    [Senate Hearing 110-521]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 110-521

      STATE, FOREIGN OPERATIONS, AND RELATED PROGRAMS APPROPRIATIONS FOR
                                FISCAL YEAR 2008

    =======================================================================

                                    HEARINGS

                                    before a

                              SUBCOMMITTEE OF THE

                COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE

                           ONE HUNDRED TENTH CONGRESS

                                 FIRST SESSION

                                       on

                                   H.R. 2764

    AN ACT MAKING APPROPRIATIONS FOR FOREIGN OPERATIONS, EXPORT FINANCING,
    AND RELATED PROGRAMS FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2008, AND
                               FOR OTHER PURPOSES

                                   __________

                              Department of State
                            Nondepartmental Witness
               United States Agency for International Development

                                   __________

             Printed for the use of the Committee on Appropriations

      Available via the World Wide Web: http://www.gpoaccess.gov/congress/
                                   index.html

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                                   __________
                          COMMITTEE ON APPROPRIATIONS

                    ROBERT C. BYRD, West Virginia, Chairman
    DANIEL K. INOUYE, Hawaii             THAD COCHRAN, Mississippi
    PATRICK J. LEAHY, Vermont            TED STEVENS, Alaska
    TOM HARKIN, Iowa                     ARLEN SPECTER, Pennsylvania
    BARBARA A. MIKULSKI, Maryland        PETE V. DOMENICI, New Mexico
    HERB KOHL, Wisconsin                 CHRISTOPHER S. BOND, Missouri
    PATTY MURRAY, Washington             MITCH McCONNELL, Kentucky
    BYRON L. DORGAN, North Dakota        RICHARD C. SHELBY, Alabama
    DIANNE FEINSTEIN, California         JUDD GREGG, New Hampshire
    RICHARD J. DURBIN, Illinois          ROBERT F. BENNETT, Utah
    TIM JOHNSON, South Dakota            LARRY CRAIG, Idaho
    MARY L. LANDRIEU, Louisiana          KAY BAILEY HUTCHISON, Texas
    JACK REED, Rhode Island              SAM BROWNBACK, Kansas
    FRANK R. LAUTENBERG, New Jersey      WAYNE ALLARD, Colorado
    BEN NELSON, Nebraska                 LAMAR ALEXANDER, Tennessee
                        Charles Kieffer, Staff Director
                      Bruce Evans, Minority Staff Director
                                     ------

        Subcommittee on State, Foreign Operations, and Related Programs

                      PATRICK J. LEAHY, Vermont, Chairman
    DANIEL K. INOUYE, Hawaii             JUDD GREGG, New Hampshire
    TOM HARKIN, Iowa                     MITCH McCONNELL, Kentucky
    BARBARA A. MIKULSKI, Maryland        ARLEN SPECTER, Pennsylvania
    RICHARD J. DURBIN, Illinois          ROBERT F. BENNETT, Utah
    TIM JOHNSON, South Dakota            CHRISTOPHER S. BOND, Missouri
    MARY L. LANDRIEU, Louisiana          SAM BROWNBACK, Kansas
    JACK REED, Rhode Island              LAMAR ALEXANDER, Tennessee
                               Professional Staff
                                   Tim Rieser
                                  Kate Eltrich
                                 Nikole Manatt
                             Paul Grove (Minority)
                            Michele Wymer (Minority)
                           LaShawnda Smith (Minority)

                             Administrative Support
                                 Renan Snowden

                                C O N T E N T S

                                  ----------

                           Wednesday, March 28, 2007

                                                                       Page

    United States Agency for International Development...............     1

                           Wednesday, April 18, 2007

    United States Agency for International Development: Bureau for
      Global Health..................................................    25

                             Thursday, May 10, 2007

    Department of State: Office of the Secretary.....................    93

      STATE, FOREIGN OPERATIONS, AND RELATED PROGRAMS APPROPRIATIONS FOR
                                FISCAL YEAR 2008

                                  ----------

                           WEDNESDAY, MARCH 28, 2007

                                           U.S. Senate,
               Subcommittee of the Committee on Appropriations,
                                                        Washington, DC.
        The subcommittee met at 10:03 a.m., in room SD-138, Dirksen
    Senate Office Building, Hon. Patrick J. Leahy (chairman)
    presiding.
        Present: Senators Leahy, Bond, and Gregg.

               UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

    STATEMENT OF HON. RANDALL L. TOBIAS, ADMINISTRATOR

                 OPENING STATEMENT OF SENATOR PATRICK J. LEAHY

        Senator Leahy. Good morning. Ambassador Tobias, I'm glad
    you're here. This is a very busy day. We considered postponing
    this hearing because the votes are set at 11 o'clock, but we
    don't have hearing dates available in April, we can't be sure
    what dates are available in May, so I'm going to put my opening
    statement in the record.
        I would hope that you would summarize yours so we can go to
    questions.
        [The statement follows:]

                 Prepared Statement of Senator Patrick J. Leahy

        I want to begin by welcoming Senator Gregg who is the new ranking
    member of this subcommittee. Senator Gregg and I come from States that
    share a border and I look forward to working with him in the same
    bipartisan way that his predecessor, Senator McConnell, and I worked
    together for so many years.
        I think we both agree that the United States does not need a
    Democratic or Republican foreign policy, we need an American foreign
    policy, and that is what I intend to strive for.
        Ambassador Tobias, we appreciate you being here. We also appreciate
    your past leadership as the Global AIDS Coordinator. You got that
    program off to a good start.
        The jobs of USAID Administrator and Director of Foreign Assistance
    are quite different from either the CEO of a private corporation or the
    AIDS Coordinator, as I'm sure you have discovered.
        Today we want to focus on the President's fiscal year 2008 budget
    request for USAID, and on your proposals for reforming our foreign aid
    programs.
        I think most people would agree that there is a lot of room for
    improvement in our foreign aid budget, personnel and procurement
    policies, and programs. But the issue is how you do it, and what
    decision-making authority is retained by USAID.
        On the positive side, you have developed a more coherent process
    that will enable your office to more accurately show where and how
    funds are spent. That will help and we welcome it.
        We are also assured by your office that you consulted extensively
    during this process, although that is not what we have heard from some
    of those whose views we would have wanted to see reflected, including
    within USAID itself.
        While the budget process may be more coherent and transparent, I am
    mystified by many of the results.
        A glance at your budget request yields as many questions as
    answers. A country like Colombia, that has received roughly $565
    million in each of the past 5 years, gets the same amount for the same
    purposes in fiscal year 2008, even though we know that some things have
    not worked and that conditions in Colombia have changed.
        In Nepal, a country where years of fighting has cost thousands of
    lives, there is a chance to end the Maoist insurgency and replace
    feudalism with democracy. Yet you propose to cut our assistance.
        The Democratic Republic of the Congo, a huge country with every
    imaginable problem, has emerged from conflict and completed its first
    election in 40 years. It holds the key to the future of central Africa,
    yet you propose to cut our assistance.
        Vietnam, a country of 80 million people, seeks closer ties with the
    United States, and there are so many opportunities for working
    together. Yet, with the exception of HIV/AIDS, you propose to cut our
    assistance.
        The Congress has worked hard to increase funding for global
    environment programs, particularly to protect biodiversity in the
    Amazon and central Africa where the forests are being destroyed. Yet
    you propose to slash funding for those programs.
        Last year, you testified before this subcommittee that, and I am
    quoting you, ``our intent is not to have a USAID budget or a State
    Department budget, but a Foreign Assistance budget that will make all
    of it more coherent in a way that all of us can better understand.''
        I have mentioned just a few of many examples. I have to ask what is
    the purpose of this stated ``coherence'' if it produces illogical
    outcomes? What was the strategic thinking behind these decisions? How
    were the views of USAID program officers in the field and their
    implementing partners reflected? How were the Congress' views
    reflected?
        We know you have to make hard choices. We all face budget
    constraints. But Pakistan, Afghanistan, Iraq, and Indonesia are not the
    only countries where the United States has important economic and
    security interests. You need to make sense of this for us if we are
    going to be able to work together.

        Senator Leahy. I do want to begin by welcoming Senator
    Gregg, who is the new ranking member of this subcommittee.
    Senator Gregg and I share a border, a beautiful border along
    the Connecticut River. We've known each other for a long time
    and, of course, he had a distinguished career as Governor
    before, and I feel privileged that he's here.
        As you know, Senator McConnell and I worked together for
    years--sometimes he'd be chairman, sometimes I'd be chairman,
    but I think the hallmark of this subcommittee during that time
    was that we would try to get the foreign aid bill passed in
    bipartisan fashion. As a result, we've been able to pass the
    bill in about a tenth the amount of the time that it used to
    take. Senator Gregg, would you like to say anything before we
    begin.
        Senator Gregg. Well, let me put my statement on the record
    and say how much I'm looking forward to working with you.
        We had a great relationship over the years on a lot of
    issues and it's going to be--it's an interesting committee with
    tremendously important jurisdiction, and I'm excited to have
    the chance to be the ranking member on it, and to follow in the
    footsteps of who we've mentioned. It's such a such a great job
    and certainly a team effort here to try to make sure that our
    foreign accounts are strongly supported.
        [The statement follows:]

                    Prepared Statement of Senator Judd Gregg

        Welcome, Ambassador Tobias. You have the distinction of being the
    first witness to appear before this subcommittee in the 110th Congress.
        We appreciate the opportunity to discuss the $3.8 billion, fiscal
    year 2008 budget request for the operations and activities of the
    United States Agency for International Development (USAID), and to
    learn more about your efforts to reform foreign assistance. Both are
    difficult and challenging tasks, and I know many of us are curious how
    you divide your time between your jobs of USAID Administrator and the
    Director of Foreign Assistance.
        When it comes to foreign aid reform, what is past is prologue.
    Beginning with the Foreign Assistance Act of 1961 (which provided USAID
    its mandate), numerous Administrations--Republican and Democrat--
    attempted to improve the efficiency and effectiveness of foreign
    assistance. Since 1961, the goals and objectives of U.S. aid have
    changed due to the shifting priorities of Administrations and
    Congresses which seek to keep apace with an ever-changing world.
        The Government Accountability Office notes in reports dating from
    the late 1970s that investments in large infrastructure projects
    overseas (intending, in part, to blunt the influence of the Soviet
    Union) were redirected by Congress to smaller programs targeting
    agriculture, nutrition, education, healthcare, and family planning for
    the poor. During the immediate post-Cold War period, U.S. aid supported
    emerging democracies throughout the former Soviet Union and significant
    emphasis was placed on activities targeted toward economic growth and
    development.
        Following the September 11, 2001 terrorist attacks, foreign
    assistance serves a renewed purpose to improve the lives and
    livelihoods of people who might be open to the hateful and violent
    ideology of extremists. I expect that everyone who sits on this
    Subcommittee would agree that foreign aid, if properly managed, can be
    an effective bulwark against terrorism.
        Afghanistan serves as example of the success that can be
    accomplished through the generosity of the American people. It is
    interesting to note that U.S. assistance supports large infrastructure
    projects throughout that country, smaller programs intending to improve
    the lives of the most destitute Afghans, and economic growth and
    development programs. We know from the pending supplemental request for
    Afghanistan that reconstruction is a long-term endeavor and that more
    needs to be done by all international donors.
        Your immediate challenge as Director of Foreign Assistance appears
    two-fold: first, to convince often entrenched bureaucracies that change
    is necessary, and second, to work hand-in-hand with Congress to enact
    proposed reforms, including the fiscal year 2008 budget request. I
    commend you on the improved Congressional Budget Justification
    materials, and I look forward to learning more about the process by
    which the fiscal year 2008 State and foreign operations budget request
    was crafted.

        Senator Leahy. Thank you. Ambassador, would you----
        Ambassador Tobias. Mr. Chairman, Thank you very much for
    the opportunity. I think that I will follow your example and
    ask that my opening statement be submitted for the record.
        [The statement follows:]

                  Prepared Statement of Hon. Randall L. Tobias

        Thank you, Mr. Chairman and Ranking Member Gregg, for the
    opportunity to testify before the subcommittee today on the fiscal year
    2008 budget for foreign assistance.
        When I came before you last year, I outlined a series of challenges
    I sought to undertake as the first ever Director of U.S. Foreign
    Assistance. Now, after nearly a year in this role, I appreciate the
    opportunity to share with you what we have achieved, and what I hope we
    can achieve together through the fiscal year 2008 budget process.

                      RESPONSIVENESS TO THIS SUBCOMMITTEE

        I want to begin by thanking this subcommittee for its work and for
    the support you provided before these reforms even got off the ground.
    Before discussing the budget, I would like to note our efforts to
    address your concerns raised in report language. Emphasized in fiscal
    year 2006 report language, and then re-emphasized in fiscal year 2007
    report language, this subcommittee directed that Congressional Budget
    Justification materials improve in both the timing of their delivery
    and the quality of information put forth. I am happy to say that this
    year, we delivered material to support the Congressional Budget
    Justification on February 14th, nearly a month before the March
    deadline put into report language. Further, we included standardized
    budget tables per country to allow the public to meaningfully compare
    request levels per country. In addition, we have addressed the
    coordination concerns between USAID and State programs raised in fiscal
    year 2007 report language by bringing State and USAID staff and senior
    managers to the same table to discuss budget priorities for fiscal year
    2008.
        We have done far more than make process changes, however. With the
    new budget package comes a carefully considered set of budget
    priorities that, combined, will help advance our National Security
    Strategy. I realize that not all of the changes that we are proposing
    will sit entirely comfortably with each Member of this distinguished
    subcommittee. To the contrary, it is more likely that at least one of
    the changes we propose will raise concerns with you about our
    prioritization. I look forward to engaging with you to discuss your
    concerns. Part of my drive, to lay out the budget transparently in a
    way that can be compared across countries, is so that we can have a
    discussion, using common understandings and terminology, about just
    where our foreign assistance dollars are going and what we are trying
    to accomplish by allocating them as we have.
        We have taken big steps to increase transparency, accountability,
    and coherence of strategy in the allocation of our resources, including
    the creation of one office, under my direction, to oversee all USAID
    and State foreign assistance resources. I hope to make your oversight
    responsibility less burdensome by laying our principles and priorities
    clearly on the table, and providing tools by which we can consistently
    assess results.
        Specifically, we applied six principles to the allocation of the
    fiscal year 2008 budget, in response to concerns raised by Congress and
    the President himself about the lack of coordination and coherence in
    our planning, allocation and monitoring of foreign assistance funds. I
    would like to take a moment to elaborate on them now.

                                   PRINCIPLES

        The fiscal year 2008 State and USAID foreign assistance request is
    $20.3 billion, a $2.2 billion or 12 percent increase over fiscal year
    2006 enacted levels, the last year for which we have completed
    allocations. Given current budget pressures and a shared commitment
    with Congress for deficit control, this increase reflects the
    importance this Administration places on foreign assistance, not just
    as a moral obligation to alleviate suffering, but as a foundation of
    our national security strategy.
        As a result of foreign assistance reform, this year's request
    reflects a different approach to building the budget from previous
    years' methods, and I would like to take a moment now to explain the
    six principles that governed our prioritization.
        First, we integrated planning based on the totality of U.S.
    Government resources and the commitment to a shared goal.--Consistent
    with your request that we improve coherence and coordination of State
    and USAID foreign assistance, for the first time in our Nation's
    history, all $20.3 billion of U.S. foreign assistance under the
    authority of the Department of State and USAID, as well as resources
    provided by the Millennium Challenge Corporation, are being applied to
    the achievement of a single overarching goal--transformational
    diplomacy. In response to input received from many of you, our
    colleagues in the international development community, and our host
    government counterparts, that goal now reads: To help build and sustain
    democratic, well-governed states that respond to the needs of their
    people, reduce widespread poverty and conduct themselves responsibly in
    the international system.
        Over 100 interagency teams, organized by country, were tasked with
    ensuring that all State and USAID resources were coordinated for
    maximum efficiency and impact, and targeted to the achievement of
    shared objectives. Teams considered investments from the President's
    Emergency Plan for AIDS Relief and the Millennium Challenge Account
    (MCC) when allocating resources. As a result, in countries that will
    receive MCC Compact funds in 2008, you will see funds allocated to
    programs that will support the success of these investments, such as an
    increase in trade and investment funds and private sector
    competitiveness in Honduras, and in Ghana, a shift in funding to
    enhance the capacity of local government, who will be responsible for
    implementing the MCC Compact's programs.
        Second, we focused on country progress.--The ultimate goal of
    transformational diplomacy is to support recipient country efforts to
    move from a relationship defined by dependence on traditional foreign
    assistance to one defined by full sustaining partnership status. Now, I
    will spend a bit of time on this principle, because, while it seems
    like this is what we have been doing all along, this year's approach
    was quite different.
        In past budget years, funds were allocated first by account, then
    by sector, and lastly, by country. Much of the budget was built by
    determining so much for family planning, so much for basic education,
    so much for security assistance, and so on. Funding from within these
    sector levels was then parceled out to countries on the basis of
    multiple sector-based strategies--one for family planning, etc. You get
    the picture.
        It is not that these sectors are not critical to a country's
    development strategy--clearly they are, and we continue to evaluate
    resources by sector, ensure appropriate targeting, and incorporate best
    practices. It's a matter of what should drive the country's development
    program--country-prioritized need or a set global amount for a sector.
    We must tailor programs to the unique needs of each recipient country
    in reaching the transformational diplomacy goal.
        This year, we led with country progress. We brought together teams
    of experts from USAID and State, in consultation with their field
    counterparts, and we gave them an overall planning number for each
    country--not by account, not by sector, just a total.
        We gave them data on the status of country progress against
    independent indicators assessing poverty, human capacity, life
    expectancy, governance, and barriers to economic growth. We gave them
    the new Strategic Framework for U.S. Foreign Assistance, which outlines
    interventions according to countries' common country traits. We then
    asked them to allocate that budget to the areas that would best advance
    individual country progress, based on the opportunities and challenges
    that exist on the ground, and in turn, advance U.S. policy. The result
    is an fiscal year 2008 budget focused on country progress.
        Third, consistent with concerns raised by this subcommittee to
    align our foreign assistance resources with our National Security
    Strategy, we invested in states critical to long-term regional
    stability and prosperity.--As many of you are aware, the new Strategic
    Framework for Foreign Assistance categorizes each country receiving
    U.S. foreign assistance based on common traits and places them on a
    trajectory to measure their development progress against standardized
    indicators. The country categories are largely explained by their
    category name: Rebuilding, Developing, Transforming, Sustaining
    Partnership and Restrictive.
        In the fiscal year 2008 budget request, you will find that 51
    percent of Department of State and USAID program assistance resources
    are concentrated in Rebuilding and Developing countries. These are the
    countries that are farthest away from sustaining partnership status, as
    measured by instability, poverty, human capacity, life expectancy,
    governance, and barriers to economic growth--all critical barriers to
    regional stability and success in the War on Terror.
        We have seen the risks that ``ungoverned spaces'' can pose to our
    national security and to their regional neighbors; we are also very
    aware of the costs of these ``ungoverned spaces'' to their own
    citizens. States like Somalia, Afghanistan, Sudan, and the Democratic
    Republic of the Congo are among the poorest in the world. Their
    citizens are among the least able to access basic needs--including
    security.
        At the same time, to truly transform the development landscape, we
    need to focus on Developing States such as Nigeria, Ukraine, Georgia,
    Pakistan, Jordan, and Indonesia--states that are on the cusp of
    transitioning to economic, political and social self-sustenance, and
    that, with continuing progress, can serve as anchors for regional
    stability and prosperity. We need to work with them to help them
    strengthen their institutions to make their progress permanent.
        Fourth, we focused on demand-driven interventions that are critical
    levers for sustainable progress and transformation.--Foreign assistance
    in the past has run the risk of being a mile wide and an inch deep.
    With a thousand agendas embedded in our foreign assistance programs,
    our impact was diluted and diffuse. It is important to note, as I often
    do, that there is very little that we do in our development portfolio
    that is bad. Someone, some community, is benefiting from the services
    we are providing and the interventions we are supporting.
        But that is not the point. The real question is, are we achieving
    sustainable impact? Are we, in fact, enabling transformation? Are we
    giving people what they need to sustain further progress on their own?
        Based on the new country-driven process, we have prioritized
    resources to the areas that we believe will promote and sustain long-
    term country progress. Funding is increased to programs targeted to
    improving governance and democratic participation, programs mitigating
    diseases that threaten the human and economic capacity of countries to
    progress on their own, programs that expand access to and improve the
    quality of education, and programs that enhance economic opportunity
    and the skills needed to participate in the global economy. These
    resource allocations reflect the wisdom of our interagency teams of
    country experts.
        I often think about our past practice of allocating funds as being
    similar to teaching an individual a little French, a little German, and
    a little Spanish. If we keep doing it, that person will very slowly be
    able to speak a little more French, a little more German, and a little
    more Spanish. But if we instead took the resources spent on each
    language and put them toward one language, that person would be able to
    communicate fluently, and would then be better able to learn the other
    languages on his or her own.
        Similarly, when we split up our resources into too many sectors in
    one country, progress will be slow and often imperceptible. If we
    instead focus our resources, we enhance the ability of countries to
    gain enough strength and stability in areas critical to sustaining
    further progress on their own.
        Focusing resources in this way has its tradeoffs. When one area
    goes up, unless there is an abundance of new resources, other areas go
    down. While the fiscal year 2008 budget increased by $2.2 billion over
    fiscal year 2006 enacted levels, we squeezed far more in the budget.
    The budget includes important increases for HIV/AIDS, malaria, and
    humanitarian assistance; and for countries in which there are new
    requirements and opportunities such as in Kosovo, Iran, and Cuba. The
    fiscal year 2008 budget also reflects efforts to continue to shift
    program funding, where requirements are predictable, from supplemental
    requests for Iraq, Afghanistan, Sudan and avian influenza into the base
    budget.
        Within the country-level requests, you will also find quite a bit
    of smaller, yet equally important, shifts. Country teams prioritized
    interventions that would help a country's institutions to build the
    capacity to take on challenges in the longer term. So you will see
    increases in resources for conflict mitigation, justice systems,
    executive branch institution-building, anti-corruption, basic
    education, energy services, agriculture policy, workforce development,
    and clean environment. But with these increases, certain sectors were
    not prioritized by the country teams to the degree that they have been
    funded in the past. These areas include sectors that we realize are
    important to members of Congress, including family planning, maternal
    and child health, and biodiversity. We know that putting decreases
    forward in these areas requires a robust justification of our reasons,
    and I hope we will have a substantive dialogue about why our teams made
    the choices that they did.
        At the outset of the reform process, some members of this committee
    expressed concern that greater alignment between State and USAID
    foreign assistance resources would result in a short-shrifting of long-
    term development goals. I am pleased to note that in fact the opposite
    occurred. In fiscal year 2008, resources for the three objectives
    targeted to achieving long-term development progress--Governing Justly
    and Democratically, Investing in People, and Economic Growth--increase
    by 19 percent over fiscal year 2006 levels for these Objectives. The
    fiscal year 2008 request includes the largest request this
    Administration has ever made for basic education, and when projected
    fiscal year 2008 MCC disbursements are considered, investments in these
    objectives increased by 29 percent over fiscal year 2006.
        Fifth, we allocated funds intended for country programs to country-
    level budgets.--In the past, ambassadors and mission directors often
    did not have a full picture of the resources being implemented in their
    countries, because some activities were planned and implemented from
    Washington. Consequently, they did not exercise full oversight over
    these programs, and doing so from Washington was costly and time-
    consuming.
        To empower our mission directors, ambassadors, and country teams,
    who are our people in the field with the best knowledge of country
    circumstances, the reform process maximized resources implemented at
    the country level into country-level budgets. Resources within global
    or regional budgets that had been planned for specific countries were
    accordingly shifted to those countries' budgets and planned together
    with other country-based support. As a result, such resources can be
    implemented consistent with country strategies and benefiting from
    expertise on the ground.
        Recognizing that not all foreign assistance is most effectively
    implemented on a country basis, and that issues that transcend a single
    country's borders are best addressed as part of a global or regional
    strategy, activities such as support to regional institutions,
    multilateral organizations, or cross-cutting research remain funded
    within global and regional budgets. Humanitarian assistance, which is
    allocated on the basis of emerging crises, also remains funded within
    global budgets.
        Finally, we matched accounts with country circumstances and the
    priorities the county categories are designed to address.--Many of you
    may be used to hearing about the budget less in terms of countries and
    more in terms of accounts. There is a specific reason I have not
    mentioned accounts until now.
        Account levels did not drive our allocation process. Country
    progress did. After the country teams submitted their allocations by
    program, we centrally aggregated them to their appropriate accounts. In
    doing so, we sought to maximize the use of account authorities and
    establish clear priorities in support of effective implementation of
    foreign assistance programs.
        This means that, overall, funding for the Development Assistance
    account (DA), which has traditionally supported assistance in poor
    countries that demonstrate performance or a commitment to development,
    has been prioritized to Developing and Transforming countries. The
    Economic Support Fund (ESF), which focuses primarily on providing
    economic support under special economic, political, or security
    conditions, has been prioritized to support activities in the
    Rebuilding and Restrictive Country Categories.
        However, activities to support the poor and invest in development
    have not changed. For the three objectives supporting long-term
    development: Governing Justly and Democratically, Investing in People,
    and Economic Growth, DA and ESF totaled $3.7 billion in fiscal year
    2006. For fiscal year 2008, DA and ESF in these objectives total $3.8
    billion.
        The real change is within Restrictive and Rebuilding countries:
    Total funding in the three objectives supporting long-term development
    increased by 63 percent over fiscal year 2006 levels. However, the
    balance between DA and ESF changed, with DA declining from $331 million
    in fiscal year 2006 to $42 million in fiscal year 2008; and ESF
    increasing from $525 million in fiscal year 2006 to $1.4 billion in
    fiscal year 2008.
        Now I realize that this may have many of you worried that this DA
    decrease and ESF increase means that foreign assistance will now be
    used increasingly for political ends and that poor people will suffer.
    I know there is often a skepticism between our two branches when one
    side or the other presents a series of numbers, so let me address any
    doubts by citing a group many consider an ``Honest broker''--the Global
    Leadership Campaign. In their February 26, 2007, analysis, they point
    out, ``Overall `development-type' activities do not decline in fiscal
    year 2008 due to the shift between DA and ESF, and in fact, increase in
    the aggregate.''
        Let me assure you of this point. Our intent in shifting funds from
    DA to ESF is to draw cleaner lines around their use, as identified by
    country characteristics. Period. These cleaner lines allow us to
    justify to you why we have requested amounts for each account. There is
    no intent to take the ``development'' out of any of our development
    resources.

                            REGIONAL FUNDING TRENDS

        Consistent with the principles mentioned above, I would like to
    review briefly the regional funding trends you will see in the fiscal
    year 2008 budget.
        Africa.--When projected MCC disbursements are included, the fiscal
    year 2008 request for Africa represents a 54 percent increase over
    fiscal year 2006. Including actual disbursements and projected fiscal
    year 2008 disbursements from the MCC, resources for Africa have nearly
    quadrupled from 2001-2008. Over 75 percent of the fiscal year 2008
    budget will focus on Investing in People in order to address the
    crippling effects of disease and poverty, a $2 billion increase from
    fiscal year 2006. These increases are largely due to HIV/AIDS
    resources, but not entirely. When HIV/AIDS, MCC and the emergency-
    oriented accounts of Public Law 480 Title II food aid, Migration and
    Refugee Assistance, and International Disaster and Famine Assistance
    are excluded in both fiscal year 2006 and fiscal year 2008 (as
    allocation of emergency funds is often unknown until the end of a
    fiscal year), there is actually a 15 percent increase in resources to
    Africa.
        East Asia and the Pacific.--With projected fiscal year 2008 MCC
    disbursements included, proposed fiscal year 2008 funding for the
    region increases by 15 percent over fiscal year 2006. Democratic
    challenges and terrorist threats require that peace and security
    programs emphasize counterterrorism and conflict mitigation while also
    maintaining military assistance for key War on Terror partners.
    Resources for these types of key security programs make up 18 percent
    of the request for the region. Countries such as Indonesia, the
    Philippines, and Mongolia collectively receive 53 percent of the
    region's request.
        Near East.--The fiscal year 2008 request for the Near East
    represents a 4 percent increase over fiscal year 2006, including
    reduced levels for Egypt and Israel under glidepath agreements. The
    fiscal year 2008 request emphasizes continued investments in Peace and
    Security and political reform. Accordingly, funding for Peace and
    Security increase by 4 percent, while investments in Governing Justly
    and Democratically increase by more than 80 percent. The fiscal year
    2008 request is concentrated in Iraq, Israel, Egypt and Jordan,
    representing 93 percent of the region's budget.
        South and Central Asia.--Funding to South and Central Asia
    increased by 6 percent in the fiscal year 2008 request compared to
    fiscal year 2006 levels for the region. Funding will continue to
    support the Global War on Terror through security, reconstruction,
    development and democracy efforts, particularly in Afghanistan and
    Pakistan, which represent 84 percent of the region's request. Success
    in these countries is critical to achieving peace, stability, and
    development progress throughout South and Central Asia. Funding for the
    five Central Asian countries declined by nearly 24 percent from fiscal
    year 2006 to fiscal year 2008. Much of the decline comes in Uzbekistan,
    where the government has worked actively to limit U.S. assistance
    related to reform, and in Kazakhstan, whose oil wealth lessens the need
    for our assistance.
        Western Hemisphere.--Foreign assistance for Latin America has risen
    dramatically since the start of the Administration, rising from $862
    million in fiscal year 2001 to a requested $1.4 billion in fiscal year
    2008 for State and USAID Administered programs. If the fiscal year 2008
    request is fully funded and MCC fiscal year 2008 disbursements are
    taken into account, resources to the Western Hemisphere will have
    doubled under this Administration, from $862 million in fiscal year
    2001 to $1.66 billion in fiscal year 2008--a 4 percent increase over
    fiscal year 2006.
        The focus of resources within the region has also changed. The
    Western Hemisphere, in general, has made significant progress over the
    last decade, although major challenges remain. Funds have therefore
    shifted from service-delivery in health and basic education, where the
    region has made progress relative to other regions, to economic growth
    and activities to help consolidate democratic gains. Our programs are
    targeted to improve government capacity and provide access to economic
    opportunity to all citizens, especially the poor and marginalized, by
    catalyzing private sector investments, reducing the cost of doing
    business, and expanding access to microcredit. With MCC disbursements
    considered, economic growth resources are up 80 percent in fiscal year
    2008. Resources to improve government capacity and strengthen
    democratic institutions are up 5 percent.
        I am aware of recent briefings where concern has been expressed
    about declining funding for our neighbors. In fact, my very first trip
    since submitting the fiscal year 2008 budget was to Bolivia, Ecuador,
    and Peru, three countries that have sustained decreases in the fiscal
    year 2008 budget. In each of these countries, the positive impact of
    our past investments was clear, and our ability to build on them with
    innovative programming and partnerships was also evident.
        Europe and Eurasia.--This region represents another success story
    in development. The fiscal year 2008 request for Europe and Eurasia
    represents a 26 percent decrease from fiscal year 2006, reflecting
    success achieved in the region. When projected fiscal year 2008 MCC
    disbursements in Georgia and Armenia are included, the reduction is 13
    percent from fiscal year 2006. While United States assistance has
    played a substantial role in supporting further integration of
    countries in Eastern Europe and the Western Balkans into Euro-Atlantic
    institutions, a number of difficult challenges remain across the range
    of foreign assistance objectives. Funds for Kosovo and Serbia represent
    27 percent of the region's request. Countries at the forefront of
    reform--Ukraine, Georgia, and Moldova--and countries that present
    democratic challenges--Russia and Belarus--together represent 30
    percent of the region's budget.

                                   CONCLUSION

        For too long, the debate between Congress and the Administration
    regarding foreign assistance has lacked focus. Very much like a ship
    with too many calibrations, the foreign assistance boat would move in
    one direction for a while, then shift directions with a new
    Administration or a new Congress, oftentimes back-tracking over the
    same course it had traveled just a few years ago. As a consequence,
    many recipient countries have not been given the tools they need for a
    long enough period of time to help their countries sustain progress.
    Globally, progress has been slow and often imperceptible.
        The fiscal year 2008 Foreign Operations budget, built on the basis
    of the principles and methodologies described above, reflects country-
    based strategies for progress, evaluated within the context of regional
    challenges and opportunities, and responsive to a shared goal and
    objectives targeted to achieve that goal. And since budget planning was
    thoroughly integrated, the fiscal year 2008 budget, like a Rubic's
    Cube, relies on each individual piece to maintain the integrity of the
    whole.
        In addition to developing the new Strategic Framework for Foreign
    Assistance, we have developed a standardized set of definitions, or a
    ``Development Dictionary,'' if you will, of the programs that relate to
    our five priority objectives, and ultimately to the transformational
    diplomacy goal. The Development Dictionary describes what we mean,
    across all programs and sources of funding, when we describe a program
    as ``justice system reform'' or ``conflict mitigation.'' We published
    this reference on line and have invited comments from your staffs and
    the NGO community. Every dollar of the fiscal year 2008 budget is
    identified against these common definitions, making comparisons across
    fiscal years, countries, programs, and regions transparent and easy.
        We have developed common indicators for each of the programs
    defined in the development dictionary, such that we will be able to
    compare partner, program, and country performance across agencies and
    sources of funding. We developed these indicators with input from the
    NGO community and have posted them on line, together with an email
    address to collect comments.
        We have wrapped the money, definitions, and indicators into one
    system that will be able to tell you who is getting the money, what
    they are spending it on, and what results we expect to be achieved.
    This information will come together in an annual Operational Plan
    submitted to Washington for each country where foreign assistance funds
    are provided. For the first time, starting with fiscal year 2007 funds,
    we will be able to tell you what a $1 million change from X activity to
    Y activity will mean for a program so that you can better determine
    whether such a change, and its opportunity cost, best reflects the
    impact you want to have.
        In making these changes, we sought explicitly to be responsive to
    concerns raised by Congress about the transparency of our
    decisionmaking, the coherence of our resources, and our ability to
    account for results. My hope is that the first steps taken over the
    past nine months will support a robust dialogue between the legislative
    and executive branches about funding priorities. Because with this new
    transparency of information comes a new responsibility on both of our
    parts to raise concerns where we feel our differing priorities will
    have a detrimental impact on transformational diplomacy progress. I
    look forward to hearing your input regarding the prioritization of
    resources that we have laid on the table.
        Far more than just moving the deck chairs, the reform reflected in
    the fiscal year 2008 budget represents the re-calibration of the ship.
    But only when we discuss our differing priorities, in the spirit
    intended by the balance of powers between the executive and legislative
    branches, will the ship find its most appropriate and progressive
    course. We need to develop common priorities for the ship's movement to
    sustain permanent progress.
        I look forward to engaging and working with you over the coming
    months to develop our common path and urge you to fund the full fiscal
    year 2008 request.
        Thank you.

                           TRANSFORMATIONAL DIPLOMACY

        Senator Leahy. Well, thank you and it will be. You say in
    your statement that for the first time in the Nation's history
    all of our foreign assistance resources are being applied to
    the achievement of the single over-arching goal,
    transformational diplomacy, and how democratic, well-governed
    states respond to the needs of their people, reduce wide-spread
    poverty, and conduct themselves responsibly in the
    international system. I think that is a fair summary of what
    you said, and I support that. We all do.
        But isn't that what we've been trying to do ever since
    World War II?
        Ambassador Tobias. Well, yes, I think we have. I think the
    question is: Have we been as effective in doing it as we might
    be and what can we do as we go forward to do a better job of
    it?
        Senator Leahy. I think what I mean is we do a lot of
    things. We train teachers, we strengthen healthcare systems, we
    reform judicial systems which is extremely important to build
    trade capacity. So may I ask you this: What have we been doing
    that we're not going to do and what are we going to do that we
    haven't been doing?
        Ambassador Tobias. Senator, I think that it begins with all
    of us, those in the Congress and those in the administration,
    as well as people in the NGO community and others that have an
    important interest in all of this coming to a common conclusion
    around what is it we're really trying to get done here, and
    what is the best way to get it done. So the administration has
    laid out this framework as a point of at least starting the
    discussion, with the idea being that in some instances I think
    our activities, well intended as they have been, have been more
    successful in building dependency than they have been in
    building a sustainable set of programs to allow countries to
    progress on a trajectory and eventually graduate from the need
    to be dependent on foreign assistance.
        I think that our foreign assistance has sometimes had a
    thousand objectives. We've been a mile wide and an inch deep,
    and we haven't been clear and crisp----

                           FOREIGN ASSISTANCE BUDGET

        Senator Leahy. But I can think of some of the times when we
    supported some of the worst heads of state because they said
    they were anti-communist.
        Then after the breakup of the Soviet Union it was Mr.
    Putin's method of governing. I'm not sure what the major
    changes are sometimes but after that, we said we would support
    anybody who said they were anti-drugs, because that became the
    mantra, and in a number of instances we closed our eyes to
    severe problems in countries that we were supporting because of
    that.
        Now if they say they are anti-terrorist, even some
    countries that have harbored terrorists, well, then we support
    them.
        These mistakes have been made by both democratic and
    republican administrations.
        You testified that contrary to concerns expressed by some
    Members of Congress in fiscal year 2008, resources for the
    objectives targeted to achieving long-term development,
    governing justly and democratically and investing in people
    increased by 19 percent over fiscal year 2006 levels.
        But if you take the Millenium Challenge Corporation and
    HIV/AIDS out of the equation, then how do fiscal year 2006 and
    fiscal year 2008 compare?
        Ambassador Tobias. Well, first of all, I'm not a fan of
    taking HIV/AIDS and the Millennium Challenge Corporation out of
    the equation.
        Senator Leahy. Well, the reason I ask that is because the
    Millennium Challenge Corporation has a huge amount in the
    pipeline but hasn't spent much at all, so that's why I asked
    the question.
        Ambassador Tobias. Well, the way we have done the
    calculation is to work with the Millennium Challenge
    Corporation to determine what they believe their actual outlay
    will be during the year 2008 in each of the countries where
    they have a compact. We have assessed what we believe our
    foreign assistance will be on a country-by-country basis--not
    on the size of the compact but on what will actually happen in
    2008.
        But in many countries in Africa, for example, if you look
    at an education program in a country where 20 percent of the
    teachers are dying every year, it becomes pretty clear that the
    AIDS initiative is dealing with more than just AIDS; it's
    dealing with the fundamental fabric of the country, so I really
    do think it's appropriate to count all of it.
        Senator Leahy. Let's talk about that. For example, in
    Nigeria, you said you want to help them strengthen their
    institutions and make progress permanent. But if you take out
    the AIDS money--and I'm not suggesting we do--I've been a
    strong supporter, as you know, of adding money for HIV/AIDS
    long before it became popular. But if you take out AIDS you
    only propose an additional $20 million for Nigeria, a country
    of 125 million people. You cut aid to the Ukraine by $16
    million, I believe. Georgia by $21 million. How does this show
    us strengthening their institutions? You see what I'm getting
    at?
        Ambassador Tobias. Of course I do.
        Senator Leahy. We're going to put the money in for HIV/
    AIDS. I've worked closely with the President and others on
    that. Even when he hasn't had it in the budget we've put it in,
    but how do we strengthen democracy with only $20 million for
    Nigeria?
        Ambassador Tobias. Well, we're proposing to spend a
    significant amount of money on democracy programs because
    they're so incredibly important. Indeed, in a number of
    countries, unless we have rule of law and solid democracy
    programs, it's not likely that other things are really going to
    work in a sustainable way.
        But in all cases, we have put the budgets together on a
    country-by-country basis using people with expertise both here
    in Washington and in the field assessing the resources that we
    felt we could make available, and making a determination based
    on what the most compelling issues are in that country as to
    where can we spend the money and make the greatest difference
    in moving that country forward.
        Senator Leahy. Sure, but in Nigeria that's about 20 cents a
    person, and I'm not sure you're going to build an awful lot of
    democracy or better court systems in that way. I know we have a
    huge amount of money going to Pakistan and Afghanistan and
    Iraq. We have a huge amount of money that goes to Israel and
    Egypt, and a lot goes to Colombia even though it hasn't stopped
    drugs coming into this country.
        I worry about the areas where--I think you'd agree with
    me--there are going to be problems if the United States does
    not get involved. My time is up, and I yield to Senator Gregg.

                            FORMER SOVIET REPUBLICS

        Senator Gregg. Thank you, and picking up on that note I
    recognize that you've got to cover the whole globe and you have
    to--therefore you end up not putting a lot of money except into
    a few nations that have high-visibility issues, such as Iraq,
    Afghanistan, Egypt, and Israel.
        But accepting that as the context, why is the budget deduce
    the funding for the former Soviet Republics that are, basically
    it seems, some of the most fertile ground in the world for
    developing democracies, and the rule of law in countries that
    would be natural allies, especially since many of them are on
    the rim of the Middle East and represent marginally Islamic
    countries that could be friendly.
        Ambassador Tobias. Are you talking about Russia or are you
    talking about----
        Senator Gregg. The former Republics.
        Ambassador Tobias. The former Republics. Well, again, we've
    tried to prioritize within each region the countries in that
    region that our people with expertise have felt were the
    greatest priorities, and then within each country we've tried
    to prioritize those particular areas where people have felt we
    could make the most difference. I'd have to go through on a
    country-by-country basis, which I'd be happy to do, but at the
    end of the day it's----
        Senator Gregg. Let's do that, because your funding to the
    Former Soviet Republics which are now independent has been cut.
        Ambassador Tobias. Senator, I'm sorry. I'm having a little
    trouble hearing you.
        Senator Gregg. The funding to the Former Soviet Republics
    has been cut in this budget; I'm wondering why. So let's go
    through each one. Let's start with Georgia. Why did you cut
    funds to Georgia?
        Ambassador Tobias. Do you want me to find the list now?
        Senator Gregg. No. I want you to answer the question: Why
    did you cut funds to Georgia?
        Ambassador Tobias. Well, funds were reduced in the sense of
    looking at the resources that were available, and the people
    with the expertise on the region and on the countries in the
    region making the choices that with scarce resources, we would
    put the money in the places that----
        Senator Gregg. Because there was obviously a tactical
    decision made, or a strategic decision made, that you would
    focus dollars on other accounts at a more significant level and
    reduce dollars to what are now Republics that used to be Soviet
    client states. I guess the bottom-line question is: Why was
    that decision made? Clearly there was a decision made to do
    that.
        Ambassador Tobias. Well, again, I don't know how to answer
    it other than to say that it was a matter of----
        Senator Gregg. Give me some specifics as to what made
    that----
        Ambassador Tobias. There was no systematic intent to reduce
    levels in the former Soviet Republics. We considered each
    country program on an individual basis and in the broader
    context of competing needs around the globe. The request for
    the region overall reflects successes in promoting reform and
    creating legacy institutions, as well as increases for some
    countries with pressing needs or significant opportunities. As
    a result, you will see funding increases for Turkmenistan, for
    example, in response to opportunities presented by the
    transition of power in the presidency, and for Tajikistan
    (excluding emergency food aid) to respond to the urgent need to
    secure its border with Afghanistan and promote reform. Funding
    has decreased in Uzbekistan, where the government has worked to
    actively limit United States assistance related to reform and
    in Kazakhstan, whose oil wealth lessens the need for our
    assistance. In Georgia and the Ukraine, we see increasing
    capacity and contributions from host governments, thereby
    justifying lower assistance levels.
        Senator Gregg. Well, I honestly can't believe that as head
    of the foreign assistance and head of USAID, you can't give me
    something--a specific rational for why we are--we have decided
    to turn away from those nations and move the dollars to other
    nations. Other nations seem to be such fertile ground for our
    capacity to develop stable nations and nations which have
    democracy, which have rule of law, and which are potentially
    significant allies in the war against fundamentalism.
        Ambassador Tobias. Well, it certainly isn't that we've
    decided to turn away from them; it's simply been a matter of
    taking the resources that are available and trying to make a
    determination about what is the best way to use those
    resources. But I will be very happy to respond on a specific
    basis on what the rationale was in each case.

             USAID ADMINISTRATOR AND DIRECTOR OF FOREIGN ASSISTANCE

        Senator Gregg. Well, it doesn't make sense to me that there
    was a rationale in each case, because it had to be a
    philosophical decision because it's so apparent that you have
    moved away from this region of the world and moved money into
    another region of the world, specifically Africa, it looks
    like. It was a regional decision; it wasn't country-by-country,
    I don't think, but certainly the dollars have been flying out.
    How do you divide your time between being head of foreign
    assistance and USAID?
        Ambassador Tobias. In a typical day, Senator, I start my
    day, when I'm in Washington, in the State Department and spend
    the morning, usually, in the State Department. Then at about
    lunchtime I go over to USAID and we set up the schedule for
    meetings and things over there for the afternoon.
        Some days I'm over there longer; some days I'm in the State
    Department longer, depending on what's going on on that
    particular day, but that's my basic plan.
        Senator Gregg. How does that work? I mean, that seems
    inherently disjointed.
        Ambassador Tobias. Well, I think it's working well. I think
    it will work even better a year from now, because when my
    predecessor was the head of USAID and there were two separate
    foreign assistance budgets, one for USAID and one for State
    Department foreign assistance, you'd have programs coming from
    different directions in a country. There was an enormous amount
    of coordination that needed to take place, and the
    Administrator of USAID spent an awful lot of time talking to a
    variety of people in the State Department in an effort to
    coordinate.
        I'm now talking to myself for those kinds of things, and I
    think the coordination is much easier and much better, so I
    think it's been a significant improvement.
        Senator Gregg. Should there even be more integration then?
    Should, I mean, the physical location of the two organizations
    be merged?
        Ambassador Tobias. Well, I would not favor that. I think
    that we need a strong USAID, we need a strong organization of
    professionals who are focused on foreign assistance who have
    chosen to focus their careers in that way, and I'm very, very
    proud of the people in the organization, for their dedication,
    their knowledge, and their hard work.
        At the same time, I think that we need to ensure that we
    have USAID strategically lined up with what the United States
    Foreign Policy interests are in the countries where we are
    working.
        I think on the ground, on a country-by-country basis,
    historically and currently, I think it's probably worked better
    than it has here in Washington, where the U.S. Ambassador is
    leading the U.S. Government team on the ground. The USAID
    Mission Director reports, in part to the Ambassador, and in
    part back here to USAID, but is the principal professional
    development person on the Ambassador's team, and the
    integration of what the U.S. Government is doing on the ground,
    you know, begins there.
        But in the planning process, and the coordination process,
    and the technical expertise and so forth that takes place in
    Washington, it's been more fragmented than it needs to be. But
    I don't think the solution would be to totally merge the two
    organizations.
        Senator Gregg. Thank you.

                    STATEMENT OF SENATOR CHRISTOPHER S. BOND

        Senator Bond. Thank you very much, Mr. Chairman, and I
    would say to you and ranking member Gregg that even though I
    spend a very large part of my time working on military defense
    matters and intelligence matters, I believe this committee is
    extremely important because the old saw that in a battle
    against ideology, it's 20 percent kinetic and 80 percent
    economic development, ideological, and this committee, I
    believe, has a much more important role than we have been able
    to recognize in the budget to achieve our goal through
    diplomacy and economic development. So I think this is
    extremely important, and I am very much concerned about some of
    the things that are going on, Mr. Ambassador. Excuse me. You
    wanted to say?
        Senator Leahy. I was just going to say I appreciate that.
    I, having served on the intelligence committee here, was the
    vice chairman of it, and you see a global view that the rest of
    us do not see, and I appreciate that very much.

                     AGRICULTURE DEVELOPMENT IN AFGHANISTAN

        Senator Bond. Well, thank you. I think our members of the
    intelligence committee would agree. But Mr. Ambassador, I have
    some real concerns about some of the specifics I've learned.
        A little over a year ago I was in Afghanistan. This year,
    Senators Mikulski, Hutchison, Brownback, Cornyn, and I are
    again requesting $20 million be made out of USAID's 2008
    foreign operations bill for the establishment of a U.S. land
    grant consortium to be led by Texas A&M to implement widespread
    training activities, to assist farmers to comprehensive level
    not being achieved, to teach them how to use best techniques to
    grow pomegranates and other alternative crops and set up
    independent credit cooperatives.
        Last year USAID totally ignored the congressional intent
    when we put in $5 million and the money was dribbled out to
    individual initiatives--underway with individual colleges. The
    intent of that money was, and still is, to strengthen a
    nationwide agricultural extension system through programs
    planned and delivered by people who have been working over 100
    years to help farmers in the United States.
        I remain concerned about what appears to be a deeply
    entrenched relationship between Kimonics and USAID and Kabul
    and DC. It's making it very difficult if not impossible for
    other proven contractors and even other NGOs from getting
    funds.
        I've spoken with a number of people inside and outside of
    Afghanistan who are trying to do some good and are extremely
    frustrated when they run into the monopoly between USAID,
    Kimonics, and other large USAID contractors. Some of those
    people, I will tell you, include our military commander in
    Afghanistan, a top expert from USDA Department of Agriculture
    who was there, and President Hamin Karzaj who told me that he
    wanted to have this assistance.
        I understand over the last 4 years USAID have gone through
    some $600 million on agricultural development in Afghanistan
    and had shown darn little for it.
        Now, I know it's easier to shovel out a couple of hundred
    million dollars to a big contractor, but when it's not getting
    the job done, what I want to know is: Why will you not take the
    time and make the effort to utilize resources where we can get
    volunteers from extension services, men and women who have been
    trained for years to help farmers, why you are not willing to
    accept this idea for Afghanistan?
        Ambassador Tobias. Senator, I'm a big supporter of the
    contributions that the land grant universities make. I just
    came back from Lebanon a few weeks ago where I saw a program
    where dairy farmers who had been selling their products on the
    side of the road 2 or 3 years ago, are now competing in global
    markets because of a USAID project that created a cooperative,
    and the expertise that has come from land grant universities in
    this country to help them have the skills they need to provide
    high-quality products.
        I'll take a fresh look at what we're doing in Afghanistan
    and see who all is involved, and whether or not there's more we
    can do, because----

                         FINANCIAL SERVICES VOLUNTEERS

        Senator Bond. I want a response for the record. I know in--
    I was in India about a year ago, and the President's
    agricultural knowledge initiative envisioned you using land
    grant colleges. What I want to know is why the hell we can't
    get you to follow congressional intent to start out on a small
    program in Afghanistan and save a whole bunch of money that
    nobody seems to know what good it has produced.
        I think this is--it's unbelievable that the amount of money
    that's been spent, and the apparent lack of any demonstrable
    progress. I think you can do a very good job if you'll work
    with volunteer organizations.
        By the way, that brings to mind, I had a visit recently
    from some of the outstanding leaders who had the Financial
    Services Volunteer Corp. These are experts in financial
    systems, banking from--some volunteers from our largest banks,
    from accounting institutions. They have worked in countries
    to--they developed the currency for Afghanistan. They were
    working in Indonesia to help them develop a system for
    countering money laundering.
        They have--they bring on a volunteer basis, with just
    support services needed, the expertise of our top financial
    professionals in the United States, the countries who need that
    help. They tell me that they are not getting funding anymore
    from USAID, and I would like to know why a dedicated group of
    professionals who are doing a highly sophisticated job for
    countries that need it, are being shut out. Do you know what
    the reason is?
        Ambassador Tobias. No, I don't, Senator, but I'll take a
    good look at that. I'm familiar with the organization, but----
        Senator Bond. I mean, they had John Whitehead, they've had
    other top professionals, and I'm just dumbfounded that you
    wouldn't be looking, looking for pools of volunteers that could
    help like that. Thank you, Mr. Ambassador. Thank you, Mr.
    Chairman.

                         FOREIGN ASSISTANCE BUDGET CUTS

        Senator Leahy. Thank you very much. I have some of these
    same concerns about grants going just to a small handful of
    contractors, big contractors who also have lobbyists here in
    Washington, and then it closes out others who often have very
    innovative and very good ideas.
        Now, the changes you've made to the budget process may be
    more coherent and transparent, but I'm mystified by some of the
    results. Take a country like Colombia that has received roughly
    a half a billion dollars, $565 million, in each of the past 5
    years. They get the same amount this coming year, although we
    know a number of things that have not worked. We know
    conditions in Colombia have changed.
        We know that the idea of stopping cocaine from coming into
    America has been basically a failure. The price of cocaine and
    availability is the same today as it was before we took
    billions of dollars out of programs that might've stopped
    people from using cocaine, put it into Colombia to stop it from
    coming in here.
        In Nepal, a country where years of fighting has cost
    thousands of lives, there's a chance to end the Maoist
    insurgency and bring democracy to replace a feudalist system,
    but you propose to cut our assistance.
        Democratic Republic of the Congo, a huge country. I can't
    think of many places that have more problems, but they had
    their first election in 40 years. It holds the key, I think, in
    many ways to the future of all of central Africa, and is very
    important to us. You want to cut our assistance.
        Certainly other countries, like China and others, seem to
    be ahead of us in realizing its importance but you propose to
    cut our assistance there.
        Vietnam, a country of 80 million people that is trying to
    build closer ties with the United States and the President
    actually went there last fall. With the exception of HIV and
    AIDS, you're going to cut our assistance there.
        Congress has tried to increase funding for global
    environment programs which have bipartisan support,
    particularly biodiversity in the Amazon. Central Africa where
    forests are being destroyed at breakneck speed. I mean, in 5
    year's time what may have taken 400 or 500 years before, you're
    slashing funding for those programs.
        Last year you said our intent is not to have a USAID budget
    or State Department budget, but a foreign assistance budget
    that would make all of it more coherent in a way that all of us
    could better understand.
        I'm all for that, but what good is coherence if it produces
    illogical outcomes? I mean, what do people say in the field? It
    certainly doesn't reflect what a lot in Congress and both
    parties have been saying. What is the thinking behind these
    outcomes?
        Ambassador Tobias. Senator, you are making very eloquently
    the point that I would hope to make this morning, and that is
    that I'm very, very hopeful that this year the Congress will
    not cut the administration's fiscal year 2008 request for
    foreign assistance, because we need every penny.
        If I take the $20.3----
        Senator Leahy. If I might, and I apologize for
    interrupting, but you know, we need every penny, but I want to
    know where it's spent.
        I've had times up here when we've had grandiose proposals
    for budgets in various administrations knowing that there's no
    money for the things that many people feel we should have and
    somehow we have to find the money. At Millennium Challenge
    there's huge amounts of money in the pipeline. I think you have
    to admit that started off with a very, very slow start.
        Ambassador Tobias. Well, if I take the $20.3 billion in the
    request for foreign assistance, and if I back out of that the
    Global AIDS Initiative, and if I back out of that the
    approximate $1.8 billion in funding request for those
    contingency accounts that will be allocated as we go through
    the year, like emergency food aid, and refugee assistance, and
    that kind of thing, and then if I take the 31 largest country
    programs, which I think tend to be less controversial, and
    represent those programs at $50 million or higher, I'm left,
    out of that $20.3 billion, with $3.6 billion to spread over the
    124 remaining country programs.
        So we have made some very, very difficult decisions in
    allocating this budget. We have tried to do it in a far more
    transparent way than it has ever been done historically, with a
    level of detail that neither the Congress, nor the
    administration has had access to in the past, so that as we
    continue our dialog we can determine why the decisions were
    made in putting this budget together, and understand where we
    did not get it right. What are the things that we may need to
    think about in different ways?
        But this has been a very conscious good-faith effort to try
    to be sure that each country's program is driven by what people
    on the ground in that country and here in Washington believe,
    given the resources available, can make the most difference in
    moving that country on a path toward independence.
        Senator Leahy. Well, what are the five countries that get
    the most money?
        Ambassador Tobias. Let's see. They are Israel, Egypt,
    Afghanistan, Pakistan, and Sudan.
        Senator Leahy. Sudan gets more money than Iraq? Or are we
    talking about----
        Ambassador Tobias. Israel, Egypt, Afghanistan, Pakistan,
    Sudan, South Africa, Colombia, Kenya, Nigeria, Jordan,
    Ethiopia, and Iraq. I'm talking there about the 2008 budget
    request.
        Senator Leahy. Well, maybe we have different ways to count
    how much goes into Iraq. I noticed recently the President cut
    funds for the cops program but we're adding increased money for
    police forces in Iraq. I heard in the paper today that we've
    trained them so well they went in and killed 40 people as
    revenge killings, the police did, today in Iraq.
        Anyway, my time's up. Let me yield to Senator Gregg. We're
    all trying to do the same thing. I'm just worried that we spend
    an awful lot of money in places where we aren't getting much
    out of it, and there's been too little in places where we have
    a great potential.
        Ambassador Tobias. Well, Senator, I share that concern and
    that's why we are trying, on the one hand, to make the most
    conscientious effort we can to be sure that we are spending the
    money in the most appropriate, effective way we can, and to lay
    out the data as transparently as possible so that we will all
    know how those decisions are made, and I think it will be
    easier for us to collaborate going forward as to what we ought
    to be doing.

                         ASSISTANCE FOR THE MIDDLE EAST

        Senator Gregg. Can you read those five countries again?
    Egypt, Israel--the five countries that have the highest? Egypt,
    Israel----
        Ambassador Tobias. Israel, Egypt, Afghanistan, Pakistan,
    and Sudan.
        Senator Gregg. How much money have we given to Egypt over
    the last 20 years?
        Ambassador Tobias. The 2008 request is $1.720 billion.
        Senator Gregg. What's the total we've given to Egypt and
    Israel in the last 20 years?
        Ambassador Tobias. U.S. assistance to Egypt and Israel has
    been governed by similar ``glidepath'' agreements since 1998.
    The agreement between the U.S. Government and the Government of
    Egypt established steady Foreign Military Finance (FMF)
    assistance at roughly $1.3 billion per year. In contrast,
    Economic Support Fund (ESF) assistance has declined $40 million
    per year from a starting level of $815 million in 1998.
        In the 10 years prior to the signing of the glidepath
    agreement (1988-1998), the United States obligated
    approximately $24 billion of economic and military assistance
    to Egypt. We have provided approximately $19 billion to Egypt
    since the signing of the glidepath agreement in 1998. This
    total includes fiscal year 1999 levels through the fiscal year
    2008 request, if fully funded. The share of Peace and Security
    assistance as a share of total assistance has increased from
    approximately 61 percent in 1998 to 73 percent in 2007. Peace
    and Security assistance funds primarily Egyptian purchase of
    U.S. military equipment to shift Egyptian orientation to the
    United States and to increase our interoperability.
        The agreement expires in 2008, and we are currently working
    with both Israel and Egypt on what the future may hold with
    regard to foreign assistance levels.
        Senator Gregg. So there's a lot of money going to the same
    places over and over again.
        Ambassador Tobias. That's right.

                        MILLENNIUM CHALLENGE CORPORATION

        Senator Gregg. But there's not a lot of money to places
    where we might have an opportunity to do some significant
    activities, such as we talked about earlier, the Former Soviet
    Republics. How much money is in the Millennium Challenge right
    now?
        Ambassador Tobias. I'm sorry?
        Senator Gregg. How much money is in the Millennium
    Challenge right now?
        Ambassador Tobias. I think their request, which is separate
    from the $20.3 billion, I believe their request in the budget
    is $3 billion in the 2008 budget.
        Senator Gregg. Do you know how much is unspent?
        Ambassador Tobias. No, I don't. I don't.
        Senator Gregg. How many countries qualify for the money in
    Millennium Challenge?
        Ambassador Tobias. I don't know. I don't think I have that
    data.
        Senator Gregg. I mean, do you expect any more countries to
    come on line and qualify for the Millennium Challenge in the
    near future?
        Ambassador Tobias. Well, there are a number of countries
    that are working hard to meet the MCC requirements. There are
    several countries who are in a so-call threshold status where
    we are funding threshold programs to work with them to get them
    to the point where they will meet the criteria, and yes, I
    would expect there will be more countries coming on board.
        Senator Gregg. You don't know who's in line, though, do
    you?
        Ambassador Tobias. No, I don't.
        Senator Gregg. I notice you've got Laos listed as something
    above the lowest category of nations where it seems to me it's
    a pretty repressive nation. Shouldn't it be lumped in there
    with Cuba and North Korea and----
        Ambassador Tobias. Well, these designations are determined
    by a lot of indicators that come from various organizations
    like Freedom House, and the World Bank, and so forth, and they
    fall where they fall.
        Senator Gregg. The State Department doesn't have any role
    in making those designations?
        Ambassador Tobias. Well, we have used a set of indicators,
    but the purpose of that categorization is to try to give us a
    sense of the kinds of development interventions that we likely
    need to be using in each of these categories of countries.
    Obviously in countries like that, we would expect that more of
    our effort would be focused on democracy programs.
        Senator Gregg. Well, I wish you'd go back and explain to us
    why Laos and Sudan are not in the restrictive category. I just
    don't see how either of those elements could possibly not be in
    the restrictive category. The import/export bank, what's the
    status in that?
        Ambassador Tobias. Senator, that's beyond my area of focus
    and expertise. I'll be happy to pursue anything that you'd like
    for me to, but I'll have to do that for the record.

                                  AFGHANISTAN

        Senator Gregg. Okay. We've now spent how much money in
    Afghanistan?
        Ambassador Tobias. Since 2001 through fiscal year 2006, the
    U.S. Government has provided over $14.2 billion in foreign
    assistance to Afghanistan. Of this amount nearly $9 billion has
    gone for security assistance and $5.2 billion for
    reconstruction, humanitarian and governance assistance.
        Senator Gregg. Well, what are we spending the money on?
    Let's try it this way. How are we spending the money in
    Afghanistan?
        Ambassador Tobias. A lot of the money is going into
    building infrastructure that will help the economy. There's
    been a lot of money going into roads, a lot of money going into
    electricity, money going into programs to provide and enhance
    the capacity and capability of the government ministries.
        I have visited programs in Afghanistan out in the rural
    areas where we're teaching farmers, who have been former poppy
    growers, the skills to grow alternative crops. We have programs
    where farmers who have been poppy growers are being taught to
    be electricians, or plumbers, or other skills that can give
    them a livelihood in other areas.
        Senator Gregg. Do we expect that you're going to change the
    forces of the marketplace in Afghanistan and cause people to
    stop growing poppies when it's the most lucrative crop?
        Ambassador Tobias. Well, that's probably one of the most
    difficult issues in Afghanistan, and there's a hard look being
    taken right now at the whole poppy issue to look at what we've
    been doing, what's worked, what has not worked, what lessons
    can we learn from other places in the world.
        I just visited a program in Peru a couple of weeks ago
    where villagers that are growing coca leaves, it's made very
    clear to them that their coca plants are going to be
    eradicated, but if they are willing to band together and sign a
    compact with the government that they're going to get out of
    the coca plant business, then we are working with them to
    address other issues that may improve the quality of life in
    those villages--building a school, building a health clinic,
    whatever kinds of things that the village may think is a
    priority, and----
        Senator Gregg. Is that in Afghanistan?
        Ambassador Tobias. That's in Peru, but the program's been
    very successful and we're not doing that in Afghanistan but
    we're looking at that as something to take to Afghanistan as an
    example.
        Senator Gregg. I'd be interested in knowing to what extent
    the poppy growing has been abated by the dollars we've spend in
    Afghanistan. Do we have any studies to that?
        Ambassador Tobias. The United Nations Office on Drugs and
    Crime published a report in February 2007: Afghanistan Opium
    Winter Rapid Assessment Survey. With increasing ties between
    narcotics traffickers and elements of insurgency in southern
    Afghanistan, poppy cultivation in the South has increased. In
    contrast, a mixture of political will and incentives and
    disincentives, such as eradication programs funded by the U.S.
    Government, contributed to a decline in opium cultivation in
    the Northern provinces. As a result, several Northern provinces
    with very low amounts of poppy are well on their way to
    becoming poppy free.
        Senator Gregg. What percentage of our dollars--we've spent
    somewhere in the vicinity of $3 billion in Afghanistan--what
    percentage of those dollars have been directed at poppy-growing
    suppression?
        Ambassador Tobias. Since 2001 through fiscal year 2006, the
    U.S. Government has provided over $14.2 billion in foreign
    assistance to Afghanistan. Approximately 9.5 percent has been
    provided for counter narcotics.
        There are other areas in Afghanistan where we can look at
    the things we've been doing and there's been significant
    progress. School enrollment in the Taliban time was about
    900,000 people, it's now about 5 million. When the Taliban was
    there, about 8 percent of the Afghan population had access to
    healthcare; it's now about 80 percent. It used to take 15 hours
    to get from Kabul to Kandahar; it now takes about 6 hours on
    the highway that's been built.
        The economy in Afghanistan has gone from about $2.5 billion
    to $.4 billion at the time the Taliban was there, to about $8.8
    billion now, so there are a number of areas where we're making
    progress, but the drug part of the equation has not been, and
    that's why we're all taking a very hard look now at what's
    failed, and what's worked, and how can we do better.
        Senator Leahy. Afghanistan is a difficult case. We've made
    colossal mistakes in the past and again, you know, if you're
    anti-communist, so we arm the Taliban with a lot of weapons
    that they're still using. We get them Stinger missiles to go
    after--or shoulder-fired missiles to go after the Russians. I
    don't know if those things deteriorate after a while, but a lot
    of them they never turn back in, obviously, and still have.
        You say some things have worked and some haven't. If you're
    in an area where the Taliban has control, I don't know of any
    program that works. We did build the highway and I think that's
    good news, but the fact of the matter is most of the economy
    you've talked about is in the Kabul area.
        Some have said that President Karzai is really president of
    Kabul, not of Afghanistan, and that there is lawlessness
    outside. I would like to see everybody go to school. I want to
    see both boys and girls go to school, and it is hard to find a
    country that is more oppressive toward women than Afghanistan
    under the Taliban, but I'm afraid that a lot of that power is
    still with the Taliban.

                                     EGYPT

        In your budget justification--and I was thinking of this as
    I read some of the press in the last few days--you say that the
    U.S. Government supports the enactment of the political reforms
    outlined by President Mubarek during the 2005 presidential
    campaign, namely replacement of the emergency law with a modern
    counter-terrorism law, revision of the modernization law
    governing the judiciary, revision of the media law to expand
    press freedom, revision of the penal code to narrow the power
    of authorities to hold people without charge, and parliamentary
    input on broader constitutional reform. Any one of those
    happen?
        Ambassador Tobias. Well, we've been working very hard with
    the Egyptian Government in a variety of ways.
        Senator Leahy. I've talked to President Mubarek a number of
    times.
        Ambassador Tobias. Oh. I'm sorry. I misunderstood what you
    said.
        Senator Leahy. Because I've talked to President Mubarek a
    number of times. Everybody, and they're most gracious people,
    friendliest, they'll always talk to you, but name anything
    that's happened. We pour a huge amount of money in there. Name
    anything that's happened. I mean, any reforms, whether of the
    judiciary, or press freedom, any reform of political parties,
    any reforms in arresting people without charge? I mean, there
    may have been, I just totally missed it.
        Ambassador Tobias. Well, there's been some recent reforms
    in the financial services industry, for example, where they've
    gone from monopoly, a government-owned bank, to a more
    competitive banking industry, and our people there are working
    very hard with reform-minded people inside and outside the
    government.
        Senator Leahy. What has that done for people's rights?
        Ambassador Tobias. I'm sorry?
        Senator Leahy. What has that done to improve anybody's
    rights?
        Ambassador Tobias. Well, I think as the economy has grown
    and as civil society has grown, that has certainly put people
    on a journey in the right direction, but there's much, much
    more to do.
        Senator Leahy. You said puts them on a journey. If you're
    the person being thrown in an Egyptian jail because you dared
    speak out against the government, you're not on a journey in
    the right direction.
        We haven't had the right to legal counsel strengthened, we
    haven't had the media law expanded for press freedom, we have
    not had revision of the modernization law governing the
    judiciary. I don't see where the emergency law has been
    replaced. I don't see that they have narrowed the power to hold
    people without charge. Tell me honestly. Do you feel there's
    forward progress in Egypt?
        Ambassador Tobias. I think there is in some areas, but I
    think there's a great deal more to do, and I think it's
    important to ensure that the money we're spending and that the
    programs that we have in place are tied to clear expectations
    about what we believe ought to happen in that partnership, and
    lots of people are working very hard on those issues.
        Senator Leahy. I know they're working very hard. We have a
    huge embassy there, we've got all kinds of people running
    around, and it's wonderful--it adds to the traffic jams in
    Cairo, and I know they're dedicated people, but I don't see
    where we're getting a heck of a lot for our dollar there.
        I understand there are political considerations in sending
    money there, but we don't have money for other things. Senator
    McConnell and I worked to expand programs to strengthen the
    rule of law in China. Your budget justification, the fiscal
    year 2006 level for these programs was $1.1 million. In fiscal
    year 2006 we provided $20 million in the human rights and
    democracy fund for China, Hong Kong, and Taiwan. Where did that
    money go? Certainly the administrative cost wasn't $19 million
    out of that $20 million. How come there's only $1.1 million in
    there?
        Ambassador Tobias. I don't know the details of that
    program, but----
        Senator Leahy. I'm sure you're going to want to get me an
    answer.
        Ambassador Tobias. Well, what my effort is really focused
    on is trying to go forward and ensure that you know and we know
    exactly what we're proposing the money be used for, and that we
    have a very transparent way of measuring that, and that we're
    doing the best job we can focusing it.

                                      IRAN

        Senator Leahy. If the transparency is there, somebody let
    me know where the money went. I mean, when we went from $20
    million to $1 million, just what's happened. You propose $75
    million for Iran to support human rights defenders, labor
    activists, women, student, religious, ethic, minorities, rule
    of law and justice programs. Heck, I'd love to see money for
    all those things, but in Iraq if you accept money from the
    United State you become a target. Won't the same thing happen
    to Iran?
        Ambassador Tobias. Well, I think there are probably a lot
    of brave people who are willing to engage and take that risk.
    Some of that money is in----
        Senator Leahy. Take money from the United States?
        Ambassador Tobias. I'm sorry?
        Senator Leahy. Willing to take money from, as they call it,
    the Great Satan?
        Ambassador Tobias. Well, some of the money in that program
    is intended to develop a new independent media in order to
    reach the people of Iran with messages, and news, and
    information that's----
        Senator Leahy. Inside Iran?
        Ambassador Tobias. Probably not.
        Senator Leahy. I'm all for getting more media in there, and
    I understand--I've not been to Iran--but I understand from
    people I know and respect who've been to Iran that there's a
    great deal of interest in the United States. I have other
    questions for the record.
        Some of these questions Senator Gregg and I and Senator
    Bond ask, we're not trying to play ``gotcha,'' we're just very
    concerned where the money goes. I understand some of the
    political considerations; every administration's had political
    considerations. But it's one thing to speak of lofty goals;
    it's another to affect the people on the ground. I'd like to
    see more competition among those who seek these kind of grants.
        Ambassador Tobias. One of the considerations that I have
    put into the country Operational Plan Process is that any
    country where the U.S. Government program is spending more than
    15 percent of its resources with a single source, I want to see
    it put on the table and justified as to why we're doing that.
        Now as you said, in some cases where people are shorthanded
    and operating expenses have been cut, it's easier to administer
    1 big contract rather than 10 small contracts. We, the Congress
    and the administration together, need to address that, and be
    sure that people have the tools to be able to operate with a
    lot more and newer participants and I'm trying pretty hard to
    do that.
        Senator Leahy. Especially among those 10 separate
    contracts, there may be three or four that are really going to
    hit the mark and would be a model for elsewhere.
        Ambassador Tobias. Yes.
        Senator Leahy. Okay. Well, thank you. I will place the rest
    in the record. I thank you for being here. You have one of the
    most difficult jobs in Government and I don't envy you that at
    all. Thank you.
        Ambassador Tobias. Thank you, Senator.

                              SUBCOMMITTEE RECESS

        Senator Leahy. Thank you all very much. The subcommittee
    will stand in recess to reconvene at 10:30 a.m. on Wednesday,
    April 18, in room SD-138. At that time we will hear testimony
    from Dr. Kent R. Hill, Assistant Administrator, United States
    Agency for International Development.
        [Whereupon, at 11 a.m., Thursday, March 28, the
    subcommittee was recessed, to reconvene at 10:30 a.m.,
    Wednesday, April 18.]

      STATE, FOREIGN OPERATIONS, AND RELATED PROGRAMS APPROPRIATIONS FOR
                                FISCAL YEAR 2008

                                  ----------

                           WEDNESDAY, APRIL 18, 2007

                                           U.S. Senate,
               Subcommittee of the Committee on Appropriations,
                                                        Washington, DC.
        The subcommittee met at 10:30 a.m., in room SD-138, Dirksen
    Senate Office Building, Hon. Patrick J. Leahy (chairman)
    presiding.
        Present: Senator Leahy.

               UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

                            Bureau for Global Health

    STATEMENT OF DR. KENT R. HILL, ASSISTANT ADMINISTRATOR

                 OPENING STATEMENT OF SENATOR PATRICK J. LEAHY

        Senator Leahy. I apologize for being late. It's not often
    we have this distinguished a panel. We had votes that were
    supposed to have been earlier today, partly to accommodate this
    hearing, and then as sometimes happens in the Senate, things
    slipped.
        This hearing focuses on the aspects of our global health
    programs which address the core public health needs of the
    world's poorest people. I think of when children of people in
    my office, or my own grandchildren, get immunizations and it is
    a routine thing, and I think of so many children around the
    world where this does not happen, for them or their families.
        The chart on my right shows funding for HIV and AIDS, which
    has--for obvious reasons, and with bipartisan support of this
    subcommittee--increased dramatically in recent years, but
    funding for maternal and child health, and family planning and
    reproductive health, has languished.
        I don't want this to be an either/or thing, by any means.
    But, I am concerned, when you consider what a difference these
    programs make, and what we take for granted in our own country.
        Over the past 30 years, expanded immunization programs,
    often costing only pennies a child, have saved millions of
    lives. Family planning and reproductive health programs have
    also made enormous differences in child survival and women's
    health. USAID has been in the forefront of these efforts.
        But despite the great progress and countless lives saved,
    11 million children--11 million children under age 5--die each
    year, mostly from easily preventable and treatable causes, like
    diarrhea, pneumonia, or measles. Eleven million children each
    year--that's about 20 times the total population of my State of
    Vermont. Twenty times. That's each year.
        The administration's fiscal year 2008 budget request for
    these programs is $373 million, but that's compared to $420
    million in fiscal year 2007. An estimated 200 million women
    still lack access to family planning. Half a million yearly
    maternal deaths would be prevented with basic reproductive
    health services. The administration's budget request for these
    programs is $325 million, compared to $436 million in fiscal
    year 2007.
        What I worry about is we're short-changing the programs
    that have a proven and long history of success. We're also
    witnessing an alarming exodus of health professionals from
    developing countries, to higher-paying jobs in industrialized
    countries. The short- and long-term consequences of this brain
    drain, coupled with the deaths of countless health workers from
    AIDS, are staggering.
        I think of a country as great and powerful as the United
    States, and a country that has great economic means, that
    spends far less on maternal and child health, and on family
    planning and reproductive health for the world's 2 billion
    poorest people than we spend for the same purposes in the State
    of Vermont, with 625,000 people. We are far from being a
    wealthy State. I think most Vermonters would find that
    unacceptable, and I hope most Americans would find it
    unacceptable.
        Dr. Hill, who is the Assistant USAID Administrator for
    Global Health, will describe the administration's request.
        Dr. Helene Gayle is currently the President of CARE, one of
    the country's leading organizations fighting global poverty.
    She previously headed USAID's HIV/AIDS programs, and at the
    Gates Foundation she was the Director of HIV, TB, and
    reproductive health. Dr. Gayle and I have had discussions
    before, and my wife has, too, with her, and we consider that a
    privilege.
        Laurie Garrett is Senior Fellow for Global Health at the
    Council on Foreign Relations. Her Pulitzer Prize-winning book
    ``The Coming Plague'', and her recent book ``Betrayal of Trust,
    the Collapse of Global Public Health'', should be read by every
    Senator, and every House Member, for that matter.
        Dr. Nils Daulaire is an old friend from my own State of
    Vermont, he's President of the Global Health Council, and after
    serving as USAID's Senior Health Advisor, he has been a friend
    and advisor to me and to others.
        So why don't we start with Dr. Hill, and place your full
    statement in the record. I wonder if you might sum up in 5 or 6
    minutes. Then we will go to Dr. Gayle, and Ms. Garrett, then
    Dr. Daulaire.

                       SUMMARY STATEMENT OF DR. KENT HILL

        Dr. Hill. Thank you, Chairman Leahy. I want to thank you,
    first of all, for holding this hearing, for your personal
    passion on these issues, which has been evident for so many
    years, and for the opportunity to testify with my esteemed
    colleagues and friends about these important issues.
        As you're well aware, over many years USAID has contributed
    to impressive reductions in child and maternal mortality, and
    in helping women and couples achieve the size of family they
    desire. In the process, we have strengthened health systems,
    built the capacity of developing countries to reduce maternal
    and child deaths, and provided basic health services.
        Maternal and child health, and family planning are often
    seen as separate and distinct, vertical and disconnected. But
    USAID is working very hard to integrate our programming, an
    approach that promotes efficiency and sustainability.
        I will talk about maternal and child health, and family
    health planning separately, but I do so only for ease of
    presentation--as they are, in fact, implemented in an
    integrated fashion in our country programs.
        Mothers and their young children bear a disproportionate
    share of the burden of diseases and preventable mortality in
    developing countries each year. More than 500,000 women die of
    complications of pregnancy and childbirth.
        Women in sub-Saharan Africa have more than a 150-times
    greater risk of dying in childbirth over a lifetime than women
    in the United States. Our programs focus on interventions
    targeting the high mortality complications of pregnancy and
    birth that account for two-thirds of maternal mortality; this
    would be hemorrhage, hypertension, infections, anemia, and
    prolonged labor.
        In USAID-assisted countries, skilled birth attendance has
    increased from an average of 37 percent in 1990 to 50 percent
    in 2005. Ten USAID-assisted countries have reduced maternal
    mortality by 33 percent on average over a decade, demonstrating
    that substantial progress is achievable.
        In this chart, which I won't detail for you, you can see
    all the lines going down; these are all countries that, over 10
    years, have seen a substantial decline in maternal mortality.
        But, every year, 3.7 million newborns fail to survive even
    the first month of life. Newborn mortality has not been reduced
    as much as mortality among older infants and children, making
    it the unfinished agenda of child survival.
        Let me now turn to child survival. Twenty years ago when
    USAID and UNICEF launched the Child Survival Revolution with
    the support of Congress, an estimated 15 million children in
    the developing world died every year. Without action, the
    number of deaths today would be more than 17 million each year.
        Instead, as a result of global child survival efforts, by
    2005, the number of child deaths was reduced to about 10.5
    million--still far too many, but representing more than 6
    million childrens' lives now being saved every year.
        Over the past 20 years, the United States has committed
    more than $6 billion to this effort, which has yielded public
    health successes at an unprecedented global scale. For example,
    almost 1 billion episodes of child diarrhea are treated with
    oral rehydration therapy each year, reducing deaths from
    diarrhea by more than half since 1990. More than 100 million
    children receive basic immunizations every year. More than 75
    million cases of child pneumonia receive treatment. Child
    malnutrition has been reduced by 25 percent, from 1 in 3 to 1
    in 4. An estimated 5 million children have been saved from
    death from paralysis through the polio eradication initiative.
    Finally, 500,000 children were saved last year by micro-
    nutrition supplementation.
        These accomplishments are not attributable to USAID alone.
    Yet, as the graph to my left shows, in almost 30 countries with
    sustained USAID investment in child survival, we have seen
    significant reductions in mortality of children under the age
    of 5. The takeaway here is that the lines that are higher, in
    blue, are 1990, and the red shows what it's been reduced to.
    Wherever we've had a chance to work on these issues, we have
    been able to make a tremendous difference.
        These are great accomplishments. But even greater
    challenges remain, such as saving the lives of the more than 10
    million children who still die each year. I appreciate the
    chairman mentioning that fact--we must focus on the work left
    to be done.
        As the next graph shows, over two-thirds of the remaining
    child deaths--6.5 million--are preventable. Now, I want to make
    a point here. You saw the 15 million that were dying in the
    Eighties; you can see how many would be dying today if we did
    not act and that is 17 million. You see the number, the 10.5
    million that are still dying. Despite saving the lives of 6.5
    million, the point I want to make is the next one. Of that 10.5
    million, two-thirds of those deaths can be averted through
    proven interventions. Only 4 million of that 17 million
    represent things that would be very tough for us to get at.
        Now, to be sure, a lot of that remaining work is in remote
    areas and would cost a bit more, but it is what we ought to aim
    at. By replicating our best practices, I hope some of this came
    through. Anyway, by replicating our best practices and new
    approaches and interventions, we believe that it is possible to
    achieve reductions of 25 percent in under 5 years and maternal
    mortality in most of these countries by 2011.
        Now, let me turn to family planning for a minute. USAID and
    Congress's joint support for family planning has resulted in
    many successes since 1965. The use of modern family planning
    methods in the developing world has increased by a factor of
    four, from less than 10 percent to over 40 percent in the 28
    countries with the largest USAID-sponsored programs. The
    average number of children, per family, has dropped from more
    than six to less than four. Enabling women and couples to
    determine the number and the timing of their births has been
    crucial in preventing child and maternal deaths, improving
    women's health, reducing abortion, preserving often scarce
    resources, and ensuring a better life for individuals and their
    communities.
        To be sure, the United States is the largest bilateral
    donor and the acknowledged world leader in advancing and
    supporting voluntary family planning services.
        Because of our success, we are now able to address those
    countries with the greatest need for family planning and have
    strategically shifted our resources to do so. Many countries in
    Africa, for example, are characterized by low rates of
    contraceptive use, high fertility, and high unmet need for
    voluntary family planning.
        Between 1994 and 2000, there were nearly 39 million
    unintended pregnancies in Africa, and 24 percent of the women
    there expressed an unmet need for family planning. Nearly half
    of the world's maternal mortality occurs in Africa. As you can
    see in this particular chart, the unmet need is highest in sub-
    Saharan Africa, but it is very great in areas of Asia, the
    Middle East, Latin America and Central Asia. To be sure, we try
    to graduate countries, and we have done so successfully.
        One final issue, perhaps, deserves our attention and that
    has to do with the ``brain drain.'' One challenge that faces us
    is the movement of trained healthcare providers away from the
    developing countries into more developed countries, commonly
    referred to as a ``brain drain.''
        USAID is trying to deal with this, and deal with health
    worker retention, in almost every country in which we work by
    strengthening in-service training, by reinforcing supervision
    systems so that they provide positive support to these workers,
    and by instituting quality improvement methods. This won't
    completely solve the problem, but this is what we have to work
    very hard on. There has been an increase in retention in places
    like Ghana, Namibia, and Uganda.

                               PREPARED STATEMENT

        USAID-supported maternal-child health programs and family
    planning programs have a proven success record. Our support has
    reduced under-5 mortality in almost 30 countries and maternal
    mortality in 10 countries. USAID-supported family planning
    programs have been successful in increasing access to and use
    of modern contraceptives in all regions of the world. We now
    have program approaches and interventions that will allow us to
    build on these successes. We have the experience to do it, and
    with the continued support of Congress, we will be able to
    contribute to further gains in maternal and child health, and
    family planning throughout the developing world.
        Thank you very much.
        [The statement follows:]

                     Prepared Statement of Dr. Kent R. Hill

                                  INTRODUCTION

        Chairman Leahy, Senator Gregg, and other distinguished members of
    the Committee, I would like to thank you for convening this important
    hearing and for inviting me to testify. U.S. development assistance has
    brought dramatic improvements in health, income advancement, and
    education to much of the developing world in the last 50 years. Average
    life expectancy in low and middle-income countries increased
    significantly during this same period. Good public health underpins
    these advances. Indeed, research findings and country experience have
    demonstrated an inextricable link between investments in improving
    individual and collective health status and a nation's economic
    development and performance. Many of these advances are due, in large
    part, to your continued support for maternal and child health and
    reproductive health programs.
        USAID has a proven track record that has contributed to impressive
    reductions in child and maternal mortality and in helping women and
    couples achieve the size of families they desire in all regions of the
    world. Our support has helped to reduce under-five mortality in almost
    30 countries and maternal mortality in ten countries. USAID-supported
    voluntary family planning programs have been successful in increasing
    access to and use of modern contraceptives in all regions of the world.
    In the process, we have strengthened health systems and built the
    capacity of developing country institutions to reduce preventable
    maternal and child deaths and provide basic health services. Your on-
    going commitment and support for maternal and child health has been and
    is critically important. As I often remind my staff, it is a great
    privilege to have work to do which matters, which saves lives of
    children and mothers, and it is you in the Congress whose compassion
    and support makes this work possible. And I want to express my great
    appreciation to you for this.
        In talking to you about our work in improving maternal and child
    health (MCH) and family planning and reproductive health (FP/RH), I
    would like to focus on five key points:
      --Our programs have a proven record of success.
      --Despite real progress, our work is not done.
      --We have pioneered program approaches and continually develop new
            interventions that have made and will make a difference in our
            progress.
      --There are crucial opportunities to accelerate progress.
      --We can take advantage of these opportunities by capitalizing on
            existing resources and by focusing on key countries.
        Maternal and Child Health and Family Planning are often seen as
    separate and distinct--vertical and disconnected. But USAID is working
    to integrate our programming to the fullest extent possible, an
    approach which increases the affordability and sustainability of our
    global efforts to tackle these important public health challenges. For
    example, we are making substantial progress integrating our programs
    for women and children and building consolidated platforms such as
    antenatal care and community-based distribution approaches for family
    planning, child vaccinations, and other important health interventions.
    Most of our missions already support integrated MCH/FP programs and
    help to build broad-based health systems. These programs strengthen
    drug management, supervision, community outreach, and other critical
    systems needed to deliver basic public health services.
        In all our health programs, including MCH and family planning and
    reproductive health, we work to build human and organizational
    capacity, including taking steps to address the so-called ``brain
    drain.'' Our programs help strengthen human resources to implement
    quality health care services through workforce planning, allocation,
    and utilization; strengthened systems for sustained health worker
    performance on the job; and training of health professionals. While, as
    a development agency, we cannot affect recruitment policies of the
    developed world, we are working on ways to keep health workers in their
    countries by working with governments on developing appropriate
    incentives, providing clear and equitable career paths, and offering
    continuing education and professional development. Other projects also
    work to strengthen management systems and increase leadership capacity.
        By strengthening and building upon common service delivery
    platforms, we help to support the specific goals of new high-intensity
    initiatives like the President's Emergency Plan for AIDS Relief
    (PEPFAR) and the President's Malaria Initiative (PMI), and therefore
    advance countries' ability to deliver the full range of health
    services.
        I will talk about MCH and FP in separate sections, but I do so only
    for ease of presentation, as they are implemented more and more in a
    fully integrated fashion in country programs.
        Using cost-effective tools and approaches, USAID and its
    international development partners have an unprecedented opportunity to
    accelerate progress in MCH and family planning, leading to further
    reductions in maternal and child mortality and unintended fertility.

                MATERNAL, NEWBORN, AND CHILD SURVIVAL AND HEALTH

        To achieve impact in maternal, newborn, and child health, USAID has
    consistently applied an approach that focuses on:
      --working with countries having high burdens of maternal and child
            mortality and malnutrition;
      --developing and delivering high impact maternal and child health
            interventions such as increasing skilled attendance at birth,
            control of post-partum hemorrhage, oral rehydration therapy
            (ORT), immunization, and vitamin A;
      --bringing these interventions as close as possible to the families
            who need them;
      --supporting results-oriented research to develop new interventions
            and strengthen programs;
      --monitoring progress; and,
      --strengthening the capacity of countries and communities to save the
            lives of their own women and children.

                          MATERNAL AND NEWBORN HEALTH

    The burden of maternal and newborn mortality and disability
        Each year more than 500,000 women die of complications of pregnancy
    and childbirth. Indeed, this is the second most common cause of death
    of women of reproductive age. While the number of deaths is disturbing
    enough, it is estimated that an additional 15-20 million women suffer
    debilitating consequences of pregnancy. Pregnancy-related mortality
    shows the greatest inequity of all health indicators between the
    developed and the developing worlds. For example, the one-in-16 chance
    over a lifetime that a woman in sub-Saharan Africa has of dying as a
    result of pregnancy is more than 150 times greater than the one-in-
    2,500 risk of a woman in the United States. In many Asian and Latin
    American countries, improved national averages often obscure the
    substantial risk of pregnancy that still remains for women living in
    poverty.

        In addition, 3.7 million newborns die annually, failing to complete
    even the first month of life. As noted, newborn survival is
    inextricably linked to the health and nutritional status of the mother
    before and during pregnancy, as well as her care during labor and
    delivery. For this reason, USAID's programs always link mother and
    infant. As we make progress in reducing under-five mortality in
    general, the deaths of newborns in the first 28 days of life comprise a
    greater proportion of under-five and infant deaths. Globally, newborn
    mortality represents over one-third of all mortality among children
    under age five; however, in countries which have made greatest progress
    in child survival, newborn mortality can be more than half of the
    remaining deaths of infants and children. Thus, further progress in
    child survival must emphasize reduction of newborn deaths as a
    critically important element.

    We have shown that substantial progress can be made in reducing
            maternal and newborn deaths
        Despite the challenges faced in reducing maternal mortality, USAID
    has helped demonstrate that real progress can be made. Because maternal
    mortality is normally measured every 5-10 years, the globally-accepted
    proxy for maternal mortality is coverage at birth by skilled
    attendants. Across all USAID-assisted countries, skilled attendance has
    increased from an average of 37 percent in 1990 to 50 percent in 2005;
    the greatest progress has been in the Asia and Near East region, where
    coverage has more than doubled, increasing from 21 to 47 percent.

        Most important, although global progress in reducing maternal
    deaths has generally been slow, ten USAID-assisted countries have
    achieved average reductions of maternal mortality of 33 percent over a
    decade.

        Family planning also makes a substantial contribution to saving the
    lives of women by reducing the number of unintended pregnancies (each
    of which exposes a woman to risk) and by reducing abortions.
        For newborn mortality reduction, USAID funded-research has
    documented a 33 percent decline in newborn mortality in Sylhet,
    Bangladesh with a package of home-based essential newborn care, and a
    50 percent decline in Shivgarh, India with a similar program. Such
    programs have the potential to produce widespread impact on newborn
    survival in settings where most births take place at home, and they are
    now being scaled-up. In large controlled trials, community-based
    programs for detection and antibiotic treatment of life-threatening
    neonatal infections have also demonstrated the potential to reduce
    newborn mortality by almost half. We and other partners are replicating
    these trials and--if they are successful--will work with countries to
    apply the results in MCH programs. Neonatal interventions are
    relatively new in such programs, so we do not yet have examples of
    national-level mortality reduction. However, very recent analyses
    suggest that, as these interventions are scaled-up, we are beginning to
    see overall declines in newborn mortality at the global level.

    This success can be scaled-up through expanding the use of proven, low-
            cost interventions
        Our work demonstrates that many of the major causes of maternal
    death are substantially preventable and treatable with low-cost
    interventions. USAID has sharpened its focus on a set of highly-
    effective interventions targeting specific high-mortality complications
    of pregnancy and birth--hemorrhage, hypertension, infections, anemia,
    and prolonged labor. Together, these complications account for two-
    thirds of maternal mortality. Hemorrhage alone accounts for almost one-
    third, and USAID has been in the forefront of promoting ``active
    management of the third stage of labor,'' a highly-effective technique
    for preventing postpartum hemorrhage.
        USAID has recognized that attention to the newborn is essential to
    success in our child survival programs. Increasing evidence and program
    experience indicate that we can significantly reduce newborn mortality
    by combining focused antenatal care, a package of essential newborn
    care that enhances the survival of all infants, detection and treatment
    of serious neonatal infections, and community and facility-based
    approaches to special care for low birth weight babies. These
    approaches especially target newborn infection and birth asphyxia,
    which together account for more than 60 percent of newborn deaths.
    USAID is presently supporting introduction or expansion of newborn care
    programs based on these elements in 20 countries.

    Accelerating progress
        While we have been able to demonstrate important progress in
    maternal survival in a number of countries, we recognize that sub-
    Saharan Africa has generally made little progress and represents a
    special challenge. In response to this stagnation of progress in sub-
    Saharan Africa, USAID has initiated a new ``Safe Birth Africa''
    initiative to increase skilled attendance at birth, beginning in Rwanda
    and Senegal. This initiative includes a focus on decreasing financial
    barriers for families so that they will be more likely to bring
    expectant mothers for skilled care at birth. It also involves expanding
    the mandate of frontline providers so that they can perform life-saving
    measures, along with quality improvement approaches to ensure that good
    clinical practice standards are systematically applied. USAID plans to
    expand this work to other high burden countries in order to increase
    skilled attendance at birth and coverage with life-saving care.
        In all countries where maternal mortality is high, as well as in
    countries where there is wide disparity in birth outcomes between rich
    and poor, USAID is intensifying its work to spotlight specific life-
    saving interventions. To expand the use of ``active management of the
    third stage of labor'' to prevent postpartum hemorrhage, USAID launched
    the Prevention of Postpartum Hemorrhage Initiative in 2002. As of 2006,
    this approach had been introduced into MCH programs in 15 countries. In
    support of this intervention, we are working to get oxytocin, the drug
    that contracts the uterus to reduce bleeding after birth, into single-
    use UNIJECT injection devices, so that it can be provided by skilled
    birth attendants to women in peripheral health centers and homes.
    Because oxytocin is sensitive to heat, we are also exploring a time/
    temperature index to be put on the oxytocin vial, similar to the
    Vaccine Vial Monitor, to ensure that medication given to women is
    potent and that health workers do not unnecessarily discard oxytocin
    that has not been refrigerated.
        In addition to further expansion of essential newborn care at
    birth, USAID is applying research results on treatment of sick newborns
    with antibiotics in the community. One step is testing the delivery of
    antibiotics in UNIJECT devices, so that treatment can be administered
    easily and safely by frontline-care providers. These newborn activities
    represent the combination of technical leadership and program
    application that USAID brings to MCH programs, working in partnership
    with other donors and recipient countries.

    Reversing maternal disability
        While our efforts continue to emphasize safe births and prevention
    of maternal mortality and disability, we are also providing
    compassionate care for women who suffer the devastating problem of
    obstetric fistula, a consequence of prolonged labor that can cause a
    woman to leak urine or feces, often resulting in divorce and social
    isolation. In 2004, USAID began a program to provide surgical treatment
    for such women. By the end of 2006, USAID was supporting eighteen
    fistula repair centers in eight countries of south Asia and sub-Saharan
    Africa. This support included physical upgrading of centers, training
    of surgeons, nurses and counselors, and mobilizing more than 5,000
    community agents to change norms to delay pregnancy, reduce stigma of
    affected women, and promote use of family planning and maternity
    services. Over 2,000 surgeries have been completed.

                                 CHILD SURVIVAL

        Let me now turn to the child survival component of our MCH program.
    This is one of the cornerstone components of USAID's health
    programming. Arguably, the quantifiable, at-scale results generated by
    the child survival and family planning programs helped build the
    confidence that paved the away for later investment in other global
    health programs, from TB and malaria to HIV/AIDS and Avian Influenza.
        The child survival program has a proven record of success, achieved
    by delivering high-impact interventions. Twenty years ago, when USAID
    and UNICEF launched the ``child survival revolution'' with the support
    of Congress, an estimated 15 million children under age five in the
    developing world died from common, preventable diseases each year.
    Across the developing world, more than one in 10 children did not
    survive to see their fifth birthday; in some countries, it was one in
    five. If the same rates of infant and child mortality existed today,
    the number of deaths would be more than 17 million each year. In
    contrast, for 2005 WHO and UNICEF estimate the number of children under
    five who died to have been reduced by more than one-third, to 10.5
    million--this is still far too many preventable deaths, but it means
    that more than 6 million children's lives are now being saved every
    year through global child survival efforts.
        Over the past 20 years, the United States has committed more than
    $6 billion in support of USAID's global child survival efforts. In
    collaboration with international, national, and private sector
    partners, this effort has yielded public health successes on an
    unprecedented global scale:
      --Almost a billion episodes of child diarrhea are treated with
            lifesaving ORT each year, reducing child deaths from diarrheal
            disease by more than 50 percent since 1990.
      --More than 100 million children receive a set of basic immunizations
            each year, and tens of millions more receive supplemental
            immunizations against polio, measles, and other killer
            diseases.
      --More than 75 million cases of infant and child pneumonia are taken
            for treatment by trained health workers.
      --Malnutrition among children under age five has been reduced from
            one in three to one in four, a 25 percent reduction.
      --The Polio Eradication initiative has saved an estimated five
            million children from death or paralysis.
      --Half a million children are estimated to have been saved last year
            alone by micronutrient supplementation programs.
        These accomplishments are not attributable to USAID alone. In
    virtually all countries where it carries out child survival and
    maternal health efforts, USAID invests its resources in ways that best
    interact with and leverage the contributions of other donors and of the
    country itself. Yet, as the attached graphic demonstrates, in almost
    all the countries where USAID made an average annual investment of at
    least $1 million of child survival and maternal health funds each year
    during 2003-2005, we have seen significant reductions in mortality of
    children under age five.

    Despite real progress, there is still a substantial job left to do
        Sustaining this progress is itself a challenge, especially in the
    poorest countries with the weakest governments and health systems. A
    greater challenge is saving the lives of the remaining 10.5 million
    children who still die each year. As shown in the graph from the 2003
    authoritative review of Child Survival in the medical journal The
    Lancet, the causes of most of these child deaths continue to be
    malnutrition, the common infections of newborns and young children--
    diarrhea, pneumonia, infections of newborns, and, especially in Africa,
    malaria--and other life-threatening newborn conditions.\1\
    ---------------------------------------------------------------------------
        \1\ ``All other causes'' includes principally congenital anomalies,
    malignancies, all other infectious diseases, and injuries & accidents.

        The Lancet analysis indicates that over two-thirds of these child
    deaths are preventable with interventions that are available or in the
    pipeline, including Oral Rehydration Therapy for dehydrating diarrheal
    illness; basic treatment of serious infections including pneumonia,
    malaria, and newborn sepsis; improved nutrition through breastfeeding,
    better child feeding practices, and management of acute malnutrition;
    and delivery of micronutrients, especially vitamin A and zinc, which
    improve children's ability to resist infections or help them fight them
    off when they occur.
        Countries and the global community--with USAID playing an important
    leadership and program role--have been able to make substantial
    progress in delivering these high impact interventions. In addition to
    our substantial contributions to increased global coverage of
    interventions including immunization and oral rehydration therapy,
    there are several areas where USAID's contribution has been especially
    important. One of these is vitamin A. USAID supported a large part of
    the research demonstrating that vitamin A deficiency was widespread
    among young children in developing countries, and that preventing or
    repairing this deficiency could reduce overall mortality among children
    under age five by about one-fourth. Since then, integrating vitamin A
    supplementation into maternal, newborn, and child health programs has
    been one element of our work in most countries, working with UNICEF and
    the Canadian International Development Agency. One result is that by
    2004 (the latest year with complete estimates) almost 70 percent of
    children in the developing world had received at least one semi-annual
    dose of vitamin A supplementation, and almost 60 percent had received
    both doses needed each year for full protection. This achievement,
    combined with the increasing coverage of micronutrient fortification
    programs, of which we are also major supporters, means that tens of
    millions of children are receiving this important nutritional
    intervention.
        Another area worth special comment is breastfeeding, because
    malnutrition underlies over half of all under-five child deaths.
    Breastfeeding is one of the highest impact child survival
    interventions, but improving feeding practices and children's nutrition
    is one of the most challenging areas of child survival. The global rate
    of improvement in exclusive breastfeeding of children for the first six
    months of life is less than one percent annually. However, USAID
    demonstrated that this challenge can be effectively addressed through a
    multi-pronged approach that incorporates community workers, media,
    health services, and policy changes. Using this approach, seven USAID-
    assisted countries have made at-scale improvements in exclusive
    breastfeeding of as much as 10 percentage points a year, well above the
    global trend. We are now working with partners to apply this experience
    in additional countries.
        A major challenge is that many of the remaining child deaths are
    occurring in places where existing services often do not reach: in the
    poorest countries and countries emerging from conflict (like Sudan,
    Afghanistan, and the Democratic Republic of Congo), in the huge rural
    areas of countries like India and Pakistan, and increasingly in the
    slums of the developing world's rapidly growing urban population.

    We have new program approaches and new interventions that will make
            additional impact
        Our response to these challenges is not just to do more of the
    same. Bringing high impact interventions to additional children who
    need them requires new approaches. One of these is our increasing
    emphasis on community-based programs, learning from our extensive
    partnerships with U.S. Private Voluntary Organizations and our
    experience working with countries that have pioneered these approaches
    as part of their national program strategies.
        One example is community treatment of pneumonia. At the end of the
    1990s, our analyses showed that progress in delivering simple oral
    antibiotic treatment to children with pneumonia--a treatment that
    research had shown reduces mortality by at least one-third--had leveled
    off, with only about 50 per cent of children needing treatment actually
    getting it. The reason was that in most countries, this treatment was
    restricted to formal health facilities. With the support of USAID and
    others, a few innovative programs in Nepal, Honduras, and Pakistan had,
    however, implemented treatment through trained community health
    workers. In Nepal, this approach more than doubled the number of
    children receiving treatment for pneumonia, and did so with excellent
    quality of care. We documented and presented this program experience to
    international partners including WHO and UNICEF, with the result that
    this is now the recommended approach to pneumonia treatment for
    countries where formal health services fail to reach many children.
    USAID itself has helped introduce this approach in Africa, beginning in
    Senegal; six additional countries are now implementing this community-
    based approach, and several others are introducing it.
        Similarly, we helped pioneer ``Child Health Weeks,'' which are
    outreach approaches that bring vitamin A, immunization, insecticide-
    treated nets, and other health interventions to underserved areas. The
    aim is to get basic interventions to all children possible now, while
    building countries' systems and capacities to do so through more
    systematic approaches in the future.
        Our program has also played a key role in developing, testing, and
    introducing new interventions and technologies that will save
    additional lives.
        One of these is zinc treatment for child diarrheal illness.
    Research--much of it supported by USAID--has clearly shown that zinc
    treatment reduces the severity and duration of these illnesses; as a
    result, zinc is now recommended by WHO and UNICEF as part of the
    treatment of diarrheal illness, along with oral rehydration. To
    implement this recommendation, we are supporting introduction of zinc
    treatment in countries including India, Indonesia, and Tanzania. We are
    also collaborating with UNICEF and potential zinc supplement producers
    to assure the availability of safe, standardized, high quality products
    to supply these new programs.
        Another example is ``point-of-use'' (POU) water disinfection
    technologies. These simple and cheap methods were first developed and
    used through collaboration of USAID and the Centers for Disease Control
    and Prevention (CDC) during cholera outbreaks in Latin America in the
    1990s. Subsequent research showed that ``POU'' water treatment can
    reduce diarrheal and other water-transmitted illnesses by one-fourth or
    more. Since then, we have collaboratively developed programs for their
    production and distribution in twelve countries. In some countries,
    like Indonesia, this is a purely private sector partnership, with the
    United States providing just the technical know-how. In poorer
    countries like Madagascar and Zambia, we are using social marketing
    approaches that involve some degree of subsidy to make sure they are
    available to low-income households (often most impacted by bad quality
    water). In emergencies--including the 2004 tsunami--these ``POU''
    technologies have played an important part in reducing disease
    transmission, especially among children. Because over a billion people
    in the developing world still live without access to safe water, these
    simple technologies can play an important role in reducing the disease
    burden on young children.
        One other important new intervention is ``community therapeutic
    care'' (CTC), an innovative approach to therapeutic feeding and medical
    treatment of children with acute severe malnutrition in field
    environments with few human and medical resources. Many families
    impacted by emergencies cannot reach therapeutic centers, or cannot
    spare the family members needed to accompany a child in such a center
    for the days or weeks required to reverse malnutrition. In response,
    USAID has worked with non-government agencies and international relief
    organizations to develop this approach for children with severe acute
    malnutrition. A central innovation of CTC is the use of ready-to-use
    therapeutic foods such as Plumpy'nut, an energy-dense peanut paste.
    Plumpy'nut can be safely given by parents in the home, eliminating the
    need for a prolonged stay in feeding centers. CTC has already been
    introduced in several African countries as well as in Bangladesh. USAID
    is now working with WHO and UNICEF to endorse CTC as the standard of
    care in all countries for managing acute malnutrition.
        My testimony on child survival may best be summarized by the
    following graph.

        As I noted early in my statement, global efforts to improve Child
    Survival now result in the saving of over 6 million children's lives
    each year. This is a tremendous accomplishment, and one that needs to
    be sustained. At the same time, authoritative analyses tell us that we
    can save at least an equal number of those children who still are dying
    unnecessarily, using the tools and program experience that are already
    available to us. It is our intention to do our utmost with the
    resources provided to us to accomplish this important goal.

    There is now an important opportunity to accelerate progress in
            maternal, newborn, and child survival
        During the past few years, we have seen new commitments that we
    believe can lead to a ``second wave'' of global effort to improve
    maternal and child survival. There are new resources appearing from
    private sector partners like the Bill and Melinda Gates Foundation,
    from bilateral donors like the U.K. and Norway, and from multilateral
    partners including UNICEF. One of the largest increases is through
    funding from the International Funding Facility of the U.K. and Europe
    for immunization, through the Global Alliance for Vaccines and
    Immunization (GAVI). The European Union is providing substantial
    amounts of new funding to several countries to support maternal
    mortality reduction.
        The Millennium Development Goals (MDGs) are stimulating increased
    international attention to the need for accelerated progress to reach
    the child and maternal survival goals; this attention is producing new
    international cooperation, like the inter-agency ``Countdown 2015''
    collaboration to monitor and report on progress toward these goals and
    the inter-agency ``Partnership for Maternal, Newborn, and Child
    Health.'' The African Union has recently developed and approved a new
    ``Framework for Accelerated Progress in Child Survival'' as well as a
    new reproductive health regional strategy; work on a similar regional
    framework for maternal, newborn, and child health is beginning in Asia.
        Partly in response to the MDGs, and partly in response to their
    understanding of the need to accelerate social development, some
    countries themselves are substantially increasing their own investments
    in maternal and child health. One impressive example is India, whose
    Prime Ministerial ``National Rural Health Mission'' and new second
    stage Reproductive and Child Health Project represent the commitment of
    over $2 billion a year to improved health status among the underserved.
    There is also increasing public visibility, including ongoing attention
    by The Lancet to child survival, maternal and newborn health, and
    global public health in general.

    Against this background, we have a strategy to use our existing
            resources to substantially reduce maternal, newborn, and child
            mortality and malnutrition in a focused set of high burden
            countries
        To take advantage of this opportunity, we plan to focus resources
    on a set of countries which have the highest need, in terms of both the
    magnitude and the severity of under-five and maternal mortality; that
    is, countries that have the largest number of preventable deaths as
    well as the highest rates of mortality. We will focus on countries that
    have strong commitment to improving MCH and the capacity to program
    resources effectively, and wherever possible, offer the potential for
    interaction with other USG investments, including the President's
    Malaria Initiative and GAVI funding. We believe it is possible to
    achieve reductions of 25 percent in under-five and maternal mortality
    in most of these countries by 2011; and in many of them, we also
    believe it possible to achieve reductions of 15 percent in the number
    of children who are below weight-for-age.
        We will do this by applying our successful lessons from the past
    and the new approaches and interventions we now have. We will work with
    countries and partners to identify the most important maternal,
    newborn, and child health and nutrition problems, and the most
    important interventions that can be implemented at scale to address
    those problems. We will support those interventions through appropriate
    integrated delivery approaches, involving the public health system,
    private sector providers, NGOs, and community-based approaches. We will
    identify the best fit of our resources alongside those of other
    initiatives, partners, and the countries themselves. We will join with
    countries and partners to monitor progress in terms of improved
    coverage, and ultimately improved survival, health, and nutrition
    status. And we will identify and invest in developing the capacity of
    communities, health systems, and human resources to achieve and sustain
    progress.
        Our belief that such rapid progress is possible is not
    hypothetical. It is based on the real recent performance of a number of
    USAID-assisted countries, shown in the following table.

                            RAPID REDUCTION IN UNDER-5 MORTALITY BY USAID-ASSISTED COUNTRIES
    ----------------------------------------------------------------------------------------------------------------
                                                           Under-5                     Under-5
                                                          mortality                   mortality
                          Country                          (deaths/    Year    To      (deaths/    Year    Percent
                                                            1,000                       1,000             reduction
                                                           births)                     births)
    ----------------------------------------------------------------------------------------------------------------
    Bangladesh.........................................          116   1996

    Unmet need continues to be a challenge
        There remains a great need--and desire--for family planning. While
    more than 400 million women in the developing world are now using
    family planning, there are an estimated 137 million with an unmet need
    and 64 million using traditional, rather than modern, contraceptive
    methods.
        Unmet need is particularly great in Africa. There, nearly half of
    the world's maternal mortality occurs and on average only 15 percent of
    married women use contraceptive methods. The desired fertility in the
    region is considerably lower than actual fertility, which remains high
    at 5-7 children per women in most countries. Although demographic and
    health surveys reveal that a high proportion of women and men--well
    more than half in many African countries--said they wanted to wait at
    least 2 years before having their next child or that they had the size
    family they wanted, there were, in fact, nearly 39 million unintended
    pregnancies in Africa between 1994 and 2000--clear evidence of the need
    for family planning. In too many African countries, attention to family
    planning has declined and donor and government funding has stagnated.

    There are significant opportunities to accelerate progress
        Though family planning is primarily viewed through the prism of
    women's health, research has shown that the women themselves view
    family planning in broader terms. They believe that having smaller
    families and spacing births not only improves health, but increases
    opportunities for education as well as for greater domestic and
    community involvement. Their instincts are right--women are critical to
    achieving development goals.
        The impact of family planning on children's lives often is not
    considered. More than 10.5 million children under the age of 5 die
    every year in the developing world. Many of these deaths can be reduced
    by expanding access to family planning. Births that are spaced too
    close together, too early, or too late in a woman's life decrease both
    the mother's and infant's chances for survival. Children born too close
    together face increased risk of contracting and dying from infectious
    diseases and can suffer high rates of malnutrition. By helping women
    space births at least 3 years apart and bear children during their
    healthiest years, family planning could prevent many of these deaths.
    Research done in 2003 has shown that if women had not had any births at
    intervals less than 24 months, almost two million deaths to children
    under age 5 could have been averted. Additional deaths also would have
    been averted if mothers had spaced births at least 36 months apart.

        The education of women is critical. Research has shown a strong
    link between girls' literacy and many other development objectives.
    Women who start families before age 20 are less likely to finish school
    than those who wait even a few years. Early and frequent childbearing
    can limit women's education. The importance of family planning in
    allowing women to stay in school goes beyond the women themselves.
    Mother's education is an important predictor of children's educational
    attainment and therefore of their future earnings. Conversely,
    education also improves use of family planning services. Studies show
    that women with as little as 2 or 3 years of formal schooling are
    significantly more likely to use reliable family planning methods than
    women with no formal education.
        Employment allows women to earn income, which increases life
    options and involvement in the community. Family planning users often
    are more likely than non-users to take advantage of work opportunities.
    In addition, high levels of female labor force participation and higher
    wages for women are associated with smaller family size. As women enjoy
    greater economic opportunities and as family income rises, they spend
    more money on the education and nutrition of their children, continuing
    the cycle of opportunity. This in part explain why micro-finance is
    such a powerful tool today in development, both economic and social
    development.
        Working with key international partners, family planning has now
    come to embrace a broader mandate.
      --Ensuring that family planning is introduced into policies,
            programs, and services whenever there is a natural link. At the
            country level, this aims to ensure that there are no missed
            ``good'' opportunities.
      --Recognizing that program development is situation specific, USAID
            will draw on the best current programmatic evidence to
            determine priority interventions and conduct further research
            to identify the best approaches that can be scaled up.
      --Programming for impact: underscoring that opportunities and
            challenges differ in each country, local data and experiences
            will be used to help determine which approach to strengthening
            family planning will have the greatest impact.
      --Exploring strategies to reduce the large inequities--among the poor
            and hard to reach--in family planning access, method choice,
            and information among population subgroups.
      --Promoting national ownership and responsibility for the
            strengthening of family planning services despite current
            shifts in priorities and economic environments.
      --Ensuring optimal allocation of resources and strengthening of
            technical and managerial capacity as prerequisites for
            sustainable family planning programs.
      --Multisectoral approaches: strengthening linkages between health and
            other sectors so as to make use of all available entry points
            and opportunities to introduce family planning and address
            unmet need.
        USAID also has several special initiatives that broaden our work
    beyond ``bread and butter'' family planning programs. Among them:
      --Reproductive health programs can be effective partners in HIV/AIDS
            prevention in developing countries. Incorporating education and
            counseling to promote condom use and other HIV/AIDS prevention
            methods in reproductive health programs can contribute to the
            fight to stop the spread of the epidemic. In addition, research
            shows that adding family planning into programs for the
            prevention of mother to child transmission of HIV (PMTCT) can
            greatly reduce the number of orphans while saving the lives of
            thousands of women and children.
      --Slowing the rate of population growth gives nations time to develop
            sustainable solutions to other development challenges. Access
            to reproductive health programs can contribute to preserving
            the world's endangered environments by conserving scarce
            resources. Currently, more than 505 million people live in
            areas already experiencing chronic water shortages, a number
            that is expected to increase to 2.4 billion in the next 20
            years. In addition, in the past 3 decades, growing populations
            have caused 10 percent of the world's agricultural land to be
            lost due to residential and industrial needs. When reproductive
            health and family planning information are widely available and
            accessible, couples are better able to achieve their desired
            family size. This not only directly impacts the well being of
            families, but also contributes to both better management and
            conservation of natural resources.
      --The Office of Population and Reproductive Health has other special
            initiatives that address women's health and status in society
            in innovative ways. These include working to bring about the
            abandonment of female genital cutting; increasing male
            involvement in family planning; gender violence; health equity
            which is how to ensure the poorest of the poor receive our
            services and programs; the reproductive health of refugees; the
            availability and sustainability of health commodities including
            contraceptives and condoms; and repositioning family planning
            as attention and resources to this crucial health intervention
            are sometimes neglected because of the understandable focus on
            such pressing health concerns as HIV/AIDS.
    We can take advantage of these opportunities by capitalizing on
            existing resources and by focusing on key countries
        USAID must address the great unmet need for family planning that
    continues to exist by:
      --Maximizing access to good-quality services;
      --Emphasizing communication;
      --Focusing on men as well as women;
      --Increasing our efforts to reach the very poor.

        Also, family planning programs can develop better links with other
    services for new mothers and young children. Making common cause among
    such programs should be efficient because unmet need is concentrated
    among women who are pregnant unintentionally or who have recently given
    birth. We are developing approaches to address high levels of need in
    the poorest countries of the world. I have spoken of the profound need
    to expand our programs in Africa. Significant need also continues to
    exist in low contraceptive prevalence countries in Asia, such as
    Afghanistan, Cambodia, northern India, Pakistan, and Yemen, where
    prevalence is below 25 percent. In Latin America, USAID is
    concentrating its family planning resources in Guatemala, Bolivia, and
    Haiti where contraceptive use ranges from 22 to 35 percent.
        However, USAID's targeted countries, particularly those in Africa,
    face a number of challenges in their quest to meet the family planning
    needs of its population. Among these are weak health systems, poor
    access to family planning commodities, the non-involvement of men in
    family planning interventions, and inefficient utilization of
    resources.
        We also must employ interventions that will ensure family planning
    remains on the agenda of all sectors and continue improving access to
    all services. Other interventions include strengthening national
    capacity for sustainable programs, strengthening community
    participation, addressing family planning needs of vulnerable
    populations, and conducting operations research.

                      BUILDING CAPACITY WHILE SAVING LIVES

        Our programs are aimed at achieving impact in saving the lives and
    improving the health of mothers and children. At the same time, we are
    a development agency--we therefore believe that everything we do should
    also build the capacity of countries and people to improve their own
    situations. To do this, our program investments aim to build
    integrated, sustainable approaches and develop key components of the
    health systems countries need to deliver all basic health services. Let
    me touch on several specific areas of particular importance.
    Integration
        As I noted in my introduction, we recognize the important positive
    connections among voluntary family planning and birth spacing, good
    maternal care, and child health and nutrition programs in terms of
    health outcomes for women and children. To achieve these synergies, and
    at the same time build strong and cost-effective platforms for broader
    primary health care services, we implement integrated maternal-child
    health and family planning programs in almost all countries where we
    work.
        One example is the delivery of antenatal, delivery, and post-partum
    care services. We know that good antenatal care--including promotion of
    adequate nutrition and anemia prevention, detection and treatment of
    infections and complications, and planning for adequate care at birth--
    can have important positive effects on outcomes for both women and
    their babies. It is also an important opportunity to begin discussing
    family planning options for women who want to delay a future pregnancy,
    which will help preserve their health and that of their infants. In
    areas where malaria is prevalent, we promote antenatal care as a key
    opportunity to provide antimalarial treatment and promote use of
    insecticide-treated nets, protecting women from anemia and illness, and
    protecting their unborn children from the low birth weight caused by
    maternal malaria infection. In high HIV environments, antenatal care is
    one of the best opportunities to offer testing and counseling services
    and identify mothers requiring anti-retroviral treatment or prevention
    of mother-to-child transmission of HIV (PMTCT). High quality care at
    delivery is one of the most critical interventions for the survival and
    health of mothers and newborns; it prevents or resolves life-
    threatening complications and provides essential immediate care to
    newborns who need it. It also provides a key opportunity for PMTCT. We
    are now increasingly extending care into the post-partum period,
    allowing for the detection and treatment of serious maternal and
    newborn complications and better promotion of breastfeeding and
    essential newborn care. This post-partum period is also one of the most
    important opportunities to counsel women in voluntary family planning
    methods. Thus, in practice, our MCH-FP programs are delivered
    holistically, giving greater impact, greater sustainability, and
    greater support for other important health programs.
        The same is true for the community-based program approaches that we
    support in areas where formal health services cannot meet all basic
    health needs. We support outreach programs that often deliver multiple
    interventions including immunization of mothers and children, vitamin A
    and iron supplements, insecticide-treated bednet distribution, and
    antenatal care. We support community health worker and social marketing
    programs that often deliver family planning advice and commodities,
    condoms and information for HIV prevention, oral rehydration, and
    increasingly treatment for malaria and other child illnesses. We
    support programs for women's groups that promote family planning,
    breastfeeding and child nutrition, and birth planning; these groups
    often engage in income-generating and micro-finance activities that
    enhance their effectiveness and influence in their communities.
        Such integrated approaches reap the benefits of synergies among
    specific interventions and parts of our health programs. They also
    maximize the potential for sustainability by making the most effective
    use of each contact of services with families.
    Strengthening Health Systems
        Achieving impact while investing in health systems is challenging,
    given the low levels of resources available in most countries with high
    fertility and mortality, and thus the huge number of potential claims
    on additional resources. As has been seen in some countries where a
    broad focus on health systems has replaced a clear focus on health
    outcomes (Zambia in the 1990s, Ghana recently), investment in systems
    not linked to outcomes will not necessarily improve the survival and
    health of women and children. USAID is recognized as a major
    contributor to approaches that strengthen key elements of health
    systems, while doing so in ways that link these investments to
    outcomes. Our efforts have made important contributions in several
    critical dimensions of health systems, including:
        Quality improvement.--USAID has been a global leader in the
    application of modern quality improvement approaches to health and
    family planning programs in developing countries. The Agency's
    ``Maximizing Access and Quality'' initiative has impacted every country
    we assist and has even further reach. For example, quality improvement
    approaches have led to the development of a Global Handbook that
    documents protocols and best practices for family planning services.
    This document, which has been translated into eight languages, is
    published by the WHO and is used by USAID funded programs in more than
    60 countries through WHO's reach. Quality improvement approaches have
    led to the development of ``standards of care'' for maternal and child
    health services and the use of these standards to measure and improve
    quality of services. These approaches are being used to improve basic
    services, such as reducing delays in management of life-threatening
    obstetric complications and improving care of severely ill children; in
    hospitals in Nicaragua, this approach reduced child deaths from malaria
    by 86 percent, from diarrhea by 57 percent, and by pneumonia by 38
    percent.
        Drug and Commodity Supply and Logistics.--USAID is a major
    supporter of systems that provide, distribute, and track contraceptive
    commodities and other essential public health commodities. Last year,
    shipments for contraceptives and condoms were provided to 52 countries
    and additionally, many of these countries also received anti-retroviral
    drugs and diagnostics. Additionally, technical assistance
    pharmaceutical management and/or supply chain strengthening was
    provided in at least 39 countries. For maternal and child health, where
    most drugs and commodities are parts of routine health systems, efforts
    have focused on making MCH drugs parts of ``tracer'' systems that
    evaluate the functioning of overall logistics systems by tracking the
    availability and use of selected drugs. For new products, like zinc for
    treatment of diarrhea, USAID works with the U.S. Pharmacopoeia to
    develop quality and manufacturing standards needed to allow
    international procurement by UNICEF and countries, and also works with
    manufacturers to assure adequate quantity and quality of products
    required by programs.
        Financing.--USAID worked with WHO and the World Bank to develop
    ``National Health Accounts,'' tools that for the first time allow
    country governments and their partners to see all the resources
    available for health--not just from government, but from donors and
    from families themselves. These important decision-making tools are now
    being utilized in approximately 70 countries, with direct USAID
    assistance to 26 of these. Another important area of USAID engagement
    is support for ``risk pooling'' approaches that remove cost barriers to
    care. One important approach is technical assistance to community-based
    insurance plans, or ``mutuelles,'' which is an innovative way to
    finance health care in Africa. These community-based plans now exist in
    about a dozen African countries; in Rwanda alone, where USAID is
    providing assistance, by 2006 there were over 300 community-based plans
    serving over 3.1 million people (or 40 percent of the population).
    Human Resources and ``Brain Drain"
        One challenge which faces virtually all of our health programs is
    the movement of trained health care providers away from developing
    countries and into more developed countries--commonly referred to as
    the ``brain drain.''
        As a development agency, USAID has little influence on the policies
    of wealthy countries that receive emigrating health professionals, the
    demand side of this issue. Our strategy in this area focuses on
    retaining trained providers in their countries' health systems, the
    supply side of the issue.
        The in-country factors affecting the healthcare human resource
    supply are more than a shortage of workers or absentee-ism due to
    training. Low salaries and poor working conditions drive workers to
    other types of employment even within their own country. Weak human
    resource management systems do not support workers. The recruitment,
    deployment and promotion of workers are often politicized and not
    performance-based. Additionally, an inappropriate alignment of the
    workforce means that tasks are often assigned to the wrong types of
    workers causing overly burdensome workloads.
        USAID is actively engaged in multiple efforts within countries to
    increase retention and contribute to greater worker productivity.
    Specifically, in almost every country where USAID has programs, USAID
    is developing and/or strengthening in-service training systems to
    provide workers with the knowledge and skills needed to do their jobs;
    often utilizing innovative learning approaches, such as distance
    learning and self-directed learning, in order to minimize the time
    workers are out of post for training. USAID is collaborating with
    Ministries of Health to strengthen supervision systems so that they
    provide positive support to workers, and is instituting quality
    improvement methodologies that encourage workers to take an active role
    in ensuring the quality of the services they provide.
        Keeping workers on the job is essential to increasing the number of
    workers. In five African countries, several approaches are being tested
    and implemented in USAID programs, including: piloting financial and
    non-financial incentives; developing clear and equitable careers paths;
    offering continuing education and professional development. There has
    been an increased retention of workers in Ghana, Namibia and Uganda
    with improvements to the working environments and benefits such as
    transportation reimbursements.
        Improved management and modern quality improvement approaches are
    affordable and have the potential to improve dramatically the way
    health systems manage their human resources, helping to retain workers.
    USAID provides support for workforce planning and rationalization in
    six countries. Human resource (HR) managers are assisted to develop the
    skills needed to scan and analyze HR data, determine relevant policy
    questions, and make policies to ensure that workers with appropriate
    skills are available when and where they are needed. In several
    countries, HR Directorates in Ministries of Health are being
    strengthened through training of key staff and through secondments of
    HR experts who then share their knowledge and skills so as to create
    strong HR managers. In a number of countries, USAID is assisting MOHs,
    licensing and certification bodies, private-sector organizations and
    other stakeholders to develop the human resource information systems
    they need.

    Sustainability
        Sustainability of MCH and family planning programs is a critical
    goal of USAID. To this end, we aim to:
      --Increase funding by host governments of national MCH/FP programs.
      --Increase diversification and long-term funding of MCH/FP activities
            by donors and international organizations.
      --Improve the quality of national MCH/FP activities and establish
            critical masses of health workers competent in MCH/FP
            interventions.
      --Achieve high and sustained national coverage rates for MCH/FP
            interventions.
      --Reduce inequities in access to health care and in health outcomes.
      --Involve community, voluntary and private sector organizations in
            MCH/FP activities at national, district and community levels.
        With progress on each of these elements, MCH/FP programs will
    become more effective and sustainable. More importantly, national
    leaders, health managers, and the general population will expect and
    demand effective, nationwide MCH/FP programs and will help to make this
    happen. There will also develop an international mandate that no
    country will suffer stock-outs of essential MCH/FP commodities. This
    has already occurred for child vaccines. Finally, national governments
    and international donors and organizations will be judged by the
    quality and coverage of their MCH/FP programs.
        There is now evidence that USAID, other donors, and national
    governments are helping to make important progress on all these key
    elements of sustainability. For example:
      --There is evidence that host government contributions to MCH/FP
            programs have increased in real dollar terms over the past 10
            years.
      --Coverage rates for key MCH/FP interventions are steadily
            increasing. For example, the worldwide coverage for the third
            dose of the DPT vaccine is 74 percent and for vitamin A is over
            50 percent.
      --As highlighted above, there are major new commitments of
            international partners to MCH/FP and some new funding
            mechanisms that promise long-term support for the sub-sector.
    Complementary Funding and Global Development Alliances
        USAID funds have complemented over $4.6 billion from partners to
    advance development objectives worldwide.
        USAID provides leadership in the Reproductive Health Supplies
    Coalition (RHSC), a coalition of 21 members--multinational
    organizations, bilateral and private foundation donors, low and
    moderate income country governments, civil society, and the private
    sector--that works to increase political commitment and public and
    private financial resources, as well as more effective use of resources
    to ensure sustained access to quality reproductive health supplies
    through public, private, and commercial sectors.
        USAID supports the Global Alliance for Improved Nutrition (GAIN) to
    accelerate micronutrient fortification programs globally and to
    mobilize the private sector to deliver fortified products to the poor.
    The Alliance includes 14 governments; three donors; the United Nations;
    the private sector including Proctor and Gamble, Unilever, Danonoe, and
    Heinz; development agencies such as the World Bank; education and
    training institutions; and civil society. The Alliance has supported 15
    national food fortification programs projected to reach 446 million
    people.
        Between fiscal year 2001 and fiscal year 2006, USAID contributed
    $352.5 million to GAVI as one of the largest government donors
    representing nearly 20 percent of GAVI's funding. Since GAVI's
    inception in 1999, the Gates Foundation combined with a variety of
    donor governments has contributed a total of $1.9 billion.

                                   CONCLUSION

        USAID sees improved health for the world's poorest people not only
    as a moral imperative but also as a pragmatic investment of U.S.
    funding for peace, security, and world-wide economic growth. USAID-
    supported MCH/FP programs have a proven record of success which is
    helping to save lives and build health systems. Our support has helped
    to reduce under-five mortality in almost 30 countries and maternal
    mortality in ten countries. USAID-supported family planning programs
    have been successful in increasing access to and use of modern
    contraceptives in all regions of the world. We now have program
    approaches and new interventions that will allow us to build on these
    successes and make additional progress. We also have valuable
    experience in delivering these interventions and approaches in a fully
    integrated and cost-effective manner at district, health center, and
    community levels so that these life-saving services can be affordable
    and sustainable. With the continued support of Congress, we will be
    able to contribute to further gains in maternal and child health and
    family planning throughout the developing world. Thank you for your
    support.

        Senator Leahy. Thank you very much. I read your testimony
    last night, and I know your personal commitment to this.
        Dr. Gayle, thank you for being here. I've heard you speak
    many times before, and I just appreciate you taking the time
    here.

    STATEMENT OF DR. HELENE GAYLE, PRESIDENT, COOPERATIVE
                FOR ASSISTANCE AND RELIEF EVERYWHERE
        Dr. Gayle. Thank you very much, Chairman Leahy, and thank
    you for having us here, and thank you for your consistent and
    passionate commitment to these issues.
        I'm really honored to be here in front of you, and with the
    other witnesses here who, also, as you said, bring a lot of
    experience, and are very distinguished in this area.
        I represent the organization CARE, which is committed to
    reducing global poverty, and have broadened from what I was
    doing in the past, focusing on health issues, because I believe
    strongly that poor health and poverty are very intertwined. And
    so, that's the context in which our work is done, where we feel
    that health has such an important contribution to our work in
    eradicating global poverty, and vice versa.
        I'm not going to go through a lot of the facts, I think
    people have put those on the table, and I think have very
    eloquently pointed out that there are very unacceptable gaps in
    maternal mortality and child health and child survival around
    the world, and important unmet needs in family planning and
    contraception.
        Also, I think the testimony that Dr. Hill gave pointed out
    the incredible advances that the U.S. Government, particularly
    through USAID, has made, and the real leadership role that we
    have played around the world on these important health issues.
    I think--if nothing else--I would say our message is that we
    would like to continue to see the United States play that kind
    of global leadership role in these issues, and that we have an
    opportunity to continue to build on these incredible advances
    that have already been made.
        So, important progress has been made, but I think as has
    been pointed out, there is still a lot that remains, and that
    in some ways, we've become complacent about basic public health
    issues, like maternal and child health, and family planning as
    we have moved to focus on very key, specialized issues, like
    HIV and malaria and others, where we have seen incredible, and
    important, growth. But, I think, in the meantime it means that
    we've kind of let our eyes off of some of these very basic and
    core issues, where we have such a basis for continuing to
    build.
        Let me just make a few points from our experience, and then
    some recommendations. I'll make first, four points. First of
    all, that technical solutions alone will not bring about
    lasting results. Obviously, it's important to continue to look
    for better and new technologies, but for health impacts to be
    sustainable, they must also address the underlying causes of
    poor health, and the reasons why people don't have access to
    these technologies to begin with, and making sure that we have
    a focus on that.
        So, for example, we had a project in Peru, in an area in
    rural Peru, where CARE found that only one-third of women who
    needed obstetrical services actually accessed them. I mean,
    this is in an area where mortality--maternal mortality was
    about 15 times higher than it is here in the United States.
        But, by working to understand the needs of the rural women,
    for example, giving respectful attention from staff to speak to
    women in local language, provide access to transportation,
    provide basic facilities that met the needs of those women, and
    by connecting health workers at various levels, and really
    looking at, how do you distribute health services at different
    levels, and removing blocks to emergency referral care and
    services, CARE was able to reduce maternal mortality by half.
        So, even if the services are there, if they're not
    appropriate, if they don't take local circumstances into
    consideration, the needs won't be met. And so, we have to look
    at coupling our technology with ways to get it to people that
    are appropriate.
        Second, we learn that by being marginalized and powerless
    within a society, is often closely linked to one's ability to
    access healthcare services, and is linked to overall health
    status of the most vulnerable. The--less power means that
    people have less voice, and often less access to services. In
    most developing countries, women and youth are the least
    powerful, and the roots of health problems they face are often
    hidden.
        An example, from our work in Bangladesh, where CARE is
    working on a Safe Motherhood Initiative, we found that domestic
    violence was really the--one of the greatest risks that women
    faced during pregnancy, and that if we didn't address the
    domestic violence issues, and look at women's needs in a
    holistic fashion, that our obstetrical care programs didn't
    work. We were able to modify our approach to incorporate
    efforts to prevent violence against women in our Safe
    Motherhood Work, and found that our programs were much more
    effective and were actually able to reduce maternal mortality.
        Third, and Dr. Hill mentioned this as well, we've learned
    that dividing public health into various categories--while it
    may be convenient for allocating donor funding--that it really
    doesn't, is not the most effective way to approach health
    services.
        So, for example, maternal mortality and child survival are
    not separate activities. In some countries, if the mother dies,
    the risk of death for her child and her children under 5
    doubles or triples. Sometimes, as with HIV/AIDS, and
    reproductive health, we not only pursue them as separate
    issues, but also build parallel systems to develop services, so
    that we're not wasting resources that make our services more
    ineffective.
        So, by providing HIV information and testing to reach
    women, within the context of reproductive health, we obviously
    have much more effective programs.
        Then finally, we at CARE are dismayed by what seems to be a
    tendency to move away from evidence-based programs within the
    U.S. foreign assistance programs, particularly as they relate
    to sex and reproductive health. So, for example, the abstinence
    until marriage earmark in the Global AIDS Act of 2001 is a
    concern, whether or not it impedes the ability to have
    comprehensive and evidence-based programs that focus on the
    best programs and the epidemiology within local circumstances.
        Let me just wrap up by saying a few things that we would
    like to recommend. First, investing more, and more
    strategically in reducing maternal mortality and enhancing
    child survival. Over the past 5 years, the commitment to
    maternal and child health funding has not kept pace with the
    unmet needs or growth in other international health accounts,
    as has been well outlined. We urge you to provide strong
    funding levels for international maternal and child health
    programs. In particular, CARE strongly supports the U.S. Fair
    Share levels that Nils Daulaire will outline shortly.
        Second, a recommitment to the importance of family
    planning. This is one of the most cost-effective investments
    the United States can make in the future of women, children,
    communities and nations. The administration's budget request
    proposes a 23 percent cut in family planning funding for 2008,
    noting that these efforts do not require as much U.S.
    investment, because they've been so successful. Well, this is
    obviously the case, and we urge you to, not only restore those
    cuts, but to increase funding levels for international family
    planning.
        Also like to draw attention to the reports that the World
    Bank's new Health, Nutrition, Population Strategy that's going
    to be discussed here in Washington, appears to diminish their
    commitment to family planning, and we see this as an area of
    great concern.
        Third, commit to evidence-based reproductive health
    programming for youth. With the impending youth bulge that is
    going to occur, that's anticipated by demographers, the needs
    for reproductive health services that are tailored to the
    conditions for youth are critical and important.
        Fourth, removing any legal barriers that get in the way of
    evidence-based, effective programming in reproductive health
    and HIV. As mentioned, our concerns about any particular
    earmarks that don't provide for comprehensive funding.

                               PREPARED STATEMENT

        Finally, investing more globally in global health and
    development, in ways that help to strengthen the health
    infrastructure. As is previously noted, the importance of
    building a workforce capacity, without that, and without a
    strong commitment to the overall health infrastructure, none of
    these individual programs will be successful.
        [The statement follows:]

                     Prepared Statement of Dr. Helene Gayle

        Chairman Leahy, Senator Gregg, Subcommittee Members. I am honored
    to be here, discussing issues that are vital to the future of millions
    of people. For the past 61 years, CARE has worked across a spectrum of
    poverty-fighting arenas--from child survival to clean water, and from
    basic education to HIV/AIDS. We believe that poor health and extreme
    poverty are intertwined, and that one cannot be overcome if the other
    is neglected. That is why we work on a broad range of health issues,
    including maternal and child health, infectious diseases, ranging from
    HIV/AIDS to avian influenza, and reproductive health. My testimony
    today reflects CARE's experience in thousands of poor communities
    throughout the world over the course of half a century.
        We are here today to consider some basic, yet heart-wrenching,
    questions. Why does one woman die every minute of every day from
    complications related to pregnancy and childbirth? (99 percent of these
    deaths occur in developing countries, and the reasons are basic: women
    hemorrhage to death, they lack access to antibiotics to prevent
    infection or they don't have the option of a cesarean section.) Why do
    10.5 million children die each year before their fifth birthday
    (greater than the number of adults who die from AIDS, malaria and
    tuberculosis combined), when most of these deaths are preventable? Why,
    at a time when contraception is cheap and effective, do 120 million
    couples have an unmet need for family planning? Why, when some 70
    percent of young women in Africa become sexually-active as adolescents
    and more than 20 percent have their first child by 18, do we hesitate
    to confront that reality?
        Despite the magnitude of unmet need that remains, the U.S.
    Government can be proud of the difference it has made in the global
    health arena.\1\ For example, American leadership in family planning
    has contributed to some impressive gains. In 1960, only 10 percent of
    married women in developing countries used modern contraception. By
    2000, this figure had risen to 60 percent--and the average number of
    births per woman had fallen from six to three. More broadly, in the
    past 50 years, life expectancy in the developing world has risen from
    40 to 65 years, and a child's chance of living to the age of five has
    doubled.
    ---------------------------------------------------------------------------
        \1\ A recent analysis of six projects funded by USAID's Child
    Survival and Health Grants Program indicates that mortality of children
    under 5 has been reduced by approximately 8 percent in project areas
    due to interventions supported by the program.
    ---------------------------------------------------------------------------
        We have learned that large-scale improvements in public health are
    achievable. We have seen the real difference made in lives saved and
    economies strengthened. Sri Lanka's long-term commitment to a range of
    safe motherhood services has, over four decades, decreased maternal
    mortality from 486 to 24 deaths per 100,000 live births. In Egypt, a
    national campaign that promoted the use of oral rehydration therapy
    helped reduce infant diarrheal deaths by 82 percent between 1982 and
    1987. China's national tuberculosis program helped reduce TB prevalence
    by 40 percent between 1990 and 2000, and translated directly into
    social and economic benefits: for each dollar invested in the program,
    $60 was generated in savings on treatment costs and increased earning
    power of healthy people.\2\
    ---------------------------------------------------------------------------
        \2\ Center for Global Development, Millions Saved: Proven Successes
    in Global Health, 2007 edition.
    ---------------------------------------------------------------------------
        Even though important progress has been made, the need remains
    enormous and urgent. The knowledge and experience we have already
    gained position us to invest resources more wisely--and the
    partnerships formed reflect greater capacity to turn resources into
    effective action. Yet, even as efforts to fight HIV and AIDS are
    receiving greater attention and resources (as they should), we are
    becoming too complacent about basic public health issues like maternal
    and child health, family planning, and adolescent reproductive health.
    And we are not paying sufficient attention to building the strong,
    accountable health systems (both infrastructure and workforce) required
    to support any health interventions, be it neonatal care, family
    planning or AIDS treatment. Ultimately, CARE's experience in poor
    communities strongly supports both the need for increased investment of
    resources, and better use of those resources.
        Our first, and most important, insight has been that ``technical
    solutions'' alone don't bring lasting results. For health impacts to be
    sustainable, they must address underlying causes of poor health, be
    tailored to each cultural context and be broadly owned by local
    communities. For example, emergency obstetric care is vital to reducing
    maternal mortality, but lasting improvements in maternal health are not
    achieved simply by making such care available.
        In rural Ayacucho, in Peru, CARE found that only one-third of women
    who needed obstetric services actually accessed them; and of every
    100,000 live births, 240 women died (by contrast, in the United States,
    this ratio is 17 of every 100,000 live births). CARE did not approach
    this challenge as an exclusively medical problem. Rather, we tried to
    understand the health system in Ayacucho as a unique social institution
    embedded in a specific community. We found that women did not seek care
    because health center staff often did not speak Quechua (the local
    language) and women did not feel welcome there. Health center staff
    felt inferior to regional hospital staff and often felt ridiculed by
    them when they referred an emergency case; they also did not have means
    to transport emergency cases. Hospital staff were frustrated that
    emergency referrals were often misdiagnosed or came too late to save
    women's lives.
        By working to understand the needs of rural women and health
    workers at various levels, and removing blocks in the emergency
    referral system, CARE has helped to reduce maternal mortality in
    Ayacucho by half. Now, all health centers in our project area and the
    regional hospital have Quechua-speaking staff, a friendly environment,
    and culturally-appropriate options for childbirth (such as vertical
    birthing chairs, preferred in Ayacucho). Emergency obstetric protocols
    were developed by collaboration among doctors, nurses, midwives and
    Ministry of Health staff, drawing from ideas and realities of rural
    health personnel. As a result of competency-based training provided to
    rural health personnel and cost-effective resources like two-way radios
    and ambulances, women's conditions can now be diagnosed more accurately
    and they can be transported to hospitals quickly. Currently, 75 percent
    of women who need obstetric services can access them. A key aspect of
    CARE's approach was building broad political will to address the
    exceedingly high maternal mortality rate. As a result of Ayacucho's
    success, in January 2007, the Peruvian Minister of Health established
    new national clinical guidelines for obstetric emergencies, based on
    those developed by this project.
        Second, CARE has learned that individual and collective empowerment
    has much to do with access to health care services, accountability of
    health systems and the ultimate health status of the most vulnerable.
    Less power means less voice and less access, and that inequity results
    in poorer health. In most developing countries, women and youth are the
    least powerful, and their needs are often neglected. The roots of the
    health problems they face are often hidden, but we must strive to
    uncover, understand and address them.
        In Bangladesh, where CARE had been implementing a safe motherhood
    initiative, we concluded that domestic violence was one of the greatest
    risks that women faced during pregnancy. Even the best prenatal,
    obstetric and post-partum care could not fully help these women, unless
    the phenomenon of rampant violence against women was also addressed.
    CARE's modified approach, of incorporating efforts to prevent and
    respond to violence against women into safe motherhood work, holds much
    more promise not only of helping women have healthier pregnancies but
    also of securing safer societies. In isolated southern Maniema
    province, in the Democratic Republic of Congo, local health systems
    were devastated by war and women had encountered brutal violence and
    rape in war-time. Many women had married young and had multiple
    pregnancies, and CARE's promotion of family planning and birth spacing
    was welcomed as a respite--a chance to control at least one aspect of
    their bodies and lives. A young woman named Anifa told us: ``Normally,
    I'd be pregnant again, and able only to concentrate on my new baby, and
    not my other children. Now that I can control my pregnancies, I can be
    sure that my kids go to school. I will see a better life through my
    children.''
        Third, we have learned that dividing public health into various
    categories may be convenient for allocating donor funding, but these
    inherently related issues have to be understood and addressed within a
    broader and more integrated context. For example, we talk about
    maternal mortality and child survival as separate issues, but we know
    that they cannot be separated. In some countries, if a mother dies, the
    risk of death for her children under 5 doubles or triples. When women
    cannot space the births of their children, both they and their children
    are less likely to be healthy. Sometimes--as with HIV/AIDS and
    reproductive health--we not only pursue them as separate issues, but
    also build parallel systems to deliver services. This is ultimately a
    less efficient investment of resources as well as a barrier to
    effectiveness--for example, HIV information and testing could reach
    many more women, in ways that are potentially less stigmatizing, if
    they were made available through family planning or prenatal care
    services. Even within CARE, which is considerably less complex than the
    U.S. government, maintaining a system-wide view and integrating across
    various sectors and technical specialties is a challenge. We are
    constantly trying to do better.
        Finally, we at CARE have been dismayed to witness the increasing
    politicization of U.S. foreign assistance related to programs that deal
    in any way with sex or reproduction.\3\ For example, the abstinence-
    until-marriage earmark in the Global AIDS Act of 2003 requires that
    one-third of all HIV prevention funding be spent on abstinence
    programs. Administrative guidance issued by the Office of the Global
    AIDS Coordinator translates this earmark into a requirement that fully
    two-thirds of funding for preventing sexual transmission of HIV be
    spent on abstinence and fidelity programs. It also permits condoms to
    be provided only to sexually-active youth, with little recognition of
    the fact that those who are not sexually-active today may be so
    tomorrow (no matter how much we urge them to be abstinent) due to
    economic pressures driving transactional sex or vulnerability to sexual
    violence. Although the earmark governs only the U.S. Government's HIV/
    AIDS responses, the message that A and B are the priorities have
    strongly influenced U.S. reproductive health programs--especially those
    working with adolescents. The spillover effect is that reproductive
    health programs targeting youth are increasingly constrained in terms
    of the information and services they can provide--as a result, U.S.
    funded programs are less effective at protecting young people from
    pregnancy, or HIV and other STDs.
    ---------------------------------------------------------------------------
        \3\ In addition to the abstinence-until-marriage earmark and the
    Mexico City Policy, increased politicization is also evident in the
    requirement of the Global AIDS Act of 2003 that organizations must
    adopt a policy opposing prostitution and sex trafficking in order to be
    eligible for HIV/AIDS funding authorized under the act.
    ---------------------------------------------------------------------------
        From CARE's perspective, family planning and women's reproductive
    health have become too politicized and are losing ground on the U.S.
    global health agenda. The Mexico City Policy, in particular, is
    symbolic of this politicization and has caused much difficulty for
    implementers of reproductive health programs. Much of the work of
    international NGOs like CARE is done in partnership with local
    organizations. In the reproductive health field, many of the best local
    organizations provide comprehensive family planning services, sometimes
    including counseling on safe abortion. The Mexico City Policy prohibits
    organizations like CARE from working with such organizations, and in
    some cases, prevents us from working with the only organizations that
    are capable of providing the most basic family planning services. Thus,
    it diminishes not just the availability of these services but also
    their quality.
        These are just some of CARE's experiences that are pertinent to the
    matters at hand today. Given what we have learned, I want to urge you
    to consider the following:
        First, invest more--and more strategically--in reducing maternal
    mortality and child survival. On this, the twentieth anniversary of the
    global safe motherhood movement, the slow progress on reducing maternal
    mortality undermines America's deeply-held commitment to strengthening
    health and well-being throughout the world. We must gather the will and
    do much better. Over the past 5 years, United States commitments to
    maternal and child health funding have not kept pace either with unmet
    needs or with increasing growth in other international health accounts.
    I urge you to provide strong funding levels for international maternal
    and child health programs in 2008. In particular, CARE strongly
    supports the requested United States ``fair share'' levels outlined by
    Nils Daulaire on behalf of the Global Health Council for maternal and
    child health, and I urge their adoption by this committee in the coming
    appropriations process.
        The vast majority of maternal deaths are due to hemorrhage,
    infection and obstructed labor and can be easily prevented or treated.
    For each of the half a million women who die of complications during
    pregnancy and childbirth, 30 others are injured, many of them in
    seriously disabling and socially devastating ways. Women with obstetric
    fistulas, for example, are often abandoned by their families and
    condemned to isolation. The lifetime risk of dying in pregnancy or
    childbirth is 1 in 16 for women in developing countries, as compared to
    1 in 2,800 in developed countries. In Afghanistan, where 95 percent of
    women deliver their babies at home, without a skilled attendant on
    hand, the lifetime risk of dying in pregnancy or childbirth is 1 in 6.
        We must invest more strategically, not only to strengthen and
    expand all levels of health care (particularly speed of emergency
    referrals and quality of emergency obstetric care) but also to remove
    barriers to women's access to health systems and services. We must
    strive to ensure that all pregnant women have a skilled attendant at
    delivery; this need not be a doctor, but must be someone who can
    diagnose complications, administer drugs to manage them, and (where
    possible) refer women to emergency obstetric care. Drugs like
    misoprostol, which are cheap and easy to administer, can help
    strengthen contractions and control post-partum haemorrhage, and could
    ultimately increase the effectiveness of skilled attendants and reduce
    maternal mortality.
        Maternal health and child survival go together--this is why funding
    to reduce maternal mortality is such a smart investment. Four million
    babies die each year in the first month of their life; that is roughly
    the equivalent of all babies born in the United States in 1 year.
    Simple interventions like promoting breastfeeding, oral rehydration
    therapy, vaccinations, clean water, and insecticide-treated bed nets
    could make a huge impact on child survival, even where health systems
    are weak. USAID's Child Survival and Health Grants Program has done
    excellent work in this area and deserves your increased support.\4\ In
    partnership with this program, CARE has worked in the extremely poor
    far-west region in Nepal to reduce under-5 mortality by 53 percent. A
    key approach in Nepal was community case management, whereby volunteers
    are trained to provide an antibiotic to treat pneumonia. This
    intervention effectively prevents pneumonia deaths in communities where
    many families do not have the money or means of transportation to see a
    doctor in time. In settings as diverse as Nepal, Mozambique and Sierra
    Leone, CARE has achieved significant reductions in under-5 mortality
    for a cost per life saved of between $740 and $980.
    ---------------------------------------------------------------------------
        \4\ The analysis referenced in footnote 1 indicates that these
    projects saved more than 16,000 lives of children under 5.
    ---------------------------------------------------------------------------
        Second, recommit to the importance of family planning. Access to
    family planning services represents one of the most cost-effective
    investments the United States can make in the future of women,
    children, communities and nations. Family planning returns enormous
    value in improved health outcomes, economic development and national
    security. Yet, the administration's budget request proposes a 23
    percent cut in family planning funding for 2008. I urge you to not only
    restore the cut, but also provide significantly increased funding
    levels for international family planning, as the request outlined by
    the Global Health Council indicates.
        The ability to decide when, with whom and how often to have
    children is key not only to the individual futures of women and girls,
    but also to the development of countries struggling to overcome
    poverty. Although methods for avoiding unwanted pregnancies are cheap
    and effective, every year, 80 million women have unintended
    pregnancies. The unmet need for contraception is closely related to
    maternal mortality: if every woman who needed contraception had access
    to it, an estimated 20-35 percent of maternal deaths could be averted.
    However, with other health priorities taking precedence, family
    planning seems to be declining in importance. Between 1995 and 2003,
    donor support for family planning (commodities and service delivery)
    fell from $560 million to $460 million.
        The rationale provided by the administration for the 23 percent cut
    in family planning funds for 2008 is that these efforts have been so
    successful that they don't require as much U.S. investment going
    forward. Unfortunately, that is hardly the case. Large pockets of
    substantial unmet need still remain, and gains are reversed all too
    quickly when they are not reinforced. Kenya, for example, had a
    fertility rate of about eight births per woman in the 1960s. After
    decades of investment in family planning services, the fertility rate
    had fallen to 4.8 births per woman in 1998. In the past few years,
    however, attention has shifted away from family planning. As a result,
    availability of contraceptives at health facilities declined, as did
    outreach services. Sadly, between 1998 and 2003, the proportion of
    births reported by mothers as unwanted rose from 11 percent to 21
    percent.
        On a related note, I also want to register our concern about recent
    reports that the World Bank's draft health, nutrition and population
    strategy omits any commitments to family planning. This strategy is
    under review as we speak today and, if approved, could deal a serious
    blow to reproductive health programs all over the world. CARE urges the
    United States, as the largest shareholder of the World Bank, to
    underscore the importance of family planning and reproductive health in
    achieving progress on multiple fronts, including economic development,
    basic education and public health.
        Third, commit to evidence-based reproductive health programming for
    youth that is grounded in sound public health practice. The impending
    ``youth bulge'', anticipated by demographers, demands that we act
    effectively, realistically and rapidly. Sadly, the new strategic
    framework for U.S. foreign assistance fails to highlight the specific
    needs of youth, and places their critical needs underneath a broader
    umbrella. Although the intent to ``mainstream'' youth reproductive
    health is laudable, our observation is that fewer and fewer U.S.
    funding opportunities are addressing youth issues--and we believe this
    important issue may be falling through the cracks.
        Young people, especially girls and young women, are vulnerable on
    many fronts, but especially when it comes to pregnancy, STDs and HIV/
    AIDS. They are less likely than older people to protect themselves,
    either because they are not aware of--or cannot access--the protective
    measures that can keep them safe or because they have less control over
    the terms of sexual relations. We must ensure that the needs and rights
    of the most vulnerable young people are protected: for example,
    adolescents at risk of inter-generational or transactional sex; girls
    at risk of child marriage; young people who are victims of gender-based
    violence; and youth in conflict or post-conflict settings. Many young
    people fall into the category of orphans and vulnerable children
    (OVCs), orphaned or made vulnerable due to HIV/AIDS, other diseases and
    conflict, and are left without parental guidance and are particularly
    vulnerable to sexual exploitation. These young people are at risk of
    unplanned pregnancies, HIV/AIDS and other STDs, and therefore, are
    badly in need of comprehensive reproductive health services.
        Fourth, eliminate legal barriers that impede evidence-based
    programming in reproductive health and HIV/AIDS, especially related to
    vulnerable women and adolescents. I urge Congress to repeal the
    abstinence-until-marriage earmark and request the Office of the Global
    AIDS Coordinator to revise its ABC guidance in a way that promotes
    (rather than discourages) comprehensive sex education. I also urge
    Congress to repeal the Mexico City Policy--there is no evidence that
    having this policy in place has reduced the number of abortions
    performed. In fact, by cutting off funds to foreign family planning
    organizations that reject its conditions, the Mexico City Policy has
    most likely increased the number of unplanned pregnancies and led to
    increased numbers of abortions sought.
        In some of the countries in which CARE works, we see the
    implementation of the ABC approach translating into the operational
    message that abstinence and fidelity are the most desirable and moral
    options, and positioning condoms as something used only by people
    engaging in risky sex or as a ``last resort''. When Uganda first
    developed the ABC approach, it was compelling because it demystified
    HIV/AIDS and communicated that individuals had the power to protect
    themselves by choosing among A, B or C options. Delaying sexual debut
    and partner reduction is absolutely vital to preventing HIV and other
    sexually transmitted infections, but that does not mean that A, B and C
    should be broken up into parts and promoted to different segments of
    the population. In settings where risk of HIV infection is high, it is
    a disservice to not provide comprehensive information and prevention
    methods to young people who are not yet sexually active. The young girl
    who we counsel today about abstinence may be married tomorrow (or
    coerced into transactional sex), and we have an obligation to prepare
    her for the future.
        Finally, invest more broadly and strategically in global health and
    development. The U.S. leadership on HIV/AIDS has been admirable, but it
    must be accompanied by broader investments that promote community-led
    development, strengthen health care systems and build workforce
    capacity. We cannot save babies from contracting HIV only to see them
    dying of diarrhea or languishing without access to basic health and
    social services. Our investments in drugs, tests and other health
    interventions will be constrained if there are not enough health
    workers to administer them. If all boats don't rise at similar levels,
    the bold investment in HIV/AIDS may fail to deliver on its promise--and
    other areas in which gains have been made over several decades may be
    undermined. We cannot let that happen.
        I want to thank you for inviting me here today and I look forward
    to answering your questions. CARE has been a partner in the fight
    against global poverty with the U.S. Government and the American people
    for more than half a century and we are grateful for what your support
    allows us to do in thousands of poor communities around the world. We
    look forward to a future of productive partnership and exchange.

        Senator Leahy. Thank you, and I think you understand,
    Doctor----
        Dr. Gayle. No, no, that's fine.
        Senator Leahy. No, I think you understand, also----
        Dr. Gayle. Yeah.
        Senator Leahy [continuing]. From my background that you
    preach to the converted on many of these issues.
        Ms. Garrett, again, as I said earlier, your writings have
    been extremely illuminating. It was recommended to me by my
    staff to make sure to read your testimony, which I did, but
    please, go ahead.

    STATEMENT OF LAURIE GARRETT, SENIOR FELLOW FOR GLOBAL
                HEALTH, COUNCIL ON FOREIGN RELATIONS
        Ms. Garrett. Thank you very much, Senator, and thank you
    very much for your interest and concern in this area.
        I was going to remark that most Senators don't have a
    constituency that provides them with an advantage to taking on
    these issues, they're not make or break issues, but I think
    that may be different for Vermont.
        I'm happy to say that, with my colleague here to the right.
        Speaking of my colleagues, the two prior talks----
        Senator Leahy. Dr. Daulaire is rarely to anybody's right,
    but please, go ahead.
        We don't need that--we don't need that in the transcript,
    I'm sorry. It was just too easy, it was just too easy.
        Go ahead.
        Ms. Garrett. Well, of course from your vantage point, he's
    to my left.
        Senator Leahy. There you go. In fact, Dr. Daulaire is one
    of the most respected health professionals I know--by Democrats
    and Republicans.
        Ms. Garrett. My colleagues have done a wonderful job of
    laying out some of the key issues. What I'd like to do is, you
    have the written text, let me just see if I can hit some key
    points here.
        We are in an age of such fantastic generosity, we have seen
    the amount of money, as your chart indicates, skyrocketed, as
    being dedicated to global health, but it isn't just U.S.
    Government funding, it is across-the-board in increase in the
    amount of generosity pouring into global health. This is a
    skyrocketing that, literally, has occurred in the 6 year's
    time.
        Six years doesn't provide us with a big window to reflect,
    to try to ascertain whether the way we're spending the money,
    whether it's coming from philanthropic sources, such as the
    Gates Foundation, or individuals with great celebrity cache,
    such as Bono and Angelina Jolie and Brad Pitt, or coming from a
    whole host of other Government agencies around the world, akin
    to our USAID.
        It is a phenomenal amount of money, but it has not been
    suddenly flooded in with some overview, with some perspective
    put behind it.
        So, what we're doing is, we're increasing charity, we're
    not building anything. We're increasing charity. One of the key
    pieces of why the charitable incentive has risen so much, is
    because we now have evidence that certain diseases can be held
    at bay with seeming quick-fix drugs, with medicines that can be
    applied to them, and of course, HIV is the big landmark turning
    point, with the 1996 innovation of antiretroviral combination
    therapy.
        But the problem here is that the notion that we can simply
    flood a treatment modality on top of a very, very weak public
    health infrastructure, and suddenly medicalize a public health
    infrastructure overnight, this is--6 years is overnight--and
    turn it into a medical delivery system, that can
    instantaneously get antiretrovirals out to people in rural
    areas all over sub-Saharan Africa, get tuberculosis drugs out
    all over Haiti, get malaria bed meds out all over West Africa,
    this is an absolutely asinine notion. We cannot, overnight,
    scale up, switch our public health format into a medicalized
    treatment intervention format, without having casualties, all
    along the way.
        What are the big casualties? Women and children. Because
    the safety and survival of children under 5 is really,
    absolutely a public health mission. What kills children? Dirty
    water. Getting into their bodies through water, a whole host of
    microbes that shorten their poor little lives.
        What kills those mothers? Not having any kind of health
    delivery infrastructure, so that when they're in labor, and
    when all of the crises of childbirth hit, there's nobody to
    help, there's no where to go. Or, they get there, and because
    it's so grossly underfunded, they are treated with unwashed
    hands, non-sterile instruments, and succumb to infectious
    outcomes from that childbirth.
        We, just, we've talked about the brain drain, but let's
    just really think carefully about what this means. You put that
    much more money overnight into global health, you make the
    priorities of that money about getting pills out the door for a
    variety of different things, or quick-fix technologies, just
    shove them out there, but you don't have enough healthcare
    workers to do any of it.
        Indeed, we have a shortage of well over 4 million
    healthcare workers--sub-Saharan Africa alone is short 1
    million. By the way, I'm not just talking about doctors, this
    is doctors, nurses, lab technicians, health administrators,
    people who know how to do drug procurement, process supplies,
    the logistics, the whole infrastructure that is the essence of
    both public health and medical delivery. That is so weak, it
    was already fragile to the point of breaking, and now all of a
    sudden we put this surge of funding in, but it is funding with
    the priorities set in the wealthy world, not in the poor world,
    with the sense that it's all about ``we'' in the rich world,
    we'll have bragging rights and feel terrific, because we saved
    X number of lives by shoving these pills out the door.
        What's happening in practice, on the ground, is that
    because the healthcare worker crisis is so acute, we're seeing
    healthcare workers skewed towards the places where the money
    is.
        So, I am here wearing a red ribbon, which--as everybody
    knows--is the insignia of the fight against HIV/AIDS. I'm
    wearing that, partly, because I don't want anyone to misread
    what I'm saying to indicate that I somehow oppose the largesse
    that the American taxpayers have put behind PEPFAR and other
    HIV efforts--I am all for it, I think we need more money
    directed to HIV/AIDS.
        But, in the absence of sufficient health systems, of real
    training of people who know how do to health management, and
    corral these meager, weak resources, and fragile
    infrastructures as wisely as possible, what we're going to end
    up doing, and we're already seeing it in some countries, is see
    an increase in child death. An increase in maternal mortality,
    even as we're saving millions of people suffering from HIV/AIDS
    and malaria. Because we're just skewing the programs the way we
    want that money spent.
        So, finally, my main message is, we really need to step
    back and think--how do you fund systems management? We're not
    going to instantly, overnight, get 4 million healthcare
    workers, it's impossible. We do need to be grossly increasing
    the amount of money we put into healthcare worker training, but
    we're not going to fill that gap overnight.

                               PREPARED STATEMENT

        What we need to do is think, how do you train those people
    who are on the ground, in the skill set that is about managing
    meager resources, and doing it wisely to save all lives? Lift
    all boats at once, not just those targeted disease-specific
    boats.
        [The statement follows:]

                      Prepared Statement of Laurie Garrett

        Senator Leahy, Distinguished Members of the Senate Appropriations
    Subcommittee on State, Foreign Operations and Related Programs, and
    Committee Staff: It is a distinct honor to be invited to address you
    today on the subject of global health priorities. I would especially
    like to thank the Committee for expressing interest in this matter. I
    recognize that few of you have constituents clamoring for your
    attention regarding the general health needs of people living far away,
    in desperately poor countries. These are not electoral make-and-break
    issues. It is, therefore, all the more laudable that you are devoting
    time today to their consideration. Again, I thank you.
        My esteemed colleagues preceding me today have done an excellent
    job in describing exactly who is currently under-served by U.S. foreign
    aid and investment, as well as the generous philanthropic, private
    support of the American people. I will not reiterate. I will build on
    their comments, highlighting some critical fault lines in current
    global health funding and directions, and offering some suggestions for
    fresh directions for the Committee's consideration.
        Some of the basic principles, and data, I will mention are
    delineated in a piece I authored for Foreign Affairs \1\ earlier this
    year.
    ---------------------------------------------------------------------------
        \1\ Garrett, L., ``Do No Harm: The Challenge of Global Health,''
    Foreign Affairs Jan/Feb 2007, pp 14-38.
    ---------------------------------------------------------------------------
     age of generosity commences: still not enough, but rapidly increasing
        We are in an age of fantastic generosity. Globalization has brought
    the plights of the world into every living room, and onto every
    computer. As the world public's response to the 2005 Tsunami
    illustrated this internet-driven sense of the immediacy of
    catastrophe--even in places as remote as Aceh, Indonesia--spawns
    remarkable outpourings of finances, donations and goodwill. As little
    as 6 years ago global health commitments totaled a few hundred million
    dollars: Today--combining all government and private sources--we see
    donations exceeding $18 billion. This is not enough, but it constitutes
    a dramatic, even astounding, increase in generosity, realized over a
    short period of time.
        But there are dangers in throwing billions of dollars about in
    emotionally-driven responses to news events, and disease-specific
    campaigns that capture the collective imagination of the wealthy world
    citizenry.
        First, let's be blunt: most of this generosity reflects our
    interests: causes we care about, our national security, and our moral
    concerns.
        Second, for obvious political and, in the case of the private donor
    sector, self-promotion reasons, we want bragging rights. We want to be
    able to say that X amount of money, after 2 years, saved Y amount of
    lives. Most of the health-related legislation signed by President Bush
    and created by the House and Senate is rife with short term, mandatory
    timelines. In order to achieve measurable health targets in 1 or 2
    years, we necessarily have to set extremely narrow, pinpointed goals.
    And on the ground, to achieve such goals, U.S. supported programs must
    corral all available resources, funneling them into one channel of
    health.

                   TREATMENT, YES: BUT NOT WITHOUT PREVENTION

        Let me give you an example. About a year ago I was in a small town
    in Haiti. The people in this town were overwhelmed with infectious
    diseases. Their illnesses swamped the beleaguered clinics, where long
    lines of mothers and children stood in the tropical sun for hours on
    end, waiting to see a doctor. The children's growth was stunted;
    mothers couldn't produce enough milk to feed their babies; long-
    infected teenagers fought to keep their eyes open in class. In the
    parking lot of the town's main hospital sat two rusted-out, broken
    USAID jeeps, the American insignias clearly evident. Though American
    charities were helping to subsidize the medical training and services
    in the hospital, nobody--no Haitian government agency and no foreign
    donor, looked at this town and asked the obvious question: ``Why are so
    many people sick with dysentery, typhoid fever, and intestinal
    problems? Why are so many children in this town dying before they hit
    their fifth birthdays?''
        The answer: Water. The colonial-era water filtration and pumping
    system had long ago broken down. For about $200,000 the system could be
    fixed, children would drink safe water, and the disease and death rate
    would plummet. But no donor chose to take on that water problem.
    Instead, at the cost of far more lives, and dollars, the donors--
    including USAID--funded treatment of entirely preventable diseases, and
    supported the operation of a very busy morgue.
        The emphasis my colleagues placed on maternal and child health is
    wise. What is killing babies and toddlers? The lack of essential public
    health services: clean water, mosquito control, basic nutrition,
    healthy moms.
        What is killing their moms? The lack of medical systems: No safe C-
    sections, no sterile equipment for episiotomies, no prenatal care.
        Public health systems keep babies and children alive. Medical
    delivery systems keep their moms alive.
        Systems: Not individual, disease-specific programs--health systems
    are the key. Those targeted programs, such as PEPFAR (the President's
    Emergency Plan for AIDS Relief), are terrific, but without functioning
    public health and medical systems in place, PEPFAR and its like are
    just big band-aids that barely cover gaping wounds.
        We--Americans and the wealthy world, generally--have given, and
    given, and given for decades. Yet the gap between longest and shortest
    lived societies has widened, now a full five decades long. And despite
    mountains of foreign aid from the OECD nations, basic health markers
    such as life expectancy and child survival have barely budged over the
    last 60 years in any sub-Saharan African country--except, thanks to
    HIV, to go backwards in a few.

                   GOING BACKWARDS ON HALF A TRILLION DOLLARS

        Senators, your counterparts in the Canadian Senate recently issued
    a startling report, entitled, ``Overcoming 40 Years of Failure: A New
    Road Map for sub-Saharan Africa.'' The report estimates that over the
    last 45 years the United States, Canada and the rest of the wealthy
    world has spent more than half a trillion dollars in aid and investment
    in sub-Saharan Africa. Yet the World Bank Office in Nairobi estimates,
    ``that in 1948 Africa had a 7.5 percent share of world trade; in 2004
    that share had decreased to 2.6 percent. A single percentage decrease
    represents United States $70 billion.''
        ``Africa is diverging from the rest of the world at the rate of 5
    percent per capita income each year,'' The Canadian Senate report
    concludes.\2\
    ---------------------------------------------------------------------------
        \2\ Canadian Report by the Standing Senate Committee on Foreign
    Affairs and International Trade, ``Overcoming 40 Years of Failure: A
    New Roadmap for sub-Saharan Africa,'' Feb 2007.
    ---------------------------------------------------------------------------
        Even in parts of the world we have credited as economic success
    stories--where the Asian Tiger roars, and the Latin miracle twinkles--
    health remains a striking challenge. The world nervously watches the
    spread of H5N1 influenza--``bird flu''--in Asia, largely in the same
    locations that featured SARS in 2003. Yellow fever, dengue, and malaria
    have all returned to Latin America. Indeed, Jamaica is at this moment
    battling the first malaria outbreak on that Caribbean island in more
    than 60 years, spiraling out of control right in the capital city. That
    is a public health failure. And as the previous speakers told you,
    maternal health is going backwards in much of the poor world--women are
    dying in childbirth in many of these countries at a far greater rate
    than they were half a century ago. Recent United Nations findings on
    maternal mortality show that a woman living in sub-Saharan Africa has a
    1 in 16 chance of dying in pregnancy or childbirth. This compares with
    a 1 in 2,800 risk for a woman from a developed region, and a more than
    1:28,000 risk for a mother in Scandinavia.
        Every effort to battle diseases--from bird flu to HIV--comes up
    against the same set of problems. Congress has, over the last 3 years,
    approved some $8 billion of spending--about 5 percent of it overseas--
    to make Americans safer in the face of threatened pandemic influenza.
    But in the big picture the danger has over that time only increased,
    both because of mutations in the evolving H5N1 virus, and because
    quick-fix approaches to disease surveillance and control won't work in
    countries that have no adequate systems of public health and medical
    care.
        Even the Bush administration's laudable PEPFAR program, which
    started out with a fairly minimal mission of providing prevention, care
    and treatment for a single disease, now finds itself forced to build
    medical delivery systems simply to get anti-HIV drugs to the patients
    who need them.
        A just-published critique of the Global Fund to Fight AIDS,
    Tuberculosis and Malaria \3\ charges that unless the Fund starts to
    directly underwrite the salaries of healthcare workers, including
    minimally-educated community providers, the effort will become nothing
    more than ``medicines without doctors,'' an unsustainable program for
    tossing out drugs without providing any actual healthcare.
    ---------------------------------------------------------------------------
        \3\ Ooms, G., Van Damme, W., and Temmerman, M., ``Medicines without
    Doctors: Why the Global Fund Must Fund Slaries of Health Workers to
    Expand AIDS Treatment,'' PLoS Medicine 4:0001-0004, 2007.
    ---------------------------------------------------------------------------
                       the world needs healthcare workers
        The world is desperately short of health professionals, and the
    severity of that gap promises to increase sharply in coming years. The
    World Health Organization estimates the shortage breaks down currently
    as follows: \4\
    ---------------------------------------------------------------------------
        \4\ World Health Organization, ``The global shortage of health
    workers and its impact.'' Fact sheet No. 302, April 2006. http://
    www.who.int/mediacentre/factsheets/fs302/en/index.html
    ---------------------------------------------------------------------------
      --In 57 countries the deficit is labeled by WHO as ``severe'';
      --The world needs, immediately, 2.4 million medical service
            providers;
      --1.9 million laboratory workers, health managers, and
            administrators;
      --A total of 4.3 million healthcare workers are needed at this
            moment.
        Sub-Saharan Africa faces the greatest challenges. While it has 11
    percent of the world's population and 24 percent of the global burden
    of disease, it has only 3 percent of the world's health workers.\5\
    ---------------------------------------------------------------------------
        \5\ ibid.
    ---------------------------------------------------------------------------
        The World Health Organization says:

        ``There is a direct relationship between the ratio of health
    workers to population and survival of women during childbirth and
    children in early infancy. As the number of health workers declines,
    survival declines proportionately.''

        This is going to get much worse. Why? Because the wealthy world is
    aging, therefore requiring more health attention. At the same time,
    wealthy nations are trying to reduce rapidly inflating health costs by
    holding down salaries, and increasing work loads, making the practices
    of nursing and medicine less attractive. Unless radical changes are put
    in place swiftly in the United States and other wealthy nations the gap
    will soon become catastrophic. Studies show that the United States will
    in 13 years face a shortage of 800,000 nurses and 200,000 doctors.
        How are the United States and other wealthy nations filling that
    gap? By siphoning off doctors and nurses from the poor world. We are
    guilty of bolstering our healthcare systems by weakening those of
    poorer nations.
        Here is an example: due to healthcare worker shortages, 43 percent
    of Ghana's hospitals and clinics are unable to provide child
    immunizations and 77 percent cannot provide 24-hour obstetric services
    for women in labor. So the children die of common diseases, like
    measles, and the mothers die in childbirth. In all of Ghana there are
    only 2,500 physicians. Meanwhile, in New York City, alone, there are
    600 licensed Ghanaian physicians.\6\
    ---------------------------------------------------------------------------
        \6\ Krestev, N., ``World: Maternal-Mortality Numbers Still
    Climbing,'' Radio Free Europe July 2006. http://www.rferl.org/
    featuresarticle/2006/07/10d24de4-cc8d-459c-9eed629ee1bccc4c.html
    ---------------------------------------------------------------------------
        There are a number of bills pending in both the House and Senate
    that seek, in various ways, to increase domestic education and staffing
    of healthcare workers, and bolster training in poor countries. Though
    this committee deals with foreign operations, it is vital that you
    concern yourself with the progress of measures that would decrease the
    drive to drain the health brain power of the poor world by enhancing
    education and incentives here in the United States. In the House, for
    example, H.R. 410, the United States Physician Shortage Elimination Act
    of 2007, seeks to create incentives for physicians to serve in under-
    allocated areas of America.
        Senate Bill 805, sponsored by Sen. Richard Durbin, is the ``African
    Health Capacity Investment Act of 2007.'' It seeks to amend the Foreign
    Assistance Act of 1961 to provide funding for medical training, and
    retention of healthcare staff in sub-Saharan African countries. I urge
    the Senate to pass S.805.
    Fund Programs for Systems Development
        But let's be clear: Even if we put the brakes on the brain drain
    this instant, and the United States of America no longer imported
    foreign doctors, nurses, and lab technicians, there would still be a
    crisis. And even if Senator Durbin's bill passed, fully funded, there
    would still be a crisis.
        We are in an ugly mess. If we want to do the right thing, and get
    millions more people in poor countries on anti-HIV medications, our
    U.S. tax dollars have to be put to use skewing health services towards
    AIDS, and away from general maternal health and child survival. Why:
    Because there aren't enough healthcare workers to do both.
        If we want to spend U.S. taxpayer dollars--as we should--on
    campaigns to wipe out malaria-carrying mosquitoes and get children
    under insect-barrier nets at night, then the public health workers who
    will implement such programs have to come from somewhere. Perhaps there
    will be fewer of them trying to clean the children's drinking water or
    teaching teenagers how to avoid getting infected with HIV. Why? Because
    there aren't enough trained public health experts.
        The only way American tax dollars can save lives, across the
    board--without robbing healthcare workers from one disease area to
    implement disease combat in another area--is if we start funding
    systems management. The expertise for disease prevention and treatment
    is sparse: the talent pool, along with their supplies and patient
    loads, must be carefully managed. Novel incentive systems to defy
    corruption and bring quality health to vast constituencies must be put
    in place.
        At the request of Prime Minister Tony Blair, this question of the
    relationship between wealthy world priorities, and the health--or the
    lack thereof--in Africa was studied by Lord Nigel Crisp. His recently-
    released report \7\ concludes that single-disease-specific programs can
    damage other health interests. He calls for direct funding of systems
    development and management, with far longer-term commitments than had
    been the norm for the UK. The Crisp recommendations are now being
    implemented.
    ---------------------------------------------------------------------------
        \7\ Lord Nigel Crisp. ``Global health partnerships: the UK
    contribution to health in developing countries:'' February 2007. http:/
    /www.dh.gov.uk/en/Publicationsandstatistics/Publications/
    PublicationsPolicyAndGuidance/DH_065374
    ---------------------------------------------------------------------------
        But what about the United States? Well, we do have a health systems
    management program nested inside USAID. It is working to
    professionalize health management in poor countries. It's budget? Just
    over $3 million.

                 FISCAL YEAR 2008 BUDGET: INTERNATIONAL AFFAIRS

        As you look over the White House fiscal year 2008 budget requests--
    for a total Foreign Operations request of $20.3 billion--please pay
    close attention to the following:
      --More than half of all funding for Africa will focus on 8 strategic
            states.
      --Overall health spending in designated African countries would more
            than double compared to fiscal year 2006 actual spending.
        Of the nearly $4 billion requested for health in Africa, $3.4
    billion would go for HIV/AIDS in 12 countries (under the Global HIV/
    AIDS Initiative or GHAI, formerly known as PEPFAR). The remaining $700
    million would be spent on the President's Malaria Initiative,
    Tuberculosis and a host of modest child survival and health
    initiatives.
      --Nearly all programs are heavily ear-marked, with little or no
            monies designated for general health threats or health systems
            management and support. Health management and personnel
            training is not stipulated clearly in any budget lines, either
            under disease-specific programs, nor in overall global health
            budgets.
      --Only $34 million is requested for water systems, sanitation, or
            general public health threats.
      --Under the Global War on Terror 2007 supplemental the President
            requests $161 million, in additional to the general budget $100
            million, for pandemic influenza surveillance and control,
            through USAID. The supplemental request is listed under Child
            Survival and Health Programs.
        I do not believe that we are guilty of over-spending in any global
    health initiative. Rather, we are guilty of under-valuing the necessity
    of building genuine, well-managed public health and medical systems.
    The paltry $3 million now spent on USAID's Management Sciences for
    Health program should increase dramatically, reflecting this gap.
    Further, current caps \8\ on human resources development and training
    that exist for PEPFAR funds should be lifted, for training of
    indigenous--not American NGO or FBO--personnel.
    ---------------------------------------------------------------------------
        \8\ Under PEPFAR, spending to train local healthcare workers cannot
    exceed $1 million per country per year. That is absurd.
    ---------------------------------------------------------------------------
                               WHAT IS THE GOAL?

        I think the appropriate goals for U.S. foreign aid in support of
    global health ought to be twofold:
      --Build sustainable infrastructures in poor countries that shift the
            paradigm towards fantastic improvements in maternal health,
            child survival and overall extension of life expectancy.
      --And, second, ensure the safety and security of the American people
            by lowering the global disease burden, both in terms of
            infectious threat and detrimental impact on nations' and global
            GDP and economic growth.
        The current channels of spending, though in the billions of
    dollars, will not accomplish either of these goals.
        Systems and infrastructure aren't sexy, cannot be built in short
    funding cycles, and are tough to brag about to constituents. But
    without viable systems of medical delivery and public health
    infrastructures all we will manage to do with our billions of dollars
    is save some lives, at the expense of others; achieve short term
    targets without fundamentally leaving anything in place that allows
    nations ultimate dignity and self-reliance.
        Let me close with this final story. During the 1960s, at the height
    of the Cold War, the global community committed to the astonishing goal
    of completely eradicating smallpox. The virus had killed more people
    during the first six decades of the 20th Century than all wars,
    combined. In order to accomplish this remarkable feat the World Health
    Organization and our Centers for Disease Control set up an
    unprecedented worldwide infrastructure of community health workers,
    public health advocates, disease detectives, laboratories, vaccine
    manufacturing, specialized infectious diseases clinics and hospitals
    and international-scale leadership and management. It was a
    breathtaking scale of effort. And it worked. By the end of the 1970s
    smallpox was eradicated.
        But then a tragic, inconceivable mistake was made: The entire
    worldwide smallpox infrastructure was simply shut down. Unable to find
    funding, or international interest, the infrastructure that defeated
    smallpox was, itself, eradicated at precisely the same time as a new
    scourge emerged: HIV. Since 1981 AIDS has killed more people, in 25
    years, than smallpox did in the 20th Century.
        As the late, great Kurt Vonnegut would say ``So it goes.''
        Thank you for your time, attention, and concern.

        Senator Leahy. I was discussing your testimony with my wife
    who is a registered nurse, now retired, except for children and
    grandchildren, she's traveled with me to a number of places
    around the world where we've used the Leahy War Victims Fund.
    She's been in some of these places, and she said our first-year
    nurse's training 40 years ago was more advanced than what they
    had available. We've brought thousands of sterile disposable
    gloves and needles.
        We're not trying to build the Mayo Clinic in these places.
    We're not talking about major surgery, we're talking about the
    preventive measures that we take for granted.
        I'm glad you raised the brain drain. I worry, also, though,
    that we don't have the basic--very, very basic--infrastructure.
    Where I see medications that are supposed to be refrigerated,
    there's no ability or knowledge of doing it. A pill a day for
    20 days, but, well, why not take 20 today and get it over with,
    and that kind of thing.
        Dr. Daulaire, as I said before, you and I have been friends
    for decades, and I'm delighted you're here. I'm delighted the
    Global Health Council is based in Vermont. There's some days
    when I'm down here I'm envious of you being back home.
        Please go ahead, sir.

    STATEMENT OF DR. NILS DAULAIRE, PRESIDENT, GLOBAL
                HEALTH COUNCIL
        Dr. Daulaire. Thank you, Senator Leahy, in turn I'm
    delighted to be one of your enthusiastic constituents, as are
    our staff, headquartered in Vermont, some of whom are Senator
    Gregg's constituents as well, right across the river.
        But I'm here today, not as a Vermonter, but as the head of
    the Global Health Council, an organization representing health
    professionals and service organizations working in more than
    100 countries. This is the issue of the moment, and I'm more
    delighted than I can tell you that you are hosting this hearing
    today.
        As you well know, I'm a doctor and a scientist, I've worked
    in the field for over 3 decades, and I believe deeply, as Dr.
    Gayle mentioned before, that what we do in global health has to
    be evidence-based. So, both in the submitted testimony and what
    I'm going to talk about over the next few minutes, we have hard
    facts to back up everything that we're talking about.
        I'd like to make five points--first, this is a huge issue;
    second, we have done an enormous amount, we, the United States,
    to improve the situation, and we know what to do; third, over
    the last 10 years, our investments have lagged; fourth, we can
    make a world of difference with modest additional investments,
    starting this year; and fifth, this would be good, not only for
    the women and children of the world, but it would be good for
    America.
        So, let me take those five points in order. We've already
    heard quite a number of the statistics, let me just put one
    chart up here--this is a huge issue. In many of the countries
    where I've personally worked, 1 out of 5 children do not
    survive to their fifth birthday. Take a classroom of 16
    adolescent girls, one of those girls is not going to make it
    through her fertile years, because of a death due to pregnancy
    or childbirth, and 1 out of 4 regnancies around the world is
    unintended.
        These are staggering statistics, when we consider our own
    lives and our own children and our own families, and they're
    simply unacceptable. Sitting in the Dirksen Building, I'm
    reminded that he once said, ``A million here, a million there,
    pretty soon you're talking about real money.'' In this case,
    you're talking about real lives. You've heard the lives--over
    10 million child deaths, over half a million women dying in
    pregnancy and childbirth--and as well, more than 200 million
    women living around the world with an unmet need for family
    planning.
        Some people have asked, why does the Global Health Council
    concern itself about family planning? That's a population
    thing, not a health thing. But, family planning is
    fundamentally a health intervention. It prevents abortion--I
    don't need to make that argument with you, sir, you've been
    clear on that, and you understand that well--but in addition,
    we know from the data that it saves the lives of young
    children, the older siblings. A child born more than 3 years
    after the prior birth has a one-third lower chance of dying
    than a child born within 2 years.
        Children born to teen mothers have a 30 percent higher rate
    of infant and child mortality than do children born to older
    mothers, so--family planning saves mothers' lives, and it saves
    childrens' lives.
        But this is not only about death, but also about lives. I
    have to say that, in addition to the ones dying, there are 40
    million children living stunted lives physically and
    intellectually each year. There's more than 20 million women
    who suffer lifelong consequences of complicated deliveries, and
    there are 60 million women a year making agonizing choices
    about pregnancies that they did not intend.
        The second issue, we've learned a lot, and we know what to
    do. We've talked about that already, and Dr. Hill, I think,
    made the case beautifully, that this has been an area of
    enormous scientific growth and operation growth, but it didn't
    just happen. It happened because of considerable U.S.
    Government investments in maternal and child health, and in
    family planning. Investments led to knowledge, led to
    application, and led to millions of lives saved.
        Why have our investments lagged over the past decade? We
    have this chart up here that your staff prepared, let me take
    those bottom lines that you can barely see, and show you that
    in maternal and child health in nominal dollars, the line has
    been more or less flat. Adjusted for inflation, we're actually
    spending 22 percent less than we were 10 years ago, and that's
    in a world that has 19 percent more children.
        In family planning, the situation is also very sobering.
    Again, adjusted for inflation, our investment in the past 10
    years has declined by 14 percent, and that's in a world with 30
    percent more women in need of family planning services.
        So, this is critical in terms of making an important change
    in the delivery of services. What do we need today? What U.S.
    leadership is called for? Well, analysis has shown that it
    would take $5.1 billion of global investment, not just United
    States, to save 6 million children's lives, the figure that Dr.
    Hill pointed to before. Another $3.9 billion to save, to
    provide family planning services for 200 million women, so
    we're talking about a global need of $9 billion in which the
    United States fair share would be about $1.6 billion for child
    health, $2 billion for maternal health, and about $1.3 billion
    for family planning.
        Now, as much as our community would love to have that
    investment made this year, we recognize that you have to deal
    with a difficult appropriations process. So, I'm going to tell
    you what you can buy for every $100 million that this
    committee, in its wisdom, decides to invest in maternal and
    child health and family planning.
        If you invest $100 million in child health and survival,
    you will save 113,000 to 200,000 lives every year. Nearly a
    million children will be provided with the 16 essential
    interventions that programs like CARE and others carry out.
        If you invest $100 million in mothers, you will prevent
    12,000 maternal deaths, 15,000 newborn deaths, you'll provide 4
    million women with basic, essential care, and 140,000 women
    will be treated for life-threatening conditions.
        Last but certainly not least, if you invest $100 million in
    family planning, there will be another 3.5 million additional
    family planning users, 2.1 million fewer unintended
    pregnancies, fewer infant and maternal deaths, and not
    incidentally, 825,000 fewer abortions around the world.
        Senator Leahy. So, as you're talking about that chart, the
    amount of money--it's a large amount of money--but its almost
    as much as we had spent by Tuesday morning of this week in
    Iraq.
        Dr. Daulaire. There we go.
        Senator Leahy. Not to put too fine a point on it.
        Dr. Daulaire. I----
        Senator Leahy. Or to indicate my feelings on that, but
    really, starting Sunday morning, we spent more than that by
    Tuesday noon in Iraq. We did last week, and the week before,
    and the week before, and we've been there for 5 years, longer
    than we were in World War II.
        Dr. Daulaire. Mr. Chairman, this is indeed a matter of
    making decisions about national priorities.
        Let me wrap up--Laurie Garrett has talked about the
    importance for health systems. What builds health systems
    capacity is the delivery of routine services on a daily basis,
    and what does that the most effectively and efficiently is
    maternal and child health services, and family planning,
    because those children and those mothers come through the door
    every single day. You can build other programs on top of that
    infrastructure, but that is the core of daily activities that
    is essential for infrastructure.
        Finally, I think it's self-evident, I'm preaching to the
    converted here, but this would be good for America, not only
    because healthy families lead to more stable societies, less
    turmoil, and fragmentation in the world, but because the United
    States desperately needs a more positive face overseas. United
    States programs invested in maternal and child health and
    family planning have been among the most effective and
    appreciated around the world.
        Senator, I know your children, you know mine, I know your
    wife, you know mine--we would not tolerate these levels of
    risks in our own family, and this is our family writ large.
    Women and children are at the center of global health and it's
    time for us to take action.

                               PREPARED STATEMENT

        I call on you and your committee to boldly re-establish
    that commitment, with real dollars measured in the hundreds of
    millions. Thank you very much.
        [The statement follows:]

                    Prepared Statement of Dr. Nils Daulaire

        Chairman Leahy, Ranking Member Gregg and members of the
    subcommittee, thank you for inviting me to testify before you today on
    Maternal and Child Health, Reproductive Health and Family Planning. I
    am Dr. Nils Daulaire, President and CEO of the Global Health Council,
    the world's largest membership alliance of health professionals and
    service organizations working to save lives and improve health
    throughout the world.
        Before I begin my remarks, let me thank you, Chairman Leahy, for
    your service to our home State of Vermont and your longstanding
    commitment to global health. You have been a proponent and champion of
    U.S. investment in global health for more than 30 years. Long before
    PEPFAR, the Global Fund, PMI and other welcome global health
    initiatives, you fought for basic health services in developing
    countries, committed to meeting the needs of the poor and most
    vulnerable. I applaud you, Chairman Leahy and you, Senator Gregg, for
    your bipartisan collaboration, recognizing that saving lives knows no
    party lines. On behalf of the Council's 350 member organizations
    working in over 100 countries across the globe, and the millions whose
    lives are improved by U.S. Government investments, we thank you.
        The Global Health Council's members include non-profit
    organizations, schools of public health and medicine, research
    institutions, associations, foundations, businesses and concerned
    global citizens who work in global health--delivering programs,
    building capacity, developing new tools and technologies and evaluating
    impact to improve health among the poor of the developing world. Our
    members work in a wide array of areas, including child and maternal
    health, family planning, HIV/AIDS, other infectious diseases, water and
    sanitation, primary health care and health systems strengthening. The
    members of the Council share a commitment to alleviating the great
    health disparities that affect the world's most vulnerable people. The
    Council serves its members and the broader community of global health
    stakeholders by making sure they have the information and resources
    they need to fulfill this commitment and by serving as their collective
    voice.
        It has been my privilege to be part of the global health movement
    for over 30 years, and much of my career has been spent as a physician
    and program manager in some of the world's poorest countries. Working
    in countries such as Nepal, Mali and Haiti, I have had the good fortune
    to participate in the development and introduction of some important
    child survival interventions, notably in treating childhood pneumonia
    and Vitamin A deficiency. I have also had the honor of serving in
    Government as a senior policy advisor in USAID. My remarks today derive
    from these different perspectives and experiences, as well as the
    evidence and experience of our membership.

                          THE WORLD'S WOMEN & CHILDREN

        The link between the health of the world's women and children is
    well-established, as is the link between their health and the well-
    being of the larger community. Because of these connections, we must
    view the challenges, interventions and investments as contributing to a
    continuum of care that has mutually reinforcing benefits from the
    individual all the way through global society.

    Child Health
        Today, as every other day, nearly 30,000 children under age five
    will die--1 every 3 seconds. In many countries, 1 of every 5 children
    born won't live to see their fifth birthday. If death rates of this
    magnitude were happening to the youngest and most vulnerable here in
    the United States, we would declare a state of national emergency. It
    is happening, perhaps not in our backyard, but in our world, and we
    must do more.
        This year, more than 10 million children under 5 will die, mostly
    from preventable and treatable conditions--about the same as the total
    number of American children under 5 living east of the Mississippi
    River. Almost 4 million of these deaths will occur during the first
    month of life. Two million children will die from pneumonia; 1.8
    million from diarrhea; nearly another million from malaria and almost
    half a million from measles. Virtually all of these deaths can be
    prevented--easily and cheaply.
        As American parents, we take for granted that our kids will live
    and thrive. We recall when a skilled medical provider coached us
    through the stages of labor. We remember when our babies were whisked
    away to be dressed with head caps and swaddled to keep them warm. We
    have all taken our children in for their immunizations to protect them
    against measles, diphtheria, pertussis, tetanus and polio, diseases
    which, as a result, are today practically unknown in our country. If my
    daughter developed diarrhea, she was hydrated and her risks were very
    low. If my son developed pneumonia, rapid cure was ensured through
    antibiotics. These are all simple, basic practices that kept our
    children alive, and we are blessed to be able to take them for granted.
        In the developing world, however, too many parents live with the
    very real fear that death will take their children. The interventions
    that I have named are neither difficult to administer nor expensive.
    The cost of some, such as oral rehydration salts, vitamin A supplements
    and even antibiotics, are measured in cents, not dollars. Breastfeeding
    and kangaroo care, where mothers hold newborn babies to their breasts
    to keep them warm, cost nothing at all beyond educating parents. Yet
    children are still dying because these basic interventions are not
    reaching them. I couldn't imagine that expectation when my children
    were born. No parent should have to.

    Maternal Health
        In the United States and other developed nations, the risk of death
    from complications of pregnancy and childbirth is extremely low.
    Although the risk of a woman in a developed country dying is about 1 in
    2,800, the lifetime risk of sub-Saharan African women dying from
    complications in pregnancy or childbirth is 1 in 16. Over half a
    million women die each year from pregnancy-related causes, and up to 20
    million develop long-term physical disabilities each year because of
    complications or poor management of pregnancy or childbirth. Almost 4
    million newborn deaths are closely linked to poor maternal health care,
    especially the absence of a trained provider during and immediately
    after birth. And each year, more than 1 million children are left
    motherless.

    Reproductive Health/Family Planning
        Notwithstanding the progress in making family planning services
    available, over 200 million women still have an unmet need for family
    planning. These are women who are at risk of becoming pregnant, who
    wish to delay or end childbearing and yet do not have effective access
    to family planning. This is a denial of the basic right of every woman
    to decide if and when she will become pregnant. It is utterly
    meaningless to declare support for the human rights of women and yet
    fail to provide them with the information, services and commodities
    that will allow them to make a free, informed and safe decision about
    whether and when to become pregnant. Women cannot fulfill their
    potential or assert their rightful place in economies and societies
    unless they have such access. The decline in United States support for
    family planning flies in the face of our stated national commitment to
    overcoming the second class status of women in much of the world.
        What is less well understood but equally important is that family
    planning is essential to protecting the health of mothers and their
    children. Family planning helps young women delay or space pregnancies.
    Family planning helps all women avoid high risk pregnancies;
    approximately 215,000 maternal deaths will be averted this year alone
    thanks to the family planning that is available.
        Debate over abortion continues to create stark political divides.
    Yet, there is one thing we can agree upon--family planning reduces
    recourse to abortion by enabling women to avoid unintended pregnancies.
    Every year, there are more than 46 million abortions. 68,000 will also
    end in the death of the mother. Increasing access to family planning is
    the surest path to decreasing the number of abortions.
        Speaking as a physician who has devoted years to improving
    children's health worldwide, let me make this clear: family planning is
    also critical to saving children's lives. Closely spaced births and
    births to young mothers dramatically raise the risk that the infant
    will die. A child born less than 2 years after a sibling is 67 percent
    more likely to die than a child born after a 3 year interval. The child
    of a teenage mother is 30 percent more likely to die than that of a
    woman aged 20 to 29. Between 20 percent and 40 percent of all infant
    deaths could be prevented if all women had access to family planning.

    Lives, Not Just Deaths
        I should point out that the issues of maternal and child health as
    well as reproductive health are not limited to averting deaths. They
    are also cause for diminished lives. For every woman who dies during
    pregnancy, childbirth or immediately following, another 30 suffer
    debilitating life-long consequences. Each year, nearly 40 million
    children who suffer early childhood illnesses but do not die become
    physically or mentally impaired. All of this contributes to the cycle
    of poverty and the failure of poor countries to develop.

                     U.S. INVESTMENTS--PROGRESS UNDERMINED

        The United States is a tremendously important force in global
    health. Its decisions about priorities, resource allocation, policies
    and technical leadership have profound consequences--that is the
    privilege and burden of our country's unique role. It is widely
    acknowledged that the United States has made very important and
    enduring contributions to global health. Yet today, U.S. global health
    policy is marked by two trends that are in stark opposition and
    mutually inconsistent. On the one hand we see the rapid expansion of
    U.S. programs in HIV and malaria; on the other we witness the neglect
    of maternal health, child health and family planning. This makes no
    sense.

    Contradictory Trends
        The U.S. Government (USG) investment in global health has grown and
    evolved dramatically in just a decade. In fiscal year 1997, USG
    spending on global health sat just below $1 billion. Ten years later,
    global health spending is well over $5 billion from the foreign
    operations budget alone, with additional investments from the
    Department of Health and Human Services and the Department of Defense.
    However, the devil is in the details.
        Most of the exponential growth in global health spending over the
    past decade is due to USG investments in HIV/AIDS--over $14 billion
    since the advent of the PEPFAR, the President's emergency program for
    AIDS relief--an important commitment that the Council applauds. More
    recently, the President Malaria Initiative (PMI) has joined PEPFAR as a
    priority program of this administration, with a $1.2 billion pledge
    over 5 years. PEPFAR and PMI speak to the USG's generosity and ability
    to make a difference and, through these programs, many lives are being
    saved. The USG deserves tremendous credit for its global leadership.
        But the U.S. Government has not seen fit to increase in a similar
    way its historic leadership in maternal and child health and family
    planning. Once the investment in AIDS and malaria is subtracted from
    current spending totals, investments in child health, maternal health,
    family planning and the remaining infectious diseases remain at about
    $1 billion, roughly where they were a decade ago. There has been level
    funding in most program areas and cuts in others, which means a
    decrease in programming power once adjusted for inflation and the
    increase of the number of people in need. This is most notable in the
    areas of child health and reproductive health and family planning
    which, when adjusted for inflation, have declined 22 percent and 14
    percent, respectively, over the past decade. To this must be added the
    impact of a 19 percent increase in the number children under five and a
    30 percent increase in the number of reproductive age women in the 43
    least developed nations. So while the dollars have gone down, the need
    has gone up. Reduced investment translates into lives--millions lost
    unnecessarily.

    Complements not Contradictions
        Let me say again, the Council enthusiastically applauds the growth
    in spending for AIDS and malaria and the leadership President Bush and
    the Congress have shown in these areas. But while funding flows through
    independent and issue-specific channels, these health threats do not
    occur in isolation. The same communities where individuals are living
    with AIDS are also those in which non-HIV infected women are at very
    high risk of dying during child birth from lack of family planning and
    basic obstetric care. The same young children who now sleep under bed
    nets to guard against malaria are no less likely to die from diarrhea
    or pneumonia. We have confused the laudable objective of fighting
    disease with the fundamental goal of saving and bettering lives, and
    our investment is undermined by an excessively narrow perspective.
    Fortunately, relatively modest increases in USG investment in these
    neglected areas can save millions of lives through simple, cost-
    effective interventions.
        That is the good news--solutions are within easy reach at low cost.
    In the past 30 years, thanks to the investments and efforts that have
    been undertaken, the child mortality rate in the poorest parts of the
    world has declined by 40 percent. Because of family planning efforts,
    birth rates have also declined by 40 percent. What an incredible
    moment: For all of human history, people have lived with the
    expectation that many of their children will die young and that women
    will endure one pregnancy after another, regardless of the impact on
    their health and survival. The 40 percent decline in birth and death
    rates is a stunning change. The advent of simple, inexpensive vaccines,
    antibiotics, oral rehydration salts, anti-malarials, micronutrients and
    contraceptives have radically changed expectations and reality in many
    parts of the world. What a tragedy it would be not to finish a job so
    well begun.
        This progress makes the choice not to increase our investment in
    women and children intolerable. Allowing women and children to die from
    easily preventable causes is just that--a choice. We are at a loss to
    understand how this administration, so generous in the response to HIV/
    AIDS and malaria, now proposes substantial cuts in maternal and child
    health and family planning.

                         IMPROVING HEALTH, SAVING LIVES

        As I have described, U.S. support for basic maternal health, child
    health and family planning services has been declining. This must be
    reversed. The United States must reassert its historic and essential
    leadership in saving the lives of women and children. Providing these
    basic interventions for women and children is the cornerstone for
    securing improved health and is at the heart of building sustainable
    public health systems. The record is clear. Every time the United
    States has approached a major global health problem with tenacity and
    at the requisite scale, our country has had a tremendous positive
    impact.
        On the scale of global need, the amount needed to achieve important
    gains in child health and family planning is manageable. Six million
    children could be saved every year if the global budget for child
    health were increased by $5.1 billion. Providing essential obstetric
    care to 75 percent of women in 75 countries would cost an additional
    $6.1 billion; 200 million women with an unmet need for family planning
    could receive these services for an additional $3.9 billion per year.
    So the math is simple. If--from all sources: United States, other
    donors, developing nations--the world devoted an additional $15 billion
    per year, 6 million children would be saved annually, most women would
    have maternal health care and 200 million more women would have access
    to family planning. I urge this committee and the Congress to move the
    United States into the same leadership role on family planning,
    maternal and child health that it has shown in AIDS and malaria.

                       MODEST INVESTMENTS, MAXIMUM IMPACT

        To illustrate the potential impact of a heightened U.S. commitment,
    I'd like to reflect on what even a modest ramp-up in investments could
    return. The U.S. share of the additional global investment needed to
    reduce child mortality is roughly $1.6 billion. The United States
    should add $2 billion per year to its spending on maternal health. The
    United States should increase its contribution to family planning by
    $1.3 billion per year. We have a long way to go. However, we can take
    modest steps and still see great gains. The projections I share with
    you are based on solid scientific analyses by the Council and others.
    Investment Scale-Up
        Every $100 million in attacking the most common causes of child
    death with the most cost-effective interventions would have the
    following impacts:
      --At least 113,000, and perhaps as many as 200,000, young children's
            lives saved
      --Over 812,000 children provided with 16 essential interventions, at
            an average cost of just over $12 per child
        Every $100 million devoted to maternal health programs would:
      --Avert nearly 12,000 maternal deaths
      --Avert more than 15,000 newborn deaths
      --Provide basic and essential care for 4 million women
      --Treat 140,000 women with life-threatening conditions
      --Treat an additional 880,000 women with serious pregnancy and
            childbirth-related conditions
        Every $100 million invested in family planning would have the
    following impacts:
      --3.6 million more family planning users
      --2.1 million unintended pregnancies avoided
      --825,000 abortions prevented
      --970,000 fewer births
      --70,000 fewer infant deaths
      --4,000 maternal deaths averted
        These are remarkable outcomes for relatively moderate additional
    outlays. Each increment of $100 million would yield proportionate
    gains, the virtuous cycle writ large. We therefore urge this committee
    to approve a significant increase in the budgets for maternal and child
    health and family planning with investments on par with the other
    global health priorities.

                      BUILDING CAPACITY WHILE SAVING LIVES

        There is the misperception in some quarters that U.S. assistance
    for maternal and child health has been an example of charity or created
    dependency. This is far from the truth. Improving health is not merely
    a matter of delivering pills and vaccines, though pills and vaccines
    are essential. It's about improving health equity by putting in place
    sustainable systems for delivering essential care. Improving health
    means supporting educational programs to foster new attitudes and
    behaviors; building community leadership and organizations committed to
    improved health; strengthening the capacity of health providers and
    institutions; better measurement of what programs accomplish; and,
    adopting better health policies and health financing schemes. The
    United States role has been to strengthen the capacity of national
    health systems to deliver essential maternal and child health care.
    Achieving long term sustained change requires patience and sustained
    investment, but the record of building capacity while achieving gains
    in health outcomes is clear.
        Another invaluable U.S. contribution has been to invest in
    technical leadership and research and development, areas where the
    United States has historically excelled. These core functions support
    the development of new technologies and innovative means of delivering
    services, which have enduring impact. The overall decline in resources
    has seriously affected these core functions, a consequence exacerbated
    by the declining percentage of available resources devoted to technical
    leadership and research and development. I am greatly concerned that
    the technical leadership role of the United States has been starved of
    resources and I urge the committee to be sure it is adequately funded.

                              IN THE U.S. INTEREST

        The United States has a compelling national interest in saving the
    lives of the most vulnerable women and children. The stated goal of
    U.S. foreign assistance is ``To help build and sustain democratic,
    well-governed states that respond to the needs of their people, reduce
    widespread poverty and conduct themselves responsibly in the
    international system.'' There is no more dramatic marker of this goal
    than saving the lives of millions of women and children.
        Poor maternal and child health indicators are viewed by many as
    evidence of the failure of governments to provide basic services.
    Conversely, alleviating the burden of disease among women and children
    is clear evidence of improving governance through concrete, specific
    gains. Even low income societies can achieve dramatic gains by
    providing widespread access to essential services and information.
    Improving access to basic health care for women and children is an
    exercise in good governance, meets a basic need, redresses pervasive
    inequities and creates a model for other essential services.
        Poor maternal and child health also brings economic ruin to
    families and households. What truly marks poor households is
    vulnerability. A childhood illness or complications from pregnancy
    force a poor family into excruciating choices, when they must choose
    between buying seeds or paying for basic health care. Preventable
    illness and death can tip a poor family over into destitution as they
    divest themselves of meager savings and borrow money to pay for health
    care or funerals. Efforts to alleviate poverty must address this
    underlying cause of household vulnerability.
        Mr. Chairman, it is no secret that the international reputation of
    the United States is at low point. Multiple surveys reveal the
    widespread negative perceptions of our country. One could argue whether
    these perceptions are justified, but there is no arguing with the
    urgent need for effective public diplomacy. But public diplomacy is
    more than words and promises, it is deeds. The most powerful statement
    our country could make is to save the lives of the world's most
    vulnerable women and children. This is an enormous opportunity for
    constructive engagement with much of the world. Most importantly, a
    renewed commitment to saving women and children will express the values
    of a decent and generous American people, who invariably support
    effective efforts to alleviate needless suffering.

                                A CALL TO ACTION

        Chairman Leahy, Senator Gregg, members of the subcommittee and
    colleagues, my most fundamental message to you today is of hope and
    possibility. We know how to save millions of women and children through
    simple, inexpensive means. We know what works. We know how to deliver
    the interventions. We know what they will cost and we know what will
    happen once these services are provided: lives will be saved;
    communities strengthened; futures built and countries developed.
        The responsibility for improving maternal and child health does not
    rest principally with the United States. That responsibility for
    meeting basic needs rests with national governments. Non-governmental
    organizations, faith communities, multilateral institutions and other
    donors all have a role to play. As I speak before you today, global
    partners are gathered in Tanzania under the invitation of the
    Partnership for Maternal, Newborn and Child Health. An increasing
    global commitment guarantees that the United States is not in this
    alone. But there is no substitute for U.S. leadership or for active
    U.S. partnership in a global compact for women and children.
        Mr. Chairman, we need a bold commitment on the part of the U.S.
    Government and the American people--a commitment to the world's most
    vulnerable families so that they may enjoy the same expectation we have
    for our children's survival, planned pregnancies and mothers' safe
    deliveries. We simply must decide that this is the right thing to do in
    partnership with other governments and the communities in need.
    Relatively modest yet sustained increases in resources will make a
    significant difference in the lives of millions of women and children.
    And this clear commitment to the well being of families also will make
    a significant difference in popular perceptions of the role of the
    United States abroad.
        I appeal to you to boldly reestablish that commitment with real
    dollars, measured in the hundreds of millions. It's time to act.
        Thank you for your time and for hosting this hearing. I look
    forward to addressing any questions you have, and to working with you
    to continue to save and improve lives.

        Senator Leahy. Dr. Hill, let's go into this a little bit.
    The Millennium Development Goals. I read that one of the goals
    is to reduce by two-thirds the mortality rate among children
    under 5 by the year 2015. That's 8 years from now. You pointed
    out a half a million women die in pregnancy and childbirth each
    year. That's one per minute. Ninety nine percent of those are
    in the poorest countries. Another one of the Millennium
    Development Goals is to reduce by three-quarters the maternal
    mortality rate by the year 2015.
        The United States has affirmed these Millennium Development
    Goals--how does the fiscal year 2008 budget request, which
    doesn't increase resources for either child health, maternal
    and reproductive health, fit into a strategy to reduce child
    death by one-half, and maternal deaths by two-thirds by 2015,
    realizing as Dr. Daulaire, and others, have pointed out, the
    world's population is increasing?
        Dr. Hill. You raise important issues, and it's very clear
    that you don't make the kind of progress towards reaching those
    MDG goals as you would like without sufficient funds.
        One of my problems, of course, is that I wear a very
    partisan global health hat, and I tend to view things as my
    colleagues on this committee do, thinking about what we could
    do with money and do with more money. Yet, I must acknowledge
    that we're part of a bigger budget process. That process is
    trying to limit resources that they're willing to ask Congress
    for, to make very tough decisions, and get at the same table at
    the same time all of these different sectors--peace and
    security, economic growth, and democracy.
        Senator Leahy. What you're saying is that you've lost the
    OMB battles.
        Dr. Hill. We've won some battles. I doubt if there's any
    part of the budget process that is fully satisfied with the end
    product. But there are a lot of tradeoffs. I do have to
    acknowledge that, as has been said by my colleagues, malaria
    and HIV have huge increases, avian influenza is in the budget
    at $100 million, and you folks are considering a $161 million
    supplemental. I know that overall health money being spent and
    being asked for by the Congress is more than in the past. But,
    it is certainly true that the way that it is prioritized within
    the health portfolio has left these two units upon which we're
    testifying today with less money than they have had in previous
    requests or appropriations. Those are very difficult tradeoffs.
        Senator Leahy. But, on these tradeoffs, for example, the
    World Bank has 54 countries designated low-income countries,
    and USAID has programs in many of these.
        Let me give you an example. In the fiscal year 2008 budget,
    where some of these tradeoffs are, there's an increase in funds
    for Liberia, and I strongly support that.
        Dr. Hill. Right.
        Senator Leahy. But, Mali, which also has similar problems,
    receives less. So, is this robbing Peter to pay Paul?
        Dr. Hill. I think you have pointed out an issue that's come
    up in this first year of the new system, which is problematic,
    and it's been noticed, and we're going to address it in two
    ways.
        As you know, the budget was put together by country teams,
    looking at and trying to prioritize within their countries. But
    when you look at the final product, you've got some inequities
    where some countries with greater need had less money than was
    being spent in the countries that needed the money, but not as
    much. Therefore, I think we're going to have to look at these
    2008 appropriations by country, and make some adjustments, but
    that's only part of the answer.
        The second part of the answer is to ask the question, what
    can you do about the process for 2009 that would make fewer
    adjustments necessary? The answer seems to be this--to ask the
    three pillar bureaus at USAID to look globally at big issues
    and give some input to the Office of the Director of Foreign
    Assistance and say: ``If you have to spend X amount of dollars
    on, say, child and maternal health, this is the priority of the
    countries you ought to spend it in.'' That will affect the
    amount that they set for the country team to consider. They
    will say to the country team: ``Be aware that we are setting
    this amount,'' partly keeping in mind that they have an unusual
    global need in this area. So, that may help us some.
        Senator Leahy. May help some, but you still have a
    limited----
        Dr. Hill. A limited pot.
        Senator Leahy. Yes.
        Dr. Hill. Now, there's one other thing I should say, and
    that is that it's probably inaccurate to describe the work in
    HIV or malaria, not suggesting you did this, but some might
    conclude this, that there's no connection to these other
    interventions. Eighty-five percent of the malaria deaths are to
    children under 5, so if we succeed there, it will actually help
    in child survival as well.
        Senator Leahy. But, it's not 85 percent of the children.
    For example, we've--I understand that USAID has cut funding for
    the oral rehydration salt program, which stops diarrhea----
        Dr. Hill. Right.
        Senator Leahy [continuing]. I mean, that doesn't seem
    right. Should the HIV/AIDS and malaria initiatives, which I
    strongly support, should they be the foundation of our global
    health strategy?
        Dr. Hill. I think it's fair to ask questions about how a
    pot of money for health ought to be divided up. I can tell you
    the experts at USAID and elsewhere strongly disagree with each
    other from time to time about what those priorities ought to
    be, measuring how many people will die in a particular
    intervention. The experts don't always agree, so it's always a
    tough process, even among the health experts to decide, with
    limited money, where you'll get the most bang for your buck.
        On HIV, the argument often goes, if that gets out of
    control, you get a lot more parents dying. This fact that a
    parent is alive is a huge factor in whether a child lives, and
    the quality of their life, so they argue that you don't have
    the children to work with if you fail, so these are the kinds
    of arguments----
        Senator Leahy. I understand.
        Dr. Hill [continuing]. Of these people.
        Senator Leahy. I've visited a number of these countries,
    and I've encouraged improvements in HIV/AIDS programs, but, I
    worry that Secretary Rice spoke of the U.S. health strategy as
    primarily being implemented through the HIV/AIDS and malaria
    initiatives, and there is much more to public health than those
    two diseases.
        Dr. Gayle, how would you respond on that?
        Dr. Gayle. Yeah, well, I think, you know, people have made
    the, several points about how we have to look at this in a much
    more integrated fashion. So, for instance, if we do a much more
    comprehensive approach in our HIV work that really looks at,
    what are some of the underlying reasons why some people are
    more at risk than others? Women, particularly who oftentimes
    are at risk for HIV because of sex, gender-based violence, or
    lack of economic opportunities. If we address some of these
    underlying causes as well, I think we will go a much longer way
    towards helping strengthen health and the root causes of poor
    health to begin with.
        So, I think, first and foremost, it's looking at these
    things in a much more integrated fashion. We do HIV testing in
    the context of reproductive health programs, and treat other
    sexually transmitted diseases for women who come for
    reproductive health services. I think we can do this in a way
    that supports building a much broader, and more comprehensive
    approach to poor health and poor nations.
        But we can't do it only by focusing on specialized
    programs. We have to do it in a way that looks at both the root
    causes, what are some of the things that are in common,
    including access to services, a strong health infrastructure,
    and do it in a way that recognizes that we can't let go of our
    core competency in programs that save the lives of children and
    women and families around the world, while we're continuing to
    focus on these other programs. It has to be integrated, or else
    in the long run, we're not doing service for HIV, malaria or
    any of the other issues, if we don't do it in a way that builds
    the platform upon which we can make health better overall.
        Senator Leahy. Ms. Garrett, do you want to add to that, and
    then I'm going to ask Dr. Daulaire the same question.
        Ms. Garrett. I think if we have two strategic targets for
    our global health/foreign aid, they would be to create
    sustainable infrastructures that can address a broad range of
    disease issues, and not be too narrowly focused, and that they
    would--in the process--ensure the safety and security of the
    American people by lowering the disease threat burden external
    to the United States. I think that we can accomplish both, but
    that the way we're going about it right now, we will fail to
    accomplish either goal.
        It is appropriate that we elevate the level of funding
    directed to H5N1, or Avian flu. That is an elevated risk, and I
    do very strongly believe that the odds are reasonably high,
    that this particular bird flu strain may make, what we now
    know, is only two amino acid changes necessary in its entire
    genome to turn into a rapid human to human transmitter.
        It is appropriate that we very heavily address concerns
    about HIV and that we have this PEPFAR, or now GHAI
    infrastructure in place to deal with specifically HIV. But,
    they--each one of them comes up against the same identical
    problem. If you talk to the people dealing with flu, and we've
    put out--I think our total expenditure now is if the fiscal
    year 2008 are approved, is going to top $8 billion, domestic
    mostly. But, if you look at the flu problem, and you talk to
    those people, they all say, you know, ``Our problem is that we
    can't find human cases of flu on the ground fast enough because
    there isn't a health infrastructure. There aren't people there
    watching, and there aren't places for the patients to go.''
        Senator Leahy. You also have some countries that don't want
    the information to come out, and you don't want----
        Ms. Garrett. Well, that's a separate issue, transparency is
    obviously a huge problem. HIV tells us the story of the lack of
    transparency, because country after country after country
    denied that they had an HIV problem, or then said, ``Oh, it's
    only foreigners,'' or ``It's only homosexuals,'' or it's only
    this or that, until they had a generalized threat.
        But I don't think that--and I know that this is going to
    come up when you hit the appropriation on the PEPFAR funding--I
    don't think that the PEPFAR infrastructure can be scaled up to
    become ``the'' infrastructure we're all looking for. I'd be
    happy to go through all the reasons why, it's a very long
    story, but bottom line is, it is an infrastructure that is
    primarily designed to address the health needs of a small
    population of adults, ranging between roughly 15 and 35 years
    of age. It is not--though it has a pediatric component--it is
    not a child health program. Though it deals with women of
    pregnancy age, it is not a maternal health program.
        In fact, you have this odd possibility that as you enhance
    PEPFAR, a woman can get Nevirapine to prevent her from
    transmitting HIV to her child, but the next time she's
    pregnant, she will die in childbirth, because she can't get a
    cesarean section.
        Senator Leahy. Dr. Daulaire?
        Dr. Daulaire. Well, let me first endorse what Laurie
    Garrett just said. There is no question that these programs for
    HIV/AIDS and malaria are, have an impact on the health of
    children and the survival of children, and of some women, but
    they are not the first and primary route for making a change in
    terms of their lives. They are, in a sense, necessary, but not
    sufficient.
        I think the question here that we often get trapped into in
    the social sector in international development, is run a first
    assumptions. If we had accepted the assumption in 2001 that the
    cap on U.S. Government spending in global health was going to
    be, as it was then, about $1 billion, we would be having
    arguments today about whether we could possibly do anything at
    all with HIV.
        You've made the case that we spend lots of money on things
    that we consider to be important National priorities, so the
    argument made that, by Secretary Rice, that this addresses the
    issues of child health and maternal health do not hold water.
    They certainly are supportive of children's health and women's
    health, the kinds of programs that we're talking about today
    are the ones that are fundamentally important to make this
    change.
        Senator Leahy. Let me ask about some of those fundamental
    things. We keep going back to this question of safe water,
    especially for child and maternal health. Now--and you've
    spoken, Dr. Gayle, about CARE and the broad things it does, all
    the various aspects, you're basically saying there's no magic
    bullet, it's everything.
        What has been the impact of USAID's Safe Water and
    Sanitation Programs?
        Dr. Gayle. Thank you, and I don't have the specific numbers
    offhand, clearly there has been a major impact. We've been very
    supportive of the Safe Water Act in Senator Simon's name that
    we feel really ought to be strengthened and supported even
    more. Clearly, having safe water where a sixth of our
    population today does not have access to clean and safe water,
    means that not only will basic hygiene not be available for
    much of our world population, but it also means that things
    like diarrheal diseases are only going to continue to be
    prevalent.
        I've been in village after village in our work, where I've
    seen what it means to a family to have clean, safe water, where
    not only does it cut down the diarrheal diseases, and the
    under-5 mortality, but it means that children can go to school
    for the first time in their lives, and start to think about a
    different kind of future for themselves and for their families
    and communities.
        So, yeah, I think the basic ability to supply clean and
    safe water, while some don't think of it as a health
    intervention, is one of the most basic interventions, and is
    something we feel is one of those cornerstones upon which a
    health--looking at improving health is critically important,
    and needs to be build upon. We think that there is more that
    needs to be done, and it is one of those areas that gets second
    shrift, because it isn't seen as one of the visible issues that
    is currently on the front lines.
        I would just say, with some of the concerns around climate
    change, we think that the issues of clean and safe water are
    only going to become more and more urgent, and particularly for
    the poor, who will be facing more erratic climate conditions,
    more drought affecting agricultural productivity and nutrition,
    et cetera. So, this issue of safe water, clean and safe water,
    is a critical one.
        Senator Leahy. Dr. Hill, and I might say, when I ask some
    of these questions, I'll be the first also to say that USAID
    has done some tremendous things around the world, and I'm just
    trying to figure out how to make it even better. What do you
    say about the importance of clean water?
        Dr. Hill. We agree with Dr. Gayle, that those who insist on
    separating water projects from health miss the point. For
    example, we have a three-part response to the question of small
    kids who die from diarrhea, and the first part of the strategy
    has to do with point-of-use water projects, second, the
    sanitation message about washing your hands; and third, dealing
    with feces. Much of this has to do with water; so we view the
    water projects as integral to what we need to do to have a big
    impact on under-5 mortality.
        Senator Leahy. Ms. Garrett, you talked about direct funding
    for systems development and management, and you say USAID is
    doing that, but they're doing it on a budget of $3 million a
    year. Do you want to address that? I'm going to follow up with
    another question, but go ahead.
        Ms. Garrett. I keep forgetting to push the button, so
    sorry. Yeah, we, if you were a CEO of a major corporation, and
    the revenue for your corporation suddenly jumped, from say,
    $800 million to, say, $18 billion. You wouldn't want to imagine
    that your $800 million management infrastructure was up to
    snuff to handle $18 billion appropriately.
        You would be even more concerned about that jump, if you
    knew that you had almost no health personnel to execute this
    giant new corporate venture. Worse yet, it's projected that by
    2013, we will have a deficit here in the United States of
    800,000 nurses, and 200,000 doctors. I, you know, I want to say
    a little on the side here, that I know that we're here dealing
    with foreign relations, but if there's one place where I feel
    that there is a need to see a conversation between--
    conversation between foreign operations and domestic--it is on
    this healthcare issue, healthcare resources issue.
        Senator Dick Durbin has a bill that would try to rapidly
    increase the number of healthcare workers we're training in
    developing countries----
        Senator Leahy. In fact, Senator Durbin was going to be here
    but he was not able to because of what's happening on the
    floor.
        Ms. Garrett. Understood.
        Senator Leahy. He's a whip, and you're talking about his
    African Health Capacity Investment Act----
        Ms. Garrett. Exactly.
        Senator Leahy. I'm co-sponsoring that and we've all touched
    on this a bit. As doctors and nurses leave for better paying
    jobs, and I think of our own country when I see the ads for
    nurses. Bringing them here from other countries to make up for
    our failure as a Nation compounds the problem.
         To go back to my earlier comment, I'm not suggesting the
    Mayo Clinic in these countries, but I am asking why can't we
    have nurse practitioners? Why can't we have people who have at
    least basic skills, and the kind of infrastructure to handle
    basic health needs.
        Ms. Garrett. Right.
        Senator Leahy. There are certain things we do almost
    unconsciously, for hygene, but they need to be taught. How do
    we do this?
        Ms. Garrett. Well, I'm so glad you're asking that, because
    it goes back to your original question to me, how do we get to
    reasonably managed health systems?
        As I was saying, I really think there needs to be a
    conversation between your counterparts dealing with domestic
    health funding, and international on this question. Because if
    we reach the point where we are trying to suck away from the
    poor world 200,000 doctors, to offset our deficit--I'm not even
    sure there are 200,000 out there--but if we go after everything
    we can get, sure, we might be able to deal with our health
    problem, but at the expense of killing people in poor
    countries.
        So, I see that----
        Senator Leahy. Is there a way we can do both? To take care
    of our health problem and also help take care of theirs?
        Ms. Garrett. Well, actually, as it turns out, with the
    nursing crisis and the physician crisis here, in terms of our
    really mediocre level of domestic production of our own
    indigenous personnel, so that we don't need to suck the talent
    away from the poor world, it turns out the disincentives are
    less about pay, salaries at the, once you are a professional,
    than they are about access to the actual training.
        We've had bills come consistently before this body and the
    House, requesting subsidies for State support of nursing
    training and physician training, and they have consistently
    failed to even get out of committee.
        One of the biggest problems that we have right now in
    nursing training is that a typical nurse earns more as a
    practicing nurse than she can earn as a Professor of Nursing.
    Most nursing training is done by land grant and State-supported
    institutions, they are underfunded, and their faculty are
    underpaid. Most of the States, a State like Michigan, for
    example, which has quite a number of nursing schools, as you
    know, Michigan is a hard-hit State right now. Its economy is in
    deep trouble. They cannot afford to even match the salary level
    that a nurse can make as a nurse, versus as a professor,
    without Federal support.
        We need to really say, I think, in no uncertain terms, that
    the foreign operation side of the Senate is saying to the
    domestic operations side, ``Unless you create the incentives
    for us to produce sufficient healthcare personnel,
    domestically, so that we do not need to absorb the talent from
    the outside, we're in an immoral position.''
        Senator Leahy. Dr. Daulaire, Dr. Gayle and Dr. Hill on
    this?
        Dr. Daulaire. Senator Leahy, there's two sides to this
    question, there's the push side, and there's the pull side. And
    the pull side is what goes on here in the United States in
    terms of our healthcare deficits, and in Europe for that
    matter.
        I think it's appropriate for this Committee to particularly
    focus its attention on the push side--why is it that healthcare
    workers are leaving, or not getting trained to begin with?
    There are a number of different issues here. One is very often
    the wrong kinds of people are being trained in these countries.
    As a physician myself I hate to say it, but what the world does
    not need more of is lots more doctors, what the world needs
    lots more of is nurses, paramedics and auxiliary health workers
    who can address the healthcare needs at the communities where
    they're taking place. My own experience in the field has
    reinforced this many times over. So, that needs to be a focus
    in terms of both National priorities and donor assistance from
    the United States.
        Second, if the United States in its donor-assisted
    programs, HIV/AIDS, malaria, TB and all of the rest, if it
    simply recognizes the fact that there has to be a health
    systems overlay, you don't just say, ``Well, you do the health
    system, and you train the people, and then we'll give you the
    money or the drugs for specific interventions,'' there has to
    be incorporated into the framework of international assistance
    in healthcare. Third, on a very practical basis, in Africa
    where this crisis is at its worst, recently a group of African
    leaders got together and established a 15 percent target--they
    decided it themselves--of their national budgets to be used for
    their health systems. We need to encourage and reinforce this.
    This is not just a United States problem, but we can help by
    providing incentives through our international assistance for
    those countries that are actually moving forward on getting to
    that 15 percent, which, I would note, I believe no African
    country has currently reached.
        Senator Leahy. Dr. Gayle?
        Dr. Gayle. Yeah, just to basically support, I think, the
    issue--in addition to thinking about how we can make sure that
    we're not being a drain on the workforce in poor countries, but
    also that we look at what are the needs? That we are very, that
    we reinforce the kinds of health workers that will have the
    greatest impact on the lives of people in poor countries.
        As Nils said, it's not necessarily doctors or even
    sophisticated nurses, it really is, developing a core of people
    who are the auxiliary health workers, on the ground people who
    come from those communities, and understand those communities,
    who are really, the cornerstone of health interventions. By
    supporting the interventions, they are much more focused on the
    preventative side of health services, the public health
    approaches, I think we will get a lot--much more bang for the
    buck than by supporting tertiary care focus and technology
    fixes that oftentimes lead to short-term fixes, but not looking
    at the longer-term impact on lives.
        We also would like to endorse the Durbin workforce bill,
    and be happy to help in any way as that continues to move
    forward, and think about what are the best ways in which to
    build that kind of health capacity on the ground that meets the
    needs of people where they are.
        Senator Leahy. Senator Durbin and I feel very strongly, I'm
    following his leadership on it, but we feel very strongly about
    that.
        Dr. Hill?
        Dr. Hill. Three quick points--there is one piece of good
    news here. When I travel to Africa or talk to doctors here who
    came from Africa, I've been pleased to find that the
    overwhelming majority did not come here primarily because they
    would get a higher salary. They often report that they came
    here because they had a chance to work in the field they were
    trained in, and they didn't have the chance at home. It is
    generally only a secondary motive--that is they did have the
    chance, they couldn't feed their family and do it.
        Which leads me, and leads us, to the conclusion that we
    need to focus as Nils said, Dr. Daulaire said, on making sure
    that out there in the field the systems improve, so they can
    hold onto the people that are trained.
        There is also a second point that addresses some of the
    points that Dr. Garrett was bringing up about infrastructure
    and health systems, because it's all related. I think as good
    as the CBJ may be in terms of communicating some things, at 2
    inches thick you would think it could communicate a lot, but
    there's an awful lot it doesn't communicate.
        There aren't a lot of projects. There's not a category for
    infrastructure or health systems, et cetera. But as a matter of
    fact, at USAID--and at PEPFAR too--there's a strong sense that
    these issues that have been raised simply have to be dealt
    with. The surge is a big problem, and they know that we have to
    work on systems.
        But the way it tends to get done is that it is a component
    within a project that might be HIV or malaria or tuberculosis
    or contraceptive health or whatever it is, and any good program
    is going to have a component to it that specifically deals with
    this issue.
        Now, there are two questions that Ambassador Tobias always
    asks at a review of programs. One, ``Show me how this
    correlates with the work of other donors, so I know it's not
    duplicative.'' Number two, ``Show me how this is going to
    produce sustainability,'' which means it has to get at the
    issue of health systems, et cetera. So, we're aware this is a
    problem.
        The third simple point is that we are trying to ramp up,
    within all of the specific interventions, a component that will
    address precisely the question about what can you leave in
    place there that will allow them to do this work when we are
    gone.
        Senator Leahy. You know, in the article Challenge of Global
    Health, that Ms. Garrett wrote in Foreign Affairs, she quoted a
    Zambian doctor who said maternal death is the biggest challenge
    in strengthening health systems, if we get maternal health
    services to perform then we're nearly perfecting the entire
    health system.
        Without going into great detail, let me start, Dr. Hill,
    with you. Would you agree with that?
        Dr. Hill. Sorry, that there's a health systems problem in
    Zambia? Is that----
        Senator Leahy. No, that maternal death is the biggest
    challenge in strengthening health systems. If we can get
    maternal health services to perform, we're nearly perfecting
    the entire health system--that's what a doctor in Zambia said.
        Dr. Hill. Yes, my health experts would probably disagree
    and have a big debate about that. It is certainly a critical
    component, and one of the most important. Whether it's the very
    most important, I don't think I'd be prepared to say, but it is
    a lynchpin, a critical piece of the puzzle.
        The problem with a lot of this is that--however you decide
    to prioritize, the bottom line is, if you're not basically
    doing them all, just the top ones, whatever you choose is going
    to be undermined by what you didn't do. So, you almost have to
    find a way to take the top three, four or five, and find a way
    to do them, and to do them as well as you can, or you're going
    to undermine your successes wherever you did work.
        Senator Leahy. Which goes back to my prior
    oversimplification, my concern about robbing Peter to pay Paul,
    and making them all work.
        Dr. Gayle, how would you----
        Dr. Gayle. I wouldn't add a lot to that, only to say that
    while it may not be the thing that can fix the overall system,
    it is something that we know we can do a lot about, there's a
    lot of examples of making a difference, and I think it is
    totally unacceptable that today with all that we know and all
    that we can do that we continue to let 500 million women die
    every year from maternal mortality--something that ought to be
    a normal part of life, and that we continue to have 150 times
    greater mortality rates in poor countries, than we have here.
    So, it is one of those issues that we can do something about,
    that would strengthen the infrastructure.
        I would just go back to the point, the chart that Nils
    Daulaire showed earlier, when we look at, and the point that
    you made--when we look at talking about $100 million and what
    that does in terms of saving lives--$100 million is a small
    amount of money for a huge return in lives saved.
        So, I think, again it is a choice of where do we put our
    resources, what do we want to be known for as a Nation, where
    do we want to show our leadership, and start making some of
    those choices?
        When I headed the program for USAID program for, or Global
    AIDS Program, we at that time had $250 million in our total
    program. You know, we are now in the billions of dollars. It is
    possible, with the right kind of leadership and the right kind
    of commitment to take the cap off and stop making unnecessary
    limitations for things that we know can make a huge difference
    in people's lives around the world, and put us back in the
    global world as a compassionate Nation that does care about
    these things.
        Senator Leahy. You talk about the $100 million. It's just
    about noon, we spent that much today in Iraq.
        Whether one is for or against the war, just so we
    understand where the money is being spent.
        Ms. Garrett, did you agree with the Zambian doctor you
    quoted?
        Ms. Garrett. I did. I think that we use the phrase
    ``canaries in the coal mine'' to refer to what is the marker of
    a potential risk or threat.
        To me, the big canary in the coal mine for whether or not
    you have a public health infrastructure is dying children under
    5, and a big canary in the coal mine for whether or not you
    have a functioning health delivery system is dying mothers in
    childbirth, and childbirth-associated deaths.
        I'll give you an example from a few years ago, when I was
    in a rural clinic in Zambia, probably about an hour's drive
    from Lusaka. A woman came in with two children, one strapped to
    her back, and one trying to walk at her side. She had had to
    walk for 2 days to get to this clinic, and was doing so because
    the baby on her back was terribly sick. But, along the way the
    child became sick as well, the one that was ambulatory, and she
    ended up, for the last mile or so, carrying both children.
        When she staggered in, the doctor felt that the larger
    child looked like the more crisis case, so she left her baby
    with me, on a straw mat on the floor, and went in to see the
    doctor with the larger child. As I held the baby, it died in my
    arms, and its cause of death was measles--completely
    preventable. The larger child died of malaria, and the mother
    broke out sobbing, describing how hard it had been for her to
    give birth both times, and how frightening it was, the prospect
    of what she would have to go through just to have two children
    to replace the two she had just lost.
        To me, that anecdote has lived with me my entire
    professional life, it has been a guiding anecdote. I can't
    think of any better way to look at what we're trying to do with
    U.S. foreign aid than to focus on how we could save both of
    those babies, and make it safe for that mother to give birth to
    future children.
        Senator Leahy. Have both the mother and the child live.
        Dr. Daulaire. The question that you asked, Senator Leahy
    is, I think, a very important one, and it underlines some of
    the challenges that we have in addressing all of these issues
    in a substantive way.
        I can certainly create for you a model in which maternal
    mortality could be dramatically reduced in which other major
    causes of illness and death probably wouldn't be affected. You
    can design a health delivery system that focuses on that. So,
    the point is that you should not confuse cause and effect. A
    well-functioning medical care delivery system will reduce
    maternal deaths, but a maternal death-reducing system will not
    necessarily be a good medical system, and I reinforce what
    Laurie Garrett just said about keeping some distinction between
    public health and medical care.
        On the other hand, an awful lot of children who die around
    the world, die not only because they lack preventive services,
    but because they don't have access to the basic care that would
    get them antibiotics for their pneumonia, that would get them
    treatment for their malaria, where you actually need a trained
    healthcare provider, so there's a mix in all of these. I think,
    though, that the bottom line is, if we made the kinds of
    investments that each of our panelists has been talking about,
    it is a reasonable presumption that we would see dramatic
    reductions in both child death and maternal deaths.
        Senator Leahy. Thank you. I want to thank each of you for
    being here. Some of the questions I asked may have seemed self-
    evident, but I'm also trying to prepare a record for other
    Senators.
        I don't want to leave the impression that I simply feel
    that more money cures all things. there are very dedicated men
    and women who are out in the world, from the United States as
    well as a whole lot of other countries. Some very dedicated men
    and women from those countries, that are trying to make a
    difference. Sometimes in areas with no infrastructure, or in
    the midst of civil war.
        I think of one African country where I went with my wife
    where we were using the Leahy War Victims Fund. She had helped
    the nurses to bathe and care for a boy who was probably 10
    years old, with terribly distorted limbs. As she was bathing
    him, she didn't see a mark on him, she asked why, they said he
    had polio. She asked the obvious question, ``Why polio?'' She
    knew that we'd sent polio vaccine to that country, making it
    available? They said the people who would do the polio
    immunization could not get to his village because there were so
    many landmines around, they couldn't.
        I mention that only because too often--and I think Dr. Hill
    you were trying to point this out, there is no magic thing that
    we can do, but we should start with the health needs of women
    and children.

                       ADDITIONAL SUBCOMMITTEE QUESTIONS

        There will be some additional questions which will be
    submitted for your response in the record.
        [The following questions were not asked at the hearing, but
    were submitted to the witnesses for response subsequent to the
    hearing:]

                    Questions submitted to Dr. Kent R. Hill

                   Questions Submitted by Senator Tom Harkin

                               POLIO ERADICATION

        Question. Polio Eradication efforts are clearly working as we have
    seen the number of countries with indigenous polio drop to four, 2
    billion children have been immunized, 5 million have been spared
    disability and over 250,000 deaths have been averted from polio.
    However, until the world is polio-free, every child, even those in the
    United States, is at risk.
        In fiscal year 2007, both the House and Senate included $32 million
    for polio eradication in their respective Foreign Operations
    Appropriations bills.
        What amount is included for polio in your fiscal year 2007
    projections?
        Answer. USAID intends to provide $31,680,000 for polio eradication
    in fiscal year 2007, which meets the House and Senate report level
    minus a 1 percent rescission.
        Question. What is included for polio in your fiscal year 2008
    budget submission?
        Answer. The administration will fund polio eradication but specific
    funding levels are still under consideration.
                                     ______

                Question Submitted by Senator Richard J. Durbin

                               MATERNAL MORTALITY

        Question. The statistics are devastating--1 in 6 women in Angola or
    Afghanistan is likely to die from the complications of pregnancy or
    childbirth. UNFPA has a strong track record in this area, but the
    administration has refused to provide the funding for them that
    Congress has allocated. Women giving birth alone without access to the
    most basic care or life-saving drugs that could prevent post-partum
    hemorrhage should not be a hallmark of the 21st century, but in too
    many countries it is all too common. What are the most effective ways
    to reduce maternal mortality?
        Answer. Maternal mortality can be reduced in two major ways: (1)
    reduce the number of high-risk and unintended pregnancies and (2)
    address the life-threatening consequences of pregnancy, which can
    include hemorrhage, infection, eclampsia, obstructed labor, and unsafe
    abortion. By promoting healthy timing and spacing of births, reducing
    unintended pregnancy, and reducing abortion, voluntary family planning
    is one of the most effective ways to decrease the number of maternal
    deaths. Once a woman becomes pregnant, USAID's strategy focuses on
    high-impact interventions. These include active management of the third
    stage of labor to address post partum hemorrhage; tetanus toxoid
    immunization during pregnancy, clean delivery practices, and treatment
    by antibiotics to address infection; administration of magnesium
    sulfate for eclampsia; monitoring the duration of labor and taking
    action in the event of prolonged labor; and provision of post abortion
    care. The over-arching strategy to deliver these and other maternal
    interventions (such as nutritional support and intermittent presumptive
    treatment for malaria to address indirect causes of maternal death) is
    to increase women's access to skilled attendance at birth, emergency
    obstetric capability to deal with complications, antenatal care and
    post-partum care, and family planning information and services.
    Essential to successful maternal care programs are reduction of
    financial barriers for families, appropriate deployment and retention
    of skilled frontline workers, and institutionalization of quality
    improvement systems. USAID has a very strong track record in maternal
    mortality reduction, including demonstration of effective approaches in
    community mobilization and behavior change, policy formulation,
    financing of maternity services, effective life-saving skills training,
    quality improvement, and contribution to reduction of maternal
    mortality by 20-50 percent within 10 years in 10 countries.
                                     ______

                   Question Submitted by Senator Patty Murray

              HEALTHTECH AND THE CHILD SURVIVAL AND HEALTH ACCOUNT

        Question. Under current funding levels, successful programs such as
    HealthTech have been cut to the skeletal remains. The administration's
    proposed budget calls for further cuts to the Child Survival and Health
    account, which funds HealthTech. These cuts are proposed while the
    administration comes to the Hill and touts HealthTech's successes such
    as the UNIJECT injection device and thccine Vial Monitor. The Senate
    budget resolution recognizes how important these programs are, and has
    added additional funding. That being said, please explain how further
    reductions could inhibit USAID's ability to fund such proven programs
    with demonstrable successes at the full obligated level?
        Answer. Reduction in funds to HealthTech is not due to Agency
    funding cuts, but due to completion of certain activities. Further,
    sufficient money is already obligated to HealthTech for current needs.
    USAID is currently funding HealthTech to help develop several
    technologies--including antibiotics in UniJect and newborn
    resuscitation devices--which will improve the health of impoverished
    people.
        In this and other key health investments, USAID focuses its
    programs and efforts on the highest impact activities, works closely
    with other donors, and continues public-private collaborations to help
    fill gaps. By these means, we expect to meet our objectives with
    requested Child Survival and Health account levels.
                                     ______

                      Question Submitted to Laurie Garrett
                    Question Submitted by Richard J. Durbin

                      AFRICAN HEALTH CAPACITY/BRAIN DRAIN

        Question. The issue of health capacity is critical to addressing
    all of the problems raised today. The whole world, including the United
    Stats is experiencing a shortage of health personnel, but in Africa the
    shortage is far more dire. The math is devastatingly clear: as you
    testified, ``As the number of health workers declines, survival
    decreases.''
        Along with Senator Coleman, Senator Leahy, and others, I have
    introduced legislation to authorize a concentrated effort to help
    Africa build the health capacity that it so desperately needs, from
    personnel--doctors, nurses, and community health workers--to
    infrastructure. Africa needs both health systems and the ability to
    train and retain personnel. Our legislation is also part of an effort
    to combat the brain drain of health professionals, including the need
    to train more nurses here in the United States so that we are not
    dependent on the poorest countries in the world to supply our health
    workforce. Ethiopia has 3 physicians per 100,000 people but there are
    more Ethiopian physicians in Chicago than in all of Ethiopia (Tobias).
        What are the most effective ways to build health capacity AND fight
    this brain drain? This is an enormous problem--where can a U.S.
    contribution add the most value?
        Answer. Thank you very much for posing this critically important
    question. I am, of course, well aware of your important initiative, and
    praised it in my testimony, and during Sen. Leahy's questioning. When
    you initiated the process of drafting this bill there were few
    analogous efforts going on in the world, and the U.S. leadership in
    this area was desperately needed.
        I am happy to report that several potentially blockbuster efforts
    are underway, augmenting your efforts in this area. I will try to
    briefly describe the status of this situation, and suggest some efforts
    the United States can, and should, make.
        First of all, in the last few months there has been a striking
    sense of global recognition of this problem. Recognizing a problem, and
    understanding its roots and nuances, is always the first step. Two real
    heroes in this aspect of the situation are Mary Robinson and Tim Evans.
    Robinson, the former President of Ireland and former head of the U.N.
    Commission on Human Rights, is now heading an international group that
    is trying to find ways to slow the exodus of health care workers from
    poor countries to the rich, without violating their individual human
    rights. Her group is meeting as I write these words in Geneva, in
    tandem with the 59th World Health Assembly.
        Dr. Tim Evans, a leading Canadian health expert, now holds a top
    position in the office of WHO Director-General Margaret Chan. Together
    with Harvard's Dr. Lincoln Chen, Evans authored the groundbreaking
    analysis of the global health care workers situation, publishing 2
    years ago, that estimated current deficits at 4.3 million. Evans' high
    level position in WHO's new leadership signals Chan's appreciation of
    the dire severity of the situation, reflected in her marvelous remarks
    at the opening of the Health Assembly this week. Chan is clearly the
    sort of Director General the global health community has been waiting
    for, and I have no doubt that she will take this health crisis issue by
    the horns.
        On an entirely different front, the Prime Minister of Norway
    instigated a high-level meeting of foreign ministers, which convened in
    Oslo earlier this spring. The goal of the meeting was to better
    understand the links between national security and health, and the
    elevate discussion and action in the arena far beyond mere financial
    commitments. There is a growing recognition, as I outlined in my
    Foreign Affairs piece in January, that simply throwing billions of
    dollars at targeted global health problems, without any structural
    framework or support for public health systems development, will kill
    more people than are saved. (The one-page Oslo Ministerial Declaration
    is attached below.) The Oslo Summit promised a series of actionable
    steps.
        The first of those steps will be launched this September in New
    York, during the U.N. General Assembly: ``A Business Plan to Accelerate
    Progress Towards MDG 4 and 5''. It's not a pretty title, but the
    concept is important. The Plan recognizes that the real victims of
    health care worker and health system deficits are mothers and children,
    and seeks to create an out-put based business strategy for investment
    in developing country health systems. The Oslo declaration estimates
    that 10.5 million mothers and children die annually from preventable
    causes, nearly all of them directly resulting from lack of sufficient
    medical care or basic public health services, such as water filtration
    and sewage treatment.
        The Oslo group seeks to find business solutions to the crisis,
    creating better management of available personnel and resources,
    linking standards of care to financial rewards for providers, and
    moving the global community away from single disease targets for
    support and financial aid.
        Secretary General Ban ki-Moon is also interested in finding ways to
    move the entire U.N. system towards a health systems approach for
    achievement of the MDGs (Millennium Development Goals), hoping to bring
    the health targets of various agencies into greater harmony.
        Angela Merkel has signaled that she wants the G-8 to look at this
    issue in its upcoming Summit in Germany. Merkel has also instructed
    Germany's current leaders of the EU to examine EU foreign aid to global
    health, with an aim of building sustainable health systems.
        Meanwhile, the World Bank and its IFC are moving in a very
    different direction--at least, for now, under Wolfowitz's imperiled
    leadership. Thought the IFC recognizes the crisis in healthcare workers
    and paucity of health systems, it is not interested in building local
    capacity. Rather, it has announced a $200 million program that would
    bring massive healthcare corporations from the wealthy world into poor
    countries, providing fee-for-service healthcare delivery to the
    nations' elites. The notion is that quality care for the elites will
    have a trickle-down effect, setting a standard that the entire Ministry
    of Health operation will strive to achieve for the population, as a
    whole.
        As my tone may reveal, I do not accept this thesis. I was in Moscow
    when the U.S. Government built such an elite care facility inside the
    Kremlin Hospital, specifically to ensure that Boris Yeltsin received
    state-of-the-art cardiac care without having to leave Russian soil. The
    fantastically expensive effort was described in precisely the
    ``trickle-down'' terms now used by IFC. But in the years following
    construction of the elite facility, the Russian healthcare system
    deteriorated further, life expectancy for Russian men spiraled
    downward, drug resistant TB and HIV spread across the region, the live
    birth rate reached an all-time low for Russia and the overall health
    status of the country plummeted: So much for ``trickle-down''.
        Here is the problem with how the United States funds these issues
    (to be followed by some suggested solutions):
        (1.) Nearly the entire foreign aid budget for health and
    development is earmarked for disease-specific programs. Under the
    President's fiscal year 2008 State Department ``Strategic Framework''
    funding is further funneled according to global political exigencies,
    targeting specific countries that the Administration believes play
    crucial roles in maintaining regional stability or in the War on
    Terrorism. Funding does not reflect on-the-ground needs.
        (2.) The Administration (and many AIDS activists) argues that
    PEPFAR has created a health infrastructure in the 15 targeted countries
    that may now be solely for provision of HIV-related services, but can
    serve as a template for all health needs. In debates over
    reauthorization of PEPFAR this argument will be made. PEPFAR has become
    sensitized to the negative impact the massive AIDS-specific health
    program is having on other health services in targeted countries, and
    hopes to convince Congress to reauthorize PEPFAR, giving it more money,
    and a larger mandate.
        (3.) The United States is not now engaged in the multilateral
    efforts to address the healthcare worker and health systems crisis,
    such as Mary Robinson's plans or the Oslo Declaration. As you well
    know, the Bush Administration has not played on the global health stage
    in partnership with other wealthy nations, and has set moral standards
    for execution of health programs (e.g. sexual abstinence, faith-based
    solutions, etc.) We are not part of the global efforts to solve these
    problems.
        (4.) Overall, the U.S. foreign aid budget shares with other wealthy
    nations the problem of having been designed as a massive charity
    program. We have failed to invest in health, though we consistently use
    the term, ``invest''. Therefore, nothing is sustainable. There are no
    local profit centers, no genuine stakeholders.
        (5.) The Republican-controlled Senate, under the leadership of
    surgeon Bill Frist, favored solutions to the healthcare worker and
    health systems crises that flowed from the fundamentally charitable
    view of U.S. foreign aid. Frist introduced bills that would underwrite
    the costs of faith-based and medical societies-run programs that
    dropped American doctors (and maybe nurses) into foreign countries for
    short time periods, during which they would theoretically perform
    surgeries, and supplement the services of indigenous healthcare
    workers. Criticized as ``Safari Medicine,'' such vacation programs for
    American doctors tend to do more good for the Americans than for those
    they seek to serve, opening their eyes to the needs of the poor.
    Successes are limited to a handful of healthcare needs that are truly
    amenable to one-stop interventions, such as removal of cataracts, heart
    surgery, or limb replacement. Even acute humanitarian care
    interventions suffer if the health professionals limit their
    participation to time periods too short to allow them to learn some
    basic elements of the local language and culture.
        (6.) There is no linkage in our government currently between the
    dire healthcare worker situation overseas and our shortages of doctors,
    nurses, lab technicians and other health professionals domestically.
    Government functions as if the two issues were entirely unrelated.
    There is no official recognition that American companies and hospitals
    actively recruit doctors and nurses from poor and middle income
    countries to offset our gaps in training of domestic personnel.
    Institutionally, the federal agencies and Congressional committees that
    have oversight of the domestic and overseas issues share no lines of
    communication, whatsoever.

                                   SOLUTIONS

        (1.) A joint session should be convened of the Senate Foreign
    Relations Subcommittee on Foreign Operations and the Senate Committee
    on Health, Education, Labor and Pensions. This should be a well-
    orchestrated, and well-publicized full day joint session, aimed at
    revealing:
        a. Twenty year forecast on U.S. healthcare worker needs and
    shortfalls for all health professionals.
        b. Twenty year forecast on developing country healthcare worker
    needs and shortfalls for all health professionals.
        c. Recruitment and immigration trends of foreign healthcare
    workers, filling United States needs, and estimated damage done in home
    countries.
        d. Policies enacted by other wealthy countries to address brain
    drain.
        e. Reasons the United States is currently unable to fulfill its
    domestic healthcare worker needs through training and employment of
    Americans.
        f. Identification of legal instruments and budget initiatives that
    could be enacted by the House and Senate to radically enhance both the
    training of Americans and their conditions of employment, domestically.
        g. Identification of legal instruments and budget initiatives that
    could be enacted by the House and Senate to provide incentives to poor
    country healthcare workers for remaining in-country, based on the
    identified reasons for their departures to rich countries. (For many
    doctors, dentists, pharmacists, technicians and nurses, money is not
    the primary driver: The lack of coordinated health systems, reliable
    supply chains of medical equipment and drugs, lack of meritocracy
    within Ministries of Health and general political conditions rank far
    higher as reasons for immigration.)
        (2.) As a result of above Joint Session, corrective bills should be
    forwarded that seek not only bipartisan support, but also support that
    bridges the gap between domestic and foreign committee and agency foci.
        (3.) The Senate should push the State Department to radically
    increase its currently mere $3 million commitment to training in
    overseas health systems management. Even if your healthcare workers
    bill is passed, and fully funded, a surge in the numbers of community
    healthcare workers will have little positive impact if these
    individuals are not managed properly within an overall system of public
    health and clinical care.
        (4.) Attention should be given to the remarkable successes of BRAC,
    the Bangladeshi micro-financing program that has deployed vast networks
    of paid, trained community healthcare workers to villages in pursuit of
    cholera, tuberculosis, failures in child immunization and maternal
    health. BRAC has proven that community healthcare workers, including
    semi-literate individuals, can save thousands of lives if they are (1.)
    given a finite and clear mission to accomplish, backed by adequate
    training, and (2.) paid for their work at a rewarding scale, linked to
    success, and (3.) are part of a transparent, well-organized health
    system, in this case independent of the government.
        (5.) The foreign aid budget needs to move away from charity,
    towards support of business models and financial incentives of health.
    America cannot afford to put 20 million people on anti-retrovirals for
    HIV care, and foot the bill for their continued treatment for the next
    30-to-40 years. Even if we were, as a Nation of taxpayers, interested
    in underwriting the healthcare needs of the world, we could not afford
    to do so. Therefore, we have no choice but to move away from the
    charity model of foreign aid, towards a model that provides incentives
    for creation of local business solutions. This should not follow the
    apparent IFC model of providing support to foreign health corporations,
    to go into poor countries, and extract profits from their health needs.
    Rather, the Senate should look to the BRAC model and consider how
    providing low-interest seeds can lead to the blossoming of genuine,
    sustained health businesses in poor countries.
        (6.) The Senate should put pressure on HHS to radically speed up
    approval of appointments of federal employees for overseas health
    positions. Currently the majority of CDC overseas positions, and
    deployment of health personnel from other agencies within HHS, is mired
    in Secretary Leavitt's office, pending political litmus tests aimed,
    apparently, at finding scientists, experts and physicians who meet the
    Bush Administration's moral and political standards. At the very time
    when the world is, as a community, trying to hammer out radically new
    approaches to these health crises, America's voice on the world stage
    is diminishing. This should stop, immediately.
        (7.) When considering large initiatives for healthcare worker
    training, such as is envisioned in your bill, the Senate should also
    imagine the toolkit that these workers will draw from. With what
    supplies will these new healthcare workers execute their efforts? No
    doubt supplies will, in early days, also require outside support. To
    minimize such costs and build in incentives for performance standards
    and sustained commitment to maintaining community health practices we
    have favored exploration of franchise models, a la MacDonald's: Each
    community health worker, after some identified set of training and work
    excellence have been achieved, is given very low interest micro-finance
    loans for purchase of his or her own franchise, which would include a
    physical clinic and basic tools and supplies. All of the franchises
    would be overseen by the hub of the network, monitored closely for
    performance quality; volume of services provided and inventory needs.
        Senator, we are at your service for any further clarifications,
    brainstorming or information needs you may require. We are honored to
    be of service.

    OSLO MINISTERIAL DECLARATION: GLOBAL HEALTH--A PRESSING FOREIGN POLICY
                               ISSUE OF OUR TIME

        Under their initiative on Global Health and Foreign Policy,
    launched in September 2006 in New York, the Ministers of Foreign
    Affairs of Brazil, France, Indonesia, Norway, Senegal, South Africa and
    Thailand issued the following statement in Oslo on 20 March 2007:
        In today's era of globalisation and interdependence there is an
    urgent need to broaden the scope of foreign policy. Together, we face a
    number of pressing challenges that require concerted responses and
    collaborative efforts. We must encourage new ideas, seek and develop
    new partnerships and mechanisms, and create new paradigms of
    cooperation.
        We believe that health is one of the most important, yet still
    broadly neglected, long-term foreign policy issues of our time. Life
    and health are our most precious assets. There is a growing awareness
    that investment in health is fundamental to economic growth and
    development. It is generally acknowledged that threats to health may
    compromise a country's stability and security.
        We believe that health as a foreign policy issue needs a stronger
    strategic focus on the international agenda. We have therefore agreed
    to make ``impact on health'' a point of departure and a defining lens
    that each of our countries will use to examine key elements of foreign
    policy and development strategies, and to engage in a dialogue on how
    to deal with policy options from this perspective.
        As Ministers of Foreign Affairs, we will work to:
      --increase awareness of our common vulnerability in the face of
            health threats by bringing health issues more strongly into the
            arenas for foreign policy discussions and decisions, in order
            to strengthen our commitment to concerted action at the global
            level;
      --build bilateral, regional and multilateral cooperation for global
            health security by strengthening the case for collaboration and
            brokering broad agreement, accountability and action;
      --reinforce health as a key element in strategies for development and
            for fighting poverty, in order to reach the Millennium
            Development Goals;
      --ensure that a higher priority is given to health in dealing with
            trade issues and in conforming to the Doha principles,
            affirming the right of each country to make full use of TRIPS
            flexibilities in order to ensure universal access to medicines;
      --strengthen the place of health measures in conflict and crisis
            management and reconstruction efforts.
        For this purpose, we have prepared a first set of actionable steps
    for raising the priority of health in foreign policy in an Agenda for
    Action. We pledge to pursue these issues in our respective regional
    settings and in relevant international bodies. We invite Ministers of
    Foreign Affairs from all regions to join us in further exploring ways
    and means to achieve our objectives.

       NEW INITIATIVE SEEKS PRACTICAL SOLUTIONS TO TACKLE HEALTH WORKER
                                   MIGRATION

        Geneva.--The health worker migration policy initiative held its
    first meeting today at the headquarters of the World Health
    Organization (WHO) in Geneva. The initiative, led by Mary Robinson,
    President of Realizing Rights: the Ethical Globalization Initiative,
    and Dr. Francis Omaswa, Executive Director of the Global Health
    Workforce Alliance (GHWA), is aimed at finding practical solutions to
    the worsening problem of health worker migration from developing to
    developed countries.
        WHO Director-General Dr. Margaret Chan said, ``International
    migration of health personnel is a key challenge for health systems in
    developing countries.'' The new initiative has a Technical Working
    Group housed at WHO.
        The Health Worker Migration Policy Initiative is made up of two
    groups that will work closely together over the coming months to
    develop recommendations. The Migration Technical Working Group, which
    is being coordinated by WHO, brings together the International
    Organization for Migration, the International Labour Organization,
    professional associations, experts and academics.
        The Health Worker Global Policy Advisory Council, under the
    leadership of Mary Robinson and Francis Omaswa and with Realizing
    Rights serving as its Secretariat, is made up of senior figures from
    developed and developing countries, who will develop a roadmap and a
    framework for a global code of practice for health worker migration and
    seek high-level political backing for its recommendations.
        A recent study has shown that the number of foreign-trained doctors
    has tripled in several OECD countries over the past three decades. The
    number of foreign-trained doctors from countries with chronic shortages
    of health workers is relatively small (less than 10 percent of the
    workforce) in developed countries. However, for some African countries,
    the migration of a few dozen doctors can mean losing more than 30
    percent of their workforce, even as basic health needs remain unmet.
        Other health professions are also affected by this phenomenon. The
    study showed that in Swaziland, 60 to 80 nurses migrate to the United
    Kingdom each year, while fewer than 90 graduate from Swazi schools.
    GHWA partner and member Save the Children UK estimates that the United
    Kingdom saved 65 million in training costs between 1998 and
    2005 by recruiting Ghanaian health workers.
        Mary Robinson summarized the need for urgent action: ``We cannot
    stand alone as individual countries continue to address their own
    increased needs for health workers without looking beyond their shores
    to the situation these migrating workers have left behind in their
    homelands. We cannot continue to shake our heads and bemoan the
    devastating brain drain from some of the neediest countries on the
    planet without forcing ourselves to search for--and actively promote--
    practical solutions that protect both the right of individuals to seek
    employment through migration and the right to health for all people.''
        One of the initiative's first priorities will be to support WHO in
    drafting a framework for an International Code of Practice on Health
    Worker Migration, as called for by a resolution of the World Health
    Assembly in 2004. This framework will promote ethical recruitment, the
    protection of migrant health workers' rights and remedies for
    addressing the economic and social impact of health worker migration in
    developing countries. The Code of Practice will be the first of its
    kind on a global scale for migration.
        The initiative will also promote good practices and strategies to
    enable countries to increase supply and retain their health workers
    more effectively. The new tools and policy recommendations developed by
    the initiative will support better management of migration through
    North-South collaboration.
        Dr Francis Omaswa emphasized the importance of addressing both the
    ``push'' and ``pull'' factors simultaneously. ``Health workers are a
    valued and scarce resource. Demand is increasing worldwide, but not
    enough are being trained--in the developed or the developing world.
    Developing countries must prioritize health and health workers, with
    better working conditions and incentives so its workforce can stay and
    be more efficient, while developed countries must train more of their
    youth and try to be self-sufficient.''
        The Health Worker Migration Policy Initiative is due to make
    initial policy recommendations by the end of 2008. Its operations are
    co-funded and coordinated by Realizing Rights, the Global Health
    Workforce Alliance, and the MacArthur Foundation.

                  HEALTH WORKER GLOBAL POLICY ADVISORY COUNCIL

        Co-Chairs: Hon. Mary Robinson, President, Realizing Rights
        Dr. Francis Omaswa, Executive Director, GHWA

                                    MEMBERS

        Hon. Major Courage Quarshie, Minister of Health, Ghana; Hon. Erik
    Solheim, Minister of International Development, Norway; Hon. Patricia
    Aragon Sto Tomas, Minister of Labor and Employment, the Philippines;
    Hon. Rosie Winterton, Minister of State for Health Services, United
    Kingdom; Dr. Lincoln Chen, Director, Global Equities Initiative,
    Harvard University; Dr. Anders Nordstrom, Assistant Director General,
    Health Systems and Services, WHO; Ms. Janet Hatcher Roberts, Director,
    Migration Health Department, IOM; Mr. Ibrahim Awad Director,
    International Migration Programme, ILO; Lord Nigel Crisp, co-Chair,
    GHWA Task Force on Scaling up Education & Training; Dr. Percy Mahlati,
    Director of Human Resources, Ministry of Health, South Africa; Huguette
    Labelle, Chancellor, University of Ottawa; Dr. Titilola Banjoko,
    Managing Director, Africa Recruit; Prof. Ruairi Brugha, Head,
    Department of Epidemiology & Public Health, Ireland; Ms. Sharan Burrow,
    President, International Confederation of Free Trade Unions; Ms. Ann
    Keeling, Director, Social Transformation Programs Division,
    Commonwealth Secretariat; Mr. Markos Kyprianou, Director General,
    Health & Consumer Protection, European Commission; Mr. Peter Scherer,
    Directorate for Employment, Labour and Social Affairs, OECD; Prof. Anna
    Maslin, Nursing Officer, International Nursing & Midwifery Health
    Professions Leadership Team, Department of Health, United Kingdom; Dr.
    Mary Pittman, President, Health Research & Education Trust, American
    Hospitals Association; and Dr. Jean Yan, Chief Scientist for Nursing &
    Midwifery, WHO, chair of the Migration Technical Working Group.
            health worker global policy advisory council secretariat
        Ms Peggy Clark, Managing Director, Realizing Rights
        Dr. Ita Lynch, Health Advisor, Realizing Rights

                              SUBCOMMITTEE RECESS

        Senator Leahy. So, I thank you all very much for being
    here. The subcommittee will stand in recess.
        [Whereupon, at noon, Wednesday, April 18, the subcommittee
    was recessed, to reconvenne at 10:30 a.m., Thursay, May 10.]

      STATE, FOREIGN OPERATIONS, AND RELATED PROGRAMS APPROPRIATIONS FOR
                                FISCAL YEAR 2008

                                  ----------

                             THURSDAY, MAY 10, 2007

                                           U.S. Senate,
               Subcommittee of the Committee on Appropriations,
                                                        Washington, DC.
        The subcommittee met at 10:25 a.m., in room SD-106, Dirksen
    Senate Office Building, Hon. Patrick J. Leahy (chairman)
    presiding.
        Present: Senators Leahy, Landrieu, Gregg, Bennett, Bond,
    and Alexander.

                              DEPARTMENT OF STATE

                            Office of the Secretary

    STATEMENT OF HON. CONDOLEEZZA RICE, SECRETARY

                 OPENING STATEMENT OF SENATOR PATRICK J. LEAHY

        Senator Leahy. First I apologize to the Secretary and to
    others for the delay. As you could probably see, we had votes
    on, and Senator Gregg, Senator Bennett, and I were there.
        Madam Secretary, of course, it is good to have you here to
    discuss the administration's fiscal year 2008 budget. I have a
    lot to cover, and we are starting late.
        We've discussed this before. Whenever--wherever I go these
    days--and I travel various places outside of the country--not
    as much as you do--but I'm invariably asked, ``What does the
    United States do to repair the damage, as seen in many
    countries to our international reputation as a nation that has
    historically stood for the rule of law, including international
    peace, international law, defending the fundamental rights of
    people everywhere, regardless of race, religion, ethnicity, or
    nationality, something that makes us proud--all of us proud, as
    Americans, but which is not the view of so many of those
    countries that were united behind us the day after 9/11?'' When
    you see the policies of this administration, from Iraq to
    Guantanamo, we've turned strong allies into reluctant partners,
    friends into antagonists. According to surveys, many people,
    particularly in Muslim countries, now see America as a greater
    threat than the religious extremists. These are the people who
    have incited hatred and violence. I think this should alarm us,
    it should stir us to action. Those who hold these views, I
    believe, are horribly mistaken. But we're not doing enough to
    convince them otherwise. While some may argue that taking
    unpopular stands is a price of leadership, I reject that as a
    justification for the damage we've needlessly caused to a proud
    and principled reputation that took the founding of our Nation
    and a civil war and two world wars, and the lives of countless
    American patriots, to forge and fortify and defend.
        But where I go--and I look from the Pacific Rim to the
    Middle East, from Darfur to South America--our image, our
    influence, are waning sharply in the face of growing
    challenges. That concerns me greatly, as an American. I'm sure
    it does you. Once again, we've learned the painful lesson that
    military might is no substitute for effective policies that
    rally support and cooperation from the international community.
        Transformational diplomacy is a lofty slogan for what
    amounts to adding new positions at posts that have been
    understaffed for years. I welcome that. But, beyond that, I see
    little in this budget that offers confidence that the
    administration is prepared to devote the resources necessary to
    successfully exert America's influence in such a complex world.
        Senator Gregg and I will work together, as we have. We're
    not only neighbors across the Connecticut River, but we've
    worked very closely together in a bipartisan effort on so many
    of these foreign policy issues. We'll do our best to fund
    President Bush's request, and to incorporate the meritorious
    suggestions of Senators. But I'm afraid we're going to fall
    short of what this country is capable of, but, more
    importantly, what this country should do.
        Now, we want you to succeed. I can speak for every Senator
    here, Democratic or Republican. We want you to succeed in the
    time you have left, particularly in the Middle East, where so
    much is at stake. But much time has been wasted, goodwill has
    been squandered.
        I will go the Middle East in the next few weeks, and I'm
    going to be interested in what kind of a message we can bring
    them.
        The White House has not only favored a ``my way or the
    highway'' unilateralism in its dealings with the world, but,
    unfortunately, unlike past administrations, Democratic and
    Republican, it has often treated those members not of the
    President's party in Congress the same way. That was
    unnecessary, it was ineffective, and the American people and
    our national interests in the world have paid a high price for
    it.
        Now, we may have our disagreements, but you, Madam
    Secretary, and your staff, have always been accessible in
    wanting to discuss ways that we can work together. People would
    probably be surprised at the number of times you and I are on
    the telephone or meeting in person. I appreciate that. I hope
    we can do more in the months ahead. This is a critical time for
    the United States.
        Senator Gregg.

                    OPENING STATEMENT OF SENATOR JUDD GREGG

        Senator Gregg. Thank you, Mr. Chairman. Thank you for
    holding this hearing.
        Thank you, Madam Secretary, for being with us today. You
    keep such a hectic schedule. I don't know how you do it, and we
    appreciate your taking the time to be here.
        I know the Senator didn't mean to imply this, but I think
    it's important for us to reinforce the fact that defending
    liberty and promoting liberty around the world is not a
    mistake, it's a purpose and a cause of our Nation, has been and
    always should be, that we, as a nation, understand that freedom
    is something that comes at a dear price, and we're willing to
    pay that price. Our efforts around the world have been to
    promote freedom and to give people who haven't had the
    opportunities that we have had as a Nation, maybe, the chance
    to see the light of freedom. Have we done it correctly at all
    times? No. But have we done it with good purposes? Absolutely
    yes. I would hope that we would always view our foreign policy
    in that nature.
        In addition, the chairman asked, and rightly asked, how we
    can create better relations around the world, because that
    should be one of our causes and our goals. I would say one of
    the best ways to do it is to have the Secretary of State we
    have. You do an exceptional job. I greatly admire your efforts.
    I think when you travel across the globe, as you do on a
    regular basis, you bring a face of America that is proud,
    intelligent, thoughtful, and respected, and, as a result, you,
    yourself, personify the great strengths of our Nation and
    present so well across the world that we're very lucky to have
    you serving us.
        So, I thank you for being here today, and I appreciate your
    service.
        Senator Leahy. Thank you.
        Secretary Rice, please go ahead. Of course, your full
    statement will be placed in the record, but I would like to
    have the time--your time is precious, and I'd like to have the
    time available for questions.
        Go ahead.

                  SUMMMARY STATEMENT OF HON. CONDOLEEZZA RICE

        Secretary Rice. Thank you very much. Thank you, Mr.
    Chairman. Thank you, ranking member Gregg, members of the
    subcommittee.
        Mr. Chairman, I will place the full statement into the
    record so that we might have full time for exchange. I'll just
    start with a few comments.
        I appreciate, again, the opportunity to address this
    committee about the challenges and the opportunities that we
    face in the United States, and that the United States faces in
    the world today. I look forward to working with you, with
    Members of Congress from both sides of the aisle, so that we
    can ensure that America's diplomacy, and the courageous
    individuals who undertake it, have the necessary resources to
    protect our national security, to advance our democratic
    ideals, and to improve people's lives throughout the world.
        With these duties, we also reaffirm our responsibility to
    the American people, and that is a responsibility to be the
    best possible stewards of their hard-earned dollars.
        President Bush's fiscal year 2008 international affairs
    budget request for the Department of State, USAID, and other
    Foreign Affairs agencies totals $36.2 billion. In addition, the
    administration is requesting $3.3 billion in war supplemental
    funding in fiscal year 2008, $1.37 billion of that would be for
    foreign assistance, and $1.93 billion for State Department
    operations. It's principally to support emergency requirements
    in Iraq and Afghanistan.
        This request represents a fundamental investment in our
    national security----
        Senator Leahy. Madam Secretary?
        Secretary Rice. Yes?
        Senator Leahy. If you could withhold a moment.
        Secretary Rice. Yes.
        Senator Leahy. People who are in this room are here as
    guests of the Senate. Obviously, you have a right to express
    opinions, but when you stand up, in a way, you block others who
    have stood in line. A lot of people have stood in line for
    hours for these hearings. We want--they are televised, but we
    want people to be able to see the hearings. But when you stand
    up, you're blocking people behind you, and I think that's
    unnecessary. You can make your point. I realize there are
    people here who disagree with the war in Iraq, disagree,
    perhaps, with what's being said, but I would make it very clear
    I will not countenance, in any way, people being blocked from
    being able to watch this, nor will I countenance, in any way,
    disturbances. Just so we all understand.
        Secretary Rice, please continue.
        Secretary Rice. Thank you, Chairman.
        America remains engaged in a global war on terrorism, which
    is a war of a totally new and different kind. We face a long
    confrontation in which military strength is important, but not
    sufficient. The defining feature of our world today is its
    interdependence. The security of the American people depends on
    the stability and the success of foreign societies. If
    governments cannot, or choose not to, meet their
    responsibilities as sovereign states, nations around the globe
    are threatened by the resulting chaos and disorder.
        The President believes that the defense of our country
    depends on close integration of our multilateral diplomacy, our
    development efforts, and our support for human rights and
    democratic institutions. That is why President Bush's budget
    designates the Department of State as a national security
    agency. We must recognize that our Foreign Service, our civil
    service, and Foreign Service nationals are performing a vital
    national security role, often in difficult and dangerous posts,
    far away from friends and families, and, in many cases,
    shoulder to shoulder on the front lines with our men and women
    in uniform.
        We are asking our civilians to do far more than just manage
    an existing international order. We are charging them with
    helping foreign citizens and their governments to transform
    their countries, to move them toward peace and freedom,
    prosperity, and social justice.
        This is the national security mission of our Department of
    State which we've referred to as transformational diplomacy. To
    succeed in this critical work for the American people, we are
    making important changes to our Department's organizations,
    both in terms of roles--the roles our people are playing and
    how we are structuring our foreign assistance programs.

                               PREPARED STATEMENT

        We believe strongly that this is a challenging time for
    America, for our goals of promoting democracy, and for the
    resultant peace that it would bring. But I can tell you that I
    am very, very proud to lead the men and women of the Department
    of State. They are great patriots. They're doing hard jobs. I
    look forward to being before you to talk about the resources
    that they need to do their job well.
        Thank you very much.
        [The statement follows:]

                     Prepared Statement of Condoleezza Rice

        Mr. Chairman, ranking member Gregg, members of the subcommittee:
    Thank you for this chance once again to address the Committee about the
    many challenges and opportunities facing the United States today. I
    look forward to continue working with Congress, closely and across
    party lines, to ensure that America's diplomacy, and the courageous
    individuals who undertake it, have the necessary resources to protect
    our national security, advance our democratic ideals, and improve
    people's lives throughout the world. With these duties we also reaffirm
    our responsibility to the American people: to be the best possible
    stewards of their hard-earned dollars.
        President Bush's fiscal year 2008 International Affairs Budget
    request for the Department of State, USAID, and other foreign affairs
    agencies totals $36.2 billion. In addition, the Administration is
    requesting $3.3 billion in war supplemental funding in fiscal year
    2008--$1.37 billion for foreign assistance and $1.93 billion for State
    Department operations--to support emergency requirements in Iraq and
    Afghanistan.
        This request represents a fundamental investment in our national
    security. More than 5 years after the September 11 attacks, America
    remains engaged in a global war on terrorism, which is a war of a
    totally new and different kind. We face a long confrontation, in which
    military strength is important to our success, but is not sufficient.
    The defining feature of our world today is its interdependence. The
    security of the American people depends on the stability and the
    success of foreign societies. If governments cannot, or choose not, to
    meet their responsibilities as sovereign states, nations around the
    globe are threatened by the resulting chaos and disorder. The President
    believes that the defense of our country depends on the close
    integration of our multilateral diplomacy, our development efforts, and
    our support for human rights and democratic institutions. That is why
    President Bush's budget designates the State Department as a national
    security agency.
        We must recognize that our Foreign Service, our Civil Service, and
    our Foreign Service Nationals are performing a vital national security
    role--often in difficult and dangerous posts, far away from friends and
    families, and in many cases, shoulder to shoulder with our men and
    women in uniform. We are asking our civilians to do far more than just
    manage an existing international order; we are charging them with
    helping foreign citizens and their governments to transform their
    countries--to move them toward peace, freedom, prosperity, and social
    justice.
        This is the national security mission of our State Department
    today, which we have referred to as transformational diplomacy. To
    succeed in this critical work for the American people, we are making
    important changes to our department's organization--both in terms of
    the roles our people are playing and how we are structuring our foreign
    assistance programs. This is the foundation of our budget, and I would
    like to briefly review these important changes.

                       TRANSFORMING THE STATE DEPARTMENT

        With the support of Congress, we are moving our people off the
    front lines of the last century, in the capitals of Europe and here in
    Washington, and into the critical posts of this new century--in Asia,
    in Africa, in the Middle East, and here in the Americas. Last year, we
    reprogrammed 200 positions for this purpose; we are set to reposition
    80 more. At the same time, we are moving our people out of our
    embassies and into the field, so they can engage and work not only with
    governments but with the people of the nations in which they serve. We
    are making every necessary change--giving our diplomatic corps better
    training, better tools and technology, and more language skills--to
    empower them to meet this challenge.
        We realize that resources are tight, so in all that we do, we seek
    to be good stewards of the taxpayers' money. Last year, I created the
    position of Director of United States Foreign Assistance. On Monday,
    the White House announced it has designated Henrietta Fore as Acting
    Administrator of USAID, with the intent to nominate. I also have named
    Undersecretary Fore as Acting Director of Foreign Assistance. Our goal
    is the strategic alignment of our foreign assistance and our foreign
    policy goals.
        The main idea that I want to stress is this: Our new approach to
    foreign assistance ensures an efficient, effective, and strategic use
    of the American taxpayer's money. We adopted a country-based approach
    to achieve this. We asked our experts at State and USAID to allocate
    foreign assistance resources to activities that help countries most
    effectively develop their institutions in order to take care of their
    people and reduce widespread poverty. The adjustments you may see in
    one program are justified by what we have determined are greater needs
    elsewhere, and only after the trade offs have been thoroughly analyzed,
    in order to make the best use of our limited resources.
        As a result of this process, resources for the three objectives
    supporting long-term development--Governing Justly and Democratically,
    Investing in People, and Economic Growth--have increased by
    approximately $100 million in this year's request from fiscal year 2006
    levels. You will note some differences, however, in the structure of
    the request. For example, there is a shift in resources from the
    Development Assistance (DA) account to the Economic Support Fund (ESF)
    account. This shift represents our attempt to better justify our
    request by rationalizing the use of these two different accounts for
    different types of countries. The increase in ESF and decrease in DA
    should not be interpreted as a decrease for activities to support the
    poor and invest in development.
        With the performance and accountability measures we are putting in
    place, we aim to ensure that we are providing the necessary tools and
    the right incentives for host governments to secure the conditions
    necessary for their citizens to reach their full potential. This
    furthers our goal of helping developing nations to ``graduate'' from
    our assistance, not to grow dependent on it.

                             EMPOWERING OUR PEOPLE

        We are moving ahead on these initiatives with our existing
    authority. There are steps that need to be taken, and we are taking
    them. But we must do more, and to do it, we need additional resources.
    For this, we need the continued support of the Congress. That is why we
    are requesting $7.2 billion for State Department operations.
        As we transform our existing positions to serve new purposes, we
    must also create new positions that advance our strategic objective of
    getting more Americans onto the diplomatic frontlines of the 21st
    century. This year, we are requesting an increase of $125 million to
    create 254 new positions in critical spots like India, China,
    Indonesia, Venezuela, Nigeria, South Africa, and Lebanon. This funding
    will also enable us to establish new American Presence Posts,
    reflecting our goal of moving more of our diplomats into the regions
    and provinces of our host countries. This increase includes 57
    positions and $15 million for the Office of the Coordinator for
    Reconstruction and Stabilization. I should add here that I am grateful
    for the authority provided in the supplemental appropriation to
    transfer up to $50 million to create a Civilian Reserve Corps. These
    funds will allow us to develop a deployable cadre of civilians who will
    be able to respond quickly to a crises and stabilization missions
    overseas
        Our Department's new and evolving mission, which is vital to our
    national security, requires an increased investment in our people. Our
    people need the latest technology and the best training, in leadership
    and language skills. This budget meets those demands, including $905
    million for information technology. We must also continue to improve
    our security in a dangerous world. This budget allocates $965 million
    to strengthen security for our posts, our people, and our information
    systems worldwide, including the creation of 52 additional positions
    for security professionals.
        At the same time, we must continue to modernize and improve our
    facilities around the world. We seek $1.6 billion to address the major
    physical security and rehabilitation needs of our embassies and
    consulates worldwide so we can protect the men and women serving in our
    posts. In the fourth year of Capital Security Cost Sharing, other U.S.
    Government agencies with personnel abroad will contribute $362 million
    for the construction of new, secure diplomatic facilities.
        To continue filling the ranks of the Foreign Service with our
    Nation's best talent, we intend to revamp the pay scale for our
    diplomatic corps. State Department personnel are increasingly expected
    to serve in what we call ``hardship posts,'' which now comprise nearly
    20 percent of all department positions. We must fairly compensate our
    men and women serving abroad in difficult locations, often far away
    from their families, and we must rectify a growing disparity between
    basic salary levels for employees in the United States and overseas.
    Our budget request includes $35 million to begin a transition to a
    performance-based pay system and a global rate of pay.
        The State Department mission also extends to defending our borders
    and protecting our homeland. We must remain a welcoming nation for
    tourists, students, and businesspeople, while at the same time
    increasing our security against terrorists and criminals who would
    exploit our open society to do us harm. For this purpose, our budget
    includes $1.3 billion for the Border Security Program, and we seek to
    add 122 consular positions to address rising passport and visa demands.
    As good stewards of taxpayer dollars, we are using revenues from visa,
    passport surcharge, and visa fraud fees to fund improvements in our
    border security. In coordination with the Department of Homeland
    Security, we seek to fulfill the President's vision of secure borders
    and open doors.
        Finally, we are requesting $1.35 billion to meet our commitments to
    international organizations such as the United Nations. Over the past
    year we have seen how important it is for the United States to provide
    principled leadership in institutions of multilateral diplomacy.
    Through the United Nations, we helped to negotiate a key resolution
    that ended a month of war in Lebanon and Israel, which was launched by
    the leaders of Hezbollah. We rallied the international community to
    oppose Iran and North Korea's nuclear weapons ambitions with Chapter 7
    Security Council resolutions. And we worked to ease the suffering of
    the people of Darfur and to provide for a peacekeeping force there.
    International organizations are essential to our Nation's foreign
    policy goals, and deserve our continued support.

                      SECURING PEACE, SUPPORTING DEMOCRACY

        I have discussed the steps we are taking to support our people. Let
    me turn now to the purposes of our foreign assistance.
        Our highest priority is to defend the American people and homeland
    by doing our part in the global war on terrorism. To succeed, we need
    the continued support of key partners--our historic allies in Europe,
    Asia, and the Americas, but also in key developing countries, which
    have the will, but not the means, to fight terrorism. The fiscal year
    2008 request includes $186 million for Indonesia, $2.4 billion for
    Israel, $544 million for Kenya, and $515 million for Jordan. Our
    assistance helps those countries, and many others, to enforce their
    laws, secure their borders, gather and share intelligence, and take
    action against terrorists on their own or with us. This request also
    devotes $785 million to Pakistan to lead that country in a moderate and
    modern direction, to gain control of the border areas, and to advance
    prosperity there. Specifically, this request includes $90 million to
    support President Musharraf's 5-year development plan for the federally
    administered tribal areas.
        Across the Broader Middle East, we also look to new partners in
    embattled young democracies, who are working courageously to turn the
    tide against violent extremism in their countries. In the past several
    years, the efforts of reformers and responsible leaders have changed
    the strategic context of the region. We have offered critical support
    for civil society groups seeking political openness, economic
    opportunity, education reform, and the empowerment of women. We will
    continue to support these important reform initiatives.
        Democratic institutions in places like Iraq, Afghanistan, Lebanon,
    and the Palestinian territories are facing serious threats. They are
    under siege from violent extremists and their state supporters in the
    region. The Taliban in Afghanistan, Hamas in the Palestinian
    territories, Hezbollah in Lebanon, violent extremists in Iraq--all of
    these groups struck damaging blows last year to the cause of peace and
    freedom in the Broader Middle East. This year we must turn the tide,
    and we aim to do just that with a comprehensive strategy to help
    reformers and responsible leaders show their people that democracy can
    deliver the security, prosperity, opportunity, and dignity that they
    seek.
        In Afghanistan, we support the efforts of the new democratic
    government in Kabul to lead the nation toward freedom and prosperity.
    To achieve that goal, we have taken a hard look at our overall policy
    and adopted an effective counterinsurgency strategy--a complete
    approach that integrates military efforts with political support,
    counter-narcotics programs, development priorities, and regional
    diplomacy. There is a comprehensive, ongoing ``offensive,'' which is
    being run by the Afghanistan Government.
        Our goal is to help the Afghan Government improve the quality of
    life for its people by extending security, providing good governance,
    and opening up new economic opportunities. Along with these goals,
    President Karzai has demonstrated his determination to lead a serious
    counter-narcotics effort, but he needs our assistance. We are
    increasing our funding in this key area, along with additional funding
    for reconstruction, local economic development, and law and order. The
    base budget request of $1.4 billion for fiscal year 2008 aims to
    stimulate economic growth, establish peace and security, create jobs,
    provide essential education and health care, promote human rights,
    especially women's rights, strengthen accountability and transparency,
    and extend the reach of the democratic state.
        To achieve these broad objectives, we will continue to build roads
    and electricity grids, and support agricultural development. Working
    through Provincial Reconstruction Teams, or PRTs, and in concert with
    the Afghan government, we will build government and justice centers at
    the provincial level. We will train government personnel, and we will
    help meet local needs for markets, schools, clinics, and other vital
    services. Most importantly, we will integrate all of these efforts to
    advance our overall strategic objective of empowering Afghanistan's
    democratic government.
        In Iraq, President Bush has adopted a strategy in recognition that
    the current level of sectarian violence is unacceptable. There is a
    strong military component to this strategy, but success in Iraq depends
    on more than military efforts alone. It requires robust political,
    economic, and diplomatic measures. Our military operations must be
    fully integrated with our civilian and diplomatic efforts to advance
    the strategy of ``clear, hold, and build.'' The State Department is
    playing its role in this mission. We are strengthening, indeed surging,
    our civilian efforts. To do so, we are requesting $1.4 billion in
    fiscal year 2008 in the base budget and the fiscal year 2008
    supplemental request to fund our assistance efforts in Iraq.
        The main focus of our support will continue to shift toward helping
    the Iraqi Government expand its reach, its relevance, and its resources
    beyond Baghdad. We will help local leaders improve their capacity to
    govern and deliver public services. Our economic efforts will be
    targeted to local needs, with proven strategies of success, like micro-
    credit programs.
        Expanding our PRT presence will also enable us to diversify our
    assistance across Iraq. Iraq has a federal government. Much of the
    street-level authority, and much of the opportunity for positive change
    in Iraq, lies outside Baghdad, in local and provincial governments,
    with party leaders and tribal chiefs. By actively supporting these
    provincial groups and structures, we expand our chances of success in
    Iraq. Our PRTs have had success working at the local level in towns
    like Mosul, Tikrit, and Tal Afar. Now we will invest in other parts of
    Iraq, like Anbar province, where local leaders are showing their desire
    and building their capacity to confront violent extremists.
        In Lebanon, we are requesting approximately $60 million in fiscal
    year 2008 to complement what we requested in the fiscal year 2007
    Supplemental to support the Lebanese people's aspirations for peace,
    stability, and economic development. In November 2006, we signed a
    Trade and Investment Framework Agreement to help support Lebanon's
    development through enhanced bilateral economic ties. I made a
    significant pledge of $770 million in January at the Lebanon Donors'
    Conference, which raised $7.6 billion to support the Lebanese people
    and their democratically-elected government. Our assistance will
    support the Lebanese government's own ambitious reform program, which
    demonstrates its commitment to reducing its debt and achieving economic
    and financial stability. I continue to keep your concerns in mind
    regarding direct budget support and let me reassure you, the money
    supports the economic reform plan endorsed by the international
    financial institutions and benchmark goals supported by us.
        As we take steps in the reconstruction and development effort, we
    must not lose sight of the need to implement fully U.N. Security
    Council resolutions related to Lebanon, in particular Resolution 1701.
    We commend the Lebanese Government for deploying the Lebanese armed
    forces to the south of its country for the first time in almost 40
    years, and we applaud the international community for its successful
    deployment of the enhanced UNIFIL forces to help Lebanon secure its
    sovereignty. Much more work remains to be done, however, to ensure
    Lebanon's sovereignty is not undermined by regional actors like Syria
    and Iran and to address the threat of terrorist groups like Hezbollah.
    I look forward to continuing to work with the UN and our other
    international partners on further steps to implement Resolution 1701.
        In the Palestinian territories, President Abbas's desire to support
    a better life for his people and to make peace with Israel is being
    blocked by the radical leaders of Hamas. One year after this group's
    legitimate election, the international community continues to stand
    together in its insistence that Hamas meet the conditions set out by
    the Quartet: recognize Israel, renounce violence, and accept all
    previous agreements and obligations, including the Roadmap. Peace
    between Israel and the Palestinians will be possible only with a
    Palestinian government that recognizes Israel's right to exist and
    renounces terrorism. We will judge the Palestinian government by its
    words and by its actions.
        For fiscal year 2008, we are requesting $77 million to help meet
    Palestinian humanitarian needs, including emergency food, health and
    educational assistance, programs to strengthen democracy and good
    governance, and support private sector development in the West Bank and
    Gaza. These bilateral funds are in addition to the funds requested for
    the U.N. Relief and Works Agency for Palestine Refugees in the Near
    East (UNRWA). There is a battle in this region between moderates and
    extremists. These funds will not go to Hamas or any other terrorist
    organization, but will bolster moderate forces in the Palestinian
    territories.
        For Iran, the President has requested $109 million in funding,
    including $20 million for VOA's Persian service, $8.1 million for Radio
    Farda, $5.5 million for consular affairs, and $75 million in Economic
    Support Funds for civil society and human rights projects in Iran.
    These funds will allow us to continue with a wide range of democracy,
    educational, and cultural programs, as well as to improve the free-flow
    of information to the Iranian people. We must continue to make clear
    that while we differ fundamentally with the current government of Iran,
    and we seek friendship with the Iranian people.
        The hard work of democracy does not end with one free election;
    that is only the beginning. Lasting democratic reform must also
    encompass an independent media, free political parties, limits on state
    authority, and protections for human rights. We are funding programs in
    all of these fields of democratic reform. To support democratic
    transitions, the budget provides $1.4 billion for programs that foster
    rule of law and human rights, good governance, political competition
    and consensus-building and civil society.
        As we work to expand freedom and prosperity, we must champion these
    ideals through our public diplomacy and vital educational and cultural
    exchanges, for which we are requesting funding of $855 million. Public
    diplomacy is a vital component of our national security strategy. We
    seek to reach out to the peoples of the world in respect and
    partnership, to explain our policies and to express the power of our
    ideals--freedom and equality, prosperity and justice. Public diplomacy
    is no longer the job of our experts alone; it is the responsibility of
    every member of the State Department family, and we are mobilizing the
    private sector and the American people to help.
        People-to-people exchanges are also a vital component of our
    national security strategy. Many exchange participants report that they
    are ``forever changed'' by their direct involvement with the American
    people. Last year, the total number of student and exchange visas
    reached an all-time high of 591,000. We want to expand on this success,
    working in partnership with the private sector wherever we can.
        We seek $668 million for the Broadcasting Board of Governors, to
    support radio, television, and internet broadcasting worldwide,
    including in North Korea, Iran, and Cuba.

                           MEETING GLOBAL CHALLENGES

        We face a major challenge in the proliferation of weapons of mass
    destruction and the materials to produce them. The fiscal year 2008
    budget supports our key multilateral counter-proliferation activities--
    including the Proliferation Security Initiative, the G-8 Global
    Partnership, the Global Initiative to Combat Nuclear Terror, and U.N.
    Security Council Resolution 1540. The budget also supports our efforts
    to strengthen the global non-proliferation regime, by rallying the
    international community to hold governments accountable for these
    actions which violate their responsibilities.
        As the President said in his State of the Union address, we are
    committed to addressing ``the serious challenge of global climate
    change.'' Our approach is rooted in pragmatism and partnership. One of
    our principal initiatives is the Asia-Pacific Partnership on Clean
    Development and Climate, which we launched in concert with Australia,
    South Korea, Japan, India, and China. Together, these countries
    represent more than half of the world's economy, a large share of the
    world's emissions, and a growing demand for energy that is vital to
    economic development. The Partnership, for which we request $30 million
    for fiscal year 2008, is accelerating investment and opening markets
    for cleaner, more efficient technologies, goods, and services, while
    fostering sustainable economic growth and poverty reduction.
        In Colombia, we are requesting $506.468 million in the fiscal year
    2008 budget to sustain our commitment to counter narcotics and demand
    reduction. During his visit to Bogata on March 11, President Bush
    reaffirmed to President Uribe the importance of helping Colombia finish
    the job. With Congress's bipartisan support, the United States has
    helped the Colombian people to protect their democracy from drug
    traffickers, restore security to large parts of the country, protect
    human rights, and begin a far reaching reform of its judicial system.
    The gains have been impressive. Colombia has come back from the brink
    to become a partner. We are confident that, with Congressional support
    for our fiscal year 2008 budget request and approval of the Colombia
    free trade agreement, these hard won gains will be just the beginning
    of Colombia's dramatic transformation.
        Critical challenges remain. President Uribe is addressing these
    issues aggressively and decisively, continuing the fight against drug
    traffickers, but also focusing on winning the peace through economic
    and social development, consolidation of democratic institutions, and
    respect for human rights. In response, we have designed an assistance
    strategy that will help President Uribe and the Colombian people
    achieve the security and prosperity they have worked so hard to make
    possible. We want to improve the lives of Colombians while reducing the
    impact of narco-terrorism on the United States and the region.
        I know that there are questions about the relative mix of ``hard''
    and ``soft'' spending in our fiscal year 2008 budget request. We know
    that without security it is impossible to promote socioeconomic
    development. Our plan is to invest now in the Colombians' capabilities,
    as we gradually turn over responsibility for the counternarcotics
    programs to them. I also know that recent concerns of paramilitary ties
    to Colombian government and military figures are a serious matter. The
    Colombian Government's commitment to seeking the truth and insisting on
    justice deserves our support. I believe strongly that we need to
    recognize President Uribe's leadership and the extraordinary commitment
    of the Colombian people.
        We face another potentially deadly challenge in the threat of
    pandemic disease. The fiscal year 2008 budget request of $100 million
    supports our global strategy and partnership to address avian influenza
    outbreaks and to support prevention strategies worldwide.
        The fiscal year 2008 budget also advances the goals of the
    President's historic Emergency Plan for AIDS Relief. Thanks to the
    strong bipartisan support that this program has received from Congress,
    the Emergency Plan now supports treatment for more than 822,000 people
    in the 15 countries that are home to over half of the world's infected
    population. This year we are requesting a total of $5.4 billion for the
    Emergency Plan, including funds requested by the Department of Health
    and Human Services. This includes $4.1 billion for prevention,
    treatment, and care in the 15 focus countries. We are also seeking an
    additional $1.2 billion for bilateral programs in other countries, for
    HIV/AIDS research, for multilateral programs worldwide, and for
    tuberculosis programs.
        No less significant is President's Malaria Initiative, which has
    supported prevention and treatment for millions of people in fifteen
    African countries--Angola, Tanzania, Uganda, Malawi, Mozambique,
    Senegal, Rwanda, Benin, Ghana, Madagascar, Kenya, Zambia, Liberia,
    Mali, and Ethiopia. The fiscal year 2008 budget dedicates $300 million
    to fund our commitments under this Initiative, as well as $88 million
    for other ongoing global efforts to fight malaria.
        helping developing countries and the most vulnerable populations
        Global partnerships are essential to meeting the global challenges
    that I have just described. But many weak and poorly governed states do
    not have the capacity to fulfill their responsibilities as sovereign
    states. Our experience on September 11 showed us that weak and poorly
    governed states can pose not just humanitarian challenges, but national
    security threats. Hopelessness and oppression contribute to extremism
    and instability. Helping developing states to transform themselves--to
    govern justly, to advance economic freedom, to combat poverty, and to
    invest in their people--is a strategic imperative.
        The United States is a compassionate Nation, and we are moved to
    action when tragedy strikes, and when innocent people are in desperate
    need. The fiscal year 2008 budget provides more than $2 billion for the
    protection of refugees and for basic needs like food, water, and
    medicine for vulnerable populations. One of the major recipients is
    Sudan, for which we are requesting a total of $359 million for
    humanitarian assistance, as well as additional funding for Sudanese
    refugees in neighboring countries. We are continuing our support for
    victims of war and genocide, especially the internally displaced people
    in Darfur and the refugees in eastern Chad.
        We will continue to invest in the people of the world's poorest
    countries. Basic education is a critical part of this investment. The
    fiscal year 2008 request for resources to support basic education
    programs is $535 million.
        In addition to direct support for the world's most vulnerable
    populations, we seek to support the development of sound economies and
    political structures to raise people out of poverty. On this front, our
    flagship initiative is the Millennium Challenge Corporation (MCC).
    Since 2004, the MCC has signed development compacts with eleven
    countries, worth a total of $3 billion. MCC works with transforming
    countries that meet standards of progress for governing justly,
    advancing economic liberty, and investing in their people. The compacts
    are designed and managed by recipient countries themselves, reinforcing
    their ownership in the fight against poverty. These resources
    complement and amplify the impact of our investments in other foreign
    assistance accounts.
        For a country to unlock the potential of its people to increase
    productivity, create jobs, and combat poverty, it must integrate its
    economy into regional and global trade networks. The President remains
    committed to achieving a successful outcome to the World Trade
    Organization's Doha Development Agenda--one that opens markets, expand
    trade, and strengthens a rules-based system. As a part of the
    President's robust trade agenda, we have negotiated ten free trade
    agreements (FTAs) with 16 countries worldwide, and Congress has already
    approved agreements with 12 of these countries. We have signed FTAs
    with Colombia, Peru, Panama and South Korea. We look to Congress to
    support these important agreements.
        Mr. Chairman, members of the subcommittee: The State Department has
    assumed substantial new national security responsibilities in the war
    on terrorism. We are the lead agency on a majority of the tasks in the
    Administration's National Counterterrorism Strategy. Using our existing
    authorities, we are taking steps to reshape the State Department to
    play a forward-leaning role in advancing freedom and prosperity around
    the world.
        In this challenging time, the men and women of American diplomacy
    are doing all that we are asking of them--and more. They are nobly
    answering the call to service and shouldering their responsibilities. I
    ask you to provide the resources we need to play our part.

        Senator Leahy. Thank you, Madam Secretary.
        You and I have discussed the resignation of the
    administrator and director of foreign assistance of USAID, last
    week. Then, as you told me--and we chatted--that the
    President's going to nominate Henrietta Fore as USAID
    administrator. She'll also be designated as director of foreign
    assistance. I see these, really, as full-time jobs. Why would
    you combine--why would you combine these two positions? Before
    you answer, the reason I ask the question, Ambassador Tobias
    made a number of reforms, as he told us when he testified, but
    I'm having a hard time discerning their impact. I want to have
    more--better coordination on foreign assistance, but I've
    always felt--and I've said this with both Republican and
    Democratic administrations, USAID has to remain autonomous. So,
    why combine these two? Will they have control over their
    budget?
        Secretary Rice. Well, thank you, Senator.
        First of all, let me just note that I have great respect
    for USAID and its special mission, and for the men and women of
    USAID and the important job that they do out on the front
    lines. I think that--I hope that they would tell you that I've
    been very supportive of their mission and of their development.
    I do believe that, since about 80 percent of our foreign
    assistance--U.S. Government foreign assistance comes from
    Department of State and USAID budgets, that this is a time when
    we need to make certain that we have an integrated picture of
    what we are doing with those resources in order to promote
    certain goals, in order to make certain that programs are being
    well delivered. That's the reason for the dual-hatting of the
    director of foreign assistance.
        Senator Leahy. But does that mean that have control over
    their budget, or not?
        Secretary Rice. Well, in fact, it rests with me,
    ultimately. I am the one that has to represent to you, and
    through you to the American people, that the resources that are
    being given to USAID and to the Department of State are being
    well used. I am in a stronger position, with a director of
    foreign assistance who also is USAID administrator, to make
    certain that when a budget comes to me, which I then recommend
    to the President, which is then recommended to you, that we are
    using the resources well, that there is not duplication, that
    we are able to fill gaps where they may be, and that we are
    respecting both missions.
        Senator Leahy. But the reason I ask--I mean, we were
    somewhat disappointed in this committee--by ``we,'' I say a
    number of the Senators, both sides of the aisle, with
    Ambassador Tobias's testimony when he came here, trying to get
    any specificity about what was happening. I'm curious--I notice
    this seems to be getting down in the weeds, but there's USAID
    budget personnel shifted to the F Bureau at the State
    Department, the Office of Director of Foreign Assistance. Do
    they stay there, or do they go back to USAID? Is this----
        Secretary Rice. They are USAID, they are, in effect,
    secunded to the Department to work on budget matters. But I
    would ask you, Senator, to think about it from my point of
    view, as Secretary. I'm charged with the authorization to
    assure, really, that the resources are being used in an
    appropriate way. And----
        Senator Leahy. Well, no, I understand that. But you also--
    when the director is there, they're carrying out that
    direction. As I said, we were--many of us were concerned when
    the former director was before us, there were a lot of glowing
    slogans, but every time we asked a question, specifics, we
    didn't get the answers. Now, he may have been distracted by
    other matters at the time, but it was a--it was a concern. I
    think you should tell the new director she should be prepared
    to come up here to, at the very least, brief Senator Gregg and
    myself on some of these specifics.
        Let me switch to a different area. Now, having said, over
    and over again, that we don't want to be seen as an occupying
    force in Iraq, we're building the largest embassy that we have,
    probably the largest in the world, in Baghdad. It just seems to
    grow and grow and grow. The 2007 supplemental, I'm noticing, it
    provides the funds for most of the expansion you propose for
    the Provincial Reconstruction Teams. We agree that we should
    focus our aid locally, not in Baghdad, but we have 1,000
    Americans at the Embassy in Baghdad. You have the contractors
    and local staff, that comes to 4,000.
        The 2000 supplemental required you to submit a plan for the
    U.S. mission in Iraq, for the growing size and costs. I--you
    know, we have a deviation from the plan that we'd agreed to.
    Staffing has increased by over 30 percent in just 2 years. We
    have the largest embassy in the world. We have countries where
    we do a great deal of trade and where we have to be concerned
    about intellectual property piracy, everything else, and we
    don't--we can't seem to get the staffing there. Can we review
    who we really need, and send the rest of the people home?
        Secretary Rice. Well, thank you, Senator. In fact,
    Ambassador Crocker, as you know, has just--virtually just
    arrived in Iraq, has been out there a little over a month, and
    he has asked, and we have sent, Ambassador Pat Kennedy to go
    out and to assess the staffing and housing requirements for the
    Baghdad Embassy compound. We do believe that the embassy
    compound was right-sized at the time that it was presented to
    Congress. There have been some additional issues since that
    time, including the extension of the special IG for Iraq. And
    we have to be able to deal with those people. We have a
    security situation in which we are not able to house people in
    hotels when they're visiting. We have a number of shorter-term
    TDY staff that are out at the embassy. And, in fact, we have,
    as you know, a kind of surge in the personnel to be able to
    deal with--to provide the diplomatic and political surge----
        Senator Leahy. No, I understand that, Madam Secretary, but
    I look at China. We have enormous trade issues with China. We
    have a country that is stealing us blind in ignoring our
    copyright laws and counterfeit--everything from counterfeit
    food and drugs to stealing our intellectual property, whether
    it's computer programs to movies to--and we're talking about
    billions of dollars, to say nothing about the health problems
    we've seen very recently, where people have died here, and in
    other countries, because of the fraudulent food additives and
    so on. But our Embassy in Baghdad is much larger than our
    Embassy in Beijing. What I'm saying is, if there are people we
    don't need, why don't we just send `em home?
        Secretary Rice. We are going to make that assessment,
    Senator. I agree with you that there may be--because of the way
    that the embassy came into being--in effect, coming on the
    heels of the Coalition Provisional Authority--because there
    have been a lot of needs that I would characterize as shorter-
    term--meaning, not in the long-term steady state of how the
    embassy will be staffed. We're going to make exactly that
    assessment, and we will make certain that we have only the
    people out there that we would need.
        I would just note, Senator, that we are, in the case of
    China and a couple of other embassies where we believe that the
    needs have grown--we have, in fact, redeployed people out of
    places in Europe to China and places like that, where we
    believe that we need greater staffing. So, we're trying to
    remain flexible in making certain that we're well staffed in
    these extremely important posts.
        But I will definitely get a report back to you once
    Ambassador Kennedy has done his work.
        Senator Leahy. Can I--when I come back on my time--my time
    is up--I'm going to want to talk about the Western Hemisphere
    Travel Initiative. I--it would be nice if we allowed Canadians
    and Americans to travel back and forth across each other's
    borders. So, that's an issue we'll go into. Bothers me greatly
    what's being done.
        Senator Gregg.
        Senator Gregg. Thank you, Mr. Chairman.
        I want to echo the chairman's concerns about the size of
    the embassy also. Ironically, I chaired the subcommittee when
    the embassy decision was made, and I, at that time, had fairly
    serious concerns, and it was downscaled as a result of some of
    those concerns. But I remain skeptical of the need for this
    level. I understand that the security needs require that so
    much more be concentrated in the embassy than in most
    embassies, but, still, this is a huge facility, and it does
    have serious issues, I think, of right-sizing.
        But, on another subject, I recently had the chance to
    travel to South America, and I recently had the chance to meet
    with the President of Colombia. I would be interested in your
    assessment of the situation in South America, especially
    relative to Colombia and our relationship with Colombia and
    Venezuela, because it appears to me to be a region where we've
    got some friends and we've got some people who don't like us
    that much, and we should be with our friends.
        Secretary Rice. Well, thank you. In fact, the President,
    Senator Gregg, if you remember, was recently in Latin America,
    and visited Colombia during that time, visited Bogata. The fact
    that he was able to go to Bogata says something about how far
    Colombia has come in a relatively short period of time.
        We do have a challenge in Latin America. We have a
    challenge, because those who have been democratically elected
    are trying to deliver for their people, and trying to remain
    allies of the United States. There are those, like Venezuela,
    that would challenge just about everything about American
    interests and policy, including free markets, including
    nationalizing industry, and they're a real challenge to free
    markets, open economies, and to democracy in Latin America. It
    makes it even more important that states like Colombia, which
    are trying to do the right things, in terms of democracy and
    open economies and free trade, be supported by the United
    States.
        In the year that President Uribe came to power, I think
    it's fair to say that Colombia was on the brink of failure, on
    the brink of being a failed state. It was, after all, a country
    where large portions of the territory were uncontrolled by the
    government, where terrorists were able to prevent the police or
    the army from even coming into those areas, where bombings in
    Bogata, where security for the population was something that
    was very difficult, almost impossible, for the government to
    deliver. Through a very strong campaign against terrorism,
    President Uribe has begun to deliver some security to his
    people. I think it's why he was reelected by such large margin.
        They also are going after paramilitaries from the other
    side of the political spectrum. He ordered paramilitary leaders
    to surrender in August of 2006. Fifteen of the 24 top leaders
    did. They've been going after the others. Frankly, the
    independent judiciary and the supreme court has been bringing
    people to account for what has happened in Colombia over the
    last years.
        So, I think, while it is not by any means perfect, and we
    continue to have a dialogue with Colombia about the need for
    human rights protection, the need for labor protections, the
    need for continuing to prosecute the paramilitaries, this is
    really a case of a democratically-elected leader that has been
    able to bring his country back from the precipice of being a
    failed state. Just imagine what South America, with the
    challenge of someone like Hugo Chavez, would be without strong
    allies like Colombia in the Andean region.
        Senator Gregg. Thank you. It's represented by some that
    Chavez and the Venezuelan Government is basically protecting,
    or at least not extraditing, narcoterrorists back to Colombia,
    members of FARC. Is that the view of the State Department, that
    that's an accurate representation?
        Secretary Rice. There are cases that the Colombian
    Government has raised, I think, with the Venezuelans,
    concerning who may be continuing to live in, or operate in,
    Venezuela. We just hope that all of Colombia's neighbors will
    not harbor, in any fashion, people who ought to be brought to
    justice.
        Senator Gregg. On another subject, you recently had an
    opportunity to meet with representatives of Syria. As we look
    at the Middle East, obviously Syria has, for years, been a
    funder of terrorism and terrorist groups. There seems to be a
    mutation, however, of the terrorist cadre in that the more
    structured terrorists, such as Hamas and Hezbollah, now find
    themselves with the most distant groups, such as al Qaeda, that
    are not as orchestrated, potentially, or at least funded. And
    so, I'm interested in your view of where Syria now--what
    Syria's role now is in the area of funding, supporting, and
    promoting terrorism in the traditional struggle relative to
    Israel and in the struggle in Iraq.
        Secretary Rice. Syria continues to be a major funder of
    terrorism, major harborer of those elements of the Palestinian
    political elite, for instance, who are opposed to a two-state
    solution, who are the ones who continue to be--to perpetrate
    violence in the Palestinian territories, and to attempt to do
    it in Israel. So, in terms of Middle East peace, the Syrians
    are a real problem for leaders like Mahmoud Abbas, who want to
    take a different course toward a two-state solution.
        When it comes to Iraq, we are very concerned about the
    foreign fighters that are transiting the Syrian border, and
    are, therefore, doing great harm to innocent Iraqis and to our
    forces. That was the focus of the conversation that I had with
    the Syrian Foreign Minister. It was about Iraq. This was not a
    conversation about U.S./Syrian relations. This was about what
    Syria needs to do to stem the tide of those foreign fighters
    and to help the Iraqis to secure their borders.
        Then, finally, as to Lebanon--there, Syria and its allies
    continue, on a daily basis really, to threaten the stability of
    the democratically-elected government of Fouad Siniora, to
    resist the establishment of an international tribunal. Despite
    the fact that that tribunal is established by the United
    Nations, their allies continue to try to block the convening of
    that tribunal. Syria needs to allow that tribunal to go
    forward, because people need to answer for what happened to
    former Prime Minister Rafik Hariri, and we need to see who was
    behind it. So, Syria is a significant problem, not just for
    American policy in the Middle East, but for democratic forces
    that are trying to take hold in the Middle East. One point that
    I made to my Syrian counterpart is that we should talk about
    Iraq, and we should talk about what we can do to help the
    Iraqis, but U.S./Syrian relations would depend on a great deal
    more.
        Senator Gregg. I appreciate that. The logical follow-up
    question is, How should we engage Syria, and how does Israel
    view Syria?
        Secretary Rice. Well, I'll not try to speak for the
    Israelis, except to say that their statements are consistent in
    public and in private, with--what they say in public and what
    they've said to us in private. Obviously everyone would like to
    see peace between Israel and Syria. If it were possible, I
    think everybody would jump at the chance. But Syrian behavior
    is such that, particularly in the support that it gives to
    elements of Hamas that are preventing a two-state solution,
    it's not exhibited an attitude that suggests that it's ready
    for, or intending to try and pursue peace.
        As to how we deal with Syria, we had this--have had this
    limited discussion with them on Iraq, because we want all of
    Iraq's neighbors to help Iraq. It makes only good sense if the
    neighbors believe what they're saying, which is that a stable
    Iraq is in their interest, then they need to behave that way,
    and that was the message to Syria. But, beyond that, we've been
    very clear that there is nothing to be done that does not allow
    that tribunal to take place in Lebanon, and that does not stop
    support for the Palestinian organizations that are engaged in
    terrorism.
        Senator Gregg. Thank you.
        Senator Leahy. Thank you, Senator Gregg.
        Before I go to Senator Landrieu, I'd note Colombia has been
    in the top four or five of countries receiving foreign aid from
    the United States. I have been either chairman or ranking
    member during that whole time, both with President Uribe and
    his predecessor, and have voted for that. But, before we put
    too rosy a picture on it--and I'll come back to this later--
    there are 30,000 individuals who went through the
    demobilization ceremonies. Only 2,700 of them applied for
    reduced sentences under the Justice and Peace Law. The rest
    have received government benefits without confessing their
    crime or turning over their illegal assets.
        The government's lost track of 5,000 of them. The
    Organization of American States say new illegal groups have
    been formed in 23 of Colombia's 32 departments. We've heard of
    the extensive paramilitary infiltration of Colombia's political
    system, including the president's former director of
    intelligence--that was uncovered by the supreme court, the
    inspector general, and, as you know, by some of our own people.
        Senator Landrieu.
        Senator Landrieu. Thank you, Mr. Chairman.
        I have a full statement for the record I'd like to submit.
        Senator Leahy. Without objection, it will be included.
        Senator Landrieu. Thank you.
        [The statement follows:]

                 Prepared Statement of Senator Mary L. Landrieu

        Mr. Chairman, Senator Gregg, on September 15, 2005, President Bush
    stated that ``This government will learn from the lessons of Hurricane
    Katrina. We are going to review every action and make necessary changes
    so that we are better prepared for any challenge of nature, or act of
    evil men, that could threaten our people.'' Unfortunately, time and
    time again, Madame Secretary, we are constantly reminded of how this
    administration has failed to take every action and failed to make the
    necessary changes so that we are better prepared for tomorrow's next
    Hurricane Katrina. The recent Category 5 tornado that ripped through
    Kansas this past weekend, and the recent report by the Washington Post
    on the mishandlings of foreign aid offered in response to Hurricanes
    Katrina and Rita, both tragically demonstrate my point.
        During Hurricane Katrina, the National Guard equipment and members
    were stretched too thin--and continue to be stretched too thin to this
    day. When Katrina hit the Gulf on August 29, 2005, the Louisiana
    National Guard only had roughly 40 percent of equipment on hand and
    more than half of our Guardsmen were deployed in support of the war in
    Iraq. Here we are one-year, 8 months and 13 days later (approximately
    620 days) and Kansas Governor Kathleen Sebelius is reporting that, 50
    percent of our her trucks are in Iraq and Afghanistan and she is
    missing numerous Humvees, which move people. Unfortunately, Governor
    Sebelius is unable to borrow the necessary equipment from other states,
    like Gulf States did during Katrina, as they are also operating under
    extreme equipment shortages.
        Due to the amount of equipment being left in Iraq and Afghanistan,
    16 percent of the Kansas National Guard's equipment will not return to
    Kansas. In fact, there is a chance the amount of equipment left
    overseas will double. Louisiana's National Guard is also experiencing
    the same war fatigue, with only 33 percent of necessary equipment
    currently on hand. If all was returned from Iraq and Afghanistan, it
    would still only increase on hand availability to 44 percent. While it
    may seem the recent tragedy in Kansas may be out of scope for the basis
    of this hearing, I assure you, Madame Secretary, it is not.
        Recently, the Washington Post reported on the administration's
    turning away of nearly $1 billion of foreign aid offered in response to
    Hurricanes Katrina and Rita and the devastating failure of the federal
    levee system that followed. I was already aware that the administration
    cast aside warnings and recommendations from its own experts, dragged
    its heels on response, and drove our long-term recovery straight into a
    morass of bureaucracy. Another curtain has been pulled back and exposed
    an additional example of the seemingly endless incompetence that has
    been the trademark of this Administration's response to the hurricanes
    and the devastating failure of the federal levee system. While the
    State Department has acknowledged that mistakes were made in the
    handling of foreign donations, due to an absent implementation plan for
    the management of foreign aid, no changes have been made to the
    International Cooperation Response Index to the National Response Plan.
    In addition, no significant permanent changes have yet to be made to
    the National Response Plan itself.
        Inadequate planning on how to manage foreign aid, more specifically
    material assistance, kept valuable resources from being accepted,
    allocated and distributed. One-hundred fifty-one nations, international
    organizations and political entities offered assistance, totaling $854
    million, not including material/in-kind assistance. Of the $854
    million, $454 million was cash; $400 million was oil, which was to be
    sold for cash. To date, only $126.4 million has been accepted, numerous
    material/in-kind donations were turned away, and the $400 million in
    oil was never accepted or sold.
        For example, on September 5, 2005 FEMA received an offer from
    Switzerland to send relief supplies. However, the offer was not fully
    vetted by FEMA until September 14, 2005. With the delay and FEMA not
    being able to quickly unload and repackage the supplies into smaller
    quantities in a timely matter, the Swiss government had to cancel the
    entire shipment. Not only were donating countries victims of an
    unresponsive and ill-prepared administration, they were also thwarted
    by bureaucratic red tape. During the height of rescue and relief
    missions, a German company offered a $3 million integrated satellite
    and cellular telephone system, which is capable of handling 5,000 calls
    at once. With virtually all communications systems down in the Gulf,
    this device could have potentially saved many lives had it been
    delivered earlier. For five days, the people of Louisiana and
    Mississippi were without this key system until a written deployment
    order was issued from USNORTHCOM.
        In the administration's February 2006 report, The Federal Response
    to Hurricane Katrina: Lessons Learned, a total of nine recommendations
    were made on how to improve the management of offers of foreign
    assistance and inquiries regarding affected foreign nationals. One of
    the requirements directs DOS to lead the revision of the International
    Coordination Support Annex to the National Response Plan, to clarify
    the responsibilities of DOS, DOD, DHS, and other agencies in response
    to domestic incidents. Other recommendations direct that prior to June
    1, 2006, DOS and DHS should lead interagency efforts to:
        1. Quickly develop procedures to review, reject or accept any
    offers of international assistance
        2. Create a list of anticipated needs for foreign assistance and a
    list of items that cannot be accepted, and
        3. Develop an interagency process to determine appropriate and
    timely uses of cash donations and how to communicate to donors on how
    funds were used.
        I hope that today we can get to the bottom of how this
    Administration could turn away an outstretched hand in a time of such
    desperate need. Madame Secretary, I would like an update from you by
    May 31, 2007. I want to know where DOS is on completing the nine
    recommendations, if they were done timely, and when final amendments
    may be made to the International Coordination Support Annex to the
    National Response Plan. I need to know what works and what does not.
    Louisiana and the Gulf Coast deserve better. America deserves better.
        In the fiscal year 2008 Budget, the President has requested $36.2
    billion in Department of State, USAID and other foreign agencies. This
    is a 22 percent increase from fiscal year 2007, and only 1.2 percent of
    our total annual budget. These funds are in addition to the $3.3
    billion requested for the fiscal year 2008 Emergency Supplemental for
    foreign assistance and State Department operations. While this budget
    request contains sufficient funding for many programs, such as Global
    AIDS and the Millennium Challenge Corporation (MCC), the global
    challenges facing us today are greater than ever.
        While we have made progress over the last few years in increasing
    the amount of foreign assistance funding, continued investment in
    international affairs programs are critical to building global
    stability. By increasing the International Affairs Budget, we have a
    better chance of achieving our national security goals and of promoting
    economic prosperity and our humanitarian values. Therefore it is
    critical that we continue to increase U.S. foreign assistance and pass
    a total budget of $38.5 billion for State and Foreign Operations and
    $1.3 billion in international agricultural assistance in fiscal year
    2008.
        In the many war torn and conflict areas, such as Afghanistan, Iraq,
    Uganda and many others around the globe, thousands of children continue
    to suffer. Every day 30,000 children under 5-years-old die from
    preventable diseases, 77 million children wake up without a chance to
    go to school, and 200 million go to bed without enough to eat.
    Unfortunately, the Budget only calls for $345.6 million in maternal,
    newborn and child survival programs--this is a decrease from last
    year's level.
        The Budget also calls for $535 million for basic education
    programs. While this is an increase over the current levels, it falls
    short of the real global need. By transferring the bulk of global
    education funding from Development Assistance account to the Economic
    Support Fund account, there is a possibility the number of countries
    receiving basic education assistance, particularly Africa and Latin
    America, could decline. Additionally, this change could impede lasting
    and transformational change in those regions. While I do appreciate and
    support the changes underway at USAID, I do believe we need to study,
    closely, the real impact of each change. Currently, 42 countries
    receive basic education from the DA account, 14 in Africa, 15 in Asia/
    Near East, 5 in Europe/Eurasia and 8 in Latin America and the
    Caribbean, and we do not want to jeopardize, only improve, the
    education in these countries.
        According to Save the Children, nearly half of 6 year-olds in
    Uganda do not enroll in school. On average, 64 percent do not complete
    five years of school, and in Pader district, primary school completion
    is just 26 percent. Across Uganda more boys enroll than girls. Early
    marriage and pregnancy and fear for their lives, causes frequent drop
    outs or keeps them from attending all together. Only 45 percent of
    girls enroll in grade one, but only 32 percent complete primary school.
    Around 46 percent of teachers are untrained and class sizes can grow to
    over 200 children.
        It is vital that we recruit, train and deploy teachers in under-
    resourced areas, including female teachers to help increase enrollment
    and completion among girls. By building community support for education
    and investing in the community, we are able to help reduce the amount
    of child from being abducted. More than 30,000 children have been taken
    from their homes and abducted by the LRA. These children often become
    soldiers or sex slaves. Currently, 6,000 to 10,000 children walk miles
    from their rural homes every night to sleep in town centers, in order
    to avoid violence and abduction. These children are known as ``night
    commuters''. Last year as many as 35,000 children would leave their
    homes every night.
        Much like Uganda, Afghanistan struggles to rebuild their community
    and to find a was to redevelop essential skills in the country.
    Although Taliban control ended in 2001, and despite reconstruction
    efforts, Afghanistan is deeply poor with chronic malnutrition,
    lawlessness and frequent violence against children. Girls are still
    excluded from many activities. Half of Afghan children between 7 and 12
    attend school, but only a third are girls. Attendance is often low, due
    to the inadequate school facilities for girls and the limited number of
    female teachers. Roughly 60 percent of girls aged 7 to 13 are out of
    school and in some rural areas around 92 percent of girls are out of
    school. Only 27 percent of teachers are females, but most are in urban
    areas, and fewer than 15 percent of teachers have a teaching degree.
    Clearly you can see from these startling statistics, Madame Secretary,
    that it is very important that ensure our education funding is not
    jeopardized, but improved in a way that allows the number of countries
    and the amounts received to grow.
        As I stated above, in Afghanistan and Iraq children continue to be
    victims of: poor health care, limited and inaccessible education
    systems, and innocents of the ongoing wars. In Uganda children are
    forced to be child soldiers and young girls into becoming ``wives''.
    Madame Secretary, this is unacceptable. I know these problems cannot be
    solved overnight and not by diplomatic measures alone, which is why we
    must continue providing these countries with adequate aid assistance
    and improve intercountry adoption policies around the globe.
        As the Democratic Chair of the Congressional Coalition on Adoption
    and a proud adoptive parent myself, I truly understand the benefits and
    joys adoption brings to a family and the children being adopted.
    Although, over 20,000 children are adopted every year internationally
    by U.S. citizens, improvements can and must be made to intercountry
    adoption policies around the globe. For example, adoption by foreign
    citizens remains close in Romania and Cambodia to this day. Russia,
    although open for adoption by foreign citizens, passed an NGO law in
    May, which requires U.S. based adoption service providers be both
    registered and accredited by the Ministry of Education (MOE). Unless an
    agency complies with both they are unable to assist in any way in
    placing children. As of the end of April, no U.S. agencies had been
    successfully accredited by the MOE. Madame Secretary, all children,
    regardless of race, ethnicity, gender or disability, deserve a
    permanent and loving home. We can do better at providing these children
    with loving homes, better health care and education, and the basic
    right to food.
        Mr. Chairman, I look forward to hearing the testimony from
    Secretary Rice today and hope that she is ready to honestly and openly
    answer any questions this committee may ask.
        Thank you, Mr. Chairman.

        Senator Landrieu. Madam Secretary, be assured the people of
    Louisiana and Mississippi and the gulf coast understand the
    focus of yours and the administration on Iraq, Afghanistan, and
    other places in the world, where it's important to focus,
    because they are great challenges. But there was an incident
    that occurred in this country that was of international focus
    and importance over 18 months ago, and that was when two storms
    battered the gulf coast, which is America's energy coast, and
    the Federal levee system collapsed, flooding an area seven
    times the size of Manhattan, destroying 250,000 homes and
    20,000 businesses. Nothing like it has ever been seen in the
    United States outside of the Civil War.
        Last week, the Washington Post reported that the
    administration turned away nearly $1 billion in foreign aid.
    The State Department has acknowledged that mistakes were made
    in the handling of foreign donations due to the absence of an
    implementation plan for the management of such aid. To date, it
    is my understanding that no changes have been made to the
    International Cooperation Response Index or to the National
    Response Plan.
        In addition, no significant permanent changes have yet been
    made to the National Response Plan itself. One hundred and
    fifty-one nations, international organizations, and political
    entities offered assistance totaling $854 million, not
    including material in kind. Of the $854 million, $454 million
    was cash, $400 million was oil, which has yet to be sold for
    cash. To date, only $126.4 million has been received, numerous
    materials in kind were turned away, and $400 million in oil, as
    I said, was never accepted or sold, we don't know where those
    barrels of oil are.
        On September 5, for example, because I'm going to get to my
    question in a minute, an offer from Switzerland to send relief
    supplies was sent. The offer was not fully vetted by FEMA until
    September 14. With the delay in FEMA not being able to act
    quickly to unload and repackage the supplies, the Swiss
    Government canceled their entire shipment.
        Another example--and there are dozens; I will submit them
    for the record--a German company offered 3 million integrated
    satellite and cellular telephone systems, which is capable of
    handling 5,000 calls at once. With virtually every
    communication system collapsed in the Gulf of Mexico, where our
    own military was reduced to runners, the way we used to use
    them in wars of the past, we turned this communication
    equipment away until USNORTHCOM demanded that they be received.
        I want to, Mr. Chairman, get to my question, which is--in
    just one second. But, for the record, this was reported by the
    Washington Post, and it is upsetting that, in the first
    paragraph, a memo from Karen Hughes says, ``Echo chamber
    message,'' in quote. That is a public-relation term, as
    according to the Washington Post, for talking points designed
    to be repeated again and again. This was the directive,
    ``Assure the scores of countries that have pledged or donated
    aid that their aid was,'' quote, `practical help and moral
    support,' and highlight the concrete benefits hurricane victims
    are receiving.''
        Madam Secretary, the people that I represent were not able
    to take advantage of this aid, because there obviously is some
    major problems with how we receive aid for them when they're in
    their most desperate hours of need. I don't know what we have
    done to correct it.
        [The information follows:]

                 [The Washington Post, Sunday, April 29, 2007]

                           CORRECTION TO THIS ARTICLE

        An April 30 Page One article on foreign aid after Hurricane Katrina
    incorrectly said that a consortium led by the United Methodist
    Committee on Relief had provided social services to 45,000 individual
    disaster victims up to that point, less than half the 100,000 victims
    it promised to help. The group has provided services to 49,709
    families, not individuals, short of its goal of 100,000 families.
                 Most Katrina Aid From Overseas Went Unclaimed

      (By John Solomon and Spencer S. Hsu, Washington Post Staff Writers)

        As the winds and water of Hurricane Katrina were receding,
    presidential confidante Karen Hughes sent a cable from her State.
    Department office to U.S. ambassadors worldwide.
        Titled ``Echo-Chamber Message''--a public relations term for
    talking points designed to be repeated again and again--the Sept. 7,
    2005, directive was unmistakable: Assure the scores of countries that
    had pledged or donated aid at the height of the disaster that their
    largesse had provided Americans ``practical help and moral support''
    and ``highlight the concrete benefits hurricane victims are
    receiving.''
        Many of the U.S. diplomats who received the message, however, were
    beginning to witness a more embarrassing reality. They knew the U.S.
    Government was turning down many allies' offers of manpower, supplies
    and expertise worth untold millions of dollars. Eventually the United
    States also would fail to collect most of the unprecedented outpouring
    of international cash assistance for Katrina's victims.
        Allies offered $854 million in cash and in oil that was to be sold
    for cash. But only $40 million has been used so far for disaster
    victims or reconstruction, according to U.S. officials and contractors.
    Most of the aid went uncollected, including $400 million worth of oil.
    Some offers were withdrawn or redirected to private groups such as the
    Red Cross. The rest has been delayed by red tape and bureaucratic
    limits on how it can he spent.
        In addition, valuable supplies and services--such as cellphone
    systems, medicine and cruise ships--were delayed or declined because
    the government could not handle them. In some cases, supplies were
    wasted.
        The struggle to apply foreign aid in the aftermath of the
    hurricane, which has cost U.S. taxpayers more than $125 billion so far,
    is another reminder of the Federal Government's difficulty leading the
    recovery. Reports of Government waste and delays or denials of
    assistance have surfaced repeatedly since hurricanes Katrina and Rita
    struck in 2005.
        Administration officials acknowledged in February 2006 that they
    were ill prepared to coordinate and distribute foreign aid and that
    only about half the $126 million received had been put to use. Now, 20
    months after Katrina, newly released documents and interviews make
    clear the magnitude of the troubles.
        More than 10,000 pages of cables, telegraphs and e-mails from U.S.
    diplomats around the globe--released piecemeal since last fall under
    the Freedom of Information Act--provide a fuller account of problems
    that, at times, mystified generous allies and left U.S. representatives
    at a loss for an explanation. The documents were obtained by Citizens
    for Responsibility and Ethics in Washington, a public interest group,
    which provided them to The Washington Post.
        In one exchange, State Department officials anguished over whether
    to tell Italy that its shipments of medicine, gauze and other medical
    supplies spoiled in the elements for weeks after Katrina's landfall on
    Aug. 29, 2005, and were destroyed. ``Tell them we blew it,'' one
    disgusted official wrote. But she hedged: ``The flip side is just to
    dispose of it and not come clean. I could be persuaded.''
        In another instance, the Department of Homeland Security accepted
    an offer from Greece on Sept. 3, 2005, to dispatch two cruise ships
    that could be used free as hotels or hospitals for displaced residents.
    The deal was rescinded Sept. 15 after it became clear a ship would not
    arrive before Oct. 10. The U.S. eventually paid $249 million to use
    Carnival Cruise Lines vessels.
        And while television sets worldwide showed images of New Orleans
    residents begging to be rescued from rooftops as floodwaters rose, U.S.
    officials turned down countless offers of allied troops and search-and-
    rescue teams. The most common responses: ``sent letter of thanks'' and
    ``will keep offer on hand,'' the new documents show.
        Overall, the United States declined 54 of 77 recorded aid offers
    from three of its staunchest allies: Canada, Britain and Israel,
    according to a 40-page State Department table of the offers that had
    been received as of January 2006. ``There is a lack of accountability
    in where the money comes in and where it goes,'' said Melanie Sloan,
    executive director of the public interest group, which called for an
    investigation into the fate of foreign aid offers. She added: ``It's
    clear that they're trying to hide their ineptitude, incompetence and
    malfeasance.''
        In a statement, State Department spokesman Tom Casey said that the
    U.S. Government sincerely appreciated support from around the world and
    that Katrina had proved to be ``a unique event in many ways.''
        ``As we continue our planning for the future, we will draw on the
    lessons learned from this experience to ensure that we make the best
    use of any possible foreign assistance that might be offered,'' Casey
    said.
        Representatives of foreign countries declined to criticize the U.S.
    response to their aid offers, though some redirected their gifts.
        Of $454 million in cash that was pledged by more than 150 countries
    and foreign organizations, only $126 million from 40 donors was
    actually received. The biggest gifts were from the United Arab
    Emirates, $100 million; China and Bahrain, $5 million each; South
    Korea, $3.8 million; and Taiwan, $2 million.
        Bader Bin Saeed, spokesman for the Emirates Embassy in Washington,
    said that in future disasters, ``the UAE would not hesitate to help
    other countries, whether the United States or any other state, in
    humanitarian efforts.''
        Kuwait, which made the largest offer, pledged $100 million in cash
    and $400 million in oil. But the Kuwaitis eventually gave their money
    to two private groups: $25 million to the Bush-Clinton Katrina Fund, a
    project of the former presidents, and another $25 million to the
    American Red Cross in February 2006. They still plan to contribute
    another $50 million, said the Kuwaiti ambassador to the United States,
    Salem Abdullah al-Jaber al-Sabah.
        ``It was based on my government's assessment of the fastest way to
    get money to the people that needed it,'' he said. ``The Red Cross was
    on the ground and action-oriented.''
        In the White House's February 2006 Katrina report, U.S. officials
    said Kuwait's $400 million oil donation was to be sold for cash. Sabah
    said it was an in-kind pledge made when it appeared that U.S. refining
    capacity was devastated and that the American public would need fuel.
        ``We have to see what we have to do with that. When you pledge
    something in-kind, your intention is to give it in-kind. I do not think
    now the American people arc in need of $400 million of fuel and fuel
    products,'' he said.
        Of the $126 million in cash that has been received, most has not
    yet been used. More than $60 million was set aside in March 2006 to
    rebuild schools, colleges and universities, but so far, only $10.4
    million has been taken by schools.
        Half the $60 million was awarded last fall to 14 Louisiana and
    Mississippi colleges, but five have not started to claim the money.
    Only Dillard University in Louisiana and Mississippi Gulf Coast
    Community College have tapped their full awards, worth $6 million, U.S.
    Education Department officials said Friday.
        Another $30 million was sent to Orleans, St. Bernard and
    Plaquemines parishes in Louisiana and to the state-run Recovery School
    District in New Orleans to build libraries, laboratories and other
    facilities for 130 public schools.
        But none of that money has been used yet, said Meg Casper,
    spokeswoman for the Louisiana Department of Education. Allocations were
    just approved by the state board last week, she said, ``so the money
    should start to flow.''
        The first concrete program officials announced in October 2005--a
    $66 million contract to a consortium of 10 faith-based and charity
    groups to provide social services to displaced families--so far has
    assisted less than half the 100,000 victims it promised to help, the
    project director said.
        The group, led by the United Methodist Committee on Relief, has
    spent $30 million of the money it was given to aid about 45,000
    evacuees. Senate investigators are questioning some terms in the
    contract proposal, including a provision to pay consultants for 450
    days to train volunteers for the work the committee was paid to do.
        Jim Cox, the program director, said that the project is ``right on
    track'' but that its strategy of relying on volunteers foundered
    because of burnout and high turnover. He acknowledged that more people
    need help than are receiving it and said the program will be extended
    to March to use available funds.
        ``The resources aren't there, but these resources certainly are
    coming,'' Cox said.

        Senator Landrieu. But I also want to put in the record an
    e-mail that was received when the request was made for--an
    open-issue request. It reads, from, one, Kathleen Algaron, ``We
    need to come clean with the Italians, tell them we blew it, or
    deeply appreciate and regret handling of this, and let them
    know about the disposal. The flip side is just to dispose of it
    and not come clean. I'm willing to be persuaded either way.''
        [The information follows:]

                                Norman, Alain G

    From: Yu, Alan K.
    Sent: Wednesday, October 05, 2005 3:44 PM
    To: Volker, Kurt D; Allegrone, Kathleen H; Sterling, Adam H
        Cc: EUR-WE-Italy-DL; Cook, Nerissa J; Norman, Alain G; McCarthy,
    Deborah A; Harris, Michelle F.
    Subject: RE: Italian Meds for Katrina--Houston, we've got a problem . . .

        All--
        I spoke to a Washington FDA official. He thought our request was
    reasonable, but will need to check on what FDA personnel remain in
    Little Rock and ensure his higher-ups are okay (he didn't anticipate
    problems). He will tell me tomorrow.
        Who pays to dispose: he thought it would be FEMA--possession is
    nine-tenths . . . . We're not there yet, though; we need to get the FDA
    inspection above and then take it up with the Italians.
        Let me know when we plan to do this, so I can get my annual leave
    request in.
        Alan
                                     ______

    From: Volker, Kurt D
    Sent: Wednesday, October 05, 2005 2:45 PM
    To: Allegrone, Kathleen H; Sterling, Adam H
    Cc: Yu, Alan K; EUR-WE-Italy-DL
    Subject: RE: Italian Meds for Katrina--Houston, we've got a problem ...

        I think ``crisis situation, second hurricane, etc.'' sounds
    reasonable enough (barely) and definitely come clean, rather than try
    to conceal--never works.
                                     ______

    From: Allegrone, Kathleen H
    Sent: Wednesday, October 05, 2005 12:30 PM
    To: Volker, Kurt D; Sterling, Adam H
    Cc: Yu, Alan K; EUR-WE-Itaty-DL
    Subject: Italian Meds for Katrina--Houston, we've got a problem . . .
        Alan tells me that FDA officials believe the Italian meds are
    totally unusable--by others. They were exposed to the elements and
    heat; even the gauze etc wouldn't be worth it.
        Elan is going to go back to be sure someone really eye-balled the
    stuff. He's also going to check on disposal (and who pays--whatever . .
    .)
        Then, I think (and Elan agrees) that we need to come clean with the
    Italians; tell them we blew it; deeply appreciate and regret handling
    of this; and let them know about disposal.
        The flip side is just to dispose of it and not come clean. I'm
    willing to be persuaded, but . . .
        Thoughts?
    FW: Request to UK on MRE data
        I think asking the UK is insulting and will require that we fund
    travel for them to send a Vet to AK to review storage practices before
    they issue a certificate. If we have in house folks with training, I
    recommend that the DOS ask DOD for assistance. It is very likely that
    there is a vet with the required training at Little Rock AFB. . . .
        I left you a voice mail and an e-mail on the unclass side. I was
    out of office on Friday for a meeting at RAF Mildenhall.
        Call me and we can discuss further.
        Rob
                                     ______

    From: Donegan, James F (POL)
    Sent: Thursday, January 05, 2006 5:17 PM
    To: Letourneau, Robert M
    Subject: FW: Request to UK on MRE data
        Rob--can you look into getting a certificate per Bill's suggestion?
        Thanks
        Jim
                                     ______

    From: Meara, William R
    Sent: Wednesday, January 04, 2006 1:35 PM
    To: Donegan, James E (POL)
    Cc: Tokola, Mark A; Bonilla, Jean A; Clark, Sandra E
    Subject: RE: Request to UK on MRE data
        Jim:
        This thing keeps coming back at us, While this is an ECON issue,
    the desk seems bound and determined to talk only to POL about it.
    That's fine--I won't fight you about who covers the soon-to-be rancid
    UK MREs in Arkansas!
        A month or so ago the desk asked us to check to see if the Brits
    had any objection to us giving these MREs to third parties. MOD told
    ODC that they were washing their hands of the MREs, and didn't care
    what we did with them.
        If you do want to try to get the Brits to give us the kind of
    certificate that the desk is discussing, my suggestion would be to
    route the request through [Deleted] in ODC--he has been the Embassy's
    main point of contact with MOD on this issue.
        Another option might be to try to do this through the Embassy's
    Foreign Agricultural Service office. But I think this is really an MOD
    issue. . .
        Bill
                                     ______

    From: Donegan, James E (POL)
    Sent: Friday, December 30, 2005 3:24 PM
    To: Donegan, James E (POL.); Evans, Trevor J; Tokola, Mark A
    Cc: Johnson, David T; Meara, William R; Skinner, Charles B
    Subject: RE: Request to UK on MRE data
        Angela's request for a vet certificate comes out of an interagency
    meeting held yesterday in DC. Apparently the Georgian MOD has made a
    request for the MREs to distribute to their own troops. There has also
    been a similar request from the OSCE border monitors in Georgia. The
    feeling in the interagency was that a vet certificate would help move,
    even seal, these possibilities.
        Also in play but less likely is a request from two U.S. NGOs for
    the MREs to distribute to ``a basket of countries.'' Possible but less
    likely that the vet certificate would clinch the deal for this option.
                                     ______

    From: Donegan, James E (POL)
    Sent: Friday, December 30, 2005 8:22 AM
    To: Evans, Trevor J; Tokola, Mark A
    Cc: Johnson, David T
    Subject: FW: Request to UK on MRE data
        Know any Vets?
        PS I have asked Washington to research the veracity of a Sun report
    yesterday that these things are ``rotting'' in a warehouse somewhere in
    the States.
                                     ______

    From: Cervetti, Angela M
    Sent: Thursday, December 29, 2005 10:24 PM
    To: Donegan, James E (POL)
    Subject: FW: Request to UK on MRE data
        In Charles' absence . . .
                                     ______

    From: Cervetti, Angela M
    Sent: Thursday, December 29, 2005 5:19 PM
    To: Skinner, Charles B; Bonilla, Jean A
    Cc: O'Malley, Michael E; Nolan, Edwin R; Roy, Kenneth M
    Subject: FW: Request to UK on MRE data
        Jean, Charles,
        The MRE saga continues. Below is an e-mail from PGI asking us to
    ask post to approach the Brits for a veterinarian certificate stating
    that the meat products are fit for human consumption. Alan Yu from PGI
    seems to remember you already said that it would be very difficult and
    that the USDA should inspect the MREs and issue its own certificate.
    The problem is USDA said it does not inspect/certify non-American
    foods.
        There are some options that opened up for disposition but the
    general sense is that having papers from the Brits saying the meat
    won't poison anybody would help the process along.
        What are your thoughts?
        Angela

        Senator Landrieu. I want to know where the Department of
    State is in implementing the nine recommendations, and when
    final amendments have been made at International Cooperation
    Support Annex to the National Response Plan, if that's been
    done to date.
        Secretary Rice. We are in the process, Senator, of doing
    precisely that. I do want to note, though, that this was an
    unprecedented event. As you noted, it was an unprecedented
    event for the United States. It was also unprecedented for the
    United States to receive offers of help at the level that we
    received the offers of help. The State Department was the
    agency that took in the offers of help. We tried, then, to
    coordinate with FEMA and those on the front lines to understand
    what help could be used and what help could not be used.
        We accepted donations from 122 countries and organizations,
    $126 million in monetary donations. In fact, we ended up
    encouraging a lot of countries to give to private
    organizations, like the Clinton-Bush effort, because, frankly,
    it was difficult for us to use a lot of what was suggested.
        Senator Landrieu. I understand that, and my time is up. But
    I just want to, on the record, say that $1 billion,
    approximately, was offered; we've received $126 million. There
    was a lot of money left on the table. The people of the gulf
    coast deserve to have a better system. But, more than just the
    people of the gulf coast, this country deserves to have a
    better system in the event that this happens again.
        So, I want a specific answer, if you don't mind. When do
    you think these recommendations that have been made will be
    accepted, either presented to this committee or to the
    Congress, for adoption?
        Secretary Rice. Senator, I will get back to you with an
    update on where we are, by letter, in response to your
    question.
        But, if I may, I just want to note that, in fact, because
    it's important for our partners to know that a lot of their
    donations were used, and used well, for the people--$66 million
    to finance social service management for Katrina, $60 million
    to the Department of Education.
        Just one final point, if I may. Yes, we had to turn down
    some donations--medical equipment, a lot was in kind, for
    instance, for medical personnel who would not have been
    licensed in our country to practice; food, which didn't meet
    certain standards.
        Senator Landrieu. I understand that. Not to----
        Secretary Rice. So----
        Senator Landrieu [continuing]. Interrupt--Mr. Chairman, I
    don't mean to be disrespectful, but I have a list here that I
    would like to submit. It is not just food and diapers and
    bottles that were rejected, it was generators and communication
    systems, and, you know, medical supplies, and medical
    personnel.
        We still, just this week, have been able--now, this is not
    completely the Federal Government's fault--to finally get one
    mental-health bed in the New Orleans region. One.
        So, I suggest we have a major problem----
        Senator Leahy. Without objection, the----
        Senator Landrieu. I'm going to put this in the record. I
    thank the Chairman----
        Senator Leahy. Without objection, it will----
        Senator Landrieu [continuing]. For his----
        Senator Leahy [continuing]. Be included in the record.
        [The information follows:]

        Secretary Rice. Senator, I will get back to you with an
    answer----
        Senator Landrieu. Thank you.
        Secretary Rice [continuing]. To your question about the----
        Senator Landrieu. Thank you.
        Secretary Rice [continuing]. Various recommendations.
        [The information follows:]

                             United States Department of State,
                                         Washington, DC, July 16, 2007.
    Mary L. Landrieu, Chairman,
    Subcommittee on Disaster Recovery, Committee on Homeland Security and
            Governmental Affairs, United States Senate.
        Dear Madam Chairman: Per my June 28 letter to you, enclosed is
    additional information responding to the specific questions outlined in
    your June 14 letter. We expect to convey to you shortly information
    concerning the full set of assistance offers from the international
    community that you also requested in that letter. I hope you find this
    additional information useful.
                Sincerely,
                                            Jeffrey T. Bergner,
                               Assistant Secretary Legislative Affairs.

    Enclosure:

        Question. To the extent that the Department of State is designated
    as the lead agency responsible, what is the status of implementation of
    recommendations 89 through 97 of the White House report, ``The Federal
    Response to Hurricane Katrina: Lessons Learned?''
        Answer. Below are the nine recommendations from the Katrina Lessons
    Learned exercise and the status of each recommendation:
        Recommendation #89.--DOS should lead the revision of the
    International Coordination Support Annex (ICSA) to the National
    Response Plan (NRP), clarifying responsibilities of Department of State
    (DOS), Department of Homeland Security (DHS), Department of Defense
    (DOD), and other supporting agencies in response to domestic incidents.
    This revision should begin immediately.
        Status.--Completed. A State Department-led interagency group
    completed the first revision of the ICSA in February 2007 in
    consultation with the Homeland Security Council. The revisions clarify
    expanded roles and responsibilities of USG agencies in managing the
    international aspects of a domestic incident. The group also included
    representatives from the Departments of Homeland Security, Defense,
    Health and Human Services, Agriculture, and Transportation, and the
    Agency for International Development.
        Recommendation #90.--DOS and DHS should lead an interagency effort
    that will quickly develop procedures to review, accept or reject any
    offers of international assistance for a domestic catastrophic
    incident.
        Status.--Completed. An interagency group consisting of the
    Department of State, USAID/Office of Foreign Disaster Assistance (AID),
    DHS/FEMA, DOD, and the American Red Cross (ARC) has developed a system
    for managing international assistance during a domestic disaster. The
    system outlines policies and procedures to systematically manage offers
    of, or United States requests for, international material assistance
    during a United States domestic disaster. It also specifies the roles
    and responsibilities of participant agencies, provides standard
    operating procedures for managing offers of foreign assistance and
    domestic requests for foreign resources, and outlines the process for
    receiving and distributing international assistance that is accepted by
    the U.S. Government. The procedures and arrangements detailed in the
    manual were formally approved in 2007, but the core procedures were
    informally in place among participants by June 1, 2006.
        Recommendation #91.--DHS should lead an interagency effort to
    create and routinely update a prioritized list of anticipated disaster
    needs for foreign assistance and a list of items that cannot be
    accepted.
        Status.--Completed. The interagency has established procedures for
    coordinating with USG regulatory agencies for the entry, handling, and
    use of foreign resources during a disaster. Regulatory agencies provide
    technical advice and review offers of international assistance prior to
    FEMA acceptance. The procedures include guidance on acceptable and
    unacceptable items to assist the Department of State in communicating
    with the international community.
        Recommendation #92.--DOS should establish an interagency process
    to: determine appropriate uses of international cash donations; to
    ensure timely use of these funds in a transparent and accountable
    manner; to meet internal Federal government accounting requirements;
    and to communicate to donors how their funds were used.
        Status.--Completed. Procedures have been established to manage the
    receipt, distribution, and use of foreign cash donations made during a
    domestic disaster. FEMA has pre-identified response needs likely to
    arise soon after a domestic disaster for which cash donations could be
    quickly utilized, with the understanding that certain donations may be
    directed to longer term disaster recovery projects. An interagency
    Working Group will be convened as necessary to address fund management
    issues and make recommendations on funding longer term disaster
    recovery projects.
        Recommendation #93.--Public and Diplomatic Communications during
    domestic emergencies should both encourage cash donations--preferably
    to recognized nonprofit voluntary organizations with relevant
    experience--and emphasize that donations of equipment or personnel
    should address disaster needs.
        Status.--Completed. As was done during Katrina, the State
    Department provides instructions to all U.S. diplomatic missions abroad
    advising them to encourage foreign entities wishing to assist to make
    cash donations directly to appropriate NGOs rather than the USG.
        Recommendation #94.--The Department of State and the Department of
    Homeland Security should jointly develop procedures to ensure that the
    needs of foreign missions are included in domestic plans for tracking
    inquiries regarding persons who are unaccounted for in a disaster zone.
        Status.--Completed. The Department of State has worked with DHS/
    FEMA and the ARC to ensure that, during a domestic disaster, the USG
    honors its international obligations under the Vienna Convention on
    Consular Relations. Although the USG is not required to track down and
    find missing foreign nationals during a disaster in the United States,
    under the Convention it is obligated to assist foreign missions in
    obtaining ``appropriate consular access'' to their nationals.
        The Department of State's Office of Public Affairs has designated
    personnel to work with DHS/FEMA during domestic emergencies. These
    personnel will be part of FEMA's information operation from the outset
    of a major domestic crisis, in order to ensure efficient handling of
    queries from and consistent messaging to foreign missions and foreign
    media.
        The Department of State's Office of Foreign Missions and the ARC
    provided briefings for foreign missions in Washington, DC on how
    foreign missions can best utilize the ARC's missing persons' registry
    to locate missing foreign nationals in the United States.
        Recommendation #95.--DHS and DOS should revise the NRP to include
    DOD and Department of Agriculture (USDA)-Food Safety Inspection Service
    as cooperating agencies to the International Coordination Support
    Annex. Including DOD more directly in foreign assistance management
    would leverage existing relationships with partner military
    establishments and help to ensure that staging areas for the acceptance
    of foreign aid are preplanned and quickly available.
        Status.--Completed. The revised ICS Annex to the NRP includes both
    DOD and USDA as cooperating agencies. Within the system developed for
    managing international assistance during a domestic disaster,
    regulatory agencies such as the USDA provide technical advice and
    review offers of international assistance prior to FEMA acceptance.
        Recommendation #96.--DHS should include DOS and foreign assistance
    management in domestic interagency training and exercise events.
    Inclusion in the new National Exercise Program (NEP) should occur
    before the end of fiscal year 2006.
        Status.--We refer you to DHS regarding its training and exercise
    events. We understand DHS is developing an international assistance
    training module for use in future exercises. DHS can provide more
    detailed information.
        Recommendation #97.--DHS should provide daily disaster response
    situational updates through the Secretary of State to all Chiefs of
    Mission or Charges d'Affaires. These updates should improve situational
    awareness and provide information to address host government concerns
    or questions.
        Status.--DHS has assured State it will provide appropriate updates
    to inform U.S. Missions overseas and, by extension, foreign
    governments.
        Question. If any recommendations were not implemented by the
    deadlines identified in the report, why were they not?
        Answer. Those recommendations involving other agencies and
    departments required extensive interagency coordination. We placed a
    premium on ensuring that our improvements in response to the
    modifications were developed in concert with other agencies.
    Additionally, fulfilling the recommendations linked to revision of the
    National Response Plan hinged on a timetable established by the
    Homeland Security Council.
        However, it is important to distinguish between the practical
    elements of the recommendations and the final, formal conclusion of
    each. Many of the professionals charged with fulfilling the
    recommendations had first-hand experience with the ad hoc arrangements
    employed in responding to Katrina. By the beginning of the 2006
    hurricane season, all of the major elements of the recommendations--
    especially those suggesting improvements to assistance management--had
    been agreed informally and would have been employed had circumstances
    required.
        Question. What additional resources are needed to complete
    implementation of any as-of-yet unaddressed recommendations?
        Answer. All of the recommendations in the Federal Katrina Lessons
    Learned report have been addressed at this time.
        Question Specifically, when do you expect an amendment to the
    International Coordination Support Annex to the National Response Plan
    be complete and amended? What else must be addressed to satisfy that
    goal?
        Answer. An interagency group completed the first revision of the
    International Coordination and Support Annex in February 2007 and
    provided the revision to the Homeland Security Council. The
    International Coordination Support Annex, along with all other revised
    annexes, will be released for general comment in the near future. The
    revisions clarify expanded roles and responsibilities of USG agencies
    in managing the international aspects of a domestic incident.
        The group included representatives from the Departments of State,
    Homeland Security, Defense, Health and Human Services, Agriculture, and
    Transportation, and the Agency for International Development. Within
    the Department of State, we continue to ensure that relevant bureaus
    are familiar with the changes to the National Response Plan. However,
    the current NRP is in effect if an incident of national significance
    occurs prior to the NRP being finalized and formally approved by the
    Administration and NRP signatories.
        DHS is finalizing revisions to the entire National Response Plan
    and then the document will be circulated to the interagency community
    for comment prior to release to the general public for comment.
        Question. Of foreign assistance accepted following Hurricanes
    Katrina and Rita, how much has actually been distributed and used to
    date?
        Answer. The United States Government received $126 million of
    donations directly from foreign governments, political entities and
    individuals. All of these funds have been allocated.
        On October 20, 2005, the State Department transferred $66 million
    to FEMA. FEMA subsequently awarded a $66 million grant to the United
    Methodist Committee of Relief (UMCOR). UMCOR established Katrina Aid
    Today (KAT), a consortium of nine nongovernmental organizations, to
    provide case management services to individuals and families affected
    by Hurricane Katrina. This program filled a gap in the services
    available to victims under federally- or state-funded programs. FEMA
    has advised the Department that KAT has utilized $33 million of the
    funds to help over 149,000 people determine their specific needs and
    identify resources to help them overcome this tragedy. KAT has
    indicated to FEMA that it expects to provide similar services to
    additional people by March 2008 with the remaining funds available
    under this grant.
        On date March 17, 2006, the State Department transferred $60
    million to the Department of Education for subsequent donation to
    institutions of higher education and K-12 schools. The Department of
    Education has advised the State Department that it allocated these
    funds as follows:
        DoEd distributed $5 million to the Greater New Orleans Educational
    Foundation for the planning and implementation of a long range strategy
    for K-12 educational services.
        DoEd awarded grants totaling $30 million available to 14 Higher
    Education institutions in Louisiana and Mississippi. These institutions
    have been able to draw on those funds according to their own
    reconstruction timetables. We understand that as of April 27, 2007,
    some institutions had utilized their entire grants; others were still
    drawing on the available funds as they proceed with their
    rehabilitation plans.
        DoEd asked the Louisiana DoEd to develop a program to award grants
    totaling $25 million. On April 19, 2007, the Louisiana Board of
    Education approved grants of $190,000 each to 130 private and public
    schools. The current award period for use of these funds runs until
    November 30, 2007. Funds would be available on a year to year basis
    until all funds have been expended.
        The United States Government received over 5 million pounds in
    material contributions and relief supplies from 50 foreign governments
    and international organizations. The vast bulk of these supplies was
    transferred to FEMA upon arrival and was utilized for disaster relief.
    FEMA indicates that by April 4, 2006 all material donations were put
    into FEMA pipelines to determine disposition of resource based on
    disaster needs. Foreign governments also donated the use of highly
    specialized equipment, notably high-volume, high-pressure pumps and the
    services of personnel expert in their use. These services were utilized
    for up to 6 weeks after the storm's landfall.
        Question. As we understand the Department's Katrina task force has
    been disbanded, what process exists today to accommodate offers from
    foreign governments seeking to assist the ongoing recovery and
    rebuilding efforts along the Gulf Coast?
        Answer. The Department's crisis management system has functioned
    very well over the years; we have used it to manage an average of 13
    crises every year. This system was used to coordinate the evacuation of
    almost 15,000 American citizens from Lebanon in the midst of active
    hostilities, the largest evacuation of American citizens via primarily
    commercial assets in 60 years.
        The Department utilized this ``Task Force'' approach to support the
    Department of Homeland Security and FEMA during the immediate response
    to Hurricane Katrina. Once the immediate, acute phase of the crisis
    passed, the Department disbanded the Katrina task force. However, a
    core group of professionals with relevant expertise and with experience
    during the crisis, working under the overall direction of the
    Department's Executive Secretary, continued to address a wide range of
    Katrina-related issues, including managing ongoing operational
    coordination with FEMA and contributing to internal and USG-wide
    lessons learned' exercises.
        Should foreign governments wish to provide additional resources to
    assist .Katrina's victims directly to the U.S. Government, the
    Executive Secretary would ensure that appropriate experts at DHS and
    FEMA are engaged to ensure the foreign government's offer is promptly
    evaluated and responded to. As during the acute phase of the crisis,
    the Department would not itself evaluate the merits of a specific
    offer, but would instead assist the relevant experts at DHS and FEMA in
    soliciting sufficient information regarding the foreign government's
    offer to permit an informed decision by DHS and FEMA on whether to
    accept or decline the offer.
        Question. What additional steps is the Department of State pursuing
    to better manage foreign assistance following a domestic disaster, what
    is the status of implementing these actions and what additional
    resources are needed to complete this effort?
        Answer. The Department, together with partners at DHS/FEMA, AID,
    the Department of Defense and other Federal Departments, has developed
    detailed procedures to manage the solicitation, receipt, distribution,
    and use of foreign cash and in-kind donations prompted by a domestic
    disaster. These procedures have been agreed by all parties, are in
    place and would be used should a subsequent domestic disaster prompt
    offers of assistance from our international friends and allies.
        With respect to cash donations, FEMA has pre-identified response
    needs likely to arise soon after a domestic disaster for which cash
    donations could be quickly utilized, with the understanding that
    certain donations may be directed to longer term disaster recovery
    projects. An interagency Working Group would be convened as necessary
    to address fund management issues and make recommendations on funding
    longer term disaster recovery projects.
        The in-kind donation management system includes detailed procedures
    for coordinating with USG regulatory agencies for the entry, handling,
    and use of foreign resources during a disaster. Regulatory agencies
    provide technical advice and review offers of international assistance
    prior to FEMA acceptance. The procedures include guidance on acceptable
    and unacceptable items to assist the Department of State in
    communicating with the international community,
        Q#8: The U.S. Agency for International Development (USAID) has
    effectively managed the direction of billions of dollars in U.S.
    assistance to victims of and responders to international disasters such
    as the South Asia Tsunami and Central Asia Earthquakes. How is USAID's
    experience being applied to better manage aid following disasters here
    at home? What barriers exist to better leveraging USAID's knowledge and
    resources in this way, and what would be needed to more effectively
    draw on this expertise and infrastructure?
        Answer. USAID's role in domestic response operations is described
    in the National Response Plan (NRP), to which USAID is a signatory. The
    role described in the NRP relates to vetting, processing, and managing
    logistics for offers of foreign assistance.
        The USAID role described in the NRP is based on USAID's expertise
    in disaster logistics and its experience with, and contacts in, the
    international disaster response community. However, USAID does have
    other expertise which may be called upon for domestic response
    operations. Such skills include camp management, response planning,
    technical issues, economic recovery, reconstruction, and education. In
    addition, USAID stockpiles disaster commodities in the U.S. and around
    the world. This expertise and these commodities are available to FEMA
    for domestic operations.
        Due to the ongoing, close working relationship between FEMA and
    USAID's Office of Foreign Disaster Assistance (OFDA), FEMA is aware of
    these capacities at USAID. During Hurricane Katrina, in fact, some of
    these capacities were requested by FEMA--commodities, planners,
    translators, logisticians. In addition, FEMA has requested that USAID/
    OFDA work with them in advance to establish agreements by which such
    assistance may be quickly requested and provided during a disaster--
    this process is currently underway.
        USAID funding authorities prevent the Agency from expending
    resources for domestic activities. The International Disaster and
    Famine Account (IDFA) is legislated to fund only international
    disasters and famine. Nonetheless, during a domestic response
    operation, this funding issue is addressed through a FEMA Mission
    Assignment (MA) to USAID. The FEMA MA provides a funding source for
    USAID to carry out domestic operations under FEMA's legal authority.
    However, there is a significant barrier related to USAID preparations
    for domesticoperations. FEMA generally cannot provide an MA to USAID in
    the absence of an active disaster response operation. The result is
    that USAID cannot dedicate staff time or resources to preparing for its
    role in domestic response operations. For obvious reasons, preparation
    and training is critical to USAID's ability to respond to a disaster.
    This constraint is a serious one. USAID has not yet determined how to
    address this problem.
        Question. What other internal investigations, if any, have been
    conducted by the Department of State into its handling of foreign
    assistance following the 2005 hurricanes, and what is the status of
    those reviews?
        Answer. Hurricane Katrina was an unprecedented disaster that
    presented unique challenges to domestic agencies and foreign
    governments trying to assist. The State Department, working with other
    agencies, responded to foreign offers of assistance as quickly and
    flexibly as circumstances permitted.
        The State Department has participated in extensive interagency
    lessons learned reviews and exercises that addressed problems
    identified during Hurricane Katrina. As a result, the U.S. Government
    has developed significantly improved policies, procedures, and plans
    for managing international assistance for future domestic disasters.
        The Homeland Security Council (MSC) led an after action review of
    the U.S. Government response to Katrina, including how we handled
    offers of assistance from foreign governments. The HSC and key
    agencies, including the State Department, reviewed the response, both
    what went well and what we can do better, and updated the National
    Response Plan to guide agency actions if another major disaster were to
    strike the United States. The State Department, USAID, FEMA, the
    Defense Department and others contributed to the update.
        The Department also cooperated fully with the Government
    Accountability Office when it reviewed the handling of foreign
    assistance in response to Hurricane Katrina (GAO-06-460, April 2006).
    In its report, the GAO recognized that ``although DOS's procedures were
    ad hoc, they did ensure the proper recording of international cash
    donations that have been received to date, and [GAO was] able to
    reconcile the funds received with those held in the designated DOS
    account at Treasury.''
        The Executive Secretariat's Operations Center conducted a lessons
    learned exercise shortly after the acute phase of the Katrina crisis,
    as it does after every major crisis, to assess the Department's
    performance and to incorporate adjustments and refinements to
    procedures in order to improve our response to subsequent crises. The
    results of this exercise informed the subsequent, broader USG
    assessment and ensured the Department was better prepared to respond to
        similar situations, as early as the 2006 hurricane season, even
    before a formal set of agreed procedures were finalized through the
    interagency process.
        Question. What was communicated to foreign governments regarding
    assistance that went unused, or offers of assistance that were not
    accepted?
        Answer. For every offer of assistance, the Department, on behalf of
    the U.S. Government, accepted, politely declined the assistance, or
    referred the party offering to an alternative recipient (i.e., American
    Red Cross).
        The Department conveyed this information to the offering
    governments as soon as its partners at FEMA had evaluated the offer of
    assistance and determined whether or not it would address an unmet need
    before similar commodities or services could be identified and sourced
    within the United States.

                             United States Department of State,
                                         Washington, DC, June 28, 2007.
    Hon. Mary L. Landrieu, Chairman,
    Subcommittee on Disaster Recovery, Committee on Homeland Security and
            Governmental Affairs, United States Senate.
        Dear Madam Chairman: Thank you for your letter of June 14
    concerning the State Department's performance in responding to
    Hurricane Katrina. I welcome the opportunity to provide additional
    information and to correct some of the persistent inaccuracies reported
    in the media concerning the receipt of foreign assistance following
    Hurricane Katrina.
        Hurricane Katrina presented an unprecedented challenge; the
    Department's efforts in response also were unprecedented. Over 500
    Department employees voltuiteered to help coordinate the outpouring of
    support and assistance from our friends and allies around the world.
    Many of them deployed into the region to work on the ground in the
    relief effort, including a group of Vietnamese speakers who worked
    closely with ethnic Vietnamese residents along the Gulf Coast. These
    volunteers were motivated by a rare opportunity to help their fellow
    citizens here in the United States, just as they and their colleagues
    help American citizens every day overseas.
        Your letter asked whether the Department is better prepared now to
    execute its responsibilities in responding to domestic emergencies. The
    answer is, unequivocally, yes. The State Department learned valuable
    lessons regarding how best to manage and integrate international
    assistance offers into the federal response to a domestic emergency.
    Working with other parts of the federal government, we have
    incorporated those lessons into our planning and have developed and
    implemented detailed procedures to manage international offers of
    financial and material assistance. The basic elements of these systems
    were in place for the 2006 hurricane season; the final, detailed
    versions are now in place for the 2007 season.
        As noted in our June 19 reply to your questions for the record
    following Secretary Rice's appropriations testimony, the State
    Department completed revisions to the International Support Annex of
    the National Response Plan in February 2007, The revised annex will be
    incorporated in the global revision of the National Response Plan
    currently in progress.
        I also would like to take this opportunity to clarify inaccuracies
    in the public accounts of the Department's performance to which your
    letter refers.
        First, the Department from the outset encouraged foreign
    governments and individuals to assist victims in the most efficient,
    effective way possible: through financial contributions to
    nongovernmental organizations expert in disaster response and recovery.
    An informal tally (we cannot require foreign governments to report
    donations to U.S. NGOs) indicates approximately $220 million in
    donations initially pledged to the USG was provided directly to the Red
    Cross, Bush-Clinton Katrina Fund and other NGOs.
        Some governments wish to contribute directly to the United States
    government, and from those governments we received a total of $126
    million. As the Secretary said in her testimony, these funds have been
    allocated (via FEMA and the Department of Education) to nongovernmental
    organizations, institutions of higher education and, via the Louisiana
    Department of Education, to 130 K-12 schools. The funds are being used
    to rebuild or restock laboratories and libraries, improve school
    physical plants and help over 148,000 individuals deterniine their
    needs and plan for their futures as they continue to recover from this
    tragedy.
        A second inaccuracy is that the U.S. Government rejected or ignored
    substantial quantities of materiel and other in-kind assistance offered
    by foreign governments. The State Department's main objective
    throughout the Katrina crisis was to act as the intermediary for
    foreign offers of assistance to the U.S. Government, so that the
    Department of Homeland Security and other federal agencies could best
    help the victims of Hurricane Katrina. With respect to material
    assistance, that meant efficiently conveying all offers to departments
    and agencies charged with responding to the hurricane and coordinating
    the U.S. Government's response to offers of foreign assistance made by
    foreign governments. All offers were conveyed promptly to the Federal
    Emergency Management Agency, which, working with USAID's Office of
    Foreign Disaster Assistance, then decided which commodities could he
    utilized quickly and efficiently.
        Public accounts of the Department's performance imply that all the
    foreign assistance offered was actually needed or could be used. In
    fact, seasoned disaster logisticians evaluated the commodities and
    services offered, and accepted only those that made sense given all of
    the normal considerations during a disaster--cost and time of
    transport, storage, processing and other factors. Moreover, much of
    what was offered, including foodstuffs, medical supplies and services
    of expert personnel, could not be accepted due to federal or state
    health, safety and licensing standards. Some of the equipment, notably
    generators, was not compatible with U.S. systems.
        More detailed responses to the additional specific questions and
    requests included in your letter will be provided in the next week. I
    hope you find this information useful.
                Sincerely,
                                            Jeffrey T. Bergner,
                               Assistant Secretary Legislative Affairs.

        Senator Leahy. Thank you, Senator Landrieu, Secretary Rice.
        Senator Bennett.
        Senator Bennett. Thank you very much, Mr. Chairman.
        Madam Secretary, as you know, I go to Europe quite often,
    and was there just a few weeks ago, participating in the
    Brussels Forum of the German Marshall Fund. It's an interesting
    thing to go back to Europe from time to time, as I'm sure you
    know. Last year, when I was there, they said to me, ``The war
    over the war is over. We don't want to talk about Iraq, we want
    to talk about Russia.'' The Russians had cut off the gas supply
    to Ukraine, and were making similar kinds of statements about
    Georgia, and the Europeans, at least the ones with whom I
    spoke, were very nervous.
        This year, I had a briefing with Secretary--or with
    Ambassador Boyden Gray and Tori Newland and Sam Fox, and they
    all talked about Russia and the concern that is there with
    respect to the turn that President Putin may be taking, a turn
    away from the kind of cooperation and admiration that was there
    fairly early in President Putin's administration and President
    Bush's administration. Can you give us a sense of where the
    Russian relationship is?
        Secretary Rice. Thank you, Senator, I can.
        As with any relationship, it's complicated, any big
    relationship. I would say, on some major strategic global
    issues, we are cooperating pretty well--on North Korea; we've
    had good cooperation on Iran, it's why we have the two Security
    Council resolutions. The President and President Putin have
    done work on global nuclear terrorism. We've done work on
    trying to--we're doing work on trying to modernize the Non-
    Proliferation Treaty, to include, for instance, fuel assurances
    for countries that don't do what Iran is doing, in enriching
    and reprocessing. So, on many things, we're--we've done very
    well.
        But the fact is that on some others it's been a difficult
    period. The Russians, I think, do not accept fully that our
    relations with countries that are their neighbors, that were
    once a part of the Soviet Union, are quite honestly simply good
    relations between independent states and the United States,
    that we've tried to convince the Russians that the emergence of
    democracies on their borders, whether it's Georgia or Ukraine,
    would not be a problem, and that of course we're going to have
    good and sound relations with those countries, and we're going
    to continue to.
        It's even more difficult when one looks at what is
    happening domestically in Russia, where I think it's fair to
    say that there has been a turning back from some of the reforms
    that led to the decentralization of power out to the Kremlin, a
    strong legislature, strong free press, a--an independent
    judiciary. I think everybody around the world, in Europe, in
    the United States, is very concerned about the internal course
    that Russia has taken in recent years.
        That said, we continue to have that discussion. One of the
    advantages of President Bush's very good personal relationship
    with President Putin is he can raise those issues, and we can
    talk about them. We very much hope that there will be free--
    truly free and fair elections as Russia moves forward with
    presidential and parliamentary elections next year. But it is
    the concentration of power in the Kremlin that has been
    troubling.
        Finally, we have been pressing, along with Europeans and
    others, that there be no sense that Russia uses its great
    natural resources as a political weapon rather than in
    commercial--a commercial way. So, the--it's a complicated
    situation, but I would say, on a number of issues, we've worked
    together very well; and it's a big and important power, and
    we'll continue to try to work with the Russians.
        Senator Bennett. Thank you. As you know, I've always been a
    strong supporter of microenterprise, microcredit. I simply
    can't let your appearance here pass without mentioning it one
    more time and just keeping it on the radar screen. I'm happy
    that the State Department, during the time that I've been on
    this subcommittee, has significantly increased microcredit
    every year, which means I can take credit for it.
        Secretary Rice. Absolutely.
        Senator Bennett. As long as it happened on my watch, I did
    it. Whether I had anything to do with it, in fact, or not,
    doesn't make any difference----
        Secretary Rice. Of course you did----
        Senator Bennett [continuing]. When you're on the campaign--
    --
        Secretary Rice [continuing]. Senator.
        Senator Bennett [continuing]. Trail.
        Now, moving to another issue, let's talk about China. As I
    look at China, I think they have tremendous internal problems
    and long-term challenges, demographic challenges of nature, the
    likes of which no other country has. Maybe India. But in the
    short term, they are committed to short-term economic growth.
    If you worry about American CEOs concentrating on next
    quarter's numbers, you--they don't hold a candle to the
    Chinese.
        We're expanding our consular activities in China. We're
    doing what we can to increase the Embassy in China. Give me a--
    give us an overview of where you think things are going with
    the Chinese.
        Secretary Rice. Well, I would start by saying what I said
    about Russia, also a very complex relationship. With these big
    countries, there tend to be good things and bad things, puts
    and takes. Again, on some of the global issues, we're doing
    very well. We are--with the Chinese, I think the way we've
    worked, now, on North Korea is very effective and quite
    remarkable, given China's history with North Korea. Similarly,
    we are, again, working well together in the United Nations on
    Iran. I wish that we could have a somewhat stronger Chinese
    role on Sudan.
        I think that that would be very helpful, and we've
    encouraged the Chinese to be much more active with the Sudanese
    to get them to accept the U.N. forces. That's one of the most
    important things that they can do. They say they will. There's
    some evidence of that. But that's very important.
        I think when you look at the total picture, though, you
    recognize that this is a country in the midst of a huge and
    major transition. Our goal has to be to help make that
    transition one that ultimately makes China a more stabilizing
    force in international politics than a destabilizing force. On
    the positive side of that, the integration of China into the
    international economic system, I think, will help, although
    we've had to hold China accountable for some of its WTO
    responsibilities that we think it, frankly, hasn't fully met;
    for instance, the efforts of--on intellectual property-right
    protection, which I find perhaps one of the most important
    things we can do is get countries to protect property rights.
        Similarly, on the currency issue, Secretary Paulson has
    worked very hard on that issue. So, China has to do things to
    show that this huge economy is not going to operate outside of
    the rules of the international economy. We spend a good deal of
    time on that.
        On human rights and religious freedom, there is certainly a
    lot of work to do. We've been concerned about the direction of,
    particularly, religious freedom. This is something that we
    bring up with our colleagues.
        Finally, I would just note that when it comes to the issues
    related to Chinese security, we--Secretary Gates and others--
    have spoken to our concerns about transparency in Chinese
    military activities, because there is a rather outsized buildup
    of Chinese military activity.
        All of that said, it's our responsibility to try to make
    China--as Bob Zoellick once said, when he was Deputy
    Secretary--a stakeholder, a responsible stakeholder, in
    international affairs, because China is going to be
    influential. There's no doubt about that. Our policies have to
    be aimed at making it a--an influential power in a positive
    sense, not in a negative one.
        Senator Bennett. Thank you.
        Senator Leahy. Thank you, Senator Bennett. I do appreciate
    the Senator from Utah taking credit on the microcredit idea.
    Whenever I travel, I say it was a tall, bald Senator with
    glasses.
        Then I let people decide which of the two of us I'm talking
    about.
        Senator Alexander?
        Senator Alexander. Thank you, Mr. Chairman.
        Madam Secretary, welcome.
        My late friend Alex Haley used to say, ``Find the good and
    praise it.'' I have an--I'd like to do that, in one case here,
    in terms of the State Department. My staff in Tennessee has
    reported to me that the State Department has handled the new
    passport requirements very well, along with the increase in
    passport applications, and they sent me a number of examples,
    which--I won't read them all, but, for example--I will take one
    or two--on April 17, Kathy Smith, of Kingsport, contacted us
    about assistance with a passport. She was terminally ill and
    needed to go overseas for treatment. Her passport was pulled
    out of a stack of 32,000, and was FedEx'd to her within a few
    days.
        On April 19, Linda Hayes contacted our office. She's from
    Nashville. She had a plane ticket for a week later, to go see a
    brother who had a stroke, who couldn't be moved. Within 3 days,
    she had her passport.
        Our caseworkers say that in dealing with the passport
    office, even with the new requirements, it's always, ``Let's
    see how we could help.'' They especially pointed out the fact
    that, after Katrina, since we, in Tennessee, deal the New
    Orleans passport office, that instead of complaining about
    their circumstances down there, that they really--said they
    really didn't hear a word about that, that they found ways to
    deal with the problems, even though they had to move out and go
    to other offices and do different things.
        So, I just wanted to say that to you, and hope that you
    would pass it on to your passport office, and let them know we
    appreciate that very much.
        Secretary Rice. Thank you very much, Senator. I will pass
    it on. They'll greatly appreciate it. They've worked very hard,
    and I'm very proud of the job they've done.
        Senator Alexander. I also wanted to ask you a question and
    make a comment about the Iraq Study Group report, the work that
    former Secretary Baker and Lee Hamilton did recently. The
    President's talked about it recently in favorable terms. Just
    the other day, I noticed he had some nice things to say about
    the work of the report. As I look at the work we do here, it
    seems ironic that we, the oldest democracy, are busy lecturing
    Baghdad about--an infant democracy--about coming up with a
    political solution to what we do in Iraq, when we can't come up
    with one here, and that we ought to work a little harder to try
    to find a way to say to our troops and to the Middle East and
    to the world that we're united in the United States in our
    mission in Iraq, and we ought to work harder to find out what
    that might be.
        I've noticed that since the Iraq Study Group report was
    announced, in December, that both the administration and the
    Democratic majority seem to be using more and more elements of
    it in their different positions. For example, the
    administration has acted on recommendations by increasing the
    number of troops embedded with Iraqi forces. It's used
    milestones to help chart progress. It's even begun meeting with
    neighbors, even in meetings that might include Iran and Syria.
    The President's National Security Advisor has cited the fact
    that the Iraq Study Group said, on page 73, that a surge could
    be a part of a strategy, based upon that Iraq Study Group. On
    the other side, the Democratic Members of Congress have used
    milestones, they've limited the role of the United States in
    some of their proposals to training, equipping, and
    counterterrorism, they've used as their deadline the goal, not
    the deadline, that the Iraq Study Group mentioned, which was
    the early part of March.
        So, I wanted to let you know that later today Senator
    Salazar, of Colorado, and I are going to introduce a piece of
    legislation that would encourage the President to develop a
    plan based upon the recommendations of the Iraq Study Group.
    We're not going to introduce it today, we're going to wait
    until after--after the Congress has dealt with the current Iraq
    funding discussions.
        We know this is not the only plan that one could come up
    with about how we go forward in Iraq, but my purpose in
    bringing it up to you is to say to you, a little bit in
    advance, that we hope, at least from my point of view, that
    this is considered as a friendly gesture, as an option that the
    President could still consider, to embrace it, and that the
    advantage of it is that it doesn't come from the President, it
    comes from outside the President, and that it's not a sign of
    presidential weakness to say, ``Here's a good idea that seems
    to have bipartisan support. I accept it. I based my plan upon
    it. I ask you to accept it.'' The reason I like that is because
    I believe we have a long-term interest in Iraq, and I'm afraid
    that, if we don't get broader support for the President's
    strategy, that we won't be able to see that all the way through
    to the end.
        So, I hope that you and the President and others in the
    White House will consider what Senator Salazar and I are
    offering today as an option for the President. It won't be
    acted on in the next week or 2 or 3 or 4. Perhaps the President
    could embrace it, and there might be
        Democrats and Republicans in the Senate that could come
    behind it, support it, and provide the kind of bipartisan
    consensus that, so far, has seemed to elude us.
        Secretary Rice. Thank you very much, Senator.
        Senator Alexander. Thank you.
        Senator Leahy. Thank you.
        Senator Bond.

                    STATEMENT OF SENATOR CHRISTOPHER S. BOND

        Senator Bond. Thank you very much, Mr. Chairman.
        I'm pleased to welcome the Secretary today, here. I was
    pleased to learn that the State Department has been designated
    a national security agency, and the importance of our
    diplomatic efforts in the war on terror, which, make no
    mistake, is an existential threat to our peace and security
    here. I--while I strongly support our military efforts, I
    believe that the diplomatic efforts of the State Department are
    a critical element in trying to protect us from the war. I
    would just comment, as a member of the Senate Intelligence
    Committee, which studied extensively--solid 2 years--on the
    prewar intelligence of Iraq, I want to congratulate you and
    other members of the administration--you, in a previous
    position--who used intelligence that may not have been totally
    accurate, but we found was truthfully reported both by the
    officials in the administration and those of us in Congress who
    overwhelmingly supported our efforts. We know, according to
    David Kay's report, that--from the Iraqi Survey Group--that
    Iraq was a far more dangerous place even than we knew.
        But I want to change and ask you about another area that we
    had the opportunity to discuss a couple of weeks ago, and
    that's southeast Asia. You have recognized, as I think any
    student does, of that area, that this is a critical area,
    sometimes called the second front in the war on terror, but of
    great strategic importance, and Indonesia is the keystone.
        We appreciate the support for Indonesia. I am concerned
    about the $50 million cut in the rest of the East Asia Pacific,
    and I'm going to ask this committee to restore that. also, I
    would ask you why we have not been able to create a U.S.
    Ambassador to ASEAN, reflecting our interest and our commitment
    to that area. This is critical. Your visits there are vital,
    but appointing a full-time Ambassador seems to me to make great
    sense. Could you comment on that?
        Secretary Rice. Well, thank you very much.
        First of all, on the region, I agree with you completely
    about the importance of the region. The President was, of
    course, there. I will be there in the Philippines for the
    meetings of the Asian Regional Forum in the summer. We have
    meet, several times, at both the ministerial and at the head-
    of-state level, with the ASEAN countries. We're very actively
    engaged there, and--English-language training--and I've got New
    America's Corners--American Corners going into various places.
    Obviously it's a critical place in the war on terror. It's also
    a critical place because a place like Indonesia, which is a
    multiethnic, multireligious emerging democracy, can be a very
    important force for tolerance in the world. So, I could not
    agree with you more about the issues.
        It's a very interesting point, about somebody for ASEAN,
    and we'll take it under advisement, Senator. We've just
    recently appointed an Ambassador to the African Union, for
    instance. Of course, have one to the Organization of American
    States.
        Senator Bond. I hope you'll----
        Secretary Rice. Let me take it----
        Senator Bond [continuing]. What ASEAN----
        Secretary Rice [continuing]. Back, and we'll take it under
    advisement. It's an----
        Senator Bond. Let me----
        Secretary Rice [continuing]. Interesting idea.
        Senator Bond. Let me follow up on the Philippines. In
    Mindanao, the U.S. Institute of Peace has been facilitating a
    peace process between MILF and the Philippine Government; seems
    to be the best hope for getting that under control. I wrote to
    Ambassador Negroponte. Apparently, funding is being cut off for
    the U.S. Institute of Peace on this effort. Do you know why?
    Can this be restored? Because it is critical for that region.
        Secretary Rice. Well, we have very active programs in
    Mindanao. As a matter of fact, Karen Hughes was, herself, there
    to talk with our people. I'll have to check on the----
        Senator Bond. But the U.S. Institute----
        Secretary Rice [continuing]. Specific program----
        Senator Bond [continuing]. For Peace is the critical one
    bringing those----
        Secretary Rice. I'll check on the specific program,
    Senator. I'm not----
        Senator Bond. All right.
        Secretary Rice. I will get back to you with an----
        Senator Bond. Speaking----
        Secretary Rice [continuing]. Answer.
        [The information follows:]

                                 The Deputy Secretary of State,
                                         Washington, DC, June 18, 2007.
    Hon. Christopher S. Bond,
    U.S. Senate.
        Dear Senator Bond: Thank you for your letter concerning the
    expiration of the United States Institute of Peace's (USIP) $3 million
    grant for its work in the Philippines. I share your view of the
    importance of supporting the peace process between the Philippine
    government and the Moro Islamic Liberation Front (MILF) as part of a
    multi-faceted approach in upholding U.S. interests in Southeast Asia.
        Since receiving the grant in 2003, USIP has achieved useful results
    in building understanding and support for the peace process,
    particularly through its seminars on ancestral domain. Nonetheless, the
    original rationale for USIP's grant no longer exists. In 2003, we
    believed the USIP could fill a key niche and were concerned that direct
    U.S. involvement in the peace process would be seen as interference by
    the parties. The situation has changed since then. Most importantly,
    the U.S. Embassy in Manila has increasingly been directly involved in
    the peace process, opening a dialogue with MILF leaders and actively
    engaging with Philippine officials on the peace process. Both parties
    support this increased and direct U.S. engagement.
        Although the Department of State would welcome the opportunity to
    continue to cooperate with USIP, it is our belief that the best use of
    scarce U.S. resources is in direct support of the reintegration of
    former combatants and other assistance projects. Should the Department
    decide in the future to seek technical assistance along the lines USIP
    has been providing, USIP will of course be invited to bid on any such
    proposal.
                Sincerely,
                                                    John D. Negroponte.

        Senator Bond. Speaking of public diplomacy, we see the
    Chinese expanding and setting up throughout the world,
    throughout that region and elsewhere, the Confucius Centers,
    nonprofit public institutes promoting Chinese language and
    culture, local Chinese teaching.
        At the same time, we are closing, and, because of security
    reasons, barricading American centers because of the 9/11
    security setbacks, in Riyadh--they've been closed throughout
    the world. We're hearing where American centers, the access to
    American literature and books has to be behind great security
    barriers which prevent our--at least giving our culture an
    opportunity to be heard and understood. What can we do to--
    given the security situation, is there anything this committee
    can do to help you if we--to find a way to make our libraries
    and our resources available to people in the world who, I would
    hope, have a legitimate question in learning about America and
    what we're doing?
        Secretary Rice. Well, we have put forth a very active plan.
    It starts with funding in the supplemental. Karen Hughes has
    about 15 countries, pilot countries, for--very high important
    countries in the war on terror for English-language camps, for
    English-language-focused programs. We believe that people will
    want their kids to learn to speak English, and that's one of
    our best ways to get in. So, it would be helpful to have the
    full funding for that.
        It's also the case that--I mentioned American Corners--they
    are exactly as you talk about, and we have a number of them.
    I'm--I--let's see, it's 10 in Indonesia, 14 in the Philippines,
    6 in Malaysia. They're around the world.
        We're also using virtual posts, virtual presence posts,
    because there are places where you can get on the Internet and,
    in effect, be like a post.
        Senator Bond. Well, I know, the Internet's very important.
    But, in many of these American centers, the security
    requirements are so great that the traffic has fallen off
    significantly. That's what we like to help.
        But one, just, quick question. We've discussed the IMET
    programs, International Military and Education Training. This
    is an area that I believe is very important. I would think that
    you would agree that this is one area where it is important
    that we continue to offer fledgling democracies and allies the
    access to our training. Is that----
        Secretary Rice. Yes, I'm very big supporter of the IMET
    programs, and we're trying to expand them and extend them into
    places where they don't currently exist, because being able to
    have our military engaged with other militaries really
    sometimes gives us a generational advantage down the road. We
    have a couple of cases where people have gone----
        Senator Bond. Right.
        Secretary Rice [continuing]. On to be president, so it's a
    good thing.
        Senator Bond. Yeah. Well, I--like SBY.
        Secretary Rice. Yes.
        Senator Bond. Final question. I--public diplomacy's very
    important. State Department is hindered by security concerns.
    Right now, this weekend, I was in Baghdad, and saw what the
    U.S. military is doing to repair and reopen the largest mosque,
    providing information, they're engaging local clerics and
    building relationships, they've established a women's council,
    helping local governments. The military is in a better--is in
    the position for security, but what we can do to help you get
    public diplomacy over the hurdles of security?
        Secretary Rice. Well, in places like Afghanistan and Iraq,
    it helps us to be able, through our Provincial Reconstruction
    Teams, to effectively embed with the military, and to provide
    protection in that way. In the case of Iraq, these new
    Provincial Reconstruction Teams that we have, we embed at the
    brigade command team level, and it allows us to be out with
    them. We have very good relations. I just got a very good
    letter from one of the heads of the civil affairs in the
    military, talking about how a couple of our officers who were
    really culturally sensitive were able to help when they go into
    a place, and they need to deal with women's affairs or--so, I
    think that's really our comparative advantage. We've got people
    who can embed. Sometimes they aren't people who have been in
    the Middle East or--but they've been in other conflict areas.
    So, having our officers in these Provincial Reconstruction
    Teams, out with the military, we think is one way to deal
    simultaneously with the security situation and to bring to bear
    our best assets.
        Senator Bond. Thank you very much, Madam Secretary. We are
    very grateful for your outstanding efforts, and wish you well.
        Secretary Rice. Thank you.
        Senator Bond. Thank you, Mr. Chairman.
        Senator Leahy. Thank you.
        Madam Secretary, let me ask you just a couple of questions
    about the Western Hemisphere Travel Initiative. I believe it's
    referred to as ``witty'' [WHTI], or, as a lot of our business
    and tourism industry call it, ``witless.'' It is, for those of
    us who live, as my wife and I do, less than an hour's drive
    from the Canadian border, and we see so many--so much of our
    business, our tourism, even families going back and forth
    across that border, and have, for generations, easily--here's
    what seems to have happened. Last week, the National Institute
    of Standards and Technology certified the ``vicinity read''
    technology is appropriate for use in the so-called PASS Card as
    part of WHTI. I'm somewhat concerned that DHS has rushed that
    through and has overridden some technology concerns--just so
    they can use it at 39 of our busiest ports, it won't be
    necessary at the other 80 low-volume ports. But the State
    Department is going to have to pay to produce a card with a
    technology that's inconsistent with what's used in passports.
        Actually with security, it's inconsistent with our
    standards of security in this country, for privacy, just so
    somebody can pass through 39 ports out of 119, and do it
    faster. Even though, in my own State of Vermont, and Senator
    Gregg's State of New Hampshire, you wouldn't need it to cross
    some of the small crossing points, but you're still going to
    have to buy it. Out of the 39 ports of entry which you and DHS
    have agreed to upgrade for this, I believe 22 are on the
    southern border.
        What's the cost to the State Department to create the PASS
    Card and fully implement it?
        Secretary Rice. Senator, I'm not sure that I can give you a
    cost figure. I will get back to you with the specific cost
    figure.
        Senator Leahy. Well----
        Secretary Rice. But let me just say, we had a legal
    requirement----
        Senator Leahy. Well, the reason I ask, the administration
    wants to begin requiring a passport or a PASS Card within a
    year or----
        Secretary Rice. Yes.
        Senator Leahy [continuing]. Two of next year.
        Secretary Rice. Yes.
        Senator Leahy. Senator Stevens and I had passed
    legislation, which the administration has ignored, to push that
    back to June 2009----
        Secretary Rice. I'll----
        Senator Leahy [continuing]. For something that's going to
    be done within a year. I'd kind of like to know how much it's
    going to cost.
        Secretary Rice. I'll have to get you the specific number.
        [The information follows:]

        The passport card is adjudicated and issued by the Department of
    State. The year to date cost for the passport card initiative totals
    approximately $31 million. This includes $283,000 for initial passport
    card testing in fiscal year 2007 and $30.8 million for additional
    passport card testing, card stock and card printers in fiscal year
    2008, the first fiscal year in which we are accepting applications and
    printing cards. Our cost estimate for fiscal year 2009 is $34.5
    million, and for fiscal year 2010 is $43 million.

        Secretary Rice. But let me just say, Senator, we had a
    legal requirement, which was to have a verifiable way to--for
    people coming across the two borders--we were responding to the
    legal----
        Senator Leahy. I mean--whoa, whoa, whoa, whoa, whoa. Your
    reaction to this legal requirement is something that was
    slipped into a bill at the request of the administration
    without any hearings----
        Secretary Rice. No.
        Senator Leahy [continuing]. And nobody's come up to ask
    us--nobody's asked me, as chairman of the Judiciary Committee.
    Nobody's asked us here. Nobody's asked others. But we don't
    know what the cost is. We don't know how we're going to do it
    by June 2008. We know you've given us to June 2009 to work it
    out, but, ``The heck with that, we're going to do it by June
    2008, if it kills us, or all of you.''
        Secretary Rice. Senator, let me----
        Senator Leahy. Or hundreds of billions of dollars worth of
    trade and traffic across the U.S./Canadian border.
        Secretary Rice. Let me assure you, Senator, I believe the
    cost is known. I don't have the number at my fingertips----
        Senator Leahy. All right.
        Secretary Rice [continuing]. Right here. But the question
    of getting this done in 2008, we think it can be done in 2008.
    We believe that--I've talked with the people who are doing
    the--who have to oversee the validation of the technology. They
    believe that that validation of the technology can be done in
    time to make this PASS Card available. We've worked with DHS on
    publishing the rules, so that there can be comment about the
    rules for the Western Hemisphere Travel Initiative.
        Senator Leahy. When are they going to do that?
        Secretary Rice. The rule will be published--we're working
    now on some language concerning some issues that would be
    particularly, I would think, of interest to you, concerning how
    we would deal with the parental notification, so that we don't
    have the trafficking of children, for instance, across borders.
        Senator Leahy. Well, that raises a point. I mean, we've
    seen what happens when we rush into things and people screw up.
    An example I use, like TSA, where Senator Kennedy, stopped 10
    times or so, getting on a plane, because he's on a terrorist
    watch list. Now, I know all of us Irish look alike, but Ted's
    been taking that plane for years. Even the President called him
    to apologize. He said, ``Well, you know, I appreciate that, Mr.
    President. Just get me off the darn list.'' The President said,
    ``I don't have that power.'' We've had a year-old child told to
    get a passport, because they're listed as a 45-year-old
    terrorist. Without making my usual comments for those of us who
    went to Catholic grade schools and high schools, we have
    Catholic nuns who are on that watch list. Now, we have
    differing views about whether it should be or not, but I
    suspect the ones who are on the watch list should not be.
    Department of Homeland Security has screwed up so badly in so
    many areas. I mean, why should we have any confidence that, in
    a year from now, when they don't even have the systems in
    place, they're going to do it right?
        Secretary Rice. Well, Senator, we've had very good
    cooperation with the Department, but the Department--the
    Department of Homeland Security actually is charged with
    determining the requirements. We then implement those
    requirements. The legislation----
        Senator Leahy. But the PASS Card won't be compatible with
    the computers that you use, for example, to read passports.
    Does that mean you have to have--are we going to get a bill for
    a whole second set of computers at every border crossing?
        Secretary Rice. Senator, the reason that we went to the
    PASS Card was that there was concern that if we required a
    passport of every American trying to travel across that border,
    that it would--the expense would be too great. As you note,
    there are people who go back and forth for hockey games or
    for----
        Senator Leahy. What's the PASS Card going to----
        Secretary Rice [continuing]. For whatever. So, the----
        Senator Leahy. What's the PASS Card going to cost?
        Secretary Rice. So, the PASS Card is a cheap alternative--
    --
        Senator Leahy. What does it cost?
        Secretary Rice [continuing]. To the--I think, about--do we
    know the number? Thirty-five dollars or something like that,
    I've read? We'll get back to you with the exact number.
        Senator Leahy. Well, $35 is----
        Secretary Rice. But it--don't think that----
        Senator Leahy. A family of five----
        Secretary Rice. Senator----
        Senator Leahy [continuing]. Going shopping, ``Hey, guys''--
    --
        Secretary Rice. Senator, don't get that----
        Senator Leahy [continuing]. ``Let's''----
        Secretary Rice [continuing]. Number in your head, because--
    --
        Senator Leahy. Where do you get it?
        Secretary Rice. I----
        Senator Leahy. Where would you get it?
        Secretary Rice. Where would we get----
        Senator Leahy. This PASS Card.
        Secretary Rice. Where would you get the PASS Card? The same
    way you get any other card, through the United States
    Government. You apply for it, and you'll get it. But it's a
    cheaper----
        Senator Leahy. So, we have----
        Secretary Rice [continuing]. Alternative.
        Senator Leahy [continuing]. The efficiency of the United
    States Government standing behind us on this.
        [The information follows:]

        For first-time applicants, the card costs $45 for adult and $35 for
    children. For adults who already have a passport book, they may apply
    for the card as a passport renewal and pay only $20. The passport card
    has the same validity period as a passport book: 10 years for an adult,
    5 for children 15 and younger.

        Secretary Rice. Well, Senator, I'm not going to speak for
    the efficiency of the United States Government, but I will
    speak for the fact that this has been on the books--this law
    has been on the books, not since last year--we did have an
    extension from the time at which the legislation was made----
        Senator Leahy. Senator Stevens and I wrote that.
        Secretary Rice. We appreciate it very much. But we think we
    can meet this in 2008. We've worked with our Canadian
    counterparts, we've worked with our Mexican counterparts. The
    need for identification for air travel went, really, very
    smoothly. We've worked even with those in the Caribbean who had
    concerns about what might happen to their tourist industry if
    this did not go well.
        So, I think we have some record of having delivered, and we
    believe that we can validate----
        Senator Leahy. But the air traffic----
        Secretary Rice [continuing]. The technology and get it
    done.
        Senator Leahy [continuing]. Or the Caribbean traffic is a
    little bit different than the hundreds of thousands of people
    who go back across the border every single day, everything from
    going over to have lunch to doing business. I mean, you've
    encouraged the Canadians to apply for the NEXUS card, because
    they're interoperable with PASS. Is that correct?
        Secretary Rice. That's correct.
        Senator Leahy. But doesn't that require a background check?
        Secretary Rice. It will--that requires a background check,
    but----
        Senator Leahy. You know, I--I'm going to Ireland and--
    Italy, briefly, at the end of this month. I can just see, if I
    had to go there, if they called me up and said, ``Well, we've
    got to do a background check on you before you go.'' I'd say,
    ``The heck with that.''
        Secretary Rice. Senator, it's----
        Senator Leahy. I mean, how do we do background checks on--
    --
        Secretary Rice. So, look at----
        Senator Leahy [continuing]. Canadians?
        Secretary Rice [continuing]. Fingerprints, look for--look
    in records to see if there's a problem. But I--but, Senator,
    let me just say, I really----
        Senator Leahy. Like----
        Secretary Rice [continuing]. Do believe----
        Senator Leahy [continuing]. Like Mahar?
        Secretary Rice. I believe we can get this done if we put
    the right resources to it. We believe we can get it done. DHS--
    we are working very well with them. We did have a delay in
    determining which technology to use. That's now out for
    comment. The people who are working on this issue tell me we
    can validate the technology and have it ready to go by 2008. We
    think we ought to try to get this----
        Senator Leahy. So, in----
        Secretary Rice [continuing]. Requirement fulfilled.
        Senator Leahy [continuing]. In June 2008, none of our
    businesses, none of--nobody else is going to have to worry
    about having these PASS Cards for----
        Secretary Rice. Senator, I'm not going to----
        Senator Leahy. You're a very----
        Secretary Rice [continuing]. Comment on what we----
        Senator Leahy [continuing]. Optimistic person, Madam
    Secretary. You know, I----
        Secretary Rice. I am, Senator.
        Senator Leahy. I----
        Secretary Rice. I'm not going to tell you that there
    won't----
        Senator Leahy. I belong to----
        Secretary Rice [continuing]. Be problems.
        Senator Leahy [continuing]. A faith that believes in
    miracles, but even miracles----
        Secretary Rice. Senator, I understand, and we've worked
    very hard with our Canadian counterparts, we've worked very
    hard with our Mexican counterparts, but we have a legal
    requirement, and we're trying to meet it. We're trying to meet
    it in a way that is going to make us safer on the border, but
    doesn't hold people up who need to get back and forth.
        Senator Leahy. Madam Secretary, you say we have a legal
    requirement. Nobody from this administration has asked anybody
    up here to do anything to modify or change the requirement the
    administration slipped into a law, or was slipped in at their
    request. Makes me think of other things that have been done
    like that, one that allows for the easy firing of attorneys--of
    U.S. attorneys, for example. The--these are things--saying a
    legal requirement, with all due respect, is a bit of a copout,
    because you could ask for changes, if you want. Obviously,
    you've heard from the U.S. Chamber of Commerce and others, with
    their concern. I think there are justifiable concerns on this.
    I also am concerned about a signal we send to a country that
    has been a great friend, it becomes almost cliche to speak of
    the longest unguarded frontier in the world, but it is true--a
    friend and ally and supporter, our biggest trading partner, I
    believe. I believe it still is. We should talk some more about
    this.
        If Senator Gregg will allow me, I'm just going to mention a
    couple of quick things, then I'll yield to you whatever amount
    of time you want.
        Much of your written testimony is devoted to Iraq,
    Afghanistan, and the Middle East, and, at the very end, you--
    and I understand the importance of those--at the very end, you
    mention other developing nations and vulnerable populations.
        In Nepal, a country where years of fighting has cost
    thousands of lives, there's a chance to end the Maoist
    insurgency, replace feudalism with democracy. But you propose
    to cut our aid.
        Democratic Republic of the Congo, a huge country, with
    every conceivable problem one can think of, has had its first
    elections in 40 years. I think it's going to influence central
    Africa for the next 20 years. Yet, we're proposing to cut their
    aid.
        Vietnam, a country of 80 million people, seeking closer
    ties, and the President went there last year, but, with the
    exception of HIV and AIDS, proposes to cut our aid. I've seen
    what even a little aid can help, the Leahy War Victims Fund
    that is used there.
        Congress has worked hard to increase funding for global
    environmental programs, protect forests in the Amazon, central
    Africa, where they're being destroyed, but you propose slashing
    funding for these programs and downgrading USAID's Mission in
    Brazil, the most populous country in the hemisphere, after the
    U.S. USAID's budget--operating budget is cut. I mean, I'm just
    worried. It seems like there's this huge vacuum cleaner in Iraq
    and Afghanistan and I can debate what works and what doesn't
    work there, sucking up all this money, and these other places
    are going to create either problems or opportunities for us for
    the next generation, but we're cutting back our money.
        Secretary Rice. Senator, this administration has almost
    tripled official development assistance since the President
    came to power. We have quadrupled assistance for Africa, and
    doubled assistance for Latin America. You can look at any given
    year, and whether we think there are specific programs that
    need funding or not in a particular place--and, in Brazil, for
    instance, yes, we have moved to a different kind of
    relationship with Brazil, which is a large and increasingly
    prospering country, where we're engaged in more partnerships
    with Brazil than direct foreign assistance. But the numbers
    really do speak for themselves when you look at the commitment
    of foreign assistance by this President to the--to development.
        Senator Leahy. I've publicly praised the President----
        Secretary Rice. We appreciate----
        Senator Leahy [continuing]. As you know----
        Secretary Rice [continuing]. That.
        Senator Leahy [continuing]. On a number of areas, where he
    has, and where I have supported him. But the main increases are
    in AIDS and in the Millennium Challenge, and we still have
    questions that have been asked by both Republicans and
    Democrats, what the Millennium Challenge has accomplished.
        The point is, in a number of these very specific areas,
    where we could be helpful, we've had private philanthropists
    who have given more money, whether it's been the Gates
    Foundation or others. AIDS has been our biggest increase, and
    that's--you've had strong bipartisan support for money there.
    We're also doing things, as you know, in the Judiciary
    Committee to make it more possible to change our patent laws
    and copyright laws and what not, to move drugs into these areas
    at a much lower cost, both to us and to the receiving
    countries, who are all working together on these.
        But I worry about--whether it's Congo, Darfur, all these
    others--so----
        Secretary Rice. Well, Senator, we're putting--in Africa--
    for instance, in Latin America, the doubling of aid is not MCC
    aid. That's less MCC aid. We really have put a great deal of
    financial--of foreign assistance into these places. Yes,
    sometimes a place will--like Brazil, will, in a sense, change
    the kind--we will change the kind of relationship that we have
    with a Brazil. But if you look at the amount of money that is
    going into the Great Lakes region, the amount of money in
    Africa, the amount of money that is going into Liberia, the
    amount of money that is going into countries in Latin America,
    this administration, thanks to the support of the Congress, has
    been extraordinarily generous.
        We are trying to make better use of the resources, to go
    back to a point that we talked about early on, by being certain
    that the USAID and the State Department funds can create a
    total picture of what's going into any particular country. But
    the increases that I'm talking about are not in MCC--for
    instance, for Latin America.
        Senator Leahy. Secretary Rice, I've gone over my time, and
    you and I should probably chat about this a little bit further.
    You've--as I said, you've always been available, when I've----
        Secretary Rice. Certainly. Anytime.
        Senator Leahy [continuing]. When I've called, and we will
    talk.
        Senator Gregg?
        Senator Gregg. Thank you, Mr. Chairman.
        I wish to join you in your skepticism about the border
    cards crossing into Canada. Before I had the good fortune to
    become ranking member of this subcommittee, I was chairman of
    the Homeland Security Subcommittee, and this was a major issue.
    I think the jury's out on this technology. The responsibility
    for it is also--there's no clear line of responsibility, in my
    opinion. So, we've--we're going to need to--I'm very concerned
    that we're going to see a replication of the event when we
    stood up TSA, and it was basically, as the chairman alluded to,
    a real disruption in traffic, commercial traffic and
    individuals' traffic and in the lifestyle of Americans and
    Canadians.
        So, we should do this through demonstration exercises. We
    should not just say, ``x date, we're going to move to this
    program.'' We should try a demonstration exercise here, a
    demonstration exercise there, and work our way up to the
    Freedom Bridge in Detroit before we suddenly arrive there one
    day and say, ``This is the way it has to be.'' So, I do hope
    we'll come at that in a different way. I don't--it's not really
    your responsibility, but you're drawn into the exercise.
        On another subject, I'd be interested in your thoughts on
    what's happening in Turkey. This is a key country for us.
    They've always been a very strong ally. They're somebody we
    rely on in the region for stability. Yet, they appear to be
    going through, as many of those states are in that region, a
    resurgence of religious movement that was inconsistent with
    their, certainly, 20th century history. What do you see
    happening there? What should be our role? Obviously, it's
    internal domestic event, but what should----
        Secretary Rice. Well, I think our role has to be to stand
    for the democratic processes there, the constitutional
    processes. The government that was elected by the people there
    has actually been a government that's been dedicated to pulling
    Turkey west toward Europe. It has been the policy of that
    government, even though it is led by leadership from the AKP
    Party, which has Islamist--Islamic roots--it has been trying to
    integrate into Europe. It's been changing its laws to try to
    become consistent with European Union requirements for laws on
    individual and religious freedom and other issues of that kind.
    So, I think it's very important that we just--that we support
    their democratic processes. They are going to have new
    elections, and to stand for those elections to take place in
    the way that we would expect elections to take place in any
    democracy will be very important.
        But I think the history of the last few years has been of a
    good relationship with Turkey, probably stronger support, for
    instance, for Turkey--from Turkey for the new democracy in Iraq
    than one might have expected, given the history of Turkey in
    Iraq. Good support for policies in Afghanistan. And, of course,
    they're a strong NATO member.
        But, again, I would just note that the last few years have
    actually not been years in which one could say that Turkey was
    pulling away from its European traditions, but, I think, trying
    to move more actively toward it, which is why we've also been
    very supportive of Turkey's efforts to European Union
    accession.
        Senator Gregg. Wouldn't one of the potential consequences,
    which would be fairly dramatic and unfortunate, of leaving Iraq
    precipitously and having a breakdown in the stability, to the
    extent we can maintain it in Iraq, wouldn't it be that there
    would be a huge pressure relative to the Kurdish relationships
    with Turkey and, potentially, a very significant military
    concern there?
        Secretary Rice. Absolutely. Because Iraq sits as it does on
    the fault lines between Shi'a and Sunni, and with Kurds to the
    north, I think if you had a vacuum there, you would see that
    there--it would be pretty irresistible for Iraq's neighbors to
    try and secure their interests by meddling in Iraq's affairs.
        Now, if you have a Iraq that's able to manage its affairs,
    then I think those neighbors will be more likely to simply
    cooperate with that stable government. That was very much the
    message, Senator, when I was at Sharm el Sheikh for the
    neighbors conference, that the Iraqis need, very much, to
    pursue urgently their national reconciliation and to bring the
    various groups together, but the neighbors need to allow them
    the space in which to do that; the neighbors need to be devoted
    to helping stabilize Iraq, not destabilize it; and the
    neighbors need to have, kind of, rules of the road, which is
    really what Sharm el Sheikh was about, about they're going to
    deal with a democratic and sovereign government in Iraq.
    Because I think if we were to leave precipitously, we would
    encourage not just chaos in Iraq, but we would encourage chaos
    in the region, as well.
        Senator Gregg. On another subject, and then I'll--I know
    the Senator wants to move on--but independent of the issue of
    leadership right now, which is obviously in flux, for a variety
    of reasons, at the World Bank, do you believe the World Bank
    should be taking a different tack than what it's been taking in
    the last 20 years, that it should no longer--that it should
    restructure itself and refocus itself relative to poverty and
    alleviating poverty and addressing nations and--how it
    prioritizes nations, and how it prioritizes regions that it
    focuses on?
        Secretary Rice. Well, we've had a very good working
    relationship with the World Bank, under the leadership of Paul
    Wolfowitz, and, before that, under the leadership of Jim
    Wolfensohn. I do think that the World Bank has been--has had an
    important anticorruption agenda. That's extremely important. I,
    myself, think that there needs to be discussion about how the
    World Bank's assets can best support what is a very changing--a
    changing profile of assistance to the developing world, where,
    for instance, we are learning that, in parts of the world, the
    biggest problem may be infrastructure development, issues like
    roads or electricity, and looking at that.
        I think, also, for the World Bank, the fact that there are
    a number of countries that have graduated should be considered
    to be a very good thing, and to perhaps look, as has been the
    case when we've looked at debt relief, to what we can do for
    the poorest of countries that are not capable of dealing with
    debt--that often was brought to them by dictators or bad
    regimes--than leaving young democratic regimes with
    overwhelming debt. So, for instance, we had a joint donors
    conference for Liberia, just a little while ago, in which
    their--first and foremost, their biggest concern is to get debt
    relief.
        So, I think there is an agenda out there for the World
    Bank, but, frankly, we are, in a sense, the World Bank, as
    well, since we're all members of the board and contributors,
    and it is a discussion that needs to go on, and needs to be, I
    think, accelerated among all of the big international financial
    institutions, because the landscape for development is
    changing.
        Senator Gregg. Well, I just think we need to put some
    pressure on them to reduce their overhead and to actually get
    the money to where the rubber hit the road, as versus have it
    used up in the people between the road and the rubber.
        Thank you, Mr. Chairman.
        Senator Leahy. Thank you.
        I will submit questions. But, you know, the Republican
    leader, Senator McConnell, and I have joined together for years
    on an amendment conditioning a portion of our aid to Serbia in
    its cooperation with the War Crimes Tribunal at the Hague,
    especially to transfer Ratko Mladic and Radovan Karadzic. The
    Serb army helped protect Mladic. He remains at large. They say
    that Karadzic is not in Serbia, but suggest he--they know where
    he is. I hope we'll continue to make clear to them that the
    United States will oppose their entry into NATO and other
    regional economic and security organizations until we find out
    what's going on. I'm going to ask you questions.
        I'll submit questions about Cuba, which is listed as a
    state sponsor of terrorism. Your report said they did attempt
    to track, block, or seize terrorist assets, and I want to know
    what evidence we do have of terrorist assets actually being
    there. They did not undertake counterterrorism efforts. I would
    hope that is not the criteria, by itself, to make somebody a
    state sponsor of terrorism because they don't undertake
    counterterrorist activities. We have an awful lot of friendly
    nations that don't even have the ability to do that, would be
    on the list otherwise.
        Then, your report says they continue to provide safe haven
    for members of Colombian rebel groups, but the Colombian
    Government says they've been a facilitator in talks between
    these groups and the Colombian Government. I just want to know
    which it is.
        I have questions on aid to Russia, because of a whole host
    of problems there that we don't have to go into.
        I've got a Middle East question about both the wall and the
    property held by Israeli settlements, and whether that's theirs
    or Palestinians'.
        Peacekeeping force in Darfur--as you can see, quite a few
    things. But I would hope you'll ask your staff to get back to
    us as quickly as possible on those questions.
        Secretary Rice. Of course, Senator, I will.
        Senator Leahy. Thank you.
        Madam Secretary, thank you very much. I suspect you and I
    will be on the phone a lot in the coming weeks.
        Secretary Rice. Anytime, Senator. I look forward to your
    call.
        Senator Leahy. Thank you.
        Secretary Rice. Thank you very much.

                        ADDITIONAL SUBMITTED STATEMENTS

        Senator Leahy. We have received statements from the
    Alliance for International Educational and Cultural Exchange
    and the United States Conference of Catholic Bishops and
    Catholic Relief Services that will be made a part of the record
    at this time.
        [The statements follow:]

     Prepared Statement of the Alliance for International Educational and
       Cultural Exchange and the Association for International Practical
                                Training (AIPT)

        As Chair of the Board of the Alliance for International Educational
    and Cultural Exchange, I appreciate the opportunity to submit testimony
    in strong support of the budget request of $486.4 million for the
    educational and cultural exchange programs administered by the
    Department of State's Bureau of Educational and Cultural Affairs (ECA)
    in fiscal year 2008. If additional funds are available, the Alliance
    urges an increase in the investment in State Department exchange
    programs to $500 million to further strengthen U.S. public diplomacy.
        The Alliance comprises 78 nongovernmental organizations, with
    nearly 8,000 staff and 1.25 million volunteers throughout the United
    States. Through its members, the Alliance supports the international
    interests of 3,300 American institutions of higher education. The
    Alliance is the leading policy voice of the U.S. exchange community. We
    look forward to continuing our productive working relationship with the
    subcommittee, and appreciate the opportunity to offer this testimony.
        U.S. ambassadors consistently rank exchange programs among the most
    useful catalysts for long-term political change and mutual
    understanding, and as our experiences since September 11, 2001,
    demonstrate clearly, we need public diplomacy and exchanges more now
    than ever. Poll after poll continues to indicate rising anti-
    Americanism, even in nations we count among our closest allies. We must
    work to build trust and understanding for our people and our policy
    goals not just in the Muslim world--an effort that is of critical
    importance--but around the globe. To defeat terrorism and address other
    critical global issues, we will need the help of our friends and allies
    in every region of the world.
        The Alliance therefore urges the subcommittee to fund the
    Department of State's exchange budget at $486.4 million in fiscal year
    2008. If additional funds are available, we urge you to increase the
    allocation to $500 million in order to deepen the public diplomacy
    impact of these important programs and to sustain and strengthen the
    Department's core exchange programs worldwide while continuing to
    develop new and innovative proposals. A $500 million level of spending
    will allow robust funding for targeted, meaningful growth in every
    region of the world for the State Department's core exchange programs,
    provide additional resources for Islamic exchange, sustain funding for
    Eurasia and Eastern Europe, fund the administration's request for a new
    initiative for Latin America, and encourage the development of new and
    innovative programs worldwide, including the National Security Language
    Initiative (NSLI).

                             CORE EXCHANGE PROGRAMS

        The following data define the context for increased exchange
    program funding:
      --A recent BBC poll shows that just 29 percent of those polled in 25
            countries feel the United States exerts a mainly positive
            influence on the world, compared with 40 per cent 2 years ago.
            We clearly are losing ground in world public opinion. Exchanges
            are a proven--means to change that impression. (*BBC World
            Service poll of 26,000 people in 25 countries--mostly non-Arab)
      --A Congressional Research Service review of 29 reports on public
            diplomacy revealed that the most common recommendation of these
            reports was to increase exchange funding.
      --State Department evaluations repeatedly show that foreign exchange
            participants complete their programs in the United States with
            enhanced positive impressions of the United States, its people,
            and its values.
        The administration has requested $486.4 million in exchange program
    funding for fiscal year 2008. The Alliance urges the subcommittee to
    support the request, and if possible, to increase it to $500 million. A
    funding level of $500 million will allow for meaningful growth in the
    Department of State's time-tested exchange programs that remain at the
    core of our efforts to build mutual understanding and respect between
    the United States and critical nations around the world. These well-
    established programs--Fulbright and other academic programs,
    International Visitor Leadership, and citizen exchanges--continue to
    demonstrate their relevance and effectiveness in a rapidly evolving
    world.
        The Fulbright Program has unique value in deepening mutual
    understanding between the United States and 150 countries. Visiting
    Fulbright students report the program's deep impact: 99 percent say the
    program increased their knowledge and understanding of the United
    States and its culture; 96 percent shared their Fulbright experiences
    in their home country through media or community activities; 89 percent
    report that their Fulbright experiences allowed them to assume
    leadership roles after their programs. U.S. Fulbright students strongly
    agree (97 percent) that the program strengthens bilateral
    relationships, and deepened their understanding of their host country
    (100 percent). By several indices, American Fulbright students say the
    program enhanced their leadership skills. Upon returning, U.S.
    Fulbright scholars make their campuses and communities more
    international: 73 percent have incorporated aspects of their Fulbright
    experience into courses and teaching methods. Visiting Fulbright
    scholars are also likely to incorporate their experiences in America
    into their professional lives at home: nearly two-thirds of those
    surveyed said that they ``broadened the international aspects of their
    teaching and research in general'' and ``became . . . a resource for
    their colleagues with regard to knowledge and skills learned.''
        Approximately 279,500 United States and foreign nationals have
    participated in the Fulbright Program since its inception over 50 years
    ago. The Fulbright Program awards approximately 8,000 new grants
    annually. In 2007, over 6,000 U.S. students and young professionals
    applied for 1,400 available Fulbright grants, demonstrating the desire
    of U.S. citizens to be internationally engaged. One hundred and fifty
    students will receive on-the-ground training in critical languages in
    advance of their research grants. Of over 2,000 incoming foreign
    students from 135 countries, 300 are teaching their native languages at
    U.S. colleges and universities. Other recent program changes include:
    the cutting-edge research conducted by New Century Scholars, which
    provides deep focus on a single global problem by leading scholars from
    around the world; global expansion of the Fulbright Language Teaching
    Assistants for U.S. Students; and enrichment programs throughout the
    United States exposing students from abroad to local communities
    throughout the United States.
        Other critical academic exchange programs include the Humphrey
    Fellowships Program, which provides powerful academic and professional
    training experiences for professionals in the developing world;
    Overseas Educational Advising, through which prospective foreign
    students receive reliable information about American higher education
    and professional assistance in the application process; the Gilman
    International Scholarship Program, which enables American students with
    financial need to study abroad; and English teaching and U.S. Studies
    programs, designed to enhance understanding of American society and
    values.
        The International Visitor Leadership (IVLP) program continues to be
    ranked by many U.S. ambassadors as their most effective program tool.
    This results-oriented program allows our embassies to address directly
    their highest priority objectives by bringing emerging foreign leaders
    to the United States for intensive, short-term visits with their
    professional counterparts. The program also exposes visitors to
    American society and values in homes and other informal settings.
        Thirty-three current heads of government and chiefs of state are
    alumni of the IVLP, including Prime Minister Tony Blair of the United
    Kingdom, President Hamid Karzai of Afghanistan, and Prime Minister Ehud
    Olmert of Israel. Georgian President Mikheil Saakashvili is an alumnus
    of the IVLP and Muskie programs, and many of his cabinet members either
    attended a university in the United States or participated in exchange
    programs. Saakashvili and his colleagues were among the leaders of the
    peaceful ``Rose Revolution'' in 2003 and Georgia's subsequent
    transition to democracy.
        According to State Department evaluations, IVLP alumni returned to
    their home countries with positive feelings about democratic values,
    overwhelmingly agreeing with the following statements: citizens should
    have equal rights (99 percent); rule of law is fundamental to democracy
    (99 percent); free and fair elections are cornerstones of democracy (98
    percent); individuals and organizations have the right to free speech
    (97 percent); and independent media are important (95 percent).
        Citizen exchanges continue to engage American citizens across the
    U.S. in productive international activities. In addition, these
    programs leverage their relatively modest federal dollars into
    significantly more funding through the participation of local
    communities, schools, businesses, and nongovernmental organizations.
    Increased funding for citizen exchanges would permit an expansion of
    these highly cost-effective activities, particularly in the critical
    area of capacity building in communities across the United States There
    is no doubt that the United States needs more ``citizen diplomats.''

                               REGIONAL PROGRAMS

        The Alliance strongly supports growth in exchanges world-wide. Both
    public opinion polling and the global nature of most current issues--
    e.g., terrorism, the environment, public health--demand that we
    strengthen our public diplomacy in all world regions. In this brief
    testimony, however, we wish to draw attention to three particularly
    critical areas.
        While the need for exchanges is worldwide, increased engagement
    with the Islamic world is particularly critical as we seek to enhance
    our national security and build understanding, trust, and a sense of
    shared interests between the people of the Islamic world and the
    American people.
        The State Department has created a continuum of programs to reach
    out to Muslim participants, particularly diverse and underrepresented
    populations. The Department has instituted a very successful program of
    micro-scholarships to stimulate in-country English study by teenagers.
    In addition, the Youth Exchange and Study Program (YES), also known as
    the Cultural Bridges Program, brings high school students from the
    Islamic world to live with American families and attend American
    schools for an academic year. For the 2006-07 academic year, the
    program includes nearly 675 students from 25 countries, the West Bank
    and Gaza. We urge funding of $25 million for YES, which would allow the
    program to reach its long-term goal of 1,000 students.
        The Department has devised a variety of undergraduate exchanges
    including summer institutes, community college programs, and semester
    and year-long programs at four-year institutions, and expanded the
    Humphrey fellowships for the Muslim world. Under the National Security
    Language Initiative (NSLI), the Department has used summer institutes
    and existing programs such as Fulbright and Gilman to increase U.S.
    capacity in Arabic, Farsi, and Indic languages. The International
    Visitor Leadership Program has targeted ``key influencers'' in
    predominantly Muslim nations, bringing hundreds of clerics,
    journalists, and women and student leaders to the United States for
    programs emphasizing tolerance, interfaith dialogue, and diversity.
    These programs have had remarkable and consistent impact, and U.S.
    embassies would welcome many more if funding were available.
        We strongly support the Administration's initiative to focus
    additional exchanges on Latin America. The Bureau of Educational and
    Cultural Affairs (ECA) intends to apply its continuum approach to Latin
    America to reach out effectively to non-elite groups in this very
    important region. Program elements would include micro-scholarships for
    English language study, summer institutes for student leaders, an
    expanded Youth Ambassadors program, ``supplementary scholarships''
    covering incidental and travel expenses to allow talented but needy
    students to accept financial aid offered by U.S. colleges and
    universities, and scholarships to attend U.S. community colleges.
        In addition, the Alliance supports continued funding for exchanges
    with the countries of Eurasia and Eastern Europe at no less than the
    fiscal year 2007 levels. Funding in this area of the world has
    dramatically declined in the last several years even as on-going
    transition and challenges to democratic change grab international
    headlines. The cuts for these programs have resulted in reductions of
    more than 50 per cent for some programs and the elimination of others.
        Exchange programs have provided sustained opportunities to expose
    future leaders to American civil society and values, and to foster
    personal and professional relationships between Americans and citizens
    of the region. We must continue to employ exchanges to engage with a
    broad range of future leaders in these critical nations. Elections in
    recent years in Ukraine and Georgia are a testament to the need to keep
    active programs in this region. The peaceful government transition in
    Georgia demonstrates the ongoing value of vibrant exchange programs in
    this region. As political change continues to occur, the Alliance urges
    sustained U.S. engagement throughout the region.
        Beyond the appropriations process, we wish to recognize and commend
    ECA for the creation of a new internship category within the Exchange
    Visitor Program. The opportunity for internships with U.S. companies,
    universities, and organizations will likely prove very attractive
    around the world, and will bring many students to the United States for
    substantive experiences at virtually no cost to the taxpayer. The State
    Department developed this creative regulatory package, now pending
    approval at OMB, in close consultation with the exchange community and
    private sector, and we believe the Department is to be commended for
    this initiative, which will enhance our public diplomacy with a new
    generation of leaders around the world.
        Thank you again for this opportunity to voice the Alliance's
    support for a robust appropriation for the educational and cultural
    exchange programs administered by the Department of State's Bureau of
    Educational and Cultural Affairs in fiscal year 2008. We look forward
    to working with the Subcommittee throughout the year ahead to ensure
    that the United States continues to vigorously support the traditional
    exchange programs that have proven their success for the past 50 years,
    while also developing new and innovative programs.
                                     ______

    Prepared Statement of the United States Conference of Catholic Bishops
                          and Catholic Relief Services

        The United States Conference of Catholic Bishops (USCCB) and
    Catholic Relief Services (CRS), the relief and development agency of
    the U.S. Catholic Bishops, thank the Subcommittee for the opportunity
    to present testimony on the fiscal year 2008 International Affairs
    appropriations process.
        Our Nation's commitment to foreign aid is particularly important at
    this time when our country's global role is a focus of intense
    discussion. We appreciate this opportunity to share the values
    contained within the Church's social teaching that underline our
    nation's moral responsibility to those in need around the world. In
    addition, our perspective is informed by the practical experience of
    the relief and development work of CRS in 99 countries throughout the
    world.

                              SPECIFIC PRIORITIES

        Our specific priorities for international affairs appropriations in
    fiscal year 2008 seek to uphold human life and human dignity, support
    the development of poor nations, foster peace and improve our national
    and global security. They include:
      --$3 billion for the Millennium Challenge Corporation (MCC);
      --$2 billion for Title II Food Aid;
      --$5.78 billion (including funding from Health and Human Services
            appropriations) for morally and culturally responsible programs
            to combat HIV/AIDS, malaria and tuberculosis, with particular
            attention to Africa;
      --substantial funding for humanitarian needs in Iraq, in addition to
            $2.1 billion for reconstruction;
      --$1.1 billion for reconstruction needs in Afghanistan;
      --priority funding for economic and social development in post-
            conflict countries transitioning towards better governance,
            including: Haiti, Liberia, the Democratic Republic of Congo
            (DRC), Sierra Leone (with substantial portions of the funding
            channeled through proven partners in the NGO community), as
            well as for continued implementation of the Comprehensive Peace
            Agreement in Southern Sudan;
      --full funding for contributions to U.N. peacekeeping activities,
            especially in Sudan, Lebanon, the DRC and Haiti;
      --an increased proportion of U.S. aid dedicated to social and
            alternative agricultural development and to victim assistance
            in Colombia, and strict human rights conditions on all U.S.
            military aid to Colombia and the Philippines;
      --increased funding for the Migration and Refugee Assistance (MRA)
            and Emergency Refugee and Migration Assistance (ERMA) accounts
            to bring total funding to $1.135 billion and $90 million
            respectively to meet the needs of an ever-increasing global
            refugee population;
      --$1.06 billion for the International Development Association (IDA)
            for debt cancellation and poverty reduction programs in the
            world's poorest countries; and
      --at least $207 million for debt relief primarily for the DRC and
            Liberia whose huge debt burdens create a major obstacle to the
            efforts of their new democratically-elected governments to
            restart economies ravaged by war.
        Mexico City Policy.--We reiterate our strong support for retaining
    the Mexico City policy, which prevents our foreign aid program from
    being misused to subsidize organizations that perform or promote
    abortions in developing nations. The Kemp-Kasten provision preventing
    the support of organizations involved in coercive population programs
    should also be retained. Under this provision, funding is denied to any
    organization determined by the President to be supporting or
    participating in the management of a program of coercive abortion or
    involuntary sterilization. To ensure that the President is free to make
    this determination the subcommittee should not earmark funds to the
    United Nations Population Fund (UNFPA), whose support for the coercive
    program in the People's Republic of China has rendered it ineligible
    for U.S. funds in recent years.

                       FOREIGN AID: OUR MORAL IMPERATIVE

        Solidarity with those in need expresses a common hope for a stable
    and peaceful world. Despite the effectiveness of many U.S. foreign aid
    programs, much more needs to be done to respond to this challenge.
    Before us there is an opportunity to use our nation's wealth and
    resources to uplift human life and dignity around the globe and to work
    for the common good.
        In this year's address to the Diplomatic Corps accredited to the
    Holy See, Pope Benedict XVI specifically focused on the level of
    international aid committed by the richer nations. He said,
    ``[I]nitiatives have been undertaken to which the Holy See has not
    failed to pledge its support, at the same time reiterating that these
    projects must not supplant the commitment of developed countries to
    devote 0.7 percent of their gross domestic product to international
    aid.'' \1\
    ---------------------------------------------------------------------------
        \1\ Address of His Holiness Pope Benedict XVI to the Diplomatic
    Corps Accredited to the Holy See for the Traditional Exchange of New
    Year Greetings, January 8, 2007.
    ---------------------------------------------------------------------------
        Achieving authentic human development requires that the basic human
    needs of all are met; that social, cultural, economic and political
    rights are protected; and that all peoples participate in shaping their
    own future. Meeting these moral obligations will help our nation build
    a safer and more secure world. As the late beloved Pope John Paul II
    said: ``Development ultimately becomes a question of peace, because it
    helps to achieve what is good for others and for the human community as
    a whole.'' \2\
    ---------------------------------------------------------------------------
        \2\ Pope John Paul II, Development and Peace, January 1, 1987.
    ---------------------------------------------------------------------------
        Development is not just an aspiration but a right common to all
    people. It corresponds, then, to a duty imposed upon all of us, as
    peoples and nations, to collaborate in development, and in this, it is
    the responsibility of those who are stronger and richer to seek out,
    assist and empower those who are less so.
        This teaching informs the work of two agencies of the United States
    bishops: Migration and Refugee Services (MRS) and Catholic Relief
    Services (CRS). MRS works to address the needs of those who flee terror
    in their homeland and seek international protection, and helps settle
    one-quarter of the refugees who enter the United States each year. CRS
    works in 99 countries throughout the world, including more than 30 in
    Africa, and provides programs to address HIV/AIDS, health, education,
    building civil society, food security, agriculture, emergency relief
    and peace building. With 60 years of development experience, CRS knows
    firsthand both the tremendous needs and also the great potential of
    millions who live in poverty. CRS knows from experience how effective
    development programs can bring very real hope for prosperity and peace.
        With a greater awareness that our well-being as Americans is
    intrinsically linked to the well-being of those who live far from our
    shores, foreign aid is increasingly seen by many as capable of lifting
    up the weak and empowering people to realize their own dignity and
    destiny at the same time that it improves global security and peace.

               FOREIGN AID REFORM AND TRANSFORMATIONAL DIPLOMACY

        USCCB and CRS have repeatedly focused on the importance of the
    effectiveness of foreign aid programming with the Committee. We welcome
    efforts to promote coherence in foreign assistance through a country-
    driven process that addresses duplication, complex delivery and
    procurement procedures and other inefficiencies. We acknowledge the
    relationship of development programs to broader strategic objectives,
    and have been monitoring the reform process closely since Secretary
    Rice's articulation of the doctrine of transformational diplomacy in
    January 2006. However, we have always maintained that the interests of
    poor and vulnerable people lie at the foundation of all foreign aid. We
    welcomed, therefore, the modified Framework for U.S. Foreign Assistance
    Programs that now includes the goal of ``reducing widespread poverty.''

    Country-Focused, Objective-Based Framework: An Important First Step
            Forward
        Now that poverty reduction has become an explicit goal of foreign
    aid, we look forward to programs that give priority to the needs of the
    poor and vulnerable even for countries with limited relationships with,
    or little strategic importance to, the United States. The adoption of a
    country-focused approach and framing aid programs in terms of specific
    objectives are welcome improvements. We hope that the categorization of
    countries in the Foreign Aid Framework will help identify more clearly
    the specific challenges to progress in reducing poverty, promoting
    human development and building security in troubled parts of our world.
    We thus believe the new assistance framework represents an important
    first step in foreign aid reform, a step we hope will be followed by
    broader and deeper reforms.

    Concentration of Bilateral Aid in Too Few Countries
        We note that 40 percent of the entire bilateral aid program is
    concentrated in six countries important to U.S. strategic interests
    related to either the ``War on Terrorism'' or the ``War on Drugs.''
    Only two of the six (Afghanistan and Pakistan) are classified by the
    World Bank as low income. While we strongly support reconstruction and
    peace-building in Iraq and Afghanistan, we believe that a greater share
    of foreign aid should be assigned particularly to the very poor among
    the more than 150 other developing countries. If U.S. strategic
    interests will continue to require a major injection of foreign aid
    resources into the six priority countries, and if poverty reduction is
    in fact to be a fundamental objective of U.S. foreign aid, this
    inevitably means that the overall foreign aid budget must be
    substantially increased.

    Avoid Trade Offs in Funding
        With regard to the composition of country programs, we are pleased
    that there has been a substantial increase over fiscal year 2006 levels
    for activities related to the long-term development objectives:
        Governing Justly and Democratically, Investing in People and
    Economic Growth. At the same time we note that this increase is
    attributable almost entirely to increases in funding for combating HIV/
    AIDS and other infectious diseases and for the Millennium Challenge
    Corporation. We support robust funding for these important initiatives,
    but we believe that a country-focused approach would require
    complementing HIV/AIDS funding with resources for other sectors. While
    HIV/AIDS funding for Africa, for example, is being increased, funding
    for basic education, safe water and economic growth on the continent
    actually decline from fiscal year 2006 levels.
        We support full funding of the Administration's request for $3
    billion for the MCC. Any reduction in funding would undermine the MCC
    as channel of support for well-governed countries through multi-year
    funding. Disruption in this program through insufficient funding would
    pose serious setbacks for countries that have worked hard to prepare
    eligibility, in many cases by enacting difficult policy reforms. The
    United States must continue to plays its part.
        At the same time, the MCC should not be funded at the expense of
    the large number of non-MCC low income countries with critical needs,
    including those emerging from conflict and moving towards better
    governance, such as Liberia, Haiti, the DRC and Sierra Leone. Funding
    for basic education and other sectors critical to poverty reduction
    should be increasing. At a minimum, the President's promise that MCC
    resources will be in addition to, and not in substitution for, other
    development and humanitarian funding should be kept.
    Planning Cannot be Concentrated in Washington
        Finally, we are concerned by initial indications that the new
    process for determining priorities has resulted in decisions that are
    the byproduct of top-down decision making, as opposed to a truly
    country-driven process. Our counterparts at USAID missions have
    expressed frustration with the lack of meaningful participation in the
    planning process. We understand the abbreviated timeline involved this
    year, and the tremendous work done to coordinate this new process; but
    the decision to base program and budget decisions almost entirely on
    strategic priorities crafted at Headquarters risks failing to
    incorporate the rich expertise and experience developed in the field.
        A related concern is the absence of a clearly defined role for
    civil society. Adopting a country-needs focus highlights the need to
    take into account the experience and insight of local organizations
    closest to the reality that foreign aid is intended to impact. While
    the host government has the central role in designing and implementing
    a country's development policies and programs, close collaboration is
    needed also with civil society organizations, especially those who work
    on a daily basis with the poor and marginalized and are thus in a
    unique position to give voice to the needs of the weakest members of
    society. CRS, through its network of partners in 99 countries, has the
    ability, through direct relationships with target beneficiaries, to
    provide USAID missions with information about the needs of the people
    most directly affected.
        Experience both in Washington and in the field reveals an often
    deficient process of consultation. In the absence of close
    collaboration with civil society and governments in both planning and
    implementing foreign assistance programs, aid programs will fail to
    reach their goal of reducing widespread poverty. We urge you to ensure
    that robust consultation--especially with civil society--be not only
    mandated for foreign assistance programming, but meaningfully
    undertaken by U.S. Government agencies involved in the entire process.
                                     ______

       Prepared Statement of Hon. Douglas Bereuter, President, The Asia
                                   Foundation

        Mr. Chairman & Members of the Subcommittee: I will begin my
    testimony as President of the Asia Foundation, with a personal
    perspective which I thought the Members and staff may find interesting
    since I served 26 years in the U.S. House, 20 years on the Foreign
    Affairs Committee, led the Asia Pacific Subcommittee for 6 years, and
    also chaired the ``International Institutions'' Subcommittee of the
    Financial Services Committee. For fiscal year 2008, the Asia Foundation
    is requesting $18 million.
        When I announced I would not seek re-election to the 109th Congress
    I was unaware that the position of the presidency of The Asia
    Foundation would open, but I had long admired the work of the
    Foundation. In fact, I told my wife years earlier it was one of only
    two positions that would interest me after Congress. What I have found
    in my 2.5 years at the helm of the Foundation is what I hoped and
    expected to find: there is a strong commitment to Asian development and
    a pervasive sense of altruism among the Foundation's experienced and
    highly professional staff. Its long-term, on-the-ground presence
    through 17 Asian field offices and its work with and through literally
    hundreds of established and emerging Asian partner organizations make
    it highly knowledgeable, effective, and trusted by Asians. This
    experience base, coupled with a staff of more than 80 percent Asian
    nationals who have a sensitivity and understanding of the local
    context, makes us different from nearly all other nongovernmental
    development organizations. We do not bring in our development staff for
    work on a short-term basis and then leave. We are there for the long
    term and we are committed to building and sustaining the kinds of
    institutions and practices that enable Asians to replicate these
    successes and thereby help themselves after a funded project ends. In
    short, The Asia Foundation is the premier development organization
    focusing on Asia.
        Of perhaps particular interest to the Congress today is the fact we
    have been working with Muslims and Islamic civil and higher education
    organizations for more than 35 years. Generations of Asians know us
    from our education grants and exchange programs and through the more
    than 40 million English-language books we have provided in more than 20
    countries (920,000 last year alone). The result is that Asians respect,
    trust, and like the Foundation at a time when much of what they hear
    and think about our country is not very positive. In short, The Asia
    Foundation has an unmatched credibility. It is an irreplaceable
    American and international asset.
        My research has shown me that seven significant American task
    forces, commissions and blue-ribbon committees made policy
    recommendations to our country for the post-9/11 world. All recommended
    an accelerated and more effective public diplomacy program, especially
    for the Islamic world. All but one specifically suggested that the
    expertise of nongovernmental organizations and the private sector must
    be enlisted, suggesting explicitly or implying that effective public
    diplomacy was too important and nuanced to be the exclusive domain of
    the U.S. Government. Members of the subcommittee, much of what The Asia
    Foundation does properly may be categorized as public diplomacy. We
    don't advocate U.S. foreign policy; however, while pursuing effective
    development programs, our work and staff remind Asians of what they
    have liked most about America and Americans--that we are an innovative,
    opportunity-oriented country and people, with a respect for the rule of
    law, the freedom of expression, and an openness and expectation for
    citizen participation in a democratic society.
        It is instructive to review the Foundation's appropriations
    history. Although the Foundation has been in operation since 1954, The
    Asia Foundation Act, which was passed in 1983, provides for an annual
    appropriation from the Congress. That Act acknowledged the importance
    of stable funding for the Foundation and endorsed its ongoing value and
    contributions to U.S. interests in Asia. For a decade until 1995, the
    Foundation's annual appropriation was at least $15 million. In fiscal
    year 1996, during the government shutdown year, despite broad
    bipartisan support commending its work, the Foundation's appropriation
    was cut by two-thirds, to $5 million. The Foundation painfully was
    forced to sharply cut back its programs, but struggled to maintain
    nearly all of its most important asset, its field operation structure.
    Since that low point, the Committee, in support of the organization's
    mission, has gradually expanded funding for the Foundation to its
    current level of nearly $14 million. Past committee report language has
    commended our grant-making role in Asia, and the Foundation, at the
    Committee's encouragement, has expanded its programs in predominantly
    Muslim countries, including Afghanistan, Indonesia, and Pakistan.
    However, the Foundation has remained at a funding level below that of
    10 years ago, despite its important contributions in support of
    democracy and reform in Asia, the escalating costs of maintaining
    overseas offices, the impact of inflation, the less favorable currency
    exchange rates, and growing needs in the region.
        Despite a very positive attitude about the Foundation in the State
    Department, USAID, and especially among those U.S. ambassadors with
    deep Asian experience who often turn to our country representatives for
    information and advice, past and present administrations consistently
    have used previous year requests as the baseline for future requests,
    rather than the previous year Congressional appropriations. This has
    resulted in a low appropriation recommendation in the past and again
    for fiscal year 2008. We don't have nearly the U.S. funding base we
    once had--in either relative or absolute dollar terms. We have the
    experience, expertise, and office/staffing base to do so much more of
    great value to the United States and those Asians who need our help; we
    only need the resources to restore some of the funding base we once
    had. Our development counterparts in multilateral development
    organizations express their amazement at what we accomplish with what
    they regard as a paltry funding base. Therefore, I respectfully urge
    the Committee to sustain and increase its support for the vital work
    the Foundation is engaged in on behalf of the U.S. interests in this
    complex region. The Asia Foundation is requesting a modest increase
    back to an earlier appropriations level of $18 million.
        In making this request, we are very cognizant of the fiscal year
    2008 budgetary pressures on the Committee. However, an increase would
    enable The Asia Foundation to strengthen program investments it has
    begun in recent years with Congressional encouragement, notably in the
    areas of protecting women and children against trafficking; promoting
    women's rights; building democracy and critical government capacity in
    Afghanistan and East Timor; increasing tolerance in predominantly
    Muslim nations like Indonesia, Bangladesh and Pakistan; securing human
    rights in Cambodia, Sri Lanka, and Nepal; and strengthening good
    governance and civil society throughout Asia.

                               REGIONAL OVERVIEW

        The United States and Asia face new challenges and pressing needs,
    complicated by the war on terrorism and fragile democracies. More than
    ever, we must support political stability and economic reform, and give
    attention to countries where recent events have exacerbated bilateral
    relations, specifically in the new democracies of Asia and in countries
    with predominantly Muslim populations. Challenges to governance in
    Thailand, the Philippines, Mongolia, Indonesia, and Sri Lanka require
    different approaches than in countries struggling to achieve democracy,
    peace and stability, such as Afghanistan, Pakistan, Nepal and East
    Timor. Potential ties to regional terrorist networks threaten regional
    stability. Human rights abuses continue with impunity in parts of Asia.
    Even though women have made gains in many places, such as Cambodia,
    Thailand, Nepal and India, they still face economic and political
    inequities, and in the worst cases, are victims of trafficking and
    abuse.

           THE ASIA FOUNDATION'S MISSION, CAPABILITIES, AND APPROACH

        We are committed to the development of a peaceful, prosperous,
    just, and open Asia-Pacific region. Our core capabilities and primary
    program concentrations are central to U.S. interests in the region.
    They are as follows:
      --Democracy, human rights and the rule of law.--Strengthening
            democratic and civil society institutions; encouraging an
            active, informed and responsible nongovernmental sector;
            advancing the rule of law; and building institutions to uphold
            and protect human rights;
      --Economic Reform and Development.--Reducing barriers at the national
            and regional level to the formation and productive functioning
            of small business and entrepreneurship;
      --Women's Empowerment.--Encouraging women's participation in public
            life; protecting women's rights and supporting advocacy
            training; and prevention of trafficking and domestic violence,
            including supportive efforts to protect and provide shelter to
            victims;
      --Peaceful and Stable Regional Relations.--Promoting U.S.-Asian and
            intra-Asian dialogue on security, regional economic
            cooperation, law and human rights.
        While the Foundation does considerable development work directly
    with its own staff, the Foundation remains faithful to its primary
    focus on its grant-making role, steadily building institutions and
    strengthening Asian leadership for democratic societies. Foundation
    assistance provides training, technical assistance, and seed funding
    for new, local organizations, all aimed at promoting reform, building
    Asian capacity and strengthening U.S.-Asia relations. Foundation
    grantees can be found in every sector in Asia, leaders of government
    and industry and at the grassroots level, and in an increasingly
    diverse civil society. The Foundation is distinctive in this role, not
    only providing the technical assistance necessary, but also in
    providing grants that cover the nuts and bolts necessities to support
    that capacity-building effort. Urgent political and security needs in
    Asia have increased the need for experienced and credible American
    actors in the region. The Asia Foundation is a well recognized American
    organization, but its programs are grounded in Asia, helping to solve
    local problems in cooperation with Asian partners.

                                    PROGRAMS

        The Asia Foundation makes over 800 grants per year, and facilitates
    programs, provides technical assistance and leverages funding from
    public and private donors, to increase program impact and
    sustainability. With additional funding in fiscal year 2008, the
    Foundation's expanded activities include:
        Legal Reform.--In Afghanistan technical assistance on policy and
    management operations for the Office of Administrative Affairs of the
    President, Council of Ministers Secretariat and Ministry of
    Parliamentary Liaison, Independent Election Commission, in East Timor
    access to justice programs and public consultation in lawmaking; in
    China legal aid services and worker rights education for migrant women
    workers; in Indonesia reform of the Supreme Court including civil
    society input into the reform process; in Nepal, supporting the new
    constituent assembly process, legal analysis of constitutional issues
    engaging citizens' groups, civic and voter education, and mediation
    programs in rural areas.
        Human Rights, Conflict and Islam.--In Cambodia, Sri Lanka and the
    Philippines, human rights monitoring, and documentation through new
    information technology networking; in Indonesia, the International
    Center for Islam and Pluralism (ICIP) a unique regional center in
    Jakarta for progressive Muslim scholarship, exchange, start-up
    activities and action plans of the Thailand Center for Muslim and
    Democratic Development (TCMD), the Philippine Council for Islam and
    Democracy (PCID) and Jamaah Islah Malaysia (JIM) and International
    Islamic University (IIU) in Malaysia, to support regional Southeast
    Asian networking and strengthening democracy under Islam; education
    reform in 1,000 schools including training on pluralism, human rights
    and civic education for 160 madrassa (day schools) teachers; curriculum
    reform for 800 pesantren (boarding schools), part of the Foundation's
    education reform of 625 Islamic schools nationwide, with over 215,000
    students; and in over 70 Islamic universities, for over 120,000
    students where the Foundation has pioneered civic education on the role
    of democracy; in Bangladesh, groundbreaking training programs in
    development practices for over 4,000 imams, expanding their
    understanding of their role in national development through exposure to
    USAID programs, and advancing public diplomacy with this critical
    leadership group.
        Civil Society.--In Afghanistan, support for the Ministry of Women's
    Affairs organizational strategic planning and communications strategies
    with regional Departments of Women's Affairs across the country, girl's
    education, and civic education; in Cambodia, human rights and legal
    services; in Indonesia, promote pluralism, tolerance and moderation by
    Muslim organizations, radio programs on religion and tolerance on
    community radio stations reaching 5 million listeners a week through
    radio talk shows and education reform.
        Women's Programs.--Region wide, with particular emphasis on
    Indonesia, Cambodia, Thailand, Vietnam and Mongolia, anti-trafficking
    program including prevention, services for victims, legal drafting and
    advocacy to support increased prosecutions; technical assistance and
    grants for services and advocacy for women victims of domestic
    violence; in Afghanistan, India, Pakistan, Bangladesh, Sri Lanka,
    Indonesia, Nepal, Thailand, and Malaysia projects to advance women's
    rights within Islam through analysis, public education and outreach; in
    Afghanistan donation of 10,000 books to the Ministry of Women's
    Affairs; in Cambodia and Afghanistan, support for scholarships for
    girls' education.
        Economic Reform.--In Indonesia, Vietnam, Nepal, Bangladesh, small
    and medium enterprise policy reform; in Indonesia and Vietnam pioneered
    economic performance rating tools for local governments; in Korea,
    Japan, China, Thailand and the Philippines, corporate governance reform
    and e-government efforts to counter corruption.
        International Relations.--In China, Vietnam and India, scholarships
    for young Ministry of Foreign Affairs leaders, exchange and study
    programs for Southeast Asian and American young leaders, and support
    for programs on cross-straits relations and Council for Security
    Cooperation in the Asia Pacific (CSCAP).
        A full listing of programs may be found on our website
    www.asiafoundation.org.

                                   CONCLUSION

        The Asia Foundation is first and foremost a field-based, grant-
    making organization, committed to maximizing program impact in Asia
    while keeping costs low, despite the growing challenge of providing
    security to field offices and protecting staff. If the Committee
    provides additional funding for Foundation programs in this fiscal
    year, we pledge to use those funds to expand programs that build
    democratic capacity, strengthen civil society, increase economic
    opportunity, protect women, and work with moderate Muslim groups as
    described above. The Foundation budget needs to grow in order to meet
    the growing challenges to American interests in the Asian region.
        Public funds are critical to our capacity to do more to advance
    American interests in Asia. The Foundation has expanded its private
    funding, but potential private donors need to be assured that the U.S.
    Government supports the Foundation's efforts, and private funds are
    always tied to specific projects. Only public funding provides the
    flexibility that allows the Foundation to maintain its field presence
    and respond quickly to new developments, as we did in supporting the
    Emergency Loya Jirga in Afghanistan, where we were the first U.S.
    organization on the ground in spring 2002.
        The increase in funding to $18 million that we seek is essential if
    the Foundation is to succeed in contributing to the development of
    stable, democratic and peaceful societies in Asia. I respectfully urge
    that the Committee sustain its support for the Asia Foundation, and
    demonstrate our shared commitment to addressing the challenges and
    opportunities in Asia today.

                       ADDITIONAL SUBCOMMITTEE QUESTIONS

        Senator Leahy. There will be some additional questions
    which will be submitted for your response in the record.
        [The following questions were not asked at the hearing, but
    were submitted to the Department for response subsequent to the
    hearing:]

                Questions Submitted by Senator Patrick J. Leahy

        Question. The President's request significantly under-funds the
    United States assessed contribution to U.N. peacekeeping by projecting
    reduced costs for every mission except Sudan which is increased by only
    $10 million. This is completely unrealistic--in fact, some of these
    missions are not only being extended but the costs are going to
    increase.
        When this shortfall is added to approximately $50 million in fiscal
    year 2007 arrears, the United States could have a shortfall of at least
    $430 million owed to the United Nations. That is if the United States
    and the United Nations decide not to create any new missions in places
    that need assistance, like Somalia, Chad and the Central African
    Republic. The shortfall in fiscal year 2008 could grow to $850 million
    if this happens.
        The total fiscal year 2008 request for peacekeeping is $1.1
    billion, a decrease of $28 million from fiscal year 2007. This is
    likely to fall short of our actual 2008 dues in every mission. How did
    the Department formulate the budget request for the U.S. assessed
    contribution to U.N. peacekeeping missions? How do we avoid going
    further into arrears?
        Answer. The President's budget includes a request for $1.107
    billion for contributions to U.N. peacekeeping activities in fiscal
    year 2008. The exact requirements for U.N. peacekeeping funds for
    future years cannot be predicted, because the size and cost of U.N.
    peacekeeping missions depend on U.N. Security Council decisions based
    on conditions on the ground and U.N. General Assembly review of the
    financial implications associated with those decisions. Within the
    President's overall budget, our fiscal year 2008 request is based on
    our estimate of the requirements that take into account such relevant
    factors as uncertainties about the future size of missions, as well as
    the U.N. assessment rate and the 25 percent rate cap consistent with
    current law. The United States uses regular reviews to explore whether
    missions can be downsized or eliminated, and will continue to work with
    our partners and the United Nations to identify cost savings wherever
    possible. The request for fiscal year 2008 reflects assumptions that we
    will be able to reduce costs of many missions while maintaining the
    U.N.'s essential role in peacekeeping activities.

           U.S. ASSESSED CONTRIBUTIONS TO U.N. PEACEKEEPING MISSIONS

        Question In response to my question about U.S. assessed
    contributions to U.N. peacekeeping missions, you noted that ``the
    request for fiscal year 2008 reflects assumptions that we will be able
    to reduce costs of many missions.''
        Does the Department still believe that the budget request levels
    are realistic given the current situation in each country? Please
    provide a justification for and the assumptions underlying the proposed
    reduction in each mission?
        Answer. The fiscal year 2008 President's budget includes a request
    for $1.107 billion for contributions to U.N. peacekeeping activities.
    The exact requirements for U.N. peacekeeping funds for future years
    cannot always be predicted and the fiscal year 2008 request was our
    best estimate of the requirements. Based on the U.N. approved budget
    for existing missions for the 12 month period from July 1, 2007 through
    June 30, 2008, and preliminary estimates for the cost of the U.N.-AU
    Hybrid Mission in Darfur (UNAMID) to be assessed to member states
    during fiscal year 2008, fully funding our assessments in fiscal year
    2008 will be challenging. We are carefully reviewing these requirements
    and are having ongoing discussions with the United Nations regarding
    the Darfur costs as well as other U.N. mission costs for fiscal year
    2008.
        Question. Do you believe your fiscal year 2008 budget request
    contains sufficient funds to provide each U.S. embassy with the number
    of staff, equipment, vehicles and other resources necessary to
    effectively promote the myriad of U.S. foreign interests in each
    country?
        Answer. The fiscal year 2008 budget request, including the $230
    million in program increases requested for State Programs would provide
    the Department with the necessary resources to further our world-wide
    diplomatic efforts. These operating resources are critical in ensuring
    diplomats are properly trained and equipped--most notably with enhanced
    foreign language skills--in order to advance U.S. national security
    efforts overseas. Additionally, continued construction of secure
    buildings overseas requires Embassy Security, Construction and
    Maintenance resources which the President has requested to increase the
    near and long term security of U.S. personnel overseas.
        Question. Can you assure us that any foreign aid program
    implemented by the Department of Defense, whether humanitarian,
    reconstruction, train and equip, or other, will be subject to the prior
    concurrence of the Secretary of State?
        Answer. Under the direction of our Director of U.S. Foreign
    Assistance, and based on the President's policy priorities for foreign
    assistance as informed by consultations with the Department of Defense,
    we formulate and submit our budget for Foreign Military Financing (FMF)
    and International Military Education and Training (IMET) as part of the
    State Department's Foreign Operations budget request. Once approved by
    the Congress, this State Department funding is transferred to the
    Defense Department for actual execution.
        Select new Department of Defense authorities, coordinated closely
    with the Department of State, are an essential means of addressing
    rapidly evolving security challenges, particularly with respect to
    building the capacity of our global partners. The Secretary has
    expressed support for such select new authorities contingent upon the
    explicit preservation of her statutory role with respect to foreign
    assistance, through their exercise with the concurrence of the
    Secretary of State, and in practice through joint development
    procedures. Such new authorities should also be tailored toward the
    common goal of providing for closer integration of the administration's
    foreign assistance efforts, consistent with the Secretary's
    responsibility for the overall supervision and general direction of
    U.S. foreign assistance.
        We continue discussions with the Defense Department regarding this
    issue.
        Question. Please provide an accounting of funds appropriated for
    the Afghan Civilian Assistance Program, since its inception in 2002.
    Such an accounting should indicate the total amount obligated and
    disbursed, through which organization(s), for what types of activities.
    Please also provide your assessment of the merits of this program.
        Answer. Since 2002, funding obligations for the Afghan Civilian
    Assistance Program (ACAP) have totaled $8.6 million, of which $8.3
    million has been disbursed. In June 2007, an additional $4.5 million
    will be obligated for the program. The International Organization for
    Migration has implemented the Afghan Civilian Assistance Program since
    2002.
        Afghan Civilian Assistance Program provides direct assistance to
    Afghan civilians or their families wounded or killed either by
    Coalition/NATO forces or improvised explosive devices targeting those
    forces. The program also supports communities to rebuild public
    infrastructure damaged or destroyed by Coalition or NATO forces.
    Program activities have included infrastructure rehabilitation,
    vocational training, psycho-social care, and medical prostheses
    distribution.
        Afghan Civilian Assistance Program has been successful at providing
    rapid relief to civilian victims of war in Afghanistan. The program
    contributes to overall stabilization efforts in Afghanistan by
    redressing unintentional damage to civilian life and property, thereby
    reducing mistrust and resentment of military operations, the Afghan
    Government, and the international community.
        Question. Aside from the reduction in size of the Guatemalan Armed
    Forces, what actions have been taken to redefine the mission and reform
    the Armed Forces?
        Answer. The Guatemalan military has changed drastically since the
    days of the internal conflict. The size of the Guatemalan military has
    been reduced by two thirds since the 1996 Peace Accords and the
    military budget is under 0.38 percent of GDP, well below the level
    stipulated by the Peace Accords. The Guatemalan military abolished its
    territorial system of deployment and is now organized along functional,
    rather than geographical, lines. Many regional military bases were
    converted to civilian uses. The military developed a new military
    doctrine that eliminated internal security as a role of the military.
    The Guatemalan civil sector took part in the consultative process in
    formulating this new doctrine, as called for in the Peace Accords. The
    military's doctrine, training, and education all reflect the new limits
    on the Guatemalan military's roles to defense of sovereignty and
    territorial integrity. Military training now includes mandatory human
    rights training as an integral part of the military education system.
    During the last 10 years, there have been no credible reports of human
    rights abuses by Guatemalan military units. The Guatemalan military is
    responsive to civilian political authorities and earned significant
    international and Guatemalan public respect for its excellent work in
    support of Hurricane Stan disaster response and recovery efforts. As
    allowed under the 1996 Peace Accords,\1\ Guatemalan presidents over the
    last 10 years have deployed the military in joint patrols with the
    police in an effort to curb escalating and signficant street crime. The
    military also plays a critical role in providing air and naval support
    for counter-narcotics operations, including through participation in
    two ``Mayan Jaguar'' operations in 2006 with DOD's Joint Interagency
    Task Force South. The Guatemalan military has also earned the respect
    of the international community for its professional performance in
    peacekeeping operations in Haiti and the Democratic Republic of the
    Congo, deployments that were frequently praised at the U.N. during
    Guatemala's 2006 candidacy for a rotating UNSC seat.
    ---------------------------------------------------------------------------
        \1\ Article 45(a) of the Agreement on the Strengthening Civilian
    Power and Role of the Army in a Democratic Society, signed in Mexico on
    September 19, 1996.
    ---------------------------------------------------------------------------
        Question. Is the Embassy satisfied with the investigation and trial
    in the murder of Gilberto Soto in El Salvador? What progress has there
    been in solving this crime, and what efforts are currently underway?
        Answer. On February 17, 2006, a sentencing tribunal exonerated two
    of the three suspects in the murder of Mr. Soto. The third suspect was
    convicted and sentenced to 25 years in prison. While we believe that
    the police and prosecutors carried out a professional and thorough
    investigation, the Department did expressed disappointment at the
    decision to exonerate two of the suspects.
        The Embassy closely monitored all stages of the investigation and
    the trial itself. In addition, the Embassy established a hotline to
    collect additional information about the murder. Although the
    International Brotherhood of Teamsters offered a reward of $75,000 to
    anyone providing information that would solve the crime, no credible
    tips have been received to date. The case is still open, and the
    Embassy is willing to facilitate the participation of any witnesses who
    choose to come forward.
        Question. There are increasing concerns about the conduct of the
    Sri Lankan military. While it is fighting the Liberation Tigers of
    Tamil Eelam, an organization that has committed acts of terrorism
    against civilians, the military has also engaged in a pattern of
    violations of human rights. What amounts and what types of military
    equipment is the United States providing to Sri Lanka through the FMF
    program and through the FMS or other sales program?
        Answer. U.S. military assistance to Sri Lanka is largely focused on
    maritime activities to improve Sri Lankan armed forces capabilities to
    defend their territorial waters and interdict arms shipments to the
    Tamil Tigers, a designated Foreign Terrorist Organization. Our fiscal
    year 2007 Foreign Military Financing funding totals $890,000 and will
    be used primarily for providing equipment such as surveillance radars
    and communication linkages to the Sri Lankan armed forces. Our fiscal
    year 2007 International Military Education and Training funding totals
    $518,000 and will be used for professional military education to
    include the staff college and Non-Commissioned Officer academy, human
    rights, counter-terrorism, and maritime interdiction training.
    International Military Education and Training funding will also fund
    training to increase interoperability with U.S. forces. Foreign
    Military Financing disbursed in 2007 to date totals $310,000.
        All recipients of military assistance undergo Leahy human rights
    vetting in accordance with the provisions of the Leahy Amendment and
    the Department's policies and procedures for Leahy vetting.
        Question. In your response to this question, you noted that ``all
    recipients of military assistance undergo Leahy human rights vetting in
    accordance with provisions of the Leahy Amendment and the Department's
    policies and procedures for Leahy vetting.''
        What are the procedures for vetting Sri Lankan recipients of U.S.
    military assistance, consistent with the requirements of the Leahy
    Amendment? Which, if any, units of the Sri Lankan military have been
    credibly alleged to have committed gross violations of human rights,
    and are therefore ineligible to receive U.S. assistance?
        Answer. We look at Leahy requests on a case by case basis, using
    available information from a wide range of sources, including post
    reporting, intelligence reports, and publicly available information
    from human rights non-governmental organizations such as Human Rights
    Watch, the Asian Human Rights Commission and Amnesty International. As
    a practical matter, in the case of Sri Lanka, we normally vet
    individuals nominated for training.
        The Human Rights Officer in Embassy Colombo's political section
    takes the lead in vetting. The Consular Section, the Defense Attache,
    the Regional Security Office, and USAID also contribute to the vetting
    process. Each of these offices checks for evidence of gross human
    rights abuses by a proposed participant.
        To date in 2007, two Sri Lankan candidates were denied training.
    One was refused because there is a criminal case pending against him
    for human rights violations allegedly committed in 1997. The other was
    denied because of credible information received from a reliable source
    about his actions as the Military Intelligence Commander in Jaffna.
        We have given particularly close scrutiny to those individuals who
    have served in Jaffna or whose service records indicate they may have
    been in proximity to known, egregious human rights violations.
        Question. Why did you only request $300 million for a U.S.
    contribution to the Global Fund in fiscal year 2008, and why in the
    Labor, Health and Human Services budget which funds domestic programs,
    rather than through the State, Foreign Operations budget which funds
    contributions to international organizations?
        Answer. The Global Fund is an important part of the strategic plan
    that guides implementation of the President's Emergency Plan for AIDS
    Relief (Emergency Plan/PEPFAR). The U.S. Government (USG) share of
    total Global Fund contributions has held consistently at approximately
    30 percent. The USG initially made a 5-year pledge of $1 billion for
    the Global Fund in years 2004-2008. If the $300 million in the
    President's 2008 Budget is approved, the USG will have nearly tripled
    that commitment to the Global Fund by contributing about $2.5 billion.
        In order to provide adequate financial and human resources to
    complete the goals of PEPFAR as well as maintain U.S. leadership in the
    Global Fund, the President has spread the request for HIV/AIDS-related
    resources across the two appropriations bills (Foreign Operations and
    Labor-Health and Human Services).
        We consider this interagency approach in representing the United
    States on the Global Fund to be one of our coordination success
    stories. Through the Global Aids Coordinator, who has overall
    responsibility for ensuring that all statutory benchmarks have been met
    before any USG contribution is made, USAID, State, and HHS regularly
    meet and fully coordinate on all aspects of the Global Fund.
        The Department of Health and Human Services (HHS) was instrumental
    in the administration's efforts to establish the Global Fund and
    continues to have an active role on its Board. The National Institutes
    of Health (NIH) makes a significant contribution to global HIV/AIDS,
    TB, and Malaria activities. Requesting the USG contribution within NIH
    continues HHS' longstanding role in the advancement of the Global Fund.
        Question. How does the United States maintain leadership in the
    Global Fund, as you maintain, if we cut our contribution from $725
    million in fiscal year 2007 to $300 million in fiscal year 2008? Why
    does requesting the U.S. Government contribution within NIH, an agency
    focused on domestic health care, make more sense than within the
    Department of State, where the President's Global HIV/AIDS Initiative
    focuses on international HIV/AIDS?
        Answer. Although the United States continues to be the largest
    single source donor to the Global Fund, leadership is not determined by
    the size of contributions. The United States is one of only three
    donors to hold its own Board seat (the other two are Japan and Italy);
    the Board operates on a one seat, one vote basis. The U.S. Government's
    leadership is based on our pro-active involvement with the Fund at all
    levels, starting with chairmanship of key Board committees. Ambassador
    Mark Dybul, the U.S. Global AIDS Coordinator, currently chairs the
    Fund's Finance and Audit (FAC) Committee, while Dr. William Steiger,
    Special Assistant to the Secretary for International Affairs at the
    Department of Health and Human Services, chaired the powerful Policy
    and Strategy Committee from 2005-2007. The United States also holds
    regular committee seats on both the FAC and the PSC, and our
    representatives have served on a variety of ad hoc sub-committees, e.g.
    to identify a new Executive Director for the Fund, to shape a documents
    disclosure policy for the Office of the Inspector General, and to
    develop performance indicators to measure overall Fund progress.
        As mandated by Congress, the interagency Global Fund Core Group
    also works together with our U.S. Embassies and USAID Missions overseas
    to conduct a parallel review of new Global Fund grant applications, and
    the Global Fund Secretariat has commented more than once on the
    relevance and usefulness of insights gained during these reviews. The
    United States also conducts reviews of the Global Fund's Phase Two
    proposals, and frequently takes the lead in mobilizing Board opinion
    during this key stage in the Fund's performance-based process.
        Furthermore, the United States provides significant technical
    assistance (TA) to Global Fund grants. PEPFAR bilateral programs in
    both Focus and non-focus countries include such TA in their country
    operating budgets, in amounts ranging up to $1 million. Such TA is
    vital to the success of closely-coordinated programs in which PEPFAR
    and the Global Fund are often working together even at the site level.
    As part of this in-country coordination, U.S. Government
    representatives are well-represented on Global Fund Country
    Coordinating Mechanisms, including 59 percent of the CCMs that
    submitted round six grant proposals. U.S. country teams are also
    required to describe how they plan to coordinate with the Global Fund
    in their annual Country Operation Plans (COPs).
        Finally, the United States is authorized by Congress to use up to 5
    percent of the annual Global Fund appropriation to provide targeted,
    short-term technical assistance (TA) to Global Fund grants experiencing
    bottlenecks. Because of the success of this United States-provided TA
    in its first 2 years, the donor community is increasingly turning to
    the United States to provide leadership for global technical support
    efforts, including through the multilateral Global Implementation and
    Support Team (GIST).
        As mentioned in my previous response, in order to provide adequate
    financial and human resources to complete the goals of PEPFAR as well
    as maintain U.S. leadership in the Global Fund, the President has
    spread the request for HIV/AIDS-related resources across the two
    appropriations bills (Foreign Operations and Labor-Health and Human
    Services).
        We consider this interagency approach in representing the United
    States on the Global Fund to be one of our coordination success
    stories. Through the Global Aids Coordinator, who has overall
    responsibility for ensuring that all statutory benchmarks have been met
    before any USG contribution is made, USAID, State, and HHS regularly
    meet and fully coordinate on all aspects of the Global Fund.
        The Department of Health and Human Services (HHS) was instrumental
    in the administration's efforts to establish the Global Fund and
    continues to have an active role on its Board. The National Institutes
    of Health (NIH) makes a significant contribution to global HIV/AIDS,
    TB, and Malaria activities. Requesting the USG contribution within NIH
    continues HHS' longstanding role in the advancement of the Global Fund.
        Question. The fiscal year 2008 budget proposes to shift a
    significant amount of funding from Development Assistance to the
    Economic Support Fund. This would enable the Department to reallocate
    funds more easily, without the consent of Congress.
        Why do you need this added flexibility?
        Answer. In the fiscal year 2008 budget request, we sought to
    maximize the use of account authorities and establish clear priorities
    in support of effective implementation of foreign assistance programs.
    We, therefore, matched accounts with country circumstances and the
    priorities the county categories are designed to address.
        This means that, overall, funding for Development Assistance (DA),
    which has traditionally supported poor countries that demonstrate
    performance or a commitment to development, has been prioritized to
    Developing and Transforming countries. Economic Support Funds (ESF),
    which focus primarily on providing economic support under special
    economic, political, or security conditions, have been prioritized to
    support activities in the Rebuilding and Restrictive Country
    Categories.
        Under the Foreign Assistance Act of 1961, as amended, Congress
    established the Economic Support Fund to provide ``assistance to
    countries and organizations, on such terms and conditions as [the
    President] may determine, in order to promote economic and political
    stability.'' We are committed to working within current statutory
    authorities to use ESF and all other funds in a responsible,
    accountable manner that is consistent with the Secretary's
    transformational diplomacy goal and Congress' authorization.
        The intent in shifting funds from DA to ESF is to draw cleaner
    lines around their use, as identified by country characteristics. These
    cleaner lines allow us to justify to Congress why we have requested
    amounts for each account. The primary goal of this shift is not
    increased flexibility, and we will of course continue to notify
    Congress of significant shifts in country funding and to comply with
    any and all notification requirements. The primary rationale for using
    ESF rather than DA resources in Rebuilding Countries is that conditions
    in these countries are not stable and the primary reason for providing
    these funds contributes to objectives beyond their development impact.
    Therefore, in rebuilding countries, it is more appropriate to hold
    State and USAID accountable for the shorter-term results typically
    associated with ESF-funded programs rather than the medium to long term
    results expected from DA.
        Question. As you know I am concerned about the threats to
    scholars--university teachers, scientists, and other academics, in
    countries where they have been threatened and killed. This is
    particularly the case in Iraq today, where many have been assassinated,
    including officials at the Ministry of Education.
        The fiscal year 2007 supplemental appropriations bill includes some
    funding to resettle Iraqi scholars. I would appreciate it if someone in
    your office would stay in touch with me about the management and use of
    those funds.
        Answer. The plight of scholars in Iraq is a concern for us,
    particularly because the skills they possess will be vital in
    rebuilding the nation and recreating the institutions of a civil
    society. We are determining the best implementation policy for the
    currently appropriated funds for refugees in the fiscal year 2007
    Supplemental. These funds will be crucial to help ensure these scholars
    and others receive needed assistance and can return to Iraq when
    conditions permit. We will be happy to keep you informed as the program
    progresses.
        Question. It would be a serious mistake to reduce USAID's mission
    and bilateral assistance programs in Brazil, a country of over 170
    million people most of whom are impoverished which is facing immense
    environmental challenges of global importance. I strongly urge you not
    to do this and I would appreciate written justification for it and for
    any other USAID missions you plan to close or downgrade.
        Answer. The reduction in USAID's assistance programs in Brazil
    reflects the prioritization of U.S. global foreign policy goals against
    available resources and competing demands. Under the new Foreign
    Assistance Framework, Brazil's solid level of economic and democratic
    progress warrants only a small USAID development assistance program. In
    fiscal year 2008, USAID's program will focus on reducing tuberculosis
    in Brazil.
        The reduction in assistance from USAID does not signal a reduction
    in United States support for Brazil. While the fiscal year 2008 budget
    has diminished, significant resources have been leveraged from the
    private sector toward addressing issues such as renewable energy and
    social inequities. The U.S. mission is seeking to harness the energies
    of the private sector, including through a Chief Executive Officer
    forum, comprised of executives from both Brazil and the United States.
    We have developed a Corporate Social Responsibility (CSR) forum with
    the American Chamber of Commerce, the largest such entity in the world,
    to maximize our effectiveness in assisting those that are most in need
    of help in Brazil.
        This approach is consistent with the principles of Transformational
    Diplomacy which is rooted in partnership, and reflects the important
    position of Brazil in the Western Hemisphere as well as the world.
        Question. How much does the administration plan to allocate for
    environmental conservation activities in Brazil in fiscal year 2007,
    and for what purposes?
        Answer. In fiscal year 2007 USAID is providing a total of
    $9,269,000, which includes $4 million from the Amazon Basin
    Conservation Initiative, to support Brazil's conservation efforts in
    the Amazon. USAID is helping Brazil save its unique biodiversity while
    simultaneously reducing greenhouse gas emissions from deforestation. We
    are implementing activities that empower indigenous peoples''
    organizations, promote environmental governance and support the
    sustainable management of natural resources. USAID supports efforts to
    create and disseminate information regarding public-private
    institutional alliances that are working to incorporate sustainable
    natural resource management practices and technologies into rural
    enterprises. Additionally, USAID assistance is helping the Government
    of Brazil consolidate forest conservation in both protected areas and
    productive landscapes.
        Question. Your budget would cut USAID's Operating budget from $641
    million in fiscal year 2007 to $609 million in fiscal year 2008. Your
    supplemental request for 2008 includes $61 million for USAID Operating
    Expenses, but that is for only Iraq and Afghanistan. The rest of the
    world gets shortchanged, again.
        If you ask anyone at USAID they will tell you that the agency's
    biggest weakness is the shrinking number of professional staff. Why
    have you cut USAID's Operating budget when we should be increasing it?
        Answer. The fiscal year 2008 USAID budget request is a reflection
    of the many competing demands on resources in the current budget
    environment. We believe the President has requested the amount
    necessary to accomplish the mission of the agency.
        USAID operates in some of the most difficult circumstances in the
    world and adequate resources are critical to implementing successful
    programs. USAID is currently reviewing its budget and structure to
    ensure that operations and staffing are appropriately funded to
    continue its mission and support our national security interests
    abroad. Specific attention is being paid to rationalizing the workforce
    as USAID needs appropriate staffing both in the field and in
    Washington. Programmatic and administrative resources must be allocated
    to ensure that operations are funded in a cost-effective manner, while
    preserving the integrity of USAID's mission.
        Question. In your response to this question, you recognize that
    USAID operates ``in some of the most difficult circumstances in the
    world and adequate resources are critical to implementing successful
    programs.''
        How do you explain the substantial reduction in funding for USAID's
    Operating Expenses from the President's fiscal year fiscal year 2007
    budget request compared to the budget request for fiscal year 2008, for
    expenses outside of Iraq and Afghanistan?
        Answer. The fiscal year 2008 Operating Expense (OE) request for
    expenses outside of Iraq and Afghanistan is 3 percent less than the
    fiscal year 2007 OE appropriation. At the time the President's budget
    was submitted, USAID expected to have implemented structural and
    operational reforms during fiscal year 2007 that would allow the Agency
    to effectively perform at the operating expense level requested for
    fiscal year 2008. The fiscal year 2008 OE budget request reflected a
    strategy of repositioning resources and restructuring operations around
    the world, including Washington. With that strategy in mind, the OE
    budget request was judged sufficient to carry out the mission of USAID.
        USAID is reviewing and refining its worldwide operations to better
    serve its mission. USAID will use all available authorities and
    resources in fiscal year 2008 to ensure that its programs are
    successful.
        Question. The Congress has consistently provided increased funding
    for international environmental programs, both to protect biodiversity
    and to promote energy conservation and efficiency. These programs have
    bipartisan support, from the Russian Far East to Central Africa to the
    Amazon.
        But your fiscal year 2008 budget would either eliminate completely
    or drastically reduce funding for environment programs everywhere. How
    do you explain this when forests, wildlife, water and other natural
    resources are being polluted or destroyed at a faster and faster pace
    on virtually every continent?
        Answer. Our strategy is to link healthy ecosystems to sustainable
    economies, good governance, and equitable and just societies. The
    fiscal year 2008 budget request includes $249 million for programs to
    protect natural resources, biodiversity, and support clean, productive
    environments. The decrease in resources to support the environment,
    down 17.5 percent from the fiscal year 2006 enacted level of $302
    million, is not a reflection of a lack of commitment but rather due to
    two changes. The first is the administration's decreased request for
    DA. The second is our new allocation process which is a more demand
    driven process from our Embassies and Missions.
        Countries were given their total budget number at the outset of the
    Operational Plan Process. In some cases, the total number was lower
    than last year or lower than their request. Under this year's more
    demand focused allocation process, many of our country teams either did
    not request funds for environment or they requested funds in smaller
    amounts than previously in order to maintain or increase programs in
    sectors which they judged to be more critical to their objectives. A
    few countries did identify environment as needing a higher priority and
    chose to request more funds in the environment than they had in
    previous years. Haiti, for example, had no funds budgeted for
    environment in fiscal year 2006 and requested $2.9 million for fiscal
    year 2008. As one of the most deforested countries in the world,
    Haiti's need to address environmental problems was identified this year
    by our country team as needing funding. The Near East and Asia region
    saw a small overall increase in their environment budget due to a $10
    million increase in Lebanon's and Jordan's water programs. The country
    teams in these two countries identified the need to address and fund
    water scarcity and poor quality issues as an important factor in
    maintaining stability and security.
        This year's demand-driven process illustrates how the Department of
    State and USAID jointly determined a country's need and drove the
    selection of funds into the various sectors; a process that we believe
    will produce more robust results in transformational diplomacy.
        Sustainable conservation programs should not only be demand-driven,
    but focus on host country ownership by being developed in partnership
    with local governments, institutions, and the private sector. To
    encourage this, we will undertake an innovative approach to facilitate
    private sector investment on environmental issues. Beginning in fiscal
    year 2007, we will look to the Development Credit Authority (DCA) to
    facilitate private sector investment through partial loan guarantees
    for partnerships in environmental sustainability for commercially
    viable ventures.
        The Development Credit Authority is a USAID partial credit
    guarantee mechanism that mobilizes private financing to achieve
    transformational development. By mobilizing private resources for
    market changing impact, USAID leverages an average of roughly $25 of
    private capital for each $1 invested by the USG. For example, in India,
    DCA raised nearly $23 million from the local capital market through a
    pooled municipal bond for water transmission and distribution networks
    in eight municipalities in Bangalore. The cost to the U.S. taxpayer for
    the loan guarantee was approximately $1 million.
        USAID can also provide DCA guarantees to engage private financial
    institutions in lending for steward projects led by communities. For
    example, a DCA guarantee can mobilize financing for community managed
    forestry concessions while encouraging the tree harvesting and
    marketing to be undertaken in a sustainable manner. Because the
    community is itself invested, the likelihood of the community working
    to make it sustainable is increased. Should such investments prove
    successful and profitable, our hope is that local financial
    institutions will look for similar investment opportunities without
    further credit guarantees from the USG foreign assistance budget. While
    this DCA experiment is not appropriate for most of the environmental
    programs needed by our partner countries, it illustrates an innovative
    and low cost approach to addressing the environment in those cases
    where facilitating such private sector ventures can be helpful
    additions.

                FUNDING FOR INTERNATIONAL ENVIRONMENTAL PROGRAMS

        Question. You responded to my question about cuts in funding for
    environmental conservation programs by saying that your new allocation
    process is ``much more demand driven'' from Embassies and Missions, and
    that you plan to look to the Development Credit Authority (DCA) ``to
    facilitate private sector investment in environmental sustainability
    for commercially viable ventures.''
        This suggests two things, first, our Embassies and Missions do not
    regard environmental conservation as a priority and are therefore not
    demanding the funds. Second, by putting so much reliance on the DCA and
    the private sector you appear to have a very limited approach to
    environmental conservation. Given the increasing threats to the
    environment and the implications this has for regional and global
    stability, how much do you expect to allocate through your demand
    driven approach, and in which countries?
        Answer. In my previous answer, I did not intend to give the
    impression that the administration does not place a priority on
    environmental conservation. To the contrary, the administration is
    committed to helping developing countries address critical
    environmental threats, including climate change and biodiversity, and
    to achieving economic growth and poverty reduction that is based on
    sustainable use of natural resources.
        President Bush's major new Climate Change Initiative, announced on
    May 31 in his speech to the Global Leadership Council, is one example
    of how we are working to address environmental problems. The Initiative
    is designed to rapidly reduce global greenhouse gas emissions by
    engaging major developing country partners, who account for a large and
    growing share of greenhouse gas emissions. The President's Climate
    Change Initiative will build on a number of existing global and
    regional programs, including the Asia-Pacific Partnership and the
    Methane to Markets initiative.
        In this and other key environmental areas, our Embassies and
    Missions are working with diverse government, private sector, and civil
    society partners in more than 40 countries--and we are applying a broad
    range of country-based and regional approaches--to improve
    environmental protection and conservation.
        Our new assistance process is also helping to address these issues.
    The After Action Review of the fiscal year 2008 budget process resulted
    in the adoption of Assistance Working Groups (AWGs). The AWGs are
    tasked with determining what approaches may be appropriate in a given
    country or region based on a holistic view of the critical development
    gaps and the perspective of the relevant host government(s). The
    purpose of the AWGs is to bring together expertise from across State
    and USAID to identify the most effective and efficient way to use USG
    foreign assistance to advance USG foreign policy priorities.
        In the fiscal year 2009 budget allocation process, to consider how
    economic growth programs and activities, including the environment,
    could be implemented to advance our foreign policy priorities, an
    economic growth AWG, co-chaired by Office of the Director of U.S.
    Foreign Assistance with State and USAID Functional Bureau leadership,
    was assembled. This AWG also considered other USG global, regional, and
    bilateral resources, such as fiscal year 2009 anticipated MCC
    allocations, and were encouraged to reach out to other implementing
    agencies with questions or a request for additional details. Taking
    into account this information and the Mission Strategic Plans from the
    field, the economic growth AWG provided program allocations to the
    program element and account level, and, where possible, attributed
    funds to specific countries and/or programs.
        In developing our foreign assistance budget in the constrained
    budget environment that is our reality, there are numerous competing
    demands in supporting development, including security and governance
    issues, and raging health crises. In setting our budgets, we are
    looking to address immediate problems in a sustainable way and to find
    the best opportunities to impact the lives of the most people. At the
    same time, we recognize that addressing stability and governance can
    achieve environmental results, as conflict, poverty and poor governance
    are significant contributors to environmental degradation in the
    developing world. The fiscal year 2008 budget request includes $249
    million for programs to protect natural resources, biodiversity, and
    support clean, productive environments although final allocations for
    fiscal year 2008 will be impacted by the fiscal year 2008
    appropriations bill. We anticipate that the heightened cooperation
    arising from the AWG process may well result in a fine tuning and
    perhaps even expansion of regional and country environmental programs
    in the fiscal year 2009 request which we are currently working on with
    the Office of Management and Budget.
        Question. I am leading a CODEL to the Middle East over Memorial Day
    recess, including to Israel and the West Bank. Since the beginning of
    this administration I and others have called for sustained, high level
    engagement with Israelis and Palestinians, but for the most part the
    administration's focus has been elsewhere. Your recent efforts are
    welcome, but it is very late in the game. In the past 6 years the
    situation has, if anything, become more intractable. We need to see
    real progress in resolving the key issues that underlie this conflict.
        When was the last suicide bombing for which Hamas was responsible?
        Which Palestinian faction(s) are responsible for recent rocket
    attacks against Israel?
        The Arab countries have proposed an initiative which offers Israel
    full recognition by the 22 members of the Arab League in exchange for
    Israel's withdrawal to its pre-1967 borders. Does the administration
    support this proposal? If not, what aspects of it does the
    administration not support?
        Who is responsible for recent rocket attacks from Gaza into Israel?
    In 2007, what if any acts of terrorism against Israeli targets are
    credibly attributable to Hamas?
        Answer. In his September 19, 2006, UNGA address, President Bush
    said that fulfilling his vision of two states--Israel and Palestine--
    living side by side in peace and security, was one of his greatest
    priorities. Internationally, the Quartet--made up of the United States,
    EU, United Nations and Russia--has declared repeatedly the need to make
    progress toward peace in the Middle East.
        During my repeated trips to the region over recent months, I have
    emphasized the importance of continued bilateral discussions between
    Prime Minister Olmert and President Abbas both on day-to-day practical
    issues such as security, movement, and access, as well as on elements
    of a political horizon for Palestinian statehood. I traveled to the
    region on March 23rd to continue discussions with the parties as well
    as with our Arab partners in the region. This trip resulted in
    agreement by Olmert and Abbas to hold regular meetings addressing
    practical issues affecting the quality of life of Israelis and
    Palestinians, as well as beginning to discuss some of the
    characteristics of a future Palestinian state, such as governing
    institutions and economic relations with Israel. These discussions
    should build confidence between the parties and begin to lay the
    foundation for meaningful negotiations leading to the establishment of
    a Palestinian state, consistent with the Roadmap.
        The last suicide bombing for which Hamas was responsible took place
    on January 18, 2005 in Gaza, killing an Israeli security officer and
    injuring eight other soldiers and security agents. In March of this
    year, Hamas claimed responsibility for shooting an Israel Electric
    Corporation worker near the Karni/al-Mintar crossing between the Gaza
    Strip and Israel, moderately wounding him. According to press reports,
    that same month, Egyptian authorities detained an alleged would-be
    Hamas suicide bomber next to the Israeli border as he awaited
    instructions to carry out a terrorist attack inside Israel.
        Individuals linked to Hamas were involved in the September 21, 2005
    kidnapping and murder of an Israeli citizen in the West Bank. According
    to claims by Hamas, al-Aqsa Martyrs Brigade, and the Popular Resistance
    Committees (PRCs), a number of terrorist attacks were perpetrated by
    one or more organizations acting together, including the January 13,
    2005 truck bombing of the Karni/al-Mintar cargo crossing terminal on
    the Israeli-Gaza border, which killed six Israeli civilians and wounded
    another five.
        In November 2006, President Abbas and Prime Minister Olmert agreed
    to a ceasefire in Gaza. Following this announcement, Hamas stopped
    launching rocket attacks into Israel. No action was taken, however, by
    the forces of the Hamas-led Interior Ministry to stop rocket attacks
    launched against Israel by Palestinian Islamic Jihad (PIJ) and the al-
    Aqsa Martyrs Brigade. Over recent weeks, as intra-Palestinian violence
    escalated, Hamas disavowed the ceasefire and Hamas and PIJ have been
    responsible for much of the recent spate of Qassam rocket attacks
    against Israel.
        The United States welcomes the Arab Peace Initiative, which
    provides a regional political horizon for Israel, complementing the
    efforts of the Quartet and of the parties themselves to advance towards
    peace.
        Question. According to recent press reports a current Israeli
    Government registry shows that more than 30 percent of property held by
    Israeli settlements in the West Bank is actually private Palestinian
    land. I have also read that the separation wall exacerbates this
    problem because in many places it does not follow the 1967 border and
    instead encroaches into the West Bank, cutting off villagers from their
    fields or access to water, and in some places dividing Palestinians
    from their neighbors. I've not heard anything from the administration
    on either of these issues. What is your position?
        Has the administration completed its review of Israel's use of
    cluster munitions in Lebanon last year, particularly during the final 3
    days of the conflict, and has it taken any action as a result of the
    findings of that review?
        Answer. The President stated in April 2005 that ``Israel has
    obligations under the roadmap. The roadmap clearly says no expansion of
    settlements. And we'll continue to work with Israel on their
    obligations. Israel should remove unauthorized outposts and meet its
    roadmap obligations regarding settlements in the West Bank.''
        The Government of Israel has legitimate defense needs to secure its
    border in response to attacks and infiltrations by those who commit
    suicide attacks against citizens. Our view remains that the barrier
    should be a security rather than a political barrier, should be
    temporary rather than permanent, and should therefore not prejudice any
    final status issues including final borders, and its route should be
    taken into account, consistent with security needs, its impact on
    Palestinians not engaged in terrorist activities.
        Regarding cluster munitions, the Department provided a report to
    Congress on this matter in January, and will continue to update the
    Senate Appropriations and Foreign Relations Committees staffs on this
    issue through additional briefings, including the results of the
    Government of Israel's ongoing internal investigation. As the contents
    of our agreements with Israel are classified, we are not in a position
    to provide further information in this letter.
        Question. Last year, when the White House announced that its survey
    indicated a slight rise in the price of cocaine in the United States
    over a period of 6 months, the State Department claimed it was proof
    that Plan Colombia was finally beginning to show the results we were
    promised. When this year's report was released and the survey showed
    that the price of cocaine had fallen to a new low, the administration
    said nothing.
        Since then, the only argument the administration makes that its
    counterdrug policy is working is that if the cocaine that has been
    seized or eradicated had made it to the United States, the drug problem
    would be worse. But that ignores the fact that the flow of cocaine is
    determined by the demand. There is no evidence that Plan Colombia,
    after $5 billion in U.S. aid, has made a dent in the availability or
    price of cocaine in this country.
        Your fiscal year 2008 budget request for Colombia is almost exactly
    the same amount for the same purposes as it has been for the past 5
    years. Isn't it time to evaluate why it isn't working, and try another
    approach?
        Answer. This question provides an important opportunity to examine
    and clarify what we are doing in Colombia and why we are doing it. The
    U.S. Government strategy against cocaine is based on the underlying
    principle of action against the early stages of drug production--to
    disrupt activities, eradicate crops and interrupt materials flow as
    much as possible in the source zones.
        A key goal of Plan Colombia's comprehensive approach, which
    encompassed our strategy plus the strengthening and expanding of
    government presence, eradicating and interdicting the drugs that fueled
    the conflict, and implementing alternative and social development
    programs, was to reduce significantly the supply of cocaine to the
    United States. Although these measures arrested, and temporarily
    reversed, the almost unfettered increase in coca cultivation that
    occurred through 2001, they did not permanently diminish the supply of
    cocaine to the degree necessary to increase its price significantly or
    reduce its purity on U.S. streets.
        Contrary to the assertion in the question, cocaine supply is not
    solely determined by demand. The supply of a substance as addictive and
    as aggressively marketed as cocaine itself influences the level of
    demand. Suppliers are in the business of expanding their market, and
    they use whatever means available to them. Also, one explanation for
    the reported lack of progress on price and purity could be that because
    U.S. cocaine use has steadily declined over the same period, it simply
    takes less product to meet market demand.
        We continue to believe that the removal of hundreds of metric tons
    of cocaine from the supply chain every year (approximately 500 MT in
    2006 alone) through United States-supported eradication and
    interdiction efforts has a very real and positive impact on cocaine
    availability, as well as a very real reduction in illicit drug
    finances. Conversely, because those eradication and interdiction
    efforts place the illicit drug industry under great pressure, abatement
    of those efforts would yield real and negative results.
        More broadly, we do not believe that the price and purity of
    cocaine in the United States should be the primary benchmark by which
    the success of foreign assistance to Colombia in general, and support
    for Plan Colombia in particular, is measured. Colombia's democratic
    security policy--and the paramilitary demobilization--has strengthened
    Colombia's democratic institutions, and led to substantial improvements
    in human rights protection. Murders are down almost 40 percent, from
    29,000 in 2002 to 17,300 in 2006. Colombia's aggregate homicide rate is
    at its lowest level since 1987. Kidnappings fell 75 percent over the
    same time period, from 2,885 to 687. Victims of massacres fell from 680
    in 2002 to a little over one third that amount in 2006. The dispersion
    and decentralization of the coca crop in Colombia is a reflection of
    the dispersion and weakening of the cartels and terrorists that once
    threatened to overrun the country.
        The improved security climate has promoted Colombians' freedom to
    travel, work, socialize, and invest. Economic growth has averaged over
    5 percent since 2002. Civil society and political parties operate more
    openly than ever before. The labor-affiliated National Unionist College
    reported that murders of unionists fell by over 60 percent between 2001
    and 2006. The number of human rights defenders killed or missing
    dropped from 17 to 4 over this same time period. Much of this
    improvement can be attributed to greater government control and
    participation, brought about by the improved security situation
    generated by our eradication and interdiction efforts.
        In most categories by which we can measure the success of our
    foreign assistance investment, Colombia is vastly improved over its
    pre-Plan Colombia days. Indeed, it is difficult to imagine another
    country in which U.S. foreign assistance has produced more impressive
    returns. Of course, many serious challenges remain, including bringing
    perpetrators of crimes against humanity to justice and providing
    alternative livelihood opportunities for those now compelled by
    coercion or economic circumstance to collaborate with drug traffickers
    or to engage in armed actions against the legitimate government.
    However, exclusively defining foreign assistance success in Colombia by
    the price and purity of cocaine in the United States, or by the number
    of hectares under coca cultivation, overlooks these broader successes.
        Moreover, eradication and interdiction are reasonable law
    enforcement efforts in their own right. Growing coca is illegal in
    Colombia. Transporting and processing coca, coca base, and cocaine are
    also illegal. The terrorist groups and others which these illegal
    activities fund are a threat to Colombia's democratic society.
        We are not advocating continuance of the status quo without
    critical review and development of more effective strategies. Indeed,
    we have been engaged with the Government of Colombia for over a year in
    developing a new strategy that would carry through fiscal year 2013 and
    that, subject to yearly Congressional approval, would shift funding to
    social programs and reduce by one third U.S. funding to law enforcement
    and military (``hard side'') programs. In the near term, we are looking
    for ways to strengthen the Prosecutor General's office and produce
    movement on longstanding cases. In addition, we are continually
    reviewing operational strategy and tactics to find more efficient and
    effective methods. A prime example is the change to our aerial
    eradication strategy in which we stay longer in the three primary
    growing areas, instead of trying to spray every major and minor growing
    area once a year. This new strategy is designed to directly address
    replanting and break the cultivation cycle.
        However, as long as illicit drug trafficking remains a highly
    profitable enterprise, this battle will require the full array of law
    enforcement, military, alternative development, social, judicial, and
    economic assistance. The fiscal year 2008 budget request is similar to
    fiscal year 2007 in part because it is necessary to maintain aviation
    asset availability to keep eradication apace (including manual
    eradication, which is also partially dependent on United States-
    supported aviation assets).
        Aviation-intensive counternarcotics and counter-terrorism programs
    have filled a critical need in Colombia's war against drugs and
    terrorist groups. The Colombian Government has clearly stated that
    continued U.S. support for these programs remains critical, and that,
    for now, our proposed mix of U.S. assistance continues to reflect their
    most urgent needs.
        Question. You recently certified that the Colombian Government and
    military have met the human rights conditions in our law. According to
    information we have received from the United Nations, the Procuraduria,
    and the Colombian Commission of Jurists, extrajudicial killings by the
    Army rose sharply last year, to between 150-250 depending on the source
    of the information. Did the Embassy discuss these cases with the United
    Nations, the Procuraduria, or the Colombian Commission of Jurists prior
    to making the certification? If so, what conclusions did the Embassy
    reach as a result of those discussions? Why, given this negative trend,
    did you certify substantial progress? Has anyone been convicted of any
    of those crimes?
        The United Nations and the Colombian Commission of Jurists also
    estimate over 800 targeted killings by paramilitaries, despite the
    demobilization, last year. Has anyone been convicted of any of these
    crimes?
        What has the Embassy done to determine whether paramilitary
    commanders in the Itagui prison are continuing to engage in criminal
    activity? In light of recent revelations that they were apparently
    using cell phones to continue committing killings and other crimes, has
    the Colombian Government ordered the cell phones removed? Was the
    Colombian Government legally monitoring paramilitaries' calls?
        We are told that Mancuso has confessed that General Rito del Rio
    collaborated with the AUC, and that he told the AUC which areas of the
    country they could control. Is it true that President Uribe publicly
    praised Rito del Rio in a ceremony organized to honor del Rio after the
    United States revoked his visa and after he was fired from the Army?
    What is the Fiscalia doing to investigate the allegations against del
    Rio? What is the Fiscalia doing to investigate other members of the
    military named by Mancuso?
        Answer. The Embassy discussed the issue of alleged extrajudicial
    killings with the U.N. High Commissioner's Office on Human Rights, the
    Colombian Commission of Jurists (CCJ), and the Inspector General's
    Office (Procuraduria), as well as with the International Committee of
    the Red Cross (ICRC). The Embassy has also emphasized to the Prosecutor
    General's Office (Fiscalia), the Minister of Defense, the Armed Forces
    and Army Commanders, and the Procuraduria the need to investigate these
    cases in a rapid and thorough manner and to review military practices,
    training, and doctrine to prevent such cases from occurring.
        The CCJ provided the Embassy with information that showed 93 people
    were allegedly killed or disappeared by paramilitaries in the first
    half (Jan-July) of 2006. During the period June 2005 to July 2006, the
    CCJ reported 354 individuals were allegedly killed by paramilitaries,
    down from the 1,234 reported during the comparable period from June
    2003 to July 2004. The Fiscalia told us it currently has multiple cases
    open against former paramilitaries, but was not able to provide an
    exact nationwide figure. The Fiscalia also said there have been
    convictions over the past year, but that the Human Rights unit does not
    have centralized statistics on the exact number of convictions.
        The Fiscalia has 77 cases of extrajudicial killings open at the
    moment, with a total of 133 victims. According to the Fiscalia, there
    are 48 members of the military now in preventive detention in
    connection with these cases. The Procuraduria has since told the
    Embassy that 131 cases of alleged forced disappearance committed by the
    military have been reopened. We will continue to follow these cases.
        There is an ongoing investigation by a USG law enforcement agency,
    in cooperation with the Colombian authorities, of criminal activities
    allegedly being committed by former paramilitary commanders currently
    in Itagui prison. The Colombian government reports that paramilitary
    leaders held in Itagui--who have the formal status of negotiators in
    the paramilitary process--enjoy access to cell phones similar to that
    provided to ELN negotiators Francisco Galan and Juan Carlos Cuellar.
    Colombian law enforcement agencies are investigating the alleged
    involvement of paramilitary commanders in Itagui in criminal
    activities, but have not ordered the cell phones be removed. Colombian
    National Police Commander Oscar Naranjo has since told the Colombian
    Congress that the Police's monitoring of communications in Itagui was
    legal. The Fiscalia and the Procuraduria are reviewing the monitoring
    and will make a determination regarding its legality.
        According to the Fiscalia, currently there are no active
    investigations linked to Mancuso's testimony. In particular, General
    Rito Alejo del Rio is not presently under investigation by the
    Fiscalia. However, the Fiscalia plans to follow-up with Mancuso
    regarding his testimony that concerns General del Rio; it will make a
    decision on whether to reopen the case and undertake a formal
    investigation at that time.
        We understand that the Inspector General has reopened its
    investigation into General del Rio's actions while serving as commander
    of the 17th Brigade, as a result of disclosures from the paramilitary
    investigations. The reported praise of del Rio by President Uribe
    occurred at a dinner at the Hotel Tequendama in Bogata in May 1999.
    This was 2 months before the United States revoked his visa.
        Question. What will it take to get a U.N. peacekeeping force
    deployed of sufficient size to stop the genocide in Darfur? Is it just
    a question of how much international pressure the Sudanese Government
    can withstand? Where does that pressure need to come from? What is the
    administration doing, since past efforts have failed?
        Answer. The United States and the international community are
    firmly committed to resolving the crisis in Darfur and bringing
    sustainable peace to Sudan. Transition of the current African Union
    Mission in Sudan (AMIS) to a more robust United Nations/African Union
    (U.N./AU) hybrid peacekeeping operation remains a policy priority for
    the United States and its allies. However, President Bashir continues
    to defy his international obligations and reject the deployment of an
    U.N.-led hybrid force in spite of previously stated support for the
    Addis Ababa framework of a three-phased peacekeeping plan to Darfur.
        We believe that continued unified multilateral pressure from key
    players, including members of the U.N. Security Council, European
    Union, AU, and Arab League is required to convince the Government of
    Sudan (GoS) to accept the U.N./AU hybrid force with U.N. command and
    control structures that conform to U.N. standards. We continue to reach
    out to international partners in the United Nations and European Union
    to urge sustained pressure on Khartoum. We believe that all options
    must remain on the table. This includes possible multilateral and
    further bilateral sanctions.
        In preparation for the hybrid deployment, we are also working with
    the United Nations and our international partners to accelerate
    implementation of the Addis Ababa framework and to mobilize potential
    Troop Contributing Countries (TCCs) to contribute to a stronger Darfur
    peacekeeping mission. This includes U.S. logistical support for the
    United Nations Light Support Package to AMIS to bolster the current
    mission on the ground and facilitate transition to a robust hybrid
    operation as well as training and equipping of additional TCCs through
    the African Contingency Operations Training and Assistance (ACOTA)
    program.
        Question. Do we have any evidence of the existence of terrorist
    assets in Cuba?
        Your [U.S. State Department Country Report on Terrorism] report
    says Cuba did ``not undertake any counterterrorism efforts.'' Does that
    make them a state sponsor of terrorism? Your report says Cuba continued
    to provide ``safe haven'' for members of Colombian rebel groups. But
    according to the Colombian Government, Cuba has been acting as a
    facilitator for peace talks between the government and these groups.
    How does this make them a state sponsor of terrorism?
        Answer. Cuba has been on the State Sponsors of Terrorism list since
    1982. The decision to place Cuba on that list was originally based on
    Cuban support for terrorist insurgencies attempting to overthrow
    democratic governments in Latin America.
        Cuba has provided on-going safe haven to several U.S. designated
    terrorist organizations such as the FARC, ELN, and ETA. If Cuba were
    serious about fighting terrorism, it would renounce the support it
    offers to these terrorist groups, arrest members and seize their
    assets. The fact that the Cuban government allows the presence of these
    groups in Cuba is an indication that terrorist assets or support
    structures exist as well. Cuba's role in dialogue between Colombian
    terrorist organizations and the Colombian government does not discount
    the support it provides these terrorist organizations.
        Cuba also remains on the list since it continues to harbor
    fugitives from U.S. justice, including Joanne Chesimard, who escaped
    from prison after her conviction for the murder of a New Jersey State
    Trooper while a member of a domestic terrorist group. In addition, Cuba
    provides shelter to Victor Manuel Gerena, an FBI Top-Ten Most Wanted
    fugitive. Gerena, a member of the ``Macheteros'' terrorist group,
    participated in the 1983 armed robbery of an armored car that netted $7
    million.
        Question. Why are we backing a general who seized power in a coup
    and has used his position to weaken democracy and the rule of law in
    Pakistan, without clear benchmarks with which to measure progress on
    democracy and human rights?
        Answer. We have made it clear to the Pakistan Government that we
    expect Pakistan's upcoming national elections, which are likely to take
    place in late 2007 or early 2007, to be free and fair. In those
    elections, Pakistani voters will have the opportunity to select the
    government that will lead the country forward.
        We have also been clear to the Pakistan Government about our
    appreciation for the enduring, substantial support that President
    Musharraf has provided in the Global War on Terror--and we have been
    clear that we believe that his vision of ``enlightened moderation''
    represents a positive future for Pakistan.
        During meetings in Islamabad in March 2006, President Musharraf and
    President Bush agreed the United States would support Pakistan as it
    builds strong and transparent democratic institutions and conducts free
    and fair elections to ensure sustainable democracy. We continue to
    support these goals.
        President Musharraf has stated that his plan remains the same--to
    move toward a civilian-controlled democracy. We have seen some positive
    progress in Pakistan in key areas such as electoral reform, women's
    rights, local governance, and--despite recent setbacks--freedom of the
    press.
        To take a few examples: in the area of election reform, Pakistan--
    with USAID assistance--is assembling the highest-quality and most-
    reliable electoral roll in its history, to be finished in time for the
    upcoming national elections. In the civil liberties arena, in December
    2006 President Musharraf signed the Women's Protection Act amending the
    Hudood Ordinance, marking a significant step toward improving the legal
    rights of women in Pakistan by allowing criminal courts (rather than
    religious courts) to try rape cases. The act marks the first time in
    nearly three decades that a Pakistani government has rolled back
    discriminatory laws that have stood virtually untouched since the time
    of General Zia-ul-Haq. In the area of local governance, the devolution
    reforms implemented by the Government have increased public access to
    local government, and government accountability.
        We have also seen, over the past 6 or 7 years, significant
    increases in the freedom of the Pakistani press and in the Pakistani
    public's access to reliable information and outspoken views in the
    media. We have made our views clear that this is a trend that must
    continue, and that cannot be set aside or reversed. We urge the
    Pakistan government to continue their progress by holding free and fair
    multi-party elections as scheduled in 2007 or early 2008 that meet
    international standards.
        As the President recently stated, ``We have a fundamental interest
    in the success of Pakistan as a moderate, stable, democratic Muslim
    nation.''
        Question. When Speaker Pelosi met recently with Syrian President
    Assad, the White House accused her of meddling in foreign policy and
    undermining the administration's efforts to isolate Syria. However,
    when other Members of Congress, including Republicans, met with Assad,
    the White House said nothing. And in Egypt recently you met with
    Syria's foreign minister in what were described as substantive and
    professional discussions. Is the administration's position that it is
    okay for Republicans to meet with the Syrians, but not Democrats? Or
    that it is okay for the administration, but not Congress?
        Answer. In an effort to ensure that the legislative and executive
    branches of the U.S. Government deliver the same message that Syria
    must change its behavior on a broad range of issues, the Department
    continues to advise against Congressional travel to Damascus. High-
    level United States visits to Damascus are exploited by the Syrian
    regime to demonstrate a degree of legitimacy and international
    acceptance that Syria has not yet earned.
        The United States remains committed to maintaining peace and
    security in the region. To this end, we continue to review what tools
    are available to pressure the Syrian regime into changing its behavior.
        The Syrian Foreign Minister and the Secretary's discussion on the
    margins of the Expanded Iraq Neighbors' Conference meeting in Sharm el-
    Sheikh was limited to Iraq. Moreover, the Secretary relayed to the
    Syrians that we have no desire to have bad relations with Syria. As the
    Secretary said, ``the Syrians clearly say that they believe that
    stability in Iraq is in their interest, but actions speak louder than
    words we will have to see how this develops.'' Before we can accept
    Syria into the international community, ``there need to be concrete
    steps that show that on the Iraqi issue, for instance, that there is
    actually going to be action.''
        Question. You have already heard many of us mention China this
    morning. China is our fastest growing competitor on every front, but
    the rule of law is often violated by Chinese authorities and civil
    society has few rights. The courts are not independent and there are
    almost no checks on government power.
        Each year, Senator McConnell when he was Chairman and I, as well as
    Senator Specter, have tried to increase our assistance for rule of law
    and justice programs in China. Yet each year, the administration
    proposes to cut these programs. For fiscal year 2008 you propose only
    $1.3 million. How can we have a meaningful impact on issues as
    important as these in a country of over 1.2 billion people with such a
    tiny amount of money?
        Answer. We share Congress' support for rule of law, public
    participation and civil society programs in China.
        We concur with your assessment and concerns that China's
    authoritarian system and a lack of judicial independence pose enormous
    challenges for reform. However, within these constraints, our China
    programs are working to foster judicial independence and legal reform;
    improve citizen access to legal services; increase the capacity of
    legal professionals; and help to produce better laws through public
    participation and strategic assistance from outside experts.
        We hope to have a long-term impact because these programs foster
    the growth of civil society both as a counterweight to the government
    and a provider of public services.
        A substantial amount of Governing Justly and Democratically
    programming in China is supported by funds from the Human Rights and
    Democracy Fund, administered by the Bureau of Democracy, Human Rights,
    and Labor (DRL). By the end of this fiscal year alone, DRL will have
    openly competed and awarded $19.8 million in 25 grants using fiscal
    year 2006 appropriated funds. While democracy and rule of law
    development are long-term efforts, programs have already produced
    concrete successes that are indicative of greater changes to come. For
    example, in the area of women's rights, provincial level stakeholders
    used DRL-supported technical assistance to advocate and win passage of
    refinements to workplace sexual harassment laws in six provinces--
    including definitions and forms of sexual harassment that provide
    greater clarity than national law. DRL assistance is also helping to
    clarify judicial interpretations on sexual harassment claims. These
    clarifications and refinements will afford women greater protection
    from sexual harassment and form the foundation for future legal reform.
        For fiscal year 2008, DRL intends to dedicate $5 million out of the
    $35 million requested for the global Human Rights and Democracy Fund to
    programs in China. This figure is a product of the new Foreign
    Assistance Framework and the USG's prioritization of China as a country
    of high importance. DRL will continue to include rule of law issues in
    its competitive calls for proposals to support the best initiatives
    proposed by partners in the NGO and academic communities.
        Additionally, our Bureau for International Narcotics and Law
    Enforcement Affairs continues to use International Narcotics and Law
    Enforcement funds to support a Department of Justice Resident Legal
    Advisor (RLA). The RLA provides Chinese government officials, jurists,
    and academics with expertise on U.S. criminal law and procedure, and to
    promote long-term criminal justice reform in China consistent with
    international human rights. To this end, the RLA seeks to facilitate
    contacts between the United States and China, and introduce Chinese
    officials to U.S. justice sector values and practices.
        USAID also is carrying out significant rule of law programs in
    China through partnerships between United States and Chinese
    universities. In 2006, USAID provided $5 million, in line with the
    Congressional mandate, to university partnerships in the area of rule
    of law and the environment. A partnership between Vermont Law School
    and Sun Yat-sen University is strengthening environmental rule of law
    in China, focused on application and enforcement of environmental
    regulations. A consortium including the University of the Pacific
    McGeorge School of Law and American University's Washington College of
    Law with the South China University of Technology and Zhejiang Gongshan
    University focuses on the application of law in practice. Another
    premier college of law in China is expected to join the consortium in
    the coming year.
        In 2007, USAID will be providing another $2 million for rule of law
    and $3 million for environmental governance programs, and has requested
    another $5 million for fiscal year 2009.
        Question. You propose to cut our aid to Russia from $84 million in
    fiscal year 2007 to $52 million in fiscal year 2008. If this aid was
    for the Russian Government I would agree with that. But most is to
    support Russia's beleaguered democratic forces and for health and other
    programs to help the Russian people, who number over 140 million. So
    far, your efforts to strengthen democracy in Russia seem to have
    failed. What is your policy toward Russia today?
        By comparison, you propose $71 million for Ukraine with 46 million
    people and $35 million for Armenia with 3 million people. Given
    Russia's problems, why do you believe that $52 million is adequate?
        Answer. Our policy toward Russia is to cooperate when we can and to
    push back when we must. We work well and closely with Russia on
    counterterrorism, many non-proliferation issues, and nuclear issues. We
    have discussed our concerns over Russia's backsliding on democracy
    issues and relations with its neighbors.
        This decline in the request for Russia reflects, in part, Russia's
    high economic growth rates and the related decision to phase out
    economic reform assistance for Russia. fiscal year 2008 is the first
    year where no funds are budgeted for assistance in this area. Democracy
    programs in Russia remain a top U.S. priority, with particular focus on
    helping to strengthen civil society, democratic institutions,
    independent media, and the rule of law. As in previous years, over half
    of the Russia budget (in fiscal year 2008, approximately $26.2 million)
    will continue to be devoted to supporting efforts to promote democracy
    and rule of law.
        The reduced request for civil society programs this year is based
    on the expectation that support for democratic development will be
    bolstered by over $180 million recovered from previous activities: The
    U.S.-Russia Investment Fund (TUSRIF) will invest its profits in a new
    foundation that will give grants to support entrepreneurship, the rule
    of law and the free flow of information in Russia. Funds recovered
    through the settlement of a civil lawsuit against a USAID contractor
    will be programmed to bolster Russian civil society groups.
        Combating HIV/AIDS is also a priority, given that Russia has one of
    the fastest growing epidemics in the world. President Putin joined
    President Bush in recognizing HIV/AIDS as a threat to Russia's national
    security and has made fighting the disease a priority. As a result of
    programs in this area, United States and Russian lab specialists are
    working side by side to strengthen HIV/AIDS laboratory capacity in
    Russia and Africa. Funding in this area will increase to $11 million in
    fiscal year 2008. U.S. programs also support joint efforts with Russia
    to combat transnational threats such as organized crime, drug
    smuggling, trafficking in persons, cyber-crime, and terrorist
    financing.
        In the North Caucasus, the Russian Government's unwillingness to
    meet the needs of internally displaced persons exacerbates regional
    instability and creates an environment ripe for extremism. fiscal year
    2008 funding will also support conflict mitigation programs in the
    region as well as humanitarian assistance to help stem the spread of
    violence and promote health, sanitation, and community development.
        Question. Your fiscal year 2008 budget would cut aid for Guatemala,
    Honduras, and Nicaragua, three of the poorest countries in the
    hemisphere. Each of these countries is a source of illegal immigrants
    to the United States. Why does this make sense?
        Answer. The Americas are an important priority for the
    administration. Overall foreign assistance to the region has nearly
    doubled since the start of this administration, from $862 million in
    fiscal year 2001 to $1.5 billion in fiscal year 2008 (requested). This
    amount does not include MCA compacts.
        The traditional bilateral assistance programs for Guatemala,
    Honduras, and Nicaragua in fiscal year 2007 are reduced from their
    fiscal year 2006 levels. However, pending the final fiscal year 2007
    allocations, we expect that all three bilateral programs will be
    increased in fiscal year 2008. It is important to note that our
    bilateral programs do not reflect the totality of our assistance. For
    example, in fiscal year 2008, we requested $40 million for the regional
    CAFTA-DR TCB program focused on helping these economies take full
    advantage of the benefits of the CAFTA-DR Free Trade Agreement. USAID
    also administers several significant development programs focused on
    health, education, and environment throughout Central America. The
    Peace Corps is also very active with robust programs in all three
    countries.
        In addition to traditional foreign assistance programs, the United
    States contributes to the region through innovative mechanisms such as
    the Millennium Challenge Account (MCA) and debt relief programs. The
    Millennium Challenge Corporation (MCC) has approved five-year compacts
    for Nicaragua ($175 million) and Honduras ($215 million), and we are
    working closely with Guatemala to help them qualify for future MCA
    assistance.
        In his March 5 speech to the Hispanic Chamber of Commerce, the
    President announced several additional development initiatives for
    Latin America, including a $385 million expansion of a $100 million
    OPIC program that helps underwrite mortgages to families in the
    countries of Central America, and an agreement with the IDB to extend
    debt relief to the most highly indebted countries in the region
    (including Honduras and Nicaragua) by $3.4 billion. The latter would be
    in addition to an earlier agreement with the Group of 8 industrialized
    nations to reduce the debt of Latin America and Caribbean nations by
    $4.8 billion. That works out to about $110 for every man, woman, and
    child in these countries, monies that their government should use to
    invest in the education and health of their citizens.
        In 2006, the United States spent nearly $3 million and conducted 70
    medical readiness and training exercises, or MEDRETEs, in 18 countries
    throughout Central and South America and the Caribbean at an estimated
    cost of nearly $3 million. In 2007, we have already conducted 65, in 15
    countries, including activities in Guatemala, Honduras, and Nicaragua.
    Combined, the MEDRETEs provide medical care to more than 200,000
    individuals--in many cases the only professional medical care they will
    receive.
        Additionally, Health and Human Services Secretary Mike Leavitt and
    his Panamanian counterpart just inaugurated during the OAS General
    Assembly the ``Initiative for Health Diplomacy in the Americas,'' which
    is providing technical and financial resources from the U.S. Government
    and private-sector to improve health care for people in Central
    America. One of the main objectives of this initiative is to train
    community health workers and nurses from across Central America in
    providing basic preventive care and in responding to infectious disease
    outbreaks. We remain committed to assisting governments to address the
    needs of their peoples, and are now taking advantage of non-traditional
    ways to do so.
        Question. The Millennium Challenge Corporation was established in
    2003, and since then we have appropriated $5.9 billion for it. The MCC
    has signed 11 compacts to date and six more are projected in 2008. To
    date, $3 billion obligated and only $68 million has been disbursed to
    governments, much of which has not actually been used yet to purchase
    anything. What has actually been accomplished with the funds?
        Answer. Early year MCC disbursements have been admittedly modest,
    but we are working with MCC to match disbursements with expectations.
    During a typical 5-year Compact, MCC generally expects to disburse less
    than 8 percent of total funds during the first year, nearly 28 percent
    the second year, around 31 percent the third year, 22 percent the
    fourth year, and 11 percent during the final year as projects and
    related contracts are completed. This is consistent with large project
    implementation even in the private sector. While actual disbursements
    are modest at around $84 million, contracts and commitments
    (administrative reservations of funds not based on legally binding
    transactions or documents) are nearly double that amount. In
    Madagascar, MCC's first Compact partner country, 23 percent of the
    total Compact amount has been committed.
        MCC has every intention of using the entire amount obligated to
    each and every Compact and Threshold partner country, but in many cases
    MCC's high standards--on procurement processes, environmental and
    social impact mitigation, monitoring and evaluation--have slowed down
    the process. In some cases, disbursements are triggered only when
    conditions precedent, as spelled out in Compact and Threshold
    documents, are met. Indeed, we often remind countries that MCC should
    not be taken for granted, since continued engagement is conditional on
    good policy performance. That is one of the core principles of the
    Millennium Challenge Account, distinguishing it from foreign assistance
    policies of the past.
        However, MCC's high standards are not the only reason behind modest
    disbursements. In some cases, MCC overestimated country capacity or
    misjudged the political independence of the programs. MCC works with
    host countries as partners, but sometimes those partners are slow to
    establish key structures, have complex plans or government systems, or
    lack the full technical capacity to manage and implement the programs
    they propose.
        To address these problems, MCC is offering better guidance to
    partner countries and developing standard operating documents. MCC is
    also conducting up-front analysis of host country capacity and
    developing explicit capacity-building plans, which include specialized
    training. In addition, MCC is using 609(g) authority to provide pre-
    Compact funds to establish systems and structures needed to get a
    Compact implemented. Finally, MCC is developing more realistic first-
    year disbursement projections.
        To date, MCC has signed 11 Compacts worth a total value of $3
    billion. MCC expects that two more will be approved and signed within
    the coming weeks, another before the end of the fiscal year, and four
    more early in fiscal year 2008. MCC hopes to conclude another four
    later in fiscal year 2008. Indeed, the eight Compacts in the pipeline
    for fiscal year 2008 total roughly $3 billion, the amount the President
    put forward for MCC in his fiscal year 2008 budget request.
        As MCC Board Chair, I plan to follow-up with MCC on the issue of
    disbursements and budget pipelines to ensure that MCC budget requests
    are fully aligned with these realities and, just as importantly, so
    that partner country expectations regarding rewards for good policies
    and consequences for bad behavior are met. This will ensure that the
    MCC's positive multiplier effect will continue to influence host
    country actions and encourage constructive policy reforms within MCC
    partner countries and beyond.
        Question. For years, an amendment Senator McConnell and I wrote has
    conditioned a portion of our aid to Serbia on its cooperation with the
    war crimes tribunal at The Hague, including apprehending and
    transferring to The Hague former Bosnian Serb leaders Ratko Mladic and
    Radovan Karadzic.
        We know the Serb Army helped protect Mladic, and he remains at
    large. The Serbs say Karadzic is not in Serbia, but that suggests they
    know where he is. The Hague prosecutor says he is there. How is it
    possible that two of Europe's worse war criminals have escaped justice
    for so long? Can we count on you to make clear to the Serb authorities
    and to the European governments that the United States will oppose
    their entry into NATO and other regional economic and security
    organizations unless these men are turned over?
        Answer. We continue to make clear publicly and privately that
    Serbia needs to fully cooperate with the International Criminal
    Tribunal for the Former Yugoslavia before it can completely integrate
    into Euro-Atlantic institutions. While I am fully supportive of Serbia
    becoming part of a united Europe, whole, free, and at peace, and while
    many reforms have been successfully implemented, Serbia simply cannot
    complete its process of integration without several final changes.
    Fundamental to this is the full establishment of the rule of law,
    including the establishment of accountability for war criminals.
        Our policy has been a balanced one. By constructively engaging
    Serbia, encouraging integration, and offering some forms of assistance,
    we have increased our influence, given impetus to reformers within
    Serbia, and have moved our bilateral relationship forward. At the same
    time, we have made clear to the Serbian leadership that their ultimate
    goal of full integration and membership will not come to pass until
    they deal with this issue. This is a point we make in virtually every
    meeting we have with their political and military leadership. And we
    have consistently encouraged our European allies to do the same.
        Ensuring accountability for war criminals is a priority for this
    administration. In March of this year, we critically re-examined our
    efforts to secure the capture of the remaining ICTY fugitives in light
    of recent developments. I can assure you that I continue working to
    realize justice for the victims of atrocities in the Former Yugoslavia.
    As one example, we are currently working towards the establishment of
    mechanisms through which each of the five remaining ICTY fugitives will
    face justice even if their capture eludes us by the time the ICTY
    closes, currently scheduled for the end of 2010. This will send a clear
    signal that fugitives cannot out-wait justice.
        But we are not idly waiting for the remaining fugitives to turn
    themselves in. We are actively encouraging their apprehension. The
    State Department's Office of War Crimes Issues, in coordination with
    the Bureau of European and Eurasian Affairs, has been facilitating
    better cooperation among security services in the region in the
    handling of investigations of fugitives. To that effect, we have
    designated a regional liaison officer to assist war crimes cooperation.
        While it is a disappointment to me that Ratko Mladic and Radovan
    Karadzic remain at large, ultimately, responsibility lies with local
    authorities to apprehend those fugitives who are on their territory. We
    have seen progress recently, including, notably, the recent arrest of
    Zdravko Tolimir, one of the architects of the Srebrenica genocide, but
    we remain focused on the capture of Ratko Mladic and Radovan Karadzic.
        Question. In November 2006 an Indonesian court found Antonius
    Wamang guilty of leading an attack that left two Americans dead and
    eleven people wounded near the gold and copper mine of Freeport McMoRan
    in Timika, West Papua. The conviction of Wamang represents the success
    of years of diplomacy--only after years of pressure from your good
    offices did the Indonesian authorities bring anyone to justice for this
    assault on Americans. Six other men were charged in November as
    Wamang's accomplices. But questions remain about the evidence that
    links some of these men to the murders. Reverend Isak Onawame, a local
    human rights advocate who has met with congressional offices and State
    Department officials, helped convince Wamang to surrender. Reverend
    Onawame accompanied Wamang when he surrendered to FBI special agents in
    Timika. The FBI delivered Wamang, Onawame, and other men to the custody
    of Indonesian police officers. Alleged police mistreatment led to a
    ``confession'' of involvement by Reverend Onawame: he told the
    interrogators that he supplied the attackers with rice. Onawame and
    others have since recounted their statements, saying that they were
    made under duress. Is the administration aware of any credible evidence
    linking Reverend Onawame to the murder of American citizens?
        According to the ballistics evidence, 13 guns were fired in the
    attack, including M-16's, yet only three shooters were accounted for.
    The police who conducted the initial investigation concluded the
    military was involved, but the case was taken away from them. Does the
    administration know who supplied the bullets? Does the administration
    have any idea who fired the 10 other guns? What effort is being made to
    find out?
        Answer. The Department also welcomed the conviction of Antonius
    Wamang and his accomplices. The defendants were afforded legal counsel
    and a public trial. It is our understanding that, while the FBI
    continues to pursue investigative leads, it typically does not disclose
    details regarding pending investigations. To the extent the Committee
    is seeking other information regarding this matter, we suggest the
    Committee seek this information from the FBI.
        Question. There have been several cases recently of domestic
    employees, such as housekeepers and gardeners, working at embassies in
    Washington being exploited and abused, their passports seized, and
    being detained against their will by foreign diplomats. I understand
    that in 2000 the State Department informed foreign embassies that visas
    for domestic staff would only be considered if the embassy has a
    contract with the staff person and steps have been taken to ensure they
    understand the terms.
        What is the role of the State Department in ensuring the fair
    treatment of domestic staff at foreign embassies located in the United
    States?
        How is the Department monitoring and enforcing the requirement that
    foreign embassies have a written and understood contract with domestic
    staff?
        Have any visas been denied because of a lack of such contracts, or
    because of prior violations?
        Has the State Department ever pressured a foreign government to
    waive the immunity of any diplomats when there was credible evident
    that they were involved in a serious crime? Could that be done in cases
    of abuse of embassy domestic employees?
        Answer. The State Department has implemented several measures to
    address complaints that diplomatic personnel exploit foreign domestic
    workers. The Department has issued periodic diplomatic notes to
    diplomatic missions containing model employment contracts and
    underscoring the importance of humane treatment of domestic staff. In
    particular, the Department requires that in order for a visa to be
    issued to a foreign domestic worker to come to the United States to
    work for diplomatic or consular personnel, or persons working for an
    international organization, the worker and employer must have agreed to
    a contract that provides fair terms of employment. The contract must be
    in the worker's language and must provide that the worker will be paid
    minimum or prevailing wage, whichever is higher. The contract must also
    have other provisions intended to ensure fair treatment of the worker,
    e.g, a requirement that the worker be given his or her passport. If a
    visa is issued, the issuing consular facility also gives the worker a
    brochure explaining some basic rights of persons in the United States;
    that brochure has a ``hotline'' telephone number that can be called if
    a worker suffers abuse.
        Following issuance of the contract requirement, the numbers of
    visas issued have dropped:
        Fiscal year 1999: A-3/2,279 G-5/1,737
        Fiscal year 2000: A-3/2,486 G-5/1,737
        Fiscal year 2001: A-3/2,228 G-5/1,645
        Fiscal year 2005: A-3/1,227 G-5/998
        Fiscal year 2006: A-3/1,017 G-5/940
        Although there may be several reasons for this, inquiries received
    from consular officers concerning issuance of these visas suggest that
    the contract requirement, coupled with instructions from the Department
    concerning treatment of these workers, has caused fewer visas to be
    issued.
        Recent complaints of abusive conditions that have been brought to
    the Department's attention have prompted Department offices to examine
    what additional steps may be appropriate. The Department plans to
    increase its efforts to obtain better compliance by embassy personnel
    with the registration requirement of the Vienna Convention on
    Diplomatic Relations and to draw to the attention of the diplomatic
    community the importance the Department and other U.S. agencies place
    on compliance with U.S. laws and fair treatment of these workers.
    Additionally, the Department is reviewing the visa issuance process for
    these workers.
        When potential cases of abuse arise, it is the Department's policy,
    stated in internal regulations (2 FAM 234), to request a waiver of
    immunity of a diplomat if a prosecutor informs the Department that
    ``but for immunity'' the prosecutor would bring criminal charges
    against a diplomat. This rule is equally applicable to cases of abuse
    of domestic staff. It is important to underscore, however, that many
    members of the diplomatic community, e.g., most consular personnel and
    employees of international organizations, will likely not have immunity
    from either criminal prosecution or civil suit involving abuse of
    domestic staff, so that no waiver of immunity is required for criminal
    and civil actions.
        Question. I understand that when Deputy Secretary Negroponte was in
    Libya last month he raised the case of the Bulgarian nurses and
    Palestinian doctor who were re-sentenced to death last year for
    allegedly infecting children with HIV. Many scientists and physicians
    are concerned that the trial ignored evidence that the virus was spread
    through lack of safe hygiene in the hospital, which may deter other
    health professionals from working in the developing world where they
    might be subject to unfair prosecution. They believe it is important
    that the nurses and doctor not only be released but be exonerated.
        Is it the United States position that they should be exonerated?
    Did the Deputy Secretary ask that the Libyans exonerate them or just
    release them?
        Answer. Deputy Secretary Negroponte met with Libyan Foreign
    Minister Shalgam and other senior Libyan officials during his April 18-
    19, 2007, visit to Tripoli. In each of these meetings, the Deputy
    Secretary called upon the Libyan government to find a way to release
    the five Bulgarian nurses and Palestinian doctor imprisoned on charges
    of deliberately infecting over 400 Libyan children with HIV. The U.S.
    Government, including President Bush, has repeatedly expressed its view
    that there is no evidence to suggest that the medical personnel
    conspired to infect the children.
        At the same time, we recognize the human tragedy posed by the
    infection of more than 400 children. The United States is working with
    the EU, UK, and Bulgaria, to help Libya provide necessary medical and
    psychological care to the children and their families.
        Question. There has been a continuing failure to achieve
    accountability for crimes against humanity committed in East Timor in
    1999. At the end of April 2007, Indonesian General Noer Muis
    participated in a joint military exercise with the U.S. Army in
    Indonesia. On February 24, 2003, Muis was indicted with other senior
    officers by the U.N.-backed serious crimes process in East Timor.
    General Muis was tried and convicted for crimes against humanity by
    Indonesia's Ad Hoc Human Rights Court in 2003 for his role in brutal
    attacks on East Timor's Dili Diocese, Bishop Belo's residence and the
    Suai Church massacre in September 1999. However, his conviction, like
    most involving Indonesian military officers, was overturned on appeal.
        Did the State Department know that the U.S. Army was collaborating
    with General Muis, an indicted human rights violator? What does this
    say about the Department's ability to effectively vet lesser known
    military officers to weed out human rights violators, as required by
    U.S. law? What if any steps have been taken to prevent the recurrence
    of a mistake like this?
        Answer. The State Department knows Indonesian General Noer Muis has
    been indicted for war crimes for his role in the events in East Timor
    in 1999. General Muis did not participate in the two-week tabletop
    exercise that was recently conducted in Indonesia by elements of the
    U.S. Pacific Command with members of the Indonesian First Infantry
    Division Strategic Reserve Command (KOSTRAD). Rather, as commander of
    the KOSTRAD, General Muis observed a portion of the exercise for a
    single day. KOSTRAD provided most of the 850 Indonesian soldiers who
    deployed to Lebanon last year as part of the U.N. Interim Force in
    Lebanon (UNIFIL) and is expected to deploy another battalion to Lebanon
    later this year to replace the current battalion. Such exercises serve
    to prepare the Indonesian military (TNI) for peacekeeping duties. It is
    manifestly in our national interest and the interests of the United
    Nations that Indonesia participate in this and other peacekeeping
    operations.
        As required by law, all foreign security force personnel involve in
    State Department-funded training and assistance are subjected to
    vetting for past human rights violations, and known human rights
    violators are not provided such training. In the past 3 years we have
    denied 122 Indonesian applicants training, DOD requests vetting when
    they deem it necessary to comply with their statute and State responds
    to their requests.
        Our interaction with the TNI necessarily means that American
    military and civilian personnel work with those in positions of
    authority. When, in the course of our duties, we must engage with TNI
    leaders with troubling human rights backgrounds, we limit that
    engagement to official business and do not engage in social activities.
    We do not, however, refuse to engage with such individuals in the
    ordinary course of official business nor to accord them the normal
    courtesy that is due official counterparts; such actions would be
    counterproductive. The Department and Embassy Jakarta are working with
    Pacific Command to ensure that in the future such engagement is not
    publicized in a manner that appears to imply USG assistance or support
    for individuals with suspect human rights backgrounds.
        The extraordinary democratic transformation of Indonesia is one of
    the world's great successes of the past 10 years. As integral elements
    of Indonesian society, the Indonesian military (TNI) must be part of
    this transformation. Our interaction with the TNI facilitates the
    adoption of democratic norms such as greater transparency, respect for
    human rights, civilian control, and builds capacity to address
    immediate threats such as terrorism and natural disasters. Indeed,
    these democratic principles are a key component of all training that we
    provide to TNI, after vetting to ensure that gross human rights
    violators are excluded. Our normalized relationship with the TNI is
    producing enormous dividends, both in terms of improving respect for
    human rights and in promoting regional stability. The TNI is out of
    politics, is under civilian leadership, has abolished the ``dual
    function'' role under which military leaders often held positions in
    local civilian government, and is moving to divest itself of business
    interests. Allegations of human rights abuses in Papua and elsewhere
    have fallen steadily.
        We continue on a regular basis to insist in all appropriate fora
    for accountability for past human rights abuses, including during the
    recent Indonesian-U.S. Strategic Dialogue talks conducted by DOD, in
    public remarks, and in meetings with the country's senior leaders. Our
    consistent message is that Indonesia's partners will have more
    confidence in the deep and genuine reforms the Indonesian military has
    undertaken and continues to undertake if credible steps are taken to
    address widespread perceptions that a culture of impunity continues to
    exist.
        Question. Last year on October 27, a young American journalist,
    Bradley Roland Will, was killed as he was filming a political
    demonstration in Oaxaca, Mexico.
        There are photographs and video footage of municipal officials
    including police officers in civilian clothes shooting at demonstrators
    with rifles and pistols, the same day that Bradley Will was shot. At
    least 2 others were killed and 23 were wounded that day. More than 20
    people were killed during the many months that the demonstrations took
    place, and some of those who were arrested were reportedly physically
    and sexually abused in the custody of state and federal police
    officers.
        My office has tried unsuccessfully to get any information from the
    Mexican Government about the killings of civilians in Oaxaca, including
    Bradley Will. Are you satisfied with the investigation of Bradley
    Will's murder? Have any of the municipal officials or police been
    charged with any of the killings of civilians? Is there any hope for a
    thorough, independent investigation into the police conduct in Oaxaca
    during the demonstrations last year?
        Answer. The U.S. Embassy in Mexico City and the Department of State
    have been monitoring the ongoing investigation into the death of Mr.
    Will from the beginning. Embassy officials, including U.S. Ambassador
    to Mexico Antonio Garza, have expressed the concerns and interests of
    the U.S. Government and of the Will family to the Mexican federal and
    Oaxacan state authorities and have offered assistance to ensure a
    complete and proper investigation. The Mexican Government has conducted
    an investigation into the conduct of law enforcement during last year's
    demonstrations, but to date has not filed any charges against local or
    municipal police. The investigation remains ongoing. At this time no
    one has been charged in Mr. Will's death. We hope the involvement of
    the federal Attorney General's Office will move this case forward. The
    Embassy will continue to express our interest in the case at the
    highest levels of the Mexican Government until it is completed.
        Question. In March 2003, Rachel Corrie, a young American woman, was
    run over by an Israeli bulldozer and killed as she was peacefully
    protesting the destruction of a Palestinian family's property. An
    investigation was conducted by the Israeli military, who concluded it
    was a tragic accident. However, the Israeli investigation, which was
    neither thorough nor independent, satisfied neither the State
    Department nor Ms. Corrie's family. As far as I know, there has been no
    follow up. What is being done to obtain a thorough, independent
    investigation of this case involving the death of an American citizen?
        Answer. The Government of Israel conducted two separate
    investigations, one by the Israeli Defense Forces and the other by the
    Military Advocate General's Office. While the second investigation was
    more thorough, we nonetheless made clear to the Government of Israel
    that the investigation failed to meet the standard of thoroughness we
    would expect in such a case. The Corrie family has informed us that
    they are pursuing legal options with the courts in Israel against the
    Israeli Defense Forces. We continue to maintain contact with the Corrie
    family regarding the death of their daughter.
        Question. Despite two separate investigations into the death of
    Rachel Corrie by the Government of Israel, you noted that the
    Government of Israel's investigation ``failed to meet the standard of
    thoroughness we would expect in such a case.''
        Given that this case involved the death of an American citizen, and
    the inadequacies of the investigation by the Government of Israel, what
    further action is the administration taking to obtain an investigation
    that is thorough and credible?
        Answer. The U.S. Government takes matters involving American
    citizens abroad very seriously. In late October, representatives from
    the Department of State met with the Corrie family, along with
    Congressman Baird, to discuss concerns that they have have with respect
    to the tragic death of Rachel Corrie.
        The U.S. Government continues to raise this issue with senior level
    officials in the Israeli Government. On her recent trip to Israel and
    the Palestinian territories, Assistant Secretary of State for Consular
    Affairs Maura Harty raised the issue of Rachel Corrie's death with her
    counterpart at the Israeli Ministry of Foreign Affairs, Mr. Yigal
    Tzarfati. Assistant Secretary Harty gave Mr. Tzarfati a letter
    reiterating the U.S. Government's request that a full and transparent
    investigation of the incident be conducted. She has asked the U.S.
    Embassy in Tel Aviv to follow up with the Government of Israel in
    obtaining a response to her inquiry.
        Question. The Senator Paul Simon Water for the Poor Act of 2005
    commits the United States to support international clean drinking water
    and sanitation. The act calls on the United States to increase support
    for sustainable drinking water supplies and adequate sanitation in
    countries with the greatest need where aid can be used most
    effectively. Yet the State Department's June 2006 ``Report to
    Congress'' showed that U.S. aid for drinking water and sanitation is
    overwhelmingly spent on short-term emergency relief efforts and in a
    few strategically important countries like Afghanistan. Only $24
    million, less than 10 percent of the total, was used for long-term
    development projects. What plans does the administration have to
    allocate increased funds to support long-term, sustainable drinking
    water and sanitation projects, as called for by the act?
        Answer. USAID's fiscal year 2005 Report to Congress showed actual
    obligations of $161 million for drinking water supply projects and
    related activities. Of this amount, $96 million was obligated in the
    International Disaster and Famine Assistance Account (IDFA). While some
    of the IDFA resources are used for short-term relief efforts, these
    funds are also used to establish permanent wells and sanitation
    facilities or other facilities necessary for the longer-term provision
    of water and sanitation services. All of the remaining resources were
    used for long-term sustainable activities regardless of the account.
        In fiscal year 2006 (this report will be delivered to Congress
    shortly) USAID increased total water and sanitation obligations to $203
    million. Of this amount, $86 million came from the IDFA account. USAID
    hopes to maintain this increase in fiscal year 2007.
        Most of the countries with the greatest need are located in Sub-
    Saharan Africa. The attached spreadsheet shows that USAID non-IDFA
    funding for water and sanitation in Sub-Saharan Africa increased each
    year from 2002 thru 2006. Again, USAID hopes to maintain this upward
    trend in fiscal year 2007.

                                       2002-2006 USAID WATER OBLIGATIONS IN AFRICA
                                                [In millions of dollars]
    ----------------------------------------------------------------------------------------------------------------
                                                                         Fiscal year
                                                   -------------------------------------------------------   Total
                                                       2002       2003       2004       2005       2006
    ----------------------------------------------------------------------------------------------------------------
    Water Supply and Sanitation (non-IDFA)........      8.758      9.785     15.385     19.444     22.544     75.916
    IDFA-funded Water Supply and Sanitation.......     12.383     29.449     35.230     63.926     59.738    200.726
                                                   -----------------------------------------------------------------
          Sub-Total--Water Supply Projects &           21.141     39.234     50.615     83.370     82.282    276.642
           Related Activities.....................
                                                   =================================================================
    Water Resources Management....................      6.151     14.227     14.452      9.615      4.227     48.672
    Water Productivity............................      3.790     11.056     14.640     12.912      5.119     47.517
                                                   -----------------------------------------------------------------
          Grand Total--All Water Funding               31.082     64.517     79.707    105.897     91.628    372.831
           Categories.............................
    ----------------------------------------------------------------------------------------------------------------

        Question. I am concerned about human rights in Ethiopia. Ethiopia
    is a strategic ally, but that should not prevent us from expressing our
    concern about the well-being of Ethiopia's restive and increasingly
    alienated majority populations. From the populous and economically rich
    Oromo region to the vast oil rich Ogaden region, economic and political
    tensions seem to be rising.
        The leaders of Ethiopia's most important opposition party are still
    in prison. What is the evidence against them?
        Answer. Between May 8, 2006 and November 29, 2006, the prosecution
    introduced one audio tape, 19 video tapes, 179 documents, and 54
    witnesses in support of the charges against opposition, civil society,
    and media leaders in Ethiopia's main trial of opposition leaders. This
    evidence described opposition party strategies and deliberations,
    speeches, rallies, press reports, and activities of the defendants. On
    April 9, 2007, upon reviewing the witnesses' testimony and evidence
    submitted, the court dismissed the charges against 25 defendants and
    dismissed all charges of treason and attempted genocide. The court
    found that the evidence submitted in support of the remaining charges
    against the remaining defendants warrants proceeding with the defense
    phase of the trial, which is expected to resume in June 2007. The U.S.
    Government continues to monitor every phase of the judicial
    proceedings.
        Question. Even as the Ethiopian military ends its occupation of
    Somalia, the ethnic Somali people of the Ogaden region feel they are
    oppressed and exploited by the government in Addis Ababa. The largest
    group in this diverse country is the Oromos, and they, along with other
    political groups, are losing patience with what they see as a
    repressive central government.
        We have spent a lot of money to help promote stability in the Horn
    of Africa. Can you assure us that the administration is standing up for
    democracy and human rights even when they are being threatened or
    violated by allies against terrorism like Ethiopia?
        Answer. Significant work remains to be done to strengthen
    democratic institutions and practices and to ensure for the protection
    of human rights in Ethiopia. While our annual Human Rights Report is
    the most public assessment of Ethiopia's performance in protecting the
    human and political rights of Ethiopians, democracy and human rights
    issues remain a permanent element in our bilateral dialogue with
    Ethiopian leaders and civil society.
        The United States has developed a strong partnership with Ethiopia
    to foster progress in these areas. While our foreign assistance
    contributes to capacity building efforts targeting the legislature,
    judicial independence, executive functions, and human rights awareness
    and protection, American diplomats in Ethiopia and Washington urge
    Ethiopian officials to create the environment where improvements in
    these sectors can continue.
        While significant work remains, the Government of Ethiopia has
    taken steps to improve respect for human rights and democratic
    practices following the setbacks in 2005. Through U.S. diplomatic and
    development engagements, we are contributing positively to this effort
    and will continue to encourage important reforms.
        Question. You noted that ``while significant work remains, the
    Government of Ethiopia has taken steps to improve respect for human
    rights and democratic practices following the setbacks in 2005.''
        How has the administration responded to recent reports by
    journalists and NGOs of widespread human rights abuses by Ethiopian
    security forces in the Ogaden region?
        Answer. We take very seriously any and all allegations of human
    rights abuse. Our Embassy staff in Addis Ababa is working to verify
    credible allegations to the extent possible. The Ethiopian Government
    has committed publicly to investigate such allegations.
        We will continue to insist that credible allegations be
    investigated and, where appropriate, that violators are punished. The
    Government of Ethiopia is working with Mr. Kassa, Chairman of the
    Ethiopian Human Rights Commission, to investigate allegations of abuse
    in the Ogaden. Mr. Kassa's team is in Jijiga, on the edge of the
    Ogaden, investigating reports. We are in close contact with the Human
    Rights Commission and will work with this and other groups on any human
    rights enquiry. The United Nations has called for an independent
    investigation of human rights abuses in the Ogaden.
        Question. With the G-8 summit coming up in June, some of our allies
    are focusing on global education. In particular, on May 2, 2007, the
    European Commission and the World Bank hosted a conference on basic
    education in Brussels, entitled ``Keeping our Promises on Education'',
    where they announced a number of new funding commitments to be carried
    forward to the G-8. Are any new U.S. commitments for education planned
    for the G-8 or otherwise along these lines?
        Answer. USG has increased its support for basic education five-
    fold, from less than $100 million in fiscal year 2000 to more than $500
    million in fiscal year 2006, and in the same time period more than
    doubled the number of countries receiving basic education support from
    25 to more than 50.
        As a founding partner of the Education for All Fast Track
    Initiative, and signatory to the Paris Declaration on Aid
    Effectiveness, USG has in the past and will continue to align with
    other donors behind country-driven education plans and priorities to
    best meet the human capital needs for the sustainable development of
    each country.
        On May 31, 2007 President Bush called for Congress to fund $525
    million by 2010 or $173 million more a year in fiscal years 2008-2010
    for an estimated $638 million a year for basic education--a 37 percent
    increase over current spending and a 425 percent increase over fiscal
    year 2002 ($150 million) when the President's administration started.
    He also expanded his African Education Initiative, started in 2002,
    from $300 million to $600 million by 2010.
                                     ______

                    Question Submitted by Senator Tom Harkin

        Question. Polio Eradication efforts are clearly working as we have
    seen the number of countries with indigenous polio drop to four, two
    billion children have been immunized, five million have been spared
    disability and over 250,000 deaths have been averted from polio.
    However, until the world is polio-free, every child, even those in the
    United States, is at risk.
        In fiscal year 2007, both the House and Senate included $32 million
    for polio eradication in their respective Foreign Operations
    Appropriations bills.
        A. What amount is included for polio in your fiscal year 2007
    projections?
        B. What is included for polio in your fiscal year 2008 budget
    submission?
        Answer. For fiscal year 2007, USAID intends to provide $31,680,000
    for polio eradication, which meets the House and Senate request level
    minus a 1 percent rescission.
        For fiscal year 2008, the administration will fund polio
    eradication but specific funding levels are still under consideration.
                                     ______

                Questions Submitted by Senator Richard J. Durbin

        Question. For the coming fiscal year, the President requested only
    $300 million for the Global Fund to Fight AIDS, Tuberculosis, and
    Malaria in his budget and all of that in Labor Health and Human
    Services rather than the Foreign Operations account. The Global Fund
    estimated need for the U.S. contribution is $1.3 billion. Why is the
    President continuing to lowball this important multilateral program
    that leverages U.S. contributions? Why did the President omit the
    Global Fund entirely from his Foreign Operations request and place the
    entire request in the Labor, Health and Human Services account?
        Answer. The Global Fund is an important part of the strategic plan
    that guides implementation of the President's Emergency Plan for AIDS
    Relief (Emergency Plan/PEPFAR). The U.S. Government (USG) share of
    total Global Fund contributions has held consistently at approximately
    30 percent. The USG initially made a 5-year pledge of $1 billion for
    the Global Fund in years 2004-2008. If the $300 million in the
    President's 2008 Budget is approved, the USG will have nearly tripled
    that commitment to the Global Fund by contributing about $2.5 billion.
        In order to provide adequate financial and human resources to
    complete the goals of PEPFAR as well as maintain U.S. leadership in the
    Global Fund, the President has spread the request for HIV/AIDS-related
    resources across the two appropriations bills (Foreign Operations and
    Labor-Health and Human Services).
        We consider this interagency approach in representing the United
    States on the Global Fund to be one of our coordination success
    stories. Through the Global Aids Coordinator, who has overall
    responsibility for ensuring that all statutory benchmarks have been met
    before any USG contribution is made, USAID, State, and HHS regularly
    meet and fully coordinate on all aspects of the Global Fund.
        The Department of Health and Human Services (HHS) was instrumental
    in the administration's efforts to establish the Global Fund and
    continues to have an active role on its Board. The National Institutes
    of Health (NIH) makes a significant contribution to global HIV/AIDS,
    TB, and Malaria activities. Requesting the USG contribution within NIH
    continues HHS' longstanding role in the advancement of the Global Fund.
        Question. When Beijing exercises its considerable influence,
    Khartoum appears to listen and we see progress such as the agreement to
    allow 3,000 peacekeepers. But then China provides assistance to build a
    new presidential palace and wants to develop expanded military
    cooperation in all areas. How do you evaluate China's role in Darfur?
        Answer. China has an important role to play in ending the genocide
    in Darfur. China's leverage is not absolute, but there is much that it
    can do. For example, China can do more to persuade Khartoum to accept
    the full deployment of the U.N./AU hybrid peacekeeping force under U.N.
    command structures, and to convince Khartoum to engage seriously in a
    peace process that involves all parties to the conflict. China's lead
    diplomat at the United Nations, Wang Guangya, helped broker the
    November agreement in Addis Ababa in which the Government of Sudan
    accepted, in principle, the three-phase deployment of the U.N./AU
    force. As you mention, China's diplomacy was likely influential in
    convincing President Bashir to accept the 3,000-person ``heavy support
    package'' (HSP) under phase two of the deployment. Perhaps most
    significantly, Beijing recently agreed to send a 275-person engineering
    unit as part of the HSP. Special Envoy Natsios, Deputy Secretary
    Negroponte, and Assistant Secretary Frazer have all had serious, in-
    depth discussions on Sudan with the Chinese, as have I.
        President Bashir has reneged on a number of his commitments and
    continues to obstruct the full deployment of the U.N./AU force under
    phase three. Full deployment is the key, and we are committed to
    working with China and our other international partners to apply
    pressure on President Bashir to accept the full U.N./AU force
    unequivocally.
        China is not where we would like it to be on Darfur. The no-
    interest loan to build a palace in Khartoum that you mention is one
    clear example. We have also communicated our serious concerns to China
    that weapons sold to the Government of Sudan have contributed to the
    violence in Darfur. At the same time, we do see movement in China's
    position and believe that Beijing has made a decision that it must join
    with the international community in insisting that the atrocities in
    Darfur must stop.
        Question. How is the Department of State addressing the
    geopolitical implications of global warming?
        Answer. We recognize the seriousness of global climate change and
    the importance of reducing greenhouse gas emissions, enhancing energy
    security and promoting sustainable development.
        Two years ago, G8 leaders agreed that tackling climate change,
    promoting clean energy and achieving sustainable development globally
    are serious and linked challenges. The President announced on May 31
    U.S. support to develop by the end of 2008 a new post-2012 framework on
    climate change based on the principles that climate change must be
    address by fostering both energy and economic security and by
    accelerating the development and deployment of transformational clean
    energy technology.
        Secure, reliable and affordable energy sources are fundamental to
    economic stability and development. One-third of the world's people
    lack access to modern energy services. This blocks their path to better
    health and prosperity.
        In consultation with our developing country partners, G8 leaders
    committed to reduce greenhouse gas emissions, improve the global
    environment, and enhance energy security in ways that promote human
    development.
        The United States plays an integral part in promoting the advanced
    energy technologies that are helping people, while protecting the
    global environment.
        The President has in place a comprehensive strategy to address
    climate change that incorporates incentives, mandatory programs, and
    international partnerships all that will help us meet the President's
    goal to reduce greenhouse gas intensity 18 percent by 2012. This policy
    is working as we are well on track to meet that goal. The U.S.
    Department of State supports the President's strategy in international
    fora and works closely with our international partners to implement
    innovative climate change partnerships.
        For example, we are working with Brazil to advance biofuels. We
    facilitated an agreement with China to install the largest coal mine
    methane power facility in the world. Through the Asia-Pacific
    Partnership for Clean Development and Climate, we are expanding
    investment and trade in cleaner energy technologies.
        Our development assistance program, through USAID, dedicates about
    $180 million a year to build resilience to climate variability and
    change in developing countries. Our efforts include analyzing data from
    Earth observations, developing decision support tools, and integrating
    climate information into development programs.
        All of these activities are part of a broader development agenda
    that encourages global collaboration to improve energy security,
    address greenhouse gasses and reduce air pollution, while ensuring
    continued economic growth. These activities aim to achieve a secure
    energy supply and a cleaner global environment.
        The most effective way to bolster security and stability, however,
    is to increase the capacity of states to govern legitimately and
    protect basic human freedoms. States that can govern effectively can
    best anticipate and manage change.
        Stresses associated with energy shortages or climate impacts may be
    among factors putting pressure on government capacity in this century,
    as might population growth, natural disasters, but absence of these
    stresses will not eliminate civil strife.
        Successful long-term development strategies must also focus upon
    education, rule of law, good governance, and the protection of human
    freedom and economic reforms. The State Department works with countries
    across the globe to promote this integrated development agenda and
    support countries in making choices that will provide strong and
    functioning institutions and policies, and promote just governance and
    rule of law. Such choices are a much more important determinant of
    peace and security independent of any specific climate or environmental
    impact.
        The United States has a long history of extending a helping hand so
    that people can live in democratic societies with strong and stable
    governance.
        The Millennium Challenge Corporation (MCC) is a global investment
    fund based on the principle that aid is most effective when it
    reinforces good governance, economic freedom and investments in people.
    Since its establishment in 2004, MCC has provided nearly $3 billion to
    11 countries to help them reduce poverty and stimulate economic growth.
        Around the world, the United States is promoting free and fair
    election processes, full participation of all citizens, civil
    societies, and media freedom. With our international partners, these
    efforts are strengthening governance and international security.
        The State Department will continue to promote the United States'
    leadership role of engaging with other nations on these issues of vital
    importance through our bilateral and regional initiatives and in
    appropriate multilateral fora, such as the G8 and the United Nations.
        Question. What about the anticipated consequences for health and
    development? Some of the most economically vulnerable and politically
    fragile countries are also those most at risk from global warming. What
    steps are you taking to assist adaptation EFFORTS?

                             HEALTH AND DEVELOPMENT

        Answer. On the potential health implications of climate change,
    impacts are difficult to discern due to adaptation and many non-
    climatic drivers. In addition, research continues to focus on effects
    in high income countries, and there remain important gaps in
    information for the more vulnerable populations in low- and middle-
    income countries.
        According to the Intergovernmental Panel on Climate Change (IPCC)
    Fourth Assessment Report, ``projected climate change-related exposures
    are likely to affect the health status of millions of people,
    particularly those with low adaptive capacity, through:
      --increases in malnutrition and consequent disorders, with
            implications for child growth and development;
      --increased deaths, disease and injury due to heat waves, floods,
            storms, fires and droughts;
      --increased burden of diarrhoeal disease;
      --increased frequency of cardio-respiratory diseases due to higher
            concentrations of ground level ozone related to climate change;
            and,
      --altered spatial distribution of some infectious disease vectors
            (high confidence).
        ``Climate change is expected to have some mixed health effects,
    such as the decrease or increase of the range and transmission
    potential of malaria in Africa (high confidence). Studies in temperate
    areas have shown that climate change is projected to bring some
    benefits, such as fewer deaths from cold exposure. Overall it is
    expected that these benefits will be outweighed by the negative health
    effects of rising temperatures world-wide, especially in developing
    countries (high confidence). Most projections suggest modest changes in
    the burden of climate-sensitive health outcomes over the next few
    decades, with larger increases beginning mid-century. The balance of
    positive and negative health impacts will vary from one location to
    another, and will alter over time as temperatures continue to rise.
    Critically important will be factors that directly shape the health of
    populations such as education, health care, public health prevention
    and infrastructure and economic development (very high confidence).''

                              ASSISTING ADAPTATION

        Climate shapes a wide range of activities and decisions, from the
    types of crops grown to the design and construction of buildings, water
    delivery systems, and other infrastructure. In countries that are
    already at risk from food insecurity, ecosystem degradation, or weak
    institutional capacity, short- and long-term changes in the climate
    pose an additional challenge to sustainable development. A diverse,
    robust, and open economy can better withstand many types of
    disruptions, including those related to climate events.
        The United States collaborates with developing country partners in
    a broad range of activities designed to better understand climate and
    its implications for development and to build resilience to climate
    variability and change. These activities include analyzing data from
    Earth observations, developing decision support tools, and integrating
    climate information into development programs and projects.
        All of these activities assist countries in developing stronger
    institutional capacity and more flexible and resilient economies that
    have the capacity to address both the challenges and the opportunities
    presented by changing climatic conditions.
        In addition, the United States encourages all developing countries
    to establish their own national development plans with the view to
    create thriving, prosperous economies in recognition that successful
    growth must be predicated upon education, rule of law, good governance,
    the protection of human freedom and economic reforms. This successful
    and proven approach underpins our wide range of programs and activities
    that assist all developing countries through our trade policies,
    development assistance programs, and international environmental
    initiatives, as well as our support for such internationally-agreed
    strategies as the Doha Development Agenda, the Monterrey Consensus, the
    Johannesburg Plan of Implementation, and the Delhi Declaration.

                          MILLENNIUM DEVELOPMENT GOALS

        On the issue of whether climate change will negatively impact our
    ability to implement the Millennium Development Goals (MDG's), it is
    important to understand that the MDG's are set for 2015, while
    projected climate change impacts span a much larger time scale.
    According to the IPCC Working Group II Report (Chapter 20): ``The
    anthropogenic drivers of climate change, per se, affect MDG indicators
    directly in only two ways: in terms of energy use per dollar GDP and
    CO2 emissions per capita. While climate change may, with
    high confidence, have the potential for substantial effects on aspects
    of sustainability that are important for the MDG's, the literature is
    less conclusive on whether the metrics themselves will be sensitive to
    either the effects of climate change or to progress concerning its
    drivers, especially in the near-term.''
                                     ______

                Questions Submitted by Senator Mary L. Landrieu

        Question. How could such valuable assistance be turned away in such
    a great time of need? What are your reasons for turning away the
    offered foreign aid? How did this happen?
        Answer. Katrina generated an unprecedented outpouring of assistance
    from allies and friends around the world. All of these offers of
    assistance were greatly appreciated, and, in fact, many of the offers
    were accepted and directed to hurricane recovery efforts. At the same
    time, not all offers of material and personnel assistance was or could
    be accepted for reasons set forth below. Moreover, as explained more
    fully below, not all offers of financial assistance were directed to
    the U.S. Government. With our encouragement, a considerable amount of
    financial assistance was donated directly to NGOs working in the
    affected areas. While some other pledges did not materialize, all
    financial assistance that was received by the U.S. Government was
    directed toward hurricane recovery efforts.
        The Department of State moved to support the Federal Emergency
    Management Agency (FEMA), the Department of Homeland Security (DHS) and
    other Federal partners that were leading in the response to the
    disaster. One of the Department's mandates is to help American citizens
    in trouble/need overseas. This was a unique opportunity to help
    American citizens within the United States. The State Department acted
    as an intermediary for foreign offers of assistance to the U.S.
    Government and worked with FEMA, USAID, and other agencies to respond
    to such requests and expedite delivery of assistance.
        We had two main objectives:
      --Provide all possible support requested by Federal partners.
      --Protect the American people by maintaining U.S. health and safety
            standards as directed by Federal regulators.
        The U.S. Government encouraged foreign donors to direct their cash
    assistance to private organizations from the beginning, consistent with
    the consensus among aid professionals that cash assistance to relief
    organizations in the affected region was the best way for donors to
    help. The amount of cash actually donated to the U.S. Government from
    international sources totaled $126 million, all of which has been
    distributed by the Department of State to other USG agencies. Not all
    pledges of cash resulted in actual donations--over $450 million in
    pledges were not fulfilled.
        Working with imperfect information from first responders on
    conditions and needs on the ground, the Department of State worked with
    FEMA and other agencies to identify and arrange transport of
    commodities, equipment, experts and other in-kind assistance that could
    be utilized quickly and efficiently.
        Not all international material assistance offered was needed.
    Disaster logisticians at FEMA and USAID evaluated the commodities and
    services offered by foreign governments and organizations, and accepted
    only those that made sense given all of the normal considerations
    during a disaster--e.g. transport, storage, and processing. In many
    cases, material assistance was more readily available from within the
    United States. Furthermore, some of the foreign commodities offered
    were not approved for entry into the United States by U.S. regulators,
    especially foodstuffs and medical equipment and supplies. Similarly,
    some offers of medical services and emergency medical teams were also
    not accepted due to state-based licensing requirements and related
    issues. We did not want to accept goods which could or would not be
    used. In total, the Department of State, working with USAID and FEMA,
    coordinated the donation of over 5 million pounds of relief supplies.
        Question. Was an internal investigation conducted on this
    mishandling? Was any action taken against employees who were identified
    in trying to cover-up or hide mishandling of situations, specifically
    the individual just quoted in regards to the Italy debacle?
        Answer. Hurricane Katrina was an unprecedented disaster that
    presented unique challenges to domestic agencies and foreign
    governments trying to assist. The State Department, working with other
    agencies, responded to foreign offers of assistance as quickly and
    flexibly as circumstances permitted.
        The State Department has participated in extensive interagency
    lessons learned reviews and exercises that addressed problems
    identified during Hurricane Katrina. As a result, the U.S. Government
    has developed significantly improved policies, procedures, and plans
    for managing international assistance for future domestic disasters.
        The Homeland Security Council (HSC) led an after action review of
    the U.S. Government response to Katrina, including how we handled
    offers of assistance from foreign governments. The HSC and key
    agencies, including the State Department, reviewed the response, both
    what went well and what we can do better, and updated the National
    Response Plan to guide agency actions if another major disaster were to
    strike the United States. The State Department, USAID, FEMA, the
    Defense Department and others contributed to the plan.
        USG officials did the best they could under unprecedented
    circumstances. There was no cover up of the Italy medical supply
    contribution. State Department officials were in regular contact with
    Italian authorities regarding the contribution, including on the
    disposal of the spoiled supplies.
        GAO reviewed the handling of foreign assistance in its report on
    Hurricane Katrina International Aid (GAO-06-460, April 2006). In its
    report, the GAO recognized that ``although DOS's procedures were ad
    hoc, they did ensure the proper recording of international cash
    donations that have been received to date, and [GAO was] able to
    reconcile the funds received with those held in the designated DOS
    account at Treasury.''
        Question. I know $60 million of the $126.4 million has been
    allocated to Louisiana and Mississippi K-12 and Higher Ed institutions
    and that $66 million was contracted to a consortium of 10 faith-based
    and charity groups, but how much has actually been distributed/used to
    date? What is holding up the distribution of the remaining funds?
        Answer. The Department of State transferred $66 million to FEMA on
    October 20, 2005 and $60 million to the Department of Education (DoEd)
    on March 17, 2006. Although State is not directly responsible for
    managing the distribution of these funds, we understand from FEMA and
    DoEd that:
        FEMA awarded $66 million to The United Methodist Committee of
    Relief (UMCOR) as a grant to provide case management services.
        FEMA facilitates the UMCOR grant. UMCOR established Katrina Aid
    Today (KAT), a consortium of 10 non-profit relief organizations, to
    provide case management services in Louisiana and Mississippi. To date,
    KAT has utilized $33 million and are on track to utilize the balance of
    the $66 million in the remaining time of the grant.
        DoEd awarded grants totaling $30 million available to 14 Higher
    Education institutions in Louisiana and Mississippi. These institutions
    have been able to draw on those funds according to their own
    reconstruction timetables. We understand that as of April 27, 2007,
    some institutions had utilized their entire grants; others were still
    drawing on the available funds as they proceed with their
    rehabilitation plans.
        DoEd asked the Louisiana DoEd to develop a program to award grants
    totaling $25 million. On April 19, 2007, the Louisiana Board of
    Education approved grants of $190,000 each to 130 private and public
    schools. The current award period for use of these funds runs until
    November 30, 2007. Funds would be available on a year to year basis
    until all funds have been expended.
        DoEd distributed $5 million to the Greater New Orleans Educational
    Foundation for the planning and implementation of a long range strategy
    for K-12 educational services.
        Question. Also, some questions were raised surrounding the terms in
    the contract proposal for the $66 million consortium contract. Are you
    conducting oversight on this proposal, to ensure it is being used
    solely for its intended purposes?
        Answer. The Department of State distributed $66 million to the
    Federal Emergency Management Agency (FEMA) in October 2005, to finance
    a social service case management system for Katrina's victims. In
    December 2005, DHS/FEMA granted the $66 million to the United Methodist
    Committee on Relief (UMCOR), which established Katrina Aid Today, a
    case management consortium of ten social service and voluntary
    organizations.
        FEMA has assured State that it is conducting oversight of the
    contract to ensure appropriate use in accordance with standard auditing
    practice/procedures. State officials met with officials from FEMA's
    Office of Inspector General when that entity was developing its
    auditing plans.
        FEMA requires quarterly reports that address both financial and
    programmatic information as well as weekly reports detailing the number
    of cases and case managers. FEMA has appointed a liaison to Katrina Aid
    Today that not only monitors reports but attends meetings at all levels
    (national, regional, grass roots) and consults with Katrina Aid Today
    on all programmatic and informational exchanges.
        Question. What is the progress/status of the State Department's
    progress on completing all 9 recommendations from the Federal
    Government Katrina Lessons Learned exercise? If you have completed all
    recommendations, were they finished before June 1, 2006?
        Answer. Below are the recommendation and status of the nine items
    identified for the State Department from the Katrina Lessons Learned
    exercise:
        Recommendation 89. DOS should lead the revision of the
    International Coordination Support Annex (ICSA) to the National
    Response Plan (NRP), clarifying responsibilities of Department of State
    (DOS), Department of Homeland Security (DHS), Department of Defense
    (DOD), and other supporting agencies in response to domestic incidents.
    This revision should begin immediately.
        Status: Completed. A State Department-led interagency group
    completed the first revision of the ICSA in February 2007 in
    consultation with the Homeland Security Council. The revisions clarify
    expanded roles and responsibilities of USG agencies in managing the
    international aspects of a domestic incident. The group also included
    representatives from the Departments of Homeland Security, Defense,
    Health and Human Services, Agriculture, and Transportation, and the
    Agency for International Development.
        Recommendation 90. DOS and DHS should lead an interagency effort
    that will quickly develop procedures to review, accept or reject any
    offers of international assistance for a domestic catastrophic
    incident.
        Status: Completed. An interagency group consisting of the
    Department of State, USAID/Office of Foreign Disaster Assistance (AID),
    DHS/FEMA, DOD, and the American Red Cross (ARC) has developed a system
    for managing international assistance during a domestic disaster. The
    system outlines policies and procedures to systematically manage offers
    of, or United States requests for, international material assistance
    during a United States domestic disaster. It also specifies the roles
    and responsibilities of participant agencies, provides standard
    operating procedures for managing offers of foreign assistance and
    domestic requests for foreign resources, and outlines the process for
    receiving and distributing international assistance that is accepted by
    the U.S. Government. The core procedures and arrangements detailed in
    the manual were agreed informally among participants by June 1, 2006.
        Recommendation 91. DHS should lead an interagency effort to create
    and routinely update a prioritized list of anticipated disaster needs
    for foreign assistance and a list of items that cannot be accepted.
        Status: Completed. The interagency has established procedures for
    coordinating with USG regulatory agencies for the entry, handling, and
    use of foreign resources during a disaster. Regulatory agencies provide
    technical advice and review offers of international assistance prior to
    FEMA acceptance. The procedures include guidance on acceptable and
    unacceptable items to assist the Department of State in communicating
    with the international community.
        Recommendation 92. DOS should establish an interagency process to:
    determine appropriate uses of international cash donations; to ensure
    timely use of these funds in a transparent and accountable manner; to
    meet internal Federal Government accounting requirements; and to
    communicate to donors how their funds were used.
        Status: Completed. Procedures have been established to manage the
    receipt, distribution, and use of foreign cash donations made during a
    domestic disaster. An interagency Working Group will be convened as
    necessary to address fund management issues and make recommendations on
    funding disaster recovery projects. Immediate needs would be pre-
    identified by FEMA, with the understanding that certain donations may
    be directed to longer term disaster recovery.
        Recommendation 93. Public and Diplomatic Communications during
    domestic emergencies should both encourage cash donations--preferably
    to recognized nonprofit voluntary organizations with relevant
    experience--and emphasize that donations of equipment or personnel
    should address disaster needs.
        Status: Completed. As was done during Katrina, the State Department
    provides instructions to all U.S. diplomatic missions abroad advising
    them to encourage foreign entities wishing to assist to make cash
    donations directly to appropriate NGOs rather than the USG.
        Recommendation 94. The Department of State and the Department of
    Homeland Security should jointly develop procedures to ensure that the
    needs of foreign missions are included in domestic plans for tracking
    inquiries regarding persons who are unaccounted for in a disaster zone.
        Status: Completed. The Department of State has worked with DHS/FEMA
    and the ARC to ensure that, during a domestic disaster, the USG honors
    its international obligations under the Vienna Convention on Consular
    Relations. Although the USG is not required to track down and find
    missing foreign nationals during a disaster in the United States, under
    the Convention it is obligated to assist foreign missions in obtaining
    ``appropriate consular access'' to their nationals.
        The Department of State's Office of Public Affairs has designated
    personnel to work with DHS/FEMA during domestic emergencies. These
    personnel will train with DHS/FEMA and will be part of FEMA's
    information operation from the outset of a major domestic crisis, in
    order to ensure efficient handling of queries from and consistent
    messaging to foreign missions and foreign media.
        The Department of State's Office of Foreign Missions and the ARC
    have discussed with foreign missions in Washington, DC how foreign
    missions can best utilize the ARC's missing persons' registry to locate
    missing foreign nationals in the United States.
        Recommendation 95. DHS and DOS should revise the NRP to include DOD
    and Department of Agriculture (USDA)-Food Safety Inspection Service as
    cooperating agencies to the International Coordination Support Annex.
    Including DOD more directly in foreign assistance management would
    leverage existing relationships with partner military establishments
    and help to ensure that staging areas for the acceptance of foreign aid
    are preplanned and quickly available.
        Status: Completed. The revised ICSA Annex to the NRP includes both
    DOD and USDA as cooperating agencies. Within the IAS, regulatory
    agencies such as the USDA provide technical advice and review offers of
    international assistance prior to FEMA acceptance.
        Recommendation 96. DHS should include DOS and foreign assistance
    management in domestic interagency training and exercise events.
    Inclusion in the new National Exercise Program (NEP) should occur
    before the end of fiscal year 2006.
        Status: We refer you to DHS regarding its training and exercise
    events. We understand DHS is developing an international assistance
    training module for use in future exercises. DHS can provide more
    detailed information.
        Recommendation 97. DHS should provide daily disaster response
    situational updates through the Secretary of State to all Chiefs of
    Mission or Charge d'Affaires. These updates should improve situational
    awareness and provide information to address host government concerns
    or questions.
        Status: DHS has assured State it will provide appropriate updates
    to inform U.S. Missions overseas and, by extension, foreign
    governments.
        Question. What is the timeline of when an amendment to the
    International Coordination Support Annex to the National Response Plan
    may take place? What else must be completed to reach this goal?
        Answer. An interagency group completed the first revision of the
    ICSA in February 2007. The group included representatives from the
    Departments of State, Homeland Security, Defense, Health and Human
    Services, Agriculture, and Transportation, and the Agency for
    International Development. Within the Department of State, we continue
    to ensure that relevant bureaus are familiar with the changes to the
    National Response plan and prepared to act in the event the National
    Response Plan is activated.
        Question. With DOS designated the lead agency, can I get from you,
    in writing, the status of where all affected agencies are in completing
    the nine recommendations. If they are complete, I want to know their
    status on completing final recommendation for amending the
    International Coordination Support Annex to the National Response Plan?
        Answer. Below are the recommendation and status of the nine items
    identified for the State Department from the Katrina Lessons Learned
    exercise:
        Recommendation 89. DOS should lead the revision of the
    International Coordination Support Annex (ICSA) to the National
    Response Plan (NRP), clarifying responsibilities of Department of State
    (DOS), Department of Homeland Security (DHS), Department of Defense
    (DOD), and other supporting agencies in response to domestic incidents.
    This revision should begin immediately.
        Status: Completed. A State Department-led interagency group
    completed the first revision of the ICSA in February 2007 in
    consultation with the Homeland Security Council. The revisions clarify
    expanded roles and responsibilities of USG agencies in managing the
    international aspects of a domestic incident. The group also included
    representatives from the Departments of Homeland Security, Defense,
    Health and Human Services, Agriculture, and Transportation, and the
    Agency for International Development.
        Recommendation 90. DOS and DHS should lead an interagency effort
    that will quickly develop procedures to review, accept or reject any
    offers of international assistance for a domestic catastrophic
    incident.
        Status: Completed. An interagency group consisting of the
    Department of State, USAID/Office of Foreign Disaster Assistance (AID),
    DHS/FEMA, DOD, and the American Red Cross (ARC) has developed a system
    for managing international assistance during a domestic disaster. The
    system outlines policies and procedures to systematically manage offers
    of, or United States requests for, international material assistance
    during a United States domestic disaster. It also specifies the roles
    and responsibilities of participant agencies, provides standard
    operating procedures for managing offers of foreign assistance and
    domestic requests for foreign resources, and outlines the process for
    receiving and distributing international assistance that is accepted by
    the U.S. Government. The core procedures and arrangements detailed in
    the manual were agreed informally among participants by June 1, 2006.
        Recommendation 91. DHS should lead an interagency effort to create
    and routinely update a prioritized list of anticipated disaster needs
    for foreign assistance and a list of items that cannot be accepted.
        Status: Completed. The interagency has established procedures for
    coordinating with USG regulatory agencies for the entry, handling, and
    use of foreign resources during a disaster. Regulatory agencies provide
    technical advice and review offers of international assistance prior to
    FEMA acceptance. The procedures include guidance on acceptable and
    unacceptable items to assist the Department of State in communicating
    with the international community.
        Recommendation 92. DOS should establish an interagency process to:
    determine appropriate uses of international cash donations; to ensure
    timely use of these funds in a transparent and accountable manner; to
    meet internal Federal Government accounting requirements; and to
    communicate to donors how their funds were used.
        Status: Completed. Procedures have been established to manage the
    receipt, distribution, and use of foreign cash donations made during a
    domestic disaster. An interagency Working Group will be convened as
    necessary to address fund management issues and make recommendations on
    funding disaster recovery projects. Immediate needs would be pre-
    identified by FEMA, with the understanding that certain donations may
    be directed to longer term disaster recovery.
        Recommendation 93. Public and Diplomatic Communications during
    domestic emergencies should both encourage cash donations--preferably
    to recognized nonprofit voluntary organizations with relevant
    experience--and emphasize that donations of equipment or personnel
    should address disaster needs.
        Status: Completed. As was done during Katrina, the State Department
    provides instructions to all U.S. diplomatic missions abroad advising
    them to encourage foreign entities wishing to assist to make cash
    donations directly to appropriate NGOs rather than the USG.
        Recommendation 94. The Department of State and the Department of
    Homeland Security should jointly develop procedures to ensure that the
    needs of foreign missions are included in domestic plans for tracking
    inquiries regarding persons who are unaccounted for in a disaster zone.
        Status: Completed. The Department of State has worked with DHS/FEMA
    and the ARC to ensure that, during a domestic disaster, the USG honors
    its international obligations under the Vienna Convention on Consular
    Relations. Although the USG is not required to track down and find
    missing foreign nationals during a disaster in the United States, under
    the Convention it is obligated to assist foreign missions in obtaining
    ``appropriate consular access'' to their nationals.
        The Department of State's Office of Public Affairs has designated
    personnel to work with DHS/FEMA during domestic emergencies. These
    personnel will train with DHS/FEMA and will be part of FEMA's
    information operation from the outset of a major domestic crisis, in
    order to ensure efficient handling of queries from and consistent
    messaging to foreign missions and foreign media.
        The Department of State's Office of Foreign Missions and the ARC
    have discussed with foreign missions in Washington, DC how foreign
    missions can best utilize the ARC's missing persons' registry to locate
    missing foreign nationals in the United States.
        Recommendation 95. DHS and DOS should revise the NRP to include DOD
    and Department of Agriculture (USDA)-Food Safety Inspection Service as
    cooperating agencies to the International Coordination Support Annex.
    Including DOD more directly in foreign assistance management would
    leverage existing relationships with partner military establishments
    and help to ensure that staging areas for the acceptance of foreign aid
    are preplanned and quickly available.
        Status: Completed. The revised ICSA Annex to the NRP includes both
    DOD and USDA as cooperating agencies. Within the IAS, regulatory
    agencies such as the USDA provide technical advice and review offers of
    international assistance prior to FEMA acceptance.
        Recommendation 96. DHS should include DOS and foreign assistance
    management in domestic interagency training and exercise events.
    Inclusion in the new National Exercise Program (NEP) should occur
    before the end of fiscal year 2006.
        Status: We refer you to DHS regarding its training and exercise
    events. We understand DHS is developing an international assistance
    training module for use in future exercises. DHS can provide more
    detailed information.
        Recommendation 97. DHS should provide daily disaster response
    situational updates through the Secretary of State to all Chiefs of
    Mission or Charge d'Affaires. These updates should improve situational
    awareness and provide information to address host government concerns
    or questions.
        Status: DHS has assured State it will provide appropriate updates
    to inform U.S. Missions overseas and, by extension, foreign
    governments.
                                     ______

                    Questions Submitted by Senator Jack Reed

        Question. The START Strategic Arms Reduction Treaty expires
    December 2009 but either side must notify the other one year in
    advance. The Russians have expressed an interest in beginning
    discussions, but the United States does not appear to be interested.
    When will the United States begin discussions on START I extension?
        The Moscow Treaty, even though it is a Treaty of no duration beyond
    the day in 2012 when it comes into force and expires, relies on the
    inspection provisions of START I. Unless START I is extended there is
    no transparency or semblance of verification under the Moscow Treaty.
        Would the administration support multiparty talks along the lines
    of those suggested by Senator Nunn, George Schultz, and Henry
    Kissinger, to substantially reduce total stockpiles of nuclear weapons?
        Why should other nations not be worried about the U.S. decision to
    pursue a Reliable Replacement Warhead? How is this program consistent
    with the U.S. obligations under Article VI of the NPT? (Article VI
    directs the nuclear weapons states to work toward the elimination of
    nuclear weapons)
        Answer. The START Treaty was valuable in a time when the United
    States and Russia had a relationship based on enmity and distrust. The
    Moscow Treaty took the first step in formalizing our new strategic
    relationship. As a result, by the end of 2012, both sides will have
    reduced their strategic nuclear warheads to no more than 1,700-2,200,
    the lowest levels in decades and less than one quarter of their cold
    war peak. In addition, the United States and Russia have both stated
    their intention to carry out strategic offensive reductions to the
    lowest level consistent with their national security requirements,
    including commitments to allies and friends.
        By its terms, the START Treaty is scheduled to expire in December
    2009. In anticipation of the expiration, the United States and Russia
    have begun to consider and discuss what type of arrangement will follow
    START. Both sides believe that it is important for a follow-on
    arrangement to provide predictability for the sides in strategic
    matters. We need to understand the trends and directions of each
    others' strategic nuclear forces. Neither side believes that extension
    of the START Treaty is the most effective way to achieve the
    predictability we seek, although both are drawing upon the START Treaty
    to find the best tools to either employ or modify for gaining the
    predictability our two nations seek.
        Former Under Secretary of State for Arms Control and International
    Security Affairs, Robert Joseph, met several times over the past year
    with his Russian counterpart, Deputy Foreign Minister Sergey Kislyak to
    explore a post-START arrangement. At their meeting on January 29 in
    Moscow, they agreed to hold experts talks to continue the exchanges on
    this subject.
        The first of these meetings was held in Berlin on March 28. The
    United States effort is led by Assistant Secretary of State for
    Verification, Compliance and Implementation, Paula DeSutter. The
    Russian effort is lead by Ministry of Foreign Affairs Director of
    Security and Disarmament Affairs, Anatoliy Antonov.
        The United States and Russia are now engaged in discussions aimed
    at developing transparency and other measures to provide continuity and
    predictability regarding strategic nuclear forces in a post-START
    arrangement, including exchanges of information, notifications, visits,
    and other mutually agreed measures.
        With respect to the Reliable Replacement Warhead (RRW), RRW will
    enable us to fulfill the President's goal of achieving a credible
    deterrent with the lowest possible number of nuclear warheads
    consistent with our national security needs, including our obligations
    to our allies. RRW is not a new military capability, but is a means to
    incorporate new technology for safety, security, and to ensure-long-
    term reliability of the U.S. nuclear stockpile. RRW is fully consistent
    with our obligations under the Nuclear Nonproliferation treaty--
    including Article VI--and would eventually enable further reductions in
    the stockpile. RRW will reduce the likelihood of the need to return to
    underground nuclear testing. It will also strengthen extended
    deterrence and our commitment to allies and friends.
        Question. In its fiscal year 2008 budget request, the
    administration breaks the parity between Armenia and Azerbaijan, in
    favor of Azerbaijan, in both Foreign Military Financing (FMF) and
    International Military Education and Training (IMET). What is the
    rationale for the divergence from military parity between Armenia and
    Azerbaijan?
        Would a break in military parity in Azerbaijan's favor undermine
    the Nagorno Karabakh peace process and negate the role of the United
    States as an impartial broker of peace?
        Answer. In light of the ongoing conflict over Nagorno-Karabakh,
    U.S. military assistance to both Azerbaijan and Armenia is carefully
    considered to ensure that it does not undermine or hamper ongoing
    efforts to negotiate a peaceful settlement between Armenia and
    Azerbaijan or be used for offensive purposes against Armenia. In fiscal
    year 2008, the administration looks forward to a robust program of
    military cooperation with both Azerbaijan and Armenia, based on
    activities tailored to U.S. interests and local capabilities in each
    country.
        Specific increases for Azerbaijan are linked to U.S. priorities in
    the war on terror, building Azerbaijan's peacekeeping capabilities, and
    enhancing Caspian maritime security. The administration believes that
    building the maritime capabilities of Caspian Sea countries including
    Azerbaijan is important to prevent the transit of dangerous materials,
    to deter and prevent terrorist activity, and to support the growing
    contribution of the Caspian basin to world energy supplies.
        We do not believe that the differences in security assistance in
    the fiscal year 2008 budget requests undermine prospects for peace or
    compromise our ability to serve in good faith as an impartial mediator
    for the Nagorno-Karabakh conflict. As a mediator, we consistently
    deliver the message to both sides that only a peaceful solution for the
    conflict is acceptable. We hope that the presidents of Armenia and
    Azerbaijan will endorse as soon as possible the set of Basic Principles
    for the peaceful settlement of the conflict that they have been
    negotiating for the past several months. It is longstanding U.S. policy
    that we support the territorial integrity of Azerbaijan and--through
    our role as one of the three OSCE Minsk Group Co-Chair countries, along
    with Russia and France--seek to help Armenia and Azerbaijan reach a
    peaceful negotiated settlement of the Nagorno-Karabakh conflict. A
    peaceful resolution of the conflict will increase regional security and
    allow for the opening of trade and communications links that will be
    important for the future prosperity of the South Caucasus region.
        Question. On what grounds has the administration sought a
    substantial reduction in economic assistance to Armenia?
        Does the Millennium Challenge Account continue to supplement and
    not replace traditional economic assistance to Armenia?
        Answer. The administration considers the totality of U.S.
    assistance resources available when formulating its bilateral budget
    requests. The fiscal year 2008 budget request for Armenia decreased by
    48 percent (over $35 million) from fiscal year 2006. This decline
    reflects in part reduced need as a result of Armenia's successful
    indicators and performance, particularly in promoting economic growth
    and addressing rural poverty, but also Armenia's 5-year, $236 million
    Millennium Challenge Corporation (MCC) Compact. If estimated MCC
    disbursements (over $60 million) for fiscal year 2008 are taken into
    account, the actual fiscal year 2008 funding level for Armenia
    increases by 34 percent to more than $98 million.
        Armenia's MCC Compact is focused on irrigation systems and rural
    road rehabilitation. While the country's recent economic growth and
    standard of living surpass most developing countries, the
    sustainability of this performance may be weakened by the government's
    inconsistent approach to implementing democratic reforms. In line with
    the MCC Compact signed in March 2006 and Armenia's good indicators and
    performance, we have shifted some investments from Economic Growth and
    Investing in People and increased our focus on Ruling Justly to promote
    the sustainability of reform.
        Existing development funding in the economic sector is therefore
    targeted to providing support for small- and medium-sized enterprise
    development, financial sector development, and regulatory reform to
    complement the MCC program and maximize its impact.
        Question. One of the most useful tools in Afghanistan and Iraq has
    been the ``Commanders Emergency Response Program'', or CERP funds,
    which gives military commanders unrestricted, undedicated funds to
    immediately address relief and reconstruction issues. I have heard
    during my visits that it would be very useful if the State Department
    has an equivalent program--that there is too much bureaucracy in State
    Department funding and the State Department has to go the DOD for
    needed funds. Is it true State personnel ask for CERP funds? Should the
    State Department institute a CERP-like program--particularly since
    State Department and USAID workers will be in Iraq and Afghanistan long
    after the military leaves?
        Answer. The Department of State and USAID coordinate with DOD at
    the Provincial Reconstruction Team (PRT) level on the use of Commanders
    Emergency Response Program (CERP) funds. Department of State and USAID
    foreign assistance currently incorporates a number of programs to
    expediently respond to local needs in places like Iraq and Afghanistan.
    In Iraq, these programs, coordinated through the Provincial
    Reconstruction Teams, include Provincial Reconstruction Development
    Councils (PRDC), the Community Action Program (CAP) and the Community
    Stabilization Program (CSP). In close coordination with Iraqi
    officials, the Provincial Reconstruction Development Councils (PRDCs)
    in all eighteen governorates in Iraq identify critical projects that
    fulfill immediate community needs and implement those programs.
    Coordinated project selection by the PRTs and PRDCs fosters consensus-
    building among Iraqi officials, while helping to enhance the position
    of moderate officials and to isolate extremists. This program has
    already started to show impressive results and is accelerating with an
    additional $600 million appropriated in the fiscal year 2007
    supplemental.
        The PRDC program is complemented by two USAID programs, also
    coordinated through the PRTs, which reach out to neighborhoods and
    transform communities. USAID's CAP program establishes neighborhood
    councils to conduct small scale infrastructure projects and community
    revitalization. The CSP targets conflict-prone neighborhoods and works
    to revitalize the economy through job creation and infrastructure
    projects. CSP recently reached its target of establishing 40,000 jobs
    in Baghdad.
        While USAID and State do not have a precisely CERP-equivalent
    mechanism by which we can obligate funds without procurement and other
    restrictions, each of these is a flexible, quick response program that
    enables the U.S. Government to respond to relief and reconstruction
    needs in Iraq.
        We are eager, however, to continue to work with Congress to
    determine the most effective mechanisms to respond fully to relief and
    reconstruction needs worldwide. At present, we work to use existing
    authorities and funds to be as flexible and responsive as possible in
    states characterized by political, economic, and security instability.
        For example, we appreciate Congress' support for funding accounts
    like International Disaster and Famine Assistance (IDFA), Peacekeeping
    Operations (PKO), and Transition Initiatives (TI) that address urgent
    humanitarian and post-conflict needs. The President also requested
    funding in fiscal year 2008 within the PKO account to bolster flexible
    reconstruction and stabilization capability in places such as Lebanon
    and Sudan. In addition, as you are aware, the Department of State has
    created the Office of the Coordinator for Reconstruction and
    Stabilization, with the intent to foster rapid response capabilities
    and programming. We appreciate the Senate's support in its passage of
    $50 million in the fiscal year 2007 supplemental (contingent on
    specific authorization in a subsequent act of Congress) to support and
    maintain a Civilian Reserve Corps, whose expertise and rapid deployment
    will allow us to further ensure effective use of post-conflict
    assistance.
        Finally, the fiscal year 2008 budget request is built to support
    and implement stabilization strategies in such countries as Iraq,
    Afghanistan, Sudan, Liberia, and the Democratic Republic of the Congo.
    The request carefully considered the appropriate amount, account
    authorities, and purpose for the funds requested, such that
    stabilization strategies could be supported with the appropriate tools.
    Earmarks and account shifts limit our ability to effectively employ
    funds within current authorities to achieve success in difficult and
    rapidly transitioning environments. We appreciate Congress's
    consideration of these factors as you evaluate the fiscal year 2008
    request.
        Question. Report on the Need to Improve Interagency Support to
    National Security Efforts.
        Madam Secretary, section 1035 of the Fiscal Year 2007 National
    Defense Authorization bill directed the President to submit a report on
    improving interagency civil-military support for U.S. national security
    missions, including peace and stability operations. The report was due
    on April 1, but the Armed Services Committee has not received it. When
    will it be submitted? Tell us, please, why it has been delayed.
        Answer. The National Security Council tasked the Department of
    Defense with drafting the report called for in section 1035 of the
    Fiscal Year 2007 National Defense Authorization bill, in coordination
    with the State Department. Given the complexity and importance of the
    report's topic, Defense and State have worked closely together in its
    preparation. We regret the delay in its submission; the report is in
    the final stages of review and we anticipate that it will be
    transmitted to Congress shortly.
        Question. Madam Secretary, the Fiscal Year 2007 National Defense
    Authorization bill also directed the President--in section 1211--to
    appoint a senior coordinator for North Korea policy by December 16,
    2006. This is similar to action Congress took in 1998 when it directed
    President Clinton to review his North Korea policy and appoint a
    special coordinator. President Clinton appointed Former Secretary of
    Defense William J. Perry. Secretary Perry launched a comprehensive
    review, and established new unity among Republicans and Democrats and,
    the United States managed to keep most of North Korea's nuclear and
    missile activities frozen. I understand that last December diplomatic
    efforts--that led to the February 13 agreement--were ongoing. But since
    then, 3 months have gone by. This action is 5 months overdue, and our
    negotiations are stalled.
        Why have we had a 5-month delay, and when can we expect a
    coordinator to be appointed?
        Answer. As noted in your question, the Six-Party Talks have made
    progress--marked by the February 13 Initial Actions agreement to
    implement the September 2005 Joint Statement, the March 13-14 visit of
    IAEA Director General ElBaradei to North Korea and the March inaugural
    meetings of the Six-Party working groups. Assistant Secretary Hill and
    the interagency delegations supporting the Talks and its five
    constituent working groups continue to engage our Six-Party partners,
    as well as the IAEA, on the way forward on DPRK denuclearization.
    Interagency coordination and attention to North Korea issues also
    continues on a regular basis with the engagement of senior State
    Department officials.
        The 2007 National Defense Authorization Bill directed the President
    to appoint a senior coordinator for North Korea policy. The interagency
    is continuing to deliberate on this and will send its recommendation to
    the President shortly. The State Department will continue to
    concentrate its efforts on this important issue.
        Question. How does the U.S. position on Nagorno-Karabagh in the
    human rights report differ from the Azerbaijani position?
        Could you please explain the decision process behind crafting and
    introducing this new language?
        The State Department did post revised language on its website but
    then restored the original language a few days later. Can you please
    walk me through that process--who was involved in the initial revision,
    then the subsequent return to the original text, and the justifications
    they used to guide their actions?
        The press widely reported that the Azerbaijani government lodged
    protests with the administration on this issue--and even went to the
    extent of postponing a planned bilateral security meeting until the
    text of our human rights report was changed to its satisfaction. Is it
    the case that the Azerbaijani government has been in touch with the
    administration on this matter? If so, did the Azerbaijani government
    indicate that it would like to see the language changed in any way?
        In light of this recent controversy, I think it would be
    constructive for the Department of State to clearly articulate the role
    that the self-determination of the people of Nagorno Karabagh should
    play in the settlement of this conflict. Do you agree?
        Does the report's language describing Armenia as an occupier of
        Azerbaijani territory and Nagorno Karabagh reflect U.S. policy?
        Answer. Some mistakenly interpreted the language in the human
    rights report as a change in U.S. policy concerning the Nagorno-
    Karabakh conflict. There has been no change in U.S. policy. The United
    States remains deeply committed to finding a peaceful settlement of the
    Nagorno-Karabakh conflict as an honest broker in the OSCE's Minsk Group
    process. As a result of the conflict over Nagorno-Karabakh, Armenian
    forces control most of that region, as well as large portions of
    surrounding territory. We support the territorial integrity of
    Azerbaijan and hold that the future status of Nagorno-Karabakh is a
    matter of negotiations between the parties.
        The language on Nagorno-Karabakh was intended only as a brief
    backdrop to the description of human rights issues as covered in depth
    by the country report. After the report was published a number of
    questions arose about the implications of the passage in question. We
    attempted to clarify the language. In so doing, however, we encountered
    additional questions over terminology, and realized that we had only
    added to the confusion by adding new language. We therefore restored
    the original language to that of the version submitted to Congress,
    while assuring both the Government of Armenia and the Government of
    Azerbaijan that our policy had not changed.
                                     ______

                 Questions Submitted by Senator Robert C. Byrd

        Question. A. Secretary Rice, how long is this war going to
    last, and how, specifically, are you measuring ``progress?''
    What evidence can you give us that this time is different, and
    we are about to see progress in Iraq?
        B. Secretary Rice, can you explain to the Committee why a
    coordinator for Iraq policy--what has been dubbed a ``war
    czar'' by the media--is necessary? I thought, according to the
    Constitution, the President was the ``war czar.'' Who has been
    managing Iraq policy in the administration in the absence of
    this position? How do you foresee working with the new ``war
    czar,'' if one were to be appointed?
        Answer. A. We measure progress along three tracks--
    security, political, and economic--and remain fully committed
    to helping the Iraqi Government meet ``benchmarks'' it has
    articulated. This includes passing key legislation, including a
    hydrocarbons law, De-Ba'thification reform, constitutional
    review, and provincial elections. The Iraqi Government
    understands the importance of meeting these benchmarks and is
    working towards that goal. We have already seen some progress,
    but much hard work is yet to be done. For example, Iraqi
    political leaders are actively negotiating a de-Ba'thification
    Reform Law and a hydrocarbon package of laws.
        B. As the White House has said, an Assistant to the
    President and Deputy National Security Advisor for Iraq and
    Afghanistan is necessary because the President's ``New Way
    Forward'' in Iraq requires greater coordination and involvement
    from across the Government. The individual named to fill this
    role will handle, full-time, the implementation and execution
    of our strategies for Iraq and Afghanistan, and will lead the
    policy development process for these two theaters. He or she
    will report directly to the President and, as an Assistant to
    the President, will work closely with National Security Advisor
    Steven Hadley, who provides overall leadership of the National
    Security Council staff. He or she will also be empowered by the
    President to request and receive information and assistance
    from the Federal Departments and Agencies, including the
    Department of State, needed to carry out the President's
    strategies. For our part, the Department of State will work
    closely with the new Deputy National Security Advisor for Iraq
    and Afghanistan to make sure he or she has the tools and
    information needed to carry out the duties of the position.
        Question. Secretary Rice, on April 30, 2003, the State
    Department reported that the number of international terrorist
    attacks worldwide decreased 44 percent and anti-U.S. terrorist
    attacks decreased 65 percent from the previous year. A year and
    a half after September 11, we were apparently doing some things
    right. Unfortunately, 4 years later, the picture is not so
    bright: the latest ``Country Report on Terrorism'' issued by
    the State Department on April 30, 2007, concluded that
    terrorist attacks in Iraq had increased 91 percent from 2005 to
    2006 and that 65 percent of global fatalities from terrorism
    occurred in Iraq during 2005-2006. In the words of the April
    2006 National Intelligence Estimate, Iraq has become ``the
    `cause celebre' for jihadists.'' Looking back, and based on
    those figures, would you argue that the Iraq war has been a
    positive development for U.S. national security interests?
        Answer. The war in Iraq resulted in the removal of a brutal
    dictator who terrorized his people, threatened the region and
    the international community, sanctioned the massacre of more
    than 300,000 Iraqis, and launched the invasion and occupation
    of Kuwait. The international community tried to counter the
    threat posed by Saddam Hussein by imposing sanctions on his
    regime. However, the sanctions did not have their intended
    affect, and Hussein continued his course unabated, which
    prompted the administration to pursue other avenues of action.
    On balance, U.S. national security interests have been strongly
    enhanced by the removal Saddam Hussein.
        We would advise against placing too much emphasis on any
    single set of incident data to gauge success or failure against
    the forces of terrorism. Tallying incident data necessarily
    involves relying exclusively on frequently incomplete and
    ambiguous information that is not derived from Federal
    Government collection programs created or operated specifically
    to obtain the data. Simply counting terrorist incidents
    provides an incomplete measure of our counter terrorism
    efforts; this does not account for the large number of
    terrorists arrested, plots disrupted, and potential recruits
    and sympathizers who are persuaded to reject the violent
    ideology and misinformation spread by terrorists.
        Clearly, Iraq has a significant terrorism challenge. A
    paramount strategic objective in Iraq and the region is
    preventing al-Qaida, its affiliates or other terrorists from
    establishing safe haven in al-Anbar or anywhere else in Iraq.
    Groups like al-Qaida in Iraq (AQI) and Ansar al-Sunna are
    attempting to drive the United States out of Iraq in order to
    establish a safe haven from which to train and plan attacks.
    Together with the Iraqi Government and our Coalition partners,
    we are destroying terrorist networks and helping the Iraqis
    secure their territory so al-Qaida cannot do in Iraq what they
    did in Afghanistan before the fall of the Taliban.
        Although Iraq is a proven ally in the War on Terror, Iraq's
    developing security and armed forces will require further
    training and resources before they can effectively address the
    terrorist groups already operating within their borders without
    international assistance. Iraq's intelligence services continue
    to improve in both competency and confidence but will require
    additional support before they can adequately identify and
    respond to internal and external terrorist threats. The
    international community's support is critical to ensure that
    the Government of Iraq's plans to reduce violence, improve
    services, and increase economic opportunities are successful.
        Prospects for increasing stability in Iraq will depend on:
    the extent to which the Iraqi government and political leaders
    can establish effective national institutions that transcend
    sectarian or ethnic interests and, within this context, the
    ability of the Iraqi Security Forces to pursue extremist
    elements of all kinds; the extent of international assistance
    to the Government of Iraq to do so; the extent to which
    extremists, most notably AQI, can be defeated in their attempt
    to foment inter-sectarian struggle between Shia and Sunnis; and
    the extent to which Iraq's neighbors, especially Iran and
    Syria, can be persuaded to stop the flow of militants and
    munitions across their borders.
        Question. Secretary Rice, we have received reports from
    former Ambassadors and Foreign Service Officers serving
    overseas that U.S. policy toward detainees--particularly in
    Guantanamo Bay--is impacting our diplomatic credibility and
    placing our personnel at risk. There is now a widespread belief
    in the rest of the world that the United States routinely
    tortures prisoners and denies them due process when it suits
    us. The global perception that this is our policy makes it more
    likely that our own citizens could face the same treatment if
    they are detained overseas. Would you agree that it is in our
    national security interests to reverse this perception? What
    steps would you take in order to do so?
        Answer. The administration is acutely aware of concerns
    that have been raised both at home and abroad about detentions
    of individuals at Guantanamo Bay. Our challenge has been to
    explain to the world that the United States and other nations
    around the world share a common problem in dealing with
    dangerous terrorists intent on harming our civilian
    populations, while at the same time being mindful of the need
    to operate lawfully and in a manner that preserves our
    commitment to principles of human rights and international
    humanitarian law.
        Unfortunately, the detention facility at Guantanamo Bay has
    become a lightning rod for international criticisms stemming
    from the misperception that detainees there are in a ``legal
    black hole.'' In fact, detainees at Guantanamo enjoy a robust
    set of procedural and treatment protections. All detainees at
    Guantanamo have received or will receive a Combatant Status
    Review Tribunal to confirm that they are properly detained as
    enemy combatants. Under the Detainee Treatment Act of 2005,
    detainees have the opportunity to challenge these status
    determinations in the U.S. Court of Appeals for the D.C.
    Circuit.
        In addition, the administration remains committed to trying
    by military commission those who have violated the laws of war
    or committed other serious offences under the Military
    Commissions Act of 2006 (MCA). After the Supreme Court in
    Hamdan v. Rumsfeld set aside the original system of military
    commissions, we worked with the Congress to create a new set of
    military commission procedures in the MCA that are fully
    consistent with U.S. law and Common Article 3 of the Geneva
    Conventions.
        The Detainee Treatment Act, the Department of Defense
    Detainee Directive, and the revised Army Field Manual on
    interrogation collectively provide detainees at Guantanamo a
    robust set of treatment protections that are fully consistent
    with, and in some respects exceed, our international
    obligations, including Common Article 3 of the Geneva
    Conventions. The success of these legal protections in creating
    an environment at Guantanamo that meets international standards
    is reflected in the reports of visitors to Guantanamo, such as
    the Special Representative of the OSCE Parliamentary Assembly
    President for Guantanamo, Belgian Senator Anne Marie Lizin and
    the U.K. House of Commons Foreign Affairs Committee. These
    groups have found that conditions there mirror, and in some
    respects improve upon, those of high security prisons in Europe
    and the United States, with no evidence of ongoing detainee
    abuse. Where allegations are made of detainee abuse, those
    allegations are investigated fully, and if true, those
    responsible are held accountable.
        Given the national security imperative to dispel these
    misimpressions, the Department has made dialogue with our
    allies on these difficult issues a priority. The Department has
    undertaken extensive bilateral and multilateral efforts to
    discuss with our international partners a common approach to
    legal issues arising out of asymmetric armed conflicts, such as
    the one we are now in with al-Qaida. In addition, we have made
    explanation of our detainee policy a cornerstone of our public
    diplomacy efforts through the use of media events, editorials,
    and outreach to academia and international opinion makers. The
    result of these efforts has been a growing international
    recognition that the threat posed by al Qaida does not neatly
    fit within existing legal frameworks, and that the need exists
    to work on common approaches to difficult international legal
    questions posed by this conflict.
        In the long run, the President has stated that he would
    like to move towards the day when we can eventually close the
    detention facility at Guantanamo Bay. We have worked hard with
    the Department of Defense to reduce the population of
    Guantanamo by more than half. Although our critics abroad and
    at home have called for Guantanamo to be shut immediately, they
    have not offered any credible alternatives for dealing with the
    dangerous individuals that are detained there. We are
    frequently unable to transfer or release approved detainees
    because of the human rights or security conditions in the
    detainees' home countries. And with few exceptions we have been
    unable to resettle these detainees in third countries because
    other nations are unwilling to accept them for resettlement.
    Moving forward, it is critical that the international community
    recognize, as the UK Foreign Affairs Committee recently did,
    that many of the detainees at Guantanamo pose a threat not just
    to the United States but to its allies, and that the longer-
    term solution to Guantanamo, including resettlement of
    detainees who cannot be repatriated, is a responsibility shared
    between the United States and those allies.
        Question. Secretary Rice, I'm sure that you were as
    disgusted as I was to see in the latest SIGIR report that out
    of eight rebuilding projects in Iraq recently investigated,
    which cost approximately $150 million and were declared
    successes, seven are now in disrepair or have been abandoned.
    Seven out of eight projects that the U.S. taxpayer has built in
    Iraq are now falling apart. What are you doing to ensure this
    waste does not continue? Are you investigating other
    reconstruction projects that have been completed, to verify
    that they are still operational? Have any lessons been learned
    from the failure of these efforts?
        Answer. We share your concerns about operations and
    maintenance of our completed reconstruction projects in Iraq.
    Adequate operations and maintenance are essential to ensure
    that U.S. funded reconstruction projects are used to the
    maximum benefit of the Iraqi people. The Special Inspector
    General for Iraq Reconstruction (SIGIR), Stuart Bowen, has
    repeatedly acknowledged the progress that has been made in
    improving our management efforts and has stated that the
    majority of U.S. reconstruction programs have been completed on
    time and as planned.
        Initially, we anticipated that the Government of Iraq would
    assume responsibility for operations and maintenance of
    completed reconstruction projects. As SIGIR points out,
    however, there is a clear need for assistance in increasing the
    Iraqis' capacity to operate and maintain completed
    reconstruction projects. To address this need, we shifted the
    emphasis of our assistance programs away from large scale
    reconstruction projects toward capacity development programs.
    We programmed $285 million within the fiscal year 2006
    Supplemental Appropriations to contribute to the operations and
    maintenance of completed reconstruction projects and another
    $60 million for capacity development for Iraqi technicians and
    plant managers.
        We continue to work closely with SIGIR, the GAO, and our
    Inspector General to improve management and oversight of U.S.
    reconstruction projects in Iraq. We have benefited from SIGIR's
    recommendations on how we can better manage our reconstruction
    projects in Iraq.
        We are working closely with the Iraqi government to ensure
    that Iraq's own resources are used to provide essential
    services such as oil, water, and electricity for the Iraqi
    people. Despite repeated attacks, the Iraqis have been able to
    maintain key infrastructure facilities in extremely difficult
    circumstances. Our continued assistance will help Iraq improve
    the security, operation, and maintenance of these critical
    facilities.
                                    ------

                  Questions Submitted by Senator Sam Brownback

        Question. The State Department request for FMF to Ethiopia is only
    $850,000. In your estimation, does the Ethiopian Government have the
    resources it needs to continue fighting the war against the Islamic
    Courts and their allies in Somalia?
        Does the administration plan on increasing FMF for Ethiopia in the
    near future? If so, for what specifically will the money be used?
        Answer. Fiscal year 2008 funding request levels were determined in
    early 2006 before the Council of Islamic Courts in Somalia had begun to
    pose a threat to the Horn of Africa region. Ethiopia's ongoing
    intervention in Somalia to promote the Transitional Federal Government
    and to support the establishment of security and national
    reconciliation have significantly depleted its hard currency reserves
    and taxed its budget. The Ethiopian Government does not have sufficient
    resources to continue at its current pace indefinitely.
        In light of recent developments in the Horn of Africa region and
    Ethiopia's needs, the administration is reassessing assistance to
    Ethiopia.
        Questions. Recent news reports have indicated that the Iranian
    regime has targeted and harassed NGO's and human rights groups inside
    Iran in response to the announcement of the U.S. allocating $75 million
    for democracy programs in Iran. Are such reports credible, and if so,
    what kinds of steps are being taken to avoid doing harm to the very
    groups we are trying to empower?
        Where does the administration place the issue of the Iranian
    regime's human rights violations in the context of the regime's ongoing
    nuclear proliferation and state sponsorship of terrorism?
        Is there any downside to establishing a special envoy to coordinate
    human rights and democracy promotion for Iran along the lines of Sudan
    and North Korea?
        Answer. The Department of State's monitoring of Iranian regime's
    reaction to dissidents and activists indicates that the number of
    arrests has remained consistently high, with no noticeable increase
    following our announcement of the $75 million for democracy programs in
    Iran. We are sensitive to the fact that democracy and human rights
    advocates face risks in Iran. Recent criticism of the USG's Iran
    democracy programming activities has missed the mark; it is the actions
    of the Iranian regime that put its own people in danger, not USG
    support for freedom and personal liberty. We must be clear: the Iranian
    government, like other authoritarian and totalitarian regimes, views
    democracy and human rights activists as a threat. The Islamic Republic
    has little tolerance for those encouraging reform, irrespective of the
    origins of their funding. But that has never been a justification for
    us to stop supporting democratic actors around the world. Our
    programming remains important to encourage the development of personal
    liberty and freedom in Iran and we have safeguards to ensure the
    confidentiality of those with whom we work. We would be happy to
    discuss these safeguards with you.
        While the nuclear debate overshadows other categories of our Iran
    policy, we maintain a strong message on human rights, including not
    only the condemnation of random arrests and tyrannical actions, but
    also support for the universal rights of speech, assembly, press and
    religion--as a crucial element of the President's policy of support to
    the Iranian people.
        Undersecretary for Political Affairs Nick Burns coordinates the
    Department's Iran efforts, including human rights issues. We do not see
    the need for a separate human rights envoy. Human rights need to be
    advanced in the overall policies, which we are following. Since
    ultimately the Iranian people must determine their future, public
    outreach, support to Iranian civil society and people-to-people
    exchanges provide the United States the best opportunity for
    encouraging democratic reform in Iran.
        Question. What is the timeline for taking more coercive, bilateral
    and multilateral, action against the Sudanese Government if they don't
    accept U.N. peacekeeping troops and take real steps toward ending the
    genocide?
        Answer. The United States continues to engage with partners to
    press Sudan to fully cooperate in the peaceful resolution of the crisis
    in Darfur. We have repeatedly made clear to the Sudanese Government
    that all options remain on the table should Khartoum continue to defy
    the will of the international community.
        President Bush announced on April 18 the USG's intention to impose
    increased bilateral sanctions on Sudan and pursue additional
    multilateral sanctions through the United Nations if President Bashir
    does not take significant political, humanitarian and peacekeeping
    actions to improve the situation in Darfur. The USG agreed to allow
    United Nations Secretary-General Ban Ki-Moon more time to urge
    President Bashir to honor his commitments, but our patience is not
    open-ended. We continue to work towards concerted international
    pressure on Khartoum. This includes possible multilateral and bilateral
    sanctions.
        Question. What action are you, and the State Department as a whole,
    doing to engage China to play a more productive role in getting a
    robust peacekeeping force into Sudan and ending the genocide?
        Answer. One of the central objectives of our diplomatic engagement
    with China has been to persuade Beijing to assume responsibilities
    commensurate with its rising influence and stature. Nowhere is this
    more the case than on Darfur. China's leverage with Khartoum is not
    absolute, but there is much that China can do to persuade the
    Government of Sudan to accept the full deployment of the U.N./AU hybrid
    peacekeeping force under U.N. command structures, and to convince
    Khartoum to engage seriously in a peace process that involves all
    parties to the conflict. Special Envoy Natsios, Deputy Secretary
    Negroponte, and Assistant Secretary Frazer have all had serious, in-
    depth discussions on Sudan with the Chinese, as have I.
        Let me be clear. China is not where we would like it to be on
    Darfur. The no-interest loan to build a palace in Khartoum that
    President Hu announced on his February visit to Khartoum is one
    example. We have also communicated our serious concerns to China that
    weapons sold to the government of Sudan have contributed to the
    violence in Darfur. At the same time, we do see movement in China's
    position and believe that Beijing has made a decision that it must join
    with the international community in insisting that the atrocities in
    Darfur must stop.
        For example, China's lead diplomat at the United Nations, Wang
    Guangya, helped broker the November agreement in Addis Ababa in which
    the Government of Sudan accepted, in principle, the three-phase
    deployment of the U.N./AU force. China's diplomacy was likely
    influential in convincing President Bashir to accept the 3,000-person
    ``heavy support package'' (HSP) under phase two of the deployment.
    Perhaps most significantly, Beijing recently agreed to send a 275-
    person engineering unit as part of the HSP. These are important steps,
    taken with our active diplomatic encouragement and support.
        President Bashir has reneged on a number of his commitments and
    continues to obstruct the full deployment of the U.N./AU force under
    phase three. While China's support for the preliminary deployments is
    welcome, the critical element, as you suggest, is the full deployment
    of the U.N./AU force under robust U.N. command structures. China has
    said publicly (and to us in private) that it supports this. We are
    committed to working with China and our other international partners to
    apply pressure on President Bashir to accept the full U.N./AU force
    unequivocally.
        Question. Are Baghdad's mixed neighborhoods still mixed, or are
    they continuing to become mostly Sunni and mostly Shi'a enclaves? What
    about other previously mixed areas of Iraq?
        Answer. Some mixed neighborhoods still remain in Baghdad, and,
    although demographic shifts in Baghdad's neighborhoods and throughout
    Iraq continue to occur as a result of sectarian violence, such shifts
    have been slowed (and in some areas halted) by Operation Fardh al-
    Qanoon (Baghdad Security Plan). Older neighborhoods in Baghdad, which
    have been historically mixed for generations, are feeling pressures
    from rival terrorist, insurgent, and militia groups who are trying to
    win territory in these old neighborhoods, but we are working with the
    Iraqis to try to overcome these sectarian problems.
        Question. What is the strategy to diffuse tensions between the
    Iraqi Kurds and Turkey? Are you getting sufficient cooperation from the
    Iraqi Kurds on fighting the PKK terrorists based in the Kurdish region?
        Answer. We are engaged in intense diplomatic efforts to prevent an
    escalation in tension between Turkey and Iraq. Our efforts are led by
    General Joseph Ralston, the Secretary of State's Special Envoy for
    Countering the PKK. The General continues to work closely with his
    Turkish and Iraqi counterparts, as well as officials of the Kurdistan
    Regional Government, on this issue. His conversations have focused on
    building confidence between Turkey and Iraq and obtaining cooperation
    to fight against the terrorist Kurdistan Workers Party (PKK), which is
    using Northern Iraq as a base of operations for attacks against Turkey.
    Iraq and Turkey share a long border and have many common problems--
    including ending PKK terror attacks in Turkey--and interests; we are
    hopeful that leading figures in both countries will focus on solving
    problems and advancing mutual interests rather than exploiting
    differences.
        Question. After receiving reports that USAID was supporting
    programs in occupied Cyprus without consultation with the Government of
    the Republic of Cyprus, the Senate Appropriations Committee included in
    its fiscal year 2006 Report the following: ``The Committee is concerned
    that funds made available for bi-communal projects on Cyprus have been
    obligated without appropriate notification and participation of the
    Government of Cyprus. The Committee believes that if such funds are to
    improve the prospect for peaceful reunification of the island, they
    must be allocated transparently and in full consultation with the
    [Government of Cyprus] and other interested parties.''
        How does USAID engage and consult with the Government of the
    Republic of Cyprus as Congress directed in the 2006 appropriation? What
    has USAID done to address the concerns expressed by Congress?
        Since 1993, Congress has imposed a statutory restriction on the use
    of ESF monies: ``to be used only for scholarships, administrative
    support of the scholarship program, bi-communal projects, and measures
    aimed at reunification of the island and designed to reduce tensions
    and promote peace and cooperation between the two communities on
    Cyprus.'' Has USAID or the State Department used funds outside of ESF
    for programs on Cyprus, thus avoiding Congress's statutory restriction?
        Answer. The United States is committed to consultation and
    transparency with ``the Government of Cyprus and other interested
    parties'' on the U.S. foreign assistance program for Cyprus, consistent
    with the fiscal year 2006 Senate Appropriations Committee report.
    Embassy Nicosia has made it a priority to increase the frequency and
    breadth of consultations since 2005. The Ambassador, Public Affairs
    Officer and USAID Representative in Nicosia have had numerous meetings
    with Cypriot Government officials to discuss U.S. foreign assistance in
    Cyprus. USAID has also regularly provided the Government of Cyprus with
    written information on existing and planned activities, and we have
    taken into account in our programs both U.S. policy and concerns
    expressed by Cypriot officials. For example, we have been careful to
    avoid any implication of recognition of Turkish Cypriot authorities,
    and we have chosen locations for our programs, including for contractor
    offices, to ensure that they do not raise any questions of property
    claims.
        We support and consistently offer the Government of Cyprus
    consultations on our assistance programs, although the government has
    not always accepted our offers. Obtaining government approval for each
    project, however, would effectively cede decision-making authority to
    the Government of Cyprus and in so doing would nullify the basic
    premise of over 30 years of bi-communal programming. This would
    jeopardize the Turkish Cypriots' pro-solution leadership and discourage
    Turkish Cypriots from participating in our programs. Although we
    welcome consultations with the Government of Cyprus, the U.S.
    Government maintains full authority over and accountability for U.S.
    assistance programs in Cyprus to ensure that they remain consistent
    with U.S. law and U.S. Government policy in support of the
    reunification of Cyprus as a bi-zonal, bi-communal federation.
        USAID conducts its activities in Cyprus in a manner consistent with
    Congressional concerns and statutes. USAID programs in Cyprus are
    conducted exclusively through use of Economic Support Funds (ESF) and
    for the purposes outlined in the Congressional statutory restriction.
    The U.S. Embassy uses ESF as well as funds from the Department of
    State's International Information Program Office, the Education and
    Cultural Affairs Office, and the European and Eurasian Affairs Press
    and Public Diplomacy Office, for cultural and bi-communal programs in
    Cyprus, including Fulbright Scholarships. In addition, the Embassy uses
    Export and Border Security funds to help establish fully effective
    export controls and nonproliferation investigations and prosecutions in
    Cyprus. We use all of these funds transparently, and offer to the
    Government of Cyprus consultations on the use of these funds. Use of
    ESF funds in Cyprus complies fully with the 1993 restriction; non-ESF
    funds are expended in a manner fully consistent with the objectives of
    that restriction.
        Question. There have been several instances recently of Eastern
    European governments allowing excavation of and construction on
    historic Jewish cemeteries. This has taken place in Grodno, Belarus;
    Vilna, Lithuania (Snipiskes Jewish cemetery); Pilsen, Czech Republic;
    and Thessalonika, Greece.
        It has come to my attention that in some countries--particularly
    Lithuania--the U.S. embassy staff has assisted in the protection of
    Jewish cemeteries, while in other countries the U.S. mission has not
    gotten involved. Does the administration have a comprehensive plan to
    address the desecration of Jewish cemeteries abroad? What is being done
    to ensure that this issue is consistently on the agenda of U.S.
    Missions in Europe?
        Is the U.S. Mission to the European Union involved in this issue,
    and if so, how?
        Answer. The Department and our Embassies have been very much
    involved in the effort to protect historic Jewish cemeteries in Europe.
    Belarus, the Czech Republic, Greece, Ukraine and Lithuania have been
    particular areas of focus. Our Embassies have approached national,
    provincial and municipal governments, and have worked with the
    indigenous Jewish communities and with organizations that have cemetery
    protection as one of their goals.
        In addition, the Commission for the Protection of America's
    Heritage Abroad has also been helpful with threatened cemeteries. The
    Department and U.S. embassies have worked closely with the Commission
    to protect and preserve cemeteries by assisting in the negotiation of
    bilateral agreements and through joint efforts to prevent intrusions
    into burial places.
        The circumstances in each of these cases have differed, but our
    approach and commitment have been the same: the United States takes
    these issues seriously and works with interested parties to achieve a
    solution.
        The issue is essentially local in nature. Municipal planning,
    zoning, cultural, and building authorities frequently have primary
    jurisdiction. Our role has been to bring municipal and national
    authorities together with religious organizations and NGOs to seek a
    settlement that respects the interests of all concerned. In several
    cases, our Ambassadors have been directly involved in these efforts.
        Several years ago our Embassy in Prague brokered an agreement
    involving the construction of a building on a cemetery site in that
    city. More recently Embassies Prague and Minsk have been involved with
    similar situations in Pilzen and Grodno, respectively. Our Embassy in
    Vilnius has been particularly active in an effort to protect the
    Snipiskes cemetery. The cemetery issue in Greece goes back many years,
    although there have been no recent developments. There has been no
    occasion for the U.S. Mission to the European Union to be involved.
        As demonstrated above, the Department takes the issue of cemetery
    desecration extremely seriously. The Department's annual International
    Religious Freedom Report covers cemetery desecration in considerable
    detail.
        Question. On February 24, 2005 I joined all 99 of my Senate
    colleagues in signing an appeal to President Putin to return the sacred
    Schneerson Collection to its rightful owners, Agudas Chasidei Chabad of
    the United States. During the Helsinki Committee's hearings on the
    plight of these Jewish texts on April 6, 2005, I had the opportunity to
    meet with elderly survivors of Soviet and Nazi persecution who
    struggled and sacrificed to protect these holy writings and the ideals
    they represent.
        As you may recall, the case of the Schneerson Collection was raised
    with you at your Senate confirmation hearings, and I certainly
    appreciate the efforts that you and President Bush have made to
    encourage Russia to finally restore Chabad's spiritual legacy. Could
    you please provide an update on the administration's recent efforts to
    free the Schneerson Collection?
        Do you plan to raise the issue of the Schneerson Collection with
    appropriate Russian officials during your visit? Will the
    administration continue to press Moscow on this important issue?
        Answer. Shortly after the April 2005 hearing, the administration
    made a high level effort to convince the Russian Federation to transfer
    the Schneerson collection to Brooklyn. The result was a carefully
    worded but firmly negative response.
        During his visit to Russia last month, Special Envoy to Monitor and
    Combat Anti-Semitism Gregg Rickman requested that the Russian
    Government transfer the collection. The Russian authorities declined
    this request as well.
        I, and other State Department officials, will continue to raise
    this subject with Russian officials as opportunities arise.
        Question. It has come to my attention that Al-Hurra, the
    Congressionally-funded commercial-free Arabic language satellite
    television network for the Middle East, has broadcasted a number of
    problematic and inappropriate programs since its new director, Mr.
    Larry Register, assumed leadership of the station last November.
    Specifically, on December, 7, 2006, Al-Hurra broadcasted live a full
    speech given by Sheikh Hassan Nasrallah, the leader of the terrorist
    group Hezbollah. Also aired that month was coverage of the now infamous
    Holocaust denial conference in Iran, with follow-up remarks by the
    tiny, fiercely anti-Zionist Jewish group Neturei Karta, which sent
    representatives to the conference.
        During a State Department press conference on May 9, 2007,
    spokesman Sean McCormack said that Secretary Rice and the
    administration believe that Mr. Register is, ``actually doing a pretty
    good job, a very good job.''
        Does the administration still stand by this assessment of Mr.
    Register's leadership of Al-Hurra? What specific steps are being taken
    to prevent Al-Hurra in the future from serving as a platform for
    terrorists and Holocaust-deniers?
        Answer. The Broadcasting Board of Governors and the management at
    Alhurra have repeatedly and clearly acknowledged that the incidents you
    have noted were mistakes and not in line with the Middle East
    Broadcasting Network's (MBN) own editorial policies.
        To deal with this problem, MBN has re-issued its editorial policy,
    strengthened editorial controls, and provided more and better training
    to its journalists.
        At the same time, MBN has substantially increased its coverage of
    events related to U.S. foreign policy, American society and values, and
    the network is broadcasting a number of innovative programs to serve as
    a platform for dialogue between and among Americans and Arab publics, a
    niche that is nowhere else to be found on Arab television. Alhurra has
    also taken on the task of promoting democracy with its audiences; it
    did an outstanding job of covering recent elections in Mauritania and
    Egypt, and it recently added a second congressional correspondent to
    cover the policy debates occurring in our own national legislature.
    Increasingly we hear from contacts in the Arab world and elsewhere that
    this kind of coverage resonates with Alhurra's audiences and as a
    result it is gaining traction and broadening its reach.
                                     ______

                 Question Submitted by Senator Lamar Alexander

        Question. The Senate Committee report language from fiscal year
    2006 State and Foreign Operations Appropriations bill stated, ``The
    Committee directs USAID to provide $10 million to support the programs
    and activities of the Financial Services Volunteer Corps (FSVC), a
    moderate increase over prior year funding levels.'' Yet, FSVC only
    received $4.3 million in fiscal year 2006, down from $7.2 million in
    fiscal year 2005 and $8.1 million in fiscal year 2004. The mission of
    the FSVC is consistent with U.S. foreign policy objectives to
    strengthen market economies and promote democracy, and it relies on
    highly qualified volunteers from the U.S. financial sector to
    accomplish its objectives.
        What is your opinion of the Financial Services Volunteer Corps? If
    it enhances our foreign policy objectives, is there a reason why its
    funding has been reduced by almost 50 percent since fiscal year 2004--
    and is less than half of what was called for in the fiscal year 2006
    Committee report? Does USAID intend to increase FSVC funding in the
    future?
        Answer. Current USAID records indicate that new obligations to FSVC
    were $9,555,782 from fiscal year 2006 funds, $2,427,222 from fiscal
    year 2005 and $5,208,219 from fiscal year 2004.
        FSVC was created specifically to deal with the transition of
    Eastern European and former Soviet Union countries from communism to
    market economies and has played an important part in this process.
    These programs are winding down, most rapidly in the economic area.
    Russia, for example, is slated to have no programs at all in the
    economic growth area by 2008.
        In addition to the reduced demand for the kinds of sophisticated
    financial services offered by FSVC, there is an increased supply in the
    form of additional organizations like the International Executive
    Service Corps that have expanded to provide such services. This may
    result in more competition for funding.

                             CONCLUSION OF HEARINGS

        Senator Leahy. Thank you all very much for being here. That
    concludes our hearings.
        [Whereupon, at 11:59 a.m., Thursday, May 10, the hearings
    were concluded, and the subcommittee was recessed, to reconvene
    subject to the call of the Chair.]

          LIST OF WITNESSES, COMMUNICATIONS, AND PREPARED STATEMENTS

                                  ----------
                                                                       Page
    Alexander, Senator Lamar, U.S. Senator from Tennessee, question
      submitted by...................................................   232

    Bond, Senator Christopher S., U.S. Senator from Missouri,
      statements of.................................................14, 168
    Brownback, Senator Sam, U.S. Senator from Kansas, questions
      submitted by...................................................   228
    Byrd, Senator Robert C., U.S. Senator from West Virginia,
      questions submitted by.........................................   225

    Daulaire, Dr. Nils, president, Global Health Council.............    65
        Prepared statement...........................................    68
    Durbin, Senator Richard J., U.S. Senator from Illinois, questions
      submitted by..................................................85, 213

    Garrett, Laurie, senior fellow for global health, Council on
      Foreign Rela-
      tions..........................................................    59
        Prepared statement...........................................    61
    Gayle, Dr. Helene, president, Cooperative for Assistance and
      Relief Everywhere..............................................    51
        Prepared statement...........................................    54
    Gregg, Senator Judd, U.S. Senator from New Hampshire, prepared
      statements..................................................... 3, 94

    Harkin, Senator Tom, U.S. Senator from Iowa, questions submitted
      by.......................................................84, 190, 212

    Kent, Dr. R. Hill, Assistant Administrator, United States Agency
      for International Development..................................    25
        Prepared statement...........................................    29

    Landrieu, Senator Mary L., U.S. Senator from Louisiana:
        Prepared statement...........................................   108
        Questions submitted by.......................................   216
    Leahy, Senator Patrick J., U.S. Senator from Vermont:
        Opening statements........................................1, 25, 93
        Prepared statement...........................................     1
        Questions submitted by.......................................   190

    Murray, Senator Patty, U.S. Senator from Washington, question
      submitted by...................................................    85

    Reed, Senator Jack, U.S. Senator from Rhode Island, questions
      submitted by...................................................   221
    Rice, Hon. Condoleezza, Secretary, Office of the Secretary,
      Department of State............................................    93
        Prepared statement...........................................    97
        Summary statement............................................    95

    Tobias, Hon. Randall L., Administrator, United States Agency for
      International Development......................................     1
        Prepared statement...........................................     3

                                 SUBJECT  INDEX

                                  ----------

                              DEPARTMENT OF STATE

                            Office of the Secretary

                                                                       Page

    Additional Subcommittee Questions................................   190
    Assisting Adaptation.............................................   215
    Core Exchange Programs...........................................   181
    Empowering our People............................................    98
    Foreign Aid:
        Our Moral Imperative.........................................   184
        Reform and Transformational Diplomacy........................   185
    Funding for International Environmental Programs.................   197
    Health and Development...........................................   215
    Helping Developing Countries and the Most Vulnerable Populations.   102
    Meeting Global Challenges........................................   101
    Millennium Development Goals.....................................   216
    Most Katrina Aid From Overseas Went Unclaimed....................   112
    Programs.........................................................   188
    Regional:
        Overview.....................................................   188
        Programs.....................................................   182
    Securing Peace, Supporting Democracy.............................    99
    Specific Priorities..............................................   184
    The Asia Foundation's Mission, Capabilities, and Approach........   188
    Transforming the State Department................................    97
    U.S. Assessed Contributions to U.N. Peacekeeping Missions........   190

               UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

    A Call to Action.................................................    73
    Additional Subcommittee Questions................................    84
    Afghanistan......................................................    20
    African Health Capacity/Brain Drain..............................    85
    Age of Generosity Commences: Still not Enough, but Rapidly
      Increasing.....................................................    61
    Agriculture Development in Afghanistan...........................    14
    Assistance for the Middle East...................................    18
    Building Capacity While Saving Lives............................47, 722
    Child Survival...................................................    34
    Egypt............................................................    21
    Family Planning and Reproductive Health..........................    41
    Financial Services Volunteers....................................    15
    Fiscal Year 2008 Budget: International Affairs...................    64
    Foreign Assistance Budget........................................    10
        Cuts.........................................................    16
    Former Soviet Republics..........................................    11
    Going Backwards on Half a Trillion Dollars.......................    62
    Health Worker Global Policy Advisory Council.....................    90
        Secretariat..................................................    91
    Healthtech and the Child Survival and Health Account.............    85
    Improving Health, Saving Lives...................................    71
    In the U.S. Interest.............................................    72
    Iran.............................................................    23
    Maternal:
        Mortality....................................................    85
        Newborn:
            Child Survival and Health................................    30
            Health...................................................    31
    Members..........................................................    90
    Millennium Challenge Corporation.................................    19
    Modest Investments, Maximum Impact...............................    72
    New Initiative Seeks Practical Solutions to Tackle Health Worker
      Migration......................................................    89
    Oslo Ministerial Declaration: Global Health--a Pressing Foreign
      Policy Issue of our Time.......................................    89
    Polio Eradication................................................    84
    Principles.......................................................     4
    Regional Funding Trends..........................................     7
    Responsiveness to This Subcommittee..............................     3
    Solutions........................................................    88
    The World:
        Needs Healthcare Workers.....................................    63
        Women & Children.............................................    69
    Transformational Diplomacy.......................................     9
    Treatment, yes: But not Without Prevention.......................    61
    U.S. Investments--Progress Undermined............................    70
    USAID Administrator and Director of Foreign Assistance...........    13
    What is the Goal?................................................    64

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