,i #aaeth ,,congress #ast ,session ,h4 ,r4 #djbb ,,in ,,the ,,house ,,of ,,representatives ,october #aa1 #bjag,mr4 ,reichert 7for himself1 ,ms4 ,mc,collum1 ,ms4 ,lee1 and ,mr4 ,donovan7 introduced the following bill2 which was referred to the ,committee on ,foreign ,affairs ,a ,,bill ,to implement a strategic approach for providing foreign assistance in order to end preventable child and maternal deaths globally within a generation1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,reach ,every ,mother and ,child ,act of #bjag4 #b4 ,assistance to end preventable child and maternal deaths ,the ,foreign ,assistance ,act of #aifa 7#bb ,u4,s4,c4 #baea et seq47 is amended by adding at the end of chapter #a of part ,i the following3 #acg4 ,assistance to end preventable child and maternal deaths 7a7 ,sense of ,congress ,it is the sense of ,congress that ,united ,states foreign assistance efforts should focus on countries1 regions1 and communities with the greatest need and the highest burden of preventable child and maternal deaths4 7b7 ,statement of policy ,it shall be the policy of the ,united ,states1 in coordination with recipient countries and relevant partner entities1 to establish and implement a coordinated1 integrated1 and comprehensive strategy to combat the leading causes of maternal1 newborn1 and child mortality globally and ensure healthy and productive lives for women and children1 by-- 7#a7 scaling up the highest-impact1 evidence-based interventions1 including for the most vulnerable populations1 with a focus on country ownership2 7#b7 designing1 implementing1 monitoring1 and evaluating programs in a way that enhances transparency and accountability1 increases sustainability1 and improves outcomes in target countries2 and 7#c7 supporting the development and scale-up of innovative tools and approaches to accelerate progress toward ending preventable child and maternal deaths and reach the goal of saving the lives of #ae1jjj1jjj children and #fjj1jjj women4 7c7 ,strategy 7#a7 ,in general ,not later than one year after the date of the enactment of this section1 the ,president shall establish and implement a comprehensive five-year1 whole-of-government strategy to accelerate progress toward ending preventable child and maternal deaths within a generation and ensure healthy and productive lives for women and children4 7#b7 ,elements ,the strategy established under paragraph 7#a7 shall-- 7,a7 set specific1 outcome-based1 and measurable targets to achieve the goals of the strategy and identify baseline data for each target country and for all areas of focus and programming1 as of the date of the publication of such strategy2 7,b7 incorporate existing ,federal strategies and frameworks relevant to ending preventable child and maternal deaths1 including specific objectives1 programs1 and approaches to implement highest-impact1 evidence-based interventions1 to address the leading causes of death in target countries1 particularly among the most vulnerable populations1 for-- 7i7 women1 related to pregnancy1 childbirth1 or the post-delivery period2 7ii7 newborn children during their first #bh days2 and 7iii7 infants and children under the age of five2 7,c7 include development and scale up of new technologies and approaches1 including those supported by public-private partnerships for research and innovation2 7,d7 promote coordination and efficiency within and amongst the relevant ,federal departments and agencies2 7,e7 project the general levels of resources needed to achieve the strategy's stated objectives2 7,f7 identify strategies for leveraging resources with new and innovative financial tools2 7,g7 align with the maternal1 newborn1 and child health and survival plans of target countries and improve coordination with foreign governments and international organizations2 7,h7 outline consultations with target countries and relevant partner entities2 7,i7 implement results-based contracting1 such as pay-for-outcome arrangements1 and reduce financial and operational risks2 7,j7 promote a shift toward inclusive and sustainable investments2 7,k7 support the transition to sustainably financed1 domestic health systems in target countries2 and 7,l7 promote partnerships with organizations that have a long-term presence in target countries and have shown evidence of sustainable community impact1 including through the capacity building of local and community-based organizations4 7#c7 ,identification of target countries ,for purposes of the strategy under paragraph 7#a71 the ,administrator shall-- 7,a7 identify each country that has the greatest need and faces the highest burden of preventable child and maternal deaths1 taking into consideration countries that-- 7i7 have high-need1 underserved1 marginalized1 vulnerable1 or impoverished communities2 7ii7 are fragile or conflict-affected countries2 7iii7 are low- or middle-income countries2 or 7iv7 are located in regions with weak health systems2 and 7,b7 establish transparent selection criteria for such target countries4 7d7 ,improving coordination and oversight 7#a7 ,establishment of senior coordinator for child and maternal survival ,the ,administrator shall designate a current employee serving in a career or non-career position in the ,senior ,executive ,service or at the level of a ,deputy ,assistant ,administrator or higher at the ,united ,states ,agency for ,international ,development 7,,usaid7 to serve concurrently as the ,senior ,coordinator for ,child and ,maternal ,survival4 7#b7 ,duties ,the ,senior ,coordinator shall-- 7,a7 have the primary responsibility for the oversight and coordination of international maternal and child health and nutrition funding managed by the ,,usaid ,bureau of ,global ,health2 7,b7 lead the development of the strategy established under subsection 7c7 and its implementation by ,,usaid1 including by directing the budget1 planning1 and staffing with respect to such implementation2 7,c7 facilitate program and policy coordination of international maternal and child health and nutrition programs between the ,,usaid1 other relevant ,federal departments and agencies1 and relevant partner entities2 7,d7 monitor1 evaluate1 and report on any activities undertaken by ,,usaid pursuant to the strategy required under subsection 7c72 and 7,e7 provide direction to the design and oversight of grants1 contracts1 and cooperative agreements with any recipient of funds under the responsibility of the ,senior ,coordinator pursuant to subparagraph 7,a74 7#c7 ,restriction on additional or supplemental compensation ,the ,senior ,coordinator shall not receive any additional or supplemental compensation as a result of carrying out responsibilities and duties under this section4 7e7 ,prioritization of greatest need and maximum impact 7#a7 ,targets for increased implementation required ,in accordance with the guidelines established under section #c of the ,foreign ,aid ,transparency and ,accountability ,act1 any grant made available by the ,administrator and any contract or cooperative agreement entered into by the ,administrator in order to implement the strategy established under subsection 7c7 of this section shall-- 7,a7 include targets for increased implementation of high-impact1 evidence-based interventions and strengthening health systems1 as appropriate2 and 7,b7 establish baseline measurements from which to quantify progress toward such targets and towards the goal of preventing life-threatening morbidity and mortality for at least #ae1jjj1jjj children and at least #fjj1jjj women1 as described in subsection 7b77#c74 7#b7 ,exception ,in exceptional circumstances when the ,administrator determines that the inclusion of coverage targets or baseline measures is not reasonable or practicable for a grant1 contract1 or cooperative agreement1 the funding mechanism for such grant1 contract1 or agreement shall include an explanation of the omission and explicitly state how measurable impact will be targeted and tracked4 7f7 ,use of innovative public-,private financing tools 7#a7 ,in general ,in addition to existing bilateral and multilateral assistance for child and maternal survival1 the ,administrator shall implement the strategy established under subsection 7c7 through the use of innovative financing tools1 where appropriate1 to expand delivery of highest-impact1 evidence-based interventions to address the leading causes of preventable child and maternal deaths1 particularly among vulnerable populations4 ,the ,administrator shall also explore models1 whether existing or innovative1 to improve the efficiency and effectiveness of investments through results-based contracting 7such as pay-for-outcome arrangements7 and reduce financial and operational risks with respect to such implementation4 7#b7 ,authorization to fund programs on pay-for-outcome basis 7,a7 ,in general ,the ,administrator shall have the authority to provide assistance for child and maternal survival on a pay-for-outcome basis1 as described in subparagraph 7,b71 to any initiative that meets the requirements described in subparagraph 7,c74 7,b7 ,pay-for-outcome basis described ,the pay-for-outcome basis described in this paragraph is a performance-based grant1 contract1 or cooperative agreement awarded in the form of a commitment to provide payments that is contingent on improved outcomes resulting in a social benefit to the public and in direct cost savings or cost avoidance to the ,united ,states ,government4 7,c7 ,requirements for pay-for-outcome funding ,the ,administrator may only provide assistance under subparagraph 7,a7 to an initiative that includes the following3 7i7 ,a detailed implementation plan describing how the proposed pay-for-outcome initiative is based on evidence supporting an expectation of improved effectiveness4 7ii7 ,a rigorous1 independent1 third-party evaluation1 using experimental or quasi-experimental design or other quantitative research methodologies1 that allows for the strongest possible causal inferences1 when random assignment is not feasible1 to determine whether the initiative has achieved the proposed improvement in outcomes4 7,d7 ,limitation on availability of funding ,any payments provided to an initiative pursuant to the authorization under subparagraph 7,a7 may only be made available for expenditure for not more than #e years after the date on which such payments are first made available4 7g7 ,reports 7#a7 ,report required ,not later than #b years after the date of the publication of the strategy required under subsection 7c71 and annually thereafter1 the ,president shall submit to the appropriate congressional committees1 and make publicly available1 a report describing the implementation of the strategy4 7#b7 ,information included in report ,the report required under paragraph 7#a7 shall include the following3 7,a7 ,a summary and evaluation of progress made to achieve the objectives described in subsection 7b71 including the goal to end preventable child and maternal deaths1 and the progress made toward achieving the goal of reducing life threatening morbidity and mortality for at least #ae1jjj1jjj children and at least #fjj1jjj women4 7,b7 ,a description of the nature and extent of coordination among relevant ,federal departments and agencies on the implementation of the strategy4 7,c7 ,a description of how each aspect of the strategy is being implemented1 including-- 7i7 the manner in which multi-sectoral approaches and concrete1 high-impact1 evidence-based interventions are being used to address the leading causes of preventable child and maternal deaths2 7ii7 the degree to which the strategy increases assistance to and activities by the ,united ,states in target countries2 7iii7 the use of programs1 projects1 or activities to develop and scale-up new technologies and approaches1 including those identified by public-private partnerships for research and innovation1 and the degree to which such programs1 projects1 or activities are posed to go to scale2 and 7iv7 the methods used to leverage innovative financing and other public and private resources and the progress made by such methods4 7,d7 ,a description of how each program1 project1 or activity implementing the strategy is designed to-- 7i7 reach underserved1 marginalized1 vulnerable1 or impoverished populations2 7ii7 address the causes of newborn1 infant1 child1 and maternal morbidity and mortality1 including pre-term births1 with innovative efforts and interventions2 7iii7 invest in programs1 projects1 or activities that empower women1 support voluntarism1 and provide quality1 respectful1 evidence-based maternity care2 7iv7 improve transparency and accountability at all levels and include common metrics for tracking progress in achieving the objectives of the strategy2 7v7 ensure that high-impact1 evidence-based interventions are prioritized1 including interventions promoting healthy pregnancies2 and 7vi7 expand access to quality services for healthcare workers and for communities in target countries and include measures of accountability to such communities4 7,e7 ,a comprehensive list of grants1 contracts1 and cooperative agreements awarded to implement the strategy1 that includes-- 7i7 a description of the targets for coverage of interventions or services supported by such grants1 contracts1 or cooperative agreements1 the baseline against which they are measured1 and the status of their progress in meeting the targets2 or 7ii7 in the case of exceptional circumstances where the inclusion of targets or baseline measurements is not reasonable or practicable1 an explanation of how the impact of the grant1 contract1 agreement1 or resulting program is being measured4 7,f7 ,a description of how the ,administrator has partnered with relevant partner entities at the national and local levels1 including as subgrantees4 7,g7 ,a determination1 after applying rigorous monitoring and evaluation methodologies1 whether the programs1 projects1 or activities implementing the strategy have achieved measurable improvements in child and maternal health or survival1 particularly among the most vulnerable populations1 in each target country and overall1 and the specific improvements achieved with respect to-- 7i7 the maternal mortality ratio per #ajj1jjj live births and the under-#e mortality ratio per #a1jjj live births2 7ii7 the number of newborn1 infant1 child1 and maternal deaths averted2 and 7iii7 the percentage of births attended by skilled health personnel4 7,h7 ,an analysis of the gaps in the health workforce that must be filled in order to end preventable newborn1 infant1 child and maternal deaths1 including an analysis of health workforce density relating to certified health workers and community-based health workers4 7,i7 ,a description of the measured or estimated impact on newborn1 infant1 child1 and maternal survival of each ongoing program1 project1 or activity implementing the strategy4 7,j7 ,an assessment of progress made toward achieving the targets established pursuant to subsection 7c77#b77;,a74 7,k7 ,a description of any innovative public-private financing tools1 including an analysis of the feasibility and potential effectiveness1 that could be used to fund efforts to end preventable child and maternal deaths4 7h7 ,definitions ,in this section3 7#a7 ,administrator ,the term ,administrator means the ,administrator of the ,united ,states ,agency for ,international ,development4 7#b7 ,appropriate congressional committees ,the term appropriate congressional committees means-- 7,a7 the ,committee on ,foreign ,relations and the ,committee on ,appropriations of the ,senate2 and 7,b7 the ,committee on ,foreign ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 7#c7 ,relevant ,federal departments and agencies ,the term relevant ,federal departments and agencies includes each of the following3 7,a7 ,the ,department of ,state4 7,b7 ,the ,united ,states ,agency for ,international ,development1 including the ,president's ,malaria ,initiative4 7,c7 ,the ,department of ,health and ,human ,services4 7,d7 ,the ,department of the ,treasury4 7,e7 ,the ,department of ,defense4 7,f7 ,the ,centers for ,disease ,control and ,prevention4 7,g7 ,the ,national ,institutes of ,health4 7,h7 ,the ,millennium ,challenge ,corporation4 7,i7 ,the ,peace ,corps4 7,j7 ,the ,office of the ,global ,,aids ,coordinator4 7,k7 ,any other ,federal department or agency determined by the ,president to be relevant to carry out the purposes of this section4 7#d7 ,relevant partner entities ,the term relevant partner entities means each of the following3 7,a7 ,multilateral and international organizations4 7,b7 ,international financial institutions4 7,c7 ,the national and local governments of recipient countries4 7,d7 ,community nongovernmental organizations1 including faith-based1 professional1 and civil society organizations4 7,e7 ,entities in the private sector4 7,f7 ,entities in the healthcare sector of recipient countries4 7#e7 ,senior ,coordinator ,the term ,senior ,coordinator means the ,senior ,coordinator for ,child and ,maternal ,survival established under subsection 7d74 7#f7 ,target country ,the term target country means a country identified by the ,administrator pursuant to subsection 7c77#c74 4