- ASSESSING THE FISCAL YEAR 2012 BUDGET FOR AFRICA

[Senate Hearing 112-199]
[From the U.S. Government Publishing Office]

S. Hrg. 112-199

ASSESSING THE FISCAL YEAR 2012 BUDGET FOR AFRICA

=======================================================================

HEARING

BEFORE THE

SUBCOMMITTEE ON AFRICAN AFFAIRS

OF THE

COMMITTEE ON FOREIGN RELATIONS
UNITED STATES SENATE

ONE HUNDRED TWELFTH CONGRESS

FIRST SESSION

__________

APRIL 14, 2011

__________

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COMMITTEE ON FOREIGN RELATIONS

JOHN F. KERRY, Massachusetts, Chairman
BARBARA BOXER, California RICHARD G. LUGAR, Indiana
ROBERT MENENDEZ, New Jersey BOB CORKER, Tennessee
BENJAMIN L. CARDIN, Maryland JAMES E. RISCH, Idaho
ROBERT P. CASEY, Jr., Pennsylvania MARCO RUBIO, Florida
JIM WEBB, Virginia JAMES M. INHOFE, Oklahoma
JEANNE SHAHEEN, New Hampshire JIM DeMINT, South Carolina
CHRISTOPHER A. COONS, Delaware JOHNNY ISAKSON, Georgia
RICHARD J. DURBIN, Illinois JOHN BARRASSO, Wyoming
TOM UDALL, New Mexico MIKE LEE, Utah
Frank G. Lowenstein, Staff Director
Kenneth A. Myers, Jr., Republican Staff Director

------------

SUBCOMMITTEE ON AFRICAN AFFAIRS

CHRISTOPHER A. COONS, Delaware, Chairman

BENJAMIN L. CARDIN, Maryland JOHNNY ISAKSON, Georgia
JIM WEBB, Virginia JAMES M. INHOFE, Oklahoma
RICHARD J. DURBIN, Illinois MIKE LEE, Utah
TOM UDALL, New Mexico BOB CORKER, Tennessee

(ii)

C O N T E N T S

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Page

Carson, Hon. Johnnie, Assistant Secretary of State, Bureau of
African Affairs, Department of State, Washington, DC........... 4
Prepared statement........................................... 8
Responses to questions submitted by Senator Richard G. Lugar. 47
Responses to questions submitted by Senator Christopher A.
Coons...................................................... 51
Coons, Hon. Christopher A., U.S. Senator from Delaware, opening
statement...................................................... 1
Fine, Patrick C., Vice President for Compact Implementation,
Millennium Challenge Corporation, Washington, DC............... 23
Prepared statement........................................... 25
Responses to questions submitted by Senator Christopher A.
Coons...................................................... 71
Goosby, Hon. Eric P., U.S. Global AIDS Coordinator, Department of
State, Washington, DC.......................................... 16
Prepared statement........................................... 18
Responses to questions submitted by Senator Christopher A.
Coons...................................................... 65
Isakson, Hon. Johnny, U.S. Senator from Georgia, opening
statement...................................................... 3
Jandhyala, Rajakumari, Deputy Assistant Administrator, U.S.
Agency for International Development, Washington, DC........... 10
Prepared statement........................................... 12
Responses to questions submitted by Senator Christopher A.
Coons...................................................... 76

(iii)

ASSESSING THE FISCAL YEAR 2012 BUDGET FOR AFRICA

----------

THURSDAY, APRIL 14, 2011

U.S. Senate,
Subcommittee on African Affairs,
Committee on Foreign Relations,
Washington, DC.
The subcommittee met, pursuant to notice, at 2:35 p.m., in
room SD-419, Dirksen Senate Office Building, Hon. Christopher
A. Coons (chairman of the subcommittee) presiding.
Present: Senators Coons, Isakson, Inhofe, and Lee.

OPENING STATEMENT OF HON. CHRISTOPHER A. COONS,
U.S. SENATOR FROM DELAWARE

Senator Coons. I would like to call to order this hearing
of the Subcommittee on African Affairs of the U.S. Senate
Committee on Foreign Relations.
I am pleased to chair today's subcommittee hearing which
will primarily examine the President's budget request for sub-
Saharan Africa for fiscal year 2012. It is a distinct privilege
to serve as the subcommittee chairman. I am grateful for the
opportunity given me by Chairman Kerry and my colleagues on the
committee.
I am also honored to serve with my good friend, Senator
Isakson, whom I will compliment again once he joins us in just
a few moments, and look forward to working closely with him in
this Congress on issues we both care deeply about, principally
economic growth, security, stability, governance, global
health, food security, conflict prevention, and democratic
institution-building across the continent.
The goal of today's hearing is to review the President's
budget request for Africa, including both bilateral and
regional priorities for foreign assistance. This hearing will
help to inform the entire subcommittee and committee of the
administration's program and resource priorities in sub-Saharan
Africa, as well as the basis and the projections for the
requested resources. The discussion today is intended to also
include priority initiatives such as the Global Health
Initiative, including the President's Emergency Plan for AIDS
Relief, better known as PEPFAR, and the Feed the Future
program, as well as the Millennium Challenge Corporation.
One of the objectives of this hearing is to consider the
whole-of-government approach toward the region and to explore
the impact of proposed budget cuts in the continuing
resolution, or CR, for the current fiscal year, Federal fiscal
year 2011. Within a constrained budgetary environment, these
are issues of critical importance for this committee and
Congress as a whole as we consider the longer term implications
of reducing Federal spending.
Unfortunately, limited resources do require difficult
decisions and tradeoffs regarding budgetary priorities, and I
hope to hear from our four witnesses today about the
implications for the long term of potential reductions in
foreign assistance and the projected impact that these proposed
cuts will have in Africa where the need is great and sadly the
resources are already too scarce.
According to the proposed long-term CR, which may well be
considered by this body later today, the Pentagon's budget is
more than 10 times larger than that proposed for the Department
of State. Today, if I understand the proposed CR correctly, we
will consider cuts to the State budget from last year that are
significant while also raising the Pentagon budget which
demonstrates, in my view, our growing emphasis on military
spending potentially at the expense of foreign assistance.
I am pleased to be joined by my ranking minority, Senator
Isakson, who I will invite to make an opening statement as soon
as I conclude. I just want to say thank you for joining us
today, and I am greatly enjoying serving on the subcommittee
with you.
I am pleased that recently both Secretary of Defense Gates
and the Chairman of the Joint Chiefs Mullen have expressed
their strong support for increased resources for the State
Department and its critical work in development so that it can
continue to play a central role in U.S. diplomacy. I share
their expressed views that American national security is also
critically dependent upon development and the projection of our
values throughout the world through diplomacy.
Today we will hear from State Department leadership, as
well as the U.S. Agency for International Development and the
MCC, about their strategy for sub-Saharan Africa as reflected
in their budget requests for the next fiscal year. We will use
this to examine the administration's priorities and the means
by which it aims to meet competing goals in the region,
responding not only to U.S. objectives but also regional and
bilateral needs.
We have prepared a chart to, sort of at the largest level,
give an overview of how the request for fiscal year 2012 breaks
out.
The total foreign assistance request for Africa is $7.8
billion, nearly three-quarters of which denoted in red are
dedicated to the Global Health Initiative. This program
increased dramatically during the Bush administration. In fact,
I would say a number of the initiatives under the Bush
administration were significant accomplishments among the
premier accomplishments of the Bush administration in fighting
HIV/AIDS and malaria in Africa in particular. The Global Health
Initiative was developed under President Obama in 2009, and I
look forward to hearing today from the U.S. Global AIDS
Coordinator, Ambassador Eric Goosby, about the future plans for
the GHI and, in particular, PEPFAR.
Six percent of the Africa budget request is dedicated to
the Feed the Future initiative, which is in green on the chart
before you, and was developed by President Obama and the
administration last year to address systematically global
hunger and poverty. Twelve of the twenty focus countries of
Feed the Future are in Africa, representing one-third of total
funding commitments. With USAID as the agency responsible for
the coordination and implementation of Feed the Future, I look
forward to hearing from Deputy Assistant Administrator
Jandhyala--not so good, OK--about agricultural development
programs and food security, as well as the wide range of other
areas of cooperation between AID and State with regard to
African policy and planning.
After the initiative funding, just 23 percent of the total
budget, or about $1.8 billion, remains, the blue section in the
chart above you, which must be carefully divided between the
very wide range of other foreign assistance priorities overseen
by State, strengthening democratic institutions, fostering
sustainable economic growth, preventing and resolving armed
conflict, and helping to address transnational threats, among
other important issues. Assistant Secretary of State for
African Affairs, Johnnie Carson, joins us here today to discuss
these priorities as a whole and challenges, as well as current
events in Africa such as the Nigerian elections and recent
violence and transitions in Cote d'Ivoire.
Finally, we will also hear from Patrick Fine, vice
president for Compact Implementation for the Millennium
Challenge Corporation about the MCC's work in Africa where it
focuses 70 percent of its funding. The MCC in my view is a
smart, potentially game-changing investment approach to
development that has contributed to poverty reduction through
economic growth in well-governed countries, and I look forward
to hearing from Mr. Fine about his plans to sustain past
successes in light of this challenging budget environment.
So, gentleman and lady, I appreciate your being here today,
look forward to your testimony, and I will now turn it over to
my cochair, at least in my mind, Senator Isakson, for his
opening statement.
Senator.

OPENING STATEMENT OF HON. JOHNNY ISAKSON,
U.S. SENATOR FROM GEORGIA

Senator Isakson. Well, thank you, Mr. Chairman. I apologize
for being a minute late, and I will be brief but to the point.
This is a very important hearing, as those who are here to
testify here today, as well as everybody in the audience,
recognizes. Every part of the appropriations of the United
States for the fiscal year 2012 year are going to be under
tremendous scrutiny and under tremendous pressure because of
the demands on us to reduce our deficit and our debt over time.
And I think each appropriation and each budget unit in the U.S.
Government will be looked upon more and more for a cost/benefit
analysis rather than just a needs-and-wants analysis.
I bring that up to point to Mr. Fine and the Millennium
Challenge Corporation, because I have told him before and seen
firsthand in Africa myself that investment has a tremendous
payback for the United States of America in more than one way,
but, in particular, to make it easier for American companies to
go and have predictable investment opportunities and joint
venture opportunities with African countries that have improved
their democracy, their governance, and reduced their
corruption, and worked toward being an effective member of the
world economy. So that is an investment that has a huge benefit
and payback directly to who we always should look to the
taxpayers of the United States and the business community.
Although that money is not in this particular discussion, and I
realize it, I think it is important to point out that it is a
perfect example of a positive cost-benefit analysis to the
country, as I think certainly the PEPFAR program has, as well
as the President's Malaria Initiative.
I have traveled in Africa enough to have seen firsthand the
tragedy of the disease of AIDS and the transmission of AIDS on
that continent and the decimation it has done to the population
of many of those countries. But equally, I have also seen the
countries that have actually flattened the growth curve and, in
some cases, lowered the curve of the infection rate and greatly
educated the populace in how to prevent the infection from
taking place in the first place and saving the lives of
children yet to be born in the future.
And there is a huge payback on that for this reason.
Africa, I have said many times, I think, is the continent of
the 21st century as far as the United States of America is
concerned. And I think the way we are investing our money right
now, although we are not in a state of competition with anybody
and the results of how we invest that money will have a lot to
do with the relationship our country has with the continent and
the countries of Africa in the future. And when you compare
U.S. investment and humanitarian efforts, such as the PEPFAR
initiative and the antimalaria initiative, as well as economic
development issues like MCC, then you see a much better example
of being a partner with a country to solve problems and produce
benefits versus those that invest a little money but extract
the natural resources and take them back to their home country,
as happens in Africa far too often.
So I look forward to hearing the testimony today by all
those that will be testifying, and in particular, that 23
percent noninitiative money, which is kind of a catchall
phrase. I would like for you all to talk a little bit about
some of the programs that are in there that are important to
the United States and to our foreign assistance program.
With that said, I would just replicate what the chair said.
I feel very honored to work with him and appreciate his
addition to this committee and his leadership as chairman.
Senator Coons. Thank you, Senator.
Now I will turn it over to our witnesses starting, if I
might, with Secretary Carson, followed by Mrs. Jandhyala,
Ambassador Goosby, and Mr. Fine. Please, if you would, make
your best efforts to limit your remarks to roughly 5 minutes,
and your full testimony will be placed into the record of this
hearing. Now I would like to begin, if we could, with Secretary
Carson.

STATEMENT OF HON. JOHNNIE CARSON, ASSISTANT SECRETARY OF STATE,
BUREAU OF AFRICAN AFFAIRS, DEPARTMENT OF STATE, WASHINGTON, DC

Mr. Carson. Mr. Chairman, I would like to thank you and
Ranking Member Isakson for inviting me and my colleagues to
participate in this budget hearing today.
As this is my first appearance before this Congress I wish
to congratulate you, Chairman Coons, on your election to the
Senate and your assumption of leadership of the African Affairs
Subcommittee.
Senator Isakson, congratulations on your reelection and for
remaining as the minority leader of the subcommittee. I greatly
appreciate your passion for Africa and your commitment to
realizing our Nation's goals and interests on that continent.
The President's FY 2012 request for sub-Saharan Africa
reflects our core U.S. priorities and interests in Africa. I
would like to highlight those priorities, interests, and some
of the major policy challenges and opportunities that we face
in Africa today.
We remain committed to five overarching policy priorities:
strengthening democratic institutions and the rule of law;
encouraging long-term development and growth, including food
security; enhancing access to quality health care and
education; assisting in the prevention, mitigation, and
resolution of conflicts, and working with Africans to address
transnational challenges, including terrorism, maritime
security, climate change, and narcotrafficking.
The FY 2012 request of $7.8 billion represents a 10-percent
increase from the FY 2010 enacted total of $7 billion. This
increase is due in large measure to increases requested by each
of the Presidential initiatives. The request for Global Climate
Change has increased by 140 percent, Feed the Future by 20
percent, and Global Health by 12.6 percent. Our request for
discretionary funds to support noninitiative programs is at
$1.8 billion. They include programs focused on enhancing
democracy and governance, economic growth, conflict resolution,
and transnational issues.
The United States has many challenges and commitments
around the globe, but it is important for us not to lose sight
of our growing national interests in sub-Saharan Africa. Sub-
Saharan Africa is a region where the United States has
benefited from longstanding partnerships and friendships and
enjoys some of the highest approval ratings in the world. The
ties between Americans and Africans are deep and also historic.
With few exceptions, Africa is not a place where we see anti-
American demonstrations and rhetoric. That is indicative of the
prevailing appreciation for our country's longstanding
commitment to democracy and human rights and for our steadfast
support in addressing many of Africa's challenges. The spread
of democracy in Africa over the past 2 decades and the vibrancy
of prodemocracy activism across the continent is further
evidence that most Africans share our political values.
In the international arena, we might not see eye to eye
with Africans on every issue, but overall, most governments
there have been cooperative as we deal with a variety of global
challenges. We saw one recent example of this when Gabon,
Nigeria, and South Africa voted in support of the U.N. Security
Council resolution authoring the use of force to avert a
humanitarian crisis in Libya.
Our economic interests in Africa are clear and compelling.
Approximately 14 percent of all U.S. oil imports come from the
region, making it a strategic part of our energy security
portfolio. Imports from Nigeria alone are about 9 percent of
our total oil imports and almost the same volume as we receive
from Saudi Arabia. With promising exploration and development
in countries such as Ghana, Uganda, Liberia, and Tanzania, sub-
Saharan Africa's significance for global oil and gas markets
will only increase in the coming years. Africa's enormous share
of the world's mineral reserves is also vitally important to
the United States. And most importantly for the future, sub-
Saharan Africa's growing population makes it a market where
U.S. firms will need to be players if they are going to remain
globally competitive.
Helping African countries, no matter how small and poor,
realize their full potential and succeed economically as
democracies is in our national interest. If fledgling
democracies are allowed to fail and undemocratic regimes are
allowed to endure unchallenged, then people will lose
confidence in democracy and free market economic principles,
and we will find ourselves on the defensive in the global
competition for influence and ideas. Many sub-Saharan African
countries face enormous challenges to their survival as
functioning states and we must continue to help them meet those
challenges so that they can better help us as we deal with our
own. In the coming years, African cooperation will be
increasingly essential in managing a wide range of global
issues such as smuggling, piracy, climate change, infectious
disease, and food production.
With our limited resources and personnel, we are managing a
long list of near- and long-term challenges that have a direct
impact on United States security, political, economic, and
humanitarian interests.
Nigeria, where I was this past weekend, is in the middle of
a tense election process that will have a serious repercussion
for its near- and long-term stability.
In Sudan, the 6-year-old north-south peace process is at an
extremely delicate moment with independence for South Sudan
just about 3 months away. Diplomatic efforts on Darfur are
accelerating again, but a solution is still far away.
The political crisis in Cote d'Ivoire has escalated into
armed conflict and unleashed one of West Africa's worst
humanitarian crises since the Liberian war.
The eastern region of the Democratic Republic of the Congo
remains highly insecure, especially for women and children.
That country is also scheduled to have national Presidential
elections in November that will serve as a bellwether for its
post-conflict transition.
Beyond these fast-moving issues which dominate the
headlines, our Government is trying to address a number of
slower moving, but nonetheless very high impact challenges. The
greatest of these is the prevalence of HIV/AIDS and other
infectious diseases which have tragic consequences for the
economic livelihoods and the social welfare of Africans across
the continent. My colleague, Ambassador Dr. Eric Goosby, will
address this in greater detail in his testimony. But it is
estimated that some 22.5 million Africans are living with HIV/
AIDS, about two-thirds of the world's total. Millions more
suffer and die regularly from malaria and other debilitating
but preventable endemic diseases.
Although a handful of African countries have demonstrated
improved rates of macroeconomic growth compared to previous
decades, the overall poverty and social indicators for much of
the continent are sobering. Ethiopia's per capita GDP, for
example, is only $344 a year. Life expectancy in oil-rich
Nigeria is only 48 years. Basic infrastructure is lacking in
many countries struggling to keep up with their growing
populations, especially in urban areas.
I have already alluded to some of the many security
challenges in Africa. There are others such as the presence of
terrorist groups and drug traffickers in the Sahara and the
ascendancy of drug trafficking in countries such as Guinea
Bissau and Mozambique. Our preferred approach to all of these
challenges is to work through African security and judicial
institutions and develop their capacity rather than rely on
direct and potentially costly U.S. involvement. This approach
may be slow and imperfect, but we believe it is the only truly
sustainable one for the African context, and it is the most
cost-effective approach for the United States. When Africans
take ownership of their own security responsibilities, we are
more likely to have the requisite trust and political buy-in
from key leaders in those countries.
Africa's complex challenges demand considerable time,
attention, and resources, but we must also be attentive to the
significant gains and progress that have occurred in many
countries over the past decade and ensure that they continue.
Liberia and Sierra Leone, for example, require our engagement
and support to help sustain their largely successful post-
conflict transitions. Helping Africa's most democratic
countries such as Senegal, Mali, Ghana, Benin, Botswana, Cape
Verde, Mauritius, Tanzania, and South Africa, continue with
their political and economic reforms is vital for demonstrating
the sincerity of our commitment to democracy and encouraging
other countries to follow their model. In recent years,
regional organizations such as the African Union, the Economic
Community of West African States, and the East African
Community have demonstrated a growing commitment to censuring
unconstitutional seizures of power, promoting economic
integration, and addressing regional security problems. It is
in our interest to see that those organizations continue to
build their capacity and become more assertive across the
continent.
I have worked for nearly 4 decades in Africa. Whenever I
review budgets, I am still amazed at how our Government manages
to do so much with so little. Roughly speaking, one can easily
fit the land masses of the United States, China, and all of
Western Europe into sub-Saharan Africa. After Southern Sudan
becomes independent in July 2011, sub-Saharan Africa will have
49 states. We have 44 embassies, 5 consulates, and several
regional platforms used by U.S. Government agencies. Those of
you who have been out to the region know most of these missions
are thinly staffed with an ambassador and a handful of
reporting officers and support staff.
In closing, I would like to state simply that every dollar
we invest in helping Africans to address their problems and
better capitalize on their opportunities may not satisfy our
high expectations for economic growth, development, health,
security, and political stability, but they can go a long way
in preventing situations from getting worse and costing us even
more down the road. And as Ambassador Goosby and my colleagues
from USAID and the Millennium Challenge Corporation will detail
in their testimonies, many of our efforts do, in fact, have a
very positive and significant impact on the lives of Africans.
It is through these programs and our vigorous diplomacy that
the United States will remain a key player in Africa and
protect and advance our most important national interests.
Mr. Chairman and Ranking Member Isakson, thank you very
much for this opportunity to testify before you, and I will be
pleased to answer questions following the testimony of the
others.
Thank you very much.
[The prepared statement of Mr. Carson follows:]

Prepared Statement of Assistant Secretary Johnnie Carson

I would like to thank you, Chairman Coons, Ranking Member Isakson,
and all the members of the committee for inviting my colleagues and me
to testify today on the President's budget request for sub-Saharan
Africa. As this is my first appearance before this Congress, I wish to
congratulate you, Chairman Coons, on your election to the Senate and
for assuming the leadership of the African Affairs Subcommittee as a
new member. Senator Isakson, congratulations on your reelection and for
remaining as the minority leader of the subcommittee. I greatly
appreciate your passion for Africa and commitment to realizing our
Nation's goals and interests there.
The President's FY 2012 request for sub-Saharan Africa reflects our
core U.S. priorities and interests in Africa. I would like to highlight
those priorities, interests, and some of the major policy challenges
and opportunities we face on the continent.
We remain committed to five overarching policy priorities: (1)
strengthening democratic institutions and the rule of law; (2)
encouraging long-term development and growth, including food security;
(3) enhancing access to quality health care and education; (4)
assisting in the prevention, mitigation, and resolution of conflicts;
and (5) working with Africans to address transnational challenges,
including terrorism, maritime security, climate change, narcotics
trafficking, and trafficking in persons.
The FY 2012 request of $7.8 billion represents a 10-percent ($732.7
million) overall increase from the FY 2010 enacted total of $7.0
billion. This increase is due in large measure to increases requested
for each of the Presidential initiatives. The request for Global
Climate Change has increased by 140.9 percent ($73.7 million), Feed the
Future by 20 percent ($84.4 million), and Global Health by 12.6 percent
($601.22 million). Our request for discretionary funds to support
noninitiative programs is $1.8 billion. They include programs focused
on enhancing democracy and governance, economic growth, conflict
resolution, and transnational issues.
The United States has many challenges and commitments around the
globe, but it is important for us not to lose sight of our growing
national interests in sub-Saharan Africa. sub-Saharan Africa is a
region where the United States has benefited from longstanding
partnerships and friendships and enjoys some of the highest approval
ratings in the world. The ties between Americans and Africans are deep
and historic. With few exceptions, Africa is not a place where we see
anti-American demonstrations and rhetoric. That is indicative of the
prevailing appreciation for our country's longstanding commitment to
democracy and human rights, and for our steadfast support in addressing
Africa's many challenges and during times of trouble. The spread of
democracy in Africa over the past two decades and the vibrancy of
prodemocracy activism across the continent is further evidence that
most Africans share our political values.
In the international arena, we might not see eye to eye with
Africans on every issue, but, overall, most governments there have been
cooperative as we deal with a variety of global challenges such as
international terrorism, Iran, and piracy. We saw one recent example of
this when Gabon, Nigeria, and South Africa voted in support of the U.N.
Security Council resolution authorizing the use of force to avert a
humanitarian catastrophe in Libya.
Our economic interests in Africa are clear and compelling.
Approximately 14 percent of U.S. oil imports come from the region,
making it a strategic part of our energy security portfolio. Imports
from Nigeria alone are about 9 percent of our total oil imports and
almost the same volume as those from Saudi Arabia. With promising
exploration and development in countries such as Ghana, Uganda,
Liberia, and Tanzania, sub-Saharan Africa's significance for global oil
and gas markets will only increase in the coming years. Africa's
enormous share of the world's mineral reserves is vital for sustaining
continued growth of the global economy. And, most importantly, sub-
Saharan Africa's growing population makes it a market where U.S. firms
will need to be players if they are to remain globally competitive. The
region's share of the world population today is approximately 12
percent, and it is estimated to grow to 20 percent over the next two
decades.
Helping African countries, no matter how small and poor, realize
their full potential and succeed as economically viable democracies is
in our national interest. If fledgling democracies are allowed to fail
and undemocratic regimes are allowed to endure unchallenged, then
people will lose confidence in democracy and free market economic
principles, and we will find ourselves on the defensive in the global
competition for influence and ideas. Many sub-Saharan African countries
face enormous challenges to their survival as functioning states, and
we must continue to help them meet those challenges so they can better
help us as we deal with our own. In the coming years, African
cooperation will be increasingly essential in managing a wide range of
global issues such as smuggling, piracy, migration, climate change,
infectious disease, and food production.
With our limited resources and personnel, we are managing a long
list of near- and long-term challenges that have a direct impact on
U.S. security, political, economic, and humanitarian interests.
Nigeria, where I was this past weekend, is in the middle of a tense
election process that will have serious repercussions for its near- and
long-term stability. In Sudan, the 6-year-old North-South peace process
is at an extremely delicate moment with independence for the South just
about 3 months away. Diplomatic efforts on Darfur are accelerating
again, but a solution is still far away. The situation in Somalia
remains especially volatile and poses security threats throughout East
Africa and in the Indian Ocean. We may also be on the precipice of a
humanitarian catastrophe there as food supplies once again run low.
The political crisis in Cote d'Ivoire has escalated into armed
conflict and unleashed one of West Africa's worst humanitarian crises
since the Liberian war. The eastern region of the Democratic Republic
of Congo (DRC) remains highly insecure, especially for women and
children. That country is scheduled to have elections in November that
will serve as a bellwether for its post-conflict transition. Uganda and
its neighbors are struggling to eliminate the Lord's Resistance Army,
which still threaten civilian populations in northern DRC and the
Central African Republic. In Zimbabwe, President Mugabe and his ruling
ZANU-PF party continue to obstruct the democratic process and mismanage
the economy, creating a persistent and long-term threat to the
country's overall stability.
Beyond these fast-moving issues which dominate the headlines, our
government is trying to address a number of slower moving but
nonetheless high-impact challenges. The greatest of these is the
prevalence of HIV/AIDS and other infectious diseases which have tragic
consequences for economic livelihoods and social welfare of Africans
across the continent. My colleague, Ambassador Eric Goosby will address
this in greater detail. It is estimated that some 22.5 million Africans
are living with HIV/AIDS, about two-thirds of the world's total.
Millions more suffer and die regularly from malaria and other
debilitating but preventable endemic diseases. Women and children
suffer disproportionately.
Although a handful of African countries have demonstrated improved
rates of macroeconomic growth compared to previous decades, the overall
poverty and social indicators for much of the continent are sobering.
Ethiopia's per capita GDP, for example, is $344. Life expectancy in
Nigeria is 48. Basic infrastructure is lacking in many countries
struggling to keep up with their growing populations, especially in
urban areas. As of last year, Southern Sudan had only 50 kilometers of
paved road. And food security remains an ongoing concern across much of
the continent.
I have already alluded to some of the many security challenges in
Africa. There are others such as the presence of terrorist groups and
drug traffickers in the Sahara, and the ascendance of drug trafficking
in countries such as Guinea Bissau and Mozambique. Our preferred
approach to all of these challenges is to work through African security
and judicial institutions and develop their capacity rather than rely
on direct and potentially costly U.S. involvement. This approach may be
slow and imperfect, but we believe it is the only truly sustainable one
for the African context, and it is the most cost-effective approach for
the United States. When Africans take ownership of their own security
responsibilities, we are more likely to have the requisite trust and
political buy-in of key players than if quick-fix solutions are imposed
by outsiders. And this buy-in is what can lead to more durable
outcomes. To put it differently, the more proactive we are in
encouraging and supporting African-led security initiatives, the less
likely we will need to intervene directly down the road.
Africa's complex challenges demand considerable time, attention,
and resources, but we must also be attentive to the significant gains
and progress that have occurred in many countries over the past decade,
and ensure they continue. Liberia and Sierra Leone, for example,
require our engagement and support to help sustain their largely
successful post-conflict transitions. Helping Africa's most democratic
countries--such as Senegal, Mali, Ghana, Benin, Botswana, Cape Verde,
Mauritius, Tanzania, and South Africacontinue with political and
economic reforms is vital for demonstrating the sincerity of our
commitment to democracy and encouraging other countries to follow their
model. In recent years, regional organizations such as the African
Union, Economic Community of West African States, East African
Community, and the Southern African Development Community have
demonstrated a growing commitment to, for example, censuring
unconstitutional seizures of power, promoting economic integration, and
addressing regional security problems. It is in our interest to see
that these organizations continue to build capacity and become more
assertive across the continent.
I have worked on Africa for my entire career of more than 40 years,
yet, whenever I review the budget numbers, I am still amazed at how our
Government manages to do so much with so little. Roughly speaking, one
can easily fit the landmasses of the United States, China, and Western
Europe in sub-Saharan Africa. After Southern Sudan becomes independent
in July, sub-Saharan Africa will have 49 states. We have 44 embassies,
5 consulates, and several regional platforms used by various U.S.
Government agencies. Those of you who have been out to the region know
most of these missions are thinly staffed with an ambassador and a
handful of reporting officers and support personnel.
In closing, I would like to state simply that every dollar we
invest in helping Africans to address their problems and better
capitalize on their opportunities may not satisfy our high expectations
for economic growth, development, health, security, and political
stability, but they sure can go a long way in preventing situations
from getting worse and costing us even more money down the road. And,
as Ambassador Goosby and my colleagues from USAID and the Millennium
Challenge Corporation will detail in their testimonies, many of our
efforts do in fact have a very positive and significant impact on the
lives of Africans. It is through these programs and our vigorous
diplomacy that the United States will remain a player in Africa and
protect and advance our interests there.
Mr. Chairman, Ranking Member, and distinguished committee members,
thank you. I will be happy to address your more specific questions and
concerns.

Senator Coons. Thank you very much, Mr. Secretary, and
thank you for making the effort to join us today. I know that
your engagement in Nigeria was important for our Nation, and I
appreciate your making the extra effort join us for this
testimony here today.
Next we will turn to Deputy Assistant Administrator Raja
Jandhyala.

STATEMENT OF RAJAKUMARI JANDHYALA, DEPUTY ASSISTANT
ADMINISTRATOR, U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT,
WASHINGTON, DC

Ms. Jandhyala. Thank you very much. Good afternoon,
Chairman Coons, Senator Isakson, members of the subcommittee.
Thank you for inviting me to speak with you today and
congratulations, Chairman Coons, in your support to Africa. And
Senator Isakson, we are very glad that you remain a big
supporter of our work and agency.
Over the past century, the United States has played a
critical role in the transformation of countries from war to
peace and in establishing a clear, necessary path to prosperity
and to keep countries at peace and engaged in global economy.
Throughout the entirety of USAID's 50 years of existence, the
agency has taken on some of the greatest development challenges
in Africa, delivering lifesaving humanitarian assistance and
crucial health interventions, and partnering with Africans to
improve democracy, governance and education outcomes.
Today I would like to add to Assistant Secretary Carson's
statement with brief remarks and be open to the questions at
the end.
USAID celebrates 50 years of generosity from the American
people who believe we can make the world a better, safer place
if we use our wealth, expertise, and values to invest smartly.
In the last 10 years, the United States has been
instrumental in bringing many African conflicts to an end and
laying the foundation for democratic transformations and
economic growth. The United States partnership with Africa is
based on our mutual desire to boost economic growth and
prosperity for all, including not least American firms and
American workers who stand to benefit in our engagement with
the continent and the growth and the opportunities that they
present. That same growth will be shared by African businesses
and will generate the kinds of jobs necessary for real economic
transformation and political stability.
To get the kind of outcomes we are looking for, USAID now
has several new tools at its disposal. The Obama
administration's Policy Directive on Global Development is
guiding the U.S. Government to take stock of its efforts in
focusing and concentrating our resources on the continent. And
combined with Secretary Clinton's leadership on the QDDR and
Administrator Shah's efforts on USAID Forward, we are really
looking forward to how do we as the U.S. Government, using our
resources, maximize our impact and focus and concentrate our
efforts on a few countries that allow us to meet their
humanitarian needs, economic growth, and can be drivers of
economic growth on the continent and benefit national security.
The FY 2012 total budget, as Assistant Secretary Carson has
mentioned, represents a 10-percent increase over the FY 2010
enacted total. Roughly two-thirds of the request consists of
bilateral assistance for 13 priority countries that are
critical to national security and economic trade, and
approximately three-quarters of the request would go toward
President Obama's three major initiatives: Feed the Future,
which aims to address hunger and unlock the enormous potential
of African agriculture as a driver of prosperity on the
continent. The Global Health Initiative aims to save millions
of lives while building sustainable health systems and deal
with huge transnational threats of infectious disease. The
Global Climate Change Initiative aims to help mitigate the
potential dire consequences of changing ecosystems on food
production and economic development.
These initiatives are integrated, focused, and led by each
country's specific needs and opportunities. We have worked
closely with countries to develop rigorous strategies and
balance difficult tradeoffs with clear-eyed assessment of where
we can effectively achieve meaningful results for developing
countries.
In addition, we are concentrating on supporting effective
governments. A government that represents the interests of its
people and is accountable and transparent is the best insurance
of making development progress sustainable. In African
countries, long-term improvements in health, education, and
economic growth, and the environment will ultimately require
responsive and representative governments. We truly believe
that without the empowerment of the population, that the
governments will not be held accountable. In contrast, weak
governance dampens economic activity, increases the risk of
civil unrest, and creates fertile ground for terrorism.
We are also engaging heavily with the regional
organizations like East African Community, the African Union,
and SADC to work with their institutions to empower their
leadership and their policies and strategies to impact the
continent and leveraging our resources to benefit the
population.
And as we are expanding our work with local organizations
in these countries to build capacity inside these institutions
and make them a critical part of negotiations between the
government and its people on determining priorities and
enhancing their ability to be transparent to the population and
have the ability--the population--to hold the government
accountable.
Africa is a priority for USAID. There is no denying
Africa's importance to the United States, both for the moral
imperative but also for helping solve the biggest development
challenges on the planet which can create transnational
threats.
The United States, as we understand it--we are committed to
the continent in many ways--political, security, and
developmental--and we are hoping to work with our interagency
partners to make this happen. We understand the importance of
maximizing the impact of every tax dollar spent, and that is
why we are making critical reforms and asking our partners to
build the systems necessary and the institutions necessary with
us to realize those impacts. USAID is partnering with other
donors for greater impact. We are working with the United
Kingdom in Nigerian elections. We are working with the United
Kingdom and the Netherlands and other countries in rebuilding
Southern Sudan post-July 9, and we are also very proud of our
efforts working with our regional partners and nontraditional
donors such as regional organizations to make our dollars work
better.
As we continue to work with our partners toward our shared
goals over the coming months, I very much look forward to our
continued conversation on USAID efforts in Africa.
Thank you, Mr. Chairman, Senator Isakson, and members of
the subcommittee. I look forward to responding to any of your
questions.
[The prepared statement of Ms. Jandhyala follows:]

Prepared Statement of Rajakumari Jandhyala

Good afternoon Chairman Coons, Senator Isakson, and members of the
subcommittee. Thank you for inviting me to speak with you.
Congratulations to Chairman Coons who is no stranger to Africa, and
particularly east Africa which I have the great pleasure of working on
regularly. Senator Isakson, we are glad that you remain the ranking
member and a great supporter of the State Department and USAID in
Africa.
Over the past century, the United States has played a critical role
in the transformation of countries from war to peace, and in
establishing a clear and necessary path to prosperity to keep those
countries at peace and engaged in the global economy. During the 1940s
and 1950s, we helped Europe end its wars, rebuild its economies, and
protected the continent from the inherent threats of the cold war.
Throughout the 1960s and 1970s, we supported great economic growth in
Asia--countries like Korea, Japan, the Philippines, India, Pakistan,
and Indonesia. During the 1970s and 1980s, we advanced democracy and
development in Latin America and Africa. Throughout the entirety of
USAID's 50 years of existence, the Agency has taken on some of the
greatest development challenges in Africa, delivering life-saving
humanitarian assistance, crucial health interventions, and partnering
with Africans to improve democracy, governance, and education outcomes.
Today, USAID celebrates 50 years of generosity from the American
people who believe that we can make the world a better and safer place
if we use our wealth, expertise, and values to invest smartly. In the
last 10 years, the United States has been instrumental in bringing many
African conflicts to an end, laying the foundation for democratic
transformations and economic growth. At USAID, we have worked closely
with our State Department colleagues, many Congressmen, Senators,
faith-based organizations, and NGOs to move beyond simply ending wars
already raging out of control to understanding how to prevent the types
of conflicts and political instability that threaten our own national
security. Corruption, disease, environmental degradation, poverty,
illicit trade, and extremism, combined with unemployment and a
ballooning youth population require sustained and smart U.S.
investments in development. The United States partnership with Africa
is based on our mutual desire to boost economic growth and prosperity
for all, including not least American firms and American workers who
stand to benefit from the huge markets and growth opportunities present
in Africa. That same growth will be shared by African businesses that
will generate the kinds of jobs necessary for real economic
transformation and political stability. While Africa's future is driven
by Africans, the United States will continue to play a major role by
investing in our African partners to make sure the kind of economic and
democratic outcomes we know to be crucial factors for stability and
prosperity are achieved.
To get the kinds of outcomes we are looking for, USAID now has
several new tools at its disposal. The Obama administration's Policy
Directive on Global Development is guiding the U.S. Government to take
stock of its efforts contributing to development outcomes, and to focus
and improve the impacts of our interventions. Combined with Secretary
Clinton's leadership in the Quadrennial Diplomacy and Development
Review and Administrator Shah's own efforts to fundamentally change how
USAID does business through USAID Forward, the United States is
significantly improving the impact and efficiency of its work in
Africa.
USAID is focusing on President Obama's three major initiatives--
Feed the Future, which aims to address hunger and unlock the enormous
potential of African agriculture as a driver of prosperity; the Global
Health Initiative, will save millions of lives while building
sustainable health systems; and Global Climate Change, which helps
mitigate the potentially dire consequences of climate change on African
ecosystems, food production, and economic development. In addition to
our bilateral support to African countries, we are engaging heavily
with regional organizations like the East African Community, which can
work effectively across borders, easing the restrictions on trade and
investment and encouraging growth throughout Africa. As part of USAID
Forward, we are also expanding our work with local organizations to
build home-grown capacity and institutionalize our efforts to
strengthen relations between the people and their governments to
support lasting, sustainable civil society organizations, government
institutions, and educational and health providers that can exist long
after USAID support has run its course.
The total FY 2012 budget request for Africa is $7.797 billion,
representing a 10-percent ($732.7 million) increase over the FY 2010
enacted total. Roughly 65.9 percent ($5.1 billion) of that consists of
bilateral assistance for 13 priority countries (the Democratic Republic
of Congo, Ethiopia, Ghana, Kenya, Liberia, Mali, Mozambique, Nigeria,
Somalia, South Africa, Sudan, Tanzania, and Zimbabwe) that are critical
to national security and economic trade. The request for Sudan
represents an increase of 21 percent ($90.5 million), which would go
toward enhancing security, governance capacity and economic growth
throughout Southern Sudan's transition to independence.
Seventy-seven percent of the request would go toward the
President's initiatives, in which we will build on substantial
investments:

Feed the Future: $507.3 million;
Global Health Initiative: $5.4 billion;
Global Climate Change Initiative: $126 million.

These initiatives are integrated, focused, and led by each
country's specific needs and opportunities. We have worked closely with
focus countries to develop rigorous strategies and balance difficult
tradeoffs with a clear-eyed assessment of where we can most effectively
achieve dramatic, meaningful results for the developing world.
An effective government--one that represents the interests of the
people and is accountable and transparent--is the best insurance for
making development progress sustainable. In African countries, long-
term improvements in health, education, economic growth, and the
environment ultimately require responsive and representative
governments that can promote and consolidate gains. In contrast, weak
governance dampens economic activity, increases the risk of civil
unrest, and can create fertile ground for terrorists.
A number of obstacles hinder the consolidation of democratic
political systems in Africa: entrenched political leaders, a lack of
systems that provide for checks and balances, the high incidence of
conflict due to resources, endemic corruption, legal restrictions on
civil society, ethnic grievances, and a lack of a democratic political
culture. A recent spate of coups, ethnic conflict, suppression of civil
society, and political stalemates between opposing factions suggest a
trend of democratic backsliding across all regions of Africa. However,
we also see 15 emerging markets which are attracting private capital,
commercial investments and nascent bond markets. USAID has reached out
to many private sector actors to assist our work and see it expanding
in the coming years.
Positive trends have emerged in countries such as Ghana, where
democracy continues to grow stronger, enabling it to serve as a
regional role model. In 2011, 18 countries in Africa are considered
electoral democracies compared with four in 1991, reflecting the long-
term progress that has been achieved. An ongoing trend toward
decentralization brings authority and service delivery decisions from
central control to subnational and local levels. And civil society
organizations continue to grow in numbers and strength, although the
need to broaden constituency bases and create linkages between urban
and rural communities exists.
USAID's work to strengthen the principles and practices of
democracy and good governance helps to create the conditions for peace
and development in Africa. USAID helps advance democracy in Africa by
promoting the rule of law, free and fair elections, a politically
active civil society, and transparent, accountable, and participatory
governance. Through technical assistance, training, and financial
support, USAID's bilateral and regional offices focus on increasing
access to and participation in the political system, empowering local
organizations, supporting elections, and strengthening democratic
institutions.
Feed the Future affirms the United States commitment to advance
global stability and prosperity by improving the most basic of human
conditions: the need that families have for a reliable source of
quality food and the means to purchase it. Agricultural growth is
highly effective in reducing poverty--especially in Africa, where the
majority of rural poor depend on agriculture for their livelihoods. To
ensure our investments are effective, we are prioritizing and focusing
our resources on a core set of countries where food security objectives
can best be realized.
Feed the Future has two key objectives: creating inclusive growth
in the agricultural sector and improving nutrition. Women are the
backbone of the economy in Africa, gender concerns are integrated in
all our efforts, and we are helping partners strengthen their capacity
to consider gender throughout all stages of the agricultural
production, processing and marketing. Feed the Future's country-owned
plans are within the continent-wide efforts known as the Comprehensive
Africa Agriculture Development Program (CAADP).
Feed the Future has identified up to 20 potential focus countries
worldwide based on the level of need, opportunity for partnership,
potential for agriculture-led growth, opportunity for regional
collaboration, and resource availability. Twelve of these countries are
in Africa (Ethiopia, Ghana, Kenya, Liberia, Mali, Malawi, Mozambique,
Rwanda, Senegal, Tanzania, Uganda, and Zambia).
To ensure the sustainability and impact of U.S. Government
investments, Feed the Future is investing in focus countries in two
phases: Phase I investments concentrate on foundational investments,
which are designed to lay the groundwork for an expansion of core
investments during phase II. To determine whether a focus country is
ready for phase II investments, Feed the Future will look for evidence
that countries are consulting and coordinating with key stakeholders,
including affected communities, the private sector, civil society, and
the donor community and determine which countries represent the best
opportunities for rapid agricultural growth, poverty reduction, and
nutrition.
Feed the Future also invests in regional programs that encompass
focus countries and where addressing the challenges to food security
requires cooperation across national borders. Regional investments are
guided by three main objectives: expanding access to regional markets;
mitigating risks associated with drought, disaster, and disease; and
building long-term capacity of regional organizations to address
regional challenges.
The U.S. Government's longstanding bipartisan efforts in global
health are a signature of American leadership in the world. Investments
in global health strengthen fragile or failing states, promote social
and economic progress, and support the rise of capable partners who can
help to solve regional and global problems. Through the Global Health
Initiative (GHI), the United States in partnership with local
governments and donors will accelerate progress toward ambitious health
goals which will improve the lives of millions. Funding is targeted to
the highest priorities--from infectious diseases to maternal and child
health--while helping developing countries build their capacity to help
their own people. In order to maximize the sustainable health impact of
every U.S. dollar invested in global health, GHI will expand basic
health services and strengthen national health systems to significantly
improve public health especially that of women, children, and other
vulnerable populations with effective, efficient country-led plans.
Our health programs not only show America at her best, but also
deliver results. In 2000 malaria killed nearly a million people each
year in sub-Saharan Africa. The cost to the continent was $30 billion a
year in lost productivity. By 2009, that number had dropped nearly 20
percent. In all eight African countries where both baseline and
followup nationwide surveys have been conducted by the President's
Malaria Initiative, there has been reported substantial reductions in
all-cause child mortality, and growing evidence suggests that malaria
prevention and control measures have been a major factor in these
reductions. In FY 2012, PMI will continue to strengthen the capacity of
local partners to deliver highly effective malaria prevention and
treatment measures. And we will expand malaria control into two
critical countries, the Democratic Republic of Congo and Nigeria, which
have a combined population of 200 million and where 50 percent of the
African malaria burden lies. But despite these successes urgent
challenges remain. This year, more than 350,000 women will die in
pregnancy or childbirth and 8 million children will die of preventable
diseases before their fifth birthday; approximately half of these
deaths will occur in Africa.
GHI provides a platform to increase the efficiency of our
investments in global health. Rather than supporting separate lines of
health delivery--focused on diseases--GHI focuses on improving service
delivery in an integrated way--particularly for women. Doing so
generates efficiencies, allowing far more comprehensive treatment
during fewer patient interactions. But the real success will be
measured in lives saved--today and in the future. Accelerated progress
depends on our ability to develop, identify, adapt, and deliver the
game changers. We cannot be satisfied with marginal improvements for
those who are already served. That is why under GHI, we will make
substantial investments in better ways to treat diarrhea and pneumonia
in children to save lives and prioritize vaccines, like rotavirus or
pneumococcus which are now available, to more effectively prevent
disease so children don't have to be treated later. For FY 2012, we
have prioritized funding in four areas that have maximum impact on the
health of women and children: HIV/AIDS, maternal and child health,
malaria, and family planning. We are concentrating our financial,
technical, and human resources on these areas to achieve dramatic,
meaningful results for the American people and the developing world.
Bipartisan congressional support and the generosity of the American
people have long defined U.S. Government global health work. We look
forward to continued cooperation and consultation with Congress as we
work together to implement this important initiative.
The United States is resolute in its commitment to forge a truly
global solution to climate change, and established the Global Climate
Change (GCC) initiative to help countries assess their vulnerability to
climate change and begin to adapt to these changes. Africa's share of
global greenhouse gas emissions is currently small--sub-Saharan Africa
has only about 6 percent of global emissions, while encompassing about
12 percent of the world's population. In many parts of the continent,
however, emissions are rising rapidly--and there is enormous untapped
potential to control their growth. But if emissions are relatively
modest, climate impacts on Africa are unfortunately not commensurately
limited. Africa is one of the most vulnerable continents to global
climate change and climate vulnerability. The FY 2012 request includes
$126 million for GCC in Africa, which will focus on three areas--
adaptation, energy, and landscapes--while addressing each of the
sectors where the effects of climate change will be the most
pronounced: food security, health, and stability.
Of the total request for FY 2012, $53 million is planned to go
toward adaptation--helping countries increase their resilience to
changing climatic conditions. Activities will include assisting
countries in improving science, building government systems, and
identifying activities that can make people, places, and livelihoods
less vulnerable over the long term. USAID's priority is in Africa's
least developed countries and small islands--those places most
susceptible to the initial effects of climate change and least able to
combat it. Funding will go toward USAID's three regional programs in
Africa (east, west, southern Africa) and 10 bilateral programs (Angola,
Ethiopia, Kenya, Malawi, Mali, Mozambique, Rwanda, Senegal, Tanzania,
Uganda).
The FY 2012 request for GCC in Africa also includes $25 million for
clean energy programs. No country has developed without a parallel
increase in the use of energy, which is why developing economies are
projected to account for over 80 percent of the growth in emissions by
2030. These countries can and should play a major role in reducing
emissions of greenhouse gases while still continuing to develop
robustly and sustainably. Funding will be dedicated to a mix of
countries that are major greenhouse gas emitters, countries that are
committed to energy efficiency and renewable energy, and countries
where programs can exploit larger scale impacts due to regional
interconnectedness (east, west, southern Africa; Kenya, South Africa).
Finally, the FY 2012 request includes $48 million for sustainable
landscapes, which mitigate emissions caused by land degradation,
deforestation, and desertification. USAID is working to change the
economic circumstances that drive emissions, improve land management,
conserve important carbon ``sinks'' in forests, promote reforestation
and afforestation, and promote improved agricultural and agroforestry
methods to increase carbon sequestration. The priorities for this
funding are the Congo basin (an area managed by USAID's Central Africa
Regional Program for the Environment) and the west African region, as
well as Ghana, Malawi, and Zambia. These key locations were chosen
based on their potential for mitigation, their potential for carbon
markets, local political will, multilateral coordination, and the
extent to which efforts can produce best practices and scalable models
for other areas.
Our key priorities also require a cooperative approach, so regional
integration will be key to achieving the objectives of each of these
initiatives. USAID works closely with African regional institutions,
which play a vital role in bringing together member states to address
challenges that cross boundaries, such as food security, health, and
climate change. The potential benefits are significant:

Market access and more efficient economies of scale as
firms, including U.S. businesses, are able to freely access a
much larger regional market.
Reduced transaction costs associated with doing business
through reduced paperwork required to open a business and trade
across borders. Integration would also dramatically reduce the
time and cost of transport and allow banks and insurers to draw
from a larger pool, reducing the cost of finance and expanding
access for African, U.S., and international businesses.
Foreign investment as the cost of doing business in the
region is reduced, and the potential benefits increase because
of the larger size of the market place.
Food security as food moves freely from areas of surplus
production to areas of deficit.
Stability as conflicting parties are united under a larger
union and as the economic benefits of integration lead to
greater regional prosperity.

USAID, working with the Departments of State and Defense, has
increased its support to regional integration efforts by closely
working with the African Union, the East African Community, ECOWAS, and
other regional groupings to ensure that common security and economic
issues can be the platforms to creating peace and security in the
region.
USAID is serious about Africa. There is no denying Africa's
importance to the United States, both for the moral imperative of
helping to solve the biggest development challenges on the planet, and
for the very real interests of the United States national security and
economic opportunities. To accomplish our goals, we understand the
importance of getting the most out of every taxpayer dollar spent--that
is why we are committed to making crucial reforms that are already
having an effect on our work in Africa. USAID is partnering with other
donors for greater impact, as we are doing with the United Kingdom's
Department for International Development in Nigeria to jointly program
our resources to ensure the elections were free and credible. We are
also proud of our joint efforts with the State Department toward the
successful referendum on independence for southern Sudan last January.
Smart USAID investments are paying off in Tanzania and Ghana as well,
where Feed the Future is leveraging the private sector and working to
truly transform food production and the economies of our African
partners. As we continue to work with our partners toward our shared
goals over the coming months, I very much look forward to a continued
conversation on USAID in Africa.
Thank you, Mr. Chairman, Senator Isakson, and members of the
subcommittee. I look forward to responding to any questions you might
have.

Senator Coons. Thank you, Raja. Thank you very much for
your testimony, and we look forward to the exchange of
questions and answers later.
If I could now turn to the U.S. Global AIDS Coordinator,
Ambassador Eric Goosby.

STATEMENT OF HON. ERIC P. GOOSBY, U.S. GLOBAL AIDS COORDINATOR,
DEPARTMENT OF STATE, WASHINGTON, DC

Ambassador Goosby. Thank you, Mr. Chairman, Ranking Member
Isakson. Thank you for this opportunity to discuss PEPFAR's
work in Africa. You have my written testimony, so I will be
brief.
Let me begin by thanking this committee for its leadership
in our 2003 and 2008 reauthorization. We are working hard to
implement that vision, the vision you laid out in that landmark
legislation. You conceived of PEPFAR as an interagency effort
led by the Department of State and drawing on the full range of
strengths of our U.S. agencies. In Washington, I am proud to
have the opportunity and responsibility to lead this
coordination. In-country, it is our Ambassadors who are
coordinating the work of the agencies and ensure we are working
as one U.S. Government with each country's government, civil
society, multilateral organizations, and others. This unified
PEPFAR approach offers us opportunities for synergies and
increased impact and efficiency that we would miss if we were
not working together as a team. Speaking with one voice at the
country level strengthens our ability to highlight the shared
responsibility of the global resources and to call on others to
increase their efforts.
This committee has a particular right to be proud of the
investment you have made in saving lives and promoting
security. As PEPFAR is demonstrating, your investments are
working.
In my travels to Africa, I have been repeatedly struck by
the deep gratitude for PEPFAR. Simply put, America has brought
hope back to countless people and helped ensure stability and
security. As Secretary Clinton has noted, global health
programs not only save the lives of mothers and children, they
stabilize societies and halt the spread of deadly disease to
our own country.
On a personal level, I am humbled by the sheer number of
people whose lives we have saved and whose families we have
kept together. Last year, PEPFAR directly supported support for
lifesaving treatment for more than 3.2 million people, women
and children. We supported programs that helped nearly 3.8
million orphans and vulnerable children move toward a better
future.
The President's FY 2012 request for PEPFAR reflects the
fact that while much has been accomplished, much work remains.
Now is the time to keep moving forward and build on these
successes. We must continue our investments and make sure they
are smart investments. This means using each dollar to save as
many lives as we can from using less expensive generic drugs to
moving these drugs by land and sea instead of by air.
Getting smarter means achieving greater efficiency and
impact on our programs. Our work to prevent mother-to-child
transmission of HIV is an example. It has a triple benefit:
saving the life of the mother, preventing the newborn from
being born with HIV, and keeping her children from becoming
orphans, thus keeping the family intact. In the last year
alone, our investments through PEPFAR led to more than 114,000
children being born HIV-free. America is truly leading the
global effort to end pediatric AIDS worldwide and to lay the
foundation for an AIDS-free generation.
Since its inception, PEPFAR has used coordination as a tool
to maximize our impact. As we are seeing with the President's
Global Health initiative, the health systems we have
established are now helping us combat other health threats
while strengthening our focus on our own HIV/AIDS mission. We
are at a pivotal moment in making a shared response to AIDS a
reality. Partnership frameworks have helped to secure partner
government commitments to heighten efforts. And we have used
these frameworks to ensure participation of the full range of
partners, including faith-based organizations who play critical
roles, in-country health systems, and others members of civil
society.
To be clear, this work of country ownership is not yet
complete, and the timeline for these efforts will vary from
country to country. But it is well underway and we are on the
precipice of securing these gains for the long term.
Finally, shared responsibility also means that no one
country alone can win the fight against AIDS. That is why we
must support the Global Fund as an essential partner. Last
year, the Obama administration pledged to request $4 billion
for the fund over 3 years. Equally important, we issued a call
to action for reform, launching a process to improve its
operations, especially at the country level. We are also
strengthening the fund's efforts to protect both U.S.
taxpayers' investment and the people who rely upon these
programs. Simply put, we must all support a strong Global Fund.
To conclude, I say to you today that we cannot
underestimate the power of the hope we are bringing to millions
on the African Continent who once could only see despair. Hope
is the power to save lives. Hope is building stronger families
and stronger communities. It is the hope you made possible and
for this we thank you.
I look forward to your questions.
[The prepared statement of Ambassador Goosby follows:]

Prepared Statement of Ambassador Eric Goosby, M.D.

Chairman Coons, Ranking Member Isakson, thank you for inviting me
to discuss the President's Emergency Plan for AIDS Relief, or PEPFAR,
and our activities on the African Continent.
From the day it was first announced nearly 8 years ago, the story
of PEPFAR has demonstrated the remarkable good will and generosity of
the American people. Congress's ongoing bipartisan support for PEPFAR,
and President Barack Obama's continuing stewardship of a landmark
program launched by President George W. Bush, have shown the world that
this is a vital, effective, and durable element of our foreign policy.
All across Africa, I have been struck by the deep gratitude of
governments and ordinary people for PEPFAR's lifesaving mission. This
effort has provided a positive and powerful message in our public
diplomacy. Actions speak louder than words, and the people of Africa
clearly understand that this support comes from the American people,
providing them with a window into who we are as a people.
The Foreign Relations Committee has been a key partner in the
success that we have been able to achieve through the years. You played
a central role in both our 2003 authorization, and our 2008
reauthorization. Pursuant to our reauthorization, despite challenging
economic and budget times, President Obama's fiscal year (FY) 2012
request for this program reflects the administration's strong,
continuing commitment on HIV/AIDS. We are deeply appreciative of your
partnership in this work.

SAVING LIVES

When I talk about HIV/AIDS, I bring the perspective of one who has
been involved in the response for 30 years. And I believe that 2010 was
a crucial chapter in the global response, providing many reasons for
hope about the future. As has been true throughout the past decade, the
commitment of the American people was central to virtually all of the
year's breakthroughs. America is truly leading the world in this
effort.
We must always remember that numbers are not the whole story of
PEPFAR, but when those numbers represent children, women, and men whose
lives are being saved, they are critical. The people implementing
PEPFAR in the field continued to expand life-saving programs this year,
as shown by our 2010 program results--the vast majority of which were
achieved in Africa. At the end of the fiscal year, PEPFAR supported
over 3.2 million people on treatment through bilateral programs
worldwide, an increase of more than 700,000 over the previous year.
PEPFAR and the U.S.-supported Global Fund to Fight AIDS, Tuberculosis
and Malaria continue to be the leading engines of the dramatic increase
in availability of treatment. UNAIDS estimates that at least 5.2
million people in low- and middle-income countries are now receiving
treatment, predominantly in Africa. Most of these people were already
quite ill when they accessed treatment, and would have died in the near
future without it. This is truly an extraordinary global achievement.
PEPFAR programs provided more than 600,000 pregnant women with
drugs to prevent motherto-child transmission of HIV (PMTCT), reflecting
one of my top priorities. As a result, it is estimated that over
114,000 babies were born free of HIV in 2010--representing continued
sharp acceleration of PMTCT efforts relative to earlier years. PEPFAR
also provided care and support for over 11 million people in FY 2010,
including over 3.8 million orphans and vulnerable children.
When I reflect that each of the numbers represents a real person--
with a story, a family, a community--the impact of this work is too
vast to comprehend through numbers alone. I am fortunate to have
frequent opportunities to hear the stories of our real people in Africa
and around the world, which provide a window into the human impact of
America's effort. In Nigeria, I heard from a man who told me of his
fear that the U.S. Government would cut support for the drugs that kept
him alive. In Mali, I met with a young woman who was born with HIV and
has been facing stigma and discrimination for most of her life, but has
not let that keep her from pursuing her dreams of becoming a writer.
In short, much has been accomplished and much more remains to be
done. With this in mind, we will push on toward the ambitious goals in
our Five-Year Strategy--using all that we have learned, to do more and
to do better.

SMART INVESTMENTS

One encouraging aspect of these life-saving results is that they
were achieved despite the difficult economic environment. A key element
has been a heightened commitment to smart investments--that is,
stretching each dollar as far as we can to save as many lives as we
can. Let me briefly highlight areas we have identified for focus:

We are strengthening use of economic and financial data to
ensure efficient use of resources.
We are incorporating innovations that promote efficiency and
allocate resources based on impact.
We are increasing collaboration with governments, the Global
Fund and other stakeholders to align programs and target
investments.
We are reducing costs by streamlining our U.S. Government
operations and supporting increased country ownership.
We are achieving the best available, all-inclusive commodity
pricing.
We are leveraging creative mechanisms for health care
financing, in order to bring additional resources to bear.
And finally, we are developing an evaluation and research
agenda that will show all global health how to improve
efficiency and impact.

Through all of these smart investments, we are supporting countries
as they try to build an effective, durable continuum of care that meets
the needs of their people. The more impactful and efficient our
investments, the greater the country's ability to create a sustainable
response. Here are just a few examples of the impact of this focus on
smart investments to date.

Treatment and Care
Antiretroviral treatment saves lives, but it is a significant
component of our overall costs. In July, we reported on treatment
costs, based on groundbreaking studies of PEPFAR-supported treatment
sites across 12 countries. This data, indicating an estimated mean cost
to PEPFAR of $436 for each patient supported, provides a baseline for
efforts to identify treatment efficiencies.
South Africa has the world's largest number of people living with
HIV, and the world's largest treatment program. The South African
Government identified the need for additional funding that would help
to fill urgent short-terms gaps in drug availability and drive changes
in procurement policies, while greater South African investments could
be marshaled. I personally joined our country team in working with the
Ministry of Health, and we concluded there was a need for an additional
one-time $120 million dollar investment over 2 years. With this money,
PEPFAR was able to buy drugs at 50 percent of their previous prices in
South Africa. This investment, along with substantial work by the
Government, led to a historic change in South Africa's policies that
enabled the government to do what we had done, and purchase medicines
at 50 percent of its previous costs. This allowed the country to save
an estimated $600 million dollars over the next 2 years alone. In
short, the PEPFAR investment had a remarkable multiplier effect. It
will immediately allow hundreds of thousands to receive lifesaving
treatment that they would not otherwise have received, preventing the
vertical transmission of HIV to thousands of additional infants and
keeping their mothers alive and their families intact, while remaining
a South African Government investment.
Other compelling examples drawn from the treatment program area
reflect the work of the Supply Chain Management System, which PEPFAR
created and manages through USAID. Antiretroviral drugs purchased
through that mechanism are now over 98 percent generic--an amazing
achievement that saved us over $380 million dollars in 2010 alone. Our
progress toward reliance on generics was described in a recent paper in
the Journal of the American Medical Association.
And through our supply chain strengthening efforts, we're
increasingly moving those drugs and other commodities in more cost-
effective ways. SCMS estimates we've saved almost $40 million dollars
to date just by using sea rather than air freight, for example. Through
SCMS, we've also set up three state-of-the art regional distribution
centers in Ghana, Kenya, and South Africa, helping to make us more
efficient in moving products. All of these commodity savings lead
directly to being able to serve more people, and save more lives.

Prevention
In HIV prevention, smart investments are equally essential, and
this year brought much encouraging news. UNAIDS reported significant
declines in new HIV infections in over 30 countries, including 22 in
Africa--a remarkable turnaround from the trends of a few years ago. In
the past, we've used the phrase ``combination treatment'' to suggest
the need to rely on several antiretroviral drugs, not just one. Now we
also talk about ``combination prevention'' to demonstrate the
importance of relying on multiple prevention tools for a given
population--including biomedical, behavioral, and structural
approaches. It is essential for each country to know its epidemic, and
PEPFAR is seeing the payoff from heavy investments in high-impact
prevention activities tailored to the needs of specific countries.
Evidence on the epidemiology of HIV within each country helps answer
questions such as need for relative emphasis on youth or older
population groups to find the right mix of programs that promote, for
example, delay of sexual debut and partner reduction. Country
epidemiology also helps us identify and focus on most-at-risk
populations, where comprehensive prevention efforts play a critical
role in halting the advance of the epidemic, including among men who
have sex with men, sex workers, migrant workers, and those who inject
drugs. We have also strengthened efforts to rigorously evaluate the
impact of prevention activities, in order to target investments to save
more lives. Two key examples of smart prevention investments I'd like
to highlight are PMTCT and male circumcision.
Prevention of mother-to-child transmission. Vertical transmission
is a significant cause of new HIV infections worldwide--causing one in
every seven new infections. Yet PMTCT interventions are extraordinarily
effective. Without PMTCT, 25-40 percent of babies of HIV-positive
mothers will be born infected; with PMTCT that number can be reduced to
below 5 percent, as Botswana has demonstrated. PMTCT has a triple life-
saving benefit: saving the life of the woman, protecting her newborn
from HIV infection, and protecting the family from orphanhood. Because
it works so well and touches so many lives, PMTCT is a smart investment
for PEPFAR--high-impact and cost-effective. In FY 2010 alone:

PEPFAR directly supported HIV counseling and testing for
nearly 8.4 million pregnant women;
More than 600,000 HIV-positive pregnant women received
antiretroviral prophylaxis to prevent mother-to-child
transmission; and
Through these PMTCT efforts in 2010, more than 114,000
children are estimated to have been born HIV-free (adding to
the nearly 340,000 from earlier years of PEPFAR).

We are leading the global effort on PMTCT, and I'm proud to note
these are the highest PMTCT results of any year in PEPFAR's 7-year
history. We are working to ensure that every partner country affected
by the HIV epidemic has at least 80 percent coverage of testing for
pregnant women at the national level, and 85 percent coverage of
antiretroviral drug prophylaxis and treatment, as indicated, of women
found to be HIV-infected.
In 2010, PEPFAR established ``PMTCT Acceleration Plans'' for six
countries with high burdens of vertical transmission--all located in
Africa. PMTCT Acceleration Plans provided $100 million in additional FY
2010 PEPFAR funding--above the more than $956 million spent on PMTCT
from FY 2004-09--to fund plans targeting bottlenecks to expanding
services. Based on the encouraging early results of this effort, PEPFAR
has continued this funding in FY 2011. With the help of Congress, I was
proud to oversee the ``virtual elimination'' of pediatric AIDS here in
America during my tenure at HHS, and I believe PEPFAR can be
instrumental in helping to end pediatric AIDS worldwide and laying a
foundation for an AIDS-free generation.
These PMTCT efforts have benefits for overall health care for
women. Linking HIV testing with antenatal care helps to identify women
who are in need of care. In addition, counseling and testing can help
women who are HIV-negative remain HIV-free. The availability of these
additional services also provide an incentive for women to seek
antenatal care. In Kenya, Uganda, South Africa, and other countries,
strong linkages among PMTCT, maternal and child health and other
programs dramatically increased program coverage, allowing programs to
focus on the needs of each woman and family in a more holistic way.
Male circumcision and other innovations in prevention. PEPFAR is
leading the world in support for rapid scaleup of male circumcision,
which was scientifically validated in recent years as a highly
protective intervention against HIV infection. Studies show that if we
rapidly scale up circumcision to 80 percent coverage over 5 years in
Eastern and Southern Africa, we can prevent 20 percent of all new HIV
infections in that region--an incredible 4 million infections averted.
And doing so would save over $20 billion dollars over a 16-year period.
Our experience shows that there is strong demand for this service when
men are made aware of its prevention benefits. In Kenya's Nyanza
province, PEPFAR supported the Government in an intensive effort that
performed more than 30,000 male circumcisions in a 30 working days,
coupling this effort with other prevention messaging and support.
Looking to the future, we have new hope of adding much-needed new
tools to the global prevention toolkit. Especially encouraging have
been proof of concept of a woman-controlled microbicide, based on a
study funded by PEPFAR through USAID, and highly positive research
findings on pre-exposure prophylaxis, funded by the National Institutes
of Health. As we previously did with male circumcision, PEPFAR will
continue to aggressively pursue formative work that prepares for
implementation of these new tools as they become available, based upon
scientific and regulatory guidance. As the world seeks a vaccine
against HIV infection, it is also important to note the significant
U.S. Government support for the Global Alliance for Vaccines and
Immunization.

Gender
Across all programs, PEPFAR recognizes that gender inequalities
fuel the spread of HIV and supports programs that respond to this
challenge. Gender-based violence (GBV), in particular, limits women's
ability to negotiate sexual practices, disclose HIV status, and access
medical services and counseling. We have intensified our focus on GBV
with a $30 million commitment that builds on PEPFAR platforms in all
countries, with a particular focus on Mozambique, Tanzania, and the
Democratic Republic of Congo--and with strong governmental and civil
society engagement in all three countries. We have also created a
Gender Challenge Fund to stimulate our country teams to identify and
seize new opportunities. As part of a strong and growing portfolio of
innovative partnerships with the private sector, PEPFAR also joined the
Together for Girls public-private partnership to work with countries to
inform and implement a coordinated approach to surveillance, policy and
programs for ending sexual violence against girls.
Program Evaluation and Research
After 7 years of implementation, PEPFAR is generating a growing
body of evidence and lessons learned and redoubling its efforts to
apply and disseminate these. We have reformed our Public Health
Evaluation process to better allow for both U.S. Government and
externally generated studies that will provide timely operations
research on urgent questions, and instituted a Scientific Advisory
Board to ensure that programs reflect the latest science. As described
in a recent paper in the Journal of AIDS, PEPFAR has adopted an
innovative framework for implementation science, defined as ``methods
to improve the uptake, implementation, and translation of research
findings into routine and common practices,'' to improve the
development and effectiveness of our programs.

BROADER CONTEXT OF HEALTH AND DEVELOPMENT

Like all others engaged in this work, PEPFAR has encountered the
reality that HIV/AIDS is linked to a wide range of global challenges.
In her recent testimony before this subcommittee, Secretary Clinton
noted that global health programs not only stabilize societies
devastated by HIV, malaria, tuberculosis, and other illnesses, they
save the lives of mothers and children and halt the spread of deadly
disease toward our own country.
In September, President Obama announced a new global development
policy to raise the importance of development in our national security
policy decisionmaking and generate greater coherence across the U.S.
Government. The policy is the guiding framework for U.S. development
initiatives including the Global Health Initiative, of which PEPFAR is
the largest component.
All of our global health efforts reflect a vision of better
coordinated and linked U.S. development investments. This emphasis is
great news for PEPFAR, because better coordination can save both money
and lives, and help us expand the reach of our development dollars.
Since its inception, PEPFAR has used coordination as a tool to maximize
impact. Our implementers have long known that people affected by HIV
face a range of broader health and development challenges, and have
seen the opportunities to ensure that our other programs are meeting
their needs. At the same time, the health systems platforms established
under PEPFAR have much to contribute in meeting the broader health and
development challenges of partner nations. By meeting the HIV
challenge, we have naturally created significant health care systems
improvements that are important in the struggle against other threats,
and we have done so without diluting our focus on our own mission of
combating HIV/AIDS.

COUNTRY OWNERSHIP

An area of striking progress has been movement toward country
ownership, with developing countries increasingly taking the lead in
responding to HIV/AIDS, while the United States and other external
partners play key supportive roles. We have used every opportunity to
promote the centrality of country ownership principles, including both
governments and civil society. PEPFAR country teams initiated processes
to assess and support countries, across many sectors and functions, in
defining their needs for health systems capacity development and
targeted technical support. For governments, key areas of focus
included surveillance, planning, analysis, management, monitoring and
evaluation, and budgeting, at key national ministries as well as other
levels of government.
To address one central facet of the multifaceted health systems
challenge--severe shortages of well-trained health workers recognized
in the reauthorization--PEPFAR and NIH teamed up to launch Medical and
Nursing Education Partnership Initiatives. Fostering partnerships
between African and other universities to enhance the quality of
training of health professionals and increase the numbers trained as we
work to meet the goal Congress established, these initiatives are a key
part of wide-ranging U.S. support for health systems prepared to meet
the needs of their populations.
In another example of support for African institutions, PEPFAR
recently helped launch the African Society for Laboratory Medicine
(ASLM), which will advance laboratory medicine practice, science,
systems, and networks on the continent and foster South-to-South
sharing of best practices. Laboratory services are vital to support
quality medical care with correct diagnoses and monitoring, preventive
medicine, surveillance and disease control. As part of our health
systems strengthening work, PEPFAR is committed to supporting African
leadership to build strong laboratories that perform to international
standards and provide prompt diagnoses and clinical management support
for patients.
Through the mechanism of Partnership Frameworks, encouraged by
Congress in our reauthorization to promote accountability, PEPFAR and
21 partner governments have documented mutual commitments for the next
5 years, with still more to follow. Our Framework with South Africa
deserves special note in light of that nation's central role in the
global HIV/AIDS challenge. Turning a decisive page, the South African
Government has assumed increasing leadership, including a dramatically
heightened financial contribution to HIV/AIDS and an intention to
approach full financial responsibility for its program by 2016.
Secretary Clinton personally signed PEPFAR Partnership Frameworks with
South Africa, Angola, and Vietnam, signaling commitment to country
ownership as part of U.S. foreign policy at the highest level.
One thing we've tried to do with these frameworks is to secure
commitments to ensure participation of the full range of civil society
partners needed for countries to respond effectively--including faith-
based partners. In many countries, faith-based organizations play a
critical role as part of national health systems, and it is vital for
that role to be acknowledged and strengthened.

SHARED RESPONSIBILITY

The global HIV challenge cannot be met by any one country alone--
nor should it be. In addressing this complex epidemic, all have a part
to play. In addition to the contributions of the United States and
partner nations, a truly global response requires commitment by other
donor nations and the private sector.
The Global Fund is a critical vehicle for this full range of
stakeholders to contribute and heighten their commitment to the fight,
as the United States has done over the past decade. Through our
contribution to the Global Fund, the United States is able to support
the delivery of significant and concrete health results; expand the
geographic reach of and enhance bilateral efforts; catalyze
international investment in AIDS, TB, and malaria; build capacity,
country ownership, and sustainability; and demonstrate political
commitment to international cooperation. The United States remains by
far the largest contributor to the Fund, and last year, the Obama
administration made its first-ever multiyear pledge to request $4
billion for contribution to the Fund over 2011 to 2013. This strong
U.S. support for the Fund's work is vital to generating increased
commitments by others. Equally as important, we issued a Call to Action
for reform, launching a process to improve the Fund's operations,
especially at the country level. This statement has been embraced by
the Global Fund Board, which has established a Reform Working Group, to
push this reform agenda forward as a top priority. The United States is
actively advancing this work through our seat on the Global Fund Board
and leadership roles in its key committees and working groups. We are
also working to support and strengthen the Fund's efforts to root out
corruption in its grants, supporting a strong and independent Inspector
General and working to protect both U.S. taxpayers and the people who
rely upon the health programs financed through the Fund.
The Global Fund is an essential partner in the fight against AIDS,
TB, and malaria, supporting significant health results, building
country capacity, and attracting continued investments from other
donors. Simply put, the world needs a highly effective, efficient
Global Fund.
The United States has promoted the theme of shared global
responsibility in its dialogues with other international partners.
Through deepened participation in global fora, the United States has
used its opportunities to leverage more engagement by others. PEPFAR is
working with partners throughout the world to ensure that this message
is featured prominently at the United Nations General Assembly High
Level Meeting on HIV/AIDS in June.

CONCLUSION

The driving force behind all of PEPFAR's efforts has been a desire
to maximize the life-saving impact of each dollar entrusted to PEPFAR
by Congress and the American people. As we move forward, I want this
subcommittee to know that PEPFAR will maintain this focus on the people
we serve, in Africa and around the world.
Thank you very much. I look forward to our dialogue.

Senator Coons. Thank you, Mr. Ambassador.
And we now turn, last but not least, to the testimony of
Mr. Patrick Fine who is the vice president for Compact
Implementation of the Millennium Challenge Corporation.
Mr. Fine.

STATEMENT OF PATRICK C. FINE, VICE PRESIDENT FOR COMPACT
IMPLEMENTATION, MILLENNIUM CHALLENGE CORPORATION, WASHINGTON,
DC

Mr. Fine. Thank you. Chairman Coons, Ranking Member
Isakson, thank you for bringing us together today. I am pleased
to be here with my interagency colleagues and to have this
opportunity to discuss the unique mission of the Millennium
Challenge Corporation and our distinctive approach to
development in Africa.
As you have heard from my colleagues, today's hearing comes
at a time when much is at stake in Africa. Africa is home to
more impoverished countries than any other continent.
Approximately 60 percent of MCC's partner countries are in
Africa, where 70 percent of our funds are dedicated.
Although countries in conflict grab the headlines, I have
witnessed remarkable progress in the over 30 years that I have
been living and working in Africa, and I have seen the vital
role that United States assistance plays in increasing access
to education, in combating disease, and in promoting market
economies.
President Obama has laid out a clear vision for
development. It articulates the strategic, economic, and moral
imperatives that make development vital to U.S. national
security. The President's global development policy recognizes
that protecting our interests and advancing our ideals requires
economic and diplomatic tools like the MCC, USAID, and PEPFAR.
The MCC is a specialized tool. It works with poor but well-
governed countries. Our programs build capacity and strengthen
relationships with Africa's emerging economies. From Mali,
where small holders are growing rice on thousands of acres of
what was scrub land a year ago, to Mozambique, where thousands
of people will gain access to clean water for drinking and
agriculture, MCC financing is improving lives.
MCC only works with countries selected using publicly
available third-party indicators related to ruling justly,
investing in people, and economic freedom. This creates an
amazingly powerful set of incentives for good policy
performance. We have seen these incentives cause governments to
undertake reforms both to become eligible for MCC assistance,
in other words, before we put any money on the table, and to
retain programs already underway.
We have a singular focus: poverty reduction through
economic growth. By focusing on economic growth, MCC helps
farmers, entrepreneurs, and small business people create new
sources of wealth for themselves, their communities, and their
nations.
Increased prosperity creates new markets and strong allies
for America. I saw an example of this 2 weeks ago when I
visited a chicken hatchery financed by the MCC in Georgia. Not
only did this enterprise create 45 jobs and reduce Georgia's
reliance on importing eggs from Russia, but when we went to the
building where tons of chicken food were mixed, we saw that the
soybeans were imported from the United States.
In Tanzania, MCC is financing expansion of the electrical
grid, which is a basic prerequisite for modern business
expansion. A U.S. consortium led by Symbion Power and Pike
Energy won over $100 million in contracts for this work.
Investing in the hope, prosperity, and security of others is
both an investment in our own future and the representation of
America leading with its values.
Now, how we execute our model also matters. We quite
deliberately treat aid as a business, investing in programs
that yield an economic return. Diligent oversight ensures that
U.S. companies can compete for foreign contracts with
confidence that the procurement will be free of corruption and,
if they win, that they will be paid on time. Once a contract is
awarded, we are uncompromising in our enforcement of measures
to prevent, detect, and punish fraud and corruption.
Recently, after a procurement was canceled in Lesotho due
to suspicions that the technical evaluation had been tainted,
the Lesotho Times, an independent newspaper, ran the headline
``MCA Ensures Transparency.'' That is our reputation and our
partners understand it.
President Obama has requested $1,125,000,000 for MCC for
fiscal year 2012. Close to one-third of this would go to a
compact in sub-Saharan Africa for Ghana. By supporting funding
for MCC, Congress will reaffirm America's commitment to
countries that are committed to their own development. Look at
MCC's track record in terms of the results that benefit the
poor and in terms of the incentives for good policy performance
that create the business environment to allow countries to
increasingly finance their own development and to become good
trade partners for the United States, and you will see this
taxpayer money is well spent.
With that, Chairman Coons, Ranking Member Isakson, other
members of the committee, Senator Lee, I would like to again
state my appreciation for your continued support of results-
based foreign assistance, and we look forward to continuing our
strong working relationship with you.
I would be happy to answer any questions.
[The prepared statement of Mr. Fine follows:]

Prepared Statement of Patrick C. Fine

Good morning, Chairman Coons, Ranking Member Isakson, and all the
members of the subcommittee. I am pleased to be here to discuss the
unique mission of the Millennium Challenge Corporation and our
distinctive approach to development in Africa. If there are no
objections, I will summarize my remarks and submit my full statement
for the record.
Today's hearing comes at a time when much is at stake on the
continent of Africa.
Africa is home to more impoverished countries than any other
continent. Appropriately, nearly 60 percent of MCC's partner countries
are in Africa--where 70 percent of our funds are dedicated. Although
countries in conflict like Cote d'Ivoire grab the headlines, I have
witnessed remarkable progress in the over 30 years that I have been
living and working in Africa, and I've seen the vital role that U.S.
assistance has played in increasing access to education, combating
disease, and promoting market economies.
President Obama has laid out a clear vision for development that
articulates the strategic, economic, and moral imperatives that make
development vital to U.S. national security. The President's Global
Development Policy recognizes that protecting our interests and
advancing our ideals requires economic and diplomatic tools such as the
MCC, USAID, and PEPFAR.
We take collaboration seriously. We colead the Partnership for
Growth, along with State and USAID, and work with other U.S. Government
agencies in the countries where we operate to ensure our programs are
coherent and mutually reinforcing.
The MCC is a specialized tool that works with poor but well-
governed countries in Africa and around the world. Our programs build
capacity and strengthen relationships with Africa's emerging economies.
From Morocco, where private small holders are expanding olive
production; to Mozambique, where thousands of people will gain access
to clean water for drinking and agriculture; through the MCC, U.S.
assistance is improving lives.
As you know, MCC only works with countries selected using credible,
publicly available, third-party indicators related to ruling justly,
investing in people and economic freedom. This creates an amazingly
powerful set of incentives for good policy performance. We have seen
these incentives cause governments to undertake reforms both to become
eligible for MCC assistance--in other words, before we put any money on
the table--and to retain programs already underway.
A model with a singular focus--poverty reduction through economic
growth, by which we mean raising incomes--makes the MCC distinct from
other aid programs and has served us well. By focusing on economic
growth, MCC helps entrepreneurs and small businesspeople create new
sources of wealth for themselves, their communities, and their nations.
Increased prosperity creates new markets and strong allies for America.
I saw an example of this 2 weeks ago when I visited a chicken hatchery
financed by the MCC in Georgia. Not only did this enterprise create 45
jobs and reduce Georgia's reliance on importing eggs from Russia, but
when we went to the building where tons of chicken food are mixed, we
saw that the soybeans were imported from the United States. And in
Tanzania, MCC is financing expansion of the electrical grid, one of the
basic prerequisites for modern business expansion. A U.S. consortium
led by Symbion Power and Pike Energy competed and won over $100 million
in contracts for this work. And, of course, investing in the hope,
prosperity, and security of others is both an investment in our own
future and a representation of America leading with its values.
How we execute our model also matters. Selectivity and rigor
continue at this level. We only invest in areas that are binding
constraints to growth and we only invest in programs that deliver an
economic return. MCC is not your business-as-usual aid program. It is a
program that quite deliberately treats aid as a business. And it's good
for U.S. business. MCC financing and diligent oversight ensures that
U.S. companies can compete for foreign contracts with the confidence
that the procurement will be free of corruption, will be professionally
administered, and if they win, that they will be paid on time. Once a
contract is awarded, we are uncompromising in our enforcement of
measures to prevent, detect, and punish fraud and corruption. After a
procurement was cancelled in Lesotho last month due to suspicions the
technical evaluation had been tainted, the Lesotho Times, an
independent local newspaper, ran the headline, ``MCA Ensures
Transparency.'' That is our reputation and our partners understand it.
President Obama requested $1.125 billion for MCC for fiscal year
2012. By supporting funding for MCC, Congress will reaffirm America's
commitment to investing in countries that are committed to their own
development. The American people will be making investments that will
yield dividends for years to come, in the form of new export
opportunities, more capable regional security partners, and reduced
poverty. Look at MCC's track record in terms of results that benefit
the poor, and in terms of the incentives for good policy performance
that create the business environment to allow countries to increasingly
finance their own development, and you'll see this taxpayer money is
well spent.

AMERICA'S INTEREST IN AFRICAN DEVELOPMENT

Today's hearing comes at a time when much is at stake on the
continent of Africa.
Africa remains the world's poorest continent. Rising food prices
have increased hardship for poor households and in some countries, such
as Cote d'Ivoire, Zimbabwe, and the Democratic Republic of the Congo,
armed conflict, bad leadership, and corruption deny millions of good,
hardworking people the opportunity to build better lives.
Meanwhile, Africa also is presented with unprecedented
opportunities. Bill Gates noted in a recent speech that half of
American exports go to developing markets. As the population and
economy of these countries grow, so will that number. Mr. Gates calls
development ``the smartest way our government spends money.''
By investing in poor but well-governed countries in Africa and
around the world, MCC is building capacity and strengthening
relationships with these emerging economies. We must be mindful that we
are not the only country with an interest in doing so. If we cut back
on our development efforts, we will leave a vacuum in these nations
that someone else will fill, ceding valuable opportunities to build
trade relationships, create American jobs, and promote American
interests.
MCC also is helping to make Americans safer and more secure by
promoting stability and developing strong partners in key regions
around the world. Defense Secretary Robert Gates has been one of the
most persuasive advocates for financing development work. In recent
remarks, Secretary Gates stated:

. . . [I]n military planning, what we call phase zero is, how
do you prevent conflict? How do you create conditions so we
don't have to send soldiers? And the way you do that is through
development. Development contributes to stability. It
contributes to better governance. And if you are able to do
those things and you're able to do them in a focused and
sustainable way, then it may be unnecessary for you to send
soldiers. . . . Development is a lot cheaper than sending
soldiers.

That is one reason why President Obama, like President Bush, has
made development--together with defense and diplomacy--a critical
pillar of our national security.

MCC'S WORK IN AFRICA

MCC works with the world's best-governed poor countries, and
through our highly competitive country selection process, a large
portion of our investment portfolio has been dedicated to Africa.
Of the 22 MCC Compacts signed to date, 13 have been with African
countries: Benin, Burkina Faso, Cape Verde, Ghana, Lesotho, Madagascar,
Mali, Malawi, Mozambique, Morocco, Namibia, Senegal, and Tanzania. Of
the 21 countries in MCC's Threshold Program, 12 have been in Africa:
Burkina Faso, Guyana, Kenya, Liberia, Malawi, Mozambique, Niger,
Rwanda, Sao Tome and Principe, Tanzania, Uganda, and Zambia.
Sixty percent of our compact countries are located in Africa, and
projects in those nations receive 70 percent of our funds.
asking the tough questions in a budget-constrained environment
President Obama has made MCC a key part of the U.S. Global
Development Policy. When the President unveiled the new policy last
year, he made clear that the United States is ``changing the way we do
business'' in development. Laying out a set of principles and practices
that are at the core of MCC's model, he called for all U.S. Government
agencies to embrace a focus on results, selectivity, country ownership,
and transparency.
In his budget request for fiscal year 2012, President Obama
requested $1.125 billion for MCC, signaling once again that the
agency's distinctive model will continue to play an important role in
the effort to cultivate opportunity and prosperity in poor countries
around the world. President Obama's fiscal year 2012 budget request
would enable MCC to sign compacts with Georgia and Ghana, as well as
fully fund a compact with Indonesia.
MCC, like other U.S. Government agencies, is operating in a
constrained budget environment. MCC holds itself accountable to the
American people to ensure that every taxpayer dollar generates the best
possible return on investment. As good stewards of American taxpayer
resources, every day we ask ourselves the tough, fundamental questions
about the effectiveness and efficiency of our approach to development
and our operations.
For example, MCC recently took action to prohibit state-owned
enterprises from bidding on MCC contracts. MCC's original procurement
guidelines included no guidance on this matter, and many--including
some members of this committee--rightly expressed concern. MCC's aim is
to ensure a level playing field for commercial firms that bid on MCC-
funded contracts. Because state-owned enterprises have built-in
advantages such as access to preferential credit terms, we took this
step to ensure private companies--including American companies--get a
fair opportunity to compete for MCC-funded contracts.
MCC's estimated budget requirements for proposed compacts are based
on several factors, including policy performance on MCC's indicators,
total population, population living below national poverty lines,
absorptive capacity, and, specific to Africa in the case of Ghana,
performance in previous compact implementation. Final compact amounts
will be based on funding availability and on the scope of agreed-upon
projects.
MCC requests $912 million of the total fiscal year 2012 request for
compact programs, divided between a second tranche of funding for
Indonesia and subsequent compacts for Georgia (est. $100-$150 million)
and Ghana (est. $350-$400 million). Because of its proposed size, the
Indonesian compact would be funded over fiscal years 2011 and 2012, for
a total compact range of $700-$770 million.
After 7 years of operations, MCC has committed $7.9 billion to
reducing poverty in 22 countries, $4.2 billion of which has been
contracted and $2.2 billion of which has been disbursed.
For this investment of $7.9 billion in taxpayer money, we expect to
generate $12.3 billion in increased incomes for 172 million people over
the coming years.
Two of the three countries selected as eligible for a second MCC
compact are African countries, Cape Verde and Ghana. Ghana was selected
as eligible for compact assistance in January 2011 by the MCC Board and
has just begun the rigorous process of developing an MCC compact. It
was selected because of its continued strong policy performance, status
as an important emerging market, strategic importance both globally and
regionally, and the successful implementation of its first compact.
The Republic of Ghana consistently performs well on MCC's indicator
criteria and is generally viewed as one of Africa's most stable policy
performers. Since 2004, Ghana has scored among the top low-income
countries on the Control of Corruption indicator. In a region where
constitutional transfers of power are often disputed, Ghana has a
record of peaceful democratic elections and the transfer of power to
opposition parties. In 2009, Ghana ranked better than almost two-thirds
of all countries on Transparency International's Corruption Perceptions
Index, and is preparing for transparent management of potential oil
revenues.

MCC'S SELECTIVE, TARGETED APPROACH TO DEVELOPMENT ASSISTANCE

One of the most distinctive features of MCC is our broad-based,
bipartisan support. The MCC approach to development--with our focus on
economic growth, sustainability, country ownership, transparency and
accountability--has been embraced by Democrats and Republicans in
Congress; Presidents Obama and Bush; Secretaries Clinton, Rice, and
Powell; and leading voices from the right and the left, from the
Heritage Foundation and the American Enterprise Institute to the
Brookings Institution and the Center for American Progress.
Why has MCC won the support of policymakers and analysts across the
political spectrum? Because of our innovative, reform-minded mission
and business model. MCC's mission is to reduce poverty through economic
growth in a select number of well-governed countries. MCC selects
country partners carefully to ensure the highest returns on our
investments and creates strong incentives to advance democratic,
market-based principles.
Part of MCC's accountability model is the ability and willingness
to say ``no''--no to countries that do not meet MCC's high standards
for eligibility, and no to proposed investments that do not have
promising returns for economic growth and poverty reduction.
In determining eligibility for funding, MCC evaluates whether a
country has created a policy environment for sustained economic growth
through 17 independent, transparent policy indicators that measure a
country's commitment to ruling justly, economic freedom, and investing
in its own people. We believe that engaging with developing countries
in a selective, targeted way is not only fiscally responsible in the
short term, but also critical to poor countries interested in
attracting private investment and ending their reliance on aid.
Good governance is critical for economic growth. We look for
opportunities for reform in areas that will ensure the sustainability
of our investments. These reforms have included changes to national
policies, laws, regulations, and even the traditional ways of doing
business by government institutions. For example, before investing in
Lesotho, we worked with the government to change a law that treated
adult women as minors, so that women could be full participants in the
economy. In most cases, these reforms, and the domestic capacity that
MCC's country-led programs build, not only help unlock the full
potential of U.S. taxpayer dollars, but also help improve the broader
conditions for continued growth and investment in our partner
countries.
Signing up to work with MCC means a country is committing itself to
tackle the tough policy reforms necessary to create an environment in
which the private sector can thrive, citizens can hold their
governments accountable, and U.S. taxpayers can see they are getting a
good return on their investment. Our goal is to help poor countries
rise out of poverty and achieve self-sufficiency, as well as to create
stable trading and investment partners for the United States, which
will strengthen the American economy and make our nation more secure.

MCC IS DELIVERING RESULTS

MCC's focus on economic growth, sustainability, country ownership,
transparency, and accountability is working. All development partners,
both donors and host countries, are interested in achieving results.
What distinguishes MCC is our commitment to technically rigorous,
systematic, and transparent methods of projecting, tracking, and
evaluating the impact of our programs. MCC's results exist along a
continuum--from policy changes countries make to become compact
eligible (``the MCC Effect''), to interim outputs and outcomes as
compacts mature, to our ultimate goal: income increases over the long
term.
We expect MCC's current investments to benefit roughly 40 million
people in our partner countries in Africa--and we expect incomes in
those countries to rise by over $8.7 billion over the life of those
investments.
Even before these income gains are achieved, MCC and our country
partners have tangible results to show. To date, MCC investments in new
or improved irrigation and technical assistance have facilitated the
adoption of new agricultural practices on 82,510 hectares of land. Our
funded programs have trained over 150,000 farmers in techniques that
help them produce higher quality, higher value crops. We have provided
funding for $66 million in agricultural loans, and have financed
assistance for over 3,800 private enterprises involved in agriculture-
related business. We have supported construction of more than 890
kilometers of roads that link markets and encourage trade, and have
another 2,400 kilometers under construction. These interventions aim to
increase incomes though market-driven agriculture. MCC tracks these
results closely because they are the drivers of the income gains we and
our partners aim to achieve.
While these results are important indicators of success, they do
not tell the whole story. We are pleased that our program outputs are
on track, but we hold ourselves to a higher standard: are MCC
investments increasing incomes? That is why we use independent third-
party evaluators to track the results of MCC investments even after the
compact ends. We are eagerly awaiting these results from our first
compacts, but preliminary data from the field is promising.

MCC'S SUBSEQUENT COMPACTS WILL FOCUS ON CONSTRAINTS TO INVESTMENTS

Entering our 8th year, MCC is beginning a new phase of innovation
and partnership. As first compacts strengthen the foundation for
economic growth, subsequent compacts--new MCC investments with
countries that have successfully concluded their first compacts--are
expected to target constraints to private investment. MCC aims to help
countries like Ghana, which was reselected as a candidate country for
subsequent compacts, solidify an economic growth path that attracts
private investment, reducing the need for aid.
MCC's engagement with partner countries is not open-ended. MCC
carefully considers the appropriate nature and duration of each country
partnership based on the country's policy and implementation
performance, as well as the opportunities for an impact on growth and
poverty reduction. A defining characteristic of MCC's model of aid
effectiveness is selectivity, both in the countries we work with and
the investments we make. MCC's business model emphasizes selectivity
and our mandate to partner with countries where investments will have
the greatest potential returns in terms of poverty reduction and
economic growth, and where U.S. taxpayer resources can be used most
efficiently and effectively.
While a single compact alone cannot address all binding constraints
to a country's growth or transform an entire economy, a subsequent
compact in a country that continues to perform well has the potential
to help countries change their growth path away from aid dependence and
toward greater reliance on private sector investment and internally
generated revenue. For the poorest countries, even the ones with the
right policies in place, it may take decades of sustained growth to
lift citizens out of poverty. For low-income countries like Tanzania,
where the annual per capita income is $500, economists estimate that it
could take over 20 years to double per capita income even if the
country sustains annual per capita growth of 4 percent (a historically
high rate).
This does not mean, however, that MCC engagement should last
anywhere near that long. On the contrary, MCC's role is targeted and
selective, and only the best performers will be eligible for continued,
limited engagement. MCC's Board is particularly discerning when
determining eligibility for follow-on partnerships. In addition to good
policy performance, countries must show meaningful progress toward
achieving first compact results before being considered for a
subsequent compact. Of the 10 countries that will successfully conclude
first compacts by the end of 2012, MCC's Board has thus far only
selected three as eligible for a subsequent compact. Cape Verde was
selected in fiscal year 2010 and Georgia and Ghana in fiscal year 2011.
In our approach to subsequent compact design, MCC focuses
increasingly on specific constraints to investment and private sector
engagement; by removing such constraints, MCC helps to expand
opportunities for U.S. businesses in emerging markets. This is in line
with the President's Global Development Policy directive to foster the
next generation of emerging markets by encouraging broad-based economic
growth and democratic governance.
MCC supports this effort by reaching out to the private sector, by
grounding our investment choices in a constraints analysis that
identifies specific obstacles to private sector-led growth, by
introducing financial instruments designed to enhance access to
capital, and by promoting innovative project content in areas of
potential growth, such as alternative energy, applied technology and
financial inclusiveness.
The potential to leverage MCC funding with a direct impact on
investment growth serves as one of the screens for evaluation of second
compact programming, in addition to MCC's mandate to promote poverty
reduction through economic growth. By helping these countries solidify
the progress they have made and become better integrated in the global
market system, the United States is opening new investment
opportunities for American firms, as well.

MCC BELIEVES CORRUPTION ERODES PRIVATE SECTOR GROWTH

I would like to discuss another critical topic, which is how MCC
deals with corruption in potential or current partner countries.
Because corruption has the power to completely undermine private sector
growth--as well as any investment MCC or other donors make in
developing countries--we take this issue very seriously.
MCC's approach to fighting corruption begins before we even select
a country for eligibility. MCC's corruption indicator is a key part of
country eligibility decisions. In fact, it is the only ``hard hurdle''
in the eligibility system. Our scrutiny does not stop after selection.
Corruption is closely monitored as a country develops a compact and
proceeds into compact implementation. MCC has a publicly available
antifraud and corruption policy that outlines precautions that we take
and describes ways of responding to any instances of corruption in a
compact program. We are currently training our local Millennium
Challenge Account accountable entities on how to apply this policy and
develop risk assessments for their own work.
In addition to protecting against corruption in our compacts, and
assessing individual cases of corruption, MCC assesses broader patterns
of government actions that undermine institutions of accountability:
courts, anticorruption commissions, auditors, and the media.
Governmental actions that undermine these institutions of
accountability make individual instances of corruption more likely,
enable corruption to flourish, and cultivate a culture of impunity. By
emphasizing the institutional response, MCC incentivizes governments to
take greater responsibility for rooting out corruption.
For example, MCC and several other donors made clear to the
Government of Senegal that recent changes to their procurement code and
the regulatory entity responsible for its oversight, in part due to
legitimate national security concerns, were an accountability concern
to us. In response, the government entered into discussions with
donors, including MCC specifically, to address our concerns as they
further revised the procurement code. Consequently, they have taken
steps to amend the objectionable changes--including a January 2011
decree and a more recent draft decree under consideration by the
Government of Senegal and various stakeholders. MCC is studying these
amendments.
Working with some of the poorest countries in the world means
working with countries that struggle with policy performance including
corruption. MCC's challenge is to find the right way to pursue poverty
reduction while staying true to our model of selectivity and
accountability, and this is particularly true in the case of
corruption.

MCC'S PROPOSED LEGISLATIVE CHANGES WOULD STRENGTHEN
AN ALREADY STRONG MODEL

We hope to work with members of this subcommittee again this year
on passage of a package of legislative changes to MCC's current
authorities, including allowing for concurrent compact authority and
longer compacts in certain circumstances.
The proposed changes are based on lessons learned since MCC's
creation in 2004 and will provide the flexibility needed to maximize
the impact of MCC programs through more innovative approaches to
development assistance.
Concurrent compact authority would allow MCC to sign separate
compacts with a country based on the specific timing requirements of
individual projects rather than as part of a package driven on a single
timeline. Concurrent compacts would improve MCC's ability to manage our
compact pipeline with greater predictability and serve as an added
incentive for policy reforms in partner countries.
With concurrent compacts, the agency could move forward with
projects that are investment-ready, instead of putting several projects
at various stages of readiness into a single compact or delaying
compact signing for a promising but less-developed project. As part of
a larger, cohesive framework, concurrent compacts will allow for
smaller, staggered agreements; speed implementation; improve project
management by allowing countries to focus on managing fewer projects at
a time; build management capacity with early projects; ease the current
burden of managing large, complex compact programs; and foster
innovation by allowing MCC to pursue new approaches and partnerships
that could otherwise slow down the compact development process.
Additionally, while having definite timeframes for MCC compacts is
an important best practice for effective foreign assistance, in some
cases projects face implementation challenges that mean they cannot be
completed within the mandated 5-year period, particularly given MCC's
emphasis on country-led implementation and MCC's high accountability
standards. In these cases, MCC's options for responding to
implementation challenges are limited by the 5-year timeframe. Allowing
MCC, in exceptional circumstances, to extend the duration of our 5-year
compact period for up to 2 additional years would allow MCC and our
partner countries to pursue a fuller set of options for managing
challenges and achieving compact objectives.
MCC also has sought legislative changes aimed at ensuring that
changes in countries' income categories do not necessarily prevent the
agency from working with the best policy performing countries that also
have populations living in extreme poverty. Each year, countries
abruptly graduate from one income category to another with no
transition period. Sudden shifts in income category, due in part to
changes in exchange rates, pose serious issues for MCC. This impacts
whether they can be candidates for MCC assistance at all, and changes
both the policy performance standards against which they are measured
and the levels of funding they can receive.

CONCLUSION

With that, Chairman Coons, I would like to again state my
appreciation for your continued support of results-based foreign
assistance, and we look forward to continuing our strong working
relationship with you, Senator Isakson, and other members of the
subcommittee.
I would be happy to answer any questions that you may have.

Senator Coons. Thank you very much, Mr. Fine and to all the
members of the panel for your testimony today. I know members
of the committee will have access to your full statements which
will be submitted for the record.
I would like to now begin the questions, if I can, in 7-
minute rounds. My first question is literally to the whole
panel, if I might, and it might take up my whole first 7
minutes.
In a recent dinner that I attended, Shimon Peres said that
America is the first great nation that became great not by what
it took from other nations, but by what it gave to other
nations. And I am interested in and challenged by the comments
across all four of you about what we have accomplished in
recent years and yet what our challenges are to sustain
America's engagement through development and assistance. So if
you would, please identify areas of success that you would like
to highlight for the American people when helping explain why
they should support foreign aid to Africa, and why are the
requested levels of funding here worth the investment for the
United States taxpayer at a time when we are under many other
pressures and concerns? And what are the metrics that you use
to measure and demonstrate the impact and effectiveness of our
bilateral aid and assistance?
If you would, Secretary Carson.
Mr. Carson. Thank you very much, Chairman Coons.
Let me start by emphasizing the important role that we play
in encouraging the development of strong democratic
institutions across Africa. Our USAID aid dollars, our economic
support fund dollars have helped to contribute to the spread
and growth of democratic institutions and democracy across
Africa. We have funded support for parliamentary institution-
building in countries across the continent. We have funded
election monitoring and observation. We have supported
countries to develop strong electoral commissions. We have
helped to strengthen judiciary and judicial training. And I
think all of these things have helped to strengthen democracy.
We have also found that where we have democratic societies in
Africa, strong democracies, we also have countries that respect
the rights of their citizens, are generally observant of
economic contractual agreements, and are generally partners
with us in the international community.
Our money has also gone to work on combating a whole host
of transnational issues, global issues of concern to African
countries, as well as us. These are in the areas of
counterterrorism, narcotrafficking, and in the prevention of
trafficking in people. When we work with African governments in
these areas on these global issues, these are also things that
help benefit us as well.
So, yes. I do not want to monopolize this, but our dollars
do help. They help us enormously promote democracy, improve
economic development and prosperity, and every country that is
economically viable and strong is a country that we do not have
to come in to rescue with a humanitarian assistance or relief
package. So our dollars are working and they are working
effectively in many places across Africa.
Senator Coons. Thank you, Mr. Secretary.
Other members of the panel who would like to speak to that
question, please, if you would.
Mr. Fine. Yes; I would love to.
MCC works with emerging markets, and the resources that we
provide help to strengthen those markets so they can become
trading partners for us and so they can become good, stable
members of their regional community.
Let me give an example of Honduras where we had a program
that worked with farmers who were traditional farmers growing
beans and corn. Through the financing of MCC, those farmers--
over 6,000 of them--shifted to high-value crops. They increased
their incomes by 88 percent, going from an average of about
$700 per hectare to over $2,000 per hectare per year. And they
became exporters of vegetables to Wal-Mart. So if you are
buying your vegetables at Wal-Mart, you may be buying
vegetables that were produced as a result of MCC financing. It
is a very clear example of how our resources are helping people
lift themselves out of poverty through hard work and at the
same time benefiting us.
Senator Coons. Thank you.
Ambassador Goosby.
Ambassador Goosby. Thank you, Chairman.
The HIV/AIDS epidemic, at 33 million people on the planet
burdened by this disease, having extraordinary amounts of
suffering and mortality, 22 million of these 33 million are in
sub-Saharan Africa. The impact that this has had on the
continent is hard to conceptualize. But coming back now over
the last few weeks from Ethiopia, from Botswana, from South
Africa, and from Haiti as a contrast, has been one of the most
remarkable transformations that we have seen. Taking a disease
that had saturated and burdened the medical delivery systems to
the point where people were congested in waiting areas in the
inpatient areas, three, four people per bed, people underneath
the bed, people in hallways burdened by opportunistic
infections that were essentially going to take their life
eventually, only to return them to a trajectory that would
inevitably 100 percent of the time end in their death. The
chaos that that created in families, in communities, and in the
societies both from a personal and economic perspective was
extraordinary and was crescendoing.
The PEPFAR intervention, beginning in 2004, created an
emergency response that basically stopped the hemorrhaging. It
developed, in partnership with country leadership and civil
society, a response that put a clinical capability in play that
identified, tested, and treated individuals who were HIV-
infected and moved the response that was predominantly
inpatient to what is now moving into an outpatient-dominated
response. That decompressed the medical delivery systems to
allow them to open to others with other diseases that needed
care and treatment and allowed doctors and nurses to shift
toward a more holistic primary care response, not based in an
inpatient setting but try to move it down to the village level
in health centers and clinics.
PEPFAR has been a remarkable catalyst in this and indeed
has driven the shift in a way that no other country's
contributions have put forth. Talk is cheap. Actions speak
louder than words. The American people should be very proud of
the ongoing and continuing contribution they have made to stop
the death and dying and put people back to concerns around
living and participating, going back to work, participating in
economic growth, et cetera.
I have been humbled by the number of lives we have touched
because it is such a profound ripple by that individual, that
family, that community, and the country.
The big pivot that we are on now is soliciting engagement
from our partner country leadership. It is the sustainability
of these programs that we are now struggling to put in place
and have begun an aggressive strategy to engage our partner
countries in taking ownership of management, planning, and
direction of these programs, allowing our resources to shift
more from an implementing focus to that of technical
assistance. We are now in a position to better ensure that
these resources are increasing in their impact, hitting and
impacting more lives, saving more lives, but also positioning
the country to continue to manage, grow, and maintain these
services into the future.
Senator Coons. Thank you.
Raja, we are into our next round, but I would appreciate a
brief answer.
Ms. Jandhyala. In terms of results, I think the issues that
we see every day on TV that move us in many ways--two main
issues that I would like to bring to your attention is the
sexual and gender-based violence in Congo that I am asked
routinely about what are we as the United States doing about
this, about women and children who are caught in this conflict.
And that is a constant question. That is the first question I
always get about our assistance.
And I would just like to give you a bit of brief on this.
To this date, our money has helped 20,000 women access critical
care and treatment. We have served 5,000 local doctors and
health clinics to teach them how to do surgeries that repair
the horrific violence that is undertaken on them.
We are working with UNICEF to deal with child soldiers,
young children who were recruited at the age of 6 or 7 and have
been held in militias for over 5-10 years, who have not had any
education, who had been potentially recruits for other people
for criminal and violence and law and order problems.
So it is a huge effort that we have made in the Congo
regarding this issue.
On the issue of water and health, I was recently in
Zanzibar in support of the health care systems in Tanzania. I
was really amazed that our malaria assistance--that means
distributing bed nets, doing treatment of malaria--brought
infant mortality rates down by 30 percent. And I was actually
stunned that our malaria program had such a huge impact on
infant mortality. And those kinds of connections that we had
not even thought about in some ways had really stunned us.
So there are many cases like this around the continent
where we have had impact on jobs, on water, on sexual or
gender-based violence, and really not only helping their basic
needs today but actually supporting their aspirations of having
jobs and living in a safe society.
Senator Coons. Thank you. Thank you to the panel.
Senator Isakson.
Senator Isakson. Thank you, Mr. Chairman, very much.
Mr. Fine, I, in my opening remarks, commented on my
tremendous support for the Millennium Challenge, and it is the
right way to invest foreign assistance money because of the
payback.
And I want to ask you to do something for me. On page 6 of
your prepared testimony, there is a statement that for the
investment of $7.9 billion in taxpayer money, we expect to
generate $12.3 billion in increased incomes for 172 million
people. I would love for you to ask whoever came up with that
result to call me and meet with me. I think it is probably
higher, if you want to know the truth. But I would like to see
how they did their economic modeling on that, because in your
story, with regard to the soybeans--the chairman thinks they
came from Delaware--I think they came from Georgia. [Laughter.]
I will also comment that if we are successful in making the
Republic of Georgia the poultry capital of the world, it will
mean the two capitals of the world in poultry are Georgia in
the United States of America and Georgia in the old Soviet
Union.
But I would appreciate your having whoever did that
modeling call me, if you could.
Mr. Fine. I will do that, and thank you for your support.
Senator Isakson. Got you.
Ms. Jandhyala. Is that correct?
Ms. Jandhyala. That is correct.
Senator Isakson. Close enough?
Ms. Jandhyala. Close enough.
Senator Isakson. I have got a name like Isakson.
One of the things I said in my opening statement was that
the whole budget is going to be under scrutiny and all the
appropriations are, and we are going to evaluate them with
cost-benefit analysis. In your remarks you talked on the
climate change issue, and in Johnnie Carson's remarks, he
talked about, I think, the largest increase by percent, not by
dollars, but the largest increase is 140 percent increase in
budgetary requests dealing with global climate change.
I am wondering: Is that an appropriate increase in volume
and in size for a thematic program that is not necessarily
consistently agreed to around the world, in political
philosophy as well as scientific philosophy?
Ms. Jandhyala. The way we sort of approached this issue is
what are the impacts on agricultural production in terms of
water, ecosystems, livestock, and how does sort of ecosystems
impact economic growth and production on a country. So in many
ways, we are working in that economic framework at this stage
in our support.
Senator Isakson. The followup question I would make is
this. The Food for the Future--I believe that is what it is
called--which is an outstanding program because, as I
understand it, we are teaching people to farm and develop their
own food products and improve their quality of life. Is that
not correct?
Ms. Jandhyala. Yes.
Senator Isakson. Food for the Future.
Ms. Jandhyala. Feed the Future, yes, sir.
Basically there are three main objectives. It is increasing
production both at the small holder farmers but as well as
scaling up with firms. Two is having those productions actually
benefit in the economic trades of goods and services that
increase income. And last, it is how it will reduce our food
aid which in some ways might have taken away from local food
production systems and added to the economic growth of the
country.
Senator Isakson. I guess my question would then be: If we
are doing climate change primarily in its focus on agriculture
and its effect on agriculture, why would that not be a part of
the Food for the Future appropriation rather than being titled
``climate change''?
Ms. Jandhyala. Maybe I would like to also add that
currently we have many programs on different aspects of climate
change or how we are dealing with it. But at this stage, I
think what we would like to kind of focus on is a different--we
have a program called CARPE that covers eight countries in
central Africa. And we are working with communities to maintain
local forests that they would live off of to earn income on
livestock. So we kind of see all our efforts about improving
populations who have to manage their environment better and how
they use that environment to improve their economic
livelihoods.
Senator Isakson. Mr. Goosby, I want to thank you for saying
what you said at the very end of your remarks because your
comments about sustainability in-country of the PEPFAR program,
to me, is going to be probably the critical challenge, because,
thanks to the initiative of President Bush and continued by
President Obama, we have made a dramatic impact on the African
Continent.
But one of the things I have observed in being on the
continent is that most of that delivery is U.S. NGOs and it is
CDC--American people delivering the retrovirals--the testing
mechanisms, et cetera. And that is very expensive to do. But
there is a lot of equipment now that, if the African countries
could begin to take over the management of the PEPFAR program,
of the screening, and we can continue to be a partner, it could
lessen some of the financial burden on the United States and
yet sustain what has been a proven program of success.
What are you doing to try and get the countries to buy in
on a responsibility to help sustain that program within their
own resources?
Ambassador Goosby. Well, thank you, Senator. That was very
nicely stated.
It is the serious issue in front of us at this point, the
sustainability. We are at a pivot moment in PEPFAR's maturation
as a program. To now move our emergency response into, just as
you said, a more sustained, lasting response that will be there
for the duration of its need which will mean 20 to 30 years
into the future already at the given burden of disease.
In order to do that, we need to change the way we engage in
a dialogue with country. Country, both government as well as
civil society, is in a shared relationship in the response, in
mounting and defining the response in-country. We have used a
tool, the Partnership Framework instrument, to give our
Ambassadors in-country a tool to engage in a dialogue with
government around what specific issues should be addressed over
the next 5 years, and in addressing these issues, what are you
engaged with as the partner government and what are the United
States responsibilities in respective areas of prevention,
care, and treatment. This is something that was in the
reauthorization language. It was something that this committee
felt very strongly should be part of the new evolution of
PEPFAR to ensure or better ensure that that sustainability was
achieved.
We are pivoting into that now in every country that we are
in in sub-Saharan Africa. The dialogue is new for USG to engage
in such an aggressive dialogue with country leadership, but we
have been very gratified in every instance with the response
that we have received.
For example, Nigeria has gone and moved from a less than 5-
percent portion of their medical health dollar going toward HIV
committing to, over the next 5 years, moving it up to 55
percent. We have had similar but not quite as big, but the same
type of jumps in Botswana and in Namibia and in South Africa.
These dialogues have not been hostile or angry. They have
been serious and there is a lot of tension in the dialogue
because it has brought Foreign Ministers of Finance into the
dialogue sometimes for the first time around projections that
allow them to commit, such as South Africa has done in 2006 to
increasing its contribution to care, prevention, and treatment
services in South Africa to basically move into the 50- to 60-
percent range. These are extraordinary changes from prior
commitment, and I would say through these partnership
frameworks and the partnership implementation plans that
follow, we should be able to actually move significantly in
this direction over the next 5-year period.
Senator Isakson. Thank you very much.
Senator Coons. Senator Lee.
Senator Lee. Thank you, Mr. Chairman. Thanks to each of you
for joining us today. I appreciate your testimony.
Mr. Carson, I appreciate what you wrote in your written
remarks. You have your opening statement regarding the
sustainability of United States involvement in Africa when you
said when Africans take ownership of their own security
responsibilities, we are more likely to have the requisite
trust and political buy-in of key players than if quick-fix
solutions are imposed by outsiders. I think this idea of buy-in
has been a consistent theme that several of you have mentioned,
and I agree that that is important.
But my question is: With over 75 percent of the
administration's budget request going toward the Global Health
Initiative, $5.4 billion, or 70 percent; Feed the Future, $500
million, about 6 percent of the request; and the Global Climate
Change Initiative, $100 million, or about 1 percent of the
request, have you seen similar buy-in of key players or African
nations into these programs?
Mr. Carson. Senator Lee, thank you very much for your
question. The answer is ``Yes,'' and in many ways. We see
African countries stepping up and engaging increasingly more
frequently in peacekeeping programs, peacekeeping programs in
very difficult places like Sudan, both north and south, in
Darfur. We see them engaging in Somalia. We see them engaging
in Cote d'Ivoire. We see Africans willing to be peacekeepers
and to help mitigate conflicts. That is a clear example of this
sort of a buy-in.
We also have recorded increases in the amount of money that
we have spent on democracy and governance issues, and while the
amount is not nearly as large as it is for the Global Health
Initiative, we have seen increasing amounts of money go to
strengthening democratic institutions, enabling Parliaments to
do their work better, helping African judiciaries become more
independent and professionally strong, helping to strengthen
the independent media, working with civil society spending
money as we have done recently in support of the Nigerian
election commission, helping to create strong independent
election commissions capable of administering and carrying out
free and impartial elections. All of these are part of the
effort to help empower African countries, and as we spend money
on these issues, we also find that Africans are willing to
spend more money on these institutions and efforts themselves.
Senator Lee. So the buy-in is something you are seeing not
just in the security area but also in other areas of health,
climate change, and so forth?
Mr. Carson. Yes. No; absolutely. We recognize that our
funds are frequently catalytic in nature. They are force
multipliers. They not only incentivize African governments to
make contributions, but they also incentivize our partners in
the global community to make contributions as well. We work
very closely with any number of the Western European and
international donor agencies, and when we engage in activities
and put our money on the table, it frequently brings in
additional moneys from our partners, our democratic partners
around the world, and it also incentivizes and brings in money
from African countries too.
Senator Lee. OK. I think that is important.
There is a divergence of viewpoint, especially as we are
going through difficult economic times. A lot of Americans feel
differently about foreign aid than others. In other words,
there is a wide spectrum of viewpoint. There are some who say
when we are $15 trillion in debt and acquiring new debt at a
rate of $1.7 trillion a year, we should not be doing that. On
the other hand, you can point to some clear constitutional
responsibilities, including providing for our national defense.
Many of our foreign aid expenditures are security-related,
directly tied to security, and in one way or another affect our
national security.
So it seems to me whether you are very much in the
proforeign aid camp or in the antiforeign aid camp, I think
most or all people would agree with you that buy-in is good,
and that it is also a good thing to have foreign aid directed
in such a manner that it, in time, obviates the need for
itself; in other words, teach the people on the ground to do
that which you are trying to do. And I think everyone would
agree with that.
Do you see any way of measuring, any kind of metric or
standard for the success in Africa in any of these programs
that we could use to measure the buy-in for the security
programs or for the President's three main initiatives? Do you
have a way of measuring that or gauging it?
Ms. Jandhyala. We are working with each of the governments
in terms of the initiatives to really work on, first, the
strategies and getting policy right, getting the regulatory
framework and the legislative framework. So we are able to
influence very early on the legal and the regulatory frameworks
for these initiatives to work with. So that becomes the
fundamental basis for us having the tools necessary to monitor
our support. If we have agreed with them on the strategy, if we
have agreed with them on the legal framework, and we have
agreed with them on the regulatory, on the broad, sort of at
the higher level, then what we do is kind of spend time with
our partners who are helping them, who are financing, to say
where are the weaknesses in the system. If we are going to
build a car and we do not put fuel to run it, then let us find
those weaknesses because we know they are there in those
systems.
So we have spent an enormous amount of time saying if this
is going to be sustainable, we need to understand their systems
better, acknowledge their tremendous weaknesses in some areas,
and how do we mitigate that and how do we deal with that risk
that we are dealing with, and really have sort of a monitoring
and evaluation system that is very consistent, regular, and it
is a mutual compact between the government and ourselves that
we are in this together and that we can hold each other
accountable. And we want the broader population participating
in it so we are not the only ones holding them accountable. We
want the population to hold that government accountable for
these initiatives.
Senator Lee. Thank you.
Senator Coons. I will continue in the same vein, if I
might, perhaps just to continue along the same question.
Secretary Carson, you talked about how in the global
competition for influence and ideas we are making progress in
terms of the development of democratic institutions in the
continent. You are making investments, continuing to make
investments in democracy and governance.
I see that Mr. Fine would like to add, as well as
Ambassador Goosby. If I could just suggest in continuing
answers to this question, how you have struck the balance
between regional institutions that contribute to civil society,
democracy. I note a modest reduction in the funding to the
African Union, for example, and regional institutions like
ECOWAS or SADC I think are critical. But you have also got
nations where is real positive and sustained progress
democracy, Botswana, Ghana; others where there is real
challenges in front of us, Mozambique or Zimbabwe--excuse me--
Angola.
Help me understand how you strike the balance between,
given that it is a relatively modest percentage of the total
funding, individual countries, regional structures and how we
can report back or expect some sort of positive progress or
measurable outcomes, if I can suggest that, in the democracy
and governance field. If you would, Secretary Carson, and then
Mr. Fine, you would have a chance to extend.
Mr. Carson. If I could, we have focused our efforts
primarily on 13 countries in Africa and these are countries
where we pay particular attention in our efforts. These
countries are countries that are democratic--some of them are
countries that are democratic and are making great strides, and
we want to help accelerate that development, countries like
Tanzania, Ghana fall in this category. And we put our democracy
and governance money into these countries, but we also focus
the entire range of U.S. Government assistance here.
Tanzania, for example, is a country that is benefiting from
a large MCC grant. It is a recipient of a Feed the Future
grant. It is a participant in our Global Health Initiative, and
it is also a participant in our Climate Change. The desire in
providing this kind of assistance to a country like Tanzania
and a country like Ghana, both of whom are similar, is to help
them accelerate their growth and development, to be models for
the neighboring states in their development, their economic
development, the strength of their democracies, and their
contribution both to regional stability and their own growth.
So we are putting our resources into countries like this to
jump start them and to move them along.
We are also focusing on a number of countries that are
coming out of conflict, countries that have been torn apart for
many years by internal civil strife, countries like this would
be--Liberia would be a classic case in which we are spending a
great deal of money and time--Sierra Leone and the Congo. There
our efforts are designed to prevent those countries from
falling back into instability, helping them to strengthen their
democratic institutions by putting money into parliamentary
strengthening and to judicial strengthening so that they will
be more effective democracies.
But equally we are putting development assistance moneys
into these countries to help them deal with their social and
economic systems that have largely fallen into disarray as a
result of years of conflict. We believe that if we can move
these countries forward both economically and socially, they
will probably not fall back into instability and conflict.
We can, in effect, strategically measure what our resources
do. I think over the last 2 decades, if you look at where
Africa is today and where it was 20 years ago, there is, in
fact, a larger number of African countries that are clearly
democratic. Those countries have been assisted by the United
States, and we are not just talking about one or two countries.
All too frequently the discussion falls on the difficult cases
of Somalia and Sudan and Cote d'Ivoire. But what has happened
in Africa is a rising number of countries that have turned to
democracy, have embraced free market and economic reforms.
These are the South Africas, the Botswanas, the Mauritiuses,
the Malawis, the Namibias, the Ugandas, the Kenyas, the Malis,
the Senegals, the Cape Verdes. They are the Benins. They are
out there. And so frequently we dismiss them or forget them as
we look at the major problems that exist in some African
countries, but progress is being made.
If we see successful democratic elections in the second and
third rounds of the Presidential and gubernatorial elections in
Nigeria, Africa's most populous country, over the next 2 weeks,
if those elections go as well as the elections a week ago for
their Senators and House of Representatives Members, we will
see a major change in that country in strengthening its
democratic performance and activities. A lot of that will have
been driven by resources put in by the United States and the
United Kingdom and the European Union. We have put our
democracy dollars into strengthening that country's independent
electoral commission. These are the way our dollars benefit. If
Nigeria is strong and democratic, it is a source of stability
in West Africa and a potential source of greater growth and
progress.
So I think that there are ways at the strategic level to
look at this, and I think that over the last 20 years, not
measuring year by year but increments of 4 or 5 years, we have
seen progress. A lot of that progress is due to our consistent
support for institutions of democracy and our support for
promoting economic policy change that has been embraced by
these governments.
Senator Coons. Thank you, Mr. Secretary.
Mr. Fine, I am going to give you, if I might, with your
dispensation an opportunity to answer the question of some time
ago.
Mr. Fine. Thank you so much. I just wanted to say a word
about buy-in because it is such a critical factor.
One of MCC's principles is country ownership. And the way
we pursue that is we make countries responsible for the success
of these programs themselves. They implement the programs. They
are on the hook to deliver these programs. And it is not just
an administrative hook or diplomatic hook. It is a political
hook with their own constituents, and it is a powerful
motivating force.
You asked about how do you measure that. One way to measure
it is what Raja was talking about. Do they take policy actions?
Do they reform their institutions in a way that demonstrates
that they are really serious about achieving long-term
sustainable objectives?
So in some of our programs, for example, in Malawi, they
are raising tariffs toward a more economic rate so that they
can have a sustainable electrical system.
In other countries where we financed roads, countries have
taken decisions to overhaul the way their maintenance works,
their policies around maintenance of roads. And we see them
allocating more funds to road maintenance than they ever have
in the history of their nations.
So those are very clear examples of a real commitment.
The other thing that I see that signals real commitment
that you can measure is what the countries put into the
programs themselves. In the case of MCC, countries expend
significant amounts of money in designing the programs that
they eventually submit to us for financing. In the case of
Zambia, for example, the Zambians have spent more than $4
million designing a compact that we hope to present later this
fiscal year. That shows a real commitment. It shows real
ownership.
Senator Coons. Thank you.
Senator Isakson.
Senator Isakson. I was going to ask Secretary Carson.
Senator Leahy made a point which has been illustrated to me
graphically with regard to our national security. I think I am
correct in this. Correct me if I am not. But, because of our
engagement and the special envoy to the Sudan and the people of
Darfur and because of the end of the civil war and ultimately
the successful referendum in the south, the successful
completion without violence, a by-product of that investment
has been a tremendous help in terms of thwarting any terrorism
flow into southern Egypt and ultimately into Gaza, if I am not
mistaken. Is that not correct?
Mr. Carson. That is indeed correct. And we think that by
pressing for the changes that we are seeing between north and
south Sudan and the ultimate independence of the south, we have
been able to effectively engage the government in the north on
issues related to counterterrorism issues. This has been a by-
product of this; yes.
Senator Isakson. Well, I want to commend you and Secretary
Clinton because the leverage of our support in those critical
days leading up to that referendum and for what you did vis-a-
vis the offers on their help with terrorism and other things
has been instrumental for our country and very successful, and
I appreciate it and commend you for what you have done on it.
Mr. Carson. Thank you very much, Senator Isakson.
I think that a great deal of the progress that has been
made to date in the completion of the comprehensive peace
agreement between north and south Sudan is a result of active
and sustained U.S. diplomacy. And if in fact we are successful
in seeing Southern Sudan independent in July of this year, we
will have brought to an end a conflict that has lasted on and
off for the better part of 40 years, most recently 20 years up
until the CPA was signed in Naivasha in January 2005. That will
end suffering. It will end the need for sustained humanitarian
support and will help to, we hope, move a country and an area
which has been dependent on international support to a country
which can, in fact, begin to become self-sufficient and
increasingly less dependent on international assistance for its
survival.
Senator Isakson. I think the end result is that we gain two
friends in one part of the world with all our effort.
Ms. Jandhyala, in your testimony you talked about women are
the backbone of Africa. I think that was the word you used. In
talking about the food program, Feed the Future, you are trying
to ensure the African countries consider gender in all those
programs. From my visits, it is the women that are doing the
work in a lot of cases and the most responsible in economic
development.
When you say ``gender,'' you are referring to get the guys
to do as good as the women are already doing. Is that what you
meant?
Ms. Jandhyala. I say that to my husband every day. Yes.
[Laughter.]
Senator Isakson. That is what I thought you meant. But I
have been there and seen it with my own eyes. I think we have
got an NGO based out of Atlanta, GA, CARE, that has the village
savings and loan concept that they are doing in a number of
countries in Africa. And, it is the women that are the key ones
to pull off not only the economics of developing a savings
account and making loans and creating microbusinesses but in
fact also starting the businesses themselves. So the more of
that we can do and include the guys to get them concentrating
on that as well, the better economic development I think we
will see in that part of the world.
I just want to thank all of you for what you do because I
do think this is a critical part of the Department of State,
and I think Africa is a critical continent to our country in
the future. And all of your leadership is most well noted and
most appreciated.
Senator Coons. Senator Lee.
Senator Lee. Dr. Goosby, I understand that bilateral aid to
sub-Saharan Africa has had quite a significant bump over the
last decade. In fiscal year 2002, I think we were spending
about $1.1 billion on that, and in fiscal year 2010, I think it
had bumped up to $8.1 billion, if I am not mistaken, largely I
think because of increased spending in health assistance
predominantly HIV/AIDS. This started under the Bush
administration and has continued in the last few years.
Do you see this as sort of a one-time bump that has
produced some short-term results that are substantial and can
be measured, or is it a funding trend that will continue? In
other words, is the graph likely to continue on the same angle
or are we likely to see that go back down as a result of the
success of these efforts?
Ambassador Goosby. Thank you, Senator Lee. I think that is
an astute question.
PEPFAR's response and the Global Health Initiative more
recently is building on the successes of programs that have
already moved into early implementation, have set themselves
up, built the infrastructure, deployed, and now are looking to
take those structures that we have put in place and move them
to sustainable delivery systems and move the management,
operational, defining the unmet need, prioritizing the unmet
need, making the allocation decisions to country leadership,
country leadership to include both government and, very
importantly, civil society. We are at that moment in most of
our Global Health Initiative activities and specifically in
PEPFAR's activities.
That transition through these partnership framework
discussions is moving--that steep trajectory of resource
allocation will begin to flatten out as we shift into a shared
responsibility, ``shared'' meaning ourselves continuing to
contribute, country governments continuing to increase their
contribution relative, and governments outside of the partner
government, USG, European governments, other foundations.
But the most significant contributor to our effort really
is the Global Fund. This is the most effective conduit through
which other countries that do not have bilateral programs can
contribute resources that address unmet needs in these
countries. Our ability to partner with the Global Fund's
resource infusion into country, strategize around planning and
implementation issues is the most significant factor that will
start to flatten out the need and demand on USG resources. We
are well along the road to that flattening.
Senator Lee. When you say ``well along the road,'' do you
have any particular timeframe in mind? I understand if you just
cannot--obviously, you cannot read the future. But do you see
that flattening within any particular horizon?
Ambassador Goosby. Well, I think that is a fair question. I
think it is different, as you have alluded to, for each
country. But we are looking at Botswana, Namibia, South Africa,
Angola, possibly Nigeria in the 5- to 10-year timeframe who
will move very strongly into being able to sustain and support
these efforts. Middle-income countries, those countries with
higher HIV burdens, TB burdens will come in later, but I think
that the convergence of the global economic picture, activities
such as the MCC giving and infusing resources to stimulate
economic investment and growth--we all reap the benefits from
that--will move this in the right direction.
I believe it is truly a difficult dialogue to get our
partner country leadership to play that orchestrating role with
all these divergent funding lines that come into their country,
for them to organize themselves so they can effectively define
that unmet need and make those allocation decisions, even with
divergent resources coming in. Part of our technical assistance
strategy and MCC's strategy, if I might add, is focused on
developing that capacity in-country to manage large sums of
money, divergent resources.
Senator Lee. Thank you.
I have also got a question for Mr. Fine. In your written
statement, you indicated that if the United States cuts back on
some of our development efforts and our aid in Africa, we will
leave a vacuum of the particularly dangerous sort that other
nations or other entities might fill, ceding valuable
opportunities to build trade relationships, create American
jobs, and promote American interests.
Can you give any specific examples of where that has
happened, or is this more of a predictive statement?
Mr. Fine. Thank you. I do believe the extent to which we
reduce our engagement with these countries, that we are going
to see our geopolitical competitors come in, and in particular,
China. I have been living and working in Africa for 30 years.
One of the big differences that I see today as compared to,
say, in the 1980s or the 1990s is when you are in a country--I
was in Malawi last week, and the number of signs that you see
in Chinese and when you are in restaurants or hotels, the
number of Chinese business people that you see there is just a
completely new phenomenon compared to, say, 10 or 12 years ago.
Senator Lee. Are they good Chinese restaurants, just out of
curiosity? [Laughter.]
Mr. Fine. These were British restaurants.
I believe that there is a real competition. I believe that
we play a critical role, a positive role in terms of
development, in terms of promoting ideals of respect for human
rights, for example. So I do not want to see us stepping away.
Senator Lee. Have you seen some benefits from the
investment that you have seen from China? Has that assisted in
the development in some of these countries?
Mr. Fine. You know, I think it is a mixed picture. One of
the things that we see is that the Chinese way of doing
business is often at odds with the efforts by other members of
the international community to promote good governance. And so
things like combating corruption and respect for human rights
and democratic ideals does not seem to be at the top of their
agenda.
Senator Lee. Not exactly the same way we would want to do
business.
Mr. Fine. Not the way we would want to do it.
So there are some examples where their engagement has not
been supportive of what other members of the international
community have been doing to try to promote good governance.
Ultimately, we believe that in order for a country to
become prosperous, it requires good governance. If a country is
corrupt, if a country does not respect human rights, if a
country does not respect democratic rights, it is not
ultimately going to be able to create sustainable prosperity.
That is why it matters, and that is why having other actors who
do not support that is problematic.
Senator Lee. Thank you very much.
Senator Coons. I would like to follow up, Mr. Fine, if I
might, on the question of corruption. You have got about 20
countries, I think, where you have got threshold programs, and
I am just interested. I have a few questions for the whole
panel, if we can focus briefly. I am just interested in how you
see the MCC going forward. You are facing a fairly significant
cut in the continuing resolution vote we are, I think, going to
take in about an hour here. I think it was about $380 million,
if I am not mistaken.
What sort of challenges does MCC face? I support and see
real value in your work to build capacity to fight corruption
across dozens of countries in the world. Are you raising
expectations of the possibility of future grants, given the
budget environment may not materialize? And what are the most
effective tools in fighting corruption?
Mr. Fine. I am really worried about the budget situation in
part because of the commitments that our partner countries make
themselves, and I think that it can be very damaging to U.S.
credibility if we are in a position of having to step back.
In terms of corruption, the most effective tool that I see
are the sets of incentives that MCC creates that says you are
not going to qualify for one of our investments unless you
demonstrate that you are serious about combating corruption.
And that incentive is taken very seriously by countries, and we
see it really modifying their behavior, or once they have a
program with us, that if we see evidence that there is a
pattern of actions that is corrupt, that can lead to the
suspension and termination of the compacts. And we are serious
about that and we have done it.
Senator Coons. Talk about Senegal for a moment.
Mr. Fine. So I was going to mention Senegal as a specific
example. In Senegal last year, there was a decree. They have an
institution which oversees public procurements, and it has been
seen as a powerful or as an effective institution for cleaning
up public procurements which was a major source of corruption.
Last year, there was a decree to weaken the authorities of that
institution and to put in less capable people. The U.S.
Government, not just the MCC, but the State Department was a
major spokesman. Ambassador Bernicat, our Ambassador, got right
out on this. But also MCC took a stance. The U.S. Government
took a very hard stance about this.
And what we have seen is that the Government of Senegal has
amended that decree to take out those sections of their
modification that weakened the authority. They have appointed a
U.S.-trained CEO of this agency, who is a person that we
believe really does have fighting corruption at heart. So they
have stepped back in a very public, politically difficult, way,
because they had to backtrack publicly from a stance that they
took, instead reempowering this agency that oversees public
procurements. And I think it is a good example of where U.S.
influence and leverage played a very positive role.
Senator Coons. Thank you. That is an area I am interested
in pursuing further in the future, the tension between growing
Chinese influence, our commercial competition, and then our
multilateral efforts to combat corruption.
Ambassador Goosby, I am interested in how your efforts have
been adapted to or challenged in failed or failing states, some
of the places where there also happen to be fairly high
infection rates. And briefly, if you would, I would be
interested in hearing about blood supply and things that have
been done. This country has done a great deal in the last few
decades to ensure that our blood supply is secure. What sorts
of work have you been able to be a part of on the continent of
Africa around a safe blood supply?
Ambassador Goosby. Thank you, Senator. That is an excellent
question, the failing state question.
Cote d'Ivoire is a good example of a recent situation that
has been in the news that put a challenge in front of us to
address the continuation of treatment specifically with
antiretroviral therapy for 147 different sites in the country.
We, with the help of Phil Carter, the Ambassador in Cote
d'Ivoire, were able to put a plan of action in place that
allowed us to avoid stock-outs completely, no interrupted
therapy, and cover the needs of orphans and vulnerable children
that we also have many programs in Cote d'Ivoire focused on in
a way that was respectful of the changing security issues that
happened daily, hourly indeed, did not put our people, USG and
Foreign Service nationals, in undue threat of violence, gave
that decisionmaking to the sites themselves, but at the same
time anticipated the need to store antiretrovirals and some
antibiotics, cotrimoxazole, for the continuation in the
populations that we had already committed to. That took an
orchestration of many individuals, including NGO's in the
country that was really quite extraordinary and is still going
on as we speak. But I would highlight that as an example of us
avoiding what could have been a disaster because of a whole-of-
government approach really orchestrated by the Ambassador in-
country.
Your second question with the blood supply issue. We have
seen blood supply since the beginning of PEPFAR as a central
foundation of our prevention interventions in-country. The
ability to stop HIV through the blood supply and indeed the
hepatitis A, B, and C, as well as syphilis, have been a focus
really since day one. We are in 14 different efforts. We have
completed this in 13. We also have this activity in terms of
blood bank restoration and technical assistance to them in at
least double that amount. So we have completed it in 14
countries in sub-Saharan Africa and are engaged in most of the
countries in a blood bank reform effort. So a high priority
pretty much in every country we are engaged with.
Senator Coons. Thank you. There is a Delaware group, Safe
Blood International, that has been historically engaged.
Secretary Carson, if I might, the Lord's Resistance Army
was one other topic I wanted to get to before I am going to
have to leave. The LRA has terrorized a wide range of
communities over many, many years, and I am just interested in
what your implementation plans are for the Lord's Resistance
Army disarmament and Northern Uganda Recovery Act, in
particular, the appointment of a Great Lakes Coordinator, sort
of what you see as the best and most likely to be successful
path forward in dealing with the enduring challenge to the
region and to human rights and security of the LRA.
Mr. Carson. Mr. Chairman, thank you. We have worked very
closely with the Ugandan Government to do as much as we
possibly can to disable the LRA and to capture Joseph Kony. We
have provided the Government of Uganda substantial millions of
dollars to provide them with logistical support to travel into
northern Uganda, into the eastern part of the Congo, and into
the Central African Republic. We have shared information and
intelligence with them as we have acquired it, and we have
provided them with additional communications and logistical and
administrative support in their efforts.
We have encouraged them to work closely with the
governments and militaries in the DRC and also in the Central
African Republic.
As a part of our renewed efforts to assist them, we are in
the process of providing them with some U.S. personnel who will
provide them with additional training and technical support.
Our efforts, in conjunction with the Ugandans, have not
resulted in the capture of Joseph Kony, but we believe that we
have done an effective job of reducing the size of his militia,
capturing a number of the senior leadership, and reducing their
threat to the communities in which they are operating. But we
are committed to working with the Ugandans on this effort
because we believe that Joseph Kony remains one of the most
serious threats to stability in the central African region.
Senator Coons. Thank you, Mr. Secretary.
I would like to welcome Senator Inhofe and encourage you to
ask a round of questions.
Senator Inhofe. Well, I do not really have a round of
questions, but since you were talking about Joseph Kony when I
came in--nice to see you, Mr. Secretary. I hope we will have a
chance to have a personal visit at the conclusion of this.
It has been going on for a long time, the problem with the
LRA. And I have had occasion to be up in Gulu and actually see
the results, the mutilation of these kids and all the things
that are going on.
Also, we came very close to being there at the same time in
east Congo in Goma, just a matter of maybe 2 days before he
left, and he left a trail of blood behind him.
I authored the bill that would give us, I think for lack of
a better term, a policy of this country to try to eradicate
this monster, and I know that we are working with you folks, as
well as the Department of Defense and others that have an
interest. For a long time, it seemed like President Museveni
and President Kagame and President Kabila were not really
working together. It is the very nature sometimes of people,
particularly Presidents who come in from the bush, that they do
not want people to think that they need help to do it. Now they
are all working together. We have this as a policy of the
United States.
So I join the chairman in being most interested in any kind
of progress, and what we will do is share information because
mine mostly is from what we are doing through the military. So
I appreciate you are the right guy to be at the head of this
thing, and I am glad you have that as a priority. It is well
placed.
Mr. Carson. Thank you very much, Senator Inhofe.
Senator Coons. If I might, forgive me for checking my
electronic device. I am getting notice of some impending votes.
I am grateful to the whole panel for your testimony today,
for your participation. I look forward to working together in
the 112th Congress. I am grateful to the other members of the
committee who came and asked great questions, and I just want
to join the other members of the committee who have offered our
thanks for your service to our Nation over so many years. I am
facing a particularly highly qualified and expert panel, and we
are grateful for the great work that you are doing on behalf of
our Nation, its security, and the human rights and interests
and development of the people of Africa. Thank you very much.
I will keep the record of this hearing open until, I
believe, April 15 for members of the committee who might wish
to submit questions for the record. I am grateful for your
testimony before us.
This hearing is adjourned.
[Whereupon, at 4:25 p.m., the hearing was adjourned.]
----------

Additional Material Submitted for the Record

Responses of Assistant Secretary Johnnie Carson to Questions Submitted
by Senator Richard G. Lugar

Question. The relatively peaceful and apparently successful
Referendum on Unity for Southern Sudan has provided an end date for CPA
activities.

What are the resource plans for a post-CPA (July 2011) U.S.
assistance strategy for the Republic of Southern Sudan that
Secretary Clinton indicated the United States would recognize?

Answer. Since the Comprehensive Peace Agreement (CPA) was signed in
2005, U.S. assistance has focused on helping the CPA parties to support
the implementation of the agreement and mitigate potential threats to
it. This has included providing assistance to critical power-sharing
milestones, helping to stand up the new Government of Southern Sudan,
as well as providing the visible dividends of peace to the conflict
affected communities, including delivery of basic services and
infrastructure.
As Southern Sudan approaches statehood in July 2011, USAID is
finalizing a new transition strategy for South Sudan, with the overall
goal of helping to make South Sudan increasingly stable in the post-CPA
era. This transition strategy is based on the premise that increasing
stability in South Sudan depends on three things:

a. Strengthening of core governance institutions and increasing the
inclusiveness, accountability, and transparency of governance
processes.
b. Government of Southern Sudan (GoSS) capacity to respond to
expectations of citizens for essential services and improved
livelihoods.
c. Ability of the GoSS to contain conflicts that may erupt, and
addressing the grievances that drive them.

The transition strategy addresses critical local drivers of
conflict through flexible and quick-impact conflict mitigation
interventions in flashpoint areas that will be implemented in
partnership with local officials and traditional authorities. USAID
will support broad initiatives to strengthen effective, accountable,
and inclusive governance, the lack of which underpins and deepens
grievances that can be mobilized for conflict in South Sudan. Citizens'
grievances against the state will be addressed through support to both
the ``supply'' (government-provided) and ``demand'' (citizen-demanded)
sides of governance. USAID assistance will target specific
institutions, processes, and actors to build effective and transparent
institutions at the executive level, reduce corruption, and foster a
stable macroeconomic and legal framework that encourages investment.
USAID also will strengthen the capacity of citizens, civil society,
media, and other nongovernmental actors to hold the GoSS accountable
and ensure that it is responsive to its citizens.
GoSS and private sector efforts to address citizens' high
expectations for delivery of essential services will be strengthened at
the state and local levels, in coordination with ongoing humanitarian
programming, and with an aim to transition from relief to recovery to
development and from aid dependency to GoSS self-sustainability. USAID
will support, with other donors, the oil sector and oil revenue
management since South Sudan will likely remain primarily an oil-based
economy for some time to come. At the same time, USAID will support
sustained and inclusive agriculture sector-led growth to develop this
sector of the economcy, enhance economic resiliency and reinforce
stability. Economic interdependence will be reinforced through
increasing household productivity and linking communities to markets,
providing access to credit for agribusinesses and small-scale farmers,
and building strategic partnerships to better enable south Sudanese to
capture market opportunities and enhance stability in targeted areas
where lack of economic opportunity is part of the conflict dynamic.

Question. What priority does the stability of Southern Sudan have
in our global interests?

Answer. Bringing lasting peace to Sudan is a key foreign policy
priority for the U.S. Government. We are committed to full and timely
Comprehensive Peace Agreement (CPA) implementation, a definitive end to
the conflict in Darfur, and making sure Sudan does not support
terrorism. We look forward to working with southern leaders as they
undertake the tremendous amount of work necessary to prepare for
independence in July and as they collaborate with northern leaders to
ensure a peaceful transition. The United States will maintain a strong
national interest in Southern Sudan and its transition to an
independent state that is stable, democratic, economically viable, and
at peace internally and with its neighbors, both now and beyond the
expiration of the CPA. The United States is the largest single
international donor to Sudan.

Question. What impact would instability in Southern Sudan have on
our interests in the region?

Answer. Although the South will become independent July 9, the
futures of both north and south are delicately intertwined with each
depending on the political and economic stability of the other.
Southern Sudan will face a number of external and internal threats to
its stability including: relations with its northern neighbor, armed
movements within its borders, and ongoing power struggles and ethnic
division. The United States continues to press for full implementation
of the CPA and resolution of post-CPA issues including: security,
natural resource management, currency, and citizenship issues. A
failure to solidify arrangements or create continuing mechanisms to
manage interstate relations could perpetuate a vicious cycle of support
to proxies and violent conflict, economic disruptions and opportunities
for a return to war.

Question. The President named long-time diplomat, Princeton Lyman,
as his next Special Envoy for Sudan. The current SE for Darfur falls
under SE Lyman as I understand it. While the significant diplomatic and
President's emphasis had a profound effect on the conduct of the
Referendum on Unity, there is no indication that this will be sustained
for Darfur or continue for the Sudans.

What resources have been made available to SE Lyman for his
work on the Sudan portfolio, including Darfur?

Answer. The Special Envoy has the same resources at his disposal as
his predecessors, because the commitment of the United States has not
wavered. The situation in Darfur and in all of Sudan remains a U.S.
Government foreign policy priority. Special Envoy Lyman has the full
support of the administration in both the achievement of a peaceful
resolution in Darfur and the full implementation of the Comprehensive
Peace Agreement (CPA) along with the peaceful transition to an
independent Republic of South Sudan.
On the issue of Darfur, Senior Advisor for Darfur Dane Smith
actively engages with the African Union/United Nations Hybrid Operation
in Darfur (UNAMID), the African Union, the Government of Sudan, local
officials, armed movements, humanitarian aid agencies, the diaspora,
and Darfuri civil society (including displaced persons) about what is
needed to achieve a lasting peace in Darfur.

Question. What diplomatic and resource commitment will be made to
help facilitate the conclusion of a political resolution to Darfur?

Answer. Senior Advisor for Darfur Dane Smith has been engaging
actively with the African Union/United Nations Hybrid Operation in
Darfur (UNAMID), African Union, the Government of Sudan, local
officials, armed movements, humanitarian aid agencies, the diaspora,
and Darfuri civil society (including displaced persons) about what is
needed to achieve a lasting peace in Darfur.
The United States is committed to ensuring that as comprehensive an
outcome document as possible is produced in Doha between the Government
of Sudan and the armed movements that are currently engaging in the
process. To that end, the Office of the Special Envoy to Sudan
maintains a presence to monitor the progress in the negotiations and to
pressure the parties to negotiate directly and in good faith.
Additionally, the United States is encouraging armed movements not
currently participating in the Doha negotiations to participate in or
associate themselves with the process. The resulting agreement of the
Doha meetings could serve as a framework for stability, civil society,
and peace in Darfur.
Furthermore, the U.N. and the African Union are launching a Darfur-
based popular consultation process called the Darfur Political Process
(DPP). While the United States is not opposed in principle to such a
process, it remains concerned that a sufficiently secure and permissive
environment for such consultations does not yet exist. The United
States is engaging in conversations with UNAMID, the African Union High
Level Implementation Panel (AUHIP), and international partners about
what would be needed to create a permissive environment for a Darfur-
based process.
In concert with international partners, the United States continues
to focus on efforts to improve UNAMID and humanitarian access in
Darfur, as well as the protection of civilians.

Question. Somalia: The new Ambassador to Kenya will no longer be
responsible for the Somalia portfolio aside from administrative
support.

Who is the U.S. Charge d'Affaires for Somalia?

Answer. There is not a U.S. Charge d'Affaires for Somalia. The U.S.
Ambassador to Kenya oversees U.S. Government activities relating to
Somalia. He is assisted in this responsibility by two senior Foreign
Service officers and a small Somalia unit in the Embassy's political
section.

What role will the office for Somalia in Nairobi play? What
is the staffing level and what resources are available for
FY10, FY11, and requested for FY12?

Answer. The Embassy Nairobi Somalia Unit will remain, on behalf of
the U.S. Government, the overall coordinator in the field for
reporting, outreach, discussions and diplomatic initiatives for U.S.
engagement on Somalia. As called for under the Dual Track approach to
Somalia, we will maintain a U.S. diplomat of ambassadorial rank within
Embassy Nairobi to oversee pursuit of our policy objectives in Somalia,
working actively with partners throughout the region, including in
Ethiopia, Djibouti, and other capitals. The Somalia Unit maintains a
staff of approximately 15 officers and locally employed staff.
In FY 2010, the enacted bilateral assistance level for Somalia was
$133.8 million. State and USAID's central budget offices are currently
reviewing the FY 2011 appropriation language and funding levels, and
have not yet made country-specific allocation recommendations. In FY
2012, $82.4 million was requested for Somalia in the Congressional
Budget Justification, in addition to the $91.8 million request within
the Contributions for International Peacekeeping Activities (CIPA)
account.

Who is responsible for the regional integration and
coherence of Somalia policy with other U.S. missions and
policies?

Answer. In general, the development of U.S. policy resides with the
Secretary of State and her representatives in Washington, DC.
In the case of Somalia, Embassy Nairobi remains, on behalf of the
U.S. Government, the overall coordinator for reporting, outreach,
discussions and diplomatic initiatives for U.S. engagement on Somalia
in the field. As called for under the Dual Track approach to Somalia,
we will maintain a U.S. diplomat of ambassadorial rank within Embassy
Nairobi to oversee pursuit of our policy objectives in Somalia, working
actively with partners throughout the region, including in Ethiopia,
Djibouti, and other capitals.

Question. AFRICOM is now seized with planning and coordination for
U.S. military activity and other responses to the political instability
and revolutions in North Africa.

How have recent events and tasking influenced AFRICOM
cooperation and coordination with our missions in sub-Sahara
Africa?

Answer. AFRICOM's participation in the NATO efforts in Libya has
not deterred the cooperation and coordination between U.S. Africa
Command (AFRICOM) and our missions. Congressional appropriations levels
for the Department of Defense provide AFRICOM the resources to cover
its personnel and program costs in both North Africa and sub-Saharan
Africa. AFRICOM has been able to continue funding its personnel who are
integrated into many of our embassies across the continent and are
valuable members of our country teams. As such, they are a permanent
presence within each mission. They have not been reassigned for
operations such as Libya. These permanent positions provide direct and
sustained support to both State Department and Defense Department-
funded activities.

Question. What are the priorities, from a State Department
perspective, for AFRICOM in sub-Sahara Africa?

Answer. President Obama's speech in Accra in July 2009 laid out a
clear set of priorities for our policy in Africa, and we believe that
AFRICOM plays an important role in supporting our broader policy
framework. AFRICOM does this by building professional, capable
militaries that respect human rights and civilian control, which in
turn supports efforts to resolve armed conflicts, address transnational
challenges, and safeguard democratic institutions. Given the important
role militaries play in the region, Africa Command's work is critical
to the success of our broader efforts to build a peaceful, prosperous,
and democratic Africa.

Question. What are State Department expectations of the AFRICOM
role and how have they measured up to those expectations to date?

Answer. State Department's expectation is that a unified military
command for Africa would simplify our coordination with the Department
of Defense; it has indeed been easier to coordinate with the one
command instead of three separate commands. We expected that AFRICOM
would facilitate capacity-building programs on the African Continent,
and they are starting to fulfill that role. AFRICOM and the Department
of State collaborate across Africa on an array of military
professionalization, capacity-building and security sector reform
programs.

Question. What challenges exist between the individual embassies
and AFRICOM? Please provide a range of examples both positive and
negative.

Answer. The biggest challenge that has emerged between our missions
in Africa and AFRICOM is our ability to support the increased DOD
presence. Many of our facilities are now above their capacity to
support an increased DOD presence that requires housing and
administrative/logistical support on both a temporary and permanent
basis. The Department of State often does not have the amount of
personnel necessary to support the increasing amount of DOD activities
on the continent. It is imperative that we carefully calibrate the
growth of DOD programs and personnel on the continent, in order to
ensure that our embassies can provide proper support, policy guidance,
and oversight.

Question. USAID Administrator Raj Shah recently testified that
sharp cuts in U.S. Assistance would bring about death of tens of
thousands of Africans.

Is the United States responsible for all preventable deaths
across Africa?

Answer. The United States has made a substantial commitment to
addressing Africa's humanitarian needs and to lowering mortality rates.
Our efforts to respond to famine in the Horn of Africa, address long-
term food security through the Feed the Future Initiative, and
continuing efforts to combat HIV/AIDS in Africa illustrate three ways
in which we are striving toward these goals.
The current drought in the eastern Horn of Africa demonstrates the
need for the United States and other donors to work with African
countries to respond to the humanitarian crisis. We are moving
aggressively on a number of fronts to respond to this situation and to
provide life-saving food and other humanitarian assistance. In FY 2011,
the United States has provided approximately $459 million in
humanitarian assistance to the eastern Horn of Africa to date.
Additionally, the United States, through the President's Emergency
Plan for AIDS Relief (PEPFAR),directly supported life-saving
antiretroviral treatment for more than 3.2 million men, women, and
children worldwide as of September 30, 2010, up from less than 2.5
million in 2009. Through its partnerships worldwide, PEPFAR directly
supported 11 million people with care and support, including nearly 3.8
million orphans and vulnerable children, in fiscal year 2010 alone. The
United States is also the largest donor to the Global Fund to Fight
AIDS, TB, and Malaria, a key vehicle for shared responsibility. To
date, the Global Fund has disbursed about $7.8 billion to combat HIV/
AIDS, tuberculosis (TB), and malaria in Africa.

Question. Who or what are the top 10 donors, annually over the last
10 years, to sub-Saharan Africa? Please include multilateral
institution funding?

Answer. According to the OECD--Development Assistance Committee
(OECD/DAC) the top 10 ODA donors in USD million, net disbursements
between 2000-09 are provided below.

ODA: TOTAL NET
[USD millions]
------------------------------------------------------------------------
Percent
Donor 2000-2009 distribution
------------------------------------------------------------------------
United States................................. 41,412.27 15
IDA........................................... 33,965.01 12
EU Institutions............................... 30,475.06 11
France........................................ 27,121.23 9
United Kingdom................................ 23,329.93 8
Germany....................................... 16,772.40 6
Japan......................................... 11,496.16 4
Netherlands................................... 11,229.47 4
AfDF (African Dev. Fund)...................... 9,555.42 3
Sweden........................................ 6,541.58 2
Other Donors.................................. 73,694.14 26
-------------------------
Total net ODA............................. 285,592.67 100
------------------------------------------------------------------------

Question. Are these countries responsible for all preventable
deaths across Africa?

Answer. No; donor countries are not responsible for all preventable
deaths across Africa.
______

Responses of Assistant Secretary Carson to Questions Submitted
by Senator Christopher A. Coons

Question #1. FOREIGN AID: Why are the requested levels of funding
worth the investment for the U.S. taxpayer, and what metrics do you use
to measure aid impact and effectiveness?

Answer. Helping African countries realize their full potential and
succeed as economically viable democracies is in our national interest.
If fledgling democracies are allowed to fail and undemocratic regimes
are allowed to endure unchallenged, then people will lose confidence in
democracy and free market economic principles, and we will find
ourselves on the defensive in the global competition for influence and
ideas. Many sub-Saharan African countries face enormous challenges to
their survival as functioning states, and we must continue to help them
meet those challenges so they can better help us as we deal with our
own. In the coming years, African cooperation will be increasingly
essential in managing a wide range of global issues such as
international terrorism, smuggling, piracy, migration, climate change,
infectious disease, and food production.
The ties between Americans and Africans are deep and historic. With
few exceptions, Africa is not a place where we see anti-American
demonstrations and rhetoric. That is indicative of the prevailing
appreciation for our country's longstanding commitment to democracy and
human rights, and for our steadfast support in addressing Africa's many
challenges during times of trouble. The spread of democracy in Africa
over the past two decades and the vibrancy of pro-democracy activism
across the continent is further evidence that most Africans share our
political values. In the international arena, most governments in sub-
Saharan Africa have been cooperative as we deal with a variety of
global challenges. One recent example of this occurred when Gabon,
Nigeria, and South Africa voted in support of the U.N. Security Council
resolution authorizing the use of force to avert a humanitarian
catastrophe in Libya.
Our economic interests in Africa are clear and compelling.
Approximately 14 percent of U.S. oil imports come from the region,
making it a strategic part of our energy security portfolio. Imports
from Nigeria alone are about 9 percent of our total oil imports and
almost the same volume as those from Saudi Arabia. With promising
exploration and development in countries such as Ghana, Uganda,
Liberia, and Tanzania, sub-Saharan Africa's significance for global oil
and gas markets will only increase in the coming years. Africa's
enormous share of the world's mineral reserves is vital for sustaining
continued growth of the global economy. Most importantly, sub-Saharan
Africa's growing population makes it a market where U.S. firms will
need to be players if they are to remain globally competitive. The
region's share of the world's population today is approximately 12
percent, and it is estimated to grow to 20 percent over the next two
decades.
We are managing a long list of near and long-term challenges that
have a direct impact on U.S. security, political, economic, and
humanitarian interests. Every dollar we invest in helping Africans
build the capacity to address their problems and better capitalize on
their opportunities goes a long way in preventing situations from
getting worse and costing us even more money down the road. Many of our
efforts have a very positive and significant impact on the lives of
Africans. It is through our vigorous diplomacy and our targeted
assistance programs that the United States will remain a player in
Africa and protect and advance our interest there.
We are also able to leverage our assistance with other key U.S.
Government and in-country stakeholders (including civil society, the
private sector, foundations, other development partners, multilateral
institutions, host governments, and regional institutions--particularly
the African Union and the regional economic communities). This internal
and in-country coordination helps prevent duplication of effort,
maximizes the impact of U.S. taxpayers' foreign assistance dollars, and
heightens the effectiveness of programs. It also helps to ensure that
U.S. assistance is aligned with countries' national priorities and
supports country ownership. In addition, where feasible, we work
together with other partners on mutually reinforcing goals, to reduce
the number of separate, duplicative missions and diagnostic reviews,
while building on best practices and joint training.
We rely on a variety of metrics to measure aid impact and
effectiveness. For example, Freedom House's ``Freedom in the World''
survey is the most commonly referenced indicator for measuring
democratic progress in African countries. We rely on this data to track
progress in Africa from year to year and over time (since 1972).
Freedom House's ``Countries at the Crossroads'' country reports provide
scholarly detail on government performance in African countries,
allowing us to examine at a deeper level the democratic governance
issues in the countries where we work.
To assess progress toward reducing conflict in sub-Saharan Africa,
we track the percentage of U.S.-trained African units deployed to peace
support and humanitarian response operations, along with the number of
African armed conflicts resolved and peace support missions concluded.
To measure the effectiveness of efforts to promote agricultural
development and enhance food security in sub-Saharan Africa we look for
increases in rural household incomes, and increases in the number of
farmers adopting new technologies and improved agronomic practices. In-
depth analyses of the level of two-way trade between the United States
and sub-Saharan Africa, excluding U.S. energy-related imports, offer
insights on our goal of increasing Africa's share of trade in the
global market place.
To assess the effectiveness of our efforts to improve health and
social development indicators in sub-Saharan Africa, we: (1) track the
number of adults and children in the region diagnosed with new HIV
infections each year; and (2) track the number of people protected
against malaria with a prevention measure--Insecticide Treated Net and/
or Indoor Residual Spraying in countries included in the President's
Malaria Initiative.
In sum--Africa matters. The history and culture of the United
States and Africa are inextricably linked. Our partnership with Africa
is based on our mutual desire to promote democracy, good governance,
and respect for human rights; to achieve peace and security throughout
the continent; and to promote economic growth and prosperity for all.
While Africa's future is up to Africans, the United States will
continue to play a major role with its African partners in shaping that
future.

Question #2. CR CUTS: How will proposed budget cuts in the
continuing resolution, or CR, impact the administration's ability to
implement its policy agenda and priorities in Africa this fiscal year?

Answer. The President's FY 2011 request for Africa was robust, and
we acknowledge that actual levels may be less than the request. State
and USAID's central budget offices are currently reviewing the FY 2011
appropriation language and funding levels, and have not yet made bureau
or country-specific allocation recommendations. As levels are
developed, the focus will be to ensure that the President's priorities
in food security, health, and climate change are addressed, as well as
ensuring that joint State/USAID priority countries receive appropriate
funding.
We look forward to discussing our specific funding levels and
allocation rationale as part of the 653(a) consultation process.

Question #3. INTERAGENCY: Describe levels of interagency
coordination in developing the budget request for Africa.

a. To what degree have you embraced a whole of government
approach when implementing an Africa strategy?
b. Secretary Carson and Deputy Assistant Administrator
Jandhyala, please detail areas of cooperation between State and
the Department of Defense--specifically, AFRICOM.

Answer (a). Active engagement in sub-Saharan Africa advances
stability and U.S. strategic interests. Our close collaboration within
the interagency community centers on a set of jointly agreed upon
priorities for Africa. Together we remain committed to: (1)
strengthening democratic institutions and the rule of law; (2)
encouraging long-term development and growth, including food security;
(3) enhancing access to quality health care and education; (4)
assisting in the prevention, mitigation, and resolution of conflicts;
and (5) working with Africans to address transnational challenges,
including terrorism, maritime safety and security, climate change,
narcotics trafficking, and trafficking in persons.
The initial input for developing the budget request for Africa
comes from the Chiefs of Mission at each sub-Saharan post in response
to these overarching policy goals through the submission of a Mission
Strategic and Resource Plan (MSRP). The MSRP reflects the input of all
U.S. Government partners at post, and lays out an integrated approach
for meeting the diplomatic and development challenges in each country.
In-depth reviews of the MSRPs are conducted by the interagency
community in Washington, program and funding decisions are made, and a
joint State/USAID Africa Budget submission is prepared. The Africa
Bureaus at both State and USAID work hand in hand throughout all phases
of the budget development process--from the initiation of the request
in the field to the development of final requests for the President.
Other U.S. Government partners are included throughout the planning
and budget development process as appropriate for their areas of focus.
For example, through the President's Emergency Plan for HIV/AIDS Relief
(PEPFAR), the cornerstone of the Global Health Initiative, State's
Office of the Global AIDS Coordinator leads an interagency process--
including USAID, the Department of Health and Human Services, the
Department of Defense, and the U.S. Peace Corps--in planning and
implementing the comprehensive U.S. Government response to the HIV/AIDS
pandemic.
This collaboration continues throughout the implementation of
programs, with the submission of a joint State/USAID Operational Plan
to detail programming of current year appropriations, and a joint
State/USAID Performance Report on results achieved in the previous
fiscal year. These efforts are reflected in the joint State/USAID
Annual Performance Report covering activities worldwide.
The Secretary of State is the chairwoman of the Millennium
Challenge Corporation (MCC) and the USAID Administrator along with
other principals from the interagency community, including the
Secretary of the Treasury, the U.S. Trade Representative, and others,
serve as MCC board members. This participation ensures that our
respective resources are brought to bear on common objectives that both
increase the impact of developmental objectives and optimize
stewardship of U.S. resources.

Answer (b). As Africa Command (AFRICOM) has developed since its
establishment in 2008, it has brought greater depth and understanding
to many issues we must address in a coordinated manner. This is a
process that requires constant communication to make sure that
AFRICOM's activities support our broader foreign policy goals and
objectives. Areas on which we cooperate include: military
professionalization in Africa; counterterrorism capacity-building of
key militaries in West and East Africa; enhancement of disaster
management capacity; peacekeeping capacity-building; humanitarian
operations coordinated with USAID; counter piracy off the Somalia
coast; capacity-building for maritime safety and security; and civil-
military cooperation in medical and other areas. The Department of
Defense elements in our missions in Africa implement Department of
State Foreign Military Financing (FMF) and International Military
Education and Training (IMET) programs, which further U.S. interests in
Africa by ensuring that coalition partners and friendly foreign
governments are equipped and trained to work toward common security
goals and share burdens in joint missions.

Question #4. CHINA: Describe the extent and nature of China's
influence in sub-Saharan Africa, and the degree to which it impacts
America's role in the region.

Answer. China enjoys a degree of influence which one might expect
from a major trading nation with significant economic ties to most of
sub-Saharan Africa. China is an aggressive and determined commercial
competitor, but we do not assess that the United States is in strategic
competition with China in sub-Saharan Africa.

a. Are there areas of cooperation we have not fully explored
with China that may allow us to better meet shared regional
goals?

Answer. During our annual bilateral talks focused on sub-Saharan
Africa, we have proposed cooperation with the Chinese Government in the
areas of health and food security. China has agreed to explore
cooperative projects in these areas, and we have begun the preparatory
steps which will allow these projects to start. China is also an active
participant in the international effort to counter piracy off the coast
of Somalia.

b. What steps are we taking to mitigate areas of tension
with China in Africa?

Answer. Currently, there is very little tension between the United
States and China on the African Continent. While we disagree on policy
in a few African countries, for the most part our relations with China
around sub-Saharan Africa are very cordial. In order to address the few
areas of tension which do exist, our two governments meet formally at
least once a year for bilateral consultations on Africa. In addition,
we often meet informally with Chinese officials responsible for Africa
policy on the margins of international meetings like the U.N. General
Assembly or African Union summits.

c. How are U.S. businesses faring in Africa given the
economic competition with China?

Answer. China's total trade with Africa is larger and increasing
more rapidly than United States-Africa trade. While there are many
reasons for this, one factor is China's investment and competition
across all sectors of African economies--from consumer goods to large
infrastructure projects to oil and gas exploitation. Some American
companies have found success in Africa, but China is indeed a fierce
economic competitor. Although it is often difficult for American
companies to compete on price or offer comparable financing terms to
African purchasers, in many cases our companies are stymied by their
perception of the risks associated with operating in sub-Saharan Africa
and do not compete for the business. The Department of State, both in
Washington, and on the continent at our embassies and consulates,
considers assisting American companies to be a top priority. The
African Growth and Opportunities Act (AGOA) also serves as a useful
tool for promoting U.S. business opportunities by providing a mechanism
to focus dialogue on improving the investment climate and facilitating
two-way trade.

Question #5. PRIORITIES: I am struck by the fact that more than 75
percent of our budget for Africa goes toward the three initiatives--
global health, food security, and global climate change. These are
critically important programs, but the allocation of resources involves
difficult choices, and only 23 percent of the total budget remains for
noninitiative spending such as security assistance, democracy and
governance, peacekeeping, and other programs.

a. Explain the rationale for emphasizing health and food
security in Africa at the expense of other priorities.

Answer. Africa continues to have the highest poverty rates in the
world. In the United Nations' Human Development Index, 25 of the bottom
26 countries designated in the ``low human development'' category are
in Africa. Additionally, sub-Saharan Africa is more heavily affected by
HIV/AIDS than any other region--around two-thirds of the global total.
The ongoing degradation of Africa's soil, water, and biodiversity
resources is also a significant threat to the economic well-being of
future generations.
The President's Initiatives--Feed the Future (FTF), Global Health
(GHI), and Global Climate Change (GCC)--are responsive to these
challenges in Africa. These initiatives are core elements of the
President's development policy--the Presidential Policy Directive on
Global Development. The directive recognizes that development is vital
to U.S. national security and is a strategic, economic, and moral
imperative for the United States. It calls for the elevation of
development as a core pillar of American power and charts a course for
development, diplomacy, and defense to mutually reinforce and
complement one another in an integrated comprehensive approach to
national security. As reflected in the Quadrennial Diplomacy and
Development Review, these initiatives pioneer an unprecedented
integration of efforts between the Department of State and the U.S.
Agency for International Development.
Decisions regarding the selection of key countries that benefit
from the initiatives, and the determination of overall initiative
funding levels, are made through interagency working groups with
participation of all key partners, including the National Security
Staff as well as through working groups that include sector specialists
from the Africa bureaus and relevant functional bureaus at the
Department of State and USAID, in coordination with the Office of the
Director of U.S. Foreign Assistance.
FTF dedicates resources to addressing the root causes of hunger and
poverty through agriculture development in select countries in Africa.
In FY 2012, our efforts will continue to help farmers grow and sell
more of their produce, and reduce under nutrition, as well as foster
thriving rural economies in countries that offer strong opportunities
for improvement in food security, and in the regional economic
communities (the Common Market for Eastern and Southern Africa, the
Economic Community of West African States, the East African Community,
and the Southern African Development Community). We also will promote
reforms and build the capacity of African institutions to support broad
economic growth through agricultural development in the future.
GHI builds on the foundation laid by the previous administration
through the creation of the President's Emergency Program for AIDS
Relief (PEPFAR). Taking into account the lessons learned over the last
decade, and with an eye toward achieving greater and more sustainable
impact, the GHI expands the administration's global health effort and
impact by improving disease treatment, integrating interventions, and
expanding investments to strengthen health systems, improve maternal
child health, address neglected tropical diseases, and foster increased
research and development.
Africa is the largest recipient of PEPFAR program resources, with
12 of the 15 original focus countries, and the program has made major
strides in the fight against the deadly HIV/AIDS pandemic. Since its
inception, over two million Africans have received life-saving
antiretroviral treatment. The President's Malaria Initiative mobilizes
global efforts to combat a major killer, especially of Africa's
children. Malaria kills over 800,000 people annually, the vast majority
being African children under the age of 5, and causes an estimated $12
billion per year in economic losses in Africa. Through GHI, major
efforts continue to address other critical health needs in sub-Saharan
Africa, including polio eradication, control of tuberculosis, reduction
of maternal and child mortality, access to voluntary family planning
services and information, elimination of neglected diseases,
strengthening disease surveillance systems for the prevention of and
rapid response to epidemics, and strengthening of African health
systems.
U.S. assistance will also promote the productive and sustainable
management of natural resources, while helping to reduce long-term
threats to the environment. Africa is one of the most vulnerable
continents to global climate change and climate variability, and there
is enormous untapped potential to control emissions growth on the
continent. Through GCC, programs will focus on helping countries assess
their vulnerability to climate change, and on building the information
systems and governance mechanisms to adapt to these expected changes.
These programs also will help African countries reduce greenhouse gas
emissions through improved land management and greater use of clean
energy. In addition, they will build the capacity of countries to enter
international carbon markets, thereby capturing and sequestering carbon
from global greenhouse gas emissions while preserving economically and
ecologically important African landscapes.

b. How do you prioritize and direct the remaining 23% of the
budget left for everything else?

Answer. The FY 2012 budget request for Africa includes $1.8 billion
(23 percent) in noninitiative funding requests. Roughly $878 million in
noninitiative funding is for the Bureau's two highest priorities: (1)
strengthening democratic institutions and the rule of law and (2) the
promotion of long-term development and economic growth.
The biggest governance challenge in Africa in FY 2012 will be the
peaceful establishment of an independent and democratic nation for the
people of Southern Sudan. We will continue to build the capacity of
government institutions in Southern Sudan, and support the resolution
of disputes in and around the Abyei border region. We will also support
election officials, civil society, political parties, and the media to
prepare for, monitor, and conduct credible elections in the Democratic
Republic of the Congo and Liberia, just as we have recently supported
elections in Nigeria and Uganda. Our democracy and governance
assistance will also support reforms in Kenya and Zimbabwe to lead
those countries out of their current transitional governments through a
series of constitutional and legal reforms toward peaceful and credible
elections. Investments in this sector will bolster our initiative
efforts by strengthening democratic institutions and promoting
accountable governance.
African countries need rapid, sustainable, and broad-based growth
to reduce hunger and poverty, create jobs, and expand health and
education services. We will support African countries' efforts to
achieve this growth, in coordination with FTF, by supporting measures
that increase agricultural productivity in a sustainable way,
strengthen markets, improve the management of renewable and
nonrenewable natural resources, support small and medium business
growth, promote trade, and strengthen the institutions of economic and
political governance. Trade and investment programs will improve sub-
Saharan Africa's capacity for trade and its export competitiveness. We
also will continue to expand African trade with the United States and
other trading partners under the African Growth and Opportunity Act.
Roughly $430 million (24 percent) of our noninitiative funding
request would be used to support programs and activities to prevent,
mitigate, and resolve conflicts in the region, including those focused
on strengthening stabilization operations, security sector reform,
peacekeeping operations, targeted counterterrorism and counternarcotics
initiatives, and maritime safety and security.
The FY 2012 noninitiative request also seeks $267 million (15
percent of the noninitiative request) for basic education activities
that will assist Africa in meeting the Millennium Development Goals for
education, including increasing transparency and accountability, and
improving management of the education system. Programs will focus on
improving the quality of education through professional development for
teachers and administrators. Supporting community involvement in
education will continue in FY 2012, to increase access to educational
opportunities for girls and other marginalized populations.
The remaining $220 million (12 percent) in noninitiative funding
would be used to support Food for Peace, Title II (P.L. 480) programs;
efforts to improve access to high quality water and sanitation
services; humanitarian assistance programs; higher education programs;
and other social services programs.
Sixty-six percent ($5.1 billion) of the total FY 2012 request for
Africa consists of bilateral assistance for 13 priority countries. They
include six African states facing major humanitarian problems or
recovering from serious conflict--Sudan, Liberia, the Democratic
Republic of the Congo, Kenya, Zimbabwe, and Somalia; and three
countries--Ethiopia, Nigeria, and South Africa--because of the
important roles they play in advancing regional security and economic
growth. These nine countries play a major role in determining the
prospects for conflict or stability and development in their regions.
In addition, we have a special focus on strengthening elected
municipal-level officials and their civil society counterparts in
relatively well-performing African countries--specifically Ghana, Mali,
Mozambique, and Tanzania. These countries have adopted progressive
policies and are building democratic institutions that promote economic
development and improve the lives of their citizens. They serve as
models for their neighbors and voices for reform in regional bodies
such as the African Union.

c. What is the process by which these decisions are made?

Answer. The initial input for developing the budget request for
Africa comes from the Chiefs of Mission at each sub-Saharan post
through the submission of Mission Strategic and Resource Plans (MSRPs)
that incorporate overarching policy goals established by the Assistant
Secretary of State. The MSRP reflects the input of all U.S. Government
partners at post, and lays out an integrated approach for meeting the
diplomatic and development challenges in each country. In-depth reviews
of the MSRPs are conducted by the interagency community in Washington,
program and funding decisions are made, and a joint State/USAID Africa
Budget submission is prepared. The Africa Bureaus at both State and
USAID work hand in hand throughout all phases of the budget development
process--from the initiation of requests in the field to the
development of a final request for the President.

Question #6. ESF CUTS: We all recognize that budget cuts are
necessary in these difficult financial times, but we also need to
understand the impact of the cuts to foreign aid. In the FY11 CR,
Economic Support Funds, or ESF, will be cut by $1.8 billion below the
President's request.

a. Please describe the objective and impact of ESF programs
in Africa, highlighting areas where we have seen sustained
measures of success.

Answer. Economic Support Funds (ESF) are programmed bilaterally in
rebuilding countries; i.e., those that are in or coming out of
conflict, such as the Democratic Republic of the Congo, Liberia, Sierra
Leone, Somalia, Sudan, and Zimbabwe. ESF programming in these countries
focuses on efforts to strengthen stabilization operations and security
sector reform initiatives; conflict mitigation and reconciliation
programs; good governance practices, including the rule of law and
respect for human rights; political competition and consensus-building
strategies; civil society organizations; and social and economic
services and protection for vulnerable populations. ESF-supported
programming in the rebuilding countries also includes projects that
address a variety of transnational crime issues such as trafficking in
persons and narcotics smuggling, as well as efforts to strengthen basic
education systems and to promote economic growth.
The Africa Bureau also uses regional ESF primarily to support
programs in African countries that do not typically receive bilateral
assistance and programs that cross geographic boundaries to address
regional issues. Examples of regional programs supported with ESF
include the Trans-Sahara Counterterrorism Partnership Program (TSCTP)
and the Partnership for Regional East Africa Counterterrorism (PREACT,
formerly known as the East Africa Regional Strategic Initiative or
EARSI). Through TSCTP and PREACT, regional funds are being used to
promote security sector capacity-building and cross-border cooperation
in West and East Africa. Mali, for example, cooperates closely with the
United States in counterterrorism primarily through the interagency
(Department of State, USAID, and Department of Defense) TSCTP program.
The United States supports Malian counterterrorism planning and
accelerated training, and equipping of specialized Malian task forces
responsible for counterterrorism operations in northern Mali.
In January 2011, millions of Southern Sudanese citizens voted
overwhelmingly in favor of the peaceful separation of their region from
the rest of Sudan. Supporting the environment in which the Sudanese
people were able to conduct a free and fair referendum on the issue
represented a key achievement of bipartisan U.S. foreign policy since
the signature of the Comprehensive Peace Agreement (CPA) in 2005. Just
as U.S. assistance played a critical supporting role in the
implementation of the CPA and the referendum, continued U.S. support
through ESF is essential to the success of the world's newest nation
when full independence is achieved later this year.
Security-sector reform efforts supported with ESF in Somalia and
the Democratic Republic of the Congo incorporate training in human
rights and gender-based violence. In FY 2010, regional ESF resources
were used to advance a constitution-drafting process in Somalia
organized by the United Nations Development Program. The United States
supported the work of the Independent Federal Constitution Commission
in its efforts to develop and enhance the skills necessary to support
the transitional process. As a direct result of program-related
workshops, training events, and consensus-building activities, members
of all 72 parliamentary committees were trained on consensus-building
techniques and were subsequently able to develop the draft constitution
law.
In Tanzania, FY 2010 regional ESF resources supported civic
education activities conducted to help address the lack of
understanding of electoral processes in rural areas of the country.
Focus groups included women, youth, and people with disabilities, and
topics covered important key issues associated with understanding
constitutional rights and duties in the electoral process. More than a
million people now have a better understanding and appreciation of
their role in the electoral process as a consequence.

b. How will the CR impact levels of ESF for Africa, and will
a lower bottom line for FY11 decrease the expected amount of
ESF allocated for FY12?

Answer. The President's FY 2011 request for Africa was robust, and
we acknowledge that actual levels may be less than the request. State
and USAID's central budget offices are currently reviewing the FY 2011
appropriation language and funding levels for all accounts, including
ESF, and have not yet made bureau or country-specific allocation
recommendations. As levels are developed, the focus will be to ensure
that the President's priorities in food security, health, and climate
change are addressed, as well as ensuring that joint State/USAID
priority focus countries receive appropriate funding.
We look forward to discussing our specific funding levels and
allocation rationale as part of the 653(a) consultation process.

Question #7. DEMOCRACY: Sub-Saharan Africa has had a mixed record
when it comes to democratic institution-building. While there are some
models for success--such as Botswana and Ghana--there are also some
areas of concern--such as Uganda, Angola, and Zimbabwe, among others.
Unlike health programs, it can be difficult to measure success in
democracy and governance, or D&G, programs.

What are examples of countries on both upward and downward
trajectories, and how to you prioritize D&G resources when they
are so scarce?

Answer. The fact that there are 13 elections this year shows how
much our investments of money and time have paid off. It was not that
long ago that an entire year could pass in Africa without any
democratic elections whatsoever. Indeed, our assistance has resulted in
positive returns in helping institutionalizing key democratic
institution such as electoral commissions in countries in Africa
including Mali, Benin, Ghana, Sierra Leone, and Liberia, among others.
USG assistance has helped each of these countries consolidate
democratic gains over several electoral cycles. At the same time
challenges for democracy remain in countries like Ethiopia, Zimbabwe,
Rwanda, and Gambia.
The USG's approach to supporting democracy and political processes
has evolved based on the belief that elections are a critical component
of the democratic process worth prioritizing. As a result, election
support programs are best suited if they cover the entire election
cycle, from technical assistance in drafting election laws and
political party finance reforms, through preelection voter registration
and education, to the administration and monitoring of elections
themselves, and increasingly, to the resolution of post-election
disputes.
We agree that elections alone do not make a democracy or even
assure democratic transformation. That is why the USG also focuses its
scarce resources on programs which bolster the rule of law, improve
governance, support a dynamic civil society, protect human rights, and
promote a free and independent media--all critical elements that create
the foundation for long-term democratic change and stability.
Going forward, we hope to amplify and further refine our democracy
and governance assistance activities in Africa. Accountability at the
local level is often the key to public confidence in democracy. In
addition, we believe that it is critical to move beyond technical
support to election commissions and international observation to focus
equally on increasing societal demand for democracy in general.
In that context, we are prioritizing work with local civil society
groups to assist in their advocacy. We have seen that support for civic
education and election commissions in the few months prior to elections
is insufficient to build the strong democratic states needed in Africa.
Rather, we must expand assistance activities to maintain a consistent,
holistic approach on this issue.

Question #8. You just returned from Nigeria, where you witnessed
the parliamentary elections and preparations for Saturday's
Presidential election. What is your view of the steps taken by the
Nigerian Government to ensure these elections are free and fair--
especially compared to their flawed elections in 2007--and what are
potential regional implications of positive elections in Africa's most
populated country in light of disturbing events surrounding elections
elsewhere, such as Cote d'Ivoire?

Answer. Nigeria has just completed its most successful elections
since its return to multiparty democracy in 1999. Despite some
technical imperfections and isolated incidents of violence, those
elections represent a substantial improvement over the flawed 2007
electoral process and reverses Nigeria's downward democratic
trajectory. It also provides the country a solid foundation for
strengthening its electoral procedures and democratic institutions in
the years to come.
The appointment last June of Attahiru Jega as Chair of the
Independent National Electoral Commission (INEC) raised expectations
that this year's elections would meet minimum standards of credibility.
Dr. Jega--a respected civil society activist--brought well-needed
integrity and competence to the position and inspired many Nigerians to
insist on greater transparency to combat fraud. Dr. Jega gave domestic
and international observers greater access to INEC and the voting
process, and encouraged observers to utilize technology, such as mobile
phones, to inform authorities of irregularities. While the elections
were far from perfect, INEC and the security services performed
admirably and should be applauded for addressing challenges and
improving efforts with each progressive election. We will urge INEC
leaders to continue steps to further improve the electoral process and
strengthen Nigeria's democratic institutions.
The success of the Nigerian elections sends a strong signal on the
importance of credible elections and democratic transition across
Africa. The people of Nigeria have clearly demonstrated aspirations to
have a democratic government and participate in democratically run
elections, a desire of many people across Africa. If Nigeria, with its
troubled electoral history, large size, and large and diverse
population, can run and manage successful democratic elections, it is
possible for other African states to do so as well. We will continue to
work with our African partners to ensure similar success in upcoming
elections on the continent.

Question #9. Kenya is preparing for elections in 2012, and is
currently undertaking the process of implementing a new constitution
approved by an overwhelming majority of the population last year. Given
the difficult history of Kenya's last election and subsequent violence,
what are your expectations for the upcoming elections? Describe our
democracy and governance assistance programs in Kenya and the extent to
which we are assisting Kenyans lay the groundwork for elections that
are free and fair.

Answer. The 2012 election in Kenya will be an important test of the
progress the country has made on its ambitious political and
institutional reform agenda set out as part of the Kofi Annan mediated
power-sharing agreement that brought the 2007-08 post-election violence
to an end. Some progress has been made, in particular the adoption of a
new constitution in August 2010 that, if robustly implemented, will
provide a solid foundation for a peaceful, democratic future in Kenya.
To assure a fair and credible election in 2012, it is important
that reforms move forward. Kenyan leaders must work together to put in
place legislation necessary for constitutional implementation, appoint
the best qualified people to key positions in the judiciary, and
support efforts to hold accountable those responsible for the 2007-08
post-election violence.
In support of implementing the reform agenda, including the new
constitution, U.S. democracy and governance programs support a range of
government and nongovernment actors with responsibility for, and a
stake in, implementing the reform agenda.
To help ensure that electoral mechanisms and procedures are
transparent and credible--and have the confidence of the Kenyan
people--we are building on the effective work with the Interim
Independent Electoral Commission (IIEC) on voter registration, results
management, monitoring, and civic education carried out in advance of
the August 2010 constitutional referendum. We will continue to help
strengthen Kenya's electoral institutions, including the permanent
Electoral and Boundary Commission once it is established. We also are
supporting the professionalization of political parties, civic and
media education on elections and electoral processes, and civil society
monitoring and observation capacity.
We are continuing support to parliamentary capacity-building, which
is especially important in light of the need to pass more than 50
pieces of legislation to implement the new constitution and its
expanded responsibilities under it. U.S. programs focus on support to
committees, including oversight committees. We also will support
provision of technical expertise on legislative drafting if requested
by the Government of Kenya.
U.S. democracy and governance programs support a broad array of
programs with civil society, including youth, to support their efforts
to effectively promote reform, reconciliation, and conflict mitigation.
We also partner with the media on activities to educate citizens about
the reform process and are increasing our collaboration with the
National Commission for Integration and Cohesion, which is responsible
for monitoring and combating hate speech.

Question #10. CONTINGENCY PLANNING: Obviously, there are a range of
contingencies which arise in a given fiscal year, some of which are
foreseen by the State Department as it drafts its budget request--such
as the creation of a new state in Southern Sudan--and some of which are
unforeseen--such as the unrest on Cote d'Ivoire and subsequent flow of
Ivorian refugees across borders.

What is the process by which the State Department prepares
for these contingencies and what is the funding mechanism by
which we will assist the people of South Sudan and Cote
d'Ivoire this fiscal year?

Answer. We rely on in-depth analyses and ongoing reporting on
political, economic, and humanitarian issues in Cote d'Ivoire and
Sudan, submitted by the Chiefs of Mission and reporting officers in
both countries, to guide policy and programming decisions, including
those related to contingency planning.
U.S. strategy and assistance in Cote d'Ivoire for the foreseeable
future will focus on political reconciliation, economic recovery, and
security sector reform initiatives, as well as the continuation of
humanitarian response activities, as part of the international effort
to support President Ouattara's outlined plan for governing and as is
permitted with the section 7008 sanctions that are in place. We are
exploring the process for lifting those sanctions in order to broaden
the types of assistance we can provide. Our strategy and assistance in
Sudan is focused on achieving a lasting peace throughout Sudan by
ending the conflict and abuses in Darfur, fully implementing the
Comprehensive Peace Agreement (CPA) and all post-CPA arrangements
negotiated between the North and South, supporting the establishment of
two states, and ensuring that terrorists do not find safe haven in
either Sudan or South Sudan.
The United States will work to mitigate conflict in both Sudan and
the new state of South Sudan upon its independence in July 2011, as
they both face significant challenges in adjusting to the results of
separation and internal and external challenges to their stability. The
capacity of the Government of South Sudan has improved, but it will
require continued assistance to build capacity to govern effectively,
deliver basic services, and broaden its economic base beyond petroleum.
In Darfur, the United States remains very concerned about the
humanitarian and security situation. We continue to work with the
United Nations, the African Union, and others to find a comprehensive
resolution to the Darfur conflict and improve local security.
State and USAID's central budget offices are currently reviewing
the FY 2011 appropriation language and funding levels, and have not yet
made bureau or country-specific allocation recommendations. We look
forward to discussing our specific funding levels and allocation
rationale as part of the 653(a) consultation process.

Question #11. Although Gbagbo has been arrested, there is a long
road ahead for Cote d'Ivoire.

a. What comes next in terms of reconciliation and
accountability?Q02
Answer. President Ouattara has pledged to make national
reconciliation a primary focus of his presidency. He recently created a
Dialogue, Truth, and Reconciliation Commission (DTRC), and named former
Prime Minister Charles Konan Banny as chairman. While its specific plan
of action has not been finalized, President Ouattara has indicated that
the DTRC will also include two religious leaders (a Christian and a
Muslim). The DTRC will serve as a vehicle for a national dialogue and
reconciliation process.
In terms of accountability, President Ouattara has called for an
independent investigation into all alleged human rights abuses carried
out since November 28, to include allegations against both sides, and
has pledged to hold perpetrators from both sides accountable. A
Commission of Inquiry from the United Nations Human Rights Council is
currently in Cote d'Ivoire carrying out its own independent
investigation; the United States supports the work of the Commission of
Inquiry and looks forward to reading a comprehensive report.

b. Describe levels of U.S. support for President Ouattara
and his military.

Answer. Due to restrictions, some of which have been in place since
1999, U.S. assistance to Cote d'Ivoire is currently limited to
humanitarian programs including disaster relief and the President's
Emergency Plan for Aids Relief. We are exploring the process for
lifting those restrictions in order to broaden the types of assistance
we can provide. U.S. strategy and assistance in Cote d'Ivoire for the
foreseeable future will focus on political reconciliation, economic
recovery, and security sector reform initiatives, as well as the
continuation of humanitarian response activities, as part of the
international effort to support President Ouattara's outlined plan for
governing.

c. What is the status of the cocoa industry exports?

Answer. Following the European Union's lifting of sanctions against
the Port of Abidjan, several companies have begun exporting cocoa again
in recent days. The resumption of cocoa exports is an important element
of Cote d'Ivoire's overall economic recovery.

d. What comes next for Mr. Gbagbo?

Answer. Former President Gbagbo remains under house arrest in
northern Cote d'Ivoire under the protection of UNOCI. President
Ouattara's government is conducting an investigation to determine what
charges can be brought against Gbagbo and his coterie domestically, and
also has indicated that it supports the ICC's role in investigating
alleged abuses since the November elections.

Question #12. LRA: The Lord's Resistance Army, or LRA, has
terrorized remote communities in central Africa since 1986 and
continues to do so, undermining U.S. investments in peace and stability
in South Sudan and the DRC. Last year, the administration released its
strategy to support the disarmament of the LRA, as mandated by the
Lord's Resistance Army Disarmament and Northern Uganda Recovery Act.

a. What are the State Department's priorities for
implementing this strategy and how are these priorities
reflected in the budget request?

Answer. The administration's LRA strategy is focused on
simultaneously supporting regional and multilateral partners to
maintain pressure on the LRA, both militarily and diplomatically;
increasing options for LRA fighters and associated persons to
surrender; increasing the protection of civilians; and providing
humanitarian assistance to affected communities. Strategy
implementation priorities include strengthening our diplomatic efforts,
including at the U.N., the AU, regionally and bilaterally, to draw
international attention to the LRA crisis; developing broad support and
capacity for counter-LRA actions; supporting organizations responding
to the urgent humanitarian needs of civilian populations in LRA-
affected areas; providing recovery, transition, and livelihood support
for LRA-affected populations; and encouraging contributions by our
partners, particularly the European Union and member states.
To support efforts to apprehend or remove from the battlefield
Joseph Kony and senior commanders, the Department of State intends to
continue funding logistical and operational assistance to regional and
multilateral partners through the Peacekeeping Operations (PKO)
account. Our FY 2012 request includes $7.15 million in PKO funds as
part of the Africa Conflict Stabilization and Border Security (ACSBS)
program, a portion of which could be used to support counter-LRA
efforts, as needed.
Our conflict mitigation and reconciliation activities in Uganda,
much of which target former LRA-affected areas in northern Uganda, are
funded through bilateral Development Assistance. Our FY 2012 request
includes $4.4 million for these activities.
Our FY 2012 request for Contributions for International
Peacekeeping Activities (CIPA) includes $408 million in assessed
contributions for the U.N. Stabilization Mission in the DRC (MONUSCO)
and $298 million in assessed contributions for the U.N. Mission in
Sudan (UNMIS), a portion of which will continue to support these
peacekeeping operations' activities, including the protection of
civilians in LRA-affected areas.
The FY 2012 budget includes support for humanitarian operations in
the DRC, Central African Republic (CAR), and Southern Sudan within the
Migration and Refugee Assistance (MRA) and the International Disaster
Assistance (IDA) accounts. PRM and USAID will continue to monitor the
humanitarian needs of LRA-affected communities in the DRC, CAR, and
Southern Sudan and will continue to promote civilian protection and
deliver humanitarian assistance throughout the region.

b. What is your view of the appointment of a Great Lakes
Coordinator or Advisor, as I have advocated for along with
Senator Kerry?

Answer. We have considered the recommendation to name a special
envoy or adviser for the Great Lakes Region. At this time, based on
extensive discussions with NGO groups, regional states, donors, and
others with interest in the Great Lakes Region, we believe the
appointment of such an envoy or representative would not be the most
effective means to advance U.S. interests or to utilize limited
resources. We have found that the regional leaders have not been
particularly receptive to Great Lakes special envoys--either from the
United States or from other governments and have been reluctant to
engage with them. Instead, each government has sought the support of
bilateral ambassadors who could also address other problems and
challenges specific to the country. Engagement through our resident
ambassadors, with support from senior U.S. Government officials, has
proven significantly more effective from both diplomatic and resource
perspectives. My team and I are actively managing the Great Lakes
regional portfolio in close coordination with the Chiefs of Mission in
relevant capitals, as well as with the concerned governments and
regional organizations.

c. What steps is the administration taking to protect
civilians in LRA-affected areas and remove Joseph Kony from the
battlefield?

Answer. The Department of State has been working with the
Department of Defense to provide enhanced integrated logistical,
operational, and intelligence assistance in support of regional and
multilateral partners in an effort to apprehend or remove from the
battlefield Joseph Kony and senior commanders. Since the launch of
Operation Lightning Thunder (OLT) in 2008, we have obligated $29.1
million in PKO resources to provide non-lethal equipment, logistics
support, and supplies to the Uganda People's Defense Force (UPDF) in
support of its effort to defeat the LRA. This includes $6 million of FY
2011 PKO funds to support the efforts of Uganda and CAR to defeat the
LRA through early May 2011.
To support the protection of civilians, the Department of State and
USAID are installing high-frequency radio networks to expand
communication and providing support to U.N. peacekeeping missions and
humanitarian agencies in LRA-affected areas. In FY 2010, the United
States provided $387.7 million in assessed contributions for MONUSCO's
overall budget, a portion of which supported LRA-affected populations.
In FY 2010, the United States provided $361.1 million in assessed
contributions for UNMIS' overall budget.

Question #13. DRC: The FY12 budget request includes $19 million for
peacekeeping operations in the Democratic Republic of Congo, or DRC.
Despite an effort by the United States to highlight human rights
violations and gender-based violence, mass violence and rapes continue
in alarming numbers. What is the U.S. strategy for addressing this
deeply troubling issue in the DRC?

Answer. We remained deeply concerned by the ongoing violence and
human rights abuses against innocent civilians in the DRC. The United
States works in partnership with the DRC government in its efforts to
foster peace and provide security throughout the country, build
functional and accountable government institutions, and deliver public
services. Our strategy to address sexual and gender-based violence
(SGBV) and other human rights violations falls under the umbrella of
our overall DRC strategy.
Our overall human rights strategy includes the following
objectives: (1) build Congolese capacity to address the root causes of
insecurity and protect civilians; (2) support justice sector
development to combat impunity, enhance judicial independence, and
increase access to justice, including through the establishment of
mobile courts to bring essential judicial services to remote areas; and
(3) build the capacity of civil society to promote and protect human
rights, including those of the most vulnerable groups.
Our strategy to address SGBV specifically includes four key
objectives: (1) reduce impunity for perpetrators of SGBV; (2) increase
prevention of and protection against SGBV for vulnerable populations;
(3) improve the capacity of the security sector to address SGBV; and
(4) increase access to quality services for survivors of SGBV. Our
holistic approach focuses on strengthening the prevention of and
response to SGBV throughout the country. We fund programs that: improve
access to care and treatment services for survivors, fight impunity for
perpetrators through support for legal reform--possibly including
support for specialized mixed courts, assist legal aid clinics that
facilitate prosecutions, build capacity of the civilian and military
judicial systems, and promote community awareness of the response to
SGBV. The United States also recognizes that effective prevention of
SGBV requires efforts to address women's and girls' low status in
society. The DRC cannot move ahead without the full inclusion of
women--including politically, economically (through agriculture and
beyond), and socially, through a robust civil society movement.
In instances when the DRC Government has failed to take actions to
prevent human rights abuses, we have taken strategic actions in the
past year, such as removing the DRC from the list of eligible countries
to receive benefits under the African Growth and Opportunity Act (AGOA)
in January 2011. This action has created an opportunity to work with
the Government of the DRC to improve the human rights situation,
including reducing sexual and gender-based violence. Further, as a
result of pressure from the United States and others in the
international community, the GDRC recently convicted high-profile
perpetrators of a mass rape attack that occurred on New Year's Day. To
reiterate, our strategy is to help the DRC Government build its
capacity so that it will establish the government institutions
necessary to eventually take control of these deeply troubling issues.

Question #14. QDDR: Late last year, Secretary Clinton and
Administrator Shah released the results of the first Quadrennial
Diplomacy and Development Review (QDDR), which examined the need for
enhanced interagency cooperation and additional staffing to address the
numerous emerging global issues. Many of these emerging issues exist in
Africa, including food security, transitions in governance, terrorism,
and narcotrafficking.

How does the administration's FY12 budget request for Africa
reflect and implement the objectives of the QDDR?

Answer. Although the QDDR was finalized and distributed after the
submission of the FY 2012 budget request, the Bureau incorporated many
of the report's initial objectives and findings into its budget
submission. These included concerted efforts to strengthen the links
between diplomacy and development, and to better align policy
priorities, strategic responses, budget planning, and performance
management. As noted in the QDDR, Chiefs of Mission at sub-Saharan
African posts function as chief executive officers of multiagency,
whole of government efforts.
The initial input for developing budget planning and performance
management strategies in sub-Saharan Africa stems from the Chiefs of
Mission through the submission of Mission Strategic and Resource Plans
(MSRPs) that incorporate overarching policy goals established by the
Assistant Secretary of State. The MSRP reflects the input of all U.S.
Government partners at post, and lays out an integrated approach for
meeting the diplomatic and development challenges in each country. In-
depth reviews of the MSRPs are conducted by the interagency community
in Washington, program and funding decisions are made, and a joint
State/USAID Africa Bureau submission is prepared. In keeping with QDDR
objectives, the Africa Bureaus at both State and USAID work hand in
hand throughout all phases of the budget development process.
The Africa Bureau's FY 2012 budget includes funding requests to
address several of the emerging global issues referenced in the QDDR.
For example, a total of $507.3 million is requested for the Feed the
Future (FTF) Presidential Initiative which dedicates resources to
addressing the root causes of hunger and poverty through agricultural
development in select countries in Africa. This represents a 20-percent
increase ($84.94 million) over the FY 2010 enacted level for FTF
programming. The FY 2012 request also includes a total of $371.2
million in funding to support the Bureau's highest policy priority of
strengthening democratic institutions and the rule of law. This is 19
percent higher than the FY 2010 enacted level of $311.7 million.
Additionally, the Bureau's FY 2012 request for $185.8 million in
funding to address transnational challenges such as counterterrorism,
narcotics trafficking, and trafficking in persons is nearly 28 percent
higher than the FY 2010 enacted level of $145.7 million.
We are able to leverage our assistance with other key U.S.
Government and in-country stakeholders (including civil society, the
private sector, foundations, other development partners, multilateral
institutions, host governments, and regional institutions--particularly
the African Union and the regional economic communities). This internal
and in-country coordination complies with QDDR directives and helps
prevent duplication of effort, maximizes the impact of U.S. taxpayers'
foreign assistance dollars, and heightens the effectiveness of
programs. It also helps to ensure that U.S. assistance is aligned with
national priorities and supports country ownership. In addition, where
feasible, we work together with other partners with mutually
reinforcing goals, to reduce the number of separate, duplicative
missions and diagnostic reviews, while building a community of best
practice and joint training.

Question #15. On the issue of Somalia, the Transitional Federal
Government (TFG) has demonstrated a lack of capacity to expand its
institutional presence beyond Mogadishu.

How can we reach the governments and district
administrations in Somaliland and Puntland given the severe
restrictions on U.S. diplomatic personnel?

Answer. Under the Dual Track approach to Somalia announced in
September 2010, the United States will broaden our approach by taking
into account the complex nature of Somali society and politics. On
Track One, we continue support for the Djibouti Peace Process, the
Transitional Federal Government (TFG), and the African Union Mission in
Somalia (AMISOM) as a first line of effort to stabilize Somalia, as
well as to blunt al-Shabaab's efforts in Mogadishu. On Track Two, we
are deepening our engagement with the regional Governments of
Somaliland and Puntland, as well as with local and regional
administrations throughout southcentral Somalia who are opposed to al-
Shabaab, but who are not affiliated with the TFG.
State Department and USAID officials have made three brief trips to
Hargeisa since August 2010. While the United States must work to
overcome strategic disadvantages inherent in the absence of a sustained
diplomatic presence inside Somalia, our absence from Somalia is driven
by concerns for the safety and security of U.S. personnel as dictated
by local conditions. Nevertheless, we plan to provide Somaliland and
TFG police with Anti-Terrorism Assistance training before the end of
the calendar year and support several community-based income
generation, vocational training, and healthcare projects in northern
Somalia and in southern and central Somalia.
USAID has been engaged for several years with the Somaliland and
Puntland central administrations in a range of governance activities,
including parliamentary reform and elections administration. Moreover,
the majority of USAID's programs in Somalia target these two regions.
USAID implements extensive youth outreach, vocational training and
livelihoods programs, as well as teacher training and basic education
through an innovative radio-based program. We are further engaged in
conflict mitigation through assistance to local community groups for
dialogue and mediation (with a particular emphasis on women and youth).
For several years, we have supported the multi-donor Joint Program on
Local Governance operated by the United Nations Development Program
nationwide. In addition, USAID has launched two new development
programs in early 2011that will be primarily implemented in Somaliland
and Puntland.
In April of this year, as part of the ongoing political process and
continued efforts to encourage greater reconciliation and stability in
Somalia, we worked with U.N. and AU partners to convene a High Level
Consultative meeting in Nairobi. This meeting brought together
representatives from several administrations and Somali political
entities, including the Transitional Federal Parliament, Puntland,
Ahlu-Suna Wal Jama (ASWJ), and regional administration representatives
from Galmuduug, for dialogue on the political way forward in Somalia.
Long-term efforts on Somalia will continue to focus on security,
governance, humanitarian, and development assistance as we deepen our
engagement outside of Mogadishu and, security permitting, find it
possible to operate from inside Somalia on a more regular basis. As
security permits, we will seek to expand possibilities for U.S.
personnel to travel into Somalia, including Mogadishu, Boosaaso, and
Gaalkacyo, in order to more easily and effectively identify and
establish working relationships with key players on the ground.

Question #16. African Union: The FY12 budget request includes a
$500,000 decrease in funding for the African Union (AU). The AU
continues to play a significant strategic role in conflicts across the
region, including the Sudan, Cote d'Ivoire, and Libya. Please discuss
the decision to decrease funding to the AU and how the administration
anticipates the AU will move to absorb the funding reduction.

Answer. Funding for the African Union in FY12 was determined in the
context of the overall spending levels established in the budget for
sub-Saharan Africa. Having fewer resources available for foreign
assistance meant that we had to make difficult choices for programs
worldwide. Our appropriated funds for the African Union are provided to
support election monitoring and other democracy and governance
programming under the Governing Justly and Democratically objective.
The United States has been a major donor to the African Union's
Democracy and Electoral Assistance Unit for several years. We believe
that the funding levels requested by the Administration are sufficient
to achieve U.S. objectives during FY12.

Question #17. ELECTIONS: The administration has declared democracy
and governance programs its top noninitiative priority in Africa, but
the budget request proposes decreasing funding to transitioning
governments in Niger and Guinea. There are 27 African countries which
are holding, or have already held, elections in 2011, including
Nigeria, Rwanda, South Sudan, Uganda, and the DRC. How does State
intend to maximize the impact of limited funding for democracy and
governance, and how will the decreased funding affect programming in
countries such as Niger and Guinea?

Answer. We are pleased that our assistance has helped build
electoral systems and to consolidate democratic gains in key democratic
countries in Africa including Mali, Benin, Guinea, Niger, Ghana, Sierra
Leone, South Sudan, and Liberia.
Going forward, we plan to amplify and further refine our electoral
assistance activities in Africa. We will continue to work closely with
African governments and civil societies to strengthen the
infrastructure for credible elections not only at the national but also
at the provincial and local government levels? Accountability at the
local level is often the key to public confidence in democracy. In
addition to election observation, we will focus on increasing societal
demand for credible elections. In that context, we to expand work with
local civil society groups to assist in their advocacy for election
reforms and to enable them to carry out their own domestic monitoring
of elections. We have seen that support for voter education and
election commissions in the few months prior to elections is
insufficient to build the strong democratic states needed in Africa.
Rather, we must more be more creative and efficient in accomplishing a
consistent, holistic approach on this issue.
USAID recently mobilized assessment teams to Guinea and Niger to
survey the post-transition landscape and develop recommendations for
democracy and governance programming. These recommendations are
informing our budget discussions, including on necessary steps to adapt
to constrained budgets and design programs that will strengthen
democratic institutions and assist civil society in both countries.

Question #18. According to recent reports, the police have
arbitrarily arrested dozens of protesters, journalists, and community
leaders in Swaziland. Please explain what the State Department is doing
to respond to this issue.

Answer. During the April 12-13 demonstrations, police detained
leaders of labor unions, political activists, journalists, and members
of civil society, largely in order to halt the protest, deemed
``illegal'' by Prime Minister Barnabas Sibusiso Dlamini. Police
released all individuals detained during the protests. In the days
following the demonstrations, police arrested and charged two people
for offenses related to the possession of explosive devices.
On April 12, Embassy Mbabane released a widely distributed press
statement calling on the Swazi Government to uphold the freedom of
association and expression as guaranteed by the Swazi Constitution and
expressed our concern over the detentions. U.S. Ambassador to Swaziland
Earl Irving contacted the Foreign Minister and met with the Prime
Minister, Commerce Minister, and representatives from the Ministry of
Labor to express U.S. Government concerns over violations of the
freedom of association, speech, and universally recognized human
rights. Embassy Mbabane continues to meet with host government
officials regarding these issues.
Many of the activists detained by police participate in Embassy
Mbabane's human rights working group, which meets monthly. This working
group initiative aims to provide union leaders, political party
members, government representatives, academics, and members of civil
society with an impartial forum to discuss human rights challenges in
Swaziland.
______

Responses of Ambassador Eric P. Goosby to Questions Submitted
by Senator Christopher A. Coons

Question. SHARED RESPONSIBILITY: How does the U.S. commitment to
preventing and treating HIV/AIDS compare to other international donors?
Describe the model of ``shared responsibility'' used by the Global
Fund, whereby the U.S. commitment may represent no more than one-third
of the total funding, and each dollar we spend is matched by more than
$2 from international donors.

Is this model working well and can we emulate it elsewhere
in global health programs and aid to Africa in general?
How have other donor countries adjusted their contributions
to the Global Fund as a result of the global economic crisis?

Answer. The U.S. Government (USG) commitment to HIV/AIDS is the
largest international health initiative any country has ever focused on
a single disease. The USG commitment on HIV/AIDS far outpaces that of
any other country, with the USG providing an estimated 58 percent of
donor resources for global HIV/AIDS. There is a strong need for other
donors to increase their commitment as the USG has done, and the Global
Fund is the key vehicle for them to do so.
Overall, the USG believes the Global Fund model is an effective
mechanism for mobilizing resources from a diverse array of public and
private donors and leveraging USG investments in combating HIV/AIDS,
TB, and malaria to support country-owned responses to the three
diseases. The Global Fund is the world's largest multilateral financing
mechanism for global health, and has a strong track record in saving
and improving lives.
The Global Fund is a key vehicle for promoting shared
responsibility for global health efforts and has successfully attracted
contributions of $19.1 billion from public and private donors,
including more than $5.1 billion from the USG. The USG's financial
contributions and political commitment to the Global Fund, along with
the congressional requirement that the USG can provide no more than 33
percent of all contributions to the Global Fund, have played a vital
role in mobilizing financial contributions from other donors.
Importantly, the Global Fund provides a mechanism through which
countries and organizations that do not have the ability or in-country
presence to support major bilateral health programs can contribute in a
meaningful way to the fight against the three diseases. Since the
inception of the Fund, non-G8 donors have contributed $5.4 billion to
the Global Fund, or 29 percent of all contributions. In addition to
mobilizing donor resources, the Global Fund is actively seeking to
ensure the additionality of its investments, including through
strengthened cofinancing requirements that require recipient countries
to contribute.
The Global Fund has proven an effective mechanism for promoting
shared responsibility and supporting country-owned health responses. A
critical element of the Global Fund's success is its focus on results.
The Global Fund's ability to mobilize international resources depends
heavily on its ability to demonstrate clearly the results achieved
through its grants in terms of services delivered and lives saved. The
Fund's track record of success has enabled it to generate continued
international support despite the global economic crisis.
At the Third Voluntary Replenishment Meeting in October 2010,
donors pledged $11.7 billion to the Global Fund over 2011-13, including
a pledge from the USG to seek $4 billion. The USG pledge was tied to a
Call for Action for reform to improve the efficient and strategic
disbursement of resources and to maximize the impact of Global Fund
resources. In total, the pledges represent the largest ever financial
pledge for the international effort to fight the three pandemics.
Several donors decreased their pledges and/or contributions to the
Global Fund based on their domestic budget environments, including
Italy and Ireland, but overall, international commitment to the Global
Fund remains strong. This is a significant achievement, especially in
light of the economic climate.

Question. COUNTRY OWNERSHIP: One of the focuses of PEPFAR is
``country ownership,'' or partnering with NGOs to build the
institutions, infrastructure, and health systems so countries may run
the programs themselves.

Describe the challenges of pursuing a ``country ownership''
model of bilateral assistance, especially in countries that are
not financially strong enough to assume control.
What steps can be taken to advance efforts to build African
countries' capacity to sustain U.S. health programs in the near
and long term?

Answer. A central focus of PEPFAR's strategy is promotion of
country-led sustainable programs. Strong government leadership of the
health system is integral to long-term success, and health systems are
strongest where governments have leadership and technical skills to
address health system weaknesses. Civil society at the country level
also plays an important role in providing feedback on service delivery.
PEPFAR's NGO partners are playing key roles in building country-level
capacity, both in governments and in civil society, to respond to the
epidemic. Unfortunately, in many countries both government health
systems and civil society are extremely fragile, and underresourced in
human resources and infrastructure.
We have defined country ownership around the themes of political
ownership and stewardship, intuitional ownership, capabilities and
mutual accountability, in order to promote a common understanding with
our partners. We have seen some early wins using the partnership
framework process around country ownership. There are nonetheless
challenges already identified in resource constrained countries such as
Tanzania, Mozambique, and Malawi where the economic growth rate is
still nascent and it may be years before some recipients of bilateral
U.S. assistance can directly fund the majority of programs. It will
also be a challenge to maintain commitments made to finance health
programs in environments where there is political instability.
Significant challenges to capacity-building include --lack of budget or
operational planning; limited infrastructure for service delivery;
inadequate skills for programmatic oversight. However, we are taking
deliberate steps to direct country teams to inventory required
capabilities, and prioritize the interventions that will help partner
countries overcome these obstacles.
As encouraged by Congress in its reauthorization, PEPFAR is
promoting steps
to build country-capacity through Partnership Framework agreements.
Each is a
5-year joint strategic framework for cooperation between the USG, the
partner government, and other partners to combat HIV/AIDS in the host
country through service delivery, policy reform, and coordinated
financial commitments. Frameworks have provided the basis for
discussions with governments on long-term planning and alignment
between PEPFAR and national strategies. They provide the mechanism for
dialogue around investments in capacity by both the partner-country
government and PEPFAR, which both have roles to play.
Through the Partnership Framework mechanism, we have seen many
countries taking ownership of their health programs. Financing is not
the only element in country ownership, but it is part of the discussion
in each country, based on the available resources in the country. For
example, as part of the Partnership Framework on HIV/AIDS between
Nigeria and the USG, the Government of Nigeria is committed to being
the leader and steward of its efforts to fight HIV/AIDS. This includes
increasing its financing from 7 percent of the national HIV/AIDS
response in 2008 to 50 percent of the cost by 2015. To date, 19
countries and two regional programs have signed Partnership Frameworks.
To cite an example of PEPFAR's efforts to build African countries'
capacity to sustain U.S. health programs in the near and long term,
PEPFAR recently launched the Medical Education Partnership Initiative
(MEPI), which seeks to transform medical education and dramatically
increase the quality and quantity of health care workers in Africa. In
partnership with the National Institutes of Health's (NIH) Fogarty
Center and the Department of Health and Human Services (HHS) through
Health Resources and Services Administration (HRSA), PEPFAR is making
direct grants to African institutions, which are leading a network of
U.S. medical schools, regional partners, and country health and
education ministries.
Through PEPFAR, the United States will provide about $130 million
in MEPI grants that are awarded directly to African institutions,
including two in South Africa. By providing grants directly to African
institutions and supporting their partnerships with U.S. and
international medical schools and universities, we support their
leadership in developing programs that will train and retain future
health care leaders, and tailoring education to meet the needs of the
populations they serve. In some cases, the opportunities for medical
faculty to continue their professional development and engage in
research are powerful incentives to remain in their countries and
promote excellence in medical education and practice.
In addition, PEPFAR has partnered with HHS/HRSA on a Nursing
Educational Partnership Initiative (NEPI) with similar goals and
objectives as MEPI, except with a focus on nurses and midwives. The
NEPI is a $35 million award over 5 years awarded to countries, as
opposed to academic institutions, and managed by a Ministry of Health
workgroup established to represent the key nursing and midwife
educators, providers, and policymakers in the country. To date, there
are three NEPI countries--Lesotho, Zambia, and Malawi.

Question. BLOOD SAFETY: I understand that some PEPFAR funding for
blood safety programs ended in March 2010. What measures are being
taken by PEPFAR to ensure blood safety, and what progress has been made
to help countries oversee the viability and safety of their blood
supply? How does this factor into your FY12 budget request?

Answer. The President's Emergency Plan for AIDS Relief (PEPFAR)
agrees that adequate supplies of safe blood in resource-challenged
countries are important components of comprehensive HIV prevention
programming. Our blood safety work is a strong example of our efforts
to promote country ownership of HIV/AIDS responses. We are partnering
with countries to build their capacity to ensure a safe blood supply,
with valuable technical assistance from technical partners. This
capacity-building not only helps countries' HIV responses, but their
efforts to address other diseases as well. Since its launch in 2004,
PEPFAR has directly provided direct support to 14 Ministries of Health
or National Blood Transfusion Services (NBTS), including 12 in sub-
Saharan Africa, with the goal of eliminating transfusion-transmitted
HIV infections. All 14 countries achieved universal screening for HIV
at these NBTS centers; 13 countries achieved universal screening for
hepatitis B, hepatitis C, and syphilis. The United States will continue
to support blood safety activities through both PEPFAR and the broader
Global Health Initiative (GHI).
The Centers for Disease Control and Prevention (CDC) awarded a
PEPFAR Blood Safety Technical Assistance task order contract in
September 2010 as a key strategy for building blood safety capacity.
Task orders are established at the request of U.S. country teams to
meet their country's specific needs. Multiple meetings and exchanges
with Ministries of Health (MOH) and National Blood Transfusion Services
(NBTS) are needed prior to submitting a task order request to identify
needs and assure that PEPFAR programming is complementary to the
country's own efforts. In addition, assessment and prioritization of
identified blood safety needs are required. These activities took a
number of months to complete and resulted in the identification of 22
different task orders. Funding for blood safety activities was released
via PEPFAR's Congressional Notification in March 2011, and all 22 task
order requests are expected to be awarded in the near future.

Question. STRETCHING FUNDS: In this difficult budgetary
environment, how are you stretching each dollar through smart
investments to ensure taxpayer dollars are going toward programs that
have proven to save lives in terms of treatment and prevention?

Answer. Accountability to Congress and the American people is the
chief priority of the Global Health Initiative, regardless of the
budgetary environment. But in these difficult times, it is especially
important to ensure that taxpayer dollars are used efficiently and
effectively to meet the ambitious targets we have set and save lives.
Despite challenging economic times, we have achieved impressive
life-saving results by stretching every dollar through smart
investments. Allocating resources based on impact and efficacy;
incorporating innovations that promote efficiency; and increasing
collaboration with governments and stakeholders to align programs and
target investments are critical components of our effort to do more
with less. We have also looked inward, reducing costs by streamlining
U.S. Government operations and pursuing the best available, all-
inclusive commodity pricing. Through all of these smart investments, we
are supporting countries as they try to build an effective, durable
continuum of care that meets the needs of their people. The more
impactful and efficient our investments, the greater the developing
country's ability to create a sustainable response.
Coordination across the whole of government is also critical in
creating cost saving efficiencies that allow us to make life-saving
investments. Coordination means, at a minimum, that programming within
and among U.S. agencies takes advantage of each agency's strengths,
avoids duplication, and increases the efficiency and effectiveness of
each dollar spent. Better coordination of programs and delivery
platforms provides opportunities to strengthen the integration of
health services at the point of delivery to meet more of the health
care needs of individuals, as well as ensure satisfaction with, and
increase demand for, those services. For example, in Mali five separate
annual campaigns designed to provide nutrition and NTD treatments were
integrated into one, streamlined pilot program. The pilot actually
boosted health coverage while cutting the cost of delivery in half.
This single campaign approach is being brought to scale, with hopes of
expanding it to cover 80 percent of pregnant women and children under
5. This will help ensure that more people have access to high-quality
care everywhere we work.
We are grateful for the continued support of Congress in the
implementation of this critical work. By making smart investments with
taxpayer dollars, we will save more lives. This is and will remain the
first priority of the Global Health Initiative.

Question. GLOBAL FUND: As a board member of the Global Fund to
Fight AIDS, Tuberculosis, and Malaria, how have you responded to the
reported misuse of funds in 4 of 145 grant countries, and what steps
have been taken to enhance oversight, transparency, and auditing of the
Global Fund?

Answer. The USG has zero tolerance for fraud and corruption, and we
are working aggressively with and through the Global Fund Board,
Secretariat, and our bilateral programs to strengthen internal
oversight systems, increase country-level capacity to comply with
Global Fund requirements, and ensure resources reach those in need and
are used effectively to save and improve lives.
The United States has been a leader in calling for reform of the
Global Fund. In October 2010, we called upon the Board to develop an
action agenda that includes clear timelines and measures progress so
all parties can be held accountable for the strong action steps that
must be taken to improve the impact of grants and ensure the effective,
efficient, and accountable use of resources. The Board embraced this
call to action and created a Working Group, led by the Board Chair and
including a USG representative, to recommend action steps to improve
Fund procedures relating to performance and impact. Through this reform
process we have called upon the Fund to take clear steps to: strengthen
fiduciary controls; strengthen grant management; deliver better value
for money in grants; and improve governance. We believe the package of
reforms being presented to the Board for consideration and approval in
May 2011 will result in significant improvements in Global Fund
operations, oversight, and impact.
The USG is also deeply engaged in supporting country-level
oversight of Global Fund grant management and implementation through
technical assistance and engagement with Country Coordinating
Mechanisms. The USG strongly supports the Fund's Office of the
Inspector General and its efforts to prevent fraud and misuse of funds,
identify them when they occur, and take immediate steps in coordination
with the Secretariat and relevant national authorities to recover
funds, prosecute individuals implicated, and strengthen national
systems in order to prevent them from recurring. The USG pushed for the
creation of the OIG in 2005, links our contributions to the Global Fund
to its maintenance of an independent OIG, and has consistently
supported its work and advocated for transparent followup on its
findings. In 2008, the USG pushed the Global Fund Board to adopt a
policy reiterating its zero-tolerance policy for corruption and
prohibiting the approval of new grants in countries under OIG
investigation. In 2010, the USG again supported significantly increased
funding and staff for the OIG and urged greater attention to OIG
findings and accelerated followup on OIG recommendations. Finally, we
have called upon the Fund to strengthen its day-to-day working
relationship with the OIG, implement recommendations made by the OIG,
expand the capacity of Country Coordinating Mechanisms to monitor grant
performance, improve the oversight capabilities of Local Fund Agents,
and track reporting data more effectively. We have also strongly
supported the establishment of an independent High Level Panel on
Fiduciary Controls, cochaired by former Governor Leavitt and former
President Mogae (Botswana), which has been tasked with reviewing the
Global Fund's fiduciary controls and oversight mechanisms. We look
forward to the Panel's report and recommendations, which will be
presented to the Global Fund Board later this year.

Question. MOTHERS AND GIRLS: Describe PEPFAR's focus on preventing
mother-to-child transmission and other programs for mothers and girls,
including in countries afflicted with gender-based violence, such as
the DRC.

Answer. Prevention of mother-to-child transmission (PMTCT) is a
significant cause of new HIV infections worldwide--causing one in every
seven new infections. Yet PMTCT interventions are extraordinarily
effective. Because it works so well and touches so many lives, PMTCT is
a smart investment for PEPFAR--high-impact and cost-effective. In FY
2010 alone:

PEPFAR is leading the global effort on PMTCT and working to ensure
that every partner country with a generalized epidemic achieves 80
percent coverage of testing for pregnant women at the national level,
and 85 percent coverage of antiretroviral drug prophylaxis and
treatment, as indicated, of women found to be HIV-infected.
In 2010, PEPFAR also established ``PMTCT Acceleration Plans'' for
six countries with high burdens of vertical transmission. PMTCT
Acceleration Plans provided $100 million in additional FY 2010 PEPFAR
funding--above the more than $956 million spent on PMTCT from FY 2004-
09--to fund plans targeting bottlenecks to expanding services. Based on
the encouraging early results of this effort, PEPFAR has continued this
funding in FY 2011.
In addition to significantly reducing mother-to-child transmission,
PMTCT efforts have benefits for overall health care for women. Linking
HIV testing with antenatal care helps to identify women who are in need
of HIV care, and whose infants will need additional followup.
Counseling and testing can also help women who are HIV-negative remain
HIV-free. PEPFAR is also starting to scale up screening for gender-
based violence (GBV) in PMTCT clinics it funds, as well as providing
linkages and referrals to other key services, such as family planning,
malaria prevention, and clinical services for under-5. The availability
of these additional services provides an incentive for women to seek
antenatal care. In Kenya, Uganda, South Africa and other countries,
strong linkages among PMTCT, maternal and child health and other
programs dramatically increased program coverage, allowing programs to
focus on the needs of each woman and family in a more holistic way.
Beyond PMTCT, PEPFAR also helps women and girls lead healthier
lives through integrated programming that addresses their unique needs.
Gender sensitive programming is a priority across the entire
prevention, treatment, and care portfolio. This includes:

Increasing gender equity in HIV/AIDS programs and services;
Reducing violence and coercion;
Engaging men and boys to address norms and behaviors;
Increasing women's and girls' legal protection;
Increasing women's and girls' access to income and
productive resources, including education.

PEPFAR is also committed to preventing and mitigating the effects
of Gender-Based Violence (GBV). PEPFAR supports significant work in the
field to mainstream GBV into existing HIV programs. In FY 2010 PEPFAR
provided an estimated $68 million in bilateral support for activities
addressing GBV in more than 28 countries. Through the Gender Challenge
Fund, PEPFAR makes additional resources available to country programs
on a matching basis. To date, 15 countries have received additional
resources through the Gender Challenge Fund. Current activities funded
through the Gender Challenge Fund include expanding the response to GBV
in Haiti, enhancing PMTCT projects to address barriers and involve men
in Uganda, and raising awareness of new laws to protect women in
Swaziland.
In addition, PEPFAR is now investing in an intensified scale-up of
the response to GBV in three countries--the DRC, Tanzania, and
Mozambique. These programs seek both to prevent GBV and to respond to
it, ensuring that women and girls targeted with violence have access to
appropriate services. Within the DRC, for example, activities focus on
expanding access to post-rape care for victims of sexual assault,
including developing national guidelines for this care; mobilizing
communities to resist GBV; a national level communication campaign to
increase awareness of GBV, especially as it relates to HIV; and
specific programming addressing norms and behaviors, GBV and coercion,
and women's legal rights and protection related to HIV risk reduction.
By addressing sexual and other forms of gender violence, PEPFAR is
working to strengthen communities and reduce the structural factors
that place women and girls at greater risk for HIV/AIDS.

Question. The FY12 budget request includes increases for nutrition
and maternal and child health programs. How does the administration
plan to maximize the impact of these funds in the coming year? What
prompted the increased focus on these concerns?

Answer. Nutrition and Maternal and Child Health (MCH) are key
components of the Obama administration's international development
objectives. Nutrition lies at the intersection of Feed the Future and
Global Health Initiatives, since achieving improved nutrition outcomes
requires adequate health and sanitation services, as well as access to
and the availability and utilization of nutritious foods. Maternal and
child health programs, from maternity and newborn care to immunizations
and the treatment of life-threatening childhood illnesses, save lives
and provide direct investments in the human capital of populations in
great need.
Under the Global Health Initiative we are strategically integrating
our program support for women and families including in family
planning, maternal and child health, and nutrition programs. Country
teams in the 28 priority countries are developing strategic action
plans that we call ``BEST''--BEST Practices at scale in home,
community, and facilities for smart integration that draw on latest
evidence and best practices. Through these plans, USAID is sharing
learning, increasing transparency, enhancing monitoring and evaluation
and promoting innovation to accelerate use of new technologies and
approaches to bring life-saving care to women.
The administration will maximize the impact of funding by
continuing to implement programs that adhere to the principles of
effective development, as outlined in President Obama's Global
Development Policy. Feed the Future and the Global Health Initiative
will draw upon interagency cooperation that leverages expertise and
experience across the U.S. Government-including USAID, the Department
of State, the Department of Agriculture, the Department of Health and
Human Services, Peace Corps, and others--to ensure the application of
all relevant knowledge to achieve the best possible outcomes.
Initiative efforts will be targeted toward countries and sectors where
U.S. support has the greatest comparative advantage, allowing us to
scale up and focus resources for maximum effectiveness. Furthermore, we
will emphasize the importance of country leadership and accountability
by aligning our investments to plans and priorities identified by the
countries themselves. We will further expand our impact by leveraging
the resources of multilateral institutions and supporting global
efforts, such as the Scaling Up Nutrition movement and the U.N.
Secretary General's Global Strategy for Women's and Children's Health.
We will pursue innovative research programs to develop and disseminate
new knowledge and technologies, such as introduction of new vaccines
and more nutritious crop varieties, and draw upon public-private
partnerships like the ``Helping Babies Breathe'' initiative for
additional resources and expertise. Last, we will hold ourselves
accountable through a rigorous program of monitoring and evaluation
that will allow us to assess our impact, improve results, and develop
best practices for future efforts.
The administration's increased focus on nutrition and maternal and
child health stems from its recognition that healthy and well-nourished
populations form a foundation for successful economic development and
poverty alleviation. The loss of productive lives of women who die or
are incapacitated as a result of unsafe childbirth, and of young
children who die or whose physical and mental capacity is permanently
reduced from preventable and treatable illness and malnutrition, are
among the greatest losses of human capacity in developing countries.
Experts and economists have recently pointed to improved nutrition as
one of the most effective solutions to the world's most pressing
challenges. Moreover, scientific evidence has highlighted the critical
importance of proper nutrition during the window of time between the
start of a mother's pregnancy and a child's second birthday. Inadequate
nutrition in this period of approximately 1,000 days can have
detrimental and irreversible effects on a child's physical and
cognitive development, with repercussions throughout life that impact
an entire society.
Fortunately, proven and cost-effective solutions exist, and U.S.
maternal and child health and nutrition investments will focus on
scaling up such solutions. The 2007-08 food price crisis and the recent
global economic crisis led to an increase in poverty and hunger for
millions of people, as well as continued concerns about the impact of
rising food prices and the limited availability of health care on the
most vulnerable. These experiences illustrate the great need for
increased resources devoted to improving maternal and child health and
nutrition and food security more broadly.
______

Responses of MCC Vice President Patrick Fine to Questions Submitted
by Senator Christopher A. Coons

FOREIGN AID

Question. Why are the requested levels of funding worth the
investment for the U.S. taxpayer, and what metrics do you use to
measure aid impact and effectiveness?

Answer. Recent U.S. national security strategies, both under
Presidents Bush and Obama, have identified U.S. support for global
development, especially sustained economic growth, as essential for
U.S. national security, global leadership, and guiding values. MCC
understands that U.S. resources for development are scarce. For this
reason, MCC's model is designed to meet the high expectations of U.S.
taxpayers and partner countries themselves--that resources be used
well, and that they yield good and measurable returns in terms of
poverty reduction and growth.
MCC has a singular focus with partner countries: to promote poverty
reduction through economic growth, as evidenced through increased
incomes of program beneficiaries. This approach demands metrics and
approaches that are designed for
long-term investments and that enable MCC and country partners to set
clear priorities, measure cost-effectiveness, estimate returns, track
progress, and rigorously measure impact. MCC's approach to impact and
effectiveness centers around five key questions.

Question. 1. Which investments proposed to MCC will best support
economic growth and poverty reduction?

Answer. Most poor countries have many development needs, and
stakeholders, both local and international, often struggle with setting
priorities. There are also many needs that reflect objectives other
than economic growth. To identify cost-effective investments in long-
term economic growth from among this range of needs, MCC and partner
countries begin the compact development process with quantitative
analyses to identify the main barriers to investment and growth. Once
countries propose projects within these priority areas, MCC uses
economic analysis to estimate the increase in local incomes these
proposals will generate. These analyses allow MCC and partner countries
to set priorities, and identify the implementation targets that are the
drivers of expected incomes gains that will accrue largely after
compact completion.

Question. 2. Who will the investments benefit, and by how much?

Answer. MCC and country partners use beneficiary analysis to assess
how the total income gains of proposed projects will be distributed
across different income groups.

Question. 3. How do we know investments are on track to be
successfully implemented?

Answer. MCC and partner countries use monitoring and evaluation
(M&E) plans to track program performance against targets. These M&E
plans track progress from the earliest phases of implementation through
to completion. For example, the M&E plan for a farmer training program
would link early inputs (farmer training) to outputs (number of farmers
trained) to outcomes toward the end of a compact (number of farmers
actually adopting new farming practices and hectares of land under
improved production), and finally to the projected impact that will
accrue during the years following program completion (higher local
incomes). M&E plans also track progress against key policy and
institutional reforms that are integrated into compact programs to
enhance impact and sustainability. When program designs change due to
new information on costs or implementation experience, MCC and MCA
partners use M&E plans and underlying economic analysis to revise
targets, and assess implications for expected income gains and
beneficiary numbers.

Question. 4. Did investments achieve the projected impact?

Answer. Many factors can influence changes in income, so MCC uses
independent evaluations to provide rigorous assessments of the cost-
effectiveness of MCC investments. For example, an agriculture program
might report income increases among the farmers who received training,
but we would not know if these gains were caused by the program or by
some other factor, such as ample rains or changes in agricultural
prices that benefited all farmers. By measuring changes in incomes for
both program farmers and farmers who received no training but were
otherwise subject to the same influences, an impact evaluation can
determine whether gains are attributable to the program itself.

Question. 5. What did we learn to help us improve our investments
and better achieve our goals?

Answer. M&E reports and independent evaluations help us understand
what works best, enhance ongoing implementation, and inform future
project design. By making this information public, MCC contributes to
the learning of the broader development community.

CR CUTS

Question. How will proposed budget cuts in the continuing
resolution, or CR, impact the administration's ability to implement its
policy agenda and priorities in Africa this fiscal year?

Answer. Since I testified before your committee, the Continuing
Resolution has been signed into law, and contains $210 million in cuts
below the FY 2010 enacted level, which provided MCC with $1.1 billion.
MCC is beginning to consider the series of very hard choices that we
will have to make. Cuts of this magnitude will impact Indonesia,
Zambia, and Cape Verde.

INTERAGENCY

Question. Describe levels of interagency coordination in developing
the budget request for Africa.

Answer. MCC is an active partner in the U.S. interagency process,
including serving as colead for the Partnership for Growth initiative.
At the country level, where programming occurs, MCC participates in the
Embassy country team. We have been pleased with the level of
collaboration in countries across our portfolio and on special
initiatives such as Feed the Future.

Question. To what degree have you embraced a whole of government
approach when implementing an Africa strategy?

Answer. MCC works with other U.S. Government agencies across a wide
range of areas in Africa. For example, MCC and USAID are actively
working to identify areas for collaboration in food security. In Mali,
USAID is planning on complementing MCC's investments in land titling by
supporting a legal framework to resolve land conflicts. In Senegal, MCC
and USAID have identified opportunities for USAID programs in social
services, farmer training and rural infrastructure to complement MCC's
investments in road and irrigation networks. MCC and Peace Corps signed
an agreement in September 2010 to enhance cooperation and share
knowledge and resources in support of country-led development; this
MCC/Peace Corps coordination is expected to be strongest in Africa. For
example, in Lesotho, a Peace Corps Volunteer has been assigned to the
partner government entity managing the MCC compact and is helping to
implement a water supply and sanitation project. MCC is also working in
Ghana and Tanzania with the Department of State, USAID, and other U.S.
Government Agencies on a new Partnership for Growth, a whole-of-
government effort intended to accelerate growth and remove key
obstacles to investment in a small number of select countries.

CHINA

Question. Describe the extent and nature of China's influence in
sub-Saharan Africa, and the degree to which it impacts America's role
in the region.

Are there areas of cooperation we have not fully explored
with China that may allow us to better meet shared regional
goals?
What steps are we taking to mitigate areas of tension with
China in Africa?
How are U.S. businesses faring in Africa given the economic
competition with China?

Answer. MCC looks to the U.S. State and Treasury Departments,
coleads of the U.S. strategic economic dialogue with China, to frame
and pursue U.S. engagement opportunities with China and steps to
mitigate areas of tension with China in Africa.

CAPE VERDE

Question. What are the benefits and costs of a second compact with
Cape Verde, and to what degree has it served as a regional model--
originally qualifying as a low-income country, and later graduating to
the ``lower-middle'' income category?

Answer. Cape Verde was selected by the MCC Board as eligible for a
second compact in December 2009. MCC has made it clear to all current
partner countries that eligibility for a second compact is not
automatic, and depends on policy performance as well as strong compact
implementation performance.
Cape Verde's performance on MCC's eligibility indicators has been
impressive. The country is the top performer for all lower and lower-
middle-income countries in Africa on control of corruption. To become
eligible for a second compact following a graduation from lower to
lower-middle-income status, Cape Verde aggressively took on necessary
policy reforms, such as reducing the time to start a business from 52
days to as little as 1 hour.
Despite their policy progress, Cape Verde still has 40 percent of
its population living on less than $2/day.
Cape Verde achieved significant results under the first compact. I
met the beneficiaries of MCC investments in Cape Verde last year,
discussed the training and technologies that will allow farmers to
prosper by transitioning to higher value crops, and I visited the
roads, bridges, and modernized port that are spurring growth in
commerce. All civil works were completed on time, and important policy
reforms were achieved under the compact, including a new microfinance
law, launching the first private credit bureau in the country, and
lifting a 20-year embargo on agricultural produce exports from the
country's most agriculturally productive island.
The benefits of a second compact with Cape Verde are clear. First,
Cape Verde's performance on the first compact demonstrated that it is a
good partner with the United States and is committed to effectively
employing foreign assistance funding. Second, Cape Verde serves as an
example of an aggressive reformer committed to enacting and
implementing the policies needed for growth. By investing in Cape Verde
through a second compact, the United States will signal that it is also
committed to backing countries that are pursuing smart, growth-oriented
policies.

SECOND COMPACTS

Question. How do you determine the criteria for qualifying for a
second compact, especially in light of budgetary constraints? What is
the justification for opting to engage with the same country in a
second compact as opposed to creating new opportunities in other
countries? Please also discuss the proposed second compact with Ghana
in 2012.

Answer. MCC's mandate is to partner with countries where
investments will have the greatest potential returns in terms of
poverty reduction and economic growth, and where U.S. taxpayer
resources can be used most effectively. In some cases, the greatest
opportunity for impact may be in deepening partnerships with existing
MCC partner countries.
Second compacts may present some of the best opportunities to
reinforce the key elements of the MCC model. By being very selective in
choosing second compact partners, MCC creates a strong incentive for
ongoing policy and implementation performance among country partners.
By building on lessons and experience in first compacts, second compact
provide good opportunities for innovation and new partnerships with
private sector and civil society. Continued engagement with a well-
performing country gives MCC the opportunity to help countries
establish a firm path toward growth and greater private sector
investment, and away from dependence on aid.
MCC does not have an inherent preference for working with new or
existing partners. The MCC Board of Directors makes decisions on which
countries are eligible for MCC assistance. The Board's determination of
eligible countries is based primarily on country performance on MCC
selection indicators. In determining country eligibility, the Board
also considers the opportunity to reduce poverty and generate economic
growth within a country and the availability of MCC funds.
In addition, for countries that are candidates for second compact
selection, the Board considers each country's performance implementing
its first compact. To assess first compact implementation performance,
the Board considers country performance in three general areas:

Progress toward achieving compact results, including
significant progress relative to the planned compact timeline
and on process and output indicators, the degree to which
compact programs are on track to reach compact targets, and the
level of commitment to monitoring and evaluation plans included
in the compact.
The nature of the country partnership with MCC, including
political will and capacity to implement compact programs, pro-
active management of implementation challenges, and achievement
of policy reforms associated with compact investments.
The degree to which the country has implemented the compact
in accordance with MCC's core policies and standards, including
in the areas of preventing fraud and corruption, procurement,
environmental impact, gender integration, monitoring and
evaluation, and legal provisions as defined in the compact
agreement and other supplemental documents.

MCC's Board is selective when determining eligibility for
subsequent compacts. Of the eight countries that will conclude compacts
by the end of 2011 (Armenia, Benin, Cape Verde, Honduras, Ghana,
Georgia, Nicaragua, and Vanuatu), MCC's Board has selected only three
as eligible for a second compact--Cape Verde in FY10 and Georgia and
Ghana in FY11.
MCC's engagement with partner countries is not open-ended. MCC
carefully considers the appropriate nature and duration of each country
partnership based on the country's policy and implementation
performance, as well as the opportunities to have an impact on growth
and poverty reduction. This includes consideration of the potential
sustainability of MCC's investments and of the country's ability to
attract and leverage public and private resources in support of
development. MCC's targeted, selective engagements are critical to
ending the cycle of aid dependency, ensuring sustainability, and
promoting country ownership.
Ghana is a very poor country, but one of Africa's best governed.
Ghana consistently performs well on the MCC indicator criteria. Its
continued track record of democratic governance is demonstrated by its
regular ranking among the top LIC performers in the ``Ruling Justly''
category.
Implementation of Ghana's Compact is on track to achieve its
objectives, and the investment is managed by a strong Ghanaian-led and
staffed team. The Ghana Compact has already generated tangible interest
from the private sector.
Ghana was selected as second compact eligible in December 2010, and
the compact development process began in 2011. The first step in the
compact development process is for the Government of Ghana, with
support from MCC, to conduct an analysis of binding constraints to
growth. This analysis is still underway. Once the binding constraints
to growth are better understood, MCC and the Government of Ghana,
informed by a broad consultative process, will begin to set priorities
for the second MCC compact.

POVERTY REDUCTION

Question. One of the stated goals of the MCC is to reduce poverty.
How do you assess poverty reduction in Africa, and to what extent do
you believe your measurements--which include household surveys--serve
as a model which can be emulated by other U.S. Government agencies and
international institutions?

Answer. In most contexts, it is common practice to use income
levels that fall below some predetermined acceptable level to identify
poor households. In development contexts, the international lines of
$1.25 and $2 per day are generally accepted. We know that using such a
measure misses a lot of information, but household income levels
(usually measured using consumption expenditure information collected
through household surveys) represent the best single indicator of
household welfare levels.
Using this standard, recent experience in Africa is mixed, but
probably is a lot better than many casual observers might think. In
fact, 17 countries with a total population of more than 300 million
people saw their average real incomes rise by 50 percent between 1996
and 2008. In these countries, the share of the population living on
less than $1.25 per day fell from 59 percent in 1993 to 48 percent in
2005. Another six countries experienced slower growth in the 13-24
percent range. Much of this impressive performance reflects improved
democratic and economic governance.
Many of these countries are MCC partners, but it would be incorrect
for MCC to claim credit for their macroeconomic successes. Instead, we
need to look for investment-specific information that allows us to
differentiate between the broader gains that are being generated by
overall country performance and the increases in income that can be
attributed to MCC programs. Household surveys are often an important
source of such information, but in other cases, more targeted data
collection suffices. For example, for some road investments, data on
road quality (roughness) and traffic speeds and volume may provide an
adequate basis for assessing impacts on local incomes.
MCC's framework for results goes beyond surveys. The main elements,
and those worth considering for broader use, include: (i) ex ante
projections of results using benefit-cost analysis; (ii) monitoring of
performance during implementation against targets; and (iii) rigorous
independent impact evaluations, which include surveys both before and
after, and also often include designs that allow the evaluator to
attribute gains to the specific intervention. Although it may not be
cost-effective to require each government expenditure to be assessed
using such a framework, MCC has found that the clear delineation of
program logic and expected returns imposes a useful discipline around
investment decisions. This preparatory analysis, then, helps in
constructing a monitoring plan that ties program input and output
targets to the ultimate program objectives. The use of surveys and
independent research designs to document what was actually accomplished
satisfies MCC's strong commitment to transparency and accountability
and to becoming a learning institution.

INDICATORS

Question. Please discuss the range of inputs which inform MCC's
assessment of indicators, and the requirement that a country must score
above the median on performance indicators against other countries in
their income bracket. For low-income countries, therefore, the bar is
set quite low. Has the MCC considered changing its eligibility
requirements?

Answer. In keeping with MCC's commitment to aid effectiveness
through the regular evaluation of its own practices, MCC is undertaking
a comprehensive review of its selection process in 2011. At the time
the selection system was established, MCC's country scorecard
represented the most effective way to compile third-party data to
compare policy performance as objectively as possible across the broad
majority of low- and lower-middle-income countries. After using this
system for 7 years, MCC believes it is appropriate to undertake a
review to ensure that the system is remains the most effective
indicator system for evaluating and selecting countries for
eligibility. While the review may find that MCC should make no changes
to the selection system, it may, alternatively, identify recommended
adjustments.
MCC has, and will continue to use third-party indicators to
identify countries with policy environments that will allow Millennium
Challenge Account funding to be effective in reducing poverty and
promoting economic growth. MCC evaluates performance in three areas--
Ruling Justly, Investing in People, and Encouraging Economic Freedom--
using 17 independent, third-party policy indicators. MCC favors
indicators that:

Are developed by an independent third party;
Utilize an analytically rigorous methodology and objective,
high-quality data;
Are publicly available;
Have broad country-coverage;
Are comparable across countries;
Have a clear theoretical or empirical link to economic
growth and poverty reduction;
Are policy-linked, i.e., measure factors that governments
can influence; and
Have broad consistency in results from year to year.

While MCC may work with both low-income countries (LICs) and lower-
middle-income countries (LMICs), MCC is legislatively limited in the
amount of assistance that it can provide to LMICs (no more than 25
percent of the amount of assistance provided in a given year). LICs are
defined as countries with a GNI per capita of less than $1,905 in FY11.
There are 63 countries that fall into the LIC income classification in
FY11. Among those countries, MCC is committed to working with the
strongest performers, and the median system allows MCC to identify
those countries. For developing countries, with attendant capacity and
administrative challenges, the existing system is actually quite
difficult to pass because countries must perform above the median on at
least three indicators in each category, and must perform above the
median on control of corruption. Over the past 4 years, only four LICs
have passed every year (Tanzania, Lesotho, Bolivia, and Vietnam.)

MALAWI

Question. A new MCC compact with Malawi was signed last week
despite Malawi's recent enactment of new laws that tighten restrictions
on free speech and criminalize female homosexuality. I know that those
measures gave the MCC pause--given the brief suspension of the compact
by the MCC Board--but the decision was made to move forward. Please
explain the dialogue you had with the Government of Malawi before
signing the compact, and the degree to which it presented an
opportunity to engage African Governments on critical social issues.

Answer. In January 2011, the MCC Board of Directors approved a
$350.7 million compact to support the Government of Malawi's power
sector reform agenda, as well as to improve the availability,
reliability, and quality of Malawi's power supply by rehabilitating key
power generation and distribution assets and improving service to
electricity consumers. That compact was signed on April 7, 2011.
As you note, compact signing was delayed so that MCC could engage
in a direct policy dialogue with the Government of Malawi about recent
laws that could be used to restrict media freedoms and human rights
Specifically, MCC was concerned that two clauses could be used to
restrict media freedoms or individual human rights: a publications
clause (section 46), which addresses the authority of the government to
prohibit publications ``contrary to the public interest;'' and a human
rights clause (section 137A), which criminalizes female homosexual
conduct.
Following a constructive, high-level dialogue in Lilongwe, the
Malawian President and Cabinet published a statement to clarify that
the publications clause in the amendments was intended to prohibit
child-pornography or incitements to violence (not to restrict political
speech). The government publically affirmed the constitutional
protections of free speech, noting citizens' right to challenge the use
of this law in the courts.
With regard to the amendment criminalizing female homosexual
conduct, MCC has taken a clear public stand that such laws are
inconsistent with a country's human rights obligations, and with MCC's
own policy indicators. We have made clear to the Government of Malawi
that if Malawi criminally punishes any LGBT individuals under this law,
MCC would begin the investigations that represent a first step in MCC's
suspension/termination process.
I believe MCC's actions have helped prompt a level of dialogue
about human rights for LGBT populations in a country and a region where
such rights are not always protected. In the President Mutharika's own
speech at the compact signing, he described the imperative of
``uphold[ing] freedom of choice and freedom of religion, and freedom of
pursuit'' with regard to the transgender couple pardoned last June. To
our knowledge, this was the first time President Mutharika has
publically associated personal freedoms with LGBT issues.
The Malawi compact is an investment estimated to generate $3.1
billion in income benefits for close to 6 million Malawians. MCC is
watching closely to see that the Government of Malawi upholds its own
commitment to citizens' rights and freedoms. My agency has been very
frank about this, both with the Government of Malawi, and with MCC's
own stakeholders here in the United States.
______

Responses of Deputy Assistant Administrator Rajakumari Jandhyala to
Questions Submitted by Senator Christopher A. Coons

FOREIGN AID

Question #1. Why are the requested levels of funding worth the
investment for the U.S. taxpayer, and what metrics do you use to
measure aid impact and effectiveness?

Answer. The United States has significant political, economic, and
humanitarian interests in Africa. Disease and conflict know no borders,
and undeveloped markets limit the potential of global economic growth.
At the same time, we cannot turn our backs on those in need; the
American people demonstrated their overwhelming commitment to help
those in crisis through outpourings of donations after the earthquake
and tsunami in Japan, the earthquake in Haiti, and other recent
disasters. Assistance is an American value.
USAID's efforts focus on responding to crises, combating disease
and improving public health, helping to address transnational threats
and challenges, strengthening democratic institutions and protecting
the democratic gains of African countries, fostering broad-based and
sustainable economic growth, and preventing, mitigating, and resolving
armed conflict.
Since 1998, dozens of African countries have embraced democratic
rule. Today, 9 of Africa's 48 states are regarded as full democracies
while 23 others are regarded by Freedom House as partial democracies.
This is a remarkable achievement given that 30 years ago military
dictatorships and one-party states predominated throughout the
continent and we believe our sustained efforts to support democracy
both diplomatically and through our assistance programs have played a
key role in this success.
The number of conflicts that preoccupied Africa and the
international community over the past decade has been sharply reduced.
USAID employs a range of conflict mitigation and peace and
reconciliation activities in Africa. In FY 2010, support to conflict
mitigation and reconciliation in the region totaled approximately $63
million, with the majority of funding to the Democratic Republic of
Congo, Ethiopia, Somalia, and Sudan. USAID also supports conflict early
warning and prevention mechanisms in Kenya and through the Economic
Community of West African States, the East African Inter-Governmental
Authority on Development, and the African Union to analyze conflict
trends and position resources to mitigate violence before it starts.
African leaders recognize the negative impact of violent conflicts on
their region and many of them demonstrate a willingness to assume
greater responsibility for preventing and responding to conflicts. The
participation of African states in subregional peacekeeping missions
and the African Union's commitment to the establishment of five standby
brigades across the continent attest to this fact. The African Union's
principled stance opposing violent coups is another positive
development, and USAID has been strengthening its coordination with the
African Union with programming focused on conflict prevention,
democracy and governance, food security, and health.
Africa's economies have also made measurable strides. African
governments have liberalized their economies, embraced market reforms
and adopted probusiness policies. Prior to the onset of the global
financial crisis in 2008, Africa enjoyed nearly a decade of steady
economic growth, averaging over 5.3 percent a year. Although much of
this growth was driven by oil and gas exports, and the rise in mineral
and commodity prices, significant policy changes by African
governments, an upsurge in agricultural exports, and the expansion of
Africa's entrepreneurial middle class also played a major role in this
turnaround. USAID's priority is fostering this sustainable, broad-based
economic growth--one of the fundamental forces that will eventually
transform the developing world, by accelerating development and
eradicating poverty. We envision a world where private sector
investment drives sustainable growth and market-led development
replaces foreign assistance.
Strengthening democratic institutions remains our most important
policy priority, as weak governance dampens economic activity,
undermines development progress, and can require costly humanitarian
interventions. Democracy is a long-term process as opposed to a single
event such as an election. We will continue to work in partnership with
African governments and civil society organizations to strengthen their
democratic institutions and to protect democratic gains. In Africa,
USAID is working to combat corruption, and human rights violations by
abusive governments and other nonstate actors. We encourage the
development of independent judiciaries, strong legislative bodies,
independent media, robust civil societies, and transparent budgets and
elections. We help countries address technical, organizational, and
political aspects of the election cycle. And we work to reverse
democratic stagnation, military coups, and attempts by sitting
presidents to illegally extend their mandates.
The Millennium Challenge Corporation (MCC) and the African Growth
and Opportunity Act (AGOA) work to accelerate Africa's economic
development and encourage progrowth policies. Our efforts through AGOA,
which gives African countries duty-free access to the U.S. market,
focus on diversifying African exports away from petroleum products.
Supporting trade capacity-building assistance, integration efforts that
eliminate regional trade barriers, and enhanced transportation
infrastructure are important to assisting Africa to increase its share
of world trade.
Africa's poverty puts it at a distinct disadvantage in dealing with
major global and transnational problems like health pandemics, food
shortages, and the illegal exploitation of maritime and mineral
resources. Narcotics trafficking is an increasing problem in west
Africa and could become a major destabilizing force if it is not
stemmed. Africa is also acutely vulnerable to climate change, the
effects of which will impact all areas, from food security and health
to conflict and market access. USAID is leading efforts to ensure that
African countries can adapt to climate change as they grow their
economies. We help partner nations implement low-carbon development
strategies to guide investment as well as to take concrete steps to
achieve sustainable low-carbon growth. As Africa faces the impact of
these transnational challenges, we must be equally active in working
with leaders and governments across the continent and international
partners to address issues that are global in nature, not just specific
to Africa.
USAID recognizes the need to focus our resources to maximize the
impact of our assistance. Our programs focus on six African states
facing major humanitarian problems or recovering from serious conflict:
the Democratic Republic of the Congo, Kenya, Liberia, Somalia, Sudan,
and Zimbabwe. We are also providing continued significant support to
Ethiopia, Nigeria, and South Africa because of their importance in
advancing regional security and economic growth. These nine countries
play a major role in determining the prospects for conflict or
stability and development in their regions, making them critical
priorities for U.S. investments. USAID is also supporting the
relatively well-performing countries of Ghana, Mali, Mozambique, and
Tanzania to strengthen local governance and accountability to
consolidate and deliver the dividends of democracy.

CR CUTS

Question #2. How will proposed budget cuts in the continuing
resolution, or CR, impact the administration's ability to implement its
policy agenda and priorities in Africa this fiscal year?

Answer. The President's FY 2011 request for Africa was robust, and
we acknowledge that actual levels may be less than the request. State
and USAID's central budget offices are currently reviewing the FY 2011
appropriation language and funding levels, and have not yet made bureau
or country-specific allocation recommendations. However, as levels are
developed, the focus will be to ensure that the President's priorities
in food security, health, and climate change are addressed, as well as
ensuring that joint State/USAID priority focus countries receive
appropriate funding.

INTERAGENCY

Question #3. Describe levels of interagency coordination in
developing the budget request for Africa.

a. To what degree have you embraced a whole of government approach
when implementing an Africa strategy?
b. Secretary Carson and Deputy Assistant Administrator Jandhyala,
please detail areas of cooperation between State and the Department of
Defense--specifically, AFRICOM.

Answer. Collaboration begins with a shared strategic vision with
jointly agreed upon priorities for Africa. These are:

Strengthening democratic institutions and protecting the
democratic gains of African countries;
Fostering broad-based and sustainable economic growth;
Combating disease and improving public health;
Preventing, mitigating, and resolving armed conflict; and
Helping to address transnational threats and challenges.

The initial input for developing the budget request comes from the
Chiefs of Mission at each sub-Saharan Africa post in response to these
goals through a Mission Strategic Resource Plan (MSRP). This plan
reflects the input of all U.S. Government (USG) partners at post, and
lays out a USG-wide approach for meeting the development and diplomatic
challenges in each country. Reviews of these MSRPs are conducted in
Washington, program and funding decisions are made, and a joint State/
USAID Africa budget submission is prepared. State Africa Bureau and
USAID Africa Bureau work hand in hand throughout the budget development
process, from the start of the request in the field to the development
of final requests for the President.
Other USG partners are included throughout the process as
appropriate for their area of focus. For example, under the Global
Health Initiative, and particularly through the President's Emergency
Plan for HIV/AIDs Relief, State and USAID are joined by Health and
Human Services' Centers for Disease Control, the Department of Defense
and the U.S. Peace Corps in developing a comprehensive multiagency
response to the HIV/AIDS pandemic. The Feed the Future initiative
leverages a range of resources from across the U.S. Government in a
shared effort to sustainably reduce global hunger and poverty. In
Washington, the interagency Feed the Future team includes members from
USAID; the Departments of State, Agriculture, and Treasury; Peace
Corps; Millennium Challenge Corporation; Office of the U.S. Trade
Representative; U.S. African Development Foundation; and the White
House through National Security Council, Office of Management and
Budget, and Office of Science and Technology Policy. In the field,
USAID missions engage and coordinate with relevant agencies at post to
harness all available food security resources towards the goals of Feed
the Future.
This collaboration continues throughout the implementation of
programs, with the submission of a joint State/USAID Operational Plan
to detail programming of current year appropriations, and a joint
State/USAID Performance Report on results achieved in the previous
fiscal year. These efforts are reflected in the joint State/USAID
Annual Performance Report covering activities worldwide.
The USAID Administrator and the Secretary of State serve as board
members for the Millennium Challenge Corporation (MCC), along with
other principals from the interagency community including the Secretary
of Treasury, the U.S. Trade Representative, and more--which provides
the highest level forum to ensure that our respective resources are
brought to bear on common objectives that both increase the impact of
developmental objectives and optimize stewardship of U.S. resources.
Examples of USAID and MCC collaboration include:

In Mali's ongoing $461 million Compact, USAID is working
with MCC to advance work in land tenure and administration.
Through the Feed the Future initiative, USAID and MCC work in
complementary ways to strengthen local membership-based
organizations for adoption of agricultural best practices and
appropriate water management.
In Burkina Faso, USAID directly administers the education
component of the $481 million Compact ($28.9 million),
implementing the second phase of a girls' primary school
education program, which assists 132 communities throughout
Burkina Faso's rural areas.
In Tanzania, a 5-year, $698 million Compact, USAID and MCC
are collaborating to provide HIV/AIDS and other health services
to construction workers and communities, and to mitigate the
environmental impacts of MCC-funded infrastructure projects.
Feed the Future draws upon MCC infrastructure project and
procurement experience in local and international markets.
Also, regional roads funded by MCC will greatly facilitate
trade in target Feed the Future areas.

USAID and the Departments of State and Defense collaborate on
issues of diplomacy, development, and defense, and this cooperation is
fully operationalized at the U.S. Africa Command (AFRICOM). Security is
essential for long-term development to take place, and development is
critical for security to be sustained. Therefore, civil-military
cooperation with AFRICOM is a vital part of a ``3D'' (diplomacy-
development-defense) effort to achieve U.S. national security
objectives. This cooperation takes the form of interagency staff
liaisons and coordinated programming on three different levels: (i) in
Washington, DC, (ii) in Stuttgart, Germany (AFRICOM headquarters), and
(iii) on the African Continent.
In Washington, a liaison officer from AFRICOM serves in USAID's
Office of Military Affairs, in the Bureau for Democracy, Conflict, and
Humanitarian Assistance. In addition, a development officer in USAID's
Bureau for Africa conducts civil-military coordination full time with
AFRICOM and other Department of Defense offices active in Africa. In
addition to these staff exchanges, senior staff from USAID's Bureau for
Africa regularly interact with their AFRICOM counterparts as well as
with the Deputy Assistant Secretary of Defense for Africa. In one
recent example, USAID Deputy Assistant Administrator for Africa, Raja
Jandhyala, participated in an interagency forum to discuss AFRICOM's
defense posture, advising the command on ways to optimize its resources
to support both its security mission and USAID's development mission.
In Stuttgart, a USAID Senior Foreign Service officer serves as the
Senior Development Advisor to the AFRICOM Commander. A second USAID
officer heads AFRICOM's Health and Humanitarian Assistance Branch in
the Strategy, Plans, and Programs Division. Finally, an officer from
USAID's Office of U.S. Foreign Disaster Assistance serves in AFRICOM's
Operations and Logistics Division.
USAID's Senior Development Advisor works on a daily basis with
AFRICOM's senior leadership and participates actively in the command's
planning and operations activities, in conjunction with State
Department's Foreign Policy Advisor, to ensure that USAID missions in
Africa are fully aware of and coordinating with current and proposed
AFRICOM activities.
USAID's Director of AFRICOM's Health and Humanitarian Assistance
Branch is the only USAID officer in any combatant command that directly
supervises military personnel and oversees military programs. The
branch's Pandemic Response Program, funded by USAID, enables AFRICOM to
assist African militaries to improve their pandemic planning and
response capabilities. This team and USAID's officer in the Operations
and Logistics Division created a Disaster Planning and Preparedness
Program funded by AFRICOM to build African partner nations' capability
to respond to natural and man-made disasters, using a coordinated
civil-military approach.
USAID's AFRICOM team has clarified roles and responsibilities of
the agencies in support of humanitarian assistance. This was especially
important during Operation Odyssey Dawn in Libya, as well as during
planning efforts for the Democratic Republic of the Congo, Somalia, and
Sudan.
On the African Continent, the Combined Joint Task Force Horn of
Africa (CJTF-HOA) assigns liaison officers at a number of USAID
missions in east Africa and invites USAID to advise and coordinate on
CJTF-HOA civil affairs projects throughout the region.
One best practice that has emerged from USAID-AFRICOM cooperation
is the recent opening of the Guistir clinic in a remote corner of
Djibouti, near the border with Somalia. Civil-military planning in
Djibouti is an interagency effort that places the Government of
Djibouti in the lead of identifying programs that advance its own
development goals. A string of cemeteries lines the road from Guistir
to the next town, 20 kilometers to the west, where the nearest clinic
was located; each grave represents a sick patient, perhaps a young
mother in labor, who did not survive the journey. Since CJTF-HOA
constructed the clinic in Guistir and USAID helped Djibouti equip and
staff it, clinic staff have said they expect no more cemeteries would
be needed along that road--a prime example of USAID's development
leadership simultaneously contributing to CJTF-HOA's military
objectives in the Horn of Africa.

CHINA

Question #4. Describe the extent and nature of China's influence in
sub-Saharan Africa, and the degree to which it impacts America's role
in the region.

a. Are there areas of cooperation we have not fully explored with
China that may allow us to better meet shared regional goals?
b. What steps are we taking to mitigate areas of tension with China
in Africa?
c. How are U.S. businesses faring in Africa given the economic
competition with China?

Answer. China plays a significant role in Africa's economic and
human development, particularly through trade and infrastructure
development--roads, ports, and health facilities--that could help
increase farmers' access to markets, improve regional trade
integration, and improve health outcomes, which is in line with the
U.S. Government's priority investments in Africa.
Over the past several years, USAID has engaged the Chinese around
development and humanitarian issues in Africa both bilaterally through
annual high-level dialogues (U.S.-China Strategic and Economic
Dialogue; U.S.-China Sub-Dialogue on Africa) and multilaterally through
the China Organization for Economic Cooperation and Development (OECD)
Development Assistance Committee. USAID, like many other donors, has
been working to establish a regular development dialogue with China.
Chinese officials have agreed verbally to explore collaboration with
USAID in the health and agriculture sectors, with a special focus in
Africa. However, progress has been slow.
On the margins of the May 2010 U.S.-China Strategic and Economic
Strategic and Economic Dialogue, USAID Administrator Shah met with
China's Ministry of Health, Division of International Cooperation
senior staff and discussed potential cooperation in select African
countries in health and food security. We reached an agreement to
conduct a joint assessment in health in Ghana and Liberia. The
assessment was conducted in December 2010 and findings presented at the
China-Africa International Health Conference in February 2011. The
assessment allowed Chinese and U.S. health experts to examine jointly
malaria, maternal health, and other public health programs, to
determine how China and the United States could work together for
greater development impact. The assessment concluded with a very strong
recommendation, voiced by African health ministries and supported by
representatives from key international organizations, that closer
communication and collaboration between China, bilateral donors and
other international organizations offered the potential to integrate
China's strengths as a partner in health into an effective African-led
health planning and coordination system. We are encouraged that the
Chinese Government has allowed representatives from government-
affiliated think tanks to collaborate with USAID with the intent to
improve health outcomes in Africa. Through this cooperation we hope to
improve our understanding of Chinese foreign assistance structure,
objectives, and goals to formulate an effective engagement process and
mechanism to address issues that directly or indirectly affect overall
U.S. foreign assistance programs and policies as a result of China's
development activities in Africa and around the globe.
In March 2011, USAID and the State Department held a food security
and agriculture development workshop in Beijing that brought together
United States and Chinese and U.S. agricultural and development policy
experts to exchange information and discuss potential areas of
collaboration, objectives, and complementarities. These modest
collaborative efforts hold the potential in the long term to help
developing countries, particularly in sub-Saharan Africa, make the best
strategic use of opportunities and resources that China brings in
support of economic growth and poverty reduction. Improvements here are
particularly important in the agricultural sector, given the current
significant levels of U.S. and international investment in support of
the Comprehensive Africa Agriculture Development Program (CAADP).
We would like to encourage China to implement internationally
agreed standards through mechanisms such as the Extractive Industries
Transparency Initiative, World Health Organization recommendations on
good quality malaria drugs, the 2005 Paris Declaration on Aid
Effectiveness, and 2008 Accra Agenda for Action on issues such as
transparency, harmonization, ownership, and alignment.
In 2009-10, China provided $110 billion in loans to developing
countries and the private sector, compared to the World Bank's $100
billion. As the largest provider of infrastructure financing in Africa,
China is making a substantial contribution to economic development If
managed well, China's assistance could help push Africa toward
attaining the Millennium Development Goals. However, if managed poorly,
achievements could erode and further weaken economic growth and poverty
reduction efforts.

FEED THE FUTURE

Question #5. In 2009, President Obama pledged $3.5 billion over 3
years to address global hunger and poverty, and a year later launched
the Feed the Future Initiative. Twelve of the twenty Feed the Future
focus countries are located in sub-Saharan Africa, and the FY11 budget
request was the first to specifically include Feed the Future.

a. How is USAID implementing the Feed the Future effort in light of
the reduction of funding in the CR?
b. How much closer does the FY12 budget request bring us toward
achieving the goals established by the President in 2009?
c. What steps are being taken to encourage other donors to increase
their pledges to fight global hunger?

Answer. Feed the Future (FTF) embraces the country-led approach to
developing and implementing agriculture and rural development
investment plans, which increases the efficiency and impact of donor
resources. In Africa, the Comprehensive Africa Agriculture Development
Program (CAADP) processes integrate donors into the planning process
and CAADP country investment plans have improved coordination,
alignment, and harmonization of donor resources.
In the past 2 years, FTF implementation progressed rapidly. In West
Africa, for example, USG investments in food security facilitated a 5-
percent increase in intraregional trade in three value chains--maize,
onions, and livestock--by strengthening market information systems,
holding trade-related events, and providing technical assistance to
producers, trader organizations, and agriculture-related firms.
Half of the FY 2012 request for USAID and State Feed the Future
activities is prioritized and concentrated in 20 focus countries with
the political and investment environment that will produce the greatest
impact in reducing global hunger and poverty. Of the $568 million
requested for the 20 focus countries, we have further prioritized this
request by requesting $284 million for five countries: Bangladesh,
Ghana, Rwanda, Tanzania, and Uganda. In addition, FTF implementation is
concentrating available resources based on policy, socioeconomic, and
impact assessments conducted by U.S. Government country teams. The
results of these assessments guide FTF investments to areas where there
would be the greatest impact given available resources. FTF
implementation is concentrating available resources. Specifically,
investments are focusing on select crops, such as rice, sorghum, and
millet in Mali, and legumes and dairy in Malawi, that would yield the
greatest impact in securing broad-based reduction of poverty--
particularly among women--and increasing nutritional outcomes for the
most vulnerable. Investments are also geographically focused in regions
with the greatest agricultural potential and beneficiary impact, and
where overlapping regional benefits from existing U.S. Government
programs have the potential to enhance outcomes.
Feed the Future also works to increase donor funding for
agriculture-led growth. In line with the objectives of the
administration's food security initiative, the U.S. Government
supported the creation of the Global Agriculture and Food Security
Program (GAFSP) trust fund which pools donor funds to provide an
additional, unified source of financing to support sustainable food
security strategies for those developing countries which demonstrate
their commitment to addressing the food security needs of their
population. The U.S. contributions to the GAFSP are leveraged by
significant contributions from other donors.
At the G8 summit in July 2009, President Obama pledged to provide
at least $3.5 billion over 3 years (FY 2010-12) to attack the root
causes of global hunger through accelerated agricultural development
and improved nutrition. The U.S. Government commitment leveraged more
than $18 billion in support from other donors, creating the financial
capacity to significantly reduce the number of people living in extreme
poverty and suffering from hunger and undernutrition. The President's
FY 2012 budget requests $1.4 billion for State, USAID, and Treasury to
meet the President's pledge.
Like other donors, the United States is facing a tight budget
environment. Nevertheless, we are still on track to meet our L'Aquila
commitment of $3.5 billion over 3 years. To date, the United States has
provided $813 million in FY 2010 funding to meet the L'Aquila
commitment.
Feed the Future establishes the United States as a political and
moral force in the fight against hunger and poverty. The President's
pledge at L'Aquila catalyzed over $18 billion in commitments from other
donors and institutions in support of food security. Our global
leadership on this issue has brought various donors to the table in the
country-led processes for developing and implementing investment plans.
More important than ``new'' versus ``old'' money is ensuring that
pledges will be spent in support of the principles we all embraced at
the 2009 G8 summit. We are encouraging other donors to ensure that is
the case, as it is with our own pledge. Bilateral and multilateral
development partners are working together to establish a mutual
accountability framework, aimed at holding the partners accountable to
each other at the global level; as well as development partners and
beneficiary countries accountable to each other. The L'Aquila summit
donors have provided breakdowns of their own pledges, which were
compiled in a reporting tool designed by the Organization for Economic
Cooperation and Development. This information is included in the G8
Accountability Working Group's report, released at 2010 G8 summit in
Muskoka, Canada.
In addition, the United States-European Union development dialogue
is pushing donor coordination and leveraging even further. Under the
development dialogue we have agreed to work together in five pilot
countries--Ethiopia, Mali, Zambia, Bangladesh, and Guatemala--and one
region--ECOWAS (Economic Community of West African States). In these
focus countries and region, the United States and European Union are
jointly analyzing and reviewing country and regional plans,
coordinating outreach to the private sector, jointly financing the
CAADP Multi-Donor Trust Fund, and coordinating the provision of
technical support for the development of country and regional
investment plans.

Question #6. Describe the process by which USAID selected the 12
African focus countries for the Feed the Future initiative, especially
because the initiative criteria extends beyond food insecurity. To what
degree does governance and institution-building factor into your
calculations in terms of a countries ability to effectively absorb
funding?

Answer. Focus countries were selected based on five factors related
to the needs and opportunities for reducing food insecurity:

Level of Need: We assessed the level of need based on four
primary factors (1) income levels, (2) poverty rates, (3) the
Global Hunger Index (compiled by International Food Policy
Research Institute [IFPRI] in conjunction with Deutsche
Welthungerhilfe and Concern Worldwide), and (4) IFPRI's
categorization of level of food security. The Global Hunger
Index uses three equally weighted indicators to represent a
multidimensional measure of global hunger--the proportion of
undernourished as a percentage of national population,
prevalence of underweight children under the age of 5, and
mortality in children under 5.
Opportunity for Partnership: We sought to work in countries
that place a high priority on food security for all of their
citizens and that are committed to working in partnership with,
among others, donors, civil society, international
organizations, and the private sector. Our assessment was based
on a range of factors, including basic political stability and
the absence of conflict, the quality of governance, the overall
economic policy environment, and the commitment to design and
implement a high-quality strategy to enhance food security.
Potential for Agriculture-led Growth: Within our strategy,
the principle mechanism for reducing extreme hunger and poverty
is agricultural-led growth. Thus, we prioritized countries
where poverty is still predominantly rural and where there is
significant potential for improvements in agricultural
productivity and market development.
Opportunity for Regional Synergies: We prioritized countries
that present strong opportunities to strengthen regional trade
and development corridors, integrate markets and accelerate
regional growth, and play a major role in regional trade.
Resource Availability: A central tenet of our strategy is
that creating lasting progress in food security will require
deep investments in agricultural, economic, and social systems.
To achieve this, our resources are concentrated in a set of
countries that have committed a substantial proportion of their
own resources to provide the level of support necessary to
catalyze growth and significantly contribute to accelerating
progress toward the MDGs. We are committed to coordinating with
development partners to leverage additional resources, but
recognize that prioritization and strategic choices are still
required due to resource constraints.

USAID has also embarked on an ambitious reform effort, USAID
Forward, to change the way we do business--with new partnerships, an
emphasis on innovation and a relentless focus on results. FTF aligns
with USAID Forward principles to provide grants to more and varied
local partners, and to create true partnerships to create the
conditions where aid is no longer necessary in the countries where we
work. FTF host country systems are assessed for their capacity to
effectively implement food security programs. Based on findings, USAID
will use host country systems to implement FTF programs. In cases where
a FTF focus country's institutions do not have the capacity to
effectively implement food security programs, FTF investments will help
strengthen local systems to produce efficient local governments,
thriving civil societies and vibrant private sectors able to manage
USAID investments.

ASSISTANT ADMINISTRATOR FOR AFRICA

Question #7. What limitations have been placed on USAID's work in
Africa given the absence of an Assistant Administrator?

Answer. There are not limitations on our work in Africa, but the
absence of a Senate-confirmed Assistant Administrator is less than
ideal. Our White House and Agency leadership are aggressively working
to identify a candidate. In the interim, we currently have two talented
and experienced Deputy Assistant Administrators managing the Africa
Bureau. The Senior Deputy Assistant Administrator in charge of the
Bureau is a Senior Foreign Service officer with over 20 years of
experience on the continent. A third Deputy Assistant Administrator
will come on board soon.

GLOBAL HEALTH

Question #8. Advances in medical research around the world have led
to the development of new, effective vaccinations that address some of
the most pressing disease plagues facing sub-Saharan Africa. Given
USAID's large role in implementing the Global Health Initiative, please
describe how the budget request for FY12 will enable distribution of
these lifesaving treatments. The administration emphasizes increasing
``country ownership'' of U.S. health assistance programs.

a. What does this mean in the context of Africa, where many
governments are unable to assume significant financial control over
global health programs in the near term?
b. What type of investments might advance efforts to build African
countries' capacity to sustain U.S. global health programs?
c. What types of U.S. activities, if any, do you believe may
complicate country efforts to assume greater control?

Answer. The implementation of the Global Health Initiative (GHI) is
guided by several approaches that will optimize the development and
distribution of lifesaving treatments, including an emphasis on
accelerating results through research and innovation, strengthening and
leveraging key partnerships, and strengthening health systems. The FY
2012 budget request reflects a comprehensive and integrated global
health strategy to implement GHI by expanding the reach of our
investments in the President's Emergency Plan for AIDS Relief (PEPFAR),
the President's Malaria Initiative (PMI), maternal and child health,
family planning, tuberculosis, neglected tropical diseases, and other
programs, by tying individual health programs together in an
integrated, coordinated system of prevention and care. This strategy
will save lives while fostering sustainable health care delivery
systems that can address the full range of developing country health
needs.
USAID supports research though its programs and through
multilateral organizations to determine the most effective ways to take
advantage in the field of advances in medical technology. Active
measures to share learning and best practices among U.S. Government
health staff and implementers encourage adjustments that keep U.S.
assistance at the forefront of technological effectiveness.
Under USAID Forward and the GHI principles, USAID is implementing a
worldwide program to strengthen the capacity of government institutions
to manage the financial resources in a transparent and accountable
manner--to use country systems. As this capacity is developed, USAID
will provide resources to the governments in an incremental manner even
in the short run. Also, in strengthening countries' ability to make
sound health financing policy, USAID has over 15 years of experience in
developing the capacity of the countries to measure the flow of health
expenditures using national health accounts. USAID assistance to build
capacity in resource tracking and develop financial management systems
has been successful in many African countries, especially in Kenya and
Rwanda.
Throughout Africa, USAID supports countries' role in health sector
planning and strategy development, where country leaders develop and
own the priority-setting process, often leading to a comprehensive,
sectorwide plan for health development (or SWAp). USAID participates
fully in the SWAp process for planning and priority setting in African
countries, often being selected to serve as lead donor in the SWAp
meetings. USAID's longstanding technical leadership in health sector
monitoring and survey statistics, such as through the signature
Demographic and Health Survey, is relied on in many countries for
tracking progress under the country's SWAp. USAID supports technical
assistance in many countries for preparation of analyses used in SWAp
planning.
USAID has a long history of strategic investments in health systems
strengthening, providing assistance building management and
policymaking capacity to countries in all the key functional areas:
human resources, pharmaceutical management and logistics, strategic
information, health financing, health governance and leadership, and
service delivery. (See also the USAID Report to Congress on Health
Systems Strengthening.)
Under GHI, USAID places a high priority on strengthening the
management of health programs, moving away from an earlier era when
programs often were led by individuals with only clinical training and
without formal training in health management or finance. For example,
USAID provided assistance to Kenya for a comprehensive review of
management weaknesses in the Ministry of Health. In response, USAID/
Kenya is supporting a large-scale program to provide management
training to the health professionals. In other African countries, USAID
is also placing a much stronger emphasis on strengthening the capacity
of the health ministries in general and financial management in
particular.
Some observers see a tradeoff between quick implementation of
program activities and building country-owned institutions and
individual managers' capabilities. This is a false dichotomy. Through
GHI, USAID encourages achievement of ambitious goals for improved
health and country-led programs, which emphasizes countries' ownership
of planning, execution, and monitoring of results. USAID Forward
supports the use of country systems, harmonization of aid mechanisms
among donors, and unified tracking and monitoring processes. USAID
staff members routinely consult with partner country leaders and
managers to ensure we are following country priorities.
In all countries with weak health systems, USAID supports
initiatives to building their public sector and private sector capacity
for planning and management. This is a deliberate and long-term process
which, over time, will permit countries to assume greater and greater
control. In many African countries, USAID supports local universities
and other institutions to build their capacity to train key health
management and policy staff members, and provide consultations and
advice to build systems.

FOOD AID

Question #9. Please describe the relationship between Feed the
Future and U.S. emergency and humanitarian food aid programs,
especially since Africa receives the largest share of both agricultural
development assistance and emergency aid.

a. What are the linkages between the strategy and delivery of these
two types of programs?
b. What measures are in place to avoid duplication of efforts?

Answer. The United States will continue to provide food aid during
times of crisis, but a lasting solution to hunger requires a long-term
commitment to agricultural growth. Agricultural growth fosters economic
growth, reduces poverty, improves health, and is necessary to meet the
needs of a growing world population in the face of climate change and
other environmental challenges. The U.S. Government's Feed the Future
(FTF) initiative addresses the root causes of hunger that limit the
potential of millions of people, using a combination of bilateral
programs and multilateral mechanisms. FTF promotes growth in the
agriculture sector, facilitates local and regional trade, and invests
in game-changing innovations and technologies to support productivity
increases, so that countries are better able to combat hunger, feed
their people, and contribute to stable global food supplies.
One of the key principles of FTF is to support country-led
agriculture and food security efforts, including in the development of
country-owned food security strategies and investment plans, with
participation from U.S. food assistance implementing partners and their
local counterparts. In sub-Saharan Africa, this support is provided
within the framework of the Comprehensive Africa Agriculture
Development Program (CAADP), a continent-wide, African Union-led
commitment to agriculture that is changing the way governments, donors,
private sector and other stakeholders invest in agriculture and food
security. At least 22 CAADP compacts and 19 CAADP country investment
plans have been developed in Africa.
Through these country-led strategies, FTF collaborates with other
U.S. agricultural programs, such as Food for Peace, to ensure
efficiency and the greatest impact at the country level. Sub-Saharan
Africa receives approximately three-fourths of worldwide USAID-managed
food aid with 80 percent of food aid funding going to six countries.
During FTF strategy development, USG country teams analyzed current
country humanitarian food aid programs in the design of their FTF
strategy, targeting regional interventions that are complementary to
humanitarian food aid programs.
The administration's FY 2012 budget requests $79 million for a
Community Development Fund (CDF), which will play a catalytic role in
bridging humanitarian and development assistance. CDF investments will
fund community-based interventions aimed at increasing the economic and
nutritional resilience of the rural poor and accelerating their
participation in economic growth. Examples of activities that we expect
to support within integrated community development projects include
nutrition education, livelihood diversification, microcredit and
savings, conservation agriculture and other interventions adapted to
preserve natural resources, and vocational education. Increased
emphasis will be placed on building local capacity to manage risk and
protect community and household assets.

INITIATIVES

Question #10. How does Feed the Future, with its emphasis on
sustainable agricultural development, and the Global Climate Change
Initiative--or GCCI--collaborate and become mutually reinforcing
initiatives in Africa, a region that faces significant food security
issues and potentially devastating effects from climate change?

Answer. Climate change is inextricably linked to food security
because of its wide-reaching impact on agriculture and landscapes.
Studies carried out by USAID's Famine Early Warning System Network
(FEWS NET) have found that total rainfall in east Africa for example
has never been lower than over the last 5 years. Since 1980, total
rainfall during east and southern Africa's long rainy seasons has
declined an estimated 15 percent. How small-scale farmers are able to
adapt to these challenges is an important consideration for USAID.
Under the Feed the Future initiative, USAID will invest in specific
adaptive strategies such as sustainable agroecological methods and
research into drought-resistant seeds. Of the $145 million in
agriculture research and development requested in the FY 2012 budget
for Feed the Future, $87 million will be spent in sub-Saharan Africa to
increase productivity through breeding and genetics research for major
food crops such as maize, sorghum, and rice, and to integrate adaptive
technologies and practices in the production of various crops.
Furthermore, there is potential for significant mitigation from
agricultural lands through agroforestry and the adoption of perennial
crops, which sequester carbon and reduce other agricultural based
emissions, but also danger that agriculture will contribute to
degredation of natural resources. Feed the Future will integrate
indicators related to natural resource management and climate
resilience into the monitoring and evaluation system to track the
impact of agricultural productivity gains on resource management and
climate mitigation within the initiative to provide information in case
program modification is necessary.
Farmers across the Sahel have had to adapt to climatic variability
for decades, and they have been a model for USAID as we develop and
scale up Feed the Furture adaptation techniques. Over the last 25
years, as land pressure and variability increased, Sahelian farmers
adapted by turning to natural forest management. Trees are less
susceptible to rainfall fluctuations, and tree products such as fruits,
gums, and wood can find ready domestic and export markets. Niger's
farmers are managing nearly 5 million hectares of farm forests, which
were simultaneously yielding tree products and improving soil
productivity. During the aftermath of Niger's 2005 drought and food
crisis, one study found that villages that had established farm forests
suffered no increase in child mortality, and while unable to produce
grains, these villages were still able to sell tree products to
purchase food. By adapting to their changing environment, Niger's tree
farmers found a way to survive through a drought crisis--which, in the
coming years, may unfortunately become less of an anomaly and more of a
regular cycle.
However, integrating adaptive strategies of this type into food
security programs on the ground will only get us so far. Two elements
of the Global Climate Change Initiative will improve and reinforce the
on-the-ground field work critical to the success of the Feed the Future
initiative:

Improving access to science and analysis for decisionmaking:
Information and tools help nations and communities estimate the
probability of different kinds of climate effects and project
their likely impacts, assess the relative costs and benefits of
different interventions, and find ways of encouraging adoption
of the most cost-effective innovations. USAID invests through
the global climate change initiative in scientific capacity,
improved access to climate information and predictions, and
evidence-based analysis to identify vulnerable sectors,
populations, and regions and to evaluate the costs and benefits
of potential adaptation strategies. These investments will
result in better-informed choices among decisionmakers and
increase the probability of success in reducing vulnerability
to climate change. ``Decisionmakers'' includes government
policymakers at all levels, communities, farmers, firms and
entrepreneurs, and households.
Improving governance systems around adaptation to climate
change: Good decisions do not just require good science and
analysis. USAID is supporting efforts to integrate climate
information and analysis into inclusive, transparent
decisionmaking processes, effective governmental coordination
that is responsive to the needs of local constituents, improved
public communication and education, and strengthened community,
civil society, and private sector engagement. We will support
processes that include a broad range of host-country
stakeholders, including women, vulnerable populations, and
indigenous and other ethnic minorities.

These additional activities, supported specifically through the
Global Climate Change Initiative, complement and support the on-the-
ground work that is informing the Feed the Future Initiative multiyear
strategies.
USAID's core country teams working on Feed the Future activities
draw on climate change expertise from throughout the Agency. In
addition, many of the USAID staff working on these two issues are
colocated in the same field offices and work together to build
sustainable economic growth. Both Feed the Future and the Global
Climate Change Initiative provide important components addressing
climate change stresses on food security. Especially in the Africa
region, these programs are being designed in partnership in order to
enhance complementarities and to build stronger capacity among our
partner countries to address these critical issues.

CLIMATE CHANGE

Question #11. Please discuss the ways GCCI works with American
institutions and companies to promote the use of adaptive technologies
and clean energy best practices to stem the effects of climate change.

Answer. The activities of USAID's African missions and the Africa
Infrastructure Program (AIP) seek to support activities which help to
attract and advance private investments into the clean energy and
electricity sectors in sub-Saharan Africa. Most clean energy activities
supported by USAID in Africa have the potential for supporting and
creating attractive investment opportunities for private U.S.
companies. Several ongoing USAID programs have been developed in
response to conversations with U.S. companies regarding the greatest
barriers to investment on the continent.
USAID's bilateral missions in the Democratic Republic of Congo,
Kenya, Liberia, Mozambique, and Nigeria will use climate change funds
to support the planning and implementation of Low Emission Development
Strategies, renewable energy microfinance activities, rural energy
development, and the strengthening of government institutional capacity
to support and attract private investment into clean and renewable
energy technologies. Nigeria is also supporting capacity and market
development programs necessary to significantly reduce the practice of
gas flaring in the west African region. USAID's Africa regional
missions, located in west Africa, east Africa, and southern Africa,
will focus on developing regional institutional capacity to plan for
and attract private investment into clean and renewable energy projects
within their respective regions, and they are expected to continue some
level of support for strengthening regional power pools' abilities to
deliver renewable energy to customers within their respective
geographic areas.
USAID's AIP seeks to attract U.S. and international private
investment into larger scale electricity infrastructure projects in
Africa. The program does not directly partner with U.S. companies.
Instead, it provides technical assistance to strengthen foreign
governments' capabilities to successfully negotiate with U.S. companies
trying to develop projects in Africa. Providing foreign officials with
this expertise provides government negotiators with the understanding
of what is required to attract and sustain private investment in their
countries, and the confidence required to engage U.S. and other private
sector interests to develop and obtain financing for proposed
infrastructure projects on the subcontinent. The program is currently
providing capacity-building and transaction support assistance to 11
African governments which combined have the potential for constructing
over 1,800 MW, or over $3 billion of new, clean, and renewable energy
power projects in Africa.
USAID's AIP is also currently seeking to make a significant
commitment with other donors to building the capacity of governments in
the development of significant geothermal energy opportunities in the
East African Rift Valley Region. This effort could provide significant
opportunities for U.S. geothermal companies which are highly
competitive internationally.
Representatives of the AIP regularly communicate with private U.S.
companies who are developing electricity sector projects in Africa in
an effort to understand the barriers that they are encountering, the
needs and the inadequacies of government officials negotiating with
them, alert them to opportunities, and to listen to their
recommendations on what will make projects financeable. On more than
one occasion, U.S. companies have asked AIP representatives if they
would provide governments who they are negotiating with the assistance
to enable them to close projects in a more expeditious manner.
AIP also sponsors--along with U.S. Department of Treasury and the
Infrastructure Consortium for Africa--a videoconference series that
includes senior representatives of over six African governments,
international financial institutions, U.S. project development
companies, and other stakeholders that discusses what is necessary to
financially close electricity sector projects in Africa, what is
necessary to achieve common objectives and specific case studies of
projects that have successfully reached financial closure.
USAID's Private Financing Advisory Network (PFAN) partnership is
currently supporting programs in a number of African countries by
bridging the gap between investors and clean energy entrepreneurs and
project developers. The network brings in a range of skilled advisors
including project finance experts to provide project developers with
guidance on feasibility, project structure, investment and financing,
preparation of the business plan and introductions to investors that
are focused on economically viable projects with social and
environmental benefits. For example, for proposed project activity in
southern Africa, through capacity-building and network expansion
activities, PFAN expects to accelerate closure of up to 30 clean energy
projects with a total financing forecasted to range from U.S. $58-$372
million.
Under USAID's ongoing partnership with the National Association of
Regulatory Utility Commissioners (NARUC), we are supporting several
activities in Africa:

In Nigeria, a USAID/NARUC-sponsored regulatory partnership
between the Nigerian Electricity Regulatory Commission (NERC)
and the Michigan Public Service Commission is underway to
enhance NERC's ability to undertake market-based regulatory
functions and provide effective oversight of the Nigerian
electricity sector. As a result of focused discussion on
consumer affairs to date, NERC opened a branch office in Lagos
(with plans to open five more in Nigeria) to handle consumer
complaints.
In West Africa, USAID recently launched an 18-month
technical assistance program between the ECOWAS Regional
Electricity Regulatory Authority and the West Africa Gas
Pipeline Authority, in partnership with the Organization of PJM
States, Inc.,\1\ to build the regulatory capacity of these
recently established regulatory institutions.
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\1\ An organization of statutory regulatory agencies in 13 American
States and the District of Columbia, within which PJM Interconnection,
LLC, a regional transmission operator approved by the Federal Energy
Regulatory Commission, oversees the operation of the electric
transmission grid and related services.
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Under another USAID program, regulatory staff members from
six African countries will participate in an ongoing internship
program in the United States this summer to gain hands-on
knowledge of establishing regulatory incentives for renewable
energy.

USAID also partners with the U.S. Energy Association to implement
the Energy Utility Partnership Program. USEA is an association of
public and private energy-related organizations, corporations, and
government agencies. The Energy Utility Partnership Program is focused
on volunteer-based, practitioner-to-practitioner, multiyear
partnerships between U.S. and developing country utilities, regulatory
and energy agencies for the purpose of promoting the more efficient,
sustainable, and environmentally sound supply and use of energy. USEA's
approach is to transfer market-based approaches and ``best practices''
for energy system operation and regulation. USEA partnership focus on
such topics as energy sector reform; energy markets; energy efficiency
and renewable energy; energy information and research; environmental
improvement; and electricity generation, transmission, and
distribution. In this unique public-private collaboration, U.S. partner
institutions have demonstrated a commitment to the program by donating
approximately $1 in time and supplies for every U.S. Government dollar
spent. The success of USEA's partnership program results from the
extraordinary voluntary commitment and expertise of participating U.S.
utilities. USEA has supported partnerships in Egypt, Ghana, Kenya,
Namibia, Nigeria, Senegal, Tanzania, Zambia, and Zimbabwe.

COMPLEX CRISIS FUND

Question #12. The Complex Crisis Fund, first appropriated in 2010,
is a flexible funding stream that allows civilian agencies to respond
to emerging crises. How has the Complex Crisis Fund been used by USAID
to effectively prevent violent conflict and mitigate escalating crises
in Africa, and how does this fit into USAID's plan to implement the
QDDR?

Answer. Complex Crisis Funds (CCF) have been used by USAID to
effectively support efforts to prevent violent conflict and mitigate
escalating crises in Kenya, Kyrgyzstan, Sri Lanka, and Yemen.
In Kenya, $3.95 million in CCF was provided to mitigate the threat
of renewed ethnic-based violence in areas at high-risk of conflict from
the International Criminal Court (ICC) and referendum-related
activities. The referendum was calm, and the ICC announcement had
little impact on violence. While there were many factors involved in
the stability during this period, there are many that credit USAID
activities as playing a crucial role.
One way to improve civilian capacity is to expand our ability to
use resources flexibly in dynamic environments. The CCF provides State
and USAID the opportunity to quickly respond to rapidly evolving
situations, which for various reasons, would have been difficult for
the bilateral program funding mechanism to respond in a swift and
appropriate manner.