EMERGENCY 

FUNDING FOR 

EBOLA RESPONSE

Some USAID 

Reimbursements Did 

Not Comply with 

Legislative 

Requirements and 

Need to Be Reversed

Report to Congressional Committees

November 2016

GAO-17-35

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-17-35, a report to 

congressional committees

November 2016

EMERGENCY FUNDING FOR EBOLA 

RESPONSE

Some USAID Reimbursements Did Not Comply 

with Legislative Requirements and Need to Be 

Reversed

What GAO Found

As of July 1, 2016, the U.S. Agency for International Development (USAID) and 

the Department of State (State) had obligated 58 percent and disbursed more 

than one-third of the $2.5 billion appropriated for Ebola activities. In the early 

stages of the U.S. response in West Africa, USAID obligated $883 million to 

control the outbreak, and State obligated $34 million for medical evacuations, 

among other activities. Subsequently, the United States shifted focus to 

mitigating second-order impacts, such as the deterioration of health services and 

food insecurity, and strengthening global health security. Accordingly, USAID 

obligated $251 million to restore health services, among other activities, and 

$183 million for activities such as strengthening disease surveillance, while State 

obligated $5 million for biosecurity activities.

Of 271 reimbursements that USAID made for obligations incurred prior to the 

enactment of the Department of State, Foreign Operations, and Related 

Programs Appropriations Act, 2015 (the Act), USAID made 21 reimbursements, 

totaling over $60 million, that were not in accordance with the Act. These 21 

reimbursements represent roughly 15 percent of the $401 million that USAID 

obligated for reimbursements, of the almost $1.5 billion that had been obligated

as of July 1, 2016 (see fig.). For these 21 reimbursements, USAID did not 

reimburse the same appropriation accounts as the accounts from which it 

originally obligated the funds, and therefore it did not have legal authority to 

make these reimbursements. In addition, four reimbursements were for 

obligations that USAID did not document were for Ebola activities. In reviewing 

the reimbursements, GAO found that USAID does not have written policies or

procedures for staff to follow in making and documenting reimbursements. As a 

result, USAID does not have a process that could provide reasonable assurance 

that it complies with reimbursement provisions of applicable appropriations laws, 

such as the reimbursement provisions in the Act.

Total Allocations, Obligations, and Disbursements from the Department of State, Foreign 

Operations, and Related Programs Appropriations Act, 2015, as of July 1, 2016

View GAO-17-35. For more information, 

contact David B. Gootnick at (202) 512-3149 

or gootnickd@gao. 

Why GAO Did This Study

In March 2014, the World Health 

Organization reported an Ebola 

outbreak in West Africa and, as of 

June 2016, reported that the outbreak

had resulted in more than 11,000 

deaths in Guinea, Liberia, and Sierra 

Leone. USAID and State initially 

funded Ebola activities using funds

already appropriated. In December 

2014, Congress appropriated 

approximately $2.5 billion to USAID

and State, in part, for international 

efforts to prevent, prepare for, and 

respond to an Ebola outbreak and 

mandated that the agencies report 

periodically on their use of the funds. 

Congress also allowed the agencies to 

reimburse accounts for obligations

incurred for Ebola activities prior to the

fiscal year 2015 appropriation.

The Act also included a provision for 

GAO to conduct oversight of USAID 

and State activities to prevent, prepare 

for, and respond to the Ebola outbreak. 

This report examines (1) USAID’s and 

State’s obligations and disbursements 

for Ebola activities and (2) the extent to 

which USAID made reimbursements in 

accordance with the fiscal year 2015 

appropriations act. GAO analyzed 

USAID and State funding, reviewed 

documents on Ebola activities, and 

interviewed agency officials.

What GAO Recommends

GAO is making four recommendations, 

including that USAID should reverse 

reimbursements not made in 

accordance with the Act and develop

written policies and procedures for its

reimbursement process. USAID 

concurred with GAO’s 

recommendations.
Page i GAO-17-35 Emergency Funding for Ebola Response

Letter 1

Background 4

USAID and State Have Obligated 58 Percent and Disbursed More 

than One-Third of $2.5 Billion in Ebola Funding 12

USAID Made Reimbursements That Were Not in Accordance with 

the Provisions of the Act, and USAID Has Not Developed 

Reimbursement Policies 25

Conclusions 29

Recommendations for Executive Action 30

Agency Comments and Our Evaluation 31

Appendix I Objectives, Scope, and Methodology 32

Appendix II USAID and Department of State Total Obligations and 

Disbursements, by U.S. Ebola Strategy Pillar 35

Appendix III USAID Funding for Ebola Activities, by Country 37

Appendix IV Total Obligations and Disbursements for Ebola Activities, by 

Account 40

Appendix V USAID’s Reimbursements for Funds Obligated Prior to 

Enactment of the Fiscal Year 2015 Appropriations Act 43

Appendix VI Comments from the U.S. Agency for International Development 47

Appendix VII GAO Contact and Staff Acknowledgments 50

Contents
Page ii GAO-17-35 Emergency Funding for Ebola Response

Tables

Table 1: Pillars of the U.S. Strategy for Ebola 8

Table 2: Fiscal Year 2015 Appropriation for Ebola Response and 

Preparedness, by Account and Period of Availability 10

Table 3: Status of USAID and State Allocations from the 

Department of State, Foreign Operations, and Related 

Programs Appropriations Act, 2015, by Appropriation 

Account, as of July 1, 2016 15

Table 4: USAID and State Ebola Funding Allocations, by Ebola 

Strategy Pillar, as of July 1, 2016 18

Table 5: Status of USAID and State Funding for Ebola Allocated 

by Geographic Area, as of July 1, 2016 20

Table 6: USAID Obligations Prior to Enactment of the Department 

of State, Foreign Operations, and Related Programs 

Appropriations Act, 2015, and Subsequent 

Reimbursements, by Account 27

Table 7: USAID Bureau for Global Health Obligations Prior to 

Enactment of the Department of State, Foreign 

Operations, and Related Programs Appropriations Act, 

2015, and Reimbursements, by Appropriation Account 44

Table 8: Office of Food for Peace Obligations Prior to Enactment 

of the Department of State, Foreign Operations, and 

Related Programs Appropriations Act, 2015, and 

Reimbursements, by Appropriation Account 45

Table 9: USAID Missions in Liberia, Guinea, and Senegal 

Obligations Prior to Enactment of the Department of 

State, Foreign Operations, and Related Programs 

Appropriations Act, 2015, and Reimbursements, by 

Appropriation Account 46

Figures

Figure 1: Origin of the Ebola Outbreak in West Africa in December 

2013 5

Figure 2: Ebola Cases and Deaths in Guinea, Liberia, and Sierra 

Leone, as of June 2016 6

Figure 3: Numbers of Ebola Cases and Deaths in Guinea, Liberia, 

and Sierra Leone by Month, August 2014 to December 

2015 7

Figure 4: USAID’s Reported Obligations Incurred Prior to the 

Fiscal Year 2015 Appropriation, by Office and Bureau 12
Page iii GAO-17-35 Emergency Funding for Ebola Response

Figure 5: Percentage of Allocations USAID and State Obligated 

and Disbursed from the Department of State, Foreign 

Operations, and Related Programs Appropriations Act, 

2015, February 3, 2015—July 1, 2016 14

Figure 6: Total Obligations and Disbursements for Ebola Activities 

by Appropriation Account, as of July 1, 2016 17

Figure 7: Total Allocations, Obligations, and Disbursements, by 

Ebola Strategy Pillar, as of July 1, 2016 19

Figure 8: Total Allocations, Obligations, and Disbursements for 

Ebola Activities, by Country, as of July 1, 2016 21

Figure 9: Total Obligations and Disbursements, by Ebola Strategy 

Pillar, February 3, 2015—July 1, 2016 36

Figure 10: International Disaster Assistance and Economic 

Support Fund Total Obligations and Disbursements for 

Ebola Activities in Liberia, February 3, 2015—July 1, 

2016 37

Figure 11: International Disaster Assistance and Economic 

Support Fund Total Obligations and Disbursements for 

Ebola Activities in Sierra Leone, February 3, 2015—July 

1, 2016 38

Figure 12: International Disaster Assistance and Economic 

Support Fund Total Obligations and Disbursements for 

Ebola Activities in Guinea, February 3, 2015—July 1, 

2016 39

Figure 13: Total Obligations and Disbursements of the 

International Disaster Assistance Account for Ebola 

Activities, February 3, 2015—July 1, 2016 40

Figure 14: Total Obligations and Disbursements of the Economic 

Support Fund Account for Ebola Activities, February 3, 

2015—July 1, 2016 41

Figure 15: Total Obligations and Disbursements of the Global 

Health Programs Account for Ebola Activities, February 

3, 2015—July 1, 2016 42
Page iv GAO-17-35 Emergency Funding for Ebola Response

Abbreviations

CDC Centers for Disease Control and Prevention

CIO Contributions to International Organizations

DART Disaster Assistance Response Team

D&CP Diplomatic & Consular Programs

DOD Department of Defense

ESF Economic Support Fund

FFP Office of Food for Peace

GHP Global Health Programs

IDA International Disaster Assistance

MERS Middle East Respiratory Syndrome

NADR Nonproliferation, Antiterrorism, Demining, and Related 

 Programs 

OFDA Office of U.S. Foreign Disaster Assistance

State Department of State

The Act Department of State, Foreign Operations, and Related 

 Programs Appropriations Act, 2015 

Title II Title II of the Food for Peace Act

USAID U.S. Agency for International Development

WHO World Health Organization

This is a work of the U.S. government and is not subject to copyright protection in the 

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Page 1 GAO-17-35 Emergency Funding for Ebola Response

441 G St. N.W.

Washington, DC 20548

November 2, 2016

The Honorable Lindsey Graham

Chairman

The Honorable Patrick J. Leahy

Ranking Member

Subcommittee on State, Foreign Operations, and Related Programs

Committee on Appropriations

United States Senate

The Honorable Kay Granger

Chairwoman

The Honorable Nita M. Lowey

Ranking Member

Subcommittee on State, Foreign Operations, and Related Programs

Committee on Appropriations

United States House of Representatives

In March 2014, the World Health Organization (WHO) initially reported the 

occurrence of a rapidly evolving Ebola virus disease outbreak in West 

Africa.1 By August 2014, the outbreak had become the largest since the 

virus was first discovered, according to WHO. Although Ebola outbreaks 

have occurred sporadically in Africa since 1976, there were more Ebola 

cases and deaths during the 2014 outbreak than in all of the previous 

outbreaks combined. In August 2014, the WHO Director-General

declared the Ebola outbreak in West Africa a Public Health Emergency of 

International Concern.2 As of June 2016, the outbreak had resulted in 

more than 28,600 confirmed, probable, or suspected cases of Ebola and 

 1According to WHO, Ebola virus disease causes an acute, serious illness, which is often 

fatal if untreated. Symptoms of Ebola include fever, muscle pain, vomiting, diarrhea, 

impaired kidney and liver functioning and, in some cases, internal and external bleeding. 

Ebola is introduced into human populations through close contact with the blood and 

bodily fluids of infected animals. Humans spread Ebola through direct contact with the 

blood and bodily fluids of infected people or objects contaminated with these bodily fluids. 

2The International Health Regulations (2005) adopted by the World Health Assembly 

define a Public Health Emergency of International Concern as “an extraordinary event 

which is determined to constitute a public health risk to other States through the 

international spread of disease and to potentially require a coordinated international 

response.” In the event of a Public Health Emergency of International Concern, a 

committee of international experts advises the WHO Director-General on any temporary 

recommendations that the Director-General can advise countries to take in areas including 

travel, surveillance, clinical management, and infection control.

Letter
Page 2 GAO-17-35 Emergency Funding for Ebola Response

more than 11,300 deaths in the West African countries primarily 

affected—Guinea, Liberia, and Sierra Leone, according to WHO.3 These 

countries were particularly vulnerable because they had weak health 

systems and only recently emerged from long periods of conflict and 

instability. The U.S. Agency for International Development (USAID) noted 

that the outbreak caused second-order effects, including immediate 

disruptions to the three countries’ health systems, reduced economic 

activity, job loss, and food insecurity.

In response to the outbreak, USAID and the Department of State (State), 

along with other U.S. agencies and international and nongovernmental 

organizations, took urgent steps to reduce the transmission of the Ebola 

virus and provide emergency treatment and care to infected persons. In 

addition, USAID and State initiated efforts to address second-order 

effects and better prepare international health systems for future 

outbreaks. USAID and State initiated Ebola response and preparedness 

activities (Ebola activities) using current and prior year appropriations. In 

December 2014, Congress enacted the Department of State, Foreign 

Operations, and Related Programs Appropriations Act, 2015 (the Act), 

which provided approximately $2.5 billion to USAID and State for 

necessary expenses to prevent, prepare for, and respond to an Ebola 

outbreak.4 The Act also directed State, in consultation with USAID, to 

submit periodic reports to the Senate and House Committees on 

Appropriations on the proposed uses of these funds on a country and 

project basis. In addition, the Act authorized USAID and State to use the 

funds to reimburse accounts for the obligations made for Ebola activities 

prior to the December 16, 2014, enactment of the legislation.

The Act also included a provision for GAO to conduct oversight of USAID

and State activities to prevent, prepare for, and respond to the Ebola 

outbreak and reimbursements made pursuant to specific provisions in the 

Act. This report examines (1) USAID’s and State’s obligations and 

 3Although the Ebola outbreak affected other countries in Africa, including Mali, Nigeria, 

and Senegal, we focus our report on Guinea, Liberia, and Sierra Leone because these 

countries have experienced the largest numbers of Ebola cases and deaths and have 

received the largest share of allocations for Ebola response activities.

4Pub. L. No. 113-235, Div. J, Title IX, 128 Stat. 2130, 2692 (Dec. 16, 2014). The Act 

provided USAID and State these funds to assist countries affected by, or at the risk of 

being affected by, the Ebola virus disease outbreak, to address economic and stabilization 

requirements resulting from such outbreak, and to mitigate the risk of illicit acquisition of 

the Ebola virus and to promote biosecurity practices associated with the outbreak 

response efforts.
Page 3 GAO-17-35 Emergency Funding for Ebola Response

disbursements for Ebola activities and (2) the extent to which USAID 

made reimbursements in accordance with the requirements of the fiscal 

year 2015 appropriations act.5

To examine USAID’s and State’s obligations and disbursements for Ebola 

activities, we analyzed the agencies’ funding data from their reports to 

Congress to determine each agency’s allocations, obligations, and 

disbursements for Ebola activities from the fiscal year 2015 

appropriation.6 We also reviewed the agencies’ reports to Congress to 

identify agencies’ reported use of the funds. To examine USAID’s 

reimbursements, we analyzed USAID data and documentation to 

determine the dates and amounts of obligations that the agency incurred 

for Ebola activities prior to the enactment of the Act, the appropriation 

accounts that funded the obligations, and the amounts of the 

reimbursements.7 In addition, we interviewed USAID and State officials 

about the collection and reporting of the funding data and the agencies’

use of funding for Ebola activities. We also reviewed USAID policies for 

financial management. Finally, we assessed the extent to which the 

reimbursements were consistent with the provisions of the Act and met 

internal control standards. To assess the reliability of the funding data, we 

obtained data from the financial data system that USAID used to report 

the funding data and conducted interviews with USAID and State officials. 

When we found data discrepancies, we contacted agency officials and 

collaborated with them to resolve the discrepancies. We determined that 

the data we used were sufficiently reliable for our purposes. See 

appendix I for more information about how we assessed the data’s 

reliability and our overall scope and methodology.

We conducted this performance audit from June 2015 to November 2016 

in accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe that 

 5State reported that it made no reimbursements for obligations incurred prior to the fiscal 

year 2015 appropriation, and it does not plan to make reimbursements. As such, we do 

not include State in this objective.

6Some allocations data in this report include funds allocated prior to the enactment of the 

fiscal year 2015 appropriation.

7State reported that it made no reimbursements for obligations incurred prior to the fiscal 

year 2015 appropriation, and it does not plan to make reimbursements.
Page 4 GAO-17-35 Emergency Funding for Ebola Response

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives.

The Ebola outbreak was first identified in the remote Guinean village of 

Meliandou in December 2013 and subsequently spread to neighboring 

Sierra Leone and Liberia and later to other African countries, including 

Mali, Nigeria, and Senegal (see fig. 1).8 Guinea, Liberia, and Sierra Leone 

experienced the largest number of confirmed, probable, or suspected 

cases and deaths. As of June 2016, WHO reported 28,616 confirmed, 

probable, or suspected Ebola cases and 11,310 deaths in these three 

countries since the onset of the outbreak (see fig. 2).9 WHO reported the 

majority of these cases and deaths between August 2014 and December 

2014. After 2014, the number of new cases began to decline, and on 

March 29, 2016, the WHO Director-General terminated the Public Health 

Emergency of International Concern designation related to Ebola in West 

Africa and recommended lifting the temporary restrictions to travel and 

trade with Guinea, Liberia, and Sierra Leone. However, seven confirmed 

and three probable cases were reported in Guinea, and three confirmed 

cases of Ebola were reported in Liberia in March 2016 and April 2016, 

respectively. Figure 3 shows the numbers of confirmed, probable, and 

suspected Ebola cases and deaths in Guinea, Liberia, and Sierra Leone 

by month from August 2014 to December 2015.

 8Until October 2014, no Ebola cases had occurred outside of Africa. That month, one 

health-care worker in Spain and two health-care workers in the United States contracted 

Ebola while providing care for Ebola patients in those countries.

9According to WHO, various factors contributed to the spread of Ebola and impeded rapid 

containment of the virus in West African countries, resulting in the large numbers of Ebola 

cases and deaths in Guinea, Liberia, and Sierra Leone. These factors include weak health 

systems that were ill-equipped to implement disease containment and surveillance 

measures, shortages of health-care workers, and burial practices in which mourners have 

direct contact with the blood and bodily fluids of the deceased. Factors that may contribute 

to the variability of Ebola case fatality rates—the proportion of reported cases of a disease 

that are fatal—among regions and countries include the quality of care available and the 

intensity of disease surveillance, according to WHO.

Background

The 2014 Ebola Outbreak 

in West Africa
Page 5 GAO-17-35 Emergency Funding for Ebola Response

Figure 1: Origin of the Ebola Outbreak in West Africa in December 2013

Note: The village of Meliandou, Guinea, w as the origin of the Ebola outbreak in West Africa in 

December 2013.
Page 6 GAO-17-35 Emergency Funding for Ebola Response

Figure 2: Ebola Cases and Deaths in Guinea, Liberia, and Sierra Leone, as of June 2016
Page 7 GAO-17-35 Emergency Funding for Ebola Response

Figure 3: Numbers of Ebola Cases and Deaths in Guinea, Liberia, and Sierra Leone 

by Month, August 2014 to December 2015

USAID noted that the Ebola outbreak caused disruptions to health 

systems and adverse economic impacts in Guinea, Liberia, and Sierra 

Leone. Health-care resources in these countries were diverted from other 

programs to Ebola response efforts, and some patients and health-care 

workers avoided health facilities for fear of contracting the disease. 

USAID also noted that these countries experienced job loss, disruptions 

to trade, reduced agricultural production, decreased household 

purchasing power, and increased food insecurity as a consequence of the 

outbreak. The closure of international borders in response to the outbreak 

hampered economic activity by limiting trade and restricting the

movement of people, goods, and services. In addition, the Ebola outbreak 

occurred at the beginning of the planting season, which affected 

agricultural markets and food supplies.

U.S. efforts to respond to the Ebola outbreak in West Africa began in 

March 2014 when the Centers for Disease Control and Prevention (CDC) 

deployed personnel to help with initial response efforts. In August 2014, 

U.S. Role in Response to 

the Outbreak
Page 8 GAO-17-35 Emergency Funding for Ebola Response

the U.S. ambassador to Liberia and the U.S. chiefs of mission in Guinea 

and Sierra Leone declared disasters in each country. Following the 

declarations, USAID and CDC deployed medical experts to West Africa to 

augment existing staff in each of the affected countries. In August 2014, a 

USAID-led Disaster Assistance Response Team (DART) deployed to 

West Africa.10 USAID-funded organizations began to procure and 

distribute relief commodities and establish Ebola treatment units, and 

CDC began laboratory testing in West Africa. In September 2014, the 

Department of Defense (DOD) began direct support to civilian-led 

response efforts under Operation United Assistance.

In September 2014, the President announced the U.S. government’s 

strategy to address the Ebola outbreak in the three primarily affected 

West African countries. The National Security Council, the Office of 

Management and Budget, USAID, and State developed an interagency 

strategy that has been revised over time to reflect new information about 

the outbreak and changes in international response efforts. The strategy 

is organized around four pillars and their associated activities (see 

table 1).

Table 1: Pillars of the U.S. Strategy for Ebola

Pillar Examples of U.S. agency activities

Pillar 1: Controlling the outbreak Procurement and transportation of relief commodities; infection control training; 

management of Ebola care facilities; and psychosocial and survivor support to 

vulnerable populations, including women and children. 

Pillar 2: Mitigating the second-order impacts of 

the crisis

Emergency food assistance and nutritional messaging, health information systems 

improvements, infrastructure improvements, strengthening political processes in 

support of Ebola recovery efforts, and restoration of health systems and critical 

health services.

Pillar 3: Building coherent leadership and 

operations

Operational support and oversight of Ebola response and preparedness activities.

Pillar 4: Strengthening global health security Disease surveillance and case detection, laboratory support and supplies, and 

building the capacity of governments in West Africa to prepare for and respond to 

infectious disease outbreaks.

Sources: U.S. Government Strategy for Reducing Transmission of the Ebola Virus Disease in West Africa, and GAO analysis of U.S. Agency for International Development information. | GAO-17-35

 10If the size and complexity of a disaster is of a sufficient magnitude, USAID’s Office of 

U.S. Foreign Disaster Assistance deploys a DART to provide specialists trained in a 

variety of disaster relief skills to assist the relevant U.S. chief of mission and USAID 

missions in managing and coordinating the U.S. government’s response to a disaster. 
Page 9 GAO-17-35 Emergency Funding for Ebola Response

Multiple U.S. agencies have played a role in the U.S. government’s 

response to the Ebola outbreak in West Africa. USAID managed and 

coordinated the overall U.S. effort to respond to the Ebola outbreak 

overseas, and State led diplomatic efforts related to the outbreak. CDC 

led the medical and public health component of the U.S. government’s 

response efforts. For example, CDC provided technical assistance and 

disease control activities with other U.S. agencies and international 

organizations. In addition, CDC assisted in disease surveillance and 

contact tracing to identify and monitor individuals who had come into 

contact with an Ebola patient.11 DOD coordinated U.S. military efforts with 

other agencies, international organizations, and nongovernmental 

organizations. DOD also constructed Ebola treatment facilities, 

transported medical supplies and medical personnel, trained health-care 

workers, and deployed mobile laboratories to enhance diagnostic 

capabilities in the field. Other federal agencies, including the Department 

of Agriculture, also contributed to the overall U.S. response.

Although U.S. response efforts have focused primarily on Liberia, the 

United States has been engaged in all three primarily affected West 

African countries. The U.S. government also undertook response efforts 

in Mali following an Ebola outbreak in that country in October 2014. 

Currently, U.S. response efforts include regional activities that 

encompass multiple countries, including activities to build the capacity of 

West African countries to prepare for and respond to infectious disease 

outbreaks.

Prior to the fiscal year 2015 appropriation, USAID and State funded 

activities in response to the Ebola outbreak using funds already 

appropriated. On December 16, 2014, Congress appropriated 

approximately $5.4 billion in emergency funding for Ebola preparedness 

and response to multiple U.S. agencies as part of the Consolidated and 

Further Continuing Appropriations Act, 2015 (the fiscal year 2015 

 11Contact tracing locates persons who have come in direct contact with an Ebola patient. 

Contacts are monitored for signs of illness for 21 days from the last day they came into 

contact with an Ebola patient because Ebola’s incubation period is 2 to 21 days in 

humans. If a contact develops a fever or other Ebola symptoms, they are isolated, tested, 

and provided care.

Funding the U.S. 

Government’s Response 

to the Outbreak
Page 10 GAO-17-35 Emergency Funding for Ebola Response

consolidated appropriations act).12 Within the fiscal year 2015 

consolidated appropriations act, Congress provided approximately $2.5 

billion to USAID and State for necessary expenses to assist countries 

affected by, or at the risk of being affected by, the Ebola outbreak and for 

efforts to mitigate the risk of illicit acquisition of the Ebola virus and to 

promote biosecurity practices associated with Ebola outbreak response 

efforts.13 These funds were made available from different accounts and 

are subject to different periods of availability (see table 2).

Table 2: Fiscal Year 2015 Appropriation for Ebola Response and Preparedness, by Account and Period of Availability

Dollars in millions

Appropriations account Period of availability Dollar amount appropriated

International Disaster Assistance Until expended 1,436.3

Economic Support Fund September 30, 2016 711.7

Global Health Programs Until expended 312.0

Diplomatic and Consular Programs September 30, 2016 36.4

USAID Operating Expenses September 30, 2016 19.0

USAID Office of Inspector General Until expended 5.6

Nonproliferation, Antiterrorism,Demining, and Related Programs September 30, 2016 5.3

Total 2,526.4

Legend: USAID = U.S. Agency for International Development

Source: Department of State, Foreign Operations, and Related Programs Appropriations Act, 2015. | GAO-17-35

Note: Amounts shown may not sum precisely to totals because of rounding.

 12Pub. L. No. 113-235 (Dec. 16, 2014). Of the approximately $5.4 billion appropriated, the 

fiscal year 2015 consolidated appropriations act provided approximately $2.5 billion 

specifically for international efforts and approximately $2.3 billion for either international or 

domestic efforts. For example, funding appropriated to CDC has funded domestic and 

international efforts to improve laboratory capacity and train health-care workers to detect 

and respond to an Ebola outbreak. 

13In addition, the Consolidated and Further Continuing Appropriations Act, 2015 (Pub. L. 

No. 113-235, Dec. 16, 2014) (the fiscal year 2015 consolidated appropriations act) 

provided $2.7 billion in emergency funding for the Department of Health and Human 

Services for Ebola response and preparedness activities. The fiscal year 2015 

consolidated appropriations act appropriated $1.8 billion to CDC, $733 million to the 

Assistant Secretary for Preparedness and Response and the Biomedical Advanced 

Research and Development Authority, $238 million to the National Institutes of Health, 

and $25 million to the Food and Drug Administration. The funding has supported domestic 

Ebola preparedness and response efforts; containment of the outbreak in West Africa; 

development and testing of vaccines, therapeutics, and diagnostics; and public health 

infrastructure to help ensure that countries are prepared for future outbreaks.
Page 11 GAO-17-35 Emergency Funding for Ebola Response

The Act requires State, in consultation with USAID, to submit reports to 

the Senate and House Committees on Appropriations on the proposed 

uses of the funds on a country and project basis, for which the obligation 

of funds is anticipated, no later than 30 days after enactment.14 These 

reports are to be updated and submitted every 30 days until September 

30, 2016, and every 180 days thereafter until all funds have been fully 

expended. The reports are to include (1) information detailing how the 

estimates and assumptions contained in the previous reports have 

changed and (2) obligations and expenditures on a country and project 

basis.

In addition, Section 9002 of the Department of State, Foreign Operations, 

and Related Programs Appropriations Act, 2015, authorized USAID and 

State to use funds appropriated for the Global Health Programs (GHP), 

International Disaster Assistance (IDA), and Economic Support Fund 

(ESF) accounts to reimburse appropriation accounts administered by 

USAID and State for obligations incurred to prevent, prepare for, and 

respond to the Ebola outbreak prior to enactment of the Act. USAID 

reports that it has made reimbursements totaling $401 million for 

obligations made prior to the Act, using $371 million from the IDA account 

and $30 million from the ESF account of the fiscal year 2015 

appropriation. USAID reports that these obligations were incurred by the 

Office of U.S. Foreign Disaster Assistance (OFDA); the Office of Food for 

Peace (FFP); the Bureau for Global Health; and missions in Liberia, 

Guinea, and Senegal. Figure 4 shows USAID’s reported obligations by 

office and bureau. State reported that it did not reimburse funding for 

obligations made prior to the act.

 14According to agency officials, in September 2015, State delegated authority to USAID 

for the submission of their reports to relevant congressional committees.
Page 12 GAO-17-35 Emergency Funding for Ebola Response

Figure 4: USAID’s Reported Obligations Incurred Prior to the Fiscal Year 2015 

Appropriation, by Office and Bureau

As of July 1, 2016, USAID and State had obligated 58 percent and 

disbursed more than one-third of the $2.5 billion appropriated by the 

Department of State, Foreign Operations, and Related Programs 

Appropriations Act, 2015 for Ebola response and preparedness 

activities.15 USAID and State obligated funds from various appropriation 

accounts for Ebola activities during different stages of the response, with 

the largest shares of funding going to Pillar 1 activities to control the 

outbreak and to support regional Ebola activities in multiple countries. In 

response to the Ebola outbreak, USAID obligated funds from the IDA 

account, and State obligated funds from the Diplomatic & Consular 

Programs (D&CP) account. As the U.S. government shifted its focus to 

 15An allocation, for funds control purposes, is a further subdivision of an apportionment. 

Unliquidated obligations are the amount of obligations already incurred for which payment 

has not yet been made. Disbursements are amounts paid by federal agencies, by cash or 

cash equivalent, during the fiscal year to liquidate government obligations. For more 

information on the budget terms used in this report, see GAO, A Glossary of Terms Used 

in the Federal Budget Process, GAO-05-734SP (Washington, D.C.: September 2005).

USAID and State 

Have Obligated 58 

Percent and 

Disbursed More than 

One-Third of $2.5 

Billion in Ebola 

Funding
Page 13 GAO-17-35 Emergency Funding for Ebola Response

mitigating second-order impacts and strengthening global health security, 

USAID obligated funds from the ESF and GHP accounts, and State 

obligated Nonproliferation, Antiterrorism, Demining, and Related 

Programs (NADR) account funds for biosecurity activities.

As of July 1, 2016, USAID and State had obligated a total of almost $1.5 

billion (58 percent) and disbursed $875 million (35 percent) of the $2.5 

billion appropriated for Ebola response and preparedness activities (see 

fig. 5).16

16We report funding from the Act for Ebola in accordance with USAID’s reporting to 

Congress because USAID is the source of our data. USAID issues its monthly reports to 

Congress on Ebola funding as of the first day of each month, with the exception of the 

February 2015 report, which contains data as of February 3, 2015.

USAID and State Have 

Obligated 58 Percent and 

Disbursed More than OneThird of Their Appropriated 

Funding for Ebola 

Response and 

Preparedness Activities
Page 14 GAO-17-35 Emergency Funding for Ebola Response

Figure 5: Percentage of Allocations USAID and State Obligated and Disbursed from the Department of State, Foreign 

Operations, and Related Programs Appropriations Act, 2015, February 3, 2015—July 1, 2016

Notes: These data reflect funding that w as obligated prior to the enactment of the Department of 

State, Foreign Operations, and Related Programs Appropriations Act, 2015, as w ell as 

postenactment obligations. USAID and State began reporting to Congress on their obligations and 

disbursements of Ebola funding as of February 3, 2015, w ith the exception of obligations and 

disbursements from the Diplomatic & Consular Programs (D&CP) account. State began reporting 

D&CP funding as of February 28, 2015.

USAID and State used different appropriation accounts to fund Ebola 

activities. As shown in table 3 below, USAID allocated the greatest 

amount of funding for Ebola activities from the IDA account, followed by 

the ESF and GHP accounts. State allocated funding from the NADR 

account and D&CP account for Ebola activities.
Page 15 GAO-17-35 Emergency Funding for Ebola Response

Table 3: Status of USAID and State Allocations from the Department of State, Foreign Operations, and Related Programs 

Appropriations Act, 2015, by Appropriation Account, as of July 1, 2016

Dollars in thousands

Appropriation account Allocationsa Unobligated 

balances

Percentage 

obligated

Unliquidated

obligations Disbursements

Percentage of 

obligations 

disbursed

International Disaster 

Assistanceb 1,436,273 552,886 62 152,574 730,813b 83

Economic Support Fund 711,725 368,288c 48 279,511 63,926 19

Global Health Programs 312,000 129,057 59 163,887 19,057 10

Nonproliferation, Antiterrorism, 

Demining, and Related 

Programs 5,300 0 100 3,204 2,096 40

Operating Expenses 19,037 14,316 25 2,284 2,437 52

Office of Inspector General 5,626 2,508 55 538 2,580 83

Diplomatic & Consular 

Programsd 36,420 2,082 94 270 34,068 99

Contributions to International 

Organizationse 0 0 100 0 19,948 100

Total 2,526,381 1,069,136 58 602,268 874,925 59

Source: GAO analysis of U.S. Agency for International Development (USAID) and Department of State (State) data. |  GAO-17-35

Notes: Disbursements may differ from the data in USAID’s monthly reporting, as they reflect 

corrections made by GAO. State allocates Ebola funding from the Nonproliferation, Antiterrorism, 

Demining, and Related Programs; Diplomatic & Consular Programs (D&CP); and Contributions to 

International Organizations (CIO) accounts. USAID allocates Ebola funding from all other accounts 

listed in this table. Amounts show n may not sum to the totals because of rounding.

a

Allocations data include $401 million that w as obligated prior to the enactment of the Department of 

State, Foreign Operations, and Related Programs Appropriations Act, 2015.

b

International Disaster Assistance (IDA) account allocations include funding for the U.S. government’s 

contribution to the United Nations Mission for Ebola Emergency Response. Obligations and 

disbursements for this contribution are listed separately in this table under CIO.

c

USAID notified the relevant congressional committees on April 8, 2016, that it intended to reprogram 

$295 million in Economic Support Fund (ESF) Ebola funds for Zika response activities and for the 

CDC’s international Ebola response. Of the $295 million in reprogrammed ESF funds, USAID had 

obligated $92 million for Zika activities and $80 million for Ebola response activities, as of July 1, 

2016.

d

State reported D&CP funding as of June 30, 2016.

e

Allocations for the CIO account are included in the total allocations for the IDA account because this 

funding w as a transfer from the IDA account to State’s CIO account for the U.S. contribution to the 

United Nations Mission for Ebola Emergency Response on June 1, 2015.
Page 16 GAO-17-35 Emergency Funding for Ebola Response

USAID notified the relevant congressional committees on April 8, 2016, 

that it intended to obligate $295 million in ESF Ebola funds, of which 

USAID and State would reprogram17 $215 million for international 

response activities related to Zika, including $78 million to the CDC for 

Zika response activities, and $80 million for the CDC’s international 

coordination of response efforts related to Ebola.18 As USAID obligates 

funding for Zika activities, the unobligated balances in the ESF account 

will continue to decrease. ESF funds appropriated in the Act must have 

been obligated by September 30, 2016.19 See figure 6 below for 

obligations and disbursements by appropriation account, as of July 1, 

2016.

 17Reprogramming is the shifting of funds within an appropriation or account to use them 

for purposes other than those contemplated at the time of appropriation; it is the shifting of 

funds from one object class to another or from one program activity to another. See 

GAO-05-734SP.

18According to CDC, the Zika virus disease is spread primarily by the bite of an infected 

mosquito. The illness is usually mild. However, Zika virus infection during pregnancy can 

cause a serious birth defect, called microcephaly, and other severe brain defects.

19The Act specified that ESF funding for Ebola response activities was available for 

obligation until September 30, 2016. ESF funds are generally available for obligation for 2 

years. ESF funds that are obligated within their initial period of availability remain available 

for obligation for an additional 5 years. Obligated ESF funds then continue to be available 

for disbursement for an additional 5 years after the end of their period of availability for 

obligation.
Page 17 GAO-17-35 Emergency Funding for Ebola Response

Figure 6: Total Obligations and Disbursements for Ebola Activities by Appropriation Account, as of July 1, 2016

Note: These data reflect funding that w as obligated prior to the enactment of the Department of State, 

Foreign Operations, and Related Programs Appropriations Act, 2015, as w ell as postenactment 

obligations.

USAID and State used different appropriation accounts to fund Ebola 

activities across the four pillars of the U.S. government’s Ebola strategy. 

For example, USAID primarily used IDA account funds to control the 

outbreak (Pillar 1), ESF account funds to mitigate second-order impacts 

of Ebola (Pillar 2), and GHP account funds to strengthen global health 

security (Pillar 4). USAID allocated all of the funding from the Operating 

Expenses account to building coherent leadership and operations (Pillar 

3). As of July 1, 2016, USAID had obligated more than 60 percent of 

funds allocated for Pillars 1, 2, and 4 and obligated just under 50 percent 

of the funds allocated for Pillar 3; USAID and State had disbursed 85 

percent of Pillar 1 obligations. See table 4 for the status of allocated 

funding by Ebola strategy pillar.
Page 18 GAO-17-35 Emergency Funding for Ebola Response

Table 4: USAID and State Ebola Funding Allocations, by Ebola Strategy Pillar, as of July 1, 2016

Dollars in thousands

Ebola

Strategy Pillar Allocationsa Unobligated balances

Percentage 

obligated

Unliquidated 

obligations Disbursements

Percentage of 

obligations 

disbursed

Pillar 1 1,190,011 385,640 68 121,005 683,367 85

Pillar 2 368,495 124,185 66 126,924 117,385 48

Pillar 3 37,187 19,151 49 5,291 12,745 71

Pillar 4 333,178 129,057 61 176,762 27,360 13

Total 1,928,871 658,032 66 429,982 840,857 66

Source: GAO analysis of U.S. Agency for International Development (USAID) and Department of State (State) data. |  GAO-17-35

Notes: Disbursements may differ from the data in USAID’s monthly reporting, as they reflect 

corrections made by GAO. This table does not include any of the $36 million in allocated funding from 

State’s Diplomatic & Consular Program account because State does not categorize this funding by 

Ebola strategy pillar. The table also does not include $432 million of Ebola funding from the Economic 

Support Fund because it had not been programmed for an Ebola strategy pillar, as of July 1, 2016.

Amounts show n may not sum to totals because of rounding.

a

Allocations data include $401 million that w as obligated prior to the enactment of the Department of 

State, Foreign Operations, and Related Programs Appropriations Act, 2015. Allocations data do not 

include $129 million from the International Disaster Assistance account that the administration has 

proposed reprogramming to combat malaria because USAID does not categorize such funding by 

strategic pillar.

USAID allocated the greatest amount of funding to activities to control the 

Ebola outbreak (Pillar 1) and allocated approximately similar amounts of 

funding to mitigate the second-order impacts of Ebola (Pillar 2) and to 

strengthen global health security (Pillar 4). Figure 7 shows allocations, 

obligations, and disbursements by Ebola strategy pillar, as of July 1, 

2016. See appendix II for trends in obligations and disbursements by 

Ebola strategy pillar, as of July 1, 2016.
Page 19 GAO-17-35 Emergency Funding for Ebola Response

Figure 7: Total Allocations, Obligations, and Disbursements, by Ebola Strategy 

Pillar, as of July 1, 2016

Notes: These data reflect funding that w as obligated prior to the enactment of the Department of 

State, Foreign Operations, and Related Programs Appropriations Act, 2015, as w ell as 

postenactment obligations. These data do not include any funding from State’s Diplomatic & Consular 

Programs account because State does not categorize such funding by strategic pillar.

USAID allocated the largest share of its funding to support regional Ebola 

activities. Ebola funding for regional activities includes all five 

appropriation accounts administered by USAID from the fiscal year 2015 

appropriation (IDA, ESF, GHP, USAID Operating Expenses, and USAID’s 

Office of Inspector General) and State’s NADR account. The GHP 

account represents 42 percent of obligated funding for regional activities, 

while ESF and IDA represent approximately 29 percent and 21 percent of 

such funding, respectively. See table 5 below for the status of allocated 

Ebola funding by geographic area.
Page 20 GAO-17-35 Emergency Funding for Ebola Response

Table 5: Status of USAID and State Funding for Ebola Allocated by Geographic Area, as of July 1, 2016

Dollars in thousands

Geographic area Allocationsa Unobligated 

balances

Percentage 

obligated

Unliquidated 

obligations Disbursements

Percentage of 

obligations 

disbursed

Regional 1,153,451 713,618 38 303,885 135,948 31

Liberia 618,359 44,497 93 110,876 462,986 81

Sierra Leone 193,538 15,204 92 39,535 138,799 78

Guinea 166,584 13,713 92 55,633 97,237 64

Mali 5,939 0 100 52 5,887 99

Total 2,137,871 787,032 63 509,982 840,857 62

Source: GAO analysis of U.S. Agency for International Development (USAID) and Department of State (State) data. |  GAO-17-35

Notes: Disbursements may differ from the data in USAID’s monthly reporting, as they reflect 

corrections made by GAO. The $92 million that USAID had obligated for Zika response activities as of 

July 1, 2016, is not included in this table. This table does not include $352 million of Ebola funding 

from the Economic Support Fund because it had not been allocated to a geographic region as of July 

1, 2016. This table also does not include any of the $36 million in allocated funding from State’s 

Diplomatic & Consular Program account because State does not categorize such funding by country. 

Amounts show n may not sum to the totals because of rounding.

a

Allocations data include $401 million that w as obligated prior to the enactment of the Department of 

State, Foreign Operations, and Related Programs Appropriations Act, 2015.

Of the three countries most affected by the Ebola virus, USAID obligated 

and disbursed the most funding for Liberia, as the U.S. government took 

a lead role in Ebola response efforts in this country. Figure 8 shows 

allocations, obligations, and disbursements for Liberia, compared with 

Sierra Leone and Guinea. See appendix III for trends in obligations and 

disbursements for each country, as of July 1, 2016.
Page 21 GAO-17-35 Emergency Funding for Ebola Response

Figure 8: Total Allocations, Obligations, and Disbursements for Ebola Activities, by Country, as of July 1, 2016

Notes: These data reflect funding that w as obligated prior to the enactment of the Department of 

State, Foreign Operations, and Related Programs Appropriations Act, 2015, as w ell as 

postenactment obligations. These data do not include any funding from the Department of State’s 

(State) Diplomatic & Consular Programs account because State does not categorize such funding by 

country.

Prior to the enactment of the Act in December 2014, USAID had obligated 

$401 million to respond to the Ebola outbreak. USAID obligated the 

majority of this funding from the IDA account for Pillar 1 activities to 

control the outbreak in Liberia. State did not obligate any funding prior to 

the Act but began obligating D&CP funding to respond to the Ebola 

outbreak in April 2015.

During the early stages of the response to the Ebola outbreak, USAID 

obligated IDA funds for the majority of its Ebola activities, both before and 

after it received funding for Ebola activities from the Act.20 By February 

 20IDA funds in the Act are available until expended for assistance for countries affected 

by, or at risk of being affected by, the Ebola outbreak.

In Response to the Ebola 

Outbreak, USAID 

Obligated IDA Funds, and 

State Obligated D&CP 

Funds

IDA Account
Page 22 GAO-17-35 Emergency Funding for Ebola Response

2015, USAID had obligated more than $550 million in IDA funding. USAID 

obligated IDA account funding at a lower rate after July 1, 2015, as 

USAID began to shift its focus to recovery activities. As of July 1, 2016, 

USAID had obligated more than 60 percent of IDA account funding and 

disbursed more than 80 percent of obligations.

USAID used the majority of IDA funds to control the outbreak in Liberia 

(Pillar 1). Activities to control the outbreak included providing care to 

Ebola patients; supporting safe burials; promoting infection prevention 

and control at health facilities; distributing Ebola protection and treatment 

kits; and conducting Ebola awareness, communication, and training 

programs. USAID obligated approximately 60 percent of IDA funds for 

Liberia as of July 1, 2016, which reflects the U.S. government’s lead role 

in responding to the Ebola outbreak in that country.

USAID plans to use the remaining approximately 40 percent of 

unobligated IDA funds for future Ebola response activities as needed. 

According to USAID officials, since April 2016, OFDA has programmed 

IDA funding to provide support for maintaining a residual response 

capacity and for transitioning to long-term development efforts. According 

to OFDA officials, these activities will require a modest amount of funding 

in fiscal year 2017. OFDA officials also noted that the unobligated IDA 

balance would remain available to address any new cases or outbreaks 

of Ebola that spread beyond the ability of the host governments to contain 

them.

State obligated most of its D&CP account funding to respond to the Ebola 

outbreak in early 2015.21 In February 2015, State notified the relevant 

congressional committees of its intention to allocate $33 million of $36 

million in D&CP account funding to the Office of Medical Services. By the 

end of May 2015, the Office of Medical Services had obligated 97 percent 

of its allocated funding and disbursed all of its obligated funding for 

medical evacuations; overseas hospitalization expenses; and personal 

protective equipment, among other things.22 State’s Bureau of 

Administration, which provided grants to international schools affected by 

the Ebola outbreak, obligated 95 percent of its allocated D&CP funding by 

 21D&CP funds in the Act are available until September 30, 2016, for necessary expenses 

to prevent, prepare for, and respond to the Ebola outbreak.

22We report State’s D&CP account funding in accordance with State’s monthly reporting to 

Congress. State reports such funding as of the last day of the month. 

D&CP Account
Page 23 GAO-17-35 Emergency Funding for Ebola Response

the end of April 2015. State’s Africa Bureau also obligated funding in the 

early stages of the Ebola response, as it provided support for State’s 

Ebola Coordination Unit and U.S. embassies affected by Ebola. The 

Africa Bureau obligated more than half of its D&CP funding for Ebola 

activities by the end of July 2015. As of June 30, 2016, State had 

obligated 94 percent of the D&CP account funding and disbursed 99 

percent of its obligated funding.

USAID started to focus its efforts on mitigating second-order impacts of 

the outbreak and strengthening global health security between June 1, 

2015, and October 1, 2015, using funding from the ESF and GHP 

accounts. As of May 1, 2015, State began obligating NADR funds for 

biosecurity activities.

USAID increased obligations of ESF by approximately $68 million 

between June 1, 2015, and October 1, 2015, as USAID offices such as 

the Bureau for Global Health and the U.S. Global Development Lab 

obligated ESF funds for activities to mitigate the second-order impacts of 

the outbreak (Pillar 2).23 USAID disbursements of ESF funding were less 

than $5 million until September 1, 2015. As of July 1, 2016, USAID had 

obligated $251 million from the ESF account for Ebola activities, which 

represented 35 percent of its total allocated funding from the ESF 

account.

Of the ESF funding that USAID obligated to mitigate the second-order 

impacts of Ebola, USAID obligated the majority of such funding for 

activities in Liberia, Sierra Leone, and Guinea. Such activities included 

the development of facilities to decontaminate health-care workers and 

equipment, restoring routine health services, and strengthening health 

information systems to better respond to future disease outbreaks. 

Approximately 45 percent of obligated ESF funds supported such 

activities in Liberia, while 22 percent and 17 percent funded activities in 

Sierra Leone and Guinea, respectively.

 23ESF funds in the Act were available until September 30, 2016, for necessary expenses 

to prevent, prepare for, and respond to the Ebola outbreak and to address economic and 

stabilization requirements resulting from such outbreak.

To Mitigate Second-Order

Impacts and Strengthen 

Global Health Security, 

USAID Obligated ESF and 

GHP Funds, While State 

Obligated NADR Funds for

Biosecurity Activities

ESF Account
Page 24 GAO-17-35 Emergency Funding for Ebola Response

As the numbers of new Ebola cases declined, USAID also began to focus 

on longer-term efforts to strengthen global health security, using funding 

from the GHP account.24 Accordingly, USAID reported no obligations of 

GHP funding before June 1, 2015 and no disbursements until August 1, 

2015. As of July 1, 2016, USAID had obligated 59 percent and disbursed 

10 percent of its GHP account funds for Ebola response activities. The 

Bureau for Global Health, which programs the majority of GHP funding, 

added all of its GHP funding for Ebola activities to existing awards. 

Because of the method of payment used for these awards, funding from 

older appropriations is used first. As a result, the percentage of GHP 

funding that USAID has disbursed from the fiscal year 2015 appropriation 

for Ebola activities is the lowest (10 percent) of any account. GHP funding 

appropriated in the Act does not expire, so USAID can obligate and 

disburse these funds in future fiscal years.

USAID has obligated all of the funding in the GHP account to strengthen 

global health security (Pillar 4). Such activities included building 

laboratory capacity, strengthening community surveillance systems to 

detect and monitor Ebola and other diseases, and building the capacity of 

West African governments to prepare for and respond to infectious 

disease outbreaks. Nearly all GHP funding is regional funding rather than 

funding for a specific Ebola-affected country. For trends in obligations and 

disbursements of IDA, ESF, and GHP funds for Ebola from February 3,

2015 to July 1, 2016, see appendix IV.

State’s Bureau of International Security and Nonproliferation did not begin 

obligating funding from the NADR account until May 1, 2015, and did not 

disburse any NADR funds until September 1, 2015, for biosecurity 

activities.25 Such activities included training on biosecurity best practices 

and strategies for Ebola sample management as well as conducting 

biosecurity risk assessments. All NADR funding supports regional 

activities in West Africa rather than activities in a single country. As of 

 24GHP funds in the Act are available until expended for necessary expenses to prevent, 

prepare for, and respond to the Ebola outbreak in countries directly affected by, or at risk 

of being affected by, such outbreak.

25NADR funds in the Act are available until September 30, 2016, for necessary expenses 

to carry out nonproliferation and export control assistance, for efforts to mitigate the risk of 

illicit acquisition of the Ebola virus, and to promote biosecurity practices associated with 

Ebola outbreak response efforts. NADR funds are generally available for obligation for 2 

years. Obligated NADR funds then continue to be available for disbursement for an 

additional 5 years after the end of their period of availability for obligation.

GHP Account

NADR Account
Page 25 GAO-17-35 Emergency Funding for Ebola Response

July 1, 2016, State had obligated all of its NADR funding and disbursed 

40 percent of obligated funding from this account.

Twenty-one of USAID’s 271 reimbursements for obligations incurred prior 

to the enactment of the Department of State, Foreign Operations, and 

Related Programs Appropriations Act, 2015, were not in accordance with 

the reimbursement provisions of the Act.26 These 21 transactions account 

for over $60 million, or roughly 15 percent, of the approximately $401 

million reimbursed. Because USAID did not have the legal authority to 

make the reimbursements that were not in accordance with the 

reimbursement provisions in the Act, these reimbursements represent 

unauthorized transfers.27 As of October 2016, USAID had not determined 

whether it had budget authority to support the obligations against the 

accounts that were improperly reimbursed, possibly resulting in a violation 

of the Antideficiency Act.28 In addition, USAID has not developed written 

policies or procedures to guide staff on appropriate steps to take for the 

reimbursement process. Such policies or procedures could provide 

USAID with reasonable assurance that it will comply with reimbursement 

provisions and mitigate the risk of noncompliance.

Of 271 reimbursements that USAID made for obligations incurred prior to 

the enactment of the Act, USAID made 21 reimbursements (totaling over 

$60 million) that were not in accordance with the Act. These 21 

reimbursements represent roughly 15 percent of the approximately $401 

million that USAID obligated for reimbursements, of the almost $1.5 billion 

that had been obligated as of July 1, 2016. USAID made the other 250 

reimbursements (totaling about $341 million) in accordance with the 

reimbursement provisions of the Act for funds that OFDA and FFP 

obligated prior to enactment of the Act. To assess whether USAID’s 

reimbursements were in accordance with the Act, we reviewed USAID 

 26State reported that it has made no reimbursements for obligations incurred prior to the 

fiscal year 2015 appropriation, and it does not plan to make reimbursements.

27The transfer statute, codified at 31 U.S.C. § 1532, prohibits transfers between accounts, 

except as specifically provided by law.

28The Antideficiency Act, codified at 31 U.S.C. § 1341, prohibits the incurring of 

obligations or the making of expenditures in excess of the amounts available in 

appropriation or fund accounts unless specifically authorized by law. 

USAID Made 

Reimbursements That 

Were Not in 

Accordance with the 

Provisions of the Act, 

and USAID Has Not 

Developed 

Reimbursement 

Policies

Twenty-One of USAID’s 

271 Reimbursements 

Were Not Made In 

Accordance with the 

Provisions of the Act
Page 26 GAO-17-35 Emergency Funding for Ebola Response

documentation to determine whether each reimbursement met the four 

provisions described in the text box below.

Reimbursement Provisions of the Department of State, Foreign 

Operations, and Related Programs Appropriations Act, 2015

• The reimbursement was made to the same appropriation account as 

the account from which the U.S. Agency for International 

Development originally obligated the funds.

• The obligation was incurred prior to the December 16, 2014,

enactment of the Act.

• The obligation was incurred to prevent, prepare for, and respond to 

the Ebola outbreak.

• The reimbursement was made from the International Disaster 

Assistance, Economic Support Fund, and Global Health Programs 

accounts of the fiscal year 2015 appropriation.

Source: Department of State, Foreign Operations, and Related Programs Appropriations Act, 2015 (Pub. L. No. 113-235, Div. J, Title 

IX, 128 Stat. 2130, 2692 (Dec. 16, 2014). | GAO-17-35

For the 21 reimbursements (totaling over $60 million), USAID did not 

reimburse the same appropriation accounts as the accounts from which 

USAID originally obligated the funds. Moreover, for 4 of the 21 

reimbursements, USAID reimbursed obligations for which it did not 

document that it incurred the obligation to prevent, prepare for, or 

respond to the Ebola outbreak. Specifically,

• USAID did not reimburse the same appropriation account as the 

account from which USAID originally obligated the funds. The Bureau 

for Global Health; FFP; and the missions in Guinea, Liberia, and 

Senegal incurred over $60 million in obligations from the GHP, Title II 

of the Food for Peace Act (Title II), and Development Assistance 

accounts. Although USAID used funding from the ESF and IDA 

accounts of the fiscal year 2015 appropriation to make 21 

reimbursements for these obligations, the agency did not reimburse 

the GHP, Title II, and Development Assistance accounts from which 

USAID originally obligated the funds, in accordance with the Act (see 

table 6). Instead, USAID reimbursed the office, bureau or mission that 

originally obligated the funds. These reimbursements were made to 

different accounts, with different spending authorities, than those from 

which the original obligation was made. For example, FFP obligated 

approximately $30 million in Title II account funds for the World Food 

Program’s regional program to address the urgent food needs of 
Page 27 GAO-17-35 Emergency Funding for Ebola Response

populations affected by the Ebola outbreak,29 but USAID used 

approximately $30 million in IDA account funds from the fiscal year 

2015 appropriation to reimburse FFP and credited the funds to FFP’s 

IDA account.30

Table 6: USAID Obligations Prior to Enactment of the Department of State, Foreign Operations, and Related Programs 

Appropriations Act, 2015, and Subsequent Reimbursements, by Account

Dollars in millions

USAID office,

bureau or 

mission 

reimbursed

Account from 

which USAID 

obligated funds 

prior to enactment

Account to which 

USAID made the 

reimbursements

USAID reimbursed the 

same account from 

which USAID obligated 

funds prior to enactment

Dollar amount of 

reimbursements

Number of 

reimbursements

Office of U.S. 

Foreign Disaster 

Assistance

International 

Disaster Assistance

International Disaster 

Assistance ✓

328 249

Office of Food for 

Peace

International 

Disaster Assistance

International Disaster 

Assistance ✓ 13 1

Title II International Disaster 

Assistance ✗ 30 4

Bureau for Global 

Health

Global Health 

Programs

Economic Support 

Fund ✗ 20 13

USAID/Liberia Global Health 

Programs

Economic Support 

Fund ✗ 5 1

USAID/Guinea Global Health 

Programs

Economic Support 

Fund ✗ 3 2

USAID/Senegal Development 

Assistance

Economic Support 

Fund ✗ 1 1

Total — — — 401 271

Legend: ✓= yes, ✗= no

Source: GAO analysis of U.S. Agency for International Development (USAID) data and information.| GAO-17-35

Notes: Amounts show n may not sum precisely to totals because of rounding. USAID used Economic 

Support Fund and International Disaster Assistance account funds from the fiscal year 2015 

appropriation for the reimbursements, in accordance with the Department of State, Foreign 

Operations, and Related Programs Appropriations Act, 2015.

 29Title II is reauthorized through the Farm Bill approximately every 5 years and is funded 

through a U.S. Department of Agriculture appropriation. Section 3001 of Pub. L. No. 110-

246, the Food, Conservation, and Energy Act of 2008, changed the title of the underlying 

legislation from the Agriculture Trade Development Assistance Act of 1954, also known as 

P.L. 480, to the Food for Peace Act. Title II of the Food for Peace Act, administered by 

USAID, addresses the donation of U.S. agricultural commodities for humanitarian 

purposes.

30FFP implements a cash-based program—the Emergency Food Security Program—with 

funding from IDA, which is authorized by Chapter 9 of the Foreign Assistance Act of 1961, 

as amended (22 U.S.C. §491 et seq.), and receives appropriations pursuant to annual 

appropriations acts for Foreign Operations.
Page 28 GAO-17-35 Emergency Funding for Ebola Response

• USAID reimbursed obligations for which it did not document that it 

incurred the obligation to prevent, prepare for, and respond to the 

Ebola outbreak. USAID made four reimbursements, totaling about 

$3.3 million, for which USAID was unable to provide documentation 

showing that the original obligations funded activities to prevent, 

prepare for, and respond to the Ebola outbreak. For example, USAID 

reimbursed approximately $1.3 million for an obligation incurred by 

the Bureau for Global Health in September 2014. However, USAID 

officials noted that they did not document the amount or purpose of 

the obligation at the time the funds were obligated. In July 2016, in 

response to our inquiry, USAID prepared a memorandum to attest 

that the original obligation was approximately $1.3 million and funded 

technical assistance for Ebola preparedness to 13 African countries.31

In another instance, USAID reimbursed $500,000 for an obligation 

incurred for the preparation of laboratories to detect Middle East 

Respiratory Syndrome (MERS) and other acute respiratory infections 

in the Africa region. However, USAID was unable to provide us 

documentation showing how the obligation funded activities related to 

the Ebola outbreak.

Because USAID did not have the legal authority to make the 

reimbursements that were not in accordance with the reimbursement 

provisions in the Act, these 21 reimbursements represent unauthorized 

transfers.32 Further, the Antideficiency Act prohibits an agency from 

obligating or expending more than has been appropriated to it.33 As of 

October 2016, USAID had not determined whether it had the budget 

authority to support the obligations against the accounts that were 

improperly reimbursed.

See appendix V for a complete list of USAID’s reimbursements for 

obligations incurred prior to the fiscal year 2015 appropriation.

 31To ensure the integrity and reliability of agencies’ obligational accounting records, the 

recording statute, 31 U.S.C. § 1501, requires agencies to record an obligation when 

supported by documentary evidence that a legal liability for the government has been 

incurred.

32The transfer statute, 31 U.S.C. § 1532, prohibits transfers between accounts, except as 

specifically provided by law.

3331 U.S.C. § 1341.
Page 29 GAO-17-35 Emergency Funding for Ebola Response

The concerns we identified with the 21 reimbursements could partly be 

attributed to the fact that USAID has not developed written policies or 

procedures to guide staff on appropriate steps to take to make 

reimbursements and document them. Internal control standards require 

that management design control activities—actions established through 

policies and procedures—to achieve objectives and respond to risks and 

implement such activities through policies.34 By developing written 

policies and procedures, offices and bureaus would know what steps they 

should take to ensure that reimbursements are made in accordance with 

an appropriation act and other applicable appropriations laws and are 

recorded in a manner that allows documentation to be readily available 

for examination.35 Such written policies and procedures could provide 

USAID with reasonable assurance that it is complying with 

reimbursement provisions and help mitigate the risk of noncompliance.

Without written policies and procedures, USAID does not have a process 

in place for making reimbursements and maintaining documentation to 

show that it complied with the reimbursement provisions of the Act. Our 

review found that USAID made 21 reimbursements that it did not have the 

legal authority to make, possibly resulting in the obligation or expenditure

of funds in excess of appropriations, which would violate the 

Antideficiency Act. In addition, because USAID did not have written 

policies and procedures for maintaining documentation of the 

reimbursements, USAID officials spent several months locating records to 

demonstrate to us that USAID had reimbursed 250 obligations in a 

manner consistent with the provisions of the Act. USAID officials also 

noted that because they did not document the purpose of some 

obligations at the time the funds were obligated, USAID officials had to 

create a memorandum to explain how two reimbursed obligations funded 

USAID activities to prevent, prepare for, and respond to the Ebola 

outbreak.

West Africa has experienced the largest and most complex Ebola 

outbreak since the virus was first discovered, resulting in more than 

11,000 deaths. The outbreak not only disrupted the already weak healthcare systems in Guinea, Liberia, and Sierra Leone but also contributed to 

 34GAO, Standards for Internal Control in the Federal Government, GAO-14-704G 

(Washington, D.C.: Sept. 10, 2014).

35GAO-14-704G.

USAID Has Not 

Developed Written Policies 

for the Reimbursement 

Process

Conclusions
Page 30 GAO-17-35 Emergency Funding for Ebola Response

reduced economic activity, job loss, and food insecurity in these 

countries. USAID and State have funded a range of activities to control 

the outbreak and will continue to fund longer-term efforts to mitigate the 

second-order effects and strengthen global health security.

The Department of State, Foreign Operations, and Related Programs 

Appropriations Act, 2015, authorized the reimbursement of obligations 

incurred prior to enactment to prevent, prepare for, and respond to the 

Ebola outbreak. While most of USAID’s reimbursements were made in 

accordance with the reimbursement provisions of the Act, roughly 15 

percent of the funds that USAID reimbursed were not. In particular, 

USAID did not in all cases reimburse the same appropriation accounts 

from which it obligated funds as required by the Act, and in several 

instances it made reimbursements for obligations for which it did not 

document that it incurred the obligation to prevent, prepare for, and 

respond to the Ebola outbreak. As a result, USAID may not have the 

budget authority to support the obligations against the accounts that were 

erroneously reimbursed, which may result in a violation of the 

Antideficiency Act. Furthermore, without written policies and procedures, 

USAID risks the possibility of noncompliance recurring should USAID be 

granted reimbursement authority in the future.

To ensure that USAID reimburses funds in accordance with section 9002 

of the Department of State, Foreign Operations, and Related Programs 

Appropriations Act, 2015, we recommend that the Administrator of USAID 

take the following three actions:

1. Reverse reimbursements that were not made to the same 

appropriation account as the account from which USAID obligated the 

funds.

2. Reverse reimbursements for which there is no documentary evidence 

that the obligation was incurred to prevent, prepare for, and respond 

to the Ebola outbreak.

3. Determine whether reversing any of these reimbursements results in 

the obligation of funds in excess of appropriations in violation of the 

Antideficiency Act and, if so, report any violations in accordance with 

law.

To help ensure that USAID complies with reimbursement provisions that 

may arise in future appropriations laws, we recommend that the 

Administrator of USAID develop written policies and procedures for the 

agency’s reimbursement process.

Recommendations for 

Executive Action
Page 31 GAO-17-35 Emergency Funding for Ebola Response

We provided a draft of this report to USAID and State for comment. In its 

written comments, reproduced in appendix VI, USAID agreed with our 

findings and recommendations. USAID noted that it would reverse 

reimbursements that were not made to the same appropriation account 

as the account from which USAID originally obligated funds, and that it is 

reviewing whether it has violated the Antideficiency Act. State did not 

provide formal comments. USAID and State also provided technical 

comments, which we incorporated throughout the report, as appropriate.

We are sending copies of this report to the appropriate congressional 

committees, the U.S. Agency for International Development, the 

Department of State, and other interested parties. In addition, the report is 

available at no charge on the GAO website at http://www.gao.gov

If you or your staff have any questions about this report, please contact 

me at (202) 512-3149 or gootnickd@gao.gov. Contact points for our 

Offices of Congressional Relations and Public Affairs may be found on 

the last page of this report. GAO staff who made key contributions to this 

report are listed in appendix VII.

David B. Gootnick

Director, International Affairs and Trade

Agency Comments 

and Our Evaluation
Appendix I: Objectives, Scope, and 

Methodology

Page 32 GAO-17-35 Emergency Funding for Ebola Response

The Department of State, Foreign Operations, and Related Programs 

Appropriations Act, 2015 (the Act), included a provision for us to conduct 

oversight of the U.S. Agency for International Development’s (USAID) 

and the Department of State’s (State) activities to prevent, prepare for, 

and respond to the 2014 Ebola outbreak and reimbursements made.1 We 

examined (1) USAID’s and State’s obligations and disbursements for 

Ebola activities and (2) the extent to which USAID made reimbursements 

in accordance with the requirements of the fiscal year 2015 

appropriations act.

To examine USAID’s and State’s obligations and disbursements for Ebola 

activities, we analyzed each agency’s allocation, obligation, and 

disbursement data for Ebola response and preparedness activities 

reported in USAID’s and State’s reports to the Senate and House 

Committees on Appropriations mandated by the Act.2 We analyzed 

USAID’s and State’s reported data on allocations, obligations, and 

disbursements that USAID and State reported from February 3, 2015, to 

July 1, 2016.3 We obtained and analyzed the data from USAID for the 

International Disaster Assistance; Global Health Programs; Economic 

Support Fund; USAID Operating Expenses; Nonproliferation, 

Antiterrorism, Demining, and Related Programs; and USAID Office of 

Inspector General appropriation accounts. We obtained and analyzed the 

data for the Diplomatic & Consular Programs account from State, which 

State reported separately. We reviewed each agency’s reports to 

congressional committees to determine the activities funded and reasons 

for any changes in the agencies’ cost estimates and use of the funds. We 

interviewed USAID and State officials in Washington, D.C., from each 

bureau and office that administers funding from accounts of the fiscal 

year 2015 appropriation to discuss the status of the agencies’ obligations 

and disbursements for activities to prevent, prepare for, and respond to 

the Ebola outbreak in West Africa, methods for reporting the funding data, 

and plans for obligating and disbursing the funds. We also interviewed 

officials from each of USAID’s and State’s offices that report on the funds 

 1Pub. L. No. 113-235, Div. J, Title IX, 128 Stat. 2130, 2692 (Dec. 16, 2014).

2Pub. L. No. 113-235, § 9004 (Dec. 16, 2014).

3USAID has reported its funding data as of the first day of each month with the exception 

of the February 2015 report, which contains data as of February 3, 2015. When reporting 

USAID data on obligations and disbursements for each federal fiscal year quarter, we note 

that the data are as of the first day of the month following the end of each fiscal year 

quarter.

Appendix I: Objectives, Scope, and 

Methodology
Appendix I: Objectives, Scope, and 

Methodology

Page 33 GAO-17-35 Emergency Funding for Ebola Response

to obtain information about their budgeting process and terms to 

determine the best method for analyzing the data across accounts. We 

then reviewed the data and information reported and consulted with 

USAID and State officials on the accuracy and completeness of the data 

and information. When we found data discrepancies, we contacted 

relevant agency officials and obtained information from them necessary to 

resolve the discrepancies.4 To assess the reliability of the data provided, 

we requested and reviewed information from agency officials regarding 

the underlying financial data systems and the checks and reviews used to 

generate the data and ensure its accuracy and reliability. To further 

ensure the reliability of the data, we obtained from USAID officials data 

from the financial data system that USAID used to report obligation and 

disbursement data and compared them to a sample of the data that we 

analyzed. We determined that the data we used were sufficiently reliable 

for our purposes of examining USAID’s and State’s obligations and 

disbursements of the funds.

To examine the extent to which USAID made reimbursements in 

accordance with the Act, we reviewed USAID’s reports to the Senate and 

House Committees on Appropriations mandated by the Act to determine 

the obligations that the agency incurred prior to enactment and the 

reimbursements that USAID made for the obligations. We obtained data 

and documentation from each USAID bureau and office that administered 

the appropriation accounts for the obligations incurred prior to the fiscal 

year 2015 appropriation. To assess the reliability of the data provided, we 

requested and reviewed information from USAID officials regarding the 

underlying financial data systems and the checks and reviews used to 

generate the data and ensure its accuracy and reliability. We determined 

that the data we used were sufficiently reliable for our purposes of 

examining USAID’s reimbursements. We analyzed these data and

reviewed documents to determine the dates and amounts of the 

obligations, the activities that the obligations funded, and the 

appropriation accounts used for the obligations. We also analyzed the 

data and reviewed documents to determine the amounts of the

reimbursements, the appropriation accounts from the fiscal year 2015 

appropriation that USAID used for the reimbursements, and the 

appropriation accounts to which USAID reimbursed the funds. We 

reviewed USAID’s congressional notifications and award documentation 

 4As a result of our efforts to ensure data reliability, the data that we report for obligations 

and disbursements may differ from the data that USAID has reported to congressional 

committees.
Appendix I: Objectives, Scope, and 

Methodology

Page 34 GAO-17-35 Emergency Funding for Ebola Response

to determine the amounts, purposes, and appropriation accounts for the 

obligations that USAID incurred prior to the enactment of the Act as well 

as the amounts and appropriation accounts from which USAID 

reimbursed the funds. We interviewed USAID and State officials about 

the extent to which the agencies incurred obligations prior to the 

appropriation and reimbursed the funds. We also interviewed USAID 

officials and reviewed USAID’s policies for the management of funds to 

determine the extent to which the agency had developed and 

implemented written policies or procedures for the reimbursement 

process. We assessed the extent to which the obligations and 

reimbursements were consistent with the provisions of the Act as well as 

the extent to which the procedures USAID used met relevant internal 

control standards.5

We conducted this performance audit from June 2015 to November 2016 

in accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe that 

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives.

 5GAO, Standards for Internal Control in the Federal Government, GAO-14-704G 

(Washington, D.C.: Sept. 10, 2014). 
Appendix II: USAID and Department of State 

Total Obligations and Disbursements, by U.S. 

Ebola Strategy Pillar

Page 35 GAO-17-35 Emergency Funding for Ebola Response

As of July 1, 2016, the U.S. Agency for International Development 

(USAID) and the Department of State (State) had obligated the largest 

share of the Department of State, Foreign Operations, and Related 

Programs Appropriations Act, 2015 (the Act) Ebola funding for activities to 

control the outbreak (Pillar 1). USAID had obligated lesser amounts of 

funding for activities to mitigate second-order impacts of Ebola (Pillar 2) 

and activities to strengthen global health security (Pillar 4). USAID 

obligated a minimal amount of funding for building coherent leadership 

and operations (Pillar 3). For all strategy pillars, the largest percentage 

increase in obligations occurred between April 1, 2015, and July 1, 2015 

(see fig. 9).

Appendix II: USAID and Department of State 

Total Obligations and Disbursements, by 

U.S. Ebola Strategy Pillar
Appendix II: USAID and Department of State 

Total Obligations and Disbursements, by U.S. 

Ebola Strategy Pillar

Page 36 GAO-17-35 Emergency Funding for Ebola Response

Figure 9: Total Obligations and Disbursements, by Ebola Strategy Pillar, February 3, 2015—July 1, 2016

Notes: These data reflect funding that w as obligated prior to the enactment of the Department of 

State, Foreign Operations, and Related Programs Appropriations Act, 2015, as w ell as 

postenactment obligations. USAID began reporting to Congress on its obligations and disbursements 

of Ebola funding as of February 3, 2015. State began reporting to Congress on its obligations and 

disbursements of Ebola funding from the Nonproliferation, Antiterrorism, Demining, and Related 

Programs account as of February 3, 2015. These data do not include any funding from State’s 

Diplomatic & Consular Programs account because State does not categorize such funding by 

strategic pillar.
Appendix III: USAID Funding for Ebola 

Activities, by Country

Page 37 GAO-17-35 Emergency Funding for Ebola Response

The U.S. Agency for International Development (USAID) obligated 

funding from the International Disaster Assistance (IDA) and Economic 

Support Fund (ESF) accounts for almost all of its country-specific Ebola 

funding. More than 80 percent of the funding that USAID has obligated for 

Ebola activities in Guinea, Liberia, and Sierra Leone is from the IDA 

account. Since USAID began its reporting to Congress on Ebola funding 

in February 2015, IDA obligations for Liberia show the greatest increase 

between February 3, 2015, and July 1, 2015, and ESF obligations for 

Liberia show the greatest increase between April 1, 2015, and October 1, 

2015 (see fig. 10). ESF disbursements do not begin before July 1, 2015.

USAID deobligated and reprogrammed IDA funding for Liberia between 

January 1, 2016, and July 1, 2016, as it needed fewer funds to control the 

outbreak.

Figure 10: International Disaster Assistance and Economic Support Fund Total Obligations and Disbursements for Ebola 

Activities in Liberia, February 3, 2015—July 1, 2016

Notes: These data reflect funding that w as obligated prior to the enactment of the Department of 

State, Foreign Operations, and Related Programs Appropriations Act, 2015, as w ell as 

postenactment obligations. USAID began reporting to Congress on its obligations and disbursements 

of Ebola funding as of February 3, 2015.

Consistent with Liberia, since USAID began reporting to Congress on its 

Ebola funding in February 2015, USAID obligations of IDA funding for 

Sierra Leone show the greatest increases between February 3, 2015, and 

Appendix III: USAID Funding for Ebola 

Activities, by Country
Appendix III: USAID Funding for Ebola 

Activities, by Country

Page 38 GAO-17-35 Emergency Funding for Ebola Response

July 1, 2015. However, USAID made no obligations of ESF funding 

before April 1, 2015, and no disbursements of ESF funding until after July 

1, 2015 (see fig. 11).

Figure 11: International Disaster Assistance and Economic Support Fund Total Obligations and Disbursements for Ebola 

Activities in Sierra Leone, February 3, 2015—July 1, 2016

Notes: These data reflect funding that w as obligated prior to the enactment of the Department of 

State, Foreign Operations, and Related Programs Appropriations Act, 2015, as w ell as 

postenactment obligations. USAID began reporting to Congress on its obligations and disbursements 

of Ebola funding as of February 3, 2015.

Since USAID began reporting to Congress on its Ebola funding in 

February 2015, the greatest increase in obligations from the IDA account 

for Guinea occurred between February 3, 2015, and July 1, 2015 (see fig. 

12).
Appendix III: USAID Funding for Ebola 

Activities, by Country

Page 39 GAO-17-35 Emergency Funding for Ebola Response

Figure 12: International Disaster Assistance and Economic Support Fund Total Obligations and Disbursements for Ebola 

Activities in Guinea, February 3, 2015—July 1, 2016

Notes: These data reflect funding that w as obligated prior to the enactment of the Department of 

State, Foreign Operations, and Related Programs Appropriations Act, 2015, as w ell as 

postenactment obligations. USAID began reporting to Congress on its obligations and disbursements 

of Ebola funding as of February 3, 2015.
Appendix IV: Total Obligations and 

Disbursements for Ebola Activities, by 

Account

Page 40 GAO-17-35 Emergency Funding for Ebola Response

The International Disaster Assistance (IDA) account represents the 

majority of funding obligated and disbursed for Ebola activities to control 

the outbreak. After the enactment of the Department of State, Foreign 

Operations, and Related Programs Appropriations Act, 2015, obligations 

and disbursements from the IDA account increased the most between 

April 1, 2015, and July 1, 2015 (see fig. 13). The U.S. Agency for 

International Development (USAID) deobligated and reprogrammed IDA 

funding between January 1, 2016, and July 1, 2016, as it needed fewer 

funds to control the outbreak (see fig. 13). The Office of U.S. Foreign 

Disaster Assistance (OFDA) programmed the majority of IDA funding.

Figure 13: Total Obligations and Disbursements of the International Disaster 

Assistance Account for Ebola Activities, February 3, 2015—July 1, 2016

Notes: These data reflect funding that w as obligated prior to the enactment of the Department of 

State, Foreign Operations, and Related Programs Appropriations Act, 2015, as w ell as 

postenactment obligations. USAID began reporting to Congress on its obligations and disbursements 

of Ebola funding as of February 3, 2015.

The Economic Support Fund (ESF) account represents the majority of 

funding obligated and disbursed for activities to mitigate the second-order 

impacts of Ebola. USAID increased obligations of ESF significantly 

between April 1, 2015, and October 1, 2015, as new cases of Ebola 

Appendix IV: Total Obligations and 

Disbursements for Ebola Activities, by 

Account
Appendix IV: Total Obligations and 

Disbursements for Ebola Activities, by 

Account

Page 41 GAO-17-35 Emergency Funding for Ebola Response

decreased. Disbursements of ESF funding did not increase significantly 

until after July 1, 2015 (see fig. 14). USAID’s Bureau for Global Health 

and Global Development Lab programmed the majority of ESF funding.

Figure 14: Total Obligations and Disbursements of the Economic Support Fund 

Account for Ebola Activities, February 3, 2015—July 1, 2016

Notes: These data reflect funding that w as obligated prior to the enactment of the Department of 

State, Foreign Operations, and Related Programs Appropriations Act, 2015, as w ell as 

postenactment obligations. USAID began reporting to Congress on its obligations and disbursements 

of Ebola funding as of February 3, 2015.

The Global Health Programs (GHP) account represents the majority of 

funding obligated and disbursed for activities to strengthen global health 

security. USAID did not obligate any GHP funding between February 3, 

2015, and April 1, 2015, and did not report disbursements until August 1, 

2015, as USAID intends GHP to fund longer-term activities to respond to 

future outbreaks (see fig. 15). The Bureau for Global Health programs 

almost all GHP funding.
Appendix IV: Total Obligations and 

Disbursements for Ebola Activities, by 

Account

Page 42 GAO-17-35 Emergency Funding for Ebola Response

Figure 15: Total Obligations and Disbursements of the Global Health Programs 

Account for Ebola Activities, February 3, 2015—July 1, 2016

Notes: These data reflect funding that w as obligated prior to the enactment of the Department of 

State, Foreign Operations, and Related Programs Appropriations Act, 2015, as w ell as 

postenactment obligations. USAID began reporting to Congress on its obligations and disbursements 

of Ebola funding as of February 3, 2015.
Appendix V: USAID’s Reimbursements for 

Funds Obligated Prior to Enactment of the 

Fiscal Year 2015 Appropriations Act

Page 43 GAO-17-35 Emergency Funding for Ebola Response

The U.S. Agency for International Development (USAID) made 271 

reimbursements for the approximately $401 million total obligations that 

USAID’s Bureau for Global Health; Office of Food for Peace (FFP); Office 

of U.S. Foreign Disaster Assistance (OFDA); and the missions in Guinea, 

Liberia, and Senegal incurred prior to the enactment of the Department of 

State, Foreign Operations, and Related Programs Appropriations Act, 

2015 (the Act).1 Of the 271 reimbursements, USAID made 250 

reimbursements (totaling about $341 million) in accordance with the 

reimbursement provisions of the Act. USAID made these 250 

reimbursements for funds that OFDA and FFP obligated prior to 

enactment of the Act. However, USAID made 21 reimbursements 

(totaling over $60 million) that did not accord with the reimbursement 

provisions of the Act. USAID made these 21 reimbursements for funds 

that the Bureau for Global Health, FFP, and the missions obligated prior 

to enactment of the Act. Tables 7 through 9 provide information about 

these 21 reimbursements and the requirements of the Act that each of the 

reimbursements did not meet.2

 1Pub. L. No. 113-235 (Dec. 16, 2014).

2Pub. L. No. 113-235, § 9002 (Dec. 16, 2014).

Appendix V: USAID’s Reimbursements for 

Funds Obligated Prior to Enactment of the 

Fiscal Year 2015 Appropriations Act
Appendix V: USAID’s Reimbursements for 

Funds Obligated Prior to Enactment of the 

Fiscal Year 2015 Appropriations Act

Page 44 GAO-17-35 Emergency Funding for Ebola Response

Table 7: USAID Bureau for Global Health Obligations Prior to Enactment of the Department of State, Foreign Operations, and 

Related Programs Appropriations Act, 2015, and Reimbursements, by Appropriation Account

Account from 

which USAID 

obligated funds 

prior to enactment

Account to which 

USAID made the 

reimbursements 

Dollar amount of

reimbursements

USAID 

reimbursed same 

account as 

obligation prior 

to enactment

Purpose for 

Ebola

documented Description of activities

Global Health 

Programs

Economic Support 

Fund

6,400,000 ✗ ✓ Operational support to the 

World Health Organization 

and the governments of 

Guinea, Liberia, Nigeria, and 

Sierra Leone to implement 

Ebola response plans. 

Global Health 

Programs

Economic Support 

Fund

4,888,500 ✗ ✓ Development of Ebola 

communications materials.

Global Health 

Programs

Economic Support 

Fund

2,500,000 ✗ ✓ Procurement of personal 

protective equipment.

Global Health 

Programs

Economic Support 

Fund

1,250,000 ✗ ✗ Technical assistance to 13 

African countries following 

Ebola preparedness 

workshops in West Africa.

Global Health 

Programs

Economic Support 

Fund

752,000 ✗ ✗ Ebola preparedness 

workshops in West Africa.

Global Health 

Programs

Economic Support 

Fund

750,000 ✗ ✗ Deployment of technical 

experts to Guinea, Liberia, 

and Sierra Leone for Ebola 

response efforts.

Global Health 

Programs

Economic Support 

Fund

750,000 ✗ ✓ Support to the World Health 

Organization to coordinate 

disease surveillance and 

response for emerging 

pandemic threats in the Africa 

region, including Ebola. 

Global Health 

Programs

Economic Support 

Fund

700,000 ✗ ✓ Procurement of personal 

protective equipment for 

health-care workers and 

outbreak investigators in West 

Africa. 

Global Health 

Programs

Economic Support 

Fund

637,500 ✗ ✓ Support for World Health 

Organization’s preparedness 

and response efforts related 

to pandemic threats, including 

Ebola.
Appendix V: USAID’s Reimbursements for 

Funds Obligated Prior to Enactment of the 

Fiscal Year 2015 Appropriations Act

Page 45 GAO-17-35 Emergency Funding for Ebola Response

Legend: ✓= yes, ✗= no

Source: GAO analysis of U.S. Agency for International Development (USAID) data and information. | GAO-17-35

Table 8: Office of Food for Peace Obligations Prior to Enactment of the Department of State, Foreign Operations, and Related 

Programs Appropriations Act, 2015, and Reimbursements, by Appropriation Account

Global Health 

Programs

Economic Support 

Fund

500,000 ✗ ✗ Development of guidelines for 

disease surveillance, case 

detection, and infection 

control; and communications 

materials on disease 

prevention, particularly for 

Middle East Respiratory 

Syndrome. 

Global Health 

Programs

Economic Support 

Fund

500,000 ✗ ✓ Laboratory support and 

supplies for Ebola diagnoses.

Global Health 

Programs

Economic Support 

Fund

350,000 ✗ ✓ Provision of personal 

protective equipment for 

health-care workers and 

outbreak investigators in 

Guinea, Liberia, and Sierra 

Leone.

Global Health 

Programs

Economic Support 

Fund

200,000 ✗ ✓ Support for United Nations 

pandemic preparedness 

planning and disaster risk 

management for future Ebola 

outbreaks.

Total — 20,178,000 — — —

Account from 

which USAID 

obligated funds 

prior to enactment

Account to which 

USAID made the 

reimbursements 

Dollar amount of

reimbursements

USAID 

reimbursed same 

account as 

obligation prior 

to enactment

Purpose for 

Ebola

documented Description of activities

Title II International 

Disaster Assistance

11,943,900 ✗ ✓ Support for World Food 

Program emergency 

operations for populations 

affected by the Ebola 

outbreak in Guinea, Liberia, 

and Sierra Leone.

Title II International 

Disaster Assistance

9,993,700 ✗ ✓ Support for World Food 

Program relief and recovery

operations for refugees and 

vulnerable populations in 

Liberia.

Title II International 

Disaster Assistance

4,911,300 ✗ ✓ Support for World Food 

Program emergency 

operations for populations 

affected by the Ebola 

outbreak in Guinea, Liberia, 

and Sierra Leone.
Appendix V: USAID’s Reimbursements for 

Funds Obligated Prior to Enactment of the 

Fiscal Year 2015 Appropriations Act

Page 46 GAO-17-35 Emergency Funding for Ebola Response

Legend: ✓= yes, ✗= no

Source: GAO analysis of U.S. Agency for International Development (USAID) data and information. | GAO-17-35

Table 9: USAID Missions in Liberia, Guinea, and Senegal Obligations Prior to Enactment of the Department of State, Foreign 

Operations, and Related Programs Appropriations Act, 2015, and Reimbursements, by Appropriation Account

Legend: ✓= yes,✗= no

Source: GAO analysis of U.S. Agency for International Development (USAID) data and information. | GAO-17-35

Title II International 

Disaster Assistance

3,558,300 ✗ ✓ Support for World Food 

Program emergency 

operations for populations 

affected by the Ebola 

outbreak in Guinea, Liberia, 

and Sierra Leone.

Total — 30,407,200 — — —

Account from 

which USAID 

obligated funds 

prior to enactment

Account to which 

USAID made the

reimbursements

Dollar amount of

reimbursements

USAID 

reimbursed same 

account as 

obligation prior 

to enactment

Purpose for 

Ebola

documented Description of activities

Global Health 

Programs

Economic Support 

Fund

5,000,000 ✗ ✓ Salary support for health-care 

workers in Liberia.

Global Health 

Programs

Economic Support 

Fund

1,920,000 ✗ ✓ Health messaging, community 

outreach, and infection control 

training in Guinea.

Global Health 

Programs

Economic Support 

Fund

1,562,000 ✗ ✓ Health messaging, community 

outreach, and infection control 

training in Guinea.

Development 

Assistance

Economic Support 

Fund

1,000,000 ✗ ✓ Health messaging, disease 

surveillance, and Ebola case 

detection in Senegal.

Total — 9,482,000 — — —
Appendix VI: Comments from the U.S. Agency 

for International Development

Page 47 GAO-17-35 Emergency Funding for Ebola Response

Appendix VI: Comments from the U.S. 

Agency for International Development
Appendix VI: Comments from the U.S. Agency 

for International Development

Page 48 GAO-17-35 Emergency Funding for Ebola Response
Appendix VI: Comments from the U.S. Agency 

for International Development

Page 49 GAO-17-35 Emergency Funding for Ebola Response
Appendix VII: GAO Contact and Staff 

Acknowledgments

Page 50 GAO-17-35 Emergency Funding for Ebola Response

David B. Gootnick, (202) 512-3149 or gootnickd@gao.gov

In addition to the contact named above, Valérie L. Nowak (Assistant 

Director), Bradley Hunt (Analyst-in-Charge), Ashley Alley, Bryan 

Bourgault, Debbie Chung, Neil Doherty, Rachel Dunsmoor, Jill Lacey, 

Amanda Postiglione, and Matthew Valenta made key contributions to this 

report.

Appendix VII: GAO Contact and Staff 

Acknowledgments

GAO Contact

Staff 

Acknowledgments

(100141)
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