Some U.S. lawmakers are expressing concern about reductions in health spending for Africa proposed in a Bush administration budget request for the 2009 fiscal year. VOA's Dan Robinson reports, the issue was among topics discussed as the U.S. Global Aids Coordinator and an official of the U.S. Agency for International Development testified on Capitol Hill.

In its budget, the Bush administration proposes a reduction in spending from $741 million to $587 million for global health, family planning and infectious disease programs, while increasing funding for HIV/AIDS prevention and treatment.

That has caused concern, particularly with lawmakers who have played a key role in backing both President Bush's highly-praised HIV/AIDS program begun in 2003, and programs dealing with child survival, maternal health and other needs.

Congresswoman Nita Lowey (file photo)

It was on the mind of New York Democrat Congresswoman Nita Lowey as she opened the hearing of the House subcommittee on foreign operations.

"I am concerned that many health programs in Asia, Africa, and the western hemisphere will be forced to shut down or greatly reduce operations under the president's request," said Congresswoman Lowey.

While it increases funds for HIV/AIDS, Lowey notes that the president's request cuts $251 million from 2008 levels for health programs she and others say complement HIV/AIDS efforts.

Administration officials say they faced tough spending decisions, noting a shift in priorities from health to HIV/AIDS and malaria.

Kent Hill, Assistant Administrator for Global Health, at the U.S. Agency for International Development, agrees that a balance must be maintained with other health needs.

He asserts that legislation moving through Congress to reauthorize the president's HIV/AIDS program (known as PEPFAR) for another five years at a $50-billion level could add to the imbalance.

"If the bipartisan reauthorization bill passes for $50 billion, it's $50 billion for HIV, and just contributes to the imbalance you are talking about," said Kent Hill.

The White House has favored a $30-billion figure, which Hill says would among other things provide $9 billion for the President's Malaria Initiative (PMI) begun in 2005 aimed at reducing deaths from malaria by 50 percent in 15 African countries.

Illinois Democrat Jesse Jackson Junior and Congresswoman Betty McCollum, another Democrat from Minnesota, are among those concerned that too much spending on HIV-AIDS could harm other programs.

JACKSON: "Almost all PEPFAR countries in Africa are facing cuts, some drastic to their child survival and health care programs relative to fiscal 2008 levels."

MCOLLUM: "I am concerned about the lack of investment in child health, maternal health and family planning. Eighty percent of our global health investment right now is HIV/AIDS, 80 percent. That doesn't reflect the global disease burden or mortality rates."

Despite the disagreements over how the 2009 budget directs spending, Mark Dybul, U.S. Global AIDS Coordinator, points to successes over the past five years, saying Africa will continue to be the primary focus of PEPFAR.

"Haiti, Guyana, and Vietnam together don't have as many infected people as one of the focus countries in Africa," said Mark Dybul. "So as you look to the future there are other countries in Africa where we have a lot of money that aren't yet focus countries, Zimbabwe, Democratic Republic of Congo, Malawi, countries where were wave substantial investments as well, so Africa has done very well under PEPFAR, and will continue to do so in terms of our global AIDS dollars."

Dybul adds that PEPFAR has supported training and salaries for health care professionals and workers that will help sustain progress being made.

Tuesday's hearing came a day before the Senate Foreign Relations Committee considers legislation that funds the U.S. HIV/AIDS program at $50 billion over the next five years.

The House of Representatives is expected to take up its version of the legislation next month, including compromise provisions dealing with family planning issues.