,i #aacth ,,congress #b;d ,session ,h4 ,r4 #diig ,,in ,,the ,,house ,,of ,,representatives ,june #bf1 #bjad ,ms4 ,de,lauro 7for herself1 ,ms4 ,mc,collum1 and ,ms4 ,lee of ,california7 introduced the following bill2 which was referred to the ,committee on ,foreign ,affairs ,a ,,bill ,to provide assistance to sub-,saharan ,africa to combat obstetric fistula4 #a4 ,short title and table of contents 7a7 ,short title ,this ,act may be cited as the ,united ,states ,leadership to ,eradicate ,obstetric ,fistula ,act of #bjad4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title and table of contents4 ,sec4 #b4 ,findings4 ,sec4 #c4 ,definitions4 ,sec4 #d4 ,comprehensive1 integrated1 #aj-year strategy to combat obstetric fistula in sub-,saharan ,africa4 ,sec4 #e4 ,prevention1 treatment1 and monitoring of obstetric fistula in sub-,saharan ,african countries4 ,sec4 #f4 ,united ,states ,advisory ,committee for the ,eradication of ,obstetric ,fistula4 ,sec4 #g4 ,report4 ,sec4 #h4 ,authorization of appropriations4 #b4 ,findings ,congress makes the following findings3 7#a7 ,obstetric fistula is a catastrophic childbirth injury which arises as a complication of obstructed labor4 7#b7 ,an estimated #b to #c million women currently are afflicted by the devastating physical and social effects of obstetric fistula--a scourge of epidemic proportions4 ,as many as #acj1jjj new cases occur each year4 7#c7 ,historically1 obstetric fistula affected women in the ,united ,states and around the world4 ,advances in obstetric care and access to improved surgical techniques resulted in a drastic reduction in obstetric fistula by the early #bjth century in the ,united ,states4 7#d7 ,today1 obstetric fistula primarily affects the poorest women in the poorest parts of the world4 ,it disproportionately affects women in sub-,saharan ,africa and girls--some as young as #ac years old--who are subjected to child marriage and whose bodies are not fully capable of handling the demands of childbirth4 ,many of these young girls and women have been subjected to female genital mutilation1 which can increase the risk for and be a direct cause of obstetric fistula4 7#e7 ,obstetric fistula1 which usually results in fetal death by asphyxia1 occurs when the tissues that normally separate a woman's vagina from her bladder or rectum are destroyed by prolonged pressure from the fetal head trapped in the birth canal4 7#f7 ,obstetric fistula typically occurs because a woman does not have access to emergency obstetric care or because she does not have the financial means1 transportation1 or access to surgical repair4 7#g7 ,left untreated1 an obstetric fistula afflicts a woman with devastating physical conditions3 incontinence1 painful ulcers1 and constant and uncontrollable emission of offensive odors4 ,these symptoms leave a woman indelibly and perpetually stigmatized by her condition4 7#h7 ,because obstetric fistula does not heal on its own1 women affected by this condition are marginalized for the remainder of their lives4 ,expelled from their communities and denied education and health care1 obstetric fistula victims are left in desperate economic circumstances4 7#i7 ,victims also suffer social ostracism that results in involuntary divorce1 exclusion from religious activities1 deepening poverty1 malnutrition1 deteriorating physical health1 depression1 and despair4 ,as a result1 victims are left defenseless and vulnerable4 7#aj7 ,this social isolation compounds already existing problems such as illiteracy and lack of economic opportunities4 7#aa7 ,because obstetric fistula are not themselves fatal1 millions of women live with this horrific condition and have been overlooked by the international medical community4 ,at present1 humanitarian aid and nongovernmental programs treat fistula cases on a small scale and are not equipped to systematically prevent1 treat1 and eradicate obstetric fistula4 7#ab7 ,obstetric fistula can be prevented when women and their families are educated about the birthing process and are provided access to emergency obstetric care4 7#ac7 ,today1 doctors can surgically repair obstetric fistula with a low-cost1 low-technology surgery4 7#ad7 ,the impact of an obstetric fistula-repair surgery is immediate and consequential4 ,women can be re-integrated into society and are afforded basic human necessities such as familial relationships1 health care1 and the opportunity to earn a living4 7#ae7 ,the prevention1 treatment1 and ultimately the eradication of obstetric fistula will advance the emancipation and empowerment of women1 strengthen families and communities1 and improve the overall economic1 educational1 and social well-being of affected societies4 7#af7 ,basic interventions to identify and repair obstetric fistula have achieved meaningful and cost-effective results4 7#ag7 ,the best available data suggests that existing programs can only repair #aj percent of new obstetric fistula cases each year1 and less than #a percent of existing obstetric fistula cases are repaired each year4 7#ah7 ,the challenge is to expand existing pilot programs into a scalable1 comprehensive1 and sustainable campaign to eradicate obstetric fistula4 7#ai7 ,nongovernmental organizations with experience in obstetric care1 surgery1 and women's rights have proven effective in making progress towards eliminating the scourge of obstetric fistula and can be a resource in assisting indigenous organizations in severely afflicted countries in their efforts to treat and care for women with obstetric fistula4 7#bj7 ,the nature of obstetric fistula--and the fact that it affects vulnerable women in poor and isolated communities which offer little or no access to obstetric care--demands a comprehensive1 coordinated1 long-term1 international response focused on the prevention and treatment of obstetric fistula1 including-- 7,a7 safe-childbirth education and obstetric fistula prevention1 care1 and treatment2 post-operative care1 including rehabilitation1 social reintegration1 and post-surgical follow-up2 basic and applied research and clinical work2 and training of health care workers and educators1 particularly local1 grassroots educators and medical workers2 7,b7 designation of a university-based medical center in the ,united ,states1 designated as the ,international ,obstetric ,fistula ,institute for ,sub-,saharan ,africa established under section #e7;d71 responsible for marshaling surgical and other necessary health resources to effectuate the campaign against obstetric fistula2 for building prevention and treatment capacity in sub-,saharan ,africa1 including coordinating partnerships with sub-,saharan ,african institutions and governments2 and for developing and managing community education and mobilization programs at home and abroad2 7,c7 development of health care infrastructure and delivery systems through ,centers of ,clinical ,excellence for ,obstetric ,fistula ,care for ,sub-,saharan ,africa as well as through cooperative and coordinated public efforts and public-private partnerships2 7,d7 strengthening universities1 research centers1 and training programs for health professionals through institutional capacity-building partnerships2 7,e7 development and implementation of a ,united ,states ,obstetric ,fistula ,treatment and ,prevention ,corps which recruits and trains doctors--especially obstetricians1 gynecologists1 urologists1 general surgeons1 and anesthesiologists--nurses1 and other community-development and public-health personnel to serve regions affected by obstetric fistula and which partners ,united ,states medical professionals with sub-,saharan ,african professionals1 promoting a joint effort to eradicate this devastating condition2 7,f7 coordination of efforts to make the treatment of obstetric fistula a higher priority in sub-,saharan ,african hospitals1 specifically aimed at ameliorating the paucity of training related to obstetric fistula treatment2 and 7,g7 coordination of efforts between the medical community1 nongovernmental organizations1 national governments1 and private sector organizations1 including faith-based organizations4 7#ba7 ,the ,united ,states has the capacity to lead and enhance the effectiveness of the international community's response by-- 7,a7 providing substantial resources1 medical expertise1 and training1 particularly of health care personnel and community workers and leaders2 7,b7 making ,united ,states surgeons and health care professionals available to serve1 train1 and build workforce capacity in afflicted countries through a ,united ,states ,obstetric ,fistula ,treatment and ,prevention ,corps2 7,c7 encouraging governments and faith-based and community organizations to adopt policies that treat obstetric fistula and its causes as a multi-sector1 public-health problem that profoundly affects women's health1 women's empowerment1 education1 the economy1 and promotion of strong and successful families2 7,d7 encouraging education about healthy practices1 including education about the health risks associated with child marriage and female genital mutilation2 7,e7 building successful communities by preventing obstetric fistula and the ensuing social stigma which often separates an obstetric fistula victim from her family2 7,f7 contributing to public health and health-care delivery system research to improve obstetric fistula prevention1 treatment1 and reintegration2 7,g7 encouraging active involvement and cooperation across sectors1 including the medical and scientific communities1 charitable foundations1 private and voluntary organizations and nongovernmental organizations1 faith-based organizations1 community-based organizations1 and other not-for-profit entities2 and 7,h7 engaging in medical diplomacy1 with a particular focus on the further empowerment and emancipation of women4 7#bb7 ,unaddressed obstetric emergencies and untreated obstetric fistula result in the needless1 systematic degradation and marginalization of women4 ,it should be the policy of the ,united ,states to help eradicate this preventable and curable condition4 7#bc7 ,strong coordination must exist among the implementing agencies of the ,united ,states to ensure effective and efficient use of financial1 medical1 and technical resources within the ,united ,states ,government with respect to international obstetric fistula eradication4 7#bd7 ,obstetric fistula is a medical condition which historically affected women around the globe4 ,the ,united ,states long ago eliminated this needlessly oppressive condition because of access to skilled medical professionals and medical care4 ,obstetric fistula can be prevented and repaired4 ,no woman should suffer a lifetime of debilitating physical and social consequences--as obstetric fistula victims do--simply because she lacks access to basic obstetric care4 #c4 ,definitions ,in this ,act3 7#a7 ,advisory ,committee ,the term ,advisory ,committee means the ,united ,states ,advisory ,committee for the ,eradication of ,obstetric ,fistula established under section #f4 7#b7 ,clinical ,center of ,excellence ,the term ,center of ,clinical ,excellence means a ,center of ,clinical ,excellence for ,obstetric ,fistula ,care in sub-,saharan ,africa established under section #e7;d77#e74 7#c7 ,corps ,the term ,corps means the ,united ,states ,obstetric ,fistula ,treatment and ,prevention ,corps established under section #e7;d77#f74 7#d7 ,institute ,the term ,institute means the ,international ,obstetric ,fistula ,institute for ,sub-,saharan ,africa established under section #e7;d77#a74 7#e7 ,relevant executive branch agencies ,the term relevant executive branch agencies means the ,department of ,state1 the ,united ,states ,agency for ,international ,development1 and any other department or agency of the ,united ,states that participates in international health and humanitarian activities pursuant to the authorities of such department or agency or the ,foreign ,assistance ,act of #aifa4 7#f7 ,secretary ,the term ,secretary means the ,secretary of ,state4 7#g7 ,sub-,saharan ,africa ,the terms sub-,saharan ,africa1 sub-,saharan ,african1 and sub-,saharan ,african country shall have the meanings given to such terms for purposes of this ,act by the ,secretary4 #d4 ,comprehensive1 integrated1 #aj-year strategy to combat obstetric fistula in sub-,saharan ,africa 7a7 ,in general ,the ,president1 acting through the ,administrator of the ,united ,states ,agency for ,international ,development1 shall establish a comprehensive1 integrated1 #aj-year strategy to combat obstetric fistula in sub-,saharan ,africa that strengthens the capacity of the ,united ,states to be an effective leader in the movement for international women's health and empowerment4 7b7 ,elements ,such strategy shall maintain sufficient flexibility and remain responsive to the needs of women afflicted with obstetric fistula or who stand at risk of suffering from obstetric fistula and shall include the following3 7#a7 ,a plan for implementation and coordination of programs and activities under this ,act1 including grants and contracts for prevention1 treatment1 and monitoring of obstetric fistula under section #e4 7#b7 ,specific objectives1 multi-sector approaches1 and specific strategies to treat women who suffer from obstetric fistula and to prevent further occurrences of obstetric fistula4 7#c7 ,assignment of priorities for relevant executive branch agencies4 7#d7 ,public health and health care delivery system research on the prevention1 repair1 and rehabilitation of obstetric fistula4 7#e7 ,development1 implementation1 and evaluation of evidence-based systems of care connecting maternity and obstetric fistula care facilities with local care delivery and community education programs4 ,such systems of care should promote rapid and long-term prevention of obstetric fistula1 including-- 7,a7 referral to prenatal care to identify and mitigate risk factors for obstetric fistula2 7,b7 culturally appropriate childbirth education1 preparation1 and planning2 7,c7 access to skilled obstetric care2 and 7,d7 promoting prompt detection of prolonged labor and appropriate action to address it4 7#f7 ,provision that the reduction of health and social risks which increase the likelihood of obstetric fistula shall be a priority of all prevention efforts in terms of funding1 educational messages1 and activities promoting a decrease in child marriage and the adolescent pregnancy rate1 prompt detection of prolonged labor1 and immediate intervention in cases of obstructed labor through improved access to emergency obstetric services provided by partner hospitals4 7#g7 ,improvement of coordination and reduce duplication among relevant executive branch agencies1 foreign governments1 and international organizations4 7#h7 ,projection of general levels of resources needed to achieve the stated objectives4 7#i7 ,expansion of public-private partnerships and the leveraging of resources4 7#aj7 ,maximization of ,united ,states capabilities in the areas of medical training and research and application of those capabilities in sub-,saharan ,africa4 ,such efforts may include the provision of grants by relevant executive branch agencies for institutional capacity-building partnerships between ,united ,states and foreign institutions1 as well as between in-country institutions1 for the purpose of mobilizing in-country capacity1 resources1 and expertise to prevent and repair cases of obstetric fistula4 7#aa7 ,priorities for the distribution of resources based on factors such as the size and demographics of the population suffering from obstetric fistula1 the needs of that population1 and the existing infrastructure or funding levels that may exist to treat and prevent obstetric fistula4 7#ab7 ,a long-term commitment to the eradication of obstetric fistula by expanding health system capacity and training opportunities for doctors and other health service providers in sub-,saharan ,africa4 7#ac7 ,a plan to maximize ,united ,states efforts in workforce training1 capacity-building1 and retention relating to obstetric fistula prevention1 treatment1 rehabilitation1 and research4 ,such plan shall be coordinated with existing ,united ,states and in-country workforce capacity-building plans and efforts4 ,such plan may include training of foreign health workers at ,united ,states institutions and train-the-trainer programs4 7#ad7 ,a plan for institutional capacity-building partnerships to strengthen universities1 research centers1 health-profession training programs1 and government institutes to build the in-country capacity needed to eradicate obstetric fistula4 7c7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,president shall submit to ,congress a report that contains the strategy required under this section4 #e4 ,prevention1 treatment1 and monitoring of obstetric fistula in sub-,saharan ,african countries 7a7 ,in general ,the ,president1 acting through the ,administrator of the ,united ,states ,agency for ,international ,development1 is authorized to provide grants to or enter into contracts with an eligible entity described in subsection 7b7 to carry out activities to prevent1 treat1 and monitor obstetric fistula in sub-,saharan ,african countries in accordance with this section4 7b7 ,eligible entity described ,in this section1 the term eligible entity means a major1 university-based medical center in the ,united ,states4 7c7 ,application and selection 7#a7 ,application ,the ,president shall provide for eligible entities to submit applications to the ,president for grants or contracts under this section in such form and manner as the ,president may require to carry out the purposes of this section4 7#b7 ,selection 7,a7 ,in general ,from among the applications submitted under paragraph 7#a71 the ,president shall select an eligible entity to receive grants or contracts under this section pursuant to a competitive selection process4 7,b7 ,criteria ,the competitive selection process referred to in subparagraph 7,a7 shall be based upon selection criteria1 which shall include-- 7i7 the breadth and depth of medical faculty1 particularly with experience in obstetrics and reconstructive pelvic surgery2 7ii7 breadth and depth of public health and international health faculty2 7iii7 experience in and capacity to conduct training of the global health workforce and to strengthen capacity-building and health systems2 7iv7 experience in building institutional capacity in sub-,saharan ,africa1 including through institutional partnerships2 7v7 willingness to supplement amounts received under grants or contracts under subsection 7a7 by engaging in community partnerships2 and 7vi7 whether the applicant1 for purposes of this ,act1 has entered into a cooperative agreement with one or more major1 university-based medical centers in sub-,saharan ,africa4 7d7 ,use of funds 7#a7 ,international ,obstetric ,fistula ,institute for ,sub-,saharan ,africa ,amounts received under grants or contracts under subsection 7a7 shall be used to establish and operate at the eligible entity's medical center in the ,united ,states an institute to carry out paragraphs 7#b7 through 7#g71 to be known as the ,international ,obstetric ,fistula ,institute for ,sub-,saharan ,africa4 ,the purpose of the ,institute shall be to prevent1 treat1 and monitor obstetric fistula in sub-,saharan ,african countries4 7#b7 ,administration and training ,the ,institute shall-- 7,a7 serve as the primary administrative and medical-training hub for the campaign to prevent1 treat1 and monitor obstetric fistula in sub-,saharan ,african countries2 7,b7 ensure the campaign described in subparagraph 7,a7 is carried out on both a scientific and humanitarian basis2 7,c7 initiate and oversee the training and clinical activities of physicians1 other health professionals1 and educators serving at ,centers of ,clinical ,excellence2 and 7,d7 ensure a progressive increase in health system and workforce capacity to prevent1 treat1 and monitor obstetric fistula in each country in which a ,center of ,clinical ,excellence is located4 7#c7 ,enforce clinical standards and accountability ,the ,institute shall-- 7,a7 promote the utilization of standard clinical protocols1 facilitate data collection1 coordinate research efforts1 and oversee and participate in multi-center randomized surgical trials2 and 7,b7 enforce the highest standards of clinical practice and ethical behavior as described in the published code of medical ethics for obstetric fistula surgeons4 7#d7 ,develop evidence-based programs for prevention and access to emergency obstetric care ,the ,institute shall-- 7,a7 develop and implement comprehensive and culturally appropriate protocols to prevent the formation of obstetric fistula1 including the development and implementation of evidence-based systems of care1 which identify1 track1 and evaluate obstetric fistula prevention programs2 7,b7 develop and implement prevention programs that-- 7i7 teach women and family members1 in a culturally appropriate manner1 how to identify prolonged labor2 7ii7 inform women and family members of the risks of not seeking appropriate medical care2 7iii7 refer women and family members to prenatal1 perinatal1 and postnatal care2 7iv7 teach women and family members how to mobilize community resources to assist in seeking emergency obstetric care2 and 7v7 teach women and family members to identify symptoms of obstetric fistula and refer women to treatment2 7,c7 assist ,centers of ,clinical ,excellence in developing localized programs for childbirth education1 preparation and planning1 prolonged-labor detection1 labor monitoring1 and transportation from villages to local hospitals for obstetric care and to ,centers of ,clinical ,excellence for obstetric fistula care1 accounting for factors such as transportation1 geography1 and scalability of such solutions2 and 7,d7 seek to partner with ,united ,states medical personnel and volunteers to train and employ local men and women as community-based labor monitors who can educate and assist other women at risk of suffering from obstetric fistula1 thereby empowering an entire sector of women in sub-,saharan ,africa with information and employment4 7#e7 ,centers of ,clinical ,excellence for ,obstetric ,fistula ,care in ,sub-,saharan ,africa 7,a7 ,in general ,the ,institute1 in cooperation with each medical center in sub-,saharan ,african described in subsection 7b71 shall establish not less than #h centers in sub-,saharan ,africa to treat and prevent obstetric fistula in countries and areas in which obstetric fistula is widespread1 as determined by the ,institute in consultation with the ,advisory ,committee4 ,such centers shall be known as ,centers of ,clinical ,excellence for ,obstetric ,fistula ,care in sub-,saharan ,africa4 7,b7 ,general duties ,each ,center of ,clinical ,excellence shall establish programs to treat and prevent obstetric fistula at hospitals and to expand the networks of such hospitals4 the ,centers of ,excellence shall be co-located or located within reasonable proximity to hospitals capable of providing emergency and routine obstetric care1 in order to fulfill its duties and to ensure hospitals meet emergency obstetric needs4 7,c7 ,specific duties ,each ,center of ,clinical ,excellence shall function as localized epicenters of training and clinical excellence for obstetric fistula care1 and shall-- 7i7 be a major locus of medical and surgical care for obstetric fistula patients2 7ii7 be centers for the training of obstetric fistula surgeons1 nurses1 and other medical personnel2 7iii7 coordinate and implement community outreach and prevention programs2 7iv7 partner with the national ministry of health or equivalent government body and medical educators in the country in which the ,center of ,clinical ,excellence is located to develop country-specific training programs for surgeons and other health care personnel involved in obstetric fistula care2 7v7 be a vehicle for expanding access to emergency obstetric services in affiliated communities2 7vi7 establish a consulting and referral relationship with a hospital in its geographic vicinity1 assist the hospital by completing an initial1 comprehensive assessment of what resources the hospital would need to improve delivery of emergency obstetric services1 and based on the needs assessments and subject to the approval of the ,institute approve funding for each hospital to undergo appropriate physical renovation and reimburse the hospital for emergency obstetric care and cesarean deliveries2 and 7vii7 coordinate a system of village 8labor monitors0 to help prevent obstetric fistula by identifying pregnant women in their communities1 monitoring their labors1 and activating an organized emergency-transport system to move high-risk women to local hospitals with adequate obstetric care4 7#f7 ,united ,states ,obstetric ,fistula ,treatment and ,prevention ,corps 7,a7 ,in general ,the ,institute1 in cooperation with each medical center in sub-,saharan ,african described in subsection 7b71 shall establish and operate a ,united ,states ,obstetric ,fistula ,treatment and ,prevention ,corps4 7,b7 ,duties ,the ,corps shall-- 7i7 provide volunteer medical services at ,centers of ,clinical ,excellence and train local surgeons and other health professionals in techniques of obstetric fistula repair and in other aspects of the care of women with obstetric fistula2 7ii7 seek to establish an enabling environment in which patient care can be provided effectively1 consistently1 humanely1 and ethically to women with obstetric fistula2 and 7iii7 develop evidence-based systems of care for the prevention of obstetric fistula4 7,c7 ,membership ,the ,corps shall consist of-- 7i7 graduates of ,united ,states or ,african residency programs in such fields as obstetrics and gynecology1 general surgery1 urology1 and anesthesiology2 and 7ii7 other doctors1 nurses1 community-health professionals1 public-health professionals1 and other expert personnel as needed to further the duties of the ,institute to prevent1 treat1 and monitor obstetric fistula in sub-,saharan ,african countries4 7,d7 ,duration of service ,members of the ,corps shall commit to a duration of service of not less than #bh months4 7,e7 ,compensation1 other benefits ,the ,institute may provide compensation1 other employment benefits1 and loan guarantees to individuals who agree to serve as members of the ,corps4 7,f7 ,alumni ,corps ,the ,institute is authorized to establish an ,alumni ,corps1 comprised of former members of the ,corps who have completed successfully at least one period of service described in subparagraph 7,d7 in order to augment medical personnel at ,centers for ,clinical ,excellence4 7#g7 ,annual report ,the ,institute shall submit to ,congress and make available to the public an annual report on the implementation of this subsection1 including a description of-- 7,a7 the recruitment for and implementation of the ,corps2 and 7,b7 the activities of each ,center of ,clinical ,excellence1 including-- 7i7 the number of women served at the ,center2 7ii7 the success rate of obstetric fistula-repair surgeries1 prevention efforts1 and other programs used by the ,center and surrounding communities2 and 7iii7 other delivery system and quality measures as appropriate4 7e7 ,personnel ,the ,institute shall be administered by qualified1 essential personnel including-- 7#a7 a director1 who reports directly to the head of the medical center in the ,united ,states referred to in subsection 7b72 7#b7 expert leadership to oversee key aspects of the duties of the ,institute1 including-- 7,a7 medical and surgical activities2 7,b7 prevention1 education1 and outreach2 7,c7 partnerships and capacity building2 7,d7 emergency obstetric services2 and 7,e7 program management2 7#c7 professional and administrative staff responsible for administration1 coordination1 and campaign performance2 7#d7 dedicated1 full-time1 experienced surgeons responsible for the medical supervision and training of ,united ,states and sub-,saharan ,african surgeons assigned to ,centers of ,clinical ,excellence1 and for medical research1 data collection1 and successful implementation of medical programs in sub-,saharan ,africa2 7#e7 full-time prevention1 education1 and outreach coordinators1 responsible for the ,institute's outreach1 education1 prevention1 and social reintegration programs as well as for the supervision and training of outreach and education staff assigned to the ,centers of ,clinical ,excellence2 7#f7 an advisory panel for surgical outcomes and quality comprised of no fewer than #ae senior practicing surgeons from the ,united ,states and other countries-- 7,a7 to ensure a high1 uniform level of surgical care2 7,b7 to engage in clinical practice with ,centers of ,clinical ,excellence for ,sub-,saharan ,africa to share their surgical experience and to provide clinical oversight2 and 7,c7 to liaise with ,centers of ,clinical ,excellence for ,sub-,saharan ,africa and the ,institute to ensure the ,centers of ,clinical ,excellence are accountable for providing a consistent and high level of surgical care2 and 7#g7 an internal oversight and steering committee comprised of individuals who are medical professionals1 public health professionals1 international social welfare advisors1 economists specializing in international development1 or professors of law or political science4 7f7 ,additional personnel ,the ,institute may appoint and fix the pay of additional personnel as the ,institute considers appropriate4 #f4 ,united ,states ,advisory ,committee for the ,eradication of ,obstetric ,fistula 7a7 ,establishment ,there is established an advisory committee to be known as the ,united ,states ,advisory ,committee for the ,eradication of ,obstetric ,fistula4 7b7 ,membership 7#a7 ,selection2 qualifications ,the ,advisory ,committee shall be composed of #ad members selected by the ,secretary 7through a competitive process7 from among individuals who are distinguished scholars1 clinicians1 scientists1 advocates1 and philanthropists and who1 collectively-- 7,a7 have knowledge and experience in health care and global health policy1 including international health1 obstetrics1 women's empowerment1 human rights1 and international law2 and 7,b7 have direct experience abroad especially in sub-,saharan ,africa4 7#b7 ,selection ,the ,advisory ,committee shall be composed of #ad members selected by the ,secretary through a competitive process4 7#c7 ,disqualification ,an individual shall not be appointed as a member of the ,advisory ,committee if such individual possesses any personal or financial interest in the discharge of any duties of the ,advisory ,committee4 7#d7 ,terms ,the term of office of each member of the ,advisory ,committee shall be #e years4 ,members of the ,advisory ,committee shall be eligible for reappointment for up to #b terms4 7c7 ,meetings 7#a7 ,initial meeting ,the ,advisory ,committee shall hold its initial meeting on the date that is no later than #abj days after the date of the enactment of this ,act4 7#b7 ,meetings ,the ,advisory ,committee shall meet at the call of the ,chairman or a majority of its members4 ,the ,advisory ,committee shall meet no less than twice per calendar year4 7#c7 ,quorum ,six members of the ,advisory ,committee shall constitute a quorum for purposes of conducting business1 except that #b members of the ,advisory ,committee shall constitute a quorum for purposes of receiving testimony4 7#d7 ,vacancies ,any vacancy of the ,advisory ,committee shall not affect its powers1 but shall be filled promptly in the manner in which the original appointment was made4 7d7 ,administration 7#a7 ,travel expenses ,members of the ,advisory ,committee shall be allowed travel expenses1 including per diem in lieu of subsistence1 at rates authorized for employees of agencies under subchapter ,i of chapter #eg of title #e1 ,united ,states ,code1 while away from their homes or regular places of business in performance of services for the ,advisory ,committee4 7#b7 ,administrative support ,the ,secretary shall assist the ,advisory ,committee by providing to the ,advisory ,committee such staff and administrative services as may be necessary and appropriate for the ,advisory ,committee to perform its functions4 ,upon request of the ,advisory ,committee1 the head of any ,federal department or agency may detail any of the personnel of that department or agency to the ,advisory ,committee without reimbursement to the department or agency of that employee and such detail shall be without interruption or loss of civil service status or privilege4 7#c7 ,experts and consultants ,the ,advisory ,committee may procure temporary and intermittent services under section #caji7;b7 of title #e1 ,united ,states ,code4 7#d7 ,other resources ,the ,advisory ,committee shall have reasonable access to materials1 resources1 statistical data1 and other information the ,advisory ,committee determines to be necessary to carry out its duties from the ,library of ,congress1 the ,department of ,state1 the ,national ,library of ,medicine1 and other departments and agencies of the executive and legislative branches of the ,federal ,government4 ,the ,chairman of the ,advisory ,committee shall make requests for such access in writing when necessary4 7#e7 ,obtaining official data ,the ,advisory ,committee may secure directly from any department or agency of the ,united ,states information necessary to enable it to carry out this section4 ,upon the request of the ,chairman of the ,advisory ,committee1 the head of that department or agency shall furnish that information to the ,advisory ,committee4 7e7 ,duties ,the primary duties of the ,advisory ,committee shall include-- 7#a7 advising the ,institute on an ongoing basis in carrying out the duties of the ,institute2 7#b7 evaluating programs and activities to eradicate obstetric fistula and making recommendations regarding the programs of the ,institute2 7#c7 advising the ,department of ,state and the ,united ,states ,agency for ,international ,development on an ongoing basis in carrying out programs and activities to eradicate obstetric fistula2 7#d7 monitoring funds available for programs and activities to eradicate obstetric fistula to ensure such funds are used efficiently and are accounted for properly1 including through the conduct of periodic audits2 and 7#e7 advising the ,administrator of the ,united ,states ,agency for ,international ,development in an annual written report of the ,institute's performance and success in carrying out its duties4 7f7 ,actions against governments failing ,to meet minimum standards 7#a7 ,by ,advisory ,committee ,the ,advisory ,committee-- 7,a7 shall advise the ,administrator of the ,united ,states ,agency for ,international ,development1 based on information provided to the ,advisory ,committee by the ,institute or based on independent sources of information1 of each county that by reason of corruption1 indifference1 or ineffectiveness1 significantly impedes the ,institute's ability to provide services to victims of obstetric fistula and women who are vulnerable to obstetric fistula2 and 7,b7 may request the ,administrator to recommend suspension of the provision of ,united ,states nonhumanitarian1 nontrade-related foreign assistance to each country described in subparagraph 7,a74 7#b7 ,by ,,usaid ,based on the advice of the ,advisory ,committee under paragraph 7#a71 the ,administrator may accept the advice and1 in consultation with the ,secretary1 recommend to the ,president the suspension of ,united ,states nonhumanitarian1 nontrade-related foreign assistance to a county described in paragraph 7#a77;,a74 #g4 ,report ,the ,president1 acting through the ,administrator of the ,united ,states ,agency for ,international ,development1 shall submit to ,congress on an annual basis a report on the implementation of this ,act for the preceding year1 including an evaluation of the effectiveness and performance of the ,institute1 the ,centers of ,clinical ,excellence1 the ,corps1 and all related community outreach and medical programs4 #h4 ,authorization of appropriations 7a7 ,in general ,there are authorized to be appropriated to the ,president to carry out this ,act-- 7#a7 #aj1jjj1jjj for fiscal year #bjae2 and 7#b7 #ahj1jjj1jjj for the period of fiscal years #bjaf through #bjbd4 7b7 ,availability ,amounts appropriated pursuant to the authorization of appropriations under subsection 7a7 are authorized to remain available until expended4