November 1, 2012

The Global Need

Malnutrition is responsible for the deaths of over one out of every three children under age five each year— or more than 2 million children. Virtually all of these deaths are preventable. For the 170 million children1 who are living with chronic malnutrition throughout their young lives, it can cause serious, often irreversible, damage to their bodies and brains. Malnutrition among young children can severely limit or impair their ability to grow, learn, earn a living, take care of themselves and ultimately help their families rise out of poverty.2

Significance of Funding

For about $8, a child can be provided with a package of interventions designed to save their lives and help prevent the irreversible damage to their brains and bodies caused by malnutrition. These interventions include Vitamin A supplementation, therapeutic zinc for the management of diarrhea, micronutrient powders, de-worming medication, as well as adequate iron and folic acid for expectant mothers.

The extra $27 million dollars approved by the Senate Appropriations Committee for FY13 would support an additional 3,370,000 children and their moms in their fight against malnutrition.3

Importance of Funding

The quality of nutrition during pregnancy and until a child’s second birthday – the critical 1,000 day window – also has enormous, long-term macroeconomic implications. Child malnutrition is also a serious drain on economic productivity—in some cases, it costs as much as 11% of a country’s GDP—and imposes staggering health costs on countries that are already struggling to meet basic needs.4 Additionally, it often undermines the investments made in other sectors like health care, agriculture and economic development.

The Impact of Funding - Success is Possible

Evidence has shown that preventing and treating malnutrition during the first years of a child’s life offers tremendous return on investment. By investing in improved nutrition during the critical 1,000 day window, the international community can:

Save more than 1 million lives each year;5

Boost a country’s GDP by at least 2-3 percent annually;6

Build self-sufficiency: well-nourished children are more likely to continue their education, have higher IQs, and earn up to 46% more over their lifetimes;7

Significantly reduce the human and economic burden of infectious diseases such as malaria and HIV/AIDS, and chronic diseases such as diabetes; and

Help end hunger and break the cycle of poverty.

1 Onis M, Blossne M, and Borghi E, ‘Prevelance of stunting among pre-school children 1999-2020,’ Growth Assessment and Surveillance Unit, Public

Health Nutrition, 2011, Jul 14:1-7. 2 Global Monitoring Report. (2012) World Bank and International Monetary Fund.

3Based on the costing of five interventions--Vitamin A supplementation, therapeutic zinc for the management of diarrhea, micronutrient powders, de-

worming, and adequate iron and folic acid for pregnant women--using data provided by the World Bank and accessed at: http://bit.ly/VGOvIJ . 4 The Cost of Hunger: Social and economic impact of child undernutrition in Central America and the Dominican Republic,

The United Nations Economic Commission for Latin America and the Caribbean and World Food Programme, 2008. 5 Horton, Susan, et al. Scaling Up Nutrition: What will it cost? The World Bank.

6 The World Bank, Repositioning Nutrition as Central to Development, 2006.

7 Hoddinott, J., J. Maluccio, et al., 2008: Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults, The

Lancet, 371

Global Health:

Nutrition Funding

FY13 Committee Approved Funding

Senate: $122 million

House: $95 million

October 31, 2012

The Global Need

“Polio eradication is at a tipping point between success and failure,” according to the Director General of the World Health Organization.1 Less than a quarter century ago, polio was permanently disabling 350,000 children every year in 125 countries. By 2011, polio cases had declined to only 650 cases, primarily in Pakistan, Afghanistan, Nigeria, the Democratic Republic of the Congo and Chad. In 2012 (through October) only 170 people in the world had been diagnosed with polio. Complete eradication of polio is achievable in the near future. However, as long as polio remains in one country all countries are at risk.2

Significance of Funding Levels

The approved FY 2013 funding level by the Senate Appropriations Committee enables USAID to continue to support rapid response to outbreaks, surveillance in endemic and polio-free countries at risk of importations of the virus, community mobilization and other critical activities on behalf of the global eradication effort. USAID’s polio activities are particularly concerned with protecting children in under-served communities and countries in conflict.3

Importance of Funding

As long as a single child remains infected, children everywhere are at risk of contracting polio. Due to cross-border transmission, polio cases broke out in 23 previously polio-free countries between 2000 and 2010. Success hinges on continued financing of the global eradication initiative—including support for vaccinations, rapid response to outbreaks, and surveillance for cases, as well as further analysis provided by the Global Laboratory Network of 145 laboratories.4 Polio eradication benefits every society, regardless of where families live. If polio were eradicated in the next five years, it would save developing countries at least $40-$50 billion, mostly in low-income countries.5

Impact of Funding – Success is Possible

Since 1988, when the Global Polio Eradication Initiative began and polio was paralyzing a thousand children worldwide every day, 8 million people are walking paralysis-free as a result of the effort

to eradicate polio. More than 2.5 billion children have been immunized against polio since 1988, thanks to the cooperation of more than 200 countries and 20 million volunteers.

The United States took the lead in this historic Initiative, providing $2 billion of the $9 billion spent on polio eradication between 1988 and 2012. The Rotary Foundation and the Gates Foundation have each provided over $1 billion.6

*This appropriation for polio is part of the FY13 Maternal Child Health account. In addition, Congress supports global polio eradication efforts through the Department of Health and Human Services appropriations for the Centers for Disease Control. In 2011 CDC received $107 million for its work with polio. 1Polio Global Eradication Initiative. (May 24, 2012.) “Polio eradication shifts into emergency mode.” As retrieved at: http://bit.ly/MLbEK8

2Global Polio Eradication Initiative.(2012). Data and Monitoring – Polio This Week. As retrieved from http://bit.ly/9BJAP4.

3Based on a cost per dose of $0.14 and three doses per person. Global Polio Eradication Initiative.(2012). Oral Polio Vaccination. As retrieved from

http://www.polioeradication.org/Polioandprevention/Thevaccines/OralpoliovaccineOPV.aspx. 4World Health Organization.(2012). Poliomyelitis. As retrieved from http://www.who.int/mediacentre/factsheets/fs114/en/.

5World Health Organization.(2012). Poliomyelitis. As retrieved from http://www.who.int/mediacentre/factsheets/fs114/en/.

6Global Polio Eradication Initiative.(2012). History of Polio. As retrieved from http://www.polioeradication.org/Polioandprevention/Historyofpolio.aspx.

Global Health: Polio Funding

FY13 Committee Approved Funding

Senate: $40 million*

House: N/A

October 31, 2012

The Global Need Every year, 3.3 billion people are at risk of contracting malaria, leading to approximately 216 million malaria cases and an estimated 655,000 deaths. Thanks in part to President George W. Bush’s leadership and the creation of the Presidential Malaria Initiative in 2005, which currently operates in 19 focus countries, international funding to combat malaria has continued to rise. However, funding still falls short of the $5 billion per year needed from 2010 to 2015 to reach malaria control targets.1 Additionally, robust funding for malaria research and development is necessary to sustain the remarkable gains made against the disease in the last decade.

Significance of Funding Levels

The extra $20 million dollars approved by the Senate Appropriations Committee for FY13 could provide:

Bed nets for over 5 million people;

Artemisnin-based Combination Therapy (ACT) treatment for more than 14 million people; or

Rapid diagnostic testing (RDT) for 33 million people.

Cost of Care

$4.00 = Long-lasting insecticidal bed net that lasts three years

$1.40 = ACT course for an adult $0.60 = Rapid diagnostic testing for children and adults2

Importance of Funding

The World Health Organization (WHO) estimates that half of the world’s population is at risk of malaria infection. Malaria is prevalent in 106 countries, referred to as malaria-endemic countries. Malaria imposes significant costs to both individuals and governments. Direct costs such as illness, treatment, or premature death have been estimated to be at least $12 billion per year. Indirect costs, like loss of economic growth, are many times more than that.3

The Impact of Funding - Success is Possible

USAID works closely with national governments to build their capacity to prevent and treat malaria. With the help of US and global funding efforts, significant gains in combating malaria have been made, including:

43 countries have reported a reduction in malaria cases of more than 50 percent;

Estimated new cases of malaria have decreased by 17 percent globally;

Mortality in children under five has fallen dramatically across Sub-Saharan Africa due to a scale-up of malaria control efforts;4 and

The overall annual malaria death toll has declined from 985,000 to 655,000 people, a 26 percent reduction in global malaria mortality.5

By continuing these smart investments, the U.S. can continue to lead the international community in ending malaria deaths globally.

1 Kendall, Alexandra. (June 2012). Congressional Research Services: U.S Response to the Global Threat of Malaria. Retrieved from http://www.fas.org/sgp/crs/misc/R41644.pdf. 2 World Health Organization. (2011). World Malaria Report 2011: Financing Malaria Control. Retrieved from http://bit.ly/Rrtlg1 3 Center for Disease and Control Prevention. (2010). Impact of Malaria. Retrieved from http://www.cdc.gov/malaria/malaria_worldwide/impact.html. 4 The President’s Malaria Initiative: Sixth Annual Report to Congress (April 2012). Page 3. As retrieved from: http://1.usa.gov/RvHY3Q 5 The Global Fund. (2012). Fighting Malaria: The Global Malaria Epidemic. Retrieved from http://www.theglobalfund.org/en/about/diseases/malaria/.

Global Health:

Malaria Funding

FY13 Committee Approved Funding

Senate: $670 million

House: $650 million

October 31, 2012

The Global Need

In June 2012, the U.S., along with 162 other governments, made a bold promise to the world to end preventable child deaths.1 In fact, U.S. investments have made a major contribution to the 10 percent reduction in infant mortality rates worldwide over the last eight years, and USAID interventions help save the lives of more than 6 million children under 5 every year.2 Still, there are 6.9 million deaths among children under five each year, largely due to avoidable and treatable causes, including pneumonia, diarrhea, and malaria. Malnutrition is the underlying cause of about one-third of deaths in these young children.3 Every year in 358,000 women are dying from largely preventable complications related to pregnancy or childbirth.

Significance of Funding Levels

The extra $73.418 million dollars approved by the Senate Appropriations Committee for FY13 could provide:

Over 6.9 million children immunizations against tetanus, pertussis, and hepatitis, or

Over 1.8 million children immunizations against polio, measles, and rotavirus, or

Over 6.3 million children low-cost antibiotics to treat pneumonia-the leading killer of children under five, or

Over 11.5 million children oral rehydration salts that could help save many of the 1.1 million who die

needlessly from diarrhea.4

Importance of Funding

Funding for preventing illness and promoting good health in mothers and children reduces the cost of curing people when they get sick – by up to $700 million globally per year for child survival alone.5 U.S. investments and the bold child survival call to action have led to country ownership of these important health initiatives, including in India, Nigeria, Malawi and Nepal- which have prioritized and invested their own resources in maternal and child health.

Significance of Funding – Success is Possible

Since the inception of its child survival and maternal health program, the United States, in collaboration with many international partners, has delivered unprecedented successes:

• Almost a billion episodes of child diarrhea treated each year, reducing child deaths from diarrheal disease by more than 50 percent since 1990;

• More than 100 million children received basic immunizations each year; • More than 75 million infants and children with pneumonia received treatment annually; • Malnutrition among children under age 5 has been reduced from one in three to one in

four, a 25 percent reduction; and

• More than 70 percent of women receive at least some care during pregnancy.6

1 A Promise Renewed. (2012). A Call to Action. As retrieved from http://www.apromiserenewed.org/A_Call_to_Action.html.

2 USAID. (2012). USAID Maternal and Child Health. As retrieved from http://www.usaid.gov/what-we-do/global-health/maternal-and-child-health .

3 UNICEF. (2012). Committing to Child Survival: A Promise Renewed, Progress Report 2012. Forward, As retrieved from http://uni.cf/QQB5wA

4 Costs determined by average treatment costs of interventions and include vaccines, cold chain, syringes & needles, training and salaries.

5 World Health Organization. (2012). Investing in Maternal, Newborn, and Child Health. Page 3. As retrieved from http://bit.ly/VEesIW

6 USAID. (2009). USAID’s Child Survival and Maternal Health Program. Page 2. As retrieved from http://pdf.usaid.gov/pdf_docs/PDACN044.pdf.

Global Health:

Maternal and Child Health

FY13 Committee Approved Funding

Senate: $679 million

House: $605 million

October 31, 2012

The Global Need

Neglected Tropical Diseases (NTDs) impact nearly 1 in 6 people worldwide, including nearly half a billion children. These diseases include schistosomiasis, river blindness, lymphatic filariasis, trachoma, roundworm, whipworm, and hookworm. Every year up to 400,000 people die from NTDs; one billion suffer from one or more tropical diseases, causing severe disability and hindering cognitive development.1

The general consensus within the development community is it can cost as little as 50 cents per year to treat a person against the most common NTDs.

Significance of Funding Levels

The additional $36 million dollars approved by the Senate Appropriations Committee

for FY13 could provide treatment to 72,000,000 people.2

Importance of Funding

Eliminating NTDs offers one of the clearest links to cutting the cycle of poverty for millions of people. NTDs coexist with poverty because they thrive where access to clean water and sanitation are limited and people live without protection from disease vectors. NTDs are also recognized as a contributor to poverty since they can:

Impair intellectual development in children; Reduce school enrollment; and, Hinder economic productivity by limiting the ability of infected individuals to work.3

USAID support for NTDs focuses on the scale-up of efficient and sustained preventive chemotherapy in an integrated manner so that control of all and elimination of some of these diseases can be achieved.

Impact of Funding – Success is Possible

Over the past 5 years, the US Government has leveraged $3.1 billion in donated medicines, resulting in the delivery of more than:

584.6 million safe and effective treatment strategies for NTDs to approximately 257.9 million people.4

*House level of funding for Family Planning was not specified in the FY 2013 State and Foreign Operations Appropriations Amount

1 U.S. Department of State. (2011). Foreign Operations Congressional Budget Justification Fiscal Year 2011: Volume 2. Retrieved from

http://1.usa.gov/Q79zv7. 2 Based on cost per beneficiary amount of $0.50, analysis taking the number of beneficiaries over the total funding allotted over the course of several

fiscal years. 3 USAID. (2012). USAID Neglected Tropical Diseases. As retrieved from http://www.usaid.gov/what-we-do/global-health/neglected-tropical-diseases.

4 USAID. (2012). USAID’s Neglected Tropical Diseases Program. As retrieved from http://www.neglecteddiseases.gov/about/index.html.

Global Health:

Neglected Tropical Diseases

FY13 Committee Approved Funding

Senate: $125 million

FY12 Enacted: $89 million*