The U.S. Global Health Budget: Analysis of Appropriations for Fiscal Year 2016
The FY15 Omnibus bill (P.L. 113-235) included $5.4 billion in total emergency Ebola funding, of which $3.7 billion was provided for international activities (see Kaiser Family Foundation, “The U.S. Response to Ebola: Status of the FY2015 Emergency Ebola Appropriation,” December 2015).
Total earmarked global health funding in the FY16 Omnibus bill (P.L. 114-113) was $9.2 billion. Some global health funding is determined at the agency level, and is not earmarked by Congress in the annual appropriations bills (e.g. NIH estimates international HIV research. The estimated $10.2 billion in total global health funding for FY16 assumes that funding determined by the agencies (HIV and malaria research at NIH, malaria programs at DoD, U.S. contributions to WHO and PAHO, and global health funding provided through the ESF and DA accounts at USAID) is maintained at FY15 levels. Totals do not include funding provided through Food for Peace (FFP) due to the unique nature of the program.
The international affairs budget is comprised of base funding, which supports enduring programs, and funding for Overseas Contingency Operations/Global War on Terrorism (OCO/GWOT), which has been defined by the Administration as “extraordinary, but temporary” funding supporting efforts in Iraq, Afghanistan, and Pakistan (see Congressional Research Service, State, Foreign Operations, and Related Programs: FY2015 Budget and Appropriations,” December 8, 2014). The global health funding from USAID and the State Department detailed in this analysis is part of base funding in the international affairs budget. In the FY16 Omnibus bill, the total international affairs budget (base and OCO/GWOT) was $54.6 billion, an increase of approximately $3.6 billion from FY15 estimated levels. However, base funding, was $39.7 billion, a decrease of $2.0 billion from FY15 levels, while OCO/GWOT funding in the international affairs budget totaled $14.9 billion in the FY16 Omnibus, a $5.6 billion increase from FY15 levels. See “Consolidated Appropriations Act, 2016” (P.L. 114-113), and “FY 2016 Congressional Budget Justification – Department of State, Foreign Operations, and Related Programs”.
The international affairs budget includes funding for global health programs provided through the U.S. Agency for International Development (USAID) and the Department of State. Additional global health funding is provided through the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the Department of Defense (DoD).
The Assistance for Europe, Eurasia and Central Asia (AEECA) account was eliminated in FY13. Funding provided through this account was incorporated into other accounts (e.g. GHP and ESF). The FY16 Omnibus bill reestablishes the AEECA account.
Both the FY15 Omnibus (P.L. 113-235) and the FY16 Omnibus (P.L. 114-113) bills state that, of the funding appropriated for bilateral assistance, "not less than $575,000,000 should be made available for family planning/reproductive health." Both bills also provide an additional funding for the U.S. contribution to the United Nations Population Fund (UNFPA) ($35 million in FY15 and $32.5 million in FY16). According to data on ForeignAssistance.gov, actual FY15 funding for FP/RH (bilateral and UNFPA) totaled $616 million.
U.S. funding for UNFPA is provided through the International Organizations and Programs (IO&P) account at the State Department.
U.S. funding for UNICEF is provided through the International Organizations and Programs (IO&P) account at the State Department.
Congress stated in the Omnibus bill that “not less than $400,000,000 shall be made available for water and sanitation supply projects pursuant to the Senator Paul Simon Water for the Poor Act of 2005.”
WASH is considered a cross-cutting issue that receives funding from multiple accounts through both direct appropriations and as part of funding provided to other program areas (e.g. HIV and MCH). Since the FY16 Omnibus bill did not specify the accounts and program areas used to reach the $400 million in WASH funding, this amount was not included in overall global health funding totals in order to prevent double-counting of funding.