The President’s Fiscal Year 2016 (FY16) budget request, which was released on February 2, 2015 and is a key step in the federal budget process, proposed $9.9 billion in specified funding for global health programs.1 If enacted by Congress, this would represent a decline from levels set in the FY15 Omnibus Appropriations bill (not including emergency funding for Ebola that was provided in the FY15 Omnibus billi ).2 In each of the past three fiscal years (FY13-FY15), however, Congress has approved higher funding levels for global health than those proposed in the President’s budget request (see Figure 1).3 In the FY16 request, the majority of U.S. global health funding is provided as a part of the international affairs budget, which includes programs at the U.S. Agency for International Development (USAID) and the Department of State.4 Despite the proposed decrease in in global health funding, the international affairs budget increased in the request.5 As a result, when measured as a share of the international affairs budget, global health would decline from 22% in FY15 to 18% in FY16 (see Table 1). Most of the global health budget ($8.2 billion) specified in the FY16 budget request is provided through the Global Health Programs (GHP) account at USAID and the State Department (see Figure 2). Within the GHP account, funding for tuberculosis (TB), neglected tropical diseases (NTDs), global health security (formerly pandemic influenza and emerging threats), nutrition, and vulnerable children would decline The U.S. Global Health Budget: Analysis of the Fiscal Year 2016 Budget Request 2 compared to FY15 enacted levels, while malaria, maternal and child health (MCH), and family planning and reproductive health (FP/RH) funding would increase (see Figure 3 and Table 2). Funding for bilateral HIV, through the President’s Emergency Plan for AIDS Relief (PEPFAR), would remain essentially flat. The base U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) would decrease, although the State and Foreign Operations (SFOPs) Congressional Budget Justification (CBJ) states that this amount would fulfill the existing U.S. pledge to the Global Fund (see Global Fund section below). The proposed decrease for the Global Fund accounts for a significant share of the total decline in global health funding in the FY16 budget request. When comparing the President’s budget requests over time, several trends emerge (see Table 3). For instance, looking at specific program areas, MCH is the only program with a proposed increase in each budget request over the period between FY13-FY16. During the same period, TB and the Global Fund are the only programs with a proposed decrease from the prior request; all other programs either increased or remained flat. More recently, proposed funding for all programs in the FY16 request matched the levels proposed in the FY15 request, with the exception of MCH, bilateral HIV, and the Global Fund (bilateral HIV and MCH increased, while the Global Fund decreased). It is important to note that total discretionary funding in the FY16 budget request, which includes global health, exceeds the estimated budget cap instituted by the Budget Control Act of 2011.6 Therefore, if Congress were to enact the President’s budget request, it would need to adjust the existing cap for FY16, which is essentially equal to the FY15 level. Congress will begin drafting appropriations legislation in the coming months; whether or not Congress provides a higher level of global health funding than proposed in the President’s request, either under an adjusted cap or the existing cap, is unknown.
Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)