II 

Calendar No. 414 

110TH CONGRESS 

1ST SESSION S. 805 

[Report No. 110–192] 

To amend the Foreign Assistance Act of 1961 to assist countries in subSaharan Africa in the effort to achieve internationally recognized goals 

in the treatment and prevention of HIV/AIDS and other major diseases 

and the reduction of maternal and child mortality by improving human 

health care capacity and improving retention of medical health professionals in sub-Saharan Africa, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 7, 2007 

Mr. DURBIN (for himself, Mr. COLEMAN, Mr. FEINGOLD, Mr. DODD, Mr. 

KERRY, Mr. BINGAMAN, Mrs. BOXER, Mr. KENNEDY, Mr. LEAHY, Mrs. 

FEINSTEIN, Mr. OBAMA, Mr. BROWN, Mr. CASEY, Mr. SPECTER, Ms. MIKULSKI, Mr. LIEBERMAN, Mr. MENENDEZ, Ms. SNOWE, Mr. VOINOVICH, 

Mr. JOHNSON, Mr. BIDEN, Mrs. CLINTON, Mr. SANDERS, Mr. CARDIN, 

Mrs. MURRAY, Mr. HAGEL, and Mr. LAUTENBERG) introduced the following bill; which was read twice and referred to the Committee on Foreign Relations 

OCTOBER 9, 2007 

Reported, under authority of the order of the Senate of October 4, 2007, by 

Mr. BIDEN, with amendments 

[Omit the part struck through and insert the part printed in italic] 

A BILL 

To amend the Foreign Assistance Act of 1961 to assist 

countries in sub-Saharan Africa in the effort to achieve 

internationally recognized goals in the treatment and premstockstill on PROD1PC66 with BILLS

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vention of HIV/AIDS and other major diseases and the 

reduction of maternal and child mortality by improving 

human health care capacity and improving retention of 

medical health professionals in sub-Saharan Africa, and 

for other purposes. 

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 ‘‘African Health Capac5 ity Investment Act of 2007’’. 

6 SEC. 2. DEFINITIONS. 

7 In this Act, the term ‘‘HIV/AIDS’’ has the meaning 

8 given such term in section 104A(g) of the Foreign Assist9 ance Act of 1961 (22 U.S.C. 2151b–2(g)). 

10 SEC. 3. FINDINGS. 

11 Congress makes the following findings: 

12 (1) The World Health Report, 2003, Shaping 

13 the Future, states, ‘‘The most critical issue facing 

14 health care systems is the shortage of people who 

15 make them work.’’. 

16 (2) The World Health Report, 2006, Working 

17 Together for Health, states, ‘‘The unmistakable im18 perative is to strengthen the workforce so that 

19 health systems can tackle crippling diseases and 

20 achieve national and global health goals. A strong 

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1 day’s gap between health promise and health reality 

2 and anticipating the health challenges of the 21st 

3 century.’’. 

4 (3) The shortage of health personnel, including 

5 doctors, nurses, pharmacists, counselors, laboratory 

6 staff, paraprofessionals, and trained lay workers is 

7 one of the leading obstacles to fighting HIV/AIDS in 

8 sub-Saharan Africa. 

9 (4) The HIV/AIDS pandemic aggravates the 

10 shortage of health workers through loss of life and 

11 illness among medical staff, unsafe working condi12 tions for medical personnel, and increased workloads 

13 for diminished staff, while the shortage of health 

14 personnel undermines efforts to prevent and provide 

15 care and treatment for those with HIV/AIDS. 

16 (5) Workforce constraints and inefficient man17 agement are limiting factors in the treatment of tuberculosis, which infects over 1 18 ⁄3 of the global popu19 lation. 

20 (6) Over 1,200,000 people die of malaria each 

21 year. More than 75 percent of these deaths occur 

22 among African children under the age of 5 years old 

23 and the vast majority of these deaths are prevent24 able. The Malaria Initiative of President George W. 

25 Bush seeks to reduce dramatically the disease burmstockstill on PROD1PC66 with BILLS

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1 den of malaria through both prevention and treat2 ment. Paraprofessionals and community 

3 healthworkers can be instrumental in reducing mor4 tality and economic losses associated with malaria 

5 and other health problems. 

6 (7) For a woman in sub-Saharan Africa, the 

7 lifetime risk of maternal death is 1 out of 16. In 

8 highly developed countries, that risk is 1 out of 

9 2,800. Increasing access to skilled birth attendants 

10 and access to emergency obstetrical care is essential 

11 to reducing maternal and newborn mortality in sub12 Saharan Africa. 

13 (8) The Second Annual Report to Congress on 

14 the progress of the President’s Emergency Plan for 

15 AIDS Relief identifies the strengthening of essential 

16 health care systems through health care networks 

17 and infrastructure development as critical to the 

18 sustainability of funded assistance by the United 

19 States Government and states that ‘‘outside re20 sources for HIV/AIDS and other development efforts 

21 must be focused on transformational initiatives that 

22 are owned by host nations’’. This report further 

23 states, ‘‘Alongside efforts to support community ca24 pacity-building, enhancing the capacity of health 

25 care and other systems is also crucial for sustainmstockstill on PROD1PC66 with BILLS

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1 ability. Among the obstacles to these efforts in many 

2 nations are inadequate human resources and capac3 ity, limited institutional capacity, and systemic 

4 weaknesses in areas such as: quality assurance; fi5 nancial management and accounting; health net6 works and infrastructure; and commodity distribu7 tion and control.’’. 

8 (9) Vertical disease control programs represent 

9 vital components of United States foreign assistance 

10 policy, but human resources for health planning and 

11 management often demands a more systematic ap12 proach. 

13 (10) Implementation of capacity-building initia14 tives to promote more effective human resources 

15 management and development may require an ex16 tended horizon to produce measurable results, but 

17 such efforts are critical to fulfillment of many inter18 nationally recognized objectives in global health. 

19 (11) The November 2005 report of the Working 

20 Group on Global Health Partnerships for the High 

21 Level Forum on the Health Millennium Development 

22 Goals entitled ‘‘Best Practice Principles for Global 

23 Health Partnership Activities at Country Level’’, 

24 raises the concern that the collective impact of var25 ious global health programs now risks ‘‘undermining 

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1 the sustainability of national development plans, dis2 torting national priorities, diverting scarce human 

3 resources and/or establishing uncoordinated service 

4 delivery structures’’ in developing countries. This 

5 risk underscores the need to coordinate international 

6 donor efforts for these vital programs with one an7 other and with recipient countries. 

8 (12) The emigration of significant numbers of 

9 trained health care professionals from sub-Saharan 

10 African countries to the United States and other 

11 wealthier countries exacerbates often severe short12 ages of health care workers, undermines economic 

13 development efforts, and undercuts national and 

14 international efforts to improve access to essential 

15 health services in the region. 

16 (13) Addressing this problem, commonly re17 ferred to as ‘‘brain drain’’, will require increased in18 vestments in the health sector by sub-Saharan Afri19 can governments and by international partners seek20 ing to promote economic development and improve 

21 health care and mortality outcomes in the region. 

22 (14) Virtually every country in the world, in23 cluding the United States, is experiencing a shortage 

24 of health workers. The Joint Learning Initiative on 

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1 mates that the global shortage exceeds 4,000,000 

2 workers. Shortages in sub-Saharan Africa, however, 

3 are far more acute than in any other region of the 

4 world. The World Health Report, 2006, states that 

5 ‘‘[t]he exodus of skilled professionals in the midst of 

6 so much unmet health need places Africa at the 

7 epicentre of the global health workforce crisis.’’. 

8 (15) Ambassador Randall Tobias, now the Di9 rector of United States Foreign Assistance and Ad10 ministrator of the United States Agency for Inter11 national Development, has stated that there are 

12 more Ethiopian trained doctors practicing in Chi13 cago than in Ethiopia. 

14 (16) (15) According to the United Nations De15 velopment Programme, Human Development Report 

16 2003, approximately 3 out of 4 countries in sub-Sa17 haran Africa have fewer than 20 physicians per 

18 100,000 people, the minimum ratio recommended by 

19 the World Health Organization, and 13 countries 

20 have 5 or fewer physicians per 100,000 people. 

21 (17) (16) Nurses play particularly important 

22 roles in sub-Saharan African health care systems, 

but approximately 1 23 ⁄4 of sub-Saharan African coun24 tries have fewer than 50 nurses per 100,000 people 

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or less than 1 1 ⁄2 the staffing levels recommended by 

2 the World Health Organization. 

3 (18) (17) Paraprofessionals and community 

4 health workers can be trained more quickly than 

5 nurses or doctors and are critically needed in sub6 Saharan Africa to meet immediate health care 

7 needs. 

8 (19) (18) Imbalances in the distribution of 

9 countries’ health workforces represents a global 

10 problem, but the impact is particularly acute in sub11 Saharan Africa. 

12 (20) (19) In Malawi, for example, more than 95 

13 percent of clinical officers are in urban health facili14 ties, and about 25 percent of nurses and 50 percent 

15 of physicians are in the 4 central hospitals of Ma16 lawi. Yet the population of Malawi is estimated to be 

17 87 percent rural. 

18 (21) (20) In parts of sub-Saharan Africa, such 

19 as Kenya, thousands of qualified health professionals 

20 are employed outside the health care field or are un21 employed despite job openings in the health sector in 

22 rural areas because poor working and living condi23 tions, including poor educational opportunities for 

24 children, transportation, and salaries, make such 

25 openings unattractive to candidates. 

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1 (22) (21) The 2002 National Security Strategy 

2 of the United States stated, ‘‘The scale of the public 

3 health crisis in poor countries is enormous. In coun4 tries afflicted by epidemics and pandemics like HIV/ 

5 AIDS, malaria, and tuberculosis, growth and devel6 opment will be threatened until these scourges can 

7 be contained. Resources from the developed world 

8 are necessary but will be effective only with honest 

9 governance, which supports prevention programs and 

10 provides effective local infrastructure.’’. 

11 (23) (22) Public health deficiencies in sub-Sa12 haran Africa and other parts of the developing world 

13 reduce global capacities to detect and respond to po14 tential crises, such as an avian flu pandemic. 

15 (24) (23) On September 28, 2005, Secretary of 

16 State Condoleezza Rice declared that ‘‘HIV/AIDS is 

17 not only a human tragedy of enormous magnitude; 

18 it is also a threat to the stability of entire countries 

19 and to the entire regions of the world.’’. 

20 (25) (24) Foreign assistance by the United 

21 States that expands local capacities, provides com22 modities or training, or builds on and enhances com23 munity-based and national programs and leadership 

24 can increase the impact, efficiency, and sustain25 ability of funded efforts by the United States. 

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1 (26) (25) African health care professionals im2 migrate to the United States for the same set of rea3 sons that have led millions of people to come to this 

4 country, including the desire for freedom, for eco5 nomic opportunity, and for a better life for them6 selves and their children, and the rights and motiva7 tions of these individuals must be respected. 

8 (27) (26) Helping countries in sub-Saharan Af9 rica increase salaries and benefits of health care pro10 fessionals, improve working conditions, including the 

11 adoption of universal precautions against workplace 

12 infection, improve management of health care sys13 tems and institutions, increase the capacity of health 

14 training institutions, and expand education opportu15 nities will alleviate some of the pressures driving the 

16 migration of health care personnel from sub-Saharan 

17 Africa. 

18 (28) (27) While the scope of the problem of dire 

19 shortfalls of personnel and inadequacies of infra20 structure in the sub-Saharan African health systems 

21 is immense, effective and targeted interventions to 

22 improve working conditions, management, and pro23 ductivity would yield significant dividends in im24 proved health care. 

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1 (29) (28) Failure to address the shortage of 

2 health care professionals and paraprofessionals, and 

3 the factors pushing individuals to leave sub-Saharan 

4 Africa will undermine the objectives of United States 

5 development policy and will subvert opportunities to 

6 achieve internationally recognized goals for the 

7 treatment and prevention of HIV/AIDS and other 

8 diseases, in the reduction of child and maternal mor9 tality, and for economic growth and development in 

10 sub-Saharan Africa. 

11 SEC. 4. SENSE OF CONGRESS. 

12 It is the sense of Congress that— 

13 (1) the United States should help sub-Saharan 

14 African countries that have not already done so to 

15 develop national human resource plans within the 

16 context of comprehensive country health plans in17 volving a wide range of stakeholders; 

18 (2) comprehensive, rather than piecemeal ap19 proaches to advance multiple sustainable interven20 tions will better enable countries to plan for the 

21 number of health care workers they need, determine 

22 whether they need to reorganize their health work23 force, integrate workforce planning into an overall 

24 strategy to improve health system performance and 

25 impact, better budget for health care spending, and 

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1 improve the delivery of health services in rural and 

2 other underserved areas; 

3 (3) in order to promote systemic, sustainable 

4 change, the United States should seek, where pos5 sible, to strengthen existing national systems in sub6 Saharan African countries to improve national ca7 pacities in areas including fiscal management, train8 ing, recruiting and retention of health workers, dis9 tribution of resources, attention to rural areas, and 

10 education; 

11 (4) because foreign-funded efforts to fight HIV/ 

12 AIDS and other diseases may also draw health per13 sonnel away from the public sector in sub-Saharan 

14 African countries, the policies and programs of the 

15 United States should, where practicable, seek to 

16 work with national and community-based health 

17 structures and seek to promote the general welfare 

18 and enhance infrastructures beyond the scope of a 

19 single disease or condition; 

20 (5) paraprofessionals and community-level 

21 health workers can play a key role in prevention, 

22 care, and treatment services, and in the more equi23 table and effective distribution of health resources, 

24 and should be integrated into national health sys25 tems; 

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1 (6) given the current personnel shortages in 

2 sub-Saharan Africa, paraprofessionals and commu3 nity health workers represent a critical potential 

4 workforce in efforts to reduce the burdens of ma5 laria, tuberculosis, HIV/AIDS, and other deadly and 

6 debilitating diseases; 

7 (7) it is critically important that the govern8 ments of sub-Saharan African countries increase 

9 their own investments in education and health care; 

10 (8) international financial institutions have an 

11 important role to play in the achievement of inter12 nationally agreed upon health goals, and in helping 

13 countries strike the appropriate balance in encour14 aging effective public investments in the health and 

15 education sectors, particularly as foreign assistance 

16 in these areas scales up, and promoting macro17 economic stability; 

18 (9) public-private partnerships are needed to 

19 promote creative contracts, investments in sub-Saha20 ran African educational systems, codes of conduct 

21 related to recruiting, and other mechanisms to al22 leviate the adverse impacts on sub-Saharan African 

23 countries caused by the migration of health profes24 sionals; 

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1 (10) colleges and universities of the United 

2 States, as well as other members of the private sec3 tor, can play a significant role in promoting training 

4 in medicine and public health in sub-Saharan Africa 

5 by establishing or supporting in-country programs in 

6 sub-Saharan Africa through twinning programs with 

7 educational institutions in sub-Saharan Africa or 

8 through other in-country mechanisms; 

9 (11) given the substantial numbers of African 

10 immigrants to the United States working in the 

11 health sector, the United States should enact and 

12 implement measures to permit qualified aliens and 

13 their family members that are legally present in the 

14 United States to work temporarily as health care 

15 professionals in developing countries or in other 

16 emergency situations, as in S. 2611, of the 109th 

17 Congress, as passed by the Senate on May 25, 2006; 

18 (12) the President, acting through the United 

19 States Permanent Representative to the United Na20 tions, should exercise the voice and vote of the 

21 United States— 

22 (A) to ameliorate the adverse impact on 

23 less developed countries of the migration of 

24 health personnel; 

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1 (B) to promote voluntary codes of conduct 

2 for recruiters of health personnel; and 

3 (C) to promote respect for voluntary agree4 ments in which individuals, in exchange for in5 dividual educational assistance, have agreed ei6 ther to work in the health field in their home 

7 countries for a given period of time or to repay 

8 such assistance; 

9 (13) the United States, like countries in other 

10 parts of the world, is experiencing a shortage of 

11 medical personnel in many occupational specialties, 

12 and the shortage is particularly acute in rural and 

13 other underserved areas of the country; and 

14 (14) the United States should expand training 

15 opportunities for health personnel, expand incentive 

16 programs such as student loan forgiveness for people 

17 of the United States willing to work in underserved 

18 areas, and take other steps to increase the number 

19 of health personnel in the United States. 

20 SEC. 5. ASSISTANCE TO INCREASE HUMAN CAPACITY IN 

21 THE HEALTH SECTOR IN SUB-SAHARAN AFRI22 CA. 

23 Chapter 1 of part I of the Foreign Assistance Act 

24 of 1961 (22 U.S.C. 2151 et seq.) is amended— 

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1 (1) by redesignating the section 135 that was 

2 added by section 5 of the Senator Paul Simon Water 

3 for the Poor Act of 2005 (Public Law 109–121; 22 

4 U.S.C. 2152h note) as section 136; and 

5 (2) by adding at the end the following new sec6 tion: 

7 ‘‘SEC. 137. ASSISTANCE TO INCREASE HUMAN CAPACITY IN 

8 THE HEALTH SECTOR IN SUB-SAHARAN AFRI9 CA. 

10 ‘‘(a) ASSISTANCE.— 

11 ‘‘(1) AUTHORITY.—The President is authorized 

12 to provide assistance, including providing assistance 

13 through international or nongovernmental organiza14 tions, for programs in sub-Saharan Africa to im15 prove human health care capacity. 

16 ‘‘(2) TYPES OF ASSISTANCE.—Such programs 

17 should may include assistance— 

18 ‘‘(A) to provide financial and technical as19 sistance to sub-Saharan African countries in de20 veloping and implementing new or strengthened 

21 comprehensive national health workforce plans; 

22 ‘‘(B) to build and improve national and 

23 local capacities and sustainable health systems 

24 management in sub-Saharan African countries, 

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1 including financial, strategic, and technical as2 sistance for— 

3 ‘‘(i) fiscal and health personnel man4 agement; 

5 ‘‘(ii) health worker recruitment sys6 tems; 

7 ‘‘(iii) the creation or improvement of 

8 computerized health workforce databases 

9 and other human resource information sys10 tems; 

11 ‘‘(iv) implementation of measures to 

12 reduce corruption in the health sector; and 

13 ‘‘(v) monitoring, evaluation, and qual14 ity assurance in the health field, including 

15 the utilization of national and district-level 

16 mapping of health care systems to deter17 mine capacity to deliver health services; 

18 ‘‘(C) to train and retain sufficient numbers 

19 of health workers, including paraprofessionals 

20 and community health workers, to provide es21 sential health services in sub-Saharan African 

22 countries, including financing, strategic tech23 nical assistance for— 

24 ‘‘(i) health worker safety and health 

25 care, including HIV/AIDS prevention and 

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1 off-site testing and treatment programs for 

2 health workers; 

3 ‘‘(ii) increased capacity for training 

4 health professionals and paraprofessionals 

5 in such subjects as human resources plan6 ning and management, health program 

7 management, and quality improvement; 

8 ‘‘(iii) expanded access to secondary 

9 level math and science education; 

10 ‘‘(iv) expanded capacity for nursing 

11 and medical schools in sub-Saharan Africa, 

12 with particular attention to incentives or 

13 mechanisms to encourage graduates to 

14 work in the health sector in their country 

15 of residence; 

16 ‘‘(v) incentives and policies to increase 

17 retention, including salary incentives; 

18 ‘‘(vi) modern quality improvement 

19 processes and practices; 

20 ‘‘(vii) continuing education, distance 

21 education, and career development oppor22 tunities for health workers; 

23 ‘‘(viii) mechanisms to promote produc24 tivity within existing and expanding health 

25 workforces; and 

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1 ‘‘(ix) achievement of minimum infra2 structure requirements for health facilities, 

3 such as access to clean water; 

4 ‘‘(D) to support sub-Saharan African 

5 countries with financing, technical support, and 

6 personnel, including paraprofessionals and com7 munity-based caregivers, to better meet the 

8 health needs of rural and other underserved 

9 populations by providing incentives to serve in 

10 these areas, and to more equitably distribute 

11 health professionals and paraprofessionals; 

12 ‘‘(E) to support efforts to improve public 

13 health capacities in sub-Saharan Africa through 

14 education, leadership development, and other 

15 mechanisms; 

16 ‘‘(F) to provide technical assistance, equip17 ment, training, and supplies to assist in the im18 provement of health infrastructure in sub-Saha19 ran Africa; 

20 ‘‘(G) to promote efforts to improve system21 atically human resource management and devel22 opment as a critical health and development 

23 issue in coordination with specific disease con24 trol programs for sub-Saharan Africa; and 

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1 ‘‘(H) to establish a global clearinghouse or 

2 similar mechanism for knowledge sharing re3 garding human resources for health, in con4 sultation, if helpful, with the Global Health 

5 Workforce Alliance. 

6 ‘‘(3) MONITORING AND EVALUATION.— 

7 ‘‘(A) IN GENERAL.—The President shall 

8 establish a monitoring and evaluation system to 

9 measure the effectiveness of assistance by the 

10 United States to improve human health care ca11 pacity in sub-Saharan Africa in order to maxi12 mize the sustainable development impact of as13 sistance authorized under this section and pur14 suant to the strategy required under subsection 

15 (b). 

16 ‘‘(B) REQUIREMENTS.—The monitoring 

17 and evaluation system shall— 

18 ‘‘(i) establish performance goals for 

19 assistance provided under this section; 

20 ‘‘(ii) establish performance indicators 

21 to be used in measuring or assessing the 

22 achievement of performance goals; 

23 ‘‘(iii) provide a basis for recommenda24 tions for adjustments to the assistance to 

25 enhance the impact of the assistance; and 

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1 ‘‘(iv) to the extent feasible, utilize and 

2 support national monitoring and evaluation 

3 systems, with the objective of improved 

4 data collection without the imposition of 

5 unnecessary new burdens. 

6 ‘‘(b) STRATEGY OF THE UNITED STATES.— 

7 ‘‘(1) REQUIREMENT FOR STRATEGY.—Not later 

8 than 180 days after the date of the enactment of 

9 this Act, the President shall develop and transmit to 

10 the appropriate congressional committees a strategy 

11 for coordinating, implementing, and monitoring as12 sistance programs for human health care capacity in 

13 sub-Saharan Africa. 

14 ‘‘(2) CONTENT.—The strategy required by 

15 paragraph (1) shall include— 

16 ‘‘(A) a description of a coordinated strat17 egy, including coordination among agencies and 

18 departments of the Federal Government with 

19 other bilateral and multilateral donors, to pro20 vide the assistance authorized in subsection (a); 

21 ‘‘(B) a description of a coordinated strat22 egy to consult with sub-Saharan African coun23 tries and the African Union on how best to ad24 vance the goals of this Act; and 

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1 ‘‘(C) an analysis of how international fi2 nancial institutions can most effectively assist 

3 countries in their efforts to expand and better 

4 direct public spending in the health and edu5 cation sectors in tandem with the anticipated 

6 scale up of international assistance to combat 

7 HIV/AIDS and other health challenges, while 

8 simultaneously helping these countries maintain 

9 prudent fiscal balance. 

10 ‘‘(3) FOCUS OF ANALYSIS.—The analysis de11 scribed in paragraph (2)(C) should focus on 2 or 3 

12 selected countries in sub-Saharan Africa, including, 

13 if practical, 1 focus country as designated under the 

14 President’s Emergency Plan for AIDS Relief (au15 thorized by the United States Leadership Against 

16 Global HIV/AIDS, Tuberculosis, and Malaria Act of 

17 2003 (Public Law 108–25)) and 1 country without 

18 such a designation. 

19 ‘‘(4) CONSULTATION.—The President is encour20 aged to develop the strategy required under para21 graph (1) in consultation with the Secretary of 

22 State, the Administrator for the United States 

23 Agency for International Development, including em24 ployees of its field missions, the Global HIV/AIDS 

25 Coordinator, the Chief Executive Officer of the Milmstockstill on PROD1PC66 with BILLS

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1 lennium Challenge Corporation, the Secretary of the 

2 Treasury, the Director of the Bureau of Citizenship 

3 and Immigration Services, the Director of the Cen4 ters for Disease Control and Prevention, and other 

5 relevant agencies to ensure coordination within the 

6 Federal Government. 

7 ‘‘(5) COORDINATION.— 

8 ‘‘(A) DEVELOPMENT OF STRATEGY.—To 

9 ensure coordination with national strategies and 

10 objectives and other international efforts, the 

11 President should develop the strategy described 

12 in paragraph (1) by consulting appropriate offi13 cials of the United States Government and by 

14 coordinating with the following: 

15 ‘‘(i) Other donors. 

16 ‘‘(ii) Implementers. 

17 ‘‘(iii) International agencies. 

18 ‘‘(iv) Nongovernmental organizations 

19 working to increase human health capacity 

20 in sub-Saharan Africa. 

21 ‘‘(v) The World Bank. 

22 ‘‘(vi) The International Monetary 

23 Fund. 

24 ‘‘(vii) The Global Fund to Fight 

25 AIDS, Tuberculosis, and Malaria. 

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1 ‘‘(viii) The World Health Organiza2 tion. 

3 ‘‘(ix) The International Labour Orga4 nization. 

5 ‘‘(x) The United Nations Development 

6 Programme. 

7 ‘‘(xi) The United Nations Programme 

8 on HIV/AIDS. 

9 ‘‘(xii) The European Union. 

10 ‘‘(xiii) The African Union. 

11 ‘‘(B) ASSESSMENT AND COMPILATION.— 

12 The President should make the assessments 

13 and compilations required by subsection 

14 (a)(3)(B)(v), in coordination with the entities 

15 listed in subparagraph (A). 

16 ‘‘(5) COORDINATION.—To ensure coordination 

17 with national strategies and objectives and other 

18 international efforts, the President should develop the 

19 strategy described in paragraph (1) by coordinating 

20 with the following: 

21 ‘‘(A) Other donors. 

22 ‘‘(B) Implementers. 

23 ‘‘(C) International agencies. 

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1 ‘‘(D) Nongovernmental organizations work2 ing to increase human health capacity in sub3 Saharan Africa. 

4 ‘‘(E) The World Bank. 

5 ‘‘(F) The International Monetary Fund. 

6 ‘‘(G) The Global Fund to Fight AIDS, Tu7 berculosis, and Malaria. 

8 ‘‘(H) The World Health Organization. 

9 ‘‘(I) The International Labour Organiza10 tion. 

11 ‘‘(J) The United Nations Development Pro12 gramme. 

13 ‘‘(K) The United Nations Programme on 

14 HIV/AIDS. 

15 ‘‘(L) The European Union. 

16 ‘‘(M) The African Union. 

17 ‘‘(c) REPORT.— 

18 ‘‘(1) IN GENERAL.—Not later than 1 year after 

19 the date on which the President submits the strategy 

20 required in subsection (b), the President shall sub21 mit to the appropriate congressional committees a 

22 report on the implementation of this section. 

23 ‘‘(2) ASSESSMENT OF MECHANISMS FOR

24 KNOWLEDGE SHARING.—The report described in 

25 paragraph (1) shall be accompanied by a document 

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1 assessing best practices and other mechanisms for 

2 knowledge sharing about human resources for health 

3 and capacity building efforts to be shared with gov4 ernments of developing countries and others seeking 

5 to promote improvements in human resources for 

6 health and capacity building. 

7 ‘‘(3) FOLLOW-UP REPORT.—Not later than 3 

8 years after the date on which the President submits 

9 the strategy required in subsection (b), the president 

10 President shall submit to the appropriate congres11 sional committees a further report on the implemen12 tation of this section. 

13 ‘‘(d) DEFINITIONS.—In this section: 

14 ‘‘(1) APPROPRIATE CONGRESSIONAL COMMIT15 TEES.—The term ‘appropriate congressional com16 mittees’ means the Committee on Foreign Relations 

17 and the Committee on Appropriations of the Senate 

18 and the Committee on International Relations For19 eign Affairs and the Committee on Appropriations of 

20 the House of Representatives. 

21 ‘‘(2) BRAIN DRAIN.—The term ‘brain drain’ 

22 means the emigration of a significant proportion of 

23 a country’s professionals working in the health field 

24 to wealthier countries, with a resulting loss of per25 sonnel and often a loss in investment in education 

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1 and training for the countries experiencing the emi2 gration. 

3 ‘‘(3) HEALTH PROFESSIONAL.—The term 

4 ‘health professional’ means a person whose occupa5 tion or training helps to identify, prevent, or treat 

6 illness or disability. 

7 ‘‘(4) HIV/AIDS.—The term ‘HIV/AIDS’ has 

8 the meaning given such term in section 104A(g) of 

9 the Foreign Assistance Act of 1961 (22 U.S.C. 

10 2151b–2(g)). 

11 ‘‘(5) PARAPROFESSIONAL.—The term ‘para12 professional’ means an individual who is trained and 

13 employed as a health agent for the provision of basic 

14 assistance in the identification, prevention, or treat15 ment of illness or disability. 

16 ‘‘(6) COMMUNITY HEALTH WORKERS.—The 

17 term ‘community health worker’ means a community 

18 based caregiver who has received instruction and is 

19 employed to provide basic health services in specific 

20 catchment areas, most often the areas where they 

21 themselves live. 

22 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.— 

23 ‘‘(1) IN GENERAL.—There are authorized to be 

24 appropriated to the President to carry out the provi25 sions of this section— 

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28 

•S 805 RS

1 ‘‘(A) $150,000,000 for fiscal year 2008; 

2 ‘‘(B) $200,000,000 for fiscal year 2009; 

3 and 

4 ‘‘(C) $250,000,000 for fiscal year 2010. 

5 ‘‘(2) AVAILABILITY OF FUNDS.—Amounts made 

6 available under paragraph (1) are authorized to re7 main available until expended and are in addition to 

8 amounts otherwise made available for the purpose of 

9 carrying out this section.’’. 

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Calendar No. 414 

110TH CONGRESS 

1ST SESSION S. 805 

[Report No. 110

–192] 

A BILL 

To amend the Foreign Assistance Act of 1961 to 

ca, and for other purposes. medical health professionals in sub-Saharan Afrihealth care capacity and improving retention of nal and child mortality by improving human other major diseases and the reduction of materthe treatment and prevention of HIV/AIDS and fort to achieve internationally recognized goals in assist countries in sub-Saharan Africa in the efOCTOBER 9, 2007 

Reported with amendments 

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