II 

114TH CONGRESS 

1ST SESSION S. 1911 

To implement policies to end preventable maternal, newborn, and child deaths 

globally. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 30, 2015 

Ms. COLLINS (for herself and Mr. COONS) introduced the following bill; which 

was read twice and referred to the Committee on Foreign Relations 

A BILL 

To implement policies to end preventable maternal, newborn, 

and child deaths globally. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Reach Every Mother 

5 and Child Act of 2015’’. 

6 SEC. 2. PURPOSE. 

7 The purpose of this Act is to authorize coordination 

8 of a whole-of-government strategic approach to accelerate 

9 action by the United States to assist developing countries 


rfrederick on DSK6VPTVN1PROD with BILLS
2 

•S 1911 IS

1 reach the goal of ending preventable maternal, newborn, 

2 and child deaths by 2035. 

3 SEC. 3. DEFINITIONS. 

4 In this Act: 

5 (1) ADMINISTRATOR.—The term ‘‘Adminis6 trator’’ means the Administrator of the United 

7 States Agency for International Development. 

8 (2) APPROPRIATE CONGRESSIONAL COMMIT9 TEES.—The term ‘‘appropriate congressional com10 mittees’’ means— 

11 (A) the Committee on Foreign Relations 

12 and the Committee on Appropriations of the 

13 Senate; and 

14 (B) the Committee on Foreign Affairs and 

15 the Committee on Appropriations of the House 

16 of Representatives. 

17 (3) COORDINATOR.—The term ‘‘Coordinator’’ 

18 means the Maternal and Child Survival Coordinator 

19 established under section 6. 

20 (4) TARGET COUNTRIES.—The term ‘‘target 

21 countries’’ means specific countries have the greatest 

22 need and highest burden for maternal and child 

23 health interventions, taking into consideration coun24 tries that— 


rfrederick on DSK6VPTVN1PROD with BILLS
3 

•S 1911 IS

1 (A) have high-need communities in fragile 

2 and poor States; 

3 (B) are located in regions with weak health 

4 systems; and 

5 (C) have governments that have dem6 onstrated the political will necessary for mater7 nal and child efforts to be sustainable and ef8 fective. 

9 SEC. 4. STATEMENT OF POLICY. 

10 It is the policy of the United States, in partnership 

11 with developing governments, other donor country govern12 ments, international financial institutions, nongovern13 mental organizations, faith-based organizations, multilat14 eral organizations, and the private sector, to establish and 

15 implement a coordinated, integrated, whole-of-government 

16 strategy to combat the leading causes of maternal, new17 born, and child mortality by— 

18 (1) building on progress and success to date; 

19 (2) scaling up the most effective, evidence-based 

20 interventions with a focus on country ownership; 

21 (3) designing, implementing, monitoring, and 

22 evaluating programs in a way that increases the sus23 tainability and ownership of the programs and im24 proves outcomes in target countries; 


rfrederick on DSK6VPTVN1PROD with BILLS
4 

•S 1911 IS

1 (4) focusing on target countries and other areas 

2 of focus; 

3 (5) streamlining existing resources and scaling 

4 up proven interventions; 

5 (6) increasing transparency and accountability; 

6 (7) supporting the development and scale up of 

7 innovative tools and approaches to accelerate 

8 progress toward ending preventable maternal, new9 born, and child deaths; 

10 (8) creating innovative public-private financing 

11 mechanisms; 

12 (9) requiring that grants, contracts, and coop13 erative agreements for ending preventable maternal, 

14 newborn, and child deaths include targets for in15 creased implementation of proven interventions and 

16 strengthening health systems as appropriate, includ17 ing the establishment of baseline measurements from 

18 which to quantify progress; and 

19 (10) accelerating progress towards self-suffi20 ciency for maternal, newborn, and child health and 

21 survival programs in target countries and other 

22 areas of focus. 

23 SEC. 5. STRATEGY. 

24 (a) IN GENERAL.—The President shall establish an 

25 inter-agency working group, led by the Child and Maternal 


rfrederick on DSK6VPTVN1PROD with BILLS
5 

•S 1911 IS

1 Survival Coordinator at the United States Agency for 

2 International Development (USAID) and establish and 

3 implement, not later than one year after the date of the 

4 enactment of this Act, a coordinated, whole-of-govern5 ment, ten-year strategy to achieve, with partner countries 

6 and donors, the goal of ending preventable maternal, new7 born, and child deaths by 2035. 

8 (b) ELEMENTS.—The strategy established under sub9 section (a) shall— 

10 (1) set outcome-based targets to achieve the 

11 goals of the strategy and ascertain baseline data rel12 evant for each target country and for all areas of 

13 focus and programming as of the date of the release 

14 of the strategy; 

15 (2) utilize existing, reliable data and modeling 

16 to enable agencies to reach such targets; 

17 (3) include specific objectives, programs, and 

18 approaches to utilize highest impact, evidence-based 

19 interventions to address the leading causes of death 

20 among women during pregnancy, childbirth, and 

21 post-delivery; newborns in their first 28 days; and 

22 children under the age of five, building on the evi23 dence outlined in USAID’s ‘‘Acting on the Call: 

24 Ending Preventable Child and Maternal Deaths’’; 

25 (4) focus on target countries; 


rfrederick on DSK6VPTVN1PROD with BILLS
6 

•S 1911 IS

1 (5) include development and scale-up of new 

2 technologies and approaches, including those sup3 ported by public-private partnerships for research 

4 and innovation; 

5 (6) ensure coordination within and amongst the 

6 relevant executive branch agencies and initiatives, 

7 including the United States Agency for International 

8 Development, the Department of State, the Depart9 ment of Health and Human Services, the Centers 

10 for Disease Control and Prevention, the National In11 stitutes of Health, the Millennium Challenge Cor12 poration, the Peace Corps, the Department of the 

13 Treasury, the Office of the Global AIDS Coordi14 nator, and the President’s Malaria Initiative; 

15 (7) improve coordination and efficiency among 

16 relevant executive branch agencies, foreign govern17 ments, and international organizations; 

18 (8) project general levels of resources needed to 

19 achieve the strategy’s stated objectives; 

20 (9) identify strategies for leveraging resources 

21 in new and innovative ways; 

22 (10) align with country-driven maternal, new23 born, and child health and survival plans and plans 

24 of international organizations that will support 


rfrederick on DSK6VPTVN1PROD with BILLS
7 

•S 1911 IS

1 progress towards self-sustainability by partner coun2 tries; and 

3 (11) outline consultations with governments, 

4 international financial institutions, nongovernmental 

5 organizations, faith-based organizations, local and 

6 international civil society groups, multilateral organi7 zations, the private sector, and local health workers 

8 and professional associations, as appropriate. 

9 SEC. 6. ESTABLISHMENT OF A CHILD AND MATERNAL SUR10 VIVAL COORDINATOR. 

11 (a) IN GENERAL.—The President, acting through the 

12 Administrator, shall designate a current USAID employee 

13 serving in a career or non-career position in the Senior 

14 Executive Service or at the level of a Deputy Assistant 

15 Administrator or higher to serve concurrently as the Ma16 ternal and Child Survival Coordinator, who shall be re17 sponsible for overseeing maternal and child health and nu18 trition funding managed by the Bureau of Global Health 

19 of USAID and lead the inter-agency working group estab20 lished under section 5. 

21 (b) DUTIES.—The Coordinator shall— 

22 (1) direct the budget, planning, and staffing to 

23 implement the projects and programs of maternal 

24 and child health and nutrition accounts managed by 

25 the Bureau of Global Health at USAID for the purVerDate Sep 11 2014 04:12 Aug 01, 2015 Jkt 049200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1911.IS S1911

rfrederick on DSK6VPTVN1PROD with BILLS
8 

•S 1911 IS

1 pose of achieving reductions in preventable maternal, 

2 newborn, and child deaths; 

3 (2) lead implementation and revision, not less 

4 frequently than once every 10 years, of the strategy 

5 established under section 5; 

6 (3) cooperate with relevant executive branch 

7 agencies, governments of partner countries, non8 governmental organizations (including faith-based, 

9 community-based and civil society organizations), 

10 and private sector entities to carry out the strategy 

11 and to align current and future instruments with 

12 high-impact, evidence-based interventions to save 

13 lives; 

14 (4) provide direction to and oversee grants, con15 tracts, and cooperative agreements with nongovern16 mental organizations (including faith-based, commu17 nity-based and civil society organizations) and pri18 vate sector entities for the purpose of carrying out 

19 the strategy; and 

20 (5) report to the Administrator regarding im21 plementation of the strategy. 

22 (c) RESTRICTION ON ADDITIONAL OR SUPPLE23 MENTAL COMPENSATION.—The responsibilities and spe24 cific duties of the Coordinator shall be in addition to any 

25 other responsibilities or specific duties assigned to the inVerDate Sep 11 2014 04:12 Aug 01, 2015 Jkt 049200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1911.IS S1911

rfrederick on DSK6VPTVN1PROD with BILLS
9 

•S 1911 IS

1 dividual. The Coordinator shall receive no additional or 

2 supplemental compensation as a result of carrying out re3 sponsibilities and duties under this Act. 

4 SEC. 7. ANNUAL REPORTING ON MATERNAL, NEWBORN, 

5 AND CHILD SURVIVAL. 

6 The President shall update Congress on progress 

7 made to achieve the strategy established under section 5 

8 as well as progress towards the goals set forth in USAID’s 

9 2014 Acting on the Call report by submitting an annual 

10 report to the Committee on Foreign Relations of the Sen11 ate and the Committee on Foreign Affairs of the House 

12 of Representatives and publish all report data on the 

13 Internet website, www.foreignassistance.gov (also known 

14 as the ‘‘Foreign Assistance Dashboard’’). The report shall 

15 include the following elements: 

16 (1) Indicators of progress made by United 

17 States Government programs carried out under ma18 ternal and child health and nutrition accounts man19 aged by the Bureau of Global Health toward improv20 ing maternal, newborn, and child health in each tar21 get country and overall, including— 

22 (A) number of maternal deaths averted; 

23 (B) number of deaths averted of newborns 

24 in their first 28 days; 


rfrederick on DSK6VPTVN1PROD with BILLS
10 

•S 1911 IS

1 (C) number of deaths averted of child be2 fore their fifth birthday; 

3 (D) maternal mortality ratio (per 100,000 

4 live births); 

5 (E) under five mortality rate; 

6 (F) births attended by skilled health per7 sonnel; 

8 (G) density of health workforce (number of 

9 health professionals per population); 

10 (H) descriptions of the measured or esti11 mated impact on maternal, newborn, and child 

12 mortality of each on-going program or project; 

13 and 

14 (I) any other targets identified by the Co15 ordinator or the inter-agency working group as 

16 essential to meeting the goals of the President’s 

17 strategy for ending preventable maternal, new18 born, and child deaths. 

19 (2) Descriptions of how the interventions are 

20 designed— 

21 (A) to increase activities in target coun22 tries; 

23 (B) to reach underserved, marginalized, 

24 and impoverished populations; 


rfrederick on DSK6VPTVN1PROD with BILLS
11 

•S 1911 IS

1 (C) to address causes of maternal, new2 born, and child mortality with innovative efforts 

3 and interventions posed to go to scale; 

4 (D) to invest in activities that empower 

5 women, support voluntarism, and provide re6 spectful maternity care; 

7 (E) to improve transparency and account8 ability at all levels and include common metrics 

9 for tracking progress; 

10 (F) to ensure that high impact, evidence11 based interventions are prioritized; and 

12 (G) to expand access to quality services 

13 through community-based approaches and in14 clude community accountability measures. 

15 (3) Assessments of progress made over the re16 porting period towards improving the indicators set 

17 forth under paragraph (1). 

18 (4) Reporting on each aspect of the strategy es19 tablished under section 5, including— 

20 (A) multi-sectoral approaches, specific 

21 strategies, and programming utilizing high im22 pact, evidence-based interventions to address 

23 the leading causes of preventable maternal, 

24 newborn, and child deaths; 


rfrederick on DSK6VPTVN1PROD with BILLS
12 

•S 1911 IS

1 (B) activities to develop and scale up new 

2 technologies, interventions, or approaches, in3 cluding those identified by public-private part4 nerships for research and innovation; 

5 (C) coordination and efficiency within and 

6 among each agency in the inter-agency working 

7 group, foreign governments, nongovernmental 

8 organizations, and international organizations; 

9 (D) methods used to leverage new financial 

10 and other public and private resources in inno11 vative ways; and 

12 (E) best practices identified by the execu13 tive branch and its inter-agency working group. 

14 (5) Reporting on grants, contracts, and cooper15 ative agreements awarded, including— 

16 (A) a comprehensive list of USAID grants, 

17 contracts and cooperative agreements awarded 

18 in implementation of the strategy created under 

19 this Act; and 

20 (B)(i) a description of— 

21 (I) the targets for interventions or 

22 services and the baseline against which 

23 they are measured; and 

24 (II) the status of progress in meeting 

25 the targets; or 


rfrederick on DSK6VPTVN1PROD with BILLS
13 

•S 1911 IS

1 (ii) in exceptional circumstances where 

2 USAID determines that inclusion of targets or 

3 baseline measurements is not reasonably pos4 sible, an explanation of how the impact of the 

5 grant, contract, agreement or resulting program 

6 is being measured. 

7 (6) Comprehensive and disaggregated informa8 tion consistent with the United States Government’s 

9 commitment to implement transparency measures. 

10 SEC. 8. ESTABLISHMENT OF AN INNOVATIVE PUBLIC-PRI11 VATE FINANCING MECHANISM. 

12 (a) ESTABLISHMENT OF FINANCING FRAMEWORK.— 

13 The United States Government, through USAID and 

14 other relevant executive branch agencies identified by the 

15 Coordinator and the inter-agency working group, shall de16 velop a financing framework to leverage public and private 

17 capital to expand delivery of high-impact, evidence-based 

18 interventions for maternal, newborn, and child health. The 

19 framework shall also set clear expectations for co-financ20 ing, where appropriate, to increase domestic investment 

21 in maternal, newborn, and child survival with the goal of 

22 assisting countries in moving towards financial self-suffi23 ciency for such programs. 

24 (b) USE OF FRAMEWORK.— 


rfrederick on DSK6VPTVN1PROD with BILLS
14 

•S 1911 IS

1 (1) IN GENERAL.—In addition to existing bilat2 eral and multilateral assistance for maternal, new3 born, and child survival, the United States Govern4 ment is authorized to utilize the tools outlined in the 

5 framework, as well as other innovative financing 

6 mechanisms identified and approved by the inter7 agency working group, to help countries achieve 

8 clear results, exhibit transparency in the use of 

9 funds, encourage new domestic and international fi10 nancing entities, and leverage new and additional 

11 public, private, and philanthropic funds for mater12 nal, newborn, and child health and survival in part13 ner countries. 

14 (2) TOOLS AND APPROACHES.—These tools and 

15 approaches include development impact bonds, loan 

16 guarantees, revolving funds, working capital funds, 

17 performance-based financing mechanisms, public-pri18 vate partnerships, and other similar financing or 

19 monetization mechanisms that leverage funding to 

20 expand interventions that save lives and improve 

21 health and survival. 

22 (3) AUTHORITIES.—In addition to currently 

23 held authorities, USAID and other relevant execu24 tive branch agencies of the United States Govern25 ment, acting on their own or in partnership with deVerDate Sep 11 2014 04:12 Aug 01, 2015 Jkt 049200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S1911.IS S1911

rfrederick on DSK6VPTVN1PROD with BILLS
15 

•S 1911 IS

1 veloping countries, other donor countries, nongovern2 mental organizations, international organizations, or 

3 multilateral financial institutions, is authorized— 

4 (A) to grant loans; 

5 (B) to set aside funds for use in the imple6 mentation of financing mechanisms under sub7 section (a); 

8 (C) to use a financial intermediary to im9 plement a pay-for-performance financing mech10 anism, subject to the eligibility requirements set 

11 forth under subsection (c); 

12 (D) to issue sovereign level guarantees; 

13 and 

14 (E) to make equity investments. 

15 (c) ELIGIBILITY FOR PARTICIPATION.—In order to 

16 participate in the pay-for-performance program, partner 

17 countries shall be required by the United States Govern18 ment to commit to— 

19 (1) fully benchmarked plans to increase nominal 

20 and per capita health spending; and 

21 (2) fully developed and budgeted maternal and 

22 child survival plans. 

23 (d) PROJECT QUALIFICATION.—In order to have a 

24 project qualify under subsection (c), the partner country 

25 or its designated implementing partner must produce— 


rfrederick on DSK6VPTVN1PROD with BILLS
16 

•S 1911 IS

1 (1) specific outcome goals for the project; 

2 (2) a description of each intervention and pro3 jected outcome for the project; 

4 (3) rigorous evidence demonstrating that the 

5 interventions can be expected to produce the pro6 jected outcomes; 

7 (4) an estimate of projected government costs 

8 and savings to conduct the project; 

9 (5) a description of how the outcomes are mon10 etized and secured against fixed costs; 

11 (6) a description of the target population or 

12 populations that will be served by the project; 

13 (7) a description of the expected social benefits 

14 to participants who receive the interventions, as well 

15 as others who may be impacted; 

16 (8) the metrics that will be used to determine 

17 whether the outcomes have been achieved and the 

18 methods to be used to measure those metrics; and 

19 (9) a plan for sustainability of efforts. 

20 (e) ESTABLISHMENT OF DEVELOPMENT IMPACT

21 PARTNERSHIP.—The United States Government shall 

22 support the creation of a development impact partnership 

23 to act as a financial intermediary and facilitate the financ24 ing mechanism established under this section. The part25 nership shall be designed to allow for the incorporation 


rfrederick on DSK6VPTVN1PROD with BILLS
17 

•S 1911 IS

1 of private sources and other nongovernmental sources of 

2 capital to leverage United States Government investments, 

3 foster public-private partnerships, and engage private sec4 tor actors in developing countries to achieve measurable 

5 progress towards the strategy established under section 5. 

6 SEC. 9. AUTHORIZATION OF FUNDING. 

7 (a) AUTHORIZATION.—There are authorized to be ap8 propriated such sums as may be necessary to carry out 

9 the maternal and child strategy, financing framework, and 

10 Development Impact Partnership. 

11 (b) APPLICATION.—Federal funds appropriated to 

12 carry out activities under this act shall be subject to all 

13 applicable restrictions under Federal law. 

Æ 


rfrederick on DSK6VPTVN1PROD with BILLS