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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 grades are low because the only guidance that was issued in these domains included the PLGHA Six Month Review and 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 are evidence-based, based in human rights norms, and responsive to need, but are 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 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 State Department 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 that guide country-level PEPFAR programs. The Department of State also released annual reports that document programmatic progress and demonstrate areas for improvement. Overall, the guidance documents and annual reports do not include gender transformative language. The Department of State’s commitment to comprehensive HIV and AIDS programming is 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_Protecting Life in Global Health Assistance Six Month Review
The Protecting Life in Global Health Assistance (PLGHA) Six Month Review summarizes the PLGHA policy and identifies solutions to challenges that have arisen in the process of PLGHA implementation. The review is responsive to need in that it addresses concerns expressed by partners who are required to implement the policy, but it is 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 discusses the importance of addressing the impact of PLGHA on HIV and AIDS programs and assures that efforts are being made to track the impact of this policy through PEPFAR programming. Still, the Six Month Review substantially hinders the Department of State's ability to support comprehensive HIV and AIDS programs.
2018_Protecting Life in Global Health Assistance FAQs
The Protecting Life in Global Health Assistance (PLGHA) FAQ provides detailed guidance on the implementation of the expanded Global Gag Rule policy for implementing partners. The document is responsive to need in that it clarifies areas of the policy that partners have expressed are vague or unclear, but it is not evidence-based or based in human rights principles. The FAQ includes a PEPFAR-specific section that provides 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, does not discuss gender norms or include gender transformative language. This section emphasizes the importance of minimizing disruption of HIV and AIDS care and treatment and therefore receives a higher score within this domain compared to the other two domains, FP and MCH.
2018_HIV/AIDS Agency Priority Goals
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 APGs report on challenges faced by HIV and AIDS programs, but do not provide clear strategies to address them. One such challenge is that of increased HIV and AIDS among adolescent girls and young women (AGYW) and key populations. The APGs mention 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 do not include indicators specific to either population or data aggregated by gender as a means to highlight progress made in these areas. As a result, the APGs moderately promote the ability of the Department of State to support comprehensive HIV and AIDS programs.
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 is comprehensive and provides updates that are evidence-informed, responsive to need, and based in human rights principles. The 2018 COP Guidance takes a holistic approach to PEPFAR programs and discusses intersecting issues, such as: gender-based violence, post-abortion care, contraceptive access, and comprehensive HIV prevention programs. The COP Guidance illustrates gender as a cross-cutting issue within PEPFAR but should include specific guidance to increase gender transformative programming across PEPFAR countries.
2018_PEPFAR Progress Report
The PEPFAR Progress Report is issued annually to provide an overview of programs and illustrate PEPFAR priorities in the future. The report shares a program plan that is responsive to need and based in evidence and human rights principles. However, the document does not discuss gender norms or include a commitment to increase gender transformative programming.
2018_PEPFAR 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 is evidence-based, responsive to need, and includes a description of how the State Department will deliver on the mission of PEPFAR moving forward. The report also discusses factors that make HIV prevention and treatment complex for adolescent girls and young women and for key populations; however, these programmatic concerns are framed within current constructed gender norms. The programming discussed in this report does not include gender transformative components as a means to provide comprehensive HIV and AIDS services.
2018_DREAMS Report
The annual DREAMS report highlights the strengths, challenges, and future directions of the DREAMS program. The report is evidence-based and responsive to need, but lacks a clear gender transformative stance. The DREAMS program does have concrete gender transformative components, but they are not reflected in this report in a clear and substantial way. The report describes harmful gender norms that affect HIV and AIDS prevention and treatment programs for adolescent girls and young women, but does not mention how to address these barriers in a manner informed by human rights principles.
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 provides a nuanced overview of the data and concludes by issuing the guidance that all PEPFAR programs continue transitioning to a DTG-based regimen. The release recommends that "HIV-infected women who desire to become pregnant" should remain on efavirenz-based regiments until further data are available. The issuance of this statement was timely and provides an accurate explanation of the Botswana study preliminary findings; however, the State Department's recommendation took away the choice of treatment from a population based solely on their ability or desire to become pregnant. This is 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.
F
F

Maternal and Child Health (MCH)

 

The State Department received a 35 (F) with transparency and a 40 (F) without transparency for Maternal and Child Health based on two documents related to the PLGHA expansion of the Global Gag Rule: the Six Month Review and the FAQ. Neither is gender aware nor based in evidence or human rights principles. However, both documents are responsive to need because they address concerns and questions from partners regarding the implementation of PLGHA. The omittance of specific references to MCH programming in both documents indicates that the State Department is 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 State Department to implement comprehensive MCH programming. With regards to budget allocation, the State Department budget evaluation depicts that funds are 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 Six Month Review
The Protecting Life in Global Health Assistance (PLGHA) Six Month Review summarizes the PLGHA policy and identifies solutions to challenges that have arisen in the process of PLGHA implementation. The review is responsive to need in that it addresses concerns expressed by partners affected by the policy, but is not evidence-based, based in human rights principles or gender transformative. The review received a lower grade within this domain compared to FP and HIV and AIDS because the review does not mention MCH programming specifically, despite the unique impacts this policy could have on maternal and child health services. The Six Month Review significantly hinders the Department of State's ability to support comprehensive maternal and child health programming.
2018_Protecting Life in Global Health Assistance FAQs
The Protecting Life in Global Health Assistance (PLGHA) FAQs provide detailed guidance on the implementation of Trump's expanded Global Gag Rule for implementing partners. The FAQs are 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 FP and HIV and AIDS because it does not mention MCH programming specifically, despite the unique impacts this policy could have on maternal and child health services. The FAQs significantly hinder the Department of State's ability to support comprehensive maternal and child health programming.
F
D-

Family Planning (FP)

 

The Department of State received a 56 (F) with transparency and 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 FAQ. Neither is gender aware nor based in evidence or human rights principles. However, both documents are responsive to need because they address 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 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 Six Month Review
The Protecting Life in Global Health Assistance (PLGHA) Six Month Review summarizes the PLGHA policy and identifies solutions to challenges that have arisen in the process of PLGHA implementation. The review is responsive to need in that it addresses concerns expressed by partners affected by the policy, but is not evidence-informed, based in human rights principles, or gender transformative. The document states that it is too early to assess the impacts of Trump's expanded GGR on family planning despite research and literature documenting the harm caused by the current policy. The Six Month Review substantially hinders the Department of State's ability to implement comprehensive family planning programs.
2018_Protecting Life in Global Health Assistance FAQs
The Protecting Life in Global Health Assistance (PLGHA) FAQ provides detailed guidance on the implementation of Trump's expanded GGR for implementing partners. The FAQ document is responsive to need in that it clarifies areas of the policy that partners have expressed are vague or unclear. The FAQs are neither based in human rights principles nor evidence. The FAQs are also not gender transformative and substantially hinder the Department of State's ability to implement comprehensive family planning programs.