Testimony on the FY 2006 Budget Request for the President's Emergency Plan for AIDS ReliefAmbassador Randall L. Tobias, U.S. Global AIDS Coordinator
House Committee on Appropriations, Subcommittee on Foreign Operations, Export Financing and Related Programs
March 2, 2005
Mr. Chairman and Members of the Subcommittee:
Thank you for this opportunity to discuss President Bushís Fiscal Year 2006 budget request for his Emergency Plan for AIDS Relief. As the Foreign Operations Subcommittee has recognized in the past, global HIV/AIDS is one of the most daunting challenges the world faces -- indeed, has ever faced.
In my view, what the world has most needed in dealing with HIV/AIDS is hope. For there to be hope, it is essential to be able to point to real progress.
It will be a long journey for us to bring hope under the tragic circumstances of HIV/AIDS. But as the philosopher Lao Tzu wrote, the journey of a thousand miles begins with a single step.
That journey began just over two years ago, when the President proposed the largest financial commitment any nation has ever made to an international health initiative dedicated to a single disease. The Emergency Plan was conceived as a five-year, $15 billion dollar commitment -- our nationís promise to provide bold leadership and action to a world that faces a desperate emergency.
In the 13 months since funds were first appropriated, the Emergency Plan has worked throughout the world, with a special focus on 15 severely burdened nations. We believed that dramatic success in those nations, many of them among the worldís poorest, would enable us to demonstrate to the entire world what intensive leadership and commitment of resources could do in this fight.
I am pleased to report that the U.S. has begun to do what we must to bring hope to the hopeless: we are getting results. As our Report to Congress makes clear, the Emergency Plan is on track to meet the ambitious 5-year prevention, care, and treatment goals Congress set for it.
Let me give an example of these results in the area of treatment. To put them in perspective, in December 2002, one month before President Bush announced the Emergency Plan, an estimated 50,000 people were receiving antiretroviral therapy in all of sub-Saharan Africa.
In its first eight months, the Emergency Plan worked under national strategies in the 15 focus countries to support treatment for nearly 155,000 HIV-infected adults and children. That data is as of September 30th, and the number has continued to grow as we continue to scale up treatment programs.
So the U.S. has not just taken a single step, but has made great strides in fulfilling our commitment. Based on our work to date, I believe we are on track to meet the Presidentís goals, and to save a steadily increasing number of lives.
That outcome depends in part, however, on investing the resources to do the job.
Today we face a critical juncture in Americaís response. We have laid a strong foundation. The question before this Subcommittee, and our nation, is whether we will build on that foundation.
I wish I could report to you that the world has Ďturned the cornerí on HIV/AIDS, or that the hard part is behind us. But the truth is that we still have a very long way to go.
Approximately 8,000 men, women, and children continue to die every day around the world. Approximately 5 million people continue to become infected each year. Increasingly, women are disproportionately the victims. Entire nations are having their population "hollowed out" by AIDS, sowing the seeds of chaos and insecurity. The picture is a bleak one.
I am deeply grateful to this Subcommittee, and to Congress as a whole, for the appropriations we have received for the first 2 years of the Emergency Plan. In Fiscal Year 2004, our funding level was nearly $2.4 billion, and it rose to $2.8 billion for the current fiscal year. The Presidentís request for nearly $3.2 billion in 2006, therefore, would represent the third year of steadily increasing funding toward the Presidentís commitment of $15 billion in 5 years.
In the Presidentís view, global HIV/AIDS is so devastating, and the stakes so high, that we simply must keep our promise. From the outset, the President intended that funding for this initiative be increased over time. This approach is consistent with sound public health practice. His Fiscal Year 2006 request for nearly $3.2 billion is what is needed for us to keep the Emergency Plan on track to fulfill our commitment of $15 billion over 5 years, and to reach our goals of preventing 7 million new infections, supporting treatment for 2 million people, and caring for 10 million people, including orphans and vulnerable children.
We support programs in many nations where the capacity to deliver health care is severely limited by a history of poverty and neglect. At the risk of stating the obvious, our ability to put resources to work in a nation is constrained by its health care infrastructure and supply of trained health workers.
This is why we have invested so much effort in expanding that capacity in nations hard-hit by HIV/AIDS. The initial success we have been able to achieve gives us confidence that we can put steadily increasing resources to effective use.
Of course, our capacity-building work is not primarily about making it possible for the United States to do more in the future. Rather, the Emergency Plan is building local and host-nation capacity so that national programs can achieve results, monitor and evaluate their activities, and sustain their responses for the long term.
Without local capacity, nations cannot fully "own" the fight they must lead against HIV/AIDS. For that reason, a statistic I find most encouraging from the early months of our work is this one: fully 80% of our more than 1,200 partners working on the ground were indigenous organizations including faith- and community-based partners.
In the early days of the Emergency Plan, we have made tremendous strides in helping host nations develop their capacity to respond. Our recent Report to Congress provides detailed information on these achievements, so I will only briefly summarize them here.
As you know, infrastructure is a major challenge. In the early days of the Emergency Plan, the U.S. has been able to promote the expansion of existing health care networks and the development of new public and private network systems to enhance the delivery of HIV/AIDS services in remote areas.
For those networks to be effective, they require trained personnel. Responding to the critical shortage of trained health workers at all levels, the Emergency Plan has supported training that covers a broad range of services, from prevention -- including mother-to-child prevention -- to antiretroviral treatment, to palliative care, to counseling and testing, to orphan care. The American people, through the Emergency Plan, are giving people in our host nations the skills to meet their neighborsí needs.
The Emergency Plan has also fostered indigenous leadership in the fight against the HIV/AIDS pandemic. The U.S. has provided technical assistance for appropriate policy development, including policies protecting women and girls, and for strengthening local institutions and organizations, including organizations of persons living with HIV/AIDS.
Other components of local capacity on which we have focused include surveillance, reporting, evaluation, and strategic information. These tools allow us to maintain the accountability which is a cornerstone of the Emergency Plan, and to adjust our programming based on what works. Even more importantly, these tools allow host nations to monitor and adjust their national responses.
Our host nations have warmly welcomed our commitment to partnership with them, and our support for their national responses. At this early stage, U.S. support is still needed -- in fact, it is indispensable. Our support is essential to allowing host nations that have recently been able to begin antiretroviral therapy on a broad scale to maintain and expand that work. By keeping our commitment, we can help to ensure that the gains we have made are not allowed to slip away, but are built upon.
Meeting our commitment at the Presidentís proposed level is also essential to the work of our international partners in the fight. Under the "Three Ones" agreement, we are cooperating intensively with international donors in support of our host nationsí strategies. For example, we support the Global Fund to Fight AIDS, Tuberculosis, and Malaria in two ways: through our direct financial contributions, which continue to far exceed those of any other donor government, and through our efforts to build the capacity on which their programs often rely.
If America did not step up to our commitment, we would thus not only handicap our own bilateral work, we would harm the efforts of the Global Fund and others as well. This is precisely the wrong message to send at the very time when we seek to encourage other nations to dramatically increase their commitment, as we have done.
Another need that the Presidentís proposed funding level will help us meet is the need I mentioned earlier for ever-increasing accountability and transparency. From the beginning, Congress has shared the Presidentís vision of the Emergency Plan as a new way of doing business, one focused on the bottom line -- saving lives. We have made an unprecedented commitment to strategic information, monitoring and evaluation, and we have made substantial progress on that front, as described in the Report to Congress.
I have determined that there is a need for formal auditing of our grantees to help us monitor their activities, and that capability will be added to the Emergency Plan in 2005. I am also aware of the need for a user-friendly Emergency Plan website to offer Congress and the public access to information. Such a website is currently under development.
Mr. Chairman, I am mindful of the difficult trade-offs this Subcommittee has to make. In light of all the other international challenges we face, I am grateful for your continued leadership on global HIV/AIDS.
I visited Haiti this past month. Haiti faces many challenges, and 2004 was especially difficult there. Within a few months, Haiti was hit by a deadly flood and by several episodes of violent unrest.
Yet what I saw there were people who are determined to overcome tremendous obstacles to meet the challenge of HIV/AIDS. Thanks in part to the commitment of the American people and Congress, new hope is being born there. This is something of which all Americans can be proud. Mr. Chairman, I ask that my full testimony be included in the record. I would be happy to address your questions.
Released on March 4, 2005