ACCOUNTABILITY IN U.S. GLOBAL HEALTH AID

We would like US Agency for International Development (USAID) to provide better accountability to Congress and the public for the health results produced by our aid.  

USAID has many indicators for measuring what goes into a project and what is achieved.  These indicators don’t all measure important health outcomes, however, and the whole system could be simplified with fewer indicators that focus more effectively on health outcomes. This would help lighten the reporting burden for implementing partners.  

A related concern is that, for many global health programs, USAID reports on the total results achieved in a country by all actors, which does not show what U.S. aid has accomplished. We suggest that USAID instead take credit for the results of its own contribution (for example, it could take credit for country-wide results in proportion to its share of total program funding).  This would give Congress and the public a better idea of the impact and cost-effectiveness of U.S. aid. 

For each Global Health account, we propose that USAID report to Congress on their health outcome targets, the results produced as a result of U.S. government assistance, and the U.S. funds expended to achieve those results. 

In searching for a way to have better accountability for health outcomes, Fund for Global Health found that programs administered by USAID for Water, Sanitation and Hygiene (WASH) provide a good model. For example, one of their indicators for measuring health outcomes is: 

"Number of people gaining access to safely managed drinking water services as a result of US Government assistance"

The focus is on the number of people benefiting from a health intervention as a  result of U.S. assistance.

Fund for Global Health has proposed outcome-based indicators for each USAID global health program based on the WASH model. For example, this one for the Maternal and Child Health account, included in foreign aid legislation for Fiscal Year 2022, would require USAID to report:

“Number of children treated for pneumonia as a result of US Government assistance”

There is a further requirement in the legislation that the USAID report “shall include detail on funds expended to achieve such outcomes.”  This report to Congress would track progress made with US aid against the #1 killer of children in greater detail than is currently the case.  Similar reporting is required for diarrhea, post-natal care and nutrition.  Having similar requirements in other global health programs would provide a measuring stick for Congress to better evaluate “value for money” in the global health programs it funds.  

We would like to see the Maternal and Child Health and the Nutrition reporting language referenced above renewed in future foreign aid appropriations, and we propose expanding such reporting to HIV/AIDS, Tuberculosis and Malaria.  The latter three programs do report the number of people on treatment but these are country-wide results to which U.S. assistance contributed along with other funders such as the Global Fund to Fight AIDS, TB and Malaria and the country itself. 

We suggest that the HIV/AIDS, TB and Malaria programs instead take credit for the results in proportion to the U.S. share of program funding, to give Congress and the public a reasonable approximation of the impact and cost-effectiveness of U.S. aid.

Our Ask: For the HIV/AIDS, Tuberculosis and Malaria programs, that the administration be required to report to Congress for each disease on the number of additional people treated as a result of U.S. Government assistance and how much the U.S. Government spent to achieve that.

MAKE YOUR VOICE HEARD! WRITE TO YOUR MEMBER OF CONGRESS TODAY

US House of Representatives, State and Foreign Operations Subcommittee of Appropriations

US Senate, State and Foreign Operations Subcommittee of Appropriations