[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1766 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                S. 1766

 To implement policies to end preventable maternal, newborn, and child 
                            deaths globally.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 10, 2019

 Ms. Collins (for herself, Mr. Coons, Mr. Roberts, Ms. Duckworth, Mr. 
  Sullivan, Mr. Van Hollen, Mrs. Capito, Mr. Markey, Mr. Isakson, Mr. 
 Merkley, Mr. Moran, Mr. Cardin, Mr. Cornyn, Ms. Rosen, Mr. Young, Ms. 
 Stabenow, Mr. Enzi, Mr. Wyden, Mr. Cramer, Mr. Murphy, Mr. Rubio, and 
   Mr. Reed) introduced the following bill; which was read twice and 
             referred to the Committee on Foreign Relations

_______________________________________________________________________

                                 A BILL


 
 To implement policies to end preventable maternal, newborn, and child 
                            deaths globally.

    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 
2019''.

SEC. 2. ASSISTANCE TO END PREVENTABLE MATERNAL, NEWBORN, AND CHILD 
              DEATHS GLOBALLY.

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

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

    ``(a) Purpose.--The purpose of this section is to implement a 
strategic approach for providing foreign assistance in order to end 
preventable child and maternal deaths globally by 2030.
    ``(b) 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) Coordinator.--The term `Coordinator' means the Child 
        and Maternal Survival Coordinator established under subsection 
        (e).
            ``(4) International maternal and child health and nutrition 
        programs.--The term `international maternal and child health 
        and nutrition programs' means all programs carried out using 
        funds appropriated or otherwise made available for 
        international maternal and child health and nutrition that are 
        managed by the United States Agency for International 
        Development Bureau of Global Health.
            ``(5) Relevant partner entities.--The term `relevant 
        partner entities' means each of the following:
                    ``(A) The governments of other donor countries.
                    ``(B) International financial institutions.
                    ``(C) Nongovernmental organizations.
                    ``(D) Faith-based organizations.
                    ``(E) Professional organizations.
                    ``(F) The private sector.
                    ``(G) Multilateral organizations.
                    ``(H) Local and international civil society groups.
                    ``(I) Local health workers.
                    ``(J) International organizations.
            ``(6) Target countries.--The term `target countries' means 
        specific countries that have the greatest need and highest 
        burden of child and maternal deaths, taking into consideration 
        countries that--
                    ``(A) have high-need communities in fragile states 
                or conflict-affected states;
                    ``(B) are low- or middle-income countries; or
                    ``(C) are located in regions with weak health 
                systems.
    ``(c) Statement of Policy.--It is the policy of the United States, 
in partnership with target 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 by--
            ``(1) focusing on bringing to scale, specific to each 
        country's needs, the highest impact, evidence-based 
        interventions, including for the most vulnerable populations, 
        with a focus on country and community 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 research, development, and 
        introduction of innovative tools and approaches to accelerate 
        progress toward ending preventable child and maternal deaths.
    ``(d) Strategy.--
            ``(1) In general.--Not later than one year after the date 
        of the enactment of the Reach Every Mother and Child Act of 
        2019, the President shall establish and implement a 
        comprehensive five-year, whole-of-government strategy, together 
        with target countries and donors, to contribute toward the 
        global goal of ending preventable child and maternal deaths by 
        2030 as a foundation for ensuring healthy and productive lives.
            ``(2) Elements.--The strategy established under paragraph 
        (1) shall--
                    ``(A) set outcome-based targets to achieve the 
                goals of the strategy and ascertain baseline data 
                relevant for each target country and for all areas of 
                focus and programming as of the date of the release of 
                the strategy;
                    ``(B) utilize United States Government strategies 
                and frameworks relevant to ending preventable child and 
                maternal deaths, including specific objectives, 
                programs, and approaches to achieve the highest-impact, 
                evidence-based interventions to address the leading 
                causes of death, particularly among the most vulnerable 
                populations, of--
                            ``(i) women related to pregnancy, 
                        childbirth, and post-delivery;
                            ``(ii) newborns in their first 28 days; and
                            ``(iii) infants and children under the age 
                        of five years old;
                    ``(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 executive branch agencies and 
                initiatives, including the United States Agency for 
                International Development, the Department of State, the 
                Department of Health and Human Services, the Centers 
                for Disease Control and Prevention, the National 
                Institutes of Health, the Millennium Challenge 
                Corporation, the Peace Corps, the Department of the 
                Treasury, the Office of the Global AIDS Coordinator, 
                and the President's Malaria Initiative;
                    ``(E) project general levels of resources needed to 
                achieve the strategy's stated objectives;
                    ``(F) identify strategies for leveraging resources 
                in new and innovative ways;
                    ``(G) align with country- and community-driven 
                maternal, newborn, and child health and survival plans 
                and improve coordination with foreign governments and 
                international organizations;
                    ``(H) outline consultations with relevant partner 
                entities as appropriate;
                    ``(I) implement results-based contracting (such as 
                pay-for-success) and financial and operational risk 
                reduction;
                    ``(J) promote a shift towards investments that 
                support inclusive and sustainable business models; and
                    ``(K) support the transition to domestic 
                sustainably financed health systems.
            ``(3) Initial strategy.--For the purposes of this section, 
        a strategy meeting the criteria described in paragraph (2) that 
        is in effect as of the date of enactment of this section may be 
        deemed to fulfill the establishment requirement in paragraph 
        (1).
    ``(e) Establishment of Child and Maternal Survival Coordinator.--
            ``(1) In general.--The President shall designate a current 
        USAID 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 to serve concurrently as the 
        Child and Maternal Survival Coordinator. The Coordinator shall 
        be responsible for--
                    ``(A) overseeing the strategy established under 
                subsection (d); and
                    ``(B) international maternal and child health and 
                nutrition programs.
            ``(2) Duties.--The Coordinator shall--
                    ``(A) have the primary responsibility for the 
                oversight and coordination of all resources and 
                international activities, as determined appropriate by 
                the Administrator of the United States Agency for 
                International Development, of the United States 
                Government appropriated or used for international 
                maternal and child health and nutrition programs;
                    ``(B) direct the budget, planning, and staffing to 
                implement international maternal and child health and 
                nutrition programs for the purpose of ending 
                preventable child and maternal deaths;
                    ``(C) lead implementation and revision, not less 
                frequently than once every 5 years, of the strategy 
                established under subsection (d)(1);
                    ``(D) coordinate with relevant executive branch 
                agencies, target countries, and relevant partner 
                entities as appropriate, to carry out the strategy 
                established under section 5(a) and to align current and 
                future investments with high-impact, evidence-based 
                interventions to save lives;
                    ``(E) provide guidance on the design and oversight 
                of grants, contracts, and cooperative agreements with 
                nongovernmental organizations (including community, 
                faith-based, and civil society organizations) and 
                private sector entities for the purpose of carrying out 
                the strategy established under subsection (d)(1); and
                    ``(F) report directly to the Administrator 
                regarding implementation of the strategy established 
                under subsection (d)(1).
            ``(3) Restriction on additional or supplemental 
        compensation.--The Coordinator shall receive no additional or 
        supplemental compensation as a result of carrying out 
        responsibilities and duties under this section.
    ``(f) Authority To Assist in Implementation of the Strategy.--
            ``(1) In general.--The President shall provide assistance 
        to implement the strategy established under subsection (d)(1).
            ``(2) Focus on impact.--
                    ``(A) Targets for increased implementation 
                required.--Consistent with the requirements for foreign 
                assistance programs included in the Foreign Aid 
                Transparency and Accountability Act of 2016 (Public Law 
                114-119), USAID grants, contracts, and cooperative 
                agreements for the purposes of the strategy established 
                under subsection (d)(1) shall be required to include 
                targets for increased implementation of high-impact, 
                evidence-based interventions and strengthening health 
                systems, as appropriate, including the establishment of 
                baseline measurements from which to quantify progress.
                    ``(B) Exception.--In exceptional circumstances 
                where USAID determines that inclusion of coverage 
                targets or baseline measures are not reasonable or 
                practicable for the grant, contract, or cooperative 
                agreement, the funding mechanism shall include an 
                explanation of the omission and explicitly state how 
                measurable impact will be targeted and tracked.
    ``(g) Reports.--
            ``(1) Report required.--Not later than one year after the 
        date of the enactment of this section, and annually thereafter 
        for 5 additional years, the President shall submit to the 
        appropriate congressional committees a report on progress made 
        to achieve the strategy established under subsection (d)(1) as 
        well as progress toward the goal to end preventable child and 
        maternal deaths globally. The report shall be made publicly 
        available.
            ``(2) Information included in report.--The report required 
        under paragraph (1) shall include the following elements:
                    ``(A) Indicators of progress made by United States 
                Government programs carried out under international 
                maternal and child health and nutrition programs for 
                the purposes of improving maternal, newborn, and child 
                health and survival, particularly among the most 
                vulnerable populations, in each target country and 
                overall, including--
                            ``(i) maternal mortality ratio per 100,000 
                        live births and under-5 mortality ratio per 
                        1,000 live births;
                            ``(ii) number of maternal, newborn, and 
                        child deaths averted;
                            ``(iii) percentage of births attended by 
                        skilled health personnel;
                            ``(iv) an analysis of gaps in the health 
                        workforce required to end preventable child and 
                        maternal deaths, including an analysis of 
                        health workforce density (number of certified 
                        health workers, including community-based 
                        health workers, per population);
                            ``(v) a description of the measured or 
                        estimated impact on maternal, newborn, and 
                        child survival of each ongoing program or 
                        project;
                            ``(vi) progress towards achieving the goal 
                        to save 15,000,000 children's lives and 600,000 
                        women's lives, and any subsequent goals 
                        established under the strategy required under 
                        subsection (d); and
                            ``(vii) any other targets identified by the 
                        Coordinator as essential to meeting the goals 
                        of the strategy for ending preventable child 
                        and maternal deaths.
                    ``(B) Assessments of progress made toward achieving 
                the targets set forth under subparagraph (A).
                    ``(C) A description of how the interventions or 
                programs are designed to--
                            ``(i) increase activities in target 
                        countries;
                            ``(ii) reach underserved, marginalized, 
                        vulnerable, under nourished or malnourished, 
                        and impoverished populations;
                            ``(iii) address causes of maternal, 
                        newborn, and child mortality with innovative 
                        efforts and interventions posed to go to scale;
                            ``(iv) invest in activities that empower 
                        women, support voluntarism, and provide 
                        respectful maternity care;
                            ``(v) improve transparency and 
                        accountability at all levels and include common 
                        metrics for tracking progress;
                            ``(vi) ensure that high-impact, evidence-
                        based interventions are prioritized; and
                            ``(vii) expand access to quality services 
                        through community-based approaches and include 
                        community accountability measures.
                    ``(D) Reporting on each aspect of the strategy 
                established under subsection (d)(1), including--
                            ``(i) multi-sectoral approaches, specific 
                        strategies, and programming utilizing high-
                        impact, evidence-based interventions to address 
                        the leading causes of preventable child and 
                        maternal deaths;
                            ``(ii) activities to develop and scale up 
                        new technologies and approaches, including 
                        those identified by public-private 
                        partnerships, for research and innovation;
                            ``(iii) coordination with United States 
                        agencies, foreign governments, nongovernmental 
                        organizations, and international organizations;
                            ``(iv) methods used to leverage new 
                        financial and other public and private 
                        resources in innovative ways; and
                            ``(v) best practices identified by the 
                        executive branch.
                    ``(E) Reporting on grants, contracts, and 
                cooperative agreements awarded, including--
                            ``(i) a comprehensive list of USAID grants, 
                        contracts, and cooperative agreements awarded 
                        in implementation of the strategy established 
                        under subsection (d)(1); and
                            ``(ii) a description of--
                                    ``(I) the targets for coverage of 
                                interventions or services and the 
                                baseline against which they are 
                                measured and the status of progress in 
                                meeting the targets; or
                                    ``(II) in the case of exceptional 
                                circumstances where USAID determines 
                                that 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) Reporting on the innovative public-private 
                financing tools, including an analysis of the 
                feasibility and potential effectiveness of new 
                financing tools that could be used to fund efforts to 
                end preventable child and maternal deaths globally.
    ``(h) Authorization of Appropriations.--
            ``(1) Authorization.--For each of fiscal years 2020 and 
        2021, there is authorized to be appropriated to the Secretary 
        of State and the Administrator of the United States Agency for 
        International Development to carry out this section--
                    ``(A) $545,000,000 for bilateral maternal and child 
                health;
                    ``(B) $290,000,000 for Gavi, the Vaccine Alliance; 
                and
                    ``(C) $145,000,000 for nutrition.
            ``(2) Application.--Funds appropriated or otherwise made 
        available to carry out activities under this section shall be 
        subject to all applicable restrictions under Federal law.
            ``(3) Expiration of funds.--Amounts appropriated or 
        otherwise made available to carry out activities under this 
        section shall remain available for obligation for a period of 5 
        years.''.
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