YEAR 2022

Department of State

The Department of State received a 62 (D-) with transparency and a 68 (D+) without transparency in 2022. The President’s Emergency Plan for AIDS Relief (PEPFAR) Five Year Plan, along with the updated Country and Regional Operating Plans raised this actor’s grade across all domains. However, subsequent updates to PEPFAR Five Year Strategy (e.g., definitional footnotes) significantly hindered sexual and reproductive health and rights (SRHR) across all domains, as they did not provide information based in evidence about the scope of SRHR within PEPFAR programming. On the whole, the graded actions were largely based in evidence, aligned with human rights principles, and responsive to need. Transparency was low across all domains for this actor. The Department of State grade was raised by high budget scores across domains. Maternal and child health (MCH) and family planning (FP) health funds were moderately responsive to need, and HIV and AIDS funds were highly responsive to need.

A-

A+

HIV & AIDS

The Department of State received a 92 (A-) with transparency and a 99 (A+) without transparency in the HIV and AIDS domain in 2022. This domain grade was raised by the PEPFAR Five Year Plan, as well as the updated pre-exposure prophylaxis (PrEP) Ring Frequently Asked Questions (FAQs), which were both responsive to need, based in evidence, and aligned with human rights principles. However, subsequent edits to the Five Year Plan did not promote SRHR, and were not based in evidence or responsive to need, and thus negatively impacted the HIV and AIDS score. Actions graded in this domain were mostly gender accomodating, and could have included more gender transformative elements. In the budget evaluation, the Department of State allocated HIV and AIDS funds in accordance with country-level HIV incidence, which significantly promoted SRHR. Transparency was relatively low across actions but moderately high with regard to budget data in the HIV and AIDS domain.

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

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2022_Agency Priority Goal_State_Action Plan_Quarterly Updates_Equity Across Foreign Affairs Work

To report on the progress of the Department of State, the APGs on ensuring equity across foreign affairs work were released bi-annually. They aimed to “advance equity and support for underserved communities in the development and conduct of foreign policy, by developing assessment tools and establishing country-specific baselines, measurements, and reporting mechanisms for the Department.” The intent was to enable programs led and overseen by the Department of State to engage underserved communities and ensure sustainability and effectiveness in the long-term. Given the increased need to center communities and equity in U.S. foreign policy work, the APGs were aligned with human rights principles, responsive to need, and based in evidence. There was a cross-cutting focus on inclusion throughout them, specifically referencing “vulnerable and marginalized groups, including racial, ethnic, and religious groups, persons with disabilities, indigenous persons, [lesbian, gay, bisexual, transgender, queer, and intersex] LGBTQI+ persons, and women and girls in all their diversity.” The APGs neither promoted nor hindered SRHR in the HIV and AIDS domain.

2022_Agency Priority Goal_USAID-State_Action Plan_Quarterly Updates_HIV-AIDS

To report on joint progress toward PEPFAR program goals, strategies, milestones, and indicators in fiscal year (FY) 2020, the Agency Priority Goals (APGs) for HIV and AIDS were released quarterly by both the Department of State and the United States Agency for International Development (USAID). They expanded person-centered treatment services; scaled up index testing and targeted HIV testing approaches; increased access to voluntary medical male circumcision (VMMC) services; and provided comprehensive packages of health and social services for priority and key populations (KPs), including oral PrEP and education on risk reduction. Most of these programmatic efforts and indicators were based in evidence and responsive to need. They were gender adaptive rather than gender transformative, as it did not provide any gender-disaggregated insights, and only discussed gender in a binary. The APGs used improper terminology such as “transgendered people,” and did not reference any human rights principles or frameworks. Despite a clear articulation on goals and indicators for success in the HIV domain, they did not explore links to allied health outcomes in other sectors such as mental health or HIV innovation products. The APGs acknowledged the impact of COVID-19 on HIV programming, and reflected commitment from PEPFAR to ensuring that data were collected thoroughly and accurately, while also maintaining accountability to targets which were responsive to need. The APGs moderately promoted SRHR in the HIV and AIDS domain.

2022_USAID-State_FY2023_Annual Performance Plan

The joint USAID-State FY 2023 Annual Performance Plan summarized progress toward the five goals outlined in the FY 2022-2026 Joint Strategic Plan Framework. Relevant performance goals included those related to preventing maternal and child mortality, achieving the 95-95-95 goal for HIV and AIDS, and integrating voluntary FP with other health programs. Efforts to combat GBV and promote inclusion were integrated into the strategic objectives. This Plan was responsive to need, based in evidence, and aligned with human rights principles. It contained gender sensitive elements such as efforts to promote gender equality globally and build gender-responsive systems. This Plan moderately promoted SRHR in the HIV and AIDS domain.

2022_PEPFAR 2022 Annual Report to Congress

The Report to Congress detailed the achievements of PEPFAR, recapped efforts conducted to recover from COVID-19, and outlined the support to countries to achieve their 95:95:95 goals. The Report was aligned with human rights principles and highly responsive to need. Inclusion was a cross-cutting focus within the action, with KPs defined to include “the LGBTQI+ community, people who use drugs, sex workers, racial and ethnic minorities, and women and girls and others…” However, the Report also included gendered language (e.g., “breast-feeding women” rather than people, “mother to child transmission” rather than vertical transmission). Aside from the graphs, it was unclear how much of the Report had been updated since last year, which negatively impacted the transparency score. It was based in evidence, as it recognised (a) the need to build health system capacities to respond to comorbidities such as cervical cancer and tuberculosis rather than addressing HIV in a silo, (b) the linkage of PEPFAR performance with evaluations of multi-layer interventions such as the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) partnership, and (c) the inclusion of the latest population-based HIV Impact Assessment (PHIA) survey results and gender-disaggregated analyses. The Report moderately promoted SRHR in the HIV and AIDS domain.

2022_PEPFAR 2022 Annual Treatment Report to Congress

The Annual Treatment Report from PEPFAR provided information to Congress on PEPFAR-supported treatment programs as required by Section 7611 (g) of Title 22 of the U.S. Code. The Report focused on the shift to the fourth phase of PEPFAR in the Five Year Plan to end the HIV and AIDS pandemic by 2030. Highlights included reaching 95-95-95 goals for all ages, genders, and populations groups; closing equity gaps for priority populations; sustaining success; and strengthening general health systems. The Report was responsive to need and based in evidence. Inclusion and decision-making based on expanded PHIA survey data were cross-cutting themes in the Report. While there was no mention of pregnant people and KPs in the context of programming, the report was gender accomodating. It focused on norms that keep men from accessing treatment as well as the DREAMS partnership. The Report moderately promoted SRHR in the HIV and AIDS domain.

2022_U.S. Department of State and U.S. Agency for International Development FY 2023 Budget Request

The action detailed the Department of State budget request for FY 2023. It included funding for the war in Ukraine, and addressed the climate crisis (with the goal of delivering co-benefits for global health and WASH, food security, and the development of digital ecosystems. The request was responsive to need, based in evidence, and aligned with human rights principles. There were broad investments in the global health workforce and systems to enhance countries’ abilities to provide core health services and improve health systems resiliency, but the actual “transformative investments” were unclear. Despite specific commitments to the Global Fund and the GEEA  Fund, there was limited mention of how the funding would concretely advance the USG “Leadership in Global Health.” The request neither promoted nor hindered SRHR in the HIV and AIDS domain.

2022_PEPFAR 2022 Country and Regional Operational Plan (COP:ROP) Guidance for all PEPFAR Countries

A revised version of the PEPFAR Country/Regional Operational Plan for FY2023 (COP/ROP) was released in 2022, and detailed themes within the PEPFAR Strategy for 2021-2025. The COP/ROP 2022 was intended to push PEPFAR countries towards sustained epidemic control of HIV by supporting equitable health services and solutions, building enduring national health systems and capabilities, and establishing lasting collaborations. While the action included a page at the beginning of the text that listed the updates to the 2022 version, the changes were not highlighted in the body text which negatively affected the transparency score. The new implementation themes included a shift to person-centered care from client-centered care, the inclusion of KPs, and updated treatment guidelines, all of which were responsive to need and based in evidence. The action moderately promoted SRHR in the HIV and AIDS domain.

2022_PEPFAR 2023 Country and Regional Operational Plan (COP:ROP) Guidance for all PEPFAR Countries

This version of the COP/ROP was significantly updated to reflect the PEPFAR Five Year Plan, which promised to end the HIV/AIDS pandemic as a public health threat by 2030, while also sustainably strengthening public health systems. Based on partner feedback, the action was redesigned as a shorter, “more relevant” resource to support country teams, which was responsive to need and based in evidence. The action demonstrated a commitment to health equity with a focus on three priority populations: infants and children, adolescent girls and young women (AGYW), and KPs. It included a strong stance against stigma and discrimination and noted structural barriers that result in GBV, with particular impacts on AGYW and KPs. It included new issues such as mental health for AGYW and integrated SRHR and HIV care. The action was gender transformative, as it acknowledged the need for gendered considerations related to program implementation. This action also outlined a transition from annual planning to two-year operational planning. The action moderately promoted SRHR in the HIV and AIDS domain.

2022_Diversity Equity Inclusion and Accessibility Strategic Plan

The action advanced Diversity, Equity, Inclusion and Accessibility (DEIA) goals for the federal workforce by ensuring that the U.S. government (USG) was in "the strongest possible position to deliver for the U.S. people in an increasingly diverse, complex, and interconnected world." It responded to a 2021 Executive Order from the White House on enhancing DEIA in the federal workforce and intended to “transform the Department into a more just, equitable, and accessible institution internally to ensure a more equitable and inclusive world.” The action was aligned with human rights principles on inclusion, responsive to need, and based in evidence. The action moderately promoted SRHR in the HIV and AIDS domain.

2022_PEPFAR Guidance_PrEP Ring FAQ

This action detailed PEPFAR guidance to implementing programs that were funded by the Department of State about the use and distribution of the PrEP ring. The action was aligned with human rights principles and responsive to need, as it committed to “women having informed choices.” However, it also used gendered language (e.g., “women having…” rather than “people”), which excluded other KPs. The action clarified that despite constraints on use and distribution, implementation science studies could proceed, which demonstrated commitment to evidence. The action moderately promoted SRHR in the HIV and AIDS domain.

2022_PEPFAR Monitoring, Evaluation, and Reporting Indicator Reference Guide_MER 2.0 (Version 2.6.1)

The Monitoring, Evaluation, and Reporting (MER) Indicator Reference Guide is reviewed and updated annually to streamline and prioritize the standard indicators used across PEPFAR programs. The September 2022 update to the action introduced greater disaggregation by age (the 50+ age category was divided into smaller bands) across both testing and treatment. This update was responsive to need, as it allowed for greater oversight and evidence-based decisions about PEPFAR programs. The updated action was neither gender transformative nor inclusive, as it maintained the disaggregation methodology for counting KPs which directed implementing partners to report an individual in the KP category “with which he or she is most identified” which was not intersectional in approach. The update also included a sex-based indicator (male/female) instead of a gender-based indicator which was not based in evidence. The update neither promoted nor hindered SRHR in the HIV and AIDS domain.

2022_PEPFAR Technical Guidance in Context of COVID-19 Pandemic_2022.01.19

This Guidance updated earlier versions of this Technical Guidance that supported PEPFAR programming throughout the COVID-19 pandemic and ensured that programs remained consistent with recommendations from the World Health Organisation (WHO) and U.S. Centers for Disease Control and Prevention (CDC). The Guidance was responsive to need and aligned with human rights principles. It was based in evidence, as it included guidelines about universal masking for healthcare professionals. However, the sections on HIV care, maternal health, and FP, and their links to COVID-19 were not updated. The Guidance neither promoted nor hindered SRHR in the HIV and AIDS domain.

2022_Reimagining PEPFAR’s Strategic Direction_September 2022

PEPFAR reimagined its global strategy through a series of stakeholder consultations in 2021 and 2022 to produce the revised Five Year Plan, which promised to end the HIV and AIDS pandemic as a public health threat by 2030. It was aligned with human rights principles, as it referenced the Sustainable Development Goals (SDGs) as well as international commitments set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Global Fund. The action was responsive to need and based in evidence. Activities listed as part of goal one and two demonstrated a commitment to inclusion and equity in both substance and execution, with plans for working with KPs, and a clear localisation strategy for addressing health inequity. The action was gender transformative, as it focused on social and structural barriers to effective care, especially for women, girls, and the LGBTQIA+ community, and explored the integration of gender-based violence (GBV) programming into HIV programming. It prioritized community-led capacity building which was a significant sustainability goal, and demonstrated potential for effective care, even in the absence of the PEPFAR program. The action moderately promoted SRHR in the HIV and AIDS domain.

2022_Reimagining PEPFAR’s Strategic Direction_July 26 2023_Footnote Update

PEPFAR reimagined its global strategy through a series of stakeholder consultations in 2021 and 2022 to produce the revised Five Year Plan, which promised to end the HIV/AIDS pandemic as a public health threat by 2030. The document was updated to include a footnote defining the scope of SRHR programming within PEPFAR. The update was not aligned with human rights principles, responsive to need, or based in evidence. The SRHR Index team found that the update occurred on July 26, 2023 however the document kept a 2022 publication date and is therefore scored for 2022. It would be unclear to a reader when this update was added, which negatively affected the transparency score. The action significantly hindered SRHR in the HIV and AIDS domain.

2022_Reimagining PEPFAR’s Strategic Direction_July 27 2023_Footnote Update

PEPFAR reimagined its global strategy through a series of stakeholder consultations in 2021 and 2022 to produce the revised Five Year Plan, which promised to end the HIV/AIDS pandemic as a public health threat by 2030. The document was updated a second time to include a footnote that defined the scope of SRHR programming within PEPFAR. While the update improved the previously included footnote, it still was not aligned with human rights principles, responsive to need, or based in evidence. The SRHR Index team found that the update occurred on July 27, 2023 however the document kept a 2022 publication date and is therefore scored for 2022. It would be unclear to a reader when this update was added, which negatively affected the transparency score. The action moderately hindered SRHR in the HIV and AIDS domain.

2022_Strengthening Health Security Across the Globe: Progress and Impact of U.S. Government Investments in the Global Health Security Agenda

The action documented USG strategy for global health security with an emphasis on the following four areas: (1) marshaling political will, (2) developing global norms around quality of care and technical standards, (3) enhancing sustainable multilateral financing, and (4) strengthening capacities in partner countries. While the action was not explicitly based in human rights principles, it aligned to International Health Regulations, the Biological and Toxins Weapon Convention, the United Nations (UN) Security Council Resolution 1540, and other international health conventions that are rights based. It was responsive to need and based in evidence. The action was blind as it focused on supply-side interventions and did not mention gender. Despite acknowledging the work of PEPFAR globally, there was no substantive discussion of their work in discussions on health security. The action neither promoted nor hindered SRHR in the HIV and AIDS domain.

2022_FY2020_Bureau of Population, Refugees, and Migration_Summary of Major Activities

The action outlined the funded activities for the Bureau of Population, Refugees, and Migration, including supporting migrants and populations in crisis. Funding stemmed from four core sources, one of which was considered “the resource pot” for Global Health Programs within the Department of State. The allocations included the Emergency Response Fund, the Gap Priorities Fund, funding to address COVID-19, and funding for programs that addressed gender-based violence (GBV), all of which were implemented at the regional level. It also included funding for cross-cutting efforts such as evaluations, research, and inclusion. The action was aligned with human rights principles, responsive to need, and based in evidence. The action did not list how these funds were programmed, which affected its transparency score. The action neither promoted nor hindered SRHR in the HIV and AIDS domain.

2022_U.S. Government Global Food Security Strategy FY22-26

This action updated the Global Food Security Strategy and charted a course towards reducing global poverty, hunger, and malnutrition in the face of COVID-19, climate change, growing conflict, and rising inequality. The strategy's overarching goal was to sustainably reduce global poverty, hunger, and malnutrition via the Feed the Future (the USG global hunger and food-security initiative) three objectives: (1) inclusive and sustainable agriculture-led economic growth, (2) strengthened resilience among people, communities, countries, and systems; and (3) a well-nourished population, especially among women and children. The action was aligned with human rights principles, responsive to need, and based in evidence. It demonstrated a commitment to inclusion as a cross cutting strategy, and recognised groups that need targeted intervention including, but not limited to “women and girls; persons with disabilities; LGBTQI+ people; displaced persons; migrants; Indigenous peoples and communities; youth; older persons; religious minorities; ethnic and racial groups; people in lower castes; and people of diverse economic classes and political opinions.” The updated strategy acknowledged links between improved nutrition and better overall health outcomes and included updated indicators to reinforce this point. However, it was not clear if the Department of State had a role besides acting as coordinator between agencies. The action neither promoted or hindered SRHR in the HIV and AIDS domain.

2022_U.S. Government Global Water Strategy 2022-2027

This action outlined planned contributions from the Department of State to the Global Water Strategy, and its role in ensuring health, prosperity, stability, and resilience through sustainable and equitable water resources management and access to safe drinking water, sanitation services, and hygiene practices. The action was responsive to need and based in evidence, as it acknowledged the links between water security and positive health outcomes broadly. The action was not aligned with human rights principles, as it framed water security solely as an issue of national security and a pathway to engage “international partners on fundamental issues of power and politics.” Sexual and reproductive health—including menstrual hygiene management—was not discussed. GBV was discussed, but not in the sections related to the Department of State. The action moderately hindered SRHR in the HIV and AIDS domain.

2022_United States Strategy to Prevent Conflict and Promote Stability

The action affirmed U.S. intent to “strengthen fragile states “where state weakness or failure would magnify threats to the American homeland” and “empower reform-minded governments, people, and civil society” in these states. The action was responsive to need and based in evidence, but was not aligned with human rights principles. It acknowledged the “gaps between men and women in conflict-affected areas” but did not substantively address any of the domains or cross-cutting themes like GBV. The action neither promoted nor hindered SRHR in the HIV and AIDS domain.

2022_United States Strategy to Combat Gender Based Violence Globally

The action updated earlier efforts “to advance equity and inclusivity and address the factors that increase the risks of gender-based violence and undermine access to services and safety, particularly for the most marginalized groups.” It was aligned with international human rights principles, responsive to need, and recognised the most recent evidence about addressing GBV. For instance, it acknowledged other at-risk, marginalized communities such as LGBTQIA+ persons, and boys and men as survivors of violence. It explored the rise of digital platforms and social media as drivers of violence, analyzed the impact of the COVID-19 pandemic, and examined links between climate change and violence. The action was gender transformative, as it not only offered a critical examination of gender norms and dynamics, but also committed to creating systems that reinforced this critique and broke cycles of violence. The action significantly promoted SRHR in the HIV and AIDS domain.

2022_United States Government Women, Peace, and Security (WPS) Congressional Report

The WPS Report provided Congress with an overview of progress made in implementing the WPS Agenda since the Biden-Harris administration interventions in 2021. The Report evaluated progress in advancing the WPS Strategy's four lines of effort across the Department of State, Department of Defence (DoD), Department of Homeland Security (DHS), and USAID: participation, protection, internal capabilities, and partnerships. While improved health outcomes were mentioned as a positive impact of implementing the WPS Agenda on sexual exploitation and GBV, they were not included as a core focus area. It was gender accomodating, as it focused only on ‘women’s empowerment and representation’ and did not include LGBTQIA+ communities. The report did not include a discussion of how impact is measured or evaluated. The action moderately hindered SRHR in the HIV and AIDS domain.

Maternal and Child Health (MCH)

The Department of State received a 36 (F) with transparency and a 43 (F) without transparency in the MCH domain in 2022. This domain grade was raised by the PEPFAR Five Year Plan, as well as the updated PrEP Ring FAQs, which were both responsive to need, based in evidence, and aligned with human rights principles. However, subsequent edits to the Five Year Plan did not promote SRHR, and were not based in evidence or responsive to need, and thus negatively impacted the MCH score. This domain grade was low because the actions did not include data or information about activities within MCH programs, which reinforced the siloed nature of global health programs, negatively affected transparency, and hindered SRHR. In the budget evaluation, the Department of State allocated MCH funds somewhat in accordance with country-level maternal mortality, which moderately promoted SRHR. Transparency was relatively low across actions but moderately high with regard to budget data in the MCH domain.

The Fòs Feminista 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

2022_Agency Priority Goal_State_Action Plan_Quarterly Updates_Equity Across Foreign Affairs Work

To report on the progress of the Department of State, the APGs on ensuring equity across foreign affairs work were released bi-annually. They aimed to “advance equity and support for underserved communities in the development and conduct of foreign policy, by developing assessment tools and establishing country-specific baselines, measurements, and reporting mechanisms for the Department.” The intent was to enable programs led and overseen by the Department of State to engage underserved communities and ensure sustainability and effectiveness in the long-term. Given the increased need to center communities and equity in U.S. foreign policy work, the APGs were aligned with human rights principles, responsive to need, and based in evidence. There was a cross-cutting focus on inclusion throughout them, specifically referencing “vulnerable and marginalized groups, including racial, ethnic, and religious groups, persons with disabilities, indigenous persons, LGBTQI+ persons, and women and girls in all their diversity.” The APGs neither promoted nor hindered SRHR in the MCH domain.

2022_Agency Priority Goal_USAID-State_Action Plan_Quarterly Updates_HIV-AIDS

To report on joint progress toward PEPFAR program goals, strategies, milestones, and indicators in FY 2020, the APGs for HIV and AIDS were released quarterly by both the Department of State and USAID. They expanded person-centered services such as multi-month drug dispensing and self-testing modalities; focused on prevention for AGYW, young men, and orphans and vulnerable children (OVC); and increased access to VMMC. The action was responsive to need and strongly based in evidence. The APGs did not provide any gender-disaggregated insights, and limited all discussions of gender to a binary which made it gender accomodating. They used improper terminology such as “transgendered people,” and did not reference any human rights principles or frameworks. Despite a clear articulation on goals and indicators for success in the HIV domain, they did not discuss links to allied health outcomes in other sectors, including maternal health. The APGs neither promoted nor hindered SRHR in the MCH domain.

2022_USAID-State_FY2023_Annual Performance Plan

2022_PEPFAR 2022 Annual Report to Congress

The Report to Congress detailed the achievements of PEPFAR, recapped efforts conducted to recover from COVID-19 and outlined the support to countries to achieve their 95:95:95 goals. The Report was aligned with human rights principles and highly responsive to need. Inclusion was a cross-cutting focus within the action, with KPs defined to include “the LGBTQI+ community, people who use drugs, sex workers, racial and ethnic minorities, and women and girls and others…” However, the Report also included gendered language (e.g., “breast-feeding women'' rather than people, “mother to child transmission” rather than vertical transmission). Aside from the graphs, it was unclear how much of the Report had been updated since last year, which negatively impacted the transparency score. It was based in evidence, as it recognised (a) the need to build health system capacities to respond to comorbidities such as cervical cancer and tuberculosis rather than addressing HIV in a silo, (b) the linkage of PEPFAR performance with evaluations of multi-layer interventions such as DREAMS, and (c) the inclusion of the latest PHIA survey results and gender-disaggregated analyses. The Report moderately promoted SRHR in the MCH domain.

2022_PEPFAR 2022 Annual Treatment Report to Congress

The Annual Treatment Report from PEPFAR provided information to Congress on PEPFAR-supported treatment programs as required by Section 7611 (g) of Title 22 of the U.S. Code. The Report focused on the shift to the fourth phase of PEPFAR in the Five Year Plan to end the HIV and AIDS pandemic by 2030. Highlights included reaching 95-95-95 goals for all ages, genders, and populations groups; closing equity gaps for priority populations; sustaining success; and strengthening general health systems. The Report was responsive to need and based on evidence. Inclusion and data-driven decision-making based on expanded PHIA survey data were cross-cutting themes in the Report. While the Report focused on norms that keep men from accessing treatment as well as the DREAMS partnership there was no mention of pregnant people and KPs in the context of programming. The action moderately hindered SRHR in the MCH domain.

2022_U.S. Department of State and U.S. Agency for International Development FY 2023 Budget Request

The action detailed the Department of State budget request for FY 2023. It included funding for the war in Ukraine, and addressed the climate crisis (with the goal of delivering co-benefits for global health and WASH, food security, and the development of digital ecosystems. The request was responsive to need, based in evidence, and aligned with human rights principles. There were broad investments in the global health workforce and systems to enhance countries’ abilities to provide core health services and improve health systems resiliency, but the actual “transformative investments” were unclear. Despite specific commitments to the Global Fund and the GEEA Fund, there was limited mention of how the funding would concretely advance the USG “Leadership in Global Health.” The request neither promoted nor hindered SRHR in the MCH domain.

2022_PEPFAR 2022 Country and Regional Operational Plan (COP:ROP) Guidance for all PEPFAR Countries

A revised version of the PEPFAR COP/ROP was released in 2022, and detailed themes within the PEPFAR Strategy for 2021-2025. The COP/ROP was intended to push PEPFAR countries towards sustained epidemic control of HIV by supporting equitable health services and solutions, building enduring national health systems and capabilities, and establishing lasting collaborations. While the action included a page at the beginning of the text that listed the updates to the 2022 version, the changes were not highlighted in the body text which negatively affected the transparency score. The new implementation themes included a shift to person-centered care from client-centered care, the inclusion of KPs, and updated treatment guidelines, all of which were responsive to need and based in evidence. The action moderately promoted SRHR in the MCH domain.

2022_PEPFAR 2023 Country and Regional Operational Plan (COP:ROP) Guidance for all PEPFAR Countries

This version of the COP/ROP was significantly updated to reflect the PEPFAR Five Year Plan, which promised to end the HIV/AIDS pandemic as a public health threat by 2030, while also sustainably strengthening public health systems. Based on partner feedback, the action was redesigned as a shorter, “more relevant” resource to support country teams, which was responsive to need and based in evidence. The action demonstrated a commitment to health equity with a focus on three priority populations: infants and children, AGYW, and KPs. It included a strong stance against stigma and discrimination and noted structural barriers that result in GBV, with particular impacts on AGYW and KPs. It included new issues such as mental health for AGYW and integrated SRHR and HIV care. The action was gender transformative, as it acknowledged the need for gendered considerations related to program implementation. The action increased accountability and improved holistic care for children, pregnancy, and breastfeeding women, focused on reducing MTCT, and acknowledged the need for targeted interventions for pregnant/breastfeeding/parenting AGYW to increase antenatal care (ANC) retention rates and treatment adherence. This action also outlined a transition from annual planning to two-year operational planning. The action moderately promoted SRHR in the MCH domain.

2022_Diversity Equity Inclusion and Accessibility Strategic Plan

The action advanced DEIA goals for the federal workforce by ensuring that the USG was in "the strongest possible position to deliver for the U.S. people in an increasingly diverse, complex, and interconnected world." It responded to a 2021 Executive Order from the White House on enhancing DEIA in the federal workforce and intended to “transform the Department into a more just, equitable, and accessible institution internally to ensure a more equitable and inclusive world.” The action was aligned with human rights principles on inclusion, responsive to need, and based in evidence. The action moderately promoted SRHR in the MCH domain.

2022_PEPFAR Guidance_PrEP Ring FAQ

This action detailed PEPFAR guidance to implementing programs that were funded by the Department of State about the use and distribution of the PrEP ring. The action was aligned with human rights principles and responsive to need, as it committed to “women having informed choices.” However, it also used gendered language (e.g., “women having…” rather than “people”) ,which excluded other KPs. The action clarified that despite constraints on use and distribution, implementation science studies could proceed, which demonstrated commitment to evidence. The action moderately promoted SRHR in the MCH domain.

2022_PEPFAR Monitoring, Evaluation, and Reporting Indicator Reference Guide_MER 2.0 (Version 2.6.1)

The Monitoring, Evaluation, and Reporting (MER) Indicator Reference Guide is reviewed and updated annually to streamline and prioritize the standard indicators used across PEPFAR programs. The September 2022 update to the action introduced greater disaggregation by age (the 50+ age category was divided into smaller bands) across both testing and treatment. This update was responsive to need, as it allowed for greater oversight and evidence-based decisions about PEPFAR programs. The updated action was neither gender-transformative nor inclusive, as it maintained the disaggregation methodology for counting KPs which directed implementing partners to report an individual in the KP category “with which he or she is most identified” which was not intersectional in approach. The update also included a sex-based indicator (male/female) instead of a gender-based indicator which was not based in evidence. The update neither promoted nor hindered SRHR in the MCH domain.

2022_PEPFAR Technical Guidance in Context of COVID-19 Pandemic_2022.01.19

This Guidance updated earlier versions of this Technical Guidance that supported PEPFAR programming throughout the COVID-19 pandemic and ensured that programs remained consistent with recommendations from the WHO and CDC. The Guidance was responsive to need and aligned with human rights principles. It was based in evidence, as it included guidelines about universal masking for healthcare professionals. However, the sections on HIV care, maternal health, and FP, and their links to COVID-19 were not updated. The Guidance neither promoted nor hindered SRHR in the MCH domain.

2022_Reimagining PEPFAR’s Strategic Direction_September 2022

PEPFAR reimagined its global strategy through a series of stakeholder consultations in 2021 and 2022 to produce the revised Five Year Plan, which promised to end the HIV and AIDS pandemic as a public health threat by 2030. It was aligned with human rights principles, as it referenced the SDGs as well as international commitments set by UNAIDS and the Global Fund. The action was responsive to need and based in evidence. Activities listed as part of goal one and two demonstrated a commitment to inclusion and equity in both substance and execution, with plans for working with KPs, and a clear localisation strategy for addressing health inequity. The action was gender transformative, as it focused on social and structural barriers to effective care, especially for women, girls, and the LGBTQI community, and explored the integration of GBV programming into HIV programming. The action acknowledged the need to close gaps in preventing mother-to-child transmission (MTCT), provide precision medicine for children living with HIV, and support young mothers and families in need. It prioritized community-led capacity building which was a significant sustainability goal, and demonstrated potential for effective care, even in the absence of the PEPFAR program. The action moderately promoted SRHR in the MCH domain.

2022_Reimagining PEPFAR’s Strategic Direction_July 26 2023_Footnote Update

PEPFAR reimagined its global strategy through a series of stakeholder consultations in 2021 and 2022 to produce the revised Five Year Plan, which promised to end the HIV/AIDS pandemic as a public health threat by 2030. The document was updated to include a footnote that defined the scope of SRHR programming within PEPFAR. The update was not aligned with human rights principles, responsive to need, or based in evidence. The SRHR Index team found that the update occurred on July 26, 2023 however the document kept a 2022 publication date and is therefore scored for 2022. It would be unclear to a reader when this update was added, which negatively affected the transparency score. The action significantly hindered SRHR in the MCH domain.

2022_Reimagining PEPFAR’s Strategic Direction_July 27 2023_Footnote Update

PEPFAR reimagined its global strategy through a series of stakeholder consultations in 2021 and 2022 to produce the revised Five Year Plan, which promised to end the HIV/AIDS pandemic as a public health threat by 2030. The document was updated a second time to include a footnote that defined the scope of SRHR programming within PEPFAR. While the update improved the previously included footnote, it still was not aligned with human rights principles, responsive to need, or based in evidence.The SRHR Index team found that the update occurred on July 27, 2023 however the document kept a 2022 publication date and is therefore scored for 2022. It would be unclear to a reader when this update was added, which negatively affected the transparency score. The action moderately hindered SRHR in the MCH domain.

2022_Strengthening Health Security Across the Globe: Progress and Impact of U.S. Government Investments in the Global Health Security Agenda

The action documented USG strategy for global health security with an emphasis on the following four areas: (1) marshaling political will, (2) developing global norms around quality of care and technical standards, (3) enhancing sustainable multilateral financing, and (4) strengthening capacities in partner countries. While the action was not explicitly based in human rights principles, it aligned to International Health Regulations, the Biological and Toxins Weapon Convention, UN Security Council Resolution 1540, and other international health conventions that are rights-based. It was responsive to need and based in evidence. The action was gender blind , as it focused on supply-side interventions and did not mention gender. Despite acknowledging the work of PEPFAR globally, there was no substantive discussion of their work in discussions on health security. The action neither promoted nor hindered SRHR in the MCH domain.

2022_FY2020_Bureau of Population, Refugees, and Migration_Summary of Major Activities

The action outlined the funded activities for the Bureau of Population, Refugees, and Migration, including supporting migrants and populations in crisis. Funding stemmed from four core sources, one of which was considered “the resource pot” for Global Health Programs within the Department of State. The allocations included the Emergency Response Fund, the Gap Priorities Fund, funding to address COVID-19, and funding for programs that addressed GBV, all of which were implemented at the regional level. It also included funding for cross-cutting efforts such as for evaluations, research, and inclusion. The action was aligned with human rights principles, responsive to need, and based in evidence. The action did not list how these funds were programmed, which affected its transparency score. The action neither promoted nor hindered SRHR in the MCH domain.

2022_U.S. Government Global Food Security Strategy FY22-26

2022_U.S. Government Global Water Strategy 2022-2027

2022_United States Strategy to Prevent Conflict and Promote Stability

2022_United States Strategy to Combat Gender Based Violence Globally

2022_United States Government Women, Peace, and Security (WPS) Congressional Report

The WPS Report provided Congress with an overview of the progress made in implementing the WPS Agenda since the Biden-Harris administration interventions in 2021. The Report evaluated progress in advancing the WPS Strategy's four lines of effort across the Department of State, Department of Defence (DoD), Department of Homeland Security (DHS), and USAID: participation, protection, internal capabilities, and partnerships. While improved health outcomes were mentioned as a positive impact of implementing the WPS Agenda on sexual exploitation and GBV, they were not included as a core focus area. It was gender accomodating, as it focused only on ‘women’s empowerment and representation’ and did not include LGBTQIA+ communities. The report did not include a discussion of how impact is measured or evaluated. The action moderately hindered SRHR in the MCH domain.

Family Planning (FP)

The Department of State received a 57 (F) with transparency and a 63 (D) without transparency in the FP domain in 2022. This domain grade was raised by the PEPFAR Five Year Plan, as well as the updated PrEP Ring FAQs, which were both responsive to need, based in evidence, and aligned with human rights principles. However, subsequent edits to the Five Year Plan did not promote SRHR, and were not based in evidence or responsive to need, and thus negatively impacted the FP score. Though some actions integrated FP and HIV services, this domain grade was low overall because the actions did not adequately include data or information about activities within FP programs, which reinforced the siloed nature of global health programs, negatively affected transparency, and hindered SRHR. In the budget evaluation, the Department of State allocated FP funds somewhat in accordance with unmet contraceptive need at the country level, which moderately promoted SRHR. Transparency was relatively low across actions but moderately high with regard to budget data in the FP domain.

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

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2022_Agency Priority Goal_State_Action Plan_Quarterly Updates_Equity Across Foreign Affairs Work

To report on the progress of the Department of State, the APGs on ensuring equity across foreign affairs work were released bi-annually. They aimed to “advance equity and support for underserved communities in the development and conduct of foreign policy, by developing assessment tools and establishing country-specific baselines, measurements, and reporting mechanisms for the Department.” The intent was to enable programs led and overseen by the Department of State to actively engage underserved communities and ensure sustainability and effectiveness in the long-term. Given the increased need to center communities and equity in U.S. foreign policy work, the APGs were aligned with human rights principles, responsive to need, and based in evidence. There was a cross-cutting focus on inclusion throughout them, specifically referencing “vulnerable and marginalized groups, including racial, ethnic, and religious groups, persons with disabilities, indigenous persons, LGBTQIA+ persons, and women and girls in all their diversity.” The APGs neither promoted nor hindered SRHR in the FP domain.

2022_Agency Priority Goal_USAID-State_Action Plan_Quarterly Updates_HIV-AIDS

To report on joint progress toward PEPFAR program goals, strategies, milestones, and indicators in FY 2020, the APGs for HIV and AIDS were released quarterly by both the Department of State and USAID. They expanded person-centered services such as multi-month drug dispensing and self-testing modalities; focused on prevention approaches for AGYW, young men, and OVC; and increased access to VMMC. The action was responsive to need and strongly based in evidence. The APGs did not provide any gender-disaggregated insights and limited all discussions of gender to a binary. They did not reference any human rights principles or frameworks. Despite a clear articulation on goals and indicators for success in the HIV domain, it did not discuss any linkages to allied health outcomes in other sectors, including FP. The APGs neither promoted nor hindered SRHR in the FP domain.

2022_USAID-State_FY2023_Annual Performance Plan

2022_PEPFAR 2022 Annual Report to Congress

The Report to Congress detailed the achievements of PEPFAR, recapped efforts conducted to recover from COVID-19, and outlined the support to countries to achieve their 95:95:95 goals. The Report was aligned with human rights principles and highly responsive to need. Inclusion was a cross-cutting focus within the Report, with KPs defined to include “the LGBTQI+ community, people who use drugs, sex workers, racial and ethnic minorities, and women and girls and others…” However, the Report also included gendered language (e.g., “breast-feeding women'' rather than people, “mother to child transmission” rather than vertical transmission). Aside from the graphs, it was unclear how much of the Report had been updated since last year, which negatively impacted the transparency score. It was based in evidence, as it recognised (a) the need to build health system capacities to respond to comorbidities such as cervical cancer and tuberculosis rather than addressing HIV in a silo, (b) the linkage of PEPFAR performance with evaluations of multi-layer interventions such as DREAMS, and (c) the inclusion of the latest PHIA survey results and gender-disaggregated analyses. The Report moderately promoted SRHR in the FP domain.

2022_PEPFAR 2022 Annual Treatment Report to Congress

The Annual Treatment Report from PEPFAR provided information to Congress on PEPFAR-supported treatment programs as required by Section 7611 (g) of Title 22 of the U.S. Code. The Report focused on the shift to the fourth phase of PEPFAR in the Five Year Plan to end the HIV/AIDS pandemic by 2030. Highlights included reaching 95-95-95 goals for all ages, genders, and populations groups; closing equity gaps for priority populations; sustaining success; and strengthening general health systems. The Report was responsive to need and based in evidence. Inclusion and data-driven decision-making based on expanded PHIA survey data were cross-cutting themes in the Report. While there was no mention of pregnant people and KPs in the context of programming, the report wasgender accomodating. It focused on norms that keep men from accessing treatment as well as the DREAMS partnership. The Report action neither promoted nor hindered SRHR in the FP domain.

2022_U.S. Department of State and U.S. Agency for International Development FY 2023 Budget Request

The action detailed the Department of State budget request for FY 2023. It included funding for the war in Ukraine, and addressed the climate crisis (with the goal of delivering co-benefits for global health and WASH), food security, and the development of digital ecosystems. The request was responsive to need, based in evidence, and aligned with human rights principles. There were broad investments in the global health workforce and systems to enhance countries’ abilities to provide core health services and improve health systems resiliency, but the actual "transformative investments" were unclear. Despite specific commitments to the Global Fund and the GEEA Fund, there was limited mention of how the funding would concretely advance the USG “Leadership in Global Health.” The request neither promoted nor hindered SRHR in the FP domain.

2022_PEPFAR 2022 Country and Regional Operational Plan (COP:ROP) Guidance for all PEPFAR Countries

2022_PEPFAR 2023 Country and Regional Operational Plan (COP:ROP) Guidance for all PEPFAR Countries

This version of the COP/ROP was significantly updated to reflect the PEPFAR Five Year Plan, which promised to end the HIV/AIDS pandemic as a public health threat by 2030, while also sustainably strengthening public health systems. Based on partner feedback, the action was redesigned as a shorter, “more relevant” resource to support country teams, which was responsive to need and based in evidence. The action demonstrated a commitment to health equity with a focus on three priority populations: infants and children, AGYW, and KPs. It included a strong stance against stigma and discrimination and noted structural barriers that result in GBV, with particular impacts on AGYW and KPs. It included new issues such as mental health for AGYW and integrated SRHR and HIV care. The action was gender transformative, as it acknowledged need for gendered considerations related to program implementation. The action highlighted the lack of integration of SRH and HIV services—especially for AGYW—and the misalignment of age-of-consent laws for HIV and reproductive health services. This action also outlined a transition from annual planning to two-year operational planning. The action moderately promoted SRHR in the FP domain.

2022_Diversity Equity Inclusion and Accessibility Strategic Plan

2022_PEPFAR Guidance_PrEP Ring FAQ

2022_PEPFAR Monitoring, Evaluation, and Reporting Indicator Reference Guide_MER 2.0 (Version 2.6.1)

The Monitoring, Evaluation, and Reporting (MER) Indicator Reference Guide is reviewed and updated annually to streamline and prioritize the standard indicators used across PEPFAR programs. The September 2022 update to the action introduced greater disaggregation by age (the 50+ age category was divided into smaller bands) across both testing and treatment. This update was responsive to need, as it allowed for greater oversight and evidence-based decisions about PEPFAR programs. The updated action was neither gender transformative nor inclusive, as it maintained the disaggregation methodology for counting KPs which directed implementing partners to report an individual in the KP category “with which he or she is most identified” which was not intersectional. The update also included a sex-based indicator (male/female) instead of a gender-based indicator which was not based in evidence. The update neither promoted nor hindered SRHR in the FP domain.

2022_PEPFAR Technical Guidance in Context of COVID-19 Pandemic_2022.01.19

This Guidance updated earlier versions of this Technical Guidance that supported PEPFAR programming throughout the COVID-19 pandemic and ensured that programs remained consistent with recommendations from the WHO and CDC. The Guidance was responsive to need and aligned with human rights principles. It was based in evidence, as it included guidelines about universal masking for healthcare professionals. However, the sections on HIV care, maternal health and FP, and their links to COVID-19 were not updated. The Guidance neither promoted nor hindered SRHR in the FP domain.

2022_Reimagining PEPFAR’s Strategic Direction_September 2022

PEPFAR reimagined its global strategy through a series of stakeholder consultations in 2021 and 2022, to produce the revised Five Year Plan, which promised to end the HIV and AIDS pandemic as a public health threat by 2030. It was aligned with human rights principles, as it referenced the SDGs as well as international commitments set by UNAIDS and the Global Fund. The action was responsive to need and based in evidence. Activities listed as part of goal one and two demonstrated a commitment to inclusion and equity in both substance and execution, with plans for working with KPs, and a clear localisation strategy for addressing health inequity. The action was gender transformative, as it focused on social and structural barriers to effective care, especially for women, girls, and the LGBTQIA+ community, and explored the integration of GBV programming into HIV programming. It prioritized community-led capacity building which was a significant sustainability goal, and demonstrated potential for effective care even in the absence of the PEPFAR program. The action moderately promoted SRHR in the FP domain.

2022_Reimagining PEPFAR’s Strategic Direction_July 26 2023_Footnote Update

PEPFAR reimagined its global strategy through a series of stakeholder consultations in 2021 and 2022 to produce the revised Five Year Plan, which promised to end the HIV/AIDS pandemic as a public health threat by 2030. The document was updated to include a footnote that defined the scope of SRHR programming within PEPFAR. The update was aligned with human rights principles, responsive to need, or based in evidence.The SRHR Index team found that the update occurred on July 26, 2023 however the document kept a 2022 publication date and is therefore scored for 2022. It would be unclear to a reader when this update was added, which negatively affected the transparency score. The action significantly hindered SRHR in the FP domain.

2022_Reimagining PEPFAR’s Strategic Direction_July 27 2023_Footnote Update

PEPFAR reimagined its global strategy through a series of stakeholder consultations in 2021 and 2022 to produce the revised Five Year Plan, which promised to end the HIV/AIDS pandemic as a public health threat by 2030. The document was updated a second time to include a footnote that defined the scope of SRHR programming within PEPFAR. While the update improved the previously included footnote, it still was not aligned with human rights principles, responsive to need, or based in evidence. The SRHR Index team found that the update occurred on July 27, 2023 however the document kept a 2022 publication date and is therefore scored for 2022. It would be unclear to a reader when this update was added, which negatively affected the transparency score. The action moderately hindered SRHR in the FP domain.

2022_Strengthening Health Security Across the Globe: Progress and Impact of U.S. Government Investments in the Global Health Security Agenda

The action documented USG strategy for global health security with an emphasis on the following four areas: (1) marshaling political will, (2) developing global norms around quality of care and technical standards, (3) enhancing sustainable multilateral financing, and (4) strengthening capacities in partner countries. While the action was not explicitly based in human rights principles, it aligned to International Health Regulations, the Biological and Toxins Weapon Convention, UN Security Council Resolution 1540, and other international health conventions that are rights-based. It was responsive to need and based in evidence. The action was gender blind, as it focused on supply-side interventions and did not mention gender. Despite acknowledging the work of PEPFAR globally, there was no substantive discussion of their work in discussions on health security. The action neither promoted nor hindered SRHR in the FP domain.

2022_FY2020_Bureau of Population, Refugees, and Migration_Summary of Major Activities

The action outlined the funded activities for the Bureau of Population, Refugees, and Migration, including supporting migrants and populations in crisis. Funding stemmed from four core sources, one of which was considered “the resource pot” for Global Health Programs within the Department of State. The allocations included the Emergency Response Fund, the Gap Priorities Fund, funding to address COVID-19, and funding for programs that addressed GBV, all of which were implemented at the regional level. It also included funding for cross-cutting efforts such as for evaluations, research, and inclusion. The action was aligned with human rights principles, responsive to need, and based in evidence. The action did not list how these funds were programmed, which affected its transparency score. The action neither promoted nor hindered SRHR in the FP domain.

2022_U.S. Government Global Food Security Strategy FY22-26

2022_U.S. Government Global Water Strategy 2022-2027

2022_United States Strategy to Prevent Conflict and Promote Stability

2022_United States Strategy to Combat Gender Based Violence Globally

2022_United States Government Women, Peace, and Security (WPS) Congressional Report

The WPS Report provided Congress with an overview of the progress made in implementing the WPS Agenda since the Biden-Harris administration interventions in 2021. The Report evaluated progress in advancing the WPS Strategy's four lines of effort across the Department of State, Department of Defence (DoD), Department of Homeland Security (DHS), and USAID: participation, protection, internal capabilities, and partnerships. While improved health outcomes were mentioned as a positive impact of implementing the WPS Agenda on sexual exploitation and GBV, it was not a core focus. It was gender accomodating, as it focused only on ‘women’s empowerment and representation’ and did not include LGBTQIA+ communities. The report did not include a discussion of how impact is measured or evaluated. The action moderately hindered SRHR in the FP domain.

TRANSPARENCY SCORE

TRANSPARENCY SCORE

Department of State

HIV & AIDS

Maternal and Child Health (MCH)

Family Planning (FP)