[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5545 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 5545

  To authorize an Action Plan for United States foreign assistance to 
  developing countries to increase access to sustainable safe water, 
  sanitation, and hygiene in healthcare facilities, promote stronger 
health systems and sustainable health infrastructure, build capacity of 
health workers, and promote the safety of health workers and patients, 
          especially women and girls, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 18, 2023

 Ms. Meng (for herself, Mr. Blumenauer, and Mr. LaHood) introduced the 
 following bill; which was referred to the Committee on Foreign Affairs

_______________________________________________________________________

                                 A BILL


 
  To authorize an Action Plan for United States foreign assistance to 
  developing countries to increase access to sustainable safe water, 
  sanitation, and hygiene in healthcare facilities, promote stronger 
health systems and sustainable health infrastructure, build capacity of 
health workers, and promote the safety of health workers and patients, 
          especially women and girls, 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 ``Global WASH in Healthcare Facilities 
Act of 2023''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Water, sanitation, and hygiene (WASH) is critical to 
        health security, preparedness and response efforts, including 
        for the prevention of COVID-19 and future pandemics.
            (2) WASH in healthcare facilities is necessary to ensure 
        health security, including reducing preventable maternal, 
        newborn, and child deaths and reducing the spread of infectious 
        diseases such as cholera, diarrhea, and sepsis.
            (3) Globally, 1 out of every 5 healthcare facilities have 
        no basic water services, and 1 in 2 do not have adequate 
        facilities to wash hands, leaving 3,850,000,000 people, 
        including health care workers and patients, at greater risk of 
        infections.
            (4) In least-developed countries, about half of healthcare 
        facilities lack basic water services, 79 percent have no 
        sanitation services, and 68 percent lack basic hygiene 
        services.
            (5) Healthcare acquired infections arise from poor hygiene, 
        contribute to patient morbidity and mortality, increase the 
        risk of antimicrobial resistance, and contribute to increased 
        costs for patients, their families and healthcare systems.
            (6) An estimated 15 percent of patients in low- and middle-
        income countries acquire one or more infections during a 
        typical hospital stay. Infections associated with unclean 
        births account for 26 percent of neonatal deaths and 11 percent 
        of maternal deaths; together they account for more than 
        1,000,000 deaths each year.

SEC. 3. STATEMENT OF POLICY; SENSE OF CONGRESS.

    (a) Statement of Policy Objectives.--It is in the national security 
interest of the United States to increase access to sustainable and 
safe water, sanitation, and hygiene in healthcare facilities, through 
global health, maternal, newborn and child health, and global water 
programs, activities, and initiatives that--
            (1) increase access to safe water in healthcare facilities;
            (2) enable handwashing at all points of care;
            (3) increase access to toilets in healthcare facilities, 
        including non-sewered sanitation solutions and a variety of 
        technologies for sanitation and healthcare waste treatment;
            (4) provide for the safe segregation, treatment, and 
        disposal of healthcare waste and increased infection and 
        prevention control measures;
            (5) promote WASH social and behavior change to ensure the 
        safety of health workers and patients to improve infection 
        prevention and control measures;
            (6) improve the ability of patients and healthcare workers, 
        including persons with disabilities to access water, 
        sanitation, and hygiene, including for their menstrual health 
        and hygiene needs in primary, secondary, and tertiary 
        healthcare facilities;
            (7) promote health facility administration management and 
        monitoring of water, sanitation, and hygiene services in 
        healthcare facilities for infection prevention and control and 
        quality of care outcomes, including--
                    (A) ensuring operations and maintenance of water 
                and sanitation infrastructure; and
                    (B) providing support to patients to adopt 
                consistent sanitation, hygiene, and menstrual health 
                behaviors;
            (8) integrate water, sanitation, and hygiene services into 
        pandemic preparedness and response and global health security 
        initiatives, including preventive measures that help to contain 
        infectious disease outbreaks at their source and support 
        resilient health facilities to ensure continuous primary care 
        during an outbreak; and
            (9) provide technical support to partner governments, 
        particularly Ministries of Health, to improve wash systems and 
        to incorporate safe water, sanitation, and hygiene into 
        national plans, strategies, and budgets for new and existing 
        healthcare facilities.
    (b) Sense of Congress.--It is the sense of Congress that the 
Administrator of the United States Agency for International 
Development, in implementing the Global WASH in Healthcare Facilities 
Action Plan described in section 5, should--
            (1) coordinate in consultation with the USAID Assistant 
        Administrator for Global Health, the Senior Coordinator for 
        Gender Equality and Women's Empowerment, and the Global Water 
        Coordinator, to expand safe water, sanitation, and hygiene in 
        healthcare facilities;
            (2) promote assistance to and build the capacity of 
        national governments to include water, sanitation, and hygiene 
        indicators in national health systems monitoring and budgets;
            (3) coordinate implementation of existing United States 
        Government strategies related to WASH in healthcare facilities, 
        including the United States Global Water Strategy and United 
        States International Activities to Advance Global Health 
        Security and Diplomacy Strategy and Report to achieve the 
        objectives of section 3(a);
            (4) include policies that promote the privacy, safety, and 
        dignity of women and girls, and disability access in design, 
        implementation, and evaluation, in accordance with existing 
        USAID policies for people with disabilities;
            (5) promote the development of resilient water, sanitation, 
        and hygiene systems in healthcare facilities; and
            (6) prioritize high priority countries where the needs are 
        greatest.

SEC. 4. DEFINITIONS.

    In this Act:
            (1) Appropriate congressional committees.--The term 
        ``appropriate congressional committees'' means--
                    (A) the Committee on Foreign Affairs and the 
                Committee on Appropriations of the House of 
                Representatives; and
                    (B) the Committee on Foreign Relations and the 
                Committee on Appropriations of the Senate.
            (2) Sustainable.--The term ``sustainable'' means the 
        ability of a target country, community, implementing partner, 
        or intended beneficiary to maintain, over time, the programs 
        authorized and outcomes achieved pursuant to this Act.
            (3) Healthcare facility.--The term ``healthcare facility'' 
        means a hospital, clinic, health center, or other location 
        established for the purpose of providing health care.
            (4) Healthcare worker.--The term ``healthcare worker'' 
        includes doctors, nurses, lab technicians, pharmacists, 
        janitors, healthcare administrators, and other individuals 
        working at or in partnership with healthcare facilities.
            (5) High priority country.--The term ``high priority 
        country'' means a country designated pursuant to section 136(h) 
        of the Foreign Assistance Act of 1961 (22 U.S.C. 2151h(h)) and 
        any country identified by USAID as a high priority country for 
        the purposes of this Act.
            (6) Key stakeholders.--The term ``key stakeholders'' 
        means--
                    (A) communities directly affected by the lack of 
                access to safe water, sanitation or hygiene;
                    (B) other appropriate nongovernmental 
                organizations; and
                    (C) agencies or departments of countries affected 
                by the lack of access to safe water, sanitation, or 
                hygiene.
            (7) USAID.--The term ``USAID'' means the United States 
        Agency for International Development.
            (8) WASH.--The term ``WASH'' means water, sanitation, and 
        hygiene.

SEC. 5. GLOBAL WASH IN HEALTHCARE FACILITIES ACTION PLAN.

    (a) Action Plan Required.--The Administrator of the United States 
Agency for International Development, in coordination with the Director 
of the Centers for Disease Control and Prevention and the Secretary of 
State, shall develop and implement an action plan, to be known as the 
``Global WASH in Healthcare Facilities Action Plan'', to accomplish the 
policy objectives listed in section 3(a). Such action plan shall--
            (1) set specific, timebound, and measurable goals, and 
        identify relevant performance metrics drawing from existing and 
        complementary strategies and plans;
            (2) describe monitoring and evaluation plans that reflect 
        best practices relating to transparency, accountability, 
        localized sustainability, country capacity, budgetary support 
        and ownership, water, sanitation, and hygiene, including 
        appropriate use of gender disaggregated data;
            (3) establish clear and transparent criteria for WASH in 
        healthcare facilities in target countries, drawn from existing 
        water, sanitation and hygiene, need for strong health systems, 
        infection prevention and control, pandemic preparedness and 
        response, maternal, newborn and child health, and nutrition 
        programs high priority countries and assessments, and for 
        selecting regions and intended beneficiaries of assistance;
            (4) describe linkages and coordination with other relevant 
        policies, strategies, plans and initiatives including those 
        related to gender, resilience, global health, and pandemic 
        preparedness and response;
            (5) describe measures and approaches to address the issues 
        of infection prevention and control, menstrual health and 
        hygiene, safe and equitable access to WASH for health workers, 
        gaps in current data, monitoring and evaluation analysis and 
        capacity, consistent with the policy objectives described in 
        section 3(a);
            (6) support partner governments to strengthen supply chains 
        and, as appropriate, establish and maintain strategic 
        stockpiles of critical water, sanitation, hygiene and menstrual 
        health products, clean, operational and maintenance inputs, and 
        related hardware for resilient healthcare;
            (7) address women's and girls' specific needs for water, 
        sanitation, and hygiene access in healthcare facilities, in 
        particular, personal safety, privacy, dignity, and menstrual 
        health and hygiene and maternal health;
            (8) support the long-term sustainability of water, 
        sanitation, and hygiene access in healthcare facilities 
        especially at points of care, through health systems resiliency 
        approaches including capacity building;
            (9) leverage new and existing water, sanitation, and 
        hygiene technologies, including non-sewered sanitation 
        solutions, and a variety of technologies for sanitation and 
        healthcare waste treatment;
            (10) in support of sustainably increased WASH access in 
        healthcare facilities and increased local ownership, identify 
        criteria, and methodology for graduating countries from United 
        States assistance provided for the policy objectives listed in 
        section 3(a); and
            (11) anticipate resource needs to implement the Action 
        Plan, including such amounts to be transferred by the Secretary 
        of State to the Administrator of USAID pursuant to section 
        6(a).
    (b) Inclusion in Other Strategies, Policies, Plans, and 
Initiatives.--The Administrator may include the Action Plan required by 
subsection (a) as a component of the USAID Agency-Specific Plan for the 
United States International Activities to Advance Global Health 
Security and Diplomacy Strategy required by the Global Health Security 
and International Pandemic, Preparedness and Response Act (subtitle D 
of title LV of the National Defense Authorization Act for Fiscal Year 
2023), or as a component of other USAID strategies, policies, plans or 
initiatives, as appropriate.
    (c) Action Plan Submission.--Not later than 1 year after the date 
of the enactment of this Act, the Administrator of USAID shall submit 
to the appropriate congressional committees a report consisting of--
            (1) the Global WASH in Healthcare Facilities Action Plan 
        required under subsection (a); and
            (2) a description of the manner in which the Administrator 
        intends to advance the policy objectives listed in section 3(a) 
        through such action plan.

SEC. 6. ASSISTANCE TO IMPLEMENT THE GLOBAL WASH IN HEALTHCARE 
              FACILITIES ACTION PLAN.

    (a) Authorization of Appropriations.--Amounts appropriated pursuant 
to the authorization under section 5564 of the National Defense 
Authorization Act for Fiscal Year 2023 are also authorized to be made 
available during fiscal years 2024 through 2027 to carry out the Global 
WASH in Health Care Facilities Action Plan described in section 5 in 
support of the United States International Activities to Advance the 
Global WASH in Healthcare Facilities Action Plan.
    (b) Authorization of Transfers.--Subject to the availability of 
funds appropriated pursuant to the authorization under section 5564 of 
the National Defense Authorization Act for Fiscal Year 2023 and in 
accordance with subsection (a), the Secretary of State is authorized to 
transfer to the Administrator of the USAID such sums as may be 
necessary to implement the Global WASH in Health Care Facilities Action 
Plan described in section 5 of this Act.
    (c) Monitoring and Evaluation.--The Administrator shall seek to 
ensure that assistance to implement the Global WASH in Healthcare 
Facilities Action Plan is provided under established parameters for a 
rigorous accountability system to monitor and evaluate progress and 
impact of the action plan, including by reporting to the appropriate 
congressional committees and the public on an annual basis, in 
accordance with section 7.

SEC. 7. REPORTS.

    (a) Initial Report.--Not later than 1 year after the date of the 
submission of the Global WASH in Healthcare Facilities Action Plan 
required under section 5, the Administrator shall submit to the 
appropriate congressional committees a report that describes the status 
of the implementation of the Action Plan.
    (b) Content.--The report required under subsection (a) shall--
            (1) contain a summary of the Global WASH in Healthcare 
        Facilities Action Plan as an appendix;
            (2) describe the progress made in implementing the Action 
        Plan;
            (3) identify the indicators and measure results over time, 
        as well as the mechanisms for reporting such results in an open 
        and transparent manner, including disaggregated data on 
        healthcare facilities with basic or safe access to water, 
        sanitation and hygiene defined by the World Health Organization 
        and UNICEF;
            (4) contain a transparent and detailed accounting of USAID 
        spending to implement the Global WASH in Healthcare Facilities 
        Action Plan and related activities;
            (5) describe how the Global WASH in Healthcare Facilities 
        Action Plan leverages other United States global health 
        programs including but not limited to maternal and child 
        health, health systems, and global health security;
            (6) describe the impact of the Global WASH in Healthcare 
        Facilities Action Plan on other global health programs, 
        including progress in the promotion of infection prevention and 
        control, strengthening global health security and pandemic 
        preparedness, prevention and response and reducing preventable 
        maternal and child deaths;
            (7) assess efforts to coordinate United States global 
        health programs, activities, and initiatives with key 
        stakeholders;
            (8) assess United States Government-facilitated private 
        investment in related sectors and the impact of private sector 
        investment in target countries and communities;
            (9) assess the increased access to safe sanitation and hand 
        washing stations in healthcare facilities, including to address 
        menstrual health and hygiene needs;
            (10) incorporate a plan for regularly sharing lessons 
        learned with a wide range of stakeholders, including local 
        civil society organizations in an open, transparent manner and 
        through biennial stakeholder consultation; and
            (11) establish mechanisms for receiving feedback from 
        stakeholders and incorporating feedback into updates of 
        relevant congressionally mandated strategies and action plans.
    (c) Subsequent Reports.--For the five-year period beginning on the 
date of the submission of the initial report required under subsection 
(a), the Administrator shall annually submit to the appropriate 
congressional committees a report on the status of the implementation 
of the action plan, the progress made in achieving the elements 
described in section 5, and any changes to the action plan since the 
date of the submission of the most recent prior report.
    (d) Inclusion in Other Reports.--The Administrator may include the 
report required by subsection (a) as a component of the United States 
International Activities to Advance Global Health Security and 
Diplomacy Strategy report or as a component of other USAID reports, as 
appropriate.
    (e) Public Availability of Information.--The information referred 
to in subsections (a) and (b) shall be timely made available on the 
public website of USAID in a consolidated, downloadable, and machine-
searchable format.
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