1.Short title; table of
contents
(a)This Act may be cited
as the Global Health Expansion, Access
to Labor, Transparency, and Harmonization Act of 2010
or
the Global HEALTH Act of
2010
.
(b)The table of contents for this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Purpose.
Sec. 3. United States Global Health Strategy.
Sec. 4. Assistance for developing countries to improve delivery
of health services.
Sec. 5. Global Health Workforce Initiative.
Sec. 6. Relation to other United States laws and
policies.
Sec. 7. Definitions.
2.The purpose of this Act is to strengthen and
improve the health systems of developing countries and the delivery of health
services in developing countries to assist their national governments in
reducing mortality and improving health outcomes among their populations,
consistent with the United Nations Millennium Development Goals, by—
(1)improving the coordination and
effectiveness of all health-related United States foreign assistance by
establishing under section 3 a comprehensive and integrated 5-year United
States Global Health Strategy that—
(A)supports
developing countries in their efforts to expand and develop their health
systems and increase their numbers of trained health workers;
(B)encourages and
supports developing countries to adopt policies that produce positive health
outcomes; and
(C)coordinates the global health-related work
of United States global health programs and relevant United States executive
branch agencies with the global health-related work of governments of other
countries and international organizations;
(2)providing assistance under section 4 for
developing countries to improve the delivery of health services by their health
systems;
(3)supporting the efforts of developing
countries to strengthen their indigenous health workforces and expand the
supply and equitable distribution within such countries of skilled health
workers by establishing under section 5 a Global Health Workforce Initiative;
and
(4)ensuring, as outlined in section 6, that
the laws and policies of the United States and multilateral organizations of
which the United States is a member do not interfere with the ability of
developing countries to establish and maintain skilled indigenous health
workforces, to obtain pharmaceuticals and other medical supplies and equipment,
or to otherwise develop the capacity of their health systems.
3.United States
Global Health Strategy
(a)Not later than 1 year after the date of the
enactment of this Act, the President shall transmit to Congress and make
publicly available a comprehensive and integrated 5-year United States Global
Health Strategy (in this section referred to as the “Global Health Strategy”)
to coordinate all health-related United States foreign assistance and to
integrate and harmonize such assistance with the work of relevant United States
executive branch agencies, governments of other countries, and international
organizations.
(b)
(1)The President shall ensure that the Global
Health Strategy will assist countries in achieving the health-related goals and
targets of the United Nations Millennium Development Goals and Targets,
including—
(A)reducing child mortality, with special
emphasis on reducing the mortality rate of children under 5 years of age by
2/3 between 1990 and 2015;
(B)improving maternal health, with special
emphasis on reducing the maternal mortality ratio by 3/4
between 1990 and 2015, and achieving universal access to reproductive health
services by 2015; and
(C)combating HIV/AIDS, tuberculosis, malaria,
and other diseases, with special emphasis on halting and beginning to reverse
by 2015 the spread of HIV/AIDS and the incidence of malaria and other major
diseases.
(2)The President shall ensure that the goals listed in
paragraph (1) are achieved in a manner that, to the maximum extent
practicable—
(A)improves access to quality health services
for poor, vulnerable, or marginalized populations in countries receiving
health-related United States foreign assistance;
(B)ensures that skilled health workers are
available in sufficient numbers and on a sufficiently sustainable and equitably
distributed basis within each country that their participation in programs
supported by health-related United States foreign assistance does not
negatively impact the health workforce of any component of a developing
country’s health system that is not supported by such assistance; and
(C)advances the efforts of developing
countries to develop health systems capable of providing universal access to a
comprehensive package of primary health services.
(3)The goals and objectives listed in this subsection
are in addition to and shall not be construed to supplant the goals or
objectives of any program under a law, regulation, Executive order, or
international commitment of the United States.
(c)In
developing the Global Health Strategy, the President shall consult with—
(1)each executive
branch agency administering United States foreign assistance related to—
(A)improving global
health;
(B)strengthening
financial management systems;
(C)monitoring animal
and plant populations; and
(D)addressing
environmental problems such as pollution and climate change;
(2)personnel at United States embassies and
country missions involved in the administration of the types of United States
foreign assistance described in paragraph (1);
(3)the appropriate
congressional committees with jurisdiction over the agencies described in
paragraph (1);
(4)civil society and
nongovernmental organizations engaged in improving health care and health
outcomes in developing countries, including indigenous community and
faith-based organizations;
(5)international organizations engaged in
improving health care and health outcomes in developing countries and of which
the United States is a voting member, with which the United States coordinates
the delivery of foreign assistance, or to which the United States contributes
funding for the purpose of providing such assistance;
(6)academic
organizations, private foundations, businesses, and other organizations engaged
in improving health care and health outcomes in developing countries and not
receiving United States funding for such purposes;
(7)other donor
nations engaged in improving health care and health outcomes in developing
countries;
(8)countries
receiving health-related United States foreign assistance; and
(9)any other global,
regional, or subregional organizations or partnerships engaged in improving
health care and health outcomes in developing countries.
(d)Elements of
United States Global Health StrategyThe Global Health Strategy
shall include the following elements:
(1)Plans for
coordinating all health-related United States foreign assistance among the
executive branch agencies authorized to deliver such assistance in order to
achieve the goals listed in subsection (b)(1) in a manner that facilitates
harmonization with partners at the country level and takes maximum advantage of
the expertise of personnel at the United States embassy and country mission
level, including plans—
(A)that incorporate
all United States programs related to global health and their goals and
strategies, including programs related to child survival and maternal health,
vulnerable children, family planning and reproductive health, nutrition, health
systems and infrastructure, health care workforces, HIV/AIDS, tuberculosis,
malaria, pandemic influenza, chronic and noncommunicable diseases, neglected
diseases, and other infectious diseases;
(B)to assist
countries in strengthening their financial management, accounting, auditing,
and reporting systems, and to ensure the effectiveness of such
assistance;
(C)to monitor the
spread of disease among animal and plant populations, including livestock and
wildlife;
(D)to assist
countries in addressing the health-related threats posed by environmental
problems, including pollution and climate change; and
(E)for oversight of
all health-related United States foreign assistance, including an analysis of
the capacity of each executive branch agency authorized to deliver such
assistance to conduct periodic audits, inspections, and investigations and an
analysis of how oversight activities should be prioritized.
(2)Plans that describe how health-related
United States foreign assistance will help developing countries strengthen and
improve their health systems and the delivery of health services to achieve
their national health goals and the goals of all United States programs related
to global health, including the goals listed in subsection (b)(1), by means
that include—
(A)assisting
developing countries to create, strengthen, and implement their own
evidence-based national health strategies, including subnational health
strategies where appropriate;
(B)providing
technical assistance and support to national ministries of health, or their
equivalents, and other relevant ministries in overseeing the health systems of
their countries and monitoring and evaluating the effectiveness of such systems
in reducing mortality and improving health outcomes;
(C)supporting the
construction, expansion, rehabilitation, and maintenance of health facilities
at the national and local level, and ensuring the equitable distribution and
use of such facilities among and within urban, peri-urban, and rural areas in
each country;
(D)providing
assistance to national ministries of health, or their equivalents, and other
relevant ministries in recruiting, training, and retaining skilled health
workers, managers, and administrators and in ensuring the equitable
distribution of such personnel in health facilities throughout each
country;
(E)supporting the development and
implementation of national health workforce plans for achieving a combined
total of at least 2.3 doctors, nurses, and trained midwives per 1,000
residents, and comparable numbers of other health workers, such as
paraprofessionals, community health workers, managers, and administrative and
support staff, and ensuring such workers are equitably distributed within each
country;
(F)providing
assistance to developing countries to create and transparently manage their own
supply-chain management systems and to use existing nongovernmental systems,
where appropriate, to—
(i)efficiently and
equitably distribute medical and laboratory supplies, including diagnostics,
pharmaceuticals, technology, and equipment, to health facilities throughout the
country; and
(ii)perform any
maintenance necessary to ensure the continued operation of medical and
laboratory equipment;
(G)supporting the
development, improvement, and implementation of financial management systems
and the training of financial management personnel in order to track health
expenditures by the national governments of developing countries, ensure the
equitable and effective allocation of such expenditures, anticipate and budget
for annual resource needs, equitably mobilize additional domestic resources,
and increase the accountability of the health systems of such countries to
their people, including accountability at the subnational and community
levels;
(H)supporting the establishment, improvement,
and implementation, where appropriate, of mechanisms to operate, manage,
regulate, monitor, and evaluate a country’s health system, particularly its
effectiveness in reducing mortality and improving health outcomes among the
general population and for poor, vulnerable, or marginalized
populations;
(I)supporting the
development and implementation of national health information systems to
securely track, compile, and manage data collected by a country’s health system
at the individual, community, and population level, with appropriate privacy
safeguards, in order to measure the impact of health services on health
outcomes, and to provide a basis for adjustments to the health system;
(J)supporting meaningful community involvement
and participation, inclusive of poor, vulnerable, or marginalized populations
and their representative indigenous and civil society organizations, in
decisionmaking related to national and subnational health strategies and the
delivery of health services, including in decisions related to the adoption of
health policies and the total amount and distribution of health funding;
(K)further promoting
the community involvement and participation described in subparagraph (J) by
strengthening partnerships between government, civil society, and indigenous
nongovernmental organizations, including community and faith-based
organizations seeking to improve health conditions in their countries and
communities;
(L)supporting
evidence-based public health education initiatives that teach healthy habits
and behaviors, increase health literacy, and encourage greater utilization of
the health system;
(M)assisting
countries to coordinate, regulate, and harmonize the delivery of health
services provided by the United States and nongovernmental organizations,
including community and faith-based organizations, private foundations,
international organizations, and other donors, and to coordinate or integrate
such services with the health system to the maximum extent practicable;
(N)supporting indigenous nongovernmental
organizations, including community and faith-based organizations, that seek to
improve the efficiency, transparency, and delivery of health services to poor,
vulnerable, or marginalized populations; and
(O)using, to the
maximum extent practicable, local and regional entities for the provision of
technical assistance, and where the capacity of such entities is insufficient,
supporting capacity building to enable them to provide such assistance.
(3)Plans to
strengthen the ability of countries receiving health-related United States
foreign assistance to detect, identify, and respond to emerging public health
threats by—
(A)developing and
improving laboratory capacity, including constructing or rehabilitating
laboratory facilities and providing any necessary technology, equipment, or
supplies;
(B)supporting the
recruitment, training, and retention of public health professionals with the
expertise to monitor, respond to, and contain the spread of disease, including
laboratory personnel, epidemiologists, and animal and plant inspectors;
(C)supporting the
development of integrated and comprehensive surveillance and notification
systems at the national and regional level that are integrated within the
health system to address the spread of emerging diseases among human, animal,
and plant populations that may pose potential threats to public health;
and
(D)facilitating
partnerships between health systems and relevant United States Government
agencies to strengthen national and regional disease surveillance and
notification systems to address the spread of emerging diseases among human,
animal, and plant populations.
(4)Plans to improve
research collaboration with countries receiving health-related United States
foreign assistance, including plans related to—
(A)basic, clinical,
and applied research on diseases that primarily impact developing countries,
including research on medical technology and equipment, protocols, procedures,
standards, and strategies to combat such diseases;
(B)operations
research to facilitate the development and administration of effective health
systems and health-related programs;
(C)support for
developing indigenous research capacity, including the establishment of
independent and scientific peer review processes to help countries pursue their
own research agendas;
(D)encouraging the
development of sustainable, country-driven partnerships between indigenous and
United States-based research institutions; and
(E)strengthening
regional research partnerships.
(5)Plans for
encouraging and assisting national governments of developing countries to
pursue policies and legal frameworks that improve health outcomes and make
progress toward the goals listed in subsection (b)(1), including policies and
legal frameworks that—
(A)are medically
accurate and evidence-based and adhere to the latest global public health
standards for prevention, treatment, and care;
(B)integrate and
deliver, to the maximum extent practicable, a comprehensive package of primary
health services at the local clinic level, with appropriate and functional
systems for referral to secondary and tertiary medical facilities that provide
services including—
(i)preventive care;
(ii)prenatal and
perinatal services;
(iii)immunizations
and vaccinations;
(iv)family planning
and reproductive health services;
(v)chronic and
infectious disease management;
(vi)maternal and
child health services;
(vii)psychosocial and
mental health services;
(viii)nutritional
support; and
(ix)emergency
response and triage;
(C)promote and
improve the status of women and youth, ensuring their ability to access and use
health services without fear or risk of gender-based violence, reprisal,
discrimination, stigmatization, or other mistreatment;
(D)work to remove
stigmatization of and discrimination against poor, vulnerable, or
marginalized populations and to protect the rights of such
populations;
(E)provide for the
equitable allocation and distribution of health resources among rural,
peri-urban, and urban areas, including facilities, personnel, medicines,
medical technology and equipment, and health financing;
(F)ensure that all
individuals, especially the poorest of the poor, have access to high-quality,
confidential, affordable health services, including by—
(i)encouraging the
elimination of user fees or their replacement with equitable financing
strategies where appropriate; and
(ii)addressing other
persistent barriers to such access, including those related to housing,
transportation, language, and similar issues;
(G)promote
sustainable working conditions and policies that protect the health and safety
of patients and health workers within their communities and in all medical
facilities;
(H)provide
comprehensive, confidential, high-quality health services to health workers,
including for chronic and infectious diseases;
(I)respect the rights
and dignity of health workers and patients;
(J)coordinate the
delivery of health services with other core development programs to better
address the social determinants of health, including programs to reduce
poverty, expand educational opportunities, provide access to clean water and
sanitation services, improve food security and nutrition, protect women’s
rights, improve access to legal services, protect the environment, and spur
economic growth; and
(K)facilitate the
development and implementation of sustainable policies, legal frameworks, and
capacity-building activities that actively engage and support civil society
organizations and community members, including individuals from poor,
vulnerable, or marginalized populations, to monitor and enforce policies
related to the provision of health services.
(6)Plans to support
the efforts of national governments of developing countries in responding to
health-related threats posed by environmental problems, including pollution and
climate change.
(7)Plans for a review
of, including recommendations to adjust, laws and policies of the United States
Government that impact the provision of health-related United States foreign
assistance, including—
(A)recruitment,
training, and retention of the United States health workforce, including
through the immigration of foreign health professionals to the United
States;
(B)negotiation and
enforcement of bilateral, multilateral, and other international treaties and
trade and investment agreements, including any provisions related to the
delivery of health services or the supply of medical technology and equipment,
diagnostics, or pharmaceutical products;
(C)negotiation and
voting practices within international financial institutions; and
(D)negotiation and voting practices within the
World Health Organization, the Global Fund to Fight AIDS, Tuberculosis and
Malaria, the Global Alliance for Vaccines and Immunisation, and any other
international organizations of which the United States is a voting member and
to which the United States contributes funding.
(8)Plans for
establishing an integrated monitoring and evaluation system, coordinated at the
country level with any such systems previously in existence, in order to assess
the effectiveness of all health-related United States foreign
assistance.
(9)Annual resource
plans for implementing the Global Health Strategy, achieving the goals listed
in subsection (b)(1), and achieving the relevant goals of all United States
programs related to global health, including, to the extent practicable, annual
budgets, annual projected resource needs, and long-term funding commitments
of—
(A)the United States
Government;
(B)international organizations of which the
United States is a voting member and to which the United States contributes
funding for the purpose of providing health-related assistance to developing
countries; and
(C)countries receiving health-related United
States foreign assistance.
(e)
(1)The President shall designate an individual as
coordinator of the Global Health Strategy (in this section referred to as the
Strategy Coordinator
).
(2)The
duties of the Strategy Coordinator shall include—
(A)coordinating the Global Health Strategy
among all relevant executive branch agencies;
(B)serving as a point
of reference for Congress and the public regarding the implementation of the
Global Health Strategy; and
(C)producing the
annual report required by subsection (g).
(f)Performance
goals and indicatorsIn order to measure and evaluate the
effectiveness of the Global Health Strategy in achieving the goals described in
subsection (b)(1) and in order to provide a basis to periodically review and
adjust the Global Health Strategy, the President shall establish, where
appropriate, objective and quantifiable performance goals and indicators for
each element required by subsection (d).
(g)Not
later than 1 year after the President’s transmission to Congress of the Global
Health Strategy under subsection (a) and annually thereafter, the President
shall transmit to Congress a report that includes—
(1)a
description of the impact and effectiveness of all health-related United States
foreign assistance in achieving the goals listed in subsection (b)(1) and the
additional objectives listed in subsection (b)(2);
(2)a
description of the progress made toward achieving the performance goals
established under subsection (f);
(3)a
description of any audits, inspections, or investigations of health-related
United States foreign assistance completed during the year preceding the
transmission of the report, including their results, and a brief summary of any
plans to undertake similar audits, inspections, or investigations during the
subsequent year; and
(4)a
detailed programmatic list of expenditures for all United States programs
related to global health for the fiscal year preceding the transmission of the
report, including the amounts and percentages of funding that each program
allocated for—
(A)the direct
provision of health services, including directly supporting health workforces
that provide such services;
(B)the purchase of
commodities, including medicines;
(C)the construction,
expansion, rehabilitation, or maintenance of health facilities within a
country’s health system; and
(D)any technical
assistance provided to carry out the goals and objectives of the
program.
(h)Evaluation of
the Global Health Strategy by the Institute of Medicine
(1)The Strategy
Coordinator shall enter into a contract with the Institute of Medicine of the
National Academies, or, if the Institute declines, another appropriate entity,
to complete an evaluation of the effectiveness of the Global Health Strategy
not later than 4 years after the President’s transmission to Congress of such
strategy under subsection (a).
(2)The contract required by paragraph (1) shall provide
for—
(A)an assessment of the level of coordination
of health-related United States foreign assistance, including at the
country-mission level;
(B)an assessment of the progress made toward
the goals listed in subsection (b)(1) and the additional objectives listed in
subsection (b)(2);
(C)an assessment of the contributions of the
Global Health Strategy to strengthening health systems, improving the delivery
of health services, ensuring a sustainable supply of health workers, and
improving the accountability of health systems of developing countries to the
people of such countries;
(D)an assessment of the progress made toward
reviewing and evaluating the impact of existing laws and policies of the United
States Government related to the provision of health-related United States
foreign assistance, including any recommendations for the adjustment of such
laws and policies;
(E)recommendations
for improving the Global Health Strategy; and
(F)an assessment of
any additional factors that the entity with which the Strategy Coordinator
contracts under paragraph (1), in consultation with the appropriate
congressional committees and the Strategy Coordinator, considers
appropriate.
(i)Authorization of
appropriations
(1)In addition to amounts otherwise made available for such
purposes, there are authorized to be appropriated to the President such sums as
may be necessary for each of the fiscal years 2011 through 2015 to carry out
this section.
(2)Amounts appropriated pursuant to the authorization of
appropriations in paragraph (1) are authorized to remain available until
expended.
4.Assistance for
developing countries to improve delivery of health services
(a)
(1)The President is authorized to provide assistance to
developing countries to improve the delivery of health services by the health
systems of such countries.
(2)The assistance authorized by paragraph (1) includes
assistance for the following activities in order to assist a country in
providing health services:
(A)Direct support to
implement particular elements of a country’s national health strategy,
including—
(i)construction,
expansion, rehabilitation, and maintenance of health facilities at the national
and local level, including ensuring the equitable distribution and use of such
facilities among and within urban, peri-urban, and rural areas of the
country;
(ii)recruiting,
training, and retaining skilled health workers, managers, and administrators,
including ensuring the equitable distribution of such personnel in health
facilities throughout the country;
(iii)developing a
supply-chain management system to—
(I)efficiently,
transparently, and equitably purchase and distribute medical and laboratory
supplies, including diagnostics, pharmaceuticals, technology, equipment, and
other health commodities, to health facilities throughout the country;
and
(II)perform any
maintenance necessary to ensure the continued operation of medical and
laboratory equipment; and
(iv)providing the items described in clause
(iii)(I) or funds for the purchase of such items.
(B)Technical assistance and operational
support in conjunction with direct assistance described in subparagraph (A) for
national governments to develop, implement, and evaluate the relevant elements
of their national health strategies and any associated plans and
policies.
(C)Support for
indigenous civil society and nongovernmental organizations to monitor and
evaluate the development and effectiveness of their country’s health system and
national health strategy.
(3)In carrying out paragraph (1), the President is
authorized to provide assistance directly to—
(A)the national
government of each developing country that has a national health strategy,
including assistance to the national ministry of health and the national
ministry of finance, or their equivalents, and other relevant
ministries;
(B)indigenous
nongovernmental, community, and faith-based organizations and civil society
groups within each developing country that has a national health
strategy;
(C)United
States-based nongovernmental organizations and academic organizations that
provide health-related services or assistance in developing countries;
and
(D)international organizations involved in
delivering health-related assistance and of which the United States is a voting
member, with which the United States coordinates the delivery of foreign
assistance, or to which the United States contributes funding for the purpose
of providing such assistance.
(4)Relationship to
national health strategies and United States Global Health
StrategyAssistance provided
under paragraph (1) shall be—
(A)aligned to the
fullest extent possible with the national health strategy of each country
receiving such assistance; and
(B)in accordance with
the goals and additional objectives of the United States Global Health Strategy
listed in section 3(b)(1) and section 3(b)(2), respectively.
(5)The President may enter into contracts to provide the
assistance authorized by paragraph (1).
(b)Principles of
national health strategiesThe President shall encourage each
country receiving direct assistance described in subsection (a)(2)(A) to
incorporate into its national health strategy, to the maximum extent
practicable, the following principles:
(1)Goals and targets
to reduce morbidity and mortality and improve health outcomes, including to
reach commonly agreed-upon international and regional health targets.
(2)Plans to provide
universal access to a comprehensive package of primary health services.
(3)Plans to increase the equitable
distribution of health services among rural, peri-urban, and urban areas of the
country, including plans to ensure the availability of the facilities,
personnel, medical and laboratory supplies, technology and equipment,
financing, and other resources necessary to provide such services.
(4)Plans to ensure
that poor, vulnerable, or marginalized populations have access to the services
and necessary resources described in paragraph (3).
(5)Transparent annual
budget plans with cost estimates for reaching the goals and targets described
in paragraph (1), including a description of any funding gaps and plans to fill
such gaps through increased and equitable mobilization of national resources
and in partnership with external donors, including the United States, and other
funding sources.
(6)Appropriate
mechanisms and tools to monitor and evaluate the effectiveness of the country’s
health system in improving health-service delivery and to measure progress
toward achieving the goals and targets described in paragraph (1), with a
particular focus on expanding access to health services for poor, vulnerable,
or marginalized populations.
(7)Appropriate
financial management and auditing mechanisms for health financing in order to
track health expenditures by the national government, ensure the equitable
distribution of such expenditures within the country, anticipate and budget for
the annual resource needs of the health system, and increase the accountability
of the health system to the country’s people.
(8)Meaningful
participation of indigenous civil society and nongovernmental organizations,
including community and faith-based organizations, affected communities, and
poor, vulnerable, or marginalized populations, in the development and
implementation of the national health strategy, including program and budget
decisions, monitoring and evaluation, and implementation.
(9)Promotion of the
ability of women and youth to access and use health services without fear,
gender-based violence, reprisal, discrimination, or other mistreatment.
(10)Plans to reduce
stigmatization of and discrimination against poor, vulnerable, or marginalized
populations, to promote their rights, and to promote their ability to access
and use health services.
(11)Medically
accurate and evidence-based policies and program plans that adhere to the
latest global public health standards for prevention, treatment, and care and
that are contextualized within each country.
(12)Plans to ensure
that all individuals, especially the poorest of the poor, are able to exercise
their rights and have access to high-quality, confidential, affordable health
services, including by—
(A)encouraging the
elimination of user fees or their replacement with equitable financing
strategies where appropriate; and
(B)addressing other persistent barriers to
such access, including those related to housing, transportation, language, and
similar issues.
(13)Support for the creation of sustainable
working conditions and policies that protect the health and safety of patients
and health workers within their communities and in all medical facilities,
including through following recommended occupational health and safety
standards for health workers, including standards for training and protective
technology, equipment, and supplies, as well as through other forms of
infection prevention and control.
(14)Access for health
workers employed in the country’s health system to comprehensive, confidential,
high-quality health services, including prevention and treatment of chronic and
infectious diseases and psychosocial and mental health services.
(15)Promotion of
multisectoral harmonization through coordination and collaboration between the
delivery of health services and other development programs and plans that
impact public health, including programs and plans to address emerging public
health threats and health-related threats posed by environmental problems and
to advance applied research into diseases affecting the country.
(16)Support for the development and
implementation of sustainable policies, legal frameworks, and capacity-building
activities that actively engage civil society organizations and community
members, including individuals from poor, vulnerable, or marginalized
populations, to monitor and enforce policies related to the provision of health
services.
(c)
(1)The President may enter into a partnership agreement with
a developing country receiving assistance under this section in which the
country receives additional assistance to—
(A)encourage the
inclusion, adoption, and implementation of the principles listed in subsection
(b) as part of the country’s national health strategy and any associated plans
or policies; and
(B)encourage the
country to increase the amount of national resources it commits to expanding
and improving the delivery of health services.
(2)No reduction of
assistanceA partnership agreement under paragraph (1) shall not
result in a reduction of the total level of health-related United States
foreign assistance provided to a country below the level of such assistance
provided to such country in the previous fiscal year.
(d)Monitoring and
evaluation system
(1)The President shall establish an integrated monitoring
and evaluation system to measure the effectiveness of assistance provided under
this section including, where appropriate, objective and quantifiable
performance goals and indicators to measure progress toward the development and
implementation of national health strategies in accordance with the principles
listed in subsection (b).
(2)Harmonization
with systems of recipient countriesTo the maximum extent
possible, the system established under paragraph (1) shall be harmonized with
the monitoring and evaluation systems of countries receiving assistance under
this section.
(e)Not
later than 1 year after the date of the enactment of this Act and annually
thereafter, the President shall transmit to Congress a report describing the
impact and effectiveness of the assistance provided under this section,
including—
(1)a
detailed description, with respect to each country receiving assistance under
this section, of the effectiveness of such assistance in improving the delivery
of health services by the health system, including how such assistance was
aligned with each country’s national health strategy and any associated plans
or policies, as they existed before such country began receiving such
assistance;
(2)a
brief summary of plans to address gaps in the delivery of health services among
countries receiving assistance under this section during the following year and
the resources that will be required to carry out such plans;
(3)a
detailed description of any partnership agreements entered into under
subsection (c) and any potential strategies for further encouraging countries
to incorporate the principles listed in subsection (b) into their national
health strategies; and
(4)a
detailed programmatic list of expenditures under this section for the previous
fiscal year, including the amounts and percentages of funding allocated
for—
(A)the direct
provision of health services, including directly supporting health workforces
that provide such services;
(B)the purchase of
commodities, including medicines;
(C)the construction,
expansion, rehabilitation, or maintenance of health facilities within a
country’s health system; and
(D)any technical
assistance provided under this section, including a list of any contractors
providing such assistance and the impact of such assistance in improving health
outcomes and health service delivery.
(f)Certification
requirement
(1)The President shall certify to Congress that each
contract described in paragraph (2)—
(A)has been openly
and transparently secured and provides the highest quality goods and services
at the lowest cost; and
(B)wherever possible,
makes use of indigenous entities within the country receiving
assistance.
(2)A contract
described in this paragraph is a contract related to the construction,
expansion, rehabilitation, or maintenance of health facilities, the purchase of
commodities, or technical assistance that is entered into—
(A)by the United
States Government to provide health-related United States foreign assistance
under this section; or
(B)by a foreign
country or other entity to carry out a program or activity receiving
health-related United States foreign assistance under this section.
(g)Authorization of
appropriations
(1)In addition to amounts otherwise made available for such
purposes, there are authorized to be appropriated to the President such sums as
may be necessary for each of the fiscal years 2011 through 2015 to carry out
this section.
(2)Amounts appropriated pursuant to the authorization of
appropriations in paragraph (1) are authorized to remain available until
expended.
5.Global Health
Workforce Initiative
(a)The President is authorized to establish a
Global Health Workforce Initiative (in this section referred to as the
Initiative
) to provide technical and direct financial assistance
to entities described in subsection (c) to support the recruitment, training,
retention, effectiveness, and equitable distribution within each country of
skilled indigenous health workers as part of the health systems of developing
countries in order to achieve a combined total of at least 2.3 doctors, nurses,
and trained midwives per 1,000 residents, and comparable numbers of other
health workers, such as paraprofessionals, community health workers, managers,
and administrative and support staff.
(b)
(1)
(A)Not later than 90 days after the date of the enactment of
this Act, the President shall select for participation in the Initiative not
fewer than 12 developing countries and may, in consultation with Congress,
subsequently select additional developing countries.
(B)Participating
country definedA country selected under subparagraph (A) is
referred to in this section as a participating country
.
(2)The President shall not select a country under paragraph
(1)(A) unless it meets the following criteria:
(A)The government of the country has expressly
requested the assistance of the United States Government to support the
expansion of the country’s indigenous health workforce.
(B)The country is currently developing or
implementing a national health strategy.
(C)The country is
already receiving health-related United States foreign assistance and is able
to effectively use additional funding from the United States or other external
sources to expand its indigenous health workforce, reduce morbidity and
mortality, and improve health outcomes among its population.
(D)The country is
experiencing a critical shortage of health workers, which is a significant
obstacle to reducing mortality and improving health outcomes among its people
and to achieving the United Nations Millennium Development Goals and other such
international health targets.
(E)The country is
taking concrete steps to sustainably expand its indigenous health workforce,
such as direct budgetary investments, the development and implementation of
supportive policies, the development of educational, training, and clinical
care and practice standards, and direct agreements or partnerships at the
national or regional level with other countries or international
organizations.
(F)A health
professional training institution is currently located in the country, or the
country is in the process of establishing such an institution or has a
partnership with such an institution in another country in the region.
(3)The President should ensure that countries selected
under paragraph (1)(A) are diverse with respect to—
(A)total size and
demography of the population;
(B)prevalence and
incidence of disease and any associated mortality rates;
(C)levels of
development and functionality of the health system;
(D)the extent to
which financial resources are available or have been committed by the country
or by external funding sources to expand the indigenous health
workforce;
(E)the size of the
indigenous health workforce; and
(F)gross national
product and per capita income.
(c)The following entities are eligible to receive funding
under the Initiative:
(1)The national
government of each participating country, including the national ministry of
health and the national ministry of finance, or their equivalents.
(2)Indigenous
nongovernmental, community, and faith-based organizations and civil society
groups engaged in improving health care and health outcomes in 1 or more
participating countries.
(3)United
States-based nongovernmental and academic organizations that provide
health-related services or assistance in developing countries.
(4)International
organizations involved in delivering health-related assistance and of which the
United States is a voting member, with which the United States coordinates the
delivery of foreign assistance, or to which the United States contributes
funding for the purpose of providing such assistance.
(d)The activities for which the President may provide
funding under the Initiative include the following:
(1)Technical
assistance and direct support for countries to develop, strengthen, implement,
evaluate, and adjust the national health workforce plans described in
subsection (f).
(2)Programs to
prepare and encourage individuals to seek careers as health professionals and
to serve as teachers in health professional training institutions, including
through—
(A)basic education
programs;
(B)expanding the
capacity of the educational system to provide access to secondary-level and
advanced math and science education;
(C)teaching basic
health literacy and supporting basic disease prevention education; and
(D)additional
educational opportunities targeted to health professionals to enable and
prepare them to become effective teachers.
(3)Expansion and
improvement of health education and training of new health workers,
including—
(A)new construction,
expansion, rehabilitation, and maintenance of health professional training
institutions, including residential housing facilities for students, teachers,
and administrators;
(B)hiring and retention of teachers and
administrators to fully staff health professional training institutions and
other health worker training facilities and programs, including through
continuing education, professional development, and research opportunities and
such financial incentives as direct salary support and housing
assistance;
(C)providing
financial incentives to students enrolled in health professional training
institutions, including financial aid, housing assistance, and loan repayment
in exchange for defined periods of service in the country’s health
system;
(D)supporting
distance learning and community- and hospital-based clinical training;
(E)encouraging
students to pursue careers in primary care in the health system of their
country of residence, especially to meet the needs of rural areas and
underserved populations, while also supporting students who choose to pursue
careers in health administration and management or in needed tertiary care
fields;
(F)establishing
professional standards for the entire range of health workers, including
doctors, nurses, trained midwives, paraprofessionals, community health workers,
health administrators and managers, and support personnel;
(G)improving the
quality and diversity of health education and training courses and
strengthening existing curricula, including through the integration of program
planning, mangagement, leadership training, and professional standards to
better meet national and local circumstances;
(H)integrating the
use of information and communications technologies, including the management of
medical records and medical and laboratory supply inventories, into all health
education and training courses;
(I)providing health
workers with the appropriate training to pursue health-related research,
including basic, clinical, applied, and operations research to improve the
efficiency and effectiveness of health interventions and encourage the
development of innovative tools and approaches to support national health
goals;
(J)improving the
management of health professional training institutions and other health worker
training facilities and programs and reducing student attrition rates;
and
(K)encouraging
partnerships between and among health professional training institutions and
other health worker training facilities and programs, including on a regional
level and among participating countries.
(4)Retention programs
to encourage health workers to remain employed as part of the health system,
including—
(A)direct salary
support, housing assistance, and other financial incentives to enable
public-sector employers of health workers to compete with private-sector
employers of health workers;
(B)providing
comprehensive, confidential, high-quality health services to health workers,
including prevention and treatment of chronic and infectious diseases and
psychosocial and mental health services;
(C)creating
sustainable working conditions and policies that protect the health and safety
of patients and health workers within their communities and in all medical
facilities, including through—
(i)following
recommended occupational health and safety standards for health workers,
including standards for training and protective technology, equipment, and
supplies and standards for blood and injection safety; and
(ii)other forms of infection prevention and
control, including rapid access to postexposure prophylaxis in the event of
exposure to HIV;
(D)ensuring that all
medical facilities maintain stocks of medical and laboratory supplies,
including diagnostics, pharmaceuticals, technology, and equipment, that meet or
exceed recommended standards for resource-poor settings;
(E)encouraging
efficient and effective matching of patient needs with health workers of
appropriate skill levels, while providing opportunities to expand the scope of
practice for all nonphysician health workers;
(F)providing
continuing education, distance learning, career advancement, and research and
development opportunities, including through national- and regional-level
exchange programs;
(G)establishing
programs to reinforce respect for the rights and dignity of patients and health
workers; and
(H)reevaluating and
supporting the removal of any other government policies, whether at the local,
regional, national, or international level, that discourage health workers from
choosing to continue their employment in the health system.
(5)Improving health
workforce administration and management, including—
(A)direct salary
support to hire and retain qualified health administrators and managers of
hospitals, clinics, and other such health facilities;
(B)training and
education in human resource management, leadership, and financial planning for
health administrators and managers and their support staff;
(C)developing
national standards and protocols for clinical practice and program management
and other quality improvement procedures and measurements for health
administrators and managers to follow and enforce;
(D)integrating
staffing, resource, and referral systems between the community-level and
primary, secondary, and tertiary medical facilities;
(E)developing and
implementing strategies to improve staffing systems and health worker
productivity, including through regular and supportive supervision; and
(F)developing, implementing, and evaluating
health workforce policies and regulations to most effectively meet the needs of
patient populations and health workers.
(6)Ensuring the
equitable distribution of health resources and health workers to meet the needs
of rural areas and underserved populations, including by—
(A)providing direct
salary support, housing assistance, transportation, and other financial or
nonfinancial benefits or incentives to health workers working in such areas or
among such populations;
(B)improving basic
health-related infrastructure to improve access to health facilities in such
areas and among such populations;
(C)strengthening
procurement and distribution supply-chain management systems to ensure that
medical and laboratory supplies, including diagnostics, pharmaceuticals,
technology, and equipment, can reach such areas and such populations;
(D)improving
management and administrative support in such areas and among such
populations;
(E)ensuring and
prioritizing continuing onsite educational opportunities for health workers in
such areas or among such populations; and
(F)evaluating,
developing, and implementing education and health workforce policies and
regulations that incentivize the recruitment, training, and retention of health
workers most likely to work in such areas or among such populations.
(7)Establishing and
expanding the use of information and communications technologies, including the
management of human resources, medical records, and medical and laboratory
supply inventories, to—
(A)enhance the skills
and knowledge of health workers;
(B)improve
consultation and referral systems; and
(C)provide
information to health administrators, managers, and planners.
(8)Preservice and
in-service health worker education and training programs to build respect for
the rights and dignity of all patients and coworkers that are tailored to local
contexts and developed with the participation of health workers and indigenous
civil society organizations and include information about—
(A)the rights and
status of women and girls;
(B)stigmatization of
and discrimination against individuals living with diseases and against other
poor, vulnerable, or marginalized populations; and
(C)the legal, human,
and civil rights of all individuals, including the right of access to health
services.
(9)Technical support for the national ministry
of health, or its equivalent, of each participating country in its leadership
of the health system and the development of the indigenous health workforce,
including support to—
(A)coordinate resources, funding, and strategy
throughout the government;
(B)effectively mobilize government resources
and funding to support the indigenous health workforce;
(C)improve governance, accountability, and
responsiveness to the population and to civil society organizations;
(D)reduce corruption within the health system;
and
(E)coordinate with and regulate the
private-sector health workforce and any health workers employed by
nongovernmental, community, and faith-based organizations, international
organizations, private funding sources, or donor nations.
(10)Support for participating countries to
access funding related to health workforces and health systems from
multilateral organizations or other external funding sources.
(11)Direct support to
indigenous civil society organizations that promote and advocate for an
effective health system and an expanded indigenous health workforce in order
for such organizations to—
(A)monitor and
evaluate health programs, expenditures, and national health workforce plans of
their governments;
(B)access other
sources of domestic and international financing, on behalf of themselves or on
behalf of the health systems of their countries, including national health
workforces;
(C)improve the
quality, accessibility, affordability, and equitability of health services;
and
(D)measure progress
toward attaining the goals of the Initiative.
(12)Research on evidence-based policies and
practices related to health workforces and health systems to improve the
delivery of primary care in participating countries.
(13)Establishing a
system to annually monitor and make publicly available aggregate, nonpersonally
identifiable information regarding the emigration of indigenously trained
health workers from participating countries, including—
(A)the country where
the health professional was born;
(B)the country where
the health professional was educated and trained;
(C)the country to
which the health professional is immigrating in order to engage in
health-related employment; and
(D)a general
classification of the title and specialty of the health professional before and
after emigration.
(e)The President may enter into contracts to carry out the
Initiative.
(f)National health
workforce plans
(1)The President shall encourage participating countries to
develop, strengthen, and implement national health workforce plans that—
(A)are integrated
with their national health strategies, where appropriate;
(B)are based on the
situational analysis described in paragraph (2); and
(C)contain the
elements described in paragraph (3).
(2)The situational analysis described in this paragraph is
a situational analysis of the country’s indigenous health workforce, including
an initial assessment of the number per 1,000 residents of each type of health
worker, including doctors, nurses, trained midwives, paraprofessionals,
community health workers, managers, administrators, and support staff, and of
the extent to which each such type of health worker is equitably distributed
within such country.
(3)The elements
described in this paragraph are the following:
(A)Performance goals
and indicators, including interim benchmarks, over a multiyear period, to
achieve a combined total of at least 2.3 doctors, nurses, and trained midwives
per 1,000 residents, and comparable numbers of other health workers, such as
paraprofessionals, community health workers, managers, administrators, and
support staff, and to ensure that such personnel are equitably distributed
within the country and can carry out their positions effectively.
(B)Objectives and
plans of action to—
(i)recruit, prepare,
and encourage individuals to seek careers in the health professions;
(ii)expand and
improve health education and training programs for health workers;
(iii)encourage health
workers to remain employed in the health system;
(iv)reduce the
emigration of health workers and its impact on the indigenous health workforce
and health system;
(v)improve health
workforce administration and management in the health system;
(vi)increase access
to and the placement of skilled health workers among rural, poor, and other
underserved populations;
(vii)expand the use
of information and communications technologies, including the management of
medical records and medical and laboratory supply inventories;
(viii)provide
preservice and in-service education and training programs to combat stigma and
discrimination among health workers and reinforce respect for the rights and
dignity of patients;
(ix)improve the
health and safety of health workers;
(x)identify and
describe budgetary gaps related to expanding recruitment, training, and
retention of the indigenous health workforce and any financial resource
mobilization efforts to close such gaps; and
(xi)monitor and
evaluate the implementation of the plan, including identifying and addressing
barriers to implementation, and provide a basis for adjustments to the plan as
required.
(C)Participation and
input into the development, implementation, monitoring, and evaluation of all
aspects of the plan from indigenous civil society and nongovernmental,
community, and faith-based organizations dedicated to improving public health
and expanding the indigenous health workforce, with representation from a
multisectoral group of stakeholders, including health workers and
communities.
(g)Global health
workforce initiative strategy
(1)Not later than 1 year after the date of the enactment of
this Act, the President shall transmit to Congress and make publicly available
a 5-year strategy for implementing and monitoring the Initiative established
under this section.
(2)The
strategy required by paragraph (1) shall include—
(A)a description of
how assistance provided under this section will be coordinated among United
States Government agencies with responsibilities related to global
health;
(B)a description of
how assistance provided under this section will be coordinated with each
country, international organization, and other donor;
(C)a description of
how assistance provided under this section will support and encourage countries
to develop the national health workforce plans described in subsection
(f);
(D)a description, for programs carried out in
each participating country, of performance goals and indicators for each
activity listed in subsection (d);
(E)plans of action to
reach the performance goals and indicators required by subparagraph (D);
and
(F)a description of
the consultation required by paragraph (3).
(3)In
developing the strategy required by paragraph (1), the President shall ensure
proper consultation with—
(A)each executive
branch agency authorized to deliver health workforce-related foreign
assistance, including personnel at United States embassies and country
missions;
(B)the appropriate
congressional committees with jurisdiction over the agencies described in
subparagraph (A);
(C)civil society and
nongovernmental, community, and faith-based organizations engaged in improving
health care and health outcomes and in addressing health workforce needs in
developing countries;
(D)participating
countries;
(E)international organizations engaged in
delivering health-related assistance and of which the United States is a voting
member, with which the United States coordinates the delivery of foreign
assistance, or to which the United States contributes funding for the purpose
of providing such assistance;
(F)private
foundations, businesses, and organizations that provide a significant amount of
health-related assistance and do not receive United States funding for the
purpose of providing such assistance;
(G)other donor
nations that provide health-related assistance to developing countries;
and
(H)any other global,
regional, or subregional organizations or partnerships engaged in improving
health care and health outcomes in developing countries.
(h)Monitoring and
evaluation system
(1)The President shall establish an integrated monitoring
and evaluation system to measure the effectiveness of foreign assistance
provided under the Initiative.
(2)Harmonization
with systems of participating countriesTo the maximum extent
possible, the monitoring and evaluation system required by paragraph (1) shall
be harmonized with and may be modified to reflect the monitoring and evaluation
systems of participating countries.
(3)Elements of
monitoring and evaluation systemThe monitoring and evaluation
system required by paragraph (1) shall—
(A)establish
country-specific performance goals;
(B)establish
performance indicators to be used in measuring and assessing the achievement of
the performance goals established under subparagraph (A), including indicators
for—
(i)the
recruitment of health workers through the absorption capacity of the
educational system;
(ii)the
training of health workers through the absorption capacity, intake, and output
of health professional training institutions;
(iii)the retention of
health workers by the health system;
(iv)health worker
immigration and emigration;
(v)the
distribution and density of health workers, including the relative density and
absorption capacity of urban and rural health workforces and health
facilities;
(vi)vacancy rates for
health-related jobs;
(vii)the health and
safety of health workers;
(viii)the overall
effectiveness and productivity of health workers and their capacity to deliver
quality health services; and
(ix)improvements in
health outcomes tied directly to the efforts of health workers;
(C)provide a basis
for recommendations of adjustments to the strategy established under subsection
(g) to enhance the impact of assistance provided under the Initiative and
support the integration of such recommendations into the national planning
processes of participating countries; and
(D)provide regular
public accessibility to all collected data in a clear and readable
format.
(i)
(1)Not later than 1 year after the date of the enactment of
this Act and annually thereafter, the President shall transmit to Congress a
report describing the impact and effectiveness of the assistance provided under
the Initiative.
(2)The
report required by paragraph (1) shall include—
(A)an assessment and
description, for activities within each participating country, of progress
toward achieving the goals of the Initiative;
(B)an assessment and
description of the financial, policy, and other obstacles to achieving the
performance goals established under subsection (h)(3)(A) and the steps taken to
overcome such obstacles;
(C)an assessment and
description, for each participating country, of progress toward and obstacles
to developing, strengthening, and implementing a national health workforce plan
described in subsection (f), including any assistance provided by the United
States to overcome such obstacles; and
(D)an evaluation of
knowledge about strengthening health workforces that was acquired through
implementing the Initiative in each participating country.
(j)Authorization of
appropriations
(1)In addition to amounts otherwise made available for such
purposes, there are authorized to be appropriated to the President to carry out
this section—
(A)$300,000,000 for
fiscal year 2011;
(B)$350,000,000 for
fiscal year 2012;
(C)$400,000,000 for
fiscal year 2013;
(D)$450,000,000 for
fiscal year 2014; and
(E)$500,000,000 for
fiscal year 2015.
(2)Amounts appropriated pursuant to the authorization of
appropriations in paragraph (1) are authorized to remain available until
expended.
6.Relation to other
United States laws and policies
(a)Sense of
Congress on laws and policies related to the United States domestic health
workforceIt is the sense of Congress that the President, in
consultation with Congress, the States, public and private medical and health
organizations and groups, health professional training institutions, and
patients, should take steps to address the urgent shortage of health
professionals in the United States without exacerbating the shortage of health
professionals in developing countries, including by—
(1)identifying and
recommending changes to United States laws, regulations, and policies that
incentivize the immigration of foreign-educated health professionals into the
United States from countries with recognized shortages of health professionals
or further increase the reliance of the United States health care system on
such professionals;
(2)supporting
policies that mitigate the impacts of recruiting foreign-educated health
professionals away from their countries of origin for health-related employment
in the United States and ensure the continued availability of qualified health
professionals in such countries, including—
(A)establishing
relationships or partnership agreements with national and local authorities,
hospitals, clinics, and health professional training institutions in source
countries to—
(i)set
mutually agreed-upon time frames and processes for training and departure of
foreign-educated health professionals;
(ii)allow and provide
for opportunities for foreign-educated health professionals to periodically
return to their countries of origin to provide technical assistance and support
to their home communities or to work in a health care facility, particularly
for countries experiencing a critical lack of indigenous health workers;
(iii)provide
opportunities for visiting faculty and health professionals from the United
States to provide direct technical assistance and support for the training of
health professionals in source countries;
(iv)support the
direct purchase of medical or laboratory supplies, pharmaceuticals,
diagnostics, technology, and equipment for use within the source country, in
accordance with the law governing such products in such country;
(v)match a portion of
the remittances sent by recruited foreign-educated health professionals and
direct such matching funds to health care organizations or national or local
health authorities in their countries of origin; and
(vi)create
scholarships with health professional training institutions in source countries
to support the training and retention of new indigenous health professionals,
particularly to provide health services to poor, vulnerable, or marginalized
populations;
(B)respecting
contractual obligations and other agreements of foreign-educated health
professionals to serve the health systems of their countries of origin in
exchange for public education or scholarships provided in such countries,
including by encouraging foreign-educated health professionals to honor such
agreements, and, where appropriate, requiring evidence that such agreements
have been satisfied; and
(C)ending active
overseas recruitment in—
(i)countries or areas
within countries where a temporary health crisis is causing a severe shortage
of health professionals;
(ii)countries that are experiencing a chronic
shortage of health workers, with fewer than a combined total of 2.3 doctors,
nurses, and trained midwives per 1,000 residents; and
(iii)countries that
request the end of such recruitment, in whole or in part;
(3)advocating the mandatory adoption of the
policies described in paragraph (2) by recruiting organizations that receive
United States funding;
(4)establishing
programs that allow foreign-educated health professionals working in the United
States to return to their countries of origin to participate in health-related
United States foreign assistance programs without impacting their immigration
status in the United States;
(5)annually
monitoring and making publicly available aggregate, nonpersonally identifiable
information related to foreign-educated health professionals who are recruited
to or who otherwise immigrate to the United States, including information
related to—
(A)their countries of
birth;
(B)the countries
where they were educated and trained to become health professionals;
(C)the countries in
which they engaged in health-related employment immediately prior to entering
the United States; and
(D)the States to
which they were recruited or in which they otherwise intend to engage in
health-related employment;
(6)developing a
health workforce plan for the United States that includes a specific focus on
recruiting and training significant numbers of new health professionals to
address the urgent shortage of health professionals in the United States, in
accordance with the principles of paragraphs (1) through (4); and
(7)supporting the
World Health Organization in developing and implementing a Global Code of
Practice on the International Recruitment of Health Personnel that is
consistent with paragraphs (1) through (4) and that takes into consideration
the views of all relevant stakeholders.
(b)Sense of
Congress on laws and policies related to bilateral and international
tradeIt is the sense of Congress that the President should
pursue trade and investment agreements and policies that support the goals of
the United States Global Health Strategy and maximize the ability of national
governments to improve health outcomes and reduce mortality among their
populations, including by ensuring that any trade agreement—
(1)encourages broad
access for poor, vulnerable, or marginalized populations to quality, affordable
pharmaceuticals, medical products, and medical devices, including generics, if
such items are covered by such agreement;
(2)allows for the
negotiation of lower prices for pharmaceuticals, especially if no generic
alternative exists or the original product cannot be purchased at an affordable
cost;
(3)adheres to the principles of the 2001 World
Trade Organization (in this subsection referred to as the WTO
)
Doha Declaration on Trade-Related Aspects of Intellectual Property Rights (in
this subsection referred to as the Declaration
), including
measures that the Agreement on Trade-Related Aspects of Intellectual Property
Rights permits countries to take to protect public health and ensure access to
essential medicines;
(4)is negotiated,
implemented, monitored, and enforced with the input and participation, in an
advisory capacity, of a broad range of indigenous and United States-based civil
society organizations that are dedicated to improving and protecting public
health;
(5)expressly allows
for the adoption of public interest licensing agreements for medications
developed with significant public funding, such as—
(A)open
licensing;
(B)nonenforcement of
patents;
(C)licensing of such
products to international drug purchase facilities and patent pools; and
(D)other mechanisms
to make medications available at reduced cost;
(6)disavows the use
of trade threats, such as placement on watchlists
or the removal
of trade benefits, against countries using WTO-compliant trade flexibilities,
in accordance with the principles of the Declaration, in order to protect
public health and ensure access to essential medicines; and
(7)does not result in costs of
pharmaceuticals, medical products, or medical devices that are unaffordable for
the general population, and does not subject national governments to any
limitations with respect to the use, distribution, or manufacturing of such
items that are inconsistent with the principles of the Declaration.
(c)United States
participation in international financial institutions
(1)Opposition to
certain user feesThe
Secretary of the Treasury shall instruct the United States Executive Director
at each international financial institution to oppose and vote against any
proposed loan, grant, strategy, or policy of such respective institution that
would require or result in the imposition of user fees or service charges on
poor individuals in connection with such institution’s financing programs for
primary education or primary health care, including prevention, care, and
treatment for HIV/AIDS, malaria, and tuberculosis and care related to infant,
child, reproductive, and maternal well-being.
(2)Opposition to
certain IMF spending capsThe Secretary of the Treasury shall
instruct the United States Executive Director at the International Monetary
Fund to oppose and vote against any loan, project, agreement, memorandum,
instrument, or program of the International Monetary Fund that would not exempt
government spending on health care, health infrastructure, and education from
national budget caps and restraints, hiring and wage ceilings, and other limits
imposed by the International Monetary Fund.
(d)Participation of
health workers in United States global health programsFor all
United States programs related to global health that provide foreign
assistance, it shall be the policy of the United States Government to ensure
that—
(1)all health workers
participating in such programs follow recommended occupational health and
safety standards and have the proper training and access to the necessary
protective technology, equipment, and supplies, including those for blood and
injection safety, to establish and sustain safe and sanitary working conditions
in accordance with accepted forms of effective infection prevention and
control, including rapid access to postexposure prophylaxis in the event of
exposure to HIV;
(2)all health workers
participating in such programs have access to comprehensive, confidential,
high-quality health services, including prevention and treatment for chronic
and infectious diseases and psychosocial and mental health services;
(3)all health workers
participating in such programs receive training about respect for the rights
and dignity of all patients and coworkers that is tailored to local contexts,
developed with the participation of health workers and indigenous civil society
organizations, and includes information about—
(A)the rights and
status of women and girls;
(B)stigmatization of
and discrimination against individuals living with diseases and other
marginalized groups; and
(C)the legal, civil,
and human rights of all individuals, including the right of access to health
services; and
(4)community health
workers are—
(A)recognized for
their work;
(B)integrated into countries’ health systems
through—
(i)a
functional process by which community health workers may refer patients to
other appropriate health workers; and
(ii)the
provision of ongoing support and supervision;
(C)paid adequate salaries and offered tangible
pathways for career advancement; and
(D)when possible,
recruited from underserved and rural communities.
7.In this Act, the following definitions
apply:
(1)The term community health worker means a
health worker who is engaged in the provision of health services directly to
individuals and who does not have the advanced training of a health
professional.
(2)The term
health professional means a health worker who provides health
services and has received advanced training regarding the provision of such
services, including doctors, nurses, midwives, pharmacists, pharmacy
technicians, dentists, laboratory technicians, and clinical officers.
(3)Health
professional training institutionThe term health professional training
institution means an institution that trains health professionals in
accordance with generally accepted standards of clinical practice and confers a
degree or diploma on each graduate of a training program.
(4)Used in relation to a
country, the term health system means all components, public and
private, of the health care mobilization, financing, and delivery system of
such country, including health workers, health professionals, clinics,
hospitals, pharmacies, institutions performing health-related research,
producers of pharmaceuticals and medical equipment, and government
health-service agencies.
(5)The term health
worker means any individual who provides or supports the provision of
health services, directly or indirectly, including health professionals,
paraprofessionals, community health workers, social workers, caregivers,
nutritionists, health administrators and managers, and government officials who
set health care policy.
(6)International
financial institutionThe term international financial
institution means the following institutions:
(A)The International Bank for Reconstruction
and Development.
(B)The International
Development Association.
(C)The International
Finance Corporation.
(D)The Multilateral
Investment Guarantee Agency.
(E)The International
Centre for Settlement of Investment Disputes.
(F)The Inter-American
Development Bank.
(G)The Asian
Development Bank.
(H)The Asian
Development Fund.
(I)The African
Development Bank.
(J)The African
Development Fund.
(K)The International
Monetary Fund.
(L)The North American
Development Bank.
(M)The European Bank
for Reconstruction and Development.
(7)Used in relation to
a country, the term national health strategy means any set of
policies, whether or not formally enumerated and however called, aimed at
improving health outcomes in such country by improving and increasing access to
the health system of such country.
(8)Poor,
vulnerable, or marginalized populationsThe term poor,
vulnerable, or marginalized populations means—
(A)indigenous
populations;
(B)racial, ethnic,
religious, and national minorities;
(C)children who have
lost one or both parents;
(D)women and
girls;
(E)individuals with
physical or mental disabilities;
(F)individuals living
with chronic or infectious diseases;
(G)sexual minorities,
including men who have sex with men;
(H)sex
workers;
(I)drug users;
(J)incarcerated and
formerly incarcerated individuals;
(K)individuals of
foreign national origin;
(L)refugees and
internally displaced populations;
(M)the
elderly;
(N)individuals who
live in rural areas; and
(O)any other group
that has difficulty accessing health services because of economic, political,
or social status.