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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4933 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 4933

To establish a strategy to coordinate all health-related United States 
    foreign assistance, to assist developing countries in improving 
 delivery of health services, and to establish an initiative to assist 
     developing countries in strengthening their indigenous health 
                  workforces, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             March 24, 2010

Ms. Lee of California introduced the following bill; which was referred 
 to the Committee on Foreign Affairs, and in addition to the Committee 
 on Financial Services, for a period to be subsequently determined by 
the Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

 
To establish a strategy to coordinate all health-related United States 
    foreign assistance, to assist developing countries in improving 
 delivery of health services, and to establish an initiative to assist 
     developing countries in strengthening their indigenous health 
                  workforces, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Global Health 
Expansion, Access to Labor, Transparency, and Harmonization Act of 
2010'' or the ``Global HEALTH Act of 2010''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Purpose.
Sec. 3. United States Global Health Strategy.
Sec. 4. Assistance for developing countries to improve delivery of 
                            health services.
Sec. 5. Global Health Workforce Initiative.
Sec. 6. Relation to other United States laws and policies.
Sec. 7. Definitions.

SEC. 2. PURPOSE.

    The purpose of this Act is to strengthen and improve the health 
systems of developing countries and the delivery of health services in 
developing countries to assist their national governments in reducing 
mortality and improving health outcomes among their populations, 
consistent with the United Nations Millennium Development Goals, by--
            (1) improving the coordination and effectiveness of all 
        health-related United States foreign assistance by establishing 
        under section 3 a comprehensive and integrated 5-year United 
        States Global Health Strategy that--
                    (A) supports developing countries in their efforts 
                to expand and develop their health systems and increase 
                their numbers of trained health workers;
                    (B) encourages and supports developing countries to 
                adopt policies that produce positive health outcomes; 
                and
                    (C) coordinates the global health-related work of 
                United States global health programs and relevant 
                United States executive branch agencies with the global 
                health-related work of governments of other countries 
                and international organizations;
            (2) providing assistance under section 4 for developing 
        countries to improve the delivery of health services by their 
        health systems;
            (3) supporting the efforts of developing countries to 
        strengthen their indigenous health workforces and expand the 
        supply and equitable distribution within such countries of 
        skilled health workers by establishing under section 5 a Global 
        Health Workforce Initiative; and
            (4) ensuring, as outlined in section 6, that the laws and 
        policies of the United States and multilateral organizations of 
        which the United States is a member do not interfere with the 
        ability of developing countries to establish and maintain 
        skilled indigenous health workforces, to obtain pharmaceuticals 
        and other medical supplies and equipment, or to otherwise 
        develop the capacity of their health systems.

SEC. 3. UNITED STATES GLOBAL HEALTH STRATEGY.

    (a) Establishment.--Not later than 1 year after the date of the 
enactment of this Act, the President shall transmit to Congress and 
make publicly available a comprehensive and integrated 5-year United 
States Global Health Strategy (in this section referred to as the 
``Global Health Strategy'') to coordinate all health-related United 
States foreign assistance and to integrate and harmonize such 
assistance with the work of relevant United States executive branch 
agencies, governments of other countries, and international 
organizations.
    (b) Goals and Objectives.--
            (1) Goals.--The President shall ensure that the Global 
        Health Strategy will assist countries in achieving the health-
        related goals and targets of the United Nations Millennium 
        Development Goals and Targets, including--
                    (A) reducing child mortality, with special emphasis 
                on reducing the mortality rate of children under 5 
                years of age by \2/3\ between 1990 and 2015;
                    (B) improving maternal health, with special 
                emphasis on reducing the maternal mortality ratio by 
                \3/4\ between 1990 and 2015, and achieving universal 
                access to reproductive health services by 2015; and
                    (C) combating HIV/AIDS, tuberculosis, malaria, and 
                other diseases, with special emphasis on halting and 
                beginning to reverse by 2015 the spread of HIV/AIDS and 
                the incidence of malaria and other major diseases.
            (2) Additional objectives.--The President shall ensure that 
        the goals listed in paragraph (1) are achieved in a manner 
        that, to the maximum extent practicable--
                    (A) improves access to quality health services for 
                poor, vulnerable, or marginalized populations in 
                countries receiving health-related United States 
                foreign assistance;
                    (B) ensures that skilled health workers are 
                available in sufficient numbers and on a sufficiently 
                sustainable and equitably distributed basis within each 
                country that their participation in programs supported 
                by health-related United States foreign assistance does 
                not negatively impact the health workforce of any 
                component of a developing country's health system that 
                is not supported by such assistance; and
                    (C) advances the efforts of developing countries to 
                develop health systems capable of providing universal 
                access to a comprehensive package of primary health 
                services.
            (3) Rule of construction.--The goals and objectives listed 
        in this subsection are in addition to and shall not be 
        construed to supplant the goals or objectives of any program 
        under a law, regulation, Executive order, or international 
        commitment of the United States.
    (c) Consultation.--In developing the Global Health Strategy, the 
President shall consult with--
            (1) each executive branch agency administering United 
        States foreign assistance related to--
                    (A) improving global health;
                    (B) strengthening financial management systems;
                    (C) monitoring animal and plant populations; and
                    (D) addressing environmental problems such as 
                pollution and climate change;
            (2) personnel at United States embassies and country 
        missions involved in the administration of the types of United 
        States foreign assistance described in paragraph (1);
            (3) the appropriate congressional committees with 
        jurisdiction over the agencies described in paragraph (1);
            (4) civil society and nongovernmental organizations engaged 
        in improving health care and health outcomes in developing 
        countries, including indigenous community and faith-based 
        organizations;
            (5) international organizations engaged in improving health 
        care and health outcomes in developing countries and of which 
        the United States is a voting member, with which the United 
        States coordinates the delivery of foreign assistance, or to 
        which the United States contributes funding for the purpose of 
        providing such assistance;
            (6) academic organizations, private foundations, 
        businesses, and other organizations engaged in improving health 
        care and health outcomes in developing countries and not 
        receiving United States funding for such purposes;
            (7) other donor nations engaged in improving health care 
        and health outcomes in developing countries;
            (8) countries receiving health-related United States 
        foreign assistance; and
            (9) any other global, regional, or subregional 
        organizations or partnerships engaged in improving health care 
        and health outcomes in developing countries.
    (d) Elements of United States Global Health Strategy.--The Global 
Health Strategy shall include the following elements:
            (1) Plans for coordinating all health-related United States 
        foreign assistance among the executive branch agencies 
        authorized to deliver such assistance in order to achieve the 
        goals listed in subsection (b)(1) in a manner that facilitates 
        harmonization with partners at the country level and takes 
        maximum advantage of the expertise of personnel at the United 
        States embassy and country mission level, including plans--
                    (A) that incorporate all United States programs 
                related to global health and their goals and 
                strategies, including programs related to child 
                survival and maternal health, vulnerable children, 
                family planning and reproductive health, nutrition, 
                health systems and infrastructure, health care 
                workforces, HIV/AIDS, tuberculosis, malaria, pandemic 
                influenza, chronic and noncommunicable diseases, 
                neglected diseases, and other infectious diseases;
                    (B) to assist countries in strengthening their 
                financial management, accounting, auditing, and 
                reporting systems, and to ensure the effectiveness of 
                such assistance;
                    (C) to monitor the spread of disease among animal 
                and plant populations, including livestock and 
                wildlife;
                    (D) to assist countries in addressing the health-
                related threats posed by environmental problems, 
                including pollution and climate change; and
                    (E) for oversight of all health-related United 
                States foreign assistance, including an analysis of the 
                capacity of each executive branch agency authorized to 
                deliver such assistance to conduct periodic audits, 
                inspections, and investigations and an analysis of how 
                oversight activities should be prioritized.
            (2) Plans that describe how health-related United States 
        foreign assistance will help developing countries strengthen 
        and improve their health systems and the delivery of health 
        services to achieve their national health goals and the goals 
        of all United States programs related to global health, 
        including the goals listed in subsection (b)(1), by means that 
        include--
                    (A) assisting developing countries to create, 
                strengthen, and implement their own evidence-based 
                national health strategies, including subnational 
                health strategies where appropriate;
                    (B) providing technical assistance and support to 
                national ministries of health, or their equivalents, 
                and other relevant ministries in overseeing the health 
                systems of their countries and monitoring and 
                evaluating the effectiveness of such systems in 
                reducing mortality and improving health outcomes;
                    (C) supporting the construction, expansion, 
                rehabilitation, and maintenance of health facilities at 
                the national and local level, and ensuring the 
                equitable distribution and use of such facilities among 
                and within urban, peri-urban, and rural areas in each 
                country;
                    (D) providing assistance to national ministries of 
                health, or their equivalents, and other relevant 
                ministries in recruiting, training, and retaining 
                skilled health workers, managers, and administrators 
                and in ensuring the equitable distribution of such 
                personnel in health facilities throughout each country;
                    (E) supporting the development and implementation 
                of national health workforce plans for achieving a 
                combined total of at least 2.3 doctors, nurses, and 
                trained midwives per 1,000 residents, and comparable 
                numbers of other health workers, such as 
                paraprofessionals, community health workers, managers, 
                and administrative and support staff, and ensuring such 
                workers are equitably distributed within each country;
                    (F) providing assistance to developing countries to 
                create and transparently manage their own supply-chain 
                management systems and to use existing nongovernmental 
                systems, where appropriate, to--
                            (i) efficiently and equitably distribute 
                        medical and laboratory supplies, including 
                        diagnostics, pharmaceuticals, technology, and 
                        equipment, to health facilities throughout the 
                        country; and
                            (ii) perform any maintenance necessary to 
                        ensure the continued operation of medical and 
                        laboratory equipment;
                    (G) supporting the development, improvement, and 
                implementation of financial management systems and the 
                training of financial management personnel in order to 
                track health expenditures by the national governments 
                of developing countries, ensure the equitable and 
                effective allocation of such expenditures, anticipate 
                and budget for annual resource needs, equitably 
                mobilize additional domestic resources, and increase 
                the accountability of the health systems of such 
                countries to their people, including accountability at 
                the subnational and community levels;
                    (H) supporting the establishment, improvement, and 
                implementation, where appropriate, of mechanisms to 
                operate, manage, regulate, monitor, and evaluate a 
                country's health system, particularly its effectiveness 
                in reducing mortality and improving health outcomes 
                among the general population and for poor, vulnerable, 
                or marginalized populations;
                    (I) supporting the development and implementation 
                of national health information systems to securely 
                track, compile, and manage data collected by a 
                country's health system at the individual, community, 
                and population level, with appropriate privacy 
                safeguards, in order to measure the impact of health 
                services on health outcomes, and to provide a basis for 
                adjustments to the health system;
                    (J) supporting meaningful community involvement and 
                participation, inclusive of poor, vulnerable, or 
                marginalized populations and their representative 
                indigenous and civil society organizations, in 
                decisionmaking related to national and subnational 
                health strategies and the delivery of health services, 
                including in decisions related to the adoption of 
                health policies and the total amount and distribution 
                of health funding;
                    (K) further promoting the community involvement and 
                participation described in subparagraph (J) by 
                strengthening partnerships between government, civil 
                society, and indigenous nongovernmental organizations, 
                including community and faith-based organizations 
                seeking to improve health conditions in their countries 
                and communities;
                    (L) supporting evidence-based public health 
                education initiatives that teach healthy habits and 
                behaviors, increase health literacy, and encourage 
                greater utilization of the health system;
                    (M) assisting countries to coordinate, regulate, 
                and harmonize the delivery of health services provided 
                by the United States and nongovernmental organizations, 
                including community and faith-based organizations, 
                private foundations, international organizations, and 
                other donors, and to coordinate or integrate such 
                services with the health system to the maximum extent 
                practicable;
                    (N) supporting indigenous nongovernmental 
                organizations, including community and faith-based 
                organizations, that seek to improve the efficiency, 
                transparency, and delivery of health services to poor, 
                vulnerable, or marginalized populations; and
                    (O) using, to the maximum extent practicable, local 
                and regional entities for the provision of technical 
                assistance, and where the capacity of such entities is 
                insufficient, supporting capacity building to enable 
                them to provide such assistance.
            (3) Plans to strengthen the ability of countries receiving 
        health-related United States foreign assistance to detect, 
        identify, and respond to emerging public health threats by--
                    (A) developing and improving laboratory capacity, 
                including constructing or rehabilitating laboratory 
                facilities and providing any necessary technology, 
                equipment, or supplies;
                    (B) supporting the recruitment, training, and 
                retention of public health professionals with the 
                expertise to monitor, respond to, and contain the 
                spread of disease, including laboratory personnel, 
                epidemiologists, and animal and plant inspectors;
                    (C) supporting the development of integrated and 
                comprehensive surveillance and notification systems at 
                the national and regional level that are integrated 
                within the health system to address the spread of 
                emerging diseases among human, animal, and plant 
                populations that may pose potential threats to public 
                health; and
                    (D) facilitating partnerships between health 
                systems and relevant United States Government agencies 
                to strengthen national and regional disease 
                surveillance and notification systems to address the 
                spread of emerging diseases among human, animal, and 
                plant populations.
            (4) Plans to improve research collaboration with countries 
        receiving health-related United States foreign assistance, 
        including plans related to--
                    (A) basic, clinical, and applied research on 
                diseases that primarily impact developing countries, 
                including research on medical technology and equipment, 
                protocols, procedures, standards, and strategies to 
                combat such diseases;
                    (B) operations research to facilitate the 
                development and administration of effective health 
                systems and health-related programs;
                    (C) support for developing indigenous research 
                capacity, including the establishment of independent 
                and scientific peer review processes to help countries 
                pursue their own research agendas;
                    (D) encouraging the development of sustainable, 
                country-driven partnerships between indigenous and 
                United States-based research institutions; and
                    (E) strengthening regional research partnerships.
            (5) Plans for encouraging and assisting national 
        governments of developing countries to pursue policies and 
        legal frameworks that improve health outcomes and make progress 
        toward the goals listed in subsection (b)(1), including 
        policies and legal frameworks that--
                    (A) are medically accurate and evidence-based and 
                adhere to the latest global public health standards for 
                prevention, treatment, and care;
                    (B) integrate and deliver, to the maximum extent 
                practicable, a comprehensive package of primary health 
                services at the local clinic level, with appropriate 
                and functional systems for referral to secondary and 
                tertiary medical facilities that provide services 
                including--
                            (i) preventive care;
                            (ii) prenatal and perinatal services;
                            (iii) immunizations and vaccinations;
                            (iv) family planning and reproductive 
                        health services;
                            (v) chronic and infectious disease 
                        management;
                            (vi) maternal and child health services;
                            (vii) psychosocial and mental health 
                        services;
                            (viii) nutritional support; and
                            (ix) emergency response and triage;
                    (C) promote and improve the status of women and 
                youth, ensuring their ability to access and use health 
                services without fear or risk of gender-based violence, 
                reprisal, discrimination, stigmatization, or other 
                mistreatment;
                    (D) work to remove stigmatization of and 
                discrimination against poor, vulnerable, or 
                marginalized populations and to protect the rights of 
                such populations;
                    (E) provide for the equitable allocation and 
                distribution of health resources among rural, peri-
                urban, and urban areas, including facilities, 
                personnel, medicines, medical technology and equipment, 
                and health financing;
                    (F) ensure that all individuals, especially the 
                poorest of the poor, have access to high-quality, 
                confidential, affordable health services, including 
                by--
                            (i) encouraging the elimination of user 
                        fees or their replacement with equitable 
                        financing strategies where appropriate; and
                            (ii) addressing other persistent barriers 
                        to such access, including those related to 
                        housing, transportation, language, and similar 
                        issues;
                    (G) promote sustainable working conditions and 
                policies that protect the health and safety of patients 
                and health workers within their communities and in all 
                medical facilities;
                    (H) provide comprehensive, confidential, high-
                quality health services to health workers, including 
                for chronic and infectious diseases;
                    (I) respect the rights and dignity of health 
                workers and patients;
                    (J) coordinate the delivery of health services with 
                other core development programs to better address the 
                social determinants of health, including programs to 
                reduce poverty, expand educational opportunities, 
                provide access to clean water and sanitation services, 
                improve food security and nutrition, protect women's 
                rights, improve access to legal services, protect the 
                environment, and spur economic growth; and
                    (K) facilitate the development and implementation 
                of sustainable policies, legal frameworks, and 
                capacity-building activities that actively engage and 
                support civil society organizations and community 
                members, including individuals from poor, vulnerable, 
                or marginalized populations, to monitor and enforce 
                policies related to the provision of health services.
            (6) Plans to support the efforts of national governments of 
        developing countries in responding to health-related threats 
        posed by environmental problems, including pollution and 
        climate change.
            (7) Plans for a review of, including recommendations to 
        adjust, laws and policies of the United States Government that 
        impact the provision of health-related United States foreign 
        assistance, including--
                    (A) recruitment, training, and retention of the 
                United States health workforce, including through the 
                immigration of foreign health professionals to the 
                United States;
                    (B) negotiation and enforcement of bilateral, 
                multilateral, and other international treaties and 
                trade and investment agreements, including any 
                provisions related to the delivery of health services 
                or the supply of medical technology and equipment, 
                diagnostics, or pharmaceutical products;
                    (C) negotiation and voting practices within 
                international financial institutions; and
                    (D) negotiation and voting practices within the 
                World Health Organization, the Global Fund to Fight 
                AIDS, Tuberculosis and Malaria, the Global Alliance for 
                Vaccines and Immunisation, and any other international 
                organizations of which the United States is a voting 
                member and to which the United States contributes 
                funding.
            (8) Plans for establishing an integrated monitoring and 
        evaluation system, coordinated at the country level with any 
        such systems previously in existence, in order to assess the 
        effectiveness of all health-related United States foreign 
        assistance.
            (9) Annual resource plans for implementing the Global 
        Health Strategy, achieving the goals listed in subsection 
        (b)(1), and achieving the relevant goals of all United States 
        programs related to global health, including, to the extent 
        practicable, annual budgets, annual projected resource needs, 
        and long-term funding commitments of--
                    (A) the United States Government;
                    (B) international organizations of which the United 
                States is a voting member and to which the United 
                States contributes funding for the purpose of providing 
                health-related assistance to developing countries; and
                    (C) countries receiving health-related United 
                States foreign assistance.
    (e) Strategy Coordinator.--
            (1) In general.--The President shall designate an 
        individual as coordinator of the Global Health Strategy (in 
        this section referred to as the ``Strategy Coordinator'').
            (2) Duties.--The duties of the Strategy Coordinator shall 
        include--
                    (A) coordinating the Global Health Strategy among 
                all relevant executive branch agencies;
                    (B) serving as a point of reference for Congress 
                and the public regarding the implementation of the 
                Global Health Strategy; and
                    (C) producing the annual report required by 
                subsection (g).
    (f) Performance Goals and Indicators.--In order to measure and 
evaluate the effectiveness of the Global Health Strategy in achieving 
the goals described in subsection (b)(1) and in order to provide a 
basis to periodically review and adjust the Global Health Strategy, the 
President shall establish, where appropriate, objective and 
quantifiable performance goals and indicators for each element required 
by subsection (d).
    (g) Report.--Not later than 1 year after the President's 
transmission to Congress of the Global Health Strategy under subsection 
(a) and annually thereafter, the President shall transmit to Congress a 
report that includes--
            (1) a description of the impact and effectiveness of all 
        health-related United States foreign assistance in achieving 
        the goals listed in subsection (b)(1) and the additional 
        objectives listed in subsection (b)(2);
            (2) a description of the progress made toward achieving the 
        performance goals established under subsection (f);
            (3) a description of any audits, inspections, or 
        investigations of health-related United States foreign 
        assistance completed during the year preceding the transmission 
        of the report, including their results, and a brief summary of 
        any plans to undertake similar audits, inspections, or 
        investigations during the subsequent year; and
            (4) a detailed programmatic list of expenditures for all 
        United States programs related to global health for the fiscal 
        year preceding the transmission of the report, including the 
        amounts and percentages of funding that each program allocated 
        for--
                    (A) the direct provision of health services, 
                including directly supporting health workforces that 
                provide such services;
                    (B) the purchase of commodities, including 
                medicines;
                    (C) the construction, expansion, rehabilitation, or 
                maintenance of health facilities within a country's 
                health system; and
                    (D) any technical assistance provided to carry out 
                the goals and objectives of the program.
    (h) Evaluation of the Global Health Strategy by the Institute of 
Medicine.--
            (1) In general.--The Strategy Coordinator shall enter into 
        a contract with the Institute of Medicine of the National 
        Academies, or, if the Institute declines, another appropriate 
        entity, to complete an evaluation of the effectiveness of the 
        Global Health Strategy not later than 4 years after the 
        President's transmission to Congress of such strategy under 
        subsection (a).
            (2) Elements of study.--The contract required by paragraph 
        (1) shall provide for--
                    (A) an assessment of the level of coordination of 
                health-related United States foreign assistance, 
                including at the country-mission level;
                    (B) an assessment of the progress made toward the 
                goals listed in subsection (b)(1) and the additional 
                objectives listed in subsection (b)(2);
                    (C) an assessment of the contributions of the 
                Global Health Strategy to strengthening health systems, 
                improving the delivery of health services, ensuring a 
                sustainable supply of health workers, and improving the 
                accountability of health systems of developing 
                countries to the people of such countries;
                    (D) an assessment of the progress made toward 
                reviewing and evaluating the impact of existing laws 
                and policies of the United States Government related to 
                the provision of health-related United States foreign 
                assistance, including any recommendations for the 
                adjustment of such laws and policies;
                    (E) recommendations for improving the Global Health 
                Strategy; and
                    (F) an assessment of any additional factors that 
                the entity with which the Strategy Coordinator 
                contracts under paragraph (1), in consultation with the 
                appropriate congressional committees and the Strategy 
                Coordinator, considers appropriate.
    (i) Authorization of Appropriations.--
            (1) In general.--In addition to amounts otherwise made 
        available for such purposes, there are authorized to be 
        appropriated to the President such sums as may be necessary for 
        each of the fiscal years 2011 through 2015 to carry out this 
        section.
            (2) Availability of funds.--Amounts appropriated pursuant 
        to the authorization of appropriations in paragraph (1) are 
        authorized to remain available until expended.

SEC. 4. ASSISTANCE FOR DEVELOPING COUNTRIES TO IMPROVE DELIVERY OF 
              HEALTH SERVICES.

    (a) Authorization.--
            (1) In general.--The President is authorized to provide 
        assistance to developing countries to improve the delivery of 
        health services by the health systems of such countries.
            (2) Authorized activities.--The assistance authorized by 
        paragraph (1) includes assistance for the following activities 
        in order to assist a country in providing health services:
                    (A) Direct support to implement particular elements 
                of a country's national health strategy, including--
                            (i) construction, expansion, 
                        rehabilitation, and maintenance of health 
                        facilities at the national and local level, 
                        including ensuring the equitable distribution 
                        and use of such facilities among and within 
                        urban, peri-urban, and rural areas of the 
                        country;
                            (ii) recruiting, training, and retaining 
                        skilled health workers, managers, and 
                        administrators, including ensuring the 
                        equitable distribution of such personnel in 
                        health facilities throughout the country;
                            (iii) developing a supply-chain management 
                        system to--
                                    (I) efficiently, transparently, and 
                                equitably purchase and distribute 
                                medical and laboratory supplies, 
                                including diagnostics, pharmaceuticals, 
                                technology, equipment, and other health 
                                commodities, to health facilities 
                                throughout the country; and
                                    (II) perform any maintenance 
                                necessary to ensure the continued 
                                operation of medical and laboratory 
                                equipment; and
                            (iv) providing the items described in 
                        clause (iii)(I) or funds for the purchase of 
                        such items.
                    (B) Technical assistance and operational support in 
                conjunction with direct assistance described in 
                subparagraph (A) for national governments to develop, 
                implement, and evaluate the relevant elements of their 
                national health strategies and any associated plans and 
                policies.
                    (C) Support for indigenous civil society and 
                nongovernmental organizations to monitor and evaluate 
                the development and effectiveness of their country's 
                health system and national health strategy.
            (3) Eligible entities.--In carrying out paragraph (1), the 
        President is authorized to provide assistance directly to--
                    (A) the national government of each developing 
                country that has a national health strategy, including 
                assistance to the national ministry of health and the 
                national ministry of finance, or their equivalents, and 
                other relevant ministries;
                    (B) indigenous nongovernmental, community, and 
                faith-based organizations and civil society groups 
                within each developing country that has a national 
                health strategy;
                    (C) United States-based nongovernmental 
                organizations and academic organizations that provide 
                health-related services or assistance in developing 
                countries; and
                    (D) international organizations involved in 
                delivering health-related assistance and of which the 
                United States is a voting member, with which the United 
                States coordinates the delivery of foreign assistance, 
                or to which the United States contributes funding for 
                the purpose of providing such assistance.
            (4) Relationship to national health strategies and united 
        states global health strategy.--Assistance provided under 
        paragraph (1) shall be--
                    (A) aligned to the fullest extent possible with the 
                national health strategy of each country receiving such 
                assistance; and
                    (B) in accordance with the goals and additional 
                objectives of the United States Global Health Strategy 
                listed in section 3(b)(1) and section 3(b)(2), 
                respectively.
            (5) Contract authority.--The President may enter into 
        contracts to provide the assistance authorized by paragraph 
        (1).
    (b) Principles of National Health Strategies.--The President shall 
encourage each country receiving direct assistance described in 
subsection (a)(2)(A) to incorporate into its national health strategy, 
to the maximum extent practicable, the following principles:
            (1) Goals and targets to reduce morbidity and mortality and 
        improve health outcomes, including to reach commonly agreed-
        upon international and regional health targets.
            (2) Plans to provide universal access to a comprehensive 
        package of primary health services.
            (3) Plans to increase the equitable distribution of health 
        services among rural, peri-urban, and urban areas of the 
        country, including plans to ensure the availability of the 
        facilities, personnel, medical and laboratory supplies, 
        technology and equipment, financing, and other resources 
        necessary to provide such services.
            (4) Plans to ensure that poor, vulnerable, or marginalized 
        populations have access to the services and necessary resources 
        described in paragraph (3).
            (5) Transparent annual budget plans with cost estimates for 
        reaching the goals and targets described in paragraph (1), 
        including a description of any funding gaps and plans to fill 
        such gaps through increased and equitable mobilization of 
        national resources and in partnership with external donors, 
        including the United States, and other funding sources.
            (6) Appropriate mechanisms and tools to monitor and 
        evaluate the effectiveness of the country's health system in 
        improving health-service delivery and to measure progress 
        toward achieving the goals and targets described in paragraph 
        (1), with a particular focus on expanding access to health 
        services for poor, vulnerable, or marginalized populations.
            (7) Appropriate financial management and auditing 
        mechanisms for health financing in order to track health 
        expenditures by the national government, ensure the equitable 
        distribution of such expenditures within the country, 
        anticipate and budget for the annual resource needs of the 
        health system, and increase the accountability of the health 
        system to the country's people.
            (8) Meaningful participation of indigenous civil society 
        and nongovernmental organizations, including community and 
        faith-based organizations, affected communities, and poor, 
        vulnerable, or marginalized populations, in the development and 
        implementation of the national health strategy, including 
        program and budget decisions, monitoring and evaluation, and 
        implementation.
            (9) Promotion of the ability of women and youth to access 
        and use health services without fear, gender-based violence, 
        reprisal, discrimination, or other mistreatment.
            (10) Plans to reduce stigmatization of and discrimination 
        against poor, vulnerable, or marginalized populations, to 
        promote their rights, and to promote their ability to access 
        and use health services.
            (11) Medically accurate and evidence-based policies and 
        program plans that adhere to the latest global public health 
        standards for prevention, treatment, and care and that are 
        contextualized within each country.
            (12) Plans to ensure that all individuals, especially the 
        poorest of the poor, are able to exercise their rights and have 
        access to high-quality, confidential, affordable health 
        services, including by--
                    (A) encouraging the elimination of user fees or 
                their replacement with equitable financing strategies 
                where appropriate; and
                    (B) addressing other persistent barriers to such 
                access, including those related to housing, 
                transportation, language, and similar issues.
            (13) Support for the creation of sustainable working 
        conditions and policies that protect the health and safety of 
        patients and health workers within their communities and in all 
        medical facilities, including through following recommended 
        occupational health and safety standards for health workers, 
        including standards for training and protective technology, 
        equipment, and supplies, as well as through other forms of 
        infection prevention and control.
            (14) Access for health workers employed in the country's 
        health system to comprehensive, confidential, high-quality 
        health services, including prevention and treatment of chronic 
        and infectious diseases and psychosocial and mental health 
        services.
            (15) Promotion of multisectoral harmonization through 
        coordination and collaboration between the delivery of health 
        services and other development programs and plans that impact 
        public health, including programs and plans to address emerging 
        public health threats and health-related threats posed by 
        environmental problems and to advance applied research into 
        diseases affecting the country.
            (16) Support for the development and implementation of 
        sustainable policies, legal frameworks, and capacity-building 
        activities that actively engage civil society organizations and 
        community members, including individuals from poor, vulnerable, 
        or marginalized populations, to monitor and enforce policies 
        related to the provision of health services.
    (c) Partnership Agreements.--
            (1) In general.--The President may enter into a partnership 
        agreement with a developing country receiving assistance under 
        this section in which the country receives additional 
        assistance to--
                    (A) encourage the inclusion, adoption, and 
                implementation of the principles listed in subsection 
                (b) as part of the country's national health strategy 
                and any associated plans or policies; and
                    (B) encourage the country to increase the amount of 
                national resources it commits to expanding and 
                improving the delivery of health services.
            (2) No reduction of assistance.--A partnership agreement 
        under paragraph (1) shall not result in a reduction of the 
        total level of health-related United States foreign assistance 
        provided to a country below the level of such assistance 
        provided to such country in the previous fiscal year.
    (d) Monitoring and Evaluation System.--
            (1) In general.--The President shall establish an 
        integrated monitoring and evaluation system to measure the 
        effectiveness of assistance provided under this section 
        including, where appropriate, objective and quantifiable 
        performance goals and indicators to measure progress toward the 
        development and implementation of national health strategies in 
        accordance with the principles listed in subsection (b).
            (2) Harmonization with systems of recipient countries.--To 
        the maximum extent possible, the system established under 
        paragraph (1) shall be harmonized with the monitoring and 
        evaluation systems of countries receiving assistance under this 
        section.
    (e) Report.--Not later than 1 year after the date of the enactment 
of this Act and annually thereafter, the President shall transmit to 
Congress a report describing the impact and effectiveness of the 
assistance provided under this section, including--
            (1) a detailed description, with respect to each country 
        receiving assistance under this section, of the effectiveness 
        of such assistance in improving the delivery of health services 
        by the health system, including how such assistance was aligned 
        with each country's national health strategy and any associated 
        plans or policies, as they existed before such country began 
        receiving such assistance;
            (2) a brief summary of plans to address gaps in the 
        delivery of health services among countries receiving 
        assistance under this section during the following year and the 
        resources that will be required to carry out such plans;
            (3) a detailed description of any partnership agreements 
        entered into under subsection (c) and any potential strategies 
        for further encouraging countries to incorporate the principles 
        listed in subsection (b) into their national health strategies; 
        and
            (4) a detailed programmatic list of expenditures under this 
        section for the previous fiscal year, including the amounts and 
        percentages of funding allocated for--
                    (A) the direct provision of health services, 
                including directly supporting health workforces that 
                provide such services;
                    (B) the purchase of commodities, including 
                medicines;
                    (C) the construction, expansion, rehabilitation, or 
                maintenance of health facilities within a country's 
                health system; and
                    (D) any technical assistance provided under this 
                section, including a list of any contractors providing 
                such assistance and the impact of such assistance in 
                improving health outcomes and health service delivery.
    (f) Certification Requirement.--
            (1) In general.--The President shall certify to Congress 
        that each contract described in paragraph (2)--
                    (A) has been openly and transparently secured and 
                provides the highest quality goods and services at the 
                lowest cost; and
                    (B) wherever possible, makes use of indigenous 
                entities within the country receiving assistance.
            (2) Contracts described.--A contract described in this 
        paragraph is a contract related to the construction, expansion, 
        rehabilitation, or maintenance of health facilities, the 
        purchase of commodities, or technical assistance that is 
        entered into--
                    (A) by the United States Government to provide 
                health-related United States foreign assistance under 
                this section; or
                    (B) by a foreign country or other entity to carry 
                out a program or activity receiving health-related 
                United States foreign assistance under this section.
    (g) Authorization of Appropriations.--
            (1) In general.--In addition to amounts otherwise made 
        available for such purposes, there are authorized to be 
        appropriated to the President such sums as may be necessary for 
        each of the fiscal years 2011 through 2015 to carry out this 
        section.
            (2) Availability of funds.--Amounts appropriated pursuant 
        to the authorization of appropriations in paragraph (1) are 
        authorized to remain available until expended.

SEC. 5. GLOBAL HEALTH WORKFORCE INITIATIVE.

    (a) Establishment.--The President is authorized to establish a 
Global Health Workforce Initiative (in this section referred to as the 
``Initiative'') to provide technical and direct financial assistance to 
entities described in subsection (c) to support the recruitment, 
training, retention, effectiveness, and equitable distribution within 
each country of skilled indigenous health workers as part of the health 
systems of developing countries in order to achieve a combined total of 
at least 2.3 doctors, nurses, and trained midwives per 1,000 residents, 
and comparable numbers of other health workers, such as 
paraprofessionals, community health workers, managers, and 
administrative and support staff.
    (b) Participating Countries.--
            (1) Selection.--
                    (A) In general.--Not later than 90 days after the 
                date of the enactment of this Act, the President shall 
                select for participation in the Initiative not fewer 
                than 12 developing countries and may, in consultation 
                with Congress, subsequently select additional 
                developing countries.
                    (B) Participating country defined.--A country 
                selected under subparagraph (A) is referred to in this 
                section as a ``participating country''.
            (2) Mandatory criteria.--The President shall not select a 
        country under paragraph (1)(A) unless it meets the following 
        criteria:
                    (A) The government of the country has expressly 
                requested the assistance of the United States 
                Government to support the expansion of the country's 
                indigenous health workforce.
                    (B) The country is currently developing or 
                implementing a national health strategy.
                    (C) The country is already receiving health-related 
                United States foreign assistance and is able to 
                effectively use additional funding from the United 
                States or other external sources to expand its 
                indigenous health workforce, reduce morbidity and 
                mortality, and improve health outcomes among its 
                population.
                    (D) The country is experiencing a critical shortage 
                of health workers, which is a significant obstacle to 
                reducing mortality and improving health outcomes among 
                its people and to achieving the United Nations 
                Millennium Development Goals and other such 
                international health targets.
                    (E) The country is taking concrete steps to 
                sustainably expand its indigenous health workforce, 
                such as direct budgetary investments, the development 
                and implementation of supportive policies, the 
                development of educational, training, and clinical care 
                and practice standards, and direct agreements or 
                partnerships at the national or regional level with 
                other countries or international organizations.
                    (F) A health professional training institution is 
                currently located in the country, or the country is in 
                the process of establishing such an institution or has 
                a partnership with such an institution in another 
                country in the region.
            (3) Additional criteria.--The President should ensure that 
        countries selected under paragraph (1)(A) are diverse with 
        respect to--
                    (A) total size and demography of the population;
                    (B) prevalence and incidence of disease and any 
                associated mortality rates;
                    (C) levels of development and functionality of the 
                health system;
                    (D) the extent to which financial resources are 
                available or have been committed by the country or by 
                external funding sources to expand the indigenous 
                health workforce;
                    (E) the size of the indigenous health workforce; 
                and
                    (F) gross national product and per capita income.
    (c) Eligible Entities.--The following entities are eligible to 
receive funding under the Initiative:
            (1) The national government of each participating country, 
        including the national ministry of health and the national 
        ministry of finance, or their equivalents.
            (2) Indigenous nongovernmental, community, and faith-based 
        organizations and civil society groups engaged in improving 
        health care and health outcomes in 1 or more participating 
        countries.
            (3) United States-based nongovernmental and academic 
        organizations that provide health-related services or 
        assistance in developing countries.
            (4) International organizations involved in delivering 
        health-related assistance and of which the United States is a 
        voting member, with which the United States coordinates the 
        delivery of foreign assistance, or to which the United States 
        contributes funding for the purpose of providing such 
        assistance.
    (d) Authorized Activities.--The activities for which the President 
may provide funding under the Initiative include the following:
            (1) Technical assistance and direct support for countries 
        to develop, strengthen, implement, evaluate, and adjust the 
        national health workforce plans described in subsection (f).
            (2) Programs to prepare and encourage individuals to seek 
        careers as health professionals and to serve as teachers in 
        health professional training institutions, including through--
                    (A) basic education programs;
                    (B) expanding the capacity of the educational 
                system to provide access to secondary-level and 
                advanced math and science education;
                    (C) teaching basic health literacy and supporting 
                basic disease prevention education; and
                    (D) additional educational opportunities targeted 
                to health professionals to enable and prepare them to 
                become effective teachers.
            (3) Expansion and improvement of health education and 
        training of new health workers, including--
                    (A) new construction, expansion, rehabilitation, 
                and maintenance of health professional training 
                institutions, including residential housing facilities 
                for students, teachers, and administrators;
                    (B) hiring and retention of teachers and 
                administrators to fully staff health professional 
                training institutions and other health worker training 
                facilities and programs, including through continuing 
                education, professional development, and research 
                opportunities and such financial incentives as direct 
                salary support and housing assistance;
                    (C) providing financial incentives to students 
                enrolled in health professional training institutions, 
                including financial aid, housing assistance, and loan 
                repayment in exchange for defined periods of service in 
                the country's health system;
                    (D) supporting distance learning and community- and 
                hospital-based clinical training;
                    (E) encouraging students to pursue careers in 
                primary care in the health system of their country of 
                residence, especially to meet the needs of rural areas 
                and underserved populations, while also supporting 
                students who choose to pursue careers in health 
                administration and management or in needed tertiary 
                care fields;
                    (F) establishing professional standards for the 
                entire range of health workers, including doctors, 
                nurses, trained midwives, paraprofessionals, community 
                health workers, health administrators and managers, and 
                support personnel;
                    (G) improving the quality and diversity of health 
                education and training courses and strengthening 
                existing curricula, including through the integration 
                of program planning, mangagement, leadership training, 
                and professional standards to better meet national and 
                local circumstances;
                    (H) integrating the use of information and 
                communications technologies, including the management 
                of medical records and medical and laboratory supply 
                inventories, into all health education and training 
                courses;
                    (I) providing health workers with the appropriate 
                training to pursue health-related research, including 
                basic, clinical, applied, and operations research to 
                improve the efficiency and effectiveness of health 
                interventions and encourage the development of 
                innovative tools and approaches to support national 
                health goals;
                    (J) improving the management of health professional 
                training institutions and other health worker training 
                facilities and programs and reducing student attrition 
                rates; and
                    (K) encouraging partnerships between and among 
                health professional training institutions and other 
                health worker training facilities and programs, 
                including on a regional level and among participating 
                countries.
            (4) Retention programs to encourage health workers to 
        remain employed as part of the health system, including--
                    (A) direct salary support, housing assistance, and 
                other financial incentives to enable public-sector 
                employers of health workers to compete with private-
                sector employers of health workers;
                    (B) providing comprehensive, confidential, high-
                quality health services to health workers, including 
                prevention and treatment of chronic and infectious 
                diseases and psychosocial and mental health services;
                    (C) creating sustainable working conditions and 
                policies that protect the health and safety of patients 
                and health workers within their communities and in all 
                medical facilities, including through--
                            (i) following recommended occupational 
                        health and safety standards for health workers, 
                        including standards for training and protective 
                        technology, equipment, and supplies and 
                        standards for blood and injection safety; and
                            (ii) other forms of infection prevention 
                        and control, including rapid access to 
                        postexposure prophylaxis in the event of 
                        exposure to HIV;
                    (D) ensuring that all medical facilities maintain 
                stocks of medical and laboratory supplies, including 
                diagnostics, pharmaceuticals, technology, and 
                equipment, that meet or exceed recommended standards 
                for resource-poor settings;
                    (E) encouraging efficient and effective matching of 
                patient needs with health workers of appropriate skill 
                levels, while providing opportunities to expand the 
                scope of practice for all nonphysician health workers;
                    (F) providing continuing education, distance 
                learning, career advancement, and research and 
                development opportunities, including through national- 
                and regional-level exchange programs;
                    (G) establishing programs to reinforce respect for 
                the rights and dignity of patients and health workers; 
                and
                    (H) reevaluating and supporting the removal of any 
                other government policies, whether at the local, 
                regional, national, or international level, that 
                discourage health workers from choosing to continue 
                their employment in the health system.
            (5) Improving health workforce administration and 
        management, including--
                    (A) direct salary support to hire and retain 
                qualified health administrators and managers of 
                hospitals, clinics, and other such health facilities;
                    (B) training and education in human resource 
                management, leadership, and financial planning for 
                health administrators and managers and their support 
                staff;
                    (C) developing national standards and protocols for 
                clinical practice and program management and other 
                quality improvement procedures and measurements for 
                health administrators and managers to follow and 
                enforce;
                    (D) integrating staffing, resource, and referral 
                systems between the community-level and primary, 
                secondary, and tertiary medical facilities;
                    (E) developing and implementing strategies to 
                improve staffing systems and health worker 
                productivity, including through regular and supportive 
                supervision; and
                    (F) developing, implementing, and evaluating health 
                workforce policies and regulations to most effectively 
                meet the needs of patient populations and health 
                workers.
            (6) Ensuring the equitable distribution of health resources 
        and health workers to meet the needs of rural areas and 
        underserved populations, including by--
                    (A) providing direct salary support, housing 
                assistance, transportation, and other financial or 
                nonfinancial benefits or incentives to health workers 
                working in such areas or among such populations;
                    (B) improving basic health-related infrastructure 
                to improve access to health facilities in such areas 
                and among such populations;
                    (C) strengthening procurement and distribution 
                supply-chain management systems to ensure that medical 
                and laboratory supplies, including diagnostics, 
                pharmaceuticals, technology, and equipment, can reach 
                such areas and such populations;
                    (D) improving management and administrative support 
                in such areas and among such populations;
                    (E) ensuring and prioritizing continuing onsite 
                educational opportunities for health workers in such 
                areas or among such populations; and
                    (F) evaluating, developing, and implementing 
                education and health workforce policies and regulations 
                that incentivize the recruitment, training, and 
                retention of health workers most likely to work in such 
                areas or among such populations.
            (7) Establishing and expanding the use of information and 
        communications technologies, including the management of human 
        resources, medical records, and medical and laboratory supply 
        inventories, to--
                    (A) enhance the skills and knowledge of health 
                workers;
                    (B) improve consultation and referral systems; and
                    (C) provide information to health administrators, 
                managers, and planners.
            (8) Preservice and in-service health worker education and 
        training programs to build respect for the rights and dignity 
        of all patients and coworkers that are tailored to local 
        contexts and developed with the participation of health workers 
        and indigenous civil society organizations and include 
        information about--
                    (A) the rights and status of women and girls;
                    (B) stigmatization of and discrimination against 
                individuals living with diseases and against other 
                poor, vulnerable, or marginalized populations; and
                    (C) the legal, human, and civil rights of all 
                individuals, including the right of access to health 
                services.
            (9) Technical support for the national ministry of health, 
        or its equivalent, of each participating country in its 
        leadership of the health system and the development of the 
        indigenous health workforce, including support to--
                    (A) coordinate resources, funding, and strategy 
                throughout the government;
                    (B) effectively mobilize government resources and 
                funding to support the indigenous health workforce;
                    (C) improve governance, accountability, and 
                responsiveness to the population and to civil society 
                organizations;
                    (D) reduce corruption within the health system; and
                    (E) coordinate with and regulate the private-sector 
                health workforce and any health workers employed by 
                nongovernmental, community, and faith-based 
                organizations, international organizations, private 
                funding sources, or donor nations.
            (10) Support for participating countries to access funding 
        related to health workforces and health systems from 
        multilateral organizations or other external funding sources.
            (11) Direct support to indigenous civil society 
        organizations that promote and advocate for an effective health 
        system and an expanded indigenous health workforce in order for 
        such organizations to--
                    (A) monitor and evaluate health programs, 
                expenditures, and national health workforce plans of 
                their governments;
                    (B) access other sources of domestic and 
                international financing, on behalf of themselves or on 
                behalf of the health systems of their countries, 
                including national health workforces;
                    (C) improve the quality, accessibility, 
                affordability, and equitability of health services; and
                    (D) measure progress toward attaining the goals of 
                the Initiative.
            (12) Research on evidence-based policies and practices 
        related to health workforces and health systems to improve the 
        delivery of primary care in participating countries.
            (13) Establishing a system to annually monitor and make 
        publicly available aggregate, nonpersonally identifiable 
        information regarding the emigration of indigenously trained 
        health workers from participating countries, including--
                    (A) the country where the health professional was 
                born;
                    (B) the country where the health professional was 
                educated and trained;
                    (C) the country to which the health professional is 
                immigrating in order to engage in health-related 
                employment; and
                    (D) a general classification of the title and 
                specialty of the health professional before and after 
                emigration.
    (e) Contract Authority.--The President may enter into contracts to 
carry out the Initiative.
    (f) National Health Workforce Plans.--
            (1) In general.--The President shall encourage 
        participating countries to develop, strengthen, and implement 
        national health workforce plans that--
                    (A) are integrated with their national health 
                strategies, where appropriate;
                    (B) are based on the situational analysis described 
                in paragraph (2); and
                    (C) contain the elements described in paragraph 
                (3).
            (2) Situational analysis.--The situational analysis 
        described in this paragraph is a situational analysis of the 
        country's indigenous health workforce, including an initial 
        assessment of the number per 1,000 residents of each type of 
        health worker, including doctors, nurses, trained midwives, 
        paraprofessionals, community health workers, managers, 
        administrators, and support staff, and of the extent to which 
        each such type of health worker is equitably distributed within 
        such country.
            (3) Plan elements.--The elements described in this 
        paragraph are the following:
                    (A) Performance goals and indicators, including 
                interim benchmarks, over a multiyear period, to achieve 
                a combined total of at least 2.3 doctors, nurses, and 
                trained midwives per 1,000 residents, and comparable 
                numbers of other health workers, such as 
                paraprofessionals, community health workers, managers, 
                administrators, and support staff, and to ensure that 
                such personnel are equitably distributed within the 
                country and can carry out their positions effectively.
                    (B) Objectives and plans of action to--
                            (i) recruit, prepare, and encourage 
                        individuals to seek careers in the health 
                        professions;
                            (ii) expand and improve health education 
                        and training programs for health workers;
                            (iii) encourage health workers to remain 
                        employed in the health system;
                            (iv) reduce the emigration of health 
                        workers and its impact on the indigenous health 
                        workforce and health system;
                            (v) improve health workforce administration 
                        and management in the health system;
                            (vi) increase access to and the placement 
                        of skilled health workers among rural, poor, 
                        and other underserved populations;
                            (vii) expand the use of information and 
                        communications technologies, including the 
                        management of medical records and medical and 
                        laboratory supply inventories;
                            (viii) provide preservice and in-service 
                        education and training programs to combat 
                        stigma and discrimination among health workers 
                        and reinforce respect for the rights and 
                        dignity of patients;
                            (ix) improve the health and safety of 
                        health workers;
                            (x) identify and describe budgetary gaps 
                        related to expanding recruitment, training, and 
                        retention of the indigenous health workforce 
                        and any financial resource mobilization efforts 
                        to close such gaps; and
                            (xi) monitor and evaluate the 
                        implementation of the plan, including 
                        identifying and addressing barriers to 
                        implementation, and provide a basis for 
                        adjustments to the plan as required.
                    (C) Participation and input into the development, 
                implementation, monitoring, and evaluation of all 
                aspects of the plan from indigenous civil society and 
                nongovernmental, community, and faith-based 
                organizations dedicated to improving public health and 
                expanding the indigenous health workforce, with 
                representation from a multisectoral group of 
                stakeholders, including health workers and communities.
    (g) Global Health Workforce Initiative Strategy.--
            (1) In general.--Not later than 1 year after the date of 
        the enactment of this Act, the President shall transmit to 
        Congress and make publicly available a 5-year strategy for 
        implementing and monitoring the Initiative established under 
        this section.
            (2) Content.--The strategy required by paragraph (1) shall 
        include--
                    (A) a description of how assistance provided under 
                this section will be coordinated among United States 
                Government agencies with responsibilities related to 
                global health;
                    (B) a description of how assistance provided under 
                this section will be coordinated with each country, 
                international organization, and other donor;
                    (C) a description of how assistance provided under 
                this section will support and encourage countries to 
                develop the national health workforce plans described 
                in subsection (f);
                    (D) a description, for programs carried out in each 
                participating country, of performance goals and 
                indicators for each activity listed in subsection (d);
                    (E) plans of action to reach the performance goals 
                and indicators required by subparagraph (D); and
                    (F) a description of the consultation required by 
                paragraph (3).
            (3) Consultation.--In developing the strategy required by 
        paragraph (1), the President shall ensure proper consultation 
        with--
                    (A) each executive branch agency authorized to 
                deliver health workforce-related foreign assistance, 
                including personnel at United States embassies and 
                country missions;
                    (B) the appropriate congressional committees with 
                jurisdiction over the agencies described in 
                subparagraph (A);
                    (C) civil society and nongovernmental, community, 
                and faith-based organizations engaged in improving 
                health care and health outcomes and in addressing 
                health workforce needs in developing countries;
                    (D) participating countries;
                    (E) international organizations engaged in 
                delivering health-related assistance and of which the 
                United States is a voting member, with which the United 
                States coordinates the delivery of foreign assistance, 
                or to which the United States contributes funding for 
                the purpose of providing such assistance;
                    (F) private foundations, businesses, and 
                organizations that provide a significant amount of 
                health-related assistance and do not receive United 
                States funding for the purpose of providing such 
                assistance;
                    (G) other donor nations that provide health-related 
                assistance to developing countries; and
                    (H) any other global, regional, or subregional 
                organizations or partnerships engaged in improving 
                health care and health outcomes in developing 
                countries.
    (h) Monitoring and Evaluation System.--
            (1) In general.--The President shall establish an 
        integrated monitoring and evaluation system to measure the 
        effectiveness of foreign assistance provided under the 
        Initiative.
            (2) Harmonization with systems of participating 
        countries.--To the maximum extent possible, the monitoring and 
        evaluation system required by paragraph (1) shall be harmonized 
        with and may be modified to reflect the monitoring and 
        evaluation systems of participating countries.
            (3) Elements of monitoring and evaluation system.--The 
        monitoring and evaluation system required by paragraph (1) 
        shall--
                    (A) establish country-specific performance goals;
                    (B) establish performance indicators to be used in 
                measuring and assessing the achievement of the 
                performance goals established under subparagraph (A), 
                including indicators for--
                            (i) the recruitment of health workers 
                        through the absorption capacity of the 
                        educational system;
                            (ii) the training of health workers through 
                        the absorption capacity, intake, and output of 
                        health professional training institutions;
                            (iii) the retention of health workers by 
                        the health system;
                            (iv) health worker immigration and 
                        emigration;
                            (v) the distribution and density of health 
                        workers, including the relative density and 
                        absorption capacity of urban and rural health 
                        workforces and health facilities;
                            (vi) vacancy rates for health-related jobs;
                            (vii) the health and safety of health 
                        workers;
                            (viii) the overall effectiveness and 
                        productivity of health workers and their 
                        capacity to deliver quality health services; 
                        and
                            (ix) improvements in health outcomes tied 
                        directly to the efforts of health workers;
                    (C) provide a basis for recommendations of 
                adjustments to the strategy established under 
                subsection (g) to enhance the impact of assistance 
                provided under the Initiative and support the 
                integration of such recommendations into the national 
                planning processes of participating countries; and
                    (D) provide regular public accessibility to all 
                collected data in a clear and readable format.
    (i) Report.--
            (1) In general.--Not later than 1 year after the date of 
        the enactment of this Act and annually thereafter, the 
        President shall transmit to Congress a report describing the 
        impact and effectiveness of the assistance provided under the 
        Initiative.
            (2) Content.--The report required by paragraph (1) shall 
        include--
                    (A) an assessment and description, for activities 
                within each participating country, of progress toward 
                achieving the goals of the Initiative;
                    (B) an assessment and description of the financial, 
                policy, and other obstacles to achieving the 
                performance goals established under subsection 
                (h)(3)(A) and the steps taken to overcome such 
                obstacles;
                    (C) an assessment and description, for each 
                participating country, of progress toward and obstacles 
                to developing, strengthening, and implementing a 
                national health workforce plan described in subsection 
                (f), including any assistance provided by the United 
                States to overcome such obstacles; and
                    (D) an evaluation of knowledge about strengthening 
                health workforces that was acquired through 
                implementing the Initiative in each participating 
                country.
    (j) Authorization of Appropriations.--
            (1) In general.--In addition to amounts otherwise made 
        available for such purposes, there are authorized to be 
        appropriated to the President to carry out this section--
                    (A) $300,000,000 for fiscal year 2011;
                    (B) $350,000,000 for fiscal year 2012;
                    (C) $400,000,000 for fiscal year 2013;
                    (D) $450,000,000 for fiscal year 2014; and
                    (E) $500,000,000 for fiscal year 2015.
            (2) Availability of funds.--Amounts appropriated pursuant 
        to the authorization of appropriations in paragraph (1) are 
        authorized to remain available until expended.

SEC. 6. RELATION TO OTHER UNITED STATES LAWS AND POLICIES.

    (a) Sense of Congress on Laws and Policies Related to the United 
States Domestic Health Workforce.--It is the sense of Congress that the 
President, in consultation with Congress, the States, public and 
private medical and health organizations and groups, health 
professional training institutions, and patients, should take steps to 
address the urgent shortage of health professionals in the United 
States without exacerbating the shortage of health professionals in 
developing countries, including by--
            (1) identifying and recommending changes to United States 
        laws, regulations, and policies that incentivize the 
        immigration of foreign-educated health professionals into the 
        United States from countries with recognized shortages of 
        health professionals or further increase the reliance of the 
        United States health care system on such professionals;
            (2) supporting policies that mitigate the impacts of 
        recruiting foreign-educated health professionals away from 
        their countries of origin for health-related employment in the 
        United States and ensure the continued availability of 
        qualified health professionals in such countries, including--
                    (A) establishing relationships or partnership 
                agreements with national and local authorities, 
                hospitals, clinics, and health professional training 
                institutions in source countries to--
                            (i) set mutually agreed-upon time frames 
                        and processes for training and departure of 
                        foreign-educated health professionals;
                            (ii) allow and provide for opportunities 
                        for foreign-educated health professionals to 
                        periodically return to their countries of 
                        origin to provide technical assistance and 
                        support to their home communities or to work in 
                        a health care facility, particularly for 
                        countries experiencing a critical lack of 
                        indigenous health workers;
                            (iii) provide opportunities for visiting 
                        faculty and health professionals from the 
                        United States to provide direct technical 
                        assistance and support for the training of 
                        health professionals in source countries;
                            (iv) support the direct purchase of medical 
                        or laboratory supplies, pharmaceuticals, 
                        diagnostics, technology, and equipment for use 
                        within the source country, in accordance with 
                        the law governing such products in such 
                        country;
                            (v) match a portion of the remittances sent 
                        by recruited foreign-educated health 
                        professionals and direct such matching funds to 
                        health care organizations or national or local 
                        health authorities in their countries of 
                        origin; and
                            (vi) create scholarships with health 
                        professional training institutions in source 
                        countries to support the training and retention 
                        of new indigenous health professionals, 
                        particularly to provide health services to 
                        poor, vulnerable, or marginalized populations;
                    (B) respecting contractual obligations and other 
                agreements of foreign-educated health professionals to 
                serve the health systems of their countries of origin 
                in exchange for public education or scholarships 
                provided in such countries, including by encouraging 
                foreign-educated health professionals to honor such 
                agreements, and, where appropriate, requiring evidence 
                that such agreements have been satisfied; and
                    (C) ending active overseas recruitment in--
                            (i) countries or areas within countries 
                        where a temporary health crisis is causing a 
                        severe shortage of health professionals;
                            (ii) countries that are experiencing a 
                        chronic shortage of health workers, with fewer 
                        than a combined total of 2.3 doctors, nurses, 
                        and trained midwives per 1,000 residents; and
                            (iii) countries that request the end of 
                        such recruitment, in whole or in part;
            (3) advocating the mandatory adoption of the policies 
        described in paragraph (2) by recruiting organizations that 
        receive United States funding;
            (4) establishing programs that allow foreign-educated 
        health professionals working in the United States to return to 
        their countries of origin to participate in health-related 
        United States foreign assistance programs without impacting 
        their immigration status in the United States;
            (5) annually monitoring and making publicly available 
        aggregate, nonpersonally identifiable information related to 
        foreign-educated health professionals who are recruited to or 
        who otherwise immigrate to the United States, including 
        information related to--
                    (A) their countries of birth;
                    (B) the countries where they were educated and 
                trained to become health professionals;
                    (C) the countries in which they engaged in health-
                related employment immediately prior to entering the 
                United States; and
                    (D) the States to which they were recruited or in 
                which they otherwise intend to engage in health-related 
                employment;
            (6) developing a health workforce plan for the United 
        States that includes a specific focus on recruiting and 
        training significant numbers of new health professionals to 
        address the urgent shortage of health professionals in the 
        United States, in accordance with the principles of paragraphs 
        (1) through (4); and
            (7) supporting the World Health Organization in developing 
        and implementing a Global Code of Practice on the International 
        Recruitment of Health Personnel that is consistent with 
        paragraphs (1) through (4) and that takes into consideration 
        the views of all relevant stakeholders.
    (b) Sense of Congress on Laws and Policies Related to Bilateral and 
International Trade.--It is the sense of Congress that the President 
should pursue trade and investment agreements and policies that support 
the goals of the United States Global Health Strategy and maximize the 
ability of national governments to improve health outcomes and reduce 
mortality among their populations, including by ensuring that any trade 
agreement--
            (1) encourages broad access for poor, vulnerable, or 
        marginalized populations to quality, affordable 
        pharmaceuticals, medical products, and medical devices, 
        including generics, if such items are covered by such 
        agreement;
            (2) allows for the negotiation of lower prices for 
        pharmaceuticals, especially if no generic alternative exists or 
        the original product cannot be purchased at an affordable cost;
            (3) adheres to the principles of the 2001 World Trade 
        Organization (in this subsection referred to as the ``WTO'') 
        Doha Declaration on Trade-Related Aspects of Intellectual 
        Property Rights (in this subsection referred to as the 
        ``Declaration''), including measures that the Agreement on 
        Trade-Related Aspects of Intellectual Property Rights permits 
        countries to take to protect public health and ensure access to 
        essential medicines;
            (4) is negotiated, implemented, monitored, and enforced 
        with the input and participation, in an advisory capacity, of a 
        broad range of indigenous and United States-based civil society 
        organizations that are dedicated to improving and protecting 
        public health;
            (5) expressly allows for the adoption of public interest 
        licensing agreements for medications developed with significant 
        public funding, such as--
                    (A) open licensing;
                    (B) nonenforcement of patents;
                    (C) licensing of such products to international 
                drug purchase facilities and patent pools; and
                    (D) other mechanisms to make medications available 
                at reduced cost;
            (6) disavows the use of trade threats, such as placement on 
        ``watchlists'' or the removal of trade benefits, against 
        countries using WTO-compliant trade flexibilities, in 
        accordance with the principles of the Declaration, in order to 
        protect public health and ensure access to essential medicines; 
        and
            (7) does not result in costs of pharmaceuticals, medical 
        products, or medical devices that are unaffordable for the 
        general population, and does not subject national governments 
        to any limitations with respect to the use, distribution, or 
        manufacturing of such items that are inconsistent with the 
        principles of the Declaration.
    (c) United States Participation in International Financial 
Institutions.--
            (1) Opposition to certain user fees.--The Secretary of the 
        Treasury shall instruct the United States Executive Director at 
        each international financial institution to oppose and vote 
        against any proposed loan, grant, strategy, or policy of such 
        respective institution that would require or result in the 
        imposition of user fees or service charges on poor individuals 
        in connection with such institution's financing programs for 
        primary education or primary health care, including prevention, 
        care, and treatment for HIV/AIDS, malaria, and tuberculosis and 
        care related to infant, child, reproductive, and maternal well-
        being.
            (2) Opposition to certain imf spending caps.--The Secretary 
        of the Treasury shall instruct the United States Executive 
        Director at the International Monetary Fund to oppose and vote 
        against any loan, project, agreement, memorandum, instrument, 
        or program of the International Monetary Fund that would not 
        exempt government spending on health care, health 
        infrastructure, and education from national budget caps and 
        restraints, hiring and wage ceilings, and other limits imposed 
        by the International Monetary Fund.
    (d) Participation of Health Workers in United States Global Health 
Programs.--For all United States programs related to global health that 
provide foreign assistance, it shall be the policy of the United States 
Government to ensure that--
            (1) all health workers participating in such programs 
        follow recommended occupational health and safety standards and 
        have the proper training and access to the necessary protective 
        technology, equipment, and supplies, including those for blood 
        and injection safety, to establish and sustain safe and 
        sanitary working conditions in accordance with accepted forms 
        of effective infection prevention and control, including rapid 
        access to postexposure prophylaxis in the event of exposure to 
        HIV;
            (2) all health workers participating in such programs have 
        access to comprehensive, confidential, high-quality health 
        services, including prevention and treatment for chronic and 
        infectious diseases and psychosocial and mental health 
        services;
            (3) all health workers participating in such programs 
        receive training about respect for the rights and dignity of 
        all patients and coworkers that is tailored to local contexts, 
        developed with the participation of health workers and 
        indigenous civil society organizations, and includes 
        information about--
                    (A) the rights and status of women and girls;
                    (B) stigmatization of and discrimination against 
                individuals living with diseases and other marginalized 
                groups; and
                    (C) the legal, civil, and human rights of all 
                individuals, including the right of access to health 
                services; and
            (4) community health workers are--
                    (A) recognized for their work;
                    (B) integrated into countries' health systems 
                through--
                            (i) a functional process by which community 
                        health workers may refer patients to other 
                        appropriate health workers; and
                            (ii) the provision of ongoing support and 
                        supervision;
                    (C) paid adequate salaries and offered tangible 
                pathways for career advancement; and
                    (D) when possible, recruited from underserved and 
                rural communities.

SEC. 7. DEFINITIONS.

    In this Act, the following definitions apply:
            (1) Community health worker.--The term ``community health 
        worker'' means a health worker who is engaged in the provision 
        of health services directly to individuals and who does not 
        have the advanced training of a health professional.
            (2) Health professional.--The term ``health professional'' 
        means a health worker who provides health services and has 
        received advanced training regarding the provision of such 
        services, including doctors, nurses, midwives, pharmacists, 
        pharmacy technicians, dentists, laboratory technicians, and 
        clinical officers.
            (3) Health professional training institution.--The term 
        ``health professional training institution'' means an 
        institution that trains health professionals in accordance with 
        generally accepted standards of clinical practice and confers a 
        degree or diploma on each graduate of a training program.
            (4) Health system.--Used in relation to a country, the term 
        ``health system'' means all components, public and private, of 
        the health care mobilization, financing, and delivery system of 
        such country, including health workers, health professionals, 
        clinics, hospitals, pharmacies, institutions performing health-
        related research, producers of pharmaceuticals and medical 
        equipment, and government health-service agencies.
            (5) Health worker.--The term ``health worker'' means any 
        individual who provides or supports the provision of health 
        services, directly or indirectly, including health 
        professionals, paraprofessionals, community health workers, 
        social workers, caregivers, nutritionists, health 
        administrators and managers, and government officials who set 
        health care policy.
            (6) International financial institution.--The term 
        ``international financial institution'' means the following 
        institutions:
                    (A) The International Bank for Reconstruction and 
                Development.
                    (B) The International Development Association.
                    (C) The International Finance Corporation.
                    (D) The Multilateral Investment Guarantee Agency.
                    (E) The International Centre for Settlement of 
                Investment Disputes.
                    (F) The Inter-American Development Bank.
                    (G) The Asian Development Bank.
                    (H) The Asian Development Fund.
                    (I) The African Development Bank.
                    (J) The African Development Fund.
                    (K) The International Monetary Fund.
                    (L) The North American Development Bank.
                    (M) The European Bank for Reconstruction and 
                Development.
            (7) National health strategy.--Used in relation to a 
        country, the term ``national health strategy'' means any set of 
        policies, whether or not formally enumerated and however 
        called, aimed at improving health outcomes in such country by 
        improving and increasing access to the health system of such 
        country.
            (8) Poor, vulnerable, or marginalized populations.--The 
        term ``poor, vulnerable, or marginalized populations'' means--
                    (A) indigenous populations;
                    (B) racial, ethnic, religious, and national 
                minorities;
                    (C) children who have lost one or both parents;
                    (D) women and girls;
                    (E) individuals with physical or mental 
                disabilities;
                    (F) individuals living with chronic or infectious 
                diseases;
                    (G) sexual minorities, including men who have sex 
                with men;
                    (H) sex workers;
                    (I) drug users;
                    (J) incarcerated and formerly incarcerated 
                individuals;
                    (K) individuals of foreign national origin;
                    (L) refugees and internally displaced populations;
                    (M) the elderly;
                    (N) individuals who live in rural areas; and
                    (O) any other group that has difficulty accessing 
                health services because of economic, political, or 
                social status.
                                 <all>
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