U.S. foreign assistance is carried out by the State Department, the U.S. Agency for International Development (USAID), the Department of Defense (DOD) and several other federal government agencies. Presidential initiatives, such as the Leadership and Investment in Fighting an Epidemic (LIFE) Initiative in the Clinton Administration and the Millennium Challenge Corporation (MCC) and President's Emergency Plan for AIDS Relief (PEPFAR) in the Bush Administration, have expanded foreign assistance outside the traditional foreign aid agencies. Additionally, the Department of Defense has participated in an expanding amount of aid activities, both military and non-military, since the wars in Iraq and Afghanistan began. In 2007 (the most recent year for which complete data are available), about 60% of U.S. foreign assistance was disbursed by the Department of Defense, 23% by USAID, and 7% by the Department of State (see Table 1 , below). More than 20 other U.S. government agencies are responsible for the remaining 10% of foreign aid spending. There is no overarching mechanism in place to coordinate or evaluate the broad range of foreign assistance activities. Nor is there consensus about the need for better coordination, though congressional interest in the issue appears to be increasing. Provisions addressing agency coordination and structure are included in key foreign assistance reform proposals pending before the 111 th Congress, including H.R. 2410 , the Foreign Relations Authorization Act for Fiscal Years 2010 and 2011; H.R. 2139 , the Initiating Foreign Assistance Reform Act of 2009; and S. 1524 , the Foreign Assistance Revitalization and Accountability Act of 2009. Furthermore, Secretary of State Hillary Clinton testified at her confirmation hearing that her goal in regard to foreign assistance reform would be to "maximize coordination, minimize redundancy and make the case for increased resources." This report discusses the many agencies involved with U.S. foreign assistance, the mechanisms currently in place to coordinate foreign aid programs, particularly those related to development assistance, and agency coordination issues that Congress may consider as part of foreign assistance reform. The Foreign Assistance Act of 1961 (FAA), as amended, authorized the consolidation of most foreign assistance programs under a new agency that would become the U.S. Agency for International Development (USAID). It also called for the use of domestic agency expertise in foreign aid, stating that "in such fields as education, health, housing, or agriculture, the facilities and resources of other Federal agencies shall be utilized when such facilities are particularly or uniquely suitable for technical assistance, are not competitive with private enterprise, and can be made available without interfering unduly with domestic programs. " The need for coordination of these activities was recognized by the FAA's drafters, who included a provision tasking the Department of State's Chief of Mission in each country with coordinating these functions among representatives of the United States Government. The FAA states that "[n]othing in this Act shall infringe upon the powers or functions of the Secretary of State" and specifies that the Secretary of State "shall be responsible for the continuous supervision and general direction of economic assistance, military assistance, and military education and training programs...." Intervening decades, however, have given rise to a range of foreign aid programs and activities that fall outside the scope of State Department/USAID authority. The Millennium Challenge Corporation and the Peace Corps are both independent aid agencies, and many other federal agencies primarily focused on domestic issues provide foreign assistance as well. Some examples include the Department of Agriculture's (USDA) technical assistance overseas on food safety and inspection; the Department of the Interior's Fish and Wildlife Service multinational species conservation assistance; and the Department of Health and Human Services' Center for Disease Control's (CDC) activities to fight HIV/AIDS, influenza, tuberculosis, and malaria around the world. Two key trends in foreign assistance in recent years have drawn attention to and renewed concerns about the fragmentation of aid and the possible need for better coordination. First, total U.S. foreign assistance spending across appropriations bills has grown considerably in current dollars since the September 11, 2001 terrorist attacks, from just over $15 billion in FY2001 to more than $45 billion in FY2007, including supplementals ( Table 1 ). Second, it appears that the number of federal agencies playing a role in foreign assistance is growing. While some experts note that aid has always been fragmented, with domestic agencies moving in and out of the foreign assistance arena from year to year as the need for their expertise arises in the course of U.S. foreign relations and world events, there does appear to be an increase in agencies reporting aid expenditures over the last decade. For a complete list of foreign assistance disbursements reported by U.S. government agencies from FY2001 to FY2007, see Appendix A . Disbursement levels for almost all the primary agencies implementing foreign assistance rose, though sometimes erratically, between FY2001 and FY2007 ( Table 1 ). Growth rates between agencies varied considerably, however, reflecting shifts in aid composition. DOD aid disbursement levels increased more than 500% during this time, to more than $27 billion, with much of this growth reflecting military assistance to Iraq and Afghanistan, as well as humanitarian disaster assistance in response to the December 2004 tsunami. The Department of Health and Human Services (HHS) also took on a larger role in foreign assistance, largely due to PEPFAR and responses to outbreaks of avian influenza, extremely drug resistant tuberculosis, and severe acute respiratory syndrome (SARS). HHS disbursement levels rose from $96 million to $1.77 billion (a 1,744% increase) between FY2001 and FY2005, and while they have declined from their FY2005 peak, the FY2007 level of $616 million is still a 540% increase over the FY2001 level. In contrast, State and USAID disbursement rates have increased since FY2001 at a slower rate than total foreign assistance (102% and 46%, respectively) with FY2007 disbursements of $3.4 billion and $10.7 billion, respectively. The Peace Corps was the exception to the growth, with FY2007 disbursement levels falling below the FY2001 level after several years of small increases. In FY2001, nearly half of U.S. foreign assistance was disbursed by USAID (48%), while the Department of Defense (DOD) disbursed 29%, the Department of State (DOS) disbursed 11%, the Treasury disbursed 7% and the remaining 5% was spread among several other agencies. In FY2007, the portion of U.S. foreign assistance disbursed by USAID dropped to 23% and the DOS portion shrunk to 7%, while the DOD's portion doubled to 60%. Treasury disbursements fell to 3% and the share disbursed by all other agencies increased to 7%. The increasing portion of assistance disbursed by U.S. military entities since FY2002 can be largely attributed to dramatic increases in military and reconstruction assistance associated with the wars in Iraq and Afghanistan, and appears to be on the decline. The impact of these wars on foreign assistance levels is demonstrated by Figure 2 , which compares the same FY2001 agency disbursement chart in Figure 1 with a chart showing FY2007 disbursements without aid to Iraq and Afghanistan. Excluding funding to these two countries more than doubles the share of aid disbursed by State, from 11% to 25%, and gives DOD the third largest share, after USAID and State. Furthermore, it is important to note that much of the funding disbursed by DOD is military assistance, for which State plays a key role in allocation. While the trend towards greater DOD involvement in foreign assistance has raised widespread concerns, Figure 2 demonstrates that outside of spending in Iraq and Afghanistan, DOD's share of foreign aid disbursement in FY2007 (21%) was actually less than it was in FY2001(29%). Nevertheless, the 369% increase in DOD non-military assistance disbursements between FY2001 and FY2007 makes DOD a much bigger player in the development assistance field (DOD disbursed nearly 16% of total U.S. economic assistance in FY2007, compared to 6.4% in FY2001)( Figure 3 ). As Iraq Relief & Reconstruction Funds are no longer available, however, and the Iraq Security Forces Fund declining, DOD's portion of foreign assistance disbursements can be expected to decrease in FY2008 and FY2009. With so many entities administering foreign aid, often with different objectives, many aid experts have questioned whether these agencies are sometimes working at cross-purposes. Where agencies have similar objectives, there is concern that they may be duplicating each others' efforts. A 2009 report on Afghanistan, for example, described how 15 U.S. agencies were working in the Afghan energy sector, each with its own vision, objectives, and procurement strategies. Critics assert that the decentralized U.S. aid structure is inefficient and confusing, particularly for implementing partners and recipient countries. Each agency has its own unique rules and procedures that recipient countries must follow, creating a significant administrative burden on countries trying to comply with the requirements not only of multiple U.S. agencies, but often of multiple donor countries. In Mozambique, for example, a Ministry of Planning and Development staff member explained that "[d]ifferent U.S. agencies have different rules which create problems and add to confusion. The problem of multiplicity occurs even within single sectors. PEPFAR, just one of three big U.S. presidential initiatives in Mozambique, is itself implemented by five U.S. agencies: the CDC, USAID, the Defense Department, the State Department, and the Peace Corps. Insiders recognize the faulty communication while outsiders don't know whom to consult."