B-137662, NOV 30, 1979

B-137662: Nov 30, 1979

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WE HAVE REVIEWED S. 1424. OUR SPECIFIC COMMENTS ARE AS FOLLOWS: 1. VARIOUS STUDIES HAVE SHOWN A NEED FOR IMPROVED COORDINATION AMONG THE FEDERAL AGENCIES PARTICIPATING IN INTERNATIONAL HEALTH ACTIVITIES. THE ENCLOSED TABLE WHICH WAS INCLUDED IN A 1978 WHITE HOUSE STAFF REPORT TO THE PRESIDENT. SHOWS THE SCOPE OF THE FEDERAL INVOLVEMENT AND THE EXTENT THAT MULTIPLE AGENCIES ARE PARTICIPATING IN INTERNATIONAL HEALTH ACTIVITIES. THE FIRST IS AN INTERNATIONAL HEALTH FELLOWSHIP PROGRAM TO ENCOURAGE STUDIES RELATING TO ORGANIZATION. THE SECOND IS THE CREATION OF AN INTERNATIONAL HEALTH SERVICE (CORPS) WHICH IS TO BE COMPOSED OF MIDCAREER HEALTH PROFESSIONALS AND DIRECTED TOWARD THE ENHANCEMENT OF PUBLIC HEALTH.

B-137662, NOV 30, 1979

PRECIS-UNAVAILABLE

HARRISON A. WILLIAMS, JR., UNITED STATES SENATE:

AS REQUESTED, WE HAVE REVIEWED S. 1424, A BILL TO AMEND THE FOREIGN ASSISTANCE ACT AND THE PUBLIC HEALTH SERVICE ACT TO PROVIDE FOR THE ADVANCEMENT OF INTERNATIONAL COOPERATION AND ASSISTANCE IN HEALTH, AND FOR OTHER PURPOSES. WE CONCUR WITH THE BILL'S INTENT OF IMPROVING THE HEALTH STATUS OF RESIDENTS OF DEVELOPING COUNTRIES THROUGH INCREASED COORDINATED USE OF EXISTING FEDERAL MANPOWER AND TECHNOLOGY AND THROUGH INCREASED IMPLEMENTATION OF HEALTH PROGRAMS IN THE CONTEXT OF OVERALL ECONOMIC DEVELOPMENT ASSISTANCE TO THE COUNTRIES. WE WISH TO POINT OUT, HOWEVER, SOME SECTIONS OF THE BILL WHICH NEED TO BE CLARIFIED FOR EFFECTIVE IMPLEMENTATION, IF ENACTED. IN ADDITION WE SUGGEST THAT YOUR COMMITTEE AMEND THE BILL SO AS TO INCLUDE AUDIT PROVISIONS FOR THE COMPTROLLER GENERAL. OUR SPECIFIC COMMENTS ARE AS FOLLOWS:

1. TITLE I OF THE BILL ADDRESSES LACK OF COORDINATION AMONG THE VARIOUS FEDERAL AGENCIES FUNDING INTERNATIONAL HEALTH ACTIVITIES AND PROVIDES FOR THE ESTABLISHMENT OF AN INTERNATIONAL HEALTH SUBCOMMITTEE OF THE DEVELOPMENT COORDINATION COMMITTEE. VARIOUS STUDIES HAVE SHOWN A NEED FOR IMPROVED COORDINATION AMONG THE FEDERAL AGENCIES PARTICIPATING IN INTERNATIONAL HEALTH ACTIVITIES. THE ENCLOSED TABLE WHICH WAS INCLUDED IN A 1978 WHITE HOUSE STAFF REPORT TO THE PRESIDENT, SHOWS THE SCOPE OF THE FEDERAL INVOLVEMENT AND THE EXTENT THAT MULTIPLE AGENCIES ARE PARTICIPATING IN INTERNATIONAL HEALTH ACTIVITIES. THEREFORE, WE CONCUR WITH THE INTENT OF THIS TITLE. WE NOTE, HOWEVER, THAT THE PROPOSED LEGISLATION DOES NOT MENTION THE RECENTLY ESTABLISHED UNITED STATES INSTITUTE FOR SCIENTIFIC AND TECHNOLOGICAL COOPERATION AND SUGGEST THAT IT BE INCLUDED AS A MEMBER OF THE SUBCOMMITTEE.

2. TITLE II OF THE BILL AUTHORIZES THE ESTABLISHMENT OF THE OFFICE OF INTERNATIONAL HEALTH WITHIN THE DEPARTMENT OF HEALTH, EDUCATION AND WELFARE. THIS OFFICE CURRENTLY EXISTS UNDER ADMINISTRATIVE AUTHORITIES GRANTED TO THE SECRETARY. (42 U.S.C. 203) IT ALSO ESTABLISHES THREE PROGRAMS WITHIN THE DEPARTMENT'S PUBLIC HEALTH SERVICE. THE FIRST IS AN INTERNATIONAL HEALTH FELLOWSHIP PROGRAM TO ENCOURAGE STUDIES RELATING TO ORGANIZATION, MANAGEMENT AND DELIVERY OF HEALTH SERVICES. THE SECOND IS THE CREATION OF AN INTERNATIONAL HEALTH SERVICE (CORPS) WHICH IS TO BE COMPOSED OF MIDCAREER HEALTH PROFESSIONALS AND DIRECTED TOWARD THE ENHANCEMENT OF PUBLIC HEALTH, CLINICAL, AND RESEARCH CAPABILITY OF FOREIGN GOVERNMENTS AND INSTITUTIONS. THE THIRD PROGRAM ESTABLISHES AND PROVIDES SUPPORT FOR INTERNATIONAL HEALTH CENTERS AND PROGRAMS IN ACADEMIC INSTITUTIONS IN THE UNITED STATES.

WE ACKNOWLEDGE THAT SOME FOREIGN COUNTRIES COULD BENEFIT FROM HEALTH TECHNOLOGY, OUR HEALTH TRAINING CAPABILITIES AND OUR HEALTH MANPOWER POOL. AS CAN BE NOTED IN THE ENCLOSURE, AGENCIES ALREADY ENGAGE IN THE TYPES OF ACTIVITIES ANTICIPATED. THE PROPOSED LEGISLATION DOES NOT ADEQUATELY ADDRESS THE EXTENT THAT THESE AGENCIES ARE CURRENTLY INVOLVED AND WHETHER OR NOT THE PROPOSED PROGRAMS ARE TO SUPPLEMENT OR ELIMINATE CURRENT EFFORTS. IN ADDITION, WE BELIEVE THAT THE PROPOSED LEGISLATION SHOULD CLARIFY HOW THE THREE PROGRAMS PROPOSED UNDER THIS TITLE RELATE TO AND COMPLEMENT FEDERAL ACTIVITIES AUTHORIZED BY THE FOREIGN ASSISTANCE ACT OF 1961, AS AMENDED, AND THE AGRICULTURE TRADE DEVELOPMENT AND ASSISTANCE ACT OF 1954, AS AMENDED (P.L. 480). ACTIVITIES INITIATED UNDER THESE LEGISLATIVE AUTHORITIES ARE PRIMARILY DIRECTED TOWARD THE SOCIAL AND ECONOMIC DEVELOPMENT OF THE ASSISTED COUNTRIES. HEALTH IS ONE OF THE FUNCTIONS INCLUDED IN THE SCOPE OF THIS DEVELOPMENT ASSISTANCE AND SHOULD NOT BE TOTALLY DIVORCED FROM THE COUNTRY ASSISTANCE PROGRAM.

3. RECENT AMENDMENTS TO THE FOREIGN ASSISTANCE ACT OF 1961 (INTERNATIONAL DEVELOPMENT COOPERATION ACT OF 1979, ENACTED ON AUGUST 14, 1979) ESTABLISHED THE INSTITUTE FOR SCIENTIFIC AND TECHNOLOGICAL COOPERATION. THE INSTITUTE IS TO STRENGTHEN THE CAPACITY OF THE PEOPLE OF DEVELOPING COUNTRIES TO SOLVE THEIR DEVELOPMENTAL PROBLEMS THROUGH SCIENTIFIC AND TECHNOLOGICAL INNOVATION, TO FOSTER RESEARCH ON PROBLEMS OF DEVELOPMENT, AND TO FACILITATE SCIENTIFIC AND TECHNOLOGICAL COOPERATION WITH DEVELOPING COUNTRIES. SOME OF THE LEGISLATED FUNCTIONS OF THE INSTITUTE COULD INCLUDE ACTIVITIES PROPOSED THROUGH S. 1424. FOR EXAMPLE, THE NEW ACT STIPULATES THAT THE INSTITUTE SHOULD SUPPORT RESEARCH IN THE UNITED STATES AND IN DEVELOPING COUNTRIES ON CRITICAL DEVELOPMENTAL PROBLEMS. PRESUMABLY, THIS COULD INCLUDE HEALTH RESEARCH WHICH CAN BE DONE UNDER THE PROVISIONS OF TITLE II IN S. 1424. THEREFORE, WE SUGGEST THAT CLARIFICATION BE GIVEN REGARDING THE ROLE OF THE INSTITUTE AS IT RELATES TO INTERNATIONAL HEALTH.

4. TITLE III OF THE PROPOSED LEGISLATION ESTABLISHES THE HUBERT H. HUMPHREY FUND FOR INTERNATIONAL HEALTH AND STIPULATES THAT THE FUND SHALL BE A PRIVATE CORPORATION - NOT AN AGENCY OR ESTABLISHMENT OF THE UNITED STATES GOVERNMENT. THE FUND IS TO BE ESTABLISHED AS A NONPROFIT ENTITY UNDER THE DISTRICT OF COLUMBIA NONPROFIT CORPORATION ACT. THE BILL DOES NOT PROVIDE FOR THE FUND TO BE SUBJECT TO CONGRESSIONAL CONTROL OR REVIEW OTHER THAN REQUIRED ANNUAL REPORTS TO THE PRESIDENT AND THE APPROPRIATE COMMITTEES OF THE SENATE AND HOUSE OF REPRESENTATIVES. HOWEVER, THE BILL PROVIDES THAT THE FUND SHALL BE GUIDED BY THE POLICIES OF THE INTERNATIONAL HEALTH SUBCOMMITTEE AND BY POLICIES SET FORTH IN SECTION 101, 102, AND 104 OF THE FOREIGN ASSISTANCE ACT OF 1961, AS AMENDED AND AUTHORIZES APPROPRIATIONS TO THE FUND TO CARRY OUT ITS ACTIVITIES.

SINCE APPROPRIATIONS WILL BE MADE TO THE FUND, WE SUGGEST THAT THE BILL BE AMENDED TO READ:

"THE COMPTROLLER GENERAL SHALL AUDIT THE PROGRAMS, ACTIVITIES, AND FINANCIAL OPERATIONS OF THE CORPORATION FOR ANY PERIOD DURING WHICH FEDERAL FUNDS ARE AVAILABLE TO FINANCE ANY PORTION OF THE OPERATIONS AND SHALL REPORT TO THE CONGRESS AT SUCH TIMES AND TO SUCH EXTENT AS HE DEEMS NECESSARY TO KEEP THE CONGRESS INFORMED ON THE STATUS OF SUCH PROGRAMS, ACTIVITIES, AND OPERATIONS, AND TO MAKE RECOMMENDATIONS FOR ACHIEVING GREATER ECONOMY, EFFICIENCY AND EFFECTIVENESS. THE AUDIT SHALL BE MADE UNDER SUCH RULES AND REGULATIONS AS HE MAY PRESCRIBE.

"FOR THE PURPOSE OF SUCH AUDITS, THE COMPTROLLER GENERAL, OR ANY OF HIS DULY AUTHORIZED REPRESENTATIVES, SHALL HAVE ACCESS TO AND THE RIGHT TO EXAMINE ALL BOOKS, ACCOUNTS, RECORDS, REPORTS, FILES, AND ALL OTHER PAPERS, THINGS OR PROPERTY BELONGING TO OR IN USE BY THE CORPORATION."

5. IN EACH OF THE THREE TITLES AND ELSEWHERE IN THE BILL THE PROPOSED LEGISLATION DEFINES THE TERM INTERNATIONAL HEALTH ACTIVITY TO INCLUDE "POPULATION" WHEN REFERRING TO FAMILY PLANNING. BECAUSE THE INTENDED ACTIVITY IS MORE PROPERLY REFERRED TO AS "FAMILY PLANNING" WE SUGGEST THAT "POPULATION" BE DELETED FROM EACH OF THESE DEFINITIONS AND "FAMILY PLANNING" INSERTED.

6. IN TITLE I, SECTION 101(640C(4)(D)) "5703(B)" SHOULD BE CHANGED TO READ "5703".

7. IN TITLE IV, SECTION 311(B), REFERENCE TO SECTION 308 SHOULD BE CHANGED TO READ SECTION 309.

WE BELIEVE THAT THE ABOVE COMMENTS SHOULD BE BENEFICIAL TO YOUR COMMITTEE IN CONSIDERING THE PROPOSED LEGISLATION AND ARE AVAILABLE TO DISCUSS THEM IN GREATER DETAIL WITH YOU OR YOUR STAFF.