Senate Appropriations Committee Approves FY 2024 State, Foreign Operations, and Related Programs (SFOPs) Appropriations Bill
The Senate Committee on Appropriations approved the FY 2024 State, Foreign Operations, and Related Programs (SFOPs) appropriations bill, accompanying report, and amendments on July 20, 2023. The SFOPs bill includes funding for U.S. global health programs at the State Department and the U.S. Agency for International Development (USAID). Funding for these programs, through the Global Health Programs (GHP) account, which represents the bulk of global health assistance, totaled $10.3 billion, a decrease of $239 million (-3%) below the FY 2023 enacted level. All of the decrease is due to reduced funding in the bill for the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), though the accompanying report notes that the decline is “a result of the statutory cap on U.S. contributions related to other donor funds” and that “should sufficient matching contributions be available, the Committee intends to honor the $6,000,000,000 U.S. pledge for the seventh replenishment.” Funding for maternal and child health, Gavi the Vaccine Alliance, family planning and reproductive health (FP/RH), and the Health Reserve Fund increased compared to FY 2023 enacted levels; all other global health areas remained flat. See the table below (downloadable version here) for additional detail on FY 2024 Senate levels compared to the FY 2023 Omnibus as well as the FY 2024 President’s Request and FY 2024 House levels. See other budget summaries and the KFF budget tracker for details on historical annual appropriations for global health programs.
| Table 1: KFF Analysis of Global Health Funding in the FY24 Senate Appropriations Bill | |||||||
| Department / Agency / Area | FY23 Omnibus (millions) |
FY24 Request (millions) | FY24 House i (millions) |
FY24 Senate (millions) |
Difference: FY24 Senate – FY23 Omnibus |
Difference: FY24 Senate – FY24 Request |
Difference: FY24 Senate – FY24 House |
| State, Foreign Operations, and Related Programs (SFOPs) – Global Health ii | |||||||
| HIV/AIDS iii, iv | – | $4,700.0 | – | – | – | – | – |
| Global Health Programs (GHP) account | $4,725.0 | $4,700.0 | $4,725.0 | $4,725.0 | $0 (0%) |
$25 (0.5%) |
$0 (0%) |
| State Department | $4,395.0 | $4,370.0 | $4,395.0 | $4,395.0 | $0 (0%) |
$25 (0.6%) |
$0 (0%) |
| USAID | $330.0 | $330.0 | $330.0 | $330.0 | $0 (0%) |
$0 (0%) |
$0 (0%) |
| of which Microbicides | $45.0 | $45.0 | Not specified | $45.0 | $0 (0%) |
$0 (0%) |
– |
| ESF Account | Not specified | $0.0 | Not specified | Not specified | – | – | – |
| Global Fund v | $2,000.0 | $2,000.0 | $2,000.0 | $1,650.0 | $-350 (-17.5%) |
$-350 (-17.5%) |
$-350 (-17.5%) |
| Tuberculosis iii | – | $358.5 | – | – | – | – | – |
| Global Health Programs (GHP) account | $394.5 | $358.5 | $394.5 | $394.5 | $0 (0%) |
$36 (10%) |
$0 (0%) |
| Economic Support Fund (ESF) account | Not specified | $0.0 | Not specified | Not specified | – | – | – |
| Malaria | $795.0 | $780.0 | $800.0 | $795.0 | $0 (0%) |
$15 (1.9%) |
$-5 (-0.6%) |
| Maternal & Child Health (MCH)iii | – | $1,082.5 | – | – | – | – | – |
| GHP account | $910.0 | $910.0 | $910.0 | $920.0 | $10 (1.1%) |
$10 (1.1%) |
$10 (1.1%) |
| of which Gavi | $290.0 | $300.0 | $300.0 | $300.0 | $10 (3.4%) |
$0 (0%) |
$0 (0%) |
| of which Polio | $85.0 | $85.0 | $85.0 | $85.0 | $0 (0%) |
$0 (0%) |
$0 (0%) |
| UNICEF iii | $142.0 | $145.0 | Not specified | $145.0 | $3 (2.1%) |
$0 (0%) |
– |
| ESF account | Not specified | $27.0 | Not specified | Not specified | – | – | – |
| of which Polio | Not specified | $0.0 | Not specified | Not specified | – | – | – |
| Assistance for Europe, Eurasia, and Central Asia (AEECA) account | Not specified | $0.5 | Not specified | Not specified | – | – | – |
| Nutrition iii | – | $164.8 | – | – | – | – | – |
| GHP account | $160.0 | $160.0 | $172.5 | $160.0 | $0 (0%) |
$0 (0%) |
$-12.5 (-7.2%) |
| ESF account | Not specified | $4.0 | Not specified | Not specified | – | – | – |
| AEECA account | Not specified | $0.8 | Not specified | Not specified | – | – | – |
| Family Planning & Reproductive Health (FP/RH)iii, vi, vii | $607.5 | $677.2 | $461.0 | $635.1 | $27.6 (4.5%) |
$-42.1 (-6.2%) |
$174.1 (37.8%) |
| Bilateral FP/RH vi, vii | $575.0 | $619.7 | $461.0 | $600.0 | $25 (4.3%) |
$-19.7 (-3.2%) |
$139 (30.2%) |
| GHP account vi | $524.0 | $600.0 | Not specified | $549.0 | $25 (4.8%) |
$-51.1 (-8.5%) |
– |
| ESF account vi | $51.1 | $19.3 | Not specified | $51.1 | $0 (0%) |
$31.8 (164.5%) |
– |
| Assistance for Europe, Eurasia, and Central Asia (AEECA) account viii | Not specified | $0.4 | Not specified | Not specified | – | – | – |
| UNFPA ix | $32.5 | $57.5 | $0.0 | $35.1 | $2.6 (8%) |
$-22.4 (-38.9%) |
$35.1 (NA) |
| Vulnerable Children | $30.0 | $30.0 | $32.5 | $30.0 | $0 (0%) |
$0 (0%) |
$-2.5 (-7.7%) |
| Neglected Tropical Diseases (NTDs) | $114.5 | $114.5 | $114.5 | $114.5 | $0 (0%) |
$0 (0%) |
$0 (0%) |
| Global Health Security iii, vii | – | $1,260.3 | – | – | – | – | – |
| GHP account | $900.0 | $1,245.0 | Not specified | Not specified | – | – | – |
| State Department vii | – | $500.0 | Not specified | Not specified | – | – | – |
| of which Pandemic Fund xi | – | $500.0 | Not specified | Not specified | – | – | – |
| USAID | $900.0 | $745.0 | Not specified | $900.0 | $0 (0%) |
$155 (20.8%) |
– |
| of which bilateral | Not specified | $435.0 | Not specified | Not specified | – | – | – |
| of which multilateral | Not specified | $220.0 | Not specified | Not specified | – | – | – |
| of which the Coalition for Epidemic Preparedness Innovations (CEPI)xii | $100.0 | Not specified | $100.0 | $100.0 | $0 (0%) |
– | $0 (0%) |
| of which Emergency Reserve Fund | xiii | $90.0 | xiii | xiii | – | – | – |
| ESF account | Not specified | $13.3 | Not specified | Not specified | – | – | – |
| AEECA account | Not specified | $2.0 | Not specified | Not specified | – | – | – |
| Emergency Reserve Fund | xiii | xiii | xiii | xiii | – | – | – |
| Health Reserve Fund xiv | $8.0 | $10.0 | Not specified | $10.0 | $2 (25%) |
$0 (0%) |
– |
| Global Health Worker Initiative | Not specified | $20.0 | Not specified | $20.0 | – | $0 (0%) |
– |
| SFOPs Total (GHP account only) | $10,561.0 | $10,928.0 | $10,018.7 | $10,268.0 | $-293 (-2.8%) |
$-660 (-6%) |
$249.2 (2.5%) |
| Notes: | |||||||
| i – The FY24 House and Senate bill texts state that up to $200 million of the funds appropriated by this Act through various accounts “may be made available to combat such infectious disease of public health emergency.” | |||||||
| ii – Unless otherwise specified, funding amounts listed under the “State, Foreign Operations, and Related Programs (SFOPs) – Global Health” heading are provided through the Global Health Programs (GHP) account. | |||||||
| iii – Some HIV, tuberculosis, MCH, nutrition, family planning and reproductive health, and global health security funding is provided under the ESF and AEECA accounts, which is not earmarked by Congress in the annual appropriations bills and is determined at the agency level. | |||||||
| iv – The FY24 Senate report accompanying the SFOPs bill “recommends not less than $30,000,000 under the GHP heading for a pilot project in up to three current PEPFAR countries to enhance antenatal and maternity services.” | |||||||
| v – The FY24 Senate report states that the reduction in funding for the Global Fund compared to the prior fiscal year is “a result of the statutory cap on U.S. contributions related to other donor funds” and that “should sufficient matching contributions be available, the Committee intends to honor the $6,000,000,000 U.S. pledge for the seventh replenishment.” | |||||||
| vi – The FY23 Omnibus bills states that “not less than $575,000,000 should be made available for family planning/reproductive health.” The FY24 House bill states that “of the funds appropriated by this Act, not more than $461,000,000 may be made available for family planning/reproductive health.” The FY24 Senate bill states that “not less than $600,000,000 should be made available for family planning/reproductive health.” | |||||||
| vii – The explanatory statement accompanying the House FY24 SFOPs appropriations bill does not provide specific funding amounts for FPRH or GHS under the GHP account. After the funding amounts specified for all other areas (e.g., HIV, TB, MCH, etc.) are removed, $869.71 million remains under the GHP account at USAID, which is funding that could be used for FPRH and GHS (or other areas as determined by the Administration). Since the House FY24 bill text states that “of the funds appropriated by this Act, not more than $461,000,000 may be made available for family planning/reproductive health” without specifying an account, it is possible the Administration could fund all or a portion of this amount through the GHP account with the remainder directed to GHS (or other areas as determined by the Administration). | |||||||
| viii – It is possible additional funding for FPRH might be provided through the AEECA account, but these amounts, if any, will not be available until late in the fiscal year. | |||||||
| ix – The FY23 Omnibus and FY24 Senate bills state that if this funding is not provided to UNFPA it “shall be transferred to the ‘Global Health Programs’ account and shall be made available for family planning, maternal, and reproductive health activities.” | |||||||
| x – The FY24 Request states that this amount is for the Pandemic Fund to “strengthen global health security and pandemic preparedness and help make the world safer from infectious disease threats.” | |||||||
| xi – The FY24 Senate bill states that “funds appropriated by this Act under the heading ‘Global Health Programs‘ may be made available for contributions to the Financial Intermediary Fund for Pandemic Prevention, Preparedness and Response.” | |||||||
| xii – The explanatory statement accompanying the House FY24 SFOPs appropriations bill directs that $50 million in unobligated balances from previous fiscal years should be made available to CEPI in addition to the $100m provided through the bill matching the FY23 enacted level. The explanatory statement accompanying the Senate FY24 SFOPs appropriations bill recommends “not less than $100,000,000 for a U.S. contribution to the Coalition for Epidemic Preparedness Innovations.” | |||||||
| xiii – The FY23 Omnibus and FY24 Senate bills state that “up to $90,000,000 of the funds made available under the heading ‘Global Health Programs’ may be made available for the Emergency Reserve Fund.” The FY24 Request includes funding for the Emergency Reserve Fund under Global Health Security. The FY24 House bill states that “up to $50,000,000 of the funds appropriated by this Act under the heading ‘Global Health Programs’ may be made available for the Emergency Reserve Fund.” | |||||||
| xiv – The explanatory statement accompanying the FY23 Omnibus states that these funds are “to support cross-cutting health activities, including health service delivery, the health workforce, health information systems, access to essential medicines, health systems financing, and governance, in challenging environments and countries in crisis.” The FY24 Request states that these funds are to “support cross-cutting global health activities in challenging environments or countries emerging from crisis. It will provide flexible, no year funding to ensure basic health services are accessible to those most in need and to build more resilient health services and systems. Activities will focus on six key areas: support for health service delivery, the global health workforce, health information systems, access to essential medicines, health systems financing, and governance.” | |||||||
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