In recent years, some health programs have been run through special initiatives, usually spearheaded by the president. Two such initiatives today are President Bush's Emergency Plan for AIDS Relief (PEPFAR, www.state.gov/s/gac/plan/) and the Millennium Challenge Account (MCA, www.mca.gov), which provides development aid to countries that, according to the president, "rule justly, invest in their people, and encourage economic freedom." Funding for PEPFAR is incorporated into the federal government's general international health spending and spread among several programs implemented by a combination of U.S. and global agencies and organizations, including the U.S. Department of State; the U.S. Agency for International Development (USAID); and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Oversight of PEPFAR funding falls under the purview of the Office of the Global AIDS Coordinator (OGAC) at the State Department. When President Bush announced PEPFAR's initial funding -- $15 billion over five years -- this total included amounts already allocated to existing federal AIDS-related health programs. Regardless of the amounts approved for this and other discretionary funding initiatives by Congress in the enabling legislation, the actual amounts provided each year depend on how much Congress appropriates annually. Unlike PEPFAR, the Millennium Challenge Account is a specific program, run by a new government corporation, the Millennium Challenge Corporation. It receives its own funding through a congressional appropriation (by the Subcommittee on Foreign Operations and Export Financing). The MCA disburses funds directly to developing nations it deems eligible and whose program proposals it has vetted and approved.