UPDATED: The Senate Appropriations Committee approved the FY 2020 State & Foreign Operations (SFOPs) appropriations bill (and accompanying report) on September 26, 2018 (a draft version of the bill and report were released on September 18, 2019). The SFOPs bill includes funding for U.S. global health programs at the State Department and the U.S. Agency for International Development (USAID).[i] Funding for these programs, through the Global Health Programs (GHP) account, which represents the bulk of global health assistance, totaled $9.1 billion, an increase of $279 million above the FY 2019 enacted level, $2.8 billion above the President’s FY 2020 request, and $181 million below the House FY 2020 level.

Key highlights are as follows (see table for additional detail):

• Funding for most global health programs at State and USAID increased compared to the FY19 enacted level, with the exception of bilateral HIV funding at the State Department, which declined slightly, and neglected tropical diseases (NTDs) programs, which remained flat. In all cases, funding was above the President’s FY 2020 request, which had proposed significant cuts; funding levels varied compared to the House FY20 appropriations bill.
• Bilateral HIV funding through the President’s Emergency Plan for AIDS Relief (PEPFAR) is $4,650 million in the Senate FY20 bill, $50 million below the FY19 enacted and FY20 House levels ($4,700 million), but $1,300 million above the FY20 Request ($3,350 million).
• The bill includes $1,560 million as the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), an increase of $210 million above the FY19 enacted level ($1,350 million), $602 million above the FY20 Request ($958 million), and matching the FY20 House level.
  • The report accompanying the bill states that the committee “anticipates that the United States will pledge not less than [$1.56 billion] for each of the three fiscal years pertaining to the Global Fund’s Sixth Replenishment . . . [and] does not support the administration’s proposal to amend the longstanding matching rates for U.S. contributions to the Global Fund and expects the United States to continue to match other donor contributions at a rate of $1 for every $2 received from other donors.
• Funding for tuberculosis (TB) totals $310 million, $8 million above the FY19 enacted level, $49 million above the FY20 Request ($261 million), and matching the FY20 House level.
• Funding for malaria totals $789 million, $34 million above the FY19 enacted and FY20 House levels ($755 million), and $115 million above the FY20 Request ($674 million).
• The bill includes $847 million for maternal and child health (MCH), an increase of $12 million above the FY19 enacted level ($835 million), $227 million above the FY20 Request ($629 million), and $3 million below the FY20 House level ($850 million). Specific areas under MCH include:
  • Gavi, the Vaccine Alliance funding totals $290 million, matching the FY19 enacted and FY20 House levels, and $40 million above the FY20 Request ($250 million).
  • Polio funding through the GHP account totals $61 million, $2 million above the FY19 enacted and FY20 House level ($59 million).[ii] The President’s FY 2020 Request did not specify funding for polio.
  • The bill includes $137.5 million for the U.S. contribution to the United Nations Children’s Fund (UNICEF) provided through the International Organizations and Programs (IO&P) account, matching the FY19 enacted level and $10 million below the House FY20 level ($147.5 million). While the FY20 Request did not specify a funding amount for UNICEF and proposed to eliminate the IO&P account, it is possible that organizations such as UNICEF could receive funding through other accounts.
• Funding for nutrition totals $150 million, $5 million above the FY19 enacted and FY20 House level ($145 million), and $71.5 million above the FY20 Request ($78.5 million).
• Bilateral family planning and reproductive health (FP/RH) funding totals $633 million ($582 million through the GHP account and $51 million through the ESF account), $58 million above the FY19 enacted level, and $374 million above the FY20 Request ($259 million), but $117 million below the FY20 House level ($750 million).[ii]
• Funding for the United Nations Population Fund (UNFPA) totals $32.5 million, matching the FY19 enacted level, but $23 million below the FY20 House level ($55 million); the FY20 Request proposed eliminating funding for UNFPA.
• Funding for the vulnerable children program totals $26 million, $2 million above the FY19 enacted and FY20 House level ($24 million); the FY20 Request proposed eliminating funding for this program.
• Funding for neglected tropical diseases (NTDs) totals $102.5 million, matching the FY19 enacted and FY20 House level, and $27.5 million above the FY20 Request ($75 million).
• Funding for global health security totals $100 million in the bill. While this is a decrease compared to the FY19 enacted level ($138 million), $38 million of the FY19 amount was provided through a one-time transfer of unspent emergency Ebola funding. The Senate FY20 amount is an increase compared to the FY20 Request ($90 million) and matches the FY20 House level.

• FY2020 State and Foreign Operations Appropriations Bill – Draft Bill
• FY2020 State and Foreign Operations Appropriations Bill – Draft Report

The table (.xls) below compares global health funding in the FY 2020 Senate SFOPs appropriations bill to the FY 2019 enacted funding amounts as outlined in the “Consolidated Appropriations Act, 2019” (P.L. 116-6; KFF summary here), the President’s FY 2020 request (KFF summary here), and the House FY 2020 SFOPs bill (KFF summary here).