[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/
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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
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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
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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.
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\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.
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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\
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\2\ Center for Global Development, Millions Saved: Proven Successes
in Global Health, 2007 edition.
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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.
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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.
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\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.
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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\
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\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.
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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.
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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\
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\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.
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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\
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\2\ Pope John Paul II, Development and Peace, January 1, 1987.
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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.
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\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.
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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
-