Malaria prevention and control are major foreign assistance objectives of the United States Government (USG). In May 2009, President Barack Obama announced the Global Health Initiative (GHI) to reduce the burden of disease and promote healthy communities and families around the world. The President's Malaria Initiative (PMI) activities are core components of the GHI, along with activities aimed at reducing HIV/AIDS and tuberculosis. PMI was launched in June 2005 as a five-year, $1.2 billion initiative to rapidly scale up malaria prevention and treatment interventions and reduce malaria-related mortality by 50% in 15 high-burden countries in sub-Saharan Africa. With passage of the 2008 Lantos-Hyde Act, funding for PMI was extended and, as part of the GHI, the goal of PMI was adjusted to reduce malaria-related mortality by 70% in the original 15 countries by the end of 2015. Programming of PMI activities follows the core principles of GHI: focus on women, girls, and gender equality; encourage country ownership and invest in country-led plans; build sustainability through health systems strengthening; strengthen and leveraging key partnerships, multilateral organizations, and private contributions; increase impact through strategic coordination and integration; improve metrics, monitoring and evaluation, and promote research and innovation. Since the selection of the Democratic Republic of Congo (DRC) as a PMI focus country, the USG's funding for malaria control efforts in DRC has significantly increased. From $18 million in FY 2010, the USG's support for malaria control in DRC reached $35 million in FY 2011, $38 million in FY 2012 and $41.9 million in FY 2013. Malaria is a major health problem in DRC, accounting for an estimated 40% of outpatient visits by children under five and 19% of the overall mortality in children under five. Implementation of large-scale malaria control activities in DRC faces serious challenges. The country's health infrastructure is very weak and it is estimated that only about 37% of the population has access to adequate health facilities. An additional complicating factor is that external donor support of health activities in DRC remains fragmented geographically, although the Ministry of Health has engaged in efforts to better organize donors' distribution across the 516 health zones. The 2007 Demographic and Health Survey (DHS) showed very low coverage rates of major malaria prevention and control measures. Only 9% of households owned one or more insecticide-treated bed nets (ITNs), and only 6% of children under-five and 7% of pregnant women had slept under an ITN the night before the survey. The 2010 Multiple Indicator Cluster Survey (MICS) showed 51% of households owning at least one ITN and that 38% of children less than five years of age and 43% of pregnant women had slept under an ITN the night before the survey. The proportion of children under five with fever treated with artemisinin-based combination therapy (ACT) within 24 hours of the onset of illness and the proportion of pregnant women receiving two doses of intermittent preventive treatment (IPTp) were less than 1% and 5%, respectively, but implementation of those interventions only began in 2006. The 2013 DHS which will include anemia and parasitemia measurements will provide data to assess further progress in controlling malaria in the DRC.