The managers note that in fiscal year 2004, there is no request by the President for a subsidy appropriation for the Export-Import Bank of the United States. While the conference agreement provides no funding for the subsidy appropriation, the managers expect that there will be no reduction in Export-Import Bank activity levels due to the extraordinarily high level of carryover balances in fiscal year 2004, which total approximately $575,000,000.
The conference report includes no appropriation for the tied-aid `war chest'. The estimated $260,000,000 remaining `war chest' balance for tied-aid purposes may be used to support loans. The managers continue to expect that none of the funds appropriated by prior Acts for the tied-aid credits or grants may be used for any other purpose except through the regular notification procedures of the Committees on Appropriations.
The conference agreement appropriates $72,895,000 for administrative expenses for the Export-Import Bank, instead of $71,395,000 as proposed by the House and $74,395,000 as proposed by the Senate.
The conference agreement does not include a first-time appropriation for the Office of Inspector General. The Senate provided $1,000,000 for this office and the House did not address this matter. The managers note that the Export-Import
Bank already has an audit committee and other regimes in place, including independent auditors that provide financial oversight to its operations.
The managers direct the President of OPIC to continue current policy and consult with the Committees on Appropriations before any future financing for non-governmental organizations or private and voluntary organizations is approved.
The managers commend the Trade and Development Agency (TDA) for its efforts to assist countries in improving their aviation safety and security systems, which has had a positive effect on enhancing United States trade for our aviation and aerospace industries. The managers recognize that setting aviation and safety standards worldwide is an important component for integrating a global system of trade. Accordingly, the managers recommend $1,500,000 for TDA to promote its work in this area by providing for the development of training materials to help prepare participating countries for International Civil Aviation Organization (ICAO) audits and to correct safety and security deficiencies.
The conference agreement appropriates $1,835,000,000 for the Child Survival and Health Programs Fund instead of $2,235,830,000 as proposed by the House and $1,435,500,000 as proposed by the Senate. Significant funding for HIV/AIDS is in a new account, the `Global HIV/AIDS Initiative', and additional funding for HIV/AIDS, tuberculosis (TB), malaria, and other health issues is provided in Assistance for Eastern Europe and the Baltic States, Economic Support Fund, Assistance for the Independent States of the Former Soviet Union, and Foreign Military Financing accounts. The managers welcome the emergence of the Office of the Global AIDS Coordinator at the State Department, and specific direction for this office and its funding is included under the heading `Global HIV/AIDS Initiative'.
The conference agreement includes the list of funding categories as proposed by the House which makes clear that funding for children orphaned or otherwise made vulnerable by HIV/AIDS should be considered separately from that for other orphans and vulnerable children. The managers also include $250,000 for the monitoring and oversight of child survival, maternal and family planning/reproductive health, and infectious disease programs, instead of $150,000 as contained in the Senate.
The conference agreement includes language allocating $1,835,000,000 among seven program categories in the Child Survival and Health Programs Fund: $330,000,000 for child survival and maternal health, including vaccine-preventable diseases such as polio; $28,000,000 for vulnerable children (not including children affected by HIV/AIDS); $516,500,000 for HIV/AIDS, including assistance for communities, including children orphaned by HIV/AIDS and otherwise affected by the disease; $185,000,000 for other infectious diseases, including TB and malaria; $375,500,000 for reproductive health/family planning; and $400,000,000 for the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global ATM Fund). The managers expect that any change proposed subsequent to the allocation as directed in bill language will be subject to the requirements of section 515 of this Act. A definition of program categories and their components can be found on pages 9 through 11 of House Report 107-142 and under the heading `Family Planning/Reproductive Health' on page 12 of Senate Report 107-58. The managers, for the first time in several years, include funding for UNICEF in `International Organizations and Programs' rather than in this account.
The managers commend the President for his commitment to combat HIV/AIDS, TB, and malaria. The conference agreement includes $1,646,000,000
to fight these three diseases, and anticipates that $754,00,000 is available in the Labor, Health and Human Services Appropriations Act. It is anticipated that a total of $2,400,000,000 is provided to fight HIV/AIDS, TB, and malaria in these two Acts.
Of the amounts in this Foreign Operations Appropriations Act, $516,500,000, $185,000,000, and $400,000,000 are for HIV/AIDS, TB, and malaria, and a United States contribution to the Global ATM Fund, respectively. An additional $491,000,000 is included in the Global HIV/AIDS Initiative account, and $53,500,000 is in Economic Support Fund, Foreign Military Financing, and regional accounts for Eastern Europe and the Baltic States and the Former Soviet Union.
|Foreign Operations funding for HIV/AIDS, TB, and Malaria, fiscal year 2004|
|Child Survival and Health Programs Fund (CSH)||1,101,500,000|
|Other Infectious Diseases (TB + malaria)||(185,000,000)|
|Global ATM Fund||(400,000,000)|
|Global HIV/AIDS Initiative||491,000,000|
|Other bilateral accounts, HIV/AIDS, TB, malaria||53,500,000|
|Total, HIB/AIDS, TB, malaria||1,646,000,000|
The managers recognize that these three pandemics, especially HIV/AIDS and TB, are closely related, and that the response to them can not readily be separated. However, the managers have estimated how this $1,646,000,000 could be disaggregated by major infectious disease for tracking purposes. The managers also note that funding for `other infectious disease' should be allocated for activities besides fighting tuberculosis and malaria, such as disease surveillance. The TB and malaria estimates in this section should not be construed to indicate that these activities should not be undertaken.
The conference agreement provides not less than $1,283,500,000 for programs for the prevention and treatment of HIV/AIDS, and for care and support of those infected and affected by the disease. $756,500,000 is funded through the Child Survival and Health Programs Fund, including $240,000,000 as a conservative estimate of the amount form this Act that will be allocated for HIV/AIDS by the Global ATM Fund. An additional $491,000,000 is included in the Global HIV/AIDS Initiative account, and an estimated $36,000,000 is provided through other accounts, such as the Economic Support Fund, International Disaster Assistance, Foreign Military Financing, and regional accounts for Eastern Europe and the former Soviet Union. The estimate of $1,283,500,000 for HIV/AIDS does not include the United States share of HIV/AIDS assistance through the World Bank Group.
The managers provide most HIV/AIDS funding in two accounts, Child Survival and Health and a new account, the Global HIV/AIDS Initiative, similar to the structure of the Senate bill and the budget request. Instructions retained from the House bill and relevant to the Global HIV/AIDS Initiative are included under that heading. The managers intend that the $516,500,000 allocated for HIV/AIDS in the Child Survival and Health Programs Fund will be used to finance on-going programs, and that the $491,000,000 in the Global HIV/AIDS Initiative account will be used for new and expanded programs in 15 focus countries.
The managers recognize that the epicenter of the HIV/AIDS epidemic is moving from Africa and the Caribbean toward Asia, Eastern Europe, and the former Soviet Union. In order to help prevent these epidemics from exploding, the managers once again direct that funds form the Child Survival and Health Programs Fund be made available for HIV/AIDS programs in Eastern Europe and the former Soviet Union. The conference report also includes funds under several bilateral accounts specifically to fight HIV/AIDS, TB, and malaria. The managers also encourage USAID, working in coordination with the Global AIDS Coordinator, to make make available funds from Child Survival and Health Programs Fund for HIV/AIDS program in `EST countries' other than those for which funds are specifically mandated in this Act.
The managers concur with the President's 2001 remarks at the announcement of the initial United States contribution to the proposed Global Fund to Fight AIDS, Tuberculosis and Malaria that a successful approach to fighting these diseases must incorporate bilateral and multilateral programs and approaches, and that the Global ATM Fund has a crucial role to play in marshalling and distributing international resources.
The conference agreement includes $400,000,000 for a contribution to the Global ATM Fund, as proposed by the House, rather than $250,000,000 as in the Senate bill or $100,000,000 as contained in the budget request. The managers note that, of the awards pledged thus far by the Global ATM Fund to recipient countries, approximately 60 percent are for HIV/AIDS interventions, 23 percent are for malaria interventions, and 17 percent are for TB or combined TB/AIDS interventions. The managers have used these percentages to estimate the portion of the United States contributions to the Global ATM Fund that is likely be attributed for each disease.
The managers intend that the United States contributions to the Global ATM Fund be used to leverage other donors' contributions. The conference agreement does not include a provision contained in the House bill limiting the United States contribution to the Global ATM Fund to not more than one-half of all contributions
from other sources because a provision addressing the same matter is contained in section 202 of Public Law 108-25, the `United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003'. The managers expect that the Global AIDS Coordinator will use the funds provided for a United States contribution to the Global ATM Fund to maximally leverage resources from other donors.
However, the managers also recognize that funding cycles for donors vary, and that the application of the above provision may cause a portion of funds allocated for a United States contribution to the Global ATM Fund to remain unspent. Therefore, the conference report also includes a `kick-out' clause, as proposed by both the House and the Senate, which would ensure that funds are used for bilateral HIV/AIDS programs if other donors are unable to fully match the intended United States contribution to the Global ATM Fund. This provision is addressed in section 595. The managers expect that the Global AIDS Coordinator will bear in mind the managers' support for the Global ATM Fund and will judiciously use the flexibility provided by this `kick-out' clause to ensure that funds are allocated to the most effective uses.
The conference agreement does not include a Senate provision regarding the percentage of the budget for prevention and treatment programs of the Global Fund to Fight AIDS, Tuberculosis and Malaria that is made available to support technical assistance to ensure the quality of such programs. However, the managers recognize the importance of technical assistance and note the extensive resources and experience of the United States Government in providing such assistance. The managers urge the Global AIDS Coordinator to seek to ensure that an appropriate percentage of resources are utilized for this purpose.
When funding through bilateral programs administered by USAID is considered in combination with the United States contribution to the Global ATM Fund, the conference agreement provides a total of $169,000,000 for TB assistance. Of this amount, $92,500,000 is funded through the `other infectious diseases' allocation in this amount, an estimated $8,500,000 from other bilateral accounts, and $68,000,000 through the contribution to the Global ATM Fund.
For malaria, the conference agreement provides a total of $193,500,000. Of this amount, it is expected that $92,000,000 of the contribution to the Global ATM Fund will fund malaria programs, $92,500,000 is funded through the `other infectious diseases' allocation in this amount, and an estimated $9,000,000 is provided from other bilateral accounts.
The managers expect USAID to allocate up to 10 percent of its funding for malaria programs to medicines and vaccine research and development, including $3,000,000 for the Medicines for Malaria Venture, and the same amount for the Malaria Vaccine Initiative.
The conference agreement includes bill language, proposed by the Senate, regarding the development of microbicides as a means of combating HIV/AIDS.
The conference agreement does not include up to $150,000,000 for mother and child HIV prevention as contained in the Senate bill. However, the managers expect that funds will be made available from the HIV/AIDS allocation in this account and from funds provided in the Global HIV/AIDS Initiative account.
The conference account provides not less than $26,000,000 for research on and testing of HIV/AIDS vaccines. These funds should be allocated by the Global AIDS Coordinator at the Department of State to the International AIDS Vaccine Initiative. The managers expect that $10,000,000 will be used for cooperative projects coordinated with the European Union's new 5-year program, the `AIDS Vaccine Integrated Project,' and in cooperation with the Partnership for AIDS Vaccine Evaluation (PAVE) operating under the aegis of the Department of Health and Human Services.
The conference agreement also provides that not less than $26,000,000 should be made available as a United States contribution to UNAIDS, instead of $28,000,000 as proposed by the Senate. The House did not address this matter. The managers note the central role that UNAIDS plays in coordinating the work of eight U.N. agencies and the Global ATM Fund, and in providing technical support to countries as funding to combat HIV/AIDS rapidly increases.
The managers urge USAID to implement programs that address the combination of the HIV/AIDS and hunger, including programs to enhance nutrition among HIV/AIDS-affected households and communities and that strengthen the ability of HIV/AIDS-affected individuals and households to meet current and future needs. Particular attention needs to be given to dealing with orphans and other vulnerable children and to promoting overall agriculture development and food production, including through school and hospital gardens as appropriate.
The managers are aware of the efforts of Voices for Humanity and the other organizations cited on page 9 of Senate Report 108-106 and page 15 of House Report 108-222 to convey HIV/AIDS awareness, prevention, treatment and medical training among non-literate and oral communicating populations in developing countries. The managers expect that USAID and the Global AIDS Coordinator consider and, where feasible, fund pilot projects and other proposals submitted by such organizations.
The conference agreement does not include a Senate provision that funds shall be made available to the HIV/AIDS, Tuberculosis and Malaria Cluster of the World Health Organization (WHO). However, the managers recognize the central role WHO plays in fighting HIV/AIDS and other infectious diseases, and expect that funds will be made available to support this new initiative.
For health in West Africa, the conference agreement does not include section 699D of the Senate amendment providing $5,000,000 for the Carter Center's Guinea Worm Eradication Program. The managers note that the Carter Center recently released an action plan for guinea worm eradiction that target Ghana, Nigeria, and Sudan. The managers strongly support this program and expect that $5,000,000 will be a made available for this purpose. The managers also
endorse the House report language on the West African Health Organization and on obstetric fistula and urge USAID to initiate programs in heavily effected areas, and to expand the programs of the International Medical Corps in Sierra Leone that address this problem.
The conference agreement allocates $375,500,000 for family planning/reproductive health within the Child Survival and Health Programs Fund, as proposed by the Senate, instead of $368,500,000 as proposed by the House.
The managers also direct USAID to continue to provide the Committees with a detailed annual report not later than March 31, 2004, on the programs, projects, and activities undertaken by the Child Survival and Health Programs Fund during fiscal year 2003.
Funds appropriated for the Child Survival and Health Programs Fund are appropriated for programs, projects and activities. Funds for administrative expenses to manage Fund activities are provided in a separate United States Agency for International Development Operating Expenses account, with three exceptions included in the conference agreement: authority for USAID's central and regional bureaus to use up to $250,000 from program funds for Operating Expense-funded personnel to better monitor and provide oversight of the Fund; in section 522, authority to use up to $13,500,000 to reimburse other government agencies and private institutions for professional services; and in section 525, authority to hire overseas personnel on a limited term basis.
Any proposed obligations for Global Development Alliance programs, projects or activities shall be subject to the regular notification procedures of the Committees on Appropriations, as shall any proposed transfers of Child Survival and Health Programs funds to any other agency, program, or account.
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