oversight

Federal Funds: Fiscal Year 2001 Expenditures by Selected Organizations Involved in Health-Related Activities

Published by the Government Accountability Office on 2003-05-16.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

United States General Accounting Office
Washington, DC 20548



          May 16, 2003


          The Honorable Christopher H. Smith
          The Honorable Joseph R. Pitts
          House of Representatives

          Subject: Federal Funds: Fiscal Year 2001 Expenditures by Selected Organizations
                   Involved in Health-Related Activities

          This report responds to your request that we provide information on expenditures of
          federal funds by several organizations and their affiliates—the Planned Parenthood
          Federation of America, the Population Council, the International Planned Parenthood
          Federation, The Alan Guttmacher Institute, Advocates for Youth, and the Sexuality
          Information and Education Council of the United States (SIECUS)—all of which are
          involved in health-related activities. Specifically, as agreed with your staff, we
          identified (1) fiscal year 2001 expenditures of federal funds that supported the
          domestic health-related activities of the organizations, the federal agencies that
          provided the funds, and the congressional committees with jurisdiction over
          legislation authorizing or appropriating the federal funds, and (2) fiscal year 2001
          expenditures of federal funds that supported the international health-related
          activities of the organizations, the federal agencies that provided the funds, and the
          congressional committees with jurisdiction over legislation authorizing or
          appropriating the federal funds. This information updates our November 13, 2001,
          report that provided expenditure information for fiscal years 1999 and 2000.1

          In response to your request, we collected information on each of the selected
          organizations and their expenditures of federal funds, the federal agencies that
          provided the funds, and the congressional committees with jurisdiction over
          legislation authorizing or appropriating the funds. We obtained documents and held
          discussions with representatives from several of the organizations, federal officials,
          and congressional staff members. To obtain the organizations’ fiscal year 2001
          financial information, we collected information on expenditures of federal funds for
          domestic health-related activities from the organizations that had such
          expenditures—the Planned Parenthood Federation of America, the Population
          Council, The Alan Guttmacher Institute, Advocates for Youth, and SIECUS. These
          organizations also provided their independently audited financial statements and



          1
          U.S. General Accounting Office, Reproductive Health: Federal Funds That Supported Four Nonprofit
          Organizations, GAO-02-81R (Washington, D.C.: Nov. 13, 2001).


                                                GAO-03-527R Federal Funds Spent by Selected Organizations
reports on expenditures of federal funds.2 For the organizations that had
expenditures of federal funds for international health-related activities, we collected
expenditure data directly from three of the organizations—the Population Council,
The Alan Guttmacher Institute, and Advocates for Youth. These organizations also
provided their independently audited financial statements. The U.S. Agency for
International Development (USAID) reported fiscal year 2001 expenditure data for
the International Planned Parenthood Federation’s headquarters and the
International Planned Parenthood Federation’s member family planning associations.
We collected information on the organizations’ expenditures of federal funds and did
not determine the total amount of federal funds that federal agencies provided the
organizations. We collected information from the Department of Health and Human
Services’ Office of Public Health and Science to update information it provided for
our November 2001 report. We held discussions with staff members from each of the
relevant congressional committees to confirm committee jurisdiction over legislation
authorizing the federal agency programs and funding and appropriating the program
funds that supported the organizations’ activities. In the course of our work, USAID
and The Alan Guttmacher Institute revised fiscal year 2000 expenditures of federal
funds for international activities that we reported in November 2001. (See enclosure
I for this revised information.) We conducted our work from January 2003 through
April 2003 in accordance with generally accepted government auditing standards.

Results in Brief

For fiscal year 2001, the total amount of federal funds expended by the organizations
for domestic and international health-related activities, such as family planning for
individuals and health-related research, was approximately $225 million. (See table
1.) The Planned Parenthood Federation of America and its affiliates, the Population
Council, The Alan Guttmacher Institute, Advocates for Youth, and SIECUS reported
spending approximately $170 million in federal funds to support their domestic
health-related activities.




2
 With the exception of SIECUS’s financial statements, all the statements were prepared in compliance
with Office of Management and Budget Circular A-133. The independently audited financial statements
that SIECUS provided were not subject to the Circular A-133 requirement because the organization’s
expenditures of federal funds were less than the $300,000 annual minimum required under Circular A-
133. The 12-month fiscal year periods that the organizations’ year-end financial statements covered
varied.


2                                      GAO-03-527R Federal Funds Spent by Selected Organizations
Table 1: Organizations’ Expenditures of Federal Funds for Domestic and International Health-Related
Activities, Fiscal Year 2001

                                                                                              Fiscal year 2001 expendituresa
    Organization                                                                                  Domestic                  International
    Planned Parenthood Federation of America and
    its affiliates                                                                              $161,986,202                                            $0
    Population Council                                                                             6,513,859                                    30,701,137
    International Planned Parenthood Federation’s
    member family planning associations                                                                    0                                   23,413,217
    The Alan Guttmacher Institute                                                                    372,120                                      798,194
    Advocates for Youth                                                                              499,734                                      132,160
    SIECUS                                                                                           218,400                                            0
    Total                                                                                       $169,590,315                                  $55,044,708
Sources: The Planned Parenthood Federation of America, the Population Council, USAID, The Alan Guttmacher Institute, Advocates for Youth, and SIECUS.


Note: The International Planned Parenthood Federation’s headquarters received no federal funds for fiscal year 2001.
a
The 12-month fiscal year periods for the organizations’ expenditures varied.


The Department of Health and Human Services’ (HHS) grants and programs were the
major sources of the federal funds that the organizations spent for domestic health-
related activities. Two committees in the Senate—Finance; and Health, Education,
Labor, and Pensions—and two committees in the House of Representatives—Energy
and Commerce, through its Subcommittee on Health; and Ways and Means—have
jurisdiction over legislation authorizing the programs through which most of the
federal funds were provided. In addition, the Senate and House committees on
appropriations each have subcommittees that have jurisdiction over legislation
appropriating funds for the federal programs.

The Population Council, the International Planned Parenthood Federation’s member
family planning associations, The Alan Guttmacher Institute, and Advocates for
Youth reported spending more than $55 million for international health-related
activities. (See table 1.) USAID and the Centers for Disease Control and Prevention
(CDC) within HHS were the sources of the federal funds that the organizations spent.
Two committees in the Senate—Foreign Relations; and Health, Education, Labor, and
Pensions—and two committees in the House of Representatives—Energy and
Commerce, through its Subcommittee on Health; and International Relations—have
jurisdiction over legislation authorizing the programs through which the federal funds
were provided. In addition, the Senate and House committees on appropriations,
through their subcommittees on foreign operations; and labor, health and human
services, and education, have jurisdiction over legislation appropriating funds for the
federal programs.

In response to HHS’s comments on a draft of this report, we revised the report to
better reflect the scope of our work and indicated that this report updates the
information in our November 13, 2001, report.




3                                                             GAO-03-527R Federal Funds Spent by Selected Organizations
Background

The Planned Parenthood Federation of America—a nonprofit organization
headquartered in New York City—and its 126 affiliates, with 865 local health centers,
provide reproductive medical care and birth control education. The affiliates are
independent, separately incorporated organizations with their own boards of
directors and financial autonomy. In 2001, the affiliates provided health care to
 2.7 million women and men and educational services to 1.5 million individuals. The
affiliates and their clinics provide family planning counseling and birth control
services, pregnancy testing, abortions, cancer screening, human immunodeficiency
virus (HIV) testing, screening and treatment for sexually transmitted diseases,
prenatal and well-baby care, and other health care services.

The Population Council is an international, nonprofit research organization. It is
headquartered in New York City, has an office in Washington, D.C., 4 regional offices,
and 14 other offices in developing countries. In 2002, about half of the Population
Council’s staff of about 600 employees was based in developing countries. The
Population Council conducts biomedical research and develops contraceptives and
other health products including those that protect against the transmission of
HIV/AIDS and other sexually transmitted diseases. The Population Council also
conducts research on trends in health and research aimed at improving the quality
and outreach of family planning and reproductive health services. In addition, the
Population Council strengthens professional resources in developing countries
through collaborative research awards, fellowships, and training.

The International Planned Parenthood Federation is a nonprofit, family health care
organization headquartered in London and registered as a charity in the United
Kingdom. It has six regional offices, including one in the United States. The
International Planned Parenthood Federation is a volunteer membership organization
of autonomous legal entities called family planning associations. These associations
are linked to the International Planned Parenthood Federation through common
standards and objectives. The International Planned Parenthood Federation operates
in conjunction with member family planning associations in 180 countries to provide
family planning and reproductive health services, including maternal care and
screening and treatment for sexually transmitted diseases.

The Alan Guttmacher Institute was originally a division of the Planned Parenthood
Federation of America and became an independent nonprofit corporation in 1977
with offices in New York City and Washington, D.C. It remains an affiliate of the
Planned Parenthood Federation of America. The Alan Guttmacher Institute conducts
reproductive health and family planning research and policy analysis, provides public
education nationally and internationally, and publishes journals about family
planning and reproductive health.




4                                GAO-03-527R Federal Funds Spent by Selected Organizations
Advocates for Youth, established in 1980 as the Center for Population Options, is a
nonprofit organization that works in the United States and developing countries,
supporting efforts to help young people make informed and responsible decisions
about their reproductive and sexual health. Advocates for Youth provides
information, training, and assistance to educators, health care providers, youth-
serving organizations, and others about best reproductive health practices for teens
for the prevention of pregnancy and HIV and other sexually transmitted disease. In
2002, Advocates for Youth worked with more than 37,000 professionals who provided
information and assistance to more than 10 million teens around the world to help
them make decisions about their reproductive health.

SIECUS, established in 1964, is a nonprofit organization with offices in New York City
and Washington, D.C. SIECUS develops, collects, and disseminates information;
promotes comprehensive education; and advocates the right of individuals to make
responsible sexual choices.

Federal Funds Expended for Domestic Health-Related Activities

For fiscal year 2001, the Planned Parenthood Federation of America and its affiliates,
the Population Council, The Alan Guttmacher Institute, Advocates for Youth, and
SIECUS reported spending approximately $170 million in federal funds for domestic
health-related activities. Some of the domestic health-related activities these
organizations support include family planning and reproductive health services for
individuals and health research. HHS provided most of this federal funding through
grants and the Medicaid program. (See table 2.)




5                                GAO-03-527R Federal Funds Spent by Selected Organizations
Table 2: Organizations’ Expenditures of Federal Funds for Domestic Health-Related Activities,
Fiscal Year 2001

                                                             Organizations’ fiscal year 2001 expendituresa
                              Planned
                          Parenthood
                           Federation
                           of America                                           The Alan
    Federal source              and its Population                            Guttmacher            Advocates
    of funding                affiliates    Council                              Institute           for Youth            SIECUS                      Total
    Family planning grants
    HHS, Office of
    Population Affairs    $58,711,763            $0                               $315,320                       $0                $0        $59,027,083
    Medicaid
    HHS, Centers for
    Medicare &
    Medicaid Services       60,878,913            0                                           0                    0                 0           60,878,913
    Social Services Block Grant
    HHS,
    Administration for
    Children and
    Families                19,009,295            0                                           0                    0                 0           19,009,295
    Maternal and Child Health Services Block Grant
    HHS, Health
    Resources and
    Services
    Administration           5,994,185            0                                           0                    0                 0            5,994,185
    Research project grants
    HHS, National
    Institutes of Health               0  6,461,613                                   56,800                       0                 0            6,518,413
    Research grants
    National Science
    Foundation,
    Directorate for
    Biological
    Sciences                           0     52,246                                           0                    0                 0              52,246
    Cooperative agreements
    HHS, CDC                           0          0                                           0          499,734           218,400                 718,134
    Other
    Other federal
                                        b
    programs               17,392,046             0                                      0                    0                 0            17,392,046
    Total                $161,986,202 $6,513,859                                  $372,120             $499,734          $218,400          $169,590,315
Sources: The Planned Parenthood Federation of America, the Population Council, The Alan Guttmacher Institute, Advocates for Youth, and SIECUS.


Note: GAO analysis of the organizations’ data.
a
The 12-month fiscal year periods that the organizations’ year-end financial statements covered varied.
b
 Data are for the Planned Parenthood Federation of America’s affiliates that did not identify specific sources of funds and
related funding amounts.




6                                                             GAO-03-527R Federal Funds Spent by Selected Organizations
The majority of federal funding that supported the organizations’ domestic health-
related activities was provided through the following grants, programs, and
cooperative agreements:

    •   Family planning grants—Title X of the Public Health Service Act (42 U.S.C.
        §§ 300 et seq.) authorizes grants for voluntary family planning services,
        primarily for low-income women. Title X grants also provide funding for
        general and clinical specialty training programs for family planning clinic
        personnel, research to improve the delivery of family planning services, and
        information dissemination activities. Title X grantees include state and
        territorial health departments, local health departments, hospitals, and other
        organizations. Grantees can disburse title X funds to other agencies or
        organizations to provide services or to support clinics. Although there are no
        matching requirements for service grants, regulations specify that no title X
        grant may fund 100 percent of a project’s estimated costs. For fiscal year 2001,
        the Planned Parenthood Federation of America and its affiliates reported
        spending about $59 million and The Alan Guttmacher Institute reported
        spending more than $315,000 of federal funds provided through family
        planning grants.

    •   Medicaid—Title XIX of the Social Security Act (42 U.S.C. §§ 1396 et seq.)
        authorizes federal funding to states and requires state Medicaid programs to
        cover family planning services for individuals of childbearing age who are
        eligible under the state’s Medicaid plan and seek those services. Medicaid is a
        joint federal/state entitlement program that annually finances health care
        coverage for more than 40 million low-income individuals. The federal
        government pays 90 percent and states pay 10 percent of Medicaid
        expenditures for family planning services and supplies furnished to
        beneficiaries. Family planning services under Medicaid include only those
        services and supplies intended to control family size, such as counseling and
        patient education and methods of contraception. Many other reproductive
        health services covered under Medicaid are paid for under standard federal-
                                   3
        state payment formulas. The Planned Parenthood Federation of America and
        its affiliates reported fiscal year 2001 expenditures for services covered by the
        Medicaid program of about $61 million.

    •   Social Services Block Grant (SSBG) and Maternal and Child Health Services
        Block Grant (MCHBG)—Title XX of the Social Security Act (42 U.S.C. §§ 1397
        et seq.) authorizes SSBG, and title V of the act (42 U.S.C. §§ 701 et seq.)
        authorizes MCHBG. SSBG and MCHBG funds are distributed by formula to
        state and territorial health and social service agencies. Federal MCHBG funds




3
 The federal portion of payments for these Medicaid services is set annually for each state by a formula
based on state per capita income and may range from 50 to 83 percent.


7                                       GAO-03-527R Federal Funds Spent by Selected Organizations
        are matched by state funds; states provide $3 of nonfederal funds for every $4
        of MCHBG funds. Each state determines how its funds from each block grant
        are to be used. Under each block grant, state agencies may fund family
        planning activities directly or purchase them from entities such as an
        organization’s affiliates that provide family planning activities. For fiscal year
        2001, the Planned Parenthood Federation of America and its affiliates reported
        spending more than $19 million in federal SSBG funds and about $6 million in
        federal MCHBG funds that were provided through state agencies.

    •   Research project grants—Title IV and section 301 of the Public Health Service
        Act (42 U.S.C. §§ 281 et seq. and 42 U.S.C. § 241, respectively) authorize
        research project grants. The National Institutes of Health (NIH) institutes and
        centers funding these grants include the National Institute on Aging, the
        National Institute of Allergy and Infectious Diseases, the National Institute of
        Child Health and Human Development, and the National Institute of
        Environmental Health Sciences. Funds from NIH are provided directly to
        recipient organizations. The NIH research grant recipients conduct various
        kinds of reproductive health and other population research. For example,
        among its research projects, the Population Council explores ways to prevent
        the spread or transmission of HIV and trends in health among elderly Asians.
        The Alan Guttmacher Institute conducts research that focuses on the
        effectiveness of contraceptives in preventing pregnancies. For fiscal year
        2001, the Population Council reported spending about $6.5 million in NIH
        research project grant funds and The Alan Guttmacher Institute reported
        expenditures of about $57,000.

    •   Research grants—The National Science Foundation (NSF), through the
        National Science Foundation Act of 1950, as amended (42 U.S.C. 1861 et seq.),
        is authorized to award research grants. NSF’s Directorate for Biological
        Sciences, Division of Integrative Biology and Neuroscience, funds research
        that focuses on understanding multifaceted relationships among the central
        nervous system, hormones, and behavior, especially in relation to
        environmental factors. For fiscal year 2001, the Population Council reported
        spending more than $52,000 in NSF research grant funds. The grants funded
        research on the behavioral and biological effects of chronic social stress.

    •   Cooperative agreements—Title III and sections 311 and 317 of the Public
        Health Service Act (42 U.S.C. § 241 et seq., 42 U.S.C § 243, and 42 U.S.C. § 247b
        respectively) authorize the use of cooperative agreements and grants.4 CDC’s
        National Center for Chronic Disease Prevention and Health Promotion and




4
Cooperative agreements are to be used when substantial federal involvement with the recipient during
performance is anticipated. The difference between grants and cooperative agreements is the degree
of federal programmatic involvement rather than the type of administrative requirements imposed.
See 31 U.S.C. §§ 6304 and 6305.


8                                      GAO-03-527R Federal Funds Spent by Selected Organizations
      National Center for HIV, STD, and TB Prevention enter into cooperative
      agreements with entities to provide funding support for the development and
      implementation of effective health education to prevent HIV and other health
      problems for school-age populations. For fiscal year 2001, Advocates for
      Youth reported spending about $500,000 and SIECUS reported spending more
      than $218,000 in federal funds provided through cooperative agreements with
      CDC.

The Senate Committee on Finance; the Senate Committee on Health, Education,
Labor, and Pensions; the Senate Committee on Commerce, Science, and
Transportation; the House Committee on Energy and Commerce through its
Subcommittee on Health; the House Committee on Science; and the House
Committee on Ways and Means have jurisdiction over legislation authorizing the
program funds that the organizations reported spending for domestic health-related
activities. Also, the Senate Committee on Appropriations, through its Subcommittee
on Labor, Health and Human Services, and Education; and Subcommittee on VA,
HUD and Independent Agencies, and the House Committee on Appropriations,
through its Subcommittee on Labor, Health and Human Services, and Education; and
Subcommittee on VA, HUD and Independent Agencies, have jurisdiction over
legislation appropriating funds for the programs. (See table 3.)




9                               GAO-03-527R Federal Funds Spent by Selected Organizations
Table 3: Congressional Committees and Subcommittees with Jurisdiction over Legislation for the
Authorization of Federal Programs and the Appropriation of Funds That Supported the Organizations’
Domestic Health-Related Activities

                                                      Authorizing congressional         Appropriating congressional
 Program/administering agency                         committee/subcommittee            subcommittee/committee
 Family planning grants/HHS,                          Senate Committee on Health,       Subcommittee on Labor, Health
 Office of Population Affairs                         Education, Labor, and Pensions    and Human Services, and
                                                      and Subcommittee on Health,       Education, Senate Committee on
                                                      House Committee on Energy and     Appropriations and Subcommittee
                                                      Commerce                          on Labor, Health and Human
                                                                                        Services, and Education, House
                                                                                        Committee on Appropriations
 Medicaid/HHS, Centers for                            Senate Committee on Finance       Subcommittee on Labor, Health
 Medicare & Medicaid Services                         and Subcommittee on Health,       and Human Services, and
                                                      House Committee on Energy and     Education, Senate Committee on
                                                      Commerce                          Appropriations and Subcommittee
                                                                                        on Labor, Health and Human
                                                                                        Services, and Education, House
                                                                                        Committee on Appropriations
 SSBG/HHS, Administration for                         Senate Committee on Finance       Subcommittee on Labor, Health
 Children and Families                                and House Committee on Ways       and Human Services, and
                                                      and Means                         Education, Senate Committee on
                                                                                        Appropriations and Subcommittee
                                                                                        on Labor, Health and Human
                                                                                        Services, and Education, House
                                                                                        Committee on Appropriations
 MCHSBG/HHS, Health Resources                         Senate Committee on Finance;      Subcommittee on Labor, Health
 and Services Administration                          Senate Committee on Health,       and Human Services, and
                                                      Education, Labor, and Pensions;   Education, Senate Committee on
                                                      and Subcommittee on Health,       Appropriations and Subcommittee
                                                      House Committee on Energy and     on Labor, Health and Human
                                                      Commerce                          Services, and Education, House
                                                                                        Committee on Appropriations
 Research project grants/                             Senate Committee on Health,       Subcommittee on Labor, Health
 HHS, NIH                                             Education, Labor, and Pensions    and Human Services, and
                                                      and Subcommittee on Health,       Education, Senate Committee on
                                                      House Committee on Energy and     Appropriations and Subcommittee
                                                      Commerce                          on Labor, Health and Human
                                                                                        Services, and Education, House
                                                                                        Committee on Appropriations
 Research grants/NSF, Directorate for                 Senate Committee on               Subcommittees on VA, HUD, and
 Biological Sciences                                  Commerce, Science, and            Independent Agencies, Senate
                                                      Transportation; Senate            and House Committees on
                                                      Committee on Health, Education,   Appropriations
                                                      Labor, and Pensions; and House
                                                      Committee on Science
 Cooperative agreements/HHS, CDC                      Senate Committee on Health,       Subcommittee on Labor, Health
                                                      Education, Labor, and Pensions    and Human Services, and
                                                      and Subcommittee on Health,       Education, Senate Committee on
                                                      House Committee on Energy and     Appropriations and Subcommittee
                                                      Commerce                          on Labor, Health and Human
                                                                                        Services, and Education, House
                                                                                        Committee on Appropriations
Source: Congressional committees and subcommittees.

Note: GAO analysis of congressional information.




10                                                     GAO-03-527R Federal Funds Spent by Selected Organizations
Federal Funds Expended for International Health-Related Activities

For fiscal year 2001, the Population Council, the International Planned Parenthood
Federation’s member family planning associations, The Alan Guttmacher Institute,
and Advocates for Youth—reported spending more than $55 million in federal funds
for international health-related activities such as family planning and health research.
(See table 4.) The Population Council, the International Planned Parenthood
Federation’s member family planning associations, and The Alan Guttmacher
Institute received financial support for international activities from USAID.
Advocates for Youth received financial support for its international activities through
a cooperative agreement with CDC.

Table 4: Organizations’ Expenditures of Federal Funds For International Health-Related Activities, Fiscal
Year 2001



    Organization                                                                                  Fiscal year 2001 expendituresa
    Population Council                                                                                               $30,701,137
    International Planned Parenthood Federation’s member family planning
    associations
      Contraceptive shipments                                                                                         3,374,689b
      Direct agreements through USAID                                                                                18,663,788
      Subagreements through U.S.-based agencies                                                                        1,374,740
    The Alan Guttmacher Institute                                                                                        798,194
    Advocates for Youth                                                                                                  132,160
    Totals                                                                                                          $55,044,708
Sources: USAID, the Population Council, The Alan Guttmacher Institute, and Advocates for Youth.


Note: The International Planned Parenthood Federation’s headquarters received no federal funds for fiscal
year 2001.
a
The 12-month fiscal year periods for the organizations’ expenditures varied.
b
    Dollar value of the contraceptive shipments.


Expenditures of federal funds supported the following organizations’ international
health-related activities:

        •    The Population Council spent its USAID grant funds to, among other things,
             conduct research to improve the quality, accessibility, and cost-effectiveness
             of reproductive health programs; conduct research on adolescent livelihoods
             and the transition to marriage and adulthood; conduct field-based research in
             developing countries to identify best practices for the prevention, treatment,
             and mitigation of HIV/AIDS and other sexually transmitted diseases; and
             undertake research on new and improved contraceptive methods and products
             that protect against HIV and other diseases.




11                                                             GAO-03-527R Federal Funds Spent by Selected Organizations
     •   The International Planned Parenthood Federation’s family planning
         association members used USAID funds to support various international
         health-related activities, such as providing contraceptives and contraceptive
         counseling. The support included direct funding through agreements between
         USAID and the family planning associations and indirect funding through
         agreements between USAID and U.S.-based agencies that have subagreements
         with other entities. In fiscal year 2001, USAID resumed a policy of providing
         family planning assistance only to foreign nongovernmental organizations that
         chose to sign agreements to neither perform nor actively promote abortion as
         a method of family planning in other nations with the organization’s own funds
         or funds received from any other donor source. According to USAID, since
         1973, organizations have been legally prohibited from using USAID funds to
         support or encourage abortion as a method of family planning.

     •   The Alan Guttmacher Institute used USAID funds for publishing an
         international journal about family planning and reproductive health issues in
         English, French, and Spanish.

     •   Advocates for Youth used federal funds provided through a cooperative
         agreement with CDC to help foster relationships between HIV/AIDS service
         organizations in the United States and those working in developing countries.
         Specifically, Advocates for Youth created a network of service providers from
         the Washington, D.C. area, El Salvador, Honduras, and Guatemala to share
         strategies on HIV prevention services for at-risk Latino youth. Advocates for
         Youth also provided technical assistance and training to its Central American
         partners on organizational development, peer education, and outreach.

The Senate Committee on Foreign Relations and the House Committee on
International Relations have jurisdiction over legislation authorizing USAID
programs. The Senate Committee on Appropriations, through its Subcommittee on
Foreign Operations, and the House Committee on Appropriations, through its
Subcommittee on Foreign Operations, Export Financing, and Related Programs, have
jurisdiction over legislation appropriating funds for USAID programs and operations.
The Senate Committee on Health, Education, Labor, and Pensions and the House
Committee on Energy and Commerce, through its Subcommittee on Health, have
jurisdiction over legislation authorizing CDC programs. The Senate Committee on
Appropriations, through its Subcommittee on Labor, Health and Human Services, and
Education, and the House Committee on Appropriations, through its Subcommittee
on Labor, Health and Human Services, and Education have jurisdiction over
legislation appropriating funds for CDC programs.




12                                 GAO-03-527R Federal Funds Spent by Selected Organizations
Agency and Other Comments and our Response

We provided a draft of this report to HHS, USAID, the Planned Parenthood
Federation of America, the Population Council, The Alan Guttmacher Institute,
Advocates for Youth, and SIECUS for review.

In its written comments, HHS raised concern about our data collection methodology
(see enclosure II). HHS commented that the major question posed in the
congressional request was not addressed because we presented expenditure data
rather than total federal funding and that its records indicate that two organizations
received from about two to three times the amount of federal funds presented in the
draft report. We acknowledge that there could be a difference in the amount of
federal funds the organizations received and the amount they reported spending.
However, determining the amount of federal funds the organizations received was
beyond the scope of our work. We agreed with the requesters’ staff to update the
information presented in our November 2001 report. In that report, we presented
information that the organizations provided on their expenditures of federal funds for
fiscal years 1999 and 2000. This report updates those data by presenting information
on the organizations’ expenditures of federal funds for fiscal year 2001. We added
information to clarify that the scope of our work focused on expenditures rather than
the total amount of federal funding the organizations received from the federal
agencies.

HHS also commented that we had not requested information from the department’s
agencies as we have done in the past, such as with our November 2001 report.
However, we contacted the HHS agency that provided information for our November
2001 report, for updated information. For consistency, the methodology that we used
to collect data for this report was similar to the methodology we used for our
November 2001 report.

Throughout the draft report we used the term “reproductive health” in discussing the
organizations’ expenditures and the type of activities they support. HHS commented
that our use of the term reproductive health made it unclear whether we requested
information only on funding for reproductive health activities or whether we
characterized all expenditures of federal funds by the organizations as funds to
support reproductive health activities. We agree with HHS’ comment that the focus
on reproductive health should be changed and have revised the report to reflect the
broader health-related activities that the data represent.

HHS, USAID, and the organizations we reviewed provided technical comments that
we incorporated in the report where appropriate.




13                               GAO-03-527R Federal Funds Spent by Selected Organizations
                                          -----

We are sending copies of this report to the relevant congressional committees, the
Secretary of Health and Human Services, and the Administrator of the U.S. Agency
for International Development. We will also make copies available to others on
request. In addition, the report is available at no charge on GAO’s home page at
http://www.gao.gov. If you have any questions about this report, please contact me at
(202) 512-7101 or James O. McClyde at (202) 512-7152. Claude B. Hayeck made major
contributions to this report.




Marjorie E. Kanof
Director, Health Care—Clinical
 and Military Health Care Issues

Enclosures - 2




14                                 GAO-03-527R Federal Funds Spent by Selected Organizations
Enclosure I                                                                                                    Enclosure I


                                    Revised Fiscal Year 2000 Expenditures for
                                     International Health-Related Activities

In providing the nonprofit organizations’ fiscal year 2001 expenditures of federal
funds for health-related activities, the U.S. Agency for International Development
(USAID) also revised fiscal year 2000 international health-related expenditure data it
provided for the International Planned Parenthood Federation and its affiliated
associations.5 As shown in table 5, fiscal year 2000 expenditures for contraceptive
shipments increased more than $2.6 million, expenditures related to direct
agreements increased about $3.9 million, and expenditures related to subagreements
decreased about $1.3 million. The Alan Guttmacher Institute also revised its fiscal
year 2000 expenditures of federal funds for international activities that USAID
provided for our November 2001 report. These expenditures increased by $5,000.

Table 5: Federal Funds Expended by Three Nonprofit Organizations for International Health-Related
Activities, Fiscal Year 2000

                                                                                  Fiscal year 2000
                                                                            expenditures reported    Revised fiscal year 2000
    Organization                                                                in November 2001                expenditures
    Population Council                                                                $36,443,540                $36,443,540
                                                                                                 a                          a
    International Planned Parenthood Federation                                         5,000,000                  5,000,000
      International Planned Parenthood Federation’s
      affiliated family planning associations
                                                                                                 a
           Contraceptive shipments                                                        993,328                  3,631,903
           Direct agreements through USAID                                              7,531,000a                11,394,423
           Subagreements through U.S.-based agencies                                     2,244,000                   951,260
    The Alan Guttmacher Institute                                                          587,128                   592,128
    Total                                                                             $52,798,996                $58,013,254
Source: USAID, the Population Council, and The Alan Guttmacher Institute.

Note: GAO analysis of the organizations’ data. Revised expenditure data provided by USAID and The Alan Guttmacher
Institute.
a
These figures represent obligations.

This information changes the total amount of fiscal year 2000 expenditures of federal
funds that supported the domestic and international health-related activities of the
four nonprofit organizations discussed in our November 2001 report—the Planned
Parenthood Federation of America and its affiliates, the Population Council, the
International Planned Parenthood Federation and its affiliated associations, and The
Alan Guttmacher Institute—from about $196 million to approximately $201 million.
(See table 6.)




5
See U.S. General Accounting Office, Reproductive Health: Federal Funds That Supported Four
Nonprofit Organizations, GAO-02-81R (Washington, D.C.: Nov. 13, 2001).


15                                                             GAO-03-527R Federal Funds Spent by Selected Organizations
Enclosure I                                                                                     Enclosure I

Table 6: Federal Funds That Supported the Domestic and International Health-Related Activities of Four
Nonprofit Organizations, Fiscal Year 2000

                                                                      Fiscal year 2000
                                                              expenditures reported in     Revised fiscal year
 Organization                                                         November 2001        2000 expenditures
 Planned Parenthood Federation of America and its
 affiliates                                                                $137,337,724          $137,337,724
 Population Council                                                          41,347,381            41,347,381
 International Planned Parenthood Federation and
 its affiliated associations                                                 15,768,328            20,977,586
 The Alan Guttmacher Institute                                                1,113,712             1,118,712
 Total                                                                     $195,567,145         $ 200,781,403
Source: GAO analysis of the organizations’ data.


Note: Revised expenditure data provided by USAID and The Alan Guttmacher Institute.




16                                                 GAO-03-527R Federal Funds Spent by Selected Organizations
Enclosure II                                                           Enclosure II


       Comments from the Department of Health and Human Services




17                         GAO-03-527R Federal Funds Spent by Selected Organizations
Enclosure II                                               Enclosure II




18             GAO-03-527R Federal Funds Spent by Selected Organizations
Enclosure II                                               Enclosure II




(290255)


19             GAO-03-527R Federal Funds Spent by Selected Organizations
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