[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4022 Introduced in House (IH)]

<DOC>






115th CONGRESS
  1st Session
                                H. R. 4022

 To implement a strategic approach for providing foreign assistance in 
 order to end preventable child and maternal deaths globally within a 
                  generation, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 11, 2017

  Mr. Reichert (for himself, Ms. McCollum, Ms. Lee, and Mr. Donovan) 
 introduced the following bill; which was referred to the Committee on 
                            Foreign Affairs

_______________________________________________________________________

                                 A BILL


 
 To implement a strategic approach for providing foreign assistance in 
 order to end preventable child and maternal deaths globally within a 
                  generation, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Reach Every Mother and Child Act of 
2017''.

SEC. 2. ASSISTANCE TO END PREVENTABLE CHILD AND MATERNAL DEATHS.

    The Foreign Assistance Act of 1961 (22 U.S.C. 2151 et seq.) is 
amended by adding at the end of chapter 1 of part I the following:

``SEC. 137. ASSISTANCE TO END PREVENTABLE CHILD AND MATERNAL DEATHS.

    ``(a) Sense of Congress.--It is the sense of Congress that United 
States foreign assistance efforts should focus on countries, regions, 
and communities with the greatest need and the highest burden of 
preventable child and maternal deaths.
    ``(b) Statement of Policy.--It shall be the policy of the United 
States, in coordination with recipient countries and relevant partner 
entities, to establish and implement a coordinated, integrated, and 
comprehensive strategy to combat the leading causes of maternal, 
newborn, and child mortality globally and ensure healthy and productive 
lives for women and children, by--
            ``(1) scaling up the highest-impact, evidence-based 
        interventions, including for the most vulnerable populations, 
        with a focus on country ownership;
            ``(2) designing, implementing, monitoring, and evaluating 
        programs in a way that enhances transparency and 
        accountability, increases sustainability, and improves outcomes 
        in target countries; and
            ``(3) supporting the development and scale-up of innovative 
        tools and approaches to accelerate progress toward ending 
        preventable child and maternal deaths and reach the goal of 
        saving the lives of 15,000,000 children and 600,000 women.
    ``(c) Strategy.--
            ``(1) In general.--Not later than one year after the date 
        of the enactment of this section, the President shall establish 
        and implement a comprehensive five-year, whole-of-government 
        strategy to accelerate progress toward ending preventable child 
        and maternal deaths within a generation and ensure healthy and 
        productive lives for women and children.
            ``(2) Elements.--The strategy established under paragraph 
        (1) shall--
                    ``(A) set specific, outcome-based, and measurable 
                targets to achieve the goals of the strategy and 
                identify baseline data for each target country and for 
                all areas of focus and programming, as of the date of 
                the publication of such strategy;
                    ``(B) incorporate existing Federal strategies and 
                frameworks relevant to ending preventable child and 
                maternal deaths, including specific objectives, 
                programs, and approaches to implement highest-impact, 
                evidence-based interventions, to address the leading 
                causes of death in target countries, particularly among 
                the most vulnerable populations, for--
                            ``(i) women, related to pregnancy, 
                        childbirth, or the post-delivery period;
                            ``(ii) newborn children during their first 
                        28 days; and
                            ``(iii) infants and children under the age 
                        of five;
                    ``(C) include development and scale up of new 
                technologies and approaches, including those supported 
                by public-private partnerships for research and 
                innovation;
                    ``(D) promote coordination and efficiency within 
                and amongst the relevant Federal departments and 
                agencies;
                    ``(E) project the general levels of resources 
                needed to achieve the strategy's stated objectives;
                    ``(F) identify strategies for leveraging resources 
                with new and innovative financial tools;
                    ``(G) align with the maternal, newborn, and child 
                health and survival plans of target countries and 
                improve coordination with foreign governments and 
                international organizations;
                    ``(H) outline consultations with target countries 
                and relevant partner entities;
                    ``(I) implement results-based contracting, such as 
                pay-for-outcome arrangements, and reduce financial and 
                operational risks;
                    ``(J) promote a shift toward inclusive and 
                sustainable investments;
                    ``(K) support the transition to sustainably 
                financed, domestic health systems in target countries; 
                and
                    ``(L) promote partnerships with organizations that 
                have a long-term presence in target countries and have 
                shown evidence of sustainable community impact, 
                including through the capacity building of local and 
                community-based organizations.
            ``(3) Identification of target countries.--For purposes of 
        the strategy under paragraph (1), the Administrator shall--
                    ``(A) identify each country that has the greatest 
                need and faces the highest burden of preventable child 
                and maternal deaths, taking into consideration 
                countries that--
                            ``(i) have high-need, underserved, 
                        marginalized, vulnerable, or impoverished 
                        communities;
                            ``(ii) are fragile or conflict-affected 
                        countries;
                            ``(iii) are low- or middle-income 
                        countries; or
                            ``(iv) are located in regions with weak 
                        health systems; and
                    ``(B) establish transparent selection criteria for 
                such target countries.
    ``(d) Improving Coordination and Oversight.--
            ``(1) Establishment of senior coordinator for child and 
        maternal survival.--The Administrator shall designate a current 
        employee serving in a career or non-career position in the 
        Senior Executive Service or at the level of a Deputy Assistant 
        Administrator or higher at the United States Agency for 
        International Development (USAID) to serve concurrently as the 
        Senior Coordinator for Child and Maternal Survival.
            ``(2) Duties.--The Senior Coordinator shall--
                    ``(A) have the primary responsibility for the 
                oversight and coordination of international maternal 
                and child health and nutrition funding managed by the 
                USAID Bureau of Global Health;
                    ``(B) lead the development of the strategy 
                established under subsection (c) and its implementation 
                by USAID, including by directing the budget, planning, 
                and staffing with respect to such implementation;
                    ``(C) facilitate program and policy coordination of 
                international maternal and child health and nutrition 
                programs between the USAID, other relevant Federal 
                departments and agencies, and relevant partner 
                entities;
                    ``(D) monitor, evaluate, and report on any 
                activities undertaken by USAID pursuant to the strategy 
                required under subsection (c); and
                    ``(E) provide direction to the design and oversight 
                of grants, contracts, and cooperative agreements with 
                any recipient of funds under the responsibility of the 
                Senior Coordinator pursuant to subparagraph (A).
            ``(3) Restriction on additional or supplemental 
        compensation.--The Senior Coordinator shall not receive any 
        additional or supplemental compensation as a result of carrying 
        out responsibilities and duties under this section.
    ``(e) Prioritization of Greatest Need and Maximum Impact.--
            ``(1) Targets for increased implementation required.--In 
        accordance with the guidelines established under section 3 of 
        the Foreign Aid Transparency and Accountability Act, any grant 
        made available by the Administrator and any contract or 
        cooperative agreement entered into by the Administrator in 
        order to implement the strategy established under subsection 
        (c) of this section shall--
                    ``(A) include targets for increased implementation 
                of high-impact, evidence-based interventions and 
                strengthening health systems, as appropriate; and
                    ``(B) establish baseline measurements from which to 
                quantify progress toward such targets and towards the 
                goal of preventing life-threatening morbidity and 
                mortality for at least 15,000,000 children and at least 
                600,000 women, as described in subsection (b)(3).
            ``(2) Exception.--In exceptional circumstances when the 
        Administrator determines that the inclusion of coverage targets 
        or baseline measures is not reasonable or practicable for a 
        grant, contract, or cooperative agreement, the funding 
        mechanism for such grant, contract, or agreement shall include 
        an explanation of the omission and explicitly state how 
        measurable impact will be targeted and tracked.
    ``(f) Use of Innovative Public-Private Financing Tools.--
            ``(1) In general.--In addition to existing bilateral and 
        multilateral assistance for child and maternal survival, the 
        Administrator shall implement the strategy established under 
        subsection (c) through the use of innovative financing tools, 
        where appropriate, to expand delivery of highest-impact, 
        evidence-based interventions to address the leading causes of 
        preventable child and maternal deaths, particularly among 
        vulnerable populations. The Administrator shall also explore 
        models, whether existing or innovative, to improve the 
        efficiency and effectiveness of investments through results-
        based contracting (such as pay-for-outcome arrangements) and 
        reduce financial and operational risks with respect to such 
        implementation.
            ``(2) Authorization to fund programs on pay-for-outcome 
        basis.--
                    ``(A) In general.--The Administrator shall have the 
                authority to provide assistance for child and maternal 
                survival on a pay-for-outcome basis, as described in 
                subparagraph (B), to any initiative that meets the 
                requirements described in subparagraph (C).
                    ``(B) Pay-for-outcome basis described.--The pay-
                for-outcome basis described in this paragraph is a 
                performance-based grant, contract, or cooperative 
                agreement awarded in the form of a commitment to 
                provide payments that is contingent on improved 
                outcomes resulting in a social benefit to the public 
                and in direct cost savings or cost avoidance to the 
                United States Government.
                    ``(C) Requirements for pay-for-outcome funding.--
                The Administrator may only provide assistance under 
                subparagraph (A) to an initiative that includes the 
                following:
                            ``(i) A detailed implementation plan 
                        describing how the proposed pay-for-outcome 
                        initiative is based on evidence supporting an 
                        expectation of improved effectiveness.
                            ``(ii) A rigorous, independent, third-party 
                        evaluation, using experimental or quasi-
                        experimental design or other quantitative 
                        research methodologies, that allows for the 
                        strongest possible causal inferences, when 
                        random assignment is not feasible, to determine 
                        whether the initiative has achieved the 
                        proposed improvement in outcomes.
                    ``(D) Limitation on availability of funding.--Any 
                payments provided to an initiative pursuant to the 
                authorization under subparagraph (A) may only be made 
                available for expenditure for not more than 5 years 
                after the date on which such payments are first made 
                available.
    ``(g) Reports.--
            ``(1) Report required.--Not later than 2 years after the 
        date of the publication of the strategy required under 
        subsection (c), and annually thereafter, the President shall 
        submit to the appropriate congressional committees, and make 
        publicly available, a report describing the implementation of 
        the strategy.
            ``(2) Information included in report.--The report required 
        under paragraph (1) shall include the following:
                    ``(A) A summary and evaluation of progress made to 
                achieve the objectives described in subsection (b), 
                including the goal to end preventable child and 
                maternal deaths, and the progress made toward achieving 
                the goal of reducing life threatening morbidity and 
                mortality for at least 15,000,000 children and at least 
                600,000 women.
                    ``(B) A description of the nature and extent of 
                coordination among relevant Federal departments and 
                agencies on the implementation of the strategy.
                    ``(C) A description of how each aspect of the 
                strategy is being implemented, including--
                            ``(i) the manner in which multi-sectoral 
                        approaches and concrete, high-impact, evidence-
                        based interventions are being used to address 
                        the leading causes of preventable child and 
                        maternal deaths;
                            ``(ii) the degree to which the strategy 
                        increases assistance to and activities by the 
                        United States in target countries;
                            ``(iii) the use of programs, projects, or 
                        activities to develop and scale-up new 
                        technologies and approaches, including those 
                        identified by public-private partnerships for 
                        research and innovation, and the degree to 
                        which such programs, projects, or activities 
                        are posed to go to scale; and
                            ``(iv) the methods used to leverage 
                        innovative financing and other public and 
                        private resources and the progress made by such 
                        methods.
                    ``(D) A description of how each program, project, 
                or activity implementing the strategy is designed to--
                            ``(i) reach underserved, marginalized, 
                        vulnerable, or impoverished populations;
                            ``(ii) address the causes of newborn, 
                        infant, child, and maternal morbidity and 
                        mortality, including pre-term births, with 
                        innovative efforts and interventions;
                            ``(iii) invest in programs, projects, or 
                        activities that empower women, support 
                        voluntarism, and provide quality, respectful, 
                        evidence-based maternity care;
                            ``(iv) improve transparency and 
                        accountability at all levels and include common 
                        metrics for tracking progress in achieving the 
                        objectives of the strategy;
                            ``(v) ensure that high-impact, evidence-
                        based interventions are prioritized, including 
                        interventions promoting healthy pregnancies; 
                        and
                            ``(vi) expand access to quality services 
                        for healthcare workers and for communities in 
                        target countries and include measures of 
                        accountability to such communities.
                    ``(E) A comprehensive list of grants, contracts, 
                and cooperative agreements awarded to implement the 
                strategy, that includes--
                            ``(i) a description of the targets for 
                        coverage of interventions or services supported 
                        by such grants, contracts, or cooperative 
                        agreements, the baseline against which they are 
                        measured, and the status of their progress in 
                        meeting the targets; or
                            ``(ii) in the case of exceptional 
                        circumstances where the inclusion of targets or 
                        baseline measurements is not reasonable or 
                        practicable, an explanation of how the impact 
                        of the grant, contract, agreement, or resulting 
                        program is being measured.
                    ``(F) A description of how the Administrator has 
                partnered with relevant partner entities at the 
                national and local levels, including as subgrantees.
                    ``(G) A determination, after applying rigorous 
                monitoring and evaluation methodologies, whether the 
                programs, projects, or activities implementing the 
                strategy have achieved measurable improvements in child 
                and maternal health or survival, particularly among the 
                most vulnerable populations, in each target country and 
                overall, and the specific improvements achieved with 
                respect to--
                            ``(i) the maternal mortality ratio per 
                        100,000 live births and the under-5 mortality 
                        ratio per 1,000 live births;
                            ``(ii) the number of newborn, infant, 
                        child, and maternal deaths averted; and
                            ``(iii) the percentage of births attended 
                        by skilled health personnel.
                    ``(H) An analysis of the gaps in the health 
                workforce that must be filled in order to end 
                preventable newborn, infant, child and maternal deaths, 
                including an analysis of health workforce density 
                relating to certified health workers and community-
                based health workers.
                    ``(I) A description of the measured or estimated 
                impact on newborn, infant, child, and maternal survival 
                of each ongoing program, project, or activity 
                implementing the strategy.
                    ``(J) An assessment of progress made toward 
                achieving the targets established pursuant to 
                subsection (c)(2)(A).
                    ``(K) A description of any innovative public-
                private financing tools, including an analysis of the 
                feasibility and potential effectiveness, that could be 
                used to fund efforts to end preventable child and 
                maternal deaths.
    ``(h) Definitions.--In this section:
            ``(1) Administrator.--The term `Administrator' means the 
        Administrator of the United States Agency for International 
        Development.
            ``(2) Appropriate congressional committees.--The term 
        `appropriate congressional committees' means--
                    ``(A) the Committee on Foreign Relations and the 
                Committee on Appropriations of the Senate; and
                    ``(B) the Committee on Foreign Affairs and the 
                Committee on Appropriations of the House of 
                Representatives.
            ``(3) Relevant federal departments and agencies.--The term 
        `relevant Federal departments and agencies' includes each of 
        the following:
                    ``(A) The Department of State.
                    ``(B) The United States Agency for International 
                Development, including the President's Malaria 
                Initiative.
                    ``(C) The Department of Health and Human Services.
                    ``(D) The Department of the Treasury.
                    ``(E) The Department of Defense.
                    ``(F) The Centers for Disease Control and 
                Prevention.
                    ``(G) The National Institutes of Health.
                    ``(H) The Millennium Challenge Corporation.
                    ``(I) The Peace Corps.
                    ``(J) The Office of the Global AIDS Coordinator.
                    ``(K) Any other Federal department or agency 
                determined by the President to be relevant to carry out 
                the purposes of this section.
            ``(4) Relevant partner entities.--The term `relevant 
        partner entities' means each of the following:
                    ``(A) Multilateral and international organizations.
                    ``(B) International financial institutions.
                    ``(C) The national and local governments of 
                recipient countries.
                    ``(D) Community nongovernmental organizations, 
                including faith-based, professional, and civil society 
                organizations.
                    ``(E) Entities in the private sector.
                    ``(F) Entities in the healthcare sector of 
                recipient countries.
            ``(5) Senior coordinator.--The term `Senior Coordinator' 
        means the Senior Coordinator for Child and Maternal Survival 
        established under subsection (d).
            ``(6) Target country.--The term `target country' means a 
        country identified by the Administrator pursuant to subsection 
        (c)(3).''.
                                 <all>