I 
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 pur-
poses. 
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 Fi-
nancial 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 strength-
ening their indigenous health workforces, and for other 
purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Global Health Expansion, Access to Labor, Trans-
parency, 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 serv-
ices. 
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 Strat-
egy that— 
(A) supports developing countries in their 
efforts to expand and develop their health sys-
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tems 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 inter-
national organizations; 
(2) providing assistance under section 4 for de-
veloping countries to improve the delivery of health 
services by their health systems; 
(3) supporting the efforts of developing coun-
tries 
to 
strengthen 
their 
indigenous 
health 
workforces and expand the supply and equitable dis-
tribution 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 multilat-
eral organizations of which the United States is a 
member do not interfere with the ability of devel-
oping countries to establish and maintain skilled in-
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digenous health workforces, to obtain pharma-
ceuticals 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 com-
prehensive 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 chil-
dren under 5 years of age by 2⁄3 between 1990 
and 2015; 
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(B) improving maternal health, with spe-
cial emphasis on reducing the maternal mor-
tality 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 em-
phasis on halting and beginning to reverse by 
2015 the spread of HIV/AIDS and the inci-
dence 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 ex-
tent practicable— 
(A) improves access to quality health serv-
ices for poor, vulnerable, or marginalized popu-
lations in countries receiving health-related 
United States foreign assistance; 
(B) ensures that skilled health workers are 
available in sufficient numbers and on a suffi-
ciently sustainable and equitably distributed 
basis within each country that their participa-
tion in programs supported by health-related 
United States foreign assistance does not nega-
tively impact the health workforce of any com-
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ponent 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 popu-
lations; 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 
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the types of United States foreign assistance de-
scribed in paragraph (1); 
(3) the appropriate congressional committees 
with jurisdiction over the agencies described in para-
graph (1); 
(4) civil society and nongovernmental organiza-
tions engaged in improving health care and health 
outcomes in developing countries, including indige-
nous community and faith-based organizations; 
(5) international organizations engaged in im-
proving health care and health outcomes in devel-
oping countries and of which the United States is a 
voting member, with which the United States coordi-
nates the delivery of foreign assistance, or to which 
the United States contributes funding for the pur-
pose of providing such assistance; 
(6) academic organizations, private foundations, 
businesses, and other organizations engaged in im-
proving health care and health outcomes in devel-
oping countries and not receiving United States 
funding for such purposes; 
(7) other donor nations engaged in improving 
health care and health outcomes in developing coun-
tries; 
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(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 coun-
tries. 
(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 execu-
tive branch agencies authorized to deliver such as-
sistance in order to achieve the goals listed in sub-
section (b)(1) in a manner that facilitates harmoni-
zation 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 pro-
grams 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 infrastruc-
ture, health care workforces, HIV/AIDS, tuber-
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culosis, malaria, pandemic influenza, chronic 
and noncommunicable diseases, neglected dis-
eases, and other infectious diseases; 
(B) to assist countries in strengthening 
their financial management, accounting, audit-
ing, 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 assist-
ance to conduct periodic audits, inspections, 
and investigations and an analysis of how over-
sight activities should be prioritized. 
(2) Plans that describe how health-related 
United States foreign assistance will help developing 
countries strengthen and improve their health sys-
tems and the delivery of health services to achieve 
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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 imple-
mentation 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, com-
munity health workers, managers, and adminis-
trative 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 through-
out the country; and 
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(ii) perform any maintenance nec-
essary to ensure the continued operation of 
medical and laboratory equipment; 
(G) supporting the development, improve-
ment, and implementation of financial manage-
ment systems and the training of financial 
management personnel in order to track health 
expenditures by the national governments of de-
veloping countries, ensure the equitable and ef-
fective allocation of such expenditures, antici-
pate and budget for annual resource needs, eq-
uitably mobilize additional domestic resources, 
and increase the accountability of the health 
systems of such countries to their people, in-
cluding accountability at the subnational and 
community levels; 
(H) supporting the establishment, improve-
ment, and implementation, where appropriate, 
of mechanisms to operate, manage, regulate, 
monitor, and evaluate a country’s health sys-
tem, particularly its effectiveness in reducing 
mortality 
and 
improving 
health 
outcomes 
among the general population and for poor, vul-
nerable, or marginalized populations; 
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(I) supporting the development and imple-
mentation of national health information sys-
tems 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 adjust-
ments to the health system; 
(J) supporting meaningful community in-
volvement and participation, inclusive of poor, 
vulnerable, or marginalized populations and 
their representative indigenous and civil society 
organizations, in decisionmaking related to na-
tional and subnational health strategies and the 
delivery of health services, including in deci-
sions related to the adoption of health policies 
and the total amount and distribution of health 
funding; 
(K) further promoting the community in-
volvement and participation described in sub-
paragraph (J) by strengthening partnerships 
between government, civil society, and indige-
nous nongovernmental organizations, including 
community and faith-based organizations seek-
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ing to improve health conditions in their coun-
tries 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, regu-
late, and harmonize the delivery of health serv-
ices provided by the United States and non-
governmental organizations, including commu-
nity 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 
nongovern-
mental organizations, including community and 
faith-based organizations, that seek to improve 
the efficiency, transparency, and delivery of 
health services to poor, vulnerable, or marginal-
ized populations; and 
(O) using, to the maximum extent prac-
ticable, local and regional entities for the provi-
sion of technical assistance, and where the ca-
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pacity 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 assist-
ance to detect, identify, and respond to emerging 
public health threats by— 
(A) developing and improving laboratory 
capacity, including constructing or rehabili-
tating 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 con-
tain the spread of disease, including laboratory 
personnel, epidemiologists, and animal and 
plant inspectors; 
(C) supporting the development of inte-
grated and comprehensive surveillance and noti-
fication systems at the national and regional 
level that are integrated within the health sys-
tem to address the spread of emerging diseases 
among human, animal, and plant populations 
that may pose potential threats to public health; 
and 
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(D) 
facilitating 
partnerships 
between 
health systems and relevant United States Gov-
ernment agencies to strengthen national and re-
gional disease surveillance and notification sys-
tems 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 for-
eign assistance, including plans related to— 
(A) basic, clinical, and applied research on 
diseases that primarily impact developing coun-
tries, including research on medical technology 
and equipment, protocols, procedures, stand-
ards, and strategies to combat such diseases; 
(B) operations research to facilitate the de-
velopment and administration of effective health 
systems and health-related programs; 
(C) support for developing indigenous re-
search capacity, including the establishment of 
independent and scientific peer review processes 
to help countries pursue their own research 
agendas; 
(D) encouraging the development of sus-
tainable, country-driven partnerships between 
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indigenous and United States-based research 
institutions; and 
(E) strengthening regional research part-
nerships. 
(5) Plans for encouraging and assisting na-
tional 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 re-
ferral to secondary and tertiary medical facili-
ties that provide services including— 
(i) preventive care; 
(ii) prenatal and perinatal services; 
(iii) immunizations and vaccinations; 
(iv) family planning and reproductive 
health services; 
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(v) chronic and infectious disease 
management; 
(vi) maternal and child health serv-
ices; 
(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 ac-
cess and use health services without fear or risk 
of gender-based violence, reprisal, discrimina-
tion, stigmatization, or other mistreatment; 
(D) work to remove stigmatization of and 
discrimination against poor, vulnerable, or mar-
ginalized 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- 
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quality, confidential, affordable health services, 
including by— 
(i) encouraging the elimination of user 
fees or their replacement with equitable fi-
nancing strategies where appropriate; and 
(ii) addressing other persistent bar-
riers to such access, including those related 
to housing, transportation, language, and 
similar issues; 
(G) promote sustainable working condi-
tions 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 serv-
ices 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 
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rights, improve access to legal services, protect 
the environment, and spur economic growth; 
and 
(K) facilitate the development and imple-
mentation of sustainable policies, legal frame-
works, and capacity-building activities that ac-
tively engage and support civil society organiza-
tions and community members, including indi-
viduals from poor, vulnerable, or marginalized 
populations, to monitor and enforce policies re-
lated to the provision of health services. 
(6) Plans to support the efforts of national gov-
ernments of developing countries in responding to 
health-related threats posed by environmental prob-
lems, including pollution and climate change. 
(7) Plans for a review of, including rec-
ommendations 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 pro-
fessionals to the United States; 
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(B) negotiation and enforcement of bilat-
eral, multilateral, and other international trea-
ties and trade and investment agreements, in-
cluding any provisions related to the delivery of 
health services or the supply of medical tech-
nology and equipment, diagnostics, or pharma-
ceutical 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 Ma-
laria, the Global Alliance for Vaccines and 
Immunisation, and any other international or-
ganizations of which the United States is a vot-
ing member and to which the United States 
contributes funding. 
(8) Plans for establishing an integrated moni-
toring and evaluation system, coordinated at the 
country level with any such systems previously in ex-
istence, 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 
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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 assist-
ance to developing countries; and 
(C) 
countries 
receiving 
health-related 
United States foreign assistance. 
(e) STRATEGY COORDINATOR.— 
(1) IN
GENERAL.—The President shall des-
ignate 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 Coor-
dinator shall include— 
(A) coordinating the Global Health Strat-
egy among all relevant executive branch agen-
cies; 
(B) serving as a point of reference for 
Congress and the public regarding the imple-
mentation of the Global Health Strategy; and 
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(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 peri-
odically review and adjust the Global Health Strategy, the 
President shall establish, where appropriate, objective and 
quantifiable performance goals and indicators for each ele-
ment required by subsection (d). 
(g) REPORT.—Not later than 1 year after the Presi-
dent’s transmission to Congress of the Global Health 
Strategy under subsection (a) and annually thereafter, the 
President shall transmit to Congress a report that in-
cludes— 
(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 
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transmission of the report, including their results, 
and a brief summary of any plans to undertake simi-
lar 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, rehabilita-
tion, 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 pro-
gram. 
(h) EVALUATION OF THE GLOBAL HEALTH STRAT-
EGY BY THE INSTITUTE OF MEDICINE.— 
(1) IN
GENERAL.—The Strategy Coordinator 
shall enter into a contract with the Institute of Med-
icine of the National Academies, or, if the Institute 
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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 re-
quired by paragraph (1) shall provide for— 
(A) an assessment of the level of coordina-
tion of health-related United States foreign as-
sistance, 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- 
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related United States foreign assistance, includ-
ing 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 fac-
tors that the entity with which the Strategy Co-
ordinator contracts under paragraph (1), in 
consultation with the appropriate congressional 
committees and the Strategy Coordinator, con-
siders appropriate. 
(i) AUTHORIZATION OF APPROPRIATIONS.— 
(1) IN GENERAL.—In addition to amounts oth-
erwise 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 appro-
priated pursuant to the authorization of appropria-
tions in paragraph (1) are authorized to remain 
available until expended. 
SEC. 4. ASSISTANCE FOR DEVELOPING COUNTRIES TO IM-
PROVE DELIVERY OF HEALTH SERVICES. 
(a) AUTHORIZATION.— 
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(1) IN GENERAL.—The President is authorized 
to provide assistance to developing countries to im-
prove 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, rehabilita-
tion, 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 ad-
ministrators, including ensuring the equi-
table distribution of such personnel in 
health facilities throughout the country; 
(iii) developing a supply-chain man-
agement system to— 
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(I) efficiently, transparently, and 
equitably 
purchase 
and 
distribute 
medical and laboratory supplies, in-
cluding diagnostics, pharmaceuticals, 
technology, 
equipment, 
and 
other 
health commodities, to health facilities 
throughout the country; and 
(II) perform any maintenance 
necessary to ensure the continued op-
eration 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 gov-
ernments 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. 
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(3) ELIGIBLE ENTITIES.—In carrying out para-
graph (1), the President is authorized to provide as-
sistance directly to— 
(A) the national government of each devel-
oping country that has a national health strat-
egy, including assistance to the national min-
istry of health and the national ministry of fi-
nance, or their equivalents, and other relevant 
ministries; 
(B) indigenous nongovernmental, commu-
nity, and faith-based organizations and civil so-
ciety 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 pur-
pose of providing such assistance. 
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(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 coun-
try receiving such assistance; and 
(B) in accordance with the goals and addi-
tional 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 STRATE-
GIES.—The President shall encourage each country receiv-
ing direct assistance described in subsection (a)(2)(A) to 
incorporate into its national health strategy, to the max-
imum 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 re-
gional health targets. 
(2) Plans to provide universal access to a com-
prehensive package of primary health services. 
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(3) Plans to increase the equitable distribution 
of health services among rural, peri-urban, and 
urban areas of the country, including plans to en-
sure the availability of the facilities, personnel, med-
ical and laboratory supplies, technology and equip-
ment, 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 de-
scribed in paragraph (1), including a description of 
any funding gaps and plans to fill such gaps through 
increased and equitable mobilization of national re-
sources and in partnership with external donors, in-
cluding the United States, and other funding 
sources. 
(6) Appropriate mechanisms and tools to mon-
itor 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 par-
ticular focus on expanding access to health services 
for poor, vulnerable, or marginalized populations. 
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(7) Appropriate financial management and au-
diting mechanisms for health financing in order to 
track health expenditures by the national govern-
ment, ensure the equitable distribution of such ex-
penditures 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, includ-
ing community and faith-based organizations, af-
fected communities, 
and 
poor, 
vulnerable, 
or 
marginalized populations, in the development and 
implementation of the national health strategy, in-
cluding 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 dis-
crimination against poor, vulnerable, or marginalized 
populations, to promote their rights, and to promote 
their ability to access and use health services. 
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(11) Medically accurate and evidence-based 
policies and program plans that adhere to the latest 
global public health standards for prevention, treat-
ment, and care and that are contextualized within 
each country. 
(12) Plans to ensure that all individuals, espe-
cially the poorest of the poor, are able to exercise 
their rights and have access to high-quality, con-
fidential, affordable health services, including by— 
(A) encouraging the elimination of user 
fees or their replacement with equitable financ-
ing 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 occupa-
tional health and safety standards for health work-
ers, including standards for training and protective 
technology, equipment, and supplies, as well as 
through other forms of infection prevention and con-
trol. 
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(14) Access for health workers employed in the 
country’s health system to comprehensive, confiden-
tial, high-quality health services, including preven-
tion 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, in-
cluding programs and plans to address emerging 
public health threats and health-related threats 
posed by environmental problems and to advance ap-
plied research into diseases affecting the country. 
(16) Support for the development and imple-
mentation 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— 
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(A) encourage the inclusion, adoption, and 
implementation of the principles listed in sub-
section (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 ex-
panding and improving the delivery of health 
services. 
(2) NO REDUCTION OF ASSISTANCE.—A part-
nership agreement under paragraph (1) shall not re-
sult in a reduction of the total level of health-related 
United States foreign assistance provided to a coun-
try 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, ob-
jective and quantifiable performance goals and indi-
cators to measure progress toward the development 
and implementation of national health strategies in 
accordance with the principles listed in subsection 
(b). 
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(2) HARMONIZATION WITH SYSTEMS OF RECIPI-
ENT COUNTRIES.—To the maximum extent possible, 
the system established under paragraph (1) shall be 
harmonized with the monitoring and evaluation sys-
tems of countries receiving assistance under this sec-
tion. 
(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, in-
cluding how such assistance was aligned with each 
country’s national health strategy and any associ-
ated 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 re-
ceiving assistance under this section during the fol-
lowing year and the resources that will be required 
to carry out such plans; 
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(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 sub-
section (b) into their national health strategies; and 
(4) a detailed programmatic list of expenditures 
under this section for the previous fiscal year, in-
cluding the amounts and percentages of funding al-
located 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, rehabilita-
tion, 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 con-
tractors providing such assistance and the im-
pact of such assistance in improving health out-
comes and health service delivery. 
(f) CERTIFICATION REQUIREMENT.— 
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(1) IN GENERAL.—The President shall certify 
to Congress that each contract described in para-
graph (2)— 
(A) has been openly and transparently se-
cured and provides the highest quality goods 
and services at the lowest cost; and 
(B) wherever possible, makes use of indige-
nous entities within the country receiving as-
sistance. 
(2) CONTRACTS
DESCRIBED.—A contract de-
scribed in this paragraph is a contract related to the 
construction, expansion, rehabilitation, or mainte-
nance of health facilities, the purchase of commod-
ities, or technical assistance that is entered into— 
(A) by the United States Government to 
provide health-related United States foreign as-
sistance 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 oth-
erwise made available for such purposes, there are 
authorized to be appropriated to the President such 
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sums as may be necessary for each of the fiscal 
years 2011 through 2015 to carry out this section. 
(2) AVAILABILITY OF FUNDS.—Amounts appro-
priated pursuant to the authorization of appropria-
tions 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 sub-
section (c) to support the recruitment, training, retention, 
effectiveness, and equitable distribution within each coun-
try 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 paraprofes-
sionals, community health workers, managers, and admin-
istrative 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 
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Initiative not fewer than 12 developing coun-
tries and may, in consultation with Congress, 
subsequently select additional developing coun-
tries. 
(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 ex-
pressly 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 work-
force, reduce morbidity and mortality, and im-
prove health outcomes among its population. 
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(D) The country is experiencing a critical 
shortage of health workers, which is a signifi-
cant obstacle to reducing mortality and improv-
ing health outcomes among its people and to 
achieving the United Nations Millennium Devel-
opment Goals and other such international 
health targets. 
(E) The country is taking concrete steps to 
sustainably expand its indigenous health work-
force, such as direct budgetary investments, the 
development and implementation of supportive 
policies, the development of educational, train-
ing, 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 institu-
tion 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 para-
graph (1)(A) are diverse with respect to— 
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(A) total size and demography of the popu-
lation; 
(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 ex-
pand the indigenous health workforce; 
(E) the size of the indigenous health work-
force; 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 partici-
pating 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. 
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(3) United States-based nongovernmental and 
academic organizations that provide health-related 
services or assistance in developing countries. 
(4) International organizations involved in de-
livering health-related assistance and of which the 
United States is a voting member, with which the 
United States coordinates the delivery of foreign as-
sistance, 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 Initia-
tive include the following: 
(1) Technical assistance and direct support for 
countries to develop, strengthen, implement, evalu-
ate, and adjust the national health workforce plans 
described in subsection (f). 
(2) Programs to prepare and encourage individ-
uals to seek careers as health professionals and to 
serve as teachers in health professional training in-
stitutions, including through— 
(A) basic education programs; 
(B) expanding the capacity of the edu-
cational system to provide access to secondary- 
level and advanced math and science education; 
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(C) teaching basic health literacy and sup-
porting 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 edu-
cation and training of new health workers, includ-
ing— 
(A) new construction, expansion, rehabili-
tation, and maintenance of health professional 
training institutions, including residential hous-
ing facilities for students, teachers, and admin-
istrators; 
(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 de-
velopment, and research opportunities and such 
financial incentives as direct salary support and 
housing assistance; 
(C) providing financial incentives to stu-
dents enrolled in health professional training in-
stitutions, including financial aid, housing as-
sistance, and loan repayment in exchange for 
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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 popu-
lations, while also supporting students who 
choose to pursue careers in health administra-
tion and management or in needed tertiary care 
fields; 
(F) establishing professional standards for 
the entire range of health workers, including 
doctors, nurses, trained midwives, paraprofes-
sionals, community health workers, health ad-
ministrators and managers, and support per-
sonnel; 
(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 profes-
sional standards to better meet national and 
local circumstances; 
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(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 ap-
propriate training to pursue health-related re-
search, including basic, clinical, applied, and op-
erations research to improve the efficiency and 
effectiveness of health interventions and encour-
age the development of innovative tools and ap-
proaches 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— 
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(A) direct salary support, housing assist-
ance, 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, includ-
ing through— 
(i) following recommended occupa-
tional health and safety standards for 
health workers, including standards for 
training and protective technology, equip-
ment, 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; 
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(D) ensuring that all medical facilities 
maintain stocks of medical and laboratory sup-
plies, including diagnostics, pharmaceuticals, 
technology, and equipment, that meet or exceed 
recommended standards for resource-poor set-
tings; 
(E) encouraging efficient and effective 
matching of patient needs with health workers 
of appropriate skill levels, while providing op-
portunities to expand the scope of practice for 
all nonphysician health workers; 
(F) providing continuing education, dis-
tance learning, career advancement, and re-
search and development opportunities, including 
through national- and regional-level exchange 
programs; 
(G) establishing programs to reinforce re-
spect for the rights and dignity of patients and 
health workers; and 
(H) reevaluating and supporting the re-
moval 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. 
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(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 facili-
ties; 
(B) training and education in human re-
source management, leadership, and financial 
planning for health administrators and man-
agers and their support staff; 
(C) developing national standards and pro-
tocols for clinical practice and program man-
agement and other quality improvement proce-
dures and measurements for health administra-
tors and managers to follow and enforce; 
(D) integrating staffing, resource, and re-
ferral systems between the community-level and 
primary, secondary, and tertiary medical facili-
ties; 
(E) developing and implementing strate-
gies to improve staffing systems and health 
worker productivity, including through regular 
and supportive supervision; and 
(F) developing, implementing, and evalu-
ating health workforce policies and regulations 
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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, hous-
ing assistance, transportation, and other finan-
cial or nonfinancial benefits or incentives to 
health workers working in such areas or among 
such populations; 
(B) improving basic health-related infra-
structure to improve access to health facilities 
in such areas and among such populations; 
(C) strengthening procurement and dis-
tribution supply-chain management systems to 
ensure that medical and laboratory supplies, in-
cluding 
diagnostics, 
pharmaceuticals, 
tech-
nology, and equipment, can reach such areas 
and such populations; 
(D) improving management and adminis-
trative support in such areas and among such 
populations; 
(E) ensuring and prioritizing continuing 
onsite educational opportunities for health 
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workers in such areas or among such popu-
lations; and 
(F) evaluating, developing, and imple-
menting education and health workforce policies 
and regulations that incentivize the recruit-
ment, training, and retention of health workers 
most likely to work in such areas or among 
such populations. 
(7) Establishing and expanding the use of in-
formation and communications technologies, includ-
ing the management of human resources, medical 
records, and medical and laboratory supply inven-
tories, to— 
(A) enhance the skills and knowledge of 
health workers; 
(B) improve consultation and referral sys-
tems; and 
(C) provide information to health adminis-
trators, managers, and planners. 
(8) Preservice and in-service health worker edu-
cation 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 
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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 re-
sources and funding to support the indigenous 
health workforce; 
(C) improve governance, accountability, 
and responsiveness to the population and to 
civil society organizations; 
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(D) reduce corruption within the health 
system; and 
(E) coordinate with and regulate the pri-
vate-sector health workforce and any health 
workers employed by nongovernmental, commu-
nity, and faith-based organizations, inter-
national organizations, private funding sources, 
or donor nations. 
(10) Support for participating countries to ac-
cess funding related to health workforces and health 
systems from multilateral organizations or other ex-
ternal funding sources. 
(11) Direct support to indigenous civil society 
organizations that promote and advocate for an ef-
fective 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 coun-
tries, including national health workforces; 
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(C) improve the quality, accessibility, af-
fordability, 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 partici-
pating countries, including— 
(A) the country where the health profes-
sional was born; 
(B) the country where the health profes-
sional was educated and trained; 
(C) the country to which the health profes-
sional 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. 
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(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 encour-
age 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 para-
graph (3). 
(2) SITUATIONAL
ANALYSIS.—The situational 
analysis described in this paragraph is a situational 
analysis of the country’s indigenous health work-
force, including an initial assessment of the number 
per 1,000 residents of each type of health worker, 
including doctors, nurses, trained midwives, para-
professionals, community health workers, managers, 
administrators, and support staff, and of the extent 
to which each such type of health worker is equi-
tably distributed within such country. 
(3) PLAN ELEMENTS.—The elements described 
in this paragraph are the following: 
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(A) Performance goals and indicators, in-
cluding 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, adminis-
trators, 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 in-
dividuals to seek careers in the health pro-
fessions; 
(ii) expand and improve health edu-
cation and training programs for health 
workers; 
(iii) encourage health workers to re-
main employed in the health system; 
(iv) reduce the emigration of health 
workers and its impact on the indigenous 
health workforce and health system; 
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(v) improve health workforce adminis-
tration and management in the health sys-
tem; 
(vi) increase access to and the place-
ment of skilled health workers among 
rural, poor, and other underserved popu-
lations; 
(vii) expand the use of information 
and communications technologies, includ-
ing the management of medical records 
and medical and laboratory supply inven-
tories; 
(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 re-
source mobilization efforts to close such 
gaps; and 
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(xi) monitor and evaluate the imple-
mentation 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 devel-
opment, implementation, monitoring, and eval-
uation of all aspects of the plan from indige-
nous civil society and nongovernmental, commu-
nity, and faith-based organizations dedicated to 
improving public health and expanding the in-
digenous health workforce, with representation 
from a multisectoral group of stakeholders, in-
cluding 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 avail-
able a 5-year strategy for implementing and moni-
toring the Initiative established under this section. 
(2) CONTENT.—The strategy required by para-
graph (1) shall include— 
(A) a description of how assistance pro-
vided under this section will be coordinated 
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among United States Government agencies with 
responsibilities related to global health; 
(B) a description of how assistance pro-
vided under this section will be coordinated with 
each country, international organization, and 
other donor; 
(C) a description of how assistance pro-
vided under this section will support and en-
courage 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 perform-
ance goals and indicators required by subpara-
graph (D); and 
(F) a description of the consultation re-
quired by paragraph (3). 
(3) CONSULTATION.—In developing the strat-
egy required by paragraph (1), the President shall 
ensure proper consultation with— 
(A) each executive branch agency author-
ized to deliver health workforce-related foreign 
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assistance, including personnel at United States 
embassies and country missions; 
(B) the appropriate congressional commit-
tees with jurisdiction over the agencies de-
scribed in subparagraph (A); 
(C) civil society and nongovernmental, 
community, and faith-based organizations en-
gaged in improving health care and health out-
comes 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 pur-
pose 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 pro-
viding such assistance; 
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(G) other donor nations that provide 
health-related assistance to developing coun-
tries; and 
(H) any other global, regional, or sub-
regional 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 pro-
vided under the Initiative. 
(2) HARMONIZATION WITH SYSTEMS OF PAR-
TICIPATING COUNTRIES.—To the maximum extent 
possible, the monitoring and evaluation system re-
quired 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 EVALUA-
TION SYSTEM.—The monitoring and evaluation sys-
tem required by paragraph (1) shall— 
(A) establish country-specific performance 
goals; 
(B) establish performance indicators to be 
used in measuring and assessing the achieve-
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ment of the performance goals established 
under subparagraph (A), including indicators 
for— 
(i) the recruitment of health workers 
through the absorption capacity of the edu-
cational 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 den-
sity and absorption capacity of urban and 
rural health workforces and health facili-
ties; 
(vi) vacancy rates for health-related 
jobs; 
(vii) the health and safety of health 
workers; 
(viii) the overall effectiveness and pro-
ductivity of health workers and their ca-
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pacity to deliver quality health services; 
and 
(ix) improvements in health outcomes 
tied directly to the efforts of health work-
ers; 
(C) provide a basis for recommendations of 
adjustments to the strategy established under 
subsection (g) to enhance the impact of assist-
ance 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 for-
mat. 
(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 para-
graph (1) shall include— 
(A) an assessment and description, for ac-
tivities within each participating country, of 
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progress toward achieving the goals of the Ini-
tiative; 
(B) an assessment and description of the 
financial, policy, and other obstacles to achiev-
ing 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 assist-
ance provided by the United States to overcome 
such obstacles; and 
(D) an evaluation of knowledge about 
strengthening health workforces that was ac-
quired through implementing the Initiative in 
each participating country. 
(j) AUTHORIZATION OF APPROPRIATIONS.— 
(1) IN GENERAL.—In addition to amounts oth-
erwise 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; 
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(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 appro-
priated pursuant to the authorization of appropria-
tions 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 Presi-
dent, 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 coun-
tries, 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 profes-
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sionals or further increase the reliance of the United 
States health care system on such professionals; 
(2) supporting policies that mitigate the im-
pacts of recruiting foreign-educated health profes-
sionals 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 partner-
ship agreements with national and local au-
thorities, hospitals, clinics, and health profes-
sional training institutions in source countries 
to— 
(i) set mutually agreed-upon time 
frames and processes for training and de-
parture of foreign-educated health profes-
sionals; 
(ii) allow and provide for opportuni-
ties for foreign-educated health profes-
sionals to periodically return to their coun-
tries of origin to provide technical assist-
ance and support to their home commu-
nities or to work in a health care facility, 
particularly for countries experiencing a 
critical lack of indigenous health workers; 
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(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, pharma-
ceuticals, 
diagnostics, 
technology, 
and 
equipment for use within the source coun-
try, 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 na-
tional 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 re-
tention of new indigenous health profes-
sionals, particularly to provide health serv-
ices to poor, vulnerable, or marginalized 
populations; 
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(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-edu-
cated health professionals to honor such agree-
ments, and, where appropriate, requiring evi-
dence 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 or-
ganizations that receive United States funding; 
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(4) establishing programs that allow foreign- 
educated health professionals working in the United 
States to return to their countries of origin to par-
ticipate in health-related United States foreign as-
sistance programs without impacting their immigra-
tion status in the United States; 
(5) annually monitoring and making publicly 
available aggregate, nonpersonally identifiable infor-
mation related to foreign-educated health profes-
sionals who are recruited to or who otherwise immi-
grate to the United States, including information re-
lated to— 
(A) their countries of birth; 
(B) the countries where they were edu-
cated and trained to become health profes-
sionals; 
(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 re-
cruited or in which they otherwise intend to en-
gage in health-related employment; 
(6) developing a health workforce plan for the 
United States that includes a specific focus on re-
cruiting and training significant numbers of new 
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health professionals to address the urgent shortage 
of health professionals in the United States, in ac-
cordance 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 pur-
sue 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, vulner-
able, or marginalized populations to quality, afford-
able pharmaceuticals, medical products, and medical 
devices, including generics, if such items are covered 
by such agreement; 
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(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 sub-
section referred to as the ‘‘Declaration’’), including 
measures that the Agreement on Trade-Related As-
pects of Intellectual Property Rights permits coun-
tries to take to protect public health and ensure ac-
cess to essential medicines; 
(4) is negotiated, implemented, monitored, and 
enforced with the input and participation, in an ad-
visory 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 devel-
oped with significant public funding, such as— 
(A) open licensing; 
(B) nonenforcement of patents; 
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(C) licensing of such products to inter-
national drug purchase facilities and patent 
pools; and 
(D) other mechanisms to make medica-
tions 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 manufac-
turing of such items that are inconsistent with the 
principles of the Declaration. 
(c) UNITED
STATES
PARTICIPATION
IN
INTER-
NATIONAL FINANCIAL INSTITUTIONS.— 
(1) OPPOSITION TO CERTAIN USER FEES.—The 
Secretary of the Treasury shall instruct the United 
States Executive Director at each international fi-
nancial institution to oppose and vote against any 
proposed loan, grant, strategy, or policy of such re-
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spective 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 pri-
mary 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 Inter-
national Monetary Fund to oppose and vote against 
any loan, project, agreement, memorandum, instru-
ment, 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 Inter-
national Monetary Fund. 
(d) PARTICIPATION
OF
HEALTH
WORKERS
IN 
UNITED STATES GLOBAL HEALTH PROGRAMS.—For all 
United States programs related to global health that pro-
vide foreign assistance, it shall be the policy of the United 
States Government to ensure that— 
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(1) all health workers participating in such pro-
grams follow recommended occupational health and 
safety standards and have the proper training and 
access to the necessary protective technology, equip-
ment, and supplies, including those for blood and in-
jection safety, to establish and sustain safe and sani-
tary 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 pro-
grams 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 pro-
grams receive training about respect for the rights 
and dignity of all patients and coworkers that is tai-
lored to local contexts, developed with the participa-
tion of health workers and indigenous civil society 
organizations, and includes information about— 
(A) the rights and status of women and 
girls; 
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