Actor Score Overview

The Department of State received a 65 (D) with transparency and a 70 (C-) without transparency in 2021. The President’s Emergency Plan for AIDS Relief (PEPFAR) Core Program and Policy Priorities, along with the updated DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) Guidance from March 2021 raised this actor’s grade across domains. The February 2021 updates to the Country Operational Plan (COP)/Region Operational Plan (ROP) Guidance for all PEPFAR Countries significantly hindered sexual and reproductive health and rights (SRHR) across all domains because it did not provide specific guidance to help stakeholders understand how the revocation of the Protecting Life in Global Health Assistance (PLGHA) policy would impact their programs. However, the actions graded in the HIV and AIDS domain were largely based in evidence, consistent with human rights, and responsive to need. In contrast, actions graded in the maternal and child health (MCH) and family planning (FP) domains for the Department of State did not include relevant evidence and were not grounded in human rights. Transparency was lower in the MCH and FP domains than in the HIV and AIDS domain. The Department of State grade was raised by high budget scores across domains, because MCH and FP health funds were moderately responsive to need, and HIV funds were highly responsive to need in 2021.

The Department of Defense (DoD) received a 65 (D) with transparency and a 74 (C) without transparency due to the lack of explicit details about the DoD’s global HIV and AIDS programs in the two actions that were released publicly in 2021. Both actions did not promote sexual and reproductive health and rights (SRHR) and lacked transparency. Funding information about the DoD’s global HIV and AIDS programming was unavailable at the time of grading, which also contributed to the actor’s low transparency score in 2021. The Maternal and Child Health (MCH) and Family Planning (FP) domains do not factor into the DoD’s grade because this actor does not work in international MCH or FP.

The Department of Health and Human Services (HHS) received a 61 (D-) with transparency and a 70 (C-) without transparency in 2021. This grade was based on a whole-of-government global health security report and several actions specific to the Centers for Disease Control and Prevention (CDC), including CDC strategies and requirements that apply to certain CDC awards. The transparency scores for HHS were low across domains because it was unclear whether most of the graded actions were relevant to this actor’s global health programs. Similarly, there was no indication of what information had been changed from previous versions of some actions and prior versions were not available on the website for comparison. Funding data for the global HIV and AIDS and maternal and child health (MCH) programs within HHS were unavailable at the time of grading, which contributed to the low transparency grade in 2021.

The United States Agency for International Development (USAID) received a 76 (C) with transparency and a 79 (C+) without transparency in 2021. On average, the actions graded across HIV and AIDS, maternal and child health (MCH), and family planning (FP) moderately promoted sexual and reproductive health and rights (SRHR). The decision to remove the Protecting Life in Global Health Assistance (PLGHA) section of the Automated Directives System (ADS) Chapter 303 without offering additional information or guidance about how to implement the policy change decreased the actor’s grade. The transparency of funding data was generally high across domains, but there were persistent transparency issues regarding ADS chapters, the Global Health eLearning courses, and the role of USAID’s global health programs in some whole-of-government actions. USAID’s HIV and AIDS grade was higher than the MCH and FP domain grades due to the disbursement of funding in a manner that was highly responsive to need in 2021.

The White House received an 82 (B-) with transparency and an 86 (B) without transparency in 2021. This grade was the result of multiple actions that significantly or moderately promoted sexual and reproductive health and rights (SRHR) globally across all three domains, including the Executive Order on Establishment of the White House Gender Policy Council, the Executive Order on Preventing and Combatting Discrimination on the Basis of Gender Identity or Sexual Orientation, and the Memorandum on Protecting Women’s Health at Home and Abroad. In addition to immediately revoking Protecting Life in Global Health Assistance (PLGHA) (also known as the Global Gag Rule [GGR]), the latter action included an affirmative statement from the White House that confirmed the Biden administration’s commitment to supporting SRHR domestically and globally. This was the first time a U.S. administration has explicitly supported SRHR at the presidential level. The White House requested an adequate funding amount for both global HIV and AIDS and maternal and child health (MCH) efforts, but the proposed budget for family planning (FP) was low, which negatively affected the grade in this domain. Transparency was moderately high for all actions and budget data across the three domains in 2021.

President’s Budget Request: Fiscal Year 2022
2021_President’s Budget Request_FY2022

Congress received an 87 (B+) with transparency and a 91 (A-) without transparency in 2021. Congress appropriated full funding for HIV and AIDS, adequate funding for maternal and child health (MCH), and inadequate funding for family planning (FP). Congress passed the American Rescue Plan Act (H.R.1319) which moderately promoted the ability of U.S. global health assistance to support efforts to address the impacts of COVID-19, which could include the impacts of the pandemic on sexual and reproductive health and rights (SRHR). Across domains, Congress demonstrated high policy transparency in the HIV and AIDS domain, low policy transparency in the MCH and FP domains, and high transparency for funding data across domains.

Fiscal Year 2022 Approved Budget
2021_Congress Budget H.R. 2471