organizations. and in itself i think it represents part of the question, an extraordinary collaboration among governments, faith-based organizations and the academic community around these issues. anita, i think part of what we struggle with is a cultural divide. we have diven methods and diven approaches. we definitely have a common ground and as framed now by the coming sustainable development goals and this commitment to end extreme poverty, we have very clearly common grounds, we have different approaches. i think what's so heartening about the discussions over the last couple of days was the spirit of collaboration. the reciprocal frame. a call for organizations for very strong evidence granting and really a challenge to the faith-community to step up, just the kinds of evidence that jill and her team, for example, have been presenting. as a basis for discussion.

but i think that our work, the work ahead continues to be the building of trust, the building of understanding, the building of what we call faith literacy and development, this literacy across the two communities. and i would like to just point out that the materials, all the materials for the conference, are available on the website of the joint learning initiative at www.jliflc.com. i commebled those to you -- commend those to you. anita: great. thank you. now we'll open the floor to questions. there will be people coming by with microphones and so please wait to get the microphone before you ask your question. i'd like to you identify yourself and your organization before you ask a question. we'll take three at a time and then we'll pose them to the panel. we've got several hands up here.

questioner: good morning, ladies and gentlemen. thank you so much for your presentation. my organization is hope for tomorrow. a u.s.-based organization although we're also based in ken yafment thank you very much for your presentation. i just wanted to mention about what you said, there has not been cooperation partnership, outreach and awareness, true partnership with civil society, government and -- [inaudible] -- so how do we make this happen? lack of collaboration. [inaudible] we don't know what we are talking about. this message is very very important to faith-based all over the world. because without this message reaching them, they -- [inaudible] -- how do we work with you guys? we just came up with applications of communication where people in africa can hear

what we are talking about using health care, education and everything. so how do we collaborate instead of just hearing of the report, instead of -- [inaudible] -- thank you. anita: thank you. questioner: i'm the health program coordinator at the corporate council on africa. which is an association of billses interested in africa -- businesses interested in africa. this question is mostly i think for andrew. did you find big differences between religions, particularly religions that do not have sacred texts or that are not -- don't have one overarching philosophy for the entire religion? like folk-based religions. anita: thank you. questioner: my name is michael. i'm a retired -- [inaudible] --

i have worked in many countries in subsaharan africa and a lot of what is discussed is timid in the sense that i expected your team to look at the relationship between faith-based health services and government policy development. the relationship between funding agencies and faith-based institutions in countries. i give examples, to give a little clarity to my question. when i worked for the world bank and went on missions to countries my colleagues were

very reluctant for us to spend time discussing, either the baptists or the catholics or the presbyterian institutions. they were very unprepared to integrate statistical data from these facilities. i remember the case where at one time the catholic church was doing a lot more than the government was doing but this was never really integrated into the analysis for policy reforms or for program development or for program evaluation. when i myself worked for the cameroon government before i joined the world bank i helped and developed a relationship between the missionaries and the government, especially in the area of medical statistics.

most of the statistics we were collecting was from the brothers and sisters, the nuns and so on and so forth. not from the government. i worked on other countries where when you visit a health center in an urban environment that is missionary-run or faith-based-run. attendance is probably four times the size of a more equipped more staffed public health institution in the same town. there are several african countries where -- [inaudible] -- the hospital in the country is not in the capital city, it is in some remote little town.

moneys either by the catholics or baptists. so there has been a conflicting relationship. i hate to see us move ahead as if things have been very sweet and nice between government policymakers and institutions because that's not been the case. in fact, in some countries the missionaries are trading, but the government got discouraged from helping the programs because of -- world bank i.m.f. institutions discouraging the use of public funds in what was classified as private enterprises. anita: thank you. questioner: that has cost us a lot. anita: ok. thank you for your observation. let's take one more question

and then we'll go to the panel. questioner: good morning. my name is john. i'm director of the interfaith health program at emery university and the collins school of public health. my question is mainly to dr. tomp kins but i wonder if others have thoughts on it as well. in regard to reaching hard to reach and vulnerable populations, particularly in activities and programs that might be of a contentious nature in cultural context a lot of faith-based organizations that we're aware of that do that work, that work arises intrinsically around a complicated but potentially contentious negotiation between the faith-based providers that do that work and their larger religious traditions. one of our concerns is that when actors from civil society or the multilateral or bilateral donors are made aware of those programs, how does it change the impact and the affect of those programs in ways that may be negative? that it makes them and the

staff in those organizations morement is, or the work of those organizations suspect or maybe even puts those staff members the people who receive services in danger? i wonder if you saw any evidence of that and if you have any thoughts about ways that civil society organizations and the large donors can be aware of how to build respectful partnerships with those organizations reaching hard to reach and vulnerable communities. anita: thank you. andrew, do you want to go ahead and respond? andrew: those were some great questions. thank you very much. if i could start with the call which is coming out of nearly all of the questions about collaboration. if we look at the political framework in which my comments are based, it is that sustainable development goals are going to talk about universal health coverage. that's a big challenge. it's important it's vital, if we are to reduce poverty.

the bank has changed its mind. it used to be, you could only become healthy once you become rich. now they're saying, and i know this is true, that the bank is saying that you have to be healthy to increase your standard of living. so the question -- several things. part of them are comments that have come out of our review in the paper and my authorship team, and partly some comments, because i've lived in africa for many years. and have been privileged to do so. the thing is, when the faith groups are involved in health care delivery, it seems to me that often there's a tokenism rather than a true involvement. one of the challenges seems to be the coming out of this, that the governments and the agencies actually need to lose the nervousness that you, is ir-- that you, sir, described

the anxiety, and just get real and say, if we want to achieve health coverage, then we have to look at ways of working together with partners who are working in the -- working. that means that literacy needs to be developed. and there are some good examples in the paper of ways in which faith leaders have actually been the leadership of the programs particularly in some of the health damaging practices and more recently experience in northeastern nigeria, is that the faith leaders are absolutely vital in assisting the increase in development of immunization services which are tragicically declined over the last few years. you mentioned madam chairman, about kenya -- ma'am, about kenya. you give a good example of countries where there are great opportunities for people in government and the donors and the people who work at delivery , to actually understand each

other's language. i think there needs to be a greater appreciation knowledge and respect. and at the moment i have found that lacking in international development agencies. they do not want to accept that there are people who they disagree with in their own personal lives. so i think the challenge is how do we get people to move out of their personal prejudices and work into global care, which is what we're talking about. just a short answer. jill: i think there's been a bit of a change since the era that you're talking about. i've been involved in this work for a long time, like a number of friends and colleagues have been as well. in the beginning, even 15, 20 years ago, every time we started a meeting or every time we started writing something,

the first sentence would have to make an argument for the relevance of even looking at them. it would have to make a statement about the relevance of even thinking about the collaboration between what the faith community -- that's where market share figures started coming out of. but things have changed quite a bit. there is work on, and published work, on statistics, on contracting. the w.h.o. sponsored work right now on the contracting relationship and the financial conversation relationship in three african countries. universal health care coverage studies. i'm not saying relationships are not flawed and there isn't constant work to try to build the trust between the faith-based providers and the government. it's an ongoing -- all partnerships have dynamics. but i don't think it's quite the same as this, no, we're not even going to think about it. i think there has been a change. there are lingering biases,

which many of you in d.c. will be very familiar with. i think that was part of the -- what they were saying about. i think there's -- at an international level, i think there's a slight more openness to think being this and engaging this. i think up-to-date lying your question was, you know -- i think underlying your question was, you know, why talk about these things here rather than in the countries. all i can say is, these conversations and these collaborative partnerships are absolutely happening on the ground in countries. several partners here, usaid, i know they're doing lots of work on collaboration and networking in kenya, with local partners. i think it's not just here in d.c. that these conversations

are happening. if that was the subtext to your comment. jean: to support what they're saying, what i'm so excited about is that there seems to be a real movement both on the party side and the faith side to look at evidence-based developments and new approaches to forging those partnerships. i see deb in the audience there from friends of the global fight on hiv-aids, t.b.. organizations like the global fund for example are working now very, very intentionally on the challenge of how to engage more effectively and more incluesively. local faith communities and faith-based partners in country. i was so heartened during our conference to hear the global fund saying that during the ebola situation in west africa,

that they directed their grantees to basically repurpose funds that had been assigned for h.i.v. or t.b. to ebola. i thought that was a wonderful example of sort of the institutional flexibility, obviously in a crisis, but a really, really good example of that. going to jill's point in terms of contracting and new innovative financing mechanisms and contracting, going from kenya, spoke to us at the conference yesterday and challenged faith-based health care delivery systems to formalize and to strengthen their contracting mechanisms. in fact, he kind of challenged them to say that those m.o.u.'s that you have are not worth the paper that they're written on. and really pushing people toward more formal contracting. on the faith side, i think it's up to us to step up and to offer a more robust, collective

organizations that bring us together in larger scale so that we can deal as collective bodies, not necessarily just small institutions with governments. so they can achieve their escapeble objectives in terms of development -- scaleable objectives in terms of development. anita: andrew, there was one more question for you on the differences between religions. andrew: yes, that was an interesting question. you asked about were there any differences between those two had a written i think theology as opposed to a more verbal. the main thing we looked at did have a written one. what we didn't look at, and we've actually referred to this in the paper, was the enormous richness of traditional faiths. certainly i can speak mainly in africa. but i'm sure it's true in asia. where these states have been

there for years and they're sometimes sort of combined with more modern faiths such as christianity and islam. we didn't look at those because the diversity of those would have needed a lot more work. what we could see was a very interesting thing, is that there was a considerable enthusiasm among all the faith leaders for seeing how they could be more involved and actually there was a great opportunity expressed in the work that we did for making faith leaders more aware so that their sacred teachings, their preachings about traditional values could have a clear health content and they could be part of the action, rather than just leaving everything to the health professionals. i don't know if that answers the question at all. but that's how we saw it.

anita: we're closing in on the end of the hour, unfortunately. maybe we have time for two more questions. and short answers in the panel -- from the panel. any other questions? ok. i will ask each of you on the panel, you've done such amazing work and given us so much to think about. i would like to hear from you, in summary, what you would like to see as next steps as a result of your work, that you've been -- you've put so much effort into the research and the writing and not necessarily related to the piece you've written, but how you'd like to see this play out . jill: as someone immersed in information and evidence,

that's where my head is at the moment, it's very similar to the comment about, by having these papers in here, signaling in terms of something of the board of discipline. i'll give you an example. we hosted a conference last year in cape town for people there, i think there were two presentations. that had nothing to do with faith-based health providers. a big, massive, multi, you know, thousands of people at this conference. that's a signal to the fact that these issues come up in conferences, we have separate conversations about issues of faith and faith-based health providers. but they very rarely are integrated into the broader general public health development agendas and conversations. rather than this becoming a stand-alone conversation, it gets more strongly integrated into the broader public health conversation. andrew: i see this series and the amazing meeting on religion

and sustainable development being a start of a place in which things can have markers. i'm just a boring academic. i do get enthusiastic from time to time. [laughter] the markers should be gained at donors and health providers in terms of how aware are you, how much are you being inclusive? because many have been exclusive. there's a wonderful example that jill's talking about, in the paper, how inclusive are you of faith groups within your policies and your programs? and it will be possible to look at policy and to look at the international development agencies and to see how well they're coping with the challenges that this paper puts forward. similarly, i would see that the faith groups, they've made some

wonderful responses in the last 10, 20 years particularly, particularly in the area of h.i.v. care. but there are many other examples. but how do the faith leaders actually become more aware of how their teachings can actually interface most profitability -- profittably to build these partnerships up? they too, being subject to peer review, but the peer review process is a very interesting one, the faith leaders the theological colleges, all the colleges that are churning out faith leaders, it would be very interesting to see if they could become more faith aware. because that does give enormous potential for changing societies which are hurting at the present time. jean: one of our presenters at the conference yesterday, david

southerland, who is working in the philippines challenged the conference with the notion of how do you measure hope and dignity. i think that our challenge now and our real opportunity now is to build on the growing interest by virtue of the scale of the ambition of the goals, the development goals, the growing interest on the part of policymakers for engaging all hands in the development task and therefore also being very open i think, to engauging faith-based assets, our opportunity now is to pull together the evidence frame that shows to them that our work and our contribution will help achieve and help drive development outcomes and health outcomes. i think that we need to do that in creative ways. a lot of the evidence already exists and i think that we need to underscore and get much more creative at communication. at the end of the day, i think that a lot of our work going forward is about building friendship and trust that will

allow us to cross those cultural divides that we addressed earlier in the remarks in the paper. anita: thank you, thank you all. and again, thank you to the lancet bill for publishing this important series and opening the discussion, which will go on. thank you very much. [applause] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2015] >> thank you all. in the interest of time we're going to dive into the second panel which is going to give us an opportunity to look at the u.s. angle and the u.s. engagement with faith-based organizations and the genesis of those strategies and what impact and evolution we can see. we are honored today to be joined by three very respected panelists.

we have sandy thurman. many of you know her from her long work. in the middle we have mark who is the director of the center for faith-based and community initiatives at usaid. and we have jen who is the director of global health and h.i.v. policies at the kaiser family foundation. you have their full bios in the handouts so i won't go into all the details. you can see we have a very illustrious, very important panel up here and we are either -- we are eager to dive into some interesting discussion on this. i think we all know and the first panel made very clear the importance of engaging with and understanding the role of the faith-based communities in providing global health and provide information.

especially in reaching communities, the poorest of the poor, hard to reach areas. i'm reminded of a time not long ago when i was in ethiopia and interviewing an orthodox priest and we were talking about family planning and i asked him what message he gave to his followers and he said, roughly translated family planning isn't a sin, hungry children is a sin. and it's just a fascinating lens through which we can see, again, the importance of faith leaders and the information they can transfer to their communities and the importance of engaging them and ensuring that they have the information and the capacity that's necessary to reach their communities with appropriate and accurate information. we have been engaging in some very interesting conversations on this subject, most recently last week with some faith providers from kenya, on the subject of family planning. so i think it's true what the

first panel really emphasized, that things are evolving things are developing, and this is an important moment to be exploring this further. with this panel, we're very eager to talk about it from the focus of the u.s. policy perspective. and i think to begin with, we will turn to sandy. given your long involvement with h.i.v. policy from the u.s. government, can you describe to us a little bit more about how pepfar first began partnering with faith organizations and how that has evolved? sandy: sure. thank you and thank you all for being here. the faith community has been a partner in response to h.i.v. since the very beginning of the epidemic. both domestically and globally. so i think that our partnership in pepfar was an outgrowth of our experience and partnerships with faith-based organizations on the domestic side for a number of years. when we really began looking at

the disproportion at impact of the epidemic -- disproportion ath impact at the epidemic in africa in the late 1990's and early 2000's, it was a lot of our interest and a lot of the pressure that was brought to bear on the u.s. government and the policymakers was from faith-based organizations who were on the ground in africa seeing the devastation that was occurring on the continent. so they've been a natural partner for us. faith-based organizations have been a natural partner with those of us working in the h.i.v. and aids response from the very beginning. so when we began to expand the global program to focus on h.i.v. internationally and sort of put this in perspective, when i was worninging in the white house, our global aid budget had been $125 million a year.

for seven years in a row. which now, of course, was a rounding error. and our pap far program. -- pepfar program. when interest started faith-based organizations were at the forefront of encouraging us to really respond in a very robust way. and that of course ultimately led to the development of pepfar. i'll add though that our faith-based partnerships with, you know, were not based on politics. they were based on pragmatism. that when we looked at the people who were on the ground, who had access, who had trust in the communities, all the things that we knew we needed, and partners to move quickly in pepfar, they were a primary and natural partner for us. janet: it's interesting how this has evolved and we'll get more into the yupes -- specter of groups. that leads into mark to tell us

more about your office at usaid, what are the goals, what is your outreach, what is your strategy? mark: so i have the great office of running this office. trying to do a more systemic and engagement with the faith community. that said, usaid has been working with faith groups since the inception of the agency 52-odd years ago. so this wasn't in one way new to the agency. there was a new emphasis and a new way of looking at it and to reach to a broader group of partners. that continues to be a guiding star star for the agency. if you think about buckets of work, certainly to be the omnibus into the agency, to carry groups that want to work with usaid and don't know quite how to get into the door of the bureaucracy, can come through us to do that. groups act a little bit like an ombudsman, when there are problems we can facilitate finding solutions to problems

for faith-based community groups. we also try to do proactive outreach. around ebola as a recent example, we organized with the white house and the department of state, a conference call with faith-based abilitiers across the united states, and that -- actors across the united states, we had 400 people on that call talking about ebola and what the role of the faith-based community might play. we had smaller groupings of that in d.c. as well. there's a convenient role of the organization. and there's a role supporting the other parts of usaid that are trying to get things done. so we support the missions and their engagement. that's a critical part. for a big government agency, we're very decentralized. our mission in individual countries are vital and decision making processes happen there. those are ways we try to put it in. we try to make our engagement with the faith-based community as robust as possible, especially in areas like health and emergencies, when the

faith-based community have unique things to bring to the table. janet: thank you. one of the things that came up on the last panel was how much of the share of the u.s. government support goes through faith-based organizations. so many of us turn to kaiser for that kind of analysis. i wonder if could you tell us a little bit more about how that -- how much kaiser has approached that and why that's a complicated set of numbers to find. jan: thanks. i want to say that -- i want to commend the lancet and the authors that put this issue together, to start or really pick up and formalize an evidence-based framework, which is so critical. that i don't think has existed at this level ever for looking at the intersection of faith-based organizations and health. mark and i were talking in advance of this and clearly money is just one measure of this. there's many more ways to look at involvement. but money is one that we all

care about and pay attention to and so preparation for, you know thinking about that question, i will share some data that we just looked at. there's also some really good work that's being done now on this. the researchers looked recently at development assistance for health and there's an article that just came out a couple of weeks ago on this. roughly estimating that over the last decade or more, about 30% of all development assistance for health has been channeled through faith-based organizations. and that's a complex analysis there's a lot there. but i encourage people to look at that article it was in. that's available online. the other piece of work that's been done is looking specifically at the share of revenues that faith-based organizations have that are from u.s. government sources. it was about 13%. i think less than people think in their mind. so, in preparation for this

panel, i took a look at some data we recently released around nongovernmental organizations. another broad area that faith-based groups fit into that we don't know enough about, what's the role of n.g.o.'s in global health? we put out a couple reports on this. we are putting out a summary analysis soon. what do we know about faith-based organizations within that framework? what we looked at was 2013 data, that's 2014 just available now, but 2013 data, disbursements by usaid. there's all kinds of caveats there. just looking at that, when we were able to identify that faith-based organizations represented about 15% of n.g.o.'s that received a disbursement on global health from usaid in 2013. so 15% of the n.g.o.'s were faith-based. about 4% of the funding went to them. so i think it's less than people think and it would be good to look at historical analysis and see maybe how that has changed. we also found that faith-based organizations within the n.g.o.

community were more likely to be working in africa than nrment g.o.'s over-- n.g.o.'s overall. an important data point. most of the area that they were most likely to be working in, h.i.v. malaria was also a big one. and malaria and h.i.v. probably more so than n.g.o.'s overall. less so on family planning. so tho those were some of the find thags we looked at -- findings that we looked at. more likely to be in africa, h.i.v. and malaria were two big areas, and probably less funding than people think. i will just give you the funding amount, because i can see people woppedering what that amount was. it was about $96 million in 2013. for -- to give you a sense. that's less actually than the global fund amount identified in the analysis. janet: thank you. we're going to run through a series of questions and then come back and give you a chance to interact with each other.

perhaps linked to this, the question of who are these -- what are these organizations, where are they working, what are they working on? you've described from your long years of work the spectrum of kinds of organizations, which helps underscore the opportunities and the challenges of working with them. perhaps could you talk a little bit more about what you mean when you talk about different approaches needed for different kinds of faith-based organizations. sandy: sure. it's hard to, if you say faith-based organizations, that means, you know, a lot things. faith-based organizations can range from anything from the catholic health system in the united states of america, which i think is still, and i'm just using the u.s. as an example still the second largest health care system in the country to very small, you know, clinics or n.g.o.'s or orphans and

vulnerable children's programs on the ground. there's this incredible broad range. very big differences in capacity. very big differences in ability to deliver services. i think our challenge, our challenge to both donors and to faith-based organizations, is to begin to define with greater specificity and communicate what those differences are. for people. and it certainly came up a lot in the meeting that was held at the bank this week and has before. i think when we look at revamping our mechanisms in order to be more effective, build more effective partnerships, we've got to be able to name those things. so that when we have partnerships and defined roles and responsibilities and establish monitoring and evaluation and the accountability mechanisms and so forth, we to be very clear about what we're dealing with it and it could be very big or

very small. what you don't want to lose in that is that we know from all of our years in public health that if we want to really look at sustainable change at the end of the day and we want to be able to have, you know, countries take full responsibility and ownership of the work that's being done in their countries, that that has to be rooted on the ground in grassroots organizations all over country. if we want to sustain the impact that we've had at pepfar or we want to look at sustainable development, we've got to figure this out. so we need to just stay at it until we do. it won't be easy. it's like family dynamics. they're not easy. but it doesn't mean you abandon the family. you stay in there and work at it. i think that's where we are in this conversation. it's very exciting. janet: it's interesting because one of the pieces of sustainability, which is of course a big theme here in washington and everywhere, is also the link to the private sector.

and the longer term financing issues that link to sustainability. mark, you've talked about the added financial value of working with faith-based organizations and the outreach, can you describe a little bit more about your outreach to faith-based groups as a link to the private sector? mark: sure. so i think there's two elements to this. one is that faith-based organizations, like most nongovernmental organizations, have robust fundraising largely from the private sector and have partnerships via their boards and other mechanisms which they've been engaging the private sector since they existed. they've had to do that. another is a more direct to have say, as we're looking more at the importance of the private sector in development generally, health care in particular what are the ways we can think about the faith community? those business people who are motivated by their faith, but will never put a religious icon on what they do. so for example, there's a

project that we're working ot an usaid about to be finalized on health, small health experiment in a way to see if business principles can provide some sustainability and provision of health care, clean water and others, in the eastern democratic republic of congo. a consortium of business leaders that are connected to the national christian foundation in the united states have put up a million dollars of that partnership that we're working together. the national christian foundation, you know, the philanthropy that flows through every year is hundreds of millions of dollars. a lot of that a good significant part of that have go to international activities. we haven't formalized partnerships with that kind of flow and access to capital as well as the expertise that's within that community to bring it to bear. i think that's really fertile ground to build on. janet: jen, you've done a lot of work over the years on the u.s. response to the aids epidemic, of course. and there's, as we've discussed in the first panel we saw the

importance of some of the faith-based organizations' role in that response, as well as the ebola response that was touched on also in the first panel. do you want to reflect a little bit more on your view of how that has had an impact in u.s. response? join sure -- jen: sure. to pick up on something that sandy said about the role of faith-based organizations and the faith community and h.i.v. from day one, i mean, that's clear in the u.s. domestic case as well as globaly. but i think it's really important to note that from the case study perspective of pepfar how did pepfar come to be when we all look back and try to put together, you know, what are the elements that went into many of us watching that state of the union speech and hearing $15 billion and wondering how we were able to get there, it's clear that without the faith community that would not have happened. the faith community was, from the case study perspective of pepfar, an essential element to making pepfar happen. so it's not just on the ground delivering services and being

partners, but really pushing the u.s. government to go to another level. so i think that's just really important from my perspective, look at it from the long-term. i think on the ebola response, it's pretty clear that without engaging the faith community the way governments had to do realizing they had to or we would not have been able to turn around that crisis, and hopefully the lessons from that experience will be evident and ready, you know, not just put back on the shelf, but the next time a crisis like this occurs whether it's ebola again or something else, it's at the forefront, approaching communities with cultural understanding, engaging the leaders in those communities that understand them and can speak to them is the only way we can really get ahead of this. janet: quite clear there's been huge impact and benefit and also very big challenges that

have been presented by the engagement, particularly from the pepfar perspective. sandy, could you talk to us a little bit about some of the hardest parts of pepfar's history in dealing with the faith community and what lessons have been learned and how has that impacted the current pepfar strategy? sandy: sure. i think that, again, it was not new with pepfar. we've had challenges in h.i.v. and aids with the faith-based community. challenges and incredible opportunities from the beginning. it was certainly true in pepfar. i think that we've had to, a couple of things. i think it's been very, very hard for a mechanism as big as pepfar to find the way to operationalize our partnerships with faith-based organizations on the ground. and so that's one. then we've had, you know stumbles around al and challenges around issues of reproductive health, certainly around the lgbt community,

which we've seen a lot of it play out in recent days. i think where we hang on this interestingly is more in places like washington, d.c., and our big institutions rather than on the ground. what i have found always so inspire something that the way that people who are actually on the ground doing this work figure out a way to work together. oftentimes we just make everybody's -- i mean, we try to make it bet. sometimes i think we make it worse. because people are so -- people are creative, especially people who are working on the ground in very hard to serve populations, in the far-reaching places in the world, people figure this out. we need to learn from colleagues on the ground and bring those lessons learned up to the top. that's something that a doctor mentioned. i think we also have to be really careful, wanting to be

so politically correct in the way we engage as policymakers, that we don't put people at risk. we want to tell the story about the nuns who are buying office supplies for an n.g.o. that's secular so that they can trade and get condoms and won't get caught by the bishop. in the old days, i mean, we had all these wonderful stories about people just figuring it out on their own. i think we need to take lessons from our colleagues on the ground. it continues to be a challenge for us. but the other thing we talked a lot about is that finding common ground, and again, when we define with real specificity what our roles and responsibilities are, when we engage in a partnership almost like a preenough, so we have a preenough -- prenu, so we have a prenup and we have to just

define with greater spessity how we engage and i think it takes the mystery out of this. if you have secular institutions and faith-based institutions if you really dig down, up front and define with greater spessifyity, you can find that common ground and not put each other at risk in any way. janet: to be more specific we have some real controversies that have emerged, most recently in uganda. i'd like to hear more from mark about that episode, putting the lgbt community at such risk. the funding for the interreligious council being withdrawn by the u.s. because of that. what lessons were learned from that and what new practices or vetting procedures or new mechanisms arose from that? mark: i think i should summarize first. just quickly legislators

within uganda proposed an ty homosexuality act that was draconian -- anti-homosexuality act that was draconian at best in terms of its treatment by lgbt people, the discrimination of them, their description of them, who they were as people was in so many ways beyond the pale. the interreligious council and members of the interreligious council campaigned positive for that -- positively for that legislation and vocallie took out ads in the paper, -- vocally took out ads in the paper and spoke. you're thinking, this is just such a horrible situation. and essentially what happened i think the u.s. government lost confidence in the interreligious council, you know, to carry out their mandate and serb serve people without bias. because -- serve people without bias. it was so beyond the pale of what we normally saw in terms of active campaigning, the public's nature, among all of the interreligious councilmembers. there are nuances between them but largely all were for it.

funding was withdrawn from that institution and mechanisms were put in place to still meet the need of people in uganda so they weren't left without treatment. in terms of lessons learned, i think that situation's become polarized. i come out of the community organizing background, when you polarize you have to figure out how to depot larize. i don't know that we've -- depolarize. i don't know that we've done that successfully yet. how do we learn more about what the actual discrimination is on the ground? so we have the evidence that says yes this rhetoric links to a set of behaviors that are happening that are impacting people negatively. we don't know that right now. we make some assumptions that are reasonable, but in other cases, there have been legislators at the top saying bad things, but the providers on the ground continuing to do good work. so we need to figure that out of. there was a study that usaid did about bias in jamaica.

i think that's a model of what we want to do in other places and replicate that to see what are people experiencing, what can we also witness from the experience. janet: certainly another area of challenge involves family planning and reproductive health. jen, i wondered if you wanted to talk a little bit about what you've seen in terms of how that has played out. jen: i wanted to pick up where mark left off around lgbt rights and the issues that happen. there is a really good new study that came out looking at nigeria and the perceptions of gay men on the ground and their ability to get services and what they needed finding a link between the rhetoric and their own fear about seeking services. so -- but i agree. getting that evidence and summerizing it to policymakers and program managers can understand is very critical. something that goes to the family planning issue that i want to paraphrase something.

i think the overriding sort of issue here for policymakers is really about public health. it's really the public health approach. what works for public health. she said it much more eloquently and i'm going to paraphrase it, stigma in any form, discrimination in any form, is not what public health and human rights is about and cannot help us be most effective in our response to h.i.v. that plays out in the family planning discussion. but stepping back i think that the polarization around family planning is very clear in washington. and i think what happens is people don't realize or make assumptions that faith-based communities are not champions of family planning. when many, many are. in fact, leading on providing family planning services on the ground, i think that's the evidence for that is there. there's this sort of mischaracterization often of the community and it's a very diverse community. so that also doesn't work as a

characterization. i think where the challenges arise is that when there are effective services such as modern contraception being most effective in terms of what women who want family planning methods should get, according to public health evidence, if there are faith-based organizations or other organizations who can't provide that effective service or won't, it's really incumbent upon the u.s.g. to figure and look and do an assessment and say, how do we reach those who need the services the most? what's the best way to do that? i think that's really where the emphasis needs to be. from a public health perspective, meeting the goals how do we reach those who need services most and put that together? from a government perspective. janet: i know we're going to have a lot of questions from the audience. i wonder if could you talk to us for a minute about how does all this fit in to pepfar 3.0? sandy: i think it fits in squarely to pepfar 3.0. we know that we're going to have to, going forward, take a

very strong public health approach. to containing and eliminating the epidemic in ways that -- not that we didn't do before, but now that we have, you know, limited resources, we have more people on treatment we've got to continue to move forward and we're really going to have to focus more and more as the time goes on. that's very important. our best partners, or some of our best partners, in doing that work are again going to be our faith-based partners. we have to get into communities, we have to access those relationships of trust, to get people into treatment, to keep them on treatment, all the things that we know that we have to do that it often thames tyke -- that it often takes time to do. we can't do that on our own. so woveg got to find the partners who are already in community to help us do that.

expanding our partnerships with faith-based organizations is a critical part of that and it comes down to it's very prague mat frick a public health perspective -- pragmatic from a public health perspective. we have to identify folks, get them in and keep them in treatment. those programs have to be rooted in communities on the ground. otherwise there's not sustainability in our work. so they're a primary partner in a big piece of our our work going forward. janet: mark, you talked about exactly that issue. the sort of cultural literacy i think you called it, training for u.s. government agencies to work better with s.b.o.'s, if we're able to use the term for now, including new training for how to work with religious groups, can you just say a word about what that entails? mark: sure. general frame, various agencies of the u.s. government came together the past few years and

there is an interagency now strategy on global religious leader and faith community engagement. part of that strategy calls for more training within our agencies, across government, on how to work with faith-based organizations. at usaid we've received money from our human capital team and talent management team, basically our h.r. department to begin to do that within usaid. to formalize new training processes using distance learning for our missions and things. and so that's really going on for us very strongly. so i have a member of my team who has worked with many of you , who is leading that effort, to do more training and sensitivity. i would say there's also -- the other side of that coin is, how do the faith-based organizations rely the literacy training toward working with governments one-on-one? janet: thank you all. i have lots of questions but i think you all do too so let's

open it up. again, we'll take about three at a time. please identify yourself and your brief question and then we'll do another round after that. please wait for the mike so our online viewers can hear you as well. first question. questioner: hi thank you. i'm john from emery university. jonathan mann put forth the perspective that human rights has to ground the moral vision and the work of a lot of what we're talking about here. and that has been an important concept and an important kind of grounding for a lot of our work. but in our work, at least in kenya, with faith-based organizations, that work with men who have sex with men, work in lgbt communities, work with sex workers, people who use drugs, they almost never reference the term and they've talked with us, a lot of us know this, that around

contentious issues, the term and invoking human rights immediately becomes this -- has an effect of being seen as the west trying to impose cultural values on another part of the world. our faith-based partners invoke their own religious traditions and teachings to do similar kind of work. one of the things i found really powerful at the world bank meeting is dr. kim invoked a preferential option for the poor a perspective from roman catholicism it. feels to me that around finding a kind of common moral space on contentious issues, that there are intersections we haven't explored very much and i know that faith-based leaders are working to do that in some ways, in various parts of the world. i wonder if you all have any thoughts as to how we might understand those kind of common moral grounds that give us new language beyond just the language of human rights not abandoning it, but expanding it.

janet: a question in the back corner. questioner: how much, when usaid or somebody, funds these programs, are they also attaching to it the sufficient funds to then do the evidence-based analysis of the intervention as well? are they making that -- i mean it seems to me like in the first part we were talking about evidence-based interventions and faith-based and, i mean, obviously funding for that kind of analysis is also important. and how much is that attached in the packages? janet: one more question for this round. let's turn back to the panel. we have two very interesting questions. let's take the human rights question and going beyond extending -- including human rights but going beyond that

term. sandy: i think that, again there's been some really interesting work done over on this around better language and better words and defining the way that we talk to each other about these kinds of issues. but it's limited. and i think coming out of the conference, we've had a lot of dialogue about this, coming out of the conference yesterday, i think it's clear that we need to spend some time looking at expanded kind of language that works for everyone and that's not polarizing in and of itself. we all respect, i'm sure jonathan mann, who was just an extraordinary visionary in our field, but understanding that we have to -- our language has to change as time changes. we can't, you know, we're not -- we have to keep moving on and finding common language as

more partners come to the table. i think it's something that we need to invest in and we haven't and that's a conversation i'd love to have with colleagues going forward for us in pepfar and i know for others. because if these partnerships are going to work like we need them to work, then we have to invest in figuring out what the foundation of that looks like and then come to some agreement on that. janet: jen, maybe you want to come in on this issue of universality of human rights and the impact of language here. jen: language is critical. if you don't speak the same language as somebody you have to work on understanding. how people speak about a situation or a group is clearly -- there's been a lot of work on done on that. i completely agree that figuring out the right way to frame these discussions, with different communities, we have not done a good job of it. i do wonder, though, about the human rights, using that

language. when the uganda and nigeria situations were at their height, i was involved in a lot of conversations with people in d.c. as well as in africa about language and how to approach it and make the case that these were harmful laws. . lgbt rights are human rights and someone said you have to focus on human rights and will affect society that will not necessarily be part of an lgbt discussion. so to your point we have not practiced that at all. mark: our foreign service nationals, which are the people from the countries in which we

are working have been working for decades and rooted in their own communities. and they often have the relationships for longevity when foreign service officers rotate after a short number of years. i appreciate my role and how to better use and work with our foreign service nationals to address these questions of language. janet: you want to take the question of funding. mark: between evidence and evaluation and certainly we're there on evaluation and that's built into our requirements for funding. we don't fund a lot of evidence and that's a gap. and i don't know where we're going to solve that. our budgets are largely dictated

by capitol hill and there's a conversation there as well. but we're good on evaluation and not so good on evidence. sandy: we as government donors are asking for demanding and talking about data and box ourselves in to have the monitoring evaluation that mark talks about. that's a conversation we really need to have and not an easy one because we are all funded by the u.s. congress and we have our challenges around that and it's also a place advocacy could be very helpful for us, to say that there is -- we have all the data but hamstrung by the fact that you are asking for evidence and see if we can't be more creative

in these conversations with our colleagues down the street to see if we can't find a way to do that or external partners. foundations and other donors who might not be as restrictive as we are. mark: on a positive story usaid at georgetown, look at that for family planning purposes. and there has been evidence now that those do work. and so we can fund those as a tool to use to reach our goals in family planning. but that particular tool is acceptable by many religious groups that are opposed to the other tools. i think that is one positive story we would like to replicate. janet: do we have other questions from the audience?

right here in the middle. >> i'm here from the state department. and in terms of the ebola crisis in north africa and the role that faith-based organizations could play and lessons learned from ebola in the past year, two years. janet: other questions? >> how do we cooperate with usaid in the faith based initiative. how do we come up with this

collaboration of outreach and advocacy in africa and lessons learned on ebola because there was no outreach. so nobody funds them. we should look at the organizations in the rural areas. want to work with the small organization and the small organizations are the ones who do a lot. look into that and follow that up because we do a lot of work and how do we cooperate again. janet: we'll turn to the panel for these two. again the question of the role of the faith groups in pandemic preparedness.

jan: engaging faith-based organizes -- sand sandy: it's critical, if we look at strengthening it's more difficult for us to do on a global reach than it is to do at home with domestic reach. faith-based organizations and private actors have to be partners in any kind of emergency preparedness or pandemic preparedness and people are aware of that certainly in the aftermath of the ebola epidemic and the faith-based organizations were on the ground responding to the pandemic. one of the things that's come up in our conversations around emergency preparedness is training our first responders on how to engage with people who are already doing the work on the ground when they arrive.

so the transfer of and the partnership and the integration already on the ground and services is done in a way that honors the people who are responding first and engages the people who are our first responders coming from big organizations, donors and others. so we have a lot to learn, but there's no doubt from the c.d.c.'s perspective, that faith base organizations have to be a big partner in that are process. jan: the preparedness side of the equation which has been harder for policy makers to focus on. the crisis is another event to discuss. what will be important to look at going forward, what leaders are involved in preparedness now

because there is more attention to the need to have that preparedness because of ebola. i will say in 2013 i was looking back, there is a funding line that they have to look at emerging threats. very few n.g.o.'s get money in that regard. no faith-based organizations got disbursements for that in 2013. that's important to look at that going forward, i think. mark: one story when you work with small groups or not, former administrator met with a school that had to behavingly shut down and needed food for students. it was a small operation. it turned out that the pastor that ran this had a national radio show that covered the country. at first glance was small became very big because he sent messages out and widely

respected. we have to be careful of something being small may not be so small and the influence going out. i also think in terms of the second phase of the ebola response and want to build that better we are in partnership with the catholic help association, and ending child and preventable deaths. i think that is a key to reach some of these organizations in terms of doing health system strengthening across the board to building the resiliency to take these shots and respond appropriately and not get set back so far. janet: any thoughts on the collaboration piece? any additional thoughts on collaborating with community-based organizations, the last question.

sandy: we have to continue to expand our capacity and that has to be done -- government will never have the capacity to directly fund very small organizations -- we don't have the band width to be able to do that. it's often where we get the best return on our investment. we will continue to rely on robust coordinating mechanisms and organizations that comprise many different faith-based groups so we can get the money to the ground. that is the way that usaid does its funding and it's the best of what we've got. there is always room for improvement and what we are talking about is how do we improve our mechanisms and get closer to the ground.

janet: i would love to give you all a chance for final comments and ask you to reflect on that, what are the next steps, including to address some of the hard issues. the paper in the lancet that talked about child marriage, about gender, family planning and reproductive health, there are very big issues that the u.s. government is focused on in its own strategies and sometimes the faith communities can help in those strategies and at times they are a barrier to implementing u.s. goals in that area. when you are thinking about next steps, please include how to address these big challenges. january. jan: what others have said -- looking at the next phase of global health policy and global

health more generally i think better arctic can you lation that we have to reach the poorest of the poor. we can't have the world we want that we don't. faith-based organizations and religious communities have always done that in a way that haven't in the past. that's pretty clear and the evidence shows that. two, i think on the challenges we have to name them and the article does that. i think naming them and talking about them and trying to understand where there's common ground and difficulties in figuring out with the goal of getting services to people who need them from public health evidence-based services. that is the end game that we want. and lastly data, we need it. we took a look for today, but i would like to do more on that.

all of us who can should. i think really critical. mark: where i'm located in usaid, we are flooded with great fupts and how to engage. we get flustered sometimes. to see the partnerships that are going on are just really terrific. i'm very positive. i think in terms of addressing the challenges, the trip wires for the challenge and the solution to challenge. we get conversations with the chair of the north american council and he is interested in working with us and somalia taking the networks in the communities, in kenya ethiopia

and other places. he has reached out and saying will you work with us and there's an agreement with us. there are some foundations that want to come together. we want to look at that and he came to meet with us. i think we can take the mechanism with the public-private partnerships and work with faith-based groups and use the religious leaders to answer the challenges. sandy: i agree with what the other panelists have said. we need to reach the poorest of the poor but not leave it marginalized for other reasons behind and makes it a much more difficult position for us. not only hiv-aids but other reasons as well. focus on the importance of literacy and cross training of

public health practitioners and faith-based practitioners and we have had some great pioneers like jonathan man. and others who recognize the importance of this 30 years ago. there is a very robust but small body of work on cross training, are practitioners and people on the ground, to talk with each other and find some of that common language that mark was talking about. we have to have the same language to have the conversation. it's always a challenge. but to end on a trend that i see that i think speaks to the future in a very important way and that's this incredible growth that we have seen at emory that we have seen and

interdisciplinary approaches to development, public health and theology that includes all of our schools. and also a real growth and theology public health and development and all of this cross training makes me very hopeful what the leadership will look like 10 years from now and 15 years from now on these kinds of issues that we all hold so dear. there's a lot of light on the horizon when it comes to new leadership. janet: i think this has been such an interesting panel and opens the door for so many more conversations, so much more happening in the field right now and great thanks to all of you for the work you're all doing in this area and sharing your insights because this has been very enlightening. please join me in thanking our

panel. [applause] [captions copyright national cable satellite corp. 2015] [captioning performed by national captioning institute] >> it was reported earlier this week that the data breach at the office of personnel management was much larger. the personal information for 21 million individuals were compromised. the director of o.p.m. resigned in the wake of the massive breach and some reaction from capitol hill. house speaker and others released a statement. the resignation and solve the president of the president to repair this damage. a change in personnel does not always lead to real change. we applaud the work of the government and oversight reform committee and will hold the president accountable for restoring the president's confidence.

>> here are some of our featured programs this weekend.

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challenges facing the international station. among them is the ability to deliver supplies following three unsuccessful attempts over the past year. this includes last month's rocket exploded over the cape. witnesses at the hearing included officials from nasa and boeing and a former astronaut. earlier this year, the obama administration announced its support to extend it to 2024. this hearing was chaired by house an hour and 45 minutes.

>> the committee on space will come to order, without objection, the chair's authorized to declare recesses of the subcommittee at any time. good morning. welcome to today's hearing entitled the international space station addressing operational challenges. in front of you are pacts containing the written testimony and truth in testimony disclosure for today's witnesses. i recognize myself for five minutes for an opening statement.

the i.s.s. program has experienced a number of challenges. as a can-nation, america has been committed to identifying challenges addressing them and reach our goal and destiny. we have that same commitment with the i.s.s. during this time, astronauts have experienced water leaks in their suits three times with one incident occurring during a space walk. on april 26, 2013, unmanned cargo vehicle damaged a radar reflector when docking with the i.s.s. on january 14, 2015, a false alarm of an ammonia leak caused the crew to retreat into the rush and segment. an unmanned cargo launch failed

just after launch. april 28, 2015, a separate russian progress cargo vehicle failed to reach the i.s.s. on june 7 2015, a planned reboost of the i.s.s. using a docked vehicle failed but was successful after trouble shooting. on june 10, 2015, a visiting vehicle unexpectedly fired its engines without being commanded. on june 28 2015, a space -- an unmanned cargo launch failed as well. all of these incidents highlight the challenges of operating in space. and they remind us that nasa's contractors, engineers and astronauts must be ever vigilant. these have challenged i.s.s. operations. the fact that the program was

able to effectively respond is a testament to nasa, the i.s.s. partners and the contractors. we do not know the root causes of some of the accidents yet, but once we have more information, we will be better suited to review those individual events. in the meantime this hearing allows us to evaluate the operational status of the i.s.s. review efforts to assess the future prospects. the i.s.s. is one of the most complex and expensive manmade objects ever built. the american taxpayers currently invest approximately $3 billion per year in this laboratory. we must ensure that every dollar is spent effectively and efficiently. the i.s.s. offers a unique micro gravity environment for scientists and engineers to utilize.

nasa released its benefits to humanity detailing the many benefits that i.s.s. provides back to our labs here on earth. from advances in our understanding of human health and performance to our use of new materials to the utilization of robotics and satellites, the benefits we receive are many and diverse and remarkable. in addition to the benefits here on earth, the i.s.s. offers the conditions necessary to prepare and develop critical technologies for deep space and long duration, human space flight missions. successive nasa authorizations direct the administration to utilize the i.s.s. for this purpose. the human research program and advanced exploration systems program at nasa are on the cutting edge of developing systems we need to send humans ever deeper into the solar system than before. right now, captain scott kelley

is on day 104 of miss year-long mission. in addition to the utilization efforts of nasa research programs the nasa authorization act of 2005 designated part of the i.s.s. as a national lab of the nasa authorization act of 2010 directed the administration to sign a cooperative agreement with a nonprofit to manage it. nasa selected the center for the advancement of science and space to lead this effort. the government accountability office noted in a recent report that it had made great strides in fulfilling the mandate under the law but that more work needed to be done to ensure that measureable progress was being made in a quantifiable manner. i hope to hear from nasa today that the agency is making

progress towards answering this recommendation from g.a.o. as we keep an provision on the i.s.s., we must also look to the future. last year, the administration announced support for the extension of the i.s.s. program from 2020 to 2024. at present, federal law limits the life of the i.s.s. to 2020. absent action from congress to extend it, the administration would be required to begin closeout of the program. there are many questions about the request for this extension. the bipartisan house-passed nasa authorization act of 2015 requires the administration to provide a report to congress on efforts by the administration to utilize the i.s.s. and how to quantify benefits back to the nation for the required investment for this extension. it also requires the

administration to develop a government-wide utilization plan for the i.s.s. to ensure that every minute the facility is in orbit we are doing what we can to get the most out of it. it is important for congress to understand the issues whether to extend the i.s.s. this committee has the responsibility to ensure that the american taxpayers are getting all they can from every dollar that they send to the federal government. i believe this investment is worth while and that the benefits far outweigh the costs. support for the i.s.s. and operations and utilization is not a partisan issue but an american issue and i look forward to working with my friends on the other side of the aisle and our partners in the space industry to understand how we can all meet the operational challenges facing the i.s.s. program. i now recognize the ranking

member the gentlelady from maryland, for an opening statement. ms. edwards: thank you very much, mr. chairman. and good morning and welcome to our distinguished panel of witnesses. i appreciate you are holding this hearing addressing operational challenges and as i listened to the chairman, i'm reminded that the challenges that nasa faces and the agency faces in operating the international space station i would be more concerned if we weren't able to overcome some of those challenges and it's a credit to the crew and the partners that that is true. about a year ago, i and the members of our committee sat in this room and looked on the screen there and had the opportunity to communicate with our nasa crew that was on board the international space station and the astronaut from maryland

and i promised him crab cakes. the accident that the chairman referred to, my crab cakes didn't make the delivery. what happens when you connect real-time with our astronauts who are working and carrying out research in the laboratory that is 250 miles above us is really quite an inspiration. thanks to nasa and the crews and so many school children have had the opportunity to learn about human space flight through similar events we experience here in this room. yet in the thrill and seeing those who inhabit our on-orbit laboratory, we could forget just how difficult and demanding how risky it is to operate and

maintain the international space station. we sometimes think it is ordinary. orbital debris internal and external pose significant risks. the unfortunate loss of this space 7 cargoo resupply mission along with the earlier losses of the rush and progress and missions over the past eight months are stark reminders of the risk and challenges that nasa has to face. the successful management of these risks for more than 15 years is a testament to nasa and the industry and international partners. i'm confident that space x orbital e.t.k. will identify and resolve the problems that led to the launch failures resume cargo supply to the i.s.s.

and the i.s.s. has been resupplied through its partners. mr. chairman, we don't have any time to spare. i.s.s. is a temporary facility that is currently authorized for operation as you described through 2020 and given the operations cost about $3 billion in taxpayer dollars every year, costs are projected to increase coupled with the challenges involved in sustaining operations. we need to ensure our vision for the i.s.s. is clear and goal and objectives for using this unique facility are in line. i'm pleased that the number of users has actually grown. we have had concerns about that raised here in this committee. in addition to nasa researchers the i.s.s. national laboratory management has drawn new commercial users including pharmaceutical companies to the i.s.s. while the range is expanding the resources to support those

activities are not. funding for the i.s.s. research represents 12% of the overall i.s.s. budget. constraints on cargo transportation to the international space station as well as available power and precious crew time limit what research can be accomplished at the station. in that regard, i know many of us want to understand the implications of cargo resupply interruptions on crew operations and the sustainability of the station. in addition, there is critical work to be done in areas of human health research and technology development that needs to be carried out if we are going to make progress toward the long-term goal of sending humans to marches. -- mars. they are steppeding operations until 2024. they have three rationale, to complete research that supports long duration human missions

beyond lower orbit, to garner societal benefits from research, some of which we see here and give nasa and private partners more time to transition to commercial cargo and crew allowing nasa to focus on human exploration of deep space. today's hearing provides us the opportunity to examine those rationale in the context that nasa and its partners will face in sustaining the i.s.s. mr. chairman, we have a lot to discuss this morning and i thank our witnesses again for being here. with that, i yield back. mr. babin: i now recognize the ranking member of the full committee for a statement, the gentlelady from texas. ms. johnson: thank you for holding this hearing. this really is an important topic and i look forward to the testimony of our panel of witnesses and i welcome them. it is no secret that i have been

a long supporter of the i.s.s. it plays a unique role in research and inspiring our young people. in addition to being an incredible engineering achievement. it provides a visible demonstration of the benefits that can be did he riffed from peaceful international cooperation in space. failures of commercial cargo transportation missions to the i.s.s. remind us that space flight is not easy. failures will occur and unfortunately, these failures will have impacts on the program. we need to better understand the impacts as well as the plans for dealing with them going forward. and we need to whether there are any lessons learned that need to be applied to the far more challenging commercial crew transportation program. i said before that the i.s.s. is

a perishable commodity. we need to be clear on what nasa needs to accomplish with this unique laboratory while it is still operation national. while the administration has proposed to extend the i.s.s. operations until 2024, maintaining the i.s.s. involves risk and a at significant opportunity costs. we need to ensure that the i.s.s. is being used that maximizes its productivity and value to the nation. if we are to ensure that the needed i.s.s. research and activities are carried out. it is clear that we are going to need to make the necessary investments. stagnant i.s.s. research budgets do not communicate the message that we are serious about supporting the technology and research efforts that can only be accomplished on the i.s.s.

that is a problem that congress could and should fix. well, mr. chairman, we have a lot of issues to discuss today and i welcome our witnesses and look forward to a productive hearing. i thank you and yield back. mr. babin: if there are members who wish to submit additional opening statements, your statements will be added to the record at this point. at this time, i would like to introduce our witnesses. bill is the associate administrator of human exploration and operations mission director at nasa. our second witness today is john . vice president and general manager of space exploration for the boeing company. testifying third is honorable paul martin who served as nasa's inspector general since 2009. our next wet is shelby, acting director of sourcing management for the government accountability office.

today's final witness is dr. james owelsik at the pennsylvania state university and retired astronaut. in order to allow time for discussion, please limit your testimony to five minutes. your entire written statement will be made part of the record. i now recognize our first witness to present his testimony. >> thank you, mr. chairman and thank you for the opportunity to testify on behalf of myself and the men and women that work on the international space station. this is one of the most talented and dedicated international teams in the world. the i.s.s. is an amazing research facility. today there are 329 research investigations in progress. these span topics from human research into how the human body performs in micro gravity physical science, earth and

space science, technology development and education. there's never been this scope of research performed on a continuous basis in space. we are also in the midst of a one-year crew expedition. it will give us detailed information into the human adaptation to the space environment with mission durations approximately equal to mars. and we will get a chance to see how the human gene ohm changes. we have kept a continuous presence on the i.s.s. for 15 years. 83 countries have used it for research. private companies through the national laboratory and center for advancement of science and space have used the i.s.s. in boston, there was a users' conference. this is an exciting time as new researchers are seeing the advantage to augustment their investigations. the growth of none-nasa research is exciting and there an

interest in using space to investigate basic research opportunities typically only done on the earth. space provides a unique woint into any physical process that is affected by gravity. the human body reacts in space with many conditions that mimic conditions bone loss muscle wasting and balance problems. using animal models, unique insight and potential new treatments for the elderly can be developed. as the chairman stated earlier operating on frontier space is not easy. three independent cargos were lost. this shows the difficulty of living and operating in space. the lost vehicles have different designs, different hertages, different manufacturing, different build processes. the failure of these three systems shows the difficulty of launching and operating in space.

we often think that i.s.s. is only 250 miles away and the journey is easy. this is not true. we are operating these at the edge of our capability. we think we can lower the risk of cargo delivery. the demands require to escape earth's gravity exposes us to the same level of risk. but the insight can prevail and give us insight and help us understand the designs to make sure we can end up with better designs. the right level of insight can reduce the design -- reduce and find design errors. too much insight can distract the teams from working on and improving design. even after these three failures, the basic operations were not impacted. this is a tribute to the teams that manage and operate the i.s.s. they learned and implementing the hard lessons from the

columbia tragedy where the i.s.s. had to operate without the shuttle for several years. management processes and techniques learned are proving their worth. these failures are not without consequences. several of the goals associated with research and cargo flights will not be met. the i.s.s. program is reducing consumeable margins to favor research. this will not be enough to recover the research impacts. the delay in the soyez crew flight required the i.s.s. to operate with three crew for approximately three weeks longer than planned. the impact of the loss had real implications to students and researchers who lost cargo only to lose the replacement and return to flight hardware again. they suffered a double loss. the loss of the international docking adaptor can be

accommodated without hurting the crew. i.s.s. is a phenomenal resource for the nation. it can done no place else. it can serve an accelerator and help nasa prepare for journeys and benefit people on the earth. congressional support for i.s.s. operations through 2024 would be a great sign to our international partners. operating on the frontier is not easy and not get complacent thinking that operations are routine or easy. they are not. they have done a great job of managing in a difficult environment. the team will look for ways to improve. they need to be given flexibility to manage and others need to understand the benefits and how it can be used to provide robustness. the benefits will take longer to be realized but the benefits

will exceed the expectations of all involved. i thank the committee for their support for human space flight. i look forward to your questions. thank you. mr. babin: thank you. i now recognize mr. elbon to present his testimony. >> on behalf of the boeing company, thank you for the opportunity to testify today to provide an update on boeing's role on the international space station. as one of your constituents congratulations on your selection to lead this important committee. boeing is extremely proud to have supported nasa in the design, integration and assembly of the i.s.s. as nasa's prime contractor boeing delivered the components and provided system integration for the stage by stage ability.

we continue in the i.s.s. sustainment role today. on november 2, the world will celebrate 15 years of continuous presence in space, human presence in space. with international crews living and working on bort the i.s.s. at a time when many decry a gap as we transition to commercial transportation, we who know i.s.s., america and partner nations are making advances in space every day. international space station has been recognized as the largest most complex international and scientific project in history and the world's largest endeavor in space today. ongoing improvements are making i.s.s. better. hardware and software from 16 count tries and 7 states. about the size of an american football field, it is larger than a six bedroom house and

internal pressurized volume of a 747. i.s.s. is an engineering marvel, a beacon for international cooperation and shining example of what can be achieved through strong leadership and unity of purpose on behalf of humankind. boeing is responsible for maintaining the station and ensuring the full availability of the unique research laboratory for nasa, international partners and other u.s. government agencies and private companies. in performing this role, we continue to work with nasa to reduce the cost of sustaining the international space station. over the past 10 years, we have reduced the cost of our sustainment role by more than 30%. these savings as enabled nasa to fund improvements such as the nasa docking system, the critical components supporting increase in the number of vehicles visiting the station. these improvements help keep i.s.s. operating at peak

efficiency and provide a basis for performing in the future. with nasa, we completed a technical assessment of the usable life of major hardware components. the station will be operable at least through 2028. long-term viability of the station is an important factor in continuing to attract researchers who prepare experiments for operation in space. continuing reliability of i.s.s. and the improvements to further enhance research capabilities are a boon to maximizing utilization. our work enables benefits and improvements to human space exploration and improve the quality of life here on earth. i.s.s. continues to be used for developing multiple technologies to support deep space exploration. nasa is developing higher reliable life support system to address needs for future

exploration has beentation systems. it is a test bed for learning how the body reacts to prolonged weightlessness. and we are learning self-sustainment skills, such as growing food in space. these are important to learn and understand before we explore farther into our solar system. research in i.s.s. has led to numerous improvements on earth, to medical field, providing clean water in underdeveloped countries to how we diagnose and treat patients in remote areas. i have had the opportunity to interact with leaders in countries that are not engaged in i.s.s. or do not have a space program. without exception in every one of these conversations about space exploration these leaders expressed a strong desire to be involved in space and more specifically, the international space station. they see the value of i.s.s. to inspire their youth, to pursue stem yeags to create high

technology industries and to provide a significant source of national pride. this perspective from leaders outside the international partnership recognizing the tremendous value serves as a strong reminder to u.s. leaders and all who are charged with the care of this global asset. we must never take what we have in i.s.s. for granted and make sure it is well funded and maintained and operated and fully utilized in high-value research. thank you. i look forward to your questions. mr. babin: thank you. i now recognize mr. martin for five minutes to present his testimony. >> thank you for inviting us to be part of the discussion about maximizing research on the international space station. a very timely topic in light of the loss of three cargo supply flights over the past eight months. the inspector general issued four reports related to the

topic of today's hearing including reviews that examine nasa plans to extend operations until 2024 and has contract with private companies to fly cargo and eventually crew. we have five more reviews related to this topic under way including an examination of october's cargo resupply failure, nasa's efforts to manage health and behavioral risk for extended space exploration and challenges to international cooperation in space. our audit last september of nasa's plans to extend the i.s.s. reported that the agency had identified no major obstacles to continue operations through 2024. however, we found nasa must address technical challenges including ensuring adequate power generation in lied of degradation of the solar rays and the ability to transport

replacement parts to station. an annual budget of $3 billion to $4 billion, we anticipate the costs may be higher. first, much of the projected increase is attributable to higher transportation costs and we found nasa's estimates for cargo and crew transportation optimistic. second most of the agencies international partners have yet to commit to station operations beyond 2020 and a decision by one or more not to participate could drive up costs for nasa. as noted in our report, the number one operational risk for the i.s.s. program is ensuring the ability to deliver supplies and astronauts to station. while nasa is working with two commercial cargo providers flights by orbital and space x are on hold pending the outcome of accident investigations and approval of the f.a.a. and nasa. in addition to the loss of

important supplies, the failed cargo flights have affected nasa research aboard station in at least three ways. number one by reducing available crew time due to a temporary delay and returning the station's crew complement to six astronauts. by increasing the lost research and number three, delaying return of experiments due to the suspension of flights by space x, the only company capable of bringing cargo back to earth. because nasa uses the i.s.s. as a research platform to study risks associated with human travel and long-term has beentation in space, it is an important part of its plans to send humans beyond lower orbit. as we have reported in the past, utilization for research has increased, but several factors continue to limit its full potential. for example, until its seventh

astronaut is brought aboard the station, nasa will not be in a position to maximize crew time devoted to research. on-board crew will devote substantial time to reconfiguring to accommodate the commercial vehicles that nasa hopes will transfer astronauts beginning in 2017. to that point, nasa awarded $6.8 billion to boeing and space x to complete development of their space flight systems for crew. but nasa's crew program faces significant hurdles including unstable funding, the time to provide requirements and guidance to contractors and coordination issues with other federal agencies. given its importance, the o.i.g. initiated a follow-up audit to review the status of nasa's crew program. and that concludes my prepared remarks. mr. babin: thank you mr. martin.

i recognize ms. oakley to present her testimony. >> good morning members of the subcommittee. thank you for inviting me here today to discuss g.a.o.'s work on nasa's management of the international space station. as you know, the united states has spent tens of billions of dollars to develop, assemble and operate the space station over the last few decades. the u.s. could send billions more to capitalize on the investment given the potential operations to 2024. today i will discuss three areas. nasa's budget for i.s.s. second some challenges that could affect increased usage of i.s.s. and to better document and assess progress in this regard. nasa continues to make a significant investment in i.s.s. each year. this investment is projected to

increase over the next five years, mainly because the i.s.s. program will begin to fund commercial crew flights. in 2020, transportation costs will be over 55% of the projected $4 billion i.s.s. budget. unlike transportation costs, costs to operate and conduct research on i.s.s. are projected to remain relatively stable through 2020. nasa officials have indicating that the funding priorities for i.s.s. are crew safety and transportation maintaining the facility and timely research. as a result, any increases to transportation costs or operations costs could diminish available funding for research. furthermore, the potential increases to the i.s.s. budget as a result of the spland extension to 2024 are currently unknown. second, nasa faces several

challenges that could negatively affect their efforts to increase i.s.s. for science including cargo transportation failures and delays limited progress in raising additional funding for research and increased demand for crew time and facilities. recent mishaps have had a direct impact on nasa's research. for example launch failures and delays have already resulted in the loss of case responsive research and increased cost by almost $500,000 and let's now forget your crab cakes. furthermore additional increases are a result of the most recent failure. absorbing these increases has and could continue to be challenging because it has limited progress raising additional funds for science from external sources. for example, in 2014 cases had only received a little over $9,000 in contributions.

however, as cases have seen an increase in commitment. in 2014, it received commitments of over $12 million. it faces challenges with come pgs for available crew time and key facilities, which limit the amount of experiments that they can bring to i.s.s. crew time is allocated at or over 100%. to address this challenge, nasa is dependent on commercial crew providers delivering planned capabilities. with these capabilities nasa will be able to add a crew member to i.s.s. who will devote most of his or her time to research. however, many technical challenges and nasa's ability to fund the commercial crew program could delay these efforts. finally, even if nasa can effectively navigate these

challenges demonstrating a return on investment is very difficult and scientific research can oftentimes take many years. in the short-term, it is essential they continue to make progress promoting research in achieving its goal of increased use of i.s.s. we reported in april that they could do more to objectively refine and report on such progress by assigning goals to its annual performance metrics. they concurred and agreed to take action in response. in conclusion, potential inclusion of i.s.s. to 2024 will likely require continued investments. as a result, ensuring that i.s.s. capabilities are being used to support significant gains is critical. furthermore demonstrating and communicating return on investment to help support them in achieving their shared goal

of developing sustained commercial markets in low earth orbit. members of the subcommittee, this concludes my prepared remarks. i'm happy to take any questions that you have. mr. babin: thank you. now i would like to recognize our last witness to present his testimony. >> thank you mr. chairman and members of the subcommittee, good morning to you. i thank you for the opportunity to discuss the status of research using the international space station. it's the only platform of its kind and it is absolutely essential to nasa's exploration goals. to prepare for this hearing, you asked four specific questions and i would like to briefly address each in the time allotted. you asked about opportunities and challenges. well the augustine commission emphasized three unique stressors that astronauts will face prolonged exposure and

prolong exposure in gravity. all of these stressors are present in the i.s.s. environment. operations a dusty, dim environment and gravitational field environment and gravitational field not like our own. we risk sending humans to mars with little or no knowledge of how ma mallian biology responds over years in agraph station -- gravitational field less than earth's. two challenges dominate the landscape. limited crew time and limited access to the i.s.s. we can reasonably anticipate the competition for time will become worse as the facility ages and demands to perform necessary maintenance become more acute. access is really a matter of competing programs. casis