    [House Hearing, 115 Congress]
    [From the U.S. Government Publishing Office]

              THE STATE DEPARTMENT AND USAID FY 2018 AFRICA BUDGET

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

                                    HEARING

                                   BEFORE THE

                     SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH,
                            GLOBAL HUMAN RIGHTS, AND
                          INTERNATIONAL ORGANIZATIONS

                                     OF THE

                          COMMITTEE ON FOREIGN AFFAIRS
                            HOUSE OF REPRESENTATIVES

                         ONE HUNDRED FIFTEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                                OCTOBER 11, 2017

                                   __________

                               Serial No. 115-85

                                   __________

            Printed for the use of the Committee on Foreign Affairs

      [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

    Available via the World Wide Web: http://www.foreignaffairs.house.gov/
                                      or
                           http://www.gpo.gov/fdsys/

                                     ______

                      U.S. GOVERNMENT PUBLISHING OFFICE
    27-162PDF                  WASHINGTON : 2017

    ----------------------------------------------------------------------------------------
    For sale by the Superintendent of Documents, U.S. Government Publishing Office,
    http://bookstore.gpo.gov. For more information, contact the GPO Customer Contact Center,
    U.S. Government Publishing Office. Phone 202-512-1800, or 866-512-1800 (toll-free).
    E-mail, gpo@custhelp.com.

                          COMMITTEE ON FOREIGN AFFAIRS

                     EDWARD R. ROYCE, California, Chairman
    CHRISTOPHER H. SMITH, New Jersey     ELIOT L. ENGEL, New York
    ILEANA ROS-LEHTINEN, Florida         BRAD SHERMAN, California
    DANA ROHRABACHER, California         GREGORY W. MEEKS, New York
    STEVE CHABOT, Ohio                   ALBIO SIRES, New Jersey
    JOE WILSON, South Carolina           GERALD E. CONNOLLY, Virginia
    MICHAEL T. McCAUL, Texas             THEODORE E. DEUTCH, Florida
    TED POE, Texas                       KAREN BASS, California
    DARRELL E. ISSA, California          WILLIAM R. KEATING, Massachusetts
    TOM MARINO, Pennsylvania             DAVID N. CICILLINE, Rhode Island
    JEFF DUNCAN, South Carolina          AMI BERA, California
    MO BROOKS, Alabama                   LOIS FRANKEL, Florida
    PAUL COOK, California                TULSI GABBARD, Hawaii
    SCOTT PERRY, Pennsylvania            JOAQUIN CASTRO, Texas
    RON DeSANTIS, Florida                ROBIN L. KELLY, Illinois
    MARK MEADOWS, North Carolina         BRENDAN F. BOYLE, Pennsylvania
    TED S. YOHO, Florida                 DINA TITUS, Nevada
    ADAM KINZINGER, Illinois             NORMA J. TORRES, California
    LEE M. ZELDIN, New York              BRADLEY SCOTT SCHNEIDER, Illinois
    DANIEL M. DONOVAN, Jr., New York     THOMAS R. SUOZZI, New York
    F. JAMES SENSENBRENNER, Jr.,         ADRIANO ESPAILLAT, New York
        Wisconsin                        TED LIEU, California
    ANN WAGNER, Missouri
    BRIAN J. MAST, Florida
    FRANCIS ROONEY, Florida
    BRIAN K. FITZPATRICK, Pennsylvania
    THOMAS A. GARRETT, Jr., Virginia

         Amy Porter, Chief of Staff      Thomas Sheehy, Staff Director

                   Jason Steinbaum, Democratic Staff Director
                                     ------

        Subcommittee on Africa, Global Health, Global Human Rights, and
                          International Organizations

                   CHRISTOPHER H. SMITH, New Jersey, Chairman
    MARK MEADOWS, North Carolina         KAREN BASS, California
    DANIEL M. DONOVAN, Jr., New York     AMI BERA, California
    F. JAMES SENSENBRENNER, Jr.,         JOAQUIN CASTRO, Texas
        Wisconsin                        THOMAS R. SUOZZI, New York
    THOMAS A. GARRETT, Jr., Virginia
                                C O N T E N T S

                                  ----------
                                                                       Page

                                   WITNESSES

    The Honorable Donald Yamamoto, Acting Assistant Secretary, Bureau
      of African Affairs, U.S. Department of State...................     4
    Ms. Cheryl Anderson, Acting Assistant Administrator, Bureau for
      Africa, U.S. Agency for International Development..............    12

              LETTERS, STATEMENTS, ETC., SUBMITTED FOR THE HEARING

    The Honorable Donald Yamamoto: Prepared statement................     7
    Ms. Cheryl Anderson: Prepared statement..........................    15

                                    APPENDIX

    Hearing notice...................................................    38
    Hearing minutes..................................................    39
    Written responses from the Honorable Donald Yamamoto to questions
      submitted for the record by:
      The Honorable Christopher H. Smith, a Representative in
        Congress from the State of New Jersey, and chairman,
        Subcommittee on Africa, Global Health, Global Human Rights,
        and International Organizations..............................    40
      The Honorable Ami Bera, a Representative in Congress from the
        State of California..........................................    52
    Written responses from Ms. Cheryl Anderson to questions submitted
      for the record by:
      The Honorable Christopher H. Smith.............................    57
      The Honorable Ami Bera.........................................    66

              THE STATE DEPARTMENT AND USAID FY 2018 AFRICA BUDGET

                                  ----------

                          WEDNESDAY, OCTOBER 11, 2017

                           House of Representatives,

                     Subcommittee on Africa, Global Health,

             Global Human Rights, and International Organizations,

                         Committee on Foreign Affairs,

                                Washington, DC.

        The subcommittee met, pursuant to notice, at 2:00 p.m., in
    room 2200 Rayburn House Office Building, Hon. Christopher H.
    Smith (chairman of the subcommittee) presiding.
        Mr. Smith. The subcommittee will come to order and good
    afternoon to everybody. Thank you for being here.
        I really deeply appreciate our two distinguished witnesses
    who are here today to give us an inside look at the budget as
    it relates to Africa and where the challenges are and where
    funding will potentially increase.
        As you know, the appropriations budget that has passed the
    House clearly indicates that there were some differences of
    opinion as to how much and where we should be spending that
    money. And I think we have come to a consensus, at least on the
    Republican side, that extraordinary, important programs like
    PEPFAR, the President's Emergency Plan for AIDS Relief, a
    number of the refugee programs, and a whole lot of other
    programs that deal with infectious diseases like tuberculosis
    need to be funded in a very robust way in order to save lives
    and to mitigate dangers, especially to women and children.
        We also have a very strong commitment on this committee and
    from our leaders from the State Department ensuring that
    refugees in a world where we have more refugees and IDPs
    perhaps than ever before, and disproportionately in sub-Saharan
    Africa, that we ensure that the resourcing is there from food
    to medicine to shelter.
        Just recently, in June, Ranking Member Karen Bass and I did
    visit some of the refugee camps including Bidi Bidi Camp and
    had a very important take away that our food security, that
    money that we were providing for food and medicine was being
    used very efficiently and compassionately. We also saw it in
    the IDP camps especially in Unity State in South Sudan where
    again because of the generosity of the American people, people
    were getting adequate food and shelter and medicine.
        Obviously, this commingles and works synergistically with
    the United Nations' efforts, particularly in camps that are run
    by the Office of the United Nations High Commissioner for
    Refugees (UNHCR), so I think that partnership, as in the past,
    as in the present, and looking into the future, bodes well for
    doing everything humanly possible to assist.
        There are always concerns about budget cuts. I think they
    are in the process of being mitigated by congressional action
    and that is a good thing in my opinion. Because again, for the
    weakest and most vulnerable among us, particularly refugees,
    particularly women and small children in dire situations where
    famine and other disasters are wreaking havoc on them, it is
    important to ensure that we get those resources to them in a
    timely fashion again to ensure survival and hopefully
    prospering.
        Finally, one of the programs I consider to be among the
    greatest ever conceived is the first 1,000 days from conception
    to the second birthday where through adequate food security,
    children and mothers are made healthier. If ever there was a
    program that boosts immunity, ensures that mother and baby are
    healthier and can thrive, it thwarts the whole idea of
    stunting. In countries where there has been embrace of this
    important first 1,000 days of life, and it is part of,
    obviously, the fabric of the Global Food Security Act which I
    was the House sponsor of, and worked very closely with Dr.
    Shah, previously with the U.S. Agency for International
    Development (USAID). And I have been with Ambassador Green, the
    new USAID Administrator, is a wonderful man to take the helm of
    USAID. As our former Ambassador to Tanzania, also he worked for
    IRI, so he gets the democracy piece, but also sat on this
    committee, my committee, years ago.
        And to have him in such a prominent and gatekeeper position
    and Cheryl Anderson, I am sure you will agree, he is a man with
    tremendous competence and compassion who will make a huge
    difference at USAID. And so we are certainly grateful that he
    is at the helm.
        I would like to yield to my good friend and colleague, Ms.
    Bass.
        Ms. Bass. Thank you very much, Mr. Chair. I want to welcome
    the Acting Assistant Secretary Donald Yamamoto and Acting
    Assistant Administrator Cheryl Anderson and thank you both for
    joining us today.
        One of the things I always appreciate about this committee
    is the fact that so much of our work is on a bipartisan basis
    and especially as it relates to the continent of Africa. As I
    was walking in, I heard the chairman describe our trip to
    Uganda and to South Sudan and I certainly going to ask you
    about that in the Q and A.
        But we all know that there is a direct correlation between
    our budget and our foreign policy priorities which is why, of
    course, the budget has caused a great deal of concern when we
    saw the initial fiscal year 2018 budget request that called for
    a nearly 30 percent cut to the State Department and USAID.
        And I know that the administration is concerned about
    security and counterterrorism. And to me, when I look at USAID
    and the State Department, you know, we can make a choice. We
    can try to deal with security in addition through the military,
    but also through diplomacy and through development, or we can
    just fund the military. And so that really concerns me. And it
    makes me feel that the fiscal year 2018 budget is extremely
    short sighted.
        I am also concerned about the African Growth and
    Opportunity Act (AGOA), and I didn't--and perhaps you can
    answer this in the Q and A, but I didn't see support for trade
    hubs and some of the other supportive programs. Maybe I am just
    missing the details, but in the CRS document, I don't see that.
        President Bush established PEPFAR and we know that PEPFAR
    has done so much to reduce HIV and AIDS on the continent. I am
    glad that that funding has continued. But I am concerned about
    the elimination of the African Development Bank and Foundation.
    And again, I think that the overall approach is short sighted.
    It is like they picked and chose, but maybe didn't understand
    what the programs were. At least I am hoping that that is the
    case. I am hoping that it can be rectified.
        I was glad that the Young African Leaders Initiative
    (YALI), Power Africa, and Feed the Future is still in the
    budget, but the question is at what level. And the
    restructuring that collapses a bunch of programs together
    certainly causes concern for me. I don't exactly know how that
    is going to work, if that reorganization has actually take
    place or if it is a proposal or what.
        And I will leave it at that and I know we will get into a
    rich exchange during the Q and A.
        Mr. Smith. Thank you, Ms. Bass. Mr. Donovan.
        Mr. Donovan. I will yield, Mr. Chairman.
        Mr. Suozzi. I will yield, Mr. Chairman.
        Mr. Smith. Thank you. I would like to now introduce our
    very two distinguished witnesses and welcome back both of these
    great leaders.
        Beginning with Donald Yamamoto, Ambassador Yamamoto, he
    served as U.S. Ambassador to the Federal Democratic Republic of
    Ethiopia from November 2006 to July 2009. He also served as
    Deputy Assistant Secretary to the Bureau of African Affairs
    from 2003 to 2006 where he was responsible for coordinating
    U.S. policy toward over 20 countries in East and Central
    Africa. He served as U.S. Ambassador to the Republic of
    Djibouti from 2000 to 2003 and was Deputy Director of the East
    African Affairs from 1998 to 2000.
        He entered the Foreign Service in 1980--same year I got
    elected to Congress I would note parenthetically. Former
    assignments include U.S. Embassy of Beijing as Ambassador's
    staff aide and Human Rights Officer, during the Tiananmen
    Square demonstrations and massacre in 1989. In Japan, he was
    Principal Officer at a consulate; in Eritrea, as Charge
    d'Affaires of the U.S. Embassy in Asmara in the Horn of Africa.
    He attended the National War College in 1996 for senior
    training and received a Congressional Fellowship in 1991.
        Ambassador Yamamoto was a graduate of Columbia College and
    did graduate studies in Columbia, receiving a Master's Degree
    in International Affairs. He studied Chinese, Japanese, Arabic,
    and French. During his Foreign Service career, he received four
    individual Superior Honor awards, two group awards, and the
    2006 Robert Frasure Memorial Award for advancing conflict
    resolution in Africa.
        Next we will be hearing from Cheryl Anderson who is the
    Acting Assistant Administrator for the Bureau for Africa at
    USAID. She joined the Bureau as Senior Deputy Assistant
    Administrator in October 2016. Before joining the Africa
    Bureau, she served as the Mission Director for USAID, Southern
    Africa from August 2013. And prior to that, she was Mission
    Director in Ghana and the East Africa Regional Mission.
        Ms. Anderson has over 20 years of development experience,
    mostly in Africa. Her experience in Africa began in Ghana as a
    Peace Corps volunteer. Since joining USAID as a Foreign Service
    Officer in 1988, she has worked in USAID missions in the
    Democratic Republic of Congo, Uganda, Sudan, and East Africa.
    She served as the Deputy Director in the East Asia Office in
    USAID headquarters in Washington, DC, and worked as a program
    manager for Healthlink Worldwide, a U.K.-based NGO.
        She received her Bachelor of Arts degree in International
    Relations from Colgate University in Hamilton, New York, and a
    Master of Science in International Development Management from
    American University right here in Washington, DC.
        Two very experienced and dedicated public servants and
    leaders.
        I would like to now yield to Ambassador Yamamoto.

     STATEMENT OF THE HONORABLE DONALD YAMAMOTO, ACTING ASSISTANT
     SECRETARY, BUREAU OF AFRICAN AFFAIRS, U.S. DEPARTMENT OF STATE

        Ambassador Yamamoto. I submit my long form for the record.
        Mr. Smith. Without objection, your formal statements, both
    of you, and an attachments will be made a part of the record.
        Ambassador Yamamoto. I want to thank you very much, Mr.
    Chairman, for the great work you have done on the Africa issue.
    And Madam Congresswoman, thank you very much for the letter to
    the Secretary of State on your concerns on the budget. And I
    hope we can address those concerns.
        I also want to highlight a couple of points before I start
    my short form and that is Secretary Tillerson, during his
    comments before the Foreign Relations Committee on June 14th,
    noted that we have a very tight budget and that a lot of
    difficult, challenging decisions have to be made, but it aligns
    with the administration's objective of making America's
    security our top priority.
        So in that regard, Mr. Chairman, and Madam Congresswoman, I
    would like to say that we appreciate the role of this committee
    and subcommittee play in helping the America people understand
    why foreign affairs matters to them. Advancing the values and
    interests of our country, promoting stability in the world does
    matter to our citizens whether it results in jobs, in economic
    opportunities, connections between communities or the safety
    and security we aim to achieve.
        For far too long, images of poverty and insecurity have
    dominated the American perspective on Africa. Yes, these exist
    in Africa, and I would be remiss today if I did not express my
    very deep concern about the continued violence and fighting in
    places such as South Sudan, the Central African Republic, as
    well as the atrocities committed by Boko Haram and ISIS-West
    Africa against innocent civilians of all faiths in Nigeria and
    across the borders of neighboring states. These challenges are
    certainly not the whole story of what is happening on the
    continent, however. Countering the scourge of terrorism and
    resolving conflict represent just a small part of what our
    partnerships on the continent aim to address and to achieve.
        As we consider the purpose and nature of our relationship
    with Africa, it is important to note two things. The first is
    Africa's emergence as a point of global interest and strategic
    convergence. What happens on the continent over the next
    several years will help shape the world's economy, security,
    and well-being. Africa is emerging as a bridge from the Indo-
    Pacific region with the larger Atlantic community, while also
    connecting directly to Europe and the Middle East.
        Second, Africa is a continent of friends and partners to
    the United States. With the African Union as the standard
    bearer, the vast majority of African states share our
    commitment to free markets, equitable trade, democracy, the
    rule of law, secure borders, and effective responses to global
    terrorist threats.
        Active engagement in sub-Saharan Africa advances U.S.
    strategic interests. Our close collaboration with the
    interagency community centers on a set of jointly agreed-upon
    priorities for Africa. Together, we remain committed to: First,
    increasing economic growth and investment; second, advancing
    peace and security; third, countering the scourge of terrorism;
    and four, promoting democracy, human rights, and good
    governance.
        The fiscal year 2018 foreign assistance budget request for
    Africa incorporates input from chiefs of missions at each sub-
    Saharan Africa post in response to these over-arching policy
    goals and reflects an integrated approach from meeting the
    diplomatic security development challenges in each country.
        The African Bureaus at both State and USAID worked hard and
    hand-in-hand throughout all phases of the budget development
    process. The President's $5.2 billion fiscal year 2018 foreign
    assistance request for Africa supports the administration's
    focus on economic and development assistance to countries of a
    greater strategic importance to the United States such as those
    critical to advancing U.S. national security objectives.
    Difficult tradeoffs were made as we worked to streamline
    efforts to ensure the efficiency and effectiveness of U.S.
    taxpayer dollars. Focusing our efforts allows us to advance our
    most important policy goals in national security interests.
        The fiscal year 2018 request addresses key priorities in
    Africa, including promoting U.S. national security interests by
    seeking to assist partner nations to defeat ISIS branches and
    affiliates and other terrorist organization threats and
    networks in Mali and the Sahel, Nigeria, the Lake Chad Basin,
    Somalia, the Horn of Africa, and elsewhere. The request also
    seeks to assert U.S. leadership and influence by prioritizing
    funding for countries recovering from or facing violent
    conflict to prevent them from becoming safe-havens for
    terrorism and extremism.
        The fiscal year 2018 request also supports efforts to
    prevent global pandemics through robust funding for health
    programs, including the President's Emergency Plan for AIDS
    Relief, or PEPFAR, in order to control epidemics and diseases
    in key countries, and preventing their spread to the United
    States. With the transfer of Ebola funding, the budget request
    also maintains funding for malaria programs. African
    governments are increasingly acting to address HIV/AIDS,
    malaria, and other diseases, as we continue to encourage these
    efforts.
        The fiscal year 2018 request aims to foster economic
    opportunities on the continent by bolstering good governance
    and education programs in Kenya, Rwanda, Uganda, among others,
    that create a positive enabling environment for U.S.
    businesses. It will also provide sufficient resources to
    continue to partner with and provide assistance to key allies
    in sub-Saharan Africa in a manner that protects Americans and
    American interests, advances bilateral and regional
    partnerships, opens new markets for U.S. businesses, and
    promotes American values abroad.
        Many of the biggest security threats that the United States
    faces including terrorism, pandemics, transnational organized
    crime are incubated and thrive in weak, failing, and failed
    states. Recognizing the foundation and importance of democracy,
    human rights, and good governance to Africa's future and to
    U.S. foreign policy objectives on the continent. We will
    continue to encourage the development of effective justice
    sector institutions, strong legislatures, robust civil
    societies, and independent judiciaries, media, and elections-
    related bodies, all of which are to improve transparency
    through advancing human rights violations by abusive
    governments so that corruption and failure to deliver these
    basic services and lack of transparency do not create
    vulnerabilities to violent extremism in unstable regions,
    threatening the United States and its allies.
        Across the board, we are striving to move beyond outdated
    models for aid and focus on the objectives that link us as
    partners with the private sector, African governments, local
    non-governmental organizations, civil society, and citizens.
    This must be the way forward in terms of budget realities and
    in recognition of how our relationship with African partners
    have progressed.
        As we continue to streamline our approach to ensure
    efficiencies and effectiveness of U.S. taxpayer dollars, we
    will continue to prioritize resources to align with the
    administration's foreign policy objectives, focusing our
    efforts and coordinating closely with donors that will allow us
    to continue to advance our most important policy goals.
        And a final point, I want to emphasize that the way we have
    prioritized our budgeting for key, crucial areas remains
    proportional to what we have done in the past several years.
        Thank you very much. I welcome your questions.
        [The prepared statement of Ambassador Yamamoto follows:]
        [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

                                  ----------

        Mr. Smith. Ambassador, thank you very much.
        Ms. Anderson.

          STATEMENT OF MS. CHERYL ANDERSON, ACTING ASSISTANT
    ADMINISTRATOR, BUREAU FOR AFRICA, U.S. AGENCY FOR INTERNATIONAL
                              DEVELOPMENT

        Ms. Anderson. Good afternoon members of the subcommittee.
    Thank you for inviting me to speak with you today about the
    United States' investments in sub-Saharan Africa. It is an
    honor and a pleasure to have the opportunity to discuss the
    U.S. Agency for International Development's programs on the
    continent.
        United States assistance is having a transformative impact
    in sub-Saharan Africa. Between 2000 and 2015, the percentage of
    Africans living in extreme poverty has declined from 57 to 41
    percent. Under-5 mortality rates have declined from 154 per
    1,000 births in 2000 to 74 children per 1,000 in 2015. And
    African school primary enrollment rates have increased from 61
    percent in 2000 to 79 percent in 2014.
        These dramatic changes were the result of sustained efforts
    by African governments, with essential support from bilateral
    and multilateral development partners, foundations, and non-
    governmental organizations. Throughout USAID's history, we have
    confronted some of the world's greatest development challenges,
    and along with our partners, we have demonstrated that our work
    can and does have a measurable impact. Even so, every program
    should look forward to the day when it can end. So every USAID
    mission must continuously evaluate how each program dollar
    moves a country closer to that day.
        These development efforts reap dividends not just for
    Africa, but also for the United States. Administrator Green has
    stressed that the United States will not turn its back on those
    in need.
        Where can we make a real difference? That question drives
    everything we do. USAID has become more selective in how we
    choose the countries and sectors where we will invest our
    resources.
        The total fiscal year 2018 budget request for Africa is
    $5.2 billion. Roughly $3.7 billion or 70 percent of the request
    represents the top 10 country programs. In fiscal year 2018,
    our resources are allocated based on the four over-arching
    policy priorities laid out in the President's Budget Blueprint.
    First, advance U.S. national security interests in Africa
    through programs that support partners in the fight against
    terrorism, advance peace and security, and promote good
    governance. Second, ensure programming asserts U.S. leadership
    and influence. Third, design programs that foster economic
    opportunities and spur mutually beneficial trade and investment
    arrangements for both the American people and our African
    partners. Lastly, we underscore all these efforts with a
    relentless focus on efficiency, effectiveness, and
    accountability to the American taxpayer.
        Many of the biggest external security threats the United
    States faces, including terrorism and pandemics, are incubated
    and thrive in weak, failing, and failed states. The fiscal year
    2018 budget request supports our continued effort to counter
    violent extremism and support conflict prevention and
    mitigation on the continent.
        For example, in Somalia, USAID activities support the
    country's transition from decades of state failure to a more
    stable, democratic ally in the volatile Horn of Africa region.
    USAID's programs challenge extremist ideology and disrupt
    tactics of Islamic State militants and al-Shabaab. Since 2011,
    USAID investments have fostered stabilization in more than 40
    percent of districts in south central Somalia that were retaken
    from al-Shabaab by creating 6,300 new jobs and providing
    education services for more than 21,000 secondary school
    students.
        For more than 55 years, USAID programs have saved and
    improved lives around the world, advanced American values,
    increased global stability, and driven economic growth in
    emerging markets.
        Of the fiscal year 2018 request for Africa, approximately
    80 percent is allocated to global health programs. These
    programs support control of the HIV and AIDS epidemic, prevent
    child and maternal deaths, and combat infectious disease
    threats. They are hallmarks of U.S. leadership in the world.
    However, responding to global challenges is a shared
    responsibility that cannot be met by one nation alone.
        Although Africa still struggles with development
    challenges, the region has experienced rapid economic growth
    and significant poverty reduction, with a number of African
    countries now among the top fastest-growing economies in the
    world.
        Increasingly, foreign direct investment is driving growth
    in Africa, and U.S. assistance is being outpaced by private
    investment. Through Power Africa, a U.S. Government initiative,
    the private sector has invested $14 billion in 57 projects at a
    relatively minimal cost to the U.S. taxpayer.
        Through the USAID Regional Trade and Investment Hubs in
    Ghana, Kenya, and South Africa, we reduce barriers to trade and
    investment, and foster linkages between U.S. and African firms.
    In close cooperation with African countries, USAID facilitates
    trade and also reduces its time and cost.
        We have also prioritized programs that promote
    entrepreneurship, help build capacity in local institutions to
    support free markets, fight corruption, and unlock
    opportunities to formalize the huge informal economy. Our
    investments also help to empower women and youth to advance
    economically, ensuring inclusive economic growth.
        We intend to uphold the administration's commitment to
    ensure effectiveness and accountability to the U.S. taxpayer.
    Rigorous monitoring and evaluation help to ensure the
    effectiveness of USAID's programs. That being said, not
    everything we do always turns out the way we plan, so we will
    continue to manage our risks well, learn from experience, and
    correct course where necessary.
        In conclusion, the United States has a continued commitment
    to a partnership with African governments, partners, and other
    donors grounded in mutual responsibility and respect. USAID has
    a very real role in safeguarding the United States' national
    security and economic opportunities. As we continue to work
    with our partners toward our shared goals over the coming
    months, I look forward to a continued conversation on USAID's
    work in Africa.
        Thank you, Mr. Chairman, Ranking Member Bass, and members
    of the subcommittee. I look forward to responding to your
    questions.
        [The prepared statement of Ms. Anderson follows:]
        [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

                                  ----------

        Mr. Smith. Thank you so very much for your testimony. To
    begin the questioning, just let me ask you first. In year 2000
    I authored the Admiral Nance and Meg Donovan Foreign Relations
    Act. It passed the House. Wasn't taken up by the Senate so I
    attached it in its entirety to that year's appropriations bill.
    Much of it focused on the issue of security for U.S. personnel
    abroad, whether it be at USAID missions or our Embassies
    themselves with a heavy emphasis on setbacks, securing the
    windows so that they are less vulnerable to terrorist attack.
    And it came right out of the bombings in Dar es Salaam and the
    bombing in Nairobi in 1997 when we learned a painful lesson
    that international terrorism was transnational and that they
    would hit softer targets believing that we would be less
    prepared.
        So my first question really is along the lines of the
    commitment that began then under the law and the appropriators
    have been very faithful and I think diligent in trying to
    ensure that the setbacks and the compounds within which our
    deployed personnel work and our contract workers including a
    number of indigenous people from each of these countries is
    sufficient to protect. And I am wondering if you could tell us
    if, in your opinion, Ambassador, that is true and reflected in
    this year's budget?
        Ambassador Yamamoto. First, thank you very much for those
    efforts. So of our 44 Embassies and we have another 6
    consulates and other offices for a total of 50. And we have
    about 1200 officers and 3200 other agencies working those
    missions, we have about 30 or so missions and offices that have
    been or are under construction under the new standards for
    security. And so those monies have been put to good use.
        The security development, I think the Secretary raised it
    very clearly on diplomatic security and the funding, so that
    continues. We still have several Embassies that are now under
    construction. In fact, this week, we will be opening two new
    chancelleries in Mauritania and in Chad. So thank you very much
    for that work, Mr. Congressman.
        Mr. Smith. I will never forget when Admiral Crowe who then
    headed up the Accountability Review Board and testified before
    my committee then back in 1988 made the case that wonderful
    people from the United States travel abroad, often at great
    risk to themselves from disease, as well as terrorism. We
    should at least ensure that the physical plan and the protocols
    that are in place to protect them are as robust as they can be.
    And that was the reason for the law in the beginning. So I am
    grateful that progress continues under your watch.
        One area of concern with yours in this year's budget
    request, which I think frankly is in the process of being
    overcome through the appropriations process, and that is the
    issue of Feed the Future. In the last Congress, I was the
    author on the House side on the Global Food Security Act with a
    big emphasis on ensuring that nutrition, proper supplementation
    was provided for, and yet this year's budget calls for very
    significant cuts in Feed the Future and elimination of the of
    the Food for Peace program. I don't believe that will happen
    and I wish it wasn't even in the budget request to begin with.
        Already in the appropriations bill, as passed by the House,
    that is largely overcome with bipartisan efforts to ensure that
    that important food security is available. But if you would
    like to speak to that and in a like manner, PEPFAR. A visionary
    bill authored originally by Congressman Henry Hyde who was
    chairman of our full committee, but also especially inspired by
    George W. Bush who said, ``This pandemic must end.'' And I
    remember Henry Hyde explained to him, he said, ``If left
    untreated, this will be like the Bubonic Plague'' and was
    already claiming lives of so many millions of men, women, and
    children in the United States, but also in sub-Saharan Africa
    where it was particularly raging and destroying human life.
        There is a significant cut, as well, in PEPFAR and on the
    good news front, I don't it is going to happen. Already in this
    budget we are talking about the budget that the House has
    passed for appropriations. Talks about $6 billion being
    allocated for the PEPFAR program and through USAID as well. So
    I think it will be overcome by congressional intervention, but
    if you would speak to how important these programs and others--
    you know, it is not the nature of both Democratic and
    Republican administrations.
        I remind my colleagues that President Obama sent up budgets
    that cut tuberculosis by 20 percent. We added it all back. He
    had a program that neglected tropical diseases efforts which
    were at at $100 million, cut it by $20 million. We put it back.
    I tried to get it to $125 million, but at least we got it back
    to straight lining.
        And Mr. Biggs and I have introduced a bill that would
    significantly prioritize these horrific neglected tropical
    diseases including worms which about 1 billion people carry,
    which is unconscionable, when we think what that must be like.
    Rather than Feed the Future with food, we are feeding the
    worms. So we really want to ensure that people have healthier
    guts and parasites are destroyed inside of these very
    vulnerable groups of people all over the world, but especially
    in sub-Saharan Africa.
        But if you could speak to PEPFAR and this effort. Again, I
    do think the record should show it this year's budget already
    makes it clear that that money is going back into the budget
    and perhaps you might want to speak to how well utilized that
    money could be to ensure that these vulnerable populations are
    cared for.
        Ms. Anderson. Thank you, Mr. Chairman. I would emphasize
    that as we formulated the budget for fiscal year 2018, we
    worked to reflect the President's America First policy and the
    foreign policy priorities of the administration. So we focused
    our resources on the programs and the countries and the sub-
    regions where we felt we could maximize our impact on national
    security, on U.S. economic interests, U.S. influence and
    leadership, and also efficiency, effectiveness, and
    accountability to the American taxpayers.
        So we made some tough choices. And I would like to
    emphasize that at any budget level, we always have to make sure
    that we are efficient with our use of resources. And it is
    always a very good exercise to see how we can be more
    efficient. It is also important for us to look to others to do
    more, including helping our host countries to mobilize domestic
    resources to help mobilize private capital for development
    objectives. That said, we absolutely recognize the importance
    of food security and appreciate the Global Food Security Act.
        Feed the Future has already done quite a bit toward the
    development of the countries in sub-Saharan Africa. We are
    particularly concerned about building resilience to future
    shocks that we know will be coming, especially drought in some
    of the areas of sub-Saharan Africa where we see recurring
    problems.
        We also realize that the work that we do in food security
    and making the value chains more efficient is good for U.S.
    businesses. So we did announce a new set of target countries
    for Feed the Future and we will continue to prioritize our
    resources as much as we can in the countries where we will have
    a good impact.
        On PEPFAR and on health, in general, I think you will see
    in the fiscal year 2018 budget the line item for PEPFAR
    actually went up a little bit. And we recognize the importance
    of continued investments in health and especially in HIV and in
    AIDS.
        Mr. Smith. I noticed in the explanation before, Ambassador
    Yamamoto, the administration said that nobody would lose their
    ARVs. Anybody who was on treatment would continue receiving it.
    And that is important for a number of reasons, obviously. You
    don't want people who are HIV positive obviously getting full-
    blown AIDS and suffering the ravages of that deadly disease.
    But I think one of the greater stories that remains largely
    told in policy circles, but not in the general public, is that
    the viral load, as you know, is so significantly reduced to a
    treatment, not just preventive means, but the treatment itself
    down that viral load. So the more we provide treatment the more
    we are lessening or mitigating the transmission of this
    horrific disease. So I am glad to hear of the increase because
    I think it is needed and then some.
        And I do believe, as you have noted, and I have read the
    budget recommendations, we want to get others to do more and
    that is an important concept. And the American taxpayer demands
    that others step up and do more, particularly the European
    Union where much more could be done. With that said, for people
    who are suffering starvation or the ravages of disease, it
    seems to me that we always should be the first with the most to
    make sure that they survive and thrive, even if the others do
    not step up to the plate. That is just my thoughts on that.
    Ambassador.
        Ambassador Yamamoto. Thank you, Mr. Chairman, and really
    for all your great work for the committee. So just to kind of
    emphasize that the overall budgeting, if you look at the $5.2
    billion 2018 request is still over about 81 percent which is
    not really changed in the past, so 81 percent toward health and
    overall healthcare issues.
        But I think what is really important is that over the years
    since PEPFAR has developed and Feed the Future, what the
    Ambassadors are doing and what we are doing with USAID
    directors in the field is doing much more integration. So in
    other words, building on other pots of funding and also
    programs and kind of bring it together. So for instance when
    you see the PEPFAR countries from Cote d'Ivoire, Ethiopia,
    Ghana, Guinea, Namibia, Nigeria, that is just not receiving
    PEPFAR money, but they are also receiving economic support
    funds. The other issue is military assistance to help for
    security issues, education, agriculture.
        The other issue, too, is looking at supporting our NGO
    partners, the faith-based groups, etcetera. And so it is really
    a much more holistic, cohesive group.
        The other thing, too, is I think we have learned from a lot
    of areas. I think when I was the Ambassador in Ethiopia, we had
    a problem about how to utilize all the funding. And I think
    through your guidance and the guidance from USAID, we have done
    a much better job of really utilizing effectively and saving a
    lot of taxpayer money. So thank you.
        Mr. Smith. Ranking Member Bass.
        Ms. Bass. I want to compliment both of you for incredible
    careers and contributions that you have made to our country
    through your service over the years. And you don't need to
    answer this, but I know that you have to support this budget
    and it must be very painful because this is just filled with
    contradictions.
        You ran through, Ms. Anderson, you ran through--I think I
    lost track of some of your points, but U.S. national security
    to advance peace. You talked about U.S. leadership and
    influence and efficiency and effectiveness and accountability.
    I think there was one I missed. Did I miss one?
        Ms. Anderson. U.S. economic interests?
        Ms. Bass. Yes, U.S. economic interests and you also said
    America First. And to me, America First doesn't mean we
    abdicate our leadership role. And so for national security and
    advancing peace and then the budget proposes cutting
    peacekeeping and cutting development. So to me, that is a
    direct contradiction. U.S. leadership and influence, Feed the
    Future is a perfect example of U.S. leadership.
        You know, I think it is one of the best programs we have
    had and the chairman's leadership in it. Instead of us
    providing food to Africa, Africa can feed itself. And us
    providing technology and our scientific expertise so that we
    can build the capacity rather than have this charity approach
    to me is U.S. leadership. We complain about the role of the
    Chinese. Well, you know, this budget has us stepping back in my
    opinion.
        When you are looking for efficiency and effectiveness, I am
    wondering if instead of cutting programs, you are looking at or
    examining any outside contracting that might be done. And you
    know, if that is an area where you could look at cutting
    instead of cutting things like some of the programs that we
    have talked about.
        I wanted to ask you about a couple of things health
    related. It is my understanding and you can tell me if I am
    wrong, but that the budget would dramatically reduce
    reproductive health programs and family planning. And one of
    the problems in Africa is maternal deaths and one of the
    reasons why you have maternal deaths is when women cannot space
    their pregnancy. And so if I am reading it right, what is the
    logic in cutting it back?
        You know, again, we can make decisions about national
    security. We can put all of our resources in the military or we
    can help address some of the root causes for the conflicts to
    begin with. And it seems like this budget is very short sighted
    and why I said it is full of contradictions.
        Now it is a perfect example of why I am thankful we have
    three equal branches of government so that we can push back and
    not fund the way this budget is proposing to fund Africa-
    related programs. So I want to ask, am I correct in looking at
    essentially family planning would be zeroed out, if not
    drastically reduced. You can answer that, one of you.
        Ms. Anderson. That is correct. We have zeroed out family
    planning in the fiscal year 2018 budget.
        Ms. Bass. What is the reason? What is the logic for that?
        Ms. Anderson. Policy decision.
        Ms. Bass. Yes, I know it is a policy, but why?
        Ms. Anderson. I would be happy to take your thoughts back.
        Ms. Bass. You know, I know that funding is cut for anything
    related to climate change and unfortunately Africa and a lot of
    the problems that happen in Africa, the natural disasters are
    completely related to climate change. So is that just using the
    budget to express an ideology?
        Ms. Anderson. Again, that was a policy decision. I would go
    back to family planning and note that we continue our
    commitment the health of women and children with our other
    health programs including maternal and child health and malaria
    programming and HIV/AIDS.
        Ms. Bass. Maternal and child health. One of the reasons for
    maternal death are not being able to space your pregnancies. So
    you provide it in one side and then contribute to the problem
    in another way?
        Ms. Anderson. Yes, go ahead.
        Ambassador Yamamoto. And yours was a very cogent and very
    difficult question and the challenges that we had in trying to
    fashion the budget and what decisions are made, but then on the
    other side, too, we are looking at for more efficiencies. I
    will give you one example is on maternity and infant mortality
    rates. So looking at the different pots of money and looking at
    what really makes sense, so for instance, in East Africa where
    you have in many countries and areas one out of every ten will
    die before the age of 5. So if they survive to five is really
    one of our basic USAID campaigns.
        Ms. Bass. Which is our chairman's program as well. First
    1,000 Days.
        Ambassador Yamamoto. It is one of the most effective. The
    areas that we have to depend on contributions from NGO groups,
    the others, faith-based groups, and we really connected with a
    lot of faith-based groups in the United States from Oklahoma to
    Virginia to other places in the Eastern United States.
        Right, it doesn't make up all the issues that we need to do
    and to address, but it makes up a significant. The other part
    is is one of the things that----
        Ms. Bass. What do the faith-based groups have to do with
    it? I am missing your point.
        Ambassador Yamamoto. For instance, in Ethiopia and Somalia,
    you don't have incubators. And so what they have done is they
    have made these skull caps, which is to help.
        Ms. Bass. Oh.
        Ambassador Yamamoto. And then we bring in--it is called,
    the mothers are--we call them kangaroos because what they do is
    because there are no incubators, they hug the child until they
    survive.
        Ms. Bass. Right. Keep the child warm.
        Ambassador Yamamoto. That is right. And then the other
    issue, too, is looking at food aid and food assistance and then
    food development issues to help feed children, etcetera.
        The other issue that is really kind of plaguing us is
    medical care and health care. So for instance, when we were
    doing a data dumping on some of the countries, particularly
    Ethiopia, we were noticing that a lot of doctors, there were
    more Ethiopian doctors outside of Ethiopia than inside
    Ethiopia.
        Ms. Bass. There were more what?
        Ambassador Yamamoto. Ethiopian doctors.
        Ms. Bass. Right.
        Ambassador Yamamoto. In Botswana, even in Washington, DC.
        Ms. Bass. Probably in Los Angeles.
        Ambassador Yamamoto. Yes, Washington, DC. So the issue is
    what do you do? And so we learn from the U.S. program EMTs and
    how to do basic EMT work and having basic healthcare providers.
    And so the low cost, a lot of contributions, and private sector
    support and so that helps to address a lot of the basic
    maternity and infant mortality issues.
        Ms. Bass. When we had a hearing, the Deputy Secretary
    testified before the full committee regarding the State
    Department's redesign plan which really seems like it is a
    mess. I mean you might be able to talk about that, all of the
    combination of programs. But in particular, I asked about a
    special envoy, specifically the South Sudan. And the Deputy
    Secretary thought that the special envoy was put in statute by
    Congress. And that is not the case apparently.
        So what we have been told is that the Department of State
    believes that the responsibilities can be administrative
    realigned to be covered by the DAS within the Bureau of African
    Affairs. And so I want to know if you can provide additional
    details about the DAS that will cover this and how we think,
    especially given--you know again, it is shortsightedness.
        We pass close to $1 billion for famine and then we remove
    the special envoy to South Sudan?
        Ambassador Yamamoto. And so from your travels and visits to
    the region, you see very much the problems in Mali, 1.3 million
    refugees from South Sudan going to Uganda and other problems.
    What we have done on the decision made by the Secretary is that
    we have the envoy back into the Bureau. And so we still have
    those FTE positions, so in other words, the positions.
        So what we want to do is is really kind of refocus and we
    have been coordinating with the P3s and our donor colleagues,
    particularly the special reps that they have from Norway, the
    U.K. And then looking at the African Union and seeing how can
    we, the United States, play a----
        Ms. Bass. I thought we cut the African Union, we cut
    funding to the African Union.
        Ambassador Yamamoto. But the issue is that we are
    coordinating with them because they play a critical role,
    particularly in the high level dialogue run by Ethiopia's
    Hailemariam and Uganda's Museveni with Salva Kiir in Southern
    Sudan. So based on that, we are looking at how we can realign
    and support these efforts and then using our positions to use
    senior officers to play critical roles in support of and also
    taking lead in certain areas. That is something that we are
    still looking at, but I think I have a little more confidence
    now as we look in reshaping and redirect our operations.
        Ms. Bass. So you don't think a special envoy is needed?
        Ambassador Yamamoto. At this point the decision has been
    made that we will not have a special envoy.
        Ms. Bass. That was a good answer. You didn't answer that,
    but I understand that. I really do. I feel like both of you,
    this budget does not reflect your illustrious careers and I am
    sorry that you have to be put in a position to defend it.
        My final question is--I am sorry.
        Ms. Anderson. If I could just make one clarification on the
    development budget for African Union. If you are looking at the
    line items it is showing as zero, but we will be providing
    funding through the regional account.
        Ms. Bass. So the chairman asked you a question, Ambassador,
    about Embassy security. And you mentioned that several
    Embassies were on line to be built. What about the DRC? That
    Embassy, when I went there, the place was falling apart.
        Ambassador Yamamoto. That is an issue that we have been
    working on for years. We have asked President Kabila to give us
    land so we can start building. And that is something that we
    are going to be pushing very vigorously because we really need
    to get our people into safe, secure areas. And that is one of
    our top priorities.
        Ms. Bass. Well, even if he doesn't give land, do we have
    anything in the budget to repair that place? Because literally,
    it looked like it was falling apart.
        Ambassador Yamamoto. And we have done based on DS security
    regulations to look at how we can upgrade what we have now. But
    the bottom line is that we need to have a new Embassy and that
    is what we are looking and focusing on and working with the
    government on.
        Ms. Bass. Thank you. Yield back my time.
        Mr. Smith. The gentleman from New York, Mr. Donovan.
        Mr. Donovan. Thank you, Mr. Chairman. I have to attend a
    Middle East and Northern African hearing, so I just wanted to
    ask one question.
        Mr. Ambassador, you touched on it. I think you also did,
    Ms. Anderson, about efficiencies and reviewing where we are
    getting the best results from the efforts that we are making
    and where we are replacing our resources. Can you touch on some
    of the findings that you may have found as you review whether
    or not some of the programs are as efficient as we would hope
    they would be and then maybe some other areas that you might
    look at in the future to see where we would reallocate
    resources so we are getting results for our efforts?
        Ambassador Yamamoto. So as we are looking at the security
    environment right now and the problems we are seeing is flow of
    arms, criminal syndicates going through Central African
    Republic and then posing problems to the G5 countries, those
    are like Mauritania, Chad, Niger, etcetera is what is it that
    we need to do to kind of bolster the security? And the issue is
    that you don't want to do it alone.
        So from the U.N. General Assembly on we have really worked
    very effectively and hard with the key threes, that is the U.K.
    and then France and then other donor countries. And then also
    the African Union and the regional states, so ECOWAS and other
    issues. And then looking at what they are providing assistance
    or what they see the issues are, then looking at our own
    funding that we have given to countries.
        So what we have done is if you look at the budget, you see
    a lot of countries that are being decreased by 20 percent, 30
    percent or what have you. But if you look at the regional
    funding, that is where we are looking at trying to use that as
    assistance or reserve to look at the most critical areas that
    we need to provide assistance. So in other words, we have--I
    will give you some examples on the funding. So we have $131
    million that is going to be Chad-based in country. That is
    Nigeria, Mauritania and Niger. And then we look at the trans-
    Sahel and the TSTCP on the west side and the PREACT on the east
    side. And so as we see problems developing, we can use the
    funding from these regional bases to help support and bolster
    these countries' security.
        Mr. Donovan. Ms. Anderson.
        Ms. Anderson. I would say three things. On finding
    efficiencies in our programming, we have had a major push on
    putting more rigor into our monitoring evaluation since 2011.
    And that is good because that is a very good way to look back
    at the evaluations and see where we can find efficiencies.
        A couple of things, when we have very small programs, it
    takes a long time to mobilize and it can be quite costly, but I
    also appreciate Ranking Member Bass' comment about looking at
    some of the big outside contracting, so that is also where we
    will be looking.
        And then on the other side of things, improving our
    partnerships with the host country governments, with civil
    society so that we truly have a partnership in our planning and
    working together toward the same objective because what we
    always want to be doing is working toward the time where we
    don't have to have a big program that is as involved as maybe
    we have previously.
        And another aspect to that is finding ways that we can
    mobilize the private sector, private capital. I think we have
    done a pretty good job in Power Africa and even Feed the Future
    in mobilizing private capital for some of the infrastructure
    and other investments that are needed for development.
        Mr. Donovan. I have to excuse myself, but I thank both of
    you for your service to our country.
        Mr. Smith. Thank you. Dr. Bera.
        Mr. Bera. Thank you, Mr. Chairman. Before I start asking my
    questions, again I appreciate both of you being here. I
    appreciate both of your long service to our country and
    understand that your job as career diplomats are to implement
    the policies of the administration.
        I also do want to just give a shout out to the many
    employees of the State Department for the work that they are
    doing representing the United States both here and abroad under
    difficult circumstances, often having, my opinion, often having
    to implement policies that they don't believe in, but doing
    their job every day.
        I also, as a message to the administration, they are very
    much under cutting our ability to be the great country that we
    are.
        America is a better place and the world is a better place
    when America is engaged globally. We have seen that in the
    second half of the 20th century when we have been leading with
    our values, our values of compassion, our values of leadership
    in health and global health, our values of leadership and
    development.
        The second half of the 20th century was much more stable
    than the first half of the 20th century because of that
    American leadership. And much of that leadership was our
    diplomats and the valued employees of the State Department. So
    I think certainly I speak to many of the members of this
    committee that we will do everything we can as we go through
    the budgeting process to get you the resources and the
    personnel to continue to do that exemplary job. But I thought
    it was very important to make sure those employees that are out
    there representing our great nation understand that many of us
    appreciate that service.
        Now kind of getting back to some of the questions, I
    understand the President talks about an America First policy. I
    think the policy he is putting forth is going to make us weaker
    and have less influence around the world and is not a
    reflection of what our values are.
        Ms. Anderson, I want to make sure I heard correctly, the
    President's budget zeroes out all family planning funds?
        Ms. Anderson. For fiscal year 2018.
        Mr. Bera. And the budget is a reflection of a President's
    values and so forth. That is our best reflection. So my
    opinion, it is appropriate when we talk about family planning,
    that is birth control, that is other forms of contraception. We
    are not talking about abortion because we have not been using
    Federal funds for pregnancy termination. We have been using
    Federal funds and working with NGOs and others historically to
    reduce the number of unintended pregnancies. That, I think,
    most global health experts, and I am a physician who has worked
    internationally, would think that is appropriate.
        My colleague, Ms. Bass from California, has talked about
    the importance of reducing maternal and child mortality and one
    of those causes of maternal mortality is the spacing of
    pregnancies. So if it is in our values to reduce maternal
    mortality, we ought to make family planning funds more
    accessible.
        I haven't asked any questions yet because there is a lot on
    my mind here. I understand that there are Members of Congress
    that are anti-choice, along with those that do want to empower
    women to be in charge of their full reproductive rights. But
    regardless, I think we all want to reduce the number of
    unintended pregnancies. And on May 15th, the State Department
    released guidelines for the implementation of the Mexico City
    policy, the global gag rule which my understanding is for the
    first time will apply to all global health assistance programs,
    many of which are in Africa.
        Now this isn't the first time that this policy has been
    introduced. In fact, it seems to swing from administration to
    administration based on the party that is in charge. But if our
    goal is to reduce the number of pregnancy terminations and
    reduce the number of unintended pregnancies, what I will tell
    you is the last time this policy under George Bush was
    implemented, the number of abortions rose 20 percent as a
    result of curtailing the ability to have family planning out
    there.
        Ms. Anderson, would that be a somewhat accurate number?
        Ms. Anderson. I am not certain I have that kind of data
    right now, but I certainly appreciate the point. Thanks.
        Mr. Bera. Thank you. Earlier this year, I asked Secretary
    Tillerson a number of questions regarding this policy including
    as they implement the Mexico City policy. Would they be
    consulting with partners in the field, monitoring the impact of
    the policy on healthcare access as well as maternal mortality?
    And I think I was told that there would be a 6-month review of
    the policy as it was being implemented.
        Given the significant amount of healthcare funding we
    contribute to the Africa region, I have got a couple of
    questions. The Bureau of African Affairs at State and the
    Bureau for Africa at USAID obviously is playing a role in
    implementing this policy and assessing the potential impact of
    the policy such as again women's access to health care, family
    planning services, rates of unsafe abortion, and maternal
    mortality including the 6-month review.
        Do you have any idea what the time line for releasing the
    6-month review is?
        Ms. Anderson. We are working to fully implement the policy
    and I would be happy to get back to you on that.
        Mr. Bera. If you could, that would be great. Again, as you
    are implementing this policy and again, I am not holding you or
    the wonderful employees of State accountable for this policy,
    but when I questioned Secretary Tillerson, one of the things
    was look, we ought to be checking on is this impacting maternal
    mortality? What impact is it having on folks that are out in
    the field? What impact is it having on women's access to health
    care?
        Certainly, I think many on this committee would have a very
    big interest in how that policy is being implemented.
        I guess my last question and maybe it is for Ambassador
    Yamamoto, I am all for looking for efficiencies, looking for
    ways we can take our Federal dollars and our taxpayer
    resources, partnering those with NGOs that are out there
    working in the field, whether those are faith-based groups or
    folks like the Gates Foundation, etcetera, and looking at ways
    reducing morbidity and mortality and increasing health around
    the world. I just worry with the reduction in certain programs
    it is actually not helping us leverage our dollars. It is
    actually reducing our ability to have impact in the region. And
    I just would be curious about your thought on that?
        Ambassador Yamamoto. Let me give you something that you all
    worked on very hard and that is the AGOA process. And I think
    that more than anything has given a lot of hope to Africa.
    Obviously, a lot of countries don't benefit, but actually in
    many ways they do.
        And we were just going and doing the data numbering and we
    notice that exports from the United States to Africa rose from
    $6 billion in 2000 to $25 billion. That means you are talking
    about well over 35,000 U.S. jobs. But on the reverse side is
    producing and expanding the capabilities for the Africans.
        You know, today, they have a $500 billion total
    manufacturing output. That is going to be $1 trillion in the
    next decade which means that we are going to help create
    hundreds of thousands of jobs in Africa. So that, I think, if
    we can continue to do that and one of the areas that I think in
    spite of the budget cuts and restraints is that if we can
    continue our efforts on fighting corruption, building
    institutions, fighting back on non-tariff trade barriers, it is
    really opening up businesses and trade so that countries in
    Africa, their main trading partner is not going to be Europe or
    the former colonial countries, but each other.
        We have the capability or ability to produce probably $100
    billion in added value over the next several decades. That
    means that that is going to create jobs and when you create
    jobs, you create wealth and security. And those are the areas
    is how do you give them that hope? Those are the fundamental
    questions and issues that we are trying to struggle with and
    what is the best way, the most efficient and effective manners?
        And I think some of the things that we are doing on the
    budget is that we are going to meet those needs through the
    AGOA, through a lot of the programs and projects that you have
    already set up.
        I mean look at, for instance, YALI. So YALI is--we now have
    74,000 applications for 700 fellowships to come to the U.S. And
    once they come to the U.S., they are going to the already
    500,000 YALI groups that are all over Africa being kind of like
    African Ambassadors to the United States and vice versa,
    Ambassadors to Africa, who are supporting and developing and
    expanding this relationship. I think this has really been a
    very good program.
        Ms. Bass. Will the gentleman yield?
        Mr. Bera. Absolutely
        Ms. Bass. You just described YALI which I would agree with
    you 100 percent. YALI is being cut.
        Ambassador Yamamoto. It is, 50 percent. So we are getting
    700 fellowships this year as opposed to 1,000. But they were
    still going to continue to develop the fellowship programs and
    centers out in Africa. That is the issue.
        Ms. Anderson. If I could just chime in? We have had a fair
    amount of interest from private sector companies in
    contributing to YALI, especially the regional leadership
    centers in Africa. And we are hoping to mobilize those
    resources better in the coming years. We do have $5 million
    programmed for the regional leadership centers for 2018.
        Mr. Smith. Mr. Castro.
        Mr. Castro. How is the morale at the State Department?
        You don't have to answer it. I can ask you another
    question.
        Over the last year, there has been a growing call toward
    autonomy or even independence in Anglophone Cameroon. Cameroon
    military has apparently been deployed in these regions and the
    government has reportedly blocked social media and internet
    access on multiple occasions.
        Amnesty International recently reports that up to 17
    protesters died, many by the hands of police. So how is the
    State Department and USAID addressing the situation?
        Ambassador Yamamoto. And thank you for your question. And
    thank you for your concern on the issues. Cameroon is a
    critical core country, not only security-wise, but also
    economic because you know, it forms the oil pipeline from Chad
    into Cameroon.
        We have talked to President Biya. I have been almost on a
    monthly basis several years ago when I was the deputy in the
    Bureau to look at how you do the transition from post-Biya. He
    has been the President for a long time and how do you
    transition, prepare the country for a post-Biya or for the next
    leadership?
        The other issue, too, is how do you prepare and develop
    Cameroon's two groups of French speaking and Anglophone? And
    really, it comes down to does everyone have equal access to
    wealth and resources; two, education. Three is jobs. Four is
    also is there equal opportunities for security and
    opportunities afterwards? And those are issues and challenges
    that we continue to face. So the fundamental issue is right now
    is that we have issued statements calling on the government and
    all sides to refrain from the violence.
        Mr. Castro. But have we confronted them on the violence and
    the abuse and the murder?
        Ambassador Yamamoto. We have on President Biya and the
    government, we have. And we will continue to do so. And in the
    course of my going out to the region is those will be one of
    the first stops.
        Mr. Castro. Thank you. And of course, as you know, this is
    an incredible time for refugees around the world. Many Syrian
    refugees in Europe, I spoke yesterday on the Rohingya Muslims
    who have fled or have been pushed out to Bangladesh, Central
    Americans from the Northern Triangle who have come to the
    United States, and there are also refugees in Africa.
        So my question is these refugees in Somalia, South Sudan,
    and the Central African Republic, when refugees move across
    borders, how have host governments responded in those areas?
    Are host governments able to provide for refugees including
    food, water, shelter, medicine? And what can the United States
    do to address any difficulties that these host governments
    face?
        Ambassador Yamamoto. And you raise the fundamental
    difficult challenges. So if you have 65 million refugees
    worldwide and if you look at the countries that have really
    taken in a lot of the refugees, it is really the countries
    around the areas of crises.
        So if you look at Somalia right now, you have Dadaab
    refugee camp which most of us have gone to. I mean it is the
    size of San Diego. If you look at the 1.3 million refugees
    coming out of South Sudan, going into Uganda, or if you look at
    the refugee flows coming in in Ethiopia, you see now we are
    seeing some flows of refugees of the DRC into neighboring
    countries.
        And so the question is we have the Bureau of Population,
    Refugees, and Migration (PRM), our Refugee Bureau, which looks
    at funding and assisting these countries to support the
    refugees. We also looked at the UNHCR, the United Nations
    organizations. We look at other donor communities in support of
    these refugees. It is difficult. It is long-term, but the issue
    is it has to be immediate response because people are suffering
    as they go across the borders.
        Mr. Castro. Sure. And then if you will indulge me one more
    comment, chairman, just for the record and this subcommittee,
    so much of the work that all of us care about, including the
    chairman's work over the years which I have heard him speak
    strongly on human rights, for example, I believe much of that
    work is undercut by the budget cuts that we are seeing, and
    also by some of the changes in policy.
        I think that we are ceding a lot of ground to other
    countries like China to go into places like Latin America and
    Africa and build stronger relationships than perhaps even some
    of the relationships that we have. And I see that issue only
    growing in the coming years if we continue down this new path.
    But thank you all for being here. Thank you for your testimony.
        Mr. Smith. Thank you, Mr. Castro. I do have one final
    question on peacekeeping, but before we get to that just a
    point. Dr. Bera raised the issues of the Mexico City policy and
    I think people know that it got its name because under Ronald
    Reagan, it was announced at the U.N. Population Conference in
    Mexico City in 1984. And the policy was to say we want to
    protect harmless unborn children and who we contribute to does
    matter. If an organization wants to perform and promote
    abortion, except in the case of rape, incest, and life of the
    mother, and those are the three exceptions contained in the
    Mexico City policy, if they were to do that, we believe that
    the unborn child should be held harmless.
        There are members of this committee, Members of the House,
    and we just had a very divisive vote on pain-capable unborn
    children who at 20 weeks we sought, and it did pass the House
    with a rather significant majority, that pain-capable unborn
    babies ought to be protected. And I, during the course of that
    debate, quoted from a doctor, Dr. Levatino, who used to be an
    abortionist. He performed 1200 abortions himself, over 100 on
    children up to 24 weeks gestation and he told the story before
    the House Judiciary Committee how he would pull arms and legs
    off of a child and he was numb to it. He felt it was an
    abortion, so therefore it was justified. And then he had a
    complete, total, 180 degree change of heart and said, ``What am
    I doing? I am pulling a baby apart.''
        We know for a fact that children as early as 20 weeks
    survive at 20 weeks' gestation. And that they are in nurseries,
    intensive care nurseries. And one of the doctors that I quoted
    as well, who works in an intensive care neonatal unit talked
    about her patients at 20 weeks, that if she were to go and pull
    and arm or a leg, delimb that the child, that that child would
    suffer would be intense.
        So I believe, it is not shared by everyone and I respect
    all people, whatever their view, that the most fundamental
    human rights issue of our time is protecting the innocent and
    the most vulnerable from violence.
        And I do believe that abortion is violence against children
    and it also, and I work with a number of women who are post-
    abortive, that there are consequences for the women as well,
    particularly psychologically. Not all would agree with that,
    but there is no doubt that when you dismember or chemically
    poison an unborn child, it has a horrific impact on the child,
    the older he or she is, and the evidence is overwhelming, not
    even suggestive, but overwhelming that they feel pain and they
    feel even more excruciatingly in a much deeper way than we do
    because from 20 weeks to 32 weeks gestation, there are more
    receptors on the skin area available to the dismemberment and
    the child just does feel it even more.
        Dr. Anand, who is an expert, has stated that in sworn
    affidavits on behalf of the Justice Department in courts of
    law. I say that because there will be obviously on-going fights
    on this issue. President Obama reversed the Mexico City policy
    when he took office. President Clinton did the same thing.
    Ronald Reagan initiated it. George Herbert Walker Bush
    continued it and George W. Bush reinstated it.
        I am very proud of the administration for extending it to
    global health so that the child is held harmless. These are
    babies. The first amendment I offered in the U.S. House of
    Representatives in committee, in the Foreign Affairs Committee,
    was to provide $50 million to the Child Survival Fund to
    promote immunizations, oral hydration therapy, growth
    monitoring, and breast feeding, the four pillars of child
    survival.
        Unfortunately, Ronald Reagan's David Stockman had suggested
    we take the $25 million that we have in that program and we get
    rid of it. I doubled it by offering my amendment. I do believe,
    respectfully, to those who disagree, that abortion is
    antithetical to child survival because it literally takes the
    life of that child and destroys him or her and
    disproportionately women, girls, the girl child is killed.
        I chair the China Commission. We just released our most
    recent human rights report, and because of sex selection
    abortion, China is missing 62 million or more girls. Girl
    children are killed. More than that have been killed the sex
    selection abortion, but in my humble opinion, this is an act of
    gender crime when you single out a child at 5 months or so
    through ultrasound, discover that it is a girl and it was
    admitted, even was put out that said the three most dangerous
    words that could be uttered in some parts of the world, ``It is
    a girl,'' because then she is targeted for elimination and
    extermination, simply because she is a girl.
        I again want to applaud the administration for saying we
    will provide those monies and you will get more than what you
    asked for for a variety of programs, including family planning,
    but we agree with the caveat that we want to hold harmless that
    child from dismemberment or chemical poisoning because that is
    the two ways that abortions are effectuated.
        Let me just say, ask one question, and my final question on
    peacekeeping. I am concerned that the administration's budget,
    the fiscal year 2017 enacted level was $1.9 billion. The
    proposal is for $1.2 billion. There are 21 peacekeeping efforts
    under way around the world. Six are under the auspices of the
    African Union; 15 under the auspices of the United Nations.
        And Karen Bass and I, when we went to South Sudan, we both
    have been there a number of times, we went there in June. We
    were happy to see the UNMISS, the U.N. deployment there had
    greatly fine-tuned and embedded their rules of engagement
    because they had been wanted in many, many ways. I had been
    there a year before that and frankly they were not really
    protecting civilians. But we, I think you would agree, we found
    that there was an increased effort to try to be on the
    protection side and really--my question is, my concern, and I
    think it is shared by every member of this subcommittee, is a
    cut in peacekeeping, even though we always want them to do more
    with less, we want other countries, particularly in the EU to
    step up and perhaps donate more, and I agree with that.
        But it is a bargain when it comes to deployment of getting
    troops highly trained and in Africa, they are mostly African
    troops, not all of course, but for the U.S. military, this is
    incredible value added and for the civilians, the women and
    children, especially who suffer in these countries from rogue
    militaries, as well as insurgents and terrorists, it is the
    difference between life and death.
        I want to encourage you to do what you can--even more. I
    think personally both of you would be more supported, but even
    in the administration to say this is a really good deal for
    protection, making sure that the peacekeeping funding is as
    high as it could possibly be. And I say that with one other
    caveat that I know what you are doing. As you know, I am the
    author of the Traffic and Victims Protection Act and I work on
    that issue every single day.
        When we found out in the Democratic Republic of Congo that
    the peacekeepers themselves were raping children, as young as
    13, there was an outrage in a human rights violation with very
    few parallels. I know that the U.N. peacekeeping leadership
    have gone through great lengths to try to really reign in on
    that egregious practice and have done so very successfully. It
    is not perfect. Never is, but I want to applaud them in New
    York and those who are involved with this effort.
        Jane Holl Lute, who was one of the ones who helped get Kofi
    Annan to enact or put into place the zero tolerance policy, but
    again, our Government, obviously, our TIP Office, State, and
    USAID, all of us together need to be pushing to make sure the
    peacekeepers are always on the side of protection and never on
    the side of exploitation. But if you could take that back about
    the $1.9 billion and I think that needs to be augmented upwards
    simply because of more need that is out there for peacekeeping,
    if you want to speak to that.
        Ambassador Yamamoto. We will. And just to make one
    response, so yes, absolutely correct that the peacekeeping is
    critical and again, I think the regional funding is going to
    help us support a lot of the areas where we have challenges
    that we have today, the G5 in the Central Africa Republic area
    or in the future which may pop up which we don't perceive now.
    But just looking at all of the funding that the President has
    allocated, we are seeing them coming in to Africa from the $131
    million for the Lake Chad initiative. We have $121 million for
    the trans-Sahel issue and $200 million for East Africa.
        But you are absolutely correct, we are going to look very
    hard at how we can address security needs. But one thing that
    really stands out has been the ACOTA process. We have just
    completed the training of over 300,000 African troops from 26
    countries and as you rightly say, Mr. Chairman, 70 percent of
    all of the peacekeepers in Africa are from Africa, 70 percent.
    Eighty-four percent of all U.N. peacekeepers are in Africa. And
    thanks to Leahy vetting as well, those troops have been very
    supported, and so to contain and to change that mindset of
    these rogue armies and others in Africa.
        Can I just make one more comment off the record? Not off
    the record, but I mean in addition to the record. Yes.
        I know Congressman Castro made one comment, but the issue
    comes in and let me just say for my colleagues and I at the
    State Department is that I was--I worked at the National
    Defense University looking after basically our future leaders
    in the military and foreign affairs. And I was called and said
    come back to the State Department to help the Africa Bureau.
    Well, that is not going to be like--not even announced. I said
    yes, of course.
        Coming back to the Bureau really as a senior officer, our
    job and our commitment and certainly my colleagues are the same
    as to how do we develop, how do we mentor our officers? I have
    been away 3 years and I think we have probably the youngest
    Bureau in the Department of State. I mean they are really
    young. And so I think my job and the job of our senior officers
    is really to mentoring, to train, and to develop them as future
    diplomats.
        And the other issue, too, is that I have been honored to
    work on our redesign on personnel reform. How do we develop and
    train our future officers? How do we do better mentoring? And I
    think that I am really enthused about and that is what gets me
    up every day and that is what I want to every single solitary
    day.
        Ms. Bass. I appreciate that and I know from your general
    enthusiasm that your morale is high and I think that is great.
    I don't know that that translates throughout the Department,
    but I think it is really important to have your spirits
    uplifted.
        I just wanted to mention a couple of things in terms of the
    USAID, in particular, is that I hope when a reorg. is happening
    that we look at doing foreign aid much more like the Feed the
    Future, Electrify Africa model, where it is not just about--it
    is not just charity. And you know a continent like Africa has a
    capacity to do for itself and we shouldn't just look at foreign
    aid as supplying resources to our own NGOs because then you
    have a model where it never ends and I don't think that that
    should be the case. And obviously, the NGOs are very important.
    There is enough poverty to go around, so it is not like they
    are going to go out of business if, you know, our focus is more
    on building self-sufficiency rather than providing direct
    services.
        I appreciate my colleague's comments and I appreciate that
    he also respects that people see things differently and the two
    of us do in some areas, but I think where we have a common
    perspective is on the family planning side and we were both in
    South Sudan. We were in the refugee camps and you were in
    northern South Sudan. Was that Bidi Bidi?
        Ambassador Yamamoto. Unity State.
        Ms. Bass. Unity State. And there were all of these babies
    and it just broke my heart because I knew that the majority of
    those babies were not created by partners. They were created
    through rape. And we saw the children right next to bodies of
    water and it just made me scared to death at how many drowning
    deaths they must have in that camp. And so I think the best way
    to prevent abortion is to provide family planning. And I don't
    think those women chose those pregnancies. Those pregnancies
    were forced on them. And so you know, we should look at that.
    We are zeroing it out and once again, I think it is just an
    example of the hypocrisy of a lot of what is proposed in the
    budget. And I am just glad that as Congress we cannot follow
    and reverse some of the proposals that are put forward by the
    administration. Thank you.
        Mr. Smith. Anything else you would like to add before we
    close?
        Ms. Anderson. Just appreciate your comment about the
    redesign and we have submitted our proposal, but we are keeping
    it close hold for now, so I am not in a position to talk about
    it, but we do look forward to consulting as soon as we can and
    your points are very similar to the points that Administrator
    Green makes every day in terms of real partnerships and moving
    our host country partners closer to self-sufficiency.
        Mr. Smith. I want to thank both of you for your very, very
    noble service to our country. Thank you for your presentations
    today. We look forward to working with you going forward. The
    hearing is adjourned.
        [Whereupon, at 3:25 p.m., the subcommittee was adjourned.]

                                A P P E N D I X

                                  ----------
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

                                     [all]