Federal Funds
Fiscal Year 2001 Expenditures by Selected Organizations Involved in Health-Related Activities Gao ID: GAO-03-527R May 16, 2003This report responds to a Congressional 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, 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.
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. 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. 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. 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.
GAO-03-527R, Federal Funds: Fiscal Year 2001 Expenditures by Selected Organizations Involved in Health-Related Activities
This is the accessible text file for GAO report number GAO-03-527R
entitled 'Federal Funds: Fiscal Year 2001 Expenditures by Selected
Organizations Involved in Health-Related Activities' which was released
on May 16, 2003.
This text file was formatted by the U.S. General Accounting Office
(GAO) to be accessible to users with visual impairments, as part of a
longer term project to improve GAO products' accessibility. Every
attempt has been made to maintain the structural and data integrity of
the original printed product. Accessibility features, such as text
descriptions of tables, consecutively numbered footnotes placed at the
end of the file, and the text of agency comment letters, are provided
but may not exactly duplicate the presentation or format of the printed
version. The portable document format (PDF) file is an exact electronic
replica of the printed version. We welcome your feedback. Please E-mail
your comments regarding the contents or accessibility features of this
document to Webmaster@gao.gov.
This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed
in its entirety without further permission from GAO. Because this work
may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this
material separately.
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.[Footnote 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 reports on expenditures of federal funds.[Footnote 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.
Table 1: Organizations' Expenditures of Federal Funds for Domestic and
International Health-Related Activities, Fiscal Year 2001:
[See PDF for image]
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.
[End of table]
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.
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.
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.):
Table 2: Organizations' Expenditures of Federal Funds for Domestic
Health-Related Activities,
Fiscal Year 2001:
[See PDF for image]
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.
[End of table]
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-
state payment formulas.[Footnote 3] 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
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.[Footnote 4] CDC's National Center for Chronic
Disease Prevention and Health Promotion and
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.):
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:
[See PDF for image]
Source: Congressional committees and subcommittees.
Note: GAO analysis of congressional information.
[End of table]
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:
[See PDF for image]
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.
[End of table]
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.
* The International Planned Parenthood Federation's family planning
association members usedUSAID 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.
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.
- - - - -:
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:
Signed by Marjorie E. Kanof:
Enclosures - 2:
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.[Footnote 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:
[See PDF for image]
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.
[End of table]
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.):
Table 6: Federal Funds That Supported the Domestic and International
Health-Related Activities of Four Nonprofit Organizations, Fiscal Year
2000:
[See PDF for image]
Source: GAO analysis of the organizations' data.
Note: Revised expenditure data provided by USAID and The Alan
Guttmacher Institute.
[End of table]
Comments from the Department of Health and Human Services:
DEPARTMENT OF HEALTH & HUMAN SERVICES
Office of Inspector General:
APR 10 2003:
Washington, D.C. 20201:
Ms. Marjorie E. Kanof Director, Health Care - Clinical and Military
Health Issues United States General Accounting Office Washington, D.C.
20548:
Dear Ms. Kanof:
Enclosed are the department's comments on your draft report entitled,
"Reproductive Health: Federal Funds That Supported Six Nonprofit
Organizations." The comments represent the tentative position of the
department and are subject to reevaluation when the final version of
this report is received.
The department provided several technical comments directly to your
staff.
The department appreciates the opportunity to comment on this draft
report before its publication.
Sincerely,
Dennis J. Duquette:
Acting Principal Deputy Inspector General:
Signed by Dennis J. Duquette:
Enclosure:
The Office of Inspector General (OIG) is transmitting the department's
response to this draft report in our capacity as the department's
designated focal point and coordinator for General Accounting Office
reports. The OIG has not conducted an independent assessment of these
comments and therefore expresses no opinion on them.
Comments of the Department of Health and Human Services on the General
Accounting Office's Draft Report, "Reproductive Health: Federal Funds
That Supported Six Nonprofit Organizations" (GAO-03-527R):
The Department of Health and Human Services (department) has several
significant concerns regarding this draft report. First, we are
concerned that the major question posed in the congressional request
(i.e. what is "The amount of federal funding that supports these
organizations?") has not been addressed. The General Accounting Office
(GAO) has presented, for the six organizations, information on
"expenditures" which differs significantly from total "federal
funding." For example, our records for fiscal year 2001 indicate that
Advocates for Youth received approximately three times the amount
included in the draft report and that the Alan Guttmacher Institute
received approximately twice the amount included in the draft report.
Second, on a related note, in the past, in response to similar
congressional requests, GAO has sought funding information from both
the organizations receiving federal funds and from the funding
agencies. This year, with the exception of the National Institutes of
Health, GAO has not requested information from department agencies and
has chosen to rely exclusively on information provided by the six
organizations under review. We believe the approach used in past
reports (e.g. the inclusion of information on federal funding by fiscal
year as presented in Table 1 of GAO's 2001 report (GAO-02-81 R))
resulted in a more accurate representation of federal funding and is
more closely aligned with the current congressional request.
Our third concern relates to GAO's focus on "reproductive health." It
is not clear whether GAO requested only information on "reproductive
health" funding from the six organizations, or whether GAO simply
characterized all funding provided by the department as "reproductive
health." We believe GAO's use of the term is problematic in either
case. If, in fact, GAO only sought information relating to
"reproductive health" funding, we believe this is inconsistent with the
congressional request which was clearly intended to disclose all
federal funding provided to the six organizations. On the other hand,
if GAO did request information on all department funding and
characterized all department funding as "reproductive health," that
would be inaccurate. For example, funds used to prevent HIV/AIDS are
not "reproductive health" funds. In either case, the focus on
"reproductive health" (including use of the term in the title of the
draft report) should be revised.
A final issue is GAO's description of the six organizations and their
overall organizational structures and activities in the "Background"
section of the draft report. The GAO appears to have utilized the
organizations' own descriptions of themselves without clearly stating
so. The GAO may wish to make the sources of the organizations'
descriptions clear by putting the descriptions in quotation marks and
providing appropriate attribution.
We would, of course, be prepared to work with GAO to address our
concerns and provide additional information as needed. We realize that
this could further delay completion of the draft report beyond the
deadline the Members of Congress requested.
[End of section]
(290255):
FOOTNOTES
[1] U.S. General Accounting Office, Reproductive Health: Federal Funds
That Supported Four Nonprofit Organizations, GAO-02-81R (Washington,
D.C.: Nov. 13, 2001).
[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.
[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.
[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.
[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).
