadily in its first two decades5 and more recently, has remained relatively flat at just about $600 million, accounting for approximately 5-6% of the U.S. global health budget each year from FY 2013-FY 2023.
U.S. International FP/RH Funding: Figures
U.S. International FP/RH Funding: Table
U.S. Global Health Budget: Global Health Security
Since the 1990s, there has been growing concern about new infectious diseases that threaten human health including, in more recent years, the emergence and spread of threats such as Ebola, Zika, H1N1 influenza, COVID-19, and antibiotic resistance. U.S. global health security efforts aim to reduce the threat of emerging infectious diseases by supporting preparedness, detection, and response capabilities worldwide. Funding designated by Congress for global health security through both emergency and regular appropriations has fluctuated over time, rising largely in response to outbreaks, including Ebola in FY 2015, Zika in FY 2016, and COVID-19 in FY 2020 and FY 2021.6 In FY 2023, funding for global health security was $1.5 billion, its highest level to date, and accounted for 11% of the U.S. global health budget.
U.S. Global Health Security Funding: Figures
U.S. Global Health Security Funding: Table
U.S. Global Health Budget: Neglected Tropical Diseases (NTDs)
NTDs are a group of parasitic, bacterial, and viral infectious diseases that primarily affect the most impoverished and vulnerable populations in the world. The U.S. Congress first designated funding to address NTDs in 2006, through the U.S. Agency for International Development (USAID).7 Funding rose from $86 million in FY 2013 to $100 million in FY 2014 and remained flat for several years before rising to a peak of $115 million in FY 2023. Funding for NTDs accounts for a relatively small share of the U.S. global health budget (1% in FY 2023).
U.S. Global NTDs Funding: Figures
U.S. Global NTDs Funding: Table
Endnotes
In addition to regular appropriations, Congress provided $250 million in emergency supplemental funding to address the impacts of COVID-19 on U.S. bilateral HIV programs in FY 2021.
Total PEPFAR funding in FY 2023 is $6.9 billion ($4.8 billion for bilateral HIV, $50 million for UNAIDS, and $2 billion for the Global Fund).
Totals do not include funding provided through Food for Peace (FFP) due to the unique nature of the program.
Under current law, any U.S. funding withheld from UNFPA is to be made available to other family planning, maternal health, and reproductive health activities (see the KFF fact sheet on U.S. government international family planning and reproductive health statutory requirements and policies).
PAI. Cents and Sensibility: U.S. International Family Planning Assistance from 1965 to the Present. Accessed September 2022 at https://pai.org/cents-and-sensibility.
In FY15, Congress provided $5.4 billion in emergency funding to address the Ebola outbreak, of which $909.0 million was specifically designated for global health security. In FY16, Congress provided $1.1 billion in emergency funding to address the Zika outbreak, of which $145.5 million was specifically designated for global health security. In FY18, Congress provided $100 million in unspent Emergency Ebola funding for “programs to accelerate the capabilities of targeted countries to prevent, detect, and respond to infectious disease outbreaks.” In FY19, Congress provided $38 million in unspent Emergency Ebola funding for “programs to accelerate the capacities of targeted countries to prevent, detect, and respond to infectious disease outbreaks.” In FY20, Congress provided $1.235 billion in emergency COVID-19 funding to “prevent, prepare for, and respond to coronavirus” globally, and in FY21, Congress provided $9.4 billion in emergency COVID-19 funding “to prevent, prepare for, and respond to coronavirus, including for vaccine procurement and delivery.” While none of the FY20 funding was designated for global health security, all of the FY21 funding provided through CDC ($750 million) was designated as global health security and $250 million provided through USAID was designated as U.S. contributions to the Pandemic Fund.
Additional NTD funding is used for NTD research at the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH), although this funding is not specified by Congress.