[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4997 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 4997

    To provide assistance to sub-Saharan Africa to combat obstetric 
                                fistula.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 26, 2014

  Ms. DeLauro (for herself, Ms. McCollum, and Ms. Lee of California) 
 introduced the following bill; which was referred to the Committee on 
                            Foreign Affairs

_______________________________________________________________________

                                 A BILL


 
    To provide assistance to sub-Saharan Africa to combat obstetric 
                                fistula.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE AND TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``United States 
Leadership to Eradicate Obstetric Fistula Act of 2014''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title and table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.
Sec. 4. Comprehensive, integrated, 10-year strategy to combat obstetric 
                            fistula in sub-Saharan Africa.
Sec. 5. Prevention, treatment, and monitoring of obstetric fistula in 
                            sub-Saharan African countries.
Sec. 6. United States Advisory Committee for the Eradication of 
                            Obstetric Fistula.
Sec. 7. Report.
Sec. 8. Authorization of appropriations.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Obstetric fistula is a catastrophic childbirth injury 
        which arises as a complication of obstructed labor.
            (2) An estimated 2 to 3 million women currently are 
        afflicted by the devastating physical and social effects of 
        obstetric fistula--a scourge of epidemic proportions. As many 
        as 130,000 new cases occur each year.
            (3) Historically, obstetric fistula affected women in the 
        United States and around the world. Advances in obstetric care 
        and access to improved surgical techniques resulted in a 
        drastic reduction in obstetric fistula by the early 20th 
        century in the United States.
            (4) Today, obstetric fistula primarily affects the poorest 
        women in the poorest parts of the world. It disproportionately 
        affects women in sub-Saharan Africa and girls--some as young as 
        13 years old--who are subjected to child marriage and whose 
        bodies are not fully capable of handling the demands of 
        childbirth. Many of these young girls and women have been 
        subjected to female genital mutilation, which can increase the 
        risk for and be a direct cause of obstetric fistula.
            (5) Obstetric fistula, which usually results in fetal death 
        by asphyxia, occurs when the tissues that normally separate a 
        woman's vagina from her bladder or rectum are destroyed by 
        prolonged pressure from the fetal head trapped in the birth 
        canal.
            (6) Obstetric fistula typically occurs because a woman does 
        not have access to emergency obstetric care or because she does 
        not have the financial means, transportation, or access to 
        surgical repair.
            (7) Left untreated, an obstetric fistula afflicts a woman 
        with devastating physical conditions: incontinence, painful 
        ulcers, and constant and uncontrollable emission of offensive 
        odors. These symptoms leave a woman indelibly and perpetually 
        stigmatized by her condition.
            (8) Because obstetric fistula does not heal on its own, 
        women affected by this condition are marginalized for the 
        remainder of their lives. Expelled from their communities and 
        denied education and health care, obstetric fistula victims are 
        left in desperate economic circumstances.
            (9) Victims also suffer social ostracism that results in 
        involuntary divorce, exclusion from religious activities, 
        deepening poverty, malnutrition, deteriorating physical health, 
        depression, and despair. As a result, victims are left 
        defenseless and vulnerable.
            (10) This social isolation compounds already existing 
        problems such as illiteracy and lack of economic opportunities.
            (11) Because obstetric fistula are not themselves fatal, 
        millions of women live with this horrific condition and have 
        been overlooked by the international medical community. At 
        present, humanitarian aid and nongovernmental programs treat 
        fistula cases on a small scale and are not equipped to 
        systematically prevent, treat, and eradicate obstetric fistula.
            (12) Obstetric fistula can be prevented when women and 
        their families are educated about the birthing process and are 
        provided access to emergency obstetric care.
            (13) Today, doctors can surgically repair obstetric fistula 
        with a low-cost, low-technology surgery.
            (14) The impact of an obstetric fistula-repair surgery is 
        immediate and consequential. Women can be re-integrated into 
        society and are afforded basic human necessities such as 
        familial relationships, health care, and the opportunity to 
        earn a living.
            (15) The prevention, treatment, and ultimately the 
        eradication of obstetric fistula will advance the emancipation 
        and empowerment of women, strengthen families and communities, 
        and improve the overall economic, educational, and social well-
        being of affected societies.
            (16) Basic interventions to identify and repair obstetric 
        fistula have achieved meaningful and cost-effective results.
            (17) The best available data suggests that existing 
        programs can only repair 10 percent of new obstetric fistula 
        cases each year, and less than 1 percent of existing obstetric 
        fistula cases are repaired each year.
            (18) The challenge is to expand existing pilot programs 
        into a scalable, comprehensive, and sustainable campaign to 
        eradicate obstetric fistula.
            (19) Nongovernmental organizations with experience in 
        obstetric care, surgery, and women's rights have proven 
        effective in making progress towards eliminating the scourge of 
        obstetric fistula and can be a resource in assisting indigenous 
        organizations in severely afflicted countries in their efforts 
        to treat and care for women with obstetric fistula.
            (20) The nature of obstetric fistula--and the fact that it 
        affects vulnerable women in poor and isolated communities which 
        offer little or no access to obstetric care--demands a 
        comprehensive, coordinated, long-term, international response 
        focused on the prevention and treatment of obstetric fistula, 
        including--
                    (A) safe-childbirth education and obstetric fistula 
                prevention, care, and treatment; post-operative care, 
                including rehabilitation, social reintegration, and 
                post-surgical follow-up; basic and applied research and 
                clinical work; and training of health care workers and 
                educators, particularly local, grassroots educators and 
                medical workers;
                    (B) designation of a university-based medical 
                center in the United States, designated as the 
                International Obstetric Fistula Institute for Sub-
                Saharan Africa established under section 5(d), 
                responsible for marshaling surgical and other necessary 
                health resources to effectuate the campaign against 
                obstetric fistula; for building prevention and 
                treatment capacity in sub-Saharan Africa, including 
                coordinating partnerships with sub-Saharan African 
                institutions and governments; and for developing and 
                managing community education and mobilization programs 
                at home and abroad;
                    (C) development of health care infrastructure and 
                delivery systems through Centers of Clinical Excellence 
                for Obstetric Fistula Care for Sub-Saharan Africa as 
                well as through cooperative and coordinated public 
                efforts and public-private partnerships;
                    (D) strengthening universities, research centers, 
                and training programs for health professionals through 
                institutional capacity-building partnerships;
                    (E) development and implementation of a United 
                States Obstetric Fistula Treatment and Prevention Corps 
                which recruits and trains doctors--especially 
                obstetricians, gynecologists, urologists, general 
                surgeons, and anesthesiologists--nurses, and other 
                community-development and public-health personnel to 
                serve regions affected by obstetric fistula and which 
                partners United States medical professionals with sub-
                Saharan African professionals, promoting a joint effort 
                to eradicate this devastating condition;
                    (F) coordination of efforts to make the treatment 
                of obstetric fistula a higher priority in sub-Saharan 
                African hospitals, specifically aimed at ameliorating 
                the paucity of training related to obstetric fistula 
                treatment; and
                    (G) coordination of efforts between the medical 
                community, nongovernmental organizations, national 
                governments, and private sector organizations, 
                including faith-based organizations.
            (21) The United States has the capacity to lead and enhance 
        the effectiveness of the international community's response 
        by--
                    (A) providing substantial resources, medical 
                expertise, and training, particularly of health care 
                personnel and community workers and leaders;
                    (B) making United States surgeons and health care 
                professionals available to serve, train, and build 
                workforce capacity in afflicted countries through a 
                United States Obstetric Fistula Treatment and 
                Prevention Corps;
                    (C) encouraging governments and faith-based and 
                community organizations to adopt policies that treat 
                obstetric fistula and its causes as a multi-sector, 
                public-health problem that profoundly affects women's 
                health, women's empowerment, education, the economy, 
                and promotion of strong and successful families;
                    (D) encouraging education about healthy practices, 
                including education about the health risks associated 
                with child marriage and female genital mutilation;
                    (E) building successful communities by preventing 
                obstetric fistula and the ensuing social stigma which 
                often separates an obstetric fistula victim from her 
                family;
                    (F) contributing to public health and health-care 
                delivery system research to improve obstetric fistula 
                prevention, treatment, and reintegration;
                    (G) encouraging active involvement and cooperation 
                across sectors, including the medical and scientific 
                communities, charitable foundations, private and 
                voluntary organizations and nongovernmental 
                organizations, faith-based organizations, community-
                based organizations, and other not-for-profit entities; 
                and
                    (H) engaging in medical diplomacy, with a 
                particular focus on the further empowerment and 
                emancipation of women.
            (22) Unaddressed obstetric emergencies and untreated 
        obstetric fistula result in the needless, systematic 
        degradation and marginalization of women. It should be the 
        policy of the United States to help eradicate this preventable 
        and curable condition.
            (23) Strong coordination must exist among the implementing 
        agencies of the United States to ensure effective and efficient 
        use of financial, medical, and technical resources within the 
        United States Government with respect to international 
        obstetric fistula eradication.
            (24) Obstetric fistula is a medical condition which 
        historically affected women around the globe. The United States 
        long ago eliminated this needlessly oppressive condition 
        because of access to skilled medical professionals and medical 
        care. Obstetric fistula can be prevented and repaired. No woman 
        should suffer a lifetime of debilitating physical and social 
        consequences--as obstetric fistula victims do--simply because 
        she lacks access to basic obstetric care.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) Advisory committee.--The term ``Advisory Committee'' 
        means the United States Advisory Committee for the Eradication 
        of Obstetric Fistula established under section 6.
            (2) Clinical center of excellence.--The term ``Center of 
        Clinical Excellence'' means a Center of Clinical Excellence for 
        Obstetric Fistula Care in sub-Saharan Africa established under 
        section 5(d)(5).
            (3) Corps.--The term ``Corps'' means the United States 
        Obstetric Fistula Treatment and Prevention Corps established 
        under section 5(d)(6).
            (4) Institute.--The term ``Institute'' means the 
        International Obstetric Fistula Institute for Sub-Saharan 
        Africa established under section 5(d)(1).
            (5) Relevant executive branch agencies.--The term 
        ``relevant executive branch agencies'' means the Department of 
        State, the United States Agency for International Development, 
        and any other department or agency of the United States that 
        participates in international health and humanitarian 
        activities pursuant to the authorities of such department or 
        agency or the Foreign Assistance Act of 1961.
            (6) Secretary.--The term ``Secretary'' means the Secretary 
        of State.
            (7) Sub-saharan africa.--The terms ``sub-Saharan Africa'', 
        ``sub-Saharan African'', and ``sub-Saharan African country'' 
        shall have the meanings given to such terms for purposes of 
        this Act by the Secretary.

SEC. 4. COMPREHENSIVE, INTEGRATED, 10-YEAR STRATEGY TO COMBAT OBSTETRIC 
              FISTULA IN SUB-SAHARAN AFRICA.

    (a) In General.--The President, acting through the Administrator of 
the United States Agency for International Development, shall establish 
a comprehensive, integrated, 10-year strategy to combat obstetric 
fistula in sub-Saharan Africa that strengthens the capacity of the 
United States to be an effective leader in the movement for 
international women's health and empowerment.
    (b) Elements.--Such strategy shall maintain sufficient flexibility 
and remain responsive to the needs of women afflicted with obstetric 
fistula or who stand at risk of suffering from obstetric fistula and 
shall include the following:
            (1) A plan for implementation and coordination of programs 
        and activities under this Act, including grants and contracts 
        for prevention, treatment, and monitoring of obstetric fistula 
        under section 5.
            (2) Specific objectives, multi-sector approaches, and 
        specific strategies to treat women who suffer from obstetric 
        fistula and to prevent further occurrences of obstetric 
        fistula.
            (3) Assignment of priorities for relevant executive branch 
        agencies.
            (4) Public health and health care delivery system research 
        on the prevention, repair, and rehabilitation of obstetric 
        fistula.
            (5) Development, implementation, and evaluation of 
        evidence-based systems of care connecting maternity and 
        obstetric fistula care facilities with local care delivery and 
        community education programs. Such systems of care should 
        promote rapid and long-term prevention of obstetric fistula, 
        including--
                    (A) referral to prenatal care to identify and 
                mitigate risk factors for obstetric fistula;
                    (B) culturally appropriate childbirth education, 
                preparation, and planning;
                    (C) access to skilled obstetric care; and
                    (D) promoting prompt detection of prolonged labor 
                and appropriate action to address it.
            (6) Provision that the reduction of health and social risks 
        which increase the likelihood of obstetric fistula shall be a 
        priority of all prevention efforts in terms of funding, 
        educational messages, and activities promoting a decrease in 
        child marriage and the adolescent pregnancy rate, prompt 
        detection of prolonged labor, and immediate intervention in 
        cases of obstructed labor through improved access to emergency 
        obstetric services provided by partner hospitals.
            (7) Improvement of coordination and reduce duplication 
        among relevant executive branch agencies, foreign governments, 
        and international organizations.
            (8) Projection of general levels of resources needed to 
        achieve the stated objectives.
            (9) Expansion of public-private partnerships and the 
        leveraging of resources.
            (10) Maximization of United States capabilities in the 
        areas of medical training and research and application of those 
        capabilities in sub-Saharan Africa. Such efforts may include 
        the provision of grants by relevant executive branch agencies 
        for institutional capacity-building partnerships between United 
        States and foreign institutions, as well as between in-country 
        institutions, for the purpose of mobilizing in-country 
        capacity, resources, and expertise to prevent and repair cases 
        of obstetric fistula.
            (11) Priorities for the distribution of resources based on 
        factors such as the size and demographics of the population 
        suffering from obstetric fistula, the needs of that population, 
        and the existing infrastructure or funding levels that may 
        exist to treat and prevent obstetric fistula.
            (12) A long-term commitment to the eradication of obstetric 
        fistula by expanding health system capacity and training 
        opportunities for doctors and other health service providers in 
        sub-Saharan Africa.
            (13) A plan to maximize United States efforts in workforce 
        training, capacity-building, and retention relating to 
        obstetric fistula prevention, treatment, rehabilitation, and 
        research. Such plan shall be coordinated with existing United 
        States and in-country workforce capacity-building plans and 
        efforts. Such plan may include training of foreign health 
        workers at United States institutions and ``train-the-trainer'' 
        programs.
            (14) A plan for institutional capacity-building 
        partnerships to strengthen universities, research centers, 
        health-profession training programs, and government institutes 
        to build the in-country capacity needed to eradicate obstetric 
        fistula.
    (c) Report.--Not later than 1 year after the date of the enactment 
of this Act, the President shall submit to Congress a report that 
contains the strategy required under this section.

SEC. 5. PREVENTION, TREATMENT, AND MONITORING OF OBSTETRIC FISTULA IN 
              SUB-SAHARAN AFRICAN COUNTRIES.

    (a) In General.--The President, acting through the Administrator of 
the United States Agency for International Development, is authorized 
to provide grants to or enter into contracts with an eligible entity 
described in subsection (b) to carry out activities to prevent, treat, 
and monitor obstetric fistula in sub-Saharan African countries in 
accordance with this section.
    (b) Eligible Entity Described.--In this section, the term 
``eligible entity'' means a major, university-based medical center in 
the United States.
    (c) Application and Selection.--
            (1) Application.--The President shall provide for eligible 
        entities to submit applications to the President for grants or 
        contracts under this section in such form and manner as the 
        President may require to carry out the purposes of this 
        section.
            (2) Selection.--
                    (A) In general.--From among the applications 
                submitted under paragraph (1), the President shall 
                select an eligible entity to receive grants or 
                contracts under this section pursuant to a competitive 
                selection process.
                    (B) Criteria.--The competitive selection process 
                referred to in subparagraph (A) shall be based upon 
                selection criteria, which shall include--
                            (i) the breadth and depth of medical 
                        faculty, particularly with experience in 
                        obstetrics and reconstructive pelvic surgery;
                            (ii) breadth and depth of public health and 
                        international health faculty;
                            (iii) experience in and capacity to conduct 
                        training of the global health workforce and to 
                        strengthen capacity-building and health 
                        systems;
                            (iv) experience in building institutional 
                        capacity in sub-Saharan Africa, including 
                        through institutional partnerships;
                            (v) willingness to supplement amounts 
                        received under grants or contracts under 
                        subsection (a) by engaging in community 
                        partnerships; and
                            (vi) whether the applicant, for purposes of 
                        this Act, has entered into a cooperative 
                        agreement with one or more major, university-
                        based medical centers in sub-Saharan Africa.
    (d) Use of Funds.--
            (1) International obstetric fistula institute for sub-
        saharan africa.--Amounts received under grants or contracts 
        under subsection (a) shall be used to establish and operate at 
        the eligible entity's medical center in the United States an 
        institute to carry out paragraphs (2) through (7), to be known 
        as the International Obstetric Fistula Institute for Sub-
        Saharan Africa. The purpose of the Institute shall be to 
        prevent, treat, and monitor obstetric fistula in sub-Saharan 
        African countries.
            (2) Administration and training.--The Institute shall--
                    (A) serve as the primary administrative and 
                medical-training hub for the campaign to prevent, 
                treat, and monitor obstetric fistula in sub-Saharan 
                African countries;
                    (B) ensure the campaign described in subparagraph 
                (A) is carried out on both a scientific and 
                humanitarian basis;
                    (C) initiate and oversee the training and clinical 
                activities of physicians, other health professionals, 
                and educators serving at Centers of Clinical 
                Excellence; and
                    (D) ensure a progressive increase in health system 
                and workforce capacity to prevent, treat, and monitor 
                obstetric fistula in each country in which a Center of 
                Clinical Excellence is located.
            (3) Enforce clinical standards and accountability.--The 
        Institute shall--
                    (A) promote the utilization of standard clinical 
                protocols, facilitate data collection, coordinate 
                research efforts, and oversee and participate in multi-
                center randomized surgical trials; and
                    (B) enforce the highest standards of clinical 
                practice and ethical behavior as described in the 
                published code of medical ethics for obstetric fistula 
                surgeons.
            (4) Develop evidence-based programs for prevention and 
        access to emergency obstetric care.--The Institute shall--
                    (A) develop and implement comprehensive and 
                culturally appropriate protocols to prevent the 
                formation of obstetric fistula, including the 
                development and implementation of evidence-based 
                systems of care, which identify, track, and evaluate 
                obstetric fistula prevention programs;
                    (B) develop and implement prevention programs 
                that--
                            (i) teach women and family members, in a 
                        culturally appropriate manner, how to identify 
                        prolonged labor;
                            (ii) inform women and family members of the 
                        risks of not seeking appropriate medical care;
                            (iii) refer women and family members to 
                        prenatal, perinatal, and postnatal care;
                            (iv) teach women and family members how to 
                        mobilize community resources to assist in 
                        seeking emergency obstetric care; and
                            (v) teach women and family members to 
                        identify symptoms of obstetric fistula and 
                        refer women to treatment;
                    (C) assist Centers of Clinical Excellence in 
                developing localized programs for childbirth education, 
                preparation and planning, prolonged-labor detection, 
                labor monitoring, and transportation from villages to 
                local hospitals for obstetric care and to Centers of 
                Clinical Excellence for obstetric fistula care, 
                accounting for factors such as transportation, 
                geography, and scalability of such solutions; and
                    (D) seek to partner with United States medical 
                personnel and volunteers to train and employ local men 
                and women as community-based labor monitors who can 
                educate and assist other women at risk of suffering 
                from obstetric fistula, thereby empowering an entire 
                sector of women in sub-Saharan Africa with information 
                and employment.
            (5) Centers of clinical excellence for obstetric fistula 
        care in sub-saharan africa.--
                    (A) In general.--The Institute, in cooperation with 
                each medical center in sub-Saharan African described in 
                subsection (b), shall establish not less than 8 centers 
                in sub-Saharan Africa to treat and prevent obstetric 
                fistula in countries and areas in which obstetric 
                fistula is widespread, as determined by the Institute 
                in consultation with the Advisory Committee. Such 
                centers shall be known as Centers of Clinical 
                Excellence for Obstetric Fistula Care in sub-Saharan 
                Africa.
                    (B) General duties.--Each Center of Clinical 
                Excellence shall establish programs to treat and 
                prevent obstetric fistula at hospitals and to expand 
                the networks of such hospitals. the Centers of 
                Excellence shall be co-located or located within 
                reasonable proximity to hospitals capable of providing 
                emergency and routine obstetric care, in order to 
                fulfill its duties and to ensure hospitals meet 
                emergency obstetric needs.
                    (C) Specific duties.--Each Center of Clinical 
                Excellence shall function as localized epicenters of 
                training and clinical excellence for obstetric fistula 
                care, and shall--
                            (i) be a major locus of medical and 
                        surgical care for obstetric fistula patients;
                            (ii) be centers for the training of 
                        obstetric fistula surgeons, nurses, and other 
                        medical personnel;
                            (iii) coordinate and implement community 
                        outreach and prevention programs;
                            (iv) partner with the national ministry of 
                        health or equivalent government body and 
                        medical educators in the country in which the 
                        Center of Clinical Excellence is located to 
                        develop country-specific training programs for 
                        surgeons and other health care personnel 
                        involved in obstetric fistula care;
                            (v) be a vehicle for expanding access to 
                        emergency obstetric services in affiliated 
                        communities;
                            (vi) establish a consulting and referral 
                        relationship with a hospital in its geographic 
                        vicinity, assist the hospital by completing an 
                        initial, comprehensive assessment of what 
                        resources the hospital would need to improve 
                        delivery of emergency obstetric services, and 
                        based on the needs assessments and subject to 
                        the approval of the Institute approve funding 
                        for each hospital to undergo appropriate 
                        physical renovation and reimburse the hospital 
                        for emergency obstetric care and cesarean 
                        deliveries; and
                            (vii) coordinate a system of village 
                        ``labor monitors'' to help prevent obstetric 
                        fistula by identifying pregnant women in their 
                        communities, monitoring their labors, and 
                        activating an organized emergency-transport 
                        system to move high-risk women to local 
                        hospitals with adequate obstetric care.
            (6) United states obstetric fistula treatment and 
        prevention corps.--
                    (A) In general.--The Institute, in cooperation with 
                each medical center in sub-Saharan African described in 
                subsection (b), shall establish and operate a United 
                States Obstetric Fistula Treatment and Prevention 
                Corps.
                    (B) Duties.--The Corps shall--
                            (i) provide volunteer medical services at 
                        Centers of Clinical Excellence and train local 
                        surgeons and other health professionals in 
                        techniques of obstetric fistula repair and in 
                        other aspects of the care of women with 
                        obstetric fistula;
                            (ii) seek to establish an enabling 
                        environment in which patient care can be 
                        provided effectively, consistently, humanely, 
                        and ethically to women with obstetric fistula; 
                        and
                            (iii) develop evidence-based systems of 
                        care for the prevention of obstetric fistula.
                    (C) Membership.--The Corps shall consist of--
                            (i) graduates of United States or African 
                        residency programs in such fields as obstetrics 
                        and gynecology, general surgery, urology, and 
                        anesthesiology; and
                            (ii) other doctors, nurses, community-
                        health professionals, public-health 
                        professionals, and other expert personnel as 
                        needed to further the duties of the Institute 
                        to prevent, treat, and monitor obstetric 
                        fistula in sub-Saharan African countries.
                    (D) Duration of service.--Members of the Corps 
                shall commit to a duration of service of not less than 
                28 months.
                    (E) Compensation, other benefits.--The Institute 
                may provide compensation, other employment benefits, 
                and loan guarantees to individuals who agree to serve 
                as members of the Corps.
                    (F) Alumni corps.--The Institute is authorized to 
                establish an Alumni Corps, comprised of former members 
                of the Corps who have completed successfully at least 
                one period of service described in subparagraph (D) in 
                order to augment medical personnel at Centers for 
                Clinical Excellence.
            (7) Annual report.--The Institute shall submit to Congress 
        and make available to the public an annual report on the 
        implementation of this subsection, including a description of--
                    (A) the recruitment for and implementation of the 
                Corps; and
                    (B) the activities of each Center of Clinical 
                Excellence, including--
                            (i) the number of women served at the 
                        Center;
                            (ii) the success rate of obstetric fistula-
                        repair surgeries, prevention efforts, and other 
                        programs used by the Center and surrounding 
                        communities; and
                            (iii) other delivery system and quality 
                        measures as appropriate.
    (e) Personnel.--The Institute shall be administered by qualified, 
essential personnel including--
            (1) a director, who reports directly to the head of the 
        medical center in the United States referred to in subsection 
        (b);
            (2) expert leadership to oversee key aspects of the duties 
        of the Institute, including--
                    (A) medical and surgical activities;
                    (B) prevention, education, and outreach;
                    (C) partnerships and capacity building;
                    (D) emergency obstetric services; and
                    (E) program management;
            (3) professional and administrative staff responsible for 
        administration, coordination, and campaign performance;
            (4) dedicated, full-time, experienced surgeons responsible 
        for the medical supervision and training of United States and 
        sub-Saharan African surgeons assigned to Centers of Clinical 
        Excellence, and for medical research, data collection, and 
        successful implementation of medical programs in sub-Saharan 
        Africa;
            (5) full-time prevention, education, and outreach 
        coordinators, responsible for the Institute's outreach, 
        education, prevention, and social reintegration programs as 
        well as for the supervision and training of outreach and 
        education staff assigned to the Centers of Clinical Excellence;
            (6) an advisory panel for surgical outcomes and quality 
        comprised of no fewer than 15 senior practicing surgeons from 
        the United States and other countries--
                    (A) to ensure a high, uniform level of surgical 
                care;
                    (B) to engage in clinical practice with Centers of 
                Clinical Excellence for Sub-Saharan Africa to share 
                their surgical experience and to provide clinical 
                oversight; and
                    (C) to liaise with Centers of Clinical Excellence 
                for Sub-Saharan Africa and the Institute to ensure the 
                Centers of Clinical Excellence are accountable for 
                providing a consistent and high level of surgical care; 
                and
            (7) an internal oversight and steering committee comprised 
        of individuals who are medical professionals, public health 
        professionals, international social welfare advisors, 
        economists specializing in international development, or 
        professors of law or political science.
    (f) Additional Personnel.--The Institute may appoint and fix the 
pay of additional personnel as the Institute considers appropriate.

SEC. 6. UNITED STATES ADVISORY COMMITTEE FOR THE ERADICATION OF 
              OBSTETRIC FISTULA.

    (a) Establishment.--There is established an advisory committee to 
be known as the United States Advisory Committee for the Eradication of 
Obstetric Fistula.
    (b) Membership.--
            (1) Selection; qualifications.--The Advisory Committee 
        shall be composed of 14 members selected by the Secretary 
        (through a competitive process) from among individuals who are 
        distinguished scholars, clinicians, scientists, advocates, and 
        philanthropists and who, collectively--
                    (A) have knowledge and experience in health care 
                and global health policy, including international 
                health, obstetrics, women's empowerment, human rights, 
                and international law; and
                    (B) have direct experience abroad especially in 
                sub-Saharan Africa.
            (2) Selection.--The Advisory Committee shall be composed of 
        14 members selected by the Secretary through a competitive 
        process.
            (3) Disqualification.--An individual shall not be appointed 
        as a member of the Advisory Committee if such individual 
        possesses any personal or financial interest in the discharge 
        of any duties of the Advisory Committee.
            (4) Terms.--The term of office of each member of the 
        Advisory Committee shall be 5 years. Members of the Advisory 
        Committee shall be eligible for reappointment for up to 2 
        terms.
    (c) Meetings.--
            (1) Initial meeting.--The Advisory Committee shall hold its 
        initial meeting on the date that is no later than 120 days 
        after the date of the enactment of this Act.
            (2) Meetings.--The Advisory Committee shall meet at the 
        call of the Chairman or a majority of its members. The Advisory 
        Committee shall meet no less than twice per calendar year.
            (3) Quorum.--Six members of the Advisory Committee shall 
        constitute a quorum for purposes of conducting business, except 
        that 2 members of the Advisory Committee shall constitute a 
        quorum for purposes of receiving testimony.
            (4) Vacancies.--Any vacancy of the Advisory Committee shall 
        not affect its powers, but shall be filled promptly in the 
        manner in which the original appointment was made.
    (d) Administration.--
            (1) Travel expenses.--Members of the Advisory Committee 
        shall be allowed travel expenses, including per diem in lieu of 
        subsistence, at rates authorized for employees of agencies 
        under subchapter I of chapter 57 of title 5, United States 
        Code, while away from their homes or regular places of business 
        in performance of services for the Advisory Committee.
            (2) Administrative support.--The Secretary shall assist the 
        Advisory Committee by providing to the Advisory Committee such 
        staff and administrative services as may be necessary and 
        appropriate for the Advisory Committee to perform its 
        functions. Upon request of the Advisory Committee, the head of 
        any Federal department or agency may detail any of the 
        personnel of that department or agency to the Advisory 
        Committee without reimbursement to the department or agency of 
        that employee and such detail shall be without interruption or 
        loss of civil service status or privilege.
            (3) Experts and consultants.--The Advisory Committee may 
        procure temporary and intermittent services under section 
        3109(b) of title 5, United States Code.
            (4) Other resources.--The Advisory Committee shall have 
        reasonable access to materials, resources, statistical data, 
        and other information the Advisory Committee determines to be 
        necessary to carry out its duties from the Library of Congress, 
        the Department of State, the National Library of Medicine, and 
        other departments and agencies of the executive and legislative 
        branches of the Federal Government. The Chairman of the 
        Advisory Committee shall make requests for such access in 
        writing when necessary.
            (5) Obtaining official data.--The Advisory Committee may 
        secure directly from any department or agency of the United 
        States information necessary to enable it to carry out this 
        section. Upon the request of the Chairman of the Advisory 
        Committee, the head of that department or agency shall furnish 
        that information to the Advisory Committee.
    (e) Duties.--The primary duties of the Advisory Committee shall 
include--
            (1) advising the Institute on an ongoing basis in carrying 
        out the duties of the Institute;
            (2) evaluating programs and activities to eradicate 
        obstetric fistula and making recommendations regarding the 
        programs of the Institute;
            (3) advising the Department of State and the United States 
        Agency for International Development on an ongoing basis in 
        carrying out programs and activities to eradicate obstetric 
        fistula;
            (4) monitoring funds available for programs and activities 
        to eradicate obstetric fistula to ensure such funds are used 
        efficiently and are accounted for properly, including through 
        the conduct of periodic audits; and
            (5) advising the Administrator of the United States Agency 
        for International Development in an annual written report of 
        the Institute's performance and success in carrying out its 
        duties.
    (f) Actions Against Governments Failing To Meet Minimum 
Standards.--
            (1) By advisory committee.--The Advisory Committee--
                    (A) shall advise the Administrator of the United 
                States Agency for International Development, based on 
                information provided to the Advisory Committee by the 
                Institute or based on independent sources of 
                information, of each county that by reason of 
                corruption, indifference, or ineffectiveness, 
                significantly impedes the Institute's ability to 
                provide services to victims of obstetric fistula and 
                women who are vulnerable to obstetric fistula; and
                    (B) may request the Administrator to recommend 
                suspension of the provision of United States 
                nonhumanitarian, nontrade-related foreign assistance to 
                each country described in subparagraph (A).
            (2) By usaid.--Based on the advice of the Advisory 
        Committee under paragraph (1), the Administrator may accept the 
        advice and, in consultation with the Secretary, recommend to 
        the President the suspension of United States nonhumanitarian, 
        nontrade-related foreign assistance to a county described in 
        paragraph (1)(A).

SEC. 7. REPORT.

    The President, acting through the Administrator of the United 
States Agency for International Development, shall submit to Congress 
on an annual basis a report on the implementation of this Act for the 
preceding year, including an evaluation of the effectiveness and 
performance of the Institute, the Centers of Clinical Excellence, the 
Corps, and all related community outreach and medical programs.

SEC. 8. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There are authorized to be appropriated to the 
President to carry out this Act--
            (1) $10,000,000 for fiscal year 2015; and
            (2) $180,000,000 for the period of fiscal years 2016 
        through 2024.
    (b) Availability.--Amounts appropriated pursuant to the 
authorization of appropriations under subsection (a) are authorized to 
remain available until expended.
                                 <all>