[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5545 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 5545
To authorize an Action Plan for United States foreign assistance to
developing countries to increase access to sustainable safe water,
sanitation, and hygiene in healthcare facilities, promote stronger
health systems and sustainable health infrastructure, build capacity of
health workers, and promote the safety of health workers and patients,
especially women and girls, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 18, 2023
Ms. Meng (for herself, Mr. Blumenauer, and Mr. LaHood) introduced the
following bill; which was referred to the Committee on Foreign Affairs
_______________________________________________________________________
A BILL
To authorize an Action Plan for United States foreign assistance to
developing countries to increase access to sustainable safe water,
sanitation, and hygiene in healthcare facilities, promote stronger
health systems and sustainable health infrastructure, build capacity of
health workers, and promote the safety of health workers and patients,
especially women and girls, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Global WASH in Healthcare Facilities
Act of 2023''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Water, sanitation, and hygiene (WASH) is critical to
health security, preparedness and response efforts, including
for the prevention of COVID-19 and future pandemics.
(2) WASH in healthcare facilities is necessary to ensure
health security, including reducing preventable maternal,
newborn, and child deaths and reducing the spread of infectious
diseases such as cholera, diarrhea, and sepsis.
(3) Globally, 1 out of every 5 healthcare facilities have
no basic water services, and 1 in 2 do not have adequate
facilities to wash hands, leaving 3,850,000,000 people,
including health care workers and patients, at greater risk of
infections.
(4) In least-developed countries, about half of healthcare
facilities lack basic water services, 79 percent have no
sanitation services, and 68 percent lack basic hygiene
services.
(5) Healthcare acquired infections arise from poor hygiene,
contribute to patient morbidity and mortality, increase the
risk of antimicrobial resistance, and contribute to increased
costs for patients, their families and healthcare systems.
(6) An estimated 15 percent of patients in low- and middle-
income countries acquire one or more infections during a
typical hospital stay. Infections associated with unclean
births account for 26 percent of neonatal deaths and 11 percent
of maternal deaths; together they account for more than
1,000,000 deaths each year.
SEC. 3. STATEMENT OF POLICY; SENSE OF CONGRESS.
(a) Statement of Policy Objectives.--It is in the national security
interest of the United States to increase access to sustainable and
safe water, sanitation, and hygiene in healthcare facilities, through
global health, maternal, newborn and child health, and global water
programs, activities, and initiatives that--
(1) increase access to safe water in healthcare facilities;
(2) enable handwashing at all points of care;
(3) increase access to toilets in healthcare facilities,
including non-sewered sanitation solutions and a variety of
technologies for sanitation and healthcare waste treatment;
(4) provide for the safe segregation, treatment, and
disposal of healthcare waste and increased infection and
prevention control measures;
(5) promote WASH social and behavior change to ensure the
safety of health workers and patients to improve infection
prevention and control measures;
(6) improve the ability of patients and healthcare workers,
including persons with disabilities to access water,
sanitation, and hygiene, including for their menstrual health
and hygiene needs in primary, secondary, and tertiary
healthcare facilities;
(7) promote health facility administration management and
monitoring of water, sanitation, and hygiene services in
healthcare facilities for infection prevention and control and
quality of care outcomes, including--
(A) ensuring operations and maintenance of water
and sanitation infrastructure; and
(B) providing support to patients to adopt
consistent sanitation, hygiene, and menstrual health
behaviors;
(8) integrate water, sanitation, and hygiene services into
pandemic preparedness and response and global health security
initiatives, including preventive measures that help to contain
infectious disease outbreaks at their source and support
resilient health facilities to ensure continuous primary care
during an outbreak; and
(9) provide technical support to partner governments,
particularly Ministries of Health, to improve wash systems and
to incorporate safe water, sanitation, and hygiene into
national plans, strategies, and budgets for new and existing
healthcare facilities.
(b) Sense of Congress.--It is the sense of Congress that the
Administrator of the United States Agency for International
Development, in implementing the Global WASH in Healthcare Facilities
Action Plan described in section 5, should--
(1) coordinate in consultation with the USAID Assistant
Administrator for Global Health, the Senior Coordinator for
Gender Equality and Women's Empowerment, and the Global Water
Coordinator, to expand safe water, sanitation, and hygiene in
healthcare facilities;
(2) promote assistance to and build the capacity of
national governments to include water, sanitation, and hygiene
indicators in national health systems monitoring and budgets;
(3) coordinate implementation of existing United States
Government strategies related to WASH in healthcare facilities,
including the United States Global Water Strategy and United
States International Activities to Advance Global Health
Security and Diplomacy Strategy and Report to achieve the
objectives of section 3(a);
(4) include policies that promote the privacy, safety, and
dignity of women and girls, and disability access in design,
implementation, and evaluation, in accordance with existing
USAID policies for people with disabilities;
(5) promote the development of resilient water, sanitation,
and hygiene systems in healthcare facilities; and
(6) prioritize high priority countries where the needs are
greatest.
SEC. 4. DEFINITIONS.
In this Act:
(1) Appropriate congressional committees.--The term
``appropriate congressional committees'' means--
(A) the Committee on Foreign Affairs and the
Committee on Appropriations of the House of
Representatives; and
(B) the Committee on Foreign Relations and the
Committee on Appropriations of the Senate.
(2) Sustainable.--The term ``sustainable'' means the
ability of a target country, community, implementing partner,
or intended beneficiary to maintain, over time, the programs
authorized and outcomes achieved pursuant to this Act.
(3) Healthcare facility.--The term ``healthcare facility''
means a hospital, clinic, health center, or other location
established for the purpose of providing health care.
(4) Healthcare worker.--The term ``healthcare worker''
includes doctors, nurses, lab technicians, pharmacists,
janitors, healthcare administrators, and other individuals
working at or in partnership with healthcare facilities.
(5) High priority country.--The term ``high priority
country'' means a country designated pursuant to section 136(h)
of the Foreign Assistance Act of 1961 (22 U.S.C. 2151h(h)) and
any country identified by USAID as a high priority country for
the purposes of this Act.
(6) Key stakeholders.--The term ``key stakeholders''
means--
(A) communities directly affected by the lack of
access to safe water, sanitation or hygiene;
(B) other appropriate nongovernmental
organizations; and
(C) agencies or departments of countries affected
by the lack of access to safe water, sanitation, or
hygiene.
(7) USAID.--The term ``USAID'' means the United States
Agency for International Development.
(8) WASH.--The term ``WASH'' means water, sanitation, and
hygiene.
SEC. 5. GLOBAL WASH IN HEALTHCARE FACILITIES ACTION PLAN.
(a) Action Plan Required.--The Administrator of the United States
Agency for International Development, in coordination with the Director
of the Centers for Disease Control and Prevention and the Secretary of
State, shall develop and implement an action plan, to be known as the
``Global WASH in Healthcare Facilities Action Plan'', to accomplish the
policy objectives listed in section 3(a). Such action plan shall--
(1) set specific, timebound, and measurable goals, and
identify relevant performance metrics drawing from existing and
complementary strategies and plans;
(2) describe monitoring and evaluation plans that reflect
best practices relating to transparency, accountability,
localized sustainability, country capacity, budgetary support
and ownership, water, sanitation, and hygiene, including
appropriate use of gender disaggregated data;
(3) establish clear and transparent criteria for WASH in
healthcare facilities in target countries, drawn from existing
water, sanitation and hygiene, need for strong health systems,
infection prevention and control, pandemic preparedness and
response, maternal, newborn and child health, and nutrition
programs high priority countries and assessments, and for
selecting regions and intended beneficiaries of assistance;
(4) describe linkages and coordination with other relevant
policies, strategies, plans and initiatives including those
related to gender, resilience, global health, and pandemic
preparedness and response;
(5) describe measures and approaches to address the issues
of infection prevention and control, menstrual health and
hygiene, safe and equitable access to WASH for health workers,
gaps in current data, monitoring and evaluation analysis and
capacity, consistent with the policy objectives described in
section 3(a);
(6) support partner governments to strengthen supply chains
and, as appropriate, establish and maintain strategic
stockpiles of critical water, sanitation, hygiene and menstrual
health products, clean, operational and maintenance inputs, and
related hardware for resilient healthcare;
(7) address women's and girls' specific needs for water,
sanitation, and hygiene access in healthcare facilities, in
particular, personal safety, privacy, dignity, and menstrual
health and hygiene and maternal health;
(8) support the long-term sustainability of water,
sanitation, and hygiene access in healthcare facilities
especially at points of care, through health systems resiliency
approaches including capacity building;
(9) leverage new and existing water, sanitation, and
hygiene technologies, including non-sewered sanitation
solutions, and a variety of technologies for sanitation and
healthcare waste treatment;
(10) in support of sustainably increased WASH access in
healthcare facilities and increased local ownership, identify
criteria, and methodology for graduating countries from United
States assistance provided for the policy objectives listed in
section 3(a); and
(11) anticipate resource needs to implement the Action
Plan, including such amounts to be transferred by the Secretary
of State to the Administrator of USAID pursuant to section
6(a).
(b) Inclusion in Other Strategies, Policies, Plans, and
Initiatives.--The Administrator may include the Action Plan required by
subsection (a) as a component of the USAID Agency-Specific Plan for the
United States International Activities to Advance Global Health
Security and Diplomacy Strategy required by the Global Health Security
and International Pandemic, Preparedness and Response Act (subtitle D
of title LV of the National Defense Authorization Act for Fiscal Year
2023), or as a component of other USAID strategies, policies, plans or
initiatives, as appropriate.
(c) Action Plan Submission.--Not later than 1 year after the date
of the enactment of this Act, the Administrator of USAID shall submit
to the appropriate congressional committees a report consisting of--
(1) the Global WASH in Healthcare Facilities Action Plan
required under subsection (a); and
(2) a description of the manner in which the Administrator
intends to advance the policy objectives listed in section 3(a)
through such action plan.
SEC. 6. ASSISTANCE TO IMPLEMENT THE GLOBAL WASH IN HEALTHCARE
FACILITIES ACTION PLAN.
(a) Authorization of Appropriations.--Amounts appropriated pursuant
to the authorization under section 5564 of the National Defense
Authorization Act for Fiscal Year 2023 are also authorized to be made
available during fiscal years 2024 through 2027 to carry out the Global
WASH in Health Care Facilities Action Plan described in section 5 in
support of the United States International Activities to Advance the
Global WASH in Healthcare Facilities Action Plan.
(b) Authorization of Transfers.--Subject to the availability of
funds appropriated pursuant to the authorization under section 5564 of
the National Defense Authorization Act for Fiscal Year 2023 and in
accordance with subsection (a), the Secretary of State is authorized to
transfer to the Administrator of the USAID such sums as may be
necessary to implement the Global WASH in Health Care Facilities Action
Plan described in section 5 of this Act.
(c) Monitoring and Evaluation.--The Administrator shall seek to
ensure that assistance to implement the Global WASH in Healthcare
Facilities Action Plan is provided under established parameters for a
rigorous accountability system to monitor and evaluate progress and
impact of the action plan, including by reporting to the appropriate
congressional committees and the public on an annual basis, in
accordance with section 7.
SEC. 7. REPORTS.
(a) Initial Report.--Not later than 1 year after the date of the
submission of the Global WASH in Healthcare Facilities Action Plan
required under section 5, the Administrator shall submit to the
appropriate congressional committees a report that describes the status
of the implementation of the Action Plan.
(b) Content.--The report required under subsection (a) shall--
(1) contain a summary of the Global WASH in Healthcare
Facilities Action Plan as an appendix;
(2) describe the progress made in implementing the Action
Plan;
(3) identify the indicators and measure results over time,
as well as the mechanisms for reporting such results in an open
and transparent manner, including disaggregated data on
healthcare facilities with basic or safe access to water,
sanitation and hygiene defined by the World Health Organization
and UNICEF;
(4) contain a transparent and detailed accounting of USAID
spending to implement the Global WASH in Healthcare Facilities
Action Plan and related activities;
(5) describe how the Global WASH in Healthcare Facilities
Action Plan leverages other United States global health
programs including but not limited to maternal and child
health, health systems, and global health security;
(6) describe the impact of the Global WASH in Healthcare
Facilities Action Plan on other global health programs,
including progress in the promotion of infection prevention and
control, strengthening global health security and pandemic
preparedness, prevention and response and reducing preventable
maternal and child deaths;
(7) assess efforts to coordinate United States global
health programs, activities, and initiatives with key
stakeholders;
(8) assess United States Government-facilitated private
investment in related sectors and the impact of private sector
investment in target countries and communities;
(9) assess the increased access to safe sanitation and hand
washing stations in healthcare facilities, including to address
menstrual health and hygiene needs;
(10) incorporate a plan for regularly sharing lessons
learned with a wide range of stakeholders, including local
civil society organizations in an open, transparent manner and
through biennial stakeholder consultation; and
(11) establish mechanisms for receiving feedback from
stakeholders and incorporating feedback into updates of
relevant congressionally mandated strategies and action plans.
(c) Subsequent Reports.--For the five-year period beginning on the
date of the submission of the initial report required under subsection
(a), the Administrator shall annually submit to the appropriate
congressional committees a report on the status of the implementation
of the action plan, the progress made in achieving the elements
described in section 5, and any changes to the action plan since the
date of the submission of the most recent prior report.
(d) Inclusion in Other Reports.--The Administrator may include the
report required by subsection (a) as a component of the United States
International Activities to Advance Global Health Security and
Diplomacy Strategy report or as a component of other USAID reports, as
appropriate.
(e) Public Availability of Information.--The information referred
to in subsections (a) and (b) shall be timely made available on the
public website of USAID in a consolidated, downloadable, and machine-
searchable format.
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