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33–935 PDF 2008

S. HRG. 110–521 

STATE, FOREIGN OPERATIONS, AND RELATED 

PROGRAMS APPROPRIATIONS FOR FISCAL 

YEAR 2008 

HEARINGS 

BEFORE A

SUBCOMMITTEE OF THE 

COMMITTEE ON APPROPRIATIONS 

UNITED STATES SENATE 

ONE HUNDRED TENTH CONGRESS 

FIRST SESSION 

ON

H.R. 2764 

AN ACT MAKING APPROPRIATIONS FOR FOREIGN OPERATIONS, EXPORT 

FINANCING, AND RELATED PROGRAMS FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2008, AND FOR OTHER PURPOSES 

Department of State 

United States Agency for International Development 

Printed for the use of the Committee on Appropriations 

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

COMMITTEE ON APPROPRIATIONS 

ROBERT C. BYRD, West Virginia, Chairman 

DANIEL K. INOUYE, Hawaii 

PATRICK J. LEAHY, Vermont 

TOM HARKIN, Iowa 

BARBARA A. MIKULSKI, Maryland 

HERB KOHL, Wisconsin 

PATTY MURRAY, Washington 

BYRON L. DORGAN, North Dakota 

DIANNE FEINSTEIN, California 

RICHARD J. DURBIN, Illinois 

TIM JOHNSON, South Dakota 

MARY L. LANDRIEU, Louisiana 

JACK REED, Rhode Island 

FRANK R. LAUTENBERG, New Jersey 

BEN NELSON, Nebraska 

THAD COCHRAN, Mississippi 

TED STEVENS, Alaska 

ARLEN SPECTER, Pennsylvania 

PETE V. DOMENICI, New Mexico 

CHRISTOPHER S. BOND, Missouri 

MITCH MCCONNELL, Kentucky 

RICHARD C. SHELBY, Alabama 

JUDD GREGG, New Hampshire 

ROBERT F. BENNETT, Utah 

LARRY CRAIG, Idaho 

KAY BAILEY HUTCHISON, Texas 

SAM BROWNBACK, Kansas 

WAYNE ALLARD, Colorado 

LAMAR ALEXANDER, Tennessee 

CHARLES KIEFFER, Staff Director 

BRUCE EVANS, Minority Staff Director 

SUBCOMMITTEE ON STATE, FOREIGN OPERATIONS, AND RELATED PROGRAMS

PATRICK J. LEAHY, Vermont, Chairman 

DANIEL K. INOUYE, Hawaii 

TOM HARKIN, Iowa 

BARBARA A. MIKULSKI, Maryland 

RICHARD J. DURBIN, Illinois 

TIM JOHNSON, South Dakota 

MARY L. LANDRIEU, Louisiana 

JACK REED, Rhode Island 

JUDD GREGG, New Hampshire 

MITCH MCCONNELL, Kentucky 

ARLEN SPECTER, Pennsylvania 

ROBERT F. BENNETT, Utah 

CHRISTOPHER S. BOND, Missouri 

SAM BROWNBACK, Kansas 

LAMAR ALEXANDER, Tennessee 

Professional Staff 

TIM RIESER

KATE ELTRICH

NIKOLE MANATT

PAUL GROVE (Minority) 

MICHELE WYMER (Minority) 

LASHAWNDA SMITH (Minority) 

Administrative Support 

RENAN SNOWDEN
(III) 

C O N T E N T S 

WEDNESDAY, MARCH 28, 2007 

Page 

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

WEDNESDAY, APRIL 18, 2007 

United States Agency for International Development: Bureau for Global 

Health ................................................................................................................... 25 

THURSDAY, MAY 10, 2007 

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

(1) 

STATE, FOREIGN OPERATIONS, AND RELATED 

PROGRAMS APPROPRIATIONS FOR FISCAL 

YEAR 2008 

WEDNESDAY, MARCH 28, 2007 

U.S. SENATE, SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS, Washington, DC. 

The subcommittee met at 10:03 a.m., in room SD–138, Dirksen 

Senate Office Building, Hon. Patrick J. Leahy (chairman) presiding. 

Present: Senators Leahy, Bond, and Gregg. 

UNITED STATES AGENCY FOR INTERNATIONAL 

DEVELOPMENT 

STATEMENT OF HON. RANDALL L. TOBIAS, ADMINISTRATOR 

OPENING STATEMENT OF SENATOR PATRICK J. LEAHY

Senator LEAHY. Good morning. Ambassador Tobias, I’m glad 

you’re here. This is a very busy day. We considered postponing this 

hearing because the votes are set at 11 o’clock, but we don’t have 

hearing dates available in April, we can’t be sure what dates are 

available in May, so I’m going to put my opening statement in the 

record. 

I would hope that you would summarize yours so we can go to 

questions. 

[The statement follows:] 

PREPARED STATEMENT OF SENATOR PATRICK J. LEAHY

I want to begin by welcoming Senator Gregg who is the new ranking member of 

this subcommittee. Senator Gregg and I come from States that share a border and 

I look forward to working with him in the same bipartisan way that his predecessor, 

Senator McConnell, and I worked together for so many years. 

I think we both agree that the United States does not need a Democratic or Republican foreign policy, we need an American foreign policy, and that is what I intend to strive for. 

Ambassador Tobias, we appreciate you being here. We also appreciate your past 

leadership as the Global AIDS Coordinator. You got that program off to a good start. 

The jobs of USAID Administrator and Director of Foreign Assistance are quite different from either the CEO of a private corporation or the AIDS Coordinator, as I’m 

sure you have discovered. 

Today we want to focus on the President’s fiscal year 2008 budget request for 

USAID, and on your proposals for reforming our foreign aid programs. 

I think most people would agree that there is a lot of room for improvement in 

our foreign aid budget, personnel and procurement policies, and programs. But the 

issue is how you do it, and what decision-making authority is retained by USAID. 
2 

On the positive side, you have developed a more coherent process that will enable 

your office to more accurately show where and how funds are spent. That will help 

and we welcome it. 

We are also assured by your office that you consulted extensively during this process, although that is not what we have heard from some of those whose views we 

would have wanted to see reflected, including within USAID itself. 

While the budget process may be more coherent and transparent, I am mystified 

by many of the results. 

A glance at your budget request yields as many questions as answers. A country like Colombia, that has received roughly $565 million in each of the past 5 years, 

gets the same amount for the same purposes in fiscal year 2008, even though we 

know that some things have not worked and that conditions in Colombia have 

changed. 

In Nepal, a country where years of fighting has cost thousands of lives, there is 

a chance to end the Maoist insurgency and replace feudalism with democracy. Yet 

you propose to cut our assistance. 

The Democratic Republic of the Congo, a huge country with every imaginable 

problem, has emerged from conflict and completed its first election in 40 years. It 

holds the key to the future of central Africa, yet you propose to cut our assistance. 

Vietnam, a country of 80 million people, seeks closer ties with the United States, 

and there are so many opportunities for working together. Yet, with the exception 

of HIV/AIDS, you propose to cut our assistance. 

The Congress has worked hard to increase funding for global environment programs, particularly to protect biodiversity in the Amazon and central Africa where 

the forests are being destroyed. Yet you propose to slash funding for those programs. 

Last year, you testified before this subcommittee that, and I am quoting you, ‘‘our 

intent is not to have a USAID budget or a State Department budget, but a Foreign 

Assistance budget that will make all of it more coherent in a way that all of us can 

better understand.’’ 

I have mentioned just a few of many examples. I have to ask what is the purpose 

of this stated ‘‘coherence’’ if it produces illogical outcomes? What was the strategic 

thinking behind these decisions? How were the views of USAID program officers in 

the field and their implementing partners reflected? How were the Congress’ views 

reflected? 

We know you have to make hard choices. We all face budget constraints. But 

Pakistan, Afghanistan, Iraq, and Indonesia are not the only countries where the 

United States has important economic and security interests. You need to make 

sense of this for us if we are going to be able to work together. 

Senator LEAHY. I do want to begin by welcoming Senator Gregg, 

who is the new ranking member of this subcommittee. Senator 

Gregg and I share a border, a beautiful border along the Connecticut River. We’ve known each other for a long time and, of 

course, he had a distinguished career as Governor before, and I feel 

privileged that he’s here. 

As you know, Senator McConnell and I worked together for 

years—sometimes he’d be chairman, sometimes I’d be chairman, 

but I think the hallmark of this subcommittee during that time 

was that we would try to get the foreign aid bill passed in bipartisan fashion. As a result, we’ve been able to pass the bill in about 

a tenth the amount of the time that it used to take. Senator Gregg, 

would you like to say anything before we begin. 

Senator GREGG. Well, let me put my statement on the record and 

say how much I’m looking forward to working with you. 

We had a great relationship over the years on a lot of issues and 

it’s going to be—it’s an interesting committee with tremendously 

important jurisdiction, and I’m excited to have the chance to be the 

ranking member on it, and to follow in the footsteps of who we’ve 

mentioned. It’s such a such a great job and certainly a team effort 

here to try to make sure that our foreign accounts are strongly supported. 

[The statement follows:] 
3 

PREPARED STATEMENT OF SENATOR JUDD GREGG

Welcome, Ambassador Tobias. You have the distinction of being the first witness 

to appear before this subcommittee in the 110th Congress. 

We appreciate the opportunity to discuss the $3.8 billion, fiscal year 2008 budget 

request for the operations and activities of the United States Agency for International Development (USAID), and to learn more about your efforts to reform foreign assistance. Both are difficult and challenging tasks, and I know many of us are 

curious how you divide your time between your jobs of USAID Administrator and 

the Director of Foreign Assistance. 

When it comes to foreign aid reform, what is past is prologue. Beginning with the 

Foreign Assistance Act of 1961 (which provided USAID its mandate), numerous Administrations—Republican and Democrat—attempted to improve the efficiency and 

effectiveness of foreign assistance. Since 1961, the goals and objectives of U.S. aid 

have changed due to the shifting priorities of Administrations and Congresses which 

seek to keep apace with an ever-changing world. 

The Government Accountability Office notes in reports dating from the late 1970s 

that investments in large infrastructure projects overseas (intending, in part, to 

blunt the influence of the Soviet Union) were redirected by Congress to smaller programs targeting agriculture, nutrition, education, healthcare, and family planning 

for the poor. During the immediate post-Cold War period, U.S. aid supported emerging democracies throughout the former Soviet Union and significant emphasis was 

placed on activities targeted toward economic growth and development. 

Following the September 11, 2001 terrorist attacks, foreign assistance serves a renewed purpose to improve the lives and livelihoods of people who might be open to 

the hateful and violent ideology of extremists. I expect that everyone who sits on 

this Subcommittee would agree that foreign aid, if properly managed, can be an effective bulwark against terrorism. 

Afghanistan serves as example of the success that can be accomplished through 

the generosity of the American people. It is interesting to note that U.S. assistance 

supports large infrastructure projects throughout that country, smaller programs intending to improve the lives of the most destitute Afghans, and economic growth 

and development programs. We know from the pending supplemental request for Afghanistan that reconstruction is a long-term endeavor and that more needs to be 

done by all international donors. 

Your immediate challenge as Director of Foreign Assistance appears two-fold: 

first, to convince often entrenched bureaucracies that change is necessary, and second, to work hand-in-hand with Congress to enact proposed reforms, including the 

fiscal year 2008 budget request. I commend you on the improved Congressional 

Budget Justification materials, and I look forward to learning more about the process by which the fiscal year 2008 State and foreign operations budget request was 

crafted. 

Senator LEAHY. Thank you. Ambassador, would you—— 

Ambassador TOBIAS. Mr. Chairman, Thank you very much for 

the opportunity. I think that I will follow your example and ask 

that my opening statement be submitted for the record. 

[The statement follows:] 

PREPARED STATEMENT OF HON. RANDALL L. TOBIAS

Thank you, Mr. Chairman and Ranking Member Gregg, for the opportunity to testify before the subcommittee today on the fiscal year 2008 budget for foreign assistance. 

When I came before you last year, I outlined a series of challenges I sought to 

undertake as the first ever Director of U.S. Foreign Assistance. Now, after nearly 

a year in this role, I appreciate the opportunity to share with you what we have 

achieved, and what I hope we can achieve together through the fiscal year 2008 

budget process. 

RESPONSIVENESS TO THIS SUBCOMMITTEE

I want to begin by thanking this subcommittee for its work and for the support 

you provided before these reforms even got off the ground. Before discussing the 

budget, I would like to note our efforts to address your concerns raised in report 

language. Emphasized in fiscal year 2006 report language, and then re-emphasized 

in fiscal year 2007 report language, this subcommittee directed that Congressional 

Budget Justification materials improve in both the timing of their delivery and the 
4 

quality of information put forth. I am happy to say that this year, we delivered material to support the Congressional Budget Justification on February 14th, nearly 

a month before the March deadline put into report language. Further, we included 

standardized budget tables per country to allow the public to meaningfully compare 

request levels per country. In addition, we have addressed the coordination concerns 

between USAID and State programs raised in fiscal year 2007 report language by 

bringing State and USAID staff and senior managers to the same table to discuss 

budget priorities for fiscal year 2008. 

We have done far more than make process changes, however. With the new budget package comes a carefully considered set of budget priorities that, combined, will 

help advance our National Security Strategy. I realize that not all of the changes 

that we are proposing will sit entirely comfortably with each Member of this distinguished subcommittee. To the contrary, it is more likely that at least one of the 

changes we propose will raise concerns with you about our prioritization. I look forward to engaging with you to discuss your concerns. Part of my drive, to lay out 

the budget transparently in a way that can be compared across countries, is so that 

we can have a discussion, using common understandings and terminology, about 

just where our foreign assistance dollars are going and what we are trying to accomplish by allocating them as we have. 

We have taken big steps to increase transparency, accountability, and coherence 

of strategy in the allocation of our resources, including the creation of one office, 

under my direction, to oversee all USAID and State foreign assistance resources. I 

hope to make your oversight responsibility less burdensome by laying our principles 

and priorities clearly on the table, and providing tools by which we can consistently 

assess results. 

Specifically, we applied six principles to the allocation of the fiscal year 2008 

budget, in response to concerns raised by Congress and the President himself about 

the lack of coordination and coherence in our planning, allocation and monitoring 

of foreign assistance funds. I would like to take a moment to elaborate on them now. 

PRINCIPLES

The fiscal year 2008 State and USAID foreign assistance request is $20.3 billion, 

a $2.2 billion or 12 percent increase over fiscal year 2006 enacted levels, the last 

year for which we have completed allocations. Given current budget pressures and 

a shared commitment with Congress for deficit control, this increase reflects the importance this Administration places on foreign assistance, not just as a moral obligation to alleviate suffering, but as a foundation of our national security strategy. 

As a result of foreign assistance reform, this year’s request reflects a different approach to building the budget from previous years’ methods, and I would like to take 

a moment now to explain the six principles that governed our prioritization. 

First, we integrated planning based on the totality of U.S. Government resources 

and the commitment to a shared goal.—Consistent with your request that we improve coherence and coordination of State and USAID foreign assistance, for the 

first time in our Nation’s history, all $20.3 billion of U.S. foreign assistance under 

the authority of the Department of State and USAID, as well as resources provided 

by the Millennium Challenge Corporation, are being applied to the achievement of 

a single overarching goal—transformational diplomacy. In response to input received from many of you, our colleagues in the international development community, and our host government counterparts, that goal now reads: To help build and 

sustain democratic, well-governed states that respond to the needs of their people, 

reduce widespread poverty and conduct themselves responsibly in the international 

system. 

Over 100 interagency teams, organized by country, were tasked with ensuring 

that all State and USAID resources were coordinated for maximum efficiency and 

impact, and targeted to the achievement of shared objectives. Teams considered investments from the President’s Emergency Plan for AIDS Relief and the Millennium 

Challenge Account (MCC) when allocating resources. As a result, in countries that 

will receive MCC Compact funds in 2008, you will see funds allocated to programs 

that will support the success of these investments, such as an increase in trade and 

investment funds and private sector competitiveness in Honduras, and in Ghana, 

a shift in funding to enhance the capacity of local government, who will be responsible for implementing the MCC Compact’s programs. 

Second, we focused on country progress.—The ultimate goal of transformational diplomacy is to support recipient country efforts to move from a relationship defined 

by dependence on traditional foreign assistance to one defined by full sustaining 

partnership status. Now, I will spend a bit of time on this principle, because, while 
5 

it seems like this is what we have been doing all along, this year’s approach was 

quite different. 

In past budget years, funds were allocated first by account, then by sector, and 

lastly, by country. Much of the budget was built by determining so much for family 

planning, so much for basic education, so much for security assistance, and so on. 

Funding from within these sector levels was then parceled out to countries on the 

basis of multiple sector-based strategies—one for family planning, etc. You get the 

picture. 

It is not that these sectors are not critical to a country’s development strategy— 

clearly they are, and we continue to evaluate resources by sector, ensure appropriate targeting, and incorporate best practices. It’s a matter of what should drive 

the country’s development program—country-prioritized need or a set global amount 

for a sector. We must tailor programs to the unique needs of each recipient country 

in reaching the transformational diplomacy goal. 

This year, we led with country progress. We brought together teams of experts 

from USAID and State, in consultation with their field counterparts, and we gave 

them an overall planning number for each country—not by account, not by sector, 

just a total. 

We gave them data on the status of country progress against independent indicators assessing poverty, human capacity, life expectancy, governance, and barriers to 

economic growth. We gave them the new Strategic Framework for U.S. Foreign Assistance, which outlines interventions according to countries’ common country traits. 

We then asked them to allocate that budget to the areas that would best advance 

individual country progress, based on the opportunities and challenges that exist on 

the ground, and in turn, advance U.S. policy. The result is an fiscal year 2008 budget focused on country progress. 

Third, consistent with concerns raised by this subcommittee to align our foreign 

assistance resources with our National Security Strategy, we invested in states critical to long-term regional stability and prosperity.—As many of you are aware, the 

new Strategic Framework for Foreign Assistance categorizes each country receiving 

U.S. foreign assistance based on common traits and places them on a trajectory to 

measure their development progress against standardized indicators. The country 

categories are largely explained by their category name: Rebuilding, Developing, 

Transforming, Sustaining Partnership and Restrictive. 

In the fiscal year 2008 budget request, you will find that 51 percent of Department of State and USAID program assistance resources are concentrated in Rebuilding and Developing countries. These are the countries that are farthest away 

from sustaining partnership status, as measured by instability, poverty, human capacity, life expectancy, governance, and barriers to economic growth—all critical 

barriers to regional stability and success in the War on Terror. 

We have seen the risks that ‘‘ungoverned spaces’’ can pose to our national security 

and to their regional neighbors; we are also very aware of the costs of these 

‘‘ungoverned spaces’’ to their own citizens. States like Somalia, Afghanistan, Sudan, 

and the Democratic Republic of the Congo are among the poorest in the world. Their 

citizens are among the least able to access basic needs—including security. 

At the same time, to truly transform the development landscape, we need to focus 

on Developing States such as Nigeria, Ukraine, Georgia, Pakistan, Jordan, and Indonesia—states that are on the cusp of transitioning to economic, political and social 

self-sustenance, and that, with continuing progress, can serve as anchors for regional stability and prosperity. We need to work with them to help them strengthen 

their institutions to make their progress permanent. 

Fourth, we focused on demand-driven interventions that are critical levers for sustainable progress and transformation.—Foreign assistance in the past has run the 

risk of being a mile wide and an inch deep. With a thousand agendas embedded 

in our foreign assistance programs, our impact was diluted and diffuse. It is important to note, as I often do, that there is very little that we do in our development 

portfolio that is bad. Someone, some community, is benefiting from the services we 

are providing and the interventions we are supporting. 

But that is not the point. The real question is, are we achieving sustainable impact? Are we, in fact, enabling transformation? Are we giving people what they need 

to sustain further progress on their own? 

Based on the new country-driven process, we have prioritized resources to the 

areas that we believe will promote and sustain long-term country progress. Funding 

is increased to programs targeted to improving governance and democratic participation, programs mitigating diseases that threaten the human and economic capacity of countries to progress on their own, programs that expand access to and improve the quality of education, and programs that enhance economic opportunity 
6 

and the skills needed to participate in the global economy. These resource allocations reflect the wisdom of our interagency teams of country experts. 

I often think about our past practice of allocating funds as being similar to teaching an individual a little French, a little German, and a little Spanish. If we keep 

doing it, that person will very slowly be able to speak a little more French, a little 

more German, and a little more Spanish. But if we instead took the resources spent 

on each language and put them toward one language, that person would be able to 

communicate fluently, and would then be better able to learn the other languages 

on his or her own. 

Similarly, when we split up our resources into too many sectors in one country, 

progress will be slow and often imperceptible. If we instead focus our resources, we 

enhance the ability of countries to gain enough strength and stability in areas critical to sustaining further progress on their own. 

Focusing resources in this way has its tradeoffs. When one area goes up, unless 

there is an abundance of new resources, other areas go down. While the fiscal year 

2008 budget increased by $2.2 billion over fiscal year 2006 enacted levels, we 

squeezed far more in the budget. The budget includes important increases for HIV/ 

AIDS, malaria, and humanitarian assistance; and for countries in which there are 

new requirements and opportunities such as in Kosovo, Iran, and Cuba. The fiscal 

year 2008 budget also reflects efforts to continue to shift program funding, where 

requirements are predictable, from supplemental requests for Iraq, Afghanistan, 

Sudan and avian influenza into the base budget. 

Within the country-level requests, you will also find quite a bit of smaller, yet 

equally important, shifts. Country teams prioritized interventions that would help 

a country’s institutions to build the capacity to take on challenges in the longer 

term. So you will see increases in resources for conflict mitigation, justice systems, 

executive branch institution-building, anti-corruption, basic education, energy services, agriculture policy, workforce development, and clean environment. But with 

these increases, certain sectors were not prioritized by the country teams to the degree that they have been funded in the past. These areas include sectors that we 

realize are important to members of Congress, including family planning, maternal 

and child health, and biodiversity. We know that putting decreases forward in these 

areas requires a robust justification of our reasons, and I hope we will have a substantive dialogue about why our teams made the choices that they did. 

At the outset of the reform process, some members of this committee expressed 

concern that greater alignment between State and USAID foreign assistance resources would result in a short-shrifting of long-term development goals. I am 

pleased to note that in fact the opposite occurred. In fiscal year 2008, resources for 

the three objectives targeted to achieving long-term development progress—Governing Justly and Democratically, Investing in People, and Economic Growth—increase by 19 percent over fiscal year 2006 levels for these Objectives. The fiscal year 

2008 request includes the largest request this Administration has ever made for 

basic education, and when projected fiscal year 2008 MCC disbursements are considered, investments in these objectives increased by 29 percent over fiscal year 

2006. 

Fifth, we allocated funds intended for country programs to country-level budgets.— 

In the past, ambassadors and mission directors often did not have a full picture of 

the resources being implemented in their countries, because some activities were 

planned and implemented from Washington. Consequently, they did not exercise full 

oversight over these programs, and doing so from Washington was costly and timeconsuming. 

To empower our mission directors, ambassadors, and country teams, who are our 

people in the field with the best knowledge of country circumstances, the reform 

process maximized resources implemented at the country level into country-level 

budgets. Resources within global or regional budgets that had been planned for specific countries were accordingly shifted to those countries’ budgets and planned together with other country-based support. As a result, such resources can be implemented consistent with country strategies and benefiting from expertise on the 

ground. 

Recognizing that not all foreign assistance is most effectively implemented on a 

country basis, and that issues that transcend a single country’s borders are best addressed as part of a global or regional strategy, activities such as support to regional 

institutions, multilateral organizations, or cross-cutting research remain funded 

within global and regional budgets. Humanitarian assistance, which is allocated on 

the basis of emerging crises, also remains funded within global budgets. 

Finally, we matched accounts with country circumstances and the priorities the 

county categories are designed to address.—Many of you may be used to hearing 
7 

about the budget less in terms of countries and more in terms of accounts. There 

is a specific reason I have not mentioned accounts until now. 

Account levels did not drive our allocation process. Country progress did. After the 

country teams submitted their allocations by program, we centrally aggregated 

them to their appropriate accounts. In doing so, we sought to maximize the use of 

account authorities and establish clear priorities in support of effective implementation of foreign assistance programs. 

This means that, overall, funding for the Development Assistance account (DA), 

which has traditionally supported assistance in poor countries that demonstrate performance or a commitment to development, has been prioritized to Developing and 

Transforming countries. The Economic Support Fund (ESF), which focuses primarily 

on providing economic support under special economic, political, or security conditions, has been prioritized to support activities in the Rebuilding and Restrictive 

Country Categories. 

However, activities to support the poor and invest in development have not 

changed. For the three objectives supporting long-term development: Governing 

Justly and Democratically, Investing in People, and Economic Growth, DA and ESF 

totaled $3.7 billion in fiscal year 2006. For fiscal year 2008, DA and ESF in these 

objectives total $3.8 billion. 

The real change is within Restrictive and Rebuilding countries: Total funding in 

the three objectives supporting long-term development increased by 63 percent over 

fiscal year 2006 levels. However, the balance between DA and ESF changed, with 

DA declining from $331 million in fiscal year 2006 to $42 million in fiscal year 2008; 

and ESF increasing from $525 million in fiscal year 2006 to $1.4 billion in fiscal 

year 2008. 

Now I realize that this may have many of you worried that this DA decrease and 

ESF increase means that foreign assistance will now be used increasingly for political ends and that poor people will suffer. I know there is often a skepticism between our two branches when one side or the other presents a series of numbers, 

so let me address any doubts by citing a group many consider an ‘‘Honest broker’’— 

the Global Leadership Campaign. In their February 26, 2007, analysis, they point 

out, ‘‘Overall ‘development-type’ activities do not decline in fiscal year 2008 due to 

the shift between DA and ESF, and in fact, increase in the aggregate.’’ 

Let me assure you of this point. Our intent in shifting funds from DA to ESF is 

to draw cleaner lines around their use, as identified by country characteristics. Period. These cleaner lines allow us to justify to you why we have requested amounts 

for each account. There is no intent to take the ‘‘development’’ out of any of our development resources. 

REGIONAL FUNDING TRENDS

Consistent with the principles mentioned above, I would like to review briefly the 

regional funding trends you will see in the fiscal year 2008 budget. 

Africa.—When projected MCC disbursements are included, the fiscal year 2008 request for Africa represents a 54 percent increase over fiscal year 2006. Including 

actual disbursements and projected fiscal year 2008 disbursements from the MCC, 

resources for Africa have nearly quadrupled from 2001–2008. Over 75 percent of the 

fiscal year 2008 budget will focus on Investing in People in order to address the 

crippling effects of disease and poverty, a $2 billion increase from fiscal year 2006. 

These increases are largely due to HIV/AIDS resources, but not entirely. When HIV/ 

AIDS, MCC and the emergency-oriented accounts of Public Law 480 Title II food 

aid, Migration and Refugee Assistance, and International Disaster and Famine Assistance are excluded in both fiscal year 2006 and fiscal year 2008 (as allocation of 

emergency funds is often unknown until the end of a fiscal year), there is actually 

a 15 percent increase in resources to Africa. 

East Asia and the Pacific.—With projected fiscal year 2008 MCC disbursements 

included, proposed fiscal year 2008 funding for the region increases by 15 percent 

over fiscal year 2006. Democratic challenges and terrorist threats require that peace 

and security programs emphasize counterterrorism and conflict mitigation while 

also maintaining military assistance for key War on Terror partners. Resources for 

these types of key security programs make up 18 percent of the request for the region. Countries such as Indonesia, the Philippines, and Mongolia collectively receive 

53 percent of the region’s request. 

Near East.—The fiscal year 2008 request for the Near East represents a 4 percent 

increase over fiscal year 2006, including reduced levels for Egypt and Israel under 

glidepath agreements. The fiscal year 2008 request emphasizes continued investments in Peace and Security and political reform. Accordingly, funding for Peace 

and Security increase by 4 percent, while investments in Governing Justly and 
8 

Democratically increase by more than 80 percent. The fiscal year 2008 request is 

concentrated in Iraq, Israel, Egypt and Jordan, representing 93 percent of the region’s budget. 

South and Central Asia.—Funding to South and Central Asia increased by 6 percent in the fiscal year 2008 request compared to fiscal year 2006 levels for the region. Funding will continue to support the Global War on Terror through security, 

reconstruction, development and democracy efforts, particularly in Afghanistan and 

Pakistan, which represent 84 percent of the region’s request. Success in these countries is critical to achieving peace, stability, and development progress throughout 

South and Central Asia. Funding for the five Central Asian countries declined by 

nearly 24 percent from fiscal year 2006 to fiscal year 2008. Much of the decline 

comes in Uzbekistan, where the government has worked actively to limit U.S. assistance related to reform, and in Kazakhstan, whose oil wealth lessens the need 

for our assistance. 

Western Hemisphere.—Foreign assistance for Latin America has risen dramatically since the start of the Administration, rising from $862 million in fiscal year 

2001 to a requested $1.4 billion in fiscal year 2008 for State and USAID Administered programs. If the fiscal year 2008 request is fully funded and MCC fiscal year 

2008 disbursements are taken into account, resources to the Western Hemisphere 

will have doubled under this Administration, from $862 million in fiscal year 2001 

to $1.66 billion in fiscal year 2008—a 4 percent increase over fiscal year 2006. 

The focus of resources within the region has also changed. The Western Hemisphere, in general, has made significant progress over the last decade, although 

major challenges remain. Funds have therefore shifted from service-delivery in 

health and basic education, where the region has made progress relative to other 

regions, to economic growth and activities to help consolidate democratic gains. Our 

programs are targeted to improve government capacity and provide access to economic opportunity to all citizens, especially the poor and marginalized, by catalyzing 

private sector investments, reducing the cost of doing business, and expanding access to microcredit. With MCC disbursements considered, economic growth resources are up 80 percent in fiscal year 2008. Resources to improve government capacity and strengthen democratic institutions are up 5 percent. 

I am aware of recent briefings where concern has been expressed about declining 

funding for our neighbors. In fact, my very first trip since submitting the fiscal year 

2008 budget was to Bolivia, Ecuador, and Peru, three countries that have sustained 

decreases in the fiscal year 2008 budget. In each of these countries, the positive impact of our past investments was clear, and our ability to build on them with innovative programming and partnerships was also evident. 

Europe and Eurasia.—This region represents another success story in development. The fiscal year 2008 request for Europe and Eurasia represents a 26 percent 

decrease from fiscal year 2006, reflecting success achieved in the region. When projected fiscal year 2008 MCC disbursements in Georgia and Armenia are included, 

the reduction is 13 percent from fiscal year 2006. While United States assistance 

has played a substantial role in supporting further integration of countries in Eastern Europe and the Western Balkans into Euro-Atlantic institutions, a number of 

difficult challenges remain across the range of foreign assistance objectives. Funds 

for Kosovo and Serbia represent 27 percent of the region’s request. Countries at the 

forefront of reform—Ukraine, Georgia, and Moldova—and countries that present 

democratic challenges—Russia and Belarus—together represent 30 percent of the 

region’s budget. 

CONCLUSION

For too long, the debate between Congress and the Administration regarding foreign assistance has lacked focus. Very much like a ship with too many calibrations, 

the foreign assistance boat would move in one direction for a while, then shift directions with a new Administration or a new Congress, oftentimes back-tracking over 

the same course it had traveled just a few years ago. As a consequence, many recipient countries have not been given the tools they need for a long enough period of 

time to help their countries sustain progress. Globally, progress has been slow and 

often imperceptible. 

The fiscal year 2008 Foreign Operations budget, built on the basis of the principles and methodologies described above, reflects country-based strategies for 

progress, evaluated within the context of regional challenges and opportunities, and 

responsive to a shared goal and objectives targeted to achieve that goal. And since 

budget planning was thoroughly integrated, the fiscal year 2008 budget, like a 

Rubic’s Cube, relies on each individual piece to maintain the integrity of the whole. 
9 

In addition to developing the new Strategic Framework for Foreign Assistance, we 

have developed a standardized set of definitions, or a ‘‘Development Dictionary,’’ if 

you will, of the programs that relate to our five priority objectives, and ultimately 

to the transformational diplomacy goal. The Development Dictionary describes what 

we mean, across all programs and sources of funding, when we describe a program 

as ‘‘justice system reform’’ or ‘‘conflict mitigation.’’ We published this reference on 

line and have invited comments from your staffs and the NGO community. Every 

dollar of the fiscal year 2008 budget is identified against these common definitions, 

making comparisons across fiscal years, countries, programs, and regions transparent and easy. 

We have developed common indicators for each of the programs defined in the development dictionary, such that we will be able to compare partner, program, and 

country performance across agencies and sources of funding. We developed these indicators with input from the NGO community and have posted them on line, together with an email address to collect comments. 

We have wrapped the money, definitions, and indicators into one system that will 

be able to tell you who is getting the money, what they are spending it on, and what 

results we expect to be achieved. This information will come together in an annual 

Operational Plan submitted to Washington for each country where foreign assistance funds are provided. For the first time, starting with fiscal year 2007 funds, we 

will be able to tell you what a $1 million change from X activity to Y activity will 

mean for a program so that you can better determine whether such a change, and 

its opportunity cost, best reflects the impact you want to have. 

In making these changes, we sought explicitly to be responsive to concerns raised 

by Congress about the transparency of our decisionmaking, the coherence of our resources, and our ability to account for results. My hope is that the first steps taken 

over the past nine months will support a robust dialogue between the legislative 

and executive branches about funding priorities. Because with this new transparency of information comes a new responsibility on both of our parts to raise concerns where we feel our differing priorities will have a detrimental impact on transformational diplomacy progress. I look forward to hearing your input regarding the 

prioritization of resources that we have laid on the table. 

Far more than just moving the deck chairs, the reform reflected in the fiscal year 

2008 budget represents the re-calibration of the ship. But only when we discuss our 

differing priorities, in the spirit intended by the balance of powers between the executive and legislative branches, will the ship find its most appropriate and progressive course. We need to develop common priorities for the ship’s movement to sustain permanent progress. 

I look forward to engaging and working with you over the coming months to develop our common path and urge you to fund the full fiscal year 2008 request. 

Thank you. 

TRANSFORMATIONAL DIPLOMACY

Senator LEAHY. Well, thank you and it will be. You say in your 

statement that for the first time in the Nation’s history all of our 

foreign assistance resources are being applied to the achievement 

of the single over-arching goal, transformational diplomacy, and 

how democratic, well-governed states respond to the needs of their 

people, reduce wide-spread poverty, and conduct themselves responsibly in the international system. I think that is a fair summary of what you said, and I support that. We all do. 

But isn’t that what we’ve been trying to do ever since World War 

II? 

Ambassador TOBIAS. Well, yes, I think we have. I think the question is: Have we been as effective in doing it as we might be and 

what can we do as we go forward to do a better job of it? 

Senator LEAHY. I think what I mean is we do a lot of things. We 

train teachers, we strengthen healthcare systems, we reform judicial systems which is extremely important to build trade capacity. 

So may I ask you this: What have we been doing that we’re not 

going to do and what are we going to do that we haven’t been 

doing? 
10 

Ambassador TOBIAS. Senator, I think that it begins with all of 

us, those in the Congress and those in the administration, as well 

as people in the NGO community and others that have an important interest in all of this coming to a common conclusion around 

what is it we’re really trying to get done here, and what is the best 

way to get it done. So the administration has laid out this framework as a point of at least starting the discussion, with the idea 

being that in some instances I think our activities, well intended 

as they have been, have been more successful in building dependency than they have been in building a sustainable set of programs 

to allow countries to progress on a trajectory and eventually graduate from the need to be dependent on foreign assistance. 

I think that our foreign assistance has sometimes had a thousand objectives. We’ve been a mile wide and an inch deep, and we 

haven’t been clear and crisp—— 

FOREIGN ASSISTANCE BUDGET

Senator LEAHY. But I can think of some of the times when we 

supported some of the worst heads of state because they said they 

were anti-communist. 

Then after the breakup of the Soviet Union it was Mr. Putin’s 

method of governing. I’m not sure what the major changes are 

sometimes but after that, we said we would support anybody who 

said they were anti-drugs, because that became the mantra, and in 

a number of instances we closed our eyes to severe problems in 

countries that we were supporting because of that. 

Now if they say they are anti-terrorist, even some countries that 

have harbored terrorists, well, then we support them. 

These mistakes have been made by both democratic and republican administrations. 

You testified that contrary to concerns expressed by some Members of Congress in fiscal year 2008, resources for the objectives 

targeted to achieving long-term development, governing justly and 

democratically and investing in people increased by 19 percent over 

fiscal year 2006 levels. 

But if you take the Millenium Challenge Corporation and HIV/ 

AIDS out of the equation, then how do fiscal year 2006 and fiscal 

year 2008 compare? 

Ambassador TOBIAS. Well, first of all, I’m not a fan of taking 

HIV/AIDS and the Millennium Challenge Corporation out of the 

equation. 

Senator LEAHY. Well, the reason I ask that is because the Millennium Challenge Corporation has a huge amount in the pipeline but 

hasn’t spent much at all, so that’s why I asked the question. 

Ambassador TOBIAS. Well, the way we have done the calculation 

is to work with the Millennium Challenge Corporation to determine 

what they believe their actual outlay will be during the year 2008 

in each of the countries where they have a compact. We have assessed what we believe our foreign assistance will be on a countryby-country basis—not on the size of the compact but on what will 

actually happen in 2008. 

But in many countries in Africa, for example, if you look at an 

education program in a country where 20 percent of the teachers 

are dying every year, it becomes pretty clear that the AIDS initia-
11 

tive is dealing with more than just AIDS; it’s dealing with the fundamental fabric of the country, so I really do think it’s appropriate 

to count all of it. 

Senator LEAHY. Let’s talk about that. For example, in Nigeria, 

you said you want to help them strengthen their institutions and 

make progress permanent. But if you take out the AIDS money— 

and I’m not suggesting we do—I’ve been a strong supporter, as you 

know, of adding money for HIV/AIDS long before it became popular. But if you take out AIDS you only propose an additional $20 

million for Nigeria, a country of 125 million people. You cut aid to 

the Ukraine by $16 million, I believe. Georgia by $21 million. How 

does this show us strengthening their institutions? You see what 

I’m getting at? 

Ambassador TOBIAS. Of course I do. 

Senator LEAHY. We’re going to put the money in for HIV/AIDS. 

I’ve worked closely with the President and others on that. Even 

when he hasn’t had it in the budget we’ve put it in, but how do 

we strengthen democracy with only $20 million for Nigeria? 

Ambassador TOBIAS. Well, we’re proposing to spend a significant 

amount of money on democracy programs because they’re so incredibly important. Indeed, in a number of countries, unless we have 

rule of law and solid democracy programs, it’s not likely that other 

things are really going to work in a sustainable way. 

But in all cases, we have put the budgets together on a countryby-country basis using people with expertise both here in Washington and in the field assessing the resources that we felt we 

could make available, and making a determination based on what 

the most compelling issues are in that country as to where can we 

spend the money and make the greatest difference in moving that 

country forward. 

Senator LEAHY. Sure, but in Nigeria that’s about 20 cents a person, and I’m not sure you’re going to build an awful lot of democracy or better court systems in that way. I know we have a huge 

amount of money going to Pakistan and Afghanistan and Iraq. We 

have a huge amount of money that goes to Israel and Egypt, and 

a lot goes to Colombia even though it hasn’t stopped drugs coming 

into this country. 

I worry about the areas where—I think you’d agree with me— 

there are going to be problems if the United States does not get involved. My time is up, and I yield to Senator Gregg. 

FORMER SOVIET REPUBLICS

Senator GREGG. Thank you, and picking up on that note I recognize that you’ve got to cover the whole globe and you have to— 

therefore you end up not putting a lot of money except into a few 

nations that have high-visibility issues, such as Iraq, Afghanistan, 

Egypt, and Israel. 

But accepting that as the context, why is the budget deduce the 

funding for the former Soviet Republics that are, basically it seems, 

some of the most fertile ground in the world for developing democracies, and the rule of law in countries that would be natural allies, 

especially since many of them are on the rim of the Middle East 

and represent marginally Islamic countries that could be friendly. 
12 

Ambassador TOBIAS. Are you talking about Russia or are you 

talking about—— 

Senator GREGG. The former Republics. 

Ambassador TOBIAS. The former Republics. Well, again, we’ve 

tried to prioritize within each region the countries in that region 

that our people with expertise have felt were the greatest priorities, and then within each country we’ve tried to prioritize those 

particular areas where people have felt we could make the most 

difference. I’d have to go through on a country-by-country basis, 

which I’d be happy to do, but at the end of the day it’s—— 

Senator GREGG. Let’s do that, because your funding to the 

Former Soviet Republics which are now independent has been cut. 

Ambassador TOBIAS. Senator, I’m sorry. I’m having a little trouble hearing you. 

Senator GREGG. The funding to the Former Soviet Republics has 

been cut in this budget; I’m wondering why. So let’s go through 

each one. Let’s start with Georgia. Why did you cut funds to Georgia? 

Ambassador TOBIAS. Do you want me to find the list now? 

Senator GREGG. No. I want you to answer the question: Why did 

you cut funds to Georgia? 

Ambassador TOBIAS. Well, funds were reduced in the sense of 

looking at the resources that were available, and the people with 

the expertise on the region and on the countries in the region making the choices that with scarce resources, we would put the money 

in the places that—— 

Senator GREGG. Because there was obviously a tactical decision 

made, or a strategic decision made, that you would focus dollars on 

other accounts at a more significant level and reduce dollars to 

what are now Republics that used to be Soviet client states. I guess 

the bottom-line question is: Why was that decision made? Clearly 

there was a decision made to do that. 

Ambassador TOBIAS. Well, again, I don’t know how to answer it 

other than to say that it was a matter of—— 

Senator GREGG. Give me some specifics as to what made 

that—— 

Ambassador TOBIAS. There was no systematic intent to reduce 

levels in the former Soviet Republics. We considered each country 

program on an individual basis and in the broader context of competing needs around the globe. The request for the region overall 

reflects successes in promoting reform and creating legacy institutions, as well as increases for some countries with pressing needs 

or significant opportunities. As a result, you will see funding increases for Turkmenistan, for example, in response to opportunities 

presented by the transition of power in the presidency, and for 

Tajikistan (excluding emergency food aid) to respond to the urgent 

need to secure its border with Afghanistan and promote reform. 

Funding has decreased in Uzbekistan, where the government has 

worked to actively limit United States assistance related to reform 

and in Kazakhstan, whose oil wealth lessens the need for our assistance. In Georgia and the Ukraine, we see increasing capacity 

and contributions from host governments, thereby justifying lower 

assistance levels. 
13 

Senator GREGG. Well, I honestly can’t believe that as head of the 

foreign assistance and head of USAID, you can’t give me something—a specific rational for why we are—we have decided to turn 

away from those nations and move the dollars to other nations. 

Other nations seem to be such fertile ground for our capacity to develop stable nations and nations which have democracy, which 

have rule of law, and which are potentially significant allies in the 

war against fundamentalism. 

Ambassador TOBIAS. Well, it certainly isn’t that we’ve decided to 

turn away from them; it’s simply been a matter of taking the resources that are available and trying to make a determination 

about what is the best way to use those resources. But I will be 

very happy to respond on a specific basis on what the rationale was 

in each case. 

USAID ADMINISTRATOR AND DIRECTOR OF FOREIGN ASSISTANCE

Senator GREGG. Well, it doesn’t make sense to me that there was 

a rationale in each case, because it had to be a philosophical decision because it’s so apparent that you have moved away from this 

region of the world and moved money into another region of the 

world, specifically Africa, it looks like. It was a regional decision; 

it wasn’t country-by-country, I don’t think, but certainly the dollars 

have been flying out. How do you divide your time between being 

head of foreign assistance and USAID? 

Ambassador TOBIAS. In a typical day, Senator, I start my day, 

when I’m in Washington, in the State Department and spend the 

morning, usually, in the State Department. Then at about lunchtime I go over to USAID and we set up the schedule for meetings 

and things over there for the afternoon. 

Some days I’m over there longer; some days I’m in the State Department longer, depending on what’s going on on that particular 

day, but that’s my basic plan. 

Senator GREGG. How does that work? I mean, that seems inherently disjointed. 

Ambassador TOBIAS. Well, I think it’s working well. I think it 

will work even better a year from now, because when my predecessor was the head of USAID and there were two separate foreign 

assistance budgets, one for USAID and one for State Department 

foreign assistance, you’d have programs coming from different directions in a country. There was an enormous amount of coordination that needed to take place, and the Administrator of USAID 

spent an awful lot of time talking to a variety of people in the State 

Department in an effort to coordinate. 

I’m now talking to myself for those kinds of things, and I think 

the coordination is much easier and much better, so I think it’s 

been a significant improvement. 

Senator GREGG. Should there even be more integration then? 

Should, I mean, the physical location of the two organizations be 

merged? 

Ambassador TOBIAS. Well, I would not favor that. I think that we 

need a strong USAID, we need a strong organization of professionals who are focused on foreign assistance who have chosen to 

focus their careers in that way, and I’m very, very proud of the peo-
14 

ple in the organization, for their dedication, their knowledge, and 

their hard work. 

At the same time, I think that we need to ensure that we have 

USAID strategically lined up with what the United States Foreign 

Policy interests are in the countries where we are working. 

I think on the ground, on a country-by-country basis, historically 

and currently, I think it’s probably worked better than it has here 

in Washington, where the U.S. Ambassador is leading the U.S. 

Government team on the ground. The USAID Mission Director reports, in part to the Ambassador, and in part back here to USAID, 

but is the principal professional development person on the Ambassador’s team, and the integration of what the U.S. Government is 

doing on the ground, you know, begins there. 

But in the planning process, and the coordination process, and 

the technical expertise and so forth that takes place in Washington, 

it’s been more fragmented than it needs to be. But I don’t think the 

solution would be to totally merge the two organizations. 

Senator GREGG. Thank you. 

STATEMENT OF SENATOR CHRISTOPHER S. BOND

Senator BOND. Thank you very much, Mr. Chairman, and I 

would say to you and ranking member Gregg that even though I 

spend a very large part of my time working on military defense 

matters and intelligence matters, I believe this committee is extremely important because the old saw that in a battle against ideology, it’s 20 percent kinetic and 80 percent economic development, 

ideological, and this committee, I believe, has a much more important role than we have been able to recognize in the budget to 

achieve our goal through diplomacy and economic development. So 

I think this is extremely important, and I am very much concerned 

about some of the things that are going on, Mr. Ambassador. Excuse me. You wanted to say? 

Senator LEAHY. I was just going to say I appreciate that. I, having served on the intelligence committee here, was the vice chairman of it, and you see a global view that the rest of us do not see, 

and I appreciate that very much. 

AGRICULTURE DEVELOPMENT IN AFGHANISTAN

Senator BOND. Well, thank you. I think our members of the intelligence committee would agree. But Mr. Ambassador, I have some 

real concerns about some of the specifics I’ve learned. 

A little over a year ago I was in Afghanistan. This year, Senators 

Mikulski, Hutchison, Brownback, Cornyn, and I are again requesting $20 million be made out of USAID’s 2008 foreign operations bill 

for the establishment of a U.S. land grant consortium to be led by 

Texas A&M to implement widespread training activities, to assist 

farmers to comprehensive level not being achieved, to teach them 

how to use best techniques to grow pomegranates and other alternative crops and set up independent credit cooperatives. 

Last year USAID totally ignored the congressional intent when 

we put in $5 million and the money was dribbled out to individual 

initiatives—underway with individual colleges. The intent of that 

money was, and still is, to strengthen a nationwide agricultural extension system through programs planned and delivered by people 
15 

who have been working over 100 years to help farmers in the 

United States. 

I remain concerned about what appears to be a deeply entrenched relationship between Kimonics and USAID and Kabul 

and DC. It’s making it very difficult if not impossible for other 

proven contractors and even other NGOs from getting funds. 

I’ve spoken with a number of people inside and outside of Afghanistan who are trying to do some good and are extremely frustrated when they run into the monopoly between USAID, 

Kimonics, and other large USAID contractors. Some of those people, I will tell you, include our military commander in Afghanistan, 

a top expert from USDA Department of Agriculture who was there, 

and President Hamin Karzaj who told me that he wanted to have 

this assistance. 

I understand over the last 4 years USAID have gone through 

some $600 million on agricultural development in Afghanistan and 

had shown darn little for it. 

Now, I know it’s easier to shovel out a couple of hundred million 

dollars to a big contractor, but when it’s not getting the job done, 

what I want to know is: Why will you not take the time and make 

the effort to utilize resources where we can get volunteers from extension services, men and women who have been trained for years 

to help farmers, why you are not willing to accept this idea for Afghanistan? 

Ambassador TOBIAS. Senator, I’m a big supporter of the contributions that the land grant universities make. I just came back from 

Lebanon a few weeks ago where I saw a program where dairy 

farmers who had been selling their products on the side of the road 

2 or 3 years ago, are now competing in global markets because of 

a USAID project that created a cooperative, and the expertise that 

has come from land grant universities in this country to help them 

have the skills they need to provide high-quality products. 

I’ll take a fresh look at what we’re doing in Afghanistan and see 

who all is involved, and whether or not there’s more we can do, because—— 

FINANCIAL SERVICES VOLUNTEERS

Senator BOND. I want a response for the record. I know in—I 

was in India about a year ago, and the President’s agricultural 

knowledge initiative envisioned you using land grant colleges. 

What I want to know is why the hell we can’t get you to follow congressional intent to start out on a small program in Afghanistan 

and save a whole bunch of money that nobody seems to know what 

good it has produced. 

I think this is—it’s unbelievable that the amount of money that’s 

been spent, and the apparent lack of any demonstrable progress. 

I think you can do a very good job if you’ll work with volunteer organizations. 

By the way, that brings to mind, I had a visit recently from some 

of the outstanding leaders who had the Financial Services Volunteer Corp. These are experts in financial systems, banking from— 

some volunteers from our largest banks, from accounting institutions. They have worked in countries to—they developed the cur-
16 

rency for Afghanistan. They were working in Indonesia to help 

them develop a system for countering money laundering. 

They have—they bring on a volunteer basis, with just support 

services needed, the expertise of our top financial professionals in 

the United States, the countries who need that help. They tell me 

that they are not getting funding anymore from USAID, and I 

would like to know why a dedicated group of professionals who are 

doing a highly sophisticated job for countries that need it, are being 

shut out. Do you know what the reason is? 

Ambassador TOBIAS. No, I don’t, Senator, but I’ll take a good look 

at that. I’m familiar with the organization, but—— 

Senator BOND. I mean, they had John Whitehead, they’ve had 

other top professionals, and I’m just dumbfounded that you 

wouldn’t be looking, looking for pools of volunteers that could help 

like that. Thank you, Mr. Ambassador. Thank you, Mr. Chairman. 

FOREIGN ASSISTANCE BUDGET CUTS

Senator LEAHY. Thank you very much. I have some of these same 

concerns about grants going just to a small handful of contractors, 

big contractors who also have lobbyists here in Washington, and 

then it closes out others who often have very innovative and very 

good ideas. 

Now, the changes you’ve made to the budget process may be 

more coherent and transparent, but I’m mystified by some of the 

results. Take a country like Colombia that has received roughly a 

half a billion dollars, $565 million, in each of the past 5 years. They 

get the same amount this coming year, although we know a number of things that have not worked. We know conditions in Colombia have changed. 

We know that the idea of stopping cocaine from coming into 

America has been basically a failure. The price of cocaine and 

availability is the same today as it was before we took billions of 

dollars out of programs that might’ve stopped people from using cocaine, put it into Colombia to stop it from coming in here. 

In Nepal, a country where years of fighting has cost thousands 

of lives, there’s a chance to end the Maoist insurgency and bring 

democracy to replace a feudalist system, but you propose to cut our 

assistance. 

Democratic Republic of the Congo, a huge country. I can’t think 

of many places that have more problems, but they had their first 

election in 40 years. It holds the key, I think, in many ways to the 

future of all of central Africa, and is very important to us. You 

want to cut our assistance. 

Certainly other countries, like China and others, seem to be 

ahead of us in realizing its importance but you propose to cut our 

assistance there. 

Vietnam, a country of 80 million people that is trying to build 

closer ties with the United States and the President actually went 

there last fall. With the exception of HIV and AIDS, you’re going 

to cut our assistance there. 

Congress has tried to increase funding for global environment 

programs which have bipartisan support, particularly biodiversity 

in the Amazon. Central Africa where forests are being destroyed at 

breakneck speed. I mean, in 5 year’s time what may have taken 
17 

400 or 500 years before, you’re slashing funding for those programs. 

Last year you said our intent is not to have a USAID budget or 

State Department budget, but a foreign assistance budget that 

would make all of it more coherent in a way that all of us could 

better understand. 

I’m all for that, but what good is coherence if it produces illogical 

outcomes? I mean, what do people say in the field? It certainly 

doesn’t reflect what a lot in Congress and both parties have been 

saying. What is the thinking behind these outcomes? 

Ambassador TOBIAS. Senator, you are making very eloquently 

the point that I would hope to make this morning, and that is that 

I’m very, very hopeful that this year the Congress will not cut the 

administration’s fiscal year 2008 request for foreign assistance, because we need every penny. If I take the $20.3—— 

Senator LEAHY. If I might, and I apologize for interrupting, but 

you know, we need every penny, but I want to know where it’s 

spent. 

I’ve had times up here when we’ve had grandiose proposals for 

budgets in various administrations knowing that there’s no money 

for the things that many people feel we should have and somehow 

we have to find the money. At Millennium Challenge there’s huge 

amounts of money in the pipeline. I think you have to admit that 

started off with a very, very slow start. 

Ambassador TOBIAS. Well, if I take the $20.3 billion in the request for foreign assistance, and if I back out of that the Global 

AIDS Initiative, and if I back out of that the approximate $1.8 billion in funding request for those contingency accounts that will be 

allocated as we go through the year, like emergency food aid, and 

refugee assistance, and that kind of thing, and then if I take the 

31 largest country programs, which I think tend to be less controversial, and represent those programs at $50 million or higher, 

I’m left, out of that $20.3 billion, with $3.6 billion to spread over 

the 124 remaining country programs. 

So we have made some very, very difficult decisions in allocating 

this budget. We have tried to do it in a far more transparent way 

than it has ever been done historically, with a level of detail that 

neither the Congress, nor the administration has had access to in 

the past, so that as we continue our dialog we can determine why 

the decisions were made in putting this budget together, and understand where we did not get it right. What are the things that 

we may need to think about in different ways? 

But this has been a very conscious good-faith effort to try to be 

sure that each country’s program is driven by what people on the 

ground in that country and here in Washington believe, given the 

resources available, can make the most difference in moving that 

country on a path toward independence. 

Senator LEAHY. Well, what are the five countries that get the 

most money? 

Ambassador TOBIAS. Let’s see. They are Israel, Egypt, Afghanistan, Pakistan, and Sudan. 

Senator LEAHY. Sudan gets more money than Iraq? Or are we 

talking about—— 
18 

Ambassador TOBIAS. Israel, Egypt, Afghanistan, Pakistan, 

Sudan, South Africa, Colombia, Kenya, Nigeria, Jordan, Ethiopia, 

and Iraq. I’m talking there about the 2008 budget request. 

Senator LEAHY. Well, maybe we have different ways to count 

how much goes into Iraq. I noticed recently the President cut funds 

for the cops program but we’re adding increased money for police 

forces in Iraq. I heard in the paper today that we’ve trained them 

so well they went in and killed 40 people as revenge killings, the 

police did, today in Iraq. 

Anyway, my time’s up. Let me yield to Senator Gregg. We’re all 

trying to do the same thing. I’m just worried that we spend an 

awful lot of money in places where we aren’t getting much out of 

it, and there’s been too little in places where we have a great potential. 

Ambassador TOBIAS. Well, Senator, I share that concern and 

that’s why we are trying, on the one hand, to make the most conscientious effort we can to be sure that we are spending the money 

in the most appropriate, effective way we can, and to lay out the 

data as transparently as possible so that we will all know how 

those decisions are made, and I think it will be easier for us to collaborate going forward as to what we ought to be doing. 

ASSISTANCE FOR THE MIDDLE EAST

Senator GREGG. Can you read those five countries again? Egypt, 

Israel—the five countries that have the highest? Egypt, Israel—— 

Ambassador TOBIAS. Israel, Egypt, Afghanistan, Pakistan, and 

Sudan. 

Senator GREGG. How much money have we given to Egypt over 

the last 20 years? 

Ambassador TOBIAS. The 2008 request is $1.720 billion. 

Senator GREGG. What’s the total we’ve given to Egypt and Israel 

in the last 20 years? 

Ambassador TOBIAS. U.S. assistance to Egypt and Israel has 

been governed by similar ‘‘glidepath’’ agreements since 1998. The 

agreement between the U.S. Government and the Government of 

Egypt established steady Foreign Military Finance (FMF) assistance at roughly $1.3 billion per year. In contrast, Economic Support Fund (ESF) assistance has declined $40 million per year from 

a starting level of $815 million in 1998. 

In the 10 years prior to the signing of the glidepath agreement 

(1988–1998), the United States obligated approximately $24 billion 

of economic and military assistance to Egypt. We have provided approximately $19 billion to Egypt since the signing of the glidepath 

agreement in 1998. This total includes fiscal year 1999 levels 

through the fiscal year 2008 request, if fully funded. The share of 

Peace and Security assistance as a share of total assistance has increased from approximately 61 percent in 1998 to 73 percent in 

2007. Peace and Security assistance funds primarily Egyptian purchase of U.S. military equipment to shift Egyptian orientation to 

the United States and to increase our interoperability. 

The agreement expires in 2008, and we are currently working 

with both Israel and Egypt on what the future may hold with regard to foreign assistance levels. 
19 

Senator GREGG. So there’s a lot of money going to the same 

places over and over again. 

Ambassador TOBIAS. That’s right. 

MILLENNIUM CHALLENGE CORPORATION

Senator GREGG. But there’s not a lot of money to places where 

we might have an opportunity to do some significant activities, 

such as we talked about earlier, the Former Soviet Republics. How 

much money is in the Millennium Challenge right now? 

Ambassador TOBIAS. I’m sorry? 

Senator GREGG. How much money is in the Millennium Challenge right now? 

Ambassador TOBIAS. I think their request, which is separate from the $20.3 billion, I believe their request in the budget is $3 

billion in the 2008 budget. 

Senator GREGG. Do you know how much is unspent? 

Ambassador TOBIAS. No, I don’t. I don’t. 

Senator GREGG. How many countries qualify for the money in 

Millennium Challenge? 

Ambassador TOBIAS. I don’t know. I don’t think I have that data. 

Senator GREGG. I mean, do you expect any more countries to 

come on line and qualify for the Millennium Challenge in the near 

future? 

Ambassador TOBIAS. Well, there are a number of countries that 

are working hard to meet the MCC requirements. There are several countries who are in a so-call threshold status where we are 

funding threshold programs to work with them to get them to the 

point where they will meet the criteria, and yes, I would expect 

there will be more countries coming on board. 

Senator GREGG. You don’t know who’s in line, though, do you? 

Ambassador TOBIAS. No, I don’t. 

Senator GREGG. I notice you’ve got Laos listed as something 

above the lowest category of nations where it seems to me it’s a 

pretty repressive nation. Shouldn’t it be lumped in there with Cuba 

and North Korea and—— 

Ambassador TOBIAS. Well, these designations are determined by 

a lot of indicators that come from various organizations like Freedom House, and the World Bank, and so forth, and they fall where 

they fall. 

Senator GREGG. The State Department doesn’t have any role in 

making those designations? 

Ambassador TOBIAS. Well, we have used a set of indicators, but 

the purpose of that categorization is to try to give us a sense of the 

kinds of development interventions that we likely need to be using 

in each of these categories of countries. Obviously in countries like 

that, we would expect that more of our effort would be focused on 

democracy programs. 

Senator GREGG. Well, I wish you’d go back and explain to us why 

Laos and Sudan are not in the restrictive category. I just don’t see 

how either of those elements could possibly not be in the restrictive 

category. The import/export bank, what’s the status in that? 

Ambassador TOBIAS. Senator, that’s beyond my area of focus and 

expertise. I’ll be happy to pursue anything that you’d like for me 

to, but I’ll have to do that for the record. 
20 

AFGHANISTAN

Senator GREGG. Okay. We’ve now spent how much money in Afghanistan? 

Ambassador TOBIAS. Since 2001 through fiscal year 2006, the 

U.S. Government has provided over $14.2 billion in foreign assistance to Afghanistan. Of this amount nearly $9 billion has gone for 

security assistance and $5.2 billion for reconstruction, humanitarian and governance assistance. 

Senator GREGG. Well, what are we spending the money on? Let’s 

try it this way. How are we spending the money in Afghanistan? 

Ambassador TOBIAS. A lot of the money is going into building infrastructure that will help the economy. There’s been a lot of 

money going into roads, a lot of money going into electricity, money 

going into programs to provide and enhance the capacity and capability of the government ministries. 

I have visited programs in Afghanistan out in the rural areas 

where we’re teaching farmers, who have been former poppy growers, the skills to grow alternative crops. We have programs where 

farmers who have been poppy growers are being taught to be electricians, or plumbers, or other skills that can give them a livelihood 

in other areas. 

Senator GREGG. Do we expect that you’re going to change the 

forces of the marketplace in Afghanistan and cause people to stop 

growing poppies when it’s the most lucrative crop? 

Ambassador TOBIAS. Well, that’s probably one of the most difficult issues in Afghanistan, and there’s a hard look being taken 

right now at the whole poppy issue to look at what we’ve been 

doing, what’s worked, what has not worked, what lessons can we 

learn from other places in the world. 

I just visited a program in Peru a couple of weeks ago where villagers that are growing coca leaves, it’s made very clear to them 

that their coca plants are going to be eradicated, but if they are 

willing to band together and sign a compact with the government 

that they’re going to get out of the coca plant business, then we are 

working with them to address other issues that may improve the 

quality of life in those villages—building a school, building a health 

clinic, whatever kinds of things that the village may think is a priority, and—— 

Senator GREGG. Is that in Afghanistan? 

Ambassador TOBIAS. That’s in Peru, but the program’s been very 

successful and we’re not doing that in Afghanistan but we’re looking at that as something to take to Afghanistan as an example. 

Senator GREGG. I’d be interested in knowing to what extent the 

poppy growing has been abated by the dollars we’ve spend in Afghanistan. Do we have any studies to that? 

Ambassador TOBIAS. The United Nations Office on Drugs and 

Crime published a report in February 2007: Afghanistan Opium 

Winter Rapid Assessment Survey. With increasing ties between 

narcotics traffickers and elements of insurgency in southern Afghanistan, poppy cultivation in the South has increased. In contrast, a mixture of political will and incentives and disincentives, 

such as eradication programs funded by the U.S. Government, contributed to a decline in opium cultivation in the Northern prov-
21 

inces. As a result, several Northern provinces with very low 

amounts of poppy are well on their way to becoming poppy free. 

Senator GREGG. What percentage of our dollars—we’ve spent somewhere in the vicinity of $3 billion in Afghanistan—what percentage of those dollars have been directed at poppy-growing suppression? 

Ambassador TOBIAS. Since 2001 through fiscal year 2006, the U.S. Government has provided over $14.2 billion in foreign assistance to Afghanistan. Approximately 9.5 percent has been provided 

for counter narcotics. 

There are other areas in Afghanistan where we can look at the 

things we’ve been doing and there’s been significant progress. 

School enrollment in the Taliban time was about 900,000 people, 

it’s now about 5 million. When the Taliban was there, about 8 percent of the Afghan population had access to healthcare; it’s now 

about 80 percent. It used to take 15 hours to get from Kabul to 

Kandahar; it now takes about 6 hours on the highway that’s been 

built. 

The economy in Afghanistan has gone from about $2.5 billion to $.4 billion at the time the Taliban was there, to about $8.8 billion 

now, so there are a number of areas where we’re making progress, 

but the drug part of the equation has not been, and that’s why 

we’re all taking a very hard look now at what’s failed, and what’s 

worked, and how can we do better. 

Senator LEAHY. Afghanistan is a difficult case. We’ve made colossal mistakes in the past and again, you know, if you’re anti-communist, so we arm the Taliban with a lot of weapons that they’re 

still using. We get them Stinger missiles to go after—or shoulderfired missiles to go after the Russians. I don’t know if those things 

deteriorate after a while, but a lot of them they never turn back 

in, obviously, and still have. 

You say some things have worked and some haven’t. If you’re in 

an area where the Taliban has control, I don’t know of any program that works. We did build the highway and I think that’s good 

news, but the fact of the matter is most of the economy you’ve 

talked about is in the Kabul area. 

Some have said that President Karzai is really president of 

Kabul, not of Afghanistan, and that there is lawlessness outside. 

I would like to see everybody go to school. I want to see both boys 

and girls go to school, and it is hard to find a country that is more 

oppressive toward women than Afghanistan under the Taliban, but 

I’m afraid that a lot of that power is still with the Taliban. 

EGYPT

In your budget justification—and I was thinking of this as I read 

some of the press in the last few days—you say that the U.S. Government supports the enactment of the political reforms outlined 

by President Mubarek during the 2005 presidential campaign, 

namely replacement of the emergency law with a modern counterterrorism law, revision of the modernization law governing the judiciary, revision of the media law to expand press freedom, revision 

of the penal code to narrow the power of authorities to hold people 

without charge, and parliamentary input on broader constitutional 

reform. Any one of those happen? 
22 

Ambassador TOBIAS. Well, we’ve been working very hard with 

the Egyptian Government in a variety of ways. 

Senator LEAHY. I’ve talked to President Mubarek a number of 

times. 

Ambassador TOBIAS. Oh. I’m sorry. I misunderstood what you 

said. 

Senator LEAHY. Because I’ve talked to President Mubarek a 

number of times. Everybody, and they’re most gracious people, 

friendliest, they’ll always talk to you, but name anything that’s 

happened. We pour a huge amount of money in there. Name anything that’s happened. I mean, any reforms, whether of the judiciary, or press freedom, any reform of political parties, any reforms 

in arresting people without charge? I mean, there may have been, 

I just totally missed it. 

Ambassador TOBIAS. Well, there’s been some recent reforms in 

the financial services industry, for example, where they’ve gone 

from monopoly, a government-owned bank, to a more competitive 

banking industry, and our people there are working very hard with 

reform-minded people inside and outside the government. 

Senator LEAHY. What has that done for people’s rights? 

Ambassador TOBIAS. I’m sorry? 

Senator LEAHY. What has that done to improve anybody’s rights? 

Ambassador TOBIAS. Well, I think as the economy has grown and 

as civil society has grown, that has certainly put people on a journey in the right direction, but there’s much, much more to do. 

Senator LEAHY. You said puts them on a journey. If you’re the 

person being thrown in an Egyptian jail because you dared speak 

out against the government, you’re not on a journey in the right 

direction. 

We haven’t had the right to legal counsel strengthened, we 

haven’t had the media law expanded for press freedom, we have 

not had revision of the modernization law governing the judiciary. 

I don’t see where the emergency law has been replaced. I don’t see 

that they have narrowed the power to hold people without charge. 

Tell me honestly. Do you feel there’s forward progress in Egypt? 

Ambassador TOBIAS. I think there is in some areas, but I think 

there’s a great deal more to do, and I think it’s important to ensure 

that the money we’re spending and that the programs that we have 

in place are tied to clear expectations about what we believe ought 

to happen in that partnership, and lots of people are working very 

hard on those issues. 

Senator LEAHY. I know they’re working very hard. We have a 

huge embassy there, we’ve got all kinds of people running around, 

and it’s wonderful—it adds to the traffic jams in Cairo, and I know 

they’re dedicated people, but I don’t see where we’re getting a heck 

of a lot for our dollar there. 

I understand there are political considerations in sending money 

there, but we don’t have money for other things. Senator McConnell and I worked to expand programs to strengthen the rule of law 

in China. Your budget justification, the fiscal year 2006 level for 

these programs was $1.1 million. In fiscal year 2006 we provided 

$20 million in the human rights and democracy fund for China, 

Hong Kong, and Taiwan. Where did that money go? Certainly the 
23 

administrative cost wasn’t $19 million out of that $20 million. How 

come there’s only $1.1 million in there? 

Ambassador TOBIAS. I don’t know the details of that program, 

but—— 

Senator LEAHY. I’m sure you’re going to want to get me an answer. 

Ambassador TOBIAS. Well, what my effort is really focused on is 

trying to go forward and ensure that you know and we know exactly what we’re proposing the money be used for, and that we 

have a very transparent way of measuring that, and that we’re 

doing the best job we can focusing it. 

IRAN

Senator LEAHY. If the transparency is there, somebody let me 

know where the money went. I mean, when we went from $20 million to $1 million, just what’s happened. You propose $75 million 

for Iran to support human rights defenders, labor activists, women, 

student, religious, ethic, minorities, rule of law and justice programs. Heck, I’d love to see money for all those things, but in Iraq 

if you accept money from the United State you become a target. 

Won’t the same thing happen to Iran? 

Ambassador TOBIAS. Well, I think there are probably a lot of 

brave people who are willing to engage and take that risk. Some 

of that money is in—— 

Senator LEAHY. Take money from the United States? 

Ambassador TOBIAS. I’m sorry? 

Senator LEAHY. Willing to take money from, as they call it, the 

Great Satan? 

Ambassador TOBIAS. Well, some of the money in that program is 

intended to develop a new independent media in order to reach the 

people of Iran with messages, and news, and information that’s—— 

Senator LEAHY. Inside Iran? 

Ambassador TOBIAS. Probably not. 

Senator LEAHY. I’m all for getting more media in there, and I understand—I’ve not been to Iran—but I understand from people I 

know and respect who’ve been to Iran that there’s a great deal of 

interest in the United States. I have other questions for the record. 

Some of these questions Senator Gregg and I and Senator Bond 

ask, we’re not trying to play ‘‘gotcha,’’ we’re just very concerned 

where the money goes. I understand some of the political considerations; every administration’s had political considerations. But it’s 

one thing to speak of lofty goals; it’s another to affect the people 

on the ground. I’d like to see more competition among those who 

seek these kind of grants. 

Ambassador TOBIAS. One of the considerations that I have put 

into the country Operational Plan Process is that any country 

where the U.S. Government program is spending more than 15 percent of its resources with a single source, I want to see it put on 

the table and justified as to why we’re doing that. 

Now as you said, in some cases where people are shorthanded 

and operating expenses have been cut, it’s easier to administer 1 

big contract rather than 10 small contracts. We, the Congress and 

the administration together, need to address that, and be sure that 
24 

people have the tools to be able to operate with a lot more and 

newer participants and I’m trying pretty hard to do that. 

Senator LEAHY. Especially among those 10 separate contracts, 

there may be three or four that are really going to hit the mark 

and would be a model for elsewhere. 

Ambassador TOBIAS. Yes. 

Senator LEAHY. Okay. Well, thank you. I will place the rest in 

the record. I thank you for being here. You have one of the most 

difficult jobs in Government and I don’t envy you that at all. Thank 

you. 

Ambassador TOBIAS. Thank you, Senator. 

SUBCOMMITTEE RECESS

Senator LEAHY. Thank you all very much. The subcommittee will 

stand in recess to reconvene at 10:30 a.m. on Wednesday, April 18, 

in room SD–138. At that time we will hear testimony from Dr. 

Kent R. Hill, Assistant Administrator, United States Agency for 

International Development. 

[Whereupon, at 11 a.m., Thursday, March 28, the subcommittee 

was recessed, to reconvene at 10:30 a.m., Wednesday, April 18.] 
(25) 

STATE, FOREIGN OPERATIONS, AND RELATED 

PROGRAMS APPROPRIATIONS FOR FISCAL 

YEAR 2008 

WEDNESDAY, APRIL 18, 2007 

U.S. SENATE, 

SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS, 

Washington, DC. 

The subcommittee met at 10:30 a.m., in room SD–138, Dirksen 

Senate Office Building, Hon. Patrick J. Leahy (chairman) presiding. 

Present: Senator Leahy. 

UNITED STATES AGENCY FOR INTERNATIONAL 

DEVELOPMENT 

BUREAU FOR GLOBAL HEALTH

STATEMENT OF DR. KENT R. HILL, ASSISTANT ADMINISTRATOR 

OPENING STATEMENT OF SENATOR PATRICK J. LEAHY

Senator LEAHY. I apologize for being late. It’s not often we have 

this distinguished a panel. We had votes that were supposed to 

have been earlier today, partly to accommodate this hearing, and 

then as sometimes happens in the Senate, things slipped. 

This hearing focuses on the aspects of our global health programs 

which address the core public health needs of the world’s poorest 

people. I think of when children of people in my office, or my own 

grandchildren, get immunizations and it is a routine thing, and I 

think of so many children around the world where this does not 

happen, for them or their families. 

The chart on my right shows funding for HIV and AIDS, which 

has—for obvious reasons, and with bipartisan support of this subcommittee—increased dramatically in recent years, but funding for 

maternal and child health, and family planning and reproductive 

health, has languished. 

I don’t want this to be an either/or thing, by any means. But, I 

am concerned, when you consider what a difference these programs 

make, and what we take for granted in our own country. 

Over the past 30 years, expanded immunization programs, often 

costing only pennies a child, have saved millions of lives. Family 

planning and reproductive health programs have also made enormous differences in child survival and women’s health. USAID has 

been in the forefront of these efforts. 
26 

But despite the great progress and countless lives saved, 11 million children—11 million children under age 5—die each year, 

mostly from easily preventable and treatable causes, like diarrhea, 

pneumonia, or measles. Eleven million children each year—that’s 

about 20 times the total population of my State of Vermont. Twenty times. That’s each year. 

The administration’s fiscal year 2008 budget request for these 

programs is $373 million, but that’s compared to $420 million in 

fiscal year 2007. An estimated 200 million women still lack access 

to family planning. Half a million yearly maternal deaths would be 

prevented with basic reproductive health services. The administration’s budget request for these programs is $325 million, compared 

to $436 million in fiscal year 2007. 

What I worry about is we’re short-changing the programs that 

have a proven and long history of success. We’re also witnessing an 

alarming exodus of health professionals from developing countries, 

to higher-paying jobs in industrialized countries. The short- and 

long-term consequences of this brain drain, coupled with the deaths 

of countless health workers from AIDS, are staggering. 

I think of a country as great and powerful as the United States, 

and a country that has great economic means, that spends far less 

on maternal and child health, and on family planning and reproductive health for the world’s 2 billion poorest people than we 

spend for the same purposes in the State of Vermont, with 625,000 

people. We are far from being a wealthy State. I think most 

Vermonters would find that unacceptable, and I hope most Americans would find it unacceptable. 

Dr. Hill, who is the Assistant USAID Administrator for Global 

Health, will describe the administration’s request. 

Dr. Helene Gayle is currently the President of CARE, one of the 

country’s leading organizations fighting global poverty. She previously headed USAID’s HIV/AIDS programs, and at the Gates 

Foundation she was the Director of HIV, TB, and reproductive 

health. Dr. Gayle and I have had discussions before, and my wife 

has, too, with her, and we consider that a privilege. 

Laurie Garrett is Senior Fellow for Global Health at the Council 

on Foreign Relations. Her Pulitzer Prize-winning book ‘‘The Coming Plague’’, and her recent book ‘‘Betrayal of Trust, the Collapse 

of Global Public Health’’, should be read by every Senator, and 

every House Member, for that matter. 

Dr. Nils Daulaire is an old friend from my own State of Vermont, 

he’s President of the Global Health Council, and after serving as 

USAID’s Senior Health Advisor, he has been a friend and advisor 

to me and to others. 

So why don’t we start with Dr. Hill, and place your full statement in the record. I wonder if you might sum up in 5 or 6 minutes. Then we will go to Dr. Gayle, and Ms. Garrett, then Dr. 

Daulaire. 

SUMMARY STATEMENT OF DR. KENT HILL

Dr. HILL. Thank you, Chairman Leahy. I want to thank you, first 

of all, for holding this hearing, for your personal passion on these 

issues, which has been evident for so many years, and for the op-
27 

portunity to testify with my esteemed colleagues and friends about 

these important issues. 

As you’re well aware, over many years USAID has contributed 

to impressive reductions in child and maternal mortality, and in 

helping women and couples achieve the size of family they desire. 

In the process, we have strengthened health systems, built the capacity of developing countries to reduce maternal and child deaths, 

and provided basic health services. 

Maternal and child health, and family planning are often seen as 

separate and distinct, vertical and disconnected. But USAID is 

working very hard to integrate our programming, an approach that 

promotes efficiency and sustainability. 

I will talk about maternal and child health, and family health 

planning separately, but I do so only for ease of presentation—as 

they are, in fact, implemented in an integrated fashion in our country programs. 

Mothers and their young children bear a disproportionate share 

of the burden of diseases and preventable mortality in developing 

countries each year. More than 500,000 women die of complications 

of pregnancy and childbirth. 

Women in sub-Saharan Africa have more than a 150-times greater risk of dying in childbirth over a lifetime than women in the 

United States. Our programs focus on interventions targeting the 

high mortality complications of pregnancy and birth that account 

for two-thirds of maternal mortality; this would be hemorrhage, hypertension, infections, anemia, and prolonged labor. 

In USAID-assisted countries, skilled birth attendance has increased from an average of 37 percent in 1990 to 50 percent in 

2005. Ten USAID-assisted countries have reduced maternal mortality by 33 percent on average over a decade, demonstrating that 

substantial progress is achievable. 

In this chart, which I won’t detail for you, you can see all the 

lines going down; these are all countries that, over 10 years, have 

seen a substantial decline in maternal mortality. 

But, every year, 3.7 million newborns fail to survive even the 

first month of life. Newborn mortality has not been reduced as 

much as mortality among older infants and children, making it the 

unfinished agenda of child survival. 

Let me now turn to child survival. Twenty years ago when 

USAID and UNICEF launched the Child Survival Revolution with 

the support of Congress, an estimated 15 million children in the developing world died every year. Without action, the number of 

deaths today would be more than 17 million each year. 

Instead, as a result of global child survival efforts, by 2005, the 

number of child deaths was reduced to about 10.5 million—still far 

too many, but representing more than 6 million childrens’ lives 

now being saved every year. 

Over the past 20 years, the United States has committed more 

than $6 billion to this effort, which has yielded public health successes at an unprecedented global scale. For example, almost 1 billion episodes of child diarrhea are treated with oral rehydration 

therapy each year, reducing deaths from diarrhea by more than 

half since 1990. More than 100 million children receive basic immunizations every year. More than 75 million cases of child pneu-
28 

monia receive treatment. Child malnutrition has been reduced by 

25 percent, from 1 in 3 to 1 in 4. An estimated 5 million children 

have been saved from death from paralysis through the polio eradication initiative. Finally, 500,000 children were saved last year by 

micro-nutrition supplementation. 

These accomplishments are not attributable to USAID alone. Yet, 

as the graph to my left shows, in almost 30 countries with sustained USAID investment in child survival, we have seen significant reductions in mortality of children under the age of 5. The 

takeaway here is that the lines that are higher, in blue, are 1990, 

and the red shows what it’s been reduced to. Wherever we’ve had 

a chance to work on these issues, we have been able to make a tremendous difference. 

These are great accomplishments. But even greater challenges 

remain, such as saving the lives of the more than 10 million children who still die each year. I appreciate the chairman mentioning 

that fact—we must focus on the work left to be done. 

As the next graph shows, over two-thirds of the remaining child 

deaths—6.5 million—are preventable. Now, I want to make a point 

here. You saw the 15 million that were dying in the Eighties; you 

can see how many would be dying today if we did not act and that 

is 17 million. You see the number, the 10.5 million that are still 

dying. Despite saving the lives of 6.5 million, the point I want to 

make is the next one. Of that 10.5 million, two-thirds of those 

deaths can be averted through proven interventions. Only 4 million 

of that 17 million represent things that would be very tough for us 

to get at. 

Now, to be sure, a lot of that remaining work is in remote areas 

and would cost a bit more, but it is what we ought to aim at. By 

replicating our best practices, I hope some of this came through. 

Anyway, by replicating our best practices and new approaches and 

interventions, we believe that it is possible to achieve reductions of 

25 percent in under 5 years and maternal mortality in most of 

these countries by 2011. 

Now, let me turn to family planning for a minute. USAID and 

Congress’s joint support for family planning has resulted in many 

successes since 1965. The use of modern family planning methods 

in the developing world has increased by a factor of four, from less 

than 10 percent to over 40 percent in the 28 countries with the 

largest USAID-sponsored programs. The average number of children, per family, has dropped from more than six to less than four. 

Enabling women and couples to determine the number and the 

timing of their births has been crucial in preventing child and maternal deaths, improving women’s health, reducing abortion, preserving often scarce resources, and ensuring a better life for individuals and their communities. 

To be sure, the United States is the largest bilateral donor and 

the acknowledged world leader in advancing and supporting voluntary family planning services. 

Because of our success, we are now able to address those countries with the greatest need for family planning and have strategically shifted our resources to do so. Many countries in Africa, for 

example, are characterized by low rates of contraceptive use, high 

fertility, and high unmet need for voluntary family planning. 
29 

Between 1994 and 2000, there were nearly 39 million unintended 

pregnancies in Africa, and 24 percent of the women there expressed 

an unmet need for family planning. Nearly half of the world’s maternal mortality occurs in Africa. As you can see in this particular 

chart, the unmet need is highest in sub-Saharan Africa, but it is 

very great in areas of Asia, the Middle East, Latin America and 

Central Asia. To be sure, we try to graduate countries, and we 

have done so successfully. 

One final issue, perhaps, deserves our attention and that has to 

do with the ‘‘brain drain.’’ One challenge that faces us is the movement of trained healthcare providers away from the developing 

countries into more developed countries, commonly referred to as 

a ‘‘brain drain.’’ 

USAID is trying to deal with this, and deal with health worker 

retention, in almost every country in which we work by strengthening in-service training, by reinforcing supervision systems so 

that they provide positive support to these workers, and by instituting quality improvement methods. This won’t completely solve 

the problem, but this is what we have to work very hard on. There 

has been an increase in retention in places like Ghana, Namibia, 

and Uganda. 

PREPARED STATEMENT

USAID-supported maternal-child health programs and family 

planning programs have a proven success record. Our support has 

reduced under-5 mortality in almost 30 countries and maternal 

mortality in 10 countries. USAID-supported family planning programs have been successful in increasing access to and use of modern contraceptives in all regions of the world. We now have program approaches and interventions that will allow us to build on 

these successes. We have the experience to do it, and with the continued support of Congress, we will be able to contribute to further 

gains in maternal and child health, and family planning throughout the developing world. 

Thank you very much. 

[The statement follows:] 

PREPARED STATEMENT OF DR. KENT R. HILL

INTRODUCTION

Chairman Leahy, Senator Gregg, and other distinguished members of the Committee, I would like to thank you for convening this important hearing and for inviting me to testify. U.S. development assistance has brought dramatic improvements 

in health, income advancement, and education to much of the developing world in 

the last 50 years. Average life expectancy in low and middle-income countries increased significantly during this same period. Good public health underpins these 

advances. Indeed, research findings and country experience have demonstrated an 

inextricable link between investments in improving individual and collective health 

status and a nation’s economic development and performance. Many of these advances are due, in large part, to your continued support for maternal and child 

health and reproductive health programs. 

USAID has a proven track record that has contributed to impressive reductions 

in child and maternal mortality and in helping women and couples achieve the size 

of families they desire in all regions of the world. Our support has helped to reduce 

under-five mortality in almost 30 countries and maternal mortality in ten countries. 

USAID-supported voluntary family planning programs have been successful in increasing access to and use of modern contraceptives in all regions of the world. In 

the process, we have strengthened health systems and built the capacity of devel-
30 

oping country institutions to reduce preventable maternal and child deaths and provide basic health services. Your on-going commitment and support for maternal and 

child health has been and is critically important. As I often remind my staff, it is 

a great privilege to have work to do which matters, which saves lives of children 

and mothers, and it is you in the Congress whose compassion and support makes 

this work possible. And I want to express my great appreciation to you for this. 

In talking to you about our work in improving maternal and child health (MCH) 

and family planning and reproductive health (FP/RH), I would like to focus on five 

key points: 

—Our programs have a proven record of success. 

—Despite real progress, our work is not done. 

—We have pioneered program approaches and continually develop new interventions that have made and will make a difference in our progress. 

—There are crucial opportunities to accelerate progress. 

—We can take advantage of these opportunities by capitalizing on existing resources and by focusing on key countries. 

Maternal and Child Health and Family Planning are often seen as separate and 

distinct—vertical and disconnected. But USAID is working to integrate our programming to the fullest extent possible, an approach which increases the affordability and sustainability of our global efforts to tackle these important public 

health challenges. For example, we are making substantial progress integrating our 

programs for women and children and building consolidated platforms such as 

antenatal care and community-based distribution approaches for family planning, 

child vaccinations, and other important health interventions. Most of our missions 

already support integrated MCH/FP programs and help to build broad-based health 

systems. These programs strengthen drug management, supervision, community 

outreach, and other critical systems needed to deliver basic public health services. 

In all our health programs, including MCH and family planning and reproductive 

health, we work to build human and organizational capacity, including taking steps 

to address the so-called ‘‘brain drain.’’ Our programs help strengthen human resources to implement quality health care services through workforce planning, allocation, and utilization; strengthened systems for sustained health worker performance on the job; and training of health professionals. While, as a development agency, we cannot affect recruitment policies of the developed world, we are working on 

ways to keep health workers in their countries by working with governments on developing appropriate incentives, providing clear and equitable career paths, and offering continuing education and professional development. Other projects also work 

to strengthen management systems and increase leadership capacity. 

By strengthening and building upon common service delivery platforms, we help 

to support the specific goals of new high-intensity initiatives like the President’s 

Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative 

(PMI), and therefore advance countries’ ability to deliver the full range of health 

services. 

I will talk about MCH and FP in separate sections, but I do so only for ease of 

presentation, as they are implemented more and more in a fully integrated fashion 

in country programs. 

Using cost-effective tools and approaches, USAID and its international development partners have an unprecedented opportunity to accelerate progress in MCH 

and family planning, leading to further reductions in maternal and child mortality 

and unintended fertility. 

MATERNAL, NEWBORN, AND CHILD SURVIVAL AND HEALTH

To achieve impact in maternal, newborn, and child health, USAID has consistently applied an approach that focuses on: 

—working with countries having high burdens of maternal and child mortality 

and malnutrition; 

—developing and delivering high impact maternal and child health interventions 

such as increasing skilled attendance at birth, control of post-partum hemorrhage, oral rehydration therapy (ORT), immunization, and vitamin A; 

—bringing these interventions as close as possible to the families who need them; 

—supporting results-oriented research to develop new interventions and strengthen programs; 

—monitoring progress; and, 

—strengthening the capacity of countries and communities to save the lives of 

their own women and children. 
31 

MATERNAL AND NEWBORN HEALTH

The burden of maternal and newborn mortality and disability 

Each year more than 500,000 women die of complications of pregnancy and childbirth. Indeed, this is the second most common cause of death of women of reproductive age. While the number of deaths is disturbing enough, it is estimated that an 

additional 15–20 million women suffer debilitating consequences of pregnancy. Pregnancy-related mortality shows the greatest inequity of all health indicators between 

the developed and the developing worlds. For example, the one-in–16 chance over 

a lifetime that a woman in sub-Saharan Africa has of dying as a result of pregnancy 

is more than 150 times greater than the one-in-2,500 risk of a woman in the United 

States. In many Asian and Latin American countries, improved national averages 

often obscure the substantial risk of pregnancy that still remains for women living 

in poverty. 

In addition, 3.7 million newborns die annually, failing to complete even the first 

month of life. As noted, newborn survival is inextricably linked to the health and 

nutritional status of the mother before and during pregnancy, as well as her care 

during labor and delivery. For this reason, USAID’s programs always link mother 

and infant. As we make progress in reducing under-five mortality in general, the 

deaths of newborns in the first 28 days of life comprise a greater proportion of 

under-five and infant deaths. Globally, newborn mortality represents over one-third 

of all mortality among children under age five; however, in countries which have 

made greatest progress in child survival, newborn mortality can be more than half 

of the remaining deaths of infants and children. Thus, further progress in child survival must emphasize reduction of newborn deaths as a critically important element. 

We have shown that substantial progress can be made in reducing maternal and 

newborn deaths 

Despite the challenges faced in reducing maternal mortality, USAID has helped 

demonstrate that real progress can be made. Because maternal mortality is normally measured every 5–10 years, the globally-accepted proxy for maternal mortality is coverage at birth by skilled attendants. Across all USAID-assisted countries, skilled attendance has increased from an average of 37 percent in 1990 to 50 

percent in 2005; the greatest progress has been in the Asia and Near East region, 

where coverage has more than doubled, increasing from 21 to 47 percent. 
32 

Most important, although global progress in reducing maternal deaths has generally been slow, ten USAID-assisted countries have achieved average reductions of 

maternal mortality of 33 percent over a decade. 
33 

Family planning also makes a substantial contribution to saving the lives of 

women by reducing the number of unintended pregnancies (each of which exposes 

a woman to risk) and by reducing abortions. 

For newborn mortality reduction, USAID funded-research has documented a 33 

percent decline in newborn mortality in Sylhet, Bangladesh with a package of homebased essential newborn care, and a 50 percent decline in Shivgarh, India with a 

similar program. Such programs have the potential to produce widespread impact 

on newborn survival in settings where most births take place at home, and they are 

now being scaled-up. In large controlled trials, community-based programs for detection and antibiotic treatment of life-threatening neonatal infections have also demonstrated the potential to reduce newborn mortality by almost half. We and other 

partners are replicating these trials and—if they are successful—will work with 

countries to apply the results in MCH programs. Neonatal interventions are relatively new in such programs, so we do not yet have examples of national-level mortality reduction. However, very recent analyses suggest that, as these interventions 

are scaled-up, we are beginning to see overall declines in newborn mortality at the 

global level. 

This success can be scaled-up through expanding the use of proven, low-cost interventions 

Our work demonstrates that many of the major causes of maternal death are substantially preventable and treatable with low-cost interventions. USAID has sharpened its focus on a set of highly-effective interventions targeting specific high-mortality complications of pregnancy and birth—hemorrhage, hypertension, infections, 

anemia, and prolonged labor. Together, these complications account for two-thirds 

of maternal mortality. Hemorrhage alone accounts for almost one-third, and USAID 

has been in the forefront of promoting ‘‘active management of the third stage of 

labor,’’ a highly-effective technique for preventing postpartum hemorrhage. 

USAID has recognized that attention to the newborn is essential to success in our 

child survival programs. Increasing evidence and program experience indicate that 
34 

we can significantly reduce newborn mortality by combining focused antenatal care, 

a package of essential newborn care that enhances the survival of all infants, detection and treatment of serious neonatal infections, and community and facility-based 

approaches to special care for low birth weight babies. These approaches especially 

target newborn infection and birth asphyxia, which together account for more than 

60 percent of newborn deaths. USAID is presently supporting introduction or expansion of newborn care programs based on these elements in 20 countries. 

Accelerating progress 

While we have been able to demonstrate important progress in maternal survival 

in a number of countries, we recognize that sub-Saharan Africa has generally made 

little progress and represents a special challenge. In response to this stagnation of 

progress in sub-Saharan Africa, USAID has initiated a new ‘‘Safe Birth Africa’’ initiative to increase skilled attendance at birth, beginning in Rwanda and Senegal. 

This initiative includes a focus on decreasing financial barriers for families so that 

they will be more likely to bring expectant mothers for skilled care at birth. It also 

involves expanding the mandate of frontline providers so that they can perform lifesaving measures, along with quality improvement approaches to ensure that good 

clinical practice standards are systematically applied. USAID plans to expand this 

work to other high burden countries in order to increase skilled attendance at birth 

and coverage with life-saving care. 

In all countries where maternal mortality is high, as well as in countries where 

there is wide disparity in birth outcomes between rich and poor, USAID is intensifying its work to spotlight specific life-saving interventions. To expand the use of 

‘‘active management of the third stage of labor’’ to prevent postpartum hemorrhage, 

USAID launched the Prevention of Postpartum Hemorrhage Initiative in 2002. As 

of 2006, this approach had been introduced into MCH programs in 15 countries. In 

support of this intervention, we are working to get oxytocin, the drug that contracts 

the uterus to reduce bleeding after birth, into single-use UNIJECT injection devices, 

so that it can be provided by skilled birth attendants to women in peripheral health 

centers and homes. Because oxytocin is sensitive to heat, we are also exploring a 

time/temperature index to be put on the oxytocin vial, similar to the Vaccine Vial 

Monitor, to ensure that medication given to women is potent and that health workers do not unnecessarily discard oxytocin that has not been refrigerated. 

In addition to further expansion of essential newborn care at birth, USAID is applying research results on treatment of sick newborns with antibiotics in the community. One step is testing the delivery of antibiotics in UNIJECT devices, so that 

treatment can be administered easily and safely by frontline-care providers. These 

newborn activities represent the combination of technical leadership and program 

application that USAID brings to MCH programs, working in partnership with 

other donors and recipient countries. 

Reversing maternal disability 

While our efforts continue to emphasize safe births and prevention of maternal 

mortality and disability, we are also providing compassionate care for women who 

suffer the devastating problem of obstetric fistula, a consequence of prolonged labor 

that can cause a woman to leak urine or feces, often resulting in divorce and social 

isolation. In 2004, USAID began a program to provide surgical treatment for such 

women. By the end of 2006, USAID was supporting eighteen fistula repair centers 

in eight countries of south Asia and sub-Saharan Africa. This support included 

physical upgrading of centers, training of surgeons, nurses and counselors, and mobilizing more than 5,000 community agents to change norms to delay pregnancy, reduce stigma of affected women, and promote use of family planning and maternity 

services. Over 2,000 surgeries have been completed. 

CHILD SURVIVAL

Let me now turn to the child survival component of our MCH program. This is 

one of the cornerstone components of USAID’s health programming. Arguably, the 

quantifiable, at-scale results generated by the child survival and family planning 

programs helped build the confidence that paved the away for later investment in 

other global health programs, from TB and malaria to HIV/AIDS and Avian Influenza. 

The child survival program has a proven record of success, achieved by delivering 

high-impact interventions. Twenty years ago, when USAID and UNICEF launched 

the ‘‘child survival revolution’’ with the support of Congress, an estimated 15 million 

children under age five in the developing world died from common, preventable diseases each year. Across the developing world, more than one in 10 children did not 

survive to see their fifth birthday; in some countries, it was one in five. If the same 
35 

rates of infant and child mortality existed today, the number of deaths would be 

more than 17 million each year. In contrast, for 2005 WHO and UNICEF estimate 

the number of children under five who died to have been reduced by more than onethird, to 10.5 million—this is still far too many preventable deaths, but it means 

that more than 6 million children’s lives are now being saved every year through 

global child survival efforts. Over the past 20 years, the United States has committed more than $6 billion in 

support of USAID’s global child survival efforts. In collaboration with international, 

national, and private sector partners, this effort has yielded public health successes 

on an unprecedented global scale: 

—Almost a billion episodes of child diarrhea are treated with lifesaving ORT each 

year, reducing child deaths from diarrheal disease by more than 50 percent 

since 1990. 

—More than 100 million children receive a set of basic immunizations each year, 

and tens of millions more receive supplemental immunizations against polio, 

measles, and other killer diseases. 

—More than 75 million cases of infant and child pneumonia are taken for treatment by trained health workers. 

—Malnutrition among children under age five has been reduced from one in three 

to one in four, a 25 percent reduction. 

—The Polio Eradication initiative has saved an estimated five million children 

from death or paralysis. 

—Half a million children are estimated to have been saved last year alone by 

micronutrient supplementation programs. 

These accomplishments are not attributable to USAID alone. In virtually all countries where it carries out child survival and maternal health efforts, USAID invests 

its resources in ways that best interact with and leverage the contributions of other 

donors and of the country itself. Yet, as the attached graphic demonstrates, in almost all the countries where USAID made an average annual investment of at least 

$1 million of child survival and maternal health funds each year during 2003–2005, 

we have seen significant reductions in mortality of children under age five. 

Despite real progress, there is still a substantial job left to do 

Sustaining this progress is itself a challenge, especially in the poorest countries 

with the weakest governments and health systems. A greater challenge is saving 
36 

1 ‘‘All other causes’’ includes principally congenital anomalies, malignancies, all other infectious diseases, and injuries & accidents. 

the lives of the remaining 10.5 million children who still die each year. As shown 

in the graph from the 2003 authoritative review of Child Survival in the medical 

journal The Lancet, the causes of most of these child deaths continue to be malnutrition, the common infections of newborns and young children—diarrhea, pneumonia, infections of newborns, and, especially in Africa, malaria—and other lifethreatening newborn conditions.1

The Lancet analysis indicates that over two-thirds of these child deaths are preventable with interventions that are available or in the pipeline, including Oral Rehydration Therapy for dehydrating diarrheal illness; basic treatment of serious infections including pneumonia, malaria, and newborn sepsis; improved nutrition 

through breastfeeding, better child feeding practices, and management of acute malnutrition; and delivery of micronutrients, especially vitamin A and zinc, which improve children’s ability to resist infections or help them fight them off when they 

occur. 

Countries and the global community—with USAID playing an important leadership and program role—have been able to make substantial progress in delivering 

these high impact interventions. In addition to our substantial contributions to increased global coverage of interventions including immunization and oral rehydration therapy, there are several areas where USAID’s contribution has been especially important. One of these is vitamin A. USAID supported a large part of the 

research demonstrating that vitamin A deficiency was widespread among young 

children in developing countries, and that preventing or repairing this deficiency 

could reduce overall mortality among children under age five by about one-fourth. 

Since then, integrating vitamin A supplementation into maternal, newborn, and 

child health programs has been one element of our work in most countries, working 

with UNICEF and the Canadian International Development Agency. One result is 

that by 2004 (the latest year with complete estimates) almost 70 percent of children 
37 

in the developing world had received at least one semi-annual dose of vitamin A 

supplementation, and almost 60 percent had received both doses needed each year 

for full protection. This achievement, combined with the increasing coverage of 

micronutrient fortification programs, of which we are also major supporters, means 

that tens of millions of children are receiving this important nutritional intervention. 

Another area worth special comment is breastfeeding, because malnutrition 

underlies over half of all under-five child deaths. Breastfeeding is one of the highest 

impact child survival interventions, but improving feeding practices and children’s 

nutrition is one of the most challenging areas of child survival. The global rate of 

improvement in exclusive breastfeeding of children for the first six months of life 

is less than one percent annually. However, USAID demonstrated that this challenge can be effectively addressed through a multi-pronged approach that incorporates community workers, media, health services, and policy changes. Using this 

approach, seven USAID-assisted countries have made at-scale improvements in exclusive breastfeeding of as much as 10 percentage points a year, well above the global trend. We are now working with partners to apply this experience in additional 

countries. 

A major challenge is that many of the remaining child deaths are occurring in 

places where existing services often do not reach: in the poorest countries and countries emerging from conflict (like Sudan, Afghanistan, and the Democratic Republic 

of Congo), in the huge rural areas of countries like India and Pakistan, and increasingly in the slums of the developing world’s rapidly growing urban population. 

We have new program approaches and new interventions that will make additional 

impact 

Our response to these challenges is not just to do more of the same. Bringing high 

impact interventions to additional children who need them requires new approaches. 

One of these is our increasing emphasis on community-based programs, learning 

from our extensive partnerships with U.S. Private Voluntary Organizations and our 

experience working with countries that have pioneered these approaches as part of 

their national program strategies. 

One example is community treatment of pneumonia. At the end of the 1990s, our 

analyses showed that progress in delivering simple oral antibiotic treatment to children with pneumonia—a treatment that research had shown reduces mortality by 

at least one-third—had leveled off, with only about 50 per cent of children needing 

treatment actually getting it. The reason was that in most countries, this treatment 

was restricted to formal health facilities. With the support of USAID and others, 

a few innovative programs in Nepal, Honduras, and Pakistan had, however, implemented treatment through trained community health workers. In Nepal, this approach more than doubled the number of children receiving treatment for pneumonia, and did so with excellent quality of care. We documented and presented this 

program experience to international partners including WHO and UNICEF, with 

the result that this is now the recommended approach to pneumonia treatment for 

countries where formal health services fail to reach many children. USAID itself has 

helped introduce this approach in Africa, beginning in Senegal; six additional countries are now implementing this community-based approach, and several others are 

introducing it. 

Similarly, we helped pioneer ‘‘Child Health Weeks,’’ which are outreach approaches that bring vitamin A, immunization, insecticide-treated nets, and other 

health interventions to underserved areas. The aim is to get basic interventions to 

all children possible now, while building countries’ systems and capacities to do so 

through more systematic approaches in the future. 

Our program has also played a key role in developing, testing, and introducing 

new interventions and technologies that will save additional lives. 

One of these is zinc treatment for child diarrheal illness. Research—much of it 

supported by USAID—has clearly shown that zinc treatment reduces the severity 

and duration of these illnesses; as a result, zinc is now recommended by WHO and 

UNICEF as part of the treatment of diarrheal illness, along with oral rehydration. 

To implement this recommendation, we are supporting introduction of zinc treatment in countries including India, Indonesia, and Tanzania. We are also collaborating with UNICEF and potential zinc supplement producers to assure the availability of safe, standardized, high quality products to supply these new programs. 

Another example is ‘‘point-of-use’’ (POU) water disinfection technologies. These 

simple and cheap methods were first developed and used through collaboration of 

USAID and the Centers for Disease Control and Prevention (CDC) during cholera 

outbreaks in Latin America in the 1990s. Subsequent research showed that ‘‘POU’’ 

water treatment can reduce diarrheal and other water-transmitted illnesses by one- 
38 

fourth or more. Since then, we have collaboratively developed programs for their 

production and distribution in twelve countries. In some countries, like Indonesia, 

this is a purely private sector partnership, with the United States providing just the 

technical know-how. In poorer countries like Madagascar and Zambia, we are using 

social marketing approaches that involve some degree of subsidy to make sure they 

are available to low-income households (often most impacted by bad quality water). 

In emergencies—including the 2004 tsunami—these ‘‘POU’’ technologies have played 

an important part in reducing disease transmission, especially among children. Because over a billion people in the developing world still live without access to safe 

water, these simple technologies can play an important role in reducing the disease 

burden on young children. 

One other important new intervention is ‘‘community therapeutic care’’ (CTC), an 

innovative approach to therapeutic feeding and medical treatment of children with 

acute severe malnutrition in field environments with few human and medical resources. Many families impacted by emergencies cannot reach therapeutic centers, 

or cannot spare the family members needed to accompany a child in such a center 

for the days or weeks required to reverse malnutrition. In response, USAID has 

worked with non-government agencies and international relief organizations to develop this approach for children with severe acute malnutrition. A central innovation of CTC is the use of ready-to-use therapeutic foods such as Plumpy’nut, an energy-dense peanut paste. Plumpy’nut can be safely given by parents in the home, 

eliminating the need for a prolonged stay in feeding centers. CTC has already been 

introduced in several African countries as well as in Bangladesh. USAID is now 

working with WHO and UNICEF to endorse CTC as the standard of care in all 

countries for managing acute malnutrition. 

My testimony on child survival may best be summarized by the following graph. 
39 

As I noted early in my statement, global efforts to improve Child Survival now 

result in the saving of over 6 million children’s lives each year. This is a tremendous 

accomplishment, and one that needs to be sustained. At the same time, authoritative analyses tell us that we can save at least an equal number of those children 

who still are dying unnecessarily, using the tools and program experience that are 

already available to us. It is our intention to do our utmost with the resources provided to us to accomplish this important goal. 

There is now an important opportunity to accelerate progress in maternal, newborn, 

and child survival 

During the past few years, we have seen new commitments that we believe can 

lead to a ‘‘second wave’’ of global effort to improve maternal and child survival. 

There are new resources appearing from private sector partners like the Bill and 

Melinda Gates Foundation, from bilateral donors like the U.K. and Norway, and 

from multilateral partners including UNICEF. One of the largest increases is 

through funding from the International Funding Facility of the U.K. and Europe for 

immunization, through the Global Alliance for Vaccines and Immunization (GAVI). 

The European Union is providing substantial amounts of new funding to several 

countries to support maternal mortality reduction. 

The Millennium Development Goals (MDGs) are stimulating increased international attention to the need for accelerated progress to reach the child and maternal survival goals; this attention is producing new international cooperation, like 

the inter-agency ‘‘Countdown 2015’’ collaboration to monitor and report on progress 

toward these goals and the inter-agency ‘‘Partnership for Maternal, Newborn, and 

Child Health.’’ The African Union has recently developed and approved a new 
40 

‘‘Framework for Accelerated Progress in Child Survival’’ as well as a new reproductive health regional strategy; work on a similar regional framework for maternal, 

newborn, and child health is beginning in Asia. 

Partly in response to the MDGs, and partly in response to their understanding 

of the need to accelerate social development, some countries themselves are substantially increasing their own investments in maternal and child health. One impressive example is India, whose Prime Ministerial ‘‘National Rural Health Mission’’ and 

new second stage Reproductive and Child Health Project represent the commitment 

of over $2 billion a year to improved health status among the underserved. There 

is also increasing public visibility, including ongoing attention by The Lancet to 

child survival, maternal and newborn health, and global public health in general. 

Against this background, we have a strategy to use our existing resources to substantially reduce maternal, newborn, and child mortality and malnutrition in a focused set of high burden countries 

To take advantage of this opportunity, we plan to focus resources on a set of countries which have the highest need, in terms of both the magnitude and the severity 

of under-five and maternal mortality; that is, countries that have the largest number of preventable deaths as well as the highest rates of mortality. We will focus 

on countries that have strong commitment to improving MCH and the capacity to 

program resources effectively, and wherever possible, offer the potential for interaction with other USG investments, including the President’s Malaria Initiative and 

GAVI funding. We believe it is possible to achieve reductions of 25 percent in underfive and maternal mortality in most of these countries by 2011; and in many of 

them, we also believe it possible to achieve reductions of 15 percent in the number 

of children who are below weight-for-age. 

We will do this by applying our successful lessons from the past and the new approaches and interventions we now have. We will work with countries and partners 

to identify the most important maternal, newborn, and child health and nutrition 

problems, and the most important interventions that can be implemented at scale 

to address those problems. We will support those interventions through appropriate 

integrated delivery approaches, involving the public health system, private sector 

providers, NGOs, and community-based approaches. We will identify the best fit of 

our resources alongside those of other initiatives, partners, and the countries themselves. We will join with countries and partners to monitor progress in terms of improved coverage, and ultimately improved survival, health, and nutrition status. 

And we will identify and invest in developing the capacity of communities, health 

systems, and human resources to achieve and sustain progress. 

Our belief that such rapid progress is possible is not hypothetical. It is based on 

the real recent performance of a number of USAID-assisted countries, shown in the 

following table. 

RAPID REDUCTION IN UNDER-5 MORTALITY BY USAID-ASSISTED COUNTRIES 

Country 

Under-5 

mortality 

(deaths/ 

1,000 births) 

Year To 

Under-5 

mortality 

(deaths/ 

1,000 births) 

Year Percent 

reduction 

Bangladesh ..................................................................... 116 1996 ‰ 88 2004 24 

Cambodia ....................................................................... 124 2000 ‰ 83 2005 33 

Ethiopia .......................................................................... 166 2000 ‰ 123 2005 26 

Malawi ............................................................................ 189 2000 ‰ 133 2004 30 

Madagascar .................................................................... 164 1997 ‰ 94 2003 41 

Nepal .............................................................................. 139 1996 ‰ 91 2001 23 

Tanzania ......................................................................... 147 1999 ‰ 112 2004 24 

Most of these recipient countries are still very poor. Yet they have demonstrated 

that through commitment to effective programs and to bringing needed services to 

children and families, rapid progress can indeed be achieved. These achievements, 

along with those I have already presented in maternal mortality reduction, give us 

confidence that our continuing work with countries and partners can produce equally important results during the next 5 years. 

Finally, the question comes up of determining when a country is ready to go on 

its own in MCH, without continued USAID support—the ‘‘graduation’’ question. We 

plan to approach this process in a phased approach. By looking at past experiences 

and current conditions; progress on key indicators including under five and maternal mortality; and such factors as equity of health status, we will develop and apply 

graduation criteria and analyze each country receiving MCH assistance against 
41 

these criteria. Based on this analysis, we will identify countries that have strong 

chances of successfully graduating in the near term. We will then work with the 

country to focus our program investments and to address institutionalization of 

health systems, including human resources, financing, drug management, quality 

improvement, and information systems and evaluation, that will promote sustainable capacity. This process will produce a 3- to 5-year phase down plan developed 

with the country. In this way, we plan to have a responsible process for dealing with 

countries that make good progress, while at the same time keeping our eye on the 

unmet need of countries with continued high burdens. 

FAMILY PLANNING AND REPRODUCTIVE HEALTH

The United States is firmly committed to promoting the reproductive health and 

well-being of women and families around the world. Over the years, USAID has become the acknowledged leader in implementing the U.S.’s global voluntary family 

planning assistance program. Our portfolio of interventions strongly emphasizes 

method choice and includes a mix of contraceptives that are country appropriate and 

can include long-acting methods, injectibles, and fertility awareness options, sometimes known as natural family planning. We are fully committed to informed choice 

and to ensuring that family planning users know the risks and benefits of the method they choose. USAID supports these contraceptive options with a range of activities to advance service delivery, the quality of the medical care and counseling, and 

the effectiveness and sustainability of family planning programs. Our work includes 

helping to create an enabling environment for family planning programs, support 

for research on improved contraceptive methods, training of health care providers, 

and helping nations create a commodities logistics system. 

Since our program began in 1965, the use of modern family planning methods in 

the developing world, excluding China, has increased by a factor of four, from less 

than 10 percent to 42 percent. In the 28 countries with the largest USAID-supported programs, the average number of children per family has dropped from more 

than 6 to 3.4. Moreover, abortion rates have declined in Eastern Europe and Eurasia. Using Romania as an example, abortion was the primary method of family 

planning through the early 1990s, with women having as many as four abortions 

in their lifetime. When modern contraceptive use more than doubled between 1993 

and 1999, the abortion rate decreased by 35 percent and abortion-related maternal 

mortality dropped by more than 80 percent. 

USAID’s program is unique in a number of ways: it is comprehensive in its support (with activities ranging from contraceptive development, to community-based 

delivery of FP/RH services), it works through multiple channels of delivery (including private sector and NGO sector—while other donors tend to focus on public sector 

and increasingly on basket funding), and it has on-the-ground health experts that 

direct, oversee, and manage bilateral activities. We have pioneered program approaches and continually develop new interventions that will accelerate progress. 

—Our efforts have made family planning services accessible to people in hard-toreach areas. These include door-to-door distribution, clinic-based services and 

employee-based programs. 

—USAID introduced contraceptive social marketing. These programs privatize 

contraceptive distribution and marketing, using the commercial pharmaceutical 

sector to reach more people at lower cost, decreasing countries’ dependence on 

the donor community for supply and distribution of affordable commodities. 

—We support the world’s largest information/education programs that use incountry media and local entertainment outlets, performers, and groups to educate millions of people about contraception, child care, and health. 

—USAID created and standardized the largest repository of fertility and family 

health information, the Demographic and Health Survey, which is used by policy makers and program managers in developing countries and the donor community to assess impact and make informed decisions about program design 

and management. 

—We are the major donor in developing new and improved contraceptive methods 

and supporting research to improve existing contraceptive technology. These innovations provide couples in developing countries with superior and safe methods of family planning. Americans also profit from USAID-supported improvements, such as the introduction of low-dose oral contraceptives and the female 

condom. 

—USAID has always given high priority to providing contraceptive supplies and 

related assistance in logistics and quality assurance. USAID provides 50 to 70 

percent of all contraceptive assistance in the developing world and nearly all 

logistics management assistance. 
42 

We have successfully graduated numerous countries and others with mature programs are on the road towards graduation from family planning assistance, allowing 

us to respond to countries where unmet need is still critical. Currently we are strategically shifting family planning resources towards sub Saharan Africa. The fiscal 

year 2008 budget request targets 43 percent of family planning resources to the region. 

Graduation of several countries from U.S. government assistance for family planning also is an indicator of USAID’s success. In addition to the overall measures 

of lowering fertility and high levels of contraceptive use across income groups, successful graduation from family planning assistance requires that a number of specific elements are in place, including national commitment to family planning, adequate financing for programs, contraceptive security, sustainable leadership and 

technical skills, availability of high quality information, appropriate engagement of 

the private sector, and attention to access of underserved populations. 

The Asian countries of Indonesia, Thailand, and Turkey have graduated from 

family planning assistance. Egypt will graduate by 2010. In Latin America, Brazil, 

Mexico, Colombia, and Ecuador are no longer receiving family planning assistance. 

Family planning programs in the Dominican Republic, Jamaica, and Paraguay are 

on track to graduate from USAID family planning assistance in the next few years. 

In Europe and Eurasia, programs in Kazakhstan, Kyrgyzstan, Moldova, Romania, 

Russia, and Uzbekistan have successfully increased contraceptive use and thereby 

reduced abortion. 

As the world’s largest bilateral donor, USAID delivers assistance in more than 60 

countries through bilateral and regional programs. Each year, U.S. reproductive 

health programs deliver services to more than 20 million women, including clinical 

services as well as non-clinic based approaches to deliver services to the hard-toreach. The Agency works directly with hundreds of non-governmental organization 

partners, the majority of which are foreign NGOs, to provide technical assistance 

to family planning programs at the local level. Assistance is also provided through 

U.S.-based universities, and private sector companies and organizations. 

Despite our strong record of achievement, our work is not done. Women’s health 

burden remains great: 

—More than 500,000 women die annually from maternal causes, almost all of 

them in the developing world. Family planning helps reduce maternal mortality 

by reducing unintended pregnancy and the perceived need by many to resort 

to abortion, as well as by ensuring that the proper spacing is achieved between 

wanted pregnancies. 

—Of these annual pregnancy-related deaths worldwide, about 13 percent (or 

78,000) are related to complications of unsafe abortion. The United States believes one of the best ways to prevent abortion is by providing high-quality voluntary family planning services and providing assistance to prevent repeat 

abortions through the use of family planning. As a result, USAID-supported 

family planning programs in Eastern Europe have resulted in significant declines in abortion as contraceptive use has increased. 
43 

Unmet need continues to be a challenge 

There remains a great need—and desire—for family planning. While more than 

400 million women in the developing world are now using family planning, there 

are an estimated 137 million with an unmet need and 64 million using traditional, 

rather than modern, contraceptive methods. 

Unmet need is particularly great in Africa. There, nearly half of the world’s maternal mortality occurs and on average only 15 percent of married women use contraceptive methods. The desired fertility in the region is considerably lower than actual fertility, which remains high at 5–7 children per women in most countries. Although demographic and health surveys reveal that a high proportion of women and 

men—well more than half in many African countries—said they wanted to wait at 

least 2 years before having their next child or that they had the size family they 

wanted, there were, in fact, nearly 39 million unintended pregnancies in Africa between 1994 and 2000—clear evidence of the need for family planning. In too many 

African countries, attention to family planning has declined and donor and government funding has stagnated. 
44 

There are significant opportunities to accelerate progress 

Though family planning is primarily viewed through the prism of women’s health, 

research has shown that the women themselves view family planning in broader 

terms. They believe that having smaller families and spacing births not only improves health, but increases opportunities for education as well as for greater domestic and community involvement. Their instincts are right—women are critical to 

achieving development goals. 

The impact of family planning on children’s lives often is not considered. More 

than 10.5 million children under the age of 5 die every year in the developing world. 

Many of these deaths can be reduced by expanding access to family planning. Births 

that are spaced too close together, too early, or too late in a woman’s life decrease 

both the mother’s and infant’s chances for survival. Children born too close together 

face increased risk of contracting and dying from infectious diseases and can suffer 

high rates of malnutrition. By helping women space births at least 3 years apart 

and bear children during their healthiest years, family planning could prevent many 

of these deaths. Research done in 2003 has shown that if women had not had any 

births at intervals less than 24 months, almost two million deaths to children under 

age 5 could have been averted. Additional deaths also would have been averted if 

mothers had spaced births at least 36 months apart. 
45 

The education of women is critical. Research has shown a strong link between 

girls’ literacy and many other development objectives. Women who start families before age 20 are less likely to finish school than those who wait even a few years. 

Early and frequent childbearing can limit women’s education. The importance of 

family planning in allowing women to stay in school goes beyond the women themselves. Mother’s education is an important predictor of children’s educational attainment and therefore of their future earnings. Conversely, education also improves 

use of family planning services. Studies show that women with as little as 2 or 3 

years of formal schooling are significantly more likely to use reliable family planning methods than women with no formal education. 

Employment allows women to earn income, which increases life options and involvement in the community. Family planning users often are more likely than nonusers to take advantage of work opportunities. In addition, high levels of female 

labor force participation and higher wages for women are associated with smaller 

family size. As women enjoy greater economic opportunities and as family income 

rises, they spend more money on the education and nutrition of their children, continuing the cycle of opportunity. This in part explain why micro-finance is such a 

powerful tool today in development, both economic and social development. 

Working with key international partners, family planning has now come to embrace a broader mandate. 

—Ensuring that family planning is introduced into policies, programs, and services whenever there is a natural link. At the country level, this aims to ensure 

that there are no missed ‘‘good’’ opportunities. 

—Recognizing that program development is situation specific, USAID will draw 

on the best current programmatic evidence to determine priority interventions 

and conduct further research to identify the best approaches that can be scaled 

up. 
46 

—Programming for impact: underscoring that opportunities and challenges differ 

in each country, local data and experiences will be used to help determine 

which approach to strengthening family planning will have the greatest impact. 

—Exploring strategies to reduce the large inequities—among the poor and hard 

to reach—in family planning access, method choice, and information among population subgroups. 

—Promoting national ownership and responsibility for the strengthening of family 

planning services despite current shifts in priorities and economic environments. 

—Ensuring optimal allocation of resources and strengthening of technical and 

managerial capacity as prerequisites for sustainable family planning programs. 

—Multisectoral approaches: strengthening linkages between health and other sectors so as to make use of all available entry points and opportunities to introduce family planning and address unmet need. 

USAID also has several special initiatives that broaden our work beyond ‘‘bread 

and butter’’ family planning programs. Among them: 

—Reproductive health programs can be effective partners in HIV/AIDS prevention 

in developing countries. Incorporating education and counseling to promote 

condom use and other HIV/AIDS prevention methods in reproductive health 

programs can contribute to the fight to stop the spread of the epidemic. In addition, research shows that adding family planning into programs for the prevention of mother to child transmission of HIV (PMTCT) can greatly reduce the 

number of orphans while saving the lives of thousands of women and children. 

—Slowing the rate of population growth gives nations time to develop sustainable 

solutions to other development challenges. Access to reproductive health programs can contribute to preserving the world’s endangered environments by 

conserving scarce resources. Currently, more than 505 million people live in 

areas already experiencing chronic water shortages, a number that is expected 

to increase to 2.4 billion in the next 20 years. In addition, in the past 3 decades, 

growing populations have caused 10 percent of the world’s agricultural land to 

be lost due to residential and industrial needs. When reproductive health and 

family planning information are widely available and accessible, couples are 

better able to achieve their desired family size. This not only directly impacts 

the well being of families, but also contributes to both better management and 

conservation of natural resources. 

—The Office of Population and Reproductive Health has other special initiatives 

that address women’s health and status in society in innovative ways. These include working to bring about the abandonment of female genital cutting; increasing male involvement in family planning; gender violence; health equity 

which is how to ensure the poorest of the poor receive our services and programs; the reproductive health of refugees; the availability and sustainability 

of health commodities including contraceptives and condoms; and repositioning 

family planning as attention and resources to this crucial health intervention 

are sometimes neglected because of the understandable focus on such pressing 

health concerns as HIV/AIDS. 

We can take advantage of these opportunities by capitalizing on existing resources 

and by focusing on key countries 

USAID must address the great unmet need for family planning that continues to 

exist by: 

—Maximizing access to good-quality services; 

—Emphasizing communication; 

—Focusing on men as well as women; 

—Increasing our efforts to reach the very poor. 
47 

Also, family planning programs can develop better links with other services for 

new mothers and young children. Making common cause among such programs 

should be efficient because unmet need is concentrated among women who are pregnant unintentionally or who have recently given birth. We are developing approaches to address high levels of need in the poorest countries of the world. I have 

spoken of the profound need to expand our programs in Africa. Significant need also 

continues to exist in low contraceptive prevalence countries in Asia, such as Afghanistan, Cambodia, northern India, Pakistan, and Yemen, where prevalence is below 

25 percent. In Latin America, USAID is concentrating its family planning resources 

in Guatemala, Bolivia, and Haiti where contraceptive use ranges from 22 to 35 percent. 

However, USAID’s targeted countries, particularly those in Africa, face a number 

of challenges in their quest to meet the family planning needs of its population. 

Among these are weak health systems, poor access to family planning commodities, 

the non-involvement of men in family planning interventions, and inefficient utilization of resources. 

We also must employ interventions that will ensure family planning remains on 

the agenda of all sectors and continue improving access to all services. Other interventions include strengthening national capacity for sustainable programs, strengthening community participation, addressing family planning needs of vulnerable populations, and conducting operations research. 

BUILDING CAPACITY WHILE SAVING LIVES

Our programs are aimed at achieving impact in saving the lives and improving 

the health of mothers and children. At the same time, we are a development agency—we therefore believe that everything we do should also build the capacity of 

countries and people to improve their own situations. To do this, our program investments aim to build integrated, sustainable approaches and develop key compo-
48 

nents of the health systems countries need to deliver all basic health services. Let 

me touch on several specific areas of particular importance. 

Integration 

As I noted in my introduction, we recognize the important positive connections 

among voluntary family planning and birth spacing, good maternal care, and child 

health and nutrition programs in terms of health outcomes for women and children. 

To achieve these synergies, and at the same time build strong and cost-effective 

platforms for broader primary health care services, we implement integrated maternal-child health and family planning programs in almost all countries where we 

work. 

One example is the delivery of antenatal, delivery, and post-partum care services. 

We know that good antenatal care—including promotion of adequate nutrition and 

anemia prevention, detection and treatment of infections and complications, and 

planning for adequate care at birth—can have important positive effects on outcomes for both women and their babies. It is also an important opportunity to begin 

discussing family planning options for women who want to delay a future pregnancy, which will help preserve their health and that of their infants. In areas 

where malaria is prevalent, we promote antenatal care as a key opportunity to provide antimalarial treatment and promote use of insecticide-treated nets, protecting 

women from anemia and illness, and protecting their unborn children from the low 

birth weight caused by maternal malaria infection. In high HIV environments, 

antenatal care is one of the best opportunities to offer testing and counseling services and identify mothers requiring anti-retroviral treatment or prevention of mother-to-child transmission of HIV (PMTCT). High quality care at delivery is one of the 

most critical interventions for the survival and health of mothers and newborns; it 

prevents or resolves life-threatening complications and provides essential immediate 

care to newborns who need it. It also provides a key opportunity for PMTCT. We 

are now increasingly extending care into the post-partum period, allowing for the 

detection and treatment of serious maternal and newborn complications and better 

promotion of breastfeeding and essential newborn care. This post-partum period is 

also one of the most important opportunities to counsel women in voluntary family 

planning methods. Thus, in practice, our MCH–FP programs are delivered holistically, giving greater impact, greater sustainability, and greater support for other 

important health programs. 

The same is true for the community-based program approaches that we support 

in areas where formal health services cannot meet all basic health needs. We support outreach programs that often deliver multiple interventions including immunization of mothers and children, vitamin A and iron supplements, insecticide-treated 

bednet distribution, and antenatal care. We support community health worker and 

social marketing programs that often deliver family planning advice and commodities, condoms and information for HIV prevention, oral rehydration, and increasingly treatment for malaria and other child illnesses. We support programs for women’s groups that promote family planning, breastfeeding and child nutrition, and 

birth planning; these groups often engage in income-generating and micro-finance 

activities that enhance their effectiveness and influence in their communities. 

Such integrated approaches reap the benefits of synergies among specific interventions and parts of our health programs. They also maximize the potential for 

sustainability by making the most effective use of each contact of services with families. 

Strengthening Health Systems 

Achieving impact while investing in health systems is challenging, given the low 

levels of resources available in most countries with high fertility and mortality, and 

thus the huge number of potential claims on additional resources. As has been seen 

in some countries where a broad focus on health systems has replaced a clear focus 

on health outcomes (Zambia in the 1990s, Ghana recently), investment in systems 

not linked to outcomes will not necessarily improve the survival and health of 

women and children. USAID is recognized as a major contributor to approaches that 

strengthen key elements of health systems, while doing so in ways that link these 

investments to outcomes. Our efforts have made important contributions in several 

critical dimensions of health systems, including: 

Quality improvement.—USAID has been a global leader in the application of modern quality improvement approaches to health and family planning programs in developing countries. The Agency’s ‘‘Maximizing Access and Quality’’ initiative has impacted every country we assist and has even further reach. For example, quality improvement approaches have led to the development of a Global Handbook that documents protocols and best practices for family planning services. This document, 
49 

which has been translated into eight languages, is published by the WHO and is 

used by USAID funded programs in more than 60 countries through WHO’s reach. 

Quality improvement approaches have led to the development of ‘‘standards of care’’ 

for maternal and child health services and the use of these standards to measure 

and improve quality of services. These approaches are being used to improve basic 

services, such as reducing delays in management of life-threatening obstetric complications and improving care of severely ill children; in hospitals in Nicaragua, this 

approach reduced child deaths from malaria by 86 percent, from diarrhea by 57 percent, and by pneumonia by 38 percent. 

Drug and Commodity Supply and Logistics.—USAID is a major supporter of systems that provide, distribute, and track contraceptive commodities and other essential public health commodities. Last year, shipments for contraceptives and condoms 

were provided to 52 countries and additionally, many of these countries also received anti-retroviral drugs and diagnostics. Additionally, technical assistance pharmaceutical management and/or supply chain strengthening was provided in at least 

39 countries. For maternal and child health, where most drugs and commodities are 

parts of routine health systems, efforts have focused on making MCH drugs parts 

of ‘‘tracer’’ systems that evaluate the functioning of overall logistics systems by 

tracking the availability and use of selected drugs. For new products, like zinc for 

treatment of diarrhea, USAID works with the U.S. Pharmacopoeia to develop quality and manufacturing standards needed to allow international procurement by 

UNICEF and countries, and also works with manufacturers to assure adequate 

quantity and quality of products required by programs. 

Financing.—USAID worked with WHO and the World Bank to develop ‘‘National 

Health Accounts,’’ tools that for the first time allow country governments and their 

partners to see all the resources available for health—not just from government, but 

from donors and from families themselves. These important decision-making tools 

are now being utilized in approximately 70 countries, with direct USAID assistance 

to 26 of these. Another important area of USAID engagement is support for ‘‘risk 

pooling’’ approaches that remove cost barriers to care. One important approach is 

technical assistance to community-based insurance plans, or ‘‘mutuelles,’’ which is 

an innovative way to finance health care in Africa. These community-based plans 

now exist in about a dozen African countries; in Rwanda alone, where USAID is providing assistance, by 2006 there were over 300 community-based plans serving over 

3.1 million people (or 40 percent of the population). 

Human Resources and ‘‘Brain Drain′′ 

One challenge which faces virtually all of our health programs is the movement 

of trained health care providers away from developing countries and into more developed countries—commonly referred to as the ‘‘brain drain.’’ 

As a development agency, USAID has little influence on the policies of wealthy 

countries that receive emigrating health professionals, the demand side of this 

issue. Our strategy in this area focuses on retaining trained providers in their countries’ health systems, the supply side of the issue. 

The in-country factors affecting the healthcare human resource supply are more 

than a shortage of workers or absentee-ism due to training. Low salaries and poor 

working conditions drive workers to other types of employment even within their 

own country. Weak human resource management systems do not support workers. 

The recruitment, deployment and promotion of workers are often politicized and not 

performance-based. Additionally, an inappropriate alignment of the workforce 

means that tasks are often assigned to the wrong types of workers causing overly 

burdensome workloads. 

USAID is actively engaged in multiple efforts within countries to increase retention and contribute to greater worker productivity. Specifically, in almost every 

country where USAID has programs, USAID is developing and/or strengthening inservice training systems to provide workers with the knowledge and skills needed 

to do their jobs; often utilizing innovative learning approaches, such as distance 

learning and self-directed learning, in order to minimize the time workers are out 

of post for training. USAID is collaborating with Ministries of Health to strengthen 

supervision systems so that they provide positive support to workers, and is instituting quality improvement methodologies that encourage workers to take an active 

role in ensuring the quality of the services they provide. 

Keeping workers on the job is essential to increasing the number of workers. In 

five African countries, several approaches are being tested and implemented in 

USAID programs, including: piloting financial and non-financial incentives; developing clear and equitable careers paths; offering continuing education and professional development. There has been an increased retention of workers in Ghana, 
50 

Namibia and Uganda with improvements to the working environments and benefits 

such as transportation reimbursements. 

Improved management and modern quality improvement approaches are affordable and have the potential to improve dramatically the way health systems manage 

their human resources, helping to retain workers. USAID provides support for workforce planning and rationalization in six countries. Human resource (HR) managers 

are assisted to develop the skills needed to scan and analyze HR data, determine 

relevant policy questions, and make policies to ensure that workers with appropriate 

skills are available when and where they are needed. In several countries, HR Directorates in Ministries of Health are being strengthened through training of key 

staff and through secondments of HR experts who then share their knowledge and 

skills so as to create strong HR managers. In a number of countries, USAID is assisting MOHs, licensing and certification bodies, private-sector organizations and 

other stakeholders to develop the human resource information systems they need. 

Sustainability 

Sustainability of MCH and family planning programs is a critical goal of USAID. 

To this end, we aim to: 

—Increase funding by host governments of national MCH/FP programs. 

—Increase diversification and long-term funding of MCH/FP activities by donors 

and international organizations. 

—Improve the quality of national MCH/FP activities and establish critical masses 

of health workers competent in MCH/FP interventions. 

—Achieve high and sustained national coverage rates for MCH/FP interventions. 

—Reduce inequities in access to health care and in health outcomes. 

—Involve community, voluntary and private sector organizations in MCH/FP activities at national, district and community levels. 

With progress on each of these elements, MCH/FP programs will become more effective and sustainable. More importantly, national leaders, health managers, and 

the general population will expect and demand effective, nationwide MCH/FP programs and will help to make this happen. There will also develop an international 

mandate that no country will suffer stock-outs of essential MCH/FP commodities. 

This has already occurred for child vaccines. Finally, national governments and 

international donors and organizations will be judged by the quality and coverage 

of their MCH/FP programs. 

There is now evidence that USAID, other donors, and national governments are 

helping to make important progress on all these key elements of sustainability. For 

example: 

—There is evidence that host government contributions to MCH/FP programs 

have increased in real dollar terms over the past 10 years. 

—Coverage rates for key MCH/FP interventions are steadily increasing. For example, the worldwide coverage for the third dose of the DPT vaccine is 74 percent and for vitamin A is over 50 percent. 

—As highlighted above, there are major new commitments of international partners to MCH/FP and some new funding mechanisms that promise long-term 

support for the sub-sector. 

Complementary Funding and Global Development Alliances 

USAID funds have complemented over $4.6 billion from partners to advance development objectives worldwide. 

USAID provides leadership in the Reproductive Health Supplies Coalition 

(RHSC), a coalition of 21 members—multinational organizations, bilateral and private foundation donors, low and moderate income country governments, civil society, 

and the private sector—that works to increase political commitment and public and 

private financial resources, as well as more effective use of resources to ensure sustained access to quality reproductive health supplies through public, private, and 

commercial sectors. 

USAID supports the Global Alliance for Improved Nutrition (GAIN) to accelerate 

micronutrient fortification programs globally and to mobilize the private sector to 

deliver fortified products to the poor. The Alliance includes 14 governments; three 

donors; the United Nations; the private sector including Proctor and Gamble, 

Unilever, Danonoe, and Heinz; development agencies such as the World Bank; education and training institutions; and civil society. The Alliance has supported 15 national food fortification programs projected to reach 446 million people. 

Between fiscal year 2001 and fiscal year 2006, USAID contributed $352.5 million 

to GAVI as one of the largest government donors representing nearly 20 percent of 

GAVI’s funding. Since GAVI’s inception in 1999, the Gates Foundation combined 

with a variety of donor governments has contributed a total of $1.9 billion. 
51 

CONCLUSION

USAID sees improved health for the world’s poorest people not only as a moral 

imperative but also as a pragmatic investment of U.S. funding for peace, security, 

and world-wide economic growth. USAID-supported MCH/FP programs have a proven record of success which is helping to save lives and build health systems. Our 

support has helped to reduce under-five mortality in almost 30 countries and maternal mortality in ten countries. USAID-supported family planning programs have 

been successful in increasing access to and use of modern contraceptives in all regions of the world. We now have program approaches and new interventions that 

will allow us to build on these successes and make additional progress. We also 

have valuable experience in delivering these interventions and approaches in a fully 

integrated and cost-effective manner at district, health center, and community levels 

so that these life-saving services can be affordable and sustainable. With the continued support of Congress, we will be able to contribute to further gains in maternal 

and child health and family planning throughout the developing world. Thank you 

for your support. 

Senator LEAHY. Thank you very much. I read your testimony last 

night, and I know your personal commitment to this. 

Dr. Gayle, thank you for being here. I’ve heard you speak many 

times before, and I just appreciate you taking the time here. 

STATEMENT OF DR. HELENE GAYLE, PRESIDENT, COOPERATIVE FOR 

ASSISTANCE AND RELIEF EVERYWHERE 

Dr. GAYLE. Thank you very much, Chairman Leahy, and thank 

you for having us here, and thank you for your consistent and passionate commitment to these issues. 

I’m really honored to be here in front of you, and with the other 

witnesses here who, also, as you said, bring a lot of experience, and 

are very distinguished in this area. 

I represent the organization CARE, which is committed to reducing global poverty, and have broadened from what I was doing in 

the past, focusing on health issues, because I believe strongly that 

poor health and poverty are very intertwined. And so, that’s the 

context in which our work is done, where we feel that health has 

such an important contribution to our work in eradicating global 

poverty, and vice versa. 

I’m not going to go through a lot of the facts, I think people have 

put those on the table, and I think have very eloquently pointed 

out that there are very unacceptable gaps in maternal mortality 

and child health and child survival around the world, and important unmet needs in family planning and contraception. 

Also, I think the testimony that Dr. Hill gave pointed out the incredible advances that the U.S. Government, particularly through 

USAID, has made, and the real leadership role that we have 

played around the world on these important health issues. I 

think—if nothing else—I would say our message is that we would 

like to continue to see the United States play that kind of global 

leadership role in these issues, and that we have an opportunity 

to continue to build on these incredible advances that have already 

been made. 

So, important progress has been made, but I think as has been 

pointed out, there is still a lot that remains, and that in some 

ways, we’ve become complacent about basic public health issues, 

like maternal and child health, and family planning as we have 

moved to focus on very key, specialized issues, like HIV and malaria and others, where we have seen incredible, and important, 

growth. But, I think, in the meantime it means that we’ve kind of 
52 

let our eyes off of some of these very basic and core issues, where 

we have such a basis for continuing to build. 

Let me just make a few points from our experience, and then 

some recommendations. I’ll make first, four points. First of all, that 

technical solutions alone will not bring about lasting results. Obviously, it’s important to continue to look for better and new technologies, but for health impacts to be sustainable, they must also 

address the underlying causes of poor health, and the reasons why 

people don’t have access to these technologies to begin with, and 

making sure that we have a focus on that. 

So, for example, we had a project in Peru, in an area in rural 

Peru, where CARE found that only one-third of women who needed 

obstetrical services actually accessed them. I mean, this is in an 

area where mortality—maternal mortality was about 15 times 

higher than it is here in the United States. 

But, by working to understand the needs of the rural women, for 

example, giving respectful attention from staff to speak to women 

in local language, provide access to transportation, provide basic facilities that met the needs of those women, and by connecting 

health workers at various levels, and really looking at, how do you 

distribute health services at different levels, and removing blocks 

to emergency referral care and services, CARE was able to reduce 

maternal mortality by half. 

So, even if the services are there, if they’re not appropriate, if 

they don’t take local circumstances into consideration, the needs 

won’t be met. And so, we have to look at coupling our technology 

with ways to get it to people that are appropriate. 

Second, we learn that by being marginalized and powerless within a society, is often closely linked to one’s ability to access 

healthcare services, and is linked to overall health status of the 

most vulnerable. The—less power means that people have less 

voice, and often less access to services. In most developing countries, women and youth are the least powerful, and the roots of 

health problems they face are often hidden. 

An example, from our work in Bangladesh, where CARE is working on a Safe Motherhood Initiative, we found that domestic violence was really the—one of the greatest risks that women faced 

during pregnancy, and that if we didn’t address the domestic violence issues, and look at women’s needs in a holistic fashion, that 

our obstetrical care programs didn’t work. We were able to modify 

our approach to incorporate efforts to prevent violence against 

women in our Safe Motherhood Work, and found that our programs 

were much more effective and were actually able to reduce maternal mortality. 

Third, and Dr. Hill mentioned this as well, we’ve learned that dividing public health into various categories—while it may be convenient for allocating donor funding—that it really doesn’t, is not 

the most effective way to approach health services. 

So, for example, maternal mortality and child survival are not 

separate activities. In some countries, if the mother dies, the risk 

of death for her child and her children under 5 doubles or triples. 

Sometimes, as with HIV/AIDS, and reproductive health, we not 

only pursue them as separate issues, but also build parallel sys-
53 

tems to develop services, so that we’re not wasting resources that 

make our services more ineffective. 

So, by providing HIV information and testing to reach women, 

within the context of reproductive health, we obviously have much 

more effective programs. 

Then finally, we at CARE are dismayed by what seems to be a 

tendency to move away from evidence-based programs within the 

U.S. foreign assistance programs, particularly as they relate to sex 

and reproductive health. So, for example, the abstinence until marriage earmark in the Global AIDS Act of 2001 is a concern, whether or not it impedes the ability to have comprehensive and evidence-based programs that focus on the best programs and the epidemiology within local circumstances. 

Let me just wrap up by saying a few things that we would like 

to recommend. First, investing more, and more strategically in reducing maternal mortality and enhancing child survival. Over the 

past 5 years, the commitment to maternal and child health funding 

has not kept pace with the unmet needs or growth in other international health accounts, as has been well outlined. We urge you 

to provide strong funding levels for international maternal and 

child health programs. In particular, CARE strongly supports the 

U.S. Fair Share levels that Nils Daulaire will outline shortly. 

Second, a recommitment to the importance of family planning. 

This is one of the most cost-effective investments the United States 

can make in the future of women, children, communities and nations. The administration’s budget request proposes a 23 percent 

cut in family planning funding for 2008, noting that these efforts 

do not require as much U.S. investment, because they’ve been so 

successful. Well, this is obviously the case, and we urge you to, not 

only restore those cuts, but to increase funding levels for international family planning. 

Also like to draw attention to the reports that the World Bank’s 

new Health, Nutrition, Population Strategy that’s going to be discussed here in Washington, appears to diminish their commitment 

to family planning, and we see this as an area of great concern. 

Third, commit to evidence-based reproductive health programming for youth. With the impending youth bulge that is going to 

occur, that’s anticipated by demographers, the needs for reproductive health services that are tailored to the conditions for youth are 

critical and important. 

Fourth, removing any legal barriers that get in the way of evidence-based, effective programming in reproductive health and 

HIV. As mentioned, our concerns about any particular earmarks 

that don’t provide for comprehensive funding. 

PREPARED STATEMENT

Finally, investing more globally in global health and development, in ways that help to strengthen the health infrastructure. As 

is previously noted, the importance of building a workforce capacity, without that, and without a strong commitment to the overall 

health infrastructure, none of these individual programs will be 

successful. 

[The statement follows:] 
54 

1 A recent analysis of six projects funded by USAID’s Child Survival and Health Grants Program indicates that mortality of children under 5 has been reduced by approximately 8 percent 

in project areas due to interventions supported by the program. 2 Center for Global Development, Millions Saved: Proven Successes in Global Health, 2007 edition. 

PREPARED STATEMENT OF DR. HELENE GAYLE

Chairman Leahy, Senator Gregg, Subcommittee Members. I am honored to be 

here, discussing issues that are vital to the future of millions of people. For the past 

61 years, CARE has worked across a spectrum of poverty-fighting arenas—from 

child survival to clean water, and from basic education to HIV/AIDS. We believe 

that poor health and extreme poverty are intertwined, and that one cannot be overcome if the other is neglected. That is why we work on a broad range of health 

issues, including maternal and child health, infectious diseases, ranging from HIV/ 

AIDS to avian influenza, and reproductive health. My testimony today reflects 

CARE’s experience in thousands of poor communities throughout the world over the 

course of half a century. 

We are here today to consider some basic, yet heart-wrenching, questions. Why 

does one woman die every minute of every day from complications related to pregnancy and childbirth? (99 percent of these deaths occur in developing countries, and 

the reasons are basic: women hemorrhage to death, they lack access to antibiotics 

to prevent infection or they don’t have the option of a cesarean section.) Why do 10.5 

million children die each year before their fifth birthday (greater than the number 

of adults who die from AIDS, malaria and tuberculosis combined), when most of 

these deaths are preventable? Why, at a time when contraception is cheap and effective, do 120 million couples have an unmet need for family planning? Why, when 

some 70 percent of young women in Africa become sexually-active as adolescents 

and more than 20 percent have their first child by 18, do we hesitate to confront 

that reality? 

Despite the magnitude of unmet need that remains, the U.S. Government can be 

proud of the difference it has made in the global health arena.1 For example, American leadership in family planning has contributed to some impressive gains. In 

1960, only 10 percent of married women in developing countries used modern contraception. By 2000, this figure had risen to 60 percent—and the average number 

of births per woman had fallen from six to three. More broadly, in the past 50 years, 

life expectancy in the developing world has risen from 40 to 65 years, and a child’s 

chance of living to the age of five has doubled. 

We have learned that large-scale improvements in public health are achievable. 

We have seen the real difference made in lives saved and economies strengthened. 

Sri Lanka’s long-term commitment to a range of safe motherhood services has, over 

four decades, decreased maternal mortality from 486 to 24 deaths per 100,000 live 

births. In Egypt, a national campaign that promoted the use of oral rehydration 

therapy helped reduce infant diarrheal deaths by 82 percent between 1982 and 

1987. China’s national tuberculosis program helped reduce TB prevalence by 40 percent between 1990 and 2000, and translated directly into social and economic benefits: for each dollar invested in the program, $60 was generated in savings on treatment costs and increased earning power of healthy people.2

Even though important progress has been made, the need remains enormous and 

urgent. The knowledge and experience we have already gained position us to invest 

resources more wisely—and the partnerships formed reflect greater capacity to turn 

resources into effective action. Yet, even as efforts to fight HIV and AIDS are receiving greater attention and resources (as they should), we are becoming too complacent about basic public health issues like maternal and child health, family planning, and adolescent reproductive health. And we are not paying sufficient attention 

to building the strong, accountable health systems (both infrastructure and workforce) required to support any health interventions, be it neonatal care, family planning or AIDS treatment. Ultimately, CARE’s experience in poor communities strongly supports both the need for increased investment of resources, and better use of 

those resources. 

Our first, and most important, insight has been that ‘‘technical solutions’’ alone 

don’t bring lasting results. For health impacts to be sustainable, they must address 

underlying causes of poor health, be tailored to each cultural context and be broadly 

owned by local communities. For example, emergency obstetric care is vital to reducing maternal mortality, but lasting improvements in maternal health are not 

achieved simply by making such care available. 

In rural Ayacucho, in Peru, CARE found that only one-third of women who needed obstetric services actually accessed them; and of every 100,000 live births, 240 
55 

women died (by contrast, in the United States, this ratio is 17 of every 100,000 live 

births). CARE did not approach this challenge as an exclusively medical problem. 

Rather, we tried to understand the health system in Ayacucho as a unique social 

institution embedded in a specific community. We found that women did not seek 

care because health center staff often did not speak Quechua (the local language) 

and women did not feel welcome there. Health center staff felt inferior to regional 

hospital staff and often felt ridiculed by them when they referred an emergency 

case; they also did not have means to transport emergency cases. Hospital staff were 

frustrated that emergency referrals were often misdiagnosed or came too late to 

save women’s lives. 

By working to understand the needs of rural women and health workers at various levels, and removing blocks in the emergency referral system, CARE has helped 

to reduce maternal mortality in Ayacucho by half. Now, all health centers in our 

project area and the regional hospital have Quechua-speaking staff, a friendly environment, and culturally-appropriate options for childbirth (such as vertical birthing 

chairs, preferred in Ayacucho). Emergency obstetric protocols were developed by collaboration among doctors, nurses, midwives and Ministry of Health staff, drawing 

from ideas and realities of rural health personnel. As a result of competency-based 

training provided to rural health personnel and cost-effective resources like two-way 

radios and ambulances, women’s conditions can now be diagnosed more accurately 

and they can be transported to hospitals quickly. Currently, 75 percent of women 

who need obstetric services can access them. A key aspect of CARE’s approach was 

building broad political will to address the exceedingly high maternal mortality rate. 

As a result of Ayacucho’s success, in January 2007, the Peruvian Minister of Health 

established new national clinical guidelines for obstetric emergencies, based on 

those developed by this project. 

Second, CARE has learned that individual and collective empowerment has much 

to do with access to health care services, accountability of health systems and the 

ultimate health status of the most vulnerable. Less power means less voice and less 

access, and that inequity results in poorer health. In most developing countries, 

women and youth are the least powerful, and their needs are often neglected. The 

roots of the health problems they face are often hidden, but we must strive to uncover, understand and address them. 

In Bangladesh, where CARE had been implementing a safe motherhood initiative, 

we concluded that domestic violence was one of the greatest risks that women faced 

during pregnancy. Even the best prenatal, obstetric and post-partum care could not 

fully help these women, unless the phenomenon of rampant violence against women 

was also addressed. CARE’s modified approach, of incorporating efforts to prevent 

and respond to violence against women into safe motherhood work, holds much 

more promise not only of helping women have healthier pregnancies but also of securing safer societies. In isolated southern Maniema province, in the Democratic Republic of Congo, local health systems were devastated by war and women had encountered brutal violence and rape in war-time. Many women had married young 

and had multiple pregnancies, and CARE’s promotion of family planning and birth 

spacing was welcomed as a respite—a chance to control at least one aspect of their 

bodies and lives. A young woman named Anifa told us: ‘‘Normally, I’d be pregnant 

again, and able only to concentrate on my new baby, and not my other children. 

Now that I can control my pregnancies, I can be sure that my kids go to school. 

I will see a better life through my children.’’ 

Third, we have learned that dividing public health into various categories may be 

convenient for allocating donor funding, but these inherently related issues have to 

be understood and addressed within a broader and more integrated context. For example, we talk about maternal mortality and child survival as separate issues, but 

we know that they cannot be separated. In some countries, if a mother dies, the 

risk of death for her children under 5 doubles or triples. When women cannot space 

the births of their children, both they and their children are less likely to be 

healthy. Sometimes—as with HIV/AIDS and reproductive health—we not only pursue them as separate issues, but also build parallel systems to deliver services. This 

is ultimately a less efficient investment of resources as well as a barrier to effectiveness—for example, HIV information and testing could reach many more women, in 

ways that are potentially less stigmatizing, if they were made available through 

family planning or prenatal care services. Even within CARE, which is considerably 

less complex than the U.S. government, maintaining a system-wide view and integrating across various sectors and technical specialties is a challenge. We are constantly trying to do better. 

Finally, we at CARE have been dismayed to witness the increasing politicization 

of U.S. foreign assistance related to programs that deal in any way with sex or re-
56 

3 In addition to the abstinence-until-marriage earmark and the Mexico City Policy, increased 

politicization is also evident in the requirement of the Global AIDS Act of 2003 that organizations must adopt a policy opposing prostitution and sex trafficking in order to be eligible for 

HIV/AIDS funding authorized under the act. 

production.3 For example, the abstinence-until-marriage earmark in the Global 

AIDS Act of 2003 requires that one-third of all HIV prevention funding be spent 

on abstinence programs. Administrative guidance issued by the Office of the Global 

AIDS Coordinator translates this earmark into a requirement that fully two-thirds 

of funding for preventing sexual transmission of HIV be spent on abstinence and 

fidelity programs. It also permits condoms to be provided only to sexually-active 

youth, with little recognition of the fact that those who are not sexually-active today 

may be so tomorrow (no matter how much we urge them to be abstinent) due to 

economic pressures driving transactional sex or vulnerability to sexual violence. Although the earmark governs only the U.S. Government’s HIV/AIDS responses, the 

message that A and B are the priorities have strongly influenced U.S. reproductive 

health programs—especially those working with adolescents. The spillover effect is 

that reproductive health programs targeting youth are increasingly constrained in 

terms of the information and services they can provide—as a result, U.S. funded 

programs are less effective at protecting young people from pregnancy, or HIV and 

other STDs. 

From CARE’s perspective, family planning and women’s reproductive health have 

become too politicized and are losing ground on the U.S. global health agenda. The 

Mexico City Policy, in particular, is symbolic of this politicization and has caused 

much difficulty for implementers of reproductive health programs. Much of the work 

of international NGOs like CARE is done in partnership with local organizations. 

In the reproductive health field, many of the best local organizations provide comprehensive family planning services, sometimes including counseling on safe abortion. The Mexico City Policy prohibits organizations like CARE from working with 

such organizations, and in some cases, prevents us from working with the only organizations that are capable of providing the most basic family planning services. 

Thus, it diminishes not just the availability of these services but also their quality. 

These are just some of CARE’s experiences that are pertinent to the matters at 

hand today. Given what we have learned, I want to urge you to consider the following: 

First, invest more—and more strategically—in reducing maternal mortality and 

child survival. On this, the twentieth anniversary of the global safe motherhood 

movement, the slow progress on reducing maternal mortality undermines America’s 

deeply-held commitment to strengthening health and well-being throughout the 

world. We must gather the will and do much better. Over the past 5 years, United 

States commitments to maternal and child health funding have not kept pace either 

with unmet needs or with increasing growth in other international health accounts. 

I urge you to provide strong funding levels for international maternal and child 

health programs in 2008. In particular, CARE strongly supports the requested 

United States ‘‘fair share’’ levels outlined by Nils Daulaire on behalf of the Global 

Health Council for maternal and child health, and I urge their adoption by this committee in the coming appropriations process. 

The vast majority of maternal deaths are due to hemorrhage, infection and obstructed labor and can be easily prevented or treated. For each of the half a million 

women who die of complications during pregnancy and childbirth, 30 others are injured, many of them in seriously disabling and socially devastating ways. Women 

with obstetric fistulas, for example, are often abandoned by their families and condemned to isolation. The lifetime risk of dying in pregnancy or childbirth is 1 in 

16 for women in developing countries, as compared to 1 in 2,800 in developed countries. In Afghanistan, where 95 percent of women deliver their babies at home, without a skilled attendant on hand, the lifetime risk of dying in pregnancy or childbirth 

is 1 in 6. 

We must invest more strategically, not only to strengthen and expand all levels 

of health care (particularly speed of emergency referrals and quality of emergency 

obstetric care) but also to remove barriers to women’s access to health systems and 

services. We must strive to ensure that all pregnant women have a skilled attendant at delivery; this need not be a doctor, but must be someone who can diagnose 

complications, administer drugs to manage them, and (where possible) refer women 

to emergency obstetric care. Drugs like misoprostol, which are cheap and easy to 

administer, can help strengthen contractions and control post-partum haemorrhage, 

and could ultimately increase the effectiveness of skilled attendants and reduce maternal mortality. 
57 

4The analysis referenced in footnote 1 indicates that these projects saved more than 16,000 

lives of children under 5. 

Maternal health and child survival go together—this is why funding to reduce maternal mortality is such a smart investment. Four million babies die each year in 

the first month of their life; that is roughly the equivalent of all babies born in the 

United States in 1 year. Simple interventions like promoting breastfeeding, oral rehydration therapy, vaccinations, clean water, and insecticide-treated bed nets could 

make a huge impact on child survival, even where health systems are weak. 

USAID’s Child Survival and Health Grants Program has done excellent work in this 

area and deserves your increased support.4 In partnership with this program, CARE 

has worked in the extremely poor far-west region in Nepal to reduce under-5 mortality by 53 percent. A key approach in Nepal was community case management, 

whereby volunteers are trained to provide an antibiotic to treat pneumonia. This 

intervention effectively prevents pneumonia deaths in communities where many 

families do not have the money or means of transportation to see a doctor in time. 

In settings as diverse as Nepal, Mozambique and Sierra Leone, CARE has achieved 

significant reductions in under-5 mortality for a cost per life saved of between $740 

and $980. 

Second, recommit to the importance of family planning. Access to family planning 

services represents one of the most cost-effective investments the United States can 

make in the future of women, children, communities and nations. Family planning 

returns enormous value in improved health outcomes, economic development and 

national security. Yet, the administration’s budget request proposes a 23 percent cut 

in family planning funding for 2008. I urge you to not only restore the cut, but also 

provide significantly increased funding levels for international family planning, as 

the request outlined by the Global Health Council indicates. 

The ability to decide when, with whom and how often to have children is key not 

only to the individual futures of women and girls, but also to the development of 

countries struggling to overcome poverty. Although methods for avoiding unwanted 

pregnancies are cheap and effective, every year, 80 million women have unintended 

pregnancies. The unmet need for contraception is closely related to maternal mortality: if every woman who needed contraception had access to it, an estimated 20– 

35 percent of maternal deaths could be averted. However, with other health priorities taking precedence, family planning seems to be declining in importance. Between 1995 and 2003, donor support for family planning (commodities and service 

delivery) fell from $560 million to $460 million. 

The rationale provided by the administration for the 23 percent cut in family 

planning funds for 2008 is that these efforts have been so successful that they don’t 

require as much U.S. investment going forward. Unfortunately, that is hardly the 

case. Large pockets of substantial unmet need still remain, and gains are reversed 

all too quickly when they are not reinforced. Kenya, for example, had a fertility rate 

of about eight births per woman in the 1960s. After decades of investment in family 

planning services, the fertility rate had fallen to 4.8 births per woman in 1998. In 

the past few years, however, attention has shifted away from family planning. As 

a result, availability of contraceptives at health facilities declined, as did outreach 

services. Sadly, between 1998 and 2003, the proportion of births reported by mothers as unwanted rose from 11 percent to 21 percent. 

On a related note, I also want to register our concern about recent reports that 

the World Bank’s draft health, nutrition and population strategy omits any commitments to family planning. This strategy is under review as we speak today and, if 

approved, could deal a serious blow to reproductive health programs all over the 

world. CARE urges the United States, as the largest shareholder of the World Bank, 

to underscore the importance of family planning and reproductive health in achieving progress on multiple fronts, including economic development, basic education 

and public health. 

Third, commit to evidence-based reproductive health programming for youth that 

is grounded in sound public health practice. The impending ‘‘youth bulge’’, anticipated by demographers, demands that we act effectively, realistically and rapidly. 

Sadly, the new strategic framework for U.S. foreign assistance fails to highlight the 

specific needs of youth, and places their critical needs underneath a broader umbrella. Although the intent to ‘‘mainstream’’ youth reproductive health is laudable, 

our observation is that fewer and fewer U.S. funding opportunities are addressing 

youth issues—and we believe this important issue may be falling through the 

cracks. 

Young people, especially girls and young women, are vulnerable on many fronts, 

but especially when it comes to pregnancy, STDs and HIV/AIDS. They are less likely than older people to protect themselves, either because they are not aware of— 
58 

or cannot access—the protective measures that can keep them safe or because they 

have less control over the terms of sexual relations. We must ensure that the needs 

and rights of the most vulnerable young people are protected: for example, adolescents at risk of inter-generational or transactional sex; girls at risk of child marriage; young people who are victims of gender-based violence; and youth in conflict 

or post-conflict settings. Many young people fall into the category of orphans and 

vulnerable children (OVCs), orphaned or made vulnerable due to HIV/AIDS, other 

diseases and conflict, and are left without parental guidance and are particularly 

vulnerable to sexual exploitation. These young people are at risk of unplanned pregnancies, HIV/AIDS and other STDs, and therefore, are badly in need of comprehensive reproductive health services. 

Fourth, eliminate legal barriers that impede evidence-based programming in reproductive health and HIV/AIDS, especially related to vulnerable women and adolescents. I urge Congress to repeal the abstinence-until-marriage earmark and request the Office of the Global AIDS Coordinator to revise its ABC guidance in a way 

that promotes (rather than discourages) comprehensive sex education. I also urge 

Congress to repeal the Mexico City Policy—there is no evidence that having this policy in place has reduced the number of abortions performed. In fact, by cutting off 

funds to foreign family planning organizations that reject its conditions, the Mexico 

City Policy has most likely increased the number of unplanned pregnancies and led 

to increased numbers of abortions sought. 

In some of the countries in which CARE works, we see the implementation of the 

ABC approach translating into the operational message that abstinence and fidelity 

are the most desirable and moral options, and positioning condoms as something 

used only by people engaging in risky sex or as a ‘‘last resort’’. When Uganda first 

developed the ABC approach, it was compelling because it demystified HIV/AIDS 

and communicated that individuals had the power to protect themselves by choosing 

among A, B or C options. Delaying sexual debut and partner reduction is absolutely 

vital to preventing HIV and other sexually transmitted infections, but that does not 

mean that A, B and C should be broken up into parts and promoted to different 

segments of the population. In settings where risk of HIV infection is high, it is a 

disservice to not provide comprehensive information and prevention methods to 

young people who are not yet sexually active. The young girl who we counsel today 

about abstinence may be married tomorrow (or coerced into transactional sex), and 

we have an obligation to prepare her for the future. 

Finally, invest more broadly and strategically in global health and development. 

The U.S. leadership on HIV/AIDS has been admirable, but it must be accompanied 

by broader investments that promote community-led development, strengthen 

health care systems and build workforce capacity. We cannot save babies from contracting HIV only to see them dying of diarrhea or languishing without access to 

basic health and social services. Our investments in drugs, tests and other health 

interventions will be constrained if there are not enough health workers to administer them. If all boats don’t rise at similar levels, the bold investment in HIV/AIDS 

may fail to deliver on its promise—and other areas in which gains have been made 

over several decades may be undermined. We cannot let that happen. 

I want to thank you for inviting me here today and I look forward to answering 

your questions. CARE has been a partner in the fight against global poverty with 

the U.S. Government and the American people for more than half a century and 

we are grateful for what your support allows us to do in thousands of poor communities around the world. We look forward to a future of productive partnership and 

exchange. 

Senator LEAHY. Thank you, and I think you understand, Doctor—— 

Dr. GAYLE. No, no, that’s fine. 

Senator LEAHY. No, I think you understand, also—— 

Dr. GAYLE. Yeah. 

Senator LEAHY [continuing]. From my background that you 

preach to the converted on many of these issues. 

Ms. Garrett, again, as I said earlier, your writings have been extremely illuminating. It was recommended to me by my staff to 

make sure to read your testimony, which I did, but please, go 

ahead. 
59 

STATEMENT OF LAURIE GARRETT, SENIOR FELLOW FOR GLOBAL 

HEALTH, COUNCIL ON FOREIGN RELATIONS 

Ms. GARRETT. Thank you very much, Senator, and thank you 

very much for your interest and concern in this area. 

I was going to remark that most Senators don’t have a constituency that provides them with an advantage to taking on these 

issues, they’re not make or break issues, but I think that may be 

different for Vermont. 

I’m happy to say that, with my colleague here to the right. 

Speaking of my colleagues, the two prior talks—— 

Senator LEAHY. Dr. Daulaire is rarely to anybody’s right, but 

please, go ahead. 

We don’t need that—we don’t need that in the transcript, I’m 

sorry. It was just too easy, it was just too easy. 

Go ahead. 

Ms. GARRETT. Well, of course from your vantage point, he’s to my 

left. 

Senator LEAHY. There you go. In fact, Dr. Daulaire is one of the 

most respected health professionals I know—by Democrats and Republicans. 

Ms. GARRETT. My colleagues have done a wonderful job of laying 

out some of the key issues. What I’d like to do is, you have the 

written text, let me just see if I can hit some key points here. 

We are in an age of such fantastic generosity, we have seen the 

amount of money, as your chart indicates, skyrocketed, as being 

dedicated to global health, but it isn’t just U.S. Government funding, it is across-the-board in increase in the amount of generosity 

pouring into global health. This is a skyrocketing that, literally, 

has occurred in the 6 year’s time. 

Six years doesn’t provide us with a big window to reflect, to try 

to ascertain whether the way we’re spending the money, whether 

it’s coming from philanthropic sources, such as the Gates Foundation, or individuals with great celebrity cache, such as Bono and 

Angelina Jolie and Brad Pitt, or coming from a whole host of other 

Government agencies around the world, akin to our USAID. 

It is a phenomenal amount of money, but it has not been suddenly flooded in with some overview, with some perspective put behind it. 

So, what we’re doing is, we’re increasing charity, we’re not building anything. We’re increasing charity. One of the key pieces of 

why the charitable incentive has risen so much, is because we now 

have evidence that certain diseases can be held at bay with seeming quick-fix drugs, with medicines that can be applied to them, 

and of course, HIV is the big landmark turning point, with the 

1996 innovation of antiretroviral combination therapy. 

But the problem here is that the notion that we can simply flood 

a treatment modality on top of a very, very weak public health infrastructure, and suddenly medicalize a public health infrastructure overnight, this is—6 years is overnight—and turn it into a 

medical delivery system, that can instantaneously get 

antiretrovirals out to people in rural areas all over sub-Saharan Africa, get tuberculosis drugs out all over Haiti, get malaria bed meds 

out all over West Africa, this is an absolutely asinine notion. We 

cannot, overnight, scale up, switch our public health format into a 
60 

medicalized treatment intervention format, without having casualties, all along the way. 

What are the big casualties? Women and children. Because the 

safety and survival of children under 5 is really, absolutely a public 

health mission. What kills children? Dirty water. Getting into their 

bodies through water, a whole host of microbes that shorten their 

poor little lives. 

What kills those mothers? Not having any kind of health delivery 

infrastructure, so that when they’re in labor, and when all of the 

crises of childbirth hit, there’s nobody to help, there’s no where to 

go. Or, they get there, and because it’s so grossly underfunded, 

they are treated with unwashed hands, non-sterile instruments, 

and succumb to infectious outcomes from that childbirth. 

We, just, we’ve talked about the brain drain, but let’s just really 

think carefully about what this means. You put that much more 

money overnight into global health, you make the priorities of that 

money about getting pills out the door for a variety of different 

things, or quick-fix technologies, just shove them out there, but you 

don’t have enough healthcare workers to do any of it. 

Indeed, we have a shortage of well over 4 million healthcare 

workers—sub-Saharan Africa alone is short 1 million. By the way, 

I’m not just talking about doctors, this is doctors, nurses, lab technicians, health administrators, people who know how to do drug 

procurement, process supplies, the logistics, the whole infrastructure that is the essence of both public health and medical delivery. 

That is so weak, it was already fragile to the point of breaking, and 

now all of a sudden we put this surge of funding in, but it is funding with the priorities set in the wealthy world, not in the poor 

world, with the sense that it’s all about ‘‘we’’ in the rich world, we’ll 

have bragging rights and feel terrific, because we saved X number 

of lives by shoving these pills out the door. 

What’s happening in practice, on the ground, is that because the 

healthcare worker crisis is so acute, we’re seeing healthcare workers skewed towards the places where the money is. 

So, I am here wearing a red ribbon, which—as everybody 

knows—is the insignia of the fight against HIV/AIDS. I’m wearing 

that, partly, because I don’t want anyone to misread what I’m saying to indicate that I somehow oppose the largesse that the American taxpayers have put behind PEPFAR and other HIV efforts— 

I am all for it, I think we need more money directed to HIV/AIDS. 

But, in the absence of sufficient health systems, of real training 

of people who know how do to health management, and corral 

these meager, weak resources, and fragile infrastructures as wisely 

as possible, what we’re going to end up doing, and we’re already 

seeing it in some countries, is see an increase in child death. An 

increase in maternal mortality, even as we’re saving millions of 

people suffering from HIV/AIDS and malaria. Because we’re just 

skewing the programs the way we want that money spent. 

So, finally, my main message is, we really need to step back and 

think—how do you fund systems management? We’re not going to 

instantly, overnight, get 4 million healthcare workers, it’s impossible. We do need to be grossly increasing the amount of money we 

put into healthcare worker training, but we’re not going to fill that 

gap overnight. 
61 

1Garrett, L., ‘‘Do No Harm: The Challenge of Global Health,’’ Foreign Affairs Jan/Feb 2007, 

pp 14–38. 

PREPARED STATEMENT

What we need to do is think, how do you train those people who 

are on the ground, in the skill set that is about managing meager 

resources, and doing it wisely to save all lives? Lift all boats at 

once, not just those targeted disease-specific boats. 

[The statement follows:] 

PREPARED STATEMENT OF LAURIE GARRETT

Senator Leahy, Distinguished Members of the Senate Appropriations Subcommittee on State, Foreign Operations and Related Programs, and Committee 

Staff: It is a distinct honor to be invited to address you today on the subject of global 

health priorities. I would especially like to thank the Committee for expressing interest in this matter. I recognize that few of you have constituents clamoring for 

your attention regarding the general health needs of people living far away, in desperately poor countries. These are not electoral make-and-break issues. It is, therefore, all the more laudable that you are devoting time today to their consideration. 

Again, I thank you. 

My esteemed colleagues preceding me today have done an excellent job in describing exactly who is currently under-served by U.S. foreign aid and investment, as 

well as the generous philanthropic, private support of the American people. I will 

not reiterate. I will build on their comments, highlighting some critical fault lines 

in current global health funding and directions, and offering some suggestions for 

fresh directions for the Committee’s consideration. 

Some of the basic principles, and data, I will mention are delineated in a piece 

I authored for Foreign Affairs 1 earlier this year. 

AGE OF GENEROSITY COMMENCES: STILL NOT ENOUGH, BUT RAPIDLY INCREASING

We are in an age of fantastic generosity. Globalization has brought the plights of 

the world into every living room, and onto every computer. As the world public’s 

response to the 2005 Tsunami illustrated this internet-driven sense of the immediacy of catastrophe—even in places as remote as Aceh, Indonesia—spawns remarkable outpourings of finances, donations and goodwill. As little as 6 years ago global 

health commitments totaled a few hundred million dollars: Today—combining all 

government and private sources—we see donations exceeding $18 billion. This is not 

enough, but it constitutes a dramatic, even astounding, increase in generosity, realized over a short period of time. 

But there are dangers in throwing billions of dollars about in emotionally-driven 

responses to news events, and disease-specific campaigns that capture the collective 

imagination of the wealthy world citizenry. 

First, let’s be blunt: most of this generosity reflects our interests: causes we care 

about, our national security, and our moral concerns. 

Second, for obvious political and, in the case of the private donor sector, self-promotion reasons, we want bragging rights. We want to be able to say that X amount 

of money, after 2 years, saved Y amount of lives. Most of the health-related legislation signed by President Bush and created by the House and Senate is rife with 

short term, mandatory timelines. In order to achieve measurable health targets in 

1 or 2 years, we necessarily have to set extremely narrow, pinpointed goals. And 

on the ground, to achieve such goals, U.S. supported programs must corral all available resources, funneling them into one channel of health. 

TREATMENT, YES: BUT NOT WITHOUT PREVENTION

Let me give you an example. About a year ago I was in a small town in Haiti. 

The people in this town were overwhelmed with infectious diseases. Their illnesses 

swamped the beleaguered clinics, where long lines of mothers and children stood in 

the tropical sun for hours on end, waiting to see a doctor. The children’s growth was 

stunted; mothers couldn’t produce enough milk to feed their babies; long-infected 

teenagers fought to keep their eyes open in class. In the parking lot of the town’s 

main hospital sat two rusted-out, broken USAID jeeps, the American insignias 

clearly evident. Though American charities were helping to subsidize the medical 

training and services in the hospital, nobody—no Haitian government agency and 

no foreign donor, looked at this town and asked the obvious question: ‘‘Why are so 
62 

2 Canadian Report by the Standing Senate Committee on Foreign Affairs and International 

Trade, ‘‘Overcoming 40 Years of Failure: A New Roadmap for sub-Saharan Africa,’’ Feb 2007. 

many people sick with dysentery, typhoid fever, and intestinal problems? Why are 

so many children in this town dying before they hit their fifth birthdays?’’ 

The answer: Water. The colonial-era water filtration and pumping system had 

long ago broken down. For about $200,000 the system could be fixed, children would 

drink safe water, and the disease and death rate would plummet. But no donor 

chose to take on that water problem. Instead, at the cost of far more lives, and dollars, the donors—including USAID—funded treatment of entirely preventable diseases, and supported the operation of a very busy morgue. 

The emphasis my colleagues placed on maternal and child health is wise. What 

is killing babies and toddlers? The lack of essential public health services: clean 

water, mosquito control, basic nutrition, healthy moms. 

What is killing their moms? The lack of medical systems: No safe C-sections, no 

sterile equipment for episiotomies, no prenatal care. 

Public health systems keep babies and children alive. Medical delivery systems 

keep their moms alive. 

Systems: Not individual, disease-specific programs—health systems are the key. 

Those targeted programs, such as PEPFAR (the President’s Emergency Plan for 

AIDS Relief), are terrific, but without functioning public health and medical systems 

in place, PEPFAR and its like are just big band-aids that barely cover gaping 

wounds. 

We—Americans and the wealthy world, generally—have given, and given, and 

given for decades. Yet the gap between longest and shortest lived societies has widened, now a full five decades long. And despite mountains of foreign aid from the 

OECD nations, basic health markers such as life expectancy and child survival have 

barely budged over the last 60 years in any sub-Saharan African country—except, 

thanks to HIV, to go backwards in a few. 

GOING BACKWARDS ON HALF A TRILLION DOLLARS

Senators, your counterparts in the Canadian Senate recently issued a startling report, entitled, ‘‘Overcoming 40 Years of Failure: A New Road Map for sub-Saharan 

Africa.’’ The report estimates that over the last 45 years the United States, Canada 

and the rest of the wealthy world has spent more than half a trillion dollars in aid 

and investment in sub-Saharan Africa. Yet the World Bank Office in Nairobi estimates, ‘‘that in 1948 Africa had a 7.5 percent share of world trade; in 2004 that 

share had decreased to 2.6 percent. A single percentage decrease represents United 

States $70 billion.’’ 

‘‘Africa is diverging from the rest of the world at the rate of 5 percent per capita 

income each year,’’ The Canadian Senate report concludes.2

Even in parts of the world we have credited as economic success stories—where 

the Asian Tiger roars, and the Latin miracle twinkles—health remains a striking 

challenge. The world nervously watches the spread of H5N1 influenza—‘‘bird flu’’— 

in Asia, largely in the same locations that featured SARS in 2003. Yellow fever, dengue, and malaria have all returned to Latin America. Indeed, Jamaica is at this moment battling the first malaria outbreak on that Caribbean island in more than 60 

years, spiraling out of control right in the capital city. That is a public health failure. And as the previous speakers told you, maternal health is going backwards in 

much of the poor world—women are dying in childbirth in many of these countries 

at a far greater rate than they were half a century ago. Recent United Nations findings on maternal mortality show that a woman living in sub-Saharan Africa has a 

1 in 16 chance of dying in pregnancy or childbirth. This compares with a 1 in 2,800 

risk for a woman from a developed region, and a more than 1:28,000 risk for a 

mother in Scandinavia. 

Every effort to battle diseases—from bird flu to HIV—comes up against the same 

set of problems. Congress has, over the last 3 years, approved some $8 billion of 

spending—about 5 percent of it overseas—to make Americans safer in the face of 

threatened pandemic influenza. But in the big picture the danger has over that time 

only increased, both because of mutations in the evolving H5N1 virus, and because 

quick-fix approaches to disease surveillance and control won’t work in countries that 

have no adequate systems of public health and medical care. 

Even the Bush administration’s laudable PEPFAR program, which started out 

with a fairly minimal mission of providing prevention, care and treatment for a single disease, now finds itself forced to build medical delivery systems simply to get 

anti-HIV drugs to the patients who need them. 
63 

3Ooms, G., Van Damme, W., and Temmerman, M., ‘‘Medicines without Doctors: Why the 

Global Fund Must Fund Slaries of Health Workers to Expand AIDS Treatment,’’ PLoS Medicine 

4:0001–0004, 2007. 4World Health Organization, ‘‘The global shortage of health workers and its impact.’’ Fact 

sheet No. 302, April 2006. http://www.who.int/mediacentre/factsheets/fs302/en/index.html 5 ibid. 

6Krestev, N., ‘‘World: Maternal-Mortality Numbers Still Climbing,’’ Radio Free Europe July 

2006. http://www.rferl.org/featuresarticle/2006/07/10d24de4-cc8d-459c-9eed629ee1bccc4c.html 

A just-published critique of the Global Fund to Fight AIDS, Tuberculosis and Malaria 3 charges that unless the Fund starts to directly underwrite the salaries of 

healthcare workers, including minimally-educated community providers, the effort 

will become nothing more than ‘‘medicines without doctors,’’ an unsustainable program for tossing out drugs without providing any actual healthcare. 

THE WORLD NEEDS HEALTHCARE WORKERS

The world is desperately short of health professionals, and the severity of that gap 

promises to increase sharply in coming years. The World Health Organization estimates the shortage breaks down currently as follows: 4

—In 57 countries the deficit is labeled by WHO as ‘‘severe’’; 

—The world needs, immediately, 2.4 million medical service providers; 

—1.9 million laboratory workers, health managers, and administrators; 

—A total of 4.3 million healthcare workers are needed at this moment. 

Sub-Saharan Africa faces the greatest challenges. While it has 11 percent of the 

world’s population and 24 percent of the global burden of disease, it has only 3 percent of the world’s health workers.5

The World Health Organization says: 

‘‘There is a direct relationship between the ratio of health workers to population 

and survival of women during childbirth and children in early infancy. As the number of health workers declines, survival declines proportionately.’’ 

This is going to get much worse. Why? Because the wealthy world is aging, therefore requiring more health attention. At the same time, wealthy nations are trying 

to reduce rapidly inflating health costs by holding down salaries, and increasing 

work loads, making the practices of nursing and medicine less attractive. Unless 

radical changes are put in place swiftly in the United States and other wealthy nations the gap will soon become catastrophic. Studies show that the United States 

will in 13 years face a shortage of 800,000 nurses and 200,000 doctors. 

How are the United States and other wealthy nations filling that gap? By siphoning off doctors and nurses from the poor world. We are guilty of bolstering our 

healthcare systems by weakening those of poorer nations. 

Here is an example: due to healthcare worker shortages, 43 percent of Ghana’s 

hospitals and clinics are unable to provide child immunizations and 77 percent cannot provide 24-hour obstetric services for women in labor. So the children die of 

common diseases, like measles, and the mothers die in childbirth. In all of Ghana 

there are only 2,500 physicians. Meanwhile, in New York City, alone, there are 600 

licensed Ghanaian physicians.6

There are a number of bills pending in both the House and Senate that seek, in 

various ways, to increase domestic education and staffing of healthcare workers, and 

bolster training in poor countries. Though this committee deals with foreign operations, it is vital that you concern yourself with the progress of measures that would 

decrease the drive to drain the health brain power of the poor world by enhancing 

education and incentives here in the United States. In the House, for example, H.R. 

410, the United States Physician Shortage Elimination Act of 2007, seeks to create 

incentives for physicians to serve in under-allocated areas of America. 

Senate Bill 805, sponsored by Sen. Richard Durbin, is the ‘‘African Health Capacity Investment Act of 2007.’’ It seeks to amend the Foreign Assistance Act of 1961 

to provide funding for medical training, and retention of healthcare staff in sub-Saharan African countries. I urge the Senate to pass S.805. 

Fund Programs for Systems Development 

But let’s be clear: Even if we put the brakes on the brain drain this instant, and 

the United States of America no longer imported foreign doctors, nurses, and lab 

technicians, there would still be a crisis. And even if Senator Durbin’s bill passed, 

fully funded, there would still be a crisis. 

We are in an ugly mess. If we want to do the right thing, and get millions more 

people in poor countries on anti-HIV medications, our U.S. tax dollars have to be 

put to use skewing health services towards AIDS, and away from general maternal 
64 

7Lord Nigel Crisp. ‘‘Global health partnerships: the UK contribution to health in developing 

countries:’’ February 2007. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/ 

PublicationsPolicyAndGuidance/DHl065374 8 Under PEPFAR, spending to train local healthcare workers cannot exceed $1 million per 

country per year. That is absurd. 

health and child survival. Why: Because there aren’t enough healthcare workers to 

do both. 

If we want to spend U.S. taxpayer dollars—as we should—on campaigns to wipe 

out malaria-carrying mosquitoes and get children under insect-barrier nets at night, 

then the public health workers who will implement such programs have to come 

from somewhere. Perhaps there will be fewer of them trying to clean the children’s 

drinking water or teaching teenagers how to avoid getting infected with HIV. Why? 

Because there aren’t enough trained public health experts. 

The only way American tax dollars can save lives, across the board—without robbing healthcare workers from one disease area to implement disease combat in another area—is if we start funding systems management. The expertise for disease 

prevention and treatment is sparse: the talent pool, along with their supplies and 

patient loads, must be carefully managed. Novel incentive systems to defy corruption and bring quality health to vast constituencies must be put in place. 

At the request of Prime Minister Tony Blair, this question of the relationship between wealthy world priorities, and the health—or the lack thereof—in Africa was 

studied by Lord Nigel Crisp. His recently-released report 7 concludes that single-disease-specific programs can damage other health interests. He calls for direct funding 

of systems development and management, with far longer-term commitments than 

had been the norm for the UK. The Crisp recommendations are now being implemented. 

But what about the United States? Well, we do have a health systems management program nested inside USAID. It is working to professionalize health management in poor countries. It’s budget? Just over $3 million. 

FISCAL YEAR 2008 BUDGET: INTERNATIONAL AFFAIRS

As you look over the White House fiscal year 2008 budget requests—for a total 

Foreign Operations request of $20.3 billion—please pay close attention to the following: 

—More than half of all funding for Africa will focus on 8 strategic states. 

—Overall health spending in designated African countries would more than double compared to fiscal year 2006 actual spending. 

Of the nearly $4 billion requested for health in Africa, $3.4 billion would go for 

HIV/AIDS in 12 countries (under the Global HIV/AIDS Initiative or GHAI, formerly 

known as PEPFAR). The remaining $700 million would be spent on the President’s 

Malaria Initiative, Tuberculosis and a host of modest child survival and health initiatives. 

—Nearly all programs are heavily ear-marked, with little or no monies designated 

for general health threats or health systems management and support. Health 

management and personnel training is not stipulated clearly in any budget 

lines, either under disease-specific programs, nor in overall global health budgets. 

—Only $34 million is requested for water systems, sanitation, or general public 

health threats. 

—Under the Global War on Terror 2007 supplemental the President requests 

$161 million, in additional to the general budget $100 million, for pandemic influenza surveillance and control, through USAID. The supplemental request is 

listed under Child Survival and Health Programs. 

I do not believe that we are guilty of over-spending in any global health initiative. 

Rather, we are guilty of under-valuing the necessity of building genuine, well-managed public health and medical systems. The paltry $3 million now spent on 

USAID’s Management Sciences for Health program should increase dramatically, 

reflecting this gap. Further, current caps 8 on human resources development and 

training that exist for PEPFAR funds should be lifted, for training of indigenous— 

not American NGO or FBO—personnel. 

WHAT IS THE GOAL?

I think the appropriate goals for U.S. foreign aid in support of global health ought 

to be twofold: 
65 

—Build sustainable infrastructures in poor countries that shift the paradigm towards fantastic improvements in maternal health, child survival and overall extension of life expectancy. 

—And, second, ensure the safety and security of the American people by lowering 

the global disease burden, both in terms of infectious threat and detrimental 

impact on nations’ and global GDP and economic growth. 

The current channels of spending, though in the billions of dollars, will not accomplish either of these goals. 

Systems and infrastructure aren’t sexy, cannot be built in short funding cycles, 

and are tough to brag about to constituents. But without viable systems of medical 

delivery and public health infrastructures all we will manage to do with our billions 

of dollars is save some lives, at the expense of others; achieve short term targets 

without fundamentally leaving anything in place that allows nations ultimate dignity and self-reliance. 

Let me close with this final story. During the 1960s, at the height of the Cold 

War, the global community committed to the astonishing goal of completely eradicating smallpox. The virus had killed more people during the first six decades of 

the 20th Century than all wars, combined. In order to accomplish this remarkable 

feat the World Health Organization and our Centers for Disease Control set up an 

unprecedented worldwide infrastructure of community health workers, public health 

advocates, disease detectives, laboratories, vaccine manufacturing, specialized infectious diseases clinics and hospitals and international-scale leadership and management. It was a breathtaking scale of effort. And it worked. By the end of the 1970s 

smallpox was eradicated. 

But then a tragic, inconceivable mistake was made: The entire worldwide smallpox infrastructure was simply shut down. Unable to find funding, or international 

interest, the infrastructure that defeated smallpox was, itself, eradicated at precisely the same time as a new scourge emerged: HIV. Since 1981 AIDS has killed 

more people, in 25 years, than smallpox did in the 20th Century. 

As the late, great Kurt Vonnegut would say ‘‘So it goes.’’ 

Thank you for your time, attention, and concern. 

Senator LEAHY. I was discussing your testimony with my wife 

who is a registered nurse, now retired, except for children and 

grandchildren, she’s traveled with me to a number of places around 

the world where we’ve used the Leahy War Victims Fund. She’s 

been in some of these places, and she said our first-year nurse’s 

training 40 years ago was more advanced than what they had 

available. We’ve brought thousands of sterile disposable gloves and 

needles. 

We’re not trying to build the Mayo Clinic in these places. We’re 

not talking about major surgery, we’re talking about the preventive 

measures that we take for granted. 

I’m glad you raised the brain drain. I worry, also, though, that 

we don’t have the basic—very, very basic—infrastructure. Where I 

see medications that are supposed to be refrigerated, there’s no 

ability or knowledge of doing it. A pill a day for 20 days, but, well, 

why not take 20 today and get it over with, and that kind of thing. 

Dr. Daulaire, as I said before, you and I have been friends for 

decades, and I’m delighted you’re here. I’m delighted the Global 

Health Council is based in Vermont. There’s some days when I’m 

down here I’m envious of you being back home. 

Please go ahead, sir. 

STATEMENT OF DR. NILS DAULAIRE, PRESIDENT, GLOBAL HEALTH 

COUNCIL 

Dr. DAULAIRE. Thank you, Senator Leahy, in turn I’m delighted 

to be one of your enthusiastic constituents, as are our staff, 

headquartered in Vermont, some of whom are Senator Gregg’s constituents as well, right across the river. 
66 

But I’m here today, not as a Vermonter, but as the head of the 

Global Health Council, an organization representing health professionals and service organizations working in more than 100 countries. This is the issue of the moment, and I’m more delighted than 

I can tell you that you are hosting this hearing today. 

As you well know, I’m a doctor and a scientist, I’ve worked in the 

field for over 3 decades, and I believe deeply, as Dr. Gayle mentioned before, that what we do in global health has to be evidencebased. So, both in the submitted testimony and what I’m going to 

talk about over the next few minutes, we have hard facts to back 

up everything that we’re talking about. 

I’d like to make five points—first, this is a huge issue; second, 

we have done an enormous amount, we, the United States, to improve the situation, and we know what to do; third, over the last 

10 years, our investments have lagged; fourth, we can make a 

world of difference with modest additional investments, starting 

this year; and fifth, this would be good, not only for the women and 

children of the world, but it would be good for America. 

So, let me take those five points in order. We’ve already heard 

quite a number of the statistics, let me just put one chart up 

here—this is a huge issue. In many of the countries where I’ve personally worked, 1 out of 5 children do not survive to their fifth 

birthday. Take a classroom of 16 adolescent girls, one of those girls 

is not going to make it through her fertile years, because of a death 

due to pregnancy or childbirth, and 1 out of 4 regnancies around 

the world is unintended. 

These are staggering statistics, when we consider our own lives 

and our own children and our own families, and they’re simply unacceptable. Sitting in the Dirksen Building, I’m reminded that he 

once said, ‘‘A million here, a million there, pretty soon you’re talking about real money.’’ In this case, you’re talking about real lives. 

You’ve heard the lives—over 10 million child deaths, over half a 

million women dying in pregnancy and childbirth—and as well, 

more than 200 million women living around the world with an 

unmet need for family planning. 

Some people have asked, why does the Global Health Council 

concern itself about family planning? That’s a population thing, not 

a health thing. But, family planning is fundamentally a health 

intervention. It prevents abortion—I don’t need to make that argument with you, sir, you’ve been clear on that, and you understand 

that well—but in addition, we know from the data that it saves the 

lives of young children, the older siblings. A child born more than 

3 years after the prior birth has a one-third lower chance of dying 

than a child born within 2 years. 

Children born to teen mothers have a 30 percent higher rate of 

infant and child mortality than do children born to older mothers, 

so—family planning saves mothers’ lives, and it saves childrens’ 

lives. 

But this is not only about death, but also about lives. I have to 

say that, in addition to the ones dying, there are 40 million children living stunted lives physically and intellectually each year. 

There’s more than 20 million women who suffer lifelong consequences of complicated deliveries, and there are 60 million 
67 

women a year making agonizing choices about pregnancies that 

they did not intend. 

The second issue, we’ve learned a lot, and we know what to do. 

We’ve talked about that already, and Dr. Hill, I think, made the 

case beautifully, that this has been an area of enormous scientific 

growth and operation growth, but it didn’t just happen. It happened because of considerable U.S. Government investments in maternal and child health, and in family planning. Investments led to 

knowledge, led to application, and led to millions of lives saved. 

Why have our investments lagged over the past decade? We have 

this chart up here that your staff prepared, let me take those bottom lines that you can barely see, and show you that in maternal 

and child health in nominal dollars, the line has been more or less 

flat. Adjusted for inflation, we’re actually spending 22 percent less 

than we were 10 years ago, and that’s in a world that has 19 percent more children. 

In family planning, the situation is also very sobering. Again, adjusted for inflation, our investment in the past 10 years has declined by 14 percent, and that’s in a world with 30 percent more 

women in need of family planning services. 

So, this is critical in terms of making an important change in the 

delivery of services. What do we need today? What U.S. leadership 

is called for? Well, analysis has shown that it would take $5.1 billion of global investment, not just United States, to save 6 million 

children’s lives, the figure that Dr. Hill pointed to before. Another 

$3.9 billion to save, to provide family planning services for 200 million women, so we’re talking about a global need of $9 billion in 

which the United States fair share would be about $1.6 billion for 

child health, $2 billion for maternal health, and about $1.3 billion 

for family planning. 

Now, as much as our community would love to have that investment made this year, we recognize that you have to deal with a 

difficult appropriations process. So, I’m going to tell you what you 

can buy for every $100 million that this committee, in its wisdom, 

decides to invest in maternal and child health and family planning. 

If you invest $100 million in child health and survival, you will 

save 113,000 to 200,000 lives every year. Nearly a million children 

will be provided with the 16 essential interventions that programs 

like CARE and others carry out. 

If you invest $100 million in mothers, you will prevent 12,000 

maternal deaths, 15,000 newborn deaths, you’ll provide 4 million 

women with basic, essential care, and 140,000 women will be treated for life-threatening conditions. 

Last but certainly not least, if you invest $100 million in family 

planning, there will be another 3.5 million additional family planning users, 2.1 million fewer unintended pregnancies, fewer infant 

and maternal deaths, and not incidentally, 825,000 fewer abortions 

around the world. 

Senator LEAHY. So, as you’re talking about that chart, the 

amount of money—it’s a large amount of money—but its almost as 

much as we had spent by Tuesday morning of this week in Iraq. 

Dr. DAULAIRE. There we go. 

Senator LEAHY. Not to put too fine a point on it. 

Dr. DAULAIRE. I—— 
68 

Senator LEAHY. Or to indicate my feelings on that, but really, 

starting Sunday morning, we spent more than that by Tuesday 

noon in Iraq. We did last week, and the week before, and the week 

before, and we’ve been there for 5 years, longer than we were in 

World War II. 

Dr. DAULAIRE. Mr. Chairman, this is indeed a matter of making 

decisions about national priorities. 

Let me wrap up—Laurie Garrett has talked about the importance for health systems. What builds health systems capacity is 

the delivery of routine services on a daily basis, and what does that 

the most effectively and efficiently is maternal and child health 

services, and family planning, because those children and those 

mothers come through the door every single day. You can build 

other programs on top of that infrastructure, but that is the core 

of daily activities that is essential for infrastructure. 

Finally, I think it’s self-evident, I’m preaching to the converted 

here, but this would be good for America, not only because healthy 

families lead to more stable societies, less turmoil, and fragmentation in the world, but because the United States desperately needs 

a more positive face overseas. United States programs invested in 

maternal and child health and family planning have been among 

the most effective and appreciated around the world. 

Senator, I know your children, you know mine, I know your wife, 

you know mine—we would not tolerate these levels of risks in our 

own family, and this is our family writ large. Women and children 

are at the center of global health and it’s time for us to take action. 

PREPARED STATEMENT

I call on you and your committee to boldly re-establish that commitment, with real dollars measured in the hundreds of millions. 

Thank you very much. 

[The statement follows:] 

PREPARED STATEMENT OF DR. NILS DAULAIRE

Chairman Leahy, Ranking Member Gregg and members of the subcommittee, 

thank you for inviting me to testify before you today on Maternal and Child Health, 

Reproductive Health and Family Planning. I am Dr. Nils Daulaire, President and 

CEO of the Global Health Council, the world’s largest membership alliance of health 

professionals and service organizations working to save lives and improve health 

throughout the world. 

Before I begin my remarks, let me thank you, Chairman Leahy, for your service 

to our home State of Vermont and your longstanding commitment to global health. 

You have been a proponent and champion of U.S. investment in global health for 

more than 30 years. Long before PEPFAR, the Global Fund, PMI and other welcome 

global health initiatives, you fought for basic health services in developing countries, 

committed to meeting the needs of the poor and most vulnerable. I applaud you, 

Chairman Leahy and you, Senator Gregg, for your bipartisan collaboration, recognizing that saving lives knows no party lines. On behalf of the Council’s 350 member organizations working in over 100 countries across the globe, and the millions 

whose lives are improved by U.S. Government investments, we thank you. 

The Global Health Council’s members include non-profit organizations, schools of 

public health and medicine, research institutions, associations, foundations, businesses and concerned global citizens who work in global health—delivering programs, building capacity, developing new tools and technologies and evaluating impact to improve health among the poor of the developing world. Our members work 

in a wide array of areas, including child and maternal health, family planning, HIV/ 

AIDS, other infectious diseases, water and sanitation, primary health care and 

health systems strengthening. The members of the Council share a commitment to 

alleviating the great health disparities that affect the world’s most vulnerable peo-
69 

ple. The Council serves its members and the broader community of global health 

stakeholders by making sure they have the information and resources they need to 

fulfill this commitment and by serving as their collective voice. 

It has been my privilege to be part of the global health movement for over 30 

years, and much of my career has been spent as a physician and program manager 

in some of the world’s poorest countries. Working in countries such as Nepal, Mali 

and Haiti, I have had the good fortune to participate in the development and introduction of some important child survival interventions, notably in treating childhood 

pneumonia and Vitamin A deficiency. I have also had the honor of serving in Government as a senior policy advisor in USAID. My remarks today derive from these 

different perspectives and experiences, as well as the evidence and experience of our 

membership. 

THE WORLD’S WOMEN & CHILDREN

The link between the health of the world’s women and children is well-established, as is the link between their health and the well-being of the larger community. Because of these connections, we must view the challenges, interventions and 

investments as contributing to a continuum of care that has mutually reinforcing 

benefits from the individual all the way through global society. 

Child Health 

Today, as every other day, nearly 30,000 children under age five will die—1 every 

3 seconds. In many countries, 1 of every 5 children born won’t live to see their fifth 

birthday. If death rates of this magnitude were happening to the youngest and most 

vulnerable here in the United States, we would declare a state of national emergency. It is happening, perhaps not in our backyard, but in our world, and we must 

do more. 

This year, more than 10 million children under 5 will die, mostly from preventable and treatable conditions—about the same as the total number of American children under 5 living east of the Mississippi River. Almost 4 million of these deaths 

will occur during the first month of life. Two million children will die from pneumonia; 1.8 million from diarrhea; nearly another million from malaria and almost 

half a million from measles. Virtually all of these deaths can be prevented—easily 

and cheaply. 

As American parents, we take for granted that our kids will live and thrive. We 

recall when a skilled medical provider coached us through the stages of labor. We 

remember when our babies were whisked away to be dressed with head caps and 

swaddled to keep them warm. We have all taken our children in for their immunizations to protect them against measles, diphtheria, pertussis, tetanus and polio, diseases which, as a result, are today practically unknown in our country. If my daughter developed diarrhea, she was hydrated and her risks were very low. If my son 

developed pneumonia, rapid cure was ensured through antibiotics. These are all 

simple, basic practices that kept our children alive, and we are blessed to be able 

to take them for granted. 

In the developing world, however, too many parents live with the very real fear 

that death will take their children. The interventions that I have named are neither 

difficult to administer nor expensive. The cost of some, such as oral rehydration 

salts, vitamin A supplements and even antibiotics, are measured in cents, not dollars. Breastfeeding and kangaroo care, where mothers hold newborn babies to their 

breasts to keep them warm, cost nothing at all beyond educating parents. Yet children are still dying because these basic interventions are not reaching them. I 

couldn’t imagine that expectation when my children were born. No parent should 

have to. 

Maternal Health 

In the United States and other developed nations, the risk of death from complications of pregnancy and childbirth is extremely low. Although the risk of a woman 

in a developed country dying is about 1 in 2,800, the lifetime risk of sub-Saharan 

African women dying from complications in pregnancy or childbirth is 1 in 16. Over 

half a million women die each year from pregnancy-related causes, and up to 20 million develop long-term physical disabilities each year because of complications or 

poor management of pregnancy or childbirth. Almost 4 million newborn deaths are 

closely linked to poor maternal health care, especially the absence of a trained provider during and immediately after birth. And each year, more than 1 million children are left motherless. 
70 

Reproductive Health/Family Planning 

Notwithstanding the progress in making family planning services available, over 

200 million women still have an unmet need for family planning. These are women 

who are at risk of becoming pregnant, who wish to delay or end childbearing and 

yet do not have effective access to family planning. This is a denial of the basic right 

of every woman to decide if and when she will become pregnant. It is utterly meaningless to declare support for the human rights of women and yet fail to provide 

them with the information, services and commodities that will allow them to make 

a free, informed and safe decision about whether and when to become pregnant. 

Women cannot fulfill their potential or assert their rightful place in economies and 

societies unless they have such access. The decline in United States support for family planning flies in the face of our stated national commitment to overcoming the 

second class status of women in much of the world. 

What is less well understood but equally important is that family planning is essential to protecting the health of mothers and their children. Family planning 

helps young women delay or space pregnancies. Family planning helps all women 

avoid high risk pregnancies; approximately 215,000 maternal deaths will be averted 

this year alone thanks to the family planning that is available. 

Debate over abortion continues to create stark political divides. Yet, there is one 

thing we can agree upon—family planning reduces recourse to abortion by enabling 

women to avoid unintended pregnancies. Every year, there are more than 46 million 

abortions. 68,000 will also end in the death of the mother. Increasing access to family planning is the surest path to decreasing the number of abortions. 

Speaking as a physician who has devoted years to improving children’s health 

worldwide, let me make this clear: family planning is also critical to saving children’s lives. Closely spaced births and births to young mothers dramatically raise 

the risk that the infant will die. A child born less than 2 years after a sibling is 

67 percent more likely to die than a child born after a 3 year interval. The child 

of a teenage mother is 30 percent more likely to die than that of a woman aged 

20 to 29. Between 20 percent and 40 percent of all infant deaths could be prevented 

if all women had access to family planning. 

Lives, Not Just Deaths 

I should point out that the issues of maternal and child health as well as reproductive health are not limited to averting deaths. They are also cause for diminished 

lives. For every woman who dies during pregnancy, childbirth or immediately following, another 30 suffer debilitating life-long consequences. Each year, nearly 40 

million children who suffer early childhood illnesses but do not die become physically or mentally impaired. All of this contributes to the cycle of poverty and the 

failure of poor countries to develop. 

U.S. INVESTMENTS—PROGRESS UNDERMINED

The United States is a tremendously important force in global health. Its decisions about priorities, resource allocation, policies and technical leadership have profound consequences—that is the privilege and burden of our country’s unique role. 

It is widely acknowledged that the United States has made very important and enduring contributions to global health. Yet today, U.S. global health policy is marked 

by two trends that are in stark opposition and mutually inconsistent. On the one 

hand we see the rapid expansion of U.S. programs in HIV and malaria; on the other 

we witness the neglect of maternal health, child health and family planning. This 

makes no sense. 

Contradictory Trends 

The U.S. Government (USG) investment in global health has grown and evolved 

dramatically in just a decade. In fiscal year 1997, USG spending on global health 

sat just below $1 billion. Ten years later, global health spending is well over $5 billion from the foreign operations budget alone, with additional investments from the 

Department of Health and Human Services and the Department of Defense. However, the devil is in the details. 

Most of the exponential growth in global health spending over the past decade is 

due to USG investments in HIV/AIDS—over $14 billion since the advent of the 

PEPFAR, the President’s emergency program for AIDS relief—an important commitment that the Council applauds. More recently, the President Malaria Initiative 

(PMI) has joined PEPFAR as a priority program of this administration, with a $1.2 

billion pledge over 5 years. PEPFAR and PMI speak to the USG’s generosity and 

ability to make a difference and, through these programs, many lives are being 

saved. The USG deserves tremendous credit for its global leadership. 
71 

But the U.S. Government has not seen fit to increase in a similar way its historic 

leadership in maternal and child health and family planning. Once the investment 

in AIDS and malaria is subtracted from current spending totals, investments in 

child health, maternal health, family planning and the remaining infectious diseases 

remain at about $1 billion, roughly where they were a decade ago. There has been 

level funding in most program areas and cuts in others, which means a decrease 

in programming power once adjusted for inflation and the increase of the number 

of people in need. This is most notable in the areas of child health and reproductive 

health and family planning which, when adjusted for inflation, have declined 22 percent and 14 percent, respectively, over the past decade. To this must be added the 

impact of a 19 percent increase in the number children under five and a 30 percent 

increase in the number of reproductive age women in the 43 least developed nations. 

So while the dollars have gone down, the need has gone up. Reduced investment 

translates into lives—millions lost unnecessarily. 

Complements not Contradictions 

Let me say again, the Council enthusiastically applauds the growth in spending 

for AIDS and malaria and the leadership President Bush and the Congress have 

shown in these areas. But while funding flows through independent and issue-specific channels, these health threats do not occur in isolation. The same communities 

where individuals are living with AIDS are also those in which non-HIV infected 

women are at very high risk of dying during child birth from lack of family planning 

and basic obstetric care. The same young children who now sleep under bed nets 

to guard against malaria are no less likely to die from diarrhea or pneumonia. We 

have confused the laudable objective of fighting disease with the fundamental goal 

of saving and bettering lives, and our investment is undermined by an excessively 

narrow perspective. Fortunately, relatively modest increases in USG investment in 

these neglected areas can save millions of lives through simple, cost-effective interventions. 

That is the good news—solutions are within easy reach at low cost. In the past 

30 years, thanks to the investments and efforts that have been undertaken, the 

child mortality rate in the poorest parts of the world has declined by 40 percent. 

Because of family planning efforts, birth rates have also declined by 40 percent. 

What an incredible moment: For all of human history, people have lived with the 

expectation that many of their children will die young and that women will endure 

one pregnancy after another, regardless of the impact on their health and survival. 

The 40 percent decline in birth and death rates is a stunning change. The advent 

of simple, inexpensive vaccines, antibiotics, oral rehydration salts, anti-malarials, 

micronutrients and contraceptives have radically changed expectations and reality 

in many parts of the world. What a tragedy it would be not to finish a job so well 

begun. 

This progress makes the choice not to increase our investment in women and children intolerable. Allowing women and children to die from easily preventable causes 

is just that—a choice. We are at a loss to understand how this administration, so 

generous in the response to HIV/AIDS and malaria, now proposes substantial cuts 

in maternal and child health and family planning. 

IMPROVING HEALTH, SAVING LIVES

As I have described, U.S. support for basic maternal health, child health and family planning services has been declining. This must be reversed. The United States 

must reassert its historic and essential leadership in saving the lives of women and 

children. Providing these basic interventions for women and children is the cornerstone for securing improved health and is at the heart of building sustainable public 

health systems. The record is clear. Every time the United States has approached 

a major global health problem with tenacity and at the requisite scale, our country 

has had a tremendous positive impact. 

On the scale of global need, the amount needed to achieve important gains in 

child health and family planning is manageable. Six million children could be saved 

every year if the global budget for child health were increased by $5.1 billion. Providing essential obstetric care to 75 percent of women in 75 countries would cost 

an additional $6.1 billion; 200 million women with an unmet need for family planning could receive these services for an additional $3.9 billion per year. So the math 

is simple. If—from all sources: United States, other donors, developing nations—the 

world devoted an additional $15 billion per year, 6 million children would be saved 

annually, most women would have maternal health care and 200 million more 

women would have access to family planning. I urge this committee and the Congress to move the United States into the same leadership role on family planning, 

maternal and child health that it has shown in AIDS and malaria. 
72 

MODEST INVESTMENTS, MAXIMUM IMPACT

To illustrate the potential impact of a heightened U.S. commitment, I’d like to reflect on what even a modest ramp-up in investments could return. The U.S. share 

of the additional global investment needed to reduce child mortality is roughly $1.6 

billion. The United States should add $2 billion per year to its spending on maternal 

health. The United States should increase its contribution to family planning by 

$1.3 billion per year. We have a long way to go. However, we can take modest steps 

and still see great gains. The projections I share with you are based on solid scientific analyses by the Council and others. 

Investment Scale-Up 

Every $100 million in attacking the most common causes of child death with the 

most cost-effective interventions would have the following impacts: 

—At least 113,000, and perhaps as many as 200,000, young children’s lives saved 

—Over 812,000 children provided with 16 essential interventions, at an average cost of just over $12 per child Every $100 million devoted to maternal health programs would: 

—Avert nearly 12,000 maternal deaths 

—Avert more than 15,000 newborn deaths 

—Provide basic and essential care for 4 million women 

—Treat 140,000 women with life-threatening conditions 

—Treat an additional 880,000 women with serious pregnancy and childbirth-related conditions 

Every $100 million invested in family planning would have the following impacts: 

—3.6 million more family planning users 

—2.1 million unintended pregnancies avoided 

—825,000 abortions prevented 

—970,000 fewer births 

—70,000 fewer infant deaths 

—4,000 maternal deaths averted 

These are remarkable outcomes for relatively moderate additional outlays. Each increment of $100 million would yield proportionate gains, the virtuous cycle writ 

large. We therefore urge this committee to approve a significant increase in the 

budgets for maternal and child health and family planning with investments on par 

with the other global health priorities. 

BUILDING CAPACITY WHILE SAVING LIVES

There is the misperception in some quarters that U.S. assistance for maternal and 

child health has been an example of charity or created dependency. This is far from 

the truth. Improving health is not merely a matter of delivering pills and vaccines, 

though pills and vaccines are essential. It’s about improving health equity by putting in place sustainable systems for delivering essential care. Improving health 

means supporting educational programs to foster new attitudes and behaviors; 

building community leadership and organizations committed to improved health; 

strengthening the capacity of health providers and institutions; better measurement 

of what programs accomplish; and, adopting better health policies and health financing schemes. The United States role has been to strengthen the capacity of national health systems to deliver essential maternal and child health care. Achieving 

long term sustained change requires patience and sustained investment, but the 

record of building capacity while achieving gains in health outcomes is clear. 

Another invaluable U.S. contribution has been to invest in technical leadership 

and research and development, areas where the United States has historically excelled. These core functions support the development of new technologies and innovative means of delivering services, which have enduring impact. The overall decline 

in resources has seriously affected these core functions, a consequence exacerbated 

by the declining percentage of available resources devoted to technical leadership 

and research and development. I am greatly concerned that the technical leadership 

role of the United States has been starved of resources and I urge the committee 

to be sure it is adequately funded. 

IN THE U.S. INTEREST

The United States has a compelling national interest in saving the lives of the 

most vulnerable women and children. The stated goal of U.S. foreign assistance is 

‘‘To help build and sustain democratic, well-governed states that respond to the 

needs of their people, reduce widespread poverty and conduct themselves responsibly in the international system.’’ There is no more dramatic marker of this goal 

than saving the lives of millions of women and children. 
73 

Poor maternal and child health indicators are viewed by many as evidence of the 

failure of governments to provide basic services. Conversely, alleviating the burden 

of disease among women and children is clear evidence of improving governance 

through concrete, specific gains. Even low income societies can achieve dramatic 

gains by providing widespread access to essential services and information. Improving access to basic health care for women and children is an exercise in good governance, meets a basic need, redresses pervasive inequities and creates a model for 

other essential services. 

Poor maternal and child health also brings economic ruin to families and households. What truly marks poor households is vulnerability. A childhood illness or 

complications from pregnancy force a poor family into excruciating choices, when 

they must choose between buying seeds or paying for basic health care. Preventable 

illness and death can tip a poor family over into destitution as they divest themselves of meager savings and borrow money to pay for health care or funerals. Efforts to alleviate poverty must address this underlying cause of household vulnerability. 

Mr. Chairman, it is no secret that the international reputation of the United 

States is at low point. Multiple surveys reveal the widespread negative perceptions 

of our country. One could argue whether these perceptions are justified, but there 

is no arguing with the urgent need for effective public diplomacy. But public diplomacy is more than words and promises, it is deeds. The most powerful statement 

our country could make is to save the lives of the world’s most vulnerable women 

and children. This is an enormous opportunity for constructive engagement with 

much of the world. Most importantly, a renewed commitment to saving women and 

children will express the values of a decent and generous American people, who invariably support effective efforts to alleviate needless suffering. 

A CALL TO ACTION

Chairman Leahy, Senator Gregg, members of the subcommittee and colleagues, 

my most fundamental message to you today is of hope and possibility. We know how 

to save millions of women and children through simple, inexpensive means. We 

know what works. We know how to deliver the interventions. We know what they 

will cost and we know what will happen once these services are provided: lives will 

be saved; communities strengthened; futures built and countries developed. 

The responsibility for improving maternal and child health does not rest principally with the United States. That responsibility for meeting basic needs rests 

with national governments. Non-governmental organizations, faith communities, 

multilateral institutions and other donors all have a role to play. As I speak before 

you today, global partners are gathered in Tanzania under the invitation of the 

Partnership for Maternal, Newborn and Child Health. An increasing global commitment guarantees that the United States is not in this alone. But there is no substitute for U.S. leadership or for active U.S. partnership in a global compact for 

women and children. 

Mr. Chairman, we need a bold commitment on the part of the U.S. Government 

and the American people—a commitment to the world’s most vulnerable families so 

that they may enjoy the same expectation we have for our children’s survival, 

planned pregnancies and mothers’ safe deliveries. We simply must decide that this 

is the right thing to do in partnership with other governments and the communities 

in need. Relatively modest yet sustained increases in resources will make a significant difference in the lives of millions of women and children. And this clear commitment to the well being of families also will make a significant difference in popular perceptions of the role of the United States abroad. 

I appeal to you to boldly reestablish that commitment with real dollars, measured 

in the hundreds of millions. It’s time to act. 

Thank you for your time and for hosting this hearing. I look forward to addressing 

any questions you have, and to working with you to continue to save and improve 

lives. 

Senator LEAHY. Dr. Hill, let’s go into this a little bit. The Millennium Development Goals. I read that one of the goals is to reduce 

by two-thirds the mortality rate among children under 5 by the 

year 2015. That’s 8 years from now. You pointed out a half a million women die in pregnancy and childbirth each year. That’s one 

per minute. Ninety nine percent of those are in the poorest countries. Another one of the Millennium Development Goals is to re-
74 

duce by three-quarters the maternal mortality rate by the year 

2015. 

The United States has affirmed these Millennium Development 

Goals—how does the fiscal year 2008 budget request, which doesn’t 

increase resources for either child health, maternal and reproductive health, fit into a strategy to reduce child death by one-half, 

and maternal deaths by two-thirds by 2015, realizing as Dr. 

Daulaire, and others, have pointed out, the world’s population is increasing? 

Dr. HILL. You raise important issues, and it’s very clear that you 

don’t make the kind of progress towards reaching those MDG goals 

as you would like without sufficient funds. 

One of my problems, of course, is that I wear a very partisan 

global health hat, and I tend to view things as my colleagues on 

this committee do, thinking about what we could do with money 

and do with more money. Yet, I must acknowledge that we’re part 

of a bigger budget process. That process is trying to limit resources 

that they’re willing to ask Congress for, to make very tough decisions, and get at the same table at the same time all of these different sectors—peace and security, economic growth, and democracy. 

Senator LEAHY. What you’re saying is that you’ve lost the OMB 

battles. 

Dr. HILL. We’ve won some battles. I doubt if there’s any part of 

the budget process that is fully satisfied with the end product. But 

there are a lot of tradeoffs. I do have to acknowledge that, as has 

been said by my colleagues, malaria and HIV have huge increases, 

avian influenza is in the budget at $100 million, and you folks are 

considering a $161 million supplemental. I know that overall 

health money being spent and being asked for by the Congress is 

more than in the past. But, it is certainly true that the way that 

it is prioritized within the health portfolio has left these two units 

upon which we’re testifying today with less money than they have 

had in previous requests or appropriations. Those are very difficult 

tradeoffs. 

Senator LEAHY. But, on these tradeoffs, for example, the World 

Bank has 54 countries designated low-income countries, and 

USAID has programs in many of these. 

Let me give you an example. In the fiscal year 2008 budget, 

where some of these tradeoffs are, there’s an increase in funds for 

Liberia, and I strongly support that. 

Dr. HILL. Right. 

Senator LEAHY. But, Mali, which also has similar problems, receives less. So, is this robbing Peter to pay Paul? 

Dr. HILL. I think you have pointed out an issue that’s come up 

in this first year of the new system, which is problematic, and it’s 

been noticed, and we’re going to address it in two ways. 

As you know, the budget was put together by country teams, 

looking at and trying to prioritize within their countries. But when 

you look at the final product, you’ve got some inequities where 

some countries with greater need had less money than was being 

spent in the countries that needed the money, but not as much. 

Therefore, I think we’re going to have to look at these 2008 appro-
75 

priations by country, and make some adjustments, but that’s only 

part of the answer. 

The second part of the answer is to ask the question, what can 

you do about the process for 2009 that would make fewer adjustments necessary? The answer seems to be this—to ask the three 

pillar bureaus at USAID to look globally at big issues and give 

some input to the Office of the Director of Foreign Assistance and 

say: ‘‘If you have to spend X amount of dollars on, say, child and 

maternal health, this is the priority of the countries you ought to 

spend it in.’’ That will affect the amount that they set for the country team to consider. They will say to the country team: ‘‘Be aware 

that we are setting this amount,’’ partly keeping in mind that they 

have an unusual global need in this area. So, that may help us 

some. 

Senator LEAHY. May help some, but you still have a limited—— 

Dr. HILL. A limited pot. 

Senator LEAHY. Yes. 

Dr. HILL. Now, there’s one other thing I should say, and that is 

that it’s probably inaccurate to describe the work in HIV or malaria, not suggesting you did this, but some might conclude this, 

that there’s no connection to these other interventions. Eighty-five 

percent of the malaria deaths are to children under 5, so if we succeed there, it will actually help in child survival as well. 

Senator LEAHY. But, it’s not 85 percent of the children. For example, we’ve—I understand that USAID has cut funding for the 

oral rehydration salt program, which stops diarrhea—— 

Dr. HILL. Right. 

Senator LEAHY [continuing]. I mean, that doesn’t seem right. 

Should the HIV/AIDS and malaria initiatives, which I strongly support, should they be the foundation of our global health strategy? 

Dr. HILL. I think it’s fair to ask questions about how a pot of 

money for health ought to be divided up. I can tell you the experts 

at USAID and elsewhere strongly disagree with each other from 

time to time about what those priorities ought to be, measuring 

how many people will die in a particular intervention. The experts 

don’t always agree, so it’s always a tough process, even among the 

health experts to decide, with limited money, where you’ll get the 

most bang for your buck. 

On HIV, the argument often goes, if that gets out of control, you 

get a lot more parents dying. This fact that a parent is alive is a 

huge factor in whether a child lives, and the quality of their life, 

so they argue that you don’t have the children to work with if you 

fail, so these are the kinds of arguments—— 

Senator LEAHY. I understand. 

Dr. HILL [continuing]. Of these people. 

Senator LEAHY. I’ve visited a number of these countries, and I’ve 

encouraged improvements in HIV/AIDS programs, but, I worry that 

Secretary Rice spoke of the U.S. health strategy as primarily being 

implemented through the HIV/AIDS and malaria initiatives, and 

there is much more to public health than those two diseases. 

Dr. Gayle, how would you respond on that? 

Dr. GAYLE. Yeah, well, I think, you know, people have made the, 

several points about how we have to look at this in a much more 

integrated fashion. So, for instance, if we do a much more com-
76 

prehensive approach in our HIV work that really looks at, what are 

some of the underlying reasons why some people are more at risk 

than others? Women, particularly who oftentimes are at risk for 

HIV because of sex, gender-based violence, or lack of economic opportunities. If we address some of these underlying causes as well, 

I think we will go a much longer way towards helping strengthen 

health and the root causes of poor health to begin with. 

So, I think, first and foremost, it’s looking at these things in a 

much more integrated fashion. We do HIV testing in the context 

of reproductive health programs, and treat other sexually transmitted diseases for women who come for reproductive health services. I think we can do this in a way that supports building a much 

broader, and more comprehensive approach to poor health and poor 

nations. 

But we can’t do it only by focusing on specialized programs. We 

have to do it in a way that looks at both the root causes, what are 

some of the things that are in common, including access to services, 

a strong health infrastructure, and do it in a way that recognizes 

that we can’t let go of our core competency in programs that save 

the lives of children and women and families around the world, 

while we’re continuing to focus on these other programs. It has to 

be integrated, or else in the long run, we’re not doing service for 

HIV, malaria or any of the other issues, if we don’t do it in a way 

that builds the platform upon which we can make health better 

overall. 

Senator LEAHY. Ms. Garrett, do you want to add to that, and 

then I’m going to ask Dr. Daulaire the same question. 

Ms. GARRETT. I think if we have two strategic targets for our 

global health/foreign aid, they would be to create sustainable infrastructures that can address a broad range of disease issues, and 

not be too narrowly focused, and that they would—in the process— 

ensure the safety and security of the American people by lowering 

the disease threat burden external to the United States. I think 

that we can accomplish both, but that the way we’re going about 

it right now, we will fail to accomplish either goal. 

It is appropriate that we elevate the level of funding directed to 

H5N1, or Avian flu. That is an elevated risk, and I do very strongly 

believe that the odds are reasonably high, that this particular bird 

flu strain may make, what we now know, is only two amino acid 

changes necessary in its entire genome to turn into a rapid human 

to human transmitter. 

It is appropriate that we very heavily address concerns about 

HIV and that we have this PEPFAR, or now GHAI infrastructure 

in place to deal with specifically HIV. But, they—each one of them 

comes up against the same identical problem. If you talk to the 

people dealing with flu, and we’ve put out—I think our total expenditure now is if the fiscal year 2008 are approved, is going to 

top $8 billion, domestic mostly. But, if you look at the flu problem, 

and you talk to those people, they all say, you know, ‘‘Our problem 

is that we can’t find human cases of flu on the ground fast enough 

because there isn’t a health infrastructure. There aren’t people 

there watching, and there aren’t places for the patients to go.’’ 

Senator LEAHY. You also have some countries that don’t want the 

information to come out, and you don’t want—— 
77 

Ms. GARRETT. Well, that’s a separate issue, transparency is obviously a huge problem. HIV tells us the story of the lack of transparency, because country after country after country denied that 

they had an HIV problem, or then said, ‘‘Oh, it’s only foreigners,’’ 

or ‘‘It’s only homosexuals,’’ or it’s only this or that, until they had 

a generalized threat. 

But I don’t think that—and I know that this is going to come up 

when you hit the appropriation on the PEPFAR funding—I don’t 

think that the PEPFAR infrastructure can be scaled up to become 

‘‘the’’ infrastructure we’re all looking for. I’d be happy to go through 

all the reasons why, it’s a very long story, but bottom line is, it is 

an infrastructure that is primarily designed to address the health 

needs of a small population of adults, ranging between roughly 15 

and 35 years of age. It is not—though it has a pediatric component—it is not a child health program. Though it deals with women 

of pregnancy age, it is not a maternal health program. 

In fact, you have this odd possibility that as you enhance 

PEPFAR, a woman can get Nevirapine to prevent her from transmitting HIV to her child, but the next time she’s pregnant, she will 

die in childbirth, because she can’t get a cesarean section. 

Senator LEAHY. Dr. Daulaire? 

Dr. DAULAIRE. Well, let me first endorse what Laurie Garrett 

just said. There is no question that these programs for HIV/AIDS 

and malaria are, have an impact on the health of children and the 

survival of children, and of some women, but they are not the first 

and primary route for making a change in terms of their lives. 

They are, in a sense, necessary, but not sufficient. 

I think the question here that we often get trapped into in the 

social sector in international development, is run a first assumptions. If we had accepted the assumption in 2001 that the cap on 

U.S. Government spending in global health was going to be, as it 

was then, about $1 billion, we would be having arguments today 

about whether we could possibly do anything at all with HIV. 

You’ve made the case that we spend lots of money on things that 

we consider to be important National priorities, so the argument 

made that, by Secretary Rice, that this addresses the issues of 

child health and maternal health do not hold water. They certainly 

are supportive of children’s health and women’s health, the kinds 

of programs that we’re talking about today are the ones that are 

fundamentally important to make this change. 

Senator LEAHY. Let me ask about some of those fundamental 

things. We keep going back to this question of safe water, especially for child and maternal health. Now—and you’ve spoken, Dr. 

Gayle, about CARE and the broad things it does, all the various 

aspects, you’re basically saying there’s no magic bullet, it’s everything. 

What has been the impact of USAID’s Safe Water and Sanitation 

Programs? 

Dr. GAYLE. Thank you, and I don’t have the specific numbers offhand, clearly there has been a major impact. We’ve been very supportive of the Safe Water Act in Senator Simon’s name that we feel 

really ought to be strengthened and supported even more. Clearly, 

having safe water where a sixth of our population today does not 

have access to clean and safe water, means that not only will basic 
78 

hygiene not be available for much of our world population, but it 

also means that things like diarrheal diseases are only going to 

continue to be prevalent. 

I’ve been in village after village in our work, where I’ve seen 

what it means to a family to have clean, safe water, where not only 

does it cut down the diarrheal diseases, and the under-5 mortality, 

but it means that children can go to school for the first time in 

their lives, and start to think about a different kind of future for 

themselves and for their families and communities. 

So, yeah, I think the basic ability to supply clean and safe water, 

while some don’t think of it as a health intervention, is one of the 

most basic interventions, and is something we feel is one of those 

cornerstones upon which a health—looking at improving health is 

critically important, and needs to be build upon. We think that 

there is more that needs to be done, and it is one of those areas 

that gets second shrift, because it isn’t seen as one of the visible 

issues that is currently on the front lines. 

I would just say, with some of the concerns around climate 

change, we think that the issues of clean and safe water are only 

going to become more and more urgent, and particularly for the 

poor, who will be facing more erratic climate conditions, more 

drought affecting agricultural productivity and nutrition, et cetera. 

So, this issue of safe water, clean and safe water, is a critical one. 

Senator LEAHY. Dr. Hill, and I might say, when I ask some of 

these questions, I’ll be the first also to say that USAID has done 

some tremendous things around the world, and I’m just trying to 

figure out how to make it even better. What do you say about the 

importance of clean water? 

Dr. HILL. We agree with Dr. Gayle, that those who insist on separating water projects from health miss the point. For example, we 

have a three-part response to the question of small kids who die 

from diarrhea, and the first part of the strategy has to do with 

point-of-use water projects, second, the sanitation message about 

washing your hands; and third, dealing with feces. Much of this 

has to do with water; so we view the water projects as integral to 

what we need to do to have a big impact on under-5 mortality. 

Senator LEAHY. Ms. Garrett, you talked about direct funding for 

systems development and management, and you say USAID is 

doing that, but they’re doing it on a budget of $3 million a year. 

Do you want to address that? I’m going to follow up with another 

question, but go ahead. 

Ms. GARRETT. I keep forgetting to push the button, so sorry. 

Yeah, we, if you were a CEO of a major corporation, and the revenue for your corporation suddenly jumped, from say, $800 million 

to, say, $18 billion. You wouldn’t want to imagine that your $800 

million management infrastructure was up to snuff to handle $18 

billion appropriately. 

You would be even more concerned about that jump, if you knew 

that you had almost no health personnel to execute this giant new 

corporate venture. Worse yet, it’s projected that by 2013, we will 

have a deficit here in the United States of 800,000 nurses, and 

200,000 doctors. I, you know, I want to say a little on the side here, 

that I know that we’re here dealing with foreign relations, but if 

there’s one place where I feel that there is a need to see a con-
79 

versation between—conversation between foreign operations and 

domestic—it is on this healthcare issue, healthcare resources issue. 

Senator Dick Durbin has a bill that would try to rapidly increase 

the number of healthcare workers we’re training in developing 

countries—— 

Senator LEAHY. In fact, Senator Durbin was going to be here but 

he was not able to because of what’s happening on the floor. 

Ms. GARRETT. Understood. 

Senator LEAHY. He’s a whip, and you’re talking about his African 

Health Capacity Investment Act—— 

Ms. GARRETT. Exactly. 

Senator LEAHY. I’m co-sponsoring that and we’ve all touched on 

this a bit. As doctors and nurses leave for better paying jobs, and 

I think of our own country when I see the ads for nurses. Bringing 

them here from other countries to make up for our failure as a Nation compounds the problem. 

To go back to my earlier comment, I’m not suggesting the Mayo 

Clinic in these countries, but I am asking why can’t we have nurse 

practitioners? Why can’t we have people who have at least basic 

skills, and the kind of infrastructure to handle basic health needs. 

Ms. GARRETT. Right. 

Senator LEAHY. There are certain things we do almost unconsciously, for hygene, but they need to be taught. How do we do 

this? 

Ms. GARRETT. Well, I’m so glad you’re asking that, because it 

goes back to your original question to me, how do we get to reasonably managed health systems? 

As I was saying, I really think there needs to be a conversation 

between your counterparts dealing with domestic health funding, 

and international on this question. Because if we reach the point 

where we are trying to suck away from the poor world 200,000 doctors, to offset our deficit—I’m not even sure there are 200,000 out 

there—but if we go after everything we can get, sure, we might be 

able to deal with our health problem, but at the expense of killing 

people in poor countries. 

So, I see that—— 

Senator LEAHY. Is there a way we can do both? To take care of 

our health problem and also help take care of theirs? 

Ms. GARRETT. Well, actually, as it turns out, with the nursing 

crisis and the physician crisis here, in terms of our really mediocre 

level of domestic production of our own indigenous personnel, so 

that we don’t need to suck the talent away from the poor world, 

it turns out the disincentives are less about pay, salaries at the, 

once you are a professional, than they are about access to the actual training. 

We’ve had bills come consistently before this body and the House, 

requesting subsidies for State support of nursing training and physician training, and they have consistently failed to even get out of 

committee. 

One of the biggest problems that we have right now in nursing 

training is that a typical nurse earns more as a practicing nurse 

than she can earn as a Professor of Nursing. Most nursing training 

is done by land grant and State-supported institutions, they are 

underfunded, and their faculty are underpaid. Most of the States, 
80 

a State like Michigan, for example, which has quite a number of 

nursing schools, as you know, Michigan is a hard-hit State right 

now. Its economy is in deep trouble. They cannot afford to even 

match the salary level that a nurse can make as a nurse, versus 

as a professor, without Federal support. 

We need to really say, I think, in no uncertain terms, that the 

foreign operation side of the Senate is saying to the domestic operations side, ‘‘Unless you create the incentives for us to produce sufficient healthcare personnel, domestically, so that we do not need 

to absorb the talent from the outside, we’re in an immoral position.’’ 

Senator LEAHY. Dr. Daulaire, Dr. Gayle and Dr. Hill on this? 

Dr. DAULAIRE. Senator Leahy, there’s two sides to this question, 

there’s the push side, and there’s the pull side. And the pull side 

is what goes on here in the United States in terms of our 

healthcare deficits, and in Europe for that matter. 

I think it’s appropriate for this Committee to particularly focus 

its attention on the push side—why is it that healthcare workers 

are leaving, or not getting trained to begin with? There are a number of different issues here. One is very often the wrong kinds of 

people are being trained in these countries. As a physician myself 

I hate to say it, but what the world does not need more of is lots 

more doctors, what the world needs lots more of is nurses, paramedics and auxiliary health workers who can address the 

healthcare needs at the communities where they’re taking place. 

My own experience in the field has reinforced this many times 

over. So, that needs to be a focus in terms of both National priorities and donor assistance from the United States. 

Second, if the United States in its donor-assisted programs, HIV/ 

AIDS, malaria, TB and all of the rest, if it simply recognizes the 

fact that there has to be a health systems overlay, you don’t just 

say, ‘‘Well, you do the health system, and you train the people, and 

then we’ll give you the money or the drugs for specific interventions,’’ there has to be incorporated into the framework of international assistance in healthcare. Third, on a very practical basis, 

in Africa where this crisis is at its worst, recently a group of African leaders got together and established a 15 percent target—they 

decided it themselves—of their national budgets to be used for 

their health systems. We need to encourage and reinforce this. This 

is not just a United States problem, but we can help by providing 

incentives through our international assistance for those countries 

that are actually moving forward on getting to that 15 percent, 

which, I would note, I believe no African country has currently 

reached. 

Senator LEAHY. Dr. Gayle? 

Dr. GAYLE. Yeah, just to basically support, I think, the issue— 

in addition to thinking about how we can make sure that we’re not 

being a drain on the workforce in poor countries, but also that we 

look at what are the needs? That we are very, that we reinforce 

the kinds of health workers that will have the greatest impact on 

the lives of people in poor countries. 

As Nils said, it’s not necessarily doctors or even sophisticated 

nurses, it really is, developing a core of people who are the auxiliary health workers, on the ground people who come from those 
81 

communities, and understand those communities, who are really, 

the cornerstone of health interventions. By supporting the interventions, they are much more focused on the preventative side of 

health services, the public health approaches, I think we will get 

a lot—much more bang for the buck than by supporting tertiary 

care focus and technology fixes that oftentimes lead to short-term 

fixes, but not looking at the longer-term impact on lives. 

We also would like to endorse the Durbin workforce bill, and be 

happy to help in any way as that continues to move forward, and 

think about what are the best ways in which to build that kind of 

health capacity on the ground that meets the needs of people where 

they are. 

Senator LEAHY. Senator Durbin and I feel very strongly, I’m following his leadership on it, but we feel very strongly about that. 

Dr. Hill? 

Dr. HILL. Three quick points—there is one piece of good news 

here. When I travel to Africa or talk to doctors here who came from 

Africa, I’ve been pleased to find that the overwhelming majority did 

not come here primarily because they would get a higher salary. 

They often report that they came here because they had a chance 

to work in the field they were trained in, and they didn’t have the 

chance at home. It is generally only a secondary motive—that is 

they did have the chance, they couldn’t feed their family and do it. 

Which leads me, and leads us, to the conclusion that we need to 

focus as Nils said, Dr. Daulaire said, on making sure that out there 

in the field the systems improve, so they can hold onto the people 

that are trained. 

There is also a second point that addresses some of the points 

that Dr. Garrett was bringing up about infrastructure and health 

systems, because it’s all related. I think as good as the CBJ may 

be in terms of communicating some things, at 2 inches thick you 

would think it could communicate a lot, but there’s an awful lot it 

doesn’t communicate. 

There aren’t a lot of projects. There’s not a category for infrastructure or health systems, et cetera. But as a matter of fact, at 

USAID—and at PEPFAR too—there’s a strong sense that these 

issues that have been raised simply have to be dealt with. The 

surge is a big problem, and they know that we have to work on systems. 

But the way it tends to get done is that it is a component within 

a project that might be HIV or malaria or tuberculosis or contraceptive health or whatever it is, and any good program is going to 

have a component to it that specifically deals with this issue. 

Now, there are two questions that Ambassador Tobias always 

asks at a review of programs. One, ‘‘Show me how this correlates 

with the work of other donors, so I know it’s not duplicative.’’ Number two, ‘‘Show me how this is going to produce sustainability,’’ 

which means it has to get at the issue of health systems, et cetera. 

So, we’re aware this is a problem. 

The third simple point is that we are trying to ramp up, within 

all of the specific interventions, a component that will address precisely the question about what can you leave in place there that 

will allow them to do this work when we are gone. 
82 

Senator LEAHY. You know, in the article Challenge of Global 

Health, that Ms. Garrett wrote in Foreign Affairs, she quoted a 

Zambian doctor who said maternal death is the biggest challenge 

in strengthening health systems, if we get maternal health services 

to perform then we’re nearly perfecting the entire health system. 

Without going into great detail, let me start, Dr. Hill, with you. 

Would you agree with that? 

Dr. HILL. Sorry, that there’s a health systems problem in Zambia? Is that—— 

Senator LEAHY. No, that maternal death is the biggest challenge 

in strengthening health systems. If we can get maternal health 

services to perform, we’re nearly perfecting the entire health system—that’s what a doctor in Zambia said. 

Dr. HILL. Yes, my health experts would probably disagree and 

have a big debate about that. It is certainly a critical component, 

and one of the most important. Whether it’s the very most important, I don’t think I’d be prepared to say, but it is a lynchpin, a 

critical piece of the puzzle. 

The problem with a lot of this is that—however you decide to 

prioritize, the bottom line is, if you’re not basically doing them all, 

just the top ones, whatever you choose is going to be undermined 

by what you didn’t do. So, you almost have to find a way to take 

the top three, four or five, and find a way to do them, and to do 

them as well as you can, or you’re going to undermine your successes wherever you did work. 

Senator LEAHY. Which goes back to my prior oversimplification, 

my concern about robbing Peter to pay Paul, and making them all 

work. 

Dr. Gayle, how would you—— 

Dr. GAYLE. I wouldn’t add a lot to that, only to say that while 

it may not be the thing that can fix the overall system, it is something that we know we can do a lot about, there’s a lot of examples 

of making a difference, and I think it is totally unacceptable that 

today with all that we know and all that we can do that we continue to let 500 million women die every year from maternal mortality—something that ought to be a normal part of life, and that 

we continue to have 150 times greater mortality rates in poor countries, than we have here. So, it is one of those issues that we can 

do something about, that would strengthen the infrastructure. 

I would just go back to the point, the chart that Nils Daulaire 

showed earlier, when we look at, and the point that you made— 

when we look at talking about $100 million and what that does in 

terms of saving lives—$100 million is a small amount of money for 

a huge return in lives saved. 

So, I think, again it is a choice of where do we put our resources, 

what do we want to be known for as a Nation, where do we want 

to show our leadership, and start making some of those choices? 

When I headed the program for USAID program for, or Global 

AIDS Program, we at that time had $250 million in our total program. You know, we are now in the billions of dollars. It is possible, with the right kind of leadership and the right kind of commitment to take the cap off and stop making unnecessary limitations for things that we know can make a huge difference in peo-
83 

ple’s lives around the world, and put us back in the global world 

as a compassionate Nation that does care about these things. 

Senator LEAHY. You talk about the $100 million. It’s just about 

noon, we spent that much today in Iraq. 

Whether one is for or against the war, just so we understand 

where the money is being spent. 

Ms. Garrett, did you agree with the Zambian doctor you quoted? 

Ms. GARRETT. I did. I think that we use the phrase ‘‘canaries in 

the coal mine’’ to refer to what is the marker of a potential risk 

or threat. 

To me, the big canary in the coal mine for whether or not you 

have a public health infrastructure is dying children under 5, and 

a big canary in the coal mine for whether or not you have a functioning health delivery system is dying mothers in childbirth, and 

childbirth-associated deaths. 

I’ll give you an example from a few years ago, when I was in a 

rural clinic in Zambia, probably about an hour’s drive from Lusaka. 

A woman came in with two children, one strapped to her back, and 

one trying to walk at her side. She had had to walk for 2 days to 

get to this clinic, and was doing so because the baby on her back 

was terribly sick. But, along the way the child became sick as well, 

the one that was ambulatory, and she ended up, for the last mile 

or so, carrying both children. 

When she staggered in, the doctor felt that the larger child 

looked like the more crisis case, so she left her baby with me, on 

a straw mat on the floor, and went in to see the doctor with the 

larger child. As I held the baby, it died in my arms, and its cause 

of death was measles—completely preventable. The larger child 

died of malaria, and the mother broke out sobbing, describing how 

hard it had been for her to give birth both times, and how frightening it was, the prospect of what she would have to go through 

just to have two children to replace the two she had just lost. 

To me, that anecdote has lived with me my entire professional 

life, it has been a guiding anecdote. I can’t think of any better way 

to look at what we’re trying to do with U.S. foreign aid than to 

focus on how we could save both of those babies, and make it safe 

for that mother to give birth to future children. 

Senator LEAHY. Have both the mother and the child live. 

Dr. DAULAIRE. The question that you asked, Senator Leahy is, I 

think, a very important one, and it underlines some of the challenges that we have in addressing all of these issues in a substantive way. 

I can certainly create for you a model in which maternal mortality could be dramatically reduced in which other major causes 

of illness and death probably wouldn’t be affected. You can design 

a health delivery system that focuses on that. So, the point is that 

you should not confuse cause and effect. A well-functioning medical 

care delivery system will reduce maternal deaths, but a maternal 

death-reducing system will not necessarily be a good medical system, and I reinforce what Laurie Garrett just said about keeping 

some distinction between public health and medical care. 

On the other hand, an awful lot of children who die around the 

world, die not only because they lack preventive services, but because they don’t have access to the basic care that would get them 
84 

antibiotics for their pneumonia, that would get them treatment for 

their malaria, where you actually need a trained healthcare provider, so there’s a mix in all of these. I think, though, that the bottom line is, if we made the kinds of investments that each of our 

panelists has been talking about, it is a reasonable presumption 

that we would see dramatic reductions in both child death and maternal deaths. 

Senator LEAHY. Thank you. I want to thank each of you for being 

here. Some of the questions I asked may have seemed self-evident, 

but I’m also trying to prepare a record for other Senators. 

I don’t want to leave the impression that I simply feel that more 

money cures all things. there are very dedicated men and women 

who are out in the world, from the United States as well as a 

whole lot of other countries. Some very dedicated men and women 

from those countries, that are trying to make a difference. Sometimes in areas with no infrastructure, or in the midst of civil war. 

I think of one African country where I went with my wife where 

we were using the Leahy War Victims Fund. She had helped the 

nurses to bathe and care for a boy who was probably 10 years old, 

with terribly distorted limbs. As she was bathing him, she didn’t 

see a mark on him, she asked why, they said he had polio. She 

asked the obvious question, ‘‘Why polio?’’ She knew that we’d sent 

polio vaccine to that country, making it available? They said the 

people who would do the polio immunization could not get to his 

village because there were so many landmines around, they 

couldn’t. 

I mention that only because too often—and I think Dr. Hill you 

were trying to point this out, there is no magic thing that we can 

do, but we should start with the health needs of women and children. 

ADDITIONAL SUBCOMMITTEE QUESTIONS

There will be some additional questions which will be submitted 

for your response in the record. 

[The following questions were not asked at the hearing, but were 

submitted to the witnesses for response subsequent to the hearing:] 

QUESTIONS SUBMITTED TO DR. KENT R. HILL

QUESTIONS SUBMITTED BY SENATOR TOM HARKIN

POLIO ERADICATION

Question. Polio Eradication efforts are clearly working as we have seen the number of countries with indigenous polio drop to four, 2 billion children have been immunized, 5 million have been spared disability and over 250,000 deaths have been 

averted from polio. However, until the world is polio-free, every child, even those 

in the United States, is at risk. 

In fiscal year 2007, both the House and Senate included $32 million for polio 

eradication in their respective Foreign Operations Appropriations bills. 

What amount is included for polio in your fiscal year 2007 projections? 

Answer. USAID intends to provide $31,680,000 for polio eradication in fiscal year 

2007, which meets the House and Senate report level minus a 1 percent rescission. 

Question. What is included for polio in your fiscal year 2008 budget submission? 

Answer. The administration will fund polio eradication but specific funding levels 

are still under consideration. 
85 

QUESTION SUBMITTED BY SENATOR RICHARD J. DURBIN

MATERNAL MORTALITY

Question. The statistics are devastating—1 in 6 women in Angola or Afghanistan 

is likely to die from the complications of pregnancy or childbirth. UNFPA has a 

strong track record in this area, but the administration has refused to provide the 

funding for them that Congress has allocated. Women giving birth alone without access to the most basic care or life-saving drugs that could prevent post-partum hemorrhage should not be a hallmark of the 21st century, but in too many countries 

it is all too common. What are the most effective ways to reduce maternal mortality? 

Answer. Maternal mortality can be reduced in two major ways: (1) reduce the 

number of high-risk and unintended pregnancies and (2) address the life-threatening consequences of pregnancy, which can include hemorrhage, infection, eclampsia, obstructed labor, and unsafe abortion. By promoting healthy timing and spacing 

of births, reducing unintended pregnancy, and reducing abortion, voluntary family 

planning is one of the most effective ways to decrease the number of maternal 

deaths. Once a woman becomes pregnant, USAID’s strategy focuses on high-impact 

interventions. These include active management of the third stage of labor to address post partum hemorrhage; tetanus toxoid immunization during pregnancy, 

clean delivery practices, and treatment by antibiotics to address infection; administration of magnesium sulfate for eclampsia; monitoring the duration of labor and 

taking action in the event of prolonged labor; and provision of post abortion care. 

The over-arching strategy to deliver these and other maternal interventions (such 

as nutritional support and intermittent presumptive treatment for malaria to address indirect causes of maternal death) is to increase women’s access to skilled attendance at birth, emergency obstetric capability to deal with complications, 

antenatal care and post-partum care, and family planning information and services. 

Essential to successful maternal care programs are reduction of financial barriers 

for families, appropriate deployment and retention of skilled frontline workers, and 

institutionalization of quality improvement systems. USAID has a very strong track 

record in maternal mortality reduction, including demonstration of effective approaches in community mobilization and behavior change, policy formulation, financing of maternity services, effective life-saving skills training, quality improvement, and contribution to reduction of maternal mortality by 20–50 percent within 

10 years in 10 countries. 

QUESTION SUBMITTED BY SENATOR PATTY MURRAY

HEALTHTECH AND THE CHILD SURVIVAL AND HEALTH ACCOUNT

Question. Under current funding levels, successful programs such as HealthTech 

have been cut to the skeletal remains. The administration’s proposed budget calls 

for further cuts to the Child Survival and Health account, which funds HealthTech. 

These cuts are proposed while the administration comes to the Hill and touts 

HealthTech’s successes such as the UNIJECT injection device and thccine Vial Monitor. The Senate budget resolution recognizes how important these programs are, 

and has added additional funding. That being said, please explain how further reductions could inhibit USAID’s ability to fund such proven programs with demonstrable successes at the full obligated level? 

Answer. Reduction in funds to HealthTech is not due to Agency funding cuts, but 

due to completion of certain activities. Further, sufficient money is already obligated 

to HealthTech for current needs. USAID is currently funding HealthTech to help develop several technologies—including antibiotics in UniJect and newborn resuscitation devices—which will improve the health of impoverished people. 

In this and other key health investments, USAID focuses its programs and efforts 

on the highest impact activities, works closely with other donors, and continues public-private collaborations to help fill gaps. By these means, we expect to meet our 

objectives with requested Child Survival and Health account levels. 

QUESTION SUBMITTED TO LAURIE GARRETT

QUESTION SUBMITTED BY RICHARD J. DURBIN

AFRICAN HEALTH CAPACITY/BRAIN DRAIN

Question. The issue of health capacity is critical to addressing all of the problems 

raised today. The whole world, including the United Stats is experiencing a shortage 
86 

of health personnel, but in Africa the shortage is far more dire. The math is devastatingly clear: as you testified, ‘‘As the number of health workers declines, survival decreases.’’ 

Along with Senator Coleman, Senator Leahy, and others, I have introduced legislation to authorize a concentrated effort to help Africa build the health capacity that 

it so desperately needs, from personnel—doctors, nurses, and community health 

workers—to infrastructure. Africa needs both health systems and the ability to train 

and retain personnel. Our legislation is also part of an effort to combat the brain 

drain of health professionals, including the need to train more nurses here in the 

United States so that we are not dependent on the poorest countries in the world 

to supply our health workforce. Ethiopia has 3 physicians per 100,000 people but 

there are more Ethiopian physicians in Chicago than in all of Ethiopia (Tobias). 

What are the most effective ways to build health capacity AND fight this brain 

drain? This is an enormous problem—where can a U.S. contribution add the most 

value? 

Answer. Thank you very much for posing this critically important question. I am, 

of course, well aware of your important initiative, and praised it in my testimony, 

and during Sen. Leahy’s questioning. When you initiated the process of drafting this 

bill there were few analogous efforts going on in the world, and the U.S. leadership 

in this area was desperately needed. 

I am happy to report that several potentially blockbuster efforts are underway, 

augmenting your efforts in this area. I will try to briefly describe the status of this 

situation, and suggest some efforts the United States can, and should, make. 

First of all, in the last few months there has been a striking sense of global recognition of this problem. Recognizing a problem, and understanding its roots and 

nuances, is always the first step. Two real heroes in this aspect of the situation are 

Mary Robinson and Tim Evans. Robinson, the former President of Ireland and 

former head of the U.N. Commission on Human Rights, is now heading an international group that is trying to find ways to slow the exodus of health care workers 

from poor countries to the rich, without violating their individual human rights. Her 

group is meeting as I write these words in Geneva, in tandem with the 59th World 

Health Assembly. 

Dr. Tim Evans, a leading Canadian health expert, now holds a top position in the 

office of WHO Director-General Margaret Chan. Together with Harvard’s Dr. Lincoln Chen, Evans authored the groundbreaking analysis of the global health care 

workers situation, publishing 2 years ago, that estimated current deficits at 4.3 million. Evans’ high level position in WHO’s new leadership signals Chan’s appreciation of the dire severity of the situation, reflected in her marvelous remarks at the 

opening of the Health Assembly this week. Chan is clearly the sort of Director General the global health community has been waiting for, and I have no doubt that 

she will take this health crisis issue by the horns. 

On an entirely different front, the Prime Minister of Norway instigated a highlevel meeting of foreign ministers, which convened in Oslo earlier this spring. The 

goal of the meeting was to better understand the links between national security 

and health, and the elevate discussion and action in the arena far beyond mere financial commitments. There is a growing recognition, as I outlined in my Foreign 

Affairs piece in January, that simply throwing billions of dollars at targeted global 

health problems, without any structural framework or support for public health systems development, will kill more people than are saved. (The one-page Oslo Ministerial Declaration is attached below.) The Oslo Summit promised a series of actionable 

steps. 

The first of those steps will be launched this September in New York, during the 

U.N. General Assembly: ‘‘A Business Plan to Accelerate Progress Towards MDG 4 

and 5’’. It’s not a pretty title, but the concept is important. The Plan recognizes that 

the real victims of health care worker and health system deficits are mothers and 

children, and seeks to create an out-put based business strategy for investment in 

developing country health systems. The Oslo declaration estimates that 10.5 million 

mothers and children die annually from preventable causes, nearly all of them directly resulting from lack of sufficient medical care or basic public health services, 

such as water filtration and sewage treatment. 

The Oslo group seeks to find business solutions to the crisis, creating better management of available personnel and resources, linking standards of care to financial 

rewards for providers, and moving the global community away from single disease 

targets for support and financial aid. 

Secretary General Ban ki-Moon is also interested in finding ways to move the entire U.N. system towards a health systems approach for achievement of the MDGs 

(Millennium Development Goals), hoping to bring the health targets of various 

agencies into greater harmony. 
87 

Angela Merkel has signaled that she wants the G–8 to look at this issue in its 

upcoming Summit in Germany. Merkel has also instructed Germany’s current leaders of the EU to examine EU foreign aid to global health, with an aim of building 

sustainable health systems. 

Meanwhile, the World Bank and its IFC are moving in a very different direction— 

at least, for now, under Wolfowitz’s imperiled leadership. Thought the IFC recognizes the crisis in healthcare workers and paucity of health systems, it is not interested in building local capacity. Rather, it has announced a $200 million program 

that would bring massive healthcare corporations from the wealthy world into poor 

countries, providing fee-for-service healthcare delivery to the nations’ elites. The notion is that quality care for the elites will have a trickle-down effect, setting a standard that the entire Ministry of Health operation will strive to achieve for the population, as a whole. 

As my tone may reveal, I do not accept this thesis. I was in Moscow when the 

U.S. Government built such an elite care facility inside the Kremlin Hospital, specifically to ensure that Boris Yeltsin received state-of-the-art cardiac care without 

having to leave Russian soil. The fantastically expensive effort was described in precisely the ‘‘trickle-down’’ terms now used by IFC. But in the years following construction of the elite facility, the Russian healthcare system deteriorated further, 

life expectancy for Russian men spiraled downward, drug resistant TB and HIV 

spread across the region, the live birth rate reached an all-time low for Russia and 

the overall health status of the country plummeted: So much for ‘‘trickle-down’’. 

Here is the problem with how the United States funds these issues (to be followed 

by some suggested solutions): 

(1.) Nearly the entire foreign aid budget for health and development is earmarked 

for disease-specific programs. Under the President’s fiscal year 2008 State Department ‘‘Strategic Framework’’ funding is further funneled according to global political 

exigencies, targeting specific countries that the Administration believes play crucial 

roles in maintaining regional stability or in the War on Terrorism. Funding does 

not reflect on-the-ground needs. 

(2.) The Administration (and many AIDS activists) argues that PEPFAR has created a health infrastructure in the 15 targeted countries that may now be solely for 

provision of HIV-related services, but can serve as a template for all health needs. 

In debates over reauthorization of PEPFAR this argument will be made. PEPFAR 

has become sensitized to the negative impact the massive AIDS-specific health program is having on other health services in targeted countries, and hopes to convince 

Congress to reauthorize PEPFAR, giving it more money, and a larger mandate. 

(3.) The United States is not now engaged in the multilateral efforts to address 

the healthcare worker and health systems crisis, such as Mary Robinson’s plans or 

the Oslo Declaration. As you well know, the Bush Administration has not played 

on the global health stage in partnership with other wealthy nations, and has set 

moral standards for execution of health programs (e.g. sexual abstinence, faithbased solutions, etc.) We are not part of the global efforts to solve these problems. 

(4.) Overall, the U.S. foreign aid budget shares with other wealthy nations the 

problem of having been designed as a massive charity program. We have failed to 

invest in health, though we consistently use the term, ‘‘invest’’. Therefore, nothing 

is sustainable. There are no local profit centers, no genuine stakeholders. 

(5.) The Republican-controlled Senate, under the leadership of surgeon Bill Frist, 

favored solutions to the healthcare worker and health systems crises that flowed 

from the fundamentally charitable view of U.S. foreign aid. Frist introduced bills 

that would underwrite the costs of faith-based and medical societies-run programs 

that dropped American doctors (and maybe nurses) into foreign countries for short 

time periods, during which they would theoretically perform surgeries, and supplement the services of indigenous healthcare workers. Criticized as ‘‘Safari Medicine,’’ 

such vacation programs for American doctors tend to do more good for the Americans than for those they seek to serve, opening their eyes to the needs of the poor. 

Successes are limited to a handful of healthcare needs that are truly amenable to 

one-stop interventions, such as removal of cataracts, heart surgery, or limb replacement. Even acute humanitarian care interventions suffer if the health professionals 

limit their participation to time periods too short to allow them to learn some basic 

elements of the local language and culture. 

(6.) There is no linkage in our government currently between the dire healthcare 

worker situation overseas and our shortages of doctors, nurses, lab technicians and 

other health professionals domestically. Government functions as if the two issues 

were entirely unrelated. There is no official recognition that American companies 

and hospitals actively recruit doctors and nurses from poor and middle income countries to offset our gaps in training of domestic personnel. Institutionally, the federal 
88 

agencies and Congressional committees that have oversight of the domestic and 

overseas issues share no lines of communication, whatsoever. 

SOLUTIONS

(1.) A joint session should be convened of the Senate Foreign Relations Subcommittee on Foreign Operations and the Senate Committee on Health, Education, 

Labor and Pensions. This should be a well-orchestrated, and well-publicized full day 

joint session, aimed at revealing: 

a. Twenty year forecast on U.S. healthcare worker needs and shortfalls for all 

health professionals. 

b. Twenty year forecast on developing country healthcare worker needs and shortfalls for all health professionals. 

c. Recruitment and immigration trends of foreign healthcare workers, filling 

United States needs, and estimated damage done in home countries. 

d. Policies enacted by other wealthy countries to address brain drain. 

e. Reasons the United States is currently unable to fulfill its domestic healthcare 

worker needs through training and employment of Americans. 

f. Identification of legal instruments and budget initiatives that could be enacted 

by the House and Senate to radically enhance both the training of Americans and 

their conditions of employment, domestically. 

g. Identification of legal instruments and budget initiatives that could be enacted 

by the House and Senate to provide incentives to poor country healthcare workers 

for remaining in-country, based on the identified reasons for their departures to rich 

countries. (For many doctors, dentists, pharmacists, technicians and nurses, money 

is not the primary driver: The lack of coordinated health systems, reliable supply 

chains of medical equipment and drugs, lack of meritocracy within Ministries of 

Health and general political conditions rank far higher as reasons for immigration.) 

(2.) As a result of above Joint Session, corrective bills should be forwarded that 

seek not only bipartisan support, but also support that bridges the gap between domestic and foreign committee and agency foci. 

(3.) The Senate should push the State Department to radically increase its currently mere $3 million commitment to training in overseas health systems management. Even if your healthcare workers bill is passed, and fully funded, a surge in 

the numbers of community healthcare workers will have little positive impact if 

these individuals are not managed properly within an overall system of public 

health and clinical care. 

(4.) Attention should be given to the remarkable successes of BRAC, the 

Bangladeshi micro-financing program that has deployed vast networks of paid, 

trained community healthcare workers to villages in pursuit of cholera, tuberculosis, 

failures in child immunization and maternal health. BRAC has proven that community healthcare workers, including semi-literate individuals, can save thousands of 

lives if they are (1.) given a finite and clear mission to accomplish, backed by adequate training, and (2.) paid for their work at a rewarding scale, linked to success, 

and (3.) are part of a transparent, well-organized health system, in this case independent of the government. 

(5.) The foreign aid budget needs to move away from charity, towards support of 

business models and financial incentives of health. America cannot afford to put 20 

million people on anti-retrovirals for HIV care, and foot the bill for their continued 

treatment for the next 30-to-40 years. Even if we were, as a Nation of taxpayers, 

interested in underwriting the healthcare needs of the world, we could not afford 

to do so. Therefore, we have no choice but to move away from the charity model 

of foreign aid, towards a model that provides incentives for creation of local business 

solutions. This should not follow the apparent IFC model of providing support to foreign health corporations, to go into poor countries, and extract profits from their 

health needs. Rather, the Senate should look to the BRAC model and consider how 

providing low-interest seeds can lead to the blossoming of genuine, sustained health 

businesses in poor countries. 

(6.) The Senate should put pressure on HHS to radically speed up approval of appointments of federal employees for overseas health positions. Currently the majority of CDC overseas positions, and deployment of health personnel from other agencies within HHS, is mired in Secretary Leavitt’s office, pending political litmus tests 

aimed, apparently, at finding scientists, experts and physicians who meet the Bush 

Administration’s moral and political standards. At the very time when the world is, 

as a community, trying to hammer out radically new approaches to these health crises, America’s voice on the world stage is diminishing. This should stop, immediately. 
89 

(7.) When considering large initiatives for healthcare worker training, such as is 

envisioned in your bill, the Senate should also imagine the toolkit that these workers will draw from. With what supplies will these new healthcare workers execute 

their efforts? No doubt supplies will, in early days, also require outside support. To 

minimize such costs and build in incentives for performance standards and sustained commitment to maintaining community health practices we have favored exploration of franchise models, a la MacDonald’s: Each community health worker, 

after some identified set of training and work excellence have been achieved, is 

given very low interest micro-finance loans for purchase of his or her own franchise, 

which would include a physical clinic and basic tools and supplies. All of the franchises would be overseen by the hub of the network, monitored closely for performance quality; volume of services provided and inventory needs. 

Senator, we are at your service for any further clarifications, brainstorming or information needs you may require. We are honored to be of service. 

OSLO MINISTERIAL DECLARATION: GLOBAL HEALTH—A PRESSING FOREIGN POLICY ISSUE

OF OUR TIME

Under their initiative on Global Health and Foreign Policy, launched in September 2006 in New York, the Ministers of Foreign Affairs of Brazil, France, Indonesia, Norway, Senegal, South Africa and Thailand issued the following statement 

in Oslo on 20 March 2007: 

In today’s era of globalisation and interdependence there is an urgent need to 

broaden the scope of foreign policy. Together, we face a number of pressing challenges that require concerted responses and collaborative efforts. We must encourage new ideas, seek and develop new partnerships and mechanisms, and create new 

paradigms of cooperation. 

We believe that health is one of the most important, yet still broadly neglected, 

long-term foreign policy issues of our time. Life and health are our most precious 

assets. There is a growing awareness that investment in health is fundamental to 

economic growth and development. It is generally acknowledged that threats to 

health may compromise a country’s stability and security. 

We believe that health as a foreign policy issue needs a stronger strategic focus 

on the international agenda. We have therefore agreed to make ‘‘impact on health’’ 

a point of departure and a defining lens that each of our countries will use to examine key elements of foreign policy and development strategies, and to engage in a 

dialogue on how to deal with policy options from this perspective. 

As Ministers of Foreign Affairs, we will work to: 

—increase awareness of our common vulnerability in the face of health threats 

by bringing health issues more strongly into the arenas for foreign policy discussions and decisions, in order to strengthen our commitment to concerted action 

at the global level; 

—build bilateral, regional and multilateral cooperation for global health security 

by strengthening the case for collaboration and brokering broad agreement, accountability and action; 

—reinforce health as a key element in strategies for development and for fighting 

poverty, in order to reach the Millennium Development Goals; 

—ensure that a higher priority is given to health in dealing with trade issues and 

in conforming to the Doha principles, affirming the right of each country to 

make full use of TRIPS flexibilities in order to ensure universal access to medicines; 

—strengthen the place of health measures in conflict and crisis management and 

reconstruction efforts. 

For this purpose, we have prepared a first set of actionable steps for raising the 

priority of health in foreign policy in an Agenda for Action. We pledge to pursue 

these issues in our respective regional settings and in relevant international bodies. 

We invite Ministers of Foreign Affairs from all regions to join us in further exploring ways and means to achieve our objectives. 

NEW INITIATIVE SEEKS PRACTICAL SOLUTIONS TO TACKLE HEALTH WORKER MIGRATION

Geneva.—The health worker migration policy initiative held its first meeting 

today at the headquarters of the World Health Organization (WHO) in Geneva. The 

initiative, led by Mary Robinson, President of Realizing Rights: the Ethical 

Globalization Initiative, and Dr. Francis Omaswa, Executive Director of the Global 

Health Workforce Alliance (GHWA), is aimed at finding practical solutions to the 

worsening problem of health worker migration from developing to developed countries. 
90 

WHO Director-General Dr. Margaret Chan said, ‘‘International migration of 

health personnel is a key challenge for health systems in developing countries.’’ The 

new initiative has a Technical Working Group housed at WHO. 

The Health Worker Migration Policy Initiative is made up of two groups that will 

work closely together over the coming months to develop recommendations. The Migration Technical Working Group, which is being coordinated by WHO, brings together the International Organization for Migration, the International Labour Organization, professional associations, experts and academics. 

The Health Worker Global Policy Advisory Council, under the leadership of Mary 

Robinson and Francis Omaswa and with Realizing Rights serving as its Secretariat, 

is made up of senior figures from developed and developing countries, who will develop a roadmap and a framework for a global code of practice for health worker 

migration and seek high-level political backing for its recommendations. 

A recent study has shown that the number of foreign-trained doctors has tripled 

in several OECD countries over the past three decades. The number of foreigntrained doctors from countries with chronic shortages of health workers is relatively 

small (less than 10 percent of the workforce) in developed countries. However, for 

some African countries, the migration of a few dozen doctors can mean losing more 

than 30 percent of their workforce, even as basic health needs remain unmet. 

Other health professions are also affected by this phenomenon. The study showed 

that in Swaziland, 60 to 80 nurses migrate to the United Kingdom each year, while 

fewer than 90 graduate from Swazi schools. GHWA partner and member Save the 

Children UK estimates that the United Kingdom saved £65 million in training costs 

between 1998 and 2005 by recruiting Ghanaian health workers. 

Mary Robinson summarized the need for urgent action: ‘‘We cannot stand alone 

as individual countries continue to address their own increased needs for health 

workers without looking beyond their shores to the situation these migrating workers have left behind in their homelands. We cannot continue to shake our heads and 

bemoan the devastating brain drain from some of the neediest countries on the 

planet without forcing ourselves to search for—and actively promote—practical solutions that protect both the right of individuals to seek employment through migration and the right to health for all people.’’ 

One of the initiative’s first priorities will be to support WHO in drafting a framework for an International Code of Practice on Health Worker Migration, as called 

for by a resolution of the World Health Assembly in 2004. This framework will promote ethical recruitment, the protection of migrant health workers’ rights and remedies for addressing the economic and social impact of health worker migration in 

developing countries. The Code of Practice will be the first of its kind on a global 

scale for migration. 

The initiative will also promote good practices and strategies to enable countries 

to increase supply and retain their health workers more effectively. The new tools 

and policy recommendations developed by the initiative will support better management of migration through North-South collaboration. 

Dr Francis Omaswa emphasized the importance of addressing both the ‘‘push’’ 

and ‘‘pull’’ factors simultaneously. ‘‘Health workers are a valued and scarce resource. 

Demand is increasing worldwide, but not enough are being trained—in the developed or the developing world. Developing countries must prioritize health and 

health workers, with better working conditions and incentives so its workforce can 

stay and be more efficient, while developed countries must train more of their youth 

and try to be self-sufficient.’’ 

The Health Worker Migration Policy Initiative is due to make initial policy recommendations by the end of 2008. Its operations are co-funded and coordinated by 

Realizing Rights, the Global Health Workforce Alliance, and the MacArthur Foundation. 

HEALTH WORKER GLOBAL POLICY ADVISORY COUNCIL

Co-Chairs: Hon. Mary Robinson, President, Realizing Rights 

Dr. Francis Omaswa, Executive Director, GHWA 

MEMBERS

Hon. Major Courage Quarshie, Minister of Health, Ghana; Hon. Erik Solheim, 

Minister of International Development, Norway; Hon. Patricia Aragon Sto Tomas, 

Minister of Labor and Employment, the Philippines; Hon. Rosie Winterton, Minister 

of State for Health Services, United Kingdom; Dr. Lincoln Chen, Director, Global 

Equities Initiative, Harvard University; Dr. Anders Nordstro ̈m, Assistant Director 

General, Health Systems and Services, WHO; Ms. Janet Hatcher Roberts, Director, 

Migration Health Department, IOM; Mr. Ibrahim Awad Director, International Mi-
91 

gration Programme, ILO; Lord Nigel Crisp, co-Chair, GHWA Task Force on Scaling 

up Education & Training; Dr. Percy Mahlati, Director of Human Resources, Ministry of Health, South Africa; Huguette Labelle, Chancellor, University of Ottawa; 

Dr. Titilola Banjoko, Managing Director, Africa Recruit; Prof. Ruairi Brugha, Head, 

Department of Epidemiology & Public Health, Ireland; Ms. Sharan Burrow, President, International Confederation of Free Trade Unions; Ms. Ann Keeling, Director, 

Social Transformation Programs Division, Commonwealth Secretariat; Mr. Markos 

Kyprianou, Director General, Health & Consumer Protection, European Commission; Mr. Peter Scherer, Directorate for Employment, Labour and Social Affairs, 

OECD; Prof. Anna Maslin, Nursing Officer, International Nursing & Midwifery 

Health Professions Leadership Team, Department of Health, United Kingdom; Dr. 

Mary Pittman, President, Health Research & Education Trust, American Hospitals 

Association; and Dr. Jean Yan, Chief Scientist for Nursing & Midwifery, WHO, 

chair of the Migration Technical Working Group. 

HEALTH WORKER GLOBAL POLICY ADVISORY COUNCIL SECRETARIAT

Ms Peggy Clark, Managing Director, Realizing Rights 

Dr. Ita Lynch, Health Advisor, Realizing Rights 

SUBCOMMITTEE RECESS

Senator LEAHY. So, I thank you all very much for being here. 

The subcommittee will stand in recess. 

[Whereupon, at noon, Wednesday, April 18, the subcommittee 

was recessed, to reconvenne at 10:30 a.m., Thursay, May 10.] 

(93) 

STATE, FOREIGN OPERATIONS, AND RELATED 

PROGRAMS APPROPRIATIONS FOR FISCAL 

YEAR 2008 

THURSDAY, MAY 10, 2007 

U.S. SENATE, 

SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS, 

Washington, DC. 

The subcommittee met at 10:25 a.m., in room SD–106, Dirksen 

Senate Office Building, Hon. Patrick J. Leahy (chairman) presiding. 

Present: Senators Leahy, Landrieu, Gregg, Bennett, Bond, and 

Alexander. 

DEPARTMENT OF STATE 

OFFICE OF THE SECRETARY

STATEMENT OF HON. CONDOLEEZZA RICE, SECRETARY 

OPENING STATEMENT OF SENATOR PATRICK J. LEAHY

Senator LEAHY. First I apologize to the Secretary and to others 

for the delay. As you could probably see, we had votes on, and Senator Gregg, Senator Bennett, and I were there. 

Madam Secretary, of course, it is good to have you here to discuss the administration’s fiscal year 2008 budget. I have a lot to 

cover, and we are starting late. 

We’ve discussed this before. Whenever—wherever I go these 

days—and I travel various places outside of the country—not as 

much as you do—but I’m invariably asked, ‘‘What does the United 

States do to repair the damage, as seen in many countries to our 

international reputation as a nation that has historically stood for 

the rule of law, including international peace, international law, 

defending the fundamental rights of people everywhere, regardless 

of race, religion, ethnicity, or nationality, something that makes us 

proud—all of us proud, as Americans, but which is not the view of 

so many of those countries that were united behind us the day 

after 9/11?’’ When you see the policies of this administration, from 

Iraq to Guantanamo, we’ve turned strong allies into reluctant partners, friends into antagonists. According to surveys, many people, 

particularly in Muslim countries, now see America as a greater 

threat than the religious extremists. These are the people who 

have incited hatred and violence. I think this should alarm us, it 

should stir us to action. Those who hold these views, I believe, are 

horribly mistaken. But we’re not doing enough to convince them 
94 

otherwise. While some may argue that taking unpopular stands is 

a price of leadership, I reject that as a justification for the damage 

we’ve needlessly caused to a proud and principled reputation that 

took the founding of our Nation and a civil war and two world 

wars, and the lives of countless American patriots, to forge and fortify and defend. 

But where I go—and I look from the Pacific Rim to the Middle 

East, from Darfur to South America—our image, our influence, are 

waning sharply in the face of growing challenges. That concerns me 

greatly, as an American. I’m sure it does you. Once again, we’ve 

learned the painful lesson that military might is no substitute for 

effective policies that rally support and cooperation from the international community. 

Transformational diplomacy is a lofty slogan for what amounts 

to adding new positions at posts that have been understaffed for 

years. I welcome that. But, beyond that, I see little in this budget 

that offers confidence that the administration is prepared to devote 

the resources necessary to successfully exert America’s influence in 

such a complex world. 

Senator Gregg and I will work together, as we have. We’re not 

only neighbors across the Connecticut River, but we’ve worked very 

closely together in a bipartisan effort on so many of these foreign 

policy issues. We’ll do our best to fund President Bush’s request, 

and to incorporate the meritorious suggestions of Senators. But I’m 

afraid we’re going to fall short of what this country is capable of, 

but, more importantly, what this country should do. 

Now, we want you to succeed. I can speak for every Senator here, 

Democratic or Republican. We want you to succeed in the time you 

have left, particularly in the Middle East, where so much is at 

stake. But much time has been wasted, goodwill has been squandered. 

I will go the Middle East in the next few weeks, and I’m going 

to be interested in what kind of a message we can bring them. 

The White House has not only favored a ‘‘my way or the highway’’ unilateralism in its dealings with the world, but, unfortunately, unlike past administrations, Democratic and Republican, it 

has often treated those members not of the President’s party in 

Congress the same way. That was unnecessary, it was ineffective, 

and the American people and our national interests in the world 

have paid a high price for it. 

Now, we may have our disagreements, but you, Madam Secretary, and your staff, have always been accessible in wanting to 

discuss ways that we can work together. People would probably be 

surprised at the number of times you and I are on the telephone 

or meeting in person. I appreciate that. I hope we can do more in 

the months ahead. This is a critical time for the United States. 

Senator Gregg. 

OPENING STATEMENT OF SENATOR JUDD GREGG

Senator GREGG. Thank you, Mr. Chairman. Thank you for holding this hearing. 

Thank you, Madam Secretary, for being with us today. You keep 

such a hectic schedule. I don’t know how you do it, and we appreciate your taking the time to be here. 
95 

I know the Senator didn’t mean to imply this, but I think it’s important for us to reinforce the fact that defending liberty and promoting liberty around the world is not a mistake, it’s a purpose 

and a cause of our Nation, has been and always should be, that we, 

as a nation, understand that freedom is something that comes at 

a dear price, and we’re willing to pay that price. Our efforts around 

the world have been to promote freedom and to give people who 

haven’t had the opportunities that we have had as a Nation, 

maybe, the chance to see the light of freedom. Have we done it correctly at all times? No. But have we done it with good purposes? 

Absolutely yes. I would hope that we would always view our foreign policy in that nature. 

In addition, the chairman asked, and rightly asked, how we can 

create better relations around the world, because that should be 

one of our causes and our goals. I would say one of the best ways 

to do it is to have the Secretary of State we have. You do an exceptional job. I greatly admire your efforts. I think when you travel 

across the globe, as you do on a regular basis, you bring a face of 

America that is proud, intelligent, thoughtful, and respected, and, 

as a result, you, yourself, personify the great strengths of our Nation and present so well across the world that we’re very lucky to 

have you serving us. 

So, I thank you for being here today, and I appreciate your service. 

Senator LEAHY. Thank you. 

Secretary Rice, please go ahead. Of course, your full statement 

will be placed in the record, but I would like to have the time— 

your time is precious, and I’d like to have the time available for 

questions. 

Go ahead. 

SUMMMARY STATEMENT OF HON. CONDOLEEZZA RICE

Secretary RICE. Thank you very much. Thank you, Mr. Chairman. Thank you, ranking member Gregg, members of the subcommittee. 

Mr. Chairman, I will place the full statement into the record so 

that we might have full time for exchange. I’ll just start with a few 

comments. 

I appreciate, again, the opportunity to address this committee 

about the challenges and the opportunities that we face in the 

United States, and that the United States faces in the world today. 

I look forward to working with you, with Members of Congress 

from both sides of the aisle, so that we can ensure that America’s 

diplomacy, and the courageous individuals who undertake it, have 

the necessary resources to protect our national security, to advance 

our democratic ideals, and to improve people’s lives throughout the 

world. 

With these duties, we also reaffirm our responsibility to the 

American people, and that is a responsibility to be the best possible 

stewards of their hard-earned dollars. 

President Bush’s fiscal year 2008 international affairs budget request for the Department of State, USAID, and other Foreign Affairs agencies totals $36.2 billion. In addition, the administration 

is requesting $3.3 billion in war supplemental funding in fiscal 
96 

year 2008, $1.37 billion of that would be for foreign assistance, and 

$1.93 billion for State Department operations. It’s principally to 

support emergency requirements in Iraq and Afghanistan. 

This request represents a fundamental investment in our national security—— 

Senator LEAHY. Madam Secretary? 

Secretary RICE. Yes? 

Senator LEAHY. If you could withhold a moment. 

Secretary RICE. Yes. 

Senator LEAHY. People who are in this room are here as guests 

of the Senate. Obviously, you have a right to express opinions, but 

when you stand up, in a way, you block others who have stood in 

line. A lot of people have stood in line for hours for these hearings. 

We want—they are televised, but we want people to be able to see 

the hearings. But when you stand up, you’re blocking people behind you, and I think that’s unnecessary. You can make your point. 

I realize there are people here who disagree with the war in Iraq, 

disagree, perhaps, with what’s being said, but I would make it very 

clear I will not countenance, in any way, people being blocked from 

being able to watch this, nor will I countenance, in any way, disturbances. Just so we all understand. 

Secretary Rice, please continue. 

Secretary RICE. Thank you, Chairman. 

America remains engaged in a global war on terrorism, which is 

a war of a totally new and different kind. We face a long confrontation in which military strength is important, but not sufficient. The 

defining feature of our world today is its interdependence. The security of the American people depends on the stability and the success of foreign societies. If governments cannot, or choose not to, 

meet their responsibilities as sovereign states, nations around the 

globe are threatened by the resulting chaos and disorder. 

The President believes that the defense of our country depends 

on close integration of our multilateral diplomacy, our development 

efforts, and our support for human rights and democratic institutions. That is why President Bush’s budget designates the Department of State as a national security agency. We must recognize 

that our Foreign Service, our civil service, and Foreign Service nationals are performing a vital national security role, often in difficult and dangerous posts, far away from friends and families, and, 

in many cases, shoulder to shoulder on the front lines with our 

men and women in uniform. 

We are asking our civilians to do far more than just manage an 

existing international order. We are charging them with helping 

foreign citizens and their governments to transform their countries, 

to move them toward peace and freedom, prosperity, and social justice. 

This is the national security mission of our Department of State 

which we’ve referred to as transformational diplomacy. To succeed 

in this critical work for the American people, we are making important changes to our Department’s organizations, both in terms of 

roles—the roles our people are playing and how we are structuring 

our foreign assistance programs. 
97 

PREPARED STATEMENT

We believe strongly that this is a challenging time for America, 

for our goals of promoting democracy, and for the resultant peace 

that it would bring. But I can tell you that I am very, very proud 

to lead the men and women of the Department of State. They are 

great patriots. They’re doing hard jobs. I look forward to being before you to talk about the resources that they need to do their job 

well. 

Thank you very much. 

[The statement follows:] 

PREPARED STATEMENT OF CONDOLEEZZA RICE

Mr. Chairman, ranking member Gregg, members of the subcommittee: Thank you 

for this chance once again to address the Committee about the many challenges and 

opportunities facing the United States today. I look forward to continue working 

with Congress, closely and across party lines, to ensure that America’s diplomacy, 

and the courageous individuals who undertake it, have the necessary resources to 

protect our national security, advance our democratic ideals, and improve people’s 

lives throughout the world. With these duties we also reaffirm our responsibility to 

the American people: to be the best possible stewards of their hard-earned dollars. 

President Bush’s fiscal year 2008 International Affairs Budget request for the De- partment of State, USAID, and other foreign affairs agencies totals $36.2 billion. In 

addition, the Administration is requesting $3.3 billion in war supplemental funding 

in fiscal year 2008—$1.37 billion for foreign assistance and $1.93 billion for State 

Department operations—to support emergency requirements in Iraq and Afghanistan. 

This request represents a fundamental investment in our national security. More 

than 5 years after the September 11 attacks, America remains engaged in a global 

war on terrorism, which is a war of a totally new and different kind. We face a long 

confrontation, in which military strength is important to our success, but is not sufficient. The defining feature of our world today is its interdependence. The security 

of the American people depends on the stability and the success of foreign societies. 

If governments cannot, or choose not, to meet their responsibilities as sovereign 

states, nations around the globe are threatened by the resulting chaos and disorder. 

The President believes that the defense of our country depends on the close integration of our multilateral diplomacy, our development efforts, and our support for 

human rights and democratic institutions. That is why President Bush’s budget designates the State Department as a national security agency. 

We must recognize that our Foreign Service, our Civil Service, and our Foreign 

Service Nationals are performing a vital national security role—often in difficult 

and dangerous posts, far away from friends and families, and in many cases, shoulder to shoulder with our men and women in uniform. We are asking our civilians 

to do far more than just manage an existing international order; we are charging 

them with helping foreign citizens and their governments to transform their countries—to move them toward peace, freedom, prosperity, and social justice. 

This is the national security mission of our State Department today, which we 

have referred to as transformational diplomacy. To succeed in this critical work for 

the American people, we are making important changes to our department’s organization—both in terms of the roles our people are playing and how we are structuring our foreign assistance programs. This is the foundation of our budget, and 

I would like to briefly review these important changes. 

TRANSFORMING THE STATE DEPARTMENT

With the support of Congress, we are moving our people off the front lines of the 

last century, in the capitals of Europe and here in Washington, and into the critical 

posts of this new century—in Asia, in Africa, in the Middle East, and here in the 

Americas. Last year, we reprogrammed 200 positions for this purpose; we are set 

to reposition 80 more. At the same time, we are moving our people out of our embassies and into the field, so they can engage and work not only with governments 

but with the people of the nations in which they serve. We are making every necessary change—giving our diplomatic corps better training, better tools and technology, and more language skills—to empower them to meet this challenge. 

We realize that resources are tight, so in all that we do, we seek to be good stewards of the taxpayers’ money. Last year, I created the position of Director of United 
98 

States Foreign Assistance. On Monday, the White House announced it has designated Henrietta Fore as Acting Administrator of USAID, with the intent to nominate. I also have named Undersecretary Fore as Acting Director of Foreign Assistance. Our goal is the strategic alignment of our foreign assistance and our foreign 

policy goals. 

The main idea that I want to stress is this: Our new approach to foreign assistance ensures an efficient, effective, and strategic use of the American taxpayer’s 

money. We adopted a country-based approach to achieve this. We asked our experts 

at State and USAID to allocate foreign assistance resources to activities that help 

countries most effectively develop their institutions in order to take care of their 

people and reduce widespread poverty. The adjustments you may see in one program are justified by what we have determined are greater needs elsewhere, and 

only after the trade offs have been thoroughly analyzed, in order to make the best 

use of our limited resources. 

As a result of this process, resources for the three objectives supporting long-term 

development—Governing Justly and Democratically, Investing in People, and Economic Growth—have increased by approximately $100 million in this year’s request 

from fiscal year 2006 levels. You will note some differences, however, in the structure of the request. For example, there is a shift in resources from the Development 

Assistance (DA) account to the Economic Support Fund (ESF) account. This shift 

represents our attempt to better justify our request by rationalizing the use of these 

two different accounts for different types of countries. The increase in ESF and decrease in DA should not be interpreted as a decrease for activities to support the 

poor and invest in development. 

With the performance and accountability measures we are putting in place, we 

aim to ensure that we are providing the necessary tools and the right incentives for 

host governments to secure the conditions necessary for their citizens to reach their 

full potential. This furthers our goal of helping developing nations to ‘‘graduate’’ 

from our assistance, not to grow dependent on it. 

EMPOWERING OUR PEOPLE

We are moving ahead on these initiatives with our existing authority. There are 

steps that need to be taken, and we are taking them. But we must do more, and 

to do it, we need additional resources. For this, we need the continued support of 

the Congress. That is why we are requesting $7.2 billion for State Department operations. 

As we transform our existing positions to serve new purposes, we must also create 

new positions that advance our strategic objective of getting more Americans onto 

the diplomatic frontlines of the 21st century. This year, we are requesting an increase of $125 million to create 254 new positions in critical spots like India, China, 

Indonesia, Venezuela, Nigeria, South Africa, and Lebanon. This funding will also 

enable us to establish new American Presence Posts, reflecting our goal of moving 

more of our diplomats into the regions and provinces of our host countries. This increase includes 57 positions and $15 million for the Office of the Coordinator for Reconstruction and Stabilization. I should add here that I am grateful for the authority provided in the supplemental appropriation to transfer up to $50 million to create a Civilian Reserve Corps. These funds will allow us to develop a deployable 

cadre of civilians who will be able to respond quickly to a crises and stabilization 

missions overseas 

Our Department’s new and evolving mission, which is vital to our national security, requires an increased investment in our people. Our people need the latest 

technology and the best training, in leadership and language skills. This budget 

meets those demands, including $905 million for information technology. We must 

also continue to improve our security in a dangerous world. This budget allocates 

$965 million to strengthen security for our posts, our people, and our information 

systems worldwide, including the creation of 52 additional positions for security professionals. 

At the same time, we must continue to modernize and improve our facilities 

around the world. We seek $1.6 billion to address the major physical security and 

rehabilitation needs of our embassies and consulates worldwide so we can protect 

the men and women serving in our posts. In the fourth year of Capital Security Cost 

Sharing, other U.S. Government agencies with personnel abroad will contribute 

$362 million for the construction of new, secure diplomatic facilities. 

To continue filling the ranks of the Foreign Service with our Nation’s best talent, 

we intend to revamp the pay scale for our diplomatic corps. State Department personnel are increasingly expected to serve in what we call ‘‘hardship posts,’’ which 

now comprise nearly 20 percent of all department positions. We must fairly com-
99 

pensate our men and women serving abroad in difficult locations, often far away 

from their families, and we must rectify a growing disparity between basic salary 

levels for employees in the United States and overseas. Our budget request includes 

$35 million to begin a transition to a performance-based pay system and a global 

rate of pay. 

The State Department mission also extends to defending our borders and protecting our homeland. We must remain a welcoming nation for tourists, students, 

and businesspeople, while at the same time increasing our security against terrorists and criminals who would exploit our open society to do us harm. For this purpose, our budget includes $1.3 billion for the Border Security Program, and we seek 

to add 122 consular positions to address rising passport and visa demands. As good 

stewards of taxpayer dollars, we are using revenues from visa, passport surcharge, 

and visa fraud fees to fund improvements in our border security. In coordination 

with the Department of Homeland Security, we seek to fulfill the President’s vision 

of secure borders and open doors. 

Finally, we are requesting $1.35 billion to meet our commitments to international 

organizations such as the United Nations. Over the past year we have seen how important it is for the United States to provide principled leadership in institutions 

of multilateral diplomacy. Through the United Nations, we helped to negotiate a key 

resolution that ended a month of war in Lebanon and Israel, which was launched 

by the leaders of Hezbollah. We rallied the international community to oppose Iran 

and North Korea’s nuclear weapons ambitions with Chapter 7 Security Council resolutions. And we worked to ease the suffering of the people of Darfur and to provide 

for a peacekeeping force there. International organizations are essential to our Nation’s foreign policy goals, and deserve our continued support. 

SECURING PEACE, SUPPORTING DEMOCRACY

I have discussed the steps we are taking to support our people. Let me turn now 

to the purposes of our foreign assistance. 

Our highest priority is to defend the American people and homeland by doing our 

part in the global war on terrorism. To succeed, we need the continued support of 

key partners—our historic allies in Europe, Asia, and the Americas, but also in key 

developing countries, which have the will, but not the means, to fight terrorism. The 

fiscal year 2008 request includes $186 million for Indonesia, $2.4 billion for Israel, 

$544 million for Kenya, and $515 million for Jordan. Our assistance helps those 

countries, and many others, to enforce their laws, secure their borders, gather and 

share intelligence, and take action against terrorists on their own or with us. This 

request also devotes $785 million to Pakistan to lead that country in a moderate 

and modern direction, to gain control of the border areas, and to advance prosperity 

there. Specifically, this request includes $90 million to support President 

Musharraf’s 5-year development plan for the federally administered tribal areas. 

Across the Broader Middle East, we also look to new partners in embattled young 

democracies, who are working courageously to turn the tide against violent extremism in their countries. In the past several years, the efforts of reformers and responsible leaders have changed the strategic context of the region. We have offered 

critical support for civil society groups seeking political openness, economic opportunity, education reform, and the empowerment of women. We will continue to support these important reform initiatives. 

Democratic institutions in places like Iraq, Afghanistan, Lebanon, and the Palestinian territories are facing serious threats. They are under siege from violent extremists and their state supporters in the region. The Taliban in Afghanistan, 

Hamas in the Palestinian territories, Hezbollah in Lebanon, violent extremists in 

Iraq—all of these groups struck damaging blows last year to the cause of peace and 

freedom in the Broader Middle East. This year we must turn the tide, and we aim 

to do just that with a comprehensive strategy to help reformers and responsible 

leaders show their people that democracy can deliver the security, prosperity, opportunity, and dignity that they seek. 

In Afghanistan, we support the efforts of the new democratic government in 

Kabul to lead the nation toward freedom and prosperity. To achieve that goal, we 

have taken a hard look at our overall policy and adopted an effective 

counterinsurgency strategy—a complete approach that integrates military efforts 

with political support, counter-narcotics programs, development priorities, and regional diplomacy. There is a comprehensive, ongoing ‘‘offensive,’’ which is being run 

by the Afghanistan Government. 

Our goal is to help the Afghan Government improve the quality of life for its people by extending security, providing good governance, and opening up new economic 

opportunities. Along with these goals, President Karzai has demonstrated his deter-
100 

mination to lead a serious counter-narcotics effort, but he needs our assistance. We 

are increasing our funding in this key area, along with additional funding for reconstruction, local economic development, and law and order. The base budget request 

of $1.4 billion for fiscal year 2008 aims to stimulate economic growth, establish 

peace and security, create jobs, provide essential education and health care, promote 

human rights, especially women’s rights, strengthen accountability and transparency, and extend the reach of the democratic state. 

To achieve these broad objectives, we will continue to build roads and electricity 

grids, and support agricultural development. Working through Provincial Reconstruction Teams, or PRTs, and in concert with the Afghan government, we will build 

government and justice centers at the provincial level. We will train government 

personnel, and we will help meet local needs for markets, schools, clinics, and other 

vital services. Most importantly, we will integrate all of these efforts to advance our 

overall strategic objective of empowering Afghanistan’s democratic government. 

In Iraq, President Bush has adopted a strategy in recognition that the current 

level of sectarian violence is unacceptable. There is a strong military component to 

this strategy, but success in Iraq depends on more than military efforts alone. It 

requires robust political, economic, and diplomatic measures. Our military operations must be fully integrated with our civilian and diplomatic efforts to advance 

the strategy of ‘‘clear, hold, and build.’’ The State Department is playing its role in 

this mission. We are strengthening, indeed surging, our civilian efforts. To do so, 

we are requesting $1.4 billion in fiscal year 2008 in the base budget and the fiscal 

year 2008 supplemental request to fund our assistance efforts in Iraq. 

The main focus of our support will continue to shift toward helping the Iraqi Government expand its reach, its relevance, and its resources beyond Baghdad. We will 

help local leaders improve their capacity to govern and deliver public services. Our 

economic efforts will be targeted to local needs, with proven strategies of success, 

like micro-credit programs. 

Expanding our PRT presence will also enable us to diversify our assistance across 

Iraq. Iraq has a federal government. Much of the street-level authority, and much 

of the opportunity for positive change in Iraq, lies outside Baghdad, in local and provincial governments, with party leaders and tribal chiefs. By actively supporting 

these provincial groups and structures, we expand our chances of success in Iraq. 

Our PRTs have had success working at the local level in towns like Mosul, Tikrit, 

and Tal Afar. Now we will invest in other parts of Iraq, like Anbar province, where 

local leaders are showing their desire and building their capacity to confront violent 

extremists. 

In Lebanon, we are requesting approximately $60 million in fiscal year 2008 to 

complement what we requested in the fiscal year 2007 Supplemental to support the 

Lebanese people’s aspirations for peace, stability, and economic development. In November 2006, we signed a Trade and Investment Framework Agreement to help 

support Lebanon’s development through enhanced bilateral economic ties. I made a 

significant pledge of $770 million in January at the Lebanon Donors’ Conference, 

which raised $7.6 billion to support the Lebanese people and their democraticallyelected government. Our assistance will support the Lebanese government’s own 

ambitious reform program, which demonstrates its commitment to reducing its debt 

and achieving economic and financial stability. I continue to keep your concerns in 

mind regarding direct budget support and let me reassure you, the money supports 

the economic reform plan endorsed by the international financial institutions and 

benchmark goals supported by us. 

As we take steps in the reconstruction and development effort, we must not lose 

sight of the need to implement fully U.N. Security Council resolutions related to 

Lebanon, in particular Resolution 1701. We commend the Lebanese Government for 

deploying the Lebanese armed forces to the south of its country for the first time 

in almost 40 years, and we applaud the international community for its successful 

deployment of the enhanced UNIFIL forces to help Lebanon secure its sovereignty. 

Much more work remains to be done, however, to ensure Lebanon’s sovereignty is 

not undermined by regional actors like Syria and Iran and to address the threat 

of terrorist groups like Hezbollah. I look forward to continuing to work with the UN 

and our other international partners on further steps to implement Resolution 1701. 

In the Palestinian territories, President Abbas’s desire to support a better life for 

his people and to make peace with Israel is being blocked by the radical leaders of 

Hamas. One year after this group’s legitimate election, the international community 

continues to stand together in its insistence that Hamas meet the conditions set out 

by the Quartet: recognize Israel, renounce violence, and accept all previous agreements and obligations, including the Roadmap. Peace between Israel and the Palestinians will be possible only with a Palestinian government that recognizes 
101 

Israel’s right to exist and renounces terrorism. We will judge the Palestinian government by its words and by its actions. 

For fiscal year 2008, we are requesting $77 million to help meet Palestinian humanitarian needs, including emergency food, health and educational assistance, programs to strengthen democracy and good governance, and support private sector development in the West Bank and Gaza. These bilateral funds are in addition to the 

funds requested for the U.N. Relief and Works Agency for Palestine Refugees in the 

Near East (UNRWA). There is a battle in this region between moderates and extremists. These funds will not go to Hamas or any other terrorist organization, but 

will bolster moderate forces in the Palestinian territories. 

For Iran, the President has requested $109 million in funding, including $20 million for VOA’s Persian service, $8.1 million for Radio Farda, $5.5 million for consular affairs, and $75 million in Economic Support Funds for civil society and 

human rights projects in Iran. These funds will allow us to continue with a wide 

range of democracy, educational, and cultural programs, as well as to improve the 

free-flow of information to the Iranian people. We must continue to make clear that 

while we differ fundamentally with the current government of Iran, and we seek 

friendship with the Iranian people. 

The hard work of democracy does not end with one free election; that is only the 

beginning. Lasting democratic reform must also encompass an independent media, 

free political parties, limits on state authority, and protections for human rights. We 

are funding programs in all of these fields of democratic reform. To support democratic transitions, the budget provides $1.4 billion for programs that foster rule of 

law and human rights, good governance, political competition and consensus-building and civil society. 

As we work to expand freedom and prosperity, we must champion these ideals 

through our public diplomacy and vital educational and cultural exchanges, for 

which we are requesting funding of $855 million. Public diplomacy is a vital component of our national security strategy. We seek to reach out to the peoples of the 

world in respect and partnership, to explain our policies and to express the power 

of our ideals—freedom and equality, prosperity and justice. Public diplomacy is no 

longer the job of our experts alone; it is the responsibility of every member of the 

State Department family, and we are mobilizing the private sector and the American people to help. 

People-to-people exchanges are also a vital component of our national security 

strategy. Many exchange participants report that they are ‘‘forever changed’’ by 

their direct involvement with the American people. Last year, the total number of 

student and exchange visas reached an all-time high of 591,000. We want to expand 

on this success, working in partnership with the private sector wherever we can. 

We seek $668 million for the Broadcasting Board of Governors, to support radio, 

television, and internet broadcasting worldwide, including in North Korea, Iran, and 

Cuba. 

MEETING GLOBAL CHALLENGES

We face a major challenge in the proliferation of weapons of mass destruction and 

the materials to produce them. The fiscal year 2008 budget supports our key multilateral counter-proliferation activities—including the Proliferation Security Initiative, the G–8 Global Partnership, the Global Initiative to Combat Nuclear Terror, 

and U.N. Security Council Resolution 1540. The budget also supports our efforts to 

strengthen the global non-proliferation regime, by rallying the international community to hold governments accountable for these actions which violate their responsibilities. 

As the President said in his State of the Union address, we are committed to addressing ‘‘the serious challenge of global climate change.’’ Our approach is rooted in 

pragmatism and partnership. One of our principal initiatives is the Asia-Pacific 

Partnership on Clean Development and Climate, which we launched in concert with 

Australia, South Korea, Japan, India, and China. Together, these countries represent more than half of the world’s economy, a large share of the world’s emissions, 

and a growing demand for energy that is vital to economic development. The Partnership, for which we request $30 million for fiscal year 2008, is accelerating investment and opening markets for cleaner, more efficient technologies, goods, and services, while fostering sustainable economic growth and poverty reduction. 

In Colombia, we are requesting $506.468 million in the fiscal year 2008 budget 

to sustain our commitment to counter narcotics and demand reduction. During his 

visit to Bogata ́ on March 11, President Bush reaffirmed to President Uribe the importance of helping Colombia finish the job. With Congress’s bipartisan support, the 

United States has helped the Colombian people to protect their democracy from 
102 

drug traffickers, restore security to large parts of the country, protect human rights, 

and begin a far reaching reform of its judicial system. The gains have been impressive. Colombia has come back from the brink to become a partner. We are confident 

that, with Congressional support for our fiscal year 2008 budget request and approval of the Colombia free trade agreement, these hard won gains will be just the 

beginning of Colombia’s dramatic transformation. 

Critical challenges remain. President Uribe is addressing these issues aggressively and decisively, continuing the fight against drug traffickers, but also focusing 

on winning the peace through economic and social development, consolidation of 

democratic institutions, and respect for human rights. In response, we have designed an assistance strategy that will help President Uribe and the Colombian people achieve the security and prosperity they have worked so hard to make possible. 

We want to improve the lives of Colombians while reducing the impact of narco-terrorism on the United States and the region. 

I know that there are questions about the relative mix of ‘‘hard’’ and ‘‘soft’’ spending in our fiscal year 2008 budget request. We know that without security it is impossible to promote socioeconomic development. Our plan is to invest now in the Colombians’ capabilities, as we gradually turn over responsibility for the counternarcotics programs to them. I also know that recent concerns of paramilitary ties 

to Colombian government and military figures are a serious matter. The Colombian 

Government’s commitment to seeking the truth and insisting on justice deserves our 

support. I believe strongly that we need to recognize President Uribe’s leadership 

and the extraordinary commitment of the Colombian people. 

We face another potentially deadly challenge in the threat of pandemic disease. 

The fiscal year 2008 budget request of $100 million supports our global strategy and 

partnership to address avian influenza outbreaks and to support prevention strategies worldwide. 

The fiscal year 2008 budget also advances the goals of the President’s historic 

Emergency Plan for AIDS Relief. Thanks to the strong bipartisan support that this 

program has received from Congress, the Emergency Plan now supports treatment 

for more than 822,000 people in the 15 countries that are home to over half of the 

world’s infected population. This year we are requesting a total of $5.4 billion for 

the Emergency Plan, including funds requested by the Department of Health and 

Human Services. This includes $4.1 billion for prevention, treatment, and care in 

the 15 focus countries. We are also seeking an additional $1.2 billion for bilateral 

programs in other countries, for HIV/AIDS research, for multilateral programs 

worldwide, and for tuberculosis programs. 

No less significant is President’s Malaria Initiative, which has supported prevention and treatment for millions of people in fifteen African countries—Angola, Tanzania, Uganda, Malawi, Mozambique, Senegal, Rwanda, Benin, Ghana, Madagascar, 

Kenya, Zambia, Liberia, Mali, and Ethiopia. The fiscal year 2008 budget dedicates 

$300 million to fund our commitments under this Initiative, as well as $88 million 

for other ongoing global efforts to fight malaria. 

HELPING DEVELOPING COUNTRIES AND THE MOST VULNERABLE POPULATIONS

Global partnerships are essential to meeting the global challenges that I have just 

described. But many weak and poorly governed states do not have the capacity to 

fulfill their responsibilities as sovereign states. Our experience on September 11 

showed us that weak and poorly governed states can pose not just humanitarian 

challenges, but national security threats. Hopelessness and oppression contribute to 

extremism and instability. Helping developing states to transform themselves—to 

govern justly, to advance economic freedom, to combat poverty, and to invest in 

their people—is a strategic imperative. 

The United States is a compassionate Nation, and we are moved to action when 

tragedy strikes, and when innocent people are in desperate need. The fiscal year 

2008 budget provides more than $2 billion for the protection of refugees and for 

basic needs like food, water, and medicine for vulnerable populations. One of the 

major recipients is Sudan, for which we are requesting a total of $359 million for 

humanitarian assistance, as well as additional funding for Sudanese refugees in 

neighboring countries. We are continuing our support for victims of war and genocide, especially the internally displaced people in Darfur and the refugees in eastern 

Chad. 

We will continue to invest in the people of the world’s poorest countries. Basic 

education is a critical part of this investment. The fiscal year 2008 request for resources to support basic education programs is $535 million. 

In addition to direct support for the world’s most vulnerable populations, we seek 

to support the development of sound economies and political structures to raise peo-
103 

ple out of poverty. On this front, our flagship initiative is the Millennium Challenge 

Corporation (MCC). Since 2004, the MCC has signed development compacts with 

eleven countries, worth a total of $3 billion. MCC works with transforming countries 

that meet standards of progress for governing justly, advancing economic liberty, 

and investing in their people. The compacts are designed and managed by recipient 

countries themselves, reinforcing their ownership in the fight against poverty. These 

resources complement and amplify the impact of our investments in other foreign 

assistance accounts. 

For a country to unlock the potential of its people to increase productivity, create 

jobs, and combat poverty, it must integrate its economy into regional and global 

trade networks. The President remains committed to achieving a successful outcome 

to the World Trade Organization’s Doha Development Agenda—one that opens markets, expand trade, and strengthens a rules-based system. As a part of the President’s robust trade agenda, we have negotiated ten free trade agreements (FTAs) 

with 16 countries worldwide, and Congress has already approved agreements with 

12 of these countries. We have signed FTAs with Colombia, Peru, Panama and 

South Korea. We look to Congress to support these important agreements. 

Mr. Chairman, members of the subcommittee: The State Department has assumed substantial new national security responsibilities in the war on terrorism. 

We are the lead agency on a majority of the tasks in the Administration’s National 

Counterterrorism Strategy. Using our existing authorities, we are taking steps to 

reshape the State Department to play a forward-leaning role in advancing freedom 

and prosperity around the world. 

In this challenging time, the men and women of American diplomacy are doing 

all that we are asking of them—and more. They are nobly answering the call to 

service and shouldering their responsibilities. I ask you to provide the resources we 

need to play our part. 

Senator LEAHY. Thank you, Madam Secretary. 

You and I have discussed the resignation of the administrator 

and director of foreign assistance of USAID, last week. Then, as 

you told me—and we chatted—that the President’s going to nominate Henrietta Fore as USAID administrator. She’ll also be designated as director of foreign assistance. I see these, really, as fulltime jobs. Why would you combine—why would you combine these 

two positions? Before you answer, the reason I ask the question, 

Ambassador Tobias made a number of reforms, as he told us when 

he testified, but I’m having a hard time discerning their impact. I 

want to have more—better coordination on foreign assistance, but 

I’ve always felt—and I’ve said this with both Republican and 

Democratic administrations, USAID has to remain autonomous. So, 

why combine these two? Will they have control over their budget? 

Secretary RICE. Well, thank you, Senator. 

First of all, let me just note that I have great respect for USAID 

and its special mission, and for the men and women of USAID and 

the important job that they do out on the front lines. I think that— 

I hope that they would tell you that I’ve been very supportive of 

their mission and of their development. I do believe that, since 

about 80 percent of our foreign assistance—U.S. Government foreign assistance comes from Department of State and USAID budgets, that this is a time when we need to make certain that we have 

an integrated picture of what we are doing with those resources in 

order to promote certain goals, in order to make certain that programs are being well delivered. That’s the reason for the dualhatting of the director of foreign assistance. 

Senator LEAHY. But does that mean that have control over their 

budget, or not? 

Secretary RICE. Well, in fact, it rests with me, ultimately. I am 

the one that has to represent to you, and through you to the American people, that the resources that are being given to USAID and 
104 

to the Department of State are being well used. I am in a stronger 

position, with a director of foreign assistance who also is USAID 

administrator, to make certain that when a budget comes to me, 

which I then recommend to the President, which is then recommended to you, that we are using the resources well, that there 

is not duplication, that we are able to fill gaps where they may be, 

and that we are respecting both missions. 

Senator LEAHY. But the reason I ask—I mean, we were somewhat disappointed in this committee—by ‘‘we,’’ I say a number of 

the Senators, both sides of the aisle, with Ambassador Tobias’s testimony when he came here, trying to get any specificity about what 

was happening. I’m curious—I notice this seems to be getting down 

in the weeds, but there’s USAID budget personnel shifted to the F 

Bureau at the State Department, the Office of Director of Foreign 

Assistance. Do they stay there, or do they go back to USAID? Is 

this—— 

Secretary RICE. They are USAID, they are, in effect, secunded to 

the Department to work on budget matters. But I would ask you, 

Senator, to think about it from my point of view, as Secretary. I’m 

charged with the authorization to assure, really, that the resources 

are being used in an appropriate way. And—— 

Senator LEAHY. Well, no, I understand that. But you also—when 

the director is there, they’re carrying out that direction. As I said, 

we were—many of us were concerned when the former director was 

before us, there were a lot of glowing slogans, but every time we 

asked a question, specifics, we didn’t get the answers. Now, he may 

have been distracted by other matters at the time, but it was a— 

it was a concern. I think you should tell the new director she 

should be prepared to come up here to, at the very least, brief Senator Gregg and myself on some of these specifics. 

Let me switch to a different area. Now, having said, over and 

over again, that we don’t want to be seen as an occupying force in 

Iraq, we’re building the largest embassy that we have, probably the 

largest in the world, in Baghdad. It just seems to grow and grow 

and grow. The 2007 supplemental, I’m noticing, it provides the 

funds for most of the expansion you propose for the Provincial Reconstruction Teams. We agree that we should focus our aid locally, 

not in Baghdad, but we have 1,000 Americans at the Embassy in 

Baghdad. You have the contractors and local staff, that comes to 

4,000. 

The 2000 supplemental required you to submit a plan for the 

U.S. mission in Iraq, for the growing size and costs. I—you know, 

we have a deviation from the plan that we’d agreed to. Staffing has 

increased by over 30 percent in just 2 years. We have the largest 

embassy in the world. We have countries where we do a great deal 

of trade and where we have to be concerned about intellectual 

property piracy, everything else, and we don’t—we can’t seem to 

get the staffing there. Can we review who we really need, and send 

the rest of the people home? 

Secretary RICE. Well, thank you, Senator. In fact, Ambassador 

Crocker, as you know, has just—virtually just arrived in Iraq, has 

been out there a little over a month, and he has asked, and we 

have sent, Ambassador Pat Kennedy to go out and to assess the 

staffing and housing requirements for the Baghdad Embassy com-
105 

pound. We do believe that the embassy compound was right-sized 

at the time that it was presented to Congress. There have been 

some additional issues since that time, including the extension of 

the special IG for Iraq. And we have to be able to deal with those 

people. We have a security situation in which we are not able to 

house people in hotels when they’re visiting. We have a number of 

shorter-term TDY staff that are out at the embassy. And, in fact, 

we have, as you know, a kind of surge in the personnel to be able 

to deal with—to provide the diplomatic and political surge—— 

Senator LEAHY. No, I understand that, Madam Secretary, but I 

look at China. We have enormous trade issues with China. We 

have a country that is stealing us blind in ignoring our copyright 

laws and counterfeit—everything from counterfeit food and drugs 

to stealing our intellectual property, whether it’s computer programs to movies to—and we’re talking about billions of dollars, to 

say nothing about the health problems we’ve seen very recently, 

where people have died here, and in other countries, because of the 

fraudulent food additives and so on. But our Embassy in Baghdad 

is much larger than our Embassy in Beijing. What I’m saying is, 

if there are people we don’t need, why don’t we just send ‘em home? 

Secretary RICE. We are going to make that assessment, Senator. 

I agree with you that there may be—because of the way that the 

embassy came into being—in effect, coming on the heels of the Coalition Provisional Authority—because there have been a lot of 

needs that I would characterize as shorter-term—meaning, not in 

the long-term steady state of how the embassy will be staffed. 

We’re going to make exactly that assessment, and we will make 

certain that we have only the people out there that we would need. 

I would just note, Senator, that we are, in the case of China and 

a couple of other embassies where we believe that the needs have 

grown—we have, in fact, redeployed people out of places in Europe 

to China and places like that, where we believe that we need greater staffing. So, we’re trying to remain flexible in making certain 

that we’re well staffed in these extremely important posts. 

But I will definitely get a report back to you once Ambassador 

Kennedy has done his work. 

Senator LEAHY. Can I—when I come back on my time—my time 

is up—I’m going to want to talk about the Western Hemisphere 

Travel Initiative. I—it would be nice if we allowed Canadians and 

Americans to travel back and forth across each other’s borders. So, 

that’s an issue we’ll go into. Bothers me greatly what’s being done. 

Senator Gregg. 

Senator GREGG. Thank you, Mr. Chairman. 

I want to echo the chairman’s concerns about the size of the embassy also. Ironically, I chaired the subcommittee when the embassy decision was made, and I, at that time, had fairly serious 

concerns, and it was downscaled as a result of some of those concerns. But I remain skeptical of the need for this level. I understand that the security needs require that so much more be concentrated in the embassy than in most embassies, but, still, this is 

a huge facility, and it does have serious issues, I think, of rightsizing. 

But, on another subject, I recently had the chance to travel to 

South America, and I recently had the chance to meet with the 
106 

President of Colombia. I would be interested in your assessment of 

the situation in South America, especially relative to Colombia and 

our relationship with Colombia and Venezuela, because it appears 

to me to be a region where we’ve got some friends and we’ve got 

some people who don’t like us that much, and we should be with 

our friends. 

Secretary RICE. Well, thank you. In fact, the President, Senator 

Gregg, if you remember, was recently in Latin America, and visited 

Colombia during that time, visited Bogata ́. The fact that he was 

able to go to Bogata ́ says something about how far Colombia has 

come in a relatively short period of time. 

We do have a challenge in Latin America. We have a challenge, 

because those who have been democratically elected are trying to 

deliver for their people, and trying to remain allies of the United 

States. There are those, like Venezuela, that would challenge just 

about everything about American interests and policy, including 

free markets, including nationalizing industry, and they’re a real 

challenge to free markets, open economies, and to democracy in 

Latin America. It makes it even more important that states like 

Colombia, which are trying to do the right things, in terms of democracy and open economies and free trade, be supported by the 

United States. 

In the year that President Uribe came to power, I think it’s fair 

to say that Colombia was on the brink of failure, on the brink of 

being a failed state. It was, after all, a country where large portions of the territory were uncontrolled by the government, where 

terrorists were able to prevent the police or the army from even 

coming into those areas, where bombings in Bogata ́, where security 

for the population was something that was very difficult, almost 

impossible, for the government to deliver. Through a very strong 

campaign against terrorism, President Uribe has begun to deliver 

some security to his people. I think it’s why he was reelected by 

such large margin. 

They also are going after paramilitaries from the other side of 

the political spectrum. He ordered paramilitary leaders to surrender in August of 2006. Fifteen of the 24 top leaders did. They’ve 

been going after the others. Frankly, the independent judiciary and 

the supreme court has been bringing people to account for what 

has happened in Colombia over the last years. 

So, I think, while it is not by any means perfect, and we continue 

to have a dialogue with Colombia about the need for human rights 

protection, the need for labor protections, the need for continuing 

to prosecute the paramilitaries, this is really a case of a democratically-elected leader that has been able to bring his country back 

from the precipice of being a failed state. Just imagine what South 

America, with the challenge of someone like Hugo Chavez, would 

be without strong allies like Colombia in the Andean region. 

Senator GREGG. Thank you. It’s represented by some that Chavez 

and the Venezuelan Government is basically protecting, or at least 

not extraditing, narcoterrorists back to Colombia, members of 

FARC. Is that the view of the State Department, that that’s an accurate representation? 

Secretary RICE. There are cases that the Colombian Government 

has raised, I think, with the Venezuelans, concerning who may be 
107 

continuing to live in, or operate in, Venezuela. We just hope that 

all of Colombia’s neighbors will not harbor, in any fashion, people 

who ought to be brought to justice. 

Senator GREGG. On another subject, you recently had an opportunity to meet with representatives of Syria. As we look at the 

Middle East, obviously Syria has, for years, been a funder of terrorism and terrorist groups. There seems to be a mutation, however, of the terrorist cadre in that the more structured terrorists, 

such as Hamas and Hezbollah, now find themselves with the most 

distant groups, such as al Qaeda, that are not as orchestrated, potentially, or at least funded. And so, I’m interested in your view of 

where Syria now—what Syria’s role now is in the area of funding, 

supporting, and promoting terrorism in the traditional struggle relative to Israel and in the struggle in Iraq. 

Secretary RICE. Syria continues to be a major funder of terrorism, major harborer of those elements of the Palestinian political elite, for instance, who are opposed to a two-state solution, who 

are the ones who continue to be—to perpetrate violence in the Palestinian territories, and to attempt to do it in Israel. So, in terms 

of Middle East peace, the Syrians are a real problem for leaders 

like Mahmoud Abbas, who want to take a different course toward 

a two-state solution. 

When it comes to Iraq, we are very concerned about the foreign 

fighters that are transiting the Syrian border, and are, therefore, 

doing great harm to innocent Iraqis and to our forces. That was the 

focus of the conversation that I had with the Syrian Foreign Minister. It was about Iraq. This was not a conversation about U.S./ 

Syrian relations. This was about what Syria needs to do to stem 

the tide of those foreign fighters and to help the Iraqis to secure 

their borders. 

Then, finally, as to Lebanon—there, Syria and its allies continue, 

on a daily basis really, to threaten the stability of the democratically-elected government of Fouad Siniora, to resist the establishment of an international tribunal. Despite the fact that that tribunal is established by the United Nations, their allies continue to 

try to block the convening of that tribunal. Syria needs to allow 

that tribunal to go forward, because people need to answer for 

what happened to former Prime Minister Rafik Hariri, and we 

need to see who was behind it. So, Syria is a significant problem, 

not just for American policy in the Middle East, but for democratic 

forces that are trying to take hold in the Middle East. One point 

that I made to my Syrian counterpart is that we should talk about 

Iraq, and we should talk about what we can do to help the Iraqis, 

but U.S./Syrian relations would depend on a great deal more. 

Senator GREGG. I appreciate that. The logical follow-up question 

is, How should we engage Syria, and how does Israel view Syria? 

Secretary RICE. Well, I’ll not try to speak for the Israelis, except 

to say that their statements are consistent in public and in private, 

with—what they say in public and what they’ve said to us in private. Obviously everyone would like to see peace between Israel 

and Syria. If it were possible, I think everybody would jump at the 

chance. But Syrian behavior is such that, particularly in the support that it gives to elements of Hamas that are preventing a two- 
108 

state solution, it’s not exhibited an attitude that suggests that it’s 

ready for, or intending to try and pursue peace. 

As to how we deal with Syria, we had this—have had this limited discussion with them on Iraq, because we want all of Iraq’s 

neighbors to help Iraq. It makes only good sense if the neighbors 

believe what they’re saying, which is that a stable Iraq is in their 

interest, then they need to behave that way, and that was the message to Syria. But, beyond that, we’ve been very clear that there 

is nothing to be done that does not allow that tribunal to take place 

in Lebanon, and that does not stop support for the Palestinian organizations that are engaged in terrorism. 

Senator GREGG. Thank you. 

Senator LEAHY. Thank you, Senator Gregg. 

Before I go to Senator Landrieu, I’d note Colombia has been in 

the top four or five of countries receiving foreign aid from the 

United States. I have been either chairman or ranking member 

during that whole time, both with President Uribe and his predecessor, and have voted for that. But, before we put too rosy a picture on it—and I’ll come back to this later—there are 30,000 individuals who went through the demobilization ceremonies. Only 

2,700 of them applied for reduced sentences under the Justice and 

Peace Law. The rest have received government benefits without 

confessing their crime or turning over their illegal assets. 

The government’s lost track of 5,000 of them. The Organization 

of American States say new illegal groups have been formed in 23 

of Colombia’s 32 departments. We’ve heard of the extensive paramilitary infiltration of Colombia’s political system, including the 

president’s former director of intelligence—that was uncovered by 

the supreme court, the inspector general, and, as you know, by 

some of our own people. 

Senator Landrieu. 

Senator LANDRIEU. Thank you, Mr. Chairman. 

I have a full statement for the record I’d like to submit. 

Senator LEAHY. Without objection, it will be included. 

Senator LANDRIEU. Thank you. 

[The statement follows:] 

PREPARED STATEMENT OF SENATOR MARY L. LANDRIEU

Mr. Chairman, Senator Gregg, on September 15, 2005, President Bush stated that 

‘‘This government will learn from the lessons of Hurricane Katrina. We are going 

to review every action and make necessary changes so that we are better prepared 

for any challenge of nature, or act of evil men, that could threaten our people.’’ Unfortunately, time and time again, Madame Secretary, we are constantly reminded 

of how this administration has failed to take every action and failed to make the 

necessary changes so that we are better prepared for tomorrow’s next Hurricane 

Katrina. The recent Category 5 tornado that ripped through Kansas this past weekend, and the recent report by the Washington Post on the mishandlings of foreign 

aid offered in response to Hurricanes Katrina and Rita, both tragically demonstrate 

my point. 

During Hurricane Katrina, the National Guard equipment and members were 

stretched too thin—and continue to be stretched too thin to this day. When Katrina 

hit the Gulf on August 29, 2005, the Louisiana National Guard only had roughly 

40 percent of equipment on hand and more than half of our Guardsmen were deployed in support of the war in Iraq. Here we are one-year, 8 months and 13 days 

later (approximately 620 days) and Kansas Governor Kathleen Sebelius is reporting 

that, 50 percent of our her trucks are in Iraq and Afghanistan and she is missing 

numerous Humvees, which move people. Unfortunately, Governor Sebelius is unable 
109 

to borrow the necessary equipment from other states, like Gulf States did during 

Katrina, as they are also operating under extreme equipment shortages. 

Due to the amount of equipment being left in Iraq and Afghanistan, 16 percent 

of the Kansas National Guard’s equipment will not return to Kansas. In fact, there 

is a chance the amount of equipment left overseas will double. Louisiana’s National 

Guard is also experiencing the same war fatigue, with only 33 percent of necessary 

equipment currently on hand. If all was returned from Iraq and Afghanistan, it 

would still only increase on hand availability to 44 percent. While it may seem the 

recent tragedy in Kansas may be out of scope for the basis of this hearing, I assure 

you, Madame Secretary, it is not. 

Recently, the Washington Post reported on the administration’s turning away of nearly $1 billion of foreign aid offered in response to Hurricanes Katrina and Rita 

and the devastating failure of the federal levee system that followed. I was already 

aware that the administration cast aside warnings and recommendations from its 

own experts, dragged its heels on response, and drove our long-term recovery 

straight into a morass of bureaucracy. Another curtain has been pulled back and 

exposed an additional example of the seemingly endless incompetence that has been 

the trademark of this Administration’s response to the hurricanes and the devastating failure of the federal levee system. While the State Department has acknowledged that mistakes were made in the handling of foreign donations, due to 

an absent implementation plan for the management of foreign aid, no changes have 

been made to the International Cooperation Response Index to the National Response Plan. In addition, no significant permanent changes have yet to be made to 

the National Response Plan itself. 

Inadequate planning on how to manage foreign aid, more specifically material assistance, kept valuable resources from being accepted, allocated and distributed. 

One-hundred fifty-one nations, international organizations and political entities offered assistance, totaling $854 million, not including material/in-kind assistance. Of 

the $854 million, $454 million was cash; $400 million was oil, which was to be sold 

for cash. To date, only $126.4 million has been accepted, numerous material/in-kind 

donations were turned away, and the $400 million in oil was never accepted or sold. 

For example, on September 5, 2005 FEMA received an offer from Switzerland to 

send relief supplies. However, the offer was not fully vetted by FEMA until September 14, 2005. With the delay and FEMA not being able to quickly unload and 

repackage the supplies into smaller quantities in a timely matter, the Swiss government had to cancel the entire shipment. Not only were donating countries victims 

of an unresponsive and ill-prepared administration, they were also thwarted by bureaucratic red tape. During the height of rescue and relief missions, a German company offered a $3 million integrated satellite and cellular telephone system, which 

is capable of handling 5,000 calls at once. With virtually all communications systems down in the Gulf, this device could have potentially saved many lives had it 

been delivered earlier. For five days, the people of Louisiana and Mississippi were 

without this key system until a written deployment order was issued from 

USNORTHCOM. 

In the administration’s February 2006 report, The Federal Response to Hurricane 

Katrina: Lessons Learned, a total of nine recommendations were made on how to 

improve the management of offers of foreign assistance and inquiries regarding affected foreign nationals. One of the requirements directs DOS to lead the revision 

of the International Coordination Support Annex to the National Response Plan, to 

clarify the responsibilities of DOS, DOD, DHS, and other agencies in response to 

domestic incidents. Other recommendations direct that prior to June 1, 2006, DOS 

and DHS should lead interagency efforts to: 

1. Quickly develop procedures to review, reject or accept any offers of international assistance 

2. Create a list of anticipated needs for foreign assistance and a list of items that 

cannot be accepted, and 

3. Develop an interagency process to determine appropriate and timely uses of 

cash donations and how to communicate to donors on how funds were used. 

I hope that today we can get to the bottom of how this Administration could turn 

away an outstretched hand in a time of such desperate need. Madame Secretary, 

I would like an update from you by May 31, 2007. I want to know where DOS is 

on completing the nine recommendations, if they were done timely, and when final 

amendments may be made to the International Coordination Support Annex to the 

National Response Plan. I need to know what works and what does not. Louisiana 

and the Gulf Coast deserve better. America deserves better. 

In the fiscal year 2008 Budget, the President has requested $36.2 billion in Department of State, USAID and other foreign agencies. This is a 22 percent increase 

from fiscal year 2007, and only 1.2 percent of our total annual budget. These funds 
110 

are in addition to the $3.3 billion requested for the fiscal year 2008 Emergency Supplemental for foreign assistance and State Department operations. While this budget request contains sufficient funding for many programs, such as Global AIDS and 

the Millennium Challenge Corporation (MCC), the global challenges facing us today 

are greater than ever. 

While we have made progress over the last few years in increasing the amount 

of foreign assistance funding, continued investment in international affairs programs are critical to building global stability. By increasing the International Affairs Budget, we have a better chance of achieving our national security goals and 

of promoting economic prosperity and our humanitarian values. Therefore it is critical that we continue to increase U.S. foreign assistance and pass a total budget of 

$38.5 billion for State and Foreign Operations and $1.3 billion in international agricultural assistance in fiscal year 2008. 

In the many war torn and conflict areas, such as Afghanistan, Iraq, Uganda and 

many others around the globe, thousands of children continue to suffer. Every day 

30,000 children under 5-years-old die from preventable diseases, 77 million children 

wake up without a chance to go to school, and 200 million go to bed without enough 

to eat. Unfortunately, the Budget only calls for $345.6 million in maternal, newborn 

and child survival programs—this is a decrease from last year’s level. 

The Budget also calls for $535 million for basic education programs. While this 

is an increase over the current levels, it falls short of the real global need. By transferring the bulk of global education funding from Development Assistance account 

to the Economic Support Fund account, there is a possibility the number of countries receiving basic education assistance, particularly Africa and Latin America, 

could decline. Additionally, this change could impede lasting and transformational 

change in those regions. While I do appreciate and support the changes underway 

at USAID, I do believe we need to study, closely, the real impact of each change. 

Currently, 42 countries receive basic education from the DA account, 14 in Africa, 

15 in Asia/Near East, 5 in Europe/Eurasia and 8 in Latin America and the Caribbean, and we do not want to jeopardize, only improve, the education in these countries. 

According to Save the Children, nearly half of 6 year-olds in Uganda do not enroll 

in school. On average, 64 percent do not complete five years of school, and in Pader 

district, primary school completion is just 26 percent. Across Uganda more boys enroll than girls. Early marriage and pregnancy and fear for their lives, causes frequent drop outs or keeps them from attending all together. Only 45 percent of girls 

enroll in grade one, but only 32 percent complete primary school. Around 46 percent 

of teachers are untrained and class sizes can grow to over 200 children. 

It is vital that we recruit, train and deploy teachers in under-resourced areas, including female teachers to help increase enrollment and completion among girls. By 

building community support for education and investing in the community, we are 

able to help reduce the amount of child from being abducted. More than 30,000 children have been taken from their homes and abducted by the LRA. These children 

often become soldiers or sex slaves. Currently, 6,000 to 10,000 children walk miles 

from their rural homes every night to sleep in town centers, in order to avoid violence and abduction. These children are known as ‘‘night commuters’’. Last year as 

many as 35,000 children would leave their homes every night. 

Much like Uganda, Afghanistan struggles to rebuild their community and to find 

a was to redevelop essential skills in the country. Although Taliban control ended 

in 2001, and despite reconstruction efforts, Afghanistan is deeply poor with chronic 

malnutrition, lawlessness and frequent violence against children. Girls are still excluded from many activities. Half of Afghan children between 7 and 12 attend 

school, but only a third are girls. Attendance is often low, due to the inadequate 

school facilities for girls and the limited number of female teachers. Roughly 60 percent of girls aged 7 to 13 are out of school and in some rural areas around 92 percent of girls are out of school. Only 27 percent of teachers are females, but most 

are in urban areas, and fewer than 15 percent of teachers have a teaching degree. 

Clearly you can see from these startling statistics, Madame Secretary, that it is very 

important that ensure our education funding is not jeopardized, but improved in a 

way that allows the number of countries and the amounts received to grow. 

As I stated above, in Afghanistan and Iraq children continue to be victims of: poor 

health care, limited and inaccessible education systems, and innocents of the ongoing wars. In Uganda children are forced to be child soldiers and young girls into 

becoming ‘‘wives’’. Madame Secretary, this is unacceptable. I know these problems 

cannot be solved overnight and not by diplomatic measures alone, which is why we 

must continue providing these countries with adequate aid assistance and improve 

intercountry adoption policies around the globe. 
111 

As the Democratic Chair of the Congressional Coalition on Adoption and a proud 

adoptive parent myself, I truly understand the benefits and joys adoption brings to 

a family and the children being adopted. Although, over 20,000 children are adopted 

every year internationally by U.S. citizens, improvements can and must be made to 

intercountry adoption policies around the globe. For example, adoption by foreign 

citizens remains close in Romania and Cambodia to this day. Russia, although open 

for adoption by foreign citizens, passed an NGO law in May, which requires U.S. 

based adoption service providers be both registered and accredited by the Ministry 

of Education (MOE). Unless an agency complies with both they are unable to assist 

in any way in placing children. As of the end of April, no U.S. agencies had been 

successfully accredited by the MOE. Madame Secretary, all children, regardless of 

race, ethnicity, gender or disability, deserve a permanent and loving home. We can 

do better at providing these children with loving homes, better health care and education, and the basic right to food. 

Mr. Chairman, I look forward to hearing the testimony from Secretary Rice today 

and hope that she is ready to honestly and openly answer any questions this committee may ask. 

Thank you, Mr. Chairman. 

Senator LANDRIEU. Madam Secretary, be assured the people of 

Louisiana and Mississippi and the gulf coast understand the focus 

of yours and the administration on Iraq, Afghanistan, and other 

places in the world, where it’s important to focus, because they are 

great challenges. But there was an incident that occurred in this 

country that was of international focus and importance over 18 

months ago, and that was when two storms battered the gulf coast, 

which is America’s energy coast, and the Federal levee system collapsed, flooding an area seven times the size of Manhattan, destroying 250,000 homes and 20,000 businesses. Nothing like it has 

ever been seen in the United States outside of the Civil War. 

Last week, the Washington Post reported that the administration turned away nearly $1 billion in foreign aid. The State Department 

has acknowledged that mistakes were made in the handling of foreign donations due to the absence of an implementation plan for 

the management of such aid. To date, it is my understanding that 

no changes have been made to the International Cooperation Response Index or to the National Response Plan. 

In addition, no significant permanent changes have yet been 

made to the National Response Plan itself. One hundred and fiftyone nations, international organizations, and political entities offered assistance totaling $854 million, not including material in 

kind. Of the $854 million, $454 million was cash, $400 million was 

oil, which has yet to be sold for cash. To date, only $126.4 million 

has been received, numerous materials in kind were turned away, 

and $400 million in oil, as I said, was never accepted or sold, we 

don’t know where those barrels of oil are. 

On September 5, for example, because I’m going to get to my 

question in a minute, an offer from Switzerland to send relief supplies was sent. The offer was not fully vetted by FEMA until September 14. With the delay in FEMA not being able to act quickly 

to unload and repackage the supplies, the Swiss Government canceled their entire shipment. 

Another example—and there are dozens; I will submit them for 

the record—a German company offered 3 million integrated satellite and cellular telephone systems, which is capable of handling 

5,000 calls at once. With virtually every communication system collapsed in the Gulf of Mexico, where our own military was reduced 

to runners, the way we used to use them in wars of the past, we 
112 

turned this communication equipment away until USNORTHCOM 

demanded that they be received. 

I want to, Mr. Chairman, get to my question, which is—in just 

one second. But, for the record, this was reported by the Washington Post, and it is upsetting that, in the first paragraph, a 

memo from Karen Hughes says, ‘‘Echo chamber message,’’ in quote. 

That is a public-relation term, as according to the Washington 

Post, for talking points designed to be repeated again and again. 

This was the directive, ‘‘Assure the scores of countries that have 

pledged or donated aid that their aid was,’’ quote, ‘practical help 

and moral support,’ and highlight the concrete benefits hurricane 

victims are receiving.’’ 

Madam Secretary, the people that I represent were not able to 

take advantage of this aid, because there obviously is some major 

problems with how we receive aid for them when they’re in their 

most desperate hours of need. I don’t know what we have done to 

correct it. 

[The information follows:] 

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

CORRECTION TO THIS ARTICLE

An April 30 Page One article on foreign aid after Hurricane Katrina incorrectly 

said that a consortium led by the United Methodist Committee on Relief had provided social services to 45,000 individual disaster victims up to that point, less than 

half the 100,000 victims it promised to help. The group has provided services to 

49,709 families, not individuals, short of its goal of 100,000 families. 

MOST KATRINA AID FROM OVERSEAS WENT UNCLAIMED

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

As the winds and water of Hurricane Katrina were receding, presidential confidante Karen Hughes sent a cable from her State. Department office to U.S. ambassadors worldwide. 

Titled ‘‘Echo-Chamber Message’’—a public relations term for talking points designed to be repeated again and again—the Sept. 7, 2005, directive was unmistakable: Assure the scores of countries that had pledged or donated aid at the height 

of the disaster that their largesse had provided Americans ‘‘practical help and moral 

support’’ and ‘‘highlight the concrete benefits hurricane victims are receiving.’’ 

Many of the U.S. diplomats who received the message, however, were beginning 

to witness a more embarrassing reality. They knew the U.S. Government was turning down many allies’ offers of manpower, supplies and expertise worth untold millions of dollars. Eventually the United States also would fail to collect most of the 

unprecedented outpouring of international cash assistance for Katrina’s victims. 

Allies offered $854 million in cash and in oil that was to be sold for cash. But 

only $40 million has been used so far for disaster victims or reconstruction, according to U.S. officials and contractors. Most of the aid went uncollected, including 

$400 million worth of oil. Some offers were withdrawn or redirected to private 

groups such as the Red Cross. The rest has been delayed by red tape and bureaucratic limits on how it can he spent. 

In addition, valuable supplies and services—such as cellphone systems, medicine 

and cruise ships—were delayed or declined because the government could not handle them. In some cases, supplies were wasted. 

The struggle to apply foreign aid in the aftermath of the hurricane, which has 

cost U.S. taxpayers more than $125 billion so far, is another reminder of the Federal 

Government’s difficulty leading the recovery. Reports of Government waste and 

delays or denials of assistance have surfaced repeatedly since hurricanes Katrina 

and Rita struck in 2005. 

Administration officials acknowledged in February 2006 that they were ill prepared to coordinate and distribute foreign aid and that only about half the $126 million received had been put to use. Now, 20 months after Katrina, newly released 

documents and interviews make clear the magnitude of the troubles. 
113 

More than 10,000 pages of cables, telegraphs and e-mails from U.S. diplomats 

around the globe—released piecemeal since last fall under the Freedom of Information Act—provide a fuller account of problems that, at times, mystified generous allies and left U.S. representatives at a loss for an explanation. The documents were 

obtained by Citizens for Responsibility and Ethics in Washington, a public interest 

group, which provided them to The Washington Post. 

In one exchange, State Department officials anguished over whether to tell Italy 

that its shipments of medicine, gauze and other medical supplies spoiled in the elements for weeks after Katrina’s landfall on Aug. 29, 2005, and were destroyed. ‘‘Tell 

them we blew it,’’ one disgusted official wrote. But she hedged: ‘‘The flip side is just 

to dispose of it and not come clean. I could be persuaded.’’ 

In another instance, the Department of Homeland Security accepted an offer from 

Greece on Sept. 3, 2005, to dispatch two cruise ships that could be used free as hotels or hospitals for displaced residents. The deal was rescinded Sept. 15 after it became clear a ship would not arrive before Oct. 10. The U.S. eventually paid $249 

million to use Carnival Cruise Lines vessels. 

And while television sets worldwide showed images of New Orleans residents begging to be rescued from rooftops as floodwaters rose, U.S. officials turned down 

countless offers of allied troops and search-and-rescue teams. The most common responses: ‘‘sent letter of thanks’’ and ‘‘will keep offer on hand,’’ the new documents 

show. 

Overall, the United States declined 54 of 77 recorded aid offers from three of its 

staunchest allies: Canada, Britain and Israel, according to a 40-page State Department table of the offers that had been received as of January 2006. ‘‘There is a lack 

of accountability in where the money comes in and where it goes,’’ said Melanie 

Sloan, executive director of the public interest group, which called for an investigation into the fate of foreign aid offers. She added: ‘‘It’s clear that they’re trying to 

hide their ineptitude, incompetence and malfeasance.’’ 

In a statement, State Department spokesman Tom Casey said that the U.S. Government sincerely appreciated support from around the world and that Katrina had 

proved to be ‘‘a unique event in many ways.’’ 

‘‘As we continue our planning for the future, we will draw on the lessons learned 

from this experience to ensure that we make the best use of any possible foreign 

assistance that might be offered,’’ Casey said. 

Representatives of foreign countries declined to criticize the U.S. response to their 

aid offers, though some redirected their gifts. 

Of $454 million in cash that was pledged by more than 150 countries and foreign 

organizations, only $126 million from 40 donors was actually received. The biggest 

gifts were from the United Arab Emirates, $100 million; China and Bahrain, $5 million each; South Korea, $3.8 million; and Taiwan, $2 million. 

Bader Bin Saeed, spokesman for the Emirates Embassy in Washington, said that 

in future disasters, ‘‘the UAE would not hesitate to help other countries, whether 

the United States or any other state, in humanitarian efforts.’’ 

Kuwait, which made the largest offer, pledged $100 million in cash and $400 million in oil. But the Kuwaitis eventually gave their money to two private groups: $25 

million to the Bush-Clinton Katrina Fund, a project of the former presidents, and 

another $25 million to the American Red Cross in February 2006. They still plan 

to contribute another $50 million, said the Kuwaiti ambassador to the United 

States, Salem Abdullah al-Jaber al-Sabah. 

‘‘It was based on my government’s assessment of the fastest way to get money to 

the people that needed it,’’ he said. ‘‘The Red Cross was on the ground and actionoriented.’’ 

In the White House’s February 2006 Katrina report, U.S. officials said Kuwait’s 

$400 million oil donation was to be sold for cash. Sabah said it was an in-kind 

pledge made when it appeared that U.S. refining capacity was devastated and that 

the American public would need fuel. 

‘‘We have to see what we have to do with that. When you pledge something inkind, your intention is to give it in-kind. I do not think now the American people 

arc in need of $400 million of fuel and fuel products,’’ he said. 

Of the $126 million in cash that has been received, most has not yet been used. 

More than $60 million was set aside in March 2006 to rebuild schools, colleges and 

universities, but so far, only $10.4 million has been taken by schools. 

Half the $60 million was awarded last fall to 14 Louisiana and Mississippi colleges, but five have not started to claim the money. Only Dillard University in Louisiana and Mississippi Gulf Coast Community College have tapped their full awards, 

worth $6 million, U.S. Education Department officials said Friday. 
114 

Another $30 million was sent to Orleans, St. Bernard and Plaquemines parishes 

in Louisiana and to the state-run Recovery School District in New Orleans to build 

libraries, laboratories and other facilities for 130 public schools. 

But none of that money has been used yet, said Meg Casper, spokeswoman for 

the Louisiana Department of Education. Allocations were just approved by the state 

board last week, she said, ‘‘so the money should start to flow.’’ 

The first concrete program officials announced in October 2005—a $66 million 

contract to a consortium of 10 faith-based and charity groups to provide social services to displaced families—so far has assisted less than half the 100,000 victims it 

promised to help, the project director said. 

The group, led by the United Methodist Committee on Relief, has spent $30 million of the money it was given to aid about 45,000 evacuees. Senate investigators 

are questioning some terms in the contract proposal, including a provision to pay 

consultants for 450 days to train volunteers for the work the committee was paid 

to do. 

Jim Cox, the program director, said that the project is ‘‘right on track’’ but that 

its strategy of relying on volunteers foundered because of burnout and high turnover. He acknowledged that more people need help than are receiving it and said 

the program will be extended to March to use available funds. 

‘‘The resources aren’t there, but these resources certainly are coming,’’ Cox said. 

Senator LANDRIEU. But I also want to put in the record an e-mail 

that was received when the request was made for—an open-issue 

request. It reads, from, one, Kathleen Algaron, ‘‘We need to come 

clean with the Italians, tell them we blew it, or deeply appreciate 

and regret handling of this, and let them know about the disposal. 

The flip side is just to dispose of it and not come clean. I’m willing 

to be persuaded either way.’’ 

[The information follows:] 

NORMAN, ALAIN G 

From: Yu, Alan K. 

Sent: Wednesday, October 05, 2005 3:44 PM 

To: Volker, Kurt D; Allegrone, Kathleen H; Sterling, Adam H 

Cc: EUR-WE-Italy-DL; Cook, Nerissa J; Norman, Alain G; McCarthy, Deborah A; 

Harris, Michelle F. 

Subject: RE: Italian Meds for Katrina—Houston, we’ve got a problem . . . 

All— 

I spoke to a Washington FDA official. He thought our request was reasonable, but 

will need to check on what FDA personnel remain in Little Rock and ensure his 

higher-ups are okay (he didn’t anticipate problems). He will tell me tomorrow. 

Who pays to dispose: he thought it would be FEMA—possession is ninetenths . . . . We’re not there yet, though; we need to get the FDA inspection above 

and then take it up with the Italians. 

Let me know when we plan to do this, so I can get my annual leave request in. 

Alan 

From: Volker, Kurt D 

Sent: Wednesday, October 05, 2005 2:45 PM 

To: Allegrone, Kathleen H; Sterling, Adam H 

Cc: Yu, Alan K; EUR-WE-Italy-DL 

Subject: RE: Italian Meds for Katrina—Houston, we’ve got a problem . . . 

I think ‘‘crisis situation, second hurricane, etc.’’ sounds reasonable enough (barely) 

and definitely come clean, rather than try to conceal—never works. 

From: Allegrone, Kathleen H 

Sent: Wednesday, October 05, 2005 12:30 PM 

To: Volker, Kurt D; Sterling, Adam H 

Cc: Yu, Alan K; EUR-WE-Itaty-DL 

Subject: Italian Meds for Katrina—Houston, we’ve got a problem . . . 

Alan tells me that FDA officials believe the Italian meds are totally unusable— 

by others. They were exposed to the elements and heat; even the gauze etc wouldn’t 

be worth it. 
115 

Elan is going to go back to be sure someone really eye-balled the stuff. He’s also 

going to check on disposal (and who pays—whatever . . .) 

Then, I think (and Elan agrees) that we need to come clean with the Italians; tell 

them we blew it; deeply appreciate and regret handling of this; and let them know 

about disposal. 

The flip side is just to dispose of it and not come clean. I’m willing to be persuaded, but . . . 

Thoughts? 

FW: Request to UK on MRE data 

I think asking the UK is insulting and will require that we fund travel for them 

to send a Vet to AK to review storage practices before they issue a certificate. If 

we have in house folks with training, I recommend that the DOS ask DOD for assistance. It is very likely that there is a vet with the required training at Little Rock 

AFB. . . . 

I left you a voice mail and an e-mail on the unclass side. I was out of office on 

Friday for a meeting at RAF Mildenhall. 

Call me and we can discuss further. 

Rob 

From: Donegan, James F (POL) 

Sent: Thursday, January 05, 2006 5:17 PM 

To: Letourneau, Robert M 

Subject: FW: Request to UK on MRE data 

Rob—can you look into getting a certificate per Bill’s suggestion? 

Thanks 

Jim 

From: Meara, William R 

Sent: Wednesday, January 04, 2006 1:35 PM 

To: Donegan, James E (POL) 

Cc: Tokola, Mark A; Bonilla, Jean A; Clark, Sandra E 

Subject: RE: Request to UK on MRE data 

Jim: 

This thing keeps coming back at us, While this is an ECON issue, the desk seems 

bound and determined to talk only to POL about it. That’s fine—I won’t fight you 

about who covers the soon-to-be rancid UK MREs in Arkansas! 

A month or so ago the desk asked us to check to see if the Brits had any objection 

to us giving these MREs to third parties. MOD told ODC that they were washing 

their hands of the MREs, and didn’t care what we did with them. 

If you do want to try to get the Brits to give us the kind of certificate that the 

desk is discussing, my suggestion would be to route the request through [Deleted] 

in ODC—he has been the Embassy’s main point of contact with MOD on this issue. 

Another option might be to try to do this through the Embassy’s Foreign Agricultural Service office. But I think this is really an MOD issue. . . 

Bill 

From: Donegan, James E (POL) 

Sent: Friday, December 30, 2005 3:24 PM 

To: Donegan, James E (POL.); Evans, Trevor J; Tokola, Mark A 

Cc: Johnson, David T; Meara, William R; Skinner, Charles B 

Subject: RE: Request to UK on MRE data 

Angela’s request for a vet certificate comes out of an interagency meeting held 

yesterday in DC. Apparently the Georgian MOD has made a request for the MREs 

to distribute to their own troops. There has also been a similar request from the 

OSCE border monitors in Georgia. The feeling in the interagency was that a vet certificate would help move, even seal, these possibilities. 

Also in play but less likely is a request from two U.S. NGOs for the MREs to distribute to ‘‘a basket of countries.’’ Possible but less likely that the vet certificate 

would clinch the deal for this option. 

From: Donegan, James E (POL) 

Sent: Friday, December 30, 2005 8:22 AM 

To: Evans, Trevor J; Tokola, Mark A 

Cc: Johnson, David T 
116 

Subject: FW: Request to UK on MRE data 

Know any Vets? 

PS I have asked Washington to research the veracity of a Sun report yesterday 

that these things are ‘‘rotting’’ in a warehouse somewhere in the States. 

From: Cervetti, Angela M 

Sent: Thursday, December 29, 2005 10:24 PM 

To: Donegan, James E (POL) 

Subject: FW: Request to UK on MRE data 

In Charles’ absence . . . 

From: Cervetti, Angela M 

Sent: Thursday, December 29, 2005 5:19 PM 

To: Skinner, Charles B; Bonilla, Jean A 

Cc: O’Malley, Michael E; Nolan, Edwin R; Roy, Kenneth M 

Subject: FW: Request to UK on MRE data 

Jean, Charles, 

The MRE saga continues. Below is an e-mail from PGI asking us to ask post to 

approach the Brits for a veterinarian certificate stating that the meat products are 

fit for human consumption. Alan Yu from PGI seems to remember you already said 

that it would be very difficult and that the USDA should inspect the MREs and 

issue its own certificate. The problem is USDA said it does not inspect/certify nonAmerican foods. 

There are some options that opened up for disposition but the general sense is 

that having papers from the Brits saying the meat won’t poison anybody would help 

the process along. 

What are your thoughts? 

Angela 

Senator LANDRIEU. I want to know where the Department of 

State is in implementing the nine recommendations, and when 

final amendments have been made at International Cooperation 

Support Annex to the National Response Plan, if that’s been done 

to date. 

Secretary RICE. We are in the process, Senator, of doing precisely 

that. I do want to note, though, that this was an unprecedented 

event. As you noted, it was an unprecedented event for the United 

States. It was also unprecedented for the United States to receive 

offers of help at the level that we received the offers of help. The 

State Department was the agency that took in the offers of help. 

We tried, then, to coordinate with FEMA and those on the front 

lines to understand what help could be used and what help could 

not be used. 

We accepted donations from 122 countries and organizations, 

$126 million in monetary donations. In fact, we ended up encouraging a lot of countries to give to private organizations, like the 

Clinton-Bush effort, because, frankly, it was difficult for us to use 

a lot of what was suggested. 

Senator LANDRIEU. I understand that, and my time is up. But I 

just want to, on the record, say that $1 billion, approximately, was 

offered; we’ve received $126 million. There was a lot of money left 

on the table. The people of the gulf coast deserve to have a better 

system. But, more than just the people of the gulf coast, this country deserves to have a better system in the event that this happens 

again. 

So, I want a specific answer, if you don’t mind. When do you 

think these recommendations that have been made will be accepted, either presented to this committee or to the Congress, for adoption? 
117 

Secretary RICE. Senator, I will get back to you with an update 

on where we are, by letter, in response to your question. 

But, if I may, I just want to note that, in fact, because it’s important for our partners to know that a lot of their donations were 

used, and used well, for the people—$66 million to finance social 

service management for Katrina, $60 million to the Department of 

Education. 

Just one final point, if I may. Yes, we had to turn down some 

donations—medical equipment, a lot was in kind, for instance, for 

medical personnel who would not have been licensed in our country 

to practice; food, which didn’t meet certain standards. 

Senator LANDRIEU. I understand that. Not to—— 

Secretary RICE. So—— 

Senator LANDRIEU [continuing]. Interrupt—Mr. Chairman, I 

don’t mean to be disrespectful, but I have a list here that I would 

like to submit. It is not just food and diapers and bottles that were 

rejected, it was generators and communication systems, and, you 

know, medical supplies, and medical personnel. 

We still, just this week, have been able—now, this is not completely the Federal Government’s fault—to finally get one mentalhealth bed in the New Orleans region. One. 

So, I suggest we have a major problem—— 

Senator LEAHY. Without objection, the—— 

Senator LANDRIEU. I’m going to put this in the record. I thank 

the Chairman—— 

Senator LEAHY. Without objection, it will—— 

Senator LANDRIEU [continuing]. For his—— 

Senator LEAHY [continuing]. Be included in the record. 

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Secretary RICE. Senator, I will get back to you with an answer—— 

Senator LANDRIEU. Thank you. 

Secretary RICE [continuing]. To your question about the—— 

Senator LANDRIEU. Thank you. 

Secretary RICE [continuing]. Various recommendations. 

[The information follows:] 

UNITED STATES DEPARTMENT OF STATE, 

WASHINGTON, DC, July 16, 2007. 

MARY L. LANDRIEU, Chairman, 

Subcommittee on Disaster Recovery, Committee on Homeland Security and Governmental Affairs, United States Senate. 

DEAR MADAM CHAIRMAN: Per my June 28 letter to you, enclosed is additional information responding to the specific questions outlined in your June 14 letter. We 

expect to convey to you shortly information concerning the full set of assistance offers from the international community that you also requested in that letter. I hope 

you find this additional information useful. 

Sincerely, 

JEFFREY T. BERGNER, 

Assistant Secretary Legislative Affairs. 

Enclosure: 

Question. To the extent that the Department of State is designated as the lead 

agency responsible, what is the status of implementation of recommendations 89 

through 97 of the White House report, ‘‘The Federal Response to Hurricane Katrina: 

Lessons Learned?’’ 

Answer. Below are the nine recommendations from the Katrina Lessons Learned 

exercise and the status of each recommendation: 

Recommendation #89.—DOS should lead the revision of the International Coordination Support Annex (ICSA) to the National Response Plan (NRP), clarifying responsibilities of Department of State (DOS), Department of Homeland Security 

(DHS), Department of Defense (DOD), and other supporting agencies in response to 

domestic incidents. This revision should begin immediately. 

Status.—Completed. A State Department-led interagency group completed the 

first revision of the ICSA in February 2007 in consultation with the Homeland Security Council. The revisions clarify expanded roles and responsibilities of USG agencies in managing the international aspects of a domestic incident. The group also 

included representatives from the Departments of Homeland Security, Defense, 

Health and Human Services, Agriculture, and Transportation, and the Agency for 

International Development. 

Recommendation #90.—DOS and DHS should lead an interagency effort that will 

quickly develop procedures to review, accept or reject any offers of international assistance for a domestic catastrophic incident. 

Status.—Completed. An interagency group consisting of the Department of State, 

USAID/Office of Foreign Disaster Assistance (AID), DHS/FEMA, DOD, and the 

American Red Cross (ARC) has developed a system for managing international assistance during a domestic disaster. The system outlines policies and procedures to 

systematically manage offers of, or United States requests for, international material assistance during a United States domestic disaster. It also specifies the roles 

and responsibilities of participant agencies, provides standard operating procedures 

for managing offers of foreign assistance and domestic requests for foreign resources, and outlines the process for receiving and distributing international assistance that is accepted by the U.S. Government. The procedures and arrangements 

detailed in the manual were formally approved in 2007, but the core procedures 

were informally in place among participants by June 1, 2006. 

Recommendation #91.—DHS should lead an interagency effort to create and routinely update a prioritized list of anticipated disaster needs for foreign assistance 

and a list of items that cannot be accepted. 

Status.—Completed. The interagency has established procedures for coordinating 

with USG regulatory agencies for the entry, handling, and use of foreign resources 

during a disaster. Regulatory agencies provide technical advice and review offers of 

international assistance prior to FEMA acceptance. The procedures include guidance 

on acceptable and unacceptable items to assist the Department of State in communicating with the international community. 
159 

Recommendation #92.—DOS should establish an interagency process to: determine appropriate uses of international cash donations; to ensure timely use of these 

funds in a transparent and accountable manner; to meet internal Federal government accounting requirements; and to communicate to donors how their funds were 

used. 

Status.—Completed. Procedures have been established to manage the receipt, distribution, and use of foreign cash donations made during a domestic disaster. FEMA 

has pre-identified response needs likely to arise soon after a domestic disaster for 

which cash donations could be quickly utilized, with the understanding that certain 

donations may be directed to longer term disaster recovery projects. An interagency 

Working Group will be convened as necessary to address fund management issues 

and make recommendations on funding longer term disaster recovery projects. 

Recommendation #93.—Public and Diplomatic Communications during domestic 

emergencies should both encourage cash donations—preferably to recognized nonprofit voluntary organizations with relevant experience—and emphasize that donations of equipment or personnel should address disaster needs. 

Status.—Completed. As was done during Katrina, the State Department provides 

instructions to all U.S. diplomatic missions abroad advising them to encourage foreign entities wishing to assist to make cash donations directly to appropriate NGOs 

rather than the USG. 

Recommendation #94.—The Department of State and the Department of Homeland Security should jointly develop procedures to ensure that the needs of foreign 

missions are included in domestic plans for tracking inquiries regarding persons 

who are unaccounted for in a disaster zone. 

Status.—Completed. The Department of State has worked with DHS/FEMA and 

the ARC to ensure that, during a domestic disaster, the USG honors its international obligations under the Vienna Convention on Consular Relations. Although 

the USG is not required to track down and find missing foreign nationals during 

a disaster in the United States, under the Convention it is obligated to assist foreign 

missions in obtaining ‘‘appropriate consular access’’ to their nationals. 

The Department of State’s Office of Public Affairs has designated personnel to 

work with DHS/FEMA during domestic emergencies. These personnel will be part 

of FEMA’s information operation from the outset of a major domestic crisis, in order 

to ensure efficient handling of queries from and consistent messaging to foreign missions and foreign media. 

The Department of State’s Office of Foreign Missions and the ARC provided briefings for foreign missions in Washington, DC on how foreign missions can best utilize 

the ARC’s missing persons’ registry to locate missing foreign nationals in the United 

States. 

Recommendation #95.—DHS and DOS should revise the NRP to include DOD and 

Department of Agriculture (USDA)-Food Safety Inspection Service as cooperating 

agencies to the International Coordination Support Annex. Including DOD more directly in foreign assistance management would leverage existing relationships with 

partner military establishments and help to ensure that staging areas for the acceptance of foreign aid are preplanned and quickly available. 

Status.—Completed. The revised ICS Annex to the NRP includes both DOD and 

USDA as cooperating agencies. Within the system developed for managing international assistance during a domestic disaster, regulatory agencies such as the 

USDA provide technical advice and review offers of international assistance prior 

to FEMA acceptance. 

Recommendation #96.—DHS should include DOS and foreign assistance management in domestic interagency training and exercise events. Inclusion in the new National Exercise Program (NEP) should occur before the end of fiscal year 2006. 

Status.—We refer you to DHS regarding its training and exercise events. We understand DHS is developing an international assistance training module for use in 

future exercises. DHS can provide more detailed information. 

Recommendation #97.—DHS should provide daily disaster response situational 

updates through the Secretary of State to all Chiefs of Mission or Charges d’Affaires. These updates should improve situational awareness and provide information 

to address host government concerns or questions. 

Status.—DHS has assured State it will provide appropriate updates to inform 

U.S. Missions overseas and, by extension, foreign governments. 

Question. If any recommendations were not implemented by the deadlines identified in the report, why were they not? 

Answer. Those recommendations involving other agencies and departments required extensive interagency coordination. We placed a premium on ensuring that 

our improvements in response to the modifications were developed in concert with 

other agencies. Additionally, fulfilling the recommendations linked to revision of the 
160 

National Response Plan hinged on a timetable established by the Homeland Security Council. 

However, it is important to distinguish between the practical elements of the recommendations and the final, formal conclusion of each. Many of the professionals 

charged with fulfilling the recommendations had first-hand experience with the ad 

hoc arrangements employed in responding to Katrina. By the beginning of the 2006 

hurricane season, all of the major elements of the recommendations—especially 

those suggesting improvements to assistance management—had been agreed informally and would have been employed had circumstances required. 

Question. What additional resources are needed to complete implementation of 

any as-of-yet unaddressed recommendations? 

Answer. All of the recommendations in the Federal Katrina Lessons Learned report have been addressed at this time. 

Question Specifically, when do you expect an amendment to the International Coordination Support Annex to the National Response Plan be complete and amended? 

What else must be addressed to satisfy that goal? 

Answer. An interagency group completed the first revision of the International 

Coordination and Support Annex in February 2007 and provided the revision to the 

Homeland Security Council. The International Coordination Support Annex, along 

with all other revised annexes, will be released for general comment in the near future. The revisions clarify expanded roles and responsibilities of USG agencies in 

managing the international aspects of a domestic incident. 

The group included representatives from the Departments of State, Homeland Security, Defense, Health and Human Services, Agriculture, and Transportation, and 

the Agency for International Development. Within the Department of State, we continue to ensure that relevant bureaus are familiar with the changes to the National 

Response Plan. However, the current NRP is in effect if an incident of national significance occurs prior to the NRP being finalized and formally approved by the Administration and NRP signatories. 

DHS is finalizing revisions to the entire National Response Plan and then the document will be circulated to the interagency community for comment prior to release 

to the general public for comment. 

Question. Of foreign assistance accepted following Hurricanes Katrina and Rita, 

how much has actually been distributed and used to date? Answer. The United States Government received $126 million of donations directly from foreign governments, political entities and individuals. All of these funds 

have been allocated. 

On October 20, 2005, the State Department transferred $66 million to FEMA. FEMA subsequently awarded a $66 million grant to the United Methodist Committee of Relief (UMCOR). UMCOR established Katrina Aid Today (KAT), a consortium of nine nongovernmental organizations, to provide case management services 

to individuals and families affected by Hurricane Katrina. This program filled a gap 

in the services available to victims under federally- or state-funded programs. 

FEMA has advised the Department that KAT has utilized $33 million of the funds 

to help over 149,000 people determine their specific needs and identify resources to 

help them overcome this tragedy. KAT has indicated to FEMA that it expects to provide similar services to additional people by March 2008 with the remaining funds 

available under this grant. 

On date March 17, 2006, the State Department transferred $60 million to the Department of Education for subsequent donation to institutions of higher education 

and K–12 schools. The Department of Education has advised the State Department 

that it allocated these funds as follows: 

DoEd distributed $5 million to the Greater New Orleans Educational Foundation 

for the planning and implementation of a long range strategy for K–12 educational 

services. 

DoEd awarded grants totaling $30 million available to 14 Higher Education institutions in Louisiana and Mississippi. These institutions have been able to draw on 

those funds according to their own reconstruction timetables. We understand that 

as of April 27, 2007, some institutions had utilized their entire grants; others were 

still drawing on the available funds as they proceed with their rehabilitation plans. 

DoEd asked the Louisiana DoEd to develop a program to award grants totaling 

$25 million. On April 19, 2007, the Louisiana Board of Education approved grants 

of $190,000 each to 130 private and public schools. The current award period for 

use of these funds runs until November 30, 2007. Funds would be available on a 

year to year basis until all funds have been expended. 

The United States Government received over 5 million pounds in material contributions and relief supplies from 50 foreign governments and international organizations. The vast bulk of these supplies was transferred to FEMA upon arrival and 
161 

was utilized for disaster relief. FEMA indicates that by April 4, 2006 all material 

donations were put into FEMA pipelines to determine disposition of resource based 

on disaster needs. Foreign governments also donated the use of highly specialized 

equipment, notably high-volume, high-pressure pumps and the services of personnel 

expert in their use. These services were utilized for up to 6 weeks after the storm’s 

landfall. 

Question. As we understand the Department’s Katrina task force has been disbanded, what process exists today to accommodate offers from foreign governments 

seeking to assist the ongoing recovery and rebuilding efforts along the Gulf Coast? 

Answer. The Department’s crisis management system has functioned very well 

over the years; we have used it to manage an average of 13 crises every year. This 

system was used to coordinate the evacuation of almost 15,000 American citizens 

from Lebanon in the midst of active hostilities, the largest evacuation of American 

citizens via primarily commercial assets in 60 years. 

The Department utilized this ‘‘Task Force’’ approach to support the Department 

of Homeland Security and FEMA during the immediate response to Hurricane 

Katrina. Once the immediate, acute phase of the crisis passed, the Department disbanded the Katrina task force. However, a core group of professionals with relevant 

expertise and with experience during the crisis, working under the overall direction 

of the Department’s Executive Secretary, continued to address a wide range of 

Katrina-related issues, including managing ongoing operational coordination with 

FEMA and contributing to internal and USG-wide lessons learned’ exercises. 

Should foreign governments wish to provide additional resources to assist 

.Katrina’s victims directly to the U.S. Government, the Executive Secretary would 

ensure that appropriate experts at DHS and FEMA are engaged to ensure the foreign government’s offer is promptly evaluated and responded to. As during the acute 

phase of the crisis, the Department would not itself evaluate the merits of a specific 

offer, but would instead assist the relevant experts at DHS and FEMA in soliciting 

sufficient information regarding the foreign government’s offer to permit an informed decision by DHS and FEMA on whether to accept or decline the offer. 

Question. What additional steps is the Department of State pursuing to better 

manage foreign assistance following a domestic disaster, what is the status of implementing these actions and what additional resources are needed to complete this effort? 

Answer. The Department, together with partners at DHS/FEMA, AID, the Department of Defense and other Federal Departments, has developed detailed procedures to manage the solicitation, receipt, distribution, and use of foreign cash and 

in-kind donations prompted by a domestic disaster. These procedures have been 

agreed by all parties, are in place and would be used should a subsequent domestic 

disaster prompt offers of assistance from our international friends and allies. 

With respect to cash donations, FEMA has pre-identified response needs likely to 

arise soon after a domestic disaster for which cash donations could be quickly utilized, with the understanding that certain donations may be directed to longer term 

disaster recovery projects. An interagency Working Group would be convened as 

necessary to address fund management issues and make recommendations on funding longer term disaster recovery projects. 

The in-kind donation management system includes detailed procedures for coordinating with USG regulatory agencies for the entry, handling, and use of foreign resources during a disaster. Regulatory agencies provide technical advice and review 

offers of international assistance prior to FEMA acceptance. The procedures include 

guidance on acceptable and unacceptable items to assist the Department of State 

in communicating with the international community, 

Q#8: The U.S. Agency for International Development (USAID) has effectively 

managed the direction of billions of dollars in U.S. assistance to victims of and responders to international disasters such as the South Asia Tsunami and Central 

Asia Earthquakes. How is USAID’s experience being applied to better manage aid 

following disasters here at home? What barriers exist to better leveraging USAID’s 

knowledge and resources in this way, and what would be needed to more effectively 

draw on this expertise and infrastructure? 

Answer. USAID’s role in domestic response operations is described in the National 

Response Plan (NRP), to which USAID is a signatory. The role described in the NRP 

relates to vetting, processing, and managing logistics for offers of foreign assistance. 

The USAID role described in the NRP is based on USAID’s expertise in disaster 

logistics and its experience with, and contacts in, the international disaster response 

community. However, USAID does have other expertise which may be called upon 

for domestic response operations. Such skills include camp management, response 

planning, technical issues, economic recovery, reconstruction, and education. In addition, USAID stockpiles disaster commodities in the U.S. and around the world. 
162 

This expertise and these commodities are available to FEMA for domestic operations. 

Due to the ongoing, close working relationship between FEMA and USAID’s Office 

of Foreign Disaster Assistance (OFDA), FEMA is aware of these capacities at 

USAID. During Hurricane Katrina, in fact, some of these capacities were requested 

by FEMA—commodities, planners, translators, logisticians. In addition, FEMA has 

requested that USAID/OFDA work with them in advance to establish agreements 

by which such assistance may be quickly requested and provided during a disaster— 

this process is currently underway. 

USAID funding authorities prevent the Agency from expending resources for domestic activities. The International Disaster and Famine Account (IDFA) is legislated to fund only international disasters and famine. Nonetheless, during a domestic response operation, this funding issue is addressed through a FEMA Mission Assignment (MA) to USAID. The FEMA MA provides a funding source for USAID to 

carry out domestic operations under FEMA’s legal authority. However, there is a 

significant barrier related to USAID preparations for domesticoperations. FEMA 

generally cannot provide an MA to USAID in the absence of an active disaster response operation. The result is that USAID cannot dedicate staff time or resources 

to preparing for its role in domestic response operations. For obvious reasons, preparation and training is critical to USAID’s ability to respond to a disaster. This constraint is a serious one. USAID has not yet determined how to address this problem. 

Question. What other internal investigations, if any, have been conducted by the 

Department of State into its handling of foreign assistance following the 2005 hurricanes, and what is the status of those reviews? 

Answer. Hurricane Katrina was an unprecedented disaster that presented unique 

challenges to domestic agencies and foreign governments trying to assist. The State 

Department, working with other agencies, responded to foreign offers of assistance 

as quickly and flexibly as circumstances permitted. 

The State Department has participated in extensive interagency lessons learned 

reviews and exercises that addressed problems identified during Hurricane Katrina. 

As a result, the U.S. Government has developed significantly improved policies, procedures, and plans for managing international assistance for future domestic disasters. 

The Homeland Security Council (MSC) led an after action review of the U.S. Government response to Katrina, including how we handled offers of assistance from 

foreign governments. The HSC and key agencies, including the State Department, 

reviewed the response, both what went well and what we can do better, and updated the National Response Plan to guide agency actions if another major disaster 

were to strike the United States. The State Department, USAID, FEMA, the Defense Department and others contributed to the update. 

The Department also cooperated fully with the Government Accountability Office 

when it reviewed the handling of foreign assistance in response to Hurricane 

Katrina (GAO–06–460, April 2006). In its report, the GAO recognized that ‘‘although 

DOS’s procedures were ad hoc, they did ensure the proper recording of international 

cash donations that have been received to date, and [GAO was] able to reconcile the 

funds received with those held in the designated DOS account at Treasury.’’ 

The Executive Secretariat’s Operations Center conducted a lessons learned exercise shortly after the acute phase of the Katrina crisis, as it does after every major 

crisis, to assess the Department’s performance and to incorporate adjustments and 

refinements to procedures in order to improve our response to subsequent crises. 

The results of this exercise informed the subsequent, broader USG assessment and 

ensured the Department was better prepared to respond to 

similar situations, as early as the 2006 hurricane season, even before a formal set 

of agreed procedures were finalized through the interagency process. 

Question. What was communicated to foreign governments regarding assistance 

that went unused, or offers of assistance that were not accepted? 

Answer. For every offer of assistance, the Department, on behalf of the U.S. Government, accepted, politely declined the assistance, or referred the party offering to 

an alternative recipient (i.e., American Red Cross). 

The Department conveyed this information to the offering governments as soon 

as its partners at FEMA had evaluated the offer of assistance and determined 

whether or not it would address an unmet need before similar commodities or services could be identified and sourced within the United States. 
163 

UNITED STATES DEPARTMENT OF STATE, 

WASHINGTON, DC, June 28, 2007. 

Hon. MARY L. LANDRIEU, Chairman, 

Subcommittee on Disaster Recovery, Committee on Homeland Security and Governmental Affairs, United States Senate. 

DEAR MADAM CHAIRMAN: Thank you for your letter of June 14 concerning the 

State Department’s performance in responding to Hurricane Katrina. I welcome the 

opportunity to provide additional information and to correct some of the persistent 

inaccuracies reported in the media concerning the receipt of foreign assistance following Hurricane Katrina. 

Hurricane Katrina presented an unprecedented challenge; the Department’s efforts in response also were unprecedented. Over 500 Department employees 

voltuiteered to help coordinate the outpouring of support and assistance from our 

friends and allies around the world. Many of them deployed into the region to work 

on the ground in the relief effort, including a group of Vietnamese speakers who 

worked closely with ethnic Vietnamese residents along the Gulf Coast. These volunteers were motivated by a rare opportunity to help their fellow citizens here in the 

United States, just as they and their colleagues help American citizens every day 

overseas. 

Your letter asked whether the Department is better prepared now to execute its 

responsibilities in responding to domestic emergencies. The answer is, unequivocally, yes. The State Department learned valuable lessons regarding how best to 

manage and integrate international assistance offers into the federal response to a 

domestic emergency. Working with other parts of the federal government, we have 

incorporated those lessons into our planning and have developed and implemented 

detailed procedures to manage international offers of financial and material assistance. The basic elements of these systems were in place for the 2006 hurricane season; the final, detailed versions are now in place for the 2007 season. 

As noted in our June 19 reply to your questions for the record following Secretary 

Rice’s appropriations testimony, the State Department completed revisions to the 

International Support Annex of the National Response Plan in February 2007, The 

revised annex will be incorporated in the global revision of the National Response 

Plan currently in progress. 

I also would like to take this opportunity to clarify inaccuracies in the public accounts of the Department’s performance to which your letter refers. 

First, the Department from the outset encouraged foreign governments and individuals to assist victims in the most efficient, effective way possible: through financial contributions to nongovernmental organizations expert in disaster response and 

recovery. An informal tally (we cannot require foreign governments to report donations to U.S. NGOs) indicates approximately $220 million in donations initially 

pledged to the USG was provided directly to the Red Cross, Bush-Clinton Katrina 

Fund and other NGOs. 

Some governments wish to contribute directly to the United States government, 

and from those governments we received a total of $126 million. As the Secretary 

said in her testimony, these funds have been allocated (via FEMA and the Department of Education) to nongovernmental organizations, institutions of higher education and, via the Louisiana Department of Education, to 130 K–12 schools. The 

funds are being used to rebuild or restock laboratories and libraries, improve school 

physical plants and help over 148,000 individuals deterniine their needs and plan 

for their futures as they continue to recover from this tragedy. 

A second inaccuracy is that the U.S. Government rejected or ignored substantial 

quantities of materiel and other in-kind assistance offered by foreign governments. 

The State Department’s main objective throughout the Katrina crisis was to act as 

the intermediary for foreign offers of assistance to the U.S. Government, so that the 

Department of Homeland Security and other federal agencies could best help the 

victims of Hurricane Katrina. With respect to material assistance, that meant efficiently conveying all offers to departments and agencies charged with responding to 

the hurricane and coordinating the U.S. Government’s response to offers of foreign 

assistance made by foreign governments. All offers were conveyed promptly to the 

Federal Emergency Management Agency, which, working with USAID’s Office of 

Foreign Disaster Assistance, then decided which commodities could he utilized 

quickly and efficiently. 

Public accounts of the Department’s performance imply that all the foreign assistance offered was actually needed or could be used. In fact, seasoned disaster logisticians evaluated the commodities and services offered, and accepted only those that 

made sense given all of the normal considerations during a disaster—cost and time 

of transport, storage, processing and other factors. Moreover, much of what was of-
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fered, including foodstuffs, medical supplies and services of expert personnel, could 

not be accepted due to federal or state health, safety and licensing standards. Some 

of the equipment, notably generators, was not compatible with U.S. systems. 

More detailed responses to the additional specific questions and requests included 

in your letter will be provided in the next week. I hope you find this information 

useful. 

Sincerely, 

JEFFREY T. BERGNER, 

Assistant Secretary Legislative Affairs. 

Senator LEAHY. Thank you, Senator Landrieu, Secretary Rice. 

Senator Bennett. 

Senator BENNETT. Thank you very much, Mr. Chairman. 

Madam Secretary, as you know, I go to Europe quite often, and 

was there just a few weeks ago, participating in the Brussels 

Forum of the German Marshall Fund. It’s an interesting thing to 

go back to Europe from time to time, as I’m sure you know. Last 

year, when I was there, they said to me, ‘‘The war over the war 

is over. We don’t want to talk about Iraq, we want to talk about 

Russia.’’ The Russians had cut off the gas supply to Ukraine, and 

were making similar kinds of statements about Georgia, and the 

Europeans, at least the ones with whom I spoke, were very nervous. 

This year, I had a briefing with Secretary—or with Ambassador 

Boyden Gray and Tori Newland and Sam Fox, and they all talked 

about Russia and the concern that is there with respect to the turn 

that President Putin may be taking, a turn away from the kind of 

cooperation and admiration that was there fairly early in President 

Putin’s administration and President Bush’s administration. Can 

you give us a sense of where the Russian relationship is? 

Secretary RICE. Thank you, Senator, I can. 

As with any relationship, it’s complicated, any big relationship. 

I would say, on some major strategic global issues, we are cooperating pretty well—on North Korea; we’ve had good cooperation on 

Iran, it’s why we have the two Security Council resolutions. The 

President and President Putin have done work on global nuclear 

terrorism. We’ve done work on trying to—we’re doing work on trying to modernize the Non-Proliferation Treaty, to include, for instance, fuel assurances for countries that don’t do what Iran is 

doing, in enriching and reprocessing. So, on many things, we’re— 

we’ve done very well. 

But the fact is that on some others it’s been a difficult period. 

The Russians, I think, do not accept fully that our relations with 

countries that are their neighbors, that were once a part of the Soviet Union, are quite honestly simply good relations between independent states and the United States, that we’ve tried to convince 

the Russians that the emergence of democracies on their borders, 

whether it’s Georgia or Ukraine, would not be a problem, and that 

of course we’re going to have good and sound relations with those 

countries, and we’re going to continue to. 

It’s even more difficult when one looks at what is happening domestically in Russia, where I think it’s fair to say that there has 

been a turning back from some of the reforms that led to the decentralization of power out to the Kremlin, a strong legislature, strong 

free press, a—an independent judiciary. I think everybody around 
165 

the world, in Europe, in the United States, is very concerned about 

the internal course that Russia has taken in recent years. 

That said, we continue to have that discussion. One of the advantages of President Bush’s very good personal relationship with 

President Putin is he can raise those issues, and we can talk about 

them. We very much hope that there will be free—truly free and 

fair elections as Russia moves forward with presidential and parliamentary elections next year. But it is the concentration of power 

in the Kremlin that has been troubling. 

Finally, we have been pressing, along with Europeans and others, that there be no sense that Russia uses its great natural resources as a political weapon rather than in commercial—a commercial way. So, the—it’s a complicated situation, but I would say, 

on a number of issues, we’ve worked together very well; and it’s a 

big and important power, and we’ll continue to try to work with the 

Russians. 

Senator BENNETT. Thank you. As you know, I’ve always been a 

strong supporter of microenterprise, microcredit. I simply can’t let 

your appearance here pass without mentioning it one more time 

and just keeping it on the radar screen. I’m happy that the State 

Department, during the time that I’ve been on this subcommittee, 

has significantly increased microcredit every year, which means I 

can take credit for it. 

Secretary RICE. Absolutely. 

Senator BENNETT. As long as it happened on my watch, I did it. 

Whether I had anything to do with it, in fact, or not, doesn’t make 

any difference—— 

Secretary RICE. Of course you did—— 

Senator BENNETT [continuing]. When you’re on the campaign—— 

Secretary RICE [continuing]. Senator. 

Senator BENNETT [continuing]. Trail. 

Now, moving to another issue, let’s talk about China. As I look 

at China, I think they have tremendous internal problems and 

long-term challenges, demographic challenges of nature, the likes 

of which no other country has. Maybe India. But in the short term, 

they are committed to short-term economic growth. If you worry 

about American CEOs concentrating on next quarter’s numbers, 

you—they don’t hold a candle to the Chinese. 

We’re expanding our consular activities in China. We’re doing 

what we can to increase the Embassy in China. Give me a—give 

us an overview of where you think things are going with the Chinese. 

Secretary RICE. Well, I would start by saying what I said about 

Russia, also a very complex relationship. With these big countries, 

there tend to be good things and bad things, puts and takes. Again, 

on some of the global issues, we’re doing very well. We are—with 

the Chinese, I think the way we’ve worked, now, on North Korea 

is very effective and quite remarkable, given China’s history with 

North Korea. Similarly, we are, again, working well together in the 

United Nations on Iran. I wish that we could have a somewhat 

stronger Chinese role on Sudan. 

I think that that would be very helpful, and we’ve encouraged 

the Chinese to be much more active with the Sudanese to get them 

to accept the U.N. forces. That’s one of the most important things 
166 

that they can do. They say they will. There’s some evidence of that. 

But that’s very important. 

I think when you look at the total picture, though, you recognize 

that this is a country in the midst of a huge and major transition. 

Our goal has to be to help make that transition one that ultimately 

makes China a more stabilizing force in international politics than 

a destabilizing force. On the positive side of that, the integration 

of China into the international economic system, I think, will help, 

although we’ve had to hold China accountable for some of its WTO 

responsibilities that we think it, frankly, hasn’t fully met; for instance, the efforts of—on intellectual property-right protection, 

which I find perhaps one of the most important things we can do 

is get countries to protect property rights. 

Similarly, on the currency issue, Secretary Paulson has worked 

very hard on that issue. So, China has to do things to show that 

this huge economy is not going to operate outside of the rules of 

the international economy. We spend a good deal of time on that. 

On human rights and religious freedom, there is certainly a lot 

of work to do. We’ve been concerned about the direction of, particularly, religious freedom. This is something that we bring up with 

our colleagues. 

Finally, I would just note that when it comes to the issues related to Chinese security, we—Secretary Gates and others—have 

spoken to our concerns about transparency in Chinese military activities, because there is a rather outsized buildup of Chinese military activity. 

All of that said, it’s our responsibility to try to make China—as 

Bob Zoellick once said, when he was Deputy Secretary—a stakeholder, a responsible stakeholder, in international affairs, because 

China is going to be influential. There’s no doubt about that. Our 

policies have to be aimed at making it a—an influential power in 

a positive sense, not in a negative one. 

Senator BENNETT. Thank you. 

Senator LEAHY. Thank you, Senator Bennett. I do appreciate the 

Senator from Utah taking credit on the microcredit idea. Whenever 

I travel, I say it was a tall, bald Senator with glasses. 

Then I let people decide which of the two of us I’m talking about. 

Senator Alexander? 

Senator ALEXANDER. Thank you, Mr. Chairman. 

Madam Secretary, welcome. 

My late friend Alex Haley used to say, ‘‘Find the good and praise 

it.’’ I have an—I’d like to do that, in one case here, in terms of the 

State Department. My staff in Tennessee has reported to me that 

the State Department has handled the new passport requirements 

very well, along with the increase in passport applications, and 

they sent me a number of examples, which—I won’t read them all, 

but, for example—I will take one or two—on April 17, Kathy 

Smith, of Kingsport, contacted us about assistance with a passport. 

She was terminally ill and needed to go overseas for treatment. 

Her passport was pulled out of a stack of 32,000, and was FedEx’d 

to her within a few days. 

On April 19, Linda Hayes contacted our office. She’s from Nashville. She had a plane ticket for a week later, to go see a brother 
167 

who had a stroke, who couldn’t be moved. Within 3 days, she had 

her passport. 

Our caseworkers say that in dealing with the passport office, 

even with the new requirements, it’s always, ‘‘Let’s see how we 

could help.’’ They especially pointed out the fact that, after 

Katrina, since we, in Tennessee, deal the New Orleans passport office, that instead of complaining about their circumstances down 

there, that they really—said they really didn’t hear a word about 

that, that they found ways to deal with the problems, even though 

they had to move out and go to other offices and do different 

things. 

So, I just wanted to say that to you, and hope that you would 

pass it on to your passport office, and let them know we appreciate 

that very much. 

Secretary RICE. Thank you very much, Senator. I will pass it on. 

They’ll greatly appreciate it. They’ve worked very hard, and I’m 

very proud of the job they’ve done. 

Senator ALEXANDER. I also wanted to ask you a question and 

make a comment about the Iraq Study Group report, the work that 

former Secretary Baker and Lee Hamilton did recently. The President’s talked about it recently in favorable terms. Just the other 

day, I noticed he had some nice things to say about the work of 

the report. As I look at the work we do here, it seems ironic that 

we, the oldest democracy, are busy lecturing Baghdad about—an 

infant democracy—about coming up with a political solution to 

what we do in Iraq, when we can’t come up with one here, and that 

we ought to work a little harder to try to find a way to say to our 

troops and to the Middle East and to the world that we’re united 

in the United States in our mission in Iraq, and we ought to work 

harder to find out what that might be. 

I’ve noticed that since the Iraq Study Group report was announced, in December, that both the administration and the Democratic majority seem to be using more and more elements of it in 

their different positions. For example, the administration has acted 

on recommendations by increasing the number of troops embedded 

with Iraqi forces. It’s used milestones to help chart progress. It’s 

even begun meeting with neighbors, even in meetings that might 

include Iran and Syria. The President’s National Security Advisor 

has cited the fact that the Iraq Study Group said, on page 73, that 

a surge could be a part of a strategy, based upon that Iraq Study 

Group. On the other side, the Democratic Members of Congress 

have used milestones, they’ve limited the role of the United States 

in some of their proposals to training, equipping, and 

counterterrorism, they’ve used as their deadline the goal, not the 

deadline, that the Iraq Study Group mentioned, which was the 

early part of March. 

So, I wanted to let you know that later today Senator Salazar, 

of Colorado, and I are going to introduce a piece of legislation that 

would encourage the President to develop a plan based upon the 

recommendations of the Iraq Study Group. We’re not going to introduce it today, we’re going to wait until after—after the Congress 

has dealt with the current Iraq funding discussions. 

We know this is not the only plan that one could come up with 

about how we go forward in Iraq, but my purpose in bringing it up 
168 

to you is to say to you, a little bit in advance, that we hope, at least 

from my point of view, that this is considered as a friendly gesture, 

as an option that the President could still consider, to embrace it, 

and that the advantage of it is that it doesn’t come from the President, it comes from outside the President, and that it’s not a sign 

of presidential weakness to say, ‘‘Here’s a good idea that seems to 

have bipartisan support. I accept it. I based my plan upon it. I ask 

you to accept it.’’ The reason I like that is because I believe we 

have a long-term interest in Iraq, and I’m afraid that, if we don’t 

get broader support for the President’s strategy, that we won’t be 

able to see that all the way through to the end. 

So, I hope that you and the President and others in the White 

House will consider what Senator Salazar and I are offering today 

as an option for the President. It won’t be acted on in the next 

week or 2 or 3 or 4. Perhaps the President could embrace it, and 

there might be 

Democrats and Republicans in the Senate that could come behind it, support it, and provide the kind of bipartisan consensus 

that, so far, has seemed to elude us. 

Secretary RICE. Thank you very much, Senator. 

Senator ALEXANDER. Thank you. 

Senator LEAHY. Thank you. 

Senator Bond. 

STATEMENT OF SENATOR CHRISTOPHER S. BOND

Senator BOND. Thank you very much, Mr. Chairman. 

I’m pleased to welcome the Secretary today, here. I was pleased 

to learn that the State Department has been designated a national 

security agency, and the importance of our diplomatic efforts in the 

war on terror, which, make no mistake, is an existential threat to 

our peace and security here. I—while I strongly support our military efforts, I believe that the diplomatic efforts of the State Department are a critical element in trying to protect us from the 

war. I would just comment, as a member of the Senate Intelligence 

Committee, which studied extensively—solid 2 years—on the prewar intelligence of Iraq, I want to congratulate you and other members of the administration—you, in a previous position—who used 

intelligence that may not have been totally accurate, but we found 

was truthfully reported both by the officials in the administration 

and those of us in Congress who overwhelmingly supported our efforts. We know, according to David Kay’s report, that—from the 

Iraqi Survey Group—that Iraq was a far more dangerous place 

even than we knew. 

But I want to change and ask you about another area that we 

had the opportunity to discuss a couple of weeks ago, and that’s 

southeast Asia. You have recognized, as I think any student does, 

of that area, that this is a critical area, sometimes called the second front in the war on terror, but of great strategic importance, 

and Indonesia is the keystone. 

We appreciate the support for Indonesia. I am concerned about 

the $50 million cut in the rest of the East Asia Pacific, and I’m 

going to ask this committee to restore that. also, I would ask you 

why we have not been able to create a U.S. Ambassador to ASEAN, 

reflecting our interest and our commitment to that area. This is 
169 

critical. Your visits there are vital, but appointing a full-time Ambassador seems to me to make great sense. Could you comment on 

that? 

Secretary RICE. Well, thank you very much. 

First of all, on the region, I agree with you completely about the 

importance of the region. The President was, of course, there. I will 

be there in the Philippines for the meetings of the Asian Regional 

Forum in the summer. We have meet, several times, at both the 

ministerial and at the head-of-state level, with the ASEAN countries. We’re very actively engaged there, and—English-language 

training—and I’ve got New America’s Corners—American Corners 

going into various places. Obviously it’s a critical place in the war 

on terror. It’s also a critical place because a place like Indonesia, 

which is a multiethnic, multireligious emerging democracy, can be 

a very important force for tolerance in the world. So, I could not 

agree with you more about the issues. 

It’s a very interesting point, about somebody for ASEAN, and 

we’ll take it under advisement, Senator. We’ve just recently appointed an Ambassador to the African Union, for instance. Of 

course, have one to the Organization of American States. 

Senator BOND. I hope you’ll—— 

Secretary RICE. Let me take it—— 

Senator BOND [continuing]. What ASEAN—— 

Secretary RICE [continuing]. Back, and we’ll take it under advisement. It’s an—— 

Senator BOND. Let me—— 

Secretary RICE [continuing]. Interesting idea. 

Senator BOND. Let me follow up on the Philippines. In 

Mindanao, the U.S. Institute of Peace has been facilitating a peace 

process between MILF and the Philippine Government; seems to be 

the best hope for getting that under control. I wrote to Ambassador 

Negroponte. Apparently, funding is being cut off for the U.S. Institute of Peace on this effort. Do you know why? Can this be restored? Because it is critical for that region. 

Secretary RICE. Well, we have very active programs in Mindanao. 

As a matter of fact, Karen Hughes was, herself, there to talk with 

our people. I’ll have to check on the—— 

Senator BOND. But the U.S. Institute—— 

Secretary RICE [continuing]. Specific program—— 

Senator BOND [continuing]. For Peace is the critical one bringing 

those—— 

Secretary RICE. I’ll check on the specific program, Senator. I’m 

not—— 

Senator BOND. All right. 

Secretary RICE. I will get back to you with an—— 

Senator BOND. Speaking—— 

Secretary RICE [continuing]. Answer. 

[The information follows:] 

THE DEPUTY SECRETARY OF STATE, 

WASHINGTON, DC, June 18, 2007. 

Hon. CHRISTOPHER S. BOND, 

U.S. Senate. 

DEAR SENATOR BOND: Thank you for your letter concerning the expiration of the 

United States Institute of Peace’s (USIP) $3 million grant for its work in the Philippines. I share your view of the importance of supporting the peace process be-
170 

tween the Philippine government and the Moro Islamic Liberation Front (MILF) as 

part of a multi-faceted approach in upholding U.S. interests in Southeast Asia. 

Since receiving the grant in 2003, USIP has achieved useful results in building 

understanding and support for the peace process, particularly through its seminars 

on ancestral domain. Nonetheless, the original rationale for USIP’s grant no longer 

exists. In 2003, we believed the USIP could fill a key niche and were concerned that 

direct U.S. involvement in the peace process would be seen as interference by the 

parties. The situation has changed since then. Most importantly, the U.S. Embassy 

in Manila has increasingly been directly involved in the peace process, opening a 

dialogue with MILF leaders and actively engaging with Philippine officials on the 

peace process. Both parties support this increased and direct U.S. engagement. 

Although the Department of State would welcome the opportunity to continue to 

cooperate with USIP, it is our belief that the best use of scarce U.S. resources is 

in direct support of the reintegration of former combatants and other assistance 

projects. Should the Department decide in the future to seek technical assistance 

along the lines USIP has been providing, USIP will of course be invited to bid on 

any such proposal. 

Sincerely, 

JOHN D. NEGROPONTE. 

Senator BOND. Speaking of public diplomacy, we see the Chinese 

expanding and setting up throughout the world, throughout that 

region and elsewhere, the Confucius Centers, nonprofit public institutes promoting Chinese language and culture, local Chinese teaching. 

At the same time, we are closing, and, because of security reasons, barricading American centers because of the 9/11 security setbacks, in Riyadh—they’ve been closed throughout the world. We’re 

hearing where American centers, the access to American literature 

and books has to be behind great security barriers which prevent 

our—at least giving our culture an opportunity to be heard and understood. What can we do to—given the security situation, is there 

anything this committee can do to help you if we—to find a way 

to make our libraries and our resources available to people in the 

world who, I would hope, have a legitimate question in learning 

about America and what we’re doing? 

Secretary RICE. Well, we have put forth a very active plan. It 

starts with funding in the supplemental. Karen Hughes has about 

15 countries, pilot countries, for—very high important countries in 

the war on terror for English-language camps, for English-language-focused programs. We believe that people will want their 

kids to learn to speak English, and that’s one of our best ways to 

get in. So, it would be helpful to have the full funding for that. 

It’s also the case that—I mentioned American Corners—they are 

exactly as you talk about, and we have a number of them. I’m— 

I—let’s see, it’s 10 in Indonesia, 14 in the Philippines, 6 in Malaysia. They’re around the world. 

We’re also using virtual posts, virtual presence posts, because 

there are places where you can get on the Internet and, in effect, 

be like a post. 

Senator BOND. Well, I know, the Internet’s very important. But, 

in many of these American centers, the security requirements are 

so great that the traffic has fallen off significantly. That’s what we 

like to help. 

But one, just, quick question. We’ve discussed the IMET programs, International Military and Education Training. This is an 

area that I believe is very important. I would think that you would 

agree that this is one area where it is important that we continue 
171 

to offer fledgling democracies and allies the access to our training. 

Is that—— 

Secretary RICE. Yes, I’m very big supporter of the IMET programs, and we’re trying to expand them and extend them into 

places where they don’t currently exist, because being able to have 

our military engaged with other militaries really sometimes gives 

us a generational advantage down the road. We have a couple of 

cases where people have gone—— 

Senator BOND. Right. 

Secretary RICE [continuing]. On to be president, so it’s a good 

thing. 

Senator BOND. Yeah. Well, I—like SBY. 

Secretary RICE. Yes. 

Senator BOND. Final question. I—public diplomacy’s very important. State Department is hindered by security concerns. Right 

now, this weekend, I was in Baghdad, and saw what the U.S. military is doing to repair and reopen the largest mosque, providing information, they’re engaging local clerics and building relationships, 

they’ve established a women’s council, helping local governments. 

The military is in a better—is in the position for security, but what 

we can do to help you get public diplomacy over the hurdles of security? 

Secretary RICE. Well, in places like Afghanistan and Iraq, it 

helps us to be able, through our Provincial Reconstruction Teams, 

to effectively embed with the military, and to provide protection in 

that way. In the case of Iraq, these new Provincial Reconstruction 

Teams that we have, we embed at the brigade command team 

level, and it allows us to be out with them. We have very good relations. I just got a very good letter from one of the heads of the civil 

affairs in the military, talking about how a couple of our officers 

who were really culturally sensitive were able to help when they 

go into a place, and they need to deal with women’s affairs or—so, 

I think that’s really our comparative advantage. We’ve got people 

who can embed. Sometimes they aren’t people who have been in 

the Middle East or—but they’ve been in other conflict areas. So, 

having our officers in these Provincial Reconstruction Teams, out 

with the military, we think is one way to deal simultaneously with 

the security situation and to bring to bear our best assets. 

Senator BOND. Thank you very much, Madam Secretary. We are 

very grateful for your outstanding efforts, and wish you well. 

Secretary RICE. Thank you. 

Senator BOND. Thank you, Mr. Chairman. 

Senator LEAHY. Thank you. 

Madam Secretary, let me ask you just a couple of questions 

about the Western Hemisphere Travel Initiative. I believe it’s referred to as ‘‘witty’’ [WHTI], or, as a lot of our business and tourism 

industry call it, ‘‘witless.’’ It is, for those of us who live, as my wife 

and I do, less than an hour’s drive from the Canadian border, and 

we see so many—so much of our business, our tourism, even families going back and forth across that border, and have, for generations, easily—here’s what seems to have happened. Last week, the 

National Institute of Standards and Technology certified the ‘‘vicinity read’’ technology is appropriate for use in the so-called PASS 

Card as part of WHTI. I’m somewhat concerned that DHS has 
172 

rushed that through and has overridden some technology concerns—just so they can use it at 39 of our busiest ports, it won’t 

be necessary at the other 80 low-volume ports. But the State Department is going to have to pay to produce a card with a technology that’s inconsistent with what’s used in passports. 

Actually with security, it’s inconsistent with our standards of security in this country, for privacy, just so somebody can pass 

through 39 ports out of 119, and do it faster. Even though, in my 

own State of Vermont, and Senator Gregg’s State of New Hampshire, you wouldn’t need it to cross some of the small crossing 

points, but you’re still going to have to buy it. Out of the 39 ports 

of entry which you and DHS have agreed to upgrade for this, I believe 22 are on the southern border. 

What’s the cost to the State Department to create the PASS Card 

and fully implement it? 

Secretary RICE. Senator, I’m not sure that I can give you a cost 

figure. I will get back to you with the specific cost figure. 

Senator LEAHY. Well—— 

Secretary RICE. But let me just say, we had a legal requirement—— 

Senator LEAHY. Well, the reason I ask, the administration wants 

to begin requiring a passport or a PASS Card within a year or—— 

Secretary RICE. Yes. 

Senator LEAHY [continuing]. Two of next year. 

Secretary RICE. Yes. 

Senator LEAHY. Senator Stevens and I had passed legislation, 

which the administration has ignored, to push that back to June 

2009—— 

Secretary RICE. I’ll—— 

Senator LEAHY [continuing]. For something that’s going to be 

done within a year. I’d kind of like to know how much it’s going 

to cost. 

Secretary RICE. I’ll have to get you the specific number. 

[The information follows:] 

The passport card is adjudicated and issued by the Department of State. The year 

to date cost for the passport card initiative totals approximately $31 million. This 

includes $283,000 for initial passport card testing in fiscal year 2007 and $30.8 million for additional passport card testing, card stock and card printers in fiscal year 

2008, the first fiscal year in which we are accepting applications and printing cards. 

Our cost estimate for fiscal year 2009 is $34.5 million, and for fiscal year 2010 is 

$43 million. 

Secretary RICE. But let me just say, Senator, we had a legal requirement, which was to have a verifiable way to—for people coming across the two borders—we were responding to the legal—— 

Senator LEAHY. I mean—whoa, whoa, whoa, whoa, whoa. Your 

reaction to this legal requirement is something that was slipped 

into a bill at the request of the administration without any hearings—— 

Secretary RICE. No. 

Senator LEAHY [continuing]. And nobody’s come up to ask us— 

nobody’s asked me, as chairman of the Judiciary Committee. Nobody’s asked us here. Nobody’s asked others. But we don’t know 

what the cost is. We don’t know how we’re going to do it by June 

2008. We know you’ve given us to June 2009 to work it out, but, 
173 

‘‘The heck with that, we’re going to do it by June 2008, if it kills 

us, or all of you.’’ 

Secretary RICE. Senator, let me—— 

Senator LEAHY. Or hundreds of billions of dollars worth of trade 

and traffic across the U.S./Canadian border. 

Secretary RICE. Let me assure you, Senator, I believe the cost is 

known. I don’t have the number at my fingertips—— 

Senator LEAHY. All right. 

Secretary RICE [continuing]. Right here. But the question of getting this done in 2008, we think it can be done in 2008. We believe 

that—I’ve talked with the people who are doing the—who have to 

oversee the validation of the technology. They believe that that validation of the technology can be done in time to make this PASS 

Card available. We’ve worked with DHS on publishing the rules, so 

that there can be comment about the rules for the Western Hemisphere Travel Initiative. 

Senator LEAHY. When are they going to do that? 

Secretary RICE. The rule will be published—we’re working now 

on some language concerning some issues that would be particularly, I would think, of interest to you, concerning how we would 

deal with the parental notification, so that we don’t have the trafficking of children, for instance, across borders. 

Senator LEAHY. Well, that raises a point. I mean, we’ve seen 

what happens when we rush into things and people screw up. An 

example I use, like TSA, where Senator Kennedy, stopped 10 times 

or so, getting on a plane, because he’s on a terrorist watch list. 

Now, I know all of us Irish look alike, but Ted’s been taking that 

plane for years. Even the President called him to apologize. He 

said, ‘‘Well, you know, I appreciate that, Mr. President. Just get me 

off the darn list.’’ The President said, ‘‘I don’t have that power.’’ 

We’ve had a year-old child told to get a passport, because they’re 

listed as a 45-year-old terrorist. Without making my usual comments for those of us who went to Catholic grade schools and high 

schools, we have Catholic nuns who are on that watch list. Now, 

we have differing views about whether it should be or not, but I 

suspect the ones who are on the watch list should not be. Department of Homeland Security has screwed up so badly in so many 

areas. I mean, why should we have any confidence that, in a year 

from now, when they don’t even have the systems in place, they’re 

going to do it right? 

Secretary RICE. Well, Senator, we’ve had very good cooperation 

with the Department, but the Department—the Department of 

Homeland Security actually is charged with determining the requirements. We then implement those requirements. The legislation—— 

Senator LEAHY. But the PASS Card won’t be compatible with the 

computers that you use, for example, to read passports. Does that 

mean you have to have—are we going to get a bill for a whole second set of computers at every border crossing? 

Secretary RICE. Senator, the reason that we went to the PASS 

Card was that there was concern that if we required a passport of 

every American trying to travel across that border, that it would— 

the expense would be too great. As you note, there are people who 

go back and forth for hockey games or for—— 
174 

Senator LEAHY. What’s the PASS Card going to—— 

Secretary RICE [continuing]. For whatever. So, the—— 

Senator LEAHY. What’s the PASS Card going to cost? 

Secretary RICE. So, the PASS Card is a cheap alternative—— 

Senator LEAHY. What does it cost? 

Secretary RICE [continuing]. To the—I think, about—do we know 

the number? Thirty-five dollars or something like that, I’ve read? 

We’ll get back to you with the exact number. 

Senator LEAHY. Well, $35 is—— 

Secretary RICE. But it—don’t think that—— 

Senator LEAHY. A family of five—— 

Secretary RICE. Senator—— 

Senator LEAHY [continuing]. Going shopping, ‘‘Hey, guys’’—— 

Secretary RICE. Senator, don’t get that—— 

Senator LEAHY [continuing]. ‘‘Let’s’’—— 

Secretary RICE [continuing]. Number in your head, because—— 

Senator LEAHY. Where do you get it? 

Secretary RICE. I—— 

Senator LEAHY. Where would you get it? 

Secretary RICE. Where would we get—— 

Senator LEAHY. This PASS Card. 

Secretary RICE. Where would you get the PASS Card? The same 

way you get any other card, through the United States Government. You apply for it, and you’ll get it. But it’s a cheaper—— 

Senator LEAHY. So, we have—— 

Secretary RICE [continuing]. Alternative. 

Senator LEAHY [continuing]. The efficiency of the United States 

Government standing behind us on this. 

[The information follows:] 

For first-time applicants, the card costs $45 for adult and $35 for children. For 

adults who already have a passport book, they may apply for the card as a passport 

renewal and pay only $20. The passport card has the same validity period as a passport book: 10 years for an adult, 5 for children 15 and younger. 

Secretary RICE. Well, Senator, I’m not going to speak for the efficiency of the United States Government, but I will speak for the 

fact that this has been on the books—this law has been on the 

books, not since last year—we did have an extension from the time 

at which the legislation was made—— 

Senator LEAHY. Senator Stevens and I wrote that. 

Secretary RICE. We appreciate it very much. But we think we 

can meet this in 2008. We’ve worked with our Canadian counterparts, we’ve worked with our Mexican counterparts. The need for 

identification for air travel went, really, very smoothly. We’ve 

worked even with those in the Caribbean who had concerns about 

what might happen to their tourist industry if this did not go well. 

So, I think we have some record of having delivered, and we believe that we can validate—— 

Senator LEAHY. But the air traffic—— 

Secretary RICE [continuing]. The technology and get it done. 

Senator LEAHY [continuing]. Or the Caribbean traffic is a little 

bit different than the hundreds of thousands of people who go back 

across the border every single day, everything from going over to 

have lunch to doing business. I mean, you’ve encouraged the Cana-
175 

dians to apply for the NEXUS card, because they’re interoperable 

with PASS. Is that correct? 

Secretary RICE. That’s correct. 

Senator LEAHY. But doesn’t that require a background check? 

Secretary RICE. It will—that requires a background check, 

but—— 

Senator LEAHY. You know, I—I’m going to Ireland and—Italy, 

briefly, at the end of this month. I can just see, if I had to go there, 

if they called me up and said, ‘‘Well, we’ve got to do a background 

check on you before you go.’’ I’d say, ‘‘The heck with that.’’ 

Secretary RICE. Senator, it’s—— 

Senator LEAHY. I mean, how do we do background checks on—— 

Secretary RICE. So, look at—— 

Senator LEAHY [continuing]. Canadians? 

Secretary RICE [continuing]. Fingerprints, look for—look in 

records to see if there’s a problem. But I—but, Senator, let me just 

say, I really—— 

Senator LEAHY. Like—— 

Secretary RICE [continuing]. Do believe—— 

Senator LEAHY [continuing]. Like Mahar? 

Secretary RICE. I believe we can get this done if we put the right 

resources to it. We believe we can get it done. DHS—we are working very well with them. We did have a delay in determining which 

technology to use. That’s now out for comment. The people who are 

working on this issue tell me we can validate the technology and 

have it ready to go by 2008. We think we ought to try to get 

this—— 

Senator LEAHY. So, in—— 

Secretary RICE [continuing]. Requirement fulfilled. 

Senator LEAHY [continuing]. In June 2008, none of our businesses, none of—nobody else is going to have to worry about having 

these PASS Cards for—— 

Secretary RICE. Senator, I’m not going to—— 

Senator LEAHY. You’re a very—— 

Secretary RICE [continuing]. Comment on what we—— 

Senator LEAHY [continuing]. Optimistic person, Madam Secretary. You know, I—— 

Secretary RICE. I am, Senator. 

Senator LEAHY. I—— 

Secretary RICE. I’m not going to tell you that there won’t—— 

Senator LEAHY. I belong to—— 

Secretary RICE [continuing]. Be problems. 

Senator LEAHY [continuing]. A faith that believes in miracles, but 

even miracles—— 

Secretary RICE. Senator, I understand, and we’ve worked very 

hard with our Canadian counterparts, we’ve worked very hard with 

our Mexican counterparts, but we have a legal requirement, and 

we’re trying to meet it. We’re trying to meet it in a way that is 

going to make us safer on the border, but doesn’t hold people up 

who need to get back and forth. 

Senator LEAHY. Madam Secretary, you say we have a legal requirement. Nobody from this administration has asked anybody up 

here to do anything to modify or change the requirement the administration slipped into a law, or was slipped in at their request. 
176 

Makes me think of other things that have been done like that, one 

that allows for the easy firing of attorneys—of U.S. attorneys, for 

example. The—these are things—saying a legal requirement, with 

all due respect, is a bit of a copout, because you could ask for 

changes, if you want. Obviously, you’ve heard from the U.S. Chamber of Commerce and others, with their concern. I think there are 

justifiable concerns on this. I also am concerned about a signal we 

send to a country that has been a great friend, it becomes almost 

cliche to speak of the longest unguarded frontier in the world, but 

it is true—a friend and ally and supporter, our biggest trading 

partner, I believe. I believe it still is. We should talk some more 

about this. 

If Senator Gregg will allow me, I’m just going to mention a couple of quick things, then I’ll yield to you whatever amount of time 

you want. 

Much of your written testimony is devoted to Iraq, Afghanistan, 

and the Middle East, and, at the very end, you—and I understand 

the importance of those—at the very end, you mention other developing nations and vulnerable populations. 

In Nepal, a country where years of fighting has cost thousands 

of lives, there’s a chance to end the Maoist insurgency, replace feudalism with democracy. But you propose to cut our aid. 

Democratic Republic of the Congo, a huge country, with every 

conceivable problem one can think of, has had its first elections in 

40 years. I think it’s going to influence central Africa for the next 

20 years. Yet, we’re proposing to cut their aid. 

Vietnam, a country of 80 million people, seeking closer ties, and 

the President went there last year, but, with the exception of HIV 

and AIDS, proposes to cut our aid. I’ve seen what even a little aid 

can help, the Leahy War Victims Fund that is used there. 

Congress has worked hard to increase funding for global environmental programs, protect forests in the Amazon, central Africa, 

where they’re being destroyed, but you propose slashing funding for 

these programs and downgrading USAID’s Mission in Brazil, the 

most populous country in the hemisphere, after the U.S. USAID’s 

budget—operating budget is cut. I mean, I’m just worried. It seems 

like there’s this huge vacuum cleaner in Iraq and Afghanistan and 

I can debate what works and what doesn’t work there, sucking up 

all this money, and these other places are going to create either 

problems or opportunities for us for the next generation, but we’re 

cutting back our money. 

Secretary RICE. Senator, this administration has almost tripled 

official development assistance since the President came to power. 

We have quadrupled assistance for Africa, and doubled assistance 

for Latin America. You can look at any given year, and whether we 

think there are specific programs that need funding or not in a particular place—and, in Brazil, for instance, yes, we have moved to 

a different kind of relationship with Brazil, which is a large and 

increasingly prospering country, where we’re engaged in more partnerships with Brazil than direct foreign assistance. But the numbers really do speak for themselves when you look at the commitment of foreign assistance by this President to the—to development. 

Senator LEAHY. I’ve publicly praised the President—— 
177 

Secretary RICE. We appreciate—— 

Senator LEAHY [continuing]. As you know—— 

Secretary RICE [continuing]. That. 

Senator LEAHY [continuing]. On a number of areas, where he 

has, and where I have supported him. But the main increases are 

in AIDS and in the Millennium Challenge, and we still have questions that have been asked by both Republicans and Democrats, 

what the Millennium Challenge has accomplished. 

The point is, in a number of these very specific areas, where we 

could be helpful, we’ve had private philanthropists who have given 

more money, whether it’s been the Gates Foundation or others. 

AIDS has been our biggest increase, and that’s—you’ve had strong 

bipartisan support for money there. We’re also doing things, as you 

know, in the Judiciary Committee to make it more possible to 

change our patent laws and copyright laws and what not, to move 

drugs into these areas at a much lower cost, both to us and to the 

receiving countries, who are all working together on these. 

But I worry about—whether it’s Congo, Darfur, all these others— 

so—— 

Secretary RICE. Well, Senator, we’re putting—in Africa—for instance, in Latin America, the doubling of aid is not MCC aid. 

That’s less MCC aid. We really have put a great deal of financial— 

of foreign assistance into these places. Yes, sometimes a place 

will—like Brazil, will, in a sense, change the kind—we will change 

the kind of relationship that we have with a Brazil. But if you look 

at the amount of money that is going into the Great Lakes region, 

the amount of money in Africa, the amount of money that is going 

into Liberia, the amount of money that is going into countries in 

Latin America, this administration, thanks to the support of the 

Congress, has been extraordinarily generous. 

We are trying to make better use of the resources, to go back to 

a point that we talked about early on, by being certain that the 

USAID and the State Department funds can create a total picture 

of what’s going into any particular country. But the increases that 

I’m talking about are not in MCC—for instance, for Latin America. 

Senator LEAHY. Secretary Rice, I’ve gone over my time, and you 

and I should probably chat about this a little bit further. You’ve— 

as I said, you’ve always been available, when I’ve—— 

Secretary RICE. Certainly. Anytime. 

Senator LEAHY [continuing]. When I’ve called, and we will talk. 

Senator Gregg? 

Senator GREGG. Thank you, Mr. Chairman. 

I wish to join you in your skepticism about the border cards 

crossing into Canada. Before I had the good fortune to become 

ranking member of this subcommittee, I was chairman of the 

Homeland Security Subcommittee, and this was a major issue. I 

think the jury’s out on this technology. The responsibility for it is 

also—there’s no clear line of responsibility, in my opinion. So, 

we’ve—we’re going to need to—I’m very concerned that we’re going 

to see a replication of the event when we stood up TSA, and it was 

basically, as the chairman alluded to, a real disruption in traffic, 

commercial traffic and individuals’ traffic and in the lifestyle of 

Americans and Canadians. 
178 

So, we should do this through demonstration exercises. We 

should not just say, ‘‘x date, we’re going to move to this program.’’ 

We should try a demonstration exercise here, a demonstration exercise there, and work our way up to the Freedom Bridge in Detroit before we suddenly arrive there one day and say, ‘‘This is the 

way it has to be.’’ So, I do hope we’ll come at that in a different 

way. I don’t—it’s not really your responsibility, but you’re drawn 

into the exercise. 

On another subject, I’d be interested in your thoughts on what’s 

happening in Turkey. This is a key country for us. They’ve always 

been a very strong ally. They’re somebody we rely on in the region 

for stability. Yet, they appear to be going through, as many of those 

states are in that region, a resurgence of religious movement that 

was inconsistent with their, certainly, 20th century history. What 

do you see happening there? What should be our role? Obviously, 

it’s internal domestic event, but what should—— 

Secretary RICE. Well, I think our role has to be to stand for the 

democratic processes there, the constitutional processes. The government that was elected by the people there has actually been a 

government that’s been dedicated to pulling Turkey west toward 

Europe. It has been the policy of that government, even though it 

is led by leadership from the AKP Party, which has Islamist—Islamic roots—it has been trying to integrate into Europe. It’s been 

changing its laws to try to become consistent with European Union 

requirements for laws on individual and religious freedom and 

other issues of that kind. So, I think it’s very important that we 

just—that we support their democratic processes. They are going to 

have new elections, and to stand for those elections to take place 

in the way that we would expect elections to take place in any democracy will be very important. 

But I think the history of the last few years has been of a good 

relationship with Turkey, probably stronger support, for instance, 

for Turkey—from Turkey for the new democracy in Iraq than one 

might have expected, given the history of Turkey in Iraq. Good 

support for policies in Afghanistan. And, of course, they’re a strong 

NATO member. 

But, again, I would just note that the last few years have actually not been years in which one could say that Turkey was pulling 

away from its European traditions, but, I think, trying to move 

more actively toward it, which is why we’ve also been very supportive of Turkey’s efforts to European Union accession. 

Senator GREGG. Wouldn’t one of the potential consequences, 

which would be fairly dramatic and unfortunate, of leaving Iraq 

precipitously and having a breakdown in the stability, to the extent 

we can maintain it in Iraq, wouldn’t it be that there would be a 

huge pressure relative to the Kurdish relationships with Turkey 

and, potentially, a very significant military concern there? 

Secretary RICE. Absolutely. Because Iraq sits as it does on the 

fault lines between Shi’a and Sunni, and with Kurds to the north, 

I think if you had a vacuum there, you would see that there—it 

would be pretty irresistible for Iraq’s neighbors to try and secure 

their interests by meddling in Iraq’s affairs. 

Now, if you have a Iraq that’s able to manage its affairs, then 

I think those neighbors will be more likely to simply cooperate with 
179 

that stable government. That was very much the message, Senator, 

when I was at Sharm el Sheikh for the neighbors conference, that 

the Iraqis need, very much, to pursue urgently their national reconciliation and to bring the various groups together, but the neighbors need to allow them the space in which to do that; the neighbors need to be devoted to helping stabilize Iraq, not destabilize it; 

and the neighbors need to have, kind of, rules of the road, which 

is really what Sharm el Sheikh was about, about they’re going to 

deal with a democratic and sovereign government in Iraq. Because 

I think if we were to leave precipitously, we would encourage not 

just chaos in Iraq, but we would encourage chaos in the region, as 

well. 

Senator GREGG. On another subject, and then I’ll—I know the 

Senator wants to move on—but independent of the issue of leadership right now, which is obviously in flux, for a variety of reasons, 

at the World Bank, do you believe the World Bank should be taking a different tack than what it’s been taking in the last 20 years, 

that it should no longer—that it should restructure itself and 

refocus itself relative to poverty and alleviating poverty and addressing nations and—how it prioritizes nations, and how it 

prioritizes regions that it focuses on? 

Secretary RICE. Well, we’ve had a very good working relationship 

with the World Bank, under the leadership of Paul Wolfowitz, and, 

before that, under the leadership of Jim Wolfensohn. I do think 

that the World Bank has been—has had an important 

anticorruption agenda. That’s extremely important. I, myself, think 

that there needs to be discussion about how the World Bank’s assets can best support what is a very changing—a changing profile 

of assistance to the developing world, where, for instance, we are 

learning that, in parts of the world, the biggest problem may be infrastructure development, issues like roads or electricity, and looking at that. 

I think, also, for the World Bank, the fact that there are a number of countries that have graduated should be considered to be a 

very good thing, and to perhaps look, as has been the case when 

we’ve looked at debt relief, to what we can do for the poorest of 

countries that are not capable of dealing with debt—that often was 

brought to them by dictators or bad regimes—than leaving young 

democratic regimes with overwhelming debt. So, for instance, we 

had a joint donors conference for Liberia, just a little while ago, in 

which their—first and foremost, their biggest concern is to get debt 

relief. 

So, I think there is an agenda out there for the World Bank, but, 

frankly, we are, in a sense, the World Bank, as well, since we’re 

all members of the board and contributors, and it is a discussion 

that needs to go on, and needs to be, I think, accelerated among 

all of the big international financial institutions, because the landscape for development is changing. 

Senator GREGG. Well, I just think we need to put some pressure 

on them to reduce their overhead and to actually get the money to 

where the rubber hit the road, as versus have it used up in the 

people between the road and the rubber. 

Thank you, Mr. Chairman. 

Senator LEAHY. Thank you. 
180 

I will submit questions. But, you know, the Republican leader, 

Senator McConnell, and I have joined together for years on an 

amendment conditioning a portion of our aid to Serbia in its cooperation with the War Crimes Tribunal at the Hague, especially 

to transfer Ratko Mladic and Radovan Karadzic. The Serb army 

helped protect Mladic. He remains at large. They say that Karadzic 

is not in Serbia, but suggest he—they know where he is. I hope 

we’ll continue to make clear to them that the United States will oppose their entry into NATO and other regional economic and security organizations until we find out what’s going on. I’m going to 

ask you questions. 

I’ll submit questions about Cuba, which is listed as a state sponsor of terrorism. Your report said they did attempt to track, block, 

or seize terrorist assets, and I want to know what evidence we do 

have of terrorist assets actually being there. They did not undertake counterterrorism efforts. I would hope that is not the criteria, 

by itself, to make somebody a state sponsor of terrorism because 

they don’t undertake counterterrorist activities. We have an awful 

lot of friendly nations that don’t even have the ability to do that, 

would be on the list otherwise. 

Then, your report says they continue to provide safe haven for 

members of Colombian rebel groups, but the Colombian Government says they’ve been a facilitator in talks between these groups 

and the Colombian Government. I just want to know which it is. 

I have questions on aid to Russia, because of a whole host of 

problems there that we don’t have to go into. 

I’ve got a Middle East question about both the wall and the property held by Israeli settlements, and whether that’s theirs or Palestinians’. 

Peacekeeping force in Darfur—as you can see, quite a few things. 

But I would hope you’ll ask your staff to get back to us as quickly 

as possible on those questions. 

Secretary RICE. Of course, Senator, I will. 

Senator LEAHY. Thank you. 

Madam Secretary, thank you very much. I suspect you and I will 

be on the phone a lot in the coming weeks. 

Secretary RICE. Anytime, Senator. I look forward to your call. 

Senator LEAHY. Thank you. 

Secretary RICE. Thank you very much. 

ADDITIONAL SUBMITTED STATEMENTS

Senator LEAHY. We have received statements from the Alliance 

for International Educational and Cultural Exchange and the 

United States Conference of Catholic Bishops and Catholic Relief 

Services that will be made a part of the record at this time. 

[The statements follow:] 

PREPARED STATEMENT OF THE ALLIANCE FOR INTERNATIONAL EDUCATIONAL AND

CULTURAL EXCHANGE AND THE ASSOCIATION FOR INTERNATIONAL PRACTICAL

TRAINING (AIPT) 

As Chair of the Board of the Alliance for International Educational and Cultural 

Exchange, I appreciate the opportunity to submit testimony in strong support of the 

budget request of $486.4 million for the educational and cultural exchange programs 

administered by the Department of State’s Bureau of Educational and Cultural Affairs (ECA) in fiscal year 2008. If additional funds are available, the Alliance urges 
181 

an increase in the investment in State Department exchange programs to $500 million to further strengthen U.S. public diplomacy. 

The Alliance comprises 78 nongovernmental organizations, with nearly 8,000 staff 

and 1.25 million volunteers throughout the United States. Through its members, the 

Alliance supports the international interests of 3,300 American institutions of higher education. The Alliance is the leading policy voice of the U.S. exchange community. We look forward to continuing our productive working relationship with the 

subcommittee, and appreciate the opportunity to offer this testimony. 

U.S. ambassadors consistently rank exchange programs among the most useful 

catalysts for long-term political change and mutual understanding, and as our experiences since September 11, 2001, demonstrate clearly, we need public diplomacy 

and exchanges more now than ever. Poll after poll continues to indicate rising antiAmericanism, even in nations we count among our closest allies. We must work to 

build trust and understanding for our people and our policy goals not just in the 

Muslim world—an effort that is of critical importance—but around the globe. To defeat terrorism and address other critical global issues, we will need the help of our 

friends and allies in every region of the world. 

The Alliance therefore urges the subcommittee to fund the Department of State’s 

exchange budget at $486.4 million in fiscal year 2008. If additional funds are available, we urge you to increase the allocation to $500 million in order to deepen the 

public diplomacy impact of these important programs and to sustain and strengthen 

the Department’s core exchange programs worldwide while continuing to develop 

new and innovative proposals. A $500 million level of spending will allow robust 

funding for targeted, meaningful growth in every region of the world for the State 

Department’s core exchange programs, provide additional resources for Islamic exchange, sustain funding for Eurasia and Eastern Europe, fund the administration’s 

request for a new initiative for Latin America, and encourage the development of 

new and innovative programs worldwide, including the National Security Language 

Initiative (NSLI). 

CORE EXCHANGE PROGRAMS

The following data define the context for increased exchange program funding: 

—A recent BBC poll shows that just 29 percent of those polled in 25 countries 

feel the United States exerts a mainly positive influence on the world, compared 

with 40 per cent 2 years ago. We clearly are losing ground in world public opinion. Exchanges are a proven—means to change that impression. (*BBC World 

Service poll of 26,000 people in 25 countries—mostly non-Arab) 

—A Congressional Research Service review of 29 reports on public diplomacy revealed that the most common recommendation of these reports was to increase 

exchange funding. 

—State Department evaluations repeatedly show that foreign exchange participants complete their programs in the United States with enhanced positive impressions of the United States, its people, and its values. 

The administration has requested $486.4 million in exchange program funding for 

fiscal year 2008. The Alliance urges the subcommittee to support the request, and 

if possible, to increase it to $500 million. A funding level of $500 million will allow 

for meaningful growth in the Department of State’s time-tested exchange programs 

that remain at the core of our efforts to build mutual understanding and respect 

between the United States and critical nations around the world. These well-established programs—Fulbright and other academic programs, International Visitor 

Leadership, and citizen exchanges—continue to demonstrate their relevance and effectiveness in a rapidly evolving world. 

The Fulbright Program has unique value in deepening mutual understanding between the United States and 150 countries. Visiting Fulbright students report the 

program’s deep impact: 99 percent say the program increased their knowledge and 

understanding of the United States and its culture; 96 percent shared their Fulbright experiences in their home country through media or community activities; 89 

percent report that their Fulbright experiences allowed them to assume leadership 

roles after their programs. U.S. Fulbright students strongly agree (97 percent) that 

the program strengthens bilateral relationships, and deepened their understanding 

of their host country (100 percent). By several indices, American Fulbright students 

say the program enhanced their leadership skills. Upon returning, U.S. Fulbright 

scholars make their campuses and communities more international: 73 percent have 

incorporated aspects of their Fulbright experience into courses and teaching methods. Visiting Fulbright scholars are also likely to incorporate their experiences in 

America into their professional lives at home: nearly two-thirds of those surveyed 

said that they ‘‘broadened the international aspects of their teaching and research 
182 

in general’’ and ‘‘became . . . a resource for their colleagues with regard to knowledge and skills learned.’’ 

Approximately 279,500 United States and foreign nationals have participated in 

the Fulbright Program since its inception over 50 years ago. The Fulbright Program 

awards approximately 8,000 new grants annually. In 2007, over 6,000 U.S. students 

and young professionals applied for 1,400 available Fulbright grants, demonstrating 

the desire of U.S. citizens to be internationally engaged. One hundred and fifty students will receive on-the-ground training in critical languages in advance of their 

research grants. Of over 2,000 incoming foreign students from 135 countries, 300 

are teaching their native languages at U.S. colleges and universities. Other recent 

program changes include: the cutting-edge research conducted by New Century 

Scholars, which provides deep focus on a single global problem by leading scholars 

from around the world; global expansion of the Fulbright Language Teaching Assistants for U.S. Students; and enrichment programs throughout the United States exposing students from abroad to local communities throughout the United States. 

Other critical academic exchange programs include the Humphrey Fellowships 

Program, which provides powerful academic and professional training experiences 

for professionals in the developing world; Overseas Educational Advising, through 

which prospective foreign students receive reliable information about American 

higher education and professional assistance in the application process; the Gilman 

International Scholarship Program, which enables American students with financial 

need to study abroad; and English teaching and U.S. Studies programs, designed 

to enhance understanding of American society and values. 

The International Visitor Leadership (IVLP) program continues to be ranked by 

many U.S. ambassadors as their most effective program tool. This results-oriented 

program allows our embassies to address directly their highest priority objectives 

by bringing emerging foreign leaders to the United States for intensive, short-term 

visits with their professional counterparts. The program also exposes visitors to 

American society and values in homes and other informal settings. 

Thirty-three current heads of government and chiefs of state are alumni of the 

IVLP, including Prime Minister Tony Blair of the United Kingdom, President 

Hamid Karzai of Afghanistan, and Prime Minister Ehud Olmert of Israel. Georgian 

President Mikheil Saakashvili is an alumnus of the IVLP and Muskie programs, 

and many of his cabinet members either attended a university in the United States 

or participated in exchange programs. Saakashvili and his colleagues were among 

the leaders of the peaceful ‘‘Rose Revolution’’ in 2003 and Georgia’s subsequent transition to democracy. 

According to State Department evaluations, IVLP alumni returned to their home 

countries with positive feelings about democratic values, overwhelmingly agreeing 

with the following statements: citizens should have equal rights (99 percent); rule 

of law is fundamental to democracy (99 percent); free and fair elections are cornerstones of democracy (98 percent); individuals and organizations have the right to 

free speech (97 percent); and independent media are important (95 percent). 

Citizen exchanges continue to engage American citizens across the U.S. in productive international activities. In addition, these programs leverage their relatively 

modest federal dollars into significantly more funding through the participation of 

local communities, schools, businesses, and nongovernmental organizations. Increased funding for citizen exchanges would permit an expansion of these highly 

cost-effective activities, particularly in the critical area of capacity building in communities across the United States There is no doubt that the United States needs 

more ‘‘citizen diplomats.’’ 

REGIONAL PROGRAMS

The Alliance strongly supports growth in exchanges world-wide. Both public opinion polling and the global nature of most current issues—e.g., terrorism, the environment, public health—demand that we strengthen our public diplomacy in all 

world regions. In this brief testimony, however, we wish to draw attention to three 

particularly critical areas. 

While the need for exchanges is worldwide, increased engagement with the Islamic world is particularly critical as we seek to enhance our national security and 

build understanding, trust, and a sense of shared interests between the people of 

the Islamic world and the American people. 

The State Department has created a continuum of programs to reach out to Muslim participants, particularly diverse and underrepresented populations. The Department has instituted a very successful program of micro-scholarships to stimulate in-country English study by teenagers. In addition, the Youth Exchange and 

Study Program (YES), also known as the Cultural Bridges Program, brings high 
183 

school students from the Islamic world to live with American families and attend 

American schools for an academic year. For the 2006–07 academic year, the program includes nearly 675 students from 25 countries, the West Bank and Gaza. We 

urge funding of $25 million for YES, which would allow the program to reach its 

long-term goal of 1,000 students. 

The Department has devised a variety of undergraduate exchanges including 

summer institutes, community college programs, and semester and year-long programs at four-year institutions, and expanded the Humphrey fellowships for the 

Muslim world. Under the National Security Language Initiative (NSLI), the Department has used summer institutes and existing programs such as Fulbright and Gilman to increase U.S. capacity in Arabic, Farsi, and Indic languages. The International Visitor Leadership Program has targeted ‘‘key influencers’’ in predominantly Muslim nations, bringing hundreds of clerics, journalists, and women and 

student leaders to the United States for programs emphasizing tolerance, interfaith 

dialogue, and diversity. These programs have had remarkable and consistent impact, and U.S. embassies would welcome many more if funding were available. 

We strongly support the Administration’s initiative to focus additional exchanges 

on Latin America. The Bureau of Educational and Cultural Affairs (ECA) intends 

to apply its continuum approach to Latin America to reach out effectively to nonelite groups in this very important region. Program elements would include microscholarships for English language study, summer institutes for student leaders, an 

expanded Youth Ambassadors program, ‘‘supplementary scholarships’’ covering incidental and travel expenses to allow talented but needy students to accept financial 

aid offered by U.S. colleges and universities, and scholarships to attend U.S. community colleges. 

In addition, the Alliance supports continued funding for exchanges with the countries of Eurasia and Eastern Europe at no less than the fiscal year 2007 levels. 

Funding in this area of the world has dramatically declined in the last several years 

even as on-going transition and challenges to democratic change grab international 

headlines. The cuts for these programs have resulted in reductions of more than 50 

per cent for some programs and the elimination of others. 

Exchange programs have provided sustained opportunities to expose future leaders to American civil society and values, and to foster personal and professional relationships between Americans and citizens of the region. We must continue to employ exchanges to engage with a broad range of future leaders in these critical nations. Elections in recent years in Ukraine and Georgia are a testament to the need 

to keep active programs in this region. The peaceful government transition in Georgia demonstrates the ongoing value of vibrant exchange programs in this region. As 

political change continues to occur, the Alliance urges sustained U.S. engagement 

throughout the region. 

Beyond the appropriations process, we wish to recognize and commend ECA for 

the creation of a new internship category within the Exchange Visitor Program. The 

opportunity for internships with U.S. companies, universities, and organizations will 

likely prove very attractive around the world, and will bring many students to the 

United States for substantive experiences at virtually no cost to the taxpayer. The 

State Department developed this creative regulatory package, now pending approval 

at OMB, in close consultation with the exchange community and private sector, and 

we believe the Department is to be commended for this initiative, which will enhance our public diplomacy with a new generation of leaders around the world. 

Thank you again for this opportunity to voice the Alliance’s support for a robust 

appropriation for the educational and cultural exchange programs administered by 

the Department of State’s Bureau of Educational and Cultural Affairs in fiscal year 

2008. We look forward to working with the Subcommittee throughout the year 

ahead to ensure that the United States continues to vigorously support the traditional exchange programs that have proven their success for the past 50 years, 

while also developing new and innovative programs. 

PREPARED STATEMENT OF THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPS

AND CATHOLIC RELIEF SERVICES

The United States Conference of Catholic Bishops (USCCB) and Catholic Relief 

Services (CRS), the relief and development agency of the U.S. Catholic Bishops, 

thank the Subcommittee for the opportunity to present testimony on the fiscal year 

2008 International Affairs appropriations process. 

Our Nation’s commitment to foreign aid is particularly important at this time 

when our country’s global role is a focus of intense discussion. We appreciate this 

opportunity to share the values contained within the Church’s social teaching that 
184 

1 Address of His Holiness Pope Benedict XVI to the Diplomatic Corps Accredited to the Holy 

See for the Traditional Exchange of New Year Greetings, January 8, 2007. 

underline our nation’s moral responsibility to those in need around the world. In 

addition, our perspective is informed by the practical experience of the relief and 

development work of CRS in 99 countries throughout the world. 

SPECIFIC PRIORITIES

Our specific priorities for international affairs appropriations in fiscal year 2008 

seek to uphold human life and human dignity, support the development of poor nations, foster peace and improve our national and global security. They include: —$3 billion for the Millennium Challenge Corporation (MCC); 

—$2 billion for Title II Food Aid; 

—$5.78 billion (including funding from Health and Human Services appropriations) for morally and culturally responsible programs to combat HIV/AIDS, malaria and tuberculosis, with particular attention to Africa; —substantial funding for humanitarian needs in Iraq, in addition to $2.1 billion 

for reconstruction; —$1.1 billion for reconstruction needs in Afghanistan; 

—priority funding for economic and social development in post-conflict countries 

transitioning towards better governance, including: Haiti, Liberia, the Democratic Republic of Congo (DRC), Sierra Leone (with substantial portions of the 

funding channeled through proven partners in the NGO community), as well as 

for continued implementation of the Comprehensive Peace Agreement in Southern Sudan; 

—full funding for contributions to U.N. peacekeeping activities, especially in 

Sudan, Lebanon, the DRC and Haiti; 

—an increased proportion of U.S. aid dedicated to social and alternative agricultural development and to victim assistance in Colombia, and strict human 

rights conditions on all U.S. military aid to Colombia and the Philippines; 

—increased funding for the Migration and Refugee Assistance (MRA) and Emergency Refugee and Migration Assistance (ERMA) accounts to bring total funding to $1.135 billion and $90 million respectively to meet the needs of an everincreasing global refugee population; —$1.06 billion for the International Development Association (IDA) for debt cancellation and poverty reduction programs in the world’s poorest countries; and —at least $207 million for debt relief primarily for the DRC and Liberia whose 

huge debt burdens create a major obstacle to the efforts of their new democratically-elected governments to restart economies ravaged by war. 

Mexico City Policy.—We reiterate our strong support for retaining the Mexico City 

policy, which prevents our foreign aid program from being misused to subsidize organizations that perform or promote abortions in developing nations. The KempKasten provision preventing the support of organizations involved in coercive population programs should also be retained. Under this provision, funding is denied to 

any organization determined by the President to be supporting or participating in 

the management of a program of coercive abortion or involuntary sterilization. To 

ensure that the President is free to make this determination the subcommittee 

should not earmark funds to the United Nations Population Fund (UNFPA), whose 

support for the coercive program in the People’s Republic of China has rendered it 

ineligible for U.S. funds in recent years. 

FOREIGN AID: OUR MORAL IMPERATIVE

Solidarity with those in need expresses a common hope for a stable and peaceful 

world. Despite the effectiveness of many U.S. foreign aid programs, much more 

needs to be done to respond to this challenge. Before us there is an opportunity to 

use our nation’s wealth and resources to uplift human life and dignity around the 

globe and to work for the common good. 

In this year’s address to the Diplomatic Corps accredited to the Holy See, Pope 

Benedict XVI specifically focused on the level of international aid committed by the 

richer nations. He said, ‘‘[I]nitiatives have been undertaken to which the Holy See 

has not failed to pledge its support, at the same time reiterating that these projects 

must not supplant the commitment of developed countries to devote 0.7 percent of 

their gross domestic product to international aid.’’ 1

Achieving authentic human development requires that the basic human needs of 

all are met; that social, cultural, economic and political rights are protected; and 

that all peoples participate in shaping their own future. Meeting these moral obligations will help our nation build a safer and more secure world. As the late beloved 
185 

2Pope John Paul II, Development and Peace, January 1, 1987. 

Pope John Paul II said: ‘‘Development ultimately becomes a question of peace, because it helps to achieve what is good for others and for the human community as 

a whole.’’ 2

Development is not just an aspiration but a right common to all people. It corresponds, then, to a duty imposed upon all of us, as peoples and nations, to collaborate in development, and in this, it is the responsibility of those who are stronger 

and richer to seek out, assist and empower those who are less so. 

This teaching informs the work of two agencies of the United States bishops: Migration and Refugee Services (MRS) and Catholic Relief Services (CRS). MRS works 

to address the needs of those who flee terror in their homeland and seek international protection, and helps settle one-quarter of the refugees who enter the 

United States each year. CRS works in 99 countries throughout the world, including 

more than 30 in Africa, and provides programs to address HIV/AIDS, health, education, building civil society, food security, agriculture, emergency relief and peace 

building. With 60 years of development experience, CRS knows firsthand both the 

tremendous needs and also the great potential of millions who live in poverty. CRS 

knows from experience how effective development programs can bring very real 

hope for prosperity and peace. 

With a greater awareness that our well-being as Americans is intrinsically linked 

to the well-being of those who live far from our shores, foreign aid is increasingly 

seen by many as capable of lifting up the weak and empowering people to realize 

their own dignity and destiny at the same time that it improves global security and 

peace. 

FOREIGN AID REFORM AND TRANSFORMATIONAL DIPLOMACY

USCCB and CRS have repeatedly focused on the importance of the effectiveness 

of foreign aid programming with the Committee. We welcome efforts to promote coherence in foreign assistance through a country-driven process that addresses duplication, complex delivery and procurement procedures and other inefficiencies. We 

acknowledge the relationship of development programs to broader strategic objectives, and have been monitoring the reform process closely since Secretary Rice’s articulation of the doctrine of transformational diplomacy in January 2006. However, 

we have always maintained that the interests of poor and vulnerable people lie at 

the foundation of all foreign aid. We welcomed, therefore, the modified Framework 

for U.S. Foreign Assistance Programs that now includes the goal of ‘‘reducing widespread poverty.’’ 

Country-Focused, Objective-Based Framework: An Important First Step Forward 

Now that poverty reduction has become an explicit goal of foreign aid, we look 

forward to programs that give priority to the needs of the poor and vulnerable even 

for countries with limited relationships with, or little strategic importance to, the 

United States. The adoption of a country-focused approach and framing aid programs in terms of specific objectives are welcome improvements. We hope that the 

categorization of countries in the Foreign Aid Framework will help identify more 

clearly the specific challenges to progress in reducing poverty, promoting human development and building security in troubled parts of our world. We thus believe the 

new assistance framework represents an important first step in foreign aid reform, 

a step we hope will be followed by broader and deeper reforms. 

Concentration of Bilateral Aid in Too Few Countries 

We note that 40 percent of the entire bilateral aid program is concentrated in six 

countries important to U.S. strategic interests related to either the ‘‘War on Terrorism’’ or the ‘‘War on Drugs.’’ Only two of the six (Afghanistan and Pakistan) are 

classified by the World Bank as low income. While we strongly support reconstruction and peace-building in Iraq and Afghanistan, we believe that a greater share 

of foreign aid should be assigned particularly to the very poor among the more than 

150 other developing countries. If U.S. strategic interests will continue to require 

a major injection of foreign aid resources into the six priority countries, and if poverty reduction is in fact to be a fundamental objective of U.S. foreign aid, this inevitably means that the overall foreign aid budget must be substantially increased. 

Avoid Trade Offs in Funding 

With regard to the composition of country programs, we are pleased that there 

has been a substantial increase over fiscal year 2006 levels for activities related to 

the long-term development objectives: 
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Governing Justly and Democratically, Investing in People and Economic Growth. 

At the same time we note that this increase is attributable almost entirely to increases in funding for combating HIV/AIDS and other infectious diseases and for the 

Millennium Challenge Corporation. We support robust funding for these important 

initiatives, but we believe that a country-focused approach would require complementing HIV/AIDS funding with resources for other sectors. While HIV/AIDS funding for Africa, for example, is being increased, funding for basic education, safe 

water and economic growth on the continent actually decline from fiscal year 2006 

levels. 

We support full funding of the Administration’s request for $3 billion for the 

MCC. Any reduction in funding would undermine the MCC as channel of support 

for well-governed countries through multi-year funding. Disruption in this program 

through insufficient funding would pose serious setbacks for countries that have 

worked hard to prepare eligibility, in many cases by enacting difficult policy reforms. The United States must continue to plays its part. 

At the same time, the MCC should not be funded at the expense of the large number of non-MCC low income countries with critical needs, including those emerging 

from conflict and moving towards better governance, such as Liberia, Haiti, the 

DRC and Sierra Leone. Funding for basic education and other sectors critical to poverty reduction should be increasing. At a minimum, the President’s promise that 

MCC resources will be in addition to, and not in substitution for, other development 

and humanitarian funding should be kept. 

Planning Cannot be Concentrated in Washington 

Finally, we are concerned by initial indications that the new process for determining priorities has resulted in decisions that are the byproduct of top-down decision making, as opposed to a truly country-driven process. Our counterparts at 

USAID missions have expressed frustration with the lack of meaningful participation in the planning process. We understand the abbreviated timeline involved this 

year, and the tremendous work done to coordinate this new process; but the decision 

to base program and budget decisions almost entirely on strategic priorities crafted 

at Headquarters risks failing to incorporate the rich expertise and experience developed in the field. 

A related concern is the absence of a clearly defined role for civil society. Adopting 

a country-needs focus highlights the need to take into account the experience and 

insight of local organizations closest to the reality that foreign aid is intended to 

impact. While the host government has the central role in designing and implementing a country’s development policies and programs, close collaboration is needed also with civil society organizations, especially those who work on a daily basis 

with the poor and marginalized and are thus in a unique position to give voice to 

the needs of the weakest members of society. CRS, through its network of partners 

in 99 countries, has the ability, through direct relationships with target beneficiaries, to provide USAID missions with information about the needs of the people 

most directly affected. 

Experience both in Washington and in the field reveals an often deficient process 

of consultation. In the absence of close collaboration with civil society and governments in both planning and implementing foreign assistance programs, aid programs will fail to reach their goal of reducing widespread poverty. We urge you to 

ensure that robust consultation—especially with civil society—be not only mandated 

for foreign assistance programming, but meaningfully undertaken by U.S. Government agencies involved in the entire process. 

PREPARED STATEMENT OF HON. DOUGLAS BEREUTER, PRESIDENT, THE ASIA

FOUNDATION

Mr. Chairman & Members of the Subcommittee: I will begin my testimony as 

President of the Asia Foundation, with a personal perspective which I thought the 

Members and staff may find interesting since I served 26 years in the U.S. House, 

20 years on the Foreign Affairs Committee, led the Asia Pacific Subcommittee for 

6 years, and also chaired the ‘‘International Institutions’’ Subcommittee of the Financial Services Committee. For fiscal year 2008, the Asia Foundation is requesting 

$18 million. 

When I announced I would not seek re-election to the 109th Congress I was unaware that the position of the presidency of The Asia Foundation would open, but 

I had long admired the work of the Foundation. In fact, I told my wife years earlier 

it was one of only two positions that would interest me after Congress. What I have 

found in my 2.5 years at the helm of the Foundation is what I hoped and expected 
187 

to find: there is a strong commitment to Asian development and a pervasive sense 

of altruism among the Foundation’s experienced and highly professional staff. Its 

long-term, on-the-ground presence through 17 Asian field offices and its work with 

and through literally hundreds of established and emerging Asian partner organizations make it highly knowledgeable, effective, and trusted by Asians. This experience base, coupled with a staff of more than 80 percent Asian nationals who have 

a sensitivity and understanding of the local context, makes us different from nearly 

all other nongovernmental development organizations. We do not bring in our development staff for work on a short-term basis and then leave. We are there for the 

long term and we are committed to building and sustaining the kinds of institutions 

and practices that enable Asians to replicate these successes and thereby help themselves after a funded project ends. In short, The Asia Foundation is the premier development organization focusing on Asia. 

Of perhaps particular interest to the Congress today is the fact we have been 

working with Muslims and Islamic civil and higher education organizations for more 

than 35 years. Generations of Asians know us from our education grants and exchange programs and through the more than 40 million English-language books we 

have provided in more than 20 countries (920,000 last year alone). The result is that 

Asians respect, trust, and like the Foundation at a time when much of what they 

hear and think about our country is not very positive. In short, The Asia Foundation 

has an unmatched credibility. It is an irreplaceable American and international 

asset. 

My research has shown me that seven significant American task forces, commissions and blue-ribbon committees made policy recommendations to our country for 

the post-9/11 world. All recommended an accelerated and more effective public diplomacy program, especially for the Islamic world. All but one specifically suggested 

that the expertise of nongovernmental organizations and the private sector must be 

enlisted, suggesting explicitly or implying that effective public diplomacy was too 

important and nuanced to be the exclusive domain of the U.S. Government. Members of the subcommittee, much of what The Asia Foundation does properly may be 

categorized as public diplomacy. We don’t advocate U.S. foreign policy; however, 

while pursuing effective development programs, our work and staff remind Asians 

of what they have liked most about America and Americans—that we are an innovative, opportunity-oriented country and people, with a respect for the rule of law, the 

freedom of expression, and an openness and expectation for citizen participation in 

a democratic society. 

It is instructive to review the Foundation’s appropriations history. Although the 

Foundation has been in operation since 1954, The Asia Foundation Act, which was 

passed in 1983, provides for an annual appropriation from the Congress. That Act 

acknowledged the importance of stable funding for the Foundation and endorsed its 

ongoing value and contributions to U.S. interests in Asia. For a decade until 1995, 

the Foundation’s annual appropriation was at least $15 million. In fiscal year 1996, 

during the government shutdown year, despite broad bipartisan support commending its work, the Foundation’s appropriation was cut by two-thirds, to $5 million. The Foundation painfully was forced to sharply cut back its programs, but 

struggled to maintain nearly all of its most important asset, its field operation 

structure. Since that low point, the Committee, in support of the organization’s mission, has gradually expanded funding for the Foundation to its current level of nearly $14 million. Past committee report language has commended our grant-making 

role in Asia, and the Foundation, at the Committee’s encouragement, has expanded 

its programs in predominantly Muslim countries, including Afghanistan, Indonesia, 

and Pakistan. However, the Foundation has remained at a funding level below that 

of 10 years ago, despite its important contributions in support of democracy and reform in Asia, the escalating costs of maintaining overseas offices, the impact of inflation, the less favorable currency exchange rates, and growing needs in the region. 

Despite a very positive attitude about the Foundation in the State Department, 

USAID, and especially among those U.S. ambassadors with deep Asian experience 

who often turn to our country representatives for information and advice, past and 

present administrations consistently have used previous year requests as the baseline for future requests, rather than the previous year Congressional appropriations. 

This has resulted in a low appropriation recommendation in the past and again for 

fiscal year 2008. We don’t have nearly the U.S. funding base we once had—in either 

relative or absolute dollar terms. We have the experience, expertise, and office/staffing base to do so much more of great value to the United States and those Asians 

who need our help; we only need the resources to restore some of the funding base 

we once had. Our development counterparts in multilateral development organizations express their amazement at what we accomplish with what they regard as a 

paltry funding base. Therefore, I respectfully urge the Committee to sustain and in-
188 

crease its support for the vital work the Foundation is engaged in on behalf of the 

U.S. interests in this complex region. The Asia Foundation is requesting a modest 

increase back to an earlier appropriations level of $18 million. 

In making this request, we are very cognizant of the fiscal year 2008 budgetary 

pressures on the Committee. However, an increase would enable The Asia Foundation to strengthen program investments it has begun in recent years with Congressional encouragement, notably in the areas of protecting women and children 

against trafficking; promoting women’s rights; building democracy and critical government capacity in Afghanistan and East Timor; increasing tolerance in predominantly Muslim nations like Indonesia, Bangladesh and Pakistan; securing human 

rights in Cambodia, Sri Lanka, and Nepal; and strengthening good governance and 

civil society throughout Asia. 

REGIONAL OVERVIEW

The United States and Asia face new challenges and pressing needs, complicated 

by the war on terrorism and fragile democracies. More than ever, we must support 

political stability and economic reform, and give attention to countries where recent 

events have exacerbated bilateral relations, specifically in the new democracies of 

Asia and in countries with predominantly Muslim populations. Challenges to governance in Thailand, the Philippines, Mongolia, Indonesia, and Sri Lanka require 

different approaches than in countries struggling to achieve democracy, peace and 

stability, such as Afghanistan, Pakistan, Nepal and East Timor. Potential ties to regional terrorist networks threaten regional stability. Human rights abuses continue 

with impunity in parts of Asia. Even though women have made gains in many 

places, such as Cambodia, Thailand, Nepal and India, they still face economic and 

political inequities, and in the worst cases, are victims of trafficking and abuse. 

THE ASIA FOUNDATION’S MISSION, CAPABILITIES, AND APPROACH

We are committed to the development of a peaceful, prosperous, just, and open 

Asia-Pacific region. Our core capabilities and primary program concentrations are 

central to U.S. interests in the region. They are as follows: —Democracy, human rights and the rule of law.—Strengthening democratic and 

civil society institutions; encouraging an active, informed and responsible nongovernmental sector; advancing the rule of law; and building institutions to uphold and protect human rights; —Economic Reform and Development.—Reducing barriers at the national and regional level to the formation and productive functioning of small business and 

entrepreneurship; —Women’s Empowerment.—Encouraging women’s participation in public life; protecting women’s rights and supporting advocacy training; and prevention of 

trafficking and domestic violence, including supportive efforts to protect and 

provide shelter to victims; —Peaceful and Stable Regional Relations.—Promoting U.S.-Asian and intra-Asian 

dialogue on security, regional economic cooperation, law and human rights. 

While the Foundation does considerable development work directly with its own 

staff, the Foundation remains faithful to its primary focus on its grant-making role, 

steadily building institutions and strengthening Asian leadership for democratic societies. Foundation assistance provides training, technical assistance, and seed funding for new, local organizations, all aimed at promoting reform, building Asian capacity and strengthening U.S.-Asia relations. Foundation grantees can be found in 

every sector in Asia, leaders of government and industry and at the grassroots level, 

and in an increasingly diverse civil society. The Foundation is distinctive in this 

role, not only providing the technical assistance necessary, but also in providing 

grants that cover the nuts and bolts necessities to support that capacity-building effort. Urgent political and security needs in Asia have increased the need for experienced and credible American actors in the region. The Asia Foundation is a well recognized American organization, but its programs are grounded in Asia, helping to 

solve local problems in cooperation with Asian partners. 

PROGRAMS

The Asia Foundation makes over 800 grants per year, and facilitates programs, 

provides technical assistance and leverages funding from public and private donors, 

to increase program impact and sustainability. With additional funding in fiscal 

year 2008, the Foundation’s expanded activities include: 

Legal Reform.—In Afghanistan technical assistance on policy and management 

operations for the Office of Administrative Affairs of the President, Council of Ministers Secretariat and Ministry of Parliamentary Liaison, Independent Election 
189 

Commission, in East Timor access to justice programs and public consultation in 

lawmaking; in China legal aid services and worker rights education for migrant 

women workers; in Indonesia reform of the Supreme Court including civil society 

input into the reform process; in Nepal, supporting the new constituent assembly 

process, legal analysis of constitutional issues engaging citizens’ groups, civic and 

voter education, and mediation programs in rural areas. 

Human Rights, Conflict and Islam.—In Cambodia, Sri Lanka and the Philippines, 

human rights monitoring, and documentation through new information technology 

networking; in Indonesia, the International Center for Islam and Pluralism (ICIP) 

a unique regional center in Jakarta for progressive Muslim scholarship, exchange, 

start-up activities and action plans of the Thailand Center for Muslim and Democratic Development (TCMD), the Philippine Council for Islam and Democracy 

(PCID) and Jamaah Islah Malaysia (JIM) and International Islamic University (IIU) 

in Malaysia, to support regional Southeast Asian networking and strengthening democracy under Islam; education reform in 1,000 schools including training on pluralism, human rights and civic education for 160 madrassa (day schools) teachers; 

curriculum reform for 800 pesantren (boarding schools), part of the Foundation’s 

education reform of 625 Islamic schools nationwide, with over 215,000 students; and 

in over 70 Islamic universities, for over 120,000 students where the Foundation has 

pioneered civic education on the role of democracy; in Bangladesh, groundbreaking 

training programs in development practices for over 4,000 imams, expanding their 

understanding of their role in national development through exposure to USAID 

programs, and advancing public diplomacy with this critical leadership group. 

Civil Society.—In Afghanistan, support for the Ministry of Women’s Affairs organizational strategic planning and communications strategies with regional Departments of Women’s Affairs across the country, girl’s education, and civic education; 

in Cambodia, human rights and legal services; in Indonesia, promote pluralism, tolerance and moderation by Muslim organizations, radio programs on religion and tolerance on community radio stations reaching 5 million listeners a week through 

radio talk shows and education reform. 

Women’s Programs.—Region wide, with particular emphasis on Indonesia, Cambodia, Thailand, Vietnam and Mongolia, anti-trafficking program including prevention, services for victims, legal drafting and advocacy to support increased prosecutions; technical assistance and grants for services and advocacy for women victims 

of domestic violence; in Afghanistan, India, Pakistan, Bangladesh, Sri Lanka, Indonesia, Nepal, Thailand, and Malaysia projects to advance women’s rights within 

Islam through analysis, public education and outreach; in Afghanistan donation of 

10,000 books to the Ministry of Women’s Affairs; in Cambodia and Afghanistan, support for scholarships for girls’ education. 

Economic Reform.—In Indonesia, Vietnam, Nepal, Bangladesh, small and medium 

enterprise policy reform; in Indonesia and Vietnam pioneered economic performance 

rating tools for local governments; in Korea, Japan, China, Thailand and the Philippines, corporate governance reform and e-government efforts to counter corruption. 

International Relations.—In China, Vietnam and India, scholarships for young 

Ministry of Foreign Affairs leaders, exchange and study programs for Southeast 

Asian and American young leaders, and support for programs on cross-straits relations and Council for Security Cooperation in the Asia Pacific (CSCAP). 

A full listing of programs may be found on our website www.asiafoundation.org. 

CONCLUSION

The Asia Foundation is first and foremost a field-based, grant-making organization, committed to maximizing program impact in Asia while keeping costs low, despite the growing challenge of providing security to field offices and protecting staff. 

If the Committee provides additional funding for Foundation programs in this fiscal 

year, we pledge to use those funds to expand programs that build democratic capacity, strengthen civil society, increase economic opportunity, protect women, and 

work with moderate Muslim groups as described above. The Foundation budget 

needs to grow in order to meet the growing challenges to American interests in the 

Asian region. 

Public funds are critical to our capacity to do more to advance American interests 

in Asia. The Foundation has expanded its private funding, but potential private donors need to be assured that the U.S. Government supports the Foundation’s efforts, 

and private funds are always tied to specific projects. Only public funding provides 

the flexibility that allows the Foundation to maintain its field presence and respond 

quickly to new developments, as we did in supporting the Emergency Loya Jirga 
190 

in Afghanistan, where we were the first U.S. organization on the ground in spring 

2002. 

The increase in funding to $18 million that we seek is essential if the Foundation 

is to succeed in contributing to the development of stable, democratic and peaceful 

societies in Asia. I respectfully urge that the Committee sustain its support for the 

Asia Foundation, and demonstrate our shared commitment to addressing the challenges and opportunities in Asia today. 

ADDITIONAL SUBCOMMITTEE QUESTIONS

Senator LEAHY. There will be some additional questions which 

will be submitted for your response in the record. 

[The following questions were not asked at the hearing, but were 

submitted to the Department for response subsequent to the hearing:] 

QUESTIONS SUBMITTED BY SENATOR PATRICK J. LEAHY

Question. The President’s request significantly under-funds the United States assessed contribution to U.N. peacekeeping by projecting reduced costs for every mission except Sudan which is increased by only $10 million. This is completely unrealistic—in fact, some of these missions are not only being extended but the costs are 

going to increase. When this shortfall is added to approximately $50 million in fiscal year 2007 ar- rears, the United States could have a shortfall of at least $430 million owed to the 

United Nations. That is if the United States and the United Nations decide not to 

create any new missions in places that need assistance, like Somalia, Chad and the 

Central African Republic. The shortfall in fiscal year 2008 could grow to $850 million if this happens. The total fiscal year 2008 request for peacekeeping is $1.1 billion, a decrease of $28 million from fiscal year 2007. This is likely to fall short of our actual 2008 dues 

in every mission. How did the Department formulate the budget request for the U.S. 

assessed contribution to U.N. peacekeeping missions? How do we avoid going further into arrears? 

Answer. The President’s budget includes a request for $1.107 billion for contributions to U.N. peacekeeping activities in fiscal year 2008. The exact requirements for 

U.N. peacekeeping funds for future years cannot be predicted, because the size and 

cost of U.N. peacekeeping missions depend on U.N. Security Council decisions based 

on conditions on the ground and U.N. General Assembly review of the financial implications associated with those decisions. Within the President’s overall budget, our 

fiscal year 2008 request is based on our estimate of the requirements that take into 

account such relevant factors as uncertainties about the future size of missions, as 

well as the U.N. assessment rate and the 25 percent rate cap consistent with current law. The United States uses regular reviews to explore whether missions can 

be downsized or eliminated, and will continue to work with our partners and the 

United Nations to identify cost savings wherever possible. The request for fiscal 

year 2008 reflects assumptions that we will be able to reduce costs of many missions 

while maintaining the U.N.’s essential role in peacekeeping activities. 

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

Question In response to my question about U.S. assessed contributions to U.N. 

peacekeeping missions, you noted that ‘‘the request for fiscal year 2008 reflects assumptions that we will be able to reduce costs of many missions.’’ 

Does the Department still believe that the budget request levels are realistic 

given the current situation in each country? Please provide a justification for and 

the assumptions underlying the proposed reduction in each mission? 

Answer. The fiscal year 2008 President’s budget includes a request for $1.107 billion for contributions to U.N. peacekeeping activities. The exact requirements for 

U.N. peacekeeping funds for future years cannot always be predicted and the fiscal 

year 2008 request was our best estimate of the requirements. Based on the U.N. 

approved budget for existing missions for the 12 month period from July 1, 2007 

through June 30, 2008, and preliminary estimates for the cost of the U.N.–AU Hybrid Mission in Darfur (UNAMID) to be assessed to member states during fiscal 

year 2008, fully funding our assessments in fiscal year 2008 will be challenging. We 

are carefully reviewing these requirements and are having ongoing discussions with 

the United Nations regarding the Darfur costs as well as other U.N. mission costs 

for fiscal year 2008. 
191 

Question. Do you believe your fiscal year 2008 budget request contains sufficient 

funds to provide each U.S. embassy with the number of staff, equipment, vehicles 

and other resources necessary to effectively promote the myriad of U.S. foreign interests in each country? Answer. The fiscal year 2008 budget request, including the $230 million in program increases requested for State Programs would provide the Department with 

the necessary resources to further our world-wide diplomatic efforts. These operating resources are critical in ensuring diplomats are properly trained and 

equipped—most notably with enhanced foreign language skills—in order to advance 

U.S. national security efforts overseas. Additionally, continued construction of secure buildings overseas requires Embassy Security, Construction and Maintenance 

resources which the President has requested to increase the near and long term security of U.S. personnel overseas. 

Question. Can you assure us that any foreign aid program implemented by the 

Department of Defense, whether humanitarian, reconstruction, train and equip, or 

other, will be subject to the prior concurrence of the Secretary of State? 

Answer. Under the direction of our Director of U.S. Foreign Assistance, and based 

on the President’s policy priorities for foreign assistance as informed by consultations with the Department of Defense, we formulate and submit our budget for Foreign Military Financing (FMF) and International Military Education and Training 

(IMET) as part of the State Department’s Foreign Operations budget request. Once 

approved by the Congress, this State Department funding is transferred to the Defense Department for actual execution. 

Select new Department of Defense authorities, coordinated closely with the Department of State, are an essential means of addressing rapidly evolving security 

challenges, particularly with respect to building the capacity of our global partners. 

The Secretary has expressed support for such select new authorities contingent 

upon the explicit preservation of her statutory role with respect to foreign assistance, through their exercise with the concurrence of the Secretary of State, and in 

practice through joint development procedures. Such new authorities should also be 

tailored toward the common goal of providing for closer integration of the administration’s foreign assistance efforts, consistent with the Secretary’s responsibility for 

the overall supervision and general direction of U.S. foreign assistance. 

We continue discussions with the Defense Department regarding this issue. 

Question. Please provide an accounting of funds appropriated for the Afghan Civilian Assistance Program, since its inception in 2002. Such an accounting should indicate the total amount obligated and disbursed, through which organization(s), for 

what types of activities. Please also provide your assessment of the merits of this 

program. 

Answer. Since 2002, funding obligations for the Afghan Civilian Assistance Pro- gram (ACAP) have totaled $8.6 million, of which $8.3 million has been disbursed. 

In June 2007, an additional $4.5 million will be obligated for the program. The 

International Organization for Migration has implemented the Afghan Civilian Assistance Program since 2002. 

Afghan Civilian Assistance Program provides direct assistance to Afghan civilians 

or their families wounded or killed either by Coalition/NATO forces or improvised 

explosive devices targeting those forces. The program also supports communities to 

rebuild public infrastructure damaged or destroyed by Coalition or NATO forces. 

Program activities have included infrastructure rehabilitation, vocational training, 

psycho-social care, and medical prostheses distribution. 

Afghan Civilian Assistance Program has been successful at providing rapid relief 

to civilian victims of war in Afghanistan. The program contributes to overall stabilization efforts in Afghanistan by redressing unintentional damage to civilian life 

and property, thereby reducing mistrust and resentment of military operations, the 

Afghan Government, and the international community. 

Question. Aside from the reduction in size of the Guatemalan Armed Forces, what 

actions have been taken to redefine the mission and reform the Armed Forces? 

Answer. The Guatemalan military has changed drastically since the days of the 

internal conflict. The size of the Guatemalan military has been reduced by two 

thirds since the 1996 Peace Accords and the military budget is under 0.38 percent 

of GDP, well below the level stipulated by the Peace Accords. The Guatemalan military abolished its territorial system of deployment and is now organized along functional, rather than geographical, lines. Many regional military bases were converted 

to civilian uses. The military developed a new military doctrine that eliminated internal security as a role of the military. The Guatemalan civil sector took part in 

the consultative process in formulating this new doctrine, as called for in the Peace 

Accords. The military’s doctrine, training, and education all reflect the new limits 

on the Guatemalan military’s roles to defense of sovereignty and territorial integ-
192 

1 Article 45(a) of the Agreement on the Strengthening Civilian Power and Role of the Army 

in a Democratic Society, signed in Mexico on September 19, 1996. 

rity. Military training now includes mandatory human rights training as an integral 

part of the military education system. During the last 10 years, there have been no 

credible reports of human rights abuses by Guatemalan military units. The Guatemalan military is responsive to civilian political authorities and earned significant 

international and Guatemalan public respect for its excellent work in support of 

Hurricane Stan disaster response and recovery efforts. As allowed under the 1996 

Peace Accords,1Guatemalan presidents over the last 10 years have deployed the 

military in joint patrols with the police in an effort to curb escalating and signficant 

street crime. The military also plays a critical role in providing air and naval support for counter-narcotics operations, including through participation in two ‘‘Mayan 

Jaguar’’ operations in 2006 with DOD’s Joint Interagency Task Force South. The 

Guatemalan military has also earned the respect of the international community for 

its professional performance in peacekeeping operations in Haiti and the Democratic 

Republic of the Congo, deployments that were frequently praised at the U.N. during 

Guatemala’s 2006 candidacy for a rotating UNSC seat. 

Question. Is the Embassy satisfied with the investigation and trial in the murder 

of Gilberto Soto in El Salvador? What progress has there been in solving this crime, 

and what efforts are currently underway? 

Answer. On February 17, 2006, a sentencing tribunal exonerated two of the three 

suspects in the murder of Mr. Soto. The third suspect was convicted and sentenced 

to 25 years in prison. While we believe that the police and prosecutors carried out 

a professional and thorough investigation, the Department did expressed disappointment at the decision to exonerate two of the suspects. 

The Embassy closely monitored all stages of the investigation and the trial itself. 

In addition, the Embassy established a hotline to collect additional information 

about the murder. Although the International Brotherhood of Teamsters offered a 

reward of $75,000 to anyone providing information that would solve the crime, no 

credible tips have been received to date. The case is still open, and the Embassy 

is willing to facilitate the participation of any witnesses who choose to come forward. 

Question. There are increasing concerns about the conduct of the Sri Lankan military. While it is fighting the Liberation Tigers of Tamil Eelam, an organization that 

has committed acts of terrorism against civilians, the military has also engaged in 

a pattern of violations of human rights. What amounts and what types of military 

equipment is the United States providing to Sri Lanka through the FMF program 

and through the FMS or other sales program? 

Answer. U.S. military assistance to Sri Lanka is largely focused on maritime activities to improve Sri Lankan armed forces capabilities to defend their territorial 

waters and interdict arms shipments to the Tamil Tigers, a designated Foreign Terrorist Organization. Our fiscal year 2007 Foreign Military Financing funding totals 

$890,000 and will be used primarily for providing equipment such as surveillance 

radars and communication linkages to the Sri Lankan armed forces. Our fiscal year 

2007 International Military Education and Training funding totals $518,000 and 

will be used for professional military education to include the staff college and NonCommissioned Officer academy, human rights, counter-terrorism, and maritime 

interdiction training. International Military Education and Training funding will 

also fund training to increase interoperability with U.S. forces. Foreign Military Financing disbursed in 2007 to date totals $310,000. 

All recipients of military assistance undergo Leahy human rights vetting in accordance with the provisions of the Leahy Amendment and the Department’s policies and procedures for Leahy vetting. 

Question. In your response to this question, you noted that ‘‘all recipients of military assistance undergo Leahy human rights vetting in accordance with provisions 

of the Leahy Amendment and the Department’s policies and procedures for Leahy 

vetting.’’ 

What are the procedures for vetting Sri Lankan recipients of U.S. military assistance, consistent with the requirements of the Leahy Amendment? Which, if any, 

units of the Sri Lankan military have been credibly alleged to have committed gross 

violations of human rights, and are therefore ineligible to receive U.S. assistance? 

Answer. We look at Leahy requests on a case by case basis, using available information from a wide range of sources, including post reporting, intelligence reports, 

and publicly available information from human rights non-governmental organizations such as Human Rights Watch, the Asian Human Rights Commission and Amnesty International. As a practical matter, in the case of Sri Lanka, we normally 

vet individuals nominated for training. 
193 

The Human Rights Officer in Embassy Colombo’s political section takes the lead 

in vetting. The Consular Section, the Defense Attache ́, the Regional Security Office, 

and USAID also contribute to the vetting process. Each of these offices checks for 

evidence of gross human rights abuses by a proposed participant. 

To date in 2007, two Sri Lankan candidates were denied training. One was refused because there is a criminal case pending against him for human rights violations allegedly committed in 1997. The other was denied because of credible information received from a reliable source about his actions as the Military Intelligence 

Commander in Jaffna. 

We have given particularly close scrutiny to those individuals who have served 

in Jaffna or whose service records indicate they may have been in proximity to 

known, egregious human rights violations. 

Question. Why did you only request $300 million for a U.S. contribution to the 

Global Fund in fiscal year 2008, and why in the Labor, Health and Human Services 

budget which funds domestic programs, rather than through the State, Foreign Operations budget which funds contributions to international organizations? 

Answer. The Global Fund is an important part of the strategic plan that guides 

implementation of the President’s Emergency Plan for AIDS Relief (Emergency 

Plan/PEPFAR). The U.S. Government (USG) share of total Global Fund contributions has held consistently at approximately 30 percent. The USG initially made a 

5-year pledge of $1 billion for the Global Fund in years 2004–2008. If the $300 million in the President’s 2008 Budget is approved, the USG will have nearly tripled 

that commitment to the Global Fund by contributing about $2.5 billion. 

In order to provide adequate financial and human resources to complete the goals 

of PEPFAR as well as maintain U.S. leadership in the Global Fund, the President 

has spread the request for HIV/AIDS-related resources across the two appropriations bills (Foreign Operations and Labor-Health and Human Services). 

We consider this interagency approach in representing the United States on the 

Global Fund to be one of our coordination success stories. Through the Global Aids 

Coordinator, who has overall responsibility for ensuring that all statutory benchmarks have been met before any USG contribution is made, USAID, State, and 

HHS regularly meet and fully coordinate on all aspects of the Global Fund. 

The Department of Health and Human Services (HHS) was instrumental in the 

administration’s efforts to establish the Global Fund and continues to have an active 

role on its Board. The National Institutes of Health (NIH) makes a significant contribution to global HIV/AIDS, TB, and Malaria activities. Requesting the USG contribution within NIH continues HHS’ longstanding role in the advancement of the 

Global Fund. 

Question. How does the United States maintain leadership in the Global Fund, as you maintain, if we cut our contribution from $725 million in fiscal year 2007 

to $300 million in fiscal year 2008? Why does requesting the U.S. Government contribution within NIH, an agency focused on domestic health care, make more sense 

than within the Department of State, where the President’s Global HIV/AIDS Initiative focuses on international HIV/AIDS? 

Answer. Although the United States continues to be the largest single source 

donor to the Global Fund, leadership is not determined by the size of contributions. 

The United States is one of only three donors to hold its own Board seat (the other 

two are Japan and Italy); the Board operates on a one seat, one vote basis. The U.S. 

Government’s leadership is based on our pro-active involvement with the Fund at 

all levels, starting with chairmanship of key Board committees. Ambassador Mark 

Dybul, the U.S. Global AIDS Coordinator, currently chairs the Fund’s Finance and 

Audit (FAC) Committee, while Dr. William Steiger, Special Assistant to the Secretary for International Affairs at the Department of Health and Human Services, 

chaired the powerful Policy and Strategy Committee from 2005–2007. The United 

States also holds regular committee seats on both the FAC and the PSC, and our 

representatives have served on a variety of ad hoc sub-committees, e.g. to identify 

a new Executive Director for the Fund, to shape a documents disclosure policy for 

the Office of the Inspector General, and to develop performance indicators to measure overall Fund progress. 

As mandated by Congress, the interagency Global Fund Core Group also works 

together with our U.S. Embassies and USAID Missions overseas to conduct a parallel review of new Global Fund grant applications, and the Global Fund Secretariat 

has commented more than once on the relevance and usefulness of insights gained 

during these reviews. The United States also conducts reviews of the Global Fund’s 

Phase Two proposals, and frequently takes the lead in mobilizing Board opinion 

during this key stage in the Fund’s performance-based process. 

Furthermore, the United States provides significant technical assistance (TA) to 

Global Fund grants. PEPFAR bilateral programs in both Focus and non-focus coun-
194 

tries include such TA in their country operating budgets, in amounts ranging up to 

$1 million. Such TA is vital to the success of closely-coordinated programs in which 

PEPFAR and the Global Fund are often working together even at the site level. As 

part of this in-country coordination, U.S. Government representatives are well-represented on Global Fund Country Coordinating Mechanisms, including 59 percent 

of the CCMs that submitted round six grant proposals. U.S. country teams are also 

required to describe how they plan to coordinate with the Global Fund in their annual Country Operation Plans (COPs). 

Finally, the United States is authorized by Congress to use up to 5 percent of the 

annual Global Fund appropriation to provide targeted, short-term technical assistance (TA) to Global Fund grants experiencing bottlenecks. Because of the success 

of this United States-provided TA in its first 2 years, the donor community is increasingly turning to the United States to provide leadership for global technical 

support efforts, including through the multilateral Global Implementation and Support Team (GIST). 

As mentioned in my previous response, in order to provide adequate financial and 

human resources to complete the goals of PEPFAR as well as maintain U.S. leadership in the Global Fund, the President has spread the request for HIV/AIDS-related 

resources across the two appropriations bills (Foreign Operations and Labor-Health 

and Human Services). 

We consider this interagency approach in representing the United States on the 

Global Fund to be one of our coordination success stories. Through the Global Aids 

Coordinator, who has overall responsibility for ensuring that all statutory benchmarks have been met before any USG contribution is made, USAID, State, and 

HHS regularly meet and fully coordinate on all aspects of the Global Fund. 

The Department of Health and Human Services (HHS) was instrumental in the 

administration’s efforts to establish the Global Fund and continues to have an active 

role on its Board. The National Institutes of Health (NIH) makes a significant contribution to global HIV/AIDS, TB, and Malaria activities. Requesting the USG contribution within NIH continues HHS’ longstanding role in the advancement of the 

Global Fund. 

Question. The fiscal year 2008 budget proposes to shift a significant amount of 

funding from Development Assistance to the Economic Support Fund. This would 

enable the Department to reallocate funds more easily, without the consent of Congress. 

Why do you need this added flexibility? 

Answer. In the fiscal year 2008 budget request, we sought to maximize the use 

of account authorities and establish clear priorities in support of effective implementation of foreign assistance programs. We, therefore, matched accounts with country 

circumstances and the priorities the county categories are designed to address. 

This means that, overall, funding for Development Assistance (DA), which has 

traditionally supported poor countries that demonstrate performance or a commitment to development, has been prioritized to Developing and Transforming countries. Economic Support Funds (ESF), which focus primarily on providing economic 

support under special economic, political, or security conditions, have been 

prioritized to support activities in the Rebuilding and Restrictive Country Categories. 

Under the Foreign Assistance Act of 1961, as amended, Congress established the 

Economic Support Fund to provide ‘‘assistance to countries and organizations, on 

such terms and conditions as [the President] may determine, in order to promote 

economic and political stability.’’ We are committed to working within current statutory authorities to use ESF and all other funds in a responsible, accountable manner that is consistent with the Secretary’s transformational diplomacy goal and Congress’ authorization. 

The intent in shifting funds from DA to ESF is to draw cleaner lines around their 

use, as identified by country characteristics. These cleaner lines allow us to justify 

to Congress why we have requested amounts for each account. The primary goal of 

this shift is not increased flexibility, and we will of course continue to notify Congress of significant shifts in country funding and to comply with any and all notification requirements. The primary rationale for using ESF rather than DA resources 

in Rebuilding Countries is that conditions in these countries are not stable and the 

primary reason for providing these funds contributes to objectives beyond their development impact. Therefore, in rebuilding countries, it is more appropriate to hold 

State and USAID accountable for the shorter-term results typically associated with 

ESF-funded programs rather than the medium to long term results expected from 

DA. 

Question. As you know I am concerned about the threats to scholars—university 

teachers, scientists, and other academics, in countries where they have been threat-
195 

ened and killed. This is particularly the case in Iraq today, where many have been 

assassinated, including officials at the Ministry of Education. 

The fiscal year 2007 supplemental appropriations bill includes some funding to resettle Iraqi scholars. I would appreciate it if someone in your office would stay in 

touch with me about the management and use of those funds. 

Answer. The plight of scholars in Iraq is a concern for us, particularly because 

the skills they possess will be vital in rebuilding the nation and recreating the institutions of a civil society. We are determining the best implementation policy for the 

currently appropriated funds for refugees in the fiscal year 2007 Supplemental. 

These funds will be crucial to help ensure these scholars and others receive needed 

assistance and can return to Iraq when conditions permit. We will be happy to keep 

you informed as the program progresses. 

Question. It would be a serious mistake to reduce USAID’s mission and bilateral 

assistance programs in Brazil, a country of over 170 million people most of whom 

are impoverished which is facing immense environmental challenges of global importance. I strongly urge you not to do this and I would appreciate written justification for it and for any other USAID missions you plan to close or downgrade. 

Answer. The reduction in USAID’s assistance programs in Brazil reflects the 

prioritization of U.S. global foreign policy goals against available resources and competing demands. Under the new Foreign Assistance Framework, Brazil’s solid level 

of economic and democratic progress warrants only a small USAID development assistance program. In fiscal year 2008, USAID’s program will focus on reducing tuberculosis in Brazil. 

The reduction in assistance from USAID does not signal a reduction in United 

States support for Brazil. While the fiscal year 2008 budget has diminished, significant resources have been leveraged from the private sector toward addressing issues 

such as renewable energy and social inequities. The U.S. mission is seeking to harness the energies of the private sector, including through a Chief Executive Officer 

forum, comprised of executives from both Brazil and the United States. We have developed a Corporate Social Responsibility (CSR) forum with the American Chamber 

of Commerce, the largest such entity in the world, to maximize our effectiveness in 

assisting those that are most in need of help in Brazil. 

This approach is consistent with the principles of Transformational Diplomacy 

which is rooted in partnership, and reflects the important position of Brazil in the 

Western Hemisphere as well as the world. 

Question. How much does the administration plan to allocate for environmental 

conservation activities in Brazil in fiscal year 2007, and for what purposes? 

Answer. In fiscal year 2007 USAID is providing a total of $9,269,000, which includes $4 million from the Amazon Basin Conservation Initiative, to support Brazil’s 

conservation efforts in the Amazon. USAID is helping Brazil save its unique biodiversity while simultaneously reducing greenhouse gas emissions from deforestation. We are implementing activities that empower indigenous peoples’’ organizations, promote environmental governance and support the sustainable management 

of natural resources. USAID supports efforts to create and disseminate information 

regarding public-private institutional alliances that are working to incorporate sustainable natural resource management practices and technologies into rural enterprises. Additionally, USAID assistance is helping the Government of Brazil consolidate forest conservation in both protected areas and productive landscapes. 

Question. Your budget would cut USAID’s Operating budget from $641 million in 

fiscal year 2007 to $609 million in fiscal year 2008. Your supplemental request for 

2008 includes $61 million for USAID Operating Expenses, but that is for only Iraq 

and Afghanistan. The rest of the world gets shortchanged, again. 

If you ask anyone at USAID they will tell you that the agency’s biggest weakness 

is the shrinking number of professional staff. Why have you cut USAID’s Operating 

budget when we should be increasing it? 

Answer. The fiscal year 2008 USAID budget request is a reflection of the many 

competing demands on resources in the current budget environment. We believe the 

President has requested the amount necessary to accomplish the mission of the 

agency. 

USAID operates in some of the most difficult circumstances in the world and adequate resources are critical to implementing successful programs. USAID is currently reviewing its budget and structure to ensure that operations and staffing are 

appropriately funded to continue its mission and support our national security interests abroad. Specific attention is being paid to rationalizing the workforce as USAID 

needs appropriate staffing both in the field and in Washington. Programmatic and 

administrative resources must be allocated to ensure that operations are funded in 

a cost-effective manner, while preserving the integrity of USAID’s mission. 
196 

Question. In your response to this question, you recognize that USAID operates 

‘‘in some of the most difficult circumstances in the world and adequate resources 

are critical to implementing successful programs.’’ 

How do you explain the substantial reduction in funding for USAID’s Operating 

Expenses from the President’s fiscal year fiscal year 2007 budget request compared 

to the budget request for fiscal year 2008, for expenses outside of Iraq and Afghanistan? 

Answer. The fiscal year 2008 Operating Expense (OE) request for expenses outside of Iraq and Afghanistan is 3 percent less than the fiscal year 2007 OE appropriation. At the time the President’s budget was submitted, USAID expected to have 

implemented structural and operational reforms during fiscal year 2007 that would 

allow the Agency to effectively perform at the operating expense level requested for 

fiscal year 2008. The fiscal year 2008 OE budget request reflected a strategy of repositioning resources and restructuring operations around the world, including Washington. With that strategy in mind, the OE budget request was judged sufficient to 

carry out the mission of USAID. 

USAID is reviewing and refining its worldwide operations to better serve its mission. USAID will use all available authorities and resources in fiscal year 2008 to 

ensure that its programs are successful. 

Question. The Congress has consistently provided increased funding for international environmental programs, both to protect biodiversity and to promote energy conservation and efficiency. These programs have bipartisan support, from the 

Russian Far East to Central Africa to the Amazon. 

But your fiscal year 2008 budget would either eliminate completely or drastically 

reduce funding for environment programs everywhere. How do you explain this 

when forests, wildlife, water and other natural resources are being polluted or destroyed at a faster and faster pace on virtually every continent? 

Answer. Our strategy is to link healthy ecosystems to sustainable economies, good 

governance, and equitable and just societies. The fiscal year 2008 budget request 

includes $249 million for programs to protect natural resources, biodiversity, and 

support clean, productive environments. The decrease in resources to support the 

environment, down 17.5 percent from the fiscal year 2006 enacted level of $302 million, is not a reflection of a lack of commitment but rather due to two changes. The 

first is the administration’s decreased request for DA. The second is our new allocation process which is a more demand driven process from our Embassies and Missions. 

Countries were given their total budget number at the outset of the Operational 

Plan Process. In some cases, the total number was lower than last year or lower 

than their request. Under this year’s more demand focused allocation process, many 

of our country teams either did not request funds for environment or they requested 

funds in smaller amounts than previously in order to maintain or increase programs 

in sectors which they judged to be more critical to their objectives. A few countries 

did identify environment as needing a higher priority and chose to request more 

funds in the environment than they had in previous years. Haiti, for example, had 

no funds budgeted for environment in fiscal year 2006 and requested $2.9 million 

for fiscal year 2008. As one of the most deforested countries in the world, Haiti’s 

need to address environmental problems was identified this year by our country 

team as needing funding. The Near East and Asia region saw a small overall increase in their environment budget due to a $10 million increase in Lebanon’s and 

Jordan’s water programs. The country teams in these two countries identified the 

need to address and fund water scarcity and poor quality issues as an important 

factor in maintaining stability and security. 

This year’s demand-driven process illustrates how the Department of State and 

USAID jointly determined a country’s need and drove the selection of funds into the 

various sectors; a process that we believe will produce more robust results in transformational diplomacy. 

Sustainable conservation programs should not only be demand-driven, but focus 

on host country ownership by being developed in partnership with local governments, institutions, and the private sector. To encourage this, we will undertake an 

innovative approach to facilitate private sector investment on environmental issues. 

Beginning in fiscal year 2007, we will look to the Development Credit Authority 

(DCA) to facilitate private sector investment through partial loan guarantees for 

partnerships in environmental sustainability for commercially viable ventures. 

The Development Credit Authority is a USAID partial credit guarantee mechanism that mobilizes private financing to achieve transformational development. By 

mobilizing private resources for market changing impact, USAID leverages an average of roughly $25 of private capital for each $1 invested by the USG. For example, 

in India, DCA raised nearly $23 million from the local capital market through a 
197 

pooled municipal bond for water transmission and distribution networks in eight 

municipalities in Bangalore. The cost to the U.S. taxpayer for the loan guarantee 

was approximately $1 million. 

USAID can also provide DCA guarantees to engage private financial institutions 

in lending for steward projects led by communities. For example, a DCA guarantee 

can mobilize financing for community managed forestry concessions while encouraging the tree harvesting and marketing to be undertaken in a sustainable manner. 

Because the community is itself invested, the likelihood of the community working 

to make it sustainable is increased. Should such investments prove successful and 

profitable, our hope is that local financial institutions will look for similar investment opportunities without further credit guarantees from the USG foreign assistance budget. While this DCA experiment is not appropriate for most of the environmental programs needed by our partner countries, it illustrates an innovative and 

low cost approach to addressing the environment in those cases where facilitating 

such private sector ventures can be helpful additions. 

FUNDING FOR INTERNATIONAL ENVIRONMENTAL PROGRAMS

Question. You responded to my question about cuts in funding for environmental 

conservation programs by saying that your new allocation process is ‘‘much more demand driven’’ from Embassies and Missions, and that you plan to look to the Development Credit Authority (DCA) ‘‘to facilitate private sector investment in environmental sustainability for commercially viable ventures.’’ 

This suggests two things, first, our Embassies and Missions do not regard environmental conservation as a priority and are therefore not demanding the funds. 

Second, by putting so much reliance on the DCA and the private sector you appear 

to have a very limited approach to environmental conservation. Given the increasing 

threats to the environment and the implications this has for regional and global stability, how much do you expect to allocate through your demand driven approach, 

and in which countries? 

Answer. In my previous answer, I did not intend to give the impression that the 

administration does not place a priority on environmental conservation. To the contrary, the administration is committed to helping developing countries address critical environmental threats, including climate change and biodiversity, and to achieving economic growth and poverty reduction that is based on sustainable use of natural resources. 

President Bush’s major new Climate Change Initiative, announced on May 31 in 

his speech to the Global Leadership Council, is one example of how we are working 

to address environmental problems. The Initiative is designed to rapidly reduce 

global greenhouse gas emissions by engaging major developing country partners, 

who account for a large and growing share of greenhouse gas emissions. The President’s Climate Change Initiative will build on a number of existing global and regional programs, including the Asia-Pacific Partnership and the Methane to Markets initiative. 

In this and other key environmental areas, our Embassies and Missions are working with diverse government, private sector, and civil society partners in more than 

40 countries—and we are applying a broad range of country-based and regional approaches—to improve environmental protection and conservation. 

Our new assistance process is also helping to address these issues. The After Action Review of the fiscal year 2008 budget process resulted in the adoption of Assistance Working Groups (AWGs). The AWGs are tasked with determining what approaches may be appropriate in a given country or region based on a holistic view 

of the critical development gaps and the perspective of the relevant host government(s). The purpose of the AWGs is to bring together expertise from across State 

and USAID to identify the most effective and efficient way to use USG foreign assistance to advance USG foreign policy priorities. 

In the fiscal year 2009 budget allocation process, to consider how economic growth 

programs and activities, including the environment, could be implemented to advance our foreign policy priorities, an economic growth AWG, co-chaired by Office 

of the Director of U.S. Foreign Assistance with State and USAID Functional Bureau 

leadership, was assembled. This AWG also considered other USG global, regional, 

and bilateral resources, such as fiscal year 2009 anticipated MCC allocations, and 

were encouraged to reach out to other implementing agencies with questions or a 

request for additional details. Taking into account this information and the Mission 

Strategic Plans from the field, the economic growth AWG provided program allocations to the program element and account level, and, where possible, attributed 

funds to specific countries and/or programs. 
198 

In developing our foreign assistance budget in the constrained budget environment that is our reality, there are numerous competing demands in supporting development, including security and governance issues, and raging health crises. In 

setting our budgets, we are looking to address immediate problems in a sustainable 

way and to find the best opportunities to impact the lives of the most people. At 

the same time, we recognize that addressing stability and governance can achieve 

environmental results, as conflict, poverty and poor governance are significant contributors to environmental degradation in the developing world. The fiscal year 2008 

budget request includes $249 million for programs to protect natural resources, biodiversity, and support clean, productive environments although final allocations for 

fiscal year 2008 will be impacted by the fiscal year 2008 appropriations bill. We anticipate that the heightened cooperation arising from the AWG process may well result in a fine tuning and perhaps even expansion of regional and country environmental programs in the fiscal year 2009 request which we are currently working 

on with the Office of Management and Budget. 

Question. I am leading a CODEL to the Middle East over Memorial Day recess, 

including to Israel and the West Bank. Since the beginning of this administration 

I and others have called for sustained, high level engagement with Israelis and Palestinians, but for the most part the administration’s focus has been elsewhere. Your 

recent efforts are welcome, but it is very late in the game. In the past 6 years the 

situation has, if anything, become more intractable. We need to see real progress 

in resolving the key issues that underlie this conflict. 

When was the last suicide bombing for which Hamas was responsible? 

Which Palestinian faction(s) are responsible for recent rocket attacks against 

Israel? 

The Arab countries have proposed an initiative which offers Israel full recognition 

by the 22 members of the Arab League in exchange for Israel’s withdrawal to its 

pre-1967 borders. Does the administration support this proposal? If not, what aspects of it does the administration not support? 

Who is responsible for recent rocket attacks from Gaza into Israel? In 2007, what 

if any acts of terrorism against Israeli targets are credibly attributable to Hamas? 

Answer. In his September 19, 2006, UNGA address, President Bush said that fulfilling his vision of two states—Israel and Palestine—living side by side in peace 

and security, was one of his greatest priorities. Internationally, the Quartet—made 

up of the United States, EU, United Nations and Russia—has declared repeatedly 

the need to make progress toward peace in the Middle East. 

During my repeated trips to the region over recent months, I have emphasized 

the importance of continued bilateral discussions between Prime Minister Olmert 

and President Abbas both on day-to-day practical issues such as security, movement, and access, as well as on elements of a political horizon for Palestinian statehood. I traveled to the region on March 23rd to continue discussions with the parties as well as with our Arab partners in the region. This trip resulted in agreement 

by Olmert and Abbas to hold regular meetings addressing practical issues affecting 

the quality of life of Israelis and Palestinians, as well as beginning to discuss some 

of the characteristics of a future Palestinian state, such as governing institutions 

and economic relations with Israel. These discussions should build confidence between the parties and begin to lay the foundation for meaningful negotiations leading to the establishment of a Palestinian state, consistent with the Roadmap. 

The last suicide bombing for which Hamas was responsible took place on January 

18, 2005 in Gaza, killing an Israeli security officer and injuring eight other soldiers 

and security agents. In March of this year, Hamas claimed responsibility for shooting an Israel Electric Corporation worker near the Karni/al-Mintar crossing between 

the Gaza Strip and Israel, moderately wounding him. According to press reports, 

that same month, Egyptian authorities detained an alleged would-be Hamas suicide 

bomber next to the Israeli border as he awaited instructions to carry out a terrorist 

attack inside Israel. 

Individuals linked to Hamas were involved in the September 21, 2005 kidnapping 

and murder of an Israeli citizen in the West Bank. According to claims by Hamas, 

al-Aqsa Martyrs Brigade, and the Popular Resistance Committees (PRCs), a number 

of terrorist attacks were perpetrated by one or more organizations acting together, 

including the January 13, 2005 truck bombing of the Karni/al-Mintar cargo crossing 

terminal on the Israeli-Gaza border, which killed six Israeli civilians and wounded 

another five. 

In November 2006, President Abbas and Prime Minister Olmert agreed to a 

ceasefire in Gaza. Following this announcement, Hamas stopped launching rocket 

attacks into Israel. No action was taken, however, by the forces of the Hamas-led 

Interior Ministry to stop rocket attacks launched against Israel by Palestinian Islamic Jihad (PIJ) and the al-Aqsa Martyrs Brigade. Over recent weeks, as intra-Pal-
199 

estinian violence escalated, Hamas disavowed the ceasefire and Hamas and PIJ 

have been responsible for much of the recent spate of Qassam rocket attacks against 

Israel. 

The United States welcomes the Arab Peace Initiative, which provides a regional 

political horizon for Israel, complementing the efforts of the Quartet and of the parties themselves to advance towards peace. 

Question. According to recent press reports a current Israeli Government registry 

shows that more than 30 percent of property held by Israeli settlements in the West 

Bank is actually private Palestinian land. I have also read that the separation wall 

exacerbates this problem because in many places it does not follow the 1967 border 

and instead encroaches into the West Bank, cutting off villagers from their fields 

or access to water, and in some places dividing Palestinians from their neighbors. 

I’ve not heard anything from the administration on either of these issues. What is 

your position? 

Has the administration completed its review of Israel’s use of cluster munitions 

in Lebanon last year, particularly during the final 3 days of the conflict, and has 

it taken any action as a result of the findings of that review? 

Answer. The President stated in April 2005 that ‘‘Israel has obligations under the 

roadmap. The roadmap clearly says no expansion of settlements. And we’ll continue 

to work with Israel on their obligations. Israel should remove unauthorized outposts 

and meet its roadmap obligations regarding settlements in the West Bank.’’ 

The Government of Israel has legitimate defense needs to secure its border in response to attacks and infiltrations by those who commit suicide attacks against citizens. Our view remains that the barrier should be a security rather than a political 

barrier, should be temporary rather than permanent, and should therefore not prejudice any final status issues including final borders, and its route should be taken 

into account, consistent with security needs, its impact on Palestinians not engaged 

in terrorist activities. 

Regarding cluster munitions, the Department provided a report to Congress on 

this matter in January, and will continue to update the Senate Appropriations and 

Foreign Relations Committees staffs on this issue through additional briefings, including the results of the Government of Israel’s ongoing internal investigation. As 

the contents of our agreements with Israel are classified, we are not in a position 

to provide further information in this letter. 

Question. Last year, when the White House announced that its survey indicated 

a slight rise in the price of cocaine in the United States over a period of 6 months, 

the State Department claimed it was proof that Plan Colombia was finally beginning to show the results we were promised. When this year’s report was released 

and the survey showed that the price of cocaine had fallen to a new low, the administration said nothing. 

Since then, the only argument the administration makes that its counterdrug policy is working is that if the cocaine that has been seized or eradicated had made 

it to the United States, the drug problem would be worse. But that ignores the fact 

that the flow of cocaine is determined by the demand. There is no evidence that 

Plan Colombia, after $5 billion in U.S. aid, has made a dent in the availability or 

price of cocaine in this country. 

Your fiscal year 2008 budget request for Colombia is almost exactly the same 

amount for the same purposes as it has been for the past 5 years. Isn’t it time to 

evaluate why it isn’t working, and try another approach? 

Answer. This question provides an important opportunity to examine and clarify 

what we are doing in Colombia and why we are doing it. The U.S. Government 

strategy against cocaine is based on the underlying principle of action against the 

early stages of drug production—to disrupt activities, eradicate crops and interrupt 

materials flow as much as possible in the source zones. 

A key goal of Plan Colombia’s comprehensive approach, which encompassed our 

strategy plus the strengthening and expanding of government presence, eradicating 

and interdicting the drugs that fueled the conflict, and implementing alternative 

and social development programs, was to reduce significantly the supply of cocaine 

to the United States. Although these measures arrested, and temporarily reversed, 

the almost unfettered increase in coca cultivation that occurred through 2001, they 

did not permanently diminish the supply of cocaine to the degree necessary to increase its price significantly or reduce its purity on U.S. streets. 

Contrary to the assertion in the question, cocaine supply is not solely determined 

by demand. The supply of a substance as addictive and as aggressively marketed 

as cocaine itself influences the level of demand. Suppliers are in the business of expanding their market, and they use whatever means available to them. Also, one 

explanation for the reported lack of progress on price and purity could be that be-
200 

cause U.S. cocaine use has steadily declined over the same period, it simply takes 

less product to meet market demand. 

We continue to believe that the removal of hundreds of metric tons of cocaine from 

the supply chain every year (approximately 500 MT in 2006 alone) through United 

States-supported eradication and interdiction efforts has a very real and positive impact on cocaine availability, as well as a very real reduction in illicit drug finances. 

Conversely, because those eradication and interdiction efforts place the illicit drug 

industry under great pressure, abatement of those efforts would yield real and negative results. 

More broadly, we do not believe that the price and purity of cocaine in the United 

States should be the primary benchmark by which the success of foreign assistance 

to Colombia in general, and support for Plan Colombia in particular, is measured. 

Colombia’s democratic security policy—and the paramilitary demobilization—has 

strengthened Colombia’s democratic institutions, and led to substantial improvements in human rights protection. Murders are down almost 40 percent, from 

29,000 in 2002 to 17,300 in 2006. Colombia’s aggregate homicide rate is at its lowest 

level since 1987. Kidnappings fell 75 percent over the same time period, from 2,885 

to 687. Victims of massacres fell from 680 in 2002 to a little over one third that 

amount in 2006. The dispersion and decentralization of the coca crop in Colombia 

is a reflection of the dispersion and weakening of the cartels and terrorists that once 

threatened to overrun the country. 

The improved security climate has promoted Colombians’ freedom to travel, work, 

socialize, and invest. Economic growth has averaged over 5 percent since 2002. Civil 

society and political parties operate more openly than ever before. The labor-affiliated National Unionist College reported that murders of unionists fell by over 60 

percent between 2001 and 2006. The number of human rights defenders killed or 

missing dropped from 17 to 4 over this same time period. Much of this improvement 

can be attributed to greater government control and participation, brought about by 

the improved security situation generated by our eradication and interdiction efforts. 

In most categories by which we can measure the success of our foreign assistance 

investment, Colombia is vastly improved over its pre-Plan Colombia days. Indeed, 

it is difficult to imagine another country in which U.S. foreign assistance has produced more impressive returns. Of course, many serious challenges remain, including bringing perpetrators of crimes against humanity to justice and providing alternative livelihood opportunities for those now compelled by coercion or economic circumstance to collaborate with drug traffickers or to engage in armed actions against 

the legitimate government. However, exclusively defining foreign assistance success 

in Colombia by the price and purity of cocaine in the United States, or by the number of hectares under coca cultivation, overlooks these broader successes. 

Moreover, eradication and interdiction are reasonable law enforcement efforts in 

their own right. Growing coca is illegal in Colombia. Transporting and processing 

coca, coca base, and cocaine are also illegal. The terrorist groups and others which 

these illegal activities fund are a threat to Colombia’s democratic society. 

We are not advocating continuance of the status quo without critical review and 

development of more effective strategies. Indeed, we have been engaged with the 

Government of Colombia for over a year in developing a new strategy that would 

carry through fiscal year 2013 and that, subject to yearly Congressional approval, 

would shift funding to social programs and reduce by one third U.S. funding to law 

enforcement and military (‘‘hard side’’) programs. In the near term, we are looking 

for ways to strengthen the Prosecutor General’s office and produce movement on 

longstanding cases. In addition, we are continually reviewing operational strategy 

and tactics to find more efficient and effective methods. A prime example is the 

change to our aerial eradication strategy in which we stay longer in the three primary growing areas, instead of trying to spray every major and minor growing area 

once a year. This new strategy is designed to directly address replanting and break 

the cultivation cycle. 

However, as long as illicit drug trafficking remains a highly profitable enterprise, 

this battle will require the full array of law enforcement, military, alternative development, social, judicial, and economic assistance. The fiscal year 2008 budget request is similar to fiscal year 2007 in part because it is necessary to maintain aviation asset availability to keep eradication apace (including manual eradication, 

which is also partially dependent on United States-supported aviation assets). 

Aviation-intensive counternarcotics and counter-terrorism programs have filled a 

critical need in Colombia’s war against drugs and terrorist groups. The Colombian 

Government has clearly stated that continued U.S. support for these programs remains critical, and that, for now, our proposed mix of U.S. assistance continues to 

reflect their most urgent needs. 
201 

Question. You recently certified that the Colombian Government and military 

have met the human rights conditions in our law. According to information we have 

received from the United Nations, the Procuraduria, and the Colombian Commission 

of Jurists, extrajudicial killings by the Army rose sharply last year, to between 150– 

250 depending on the source of the information. Did the Embassy discuss these 

cases with the United Nations, the Procuraduria, or the Colombian Commission of 

Jurists prior to making the certification? If so, what conclusions did the Embassy 

reach as a result of those discussions? Why, given this negative trend, did you certify substantial progress? Has anyone been convicted of any of those crimes? 

The United Nations and the Colombian Commission of Jurists also estimate over 

800 targeted killings by paramilitaries, despite the demobilization, last year. Has 

anyone been convicted of any of these crimes? 

What has the Embassy done to determine whether paramilitary commanders in 

the Itagui prison are continuing to engage in criminal activity? In light of recent 

revelations that they were apparently using cell phones to continue committing 

killings and other crimes, has the Colombian Government ordered the cell phones 

removed? Was the Colombian Government legally monitoring paramilitaries’ calls? 

We are told that Mancuso has confessed that General Rito del Rio collaborated 

with the AUC, and that he told the AUC which areas of the country they could control. Is it true that President Uribe publicly praised Rito del Rio in a ceremony organized to honor del Rio after the United States revoked his visa and after he was 

fired from the Army? What is the Fiscalia doing to investigate the allegations 

against del Rio? What is the Fiscalia doing to investigate other members of the military named by Mancuso? 

Answer. The Embassy discussed the issue of alleged extrajudicial killings with the 

U.N. High Commissioner’s Office on Human Rights, the Colombian Commission of 

Jurists (CCJ), and the Inspector General’s Office (Procuraduria), as well as with the 

International Committee of the Red Cross (ICRC). The Embassy has also emphasized to the Prosecutor General’s Office (Fiscalia), the Minister of Defense, the 

Armed Forces and Army Commanders, and the Procuraduria the need to investigate 

these cases in a rapid and thorough manner and to review military practices, training, and doctrine to prevent such cases from occurring. 

The CCJ provided the Embassy with information that showed 93 people were allegedly killed or disappeared by paramilitaries in the first half (Jan-July) of 2006. 

During the period June 2005 to July 2006, the CCJ reported 354 individuals were 

allegedly killed by paramilitaries, down from the 1,234 reported during the comparable period from June 2003 to July 2004. The Fiscalia told us it currently has 

multiple cases open against former paramilitaries, but was not able to provide an 

exact nationwide figure. The Fiscalia also said there have been convictions over the 

past year, but that the Human Rights unit does not have centralized statistics on 

the exact number of convictions. 

The Fiscalia has 77 cases of extrajudicial killings open at the moment, with a 

total of 133 victims. According to the Fiscalia, there are 48 members of the military 

now in preventive detention in connection with these cases. The Procuraduria has 

since told the Embassy that 131 cases of alleged forced disappearance committed 

by the military have been reopened. We will continue to follow these cases. 

There is an ongoing investigation by a USG law enforcement agency, in cooperation with the Colombian authorities, of criminal activities allegedly being committed 

by former paramilitary commanders currently in Itagui prison. The Colombian government reports that paramilitary leaders held in Itagui—who have the formal status of negotiators in the paramilitary process—enjoy access to cell phones similar 

to that provided to ELN negotiators Francisco Galan and Juan Carlos Cuellar. Colombian law enforcement agencies are investigating the alleged involvement of paramilitary commanders in Itagui in criminal activities, but have not ordered the cell 

phones be removed. Colombian National Police Commander Oscar Naranjo has since 

told the Colombian Congress that the Police’s monitoring of communications in 

Itagui was legal. The Fiscalia and the Procuraduria are reviewing the monitoring 

and will make a determination regarding its legality. 

According to the Fiscalia, currently there are no active investigations linked to 

Mancuso’s testimony. In particular, General Rito Alejo del Rio is not presently 

under investigation by the Fiscalia. However, the Fiscalia plans to follow-up with 

Mancuso regarding his testimony that concerns General del Rio; it will make a decision on whether to reopen the case and undertake a formal investigation at that 

time. 

We understand that the Inspector General has reopened its investigation into 

General del Rio’s actions while serving as commander of the 17th Brigade, as a result of disclosures from the paramilitary investigations. The reported praise of del 
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Rio by President Uribe occurred at a dinner at the Hotel Tequendama in Bogata ́

in May 1999. This was 2 months before the United States revoked his visa. 

Question. What will it take to get a U.N. peacekeeping force deployed of sufficient 

size to stop the genocide in Darfur? Is it just a question of how much international 

pressure the Sudanese Government can withstand? Where does that pressure need 

to come from? What is the administration doing, since past efforts have failed? 

Answer. The United States and the international community are firmly committed to resolving the crisis in Darfur and bringing sustainable peace to Sudan. 

Transition of the current African Union Mission in Sudan (AMIS) to a more robust 

United Nations/African Union (U.N./AU) hybrid peacekeeping operation remains a 

policy priority for the United States and its allies. However, President Bashir continues to defy his international obligations and reject the deployment of an U.N.- 

led hybrid force in spite of previously stated support for the Addis Ababa framework 

of a three-phased peacekeeping plan to Darfur. 

We believe that continued unified multilateral pressure from key players, including members of the U.N. Security Council, European Union, AU, and Arab League 

is required to convince the Government of Sudan (GoS) to accept the U.N./AU hybrid force with U.N. command and control structures that conform to U.N. standards. We continue to reach out to international partners in the United Nations and 

European Union to urge sustained pressure on Khartoum. We believe that all options must remain on the table. This includes possible multilateral and further bilateral sanctions. 

In preparation for the hybrid deployment, we are also working with the United 

Nations and our international partners to accelerate implementation of the Addis 

Ababa framework and to mobilize potential Troop Contributing Countries (TCCs) to 

contribute to a stronger Darfur peacekeeping mission. This includes U.S. logistical 

support for the United Nations Light Support Package to AMIS to bolster the current mission on the ground and facilitate transition to a robust hybrid operation as 

well as training and equipping of additional TCCs through the African Contingency 

Operations Training and Assistance (ACOTA) program. 

Question. Do we have any evidence of the existence of terrorist assets in Cuba? 

Your [U.S. State Department Country Report on Terrorism] report says Cuba did 

‘‘not undertake any counterterrorism efforts.’’ Does that make them a state sponsor 

of terrorism? Your report says Cuba continued to provide ‘‘safe haven’’ for members 

of Colombian rebel groups. But according to the Colombian Government, Cuba has 

been acting as a facilitator for peace talks between the government and these 

groups. How does this make them a state sponsor of terrorism? 

Answer. Cuba has been on the State Sponsors of Terrorism list since 1982. The 

decision to place Cuba on that list was originally based on Cuban support for terrorist insurgencies attempting to overthrow democratic governments in Latin America. 

Cuba has provided on-going safe haven to several U.S. designated terrorist organizations such as the FARC, ELN, and ETA. If Cuba were serious about fighting terrorism, it would renounce the support it offers to these terrorist groups, arrest members and seize their assets. The fact that the Cuban government allows the presence 

of these groups in Cuba is an indication that terrorist assets or support structures 

exist as well. Cuba’s role in dialogue between Colombian terrorist organizations and 

the Colombian government does not discount the support it provides these terrorist 

organizations. 

Cuba also remains on the list since it continues to harbor fugitives from U.S. justice, including Joanne Chesimard, who escaped from prison after her conviction for 

the murder of a New Jersey State Trooper while a member of a domestic terrorist 

group. In addition, Cuba provides shelter to Victor Manuel Gerena, an FBI Top-Ten 

Most Wanted fugitive. Gerena, a member of the ‘‘Macheteros’’ terrorist group, participated in the 1983 armed robbery of an armored car that netted $7 million. 

Question. Why are we backing a general who seized power in a coup and has used 

his position to weaken democracy and the rule of law in Pakistan, without clear 

benchmarks with which to measure progress on democracy and human rights? 

Answer. We have made it clear to the Pakistan Government that we expect Pakistan’s upcoming national elections, which are likely to take place in late 2007 or 

early 2007, to be free and fair. In those elections, Pakistani voters will have the opportunity to select the government that will lead the country forward. 

We have also been clear to the Pakistan Government about our appreciation for 

the enduring, substantial support that President Musharraf has provided in the 

Global War on Terror—and we have been clear that we believe that his vision of 

‘‘enlightened moderation’’ represents a positive future for Pakistan. 

During meetings in Islamabad in March 2006, President Musharraf and President 

Bush agreed the United States would support Pakistan as it builds strong and 
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transparent democratic institutions and conducts free and fair elections to ensure 

sustainable democracy. We continue to support these goals. 

President Musharraf has stated that his plan remains the same—to move toward 

a civilian-controlled democracy. We have seen some positive progress in Pakistan in 

key areas such as electoral reform, women’s rights, local governance, and—despite 

recent setbacks—freedom of the press. 

To take a few examples: in the area of election reform, Pakistan—with USAID 

assistance—is assembling the highest-quality and most-reliable electoral roll in its 

history, to be finished in time for the upcoming national elections. In the civil liberties arena, in December 2006 President Musharraf signed the Women’s Protection 

Act amending the Hudood Ordinance, marking a significant step toward improving 

the legal rights of women in Pakistan by allowing criminal courts (rather than religious courts) to try rape cases. The act marks the first time in nearly three decades 

that a Pakistani government has rolled back discriminatory laws that have stood 

virtually untouched since the time of General Zia-ul-Haq. In the area of local governance, the devolution reforms implemented by the Government have increased 

public access to local government, and government accountability. 

We have also seen, over the past 6 or 7 years, significant increases in the freedom 

of the Pakistani press and in the Pakistani public’s access to reliable information 

and outspoken views in the media. We have made our views clear that this is a 

trend that must continue, and that cannot be set aside or reversed. We urge the 

Pakistan government to continue their progress by holding free and fair multi-party 

elections as scheduled in 2007 or early 2008 that meet international standards. 

As the President recently stated, ‘‘We have a fundamental interest in the success 

of Pakistan as a moderate, stable, democratic Muslim nation.’’ 

Question. When Speaker Pelosi met recently with Syrian President Assad, the 

White House accused her of meddling in foreign policy and undermining the administration’s efforts to isolate Syria. However, when other Members of Congress, including Republicans, met with Assad, the White House said nothing. And in Egypt 

recently you met with Syria’s foreign minister in what were described as substantive and professional discussions. Is the administration’s position that it is okay 

for Republicans to meet with the Syrians, but not Democrats? Or that it is okay 

for the administration, but not Congress? 

Answer. In an effort to ensure that the legislative and executive branches of the 

U.S. Government deliver the same message that Syria must change its behavior on 

a broad range of issues, the Department continues to advise against Congressional 

travel to Damascus. High-level United States visits to Damascus are exploited by 

the Syrian regime to demonstrate a degree of legitimacy and international acceptance that Syria has not yet earned. 

The United States remains committed to maintaining peace and security in the 

region. To this end, we continue to review what tools are available to pressure the 

Syrian regime into changing its behavior. 

The Syrian Foreign Minister and the Secretary’s discussion on the margins of the 

Expanded Iraq Neighbors’ Conference meeting in Sharm el-Sheikh was limited to 

Iraq. Moreover, the Secretary relayed to the Syrians that we have no desire to have 

bad relations with Syria. As the Secretary said, ‘‘the Syrians clearly say that they 

believe that stability in Iraq is in their interest, but actions speak louder than words 

we will have to see how this develops.’’ Before we can accept Syria into the international community, ‘‘there need to be concrete steps that show that on the Iraqi 

issue, for instance, that there is actually going to be action.’’ 

Question. You have already heard many of us mention China this morning. China 

is our fastest growing competitor on every front, but the rule of law is often violated 

by Chinese authorities and civil society has few rights. The courts are not independent and there are almost no checks on government power. 

Each year, Senator McConnell when he was Chairman and I, as well as Senator 

Specter, have tried to increase our assistance for rule of law and justice programs 

in China. Yet each year, the administration proposes to cut these programs. For fiscal year 2008 you propose only $1.3 million. How can we have a meaningful impact 

on issues as important as these in a country of over 1.2 billion people with such 

a tiny amount of money? 

Answer. We share Congress’ support for rule of law, public participation and civil 

society programs in China. 

We concur with your assessment and concerns that China’s authoritarian system 

and a lack of judicial independence pose enormous challenges for reform. However, 

within these constraints, our China programs are working to foster judicial independence and legal reform; improve citizen access to legal services; increase the capacity of legal professionals; and help to produce better laws through public participation and strategic assistance from outside experts. 
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We hope to have a long-term impact because these programs foster the growth 

of civil society both as a counterweight to the government and a provider of public 

services. 

A substantial amount of Governing Justly and Democratically programming in 

China is supported by funds from the Human Rights and Democracy Fund, administered by the Bureau of Democracy, Human Rights, and Labor (DRL). By the end 

of this fiscal year alone, DRL will have openly competed and awarded $19.8 million 

in 25 grants using fiscal year 2006 appropriated funds. While democracy and rule 

of law development are long-term efforts, programs have already produced concrete 

successes that are indicative of greater changes to come. For example, in the area 

of women’s rights, provincial level stakeholders used DRL-supported technical assistance to advocate and win passage of refinements to workplace sexual harassment laws in six provinces—including definitions and forms of sexual harassment 

that provide greater clarity than national law. DRL assistance is also helping to 

clarify judicial interpretations on sexual harassment claims. These clarifications and 

refinements will afford women greater protection from sexual harassment and form 

the foundation for future legal reform. For fiscal year 2008, DRL intends to dedicate $5 million out of the $35 million 

requested for the global Human Rights and Democracy Fund to programs in China. 

This figure is a product of the new Foreign Assistance Framework and the USG’s 

prioritization of China as a country of high importance. DRL will continue to include 

rule of law issues in its competitive calls for proposals to support the best initiatives 

proposed by partners in the NGO and academic communities. 

Additionally, our Bureau for International Narcotics and Law Enforcement Affairs 

continues to use International Narcotics and Law Enforcement funds to support a 

Department of Justice Resident Legal Advisor (RLA). The RLA provides Chinese 

government officials, jurists, and academics with expertise on U.S. criminal law and 

procedure, and to promote long-term criminal justice reform in China consistent 

with international human rights. To this end, the RLA seeks to facilitate contacts 

between the United States and China, and introduce Chinese officials to U.S. justice 

sector values and practices. 

USAID also is carrying out significant rule of law programs in China through 

partnerships between United States and Chinese universities. In 2006, USAID provided $5 million, in line with the Congressional mandate, to university partnerships 

in the area of rule of law and the environment. A partnership between Vermont 

Law School and Sun Yat-sen University is strengthening environmental rule of law 

in China, focused on application and enforcement of environmental regulations. A 

consortium including the University of the Pacific McGeorge School of Law and 

American University’s Washington College of Law with the South China University 

of Technology and Zhejiang Gongshan University focuses on the application of law 

in practice. Another premier college of law in China is expected to join the consortium in the coming year. 

In 2007, USAID will be providing another $2 million for rule of law and $3 million 

for environmental governance programs, and has requested another $5 million for 

fiscal year 2009. 

Question. You propose to cut our aid to Russia from $84 million in fiscal year 2007 

to $52 million in fiscal year 2008. If this aid was for the Russian Government I 

would agree with that. But most is to support Russia’s beleaguered democratic 

forces and for health and other programs to help the Russian people, who number 

over 140 million. So far, your efforts to strengthen democracy in Russia seem to 

have failed. What is your policy toward Russia today? 

By comparison, you propose $71 million for Ukraine with 46 million people and 

$35 million for Armenia with 3 million people. Given Russia’s problems, why do you 

believe that $52 million is adequate? 

Answer. Our policy toward Russia is to cooperate when we can and to push back 

when we must. We work well and closely with Russia on counterterrorism, many 

non-proliferation issues, and nuclear issues. We have discussed our concerns over 

Russia’s backsliding on democracy issues and relations with its neighbors. 

This decline in the request for Russia reflects, in part, Russia’s high economic 

growth rates and the related decision to phase out economic reform assistance for 

Russia. fiscal year 2008 is the first year where no funds are budgeted for assistance 

in this area. Democracy programs in Russia remain a top U.S. priority, with particular focus on helping to strengthen civil society, democratic institutions, independent media, and the rule of law. As in previous years, over half of the Russia 

budget (in fiscal year 2008, approximately $26.2 million) will continue to be devoted 

to supporting efforts to promote democracy and rule of law. 

The reduced request for civil society programs this year is based on the expectation that support for democratic development will be bolstered by over $180 million 
205 

recovered from previous activities: The U.S.-Russia Investment Fund (TUSRIF) will 

invest its profits in a new foundation that will give grants to support entrepreneurship, the rule of law and the free flow of information in Russia. Funds recovered 

through the settlement of a civil lawsuit against a USAID contractor will be programmed to bolster Russian civil society groups. 

Combating HIV/AIDS is also a priority, given that Russia has one of the fastest 

growing epidemics in the world. President Putin joined President Bush in recognizing HIV/AIDS as a threat to Russia’s national security and has made fighting 

the disease a priority. As a result of programs in this area, United States and Russian lab specialists are working side by side to strengthen HIV/AIDS laboratory capacity in Russia and Africa. Funding in this area will increase to $11 million in fiscal year 2008. U.S. programs also support joint efforts with Russia to combat 

transnational threats such as organized crime, drug smuggling, trafficking in persons, cyber-crime, and terrorist financing. 

In the North Caucasus, the Russian Government’s unwillingness to meet the 

needs of internally displaced persons exacerbates regional instability and creates an 

environment ripe for extremism. fiscal year 2008 funding will also support conflict 

mitigation programs in the region as well as humanitarian assistance to help stem 

the spread of violence and promote health, sanitation, and community development. 

Question. Your fiscal year 2008 budget would cut aid for Guatemala, Honduras, 

and Nicaragua, three of the poorest countries in the hemisphere. Each of these 

countries is a source of illegal immigrants to the United States. Why does this make 

sense? 

Answer. The Americas are an important priority for the administration. Overall 

foreign assistance to the region has nearly doubled since the start of this administration, from $862 million in fiscal year 2001 to $1.5 billion in fiscal year 2008 (requested). This amount does not include MCA compacts. 

The traditional bilateral assistance programs for Guatemala, Honduras, and Nicaragua in fiscal year 2007 are reduced from their fiscal year 2006 levels. However, 

pending the final fiscal year 2007 allocations, we expect that all three bilateral programs will be increased in fiscal year 2008. It is important to note that our bilateral 

programs do not reflect the totality of our assistance. For example, in fiscal year 

2008, we requested $40 million for the regional CAFTA–DR TCB program focused 

on helping these economies take full advantage of the benefits of the CAFTA–DR 

Free Trade Agreement. USAID also administers several significant development 

programs focused on health, education, and environment throughout Central America. The Peace Corps is also very active with robust programs in all three countries. 

In addition to traditional foreign assistance programs, the United States contributes to the region through innovative mechanisms such as the Millennium Challenge Account (MCA) and debt relief programs. The Millennium Challenge Corporation (MCC) has approved five-year compacts for Nicaragua ($175 million) and Honduras ($215 million), and we are working closely with Guatemala to help them qualify for future MCA assistance. 

In his March 5 speech to the Hispanic Chamber of Commerce, the President announced several additional development initiatives for Latin America, including a 

$385 million expansion of a $100 million OPIC program that helps underwrite mortgages to families in the countries of Central America, and an agreement with the 

IDB to extend debt relief to the most highly indebted countries in the region (including Honduras and Nicaragua) by $3.4 billion. The latter would be in addition to an 

earlier agreement with the Group of 8 industrialized nations to reduce the debt of 

Latin America and Caribbean nations by $4.8 billion. That works out to about $110 

for every man, woman, and child in these countries, monies that their government 

should use to invest in the education and health of their citizens. 

In 2006, the United States spent nearly $3 million and conducted 70 medical 

readiness and training exercises, or MEDRETEs, in 18 countries throughout Central 

and South America and the Caribbean at an estimated cost of nearly $3 million. 

In 2007, we have already conducted 65, in 15 countries, including activities in Guatemala, Honduras, and Nicaragua. Combined, the MEDRETEs provide medical care 

to more than 200,000 individuals—in many cases the only professional medical care 

they will receive. 

Additionally, Health and Human Services Secretary Mike Leavitt and his Panamanian counterpart just inaugurated during the OAS General Assembly the ‘‘Initiative for Health Diplomacy in the Americas,’’ which is providing technical and financial resources from the U.S. Government and private-sector to improve health 

care for people in Central America. One of the main objectives of this initiative is 

to train community health workers and nurses from across Central America in providing basic preventive care and in responding to infectious disease outbreaks. We 
206 

remain committed to assisting governments to address the needs of their peoples, 

and are now taking advantage of non-traditional ways to do so. 

Question. The Millennium Challenge Corporation was established in 2003, and since then we have appropriated $5.9 billion for it. The MCC has signed 11 compacts to date and six more are projected in 2008. To date, $3 billion obligated and 

only $68 million has been disbursed to governments, much of which has not actually 

been used yet to purchase anything. What has actually been accomplished with the 

funds? 

Answer. Early year MCC disbursements have been admittedly modest, but we are 

working with MCC to match disbursements with expectations. During a typical 5- 

year Compact, MCC generally expects to disburse less than 8 percent of total funds 

during the first year, nearly 28 percent the second year, around 31 percent the third 

year, 22 percent the fourth year, and 11 percent during the final year as projects 

and related contracts are completed. This is consistent with large project implementation even in the private sector. While actual disbursements are modest at around 

$84 million, contracts and commitments (administrative reservations of funds not 

based on legally binding transactions or documents) are nearly double that amount. 

In Madagascar, MCC’s first Compact partner country, 23 percent of the total Compact amount has been committed. 

MCC has every intention of using the entire amount obligated to each and every 

Compact and Threshold partner country, but in many cases MCC’s high standards— 

on procurement processes, environmental and social impact mitigation, monitoring 

and evaluation—have slowed down the process. In some cases, disbursements are 

triggered only when conditions precedent, as spelled out in Compact and Threshold 

documents, are met. Indeed, we often remind countries that MCC should not be 

taken for granted, since continued engagement is conditional on good policy performance. That is one of the core principles of the Millennium Challenge Account, 

distinguishing it from foreign assistance policies of the past. 

However, MCC’s high standards are not the only reason behind modest disbursements. In some cases, MCC overestimated country capacity or misjudged the political independence of the programs. MCC works with host countries as partners, but 

sometimes those partners are slow to establish key structures, have complex plans 

or government systems, or lack the full technical capacity to manage and implement 

the programs they propose. 

To address these problems, MCC is offering better guidance to partner countries 

and developing standard operating documents. MCC is also conducting up-front 

analysis of host country capacity and developing explicit capacity-building plans, 

which include specialized training. In addition, MCC is using 609(g) authority to 

provide pre-Compact funds to establish systems and structures needed to get a Compact implemented. Finally, MCC is developing more realistic first-year disbursement 

projections. 

To date, MCC has signed 11 Compacts worth a total value of $3 billion. MCC expects that two more will be approved and signed within the coming weeks, another 

before the end of the fiscal year, and four more early in fiscal year 2008. MCC hopes 

to conclude another four later in fiscal year 2008. Indeed, the eight Compacts in the 

pipeline for fiscal year 2008 total roughly $3 billion, the amount the President put 

forward for MCC in his fiscal year 2008 budget request. 

As MCC Board Chair, I plan to follow-up with MCC on the issue of disbursements 

and budget pipelines to ensure that MCC budget requests are fully aligned with 

these realities and, just as importantly, so that partner country expectations regarding rewards for good policies and consequences for bad behavior are met. This will 

ensure that the MCC’s positive multiplier effect will continue to influence host country actions and encourage constructive policy reforms within MCC partner countries 

and beyond. 

Question. For years, an amendment Senator McConnell and I wrote has conditioned a portion of our aid to Serbia on its cooperation with the war crimes tribunal 

at The Hague, including apprehending and transferring to The Hague former Bosnian Serb leaders Ratko Mladic and Radovan Karadzic. 

We know the Serb Army helped protect Mladic, and he remains at large. The 

Serbs say Karadzic is not in Serbia, but that suggests they know where he is. The 

Hague prosecutor says he is there. How is it possible that two of Europe’s worse 

war criminals have escaped justice for so long? Can we count on you to make clear 

to the Serb authorities and to the European governments that the United States 

will oppose their entry into NATO and other regional economic and security organizations unless these men are turned over? 

Answer. We continue to make clear publicly and privately that Serbia needs to 

fully cooperate with the International Criminal Tribunal for the Former Yugoslavia 

before it can completely integrate into Euro-Atlantic institutions. While I am fully 
207 

supportive of Serbia becoming part of a united Europe, whole, free, and at peace, 

and while many reforms have been successfully implemented, Serbia simply cannot 

complete its process of integration without several final changes. Fundamental to 

this is the full establishment of the rule of law, including the establishment of accountability for war criminals. 

Our policy has been a balanced one. By constructively engaging Serbia, encouraging integration, and offering some forms of assistance, we have increased our influence, given impetus to reformers within Serbia, and have moved our bilateral relationship forward. At the same time, we have made clear to the Serbian leadership 

that their ultimate goal of full integration and membership will not come to pass 

until they deal with this issue. This is a point we make in virtually every meeting 

we have with their political and military leadership. And we have consistently encouraged our European allies to do the same. 

Ensuring accountability for war criminals is a priority for this administration. In 

March of this year, we critically re-examined our efforts to secure the capture of the 

remaining ICTY fugitives in light of recent developments. I can assure you that I 

continue working to realize justice for the victims of atrocities in the Former Yugoslavia. As one example, we are currently working towards the establishment of 

mechanisms through which each of the five remaining ICTY fugitives will face justice even if their capture eludes us by the time the ICTY closes, currently scheduled 

for the end of 2010. This will send a clear signal that fugitives cannot out-wait justice. 

But we are not idly waiting for the remaining fugitives to turn themselves in. We 

are actively encouraging their apprehension. The State Department’s Office of War 

Crimes Issues, in coordination with the Bureau of European and Eurasian Affairs, 

has been facilitating better cooperation among security services in the region in the 

handling of investigations of fugitives. To that effect, we have designated a regional 

liaison officer to assist war crimes cooperation. 

While it is a disappointment to me that Ratko Mladic and Radovan Karadzic remain at large, ultimately, responsibility lies with local authorities to apprehend 

those fugitives who are on their territory. We have seen progress recently, including, 

notably, the recent arrest of Zdravko Tolimir, one of the architects of the Srebrenica 

genocide, but we remain focused on the capture of Ratko Mladic and Radovan 

Karadzic. 

Question. In November 2006 an Indonesian court found Antonius Wamang guilty 

of leading an attack that left two Americans dead and eleven people wounded near 

the gold and copper mine of Freeport McMoRan in Timika, West Papua. The conviction of Wamang represents the success of years of diplomacy—only after years of 

pressure from your good offices did the Indonesian authorities bring anyone to justice for this assault on Americans. Six other men were charged in November as 

Wamang’s accomplices. But questions remain about the evidence that links some of 

these men to the murders. Reverend Isak Onawame, a local human rights advocate 

who has met with congressional offices and State Department officials, helped convince Wamang to surrender. Reverend Onawame accompanied Wamang when he 

surrendered to FBI special agents in Timika. The FBI delivered Wamang, 

Onawame, and other men to the custody of Indonesian police officers. Alleged police 

mistreatment led to a ‘‘confession’’ of involvement by Reverend Onawame: he told 

the interrogators that he supplied the attackers with rice. Onawame and others 

have since recounted their statements, saying that they were made under duress. 

Is the administration aware of any credible evidence linking Reverend Onawame to 

the murder of American citizens? 

According to the ballistics evidence, 13 guns were fired in the attack, including 

M–16’s, yet only three shooters were accounted for. The police who conducted the 

initial investigation concluded the military was involved, but the case was taken 

away from them. Does the administration know who supplied the bullets? Does the 

administration have any idea who fired the 10 other guns? What effort is being 

made to find out? 

Answer. The Department also welcomed the conviction of Antonius Wamang and 

his accomplices. The defendants were afforded legal counsel and a public trial. It 

is our understanding that, while the FBI continues to pursue investigative leads, 

it typically does not disclose details regarding pending investigations. To the extent 

the Committee is seeking other information regarding this matter, we suggest the 

Committee seek this information from the FBI. 

Question. There have been several cases recently of domestic employees, such as 

housekeepers and gardeners, working at embassies in Washington being exploited 

and abused, their passports seized, and being detained against their will by foreign 

diplomats. I understand that in 2000 the State Department informed foreign embassies that visas for domestic staff would only be considered if the embassy has a con-
208 

tract with the staff person and steps have been taken to ensure they understand 

the terms. 

What is the role of the State Department in ensuring the fair treatment of domestic staff at foreign embassies located in the United States? 

How is the Department monitoring and enforcing the requirement that foreign 

embassies have a written and understood contract with domestic staff? 

Have any visas been denied because of a lack of such contracts, or because of prior 

violations? 

Has the State Department ever pressured a foreign government to waive the immunity of any diplomats when there was credible evident that they were involved 

in a serious crime? Could that be done in cases of abuse of embassy domestic employees? 

Answer. The State Department has implemented several measures to address 

complaints that diplomatic personnel exploit foreign domestic workers. The Department has issued periodic diplomatic notes to diplomatic missions containing model 

employment contracts and underscoring the importance of humane treatment of domestic staff. In particular, the Department requires that in order for a visa to be 

issued to a foreign domestic worker to come to the United States to work for diplomatic or consular personnel, or persons working for an international organization, 

the worker and employer must have agreed to a contract that provides fair terms 

of employment. The contract must be in the worker’s language and must provide 

that the worker will be paid minimum or prevailing wage, whichever is higher. The 

contract must also have other provisions intended to ensure fair treatment of the 

worker, e.g, a requirement that the worker be given his or her passport. If a visa 

is issued, the issuing consular facility also gives the worker a brochure explaining 

some basic rights of persons in the United States; that brochure has a ‘‘hotline’’ telephone number that can be called if a worker suffers abuse. 

Following issuance of the contract requirement, the numbers of visas issued have 

dropped: 

Fiscal year 1999: A–3/2,279 G–5/1,737 

Fiscal year 2000: A–3/2,486 G–5/1,737 

Fiscal year 2001: A–3/2,228 G–5/1,645 

Fiscal year 2005: A–3/1,227 G–5/998 

Fiscal year 2006: A–3/1,017 G–5/940 

Although there may be several reasons for this, inquiries received from consular 

officers concerning issuance of these visas suggest that the contract requirement, 

coupled with instructions from the Department concerning treatment of these workers, has caused fewer visas to be issued. 

Recent complaints of abusive conditions that have been brought to the Department’s attention have prompted Department offices to examine what additional 

steps may be appropriate. The Department plans to increase its efforts to obtain 

better compliance by embassy personnel with the registration requirement of the Vienna Convention on Diplomatic Relations and to draw to the attention of the diplomatic community the importance the Department and other U.S. agencies place on 

compliance with U.S. laws and fair treatment of these workers. Additionally, the 

Department is reviewing the visa issuance process for these workers. 

When potential cases of abuse arise, it is the Department’s policy, stated in internal regulations (2 FAM 234), to request a waiver of immunity of a diplomat if a 

prosecutor informs the Department that ‘‘but for immunity’’ the prosecutor would 

bring criminal charges against a diplomat. This rule is equally applicable to cases 

of abuse of domestic staff. It is important to underscore, however, that many members of the diplomatic community, e.g., most consular personnel and employees of 

international organizations, will likely not have immunity from either criminal prosecution or civil suit involving abuse of domestic staff, so that no waiver of immunity 

is required for criminal and civil actions. 

Question. I understand that when Deputy Secretary Negroponte was in Libya last 

month he raised the case of the Bulgarian nurses and Palestinian doctor who were 

re-sentenced to death last year for allegedly infecting children with HIV. Many scientists and physicians are concerned that the trial ignored evidence that the virus 

was spread through lack of safe hygiene in the hospital, which may deter other 

health professionals from working in the developing world where they might be subject to unfair prosecution. They believe it is important that the nurses and doctor 

not only be released but be exonerated. 

Is it the United States position that they should be exonerated? Did the Deputy 

Secretary ask that the Libyans exonerate them or just release them? 

Answer. Deputy Secretary Negroponte met with Libyan Foreign Minister Shalgam 

and other senior Libyan officials during his April 18–19, 2007, visit to Tripoli. In 

each of these meetings, the Deputy Secretary called upon the Libyan government 
209 

to find a way to release the five Bulgarian nurses and Palestinian doctor imprisoned 

on charges of deliberately infecting over 400 Libyan children with HIV. The U.S. 

Government, including President Bush, has repeatedly expressed its view that there 

is no evidence to suggest that the medical personnel conspired to infect the children. 

At the same time, we recognize the human tragedy posed by the infection of more 

than 400 children. The United States is working with the EU, UK, and Bulgaria, 

to help Libya provide necessary medical and psychological care to the children and 

their families. 

Question. There has been a continuing failure to achieve accountability for crimes 

against humanity committed in East Timor in 1999. At the end of April 2007, Indonesian General Noer Muis participated in a joint military exercise with the U.S. 

Army in Indonesia. On February 24, 2003, Muis was indicted with other senior officers by the U.N.-backed serious crimes process in East Timor. General Muis was 

tried and convicted for crimes against humanity by Indonesia’s Ad Hoc Human 

Rights Court in 2003 for his role in brutal attacks on East Timor’s Dili Diocese, 

Bishop Belo’s residence and the Suai Church massacre in September 1999. However, 

his conviction, like most involving Indonesian military officers, was overturned on 

appeal. 

Did the State Department know that the U.S. Army was collaborating with General Muis, an indicted human rights violator? What does this say about the Department’s ability to effectively vet lesser known military officers to weed out human 

rights violators, as required by U.S. law? What if any steps have been taken to prevent the recurrence of a mistake like this? 

Answer. The State Department knows Indonesian General Noer Muis has been 

indicted for war crimes for his role in the events in East Timor in 1999. General 

Muis did not participate in the two-week tabletop exercise that was recently conducted in Indonesia by elements of the U.S. Pacific Command with members of the 

Indonesian First Infantry Division Strategic Reserve Command (KOSTRAD). Rather, as commander of the KOSTRAD, General Muis observed a portion of the exercise 

for a single day. KOSTRAD provided most of the 850 Indonesian soldiers who deployed to Lebanon last year as part of the U.N. Interim Force in Lebanon (UNIFIL) 

and is expected to deploy another battalion to Lebanon later this year to replace 

the current battalion. Such exercises serve to prepare the Indonesian military (TNI) 

for peacekeeping duties. It is manifestly in our national interest and the interests 

of the United Nations that Indonesia participate in this and other peacekeeping operations. 

As required by law, all foreign security force personnel involve in State Department-funded training and assistance are subjected to vetting for past human rights 

violations, and known human rights violators are not provided such training. In the 

past 3 years we have denied 122 Indonesian applicants training, DOD requests vetting when they deem it necessary to comply with their statute and State responds 

to their requests. 

Our interaction with the TNI necessarily means that American military and civilian personnel work with those in positions of authority. When, in the course of our 

duties, we must engage with TNI leaders with troubling human rights backgrounds, 

we limit that engagement to official business and do not engage in social activities. 

We do not, however, refuse to engage with such individuals in the ordinary course 

of official business nor to accord them the normal courtesy that is due official counterparts; such actions would be counterproductive. The Department and Embassy 

Jakarta are working with Pacific Command to ensure that in the future such engagement is not publicized in a manner that appears to imply USG assistance or 

support for individuals with suspect human rights backgrounds. 

The extraordinary democratic transformation of Indonesia is one of the world’s 

great successes of the past 10 years. As integral elements of Indonesian society, the 

Indonesian military (TNI) must be part of this transformation. Our interaction with 

the TNI facilitates the adoption of democratic norms such as greater transparency, 

respect for human rights, civilian control, and builds capacity to address immediate 

threats such as terrorism and natural disasters. Indeed, these democratic principles 

are a key component of all training that we provide to TNI, after vetting to ensure 

that gross human rights violators are excluded. Our normalized relationship with 

the TNI is producing enormous dividends, both in terms of improving respect for 

human rights and in promoting regional stability. The TNI is out of politics, is 

under civilian leadership, has abolished the ‘‘dual function’’ role under which military leaders often held positions in local civilian government, and is moving to divest itself of business interests. Allegations of human rights abuses in Papua and 

elsewhere have fallen steadily. 

We continue on a regular basis to insist in all appropriate fora for accountability 

for past human rights abuses, including during the recent Indonesian-U.S. Strategic 
210 

Dialogue talks conducted by DOD, in public remarks, and in meetings with the 

country’s senior leaders. Our consistent message is that Indonesia’s partners will 

have more confidence in the deep and genuine reforms the Indonesian military has 

undertaken and continues to undertake if credible steps are taken to address widespread perceptions that a culture of impunity continues to exist. 

Question. Last year on October 27, a young American journalist, Bradley Roland 

Will, was killed as he was filming a political demonstration in Oaxaca, Mexico. 

There are photographs and video footage of municipal officials including police officers in civilian clothes shooting at demonstrators with rifles and pistols, the same 

day that Bradley Will was shot. At least 2 others were killed and 23 were wounded 

that day. More than 20 people were killed during the many months that the demonstrations took place, and some of those who were arrested were reportedly physically and sexually abused in the custody of state and federal police officers. 

My office has tried unsuccessfully to get any information from the Mexican Government about the killings of civilians in Oaxaca, including Bradley Will. Are you 

satisfied with the investigation of Bradley Will’s murder? Have any of the municipal 

officials or police been charged with any of the killings of civilians? Is there any 

hope for a thorough, independent investigation into the police conduct in Oaxaca 

during the demonstrations last year? 

Answer. The U.S. Embassy in Mexico City and the Department of State have been 

monitoring the ongoing investigation into the death of Mr. Will from the beginning. 

Embassy officials, including U.S. Ambassador to Mexico Antonio Garza, have expressed the concerns and interests of the U.S. Government and of the Will family 

to the Mexican federal and Oaxacan state authorities and have offered assistance 

to ensure a complete and proper investigation. The Mexican Government has conducted an investigation into the conduct of law enforcement during last year’s demonstrations, but to date has not filed any charges against local or municipal police. 

The investigation remains ongoing. At this time no one has been charged in Mr. 

Will’s death. We hope the involvement of the federal Attorney General’s Office will 

move this case forward. The Embassy will continue to express our interest in the 

case at the highest levels of the Mexican Government until it is completed. 

Question. In March 2003, Rachel Corrie, a young American woman, was run over 

by an Israeli bulldozer and killed as she was peacefully protesting the destruction 

of a Palestinian family’s property. An investigation was conducted by the Israeli 

military, who concluded it was a tragic accident. However, the Israeli investigation, 

which was neither thorough nor independent, satisfied neither the State Department nor Ms. Corrie’s family. As far as I know, there has been no follow up. What 

is being done to obtain a thorough, independent investigation of this case involving 

the death of an American citizen? 

Answer. The Government of Israel conducted two separate investigations, one by 

the Israeli Defense Forces and the other by the Military Advocate General’s Office. 

While the second investigation was more thorough, we nonetheless made clear to 

the Government of Israel that the investigation failed to meet the standard of thoroughness we would expect in such a case. The Corrie family has informed us that 

they are pursuing legal options with the courts in Israel against the Israeli Defense 

Forces. We continue to maintain contact with the Corrie family regarding the death 

of their daughter. 

Question. Despite two separate investigations into the death of Rachel Corrie by 

the Government of Israel, you noted that the Government of Israel’s investigation 

‘‘failed to meet the standard of thoroughness we would expect in such a case.’’ 

Given that this case involved the death of an American citizen, and the inadequacies of the investigation by the Government of Israel, what further action is the administration taking to obtain an investigation that is thorough and credible? 

Answer. The U.S. Government takes matters involving American citizens abroad 

very seriously. In late October, representatives from the Department of State met 

with the Corrie family, along with Congressman Baird, to discuss concerns that they 

have have with respect to the tragic death of Rachel Corrie. 

The U.S. Government continues to raise this issue with senior level officials in 

the Israeli Government. On her recent trip to Israel and the Palestinian territories, 

Assistant Secretary of State for Consular Affairs Maura Harty raised the issue of 

Rachel Corrie’s death with her counterpart at the Israeli Ministry of Foreign Affairs, 

Mr. Yigal Tzarfati. Assistant Secretary Harty gave Mr. Tzarfati a letter reiterating 

the U.S. Government’s request that a full and transparent investigation of the incident be conducted. She has asked the U.S. Embassy in Tel Aviv to follow up with 

the Government of Israel in obtaining a response to her inquiry. 

Question. The Senator Paul Simon Water for the Poor Act of 2005 commits the 

United States to support international clean drinking water and sanitation. The act 

calls on the United States to increase support for sustainable drinking water sup-
211 

plies and adequate sanitation in countries with the greatest need where aid can be 

used most effectively. Yet the State Department’s June 2006 ‘‘Report to Congress’’ 

showed that U.S. aid for drinking water and sanitation is overwhelmingly spent on 

short-term emergency relief efforts and in a few strategically important countries 

like Afghanistan. Only $24 million, less than 10 percent of the total, was used for 

long-term development projects. What plans does the administration have to allocate increased funds to support long-term, sustainable drinking water and sanitation projects, as called for by the act? 

Answer. USAID’s fiscal year 2005 Report to Congress showed actual obligations 

of $161 million for drinking water supply projects and related activities. Of this 

amount, $96 million was obligated in the International Disaster and Famine Assistance Account (IDFA). While some of the IDFA resources are used for short-term relief efforts, these funds are also used to establish permanent wells and sanitation 

facilities or other facilities necessary for the longer-term provision of water and 

sanitation services. All of the remaining resources were used for long-term sustainable activities regardless of the account. 

In fiscal year 2006 (this report will be delivered to Congress shortly) USAID increased total water and sanitation obligations to $203 million. Of this amount, $86 

million came from the IDFA account. USAID hopes to maintain this increase in fiscal year 2007. 

Most of the countries with the greatest need are located in Sub-Saharan Africa. 

The attached spreadsheet shows that USAID non-IDFA funding for water and sanitation in Sub-Saharan Africa increased each year from 2002 thru 2006. Again, 

USAID hopes to maintain this upward trend in fiscal year 2007. 

2002–2006 USAID WATER OBLIGATIONS IN AFRICA 

[In millions of dollars] 

Fiscal year 

Total 

2002 2003 2004 2005 2006 

Water Supply and Sanitation (non-IDFA) ........... 8.758 9.785 15.385 19.444 22.544 75.916 

IDFA-funded Water Supply and Sanitation ........ 12.383 29.449 35.230 63.926 59.738 200.726 

Sub-Total—Water Supply Projects & 

Related Activities ............................. 21.141 39.234 50.615 83.370 82.282 276.642 

Water Resources Management ........................... 6.151 14.227 14.452 9.615 4.227 48.672 

Water Productivity .............................................. 3.790 11.056 14.640 12.912 5.119 47.517 

Grand Total—All Water Funding Categories .............................................. 31.082 64.517 79.707 105.897 91.628 372.831 

Question. I am concerned about human rights in Ethiopia. Ethiopia is a strategic 

ally, but that should not prevent us from expressing our concern about the wellbeing of Ethiopia’s restive and increasingly alienated majority populations. From 

the populous and economically rich Oromo region to the vast oil rich Ogaden region, 

economic and political tensions seem to be rising. 

The leaders of Ethiopia’s most important opposition party are still in prison. What 

is the evidence against them? 

Answer. Between May 8, 2006 and November 29, 2006, the prosecution introduced 

one audio tape, 19 video tapes, 179 documents, and 54 witnesses in support of the 

charges against opposition, civil society, and media leaders in Ethiopia’s main trial 

of opposition leaders. This evidence described opposition party strategies and deliberations, speeches, rallies, press reports, and activities of the defendants. On April 

9, 2007, upon reviewing the witnesses’ testimony and evidence submitted, the court 

dismissed the charges against 25 defendants and dismissed all charges of treason 

and attempted genocide. The court found that the evidence submitted in support of 

the remaining charges against the remaining defendants warrants proceeding with 

the defense phase of the trial, which is expected to resume in June 2007. The U.S. 

Government continues to monitor every phase of the judicial proceedings. 

Question. Even as the Ethiopian military ends its occupation of Somalia, the ethnic Somali people of the Ogaden region feel they are oppressed and exploited by the 

government in Addis Ababa. The largest group in this diverse country is the 

Oromos, and they, along with other political groups, are losing patience with what 

they see as a repressive central government. 
212 

We have spent a lot of money to help promote stability in the Horn of Africa. Can 

you assure us that the administration is standing up for democracy and human 

rights even when they are being threatened or violated by allies against terrorism 

like Ethiopia? 

Answer. Significant work remains to be done to strengthen democratic institutions 

and practices and to ensure for the protection of human rights in Ethiopia. While 

our annual Human Rights Report is the most public assessment of Ethiopia’s performance in protecting the human and political rights of Ethiopians, democracy and 

human rights issues remain a permanent element in our bilateral dialogue with 

Ethiopian leaders and civil society. 

The United States has developed a strong partnership with Ethiopia to foster 

progress in these areas. While our foreign assistance contributes to capacity building efforts targeting the legislature, judicial independence, executive functions, and 

human rights awareness and protection, American diplomats in Ethiopia and Washington urge Ethiopian officials to create the environment where improvements in 

these sectors can continue. 

While significant work remains, the Government of Ethiopia has taken steps to 

improve respect for human rights and democratic practices following the setbacks 

in 2005. Through U.S. diplomatic and development engagements, we are contributing positively to this effort and will continue to encourage important reforms. 

Question. You noted that ‘‘while significant work remains, the Government of 

Ethiopia has taken steps to improve respect for human rights and democratic practices following the setbacks in 2005.’’ 

How has the administration responded to recent reports by journalists and NGOs 

of widespread human rights abuses by Ethiopian security forces in the Ogaden region? 

Answer. We take very seriously any and all allegations of human rights abuse. 

Our Embassy staff in Addis Ababa is working to verify credible allegations to the 

extent possible. The Ethiopian Government has committed publicly to investigate 

such allegations. 

We will continue to insist that credible allegations be investigated and, where appropriate, that violators are punished. The Government of Ethiopia is working with 

Mr. Kassa, Chairman of the Ethiopian Human Rights Commission, to investigate 

allegations of abuse in the Ogaden. Mr. Kassa’s team is in Jijiga, on the edge of 

the Ogaden, investigating reports. We are in close contact with the Human Rights 

Commission and will work with this and other groups on any human rights enquiry. 

The United Nations has called for an independent investigation of human rights 

abuses in the Ogaden. 

Question. With the G–8 summit coming up in June, some of our allies are focusing 

on global education. In particular, on May 2, 2007, the European Commission and 

the World Bank hosted a conference on basic education in Brussels, entitled ‘‘Keeping our Promises on Education’’, where they announced a number of new funding 

commitments to be carried forward to the G–8. Are any new U.S. commitments for 

education planned for the G–8 or otherwise along these lines? 

Answer. USG has increased its support for basic education five-fold, from less 

than $100 million in fiscal year 2000 to more than $500 million in fiscal year 2006, 

and in the same time period more than doubled the number of countries receiving 

basic education support from 25 to more than 50. 

As a founding partner of the Education for All Fast Track Initiative, and signatory to the Paris Declaration on Aid Effectiveness, USG has in the past and will 

continue to align with other donors behind country-driven education plans and priorities to best meet the human capital needs for the sustainable development of 

each country. 

On May 31, 2007 President Bush called for Congress to fund $525 million by 2010 

or $173 million more a year in fiscal years 2008–2010 for an estimated $638 million 

a year for basic education—a 37 percent increase over current spending and a 425 

percent increase over fiscal year 2002 ($150 million) when the President’s administration started. He also expanded his African Education Initiative, started in 2002, 

from $300 million to $600 million by 2010. 

QUESTION SUBMITTED BY SENATOR TOM HARKIN

Question. Polio Eradication efforts are clearly working as we have seen the number of countries with indigenous polio drop to four, two billion children have been 

immunized, five million have been spared disability and over 250,000 deaths have 

been averted from polio. However, until the world is polio-free, every child, even 

those in the United States, is at risk. 
213 

In fiscal year 2007, both the House and Senate included $32 million for polio 

eradication in their respective Foreign Operations Appropriations bills. 

A. What amount is included for polio in your fiscal year 2007 projections? 

B. What is included for polio in your fiscal year 2008 budget submission? 

Answer. For fiscal year 2007, USAID intends to provide $31,680,000 for polio 

eradication, which meets the House and Senate request level minus a 1 percent rescission. 

For fiscal year 2008, the administration will fund polio eradication but specific 

funding levels are still under consideration. 

QUESTIONS SUBMITTED BY SENATOR RICHARD J. DURBIN

Question. For the coming fiscal year, the President requested only $300 million 

for the Global Fund to Fight AIDS, Tuberculosis, and Malaria in his budget and all 

of that in Labor Health and Human Services rather than the Foreign Operations 

account. The Global Fund estimated need for the U.S. contribution is $1.3 billion. 

Why is the President continuing to lowball this important multilateral program that 

leverages U.S. contributions? Why did the President omit the Global Fund entirely 

from his Foreign Operations request and place the entire request in the Labor, 

Health and Human Services account? 

Answer. The Global Fund is an important part of the strategic plan that guides 

implementation of the President’s Emergency Plan for AIDS Relief (Emergency 

Plan/PEPFAR). The U.S. Government (USG) share of total Global Fund contributions has held consistently at approximately 30 percent. The USG initially made a 

5-year pledge of $1 billion for the Global Fund in years 2004–2008. If the $300 million in the President’s 2008 Budget is approved, the USG will have nearly tripled 

that commitment to the Global Fund by contributing about $2.5 billion. 

In order to provide adequate financial and human resources to complete the goals 

of PEPFAR as well as maintain U.S. leadership in the Global Fund, the President 

has spread the request for HIV/AIDS-related resources across the two appropriations bills (Foreign Operations and Labor-Health and Human Services). 

We consider this interagency approach in representing the United States on the 

Global Fund to be one of our coordination success stories. Through the Global Aids 

Coordinator, who has overall responsibility for ensuring that all statutory benchmarks have been met before any USG contribution is made, USAID, State, and 

HHS regularly meet and fully coordinate on all aspects of the Global Fund. 

The Department of Health and Human Services (HHS) was instrumental in the 

administration’s efforts to establish the Global Fund and continues to have an active 

role on its Board. The National Institutes of Health (NIH) makes a significant contribution to global HIV/AIDS, TB, and Malaria activities. Requesting the USG contribution within NIH continues HHS’ longstanding role in the advancement of the 

Global Fund. 

Question. When Beijing exercises its considerable influence, Khartoum appears to 

listen and we see progress such as the agreement to allow 3,000 peacekeepers. But 

then China provides assistance to build a new presidential palace and wants to develop expanded military cooperation in all areas. How do you evaluate China’s role 

in Darfur? 

Answer. China has an important role to play in ending the genocide in Darfur. 

China’s leverage is not absolute, but there is much that it can do. For example, 

China can do more to persuade Khartoum to accept the full deployment of the U.N./ 

AU hybrid peacekeeping force under U.N. command structures, and to convince 

Khartoum to engage seriously in a peace process that involves all parties to the conflict. China’s lead diplomat at the United Nations, Wang Guangya, helped broker 

the November agreement in Addis Ababa in which the Government of Sudan accepted, in principle, the three-phase deployment of the U.N./AU force. As you mention, 

China’s diplomacy was likely influential in convincing President Bashir to accept 

the 3,000-person ‘‘heavy support package’’ (HSP) under phase two of the deployment. Perhaps most significantly, Beijing recently agreed to send a 275-person engineering unit as part of the HSP. Special Envoy Natsios, Deputy Secretary 

Negroponte, and Assistant Secretary Frazer have all had serious, in-depth discussions on Sudan with the Chinese, as have I. 

President Bashir has reneged on a number of his commitments and continues to 

obstruct the full deployment of the U.N./AU force under phase three. Full deployment is the key, and we are committed to working with China and our other international partners to apply pressure on President Bashir to accept the full U.N./AU 

force unequivocally. 
214 

China is not where we would like it to be on Darfur. The no-interest loan to build 

a palace in Khartoum that you mention is one clear example. We have also communicated our serious concerns to China that weapons sold to the Government of 

Sudan have contributed to the violence in Darfur. At the same time, we do see 

movement in China’s position and believe that Beijing has made a decision that it 

must join with the international community in insisting that the atrocities in Darfur 

must stop. 

Question. How is the Department of State addressing the geopolitical implications 

of global warming? 

Answer. We recognize the seriousness of global climate change and the importance of reducing greenhouse gas emissions, enhancing energy security and promoting sustainable development. 

Two years ago, G8 leaders agreed that tackling climate change, promoting clean 

energy and achieving sustainable development globally are serious and linked challenges. The President announced on May 31 U.S. support to develop by the end of 

2008 a new post-2012 framework on climate change based on the principles that climate change must be address by fostering both energy and economic security and 

by accelerating the development and deployment of transformational clean energy 

technology. 

Secure, reliable and affordable energy sources are fundamental to economic stability and development. One-third of the world’s people lack access to modern energy 

services. This blocks their path to better health and prosperity. 

In consultation with our developing country partners, G8 leaders committed to reduce greenhouse gas emissions, improve the global environment, and enhance energy security in ways that promote human development. 

The United States plays an integral part in promoting the advanced energy technologies that are helping people, while protecting the global environment. 

The President has in place a comprehensive strategy to address climate change 

that incorporates incentives, mandatory programs, and international partnerships 

all that will help us meet the President’s goal to reduce greenhouse gas intensity 

18 percent by 2012. This policy is working as we are well on track to meet that goal. 

The U.S. Department of State supports the President’s strategy in international fora 

and works closely with our international partners to implement innovative climate 

change partnerships. 

For example, we are working with Brazil to advance biofuels. We facilitated an 

agreement with China to install the largest coal mine methane power facility in the 

world. Through the Asia-Pacific Partnership for Clean Development and Climate, we 

are expanding investment and trade in cleaner energy technologies. 

Our development assistance program, through USAID, dedicates about $180 million a year to build resilience to climate variability and change in developing countries. Our efforts include analyzing data from Earth observations, developing decision support tools, and integrating climate information into development programs. 

All of these activities are part of a broader development agenda that encourages 

global collaboration to improve energy security, address greenhouse gasses and reduce air pollution, while ensuring continued economic growth. These activities aim 

to achieve a secure energy supply and a cleaner global environment. 

The most effective way to bolster security and stability, however, is to increase 

the capacity of states to govern legitimately and protect basic human freedoms. 

States that can govern effectively can best anticipate and manage change. 

Stresses associated with energy shortages or climate impacts may be among factors putting pressure on government capacity in this century, as might population 

growth, natural disasters, but absence of these stresses will not eliminate civil 

strife. 

Successful long-term development strategies must also focus upon education, rule 

of law, good governance, and the protection of human freedom and economic reforms. The State Department works with countries across the globe to promote this 

integrated development agenda and support countries in making choices that will 

provide strong and functioning institutions and policies, and promote just governance and rule of law. Such choices are a much more important determinant of peace 

and security independent of any specific climate or environmental impact. 

The United States has a long history of extending a helping hand so that people 

can live in democratic societies with strong and stable governance. 

The Millennium Challenge Corporation (MCC) is a global investment fund based 

on the principle that aid is most effective when it reinforces good governance, economic freedom and investments in people. Since its establishment in 2004, MCC has 

provided nearly $3 billion to 11 countries to help them reduce poverty and stimulate 

economic growth. 
215 

Around the world, the United States is promoting free and fair election processes, 

full participation of all citizens, civil societies, and media freedom. With our international partners, these efforts are strengthening governance and international security. 

The State Department will continue to promote the United States’ leadership role 

of engaging with other nations on these issues of vital importance through our bilateral and regional initiatives and in appropriate multilateral fora, such as the G8 

and the United Nations. 

Question. What about the anticipated consequences for health and development? 

Some of the most economically vulnerable and politically fragile countries are also 

those most at risk from global warming. What steps are you taking to assist adaptation EFFORTS? 

HEALTH AND DEVELOPMENT

Answer. On the potential health implications of climate change, impacts are difficult to discern due to adaptation and many non-climatic drivers. In addition, research continues to focus on effects in high income countries, and there remain important gaps in information for the more vulnerable populations in low- and middleincome countries. 

According to the Intergovernmental Panel on Climate Change (IPCC) Fourth Assessment Report, ‘‘projected climate change-related exposures are likely to affect the 

health status of millions of people, particularly those with low adaptive capacity, 

through: 

—increases in malnutrition and consequent disorders, with implications for child 

growth and development; 

—increased deaths, disease and injury due to heat waves, floods, storms, fires and 

droughts; 

—increased burden of diarrhoeal disease; 

—increased frequency of cardio-respiratory diseases due to higher concentrations 

of ground level ozone related to climate change; and, 

—altered spatial distribution of some infectious disease vectors (high confidence). 

‘‘Climate change is expected to have some mixed health effects, such as the decrease or increase of the range and transmission potential of malaria in Africa (high 

confidence). Studies in temperate areas have shown that climate change is projected 

to bring some benefits, such as fewer deaths from cold exposure. Overall it is expected that these benefits will be outweighed by the negative health effects of rising 

temperatures world-wide, especially in developing countries (high confidence). Most 

projections suggest modest changes in the burden of climate-sensitive health outcomes over the next few decades, with larger increases beginning mid-century. The 

balance of positive and negative health impacts will vary from one location to another, and will alter over time as temperatures continue to rise. Critically important 

will be factors that directly shape the health of populations such as education, 

health care, public health prevention and infrastructure and economic development 

(very high confidence).’’ 

ASSISTING ADAPTATION

Climate shapes a wide range of activities and decisions, from the types of crops 

grown to the design and construction of buildings, water delivery systems, and other 

infrastructure. In countries that are already at risk from food insecurity, ecosystem 

degradation, or weak institutional capacity, short- and long-term changes in the climate pose an additional challenge to sustainable development. A diverse, robust, 

and open economy can better withstand many types of disruptions, including those 

related to climate events. 

The United States collaborates with developing country partners in a broad range 

of activities designed to better understand climate and its implications for development and to build resilience to climate variability and change. These activities include analyzing data from Earth observations, developing decision support tools, 

and integrating climate information into development programs and projects. 

All of these activities assist countries in developing stronger institutional capacity 

and more flexible and resilient economies that have the capacity to address both the 

challenges and the opportunities presented by changing climatic conditions. 

In addition, the United States encourages all developing countries to establish 

their own national development plans with the view to create thriving, prosperous 

economies in recognition that successful growth must be predicated upon education, 

rule of law, good governance, the protection of human freedom and economic reforms. This successful and proven approach underpins our wide range of programs 

and activities that assist all developing countries through our trade policies, devel-
216 

opment assistance programs, and international environmental initiatives, as well as 

our support for such internationally-agreed strategies as the Doha Development 

Agenda, the Monterrey Consensus, the Johannesburg Plan of Implementation, and 

the Delhi Declaration. 

MILLENNIUM DEVELOPMENT GOALS

On the issue of whether climate change will negatively impact our ability to implement the Millennium Development Goals (MDG’s), it is important to understand 

that the MDG’s are set for 2015, while projected climate change impacts span a 

much larger time scale. According to the IPCC Working Group II Report (Chapter 

20): ‘‘The anthropogenic drivers of climate change, per se, affect MDG indicators directly in only two ways: in terms of energy use per dollar GDP and CO2 emissions 

per capita. While climate change may, with high confidence, have the potential for 

substantial effects on aspects of sustainability that are important for the MDG’s, the 

literature is less conclusive on whether the metrics themselves will be sensitive to 

either the effects of climate change or to progress concerning its drivers, especially 

in the near-term.’’ 

QUESTIONS SUBMITTED BY SENATOR MARY L. LANDRIEU

Question. How could such valuable assistance be turned away in such a great 

time of need? What are your reasons for turning away the offered foreign aid? How 

did this happen? 

Answer. Katrina generated an unprecedented outpouring of assistance from allies 

and friends around the world. All of these offers of assistance were greatly appreciated, and, in fact, many of the offers were accepted and directed to hurricane recovery efforts. At the same time, not all offers of material and personnel assistance 

was or could be accepted for reasons set forth below. Moreover, as explained more 

fully below, not all offers of financial assistance were directed to the U.S. Government. With our encouragement, a considerable amount of financial assistance was 

donated directly to NGOs working in the affected areas. While some other pledges 

did not materialize, all financial assistance that was received by the U.S. Government was directed toward hurricane recovery efforts. 

The Department of State moved to support the Federal Emergency Management 

Agency (FEMA), the Department of Homeland Security (DHS) and other Federal 

partners that were leading in the response to the disaster. One of the Department’s 

mandates is to help American citizens in trouble/need overseas. This was a unique 

opportunity to help American citizens within the United States. The State Department acted as an intermediary for foreign offers of assistance to the U.S. Government and worked with FEMA, USAID, and other agencies to respond to such requests and expedite delivery of assistance. 

We had two main objectives: 

—Provide all possible support requested by Federal partners. 

—Protect the American people by maintaining U.S. health and safety standards 

as directed by Federal regulators. 

The U.S. Government encouraged foreign donors to direct their cash assistance to 

private organizations from the beginning, consistent with the consensus among aid 

professionals that cash assistance to relief organizations in the affected region was 

the best way for donors to help. The amount of cash actually donated to the U.S. 

Government from international sources totaled $126 million, all of which has been 

distributed by the Department of State to other USG agencies. Not all pledges of 

cash resulted in actual donations—over $450 million in pledges were not fulfilled. 

Working with imperfect information from first responders on conditions and needs 

on the ground, the Department of State worked with FEMA and other agencies to 

identify and arrange transport of commodities, equipment, experts and other in-kind 

assistance that could be utilized quickly and efficiently. 

Not all international material assistance offered was needed. Disaster logisticians 

at FEMA and USAID evaluated the commodities and services offered by foreign governments and organizations, and accepted only those that made sense given all of 

the normal considerations during a disaster—e.g. transport, storage, and processing. 

In many cases, material assistance was more readily available from within the 

United States. Furthermore, some of the foreign commodities offered were not approved for entry into the United States by U.S. regulators, especially foodstuffs and 

medical equipment and supplies. Similarly, some offers of medical services and 

emergency medical teams were also not accepted due to state-based licensing requirements and related issues. We did not want to accept goods which could or 
217 

would not be used. In total, the Department of State, working with USAID and 

FEMA, coordinated the donation of over 5 million pounds of relief supplies. 

Question. Was an internal investigation conducted on this mishandling? Was any 

action taken against employees who were identified in trying to cover-up or hide 

mishandling of situations, specifically the individual just quoted in regards to the 

Italy debacle? 

Answer. Hurricane Katrina was an unprecedented disaster that presented unique 

challenges to domestic agencies and foreign governments trying to assist. The State 

Department, working with other agencies, responded to foreign offers of assistance 

as quickly and flexibly as circumstances permitted. 

The State Department has participated in extensive interagency lessons learned 

reviews and exercises that addressed problems identified during Hurricane Katrina. 

As a result, the U.S. Government has developed significantly improved policies, procedures, and plans for managing international assistance for future domestic disasters. 

The Homeland Security Council (HSC) led an after action review of the U.S. Government response to Katrina, including how we handled offers of assistance from 

foreign governments. The HSC and key agencies, including the State Department, 

reviewed the response, both what went well and what we can do better, and updated the National Response Plan to guide agency actions if another major disaster 

were to strike the United States. The State Department, USAID, FEMA, the Defense Department and others contributed to the plan. 

USG officials did the best they could under unprecedented circumstances. There 

was no cover up of the Italy medical supply contribution. State Department officials 

were in regular contact with Italian authorities regarding the contribution, including on the disposal of the spoiled supplies. 

GAO reviewed the handling of foreign assistance in its report on Hurricane 

Katrina International Aid (GAO–06–460, April 2006). In its report, the GAO recognized that ‘‘although DOS’s procedures were ad hoc, they did ensure the proper recording of international cash donations that have been received to date, and [GAO 

was] able to reconcile the funds received with those held in the designated DOS account at Treasury.’’ 

Question. I know $60 million of the $126.4 million has been allocated to Louisiana 

and Mississippi K–12 and Higher Ed institutions and that $66 million was contracted to a consortium of 10 faith-based and charity groups, but how much has actually been distributed/used to date? What is holding up the distribution of the remaining funds? Answer. The Department of State transferred $66 million to FEMA on October 20, 2005 and $60 million to the Department of Education (DoEd) on March 17, 2006. 

Although State is not directly responsible for managing the distribution of these 

funds, we understand from FEMA and DoEd that: 

FEMA awarded $66 million to The United Methodist Committee of Relief 

(UMCOR) as a grant to provide case management services. 

FEMA facilitates the UMCOR grant. UMCOR established Katrina Aid Today 

(KAT), a consortium of 10 non-profit relief organizations, to provide case management services in Louisiana and Mississippi. To date, KAT has utilized $33 million 

and are on track to utilize the balance of the $66 million in the remaining time of 

the grant. 

DoEd awarded grants totaling $30 million available to 14 Higher Education institutions in Louisiana and Mississippi. These institutions have been able to draw on 

those funds according to their own reconstruction timetables. We understand that 

as of April 27, 2007, some institutions had utilized their entire grants; others were 

still drawing on the available funds as they proceed with their rehabilitation plans. 

DoEd asked the Louisiana DoEd to develop a program to award grants totaling 

$25 million. On April 19, 2007, the Louisiana Board of Education approved grants 

of $190,000 each to 130 private and public schools. The current award period for 

use of these funds runs until November 30, 2007. Funds would be available on a 

year to year basis until all funds have been expended. 

DoEd distributed $5 million to the Greater New Orleans Educational Foundation 

for the planning and implementation of a long range strategy for K–12 educational 

services. 

Question. Also, some questions were raised surrounding the terms in the contract 

proposal for the $66 million consortium contract. Are you conducting oversight on 

this proposal, to ensure it is being used solely for its intended purposes? 

Answer. The Department of State distributed $66 million to the Federal Emergency Management Agency (FEMA) in October 2005, to finance a social service case 

management system for Katrina’s victims. In December 2005, DHS/FEMA granted 

the $66 million to the United Methodist Committee on Relief (UMCOR), which es-
218 

tablished Katrina Aid Today, a case management consortium of ten social service 

and voluntary organizations. 

FEMA has assured State that it is conducting oversight of the contract to ensure 

appropriate use in accordance with standard auditing practice/procedures. State officials met with officials from FEMA’s Office of Inspector General when that entity 

was developing its auditing plans. 

FEMA requires quarterly reports that address both financial and programmatic 

information as well as weekly reports detailing the number of cases and case managers. FEMA has appointed a liaison to Katrina Aid Today that not only monitors 

reports but attends meetings at all levels (national, regional, grass roots) and 

consults with Katrina Aid Today on all programmatic and informational exchanges. 

Question. What is the progress/status of the State Department’s progress on completing all 9 recommendations from the Federal Government Katrina Lessons 

Learned exercise? If you have completed all recommendations, were they finished 

before June 1, 2006? 

Answer. Below are the recommendation and status of the nine items identified for 

the State Department from the Katrina Lessons Learned exercise: 

Recommendation 89. DOS should lead the revision of the International Coordination Support Annex (ICSA) to the National Response Plan (NRP), clarifying responsibilities of Department of State (DOS), Department of Homeland Security (DHS), 

Department of Defense (DOD), and other supporting agencies in response to domestic incidents. This revision should begin immediately. 

Status: Completed. A State Department-led interagency group completed the first 

revision of the ICSA in February 2007 in consultation with the Homeland Security 

Council. The revisions clarify expanded roles and responsibilities of USG agencies 

in managing the international aspects of a domestic incident. The group also included representatives from the Departments of Homeland Security, Defense, 

Health and Human Services, Agriculture, and Transportation, and the Agency for 

International Development. 

Recommendation 90. DOS and DHS should lead an interagency effort that will 

quickly develop procedures to review, accept or reject any offers of international assistance for a domestic catastrophic incident. 

Status: Completed. An interagency group consisting of the Department of State, 

USAID/Office of Foreign Disaster Assistance (AID), DHS/FEMA, DOD, and the 

American Red Cross (ARC) has developed a system for managing international assistance during a domestic disaster. The system outlines policies and procedures to 

systematically manage offers of, or United States requests for, international material assistance during a United States domestic disaster. It also specifies the roles 

and responsibilities of participant agencies, provides standard operating procedures 

for managing offers of foreign assistance and domestic requests for foreign resources, and outlines the process for receiving and distributing international assistance that is accepted by the U.S. Government. The core procedures and arrangements detailed in the manual were agreed informally among participants by June 

1, 2006. 

Recommendation 91. DHS should lead an interagency effort to create and routinely update a prioritized list of anticipated disaster needs for foreign assistance 

and a list of items that cannot be accepted. 

Status: Completed. The interagency has established procedures for coordinating 

with USG regulatory agencies for the entry, handling, and use of foreign resources 

during a disaster. Regulatory agencies provide technical advice and review offers of 

international assistance prior to FEMA acceptance. The procedures include guidance 

on acceptable and unacceptable items to assist the Department of State in communicating with the international community. 

Recommendation 92. DOS should establish an interagency process to: determine 

appropriate uses of international cash donations; to ensure timely use of these funds 

in a transparent and accountable manner; to meet internal Federal Government accounting requirements; and to communicate to donors how their funds were used. 

Status: Completed. Procedures have been established to manage the receipt, distribution, and use of foreign cash donations made during a domestic disaster. An 

interagency Working Group will be convened as necessary to address fund management issues and make recommendations on funding disaster recovery projects. Immediate needs would be pre-identified by FEMA, with the understanding that certain donations may be directed to longer term disaster recovery. 

Recommendation 93. Public and Diplomatic Communications during domestic 

emergencies should both encourage cash donations—preferably to recognized nonprofit voluntary organizations with relevant experience—and emphasize that donations of equipment or personnel should address disaster needs. 
219 

Status: Completed. As was done during Katrina, the State Department provides 

instructions to all U.S. diplomatic missions abroad advising them to encourage foreign entities wishing to assist to make cash donations directly to appropriate NGOs 

rather than the USG. 

Recommendation 94. The Department of State and the Department of Homeland 

Security should jointly develop procedures to ensure that the needs of foreign missions are included in domestic plans for tracking inquiries regarding persons who 

are unaccounted for in a disaster zone. 

Status: Completed. The Department of State has worked with DHS/FEMA and 

the ARC to ensure that, during a domestic disaster, the USG honors its international obligations under the Vienna Convention on Consular Relations. Although 

the USG is not required to track down and find missing foreign nationals during 

a disaster in the United States, under the Convention it is obligated to assist foreign 

missions in obtaining ‘‘appropriate consular access’’ to their nationals. 

The Department of State’s Office of Public Affairs has designated personnel to 

work with DHS/FEMA during domestic emergencies. These personnel will train 

with DHS/FEMA and will be part of FEMA’s information operation from the outset 

of a major domestic crisis, in order to ensure efficient handling of queries from and 

consistent messaging to foreign missions and foreign media. 

The Department of State’s Office of Foreign Missions and the ARC have discussed 

with foreign missions in Washington, DC how foreign missions can best utilize the 

ARC’s missing persons’ registry to locate missing foreign nationals in the United 

States. 

Recommendation 95. DHS and DOS should revise the NRP to include DOD and 

Department of Agriculture (USDA)-Food Safety Inspection Service as cooperating 

agencies to the International Coordination Support Annex. Including DOD more directly in foreign assistance management would leverage existing relationships with 

partner military establishments and help to ensure that staging areas for the acceptance of foreign aid are preplanned and quickly available. 

Status: Completed. The revised ICSA Annex to the NRP includes both DOD and 

USDA as cooperating agencies. Within the IAS, regulatory agencies such as the 

USDA provide technical advice and review offers of international assistance prior 

to FEMA acceptance. 

Recommendation 96. DHS should include DOS and foreign assistance management in domestic interagency training and exercise events. Inclusion in the new National Exercise Program (NEP) should occur before the end of fiscal year 2006. 

Status: We refer you to DHS regarding its training and exercise events. We understand DHS is developing an international assistance training module for use in 

future exercises. DHS can provide more detailed information. 

Recommendation 97. DHS should provide daily disaster response situational updates through the Secretary of State to all Chiefs of Mission or Charge ́ d’Affaires. 

These updates should improve situational awareness and provide information to address host government concerns or questions. 

Status: DHS has assured State it will provide appropriate updates to inform U.S. 

Missions overseas and, by extension, foreign governments. 

Question. What is the timeline of when an amendment to the International Coordination Support Annex to the National Response Plan may take place? What else 

must be completed to reach this goal? 

Answer. An interagency group completed the first revision of the ICSA in February 2007. The group included representatives from the Departments of State, 

Homeland Security, Defense, Health and Human Services, Agriculture, and Transportation, and the Agency for International Development. Within the Department 

of State, we continue to ensure that relevant bureaus are familiar with the changes 

to the National Response plan and prepared to act in the event the National Response Plan is activated. 

Question. With DOS designated the lead agency, can I get from you, in writing, 

the status of where all affected agencies are in completing the nine recommendations. If they are complete, I want to know their status on completing final recommendation for amending the International Coordination Support Annex to the 

National Response Plan? 

Answer. Below are the recommendation and status of the nine items identified for 

the State Department from the Katrina Lessons Learned exercise: 

Recommendation 89. DOS should lead the revision of the International Coordination Support Annex (ICSA) to the National Response Plan (NRP), clarifying responsibilities of Department of State (DOS), Department of Homeland Security (DHS), 

Department of Defense (DOD), and other supporting agencies in response to domestic incidents. This revision should begin immediately. 
220 

Status: Completed. A State Department-led interagency group completed the first 

revision of the ICSA in February 2007 in consultation with the Homeland Security 

Council. The revisions clarify expanded roles and responsibilities of USG agencies 

in managing the international aspects of a domestic incident. The group also included representatives from the Departments of Homeland Security, Defense, 

Health and Human Services, Agriculture, and Transportation, and the Agency for 

International Development. 

Recommendation 90. DOS and DHS should lead an interagency effort that will 

quickly develop procedures to review, accept or reject any offers of international assistance for a domestic catastrophic incident. 

Status: Completed. An interagency group consisting of the Department of State, 

USAID/Office of Foreign Disaster Assistance (AID), DHS/FEMA, DOD, and the 

American Red Cross (ARC) has developed a system for managing international assistance during a domestic disaster. The system outlines policies and procedures to 

systematically manage offers of, or United States requests for, international material assistance during a United States domestic disaster. It also specifies the roles 

and responsibilities of participant agencies, provides standard operating procedures 

for managing offers of foreign assistance and domestic requests for foreign resources, and outlines the process for receiving and distributing international assistance that is accepted by the U.S. Government. The core procedures and arrangements detailed in the manual were agreed informally among participants by June 

1, 2006. 

Recommendation 91. DHS should lead an interagency effort to create and routinely update a prioritized list of anticipated disaster needs for foreign assistance 

and a list of items that cannot be accepted. 

Status: Completed. The interagency has established procedures for coordinating 

with USG regulatory agencies for the entry, handling, and use of foreign resources 

during a disaster. Regulatory agencies provide technical advice and review offers of 

international assistance prior to FEMA acceptance. The procedures include guidance 

on acceptable and unacceptable items to assist the Department of State in communicating with the international community. 

Recommendation 92. DOS should establish an interagency process to: determine 

appropriate uses of international cash donations; to ensure timely use of these funds 

in a transparent and accountable manner; to meet internal Federal Government accounting requirements; and to communicate to donors how their funds were used. 

Status: Completed. Procedures have been established to manage the receipt, distribution, and use of foreign cash donations made during a domestic disaster. An 

interagency Working Group will be convened as necessary to address fund management issues and make recommendations on funding disaster recovery projects. Immediate needs would be pre-identified by FEMA, with the understanding that certain donations may be directed to longer term disaster recovery. 

Recommendation 93. Public and Diplomatic Communications during domestic 

emergencies should both encourage cash donations—preferably to recognized nonprofit voluntary organizations with relevant experience—and emphasize that donations of equipment or personnel should address disaster needs. 

Status: Completed. As was done during Katrina, the State Department provides 

instructions to all U.S. diplomatic missions abroad advising them to encourage foreign entities wishing to assist to make cash donations directly to appropriate NGOs 

rather than the USG. 

Recommendation 94. The Department of State and the Department of Homeland 

Security should jointly develop procedures to ensure that the needs of foreign missions are included in domestic plans for tracking inquiries regarding persons who 

are unaccounted for in a disaster zone. 

Status: Completed. The Department of State has worked with DHS/FEMA and 

the ARC to ensure that, during a domestic disaster, the USG honors its international obligations under the Vienna Convention on Consular Relations. Although 

the USG is not required to track down and find missing foreign nationals during 

a disaster in the United States, under the Convention it is obligated to assist foreign 

missions in obtaining ‘‘appropriate consular access’’ to their nationals. 

The Department of State’s Office of Public Affairs has designated personnel to 

work with DHS/FEMA during domestic emergencies. These personnel will train 

with DHS/FEMA and will be part of FEMA’s information operation from the outset 

of a major domestic crisis, in order to ensure efficient handling of queries from and 

consistent messaging to foreign missions and foreign media. 

The Department of State’s Office of Foreign Missions and the ARC have discussed 

with foreign missions in Washington, DC how foreign missions can best utilize the 

ARC’s missing persons’ registry to locate missing foreign nationals in the United 

States. 
221 

Recommendation 95. DHS and DOS should revise the NRP to include DOD and 

Department of Agriculture (USDA)-Food Safety Inspection Service as cooperating 

agencies to the International Coordination Support Annex. Including DOD more directly in foreign assistance management would leverage existing relationships with 

partner military establishments and help to ensure that staging areas for the acceptance of foreign aid are preplanned and quickly available. 

Status: Completed. The revised ICSA Annex to the NRP includes both DOD and 

USDA as cooperating agencies. Within the IAS, regulatory agencies such as the 

USDA provide technical advice and review offers of international assistance prior 

to FEMA acceptance. 

Recommendation 96. DHS should include DOS and foreign assistance management in domestic interagency training and exercise events. Inclusion in the new National Exercise Program (NEP) should occur before the end of fiscal year 2006. 

Status: We refer you to DHS regarding its training and exercise events. We understand DHS is developing an international assistance training module for use in 

future exercises. DHS can provide more detailed information. 

Recommendation 97. DHS should provide daily disaster response situational updates through the Secretary of State to all Chiefs of Mission or Charge ́ d’Affaires. 

These updates should improve situational awareness and provide information to address host government concerns or questions. 

Status: DHS has assured State it will provide appropriate updates to inform U.S. 

Missions overseas and, by extension, foreign governments. 

QUESTIONS SUBMITTED BY SENATOR JACK REED

Question. The START Strategic Arms Reduction Treaty expires December 2009 

but either side must notify the other one year in advance. The Russians have expressed an interest in beginning discussions, but the United States does not appear 

to be interested. When will the United States begin discussions on START I extension? 

The Moscow Treaty, even though it is a Treaty of no duration beyond the day in 

2012 when it comes into force and expires, relies on the inspection provisions of 

START I. Unless START I is extended there is no transparency or semblance of 

verification under the Moscow Treaty. 

Would the administration support multiparty talks along the lines of those suggested by Senator Nunn, George Schultz, and Henry Kissinger, to substantially reduce total stockpiles of nuclear weapons? 

Why should other nations not be worried about the U.S. decision to pursue a Reliable Replacement Warhead? How is this program consistent with the U.S. obligations under Article VI of the NPT? (Article VI directs the nuclear weapons states 

to work toward the elimination of nuclear weapons) 

Answer. The START Treaty was valuable in a time when the United States and 

Russia had a relationship based on enmity and distrust. The Moscow Treaty took 

the first step in formalizing our new strategic relationship. As a result, by the end 

of 2012, both sides will have reduced their strategic nuclear warheads to no more 

than 1,700–2,200, the lowest levels in decades and less than one quarter of their 

cold war peak. In addition, the United States and Russia have both stated their intention to carry out strategic offensive reductions to the lowest level consistent with 

their national security requirements, including commitments to allies and friends. 

By its terms, the START Treaty is scheduled to expire in December 2009. In anticipation of the expiration, the United States and Russia have begun to consider 

and discuss what type of arrangement will follow START. Both sides believe that 

it is important for a follow-on arrangement to provide predictability for the sides 

in strategic matters. We need to understand the trends and directions of each others’ strategic nuclear forces. Neither side believes that extension of the START 

Treaty is the most effective way to achieve the predictability we seek, although both 

are drawing upon the START Treaty to find the best tools to either employ or modify for gaining the predictability our two nations seek. 

Former Under Secretary of State for Arms Control and International Security Affairs, Robert Joseph, met several times over the past year with his Russian counterpart, Deputy Foreign Minister Sergey Kislyak to explore a post-START arrangement. At their meeting on January 29 in Moscow, they agreed to hold experts talks 

to continue the exchanges on this subject. 

The first of these meetings was held in Berlin on March 28. The United States 

effort is led by Assistant Secretary of State for Verification, Compliance and Implementation, Paula DeSutter. The Russian effort is lead by Ministry of Foreign Affairs 

Director of Security and Disarmament Affairs, Anatoliy Antonov. 
222 

The United States and Russia are now engaged in discussions aimed at developing transparency and other measures to provide continuity and predictability regarding strategic nuclear forces in a post-START arrangement, including exchanges 

of information, notifications, visits, and other mutually agreed measures. 

With respect to the Reliable Replacement Warhead (RRW), RRW will enable us 

to fulfill the President’s goal of achieving a credible deterrent with the lowest possible number of nuclear warheads consistent with our national security needs, including our obligations to our allies. RRW is not a new military capability, but is 

a means to incorporate new technology for safety, security, and to ensure-long-term 

reliability of the U.S. nuclear stockpile. RRW is fully consistent with our obligations 

under the Nuclear Nonproliferation treaty—including Article VI—and would eventually enable further reductions in the stockpile. RRW will reduce the likelihood of 

the need to return to underground nuclear testing. It will also strengthen extended 

deterrence and our commitment to allies and friends. 

Question. In its fiscal year 2008 budget request, the administration breaks the 

parity between Armenia and Azerbaijan, in favor of Azerbaijan, in both Foreign 

Military Financing (FMF) and International Military Education and Training 

(IMET). What is the rationale for the divergence from military parity between Armenia and Azerbaijan? 

Would a break in military parity in Azerbaijan’s favor undermine the Nagorno 

Karabakh peace process and negate the role of the United States as an impartial 

broker of peace? 

Answer. In light of the ongoing conflict over Nagorno-Karabakh, U.S. military assistance to both Azerbaijan and Armenia is carefully considered to ensure that it 

does not undermine or hamper ongoing efforts to negotiate a peaceful settlement between Armenia and Azerbaijan or be used for offensive purposes against Armenia. 

In fiscal year 2008, the administration looks forward to a robust program of military 

cooperation with both Azerbaijan and Armenia, based on activities tailored to U.S. 

interests and local capabilities in each country. 

Specific increases for Azerbaijan are linked to U.S. priorities in the war on terror, 

building Azerbaijan’s peacekeeping capabilities, and enhancing Caspian maritime 

security. The administration believes that building the maritime capabilities of Caspian Sea countries including Azerbaijan is important to prevent the transit of dangerous materials, to deter and prevent terrorist activity, and to support the growing 

contribution of the Caspian basin to world energy supplies. 

We do not believe that the differences in security assistance in the fiscal year 

2008 budget requests undermine prospects for peace or compromise our ability to 

serve in good faith as an impartial mediator for the Nagorno-Karabakh conflict. As 

a mediator, we consistently deliver the message to both sides that only a peaceful 

solution for the conflict is acceptable. We hope that the presidents of Armenia and 

Azerbaijan will endorse as soon as possible the set of Basic Principles for the peaceful settlement of the conflict that they have been negotiating for the past several 

months. It is longstanding U.S. policy that we support the territorial integrity of 

Azerbaijan and—through our role as one of the three OSCE Minsk Group Co-Chair 

countries, along with Russia and France—seek to help Armenia and Azerbaijan 

reach a peaceful negotiated settlement of the Nagorno-Karabakh conflict. A peaceful 

resolution of the conflict will increase regional security and allow for the opening 

of trade and communications links that will be important for the future prosperity 

of the South Caucasus region. 

Question. On what grounds has the administration sought a substantial reduction 

in economic assistance to Armenia? 

Does the Millennium Challenge Account continue to supplement and not replace 

traditional economic assistance to Armenia? 

Answer. The administration considers the totality of U.S. assistance resources 

available when formulating its bilateral budget requests. The fiscal year 2008 budget request for Armenia decreased by 48 percent (over $35 million) from fiscal year 

2006. This decline reflects in part reduced need as a result of Armenia’s successful 

indicators and performance, particularly in promoting economic growth and addressing rural poverty, but also Armenia’s 5-year, $236 million Millennium Challenge 

Corporation (MCC) Compact. If estimated MCC disbursements (over $60 million) for 

fiscal year 2008 are taken into account, the actual fiscal year 2008 funding level for 

Armenia increases by 34 percent to more than $98 million. 

Armenia’s MCC Compact is focused on irrigation systems and rural road rehabilitation. While the country’s recent economic growth and standard of living surpass 

most developing countries, the sustainability of this performance may be weakened 

by the government’s inconsistent approach to implementing democratic reforms. In 

line with the MCC Compact signed in March 2006 and Armenia’s good indicators 

and performance, we have shifted some investments from Economic Growth and In-
223 

vesting in People and increased our focus on Ruling Justly to promote the sustainability of reform. 

Existing development funding in the economic sector is therefore targeted to providing support for small- and medium-sized enterprise development, financial sector 

development, and regulatory reform to complement the MCC program and maximize 

its impact. 

Question. One of the most useful tools in Afghanistan and Iraq has been the 

‘‘Commanders Emergency Response Program’’, or CERP funds, which gives military 

commanders unrestricted, undedicated funds to immediately address relief and reconstruction issues. I have heard during my visits that it would be very useful if 

the State Department has an equivalent program—that there is too much bureaucracy in State Department funding and the State Department has to go the DOD for 

needed funds. Is it true State personnel ask for CERP funds? Should the State Department institute a CERP-like program—particularly since State Department and 

USAID workers will be in Iraq and Afghanistan long after the military leaves? 

Answer. The Department of State and USAID coordinate with DOD at the Provincial Reconstruction Team (PRT) level on the use of Commanders Emergency Response Program (CERP) funds. Department of State and USAID foreign assistance 

currently incorporates a number of programs to expediently respond to local needs 

in places like Iraq and Afghanistan. In Iraq, these programs, coordinated through 

the Provincial Reconstruction Teams, include Provincial Reconstruction Development Councils (PRDC), the Community Action Program (CAP) and the Community 

Stabilization Program (CSP). In close coordination with Iraqi officials, the Provincial 

Reconstruction Development Councils (PRDCs) in all eighteen governorates in Iraq 

identify critical projects that fulfill immediate community needs and implement 

those programs. Coordinated project selection by the PRTs and PRDCs fosters consensus-building among Iraqi officials, while helping to enhance the position of moderate officials and to isolate extremists. This program has already started to show 

impressive results and is accelerating with an additional $600 million appropriated 

in the fiscal year 2007 supplemental. 

The PRDC program is complemented by two USAID programs, also coordinated 

through the PRTs, which reach out to neighborhoods and transform communities. 

USAID’s CAP program establishes neighborhood councils to conduct small scale infrastructure projects and community revitalization. The CSP targets conflict-prone 

neighborhoods and works to revitalize the economy through job creation and infrastructure projects. CSP recently reached its target of establishing 40,000 jobs in 

Baghdad. 

While USAID and State do not have a precisely CERP-equivalent mechanism by 

which we can obligate funds without procurement and other restrictions, each of 

these is a flexible, quick response program that enables the U.S. Government to respond to relief and reconstruction needs in Iraq. 

We are eager, however, to continue to work with Congress to determine the most 

effective mechanisms to respond fully to relief and reconstruction needs worldwide. 

At present, we work to use existing authorities and funds to be as flexible and responsive as possible in states characterized by political, economic, and security instability. 

For example, we appreciate Congress’ support for funding accounts like International Disaster and Famine Assistance (IDFA), Peacekeeping Operations (PKO), 

and Transition Initiatives (TI) that address urgent humanitarian and post-conflict 

needs. The President also requested funding in fiscal year 2008 within the PKO account to bolster flexible reconstruction and stabilization capability in places such as 

Lebanon and Sudan. In addition, as you are aware, the Department of State has 

created the Office of the Coordinator for Reconstruction and Stabilization, with the 

intent to foster rapid response capabilities and programming. We appreciate the 

Senate’s support in its passage of $50 million in the fiscal year 2007 supplemental 

(contingent on specific authorization in a subsequent act of Congress) to support and 

maintain a Civilian Reserve Corps, whose expertise and rapid deployment will allow 

us to further ensure effective use of post-conflict assistance. 

Finally, the fiscal year 2008 budget request is built to support and implement stabilization strategies in such countries as Iraq, Afghanistan, Sudan, Liberia, and the 

Democratic Republic of the Congo. The request carefully considered the appropriate 

amount, account authorities, and purpose for the funds requested, such that stabilization strategies could be supported with the appropriate tools. Earmarks and 

account shifts limit our ability to effectively employ funds within current authorities 

to achieve success in difficult and rapidly transitioning environments. We appreciate 

Congress’s consideration of these factors as you evaluate the fiscal year 2008 request. 
224 

Question. Report on the Need to Improve Interagency Support to National Security Efforts. 

Madam Secretary, section 1035 of the Fiscal Year 2007 National Defense Authorization bill directed the President to submit a report on improving interagency civilmilitary support for U.S. national security missions, including peace and stability 

operations. The report was due on April 1, but the Armed Services Committee has 

not received it. When will it be submitted? Tell us, please, why it has been delayed. 

Answer. The National Security Council tasked the Department of Defense with 

drafting the report called for in section 1035 of the Fiscal Year 2007 National Defense Authorization bill, in coordination with the State Department. Given the complexity and importance of the report’s topic, Defense and State have worked closely 

together in its preparation. We regret the delay in its submission; the report is in 

the final stages of review and we anticipate that it will be transmitted to Congress 

shortly. 

Question. Madam Secretary, the Fiscal Year 2007 National Defense Authorization 

bill also directed the President—in section 1211—to appoint a senior coordinator for 

North Korea policy by December 16, 2006. This is similar to action Congress took 

in 1998 when it directed President Clinton to review his North Korea policy and 

appoint a special coordinator. President Clinton appointed Former Secretary of Defense William J. Perry. Secretary Perry launched a comprehensive review, and established new unity among Republicans and Democrats and, the United States 

managed to keep most of North Korea’s nuclear and missile activities frozen. I understand that last December diplomatic efforts—that led to the February 13 agreement—were ongoing. But since then, 3 months have gone by. This action is 5 

months overdue, and our negotiations are stalled. 

Why have we had a 5-month delay, and when can we expect a coordinator to be 

appointed? 

Answer. As noted in your question, the Six-Party Talks have made progress— 

marked by the February 13 Initial Actions agreement to implement the September 

2005 Joint Statement, the March 13–14 visit of IAEA Director General ElBaradei 

to North Korea and the March inaugural meetings of the Six-Party working groups. 

Assistant Secretary Hill and the interagency delegations supporting the Talks and 

its five constituent working groups continue to engage our Six-Party partners, as 

well as the IAEA, on the way forward on DPRK denuclearization. Interagency coordination and attention to North Korea issues also continues on a regular basis 

with the engagement of senior State Department officials. 

The 2007 National Defense Authorization Bill directed the President to appoint 

a senior coordinator for North Korea policy. The interagency is continuing to deliberate on this and will send its recommendation to the President shortly. The State 

Department will continue to concentrate its efforts on this important issue. 

Question. How does the U.S. position on Nagorno-Karabagh in the human rights 

report differ from the Azerbaijani position? 

Could you please explain the decision process behind crafting and introducing this 

new language? 

The State Department did post revised language on its website but then restored 

the original language a few days later. Can you please walk me through that process—who was involved in the initial revision, then the subsequent return to the 

original text, and the justifications they used to guide their actions? 

The press widely reported that the Azerbaijani government lodged protests with 

the administration on this issue—and even went to the extent of postponing a 

planned bilateral security meeting until the text of our human rights report was 

changed to its satisfaction. Is it the case that the Azerbaijani government has been 

in touch with the administration on this matter? If so, did the Azerbaijani government indicate that it would like to see the language changed in any way? 

In light of this recent controversy, I think it would be constructive for the Department of State to clearly articulate the role that the self-determination of the people 

of Nagorno Karabagh should play in the settlement of this conflict. Do you agree? 

Does the report’s language describing Armenia as an occupier of 

Azerbaijani territory and Nagorno Karabagh reflect U.S. policy? 

Answer. Some mistakenly interpreted the language in the human rights report as 

a change in U.S. policy concerning the Nagorno-Karabakh conflict. There has been 

no change in U.S. policy. The United States remains deeply committed to finding 

a peaceful settlement of the Nagorno-Karabakh conflict as an honest broker in the 

OSCE’s Minsk Group process. As a result of the conflict over Nagorno-Karabakh, 

Armenian forces control most of that region, as well as large portions of surrounding 

territory. We support the territorial integrity of Azerbaijan and hold that the future 

status of Nagorno-Karabakh is a matter of negotiations between the parties. 
225 

The language on Nagorno-Karabakh was intended only as a brief backdrop to the 

description of human rights issues as covered in depth by the country report. After 

the report was published a number of questions arose about the implications of the 

passage in question. We attempted to clarify the language. In so doing, however, we 

encountered additional questions over terminology, and realized that we had only 

added to the confusion by adding new language. We therefore restored the original 

language to that of the version submitted to Congress, while assuring both the Government of Armenia and the Government of Azerbaijan that our policy had not 

changed. 

QUESTIONS SUBMITTED BY SENATOR ROBERT C. BYRD

Question. A. Secretary Rice, how long is this war going to last, and how, specifically, are you measuring ‘‘progress?’’ What evidence can you give us that this time 

is different, and we are about to see progress in Iraq? 

B. Secretary Rice, can you explain to the Committee why a coordinator for Iraq 

policy—what has been dubbed a ‘‘war czar’’ by the media—is necessary? I thought, 

according to the Constitution, the President was the ‘‘war czar.’’ Who has been managing Iraq policy in the administration in the absence of this position? How do you 

foresee working with the new ‘‘war czar,’’ if one were to be appointed? 

Answer. A. We measure progress along three tracks—security, political, and economic—and remain fully committed to helping the Iraqi Government meet ‘‘benchmarks’’ it has articulated. This includes passing key legislation, including a hydrocarbons law, De-Ba’thification reform, constitutional review, and provincial elections. The Iraqi Government understands the importance of meeting these benchmarks and is working towards that goal. We have already seen some progress, but 

much hard work is yet to be done. For example, Iraqi political leaders are actively 

negotiating a de-Ba’thification Reform Law and a hydrocarbon package of laws. 

B. As the White House has said, an Assistant to the President and Deputy National Security Advisor for Iraq and Afghanistan is necessary because the President’s ‘‘New Way Forward’’ in Iraq requires greater coordination and involvement 

from across the Government. The individual named to fill this role will handle, fulltime, the implementation and execution of our strategies for Iraq and Afghanistan, 

and will lead the policy development process for these two theaters. He or she will 

report directly to the President and, as an Assistant to the President, will work 

closely with National Security Advisor Steven Hadley, who provides overall leadership of the National Security Council staff. He or she will also be empowered by 

the President to request and receive information and assistance from the Federal 

Departments and Agencies, including the Department of State, needed to carry out 

the President’s strategies. For our part, the Department of State will work closely 

with the new Deputy National Security Advisor for Iraq and Afghanistan to make 

sure he or she has the tools and information needed to carry out the duties of the 

position. 

Question. Secretary Rice, on April 30, 2003, the State Department reported that 

the number of international terrorist attacks worldwide decreased 44 percent and 

anti-U.S. terrorist attacks decreased 65 percent from the previous year. A year and 

a half after September 11, we were apparently doing some things right. Unfortunately, 4 years later, the picture is not so bright: the latest ‘‘Country Report on Terrorism’’ issued by the State Department on April 30, 2007, concluded that terrorist 

attacks in Iraq had increased 91 percent from 2005 to 2006 and that 65 percent of 

global fatalities from terrorism occurred in Iraq during 2005–2006. In the words of 

the April 2006 National Intelligence Estimate, Iraq has become ‘‘the ‘cause celebre’ 

for jihadists.’’ Looking back, and based on those figures, would you argue that the 

Iraq war has been a positive development for U.S. national security interests? 

Answer. The war in Iraq resulted in the removal of a brutal dictator who terrorized his people, threatened the region and the international community, sanctioned 

the massacre of more than 300,000 Iraqis, and launched the invasion and occupation of Kuwait. The international community tried to counter the threat posed by 

Saddam Hussein by imposing sanctions on his regime. However, the sanctions did 

not have their intended affect, and Hussein continued his course unabated, which 

prompted the administration to pursue other avenues of action. On balance, U.S. 

national security interests have been strongly enhanced by the removal Saddam 

Hussein. 

We would advise against placing too much emphasis on any single set of incident 

data to gauge success or failure against the forces of terrorism. Tallying incident 

data necessarily involves relying exclusively on frequently incomplete and ambiguous information that is not derived from Federal Government collection programs 
226 

created or operated specifically to obtain the data. Simply counting terrorist incidents provides an incomplete measure of our counter terrorism efforts; this does not 

account for the large number of terrorists arrested, plots disrupted, and potential 

recruits and sympathizers who are persuaded to reject the violent ideology and misinformation spread by terrorists. 

Clearly, Iraq has a significant terrorism challenge. A paramount strategic objective in Iraq and the region is preventing al-Qaida, its affiliates or other terrorists 

from establishing safe haven in al-Anbar or anywhere else in Iraq. Groups like alQaida in Iraq (AQI) and Ansar al-Sunna are attempting to drive the United States 

out of Iraq in order to establish a safe haven from which to train and plan attacks. 

Together with the Iraqi Government and our Coalition partners, we are destroying 

terrorist networks and helping the Iraqis secure their territory so al-Qaida cannot 

do in Iraq what they did in Afghanistan before the fall of the Taliban. 

Although Iraq is a proven ally in the War on Terror, Iraq’s developing security 

and armed forces will require further training and resources before they can effectively address the terrorist groups already operating within their borders without 

international assistance. Iraq’s intelligence services continue to improve in both 

competency and confidence but will require additional support before they can adequately identify and respond to internal and external terrorist threats. The international community’s support is critical to ensure that the Government of Iraq’s 

plans to reduce violence, improve services, and increase economic opportunities are 

successful. 

Prospects for increasing stability in Iraq will depend on: the extent to which the 

Iraqi government and political leaders can establish effective national institutions 

that transcend sectarian or ethnic interests and, within this context, the ability of 

the Iraqi Security Forces to pursue extremist elements of all kinds; the extent of 

international assistance to the Government of Iraq to do so; the extent to which extremists, most notably AQI, can be defeated in their attempt to foment inter-sectarian struggle between Shia and Sunnis; and the extent to which Iraq’s neighbors, 

especially Iran and Syria, can be persuaded to stop the flow of militants and munitions across their borders. 

Question. Secretary Rice, we have received reports from former Ambassadors and 

Foreign Service Officers serving overseas that U.S. policy toward detainees—particularly in Guantanamo Bay—is impacting our diplomatic credibility and placing 

our personnel at risk. There is now a widespread belief in the rest of the world that 

the United States routinely tortures prisoners and denies them due process when 

it suits us. The global perception that this is our policy makes it more likely that 

our own citizens could face the same treatment if they are detained overseas. Would 

you agree that it is in our national security interests to reverse this perception? 

What steps would you take in order to do so? 

Answer. The administration is acutely aware of concerns that have been raised 

both at home and abroad about detentions of individuals at Guantanamo Bay. Our 

challenge has been to explain to the world that the United States and other nations 

around the world share a common problem in dealing with dangerous terrorists intent on harming our civilian populations, while at the same time being mindful of 

the need to operate lawfully and in a manner that preserves our commitment to 

principles of human rights and international humanitarian law. 

Unfortunately, the detention facility at Guantanamo Bay has become a lightning 

rod for international criticisms stemming from the misperception that detainees 

there are in a ‘‘legal black hole.’’ In fact, detainees at Guantanamo enjoy a robust 

set of procedural and treatment protections. All detainees at Guantanamo have received or will receive a Combatant Status Review Tribunal to confirm that they are 

properly detained as enemy combatants. Under the Detainee Treatment Act of 2005, 

detainees have the opportunity to challenge these status determinations in the U.S. 

Court of Appeals for the D.C. Circuit. 

In addition, the administration remains committed to trying by military commission those who have violated the laws of war or committed other serious offences 

under the Military Commissions Act of 2006 (MCA). After the Supreme Court in 

Hamdan v. Rumsfeld set aside the original system of military commissions, we 

worked with the Congress to create a new set of military commission procedures in 

the MCA that are fully consistent with U.S. law and Common Article 3 of the Geneva Conventions. 

The Detainee Treatment Act, the Department of Defense Detainee Directive, and 

the revised Army Field Manual on interrogation collectively provide detainees at 

Guantanamo a robust set of treatment protections that are fully consistent with, 

and in some respects exceed, our international obligations, including Common Article 3 of the Geneva Conventions. The success of these legal protections in creating 

an environment at Guantanamo that meets international standards is reflected in 
227 

the reports of visitors to Guantanamo, such as the Special Representative of the 

OSCE Parliamentary Assembly President for Guantanamo, Belgian Senator Anne 

Marie Lizin and the U.K. House of Commons Foreign Affairs Committee. These 

groups have found that conditions there mirror, and in some respects improve upon, 

those of high security prisons in Europe and the United States, with no evidence 

of ongoing detainee abuse. Where allegations are made of detainee abuse, those allegations are investigated fully, and if true, those responsible are held accountable. 

Given the national security imperative to dispel these misimpressions, the Department has made dialogue with our allies on these difficult issues a priority. The 

Department has undertaken extensive bilateral and multilateral efforts to discuss 

with our international partners a common approach to legal issues arising out of 

asymmetric armed conflicts, such as the one we are now in with al-Qaida. In addition, we have made explanation of our detainee policy a cornerstone of our public 

diplomacy efforts through the use of media events, editorials, and outreach to academia and international opinion makers. The result of these efforts has been a 

growing international recognition that the threat posed by al Qaida does not neatly 

fit within existing legal frameworks, and that the need exists to work on common 

approaches to difficult international legal questions posed by this conflict. 

In the long run, the President has stated that he would like to move towards the 

day when we can eventually close the detention facility at Guantanamo Bay. We 

have worked hard with the Department of Defense to reduce the population of 

Guantanamo by more than half. Although our critics abroad and at home have 

called for Guantanamo to be shut immediately, they have not offered any credible 

alternatives for dealing with the dangerous individuals that are detained there. We 

are frequently unable to transfer or release approved detainees because of the 

human rights or security conditions in the detainees’ home countries. And with few 

exceptions we have been unable to resettle these detainees in third countries because other nations are unwilling to accept them for resettlement. Moving forward, 

it is critical that the international community recognize, as the UK Foreign Affairs 

Committee recently did, that many of the detainees at Guantanamo pose a threat 

not just to the United States but to its allies, and that the longer-term solution to 

Guantanamo, including resettlement of detainees who cannot be repatriated, is a responsibility shared between the United States and those allies. 

Question. Secretary Rice, I’m sure that you were as disgusted as I was to see in 

the latest SIGIR report that out of eight rebuilding projects in Iraq recently investigated, which cost approximately $150 million and were declared successes, seven 

are now in disrepair or have been abandoned. Seven out of eight projects that the 

U.S. taxpayer has built in Iraq are now falling apart. What are you doing to ensure 

this waste does not continue? Are you investigating other reconstruction projects 

that have been completed, to verify that they are still operational? Have any lessons 

been learned from the failure of these efforts? 

Answer. We share your concerns about operations and maintenance of our completed reconstruction projects in Iraq. Adequate operations and maintenance are essential to ensure that U.S. funded reconstruction projects are used to the maximum 

benefit of the Iraqi people. The Special Inspector General for Iraq Reconstruction 

(SIGIR), Stuart Bowen, has repeatedly acknowledged the progress that has been 

made in improving our management efforts and has stated that the majority of U.S. 

reconstruction programs have been completed on time and as planned. 

Initially, we anticipated that the Government of Iraq would assume responsibility 

for operations and maintenance of completed reconstruction projects. As SIGIR 

points out, however, there is a clear need for assistance in increasing the Iraqis’ capacity to operate and maintain completed reconstruction projects. To address this 

need, we shifted the emphasis of our assistance programs away from large scale reconstruction projects toward capacity development programs. We programmed $285 

million within the fiscal year 2006 Supplemental Appropriations to contribute to the 

operations and maintenance of completed reconstruction projects and another $60 

million for capacity development for Iraqi technicians and plant managers. 

We continue to work closely with SIGIR, the GAO, and our Inspector General to 

improve management and oversight of U.S. reconstruction projects in Iraq. We have 

benefited from SIGIR’s recommendations on how we can better manage our reconstruction projects in Iraq. 

We are working closely with the Iraqi government to ensure that Iraq’s own resources are used to provide essential services such as oil, water, and electricity for 

the Iraqi people. Despite repeated attacks, the Iraqis have been able to maintain 

key infrastructure facilities in extremely difficult circumstances. Our continued assistance will help Iraq improve the security, operation, and maintenance of these 

critical facilities. 
228 

QUESTIONS SUBMITTED BY SENATOR SAM BROWNBACK

Question. The State Department request for FMF to Ethiopia is only $850,000. In 

your estimation, does the Ethiopian Government have the resources it needs to continue fighting the war against the Islamic Courts and their allies in Somalia? 

Does the administration plan on increasing FMF for Ethiopia in the near future? 

If so, for what specifically will the money be used? 

Answer. Fiscal year 2008 funding request levels were determined in early 2006 

before the Council of Islamic Courts in Somalia had begun to pose a threat to the 

Horn of Africa region. Ethiopia’s ongoing intervention in Somalia to promote the 

Transitional Federal Government and to support the establishment of security and 

national reconciliation have significantly depleted its hard currency reserves and 

taxed its budget. The Ethiopian Government does not have sufficient resources to 

continue at its current pace indefinitely. 

In light of recent developments in the Horn of Africa region and Ethiopia’s needs, 

the administration is reassessing assistance to Ethiopia. 

Questions. Recent news reports have indicated that the Iranian regime has targeted and harassed NGO’s and human rights groups inside Iran in response to the 

announcement of the U.S. allocating $75 million for democracy programs in Iran. 

Are such reports credible, and if so, what kinds of steps are being taken to avoid 

doing harm to the very groups we are trying to empower? 

Where does the administration place the issue of the Iranian regime’s human 

rights violations in the context of the regime’s ongoing nuclear proliferation and 

state sponsorship of terrorism? 

Is there any downside to establishing a special envoy to coordinate human rights 

and democracy promotion for Iran along the lines of Sudan and North Korea? 

Answer. The Department of State’s monitoring of Iranian regime’s reaction to dissidents and activists indicates that the number of arrests has remained consistently 

high, with no noticeable increase following our announcement of the $75 million for 

democracy programs in Iran. We are sensitive to the fact that democracy and 

human rights advocates face risks in Iran. Recent criticism of the USG’s Iran democracy programming activities has missed the mark; it is the actions of the Iranian regime that put its own people in danger, not USG support for freedom and 

personal liberty. We must be clear: the Iranian government, like other authoritarian 

and totalitarian regimes, views democracy and human rights activists as a threat. 

The Islamic Republic has little tolerance for those encouraging reform, irrespective 

of the origins of their funding. But that has never been a justification for us to stop 

supporting democratic actors around the world. Our programming remains important to encourage the development of personal liberty and freedom in Iran and we 

have safeguards to ensure the confidentiality of those with whom we work. We 

would be happy to discuss these safeguards with you. 

While the nuclear debate overshadows other categories of our Iran policy, we 

maintain a strong message on human rights, including not only the condemnation 

of random arrests and tyrannical actions, but also support for the universal rights 

of speech, assembly, press and religion—as a crucial element of the President’s policy of support to the Iranian people. 

Undersecretary for Political Affairs Nick Burns coordinates the Department’s Iran 

efforts, including human rights issues. We do not see the need for a separate human 

rights envoy. Human rights need to be advanced in the overall policies, which we 

are following. Since ultimately the Iranian people must determine their future, public outreach, support to Iranian civil society and people-to-people exchanges provide 

the United States the best opportunity for encouraging democratic reform in Iran. 

Question. What is the timeline for taking more coercive, bilateral and multilateral, 

action against the Sudanese Government if they don’t accept U.N. peacekeeping 

troops and take real steps toward ending the genocide? 

Answer. The United States continues to engage with partners to press Sudan to 

fully cooperate in the peaceful resolution of the crisis in Darfur. We have repeatedly 

made clear to the Sudanese Government that all options remain on the table should 

Khartoum continue to defy the will of the international community. 

President Bush announced on April 18 the USG’s intention to impose increased 

bilateral sanctions on Sudan and pursue additional multilateral sanctions through 

the United Nations if President Bashir does not take significant political, humanitarian and peacekeeping actions to improve the situation in Darfur. The USG 

agreed to allow United Nations Secretary-General Ban Ki-Moon more time to urge 

President Bashir to honor his commitments, but our patience is not open-ended. We 

continue to work towards concerted international pressure on Khartoum. This includes possible multilateral and bilateral sanctions. 
229 

Question. What action are you, and the State Department as a whole, doing to 

engage China to play a more productive role in getting a robust peacekeeping force 

into Sudan and ending the genocide? 

Answer. One of the central objectives of our diplomatic engagement with China 

has been to persuade Beijing to assume responsibilities commensurate with its rising influence and stature. Nowhere is this more the case than on Darfur. China’s 

leverage with Khartoum is not absolute, but there is much that China can do to 

persuade the Government of Sudan to accept the full deployment of the U.N./AU 

hybrid peacekeeping force under U.N. command structures, and to convince Khartoum to engage seriously in a peace process that involves all parties to the conflict. 

Special Envoy Natsios, Deputy Secretary Negroponte, and Assistant Secretary Frazer have all had serious, in-depth discussions on Sudan with the Chinese, as have 

I. 

Let me be clear. China is not where we would like it to be on Darfur. The nointerest loan to build a palace in Khartoum that President Hu announced on his 

February visit to Khartoum is one example. We have also communicated our serious 

concerns to China that weapons sold to the government of Sudan have contributed 

to the violence in Darfur. At the same time, we do see movement in China’s position 

and believe that Beijing has made a decision that it must join with the international 

community in insisting that the atrocities in Darfur must stop. 

For example, China’s lead diplomat at the United Nations, Wang Guangya, helped 

broker the November agreement in Addis Ababa in which the Government of Sudan 

accepted, in principle, the three-phase deployment of the U.N./AU force. China’s diplomacy was likely influential in convincing President Bashir to accept the 3,000- 

person ‘‘heavy support package’’ (HSP) under phase two of the deployment. Perhaps 

most significantly, Beijing recently agreed to send a 275-person engineering unit as 

part of the HSP. These are important steps, taken with our active diplomatic encouragement and support. 

President Bashir has reneged on a number of his commitments and continues to 

obstruct the full deployment of the U.N./AU force under phase three. While China’s 

support for the preliminary deployments is welcome, the critical element, as you 

suggest, is the full deployment of the U.N./AU force under robust U.N. command 

structures. China has said publicly (and to us in private) that it supports this. We 

are committed to working with China and our other international partners to apply 

pressure on President Bashir to accept the full U.N./AU force unequivocally. 

Question. Are Baghdad’s mixed neighborhoods still mixed, or are they continuing 

to become mostly Sunni and mostly Shi’a enclaves? What about other previously 

mixed areas of Iraq? 

Answer. Some mixed neighborhoods still remain in Baghdad, and, although demographic shifts in Baghdad’s neighborhoods and throughout Iraq continue to occur as 

a result of sectarian violence, such shifts have been slowed (and in some areas halted) by Operation Fardh al-Qanoon (Baghdad Security Plan). Older neighborhoods in 

Baghdad, which have been historically mixed for generations, are feeling pressures 

from rival terrorist, insurgent, and militia groups who are trying to win territory 

in these old neighborhoods, but we are working with the Iraqis to try to overcome 

these sectarian problems. 

Question. What is the strategy to diffuse tensions between the Iraqi Kurds and 

Turkey? Are you getting sufficient cooperation from the Iraqi Kurds on fighting the 

PKK terrorists based in the Kurdish region? 

Answer. We are engaged in intense diplomatic efforts to prevent an escalation in 

tension between Turkey and Iraq. Our efforts are led by General Joseph Ralston, 

the Secretary of State’s Special Envoy for Countering the PKK. The General continues to work closely with his Turkish and Iraqi counterparts, as well as officials 

of the Kurdistan Regional Government, on this issue. His conversations have focused on building confidence between Turkey and Iraq and obtaining cooperation to 

fight against the terrorist Kurdistan Workers Party (PKK), which is using Northern 

Iraq as a base of operations for attacks against Turkey. Iraq and Turkey share a 

long border and have many common problems—including ending PKK terror attacks 

in Turkey—and interests; we are hopeful that leading figures in both countries will 

focus on solving problems and advancing mutual interests rather than exploiting 

differences. 

Question. After receiving reports that USAID was supporting programs in occupied Cyprus without consultation with the Government of the Republic of Cyprus, 

the Senate Appropriations Committee included in its fiscal year 2006 Report the following: ‘‘The Committee is concerned that funds made available for bi-communal 

projects on Cyprus have been obligated without appropriate notification and participation of the Government of Cyprus. The Committee believes that if such funds are 

to improve the prospect for peaceful reunification of the island, they must be allo-
230 

cated transparently and in full consultation with the [Government of Cyprus] and 

other interested parties.’’ 

How does USAID engage and consult with the Government of the Republic of Cyprus as Congress directed in the 2006 appropriation? What has USAID done to address the concerns expressed by Congress? 

Since 1993, Congress has imposed a statutory restriction on the use of ESF monies: ‘‘to be used only for scholarships, administrative support of the scholarship program, bi-communal projects, and measures aimed at reunification of the island and 

designed to reduce tensions and promote peace and cooperation between the two 

communities on Cyprus.’’ Has USAID or the State Department used funds outside 

of ESF for programs on Cyprus, thus avoiding Congress’s statutory restriction? 

Answer. The United States is committed to consultation and transparency with 

‘‘the Government of Cyprus and other interested parties’’ on the U.S. foreign assistance program for Cyprus, consistent with the fiscal year 2006 Senate Appropriations 

Committee report. Embassy Nicosia has made it a priority to increase the frequency 

and breadth of consultations since 2005. The Ambassador, Public Affairs Officer and 

USAID Representative in Nicosia have had numerous meetings with Cypriot Government officials to discuss U.S. foreign assistance in Cyprus. USAID has also regularly provided the Government of Cyprus with written information on existing and 

planned activities, and we have taken into account in our programs both U.S. policy 

and concerns expressed by Cypriot officials. For example, we have been careful to 

avoid any implication of recognition of Turkish Cypriot authorities, and we have 

chosen locations for our programs, including for contractor offices, to ensure that 

they do not raise any questions of property claims. 

We support and consistently offer the Government of Cyprus consultations on our 

assistance programs, although the government has not always accepted our offers. 

Obtaining government approval for each project, however, would effectively cede decision-making authority to the Government of Cyprus and in so doing would nullify 

the basic premise of over 30 years of bi-communal programming. This would jeopardize the Turkish Cypriots’ pro-solution leadership and discourage Turkish Cypriots from participating in our programs. Although we welcome consultations with 

the Government of Cyprus, the U.S. Government maintains full authority over and 

accountability for U.S. assistance programs in Cyprus to ensure that they remain 

consistent with U.S. law and U.S. Government policy in support of the reunification 

of Cyprus as a bi-zonal, bi-communal federation. 

USAID conducts its activities in Cyprus in a manner consistent with Congressional concerns and statutes. USAID programs in Cyprus are conducted exclusively 

through use of Economic Support Funds (ESF) and for the purposes outlined in the 

Congressional statutory restriction. The U.S. Embassy uses ESF as well as funds 

from the Department of State’s International Information Program Office, the Education and Cultural Affairs Office, and the European and Eurasian Affairs Press 

and Public Diplomacy Office, for cultural and bi-communal programs in Cyprus, including Fulbright Scholarships. In addition, the Embassy uses Export and Border 

Security funds to help establish fully effective export controls and nonproliferation 

investigations and prosecutions in Cyprus. We use all of these funds transparently, 

and offer to the Government of Cyprus consultations on the use of these funds. Use 

of ESF funds in Cyprus complies fully with the 1993 restriction; non-ESF funds are 

expended in a manner fully consistent with the objectives of that restriction. 

Question. There have been several instances recently of Eastern European governments allowing excavation of and construction on historic Jewish cemeteries. This 

has taken place in Grodno, Belarus; Vilna, Lithuania (Snipiskes Jewish cemetery); 

Pilsen, Czech Republic; and Thessalonika, Greece. 

It has come to my attention that in some countries—particularly Lithuania—the 

U.S. embassy staff has assisted in the protection of Jewish cemeteries, while in 

other countries the U.S. mission has not gotten involved. Does the administration 

have a comprehensive plan to address the desecration of Jewish cemeteries abroad? 

What is being done to ensure that this issue is consistently on the agenda of U.S. 

Missions in Europe? 

Is the U.S. Mission to the European Union involved in this issue, and if so, how? 

Answer. The Department and our Embassies have been very much involved in the 

effort to protect historic Jewish cemeteries in Europe. Belarus, the Czech Republic, 

Greece, Ukraine and Lithuania have been particular areas of focus. Our Embassies 

have approached national, provincial and municipal governments, and have worked 

with the indigenous Jewish communities and with organizations that have cemetery 

protection as one of their goals. 

In addition, the Commission for the Protection of America’s Heritage Abroad has 

also been helpful with threatened cemeteries. The Department and U.S. embassies 

have worked closely with the Commission to protect and preserve cemeteries by as-
231 

sisting in the negotiation of bilateral agreements and through joint efforts to prevent intrusions into burial places. 

The circumstances in each of these cases have differed, but our approach and commitment have been the same: the United States takes these issues seriously and 

works with interested parties to achieve a solution. 

The issue is essentially local in nature. Municipal planning, zoning, cultural, and 

building authorities frequently have primary jurisdiction. Our role has been to bring 

municipal and national authorities together with religious organizations and NGOs 

to seek a settlement that respects the interests of all concerned. In several cases, 

our Ambassadors have been directly involved in these efforts. 

Several years ago our Embassy in Prague brokered an agreement involving the 

construction of a building on a cemetery site in that city. More recently Embassies 

Prague and Minsk have been involved with similar situations in Pilzen and Grodno, 

respectively. Our Embassy in Vilnius has been particularly active in an effort to protect the Snipiskes cemetery. The cemetery issue in Greece goes back many years, 

although there have been no recent developments. There has been no occasion for 

the U.S. Mission to the European Union to be involved. 

As demonstrated above, the Department takes the issue of cemetery desecration 

extremely seriously. The Department’s annual International Religious Freedom Report covers cemetery desecration in considerable detail. 

Question. On February 24, 2005 I joined all 99 of my Senate colleagues in signing 

an appeal to President Putin to return the sacred Schneerson Collection to its rightful owners, Agudas Chasidei Chabad of the United States. During the Helsinki 

Committee’s hearings on the plight of these Jewish texts on April 6, 2005, I had 

the opportunity to meet with elderly survivors of Soviet and Nazi persecution who 

struggled and sacrificed to protect these holy writings and the ideals they represent. 

As you may recall, the case of the Schneerson Collection was raised with you at 

your Senate confirmation hearings, and I certainly appreciate the efforts that you 

and President Bush have made to encourage Russia to finally restore Chabad’s spiritual legacy. Could you please provide an update on the administration’s recent efforts to free the Schneerson Collection? 

Do you plan to raise the issue of the Schneerson Collection with appropriate Russian officials during your visit? Will the administration continue to press Moscow 

on this important issue? 

Answer. Shortly after the April 2005 hearing, the administration made a high 

level effort to convince the Russian Federation to transfer the Schneerson collection 

to Brooklyn. The result was a carefully worded but firmly negative response. 

During his visit to Russia last month, Special Envoy to Monitor and Combat AntiSemitism Gregg Rickman requested that the Russian Government transfer the collection. The Russian authorities declined this request as well. 

I, and other State Department officials, will continue to raise this subject with 

Russian officials as opportunities arise. 

Question. It has come to my attention that Al-Hurra, the Congressionally-funded 

commercial-free Arabic language satellite television network for the Middle East, 

has broadcasted a number of problematic and inappropriate programs since its new 

director, Mr. Larry Register, assumed leadership of the station last November. Specifically, on December, 7, 2006, Al-Hurra broadcasted live a full speech given by 

Sheikh Hassan Nasrallah, the leader of the terrorist group Hezbollah. Also aired 

that month was coverage of the now infamous Holocaust denial conference in Iran, 

with follow-up remarks by the tiny, fiercely anti-Zionist Jewish group Neturei 

Karta, which sent representatives to the conference. 

During a State Department press conference on May 9, 2007, spokesman Sean 

McCormack said that Secretary Rice and the administration believe that Mr. Register is, ‘‘actually doing a pretty good job, a very good job.’’ 

Does the administration still stand by this assessment of Mr. Register’s leadership 

of Al-Hurra? What specific steps are being taken to prevent Al-Hurra in the future 

from serving as a platform for terrorists and Holocaust-deniers? 

Answer. The Broadcasting Board of Governors and the management at Alhurra 

have repeatedly and clearly acknowledged that the incidents you have noted were 

mistakes and not in line with the Middle East Broadcasting Network’s (MBN) own 

editorial policies. 

To deal with this problem, MBN has re-issued its editorial policy, strengthened 

editorial controls, and provided more and better training to its journalists. 

At the same time, MBN has substantially increased its coverage of events related 

to U.S. foreign policy, American society and values, and the network is broadcasting 

a number of innovative programs to serve as a platform for dialogue between and 

among Americans and Arab publics, a niche that is nowhere else to be found on 

Arab television. Alhurra has also taken on the task of promoting democracy with 
232 

its audiences; it did an outstanding job of covering recent elections in Mauritania 

and Egypt, and it recently added a second congressional correspondent to cover the 

policy debates occurring in our own national legislature. Increasingly we hear from 

contacts in the Arab world and elsewhere that this kind of coverage resonates with 

Alhurra’s audiences and as a result it is gaining traction and broadening its reach. 

QUESTION SUBMITTED BY SENATOR LAMAR ALEXANDER

Question. The Senate Committee report language from fiscal year 2006 State and 

Foreign Operations Appropriations bill stated, ‘‘The Committee directs USAID to 

provide $10 million to support the programs and activities of the Financial Services 

Volunteer Corps (FSVC), a moderate increase over prior year funding levels.’’ Yet, 

FSVC only received $4.3 million in fiscal year 2006, down from $7.2 million in fiscal 

year 2005 and $8.1 million in fiscal year 2004. The mission of the FSVC is consistent with U.S. foreign policy objectives to strengthen market economies and promote democracy, and it relies on highly qualified volunteers from the U.S. financial 

sector to accomplish its objectives. 

What is your opinion of the Financial Services Volunteer Corps? If it enhances 

our foreign policy objectives, is there a reason why its funding has been reduced by 

almost 50 percent since fiscal year 2004—and is less than half of what was called 

for in the fiscal year 2006 Committee report? Does USAID intend to increase FSVC 

funding in the future? 

Answer. Current USAID records indicate that new obligations to FSVC were 

$9,555,782 from fiscal year 2006 funds, $2,427,222 from fiscal year 2005 and 

$5,208,219 from fiscal year 2004. 

FSVC was created specifically to deal with the transition of Eastern European 

and former Soviet Union countries from communism to market economies and has 

played an important part in this process. These programs are winding down, most 

rapidly in the economic area. Russia, for example, is slated to have no programs at 

all in the economic growth area by 2008. 

In addition to the reduced demand for the kinds of sophisticated financial services 

offered by FSVC, there is an increased supply in the form of additional organizations like the International Executive Service Corps that have expanded to provide 

such services. This may result in more competition for funding. 

CONCLUSION OF HEARINGS

Senator LEAHY. Thank you all very much for being here. That 

concludes our hearings. 

[Whereupon, at 11:59 a.m., Thursday, May 10, the hearings were 

concluded, and the subcommittee was recessed, to reconvene subject to the call of the Chair.] 
(i) 

LIST OF WITNESSES, COMMUNICATIONS, AND 

PREPARED STATEMENTS 

Page 

Alexander, Senator Lamar, U.S. Senator from Tennessee, question submitted 

by ........................................................................................................................... 232 

Bond, Senator Christopher S., U.S. Senator from Missouri, statements 

of.......................................................................................................................... 14, 168 

Brownback, Senator Sam, U.S. Senator from Kansas, questions submitted 

by ........................................................................................................................... 228 

Byrd, Senator Robert C., U.S. Senator from West Virginia, questions submitted by ............................................................................................................... 225 

Daulaire, Dr. Nils, president, Global Health Council ........................................... 65 

Prepared statement .......................................................................................... 68 

Durbin, Senator Richard J., U.S. Senator from Illinois, questions submitted 

by......................................................................................................................... 85, 213 

Garrett, Laurie, senior fellow for global health, Council on Foreign Relations ....................................................................................................................... 59

Prepared statement .......................................................................................... 61 

Gayle, Dr. Helene, president, Cooperative for Assistance and Relief Everywhere ..................................................................................................................... 51 

Prepared statement .......................................................................................... 54 

Gregg, Senator Judd, U.S. Senator from New Hampshire, prepared statements ...................................................................................................................... 3, 94

Harkin, Senator Tom, U.S. Senator from Iowa, questions submitted 

by................................................................................................................ 84, 190, 212 

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

Prepared statement .......................................................................................... 29 

Landrieu, Senator Mary L., U.S. Senator from Louisiana: 

Prepared statement .......................................................................................... 108 

Questions submitted by ................................................................................... 216 

Leahy, Senator Patrick J., U.S. Senator from Vermont: 

Opening statements .................................................................................... 1, 25, 93 

Prepared statement .......................................................................................... 1 

Questions submitted by ................................................................................... 190 

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

by ........................................................................................................................... 85 

Reed, Senator Jack, U.S. Senator from Rhode Island, questions submitted 

by ........................................................................................................................... 221 

Rice, Hon. Condoleezza, Secretary, Office of the Secretary, Department of 

State ...................................................................................................................... 93 

Prepared statement .......................................................................................... 97 

Summary statement ......................................................................................... 95 

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

Prepared statement .......................................................................................... 3 

(iii) 

SUBJECT INDEX 

DEPARTMENT OF STATE 

OFFICE OF THE SECRETARY

Page 

Additional Subcommittee Questions ...................................................................... 190 

Assisting Adaptation ............................................................................................... 215 

Core Exchange Programs ........................................................................................ 181 

Empowering our People .......................................................................................... 98 

Foreign Aid: 

Our Moral Imperative ...................................................................................... 184 

Reform and Transformational Diplomacy ...................................................... 185 

Funding for International Environmental Programs ........................................... 197 

Health and Development ........................................................................................ 215 

Helping Developing Countries and the Most Vulnerable Populations ................ 102 

Meeting Global Challenges ..................................................................................... 101 

Millennium Development Goals ............................................................................. 216 

Most Katrina Aid From Overseas Went Unclaimed ............................................. 112 

Programs .................................................................................................................. 188 

Regional: 

Overview ............................................................................................................ 188 

Programs ........................................................................................................... 182 

Securing Peace, Supporting Democracy ................................................................. 99 

Specific Priorities ..................................................................................................... 184 

The Asia Foundation’s Mission, Capabilities, and Approach ............................... 188 

Transforming the State Department ...................................................................... 97 

U.S. Assessed Contributions to U.N. Peacekeeping Missions .............................. 190 

UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT 

A Call to Action ........................................................................................................ 73 

Additional Subcommittee Questions ...................................................................... 84 

Afghanistan .............................................................................................................. 20 

African Health Capacity/Brain Drain .................................................................... 85 

Age of Generosity Commences: Still not Enough, but Rapidly Increasing ......... 61 

Agriculture Development in Afghanistan .............................................................. 14 

Assistance for the Middle East ............................................................................... 18 

Building Capacity While Saving Lives ................................................................ 47, 722 

Child Survival .......................................................................................................... 34 

Egypt ......................................................................................................................... 21 

Family Planning and Reproductive Health ........................................................... 41 

Financial Services Volunteers ................................................................................ 15 

Fiscal Year 2008 Budget: International Affairs .................................................... 64 

Foreign Assistance Budget ...................................................................................... 10 

Cuts ................................................................................................................... 16 

Former Soviet Republics ......................................................................................... 11 

Going Backwards on Half a Trillion Dollars ......................................................... 62 

Health Worker Global Policy Advisory Council .................................................... 90 

Secretariat ......................................................................................................... 91 

Healthtech and the Child Survival and Health Account ...................................... 85 

Improving Health, Saving Lives ............................................................................. 71 

In the U.S. Interest ................................................................................................. 72 

Iran ........................................................................................................................... 23 

Maternal: 

Mortality ............................................................................................................ 85 
Page

iv 

Maternal—Continued 

Newborn: 

Child Survival and Health ....................................................................... 30 

Health ......................................................................................................... 31 

Members ................................................................................................................... 90 

Millennium Challenge Corporation ........................................................................ 19 

Modest Investments, Maximum Impact ................................................................ 72 

New Initiative Seeks Practical Solutions to Tackle Health Worker Migration .. 89 

Oslo Ministerial Declaration: Global Health—a Pressing Foreign Policy Issue 

of our Time ........................................................................................................... 89 

Polio Eradication ...................................................................................................... 84 

Principles .................................................................................................................. 4 

Regional Funding Trends ........................................................................................ 7 

Responsiveness to This Subcommittee ................................................................... 3 

Solutions ................................................................................................................... 88

The World: 

Needs Healthcare Workers .............................................................................. 63 

Women & Children ........................................................................................... 69 

Transformational Diplomacy .................................................................................. 9 

Treatment, yes: But not Without Prevention ........................................................ 61 

U.S. Investments—Progress Undermined ............................................................. 70 

USAID Administrator and Director of Foreign Assistance .................................. 13 

What is the Goal? .................................................................................................... 64 

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