House Approves the FY 2024 State and Foreign Operations (SFOPs) Appropriations Bill
The House approved its FY 2024 State, Foreign Operations, and Related Programs (SFOPs) appropriations bill on September 28, 2023 (the House Committee on Appropriations released the bill on June 22, 2023 and accompanying report on July 11, 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 billion, a decrease of $542 million (-5%) below the FY 2023 enacted level and $909 million (-8%) below President Biden’s FY 2024 request. All of the decrease is due to reduced funding in the bill for both family planning and reproductive health (FP/RH) and global health security (GHS); all other global health areas either remained flat or increased compared to the FY 2023 enacted levels and the President’s FY 2024 Request.
Policy provisions in the bill include the Helms amendment (see the KFF fact sheet here) and the expanded Mexico City Policy that was put in place by President Trump and rescinded by President Biden (see the KFF explainer here). The bill also prohibits funding to the United Nations Population Fund (UNFPA) and the World Health Organization (WHO). Also, as part of the Manager’s Amendment adopted on July 12, 2023 by the full House Committee on Appropriations, the bill extends PEPFAR’s expiring provisions for one more year (see the KFF brief here). See the table below (downloadable version here) for additional detail. See other budget summaries and the KFF budget tracker for details on historical annual appropriations for global health programs.
| Table: KFF Analysis of Global Health Funding in the FY24 House State, Foreign Operations, and Related Programs (SFOPs) Appropriations Bill |
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| Department / Agency / Area | FY23 Omnibus (millions) |
FY24 Request (millions) |
FY24 Housei (millions) |
Difference: FY24 House – FY23 Omnibus |
Difference: FY24 House – FY24 Request |
| State, Foreign Operations, and Related Programs (SFOPs) – Global Healthii | |||||
| HIV/AIDSiii | – | $4,700.0 | – | – | – |
| Global Health Programs (GHP) account | $4,725.0 | $4,700.0 | $4,725.0 | $0 (0%) |
$25 (0.5%) |
| State Department | $4,395.0 | $4,370.0 | $4,395.0 | $0 (0%) |
$25 (0.6%) |
| USAID | $330.0 | $330.0 | $330.0 | $0 (0%) |
$0 (0%) |
| of which Microbicides | $45.0 | $45.0 | Not specified | – | – |
| Economic Support Fund (ESF) account | Not specified | $0.0 | Not specified | – | – |
| Global Fund | $2,000.0 | $2,000.0 | $2,000.0 | $0 (0%) |
$0 (0%) |
| Tuberculosisiii | – | $358.5 | – | – | – |
| Global Health Programs (GHP) account | $394.5 | $358.5 | $394.5 | $0 (0%) |
$36 (10%) |
| Economic Support Fund (ESF) account | Not specified | $0.0 | Not specified | – | – |
| Malaria | $795.0 | $780.0 | $800.0 | $5 (0.6%) |
$20 (2.6%) |
| Maternal & Child Health (MCH)iii | – | $1,082.5 | – | – | – |
| Global Health Programs (GHP) account | $910.0 | $910.0 | $910.0 | $0 (0%) |
$0 (0%) |
| of which Gavi | $290.0 | $300.0 | $300.0 | $10 (3.4%) |
$0 (0%) |
| of which Polio | $85.0 | $85.0 | $85.0 | $0 (0%) |
$0 (0%) |
| United Nations Children’s Fund (UNICEF) | $142.0 | $145.0 | Not specified | – | – |
| Economic Support Fund (ESF) account | Not specified | $27.0 | Not specified | – | – |
| of which Polio | Not specified | $0.0 | Not specified | – | – |
| Assistance for Europe, Eurasia, and Central Asia (AEECA) account | Not specified | $0.5 | Not specified | – | – |
| Nutritioniii | – | $164.8 | – | – | – |
| Global Health Programs (GHP) account | $160.0 | $160.0 | $172.5 | $12.5 (7.8%) |
$12.5 (7.8%) |
| Economic Support Fund (ESF) account | Not specified | $4.0 | Not specified | – | – |
| Assistance for Europe, Eurasia, and Central Asia (AEECA) account | Not specified | $0.8 | Not specified | – | – |
| Family Planning & Reproductive Health (FP/RH)iii, iv, v | $607.5 | $677.2 | $461.0 | $-146.5 (-24.1%) |
$-216.2 (-31.9%) |
| Bilateral FP/RHiv, v | $575.0 | $619.7 | $461.0 | $-114 (-19.8%) |
$-158.7 (-25.6%) |
| Global Health Programs (GHP) accountiv | $524.0 | $600.0 | Not specified | – | – |
| Economic Support Fund (ESF) accountiv | $51.1 | $19.3 | Not specified | – | – |
| Assistance for Europe, Eurasia, and Central Asia (AEECA) accountvi | Not specified | $0.4 | Not specified | – | – |
| United Nations Population Fund (UNFPA)vii | $32.5 | $57.5 | $0.0 | $-32.5 (-100%) |
$-57.5 (-100%) |
| Vulnerable Children | $30.0 | $30.0 | $32.5 | $2.5 (8.3%) |
$2.5 (8.3%) |
| Neglected Tropical Diseases (NTDs) | $114.5 | $114.5 | $114.5 | $0 (0%) |
$0 (0%) |
| Global Health Securityiii, v | – | $1,260.3 | – | – | – |
| Global Health Programs (GHP) account | $900.0 | $1,245.0 | Not specified | – | – |
| State Departmentviii | – | $500.0 | Not specified | – | – |
| of which Pandemic Fund | – | $500.0 | Not specified | – | – |
| USAID | $900.0 | $745.0 | Not specified | – | – |
| of which bilateral | Not specified | $435.0 | Not specified | – | – |
| of which multilateral | Not specified | $220.0 | Not specified | – | – |
| of which the Coalition for Epidemic Preparedness Innovations (CEPI)ix | $100.0 | Not specified | $100.0 | $0 (0%) |
– |
| of which Emergency Reserve Fund | x | $90.0 | x | – | – |
| Economic Support Fund (ESF) account | Not specified | $13.3 | Not specified | – | – |
| Assistance for Europe, Eurasia, and Central Asia (AEECA) account | Not specified | $2.0 | Not specified | – | – |
| Emergency Reserve Fund | x | x | x | – | – |
| Health Reserve Fundxi | $8.0 | $10.0 | Not specified | – | – |
| Global Health Worker Initiative | Not specified | $20.0 | Not specified | – | – |
| SFOPs Total (GHP account only) | $10,561.0 | $10,928.0 | $10,018.7 | $-542.2 (-5.1%) |
$-909.3 (-8.3%) |
| Notes: | |||||
| i – The FY24 House bill text states that up to $200 million of the funds approrpiated 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 FY23 Omnibus bills states that “not less than $575,000,000 should be made available for family planning/reproductive health.” The FY24 House 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.” | |||||
| v – 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). | |||||
| vi – It is possible additional funding for FPRH might be provided through the AEECA account in FY23, but these amounts, if any, will not be available until late 2024. | |||||
| vii – The FY23 Omnibus 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.” | |||||
| viii – 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.” | |||||
| ix – 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. | |||||
| x – The FY23 Omnibus bill states 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.” | |||||
| xi – 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.” | |||||
The KFF Daily Global Health Policy Report summarized news and information on global health policy from hundreds of sources, from May 2009 through December 2020. All summaries are archived and available via search.