SEC. 2. ASSISTANCE TO END PREVENTABLE CHILD AND MA-
TERNAL DEATHS. 
The Foreign Assistance Act of 1961 (22 U.S.C. 2151 
et seq.) is amended by adding at the end of chapter 1 
of part I the following: 
‘‘SEC. 137. ASSISTANCE TO END PREVENTABLE CHILD AND 
MATERNAL DEATHS. 
‘‘(a) SENSE OF CONGRESS.—It is the sense of Con-
gress that United States foreign assistance efforts should 
focus on countries, regions, and communities with the 
greatest need and the highest burden of preventable child 
and maternal deaths. 
‘‘(b) STATEMENT OF POLICY.—It shall be the policy 
of the United States, in coordination with recipient coun-
tries and relevant partner entities, to establish and imple-
ment a coordinated, integrated, and comprehensive strat-
egy to combat the leading causes of maternal, newborn, 
and child mortality globally and ensure healthy and pro-
ductive lives for women and children, by— 
‘‘(1) scaling up the highest-impact, evidence- 
based interventions, including for the most vulner-
able populations, with a focus on country ownership; 
‘‘(2) designing, implementing, monitoring, and 
evaluating programs in a way that enhances trans-
parency and accountability, increases sustainability, 
and improves outcomes in target countries; and 
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‘‘(3) supporting the development and scale-up 
of innovative tools and approaches to accelerate 
progress toward ending preventable child and mater-
nal deaths and reach the goal of saving the lives of 
15,000,000 children and 600,000 women. 
‘‘(c) STRATEGY.— 
‘‘(1) IN GENERAL.—Not later than one year 
after the date of the enactment of this section, the 
President shall establish and implement a com-
prehensive five-year, whole-of-government strategy to 
accelerate progress toward ending preventable child 
and maternal deaths within a generation and ensure 
healthy and productive lives for women and children. 
‘‘(2) ELEMENTS.—The strategy established 
under paragraph (1) shall— 
‘‘(A) set specific, outcome-based, and 
measurable targets to achieve the goals of the 
strategy and identify baseline data for each tar-
get country and for all areas of focus and pro-
gramming, as of the date of the publication of 
such strategy; 
‘‘(B) incorporate existing Federal strate-
gies and frameworks relevant to ending prevent-
able child and maternal deaths, including spe-
cific objectives, programs, and approaches to 
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implement highest-impact, evidence-based inter-
ventions, to address the leading causes of death 
in target countries, particularly among the most 
vulnerable populations, for— 
‘‘(i) women, related to pregnancy, 
childbirth, or the post-delivery period; 
‘‘(ii) newborn children during their 
first 28 days; and 
‘‘(iii) infants and children under the 
age of five; 
‘‘(C) include development and scale up of 
new technologies and approaches, including 
those supported by public-private partnerships 
for research and innovation; 
‘‘(D) promote coordination and efficiency 
within and amongst the relevant Federal de-
partments and agencies; 
‘‘(E) project the general levels of resources 
needed to achieve the strategy’s stated objec-
tives; 
‘‘(F) identify strategies for leveraging re-
sources with new and innovative financial tools; 
‘‘(G) align with the maternal, newborn, 
and child health and survival plans of target 
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countries and improve coordination with foreign 
governments and international organizations; 
‘‘(H) outline consultations with target 
countries and relevant partner entities; 
‘‘(I) implement results-based contracting, 
such as pay-for-outcome arrangements, and re-
duce financial and operational risks; 
‘‘(J) promote a shift toward inclusive and 
sustainable investments; 
‘‘(K) support the transition to sustainably 
financed, domestic health systems in target 
countries; and 
‘‘(L) promote partnerships with organiza-
tions that have a long-term presence in target 
countries and have shown evidence of sustain-
able community impact, including through the 
capacity building of local and community-based 
organizations. 
‘‘(3) 
IDENTIFICATION
OF
TARGET
COUN-
TRIES.—For purposes of the strategy under para-
graph (1), the Administrator shall— 
‘‘(A) identify each country that has the 
greatest need and faces the highest burden of 
preventable child and maternal deaths, taking 
into consideration countries that— 
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‘‘(i) 
have 
high-need, 
underserved, 
marginalized, vulnerable, or impoverished 
communities; 
‘‘(ii) are fragile or conflict-affected 
countries; 
‘‘(iii) are low- or middle-income coun-
tries; or 
‘‘(iv) are located in regions with weak 
health systems; and 
‘‘(B) establish transparent selection cri-
teria for such target countries. 
‘‘(d) IMPROVING COORDINATION AND OVERSIGHT.— 
‘‘(1) ESTABLISHMENT
OF
SENIOR
COORDI-
NATOR FOR CHILD AND MATERNAL SURVIVAL.—The 
Administrator shall designate a current employee 
serving in a career or non-career position in the Sen-
ior Executive Service or at the level of a Deputy As-
sistant Administrator or higher at the United States 
Agency for International Development (USAID) to 
serve concurrently as the Senior Coordinator for 
Child and Maternal Survival. 
‘‘(2) DUTIES.—The Senior Coordinator shall— 
‘‘(A) have the primary responsibility for 
the oversight and coordination of international 
maternal and child health and nutrition funding 
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managed by the USAID Bureau of Global 
Health; 
‘‘(B) lead the development of the strategy 
established under subsection (c) and its imple-
mentation by USAID, including by directing 
the budget, planning, and staffing with respect 
to such implementation; 
‘‘(C) facilitate program and policy coordi-
nation of international maternal and child 
health and nutrition programs between the 
USAID, other relevant Federal departments 
and agencies, and relevant partner entities; 
‘‘(D) monitor, evaluate, and report on any 
activities undertaken by USAID pursuant to 
the strategy required under subsection (c); and 
‘‘(E) provide direction to the design and 
oversight of grants, contracts, and cooperative 
agreements with any recipient of funds under 
the responsibility of the Senior Coordinator 
pursuant to subparagraph (A). 
‘‘(3) RESTRICTION ON ADDITIONAL OR SUPPLE-
MENTAL COMPENSATION.—The Senior Coordinator 
shall not receive any additional or supplemental 
compensation as a result of carrying out responsibil-
ities and duties under this section. 
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‘‘(e) PRIORITIZATION OF GREATEST NEED AND MAX-
IMUM IMPACT.— 
‘‘(1) TARGETS FOR INCREASED IMPLEMENTA-
TION REQUIRED.—In accordance with the guidelines 
established under section 3 of the Foreign Aid 
Transparency and Accountability Act, any grant 
made available by the Administrator and any con-
tract or cooperative agreement entered into by the 
Administrator in order to implement the strategy es-
tablished under subsection (c) of this section shall— 
‘‘(A) include targets for increased imple-
mentation of high-impact, evidence-based inter-
ventions and strengthening health systems, as 
appropriate; and 
‘‘(B) establish baseline measurements from 
which to quantify progress toward such targets 
and towards the goal of preventing life-threat-
ening morbidity and mortality for at least 
15,000,000 children and at least 600,000 
women, as described in subsection (b)(3). 
‘‘(2) 
EXCEPTION.—In 
exceptional 
cir-
cumstances when the Administrator determines that 
the inclusion of coverage targets or baseline meas-
ures is not reasonable or practicable for a grant, 
contract, or cooperative agreement, the funding 
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mechanism for such grant, contract, or agreement 
shall include an explanation of the omission and ex-
plicitly state how measurable impact will be targeted 
and tracked. 
‘‘(f) USE OF INNOVATIVE PUBLIC-PRIVATE FINANC-
ING TOOLS.— 
‘‘(1) IN GENERAL.—In addition to existing bi-
lateral and multilateral assistance for child and ma-
ternal survival, the Administrator shall implement 
the strategy established under subsection (c) 
through the use of innovative financing tools, where 
appropriate, to expand delivery of highest-impact, 
evidence-based interventions to address the leading 
causes of preventable child and maternal deaths, 
particularly among vulnerable populations. The Ad-
ministrator shall also explore models, whether exist-
ing or innovative, to improve the efficiency and ef-
fectiveness of investments through results-based con-
tracting (such as pay-for-outcome arrangements) 
and reduce financial and operational risks with re-
spect to such implementation. 
‘‘(2) AUTHORIZATION TO FUND PROGRAMS ON 
PAY-FOR-OUTCOME BASIS.— 
‘‘(A) IN
GENERAL.—The Administrator 
shall have the authority to provide assistance 
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for child and maternal survival on a pay-for- 
outcome basis, as described in subparagraph 
(B), to any initiative that meets the require-
ments described in subparagraph (C). 
‘‘(B) 
PAY-FOR-OUTCOME
BASIS
DE-
SCRIBED.—The pay-for-outcome basis described 
in this paragraph is a performance-based grant, 
contract, or cooperative agreement awarded in 
the form of a commitment to provide payments 
that is contingent on improved outcomes result-
ing in a social benefit to the public and in di-
rect cost savings or cost avoidance to the 
United States Government. 
‘‘(C) REQUIREMENTS
FOR
PAY-FOR-OUT-
COME FUNDING.—The Administrator may only 
provide assistance under subparagraph (A) to 
an initiative that includes the following: 
‘‘(i) A detailed implementation plan 
describing how the proposed pay-for-out-
come initiative is based on evidence sup-
porting an expectation of improved effec-
tiveness. 
‘‘(ii) A rigorous, independent, third- 
party evaluation, using experimental or 
quasi-experimental design or other quan-
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titative research methodologies, that allows 
for the strongest possible causal inferences, 
when random assignment is not feasible, to 
determine 
whether 
the 
initiative 
has 
achieved the proposed improvement in out-
comes. 
‘‘(D) LIMITATION
ON
AVAILABILITY
OF 
FUNDING.—Any payments provided to an initia-
tive pursuant to the authorization under sub-
paragraph (A) may only be made available for 
expenditure for not more than 5 years after the 
date on which such payments are first made 
available. 
‘‘(g) REPORTS.— 
‘‘(1) REPORT
REQUIRED.—Not later than 2 
years after the date of the publication of the strat-
egy required under subsection (c), and annually 
thereafter, the President shall submit to the appro-
priate congressional committees, and make publicly 
available, a report describing the implementation of 
the strategy. 
‘‘(2) INFORMATION
INCLUDED
IN
REPORT.— 
The report required under paragraph (1) shall in-
clude the following: 
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‘‘(A) Multilateral and international organi-
zations. 
‘‘(B) International financial institutions. 
‘‘(C) The national and local governments 
of recipient countries. 
‘‘(D) Community nongovernmental organi-
zations, including faith-based, professional, and 
civil society organizations. 
‘‘(E) Entities in the private sector. 
‘‘(F) Entities in the healthcare sector of 
recipient countries. 
‘‘(5) SENIOR COORDINATOR.—The term ‘Senior 
Coordinator’ means the Senior Coordinator for Child 
and Maternal Survival established under subsection 
(d). 
‘‘(6) TARGET
COUNTRY.—The term ‘target 
country’ means a country identified by the Adminis-
trator pursuant to subsection (c)(3).’’. 
Æ 
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