104 
Act of 2003 (22 U.S.C. 7631 et seq.) is amended by strik-
ing section 304 and inserting the following: 
‘‘SEC. 304. HEALTH CARE PARTNERSHIPS TO COMBAT HIV/ 
AIDS. 
‘‘(a) SENSE OF CONGRESS.—It is the sense of Con-
gress that the use of health care partnerships that link 
United States and host country health care institutions 
create opportunities for sharing of knowledge and exper-
tise among individuals with significant experience in 
health-related fields and build local capacity to combat 
HIV/AIDS and increase scientific understanding of the 
progression of HIV/AIDS and the HIV/AIDS epidemic. 
‘‘(b) AUTHORITY TO FACILITATE HEALTH CARE 
PARTNERSHIPS TO COMBAT HIV/AIDS.—The President, 
acting through the Coordinator of United States Govern-
ment Activities to Combat HIV/AIDS Globally, shall fa-
cilitate the development of health care partnerships de-
scribed in subsection (a) by– 
‘‘(1) supporting short- and long-term institu-
tional partnerships, including partnerships that build 
capacity in ministries of health, central- and district- 
level health agencies, medical facilities, health edu-
cation and training institutions, academic centers, 
and faith- and community-based organizations in-
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105 
volved in prevention, treatment, and care of HIV/ 
AIDS; 
‘‘(2) supporting the development of consultation 
services using appropriate technologies, including on-
line courses, DVDs, telecommunications services, 
and other technologies to eliminate the barriers that 
prevent host country professionals from accessing 
high quality health care services information, par-
ticularly providers located in rural areas; 
‘‘(3) supporting the placements of highly quali-
fied individuals to strengthen human and organiza-
tional capacity through the use of health care profes-
sionals to facilitate skills transfer, building local ca-
pacity, and to expand rapidly the pool of providers, 
managers, and other health care staff delivering 
HIV/AID services in host countries; and 
‘‘(4) meeting individual country needs and, 
where possible, insisting on the implementation of a 
national strategic plan, by providing training and 
mentoring to strengthen human and organizational 
capacity among local health care service organiza-
tions. 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—Of the 
amounts authorized to be appropriated under section 401 
for HIV/AIDS assistance, there are authorized to be ap-
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106 
propriated to the President such sums as may be nec-
essary for each of the fiscal years 2009 through 2013 to 
carry out this section.’’. 
(b) CLERICAL AMENDMENT.—The table of contents 
for the United States Leadership Against HIV/AIDS, Tu-
berculosis, and Malaria Act of 2003 (22 U.S.C. 7601 note) 
is amended by striking the item relating to section 304 
and inserting the following new item: 
‘‘Sec. 304. Health care partnerships to combat HIV/AIDS.’’. 
Subtitle B—Assistance for Women, 
Children, and Families 
SEC. 311. POLICY AND REQUIREMENTS. 
(a) POLICY.—Subsection (a) of section 312 of the 
United States Leadership Against HIV/AIDS, Tuber-
culosis, and Malaria Act of 2003 (22 U.S.C. 7652) is 
amended— 
(1) in the first sentence, by striking ‘‘The 
United States Government’s’’ and inserting the fol-
lowing: 
‘‘(1) IN GENERAL.—The United States’’; and 
(2) by adding at the end the following: 
‘‘(2) COLLABORATION.—The United States 
should work in collaboration with governments, do-
nors, the private sector, nongovernmental organiza-
tions, and other key stakeholders to carry out the 
policy described in paragraph (1).’’. 
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107 
(b) REQUIREMENTS.—Subsection (b) of such section 
is amended to read as follows: 
‘‘(b) REQUIREMENTS.—The 5-year United States 
strategy required by section 101 of this Act shall— 
‘‘(1) establish a target for prevention and treat-
ment of mother-to-child transmission of HIV that by 
2013 will reach at least 80 percent of pregnant 
women in those countries most affected by HIV/ 
AIDS; 
‘‘(2) establish a target requiring that by 2013 
up to 15 percent of individuals receiving care and up 
to 15 percent of individuals receiving treatment 
under this Act and the amendments made by this 
Act are children; 
‘‘(3) integrate care and treatment with preven-
tion of mother-to-child transmission of HIV pro-
grams in order to improve outcomes for HIV-af-
fected women and families as soon as is feasible, 
consistent with the national government policies of 
countries in which programs under this Act are ad-
ministered, and including support for strategies to 
ensure successful follow-up and continuity of care; 
‘‘(4) expand programs designed to care for chil-
dren orphaned by HIV/AIDS; 
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108 
‘‘(5) develop a timeline for expanding access to 
more effective regimes to prevent mother-to-child 
transmission of HIV, consistent with the national 
government policies of countries in which programs 
under this Act are administered and the goal of 
achieving universal use of such regimens as soon as 
possible; 
‘‘(6) ensure that women receiving voluntary 
contraceptive counseling, services, or commodities in 
programs supported by the United States Govern-
ment have access to the full range of HIV/AIDS 
services; and 
‘‘(7) ensure that women in prevention of moth-
er-to-child transmission of HIV programs are pro-
vided with appropriate maternal and child services, 
either directly or by referral.’’. 
SEC. 312. ANNUAL REPORTS ON PREVENTION OF MOTHER- 
TO-CHILD TRANSMISSION OF THE HIV INFEC-
TION. 
Section 313(a) of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7653(a)) is amended by striking ‘‘5 
years’’ and inserting ‘‘10 years’’. 
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109 
SEC. 313. STRATEGY TO PREVENT HIV INFECTIONS AMONG 
WOMEN AND YOUTH. 
(a) IN GENERAL.—Title III of the United States 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
Act of 2003 (22 U.S.C. 7631 et seq.) is amended by add-
ing at the end the following: 
‘‘SEC. 316. STRATEGY TO PREVENT HIV INFECTIONS AMONG 
WOMEN AND YOUTH. 
‘‘(a) STATEMENT OF POLICY.—In order to meet the 
United 
States 
Government’s 
goal 
of 
preventing 
12,000,000 new HIV infections worldwide, it shall be the 
policy of the United States to pursue a global HIV/AIDS 
prevention strategy that emphasizes the immediate and 
ongoing needs of women and youth and addresses the fac-
tors that lead to gender disparities in the rate of HIV in-
fection. 
‘‘(b) STRATEGY.— 
‘‘(1) IN GENERAL.—The President shall formu-
late a comprehensive, integrated, and culturally-ap-
propriate global HIV/AIDS prevention strategy that, 
to the extent epidemiologically appropriate, address-
es the vulnerabilities of women and youth to HIV in-
fection and seeks to reduce the factors that lead to 
gender disparities in the rate of HIV infection. 
‘‘(2) ELEMENTS.—The strategy required under 
paragraph (1) shall include specific goals and tar-
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110 
gets under the 5-year strategy outlined in section 
101 and shall include comprehensive HIV/AIDS pre-
vention education at the individual and national level 
including the ABC (‘Abstain, Be faithful, use 
Condoms’) model as a means to reduce HIV infec-
tions and shall include the following: 
‘‘(A) Specific goals under the five-year 
strategy outlined in section 101. 
‘‘(B) Empowering women and youth to 
avoid cross-generational sex and to decide when 
and whom to marry in order to reduce the inci-
dence of early or child marriage. 
‘‘(C) Dramatically increasing access to cur-
rently available female-controlled prevention 
methods and including investments in training 
to increase the effective and consistent use of 
both male and female condoms. 
‘‘(D) Accelerating the de-stigmatization of 
HIV/AIDS among women and youth as a major 
risk factor for the transmission of HIV. 
‘‘(E) Addressing and preventing post-trau-
matic and psycho-social consequences and pro-
viding post-exposure prophylaxis to victims of 
gender-based violence and rape against women 
and youth through appropriate medical, social, 
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111 
educational, and legal assistance and through 
prosecutions and legal penalties to address such 
violence. 
‘‘(F) Promoting changes in male attitudes 
and behavior that respect the human rights of 
women and youth and that support and foster 
gender equality. 
‘‘(G) Supporting the development of micro-
enterprise initiatives, job training programs, 
and other such efforts to assist women in devel-
oping and retaining independent economic 
means. 
‘‘(H) Supporting universal basic education 
and expanded educational opportunities for 
women and youth. 
‘‘(I) Protecting the property and inherit-
ance rights of women. 
‘‘(J) Coordinating inclusion of HIV/AIDS 
prevention information and education services 
and programs for individuals with HIV/AIDS 
with existing health care services targeted to 
women and youth, such as ensuring access to 
HIV/AIDS education and testing in family 
planning programs supported by the United 
States Government and programs to reduce 
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112 
mother-to-child transmission of HIV, and ex-
panding the reach of such HIV/AIDS health 
services. 
‘‘(K) Promoting gender equality by sup-
porting the development of nongovernmental or-
ganizations, including faith-based and commu-
nity-based organizations, that support the needs 
of women and utilizing such organizations that 
are already empowering women and youth at 
the community level. 
‘‘(L) Encouraging the creation and effec-
tive enforcement of legal frameworks that guar-
antee women equal rights and equal protection 
under the law. 
‘‘(M) Encouraging the participation and 
involvement of women in drafting, coordinating, 
and implementing the national HIV/AIDS stra-
tegic plans of their countries. 
‘‘(N) Responding to other economic and 
social factors that increase the vulnerability of 
women and youth to HIV infection. 
‘‘(3) TRANSMISSION TO CONGRESS AND PUBLIC 
AVAILABILITY.—Not later than 180 days after the 
date of the enactment of the Tom Lantos and Henry 
J. Hyde Global Leadership Against HIV/AIDS, Tu-
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113 
berculosis, and Malaria Reauthorization Act of 
2008, the President shall transmit to the appro-
priate congressional committees and make available 
to the public the strategy required under paragraph 
(1). 
‘‘(c) COORDINATION.—In formulating and imple-
menting the strategy required under subsection (b), the 
President shall ensure that the United States coordinates 
its overall HIV/AIDS policy and programs with the na-
tional governments of the countries for which the United 
States provides assistance to combat HIV/AIDS and, to 
the extent practicable, with international organizations, 
other donor countries, and indigenous organizations, in-
cluding faith-based and community-based organizations 
specifically for the purposes of ensuring gender equality 
and promoting respect of the human rights of women that 
impact their susceptibility to HIV/AIDS, improving wom-
en’s health, and expanding education for women and 
youth, and organizations, including faith-based and other 
nonprofit organizations, providing services to and advo-
cating on behalf of individuals with HIV/AIDS and indi-
viduals affected by HIV/AIDS. 
‘‘(d) GUIDANCE.— 
‘‘(1) IN GENERAL.—The President shall provide 
clear guidance to field missions of the United States 
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114 
Government in countries for which the United States 
provides assistance to combat HIV/AIDS, based on 
the strategy required under subsection (b). 
‘‘(2) TRANSMISSION TO CONGRESS AND PUBLIC 
AVAILABILITY.—The President shall transmit to the 
appropriate congressional committees and make 
available to the public a description of the guidance 
required under paragraph (1). 
‘‘(e) REPORT.— 
‘‘(1) IN GENERAL.—Not later than 1 year after 
the date of the enactment of the Tom Lantos and 
Henry J. Hyde Global Leadership Against HIV/ 
AIDS, Tuberculosis, and Malaria Reauthorization 
Act of 2008, and annually thereafter as part of the 
annual report required under section 104A(e) of the 
Foreign Assistance Act of 1961 (22 U.S.C. 2151b– 
2(e)), the President shall transmit to the appro-
priate congressional committees and make available 
to the public a report on the implementation of this 
section for the prior fiscal year. 
‘‘(2) MATTERS TO BE INCLUDED.—The report 
required under paragraph (1) shall include the fol-
lowing: 
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115 
‘‘(A) A description of the prevention pro-
grams designed to address the vulnerabilities of 
women and youth to HIV/AIDS. 
‘‘(B) A list of nongovernmental organiza-
tions in each country that receive assistance 
from the United States to carry out HIV pre-
vention activities, including the amount and the 
source of funding received.’’. 
(b) CLERICAL AMENDMENT.—The table of contents 
for the United States Leadership Against HIV/AIDS, Tu-
berculosis, and Malaria Act of 2003 (22 U.S.C. 7601 note) 
is amended by inserting after the item relating to section 
315 the following: 
‘‘Sec. 316. Strategy to prevent HIV infections among women and youth.’’. 
SEC. 314. CLERICAL AMENDMENT. 
The table of contents for the United States Leader-
ship Against HIV/AIDS, Tuberculosis, and Malaria Act 
of 2003 (22 U.S.C. 7601 note) is amended by striking 
the item relating to subtitle B of title III and inserting 
the following: 
‘‘Subtitle B—Assistance for Women, Children, and Families’’. 
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116 
TITLE IV—AUTHORIZATION OF 
APPROPRIATIONS 
SEC. 401. AUTHORIZATION OF APPROPRIATIONS. 
Section 401(a) of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7671(a)) is amended— 
(1) by striking ‘‘$3,000,000,000’’ and inserting 
‘‘$10,000,000,000’’; and 
(2) by striking ‘‘fiscal years 2004 through 
2008’’ and inserting ‘‘fiscal years 2009 through 
2013’’. 
SEC. 402. SENSE OF CONGRESS. 
Section 402(b) of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7672) is amended— 
(1) by striking paragraph (1); 
(2) by redesignating paragraphs (2) through 
(4) as paragraphs (1) through (3), respectively; and 
(3) in paragraph (2) (as redesignated by para-
graph (2) of this section), by striking ‘‘, of which’’ 
and all that follows through ‘‘programs’’. 
SEC. 403. ALLOCATION OF FUNDS. 
(a) HIV/AIDS PREVENTION
ACTIVITIES.—Sub-
section (a) of section 403 of the United States Leadership 
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117 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7673) is amended to read as follows: 
‘‘(a) HIV/AIDS PREVENTION ACTIVITIES.— 
‘‘(1) IN GENERAL.—For each of the fiscal years 
2009 through 2013, not less than 20 percent of the 
amounts appropriated pursuant to the authorization 
of appropriations under section 401 for HIV/AIDS 
assistance for each such fiscal year shall be ex-
pended for HIV/AIDS prevention activities con-
sistent with section 104A(d) of the Foreign Assist-
ance Act of 1961. 
‘‘(2) BALANCED FUNDING REQUIREMENT.—(A) 
The Coordinator of United States Government Ac-
tivities to Combat HIV/AIDS Globally shall provide 
balanced funding for prevention activities for sexual 
transmission of HIV/AIDS and shall ensure that be-
havioral change programs, including abstinence, 
delay of sexual debut, monogamy, fidelity and part-
ner reduction, are implemented and funded in a 
meaningful and equitable way in the strategy for 
each host country based on objective epidemiological 
evidence as to the source of infections and in con-
sultation with the government of each host county 
involved in HIV/AIDS prevention activities. 
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118 
‘‘(B) In fulfilling the requirement under sub-
paragraph (A), the Coordinator shall establish a 
HIV sexual transmission prevention strategy gov-
erning the expenditure of funds authorized by the 
Act used to prevent the sexual transmission of HIV 
in any host country with a generalized epidemic. In 
each such host country, if this strategy provides less 
than 50 percent of such funds for behavioral change 
programs, including abstinence, delay of sexual 
debut, monogamy, fidelity, and partner reduction, 
the Coordinator shall, within 30 days of the issuance 
of this strategy, report to the appropriate congres-
sional committees on the justification for this deci-
sion. 
‘‘(C) Programs and activities that implement or 
purchase new prevention technologies or modalities 
such as medical male circumcision, pre-exposure pro-
phylaxis, or microbicides and programs and activities 
that provide counseling and testing for HIV or pre-
vent mother-to-child prevention of HIV shall not be 
included in determining compliance with this para-
graph. 
‘‘(3) REPORT.—Not later than 1 year after the 
date of the enactment of the Tom Lantos and Henry 
J. Hyde Global Leadership Against HIV/AIDS, Tu-
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119 
berculosis, and Malaria Reauthorization Act of 
2008, and annually thereafter as part of the annual 
report required under section 104A(e) of the For-
eign Assistance Act of 1961 (22 U.S.C. 2151b– 
2(e)), the President shall transmit to the appro-
priate congressional committees and make available 
to the public a report on the implementation of 
paragraph (2) for the prior fiscal year.’’. 
(b) ORPHANS AND VULNERABLE CHILDREN.—Sub-
section (b) of such section is amended by striking ‘‘fiscal 
years 2006 through 2008’’ and inserting ‘‘fiscal years 
2009 through 2013’’. 
SEC. 404. PROHIBITION ON TAXATION BY FOREIGN GOV-
ERNMENTS. 
(a) PROHIBITION ON TAXATION.—None of the funds 
appropriated pursuant to the authorization of appropria-
tions under section 401 of the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act of 
2003 (22 U.S.C. 7671) may be made available to provide 
assistance for a foreign country under a new bilateral 
agreement governing the terms and conditions under 
which such assistance is to be provided unless such agree-
ment includes a provision stating that assistance provided 
by the United States shall be exempt from taxation, or 
reimbursed, by the foreign government, and the Secretary 
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120 
of State shall expeditiously seek to negotiate amendments 
to existing bilateral agreements, as necessary, to conform 
with this requirement. 
(b) DE MINIMUS EXCEPTION.—Foreign taxes of a de 
minimus nature shall not be subject to the provisions of 
subsection (a). 
(c) REPROGRAMMING OF FUNDS.—Funds withheld 
from obligation for each country or entity pursuant to sub-
section (a) shall be reprogrammed for assistance to coun-
tries which do not assess taxes on United States assistance 
or which have an effective arrangement that is providing 
substantial reimbursement of such taxes. 
(d) DETERMINATIONS.— 
(1) IN GENERAL.—The provisions of this sec-
tion shall not apply to any country or entity the Sec-
retary of State determines— 
(A) does not assess taxes on United States 
assistance or which has an effective arrange-
ment that is providing substantial reimburse-
ment of such taxes; or 
(B) the foreign policy interests of the 
United States outweigh the policy of this sec-
tion to ensure that United States assistance is 
not subject to taxation. 
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(2) CONSULTATION.—The Secretary of State 
shall consult with the Committees on Foreign Af-
fairs and Appropriations at least 15 days prior to 
exercising the authority of this subsection with re-
gard to any country or entity. 
(e) IMPLEMENTATION.—The Secretary of State shall 
issue rules, regulations, or policy guidance, as appropriate, 
to implement the prohibition against the taxation of assist-
ance contained in this section. 
(f) DEFINITIONS.—As used in this section— 
(1) the terms ‘‘taxes’’ and ‘‘taxation’’ refer to 
value added taxes and customs duties imposed on 
commodities financed with United States assistance 
for programs for which funds are authorized by this 
Act; and 
(2) the term ‘‘bilateral agreement’’ refers to a 
framework bilateral agreement between the Govern-
ment of the United States and the government of 
the country receiving assistance that describes the 
privileges and immunities applicable to United 
States foreign assistance for such country generally, 
or an individual agreement between the Government 
of the United States and such government that de-
scribes, among other things, the treatment for tax 
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purposes that will be accorded the United States as-
sistance provided under that agreement. 
TITLE V—SUSTAINABILITY AND 
STRENGTHENING OF HEALTH 
CARE SYSTEMS 
SEC. 
501. 
SUSTAINABILITY 
AND 
STRENGTHENING 
OF 
HEALTH CARE SYSTEMS. 
The United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601 
et seq.) is amended by adding at the end the following: 
‘‘TITLE VI—SUSTAINABILITY AND 
STRENGTHENING OF HEALTH 
CARE SYSTEMS 
‘‘SEC. 601. FINDINGS. 
‘‘Congress makes the following findings: 
‘‘(1) The shortage of health personnel, includ-
ing doctors, nurses, pharmacists, counselors, labora-
tory staff, and paraprofessionals, is one of the lead-
ing obstacles to fighting HIV/AIDS in sub-Saharan 
Africa. 
‘‘(2) The HIV/AIDS pandemic aggravates the 
shortage of health workers through loss of life and 
illness among medical staff, unsafe working condi-
tions for medical personnel, and increased workloads 
for diminished staff, while the shortage of health 
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123 
personnel undermines efforts to prevent and provide 
care and treatment for individuals with HIV/AIDS. 
‘‘(3) Failure to address the shortage of health 
care professionals and paraprofessionals, and the 
factors forcing such individuals to leave sub-Saharan 
Africa, will undermine the objectives of United 
States development policy and will subvert opportu-
nities to achieve internationally-recognized goals for 
the prevention, treatment, and care of HIV/AIDS 
and other diseases, the reduction of child and mater-
nal mortality, and for economic growth and develop-
ment in sub-Saharan Africa. 
‘‘SEC. 602. NATIONAL HEALTH WORKFORCE STRATEGIES 
AND OTHER POLICIES. 
‘‘(a) NATIONAL
HEALTH
WORKFORCE
STRATE-
GIES.— 
‘‘(1) STATEMENT OF POLICY.—It shall be the 
policy of the United States Government to support 
countries receiving United States assistance to com-
bat HIV/AIDS, tuberculosis, and malaria, and other 
health programs in developing, strengthening, and 
implementing 5-year health workforce strategies. 
‘‘(2) TECHNICAL
AND
FINANCIAL
ASSIST-
ANCE.—The Administrator of the United States 
Agency for International Development, in coordina-
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tion with the Coordinator of United States Govern-
ment Activities to Combat HIV/AIDS Globally, is 
authorized to provide technical and financial assist-
ance to countries described in paragraph (1) to en-
able such countries, in conjunction with other fund-
ing sources, to develop, strengthen, and implement 
health workforce strategies. 
‘‘(3) ACTIVITIES SUPPORTED.—Assistance pro-
vided under paragraph (2) shall, to the maximum 
extent practicable, be used to carry out the fol-
lowing: 
‘‘(A) Activities to promote an inclusive 
process that includes nongovernmental organi-
zations and individuals with HIV/AIDS in de-
veloping health workforce strategies. 
‘‘(B) Activities to achieve and sustain a 
health workforce sufficient in numbers, skill, 
and capacity to meet United States and host- 
country international health commitments, in-
cluding the Millennium Development Goals and 
universal access to HIV/AIDS prevention, treat-
ment, and care. In particular, such health work-
force strategies should include plans for 
progress toward achieving the minimum ratio of 
health professionals required to achieve these 
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