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TRANSPARENCY SCORE
The transparency grade represents the expectation that the federal government should make data about U.S. global health assistance available, accessible, and informative. To see the transparency grade, toggle below.

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TRANSPARENCY SCORE
The transparency grade represents the expectation that the federal government should make data about U.S. global health assistance available, accessible, and informative. To see the transparency grade, toggle below.

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D-

This is an average of the three domain scores below.

YEAR 2018

Department of State

The Department of State received a 60 (D-) with transparency and a 65 (D) without transparency. The Family Planning and Maternal and Child Health domain grades are low because the only guidance that was issued in these domains included the Protecting Life in Global Health Assistance (PLGHA) Six Month Review and Frequently Asked Questions (FAQs), neither of which were evidence-based, based in human rights norms, or gender transformative. The Department of State did issue technical guidance and annual reports that support HIV and AIDS programs that were evidence-based, based in human rights norms, and responsive to need, but were not gender transformative. In all three domains, the Department of State’s funding data received a high transparency score and the issued guidance received a lower transparency score.

A-
A

HIV & AIDS

 

The Department of State received a 90 (A-) with transparency and a 93 (A) without transparency for HIV and AIDS based on eight relevant guidance documents released in 2018. Aside from the guidance documents related to the implementation of PLGHA, the Department of State issued guidance documents and reports that were responsive to need, evidence-based, and grounded in human rights principles regarding HIV and AIDS. The Department of State released detailed technical guidance documents to guide country-level President’s Emergency Plan for AIDS Relief (PEPFAR) programs. The Department of State also released annual reports that documented programmatic progress and demonstrated areas for improvement. Overall, the guidance documents and annual reports did not include gender transformative language. The Department of State’s commitment to comprehensive HIV and AIDS programming was demonstrated in the disbursement of funds for HIV and AIDS programming according to country-level incidence.

The CHANGE data index grades government agencies on policies and funding impacting family planning, maternal and child health, and HIV & AIDS foreign assistance.

Selecting a document will download the file
2018_DREAMS Report: Dreaming of an AIDS-Free Future
The annual DREAMS report highlights the strengths, challenges, and future directions of the DREAMS program. The report was evidence-based and responsive to need, but lacked a clear gender transformative stance. The DREAMS program does have concrete gender transformative components, but they were not reflected in this report in a clear and substantial way. The report described harmful gender norms that affected HIV and AIDS prevention and treatment programs for adolescent girls and young women (AGYW), but did not mention how to address these barriers in a manner informed by human rights principles.
2018_PEPFAR 2018 Annual Report to Congress
The PEPFAR Annual Report to Congress provides an overview of the PEPFAR program to date and discusses future directions. The report was evidence-based, responsive to need, and included a description of how the Department of State will deliver on the mission of PEPFAR moving forward. The report also discussed factors that made HIV prevention and treatment complex for AGYW and for key populations; however, these programmatic concerns were framed within current constructed gender norms. The programming discussed in this report did not include gender transformative components as a means to provide comprehensive HIV and AIDS services.
2018_PEPFAR 2018 Progress Report
The PEPFAR Progress Report is issued annually to provide an overview of programs and illustrate PEPFAR priorities in the future. The report shared a program plan that was responsive to need and based in evidence and human rights principles. However, the document did not discuss gender norms or include a commitment to increase gender transformative programming.
2018_PEPFAR 2018 Country Operational Plan Guidance for Standard Process Countries
Released annually by the Office of the Global AIDS Coordinator, the Country Operational Plan (COP) Guidance outlines the plan for PEPFAR-funded global HIV and AIDS activities and provides the basis for the approval of annual bilateral HIV and AIDS funding for partner countries. The 2018 COP guidance was comprehensive and provided updates that were evidence-informed, responsive to need, and based in human rights principles. The 2018 COP Guidance took a holistic approach to PEPFAR programs and discussed intersecting issues, such as: gender-based violence, post-abortion care, contraceptive access, and comprehensive HIV prevention programs. The COP Guidance illustrated gender as a cross-cutting issue within PEPFAR but should have included specific guidance to increase gender transformative programming across PEPFAR countries.
2018_PEPFAR Statement on Potential Safety Issue Affecting Women Living with HIV Using Dolutegravir at the Time of Conception
This press release contains PEPFAR's policy and technical guidance in response to data from a study in Botswana indicating a potential association between women of childbearing potential taking dolutegravir (DTG), an antiretroviral, at the time of conception and the risk of neural tube defects. The statement provided a nuanced overview of the data and concluded by issuing the guidance that all PEPFAR programs continue transitioning to a DTG-based regimen. The release recommended that "HIV-infected women who desire to become pregnant" should remain on efavirenz-based regimens until further data are available. The issuance of this statement was timely and provided an accurate explanation of the Botswana study preliminary findings; however, the Department of State's recommendation took away the choice of treatment from a population based solely on their ability or desire to become pregnant. This was in conflict with a human rights, individual-centered framework. It is also unclear from the press release if PEPFAR consulted with civil society or other relevant stakeholders before issuing this statement.
2018_Protecting Life in Global Health Assistance FAQs_September 2018
The PLGHA FAQs provided detailed guidance on the implementation of the expanded Global Gag Rule for implementing partners as of September 2018. The document was responsive to need in that it clarified areas of the policy that partners had expressed are vague or unclear, but the FAQs were not evidence-based or based in human rights principles. The FAQs included a PEPFAR-specific section that provided detailed guidance on the implementation and monitoring of the impact of PLGHA on PEPFAR programs, specifically within DREAMS. However, this discussion of PEPFAR, aside from the mention of DREAMS, did not discuss gender norms or include gender transformative language. This section emphasized the importance of minimizing disruption of HIV and AIDS care and treatment and therefore received a higher score within this domain compared to the other two domains, Family Planning and Maternal and Child Health.
2018_Protecting Life in Global Health Assistance Six Month Review
The PLGHA Six Month Review summarized the PLGHA policy and identified solutions to challenges that had arisen in the process of PLGHA implementation. The review was responsive to need in that it addressed concerns expressed by partners who are required to implement the policy, but it was not evidence-based, based in human rights principles, or gender transformative. The Six Month Review received a higher grade within the HIV and AIDS domain because it discussed the importance of addressing the impact of PLGHA on HIV and AIDS programs and assured that efforts are being made to track the impact of this policy through PEPFAR programming. Still, the Six Month Review substantially hindered the Department of State's ability to support comprehensive HIV and AIDS programs.
2018_State and USAID Agency Priority Goal Action Plan_HIV/AIDS
The Agency Priority Goals (APGs) for HIV and AIDS hold PEPFAR accountable through quarterly reporting that includes details around the goals, strategies, milestones, indicators, and progress made towards controlling the HIV epidemic. Released by both the Department of State and USAID, these reports are useful for government transparency and are responsive to need, and based in evidence and human rights. The 2018 APGs reported on challenges faced by HIV and AIDS programs, but did not provide clear strategies to address them. One such challenge was high HIV and AIDS rates among AGYW and key populations. The APGs mentioned the importance of promoting layered core packages of services for AGYW through the DREAMS program and increasing access to HIV and AIDS services for key populations. However, the APGs did not include indicators specific to either population or data disaggregated by gender as a means to highlight progress made in these areas. As a result, the APGs moderately promoted the ability of the Department of State to support comprehensive HIV and AIDS programs.
2017_PEPFAR Country/Regional Operational Plan (COP/ROP) Guidance 2017
The Country Operational Plan (COP) Guidance is an annual document released by the Office of the Global AIDS Coordinator. It outlines the plan for global HIV and AIDS activities funded by PEPFAR and provides the basis for the approval of annual bilateral HIV and AIDS funding for partner countries. The 2017 COP Guidance was evidence-informed and ensured continued community and government engagement in PEPFAR programs. It also discussed the intersection of gender-based violence with HIV and AIDS and the importance of including contraception and counseling into HIV and AIDS programs. This guidance moderately promoted SRHR because it was responsive to need and addressed the disproportionate impact of HIV and AIDS on adolescent girls and young women, men who have sex with men (MSM), female sex workers, and transgender individuals. The plan was gender accommodating, as it did not seek to dismantle existing gender differences and inequalities. Such guidance should instead outline how to change inequitable gender norms and dynamics and promote gender equity.
2017_PEPFAR Evaluation Standards of Practice (Version 3.0)
The PEPFAR Evaluation Standards of Practice was released to increase the quality of evaluations conducted by all PEPFAR implementing agencies. These standards emphasized the importance of evidence-informed evaluation planning and provided a detailed explanation of the ethics and human rights principles that should be incorporated in all PEPFAR-funded evaluations, particularly for "children, prisoners, pregnant women, and other vulnerable groups." Additionally, these standards laid the groundwork for adaptive programming and the continued commitment of all key stakeholders, including community members and government personnel, in PEPFAR programs. Although the Standards of Practice acknowledged that evaluations should be “context-sensitive” and “culturally relevant,” they did not include a gender transformative component. There was no mention of the gendered power dynamics and cultural barriers that may prevent people living with HIV, sex workers, or lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) persons from participating in evaluations. Despite this, the Standards of Practice were responsive to need and were based in evidence. The Standards moderately supported the ability of PEPFAR programs to promote SRHR.
2017_PEPFAR Monitoring, Evaluation, and Reporting Indicator Reference Guide_MER 2.0 (Version 2.1)
The 2017 PEPFAR Monitoring, Evaluation, and Reporting (MER) Indicator Reference Guide provided guidance for monitoring and evaluating PEPFAR’s HIV and AIDS programs. The indicators were evidence-informed, based on human rights principles, and detailed the importance of sustained “district and community” engagement. The document included an extensive list of indicators for HIV and AIDS program evaluation, including the number of key and priority populations reached with specifically tailored HIV prevention programs, and the percentage of pregnant women living with HIV that receive antiretroviral therapy (ART) to reduce mother-to-child transmission. Though the Reference Guide listed sex workers, MSM, and transgender individuals as key populations, it did not address their distinctive needs when discussing how to evaluate interventions that were tailored for these populations. This lack of clarity can be harmful as evaluators may not understand how to meaningfully engage with these key populations during the evaluation, monitoring, and reporting processes. The indicators were somewhat gender transformative, as they included a limited discussion of gender norms and related stigma, though this element should be standardized throughout the Reference Guide. The updates within this version of the MER Reference Guide were responsive to need and based in human rights norms and evidence, including WHO and UNAIDS indicators.
2016_Department of State Implementation Plan for the U.S. Adolescent Girls Strategy
The Department of State Implementation Plan for the U.S. Adolescent Girls Strategy was launched in partnership with three other U.S. implementing agencies as part of the first U.S. Global Strategy to Empower Adolescent Girls in 2015. This Plan moderately promotes sexual and reproductive rights (SRHR) because it discussed the importance of incorporating HIV prevention in all adolescent girls' empowerment programs, especially those that address girls’ political, civic, and economic participation and programs that increase peace and security. This Plan specifically acknowledged the relationship between girls who have undergone female genital cutting (FGC) and their increased risk of acquiring HIV. The Plan also mentioned HIV as a barrier to girls’ education and provided examples of existing Department of State programs that are responsive to need and grounded in human rights, including the President’s Emergency Plan for Aids Relief (PEPFAR). However, this Plan did not disclose how to support the needs of adolescent girls and young women (AGYW) who are living with HIV. It only discussed preventing HIV transmission to AGYW. The Plan is gender accommodating, not gender transformative because it relied on existing gender norms and references unequal gender and age dynamics that put AGYW at a higher risk of HIV incidence.
2016_PEPFAR Country/Regional Operational Plan (COP/ROP) 2016 Guidance
The Country Operational Plan (COP) Guidance is an annual plan that outlines global HIV and AIDS activities funded by PEPFAR and provides the basis for the approval of annual bilateral HIV and AIDS funding for partner countries. The fiscal year (FY) 2016 COP Guidance was responsive to need and addressed the disproportionate impact of HIV and AIDS on AGYW and other key populations such as men who have sex with men (MSM), female sex workers, pregnant women and infants living with HIV, and transgender individuals. The programming was evidence-informed and promoted community and government engagement. Although the Guidance discussed the intersection of gender-based violence (GBV) and HIV and AIDS, it failed to strongly incorporate the positive impact that comprehensive and integrated sexual and reproductive health (SRH) services can have on reducing HIV transmission amongst key populations.
F
F

Maternal and Child Health (MCH)

 

The Department of State received a 35 (F) with transparency and a 40 (F) without transparency for Maternal and Child Health in 2018 based on two documents related to the PLGHA expansion of the Global Gag Rule: the Six Month Review and the FAQs. Neither document was gender aware or based in evidence or human rights principles. However, both documents were responsive to need because they addressed concerns and questions from partners regarding the implementation of PLGHA. The omittance of specific references to maternal and child health programming in both documents indicated that the Department of State was not considering the unique impact of the implementation of PLGHA on maternal and child health programs. This shortsightedness has serious implications for the ability of the Department of State to implement comprehensive maternal and child health programming. With regards to budget allocation, the Department of State budget evaluation depicted that funds were being distributed according to countries with the highest maternal mortality.

The CHANGE data index grades government agencies on policies and funding impacting family planning, maternal and child health, and HIV & AIDS foreign assistance.

Selecting a document will download the file
2018_Protecting Life in Global Health Assistance FAQs_September 2018
The PLGHA FAQs provided detailed guidance on the implementation of Trump's expanded Global Gag Rule for implementing partners as of September 2018. The FAQs were not responsive to need, evidence-based, human rights-based, or gender transformative within this domain. The FAQs received a lower grade within this domain compared to Family Planning and HIV and AIDS because they did not mention maternal and child health programming specifically, despite the unique impacts this policy could have on maternal and child health services. The FAQs significantly hindered the Department of State's ability to support comprehensive maternal and child health programming in 2018.
2018_Protecting Life in Global Health Assistance Six Month Review
The PLGHA Six Month Review summarized the PLGHA policy and identified solutions to challenges that had arisen in the process of PLGHA implementation. The review was responsive to need in that it addressed concerns expressed by partners affected by the policy, but was not evidence-based, based in human rights principles, or gender transformative. The review received a lower grade within this domain compared to Family Planning and HIV and AIDS because the review did not mention maternal and child health programming specifically, despite the unique impacts this policy could have on maternal and child health services. The Six Month Review significantly hindered the Department of State's ability to support comprehensive maternal and child health programming in 2018.
2016_Department of State Implementation Plan for the U.S. Adolescent Girls Strategy
The Department of State Implementation Plan for the U.S. Adolescent Girls Strategy was launched in partnership with three other U.S. implementing agencies as part of the first U.S. Global Strategy to Empower Adolescent Girls in 2015. This Plan acknowledged the impact of forced marriage, especially early or childhood marriage, and the impact of FGC on the health of AGYW. Specifically, it stated that these practices lead to poor maternal health outcomes, including high morbidity and mortality rates from pregnancy and birth complications, trauma, and other diseases and infections. The Plan provided details on "preserv[ing] the rights of married and pregnant girls and adolescent mothers to attend school" and "remov[ing] barriers to sexual and reproductive health and comprehensive, accessible, youth-friendly health services" to prevent early pregnancy. Though the Plan was responsive to need and grounded in human rights principles, it did not incorporate significant evidence-based programming because it did not address how to meet the clinical needs or provide maternity care of pregnant AGYW. This Plan is gender transformative in that it promoted gender equality by decreasing early marriage and pregnancy through educational empowerment. This Strategy moderately promoted SRHR through the Department of State’s maternal and child health programs.
F
D-

Family Planning (FP)

 

The Department of State received a 56 (F) with transparency and a 60 (D-) without transparency for Family Planning based on two documents related to the PLGHA expansion of the Global Gag Rule: the Six Month Review and the FAQs. Neither were gender aware nor based in evidence or human rights principles. However, both documents were responsive to need because they addressed concerns and questions from partners regarding the implementation of PLGHA. In the budget evaluation, the Department of State largely disbursed family planning funds in accordance with unmet contraceptive need. However, access to family planning and contraception was severely impacted by the Department of State once again defunding the United Nations Population Fund (UNFPA) due to an unsubstantiated Kemp-Kasten amendment violation in FY 2019.

The CHANGE data index grades government agencies on policies and funding impacting family planning, maternal and child health, and HIV & AIDS foreign assistance.

Selecting a document will download the file
2018_Protecting Life in Global Health Assistance FAQs_September 2018
The PLGHA FAQs provided detailed guidance on the implementation of Trump's expanded Global Gag Rule for implementing partners as of September 2018. The FAQs were responsive to need in that they clarified areas of the policy that partners had expressed were vague or unclear. The FAQs were neither based in human rights principles nor evidence. The FAQs were also not gender transformative and substantially hindered the Department of State's ability to implement comprehensive family planning programs in 2018.
2018_Protecting Life in Global Health Assistance Six Month Review
The PLGHA Six Month Review summarized the PLGHA policy and identified solutions to challenges that had arisen in the process of PLGHA implementation. The review was responsive to need in that it addressed concerns expressed by partners affected by the policy, but was not evidence-informed, based in human rights principles, or gender transformative. The document stated that it was too early to assess the impacts of Trump's expanded Global Gag Rule on family planning despite research and literature documenting the harm caused by the policy. The Six Month Review substantially hindered the Department of State's ability to implement comprehensive family planning programs in 2018.
2016_Department of State Implementation Plan for the U.S. Adolescent Girls Strategy
The Department of State Implementation Plan for the U.S. Adolescent Girls Strategy was launched in partnership with three other U.S. implementing agencies as part of the first U.S. Global Strategy to Empower Adolescent Girls in 2015. This Plan moderately promotes sexual and reproductive rights (SRHR) because it discussed the importance of incorporating HIV prevention in all adolescent girls' empowerment programs, especially those that address girls’ political, civic, and economic participation and programs that increase peace and security. This Plan specifically acknowledged the relationship between girls who have undergone female genital cutting (FGC) and their increased risk of acquiring HIV. The Plan also mentioned HIV as a barrier to girls’ education and provided examples of existing Department of State programs that are responsive to need and grounded in human rights, including the President’s Emergency Plan for Aids Relief (PEPFAR). However, this Plan did not disclose how to support the needs of adolescent girls and young women (AGYW) who are living with HIV. It only discussed preventing HIV transmission to AGYW. The Plan is gender accommodating, not gender transformative because it relied on existing gender norms and references unequal gender and age dynamics that put AGYW at a higher risk of HIV incidence.