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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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C

This is an average of the three domain scores below.

YEAR 2018

US Agency for International Development

USAID received a 74 (C) with transparency and a 76 (C) without transparency because the Agency issued some documents that positively impacted SRHR globally and other guidance, such as the PLGHA FAQ document, that severely harmed SRHR. In the family planning domain, USAID’s grade decreased significantly due to issued documents that did not meaningfully discuss family planning or, in the case of the PLGHA FAQ, negatively impacted USAID’s ability to implement comprehensive family planning and SRHR programs that are evidence-informed, responsive to need, consistent with internationally-recognized human rights principles, and gender transformative. For both Family Planning and Maternal and Child Health, funding allocations that were not responsive to need led to a low score in both domains. In the Maternal and Child Health and HIV and AIDS domains, USAID’s grades decreased due to issued guidance that was not gender transformative or comprehensive. In all three domains, USAID’s funding data received a high transparency score and the issued guidance received a lower transparency score.

B
B

HIV & AIDS

 

USAID received a 84 (B) with transparency and an 86 (B) without transparency for HIV and AIDS based on four HIV and AIDS-related documents issued in 2018. These documents ranged from significantly hindering to moderately promoting SRHR within the HIV and AIDS sector and all four documents issued neglected to discuss the role of gender norms in the implementation of relevant programming. USAID’s grade decreased in this domain since last year primarily due to the lack of HIV and AIDS-specific information in the 2018 Acting on the Call Report. USAID received a high budget score because disbursed funds were responsive to demonstrated HIV and AIDS programming needs. USAID’s commitment to 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_Acting on the Call Report
Acting on the Call is USAID's annual flagship report for reproductive, maternal, newborn, and child health services. Within the 2018 report, HIV and AIDS is discussed strictly in the context of child mortality despite the fact that HIV is a leading contributor of maternal mortality worldwide. Evidence suggests that HIV and AIDS are key factors in maternal mortality and wellness and in child health through the prevention of maternal to child transmission (PMTCT). By leaving out HIV and AIDS data herein, the framework of this report reinforces the siloes between MCH, FP, and HIV and AIDS programming that challenges USAID's ability to support integrated SRHR programs.
2018_Condoms and Pharmaceuticals ADS Help Document
The Automated Directives System (ADS) contains the operational policies that guide USAID's programs and operations. The Condoms and Pharmaceuticals ADS Help Document is an addendum that was revised in 2018 to guide the procurement of condoms and pharmaceuticals by the Bureau for Global Health. The updated directive requires that the procurement of all condoms (internal and external) be managed by the Office of HIV/AIDS. While this directive is detailed and informative and includes the procurement of female (internal) condoms, it is unclear what prompted this update. As a result, it is challenging to gauge whether the guidance is responsive to need, evidence-based, human rights-based or gender transformative. It is also unclear how the consolidation of procurement of all condoms under the Office of HIV/AIDS will impact USAID's HIV and AIDS programming and, therefore, SRHR overall, given that condoms are an important intervention in both family planning and maternal and child health.
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. However, the APGs do not explain the role of USAID, specifically, in HIV and AIDS programming and only discusses PEPFAR-level successes and challenges. As a result, the APGs do not hinder or promote USAID's ability to support comprehensive HIV and AIDS programs, so the APGs do not increase or decrease USAID's score in this domain.
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 USAID's ability to implement comprehensive HIV and AIDS programs that are evidence-informed, responsive to need, consistent with internationally-recognized human rights principles and gender transformative.
2018_Acquisition and Assistance Strategy
As USAID’s first-ever Acquisition and Assistance (A&A) Strategy, this guidance document increases the accountability and transparency of USAID's procurement, partnering, and project management processes across the Agency. The goal of this Strategy is to streamline "approaches to design and procurement" and develop "new and innovative methods of collaboration" to advance USAID's Journey to Self-Reliance mandate. The Strategy is responsive to need and evidence-based because it cites the current make-up of USAID foreign assistance funding recipients and sets specific goals to diversify this partner base. Many of the strategies and shifts put forward in the report incorporate feedback received from smaller and/or local partners. The Strategy also demonstrates a commitment to human rights norms, specifically to the rights of self determination, by actively incorporating local partners in the design, procurement, and implementation of USAID's programming. Though the Strategy references the importance of ""diverse"" partners, it does not define who these partners are except for a specific mention of faith-based organizations. Women's rights and human rights groups should also be explicitly mentioned as underutilized partners because of their important role in advancing SRHR for all populations. This Strategy indicates a meaningful effort by USAID to ensure that local partners and recipient countries are included and supported throughout the Journey to Self-Reliance. However, this effort by USAID seems to be in direct conflict with the Trump Administration's strategy of decreasing appropriated funds as a means to motivate self reliance and haphazardly decrease U.S. involvement in foreign assistance. It is unclear in this strategy how USAID aims to reconcile this conflict.
C-
C-

Maternal and Child Health (MCH)

 

USAID received a 70 (C-) with transparency and a 72 (C-) without transparency for Maternal and Child Health based on three documents issued in 2018 that relate to MCH. Though the impact of this guidance on SRHR ranges from positive to negative, all of the guidance focused on child survival more than maternal wellbeing and lacked a gender transformative approach to programming. Maternal health programs should address issues beyond maternal survival — such as the impact of gender norms on pregnancy and the importance of respectful maternity care to address disrespect and abuse. These factors are vital in determining the health of the mother and, subsequently, the health of the child. USAID, as the agency that coordinates maternal and child health in-country through local civil society partnerships, has the potential to support gender transformative and person-centered policies and programming that reflect the realities of the infrastructure and gender norms. These documents are evidence that USAID did not fully step into this role in 2018. Furthermore, the PLGHA FAQs did not adequately address the unique impacts the PLGHA policy could have on maternal and child health programming. The USAID budget grade reflects the conclusion that MCH programs are not responsive to need, as a significant portion of the funds disbursed for MCH programming in FY 2019 was not disbursed in 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_Acting on the Call Report
Acting on the Call is USAID's annual flagship report for reproductive, maternal, newborn, and child health services. This year's report offers thorough country-level analyses of data around maternal and child health outcomes that are evidence-based and responsive to need but are not gender transformative. The report does not discuss the importance of programming and policies to champion respectful maternity care as a means to address disrespect and abuse. Instead, the report focuses largely on USAID's "Journey to Self-Reliance" framework and provides detailed country-level updates including: population-level statistics, intervention coverage, child mortality, nutrition, and health systems strengthening. While the report aims to improve maternal and child health through the strengthening of health systems, it does not address the importance of a patient-centered approach, which includes respectful maternity care, gender transformative programming, and the improvement of working conditions for health care workers.
2018_Maternal and Child Health Agency Priority Goals
The Agency Priority Goals (APGs) for Maternal and Child Health provide a quarterly overview of MCH programs implemented by USAID. The goals in this report include intersecting issues such as family planning, nutrition, and malaria. The APGs are responsive to need and evidence-based, but are not gender transformative. The APGs are predominantly child health-focused with "All cause under 5 mortality" as a primary indicator of success in MCH programming. Using this indicator as the primary indicator for MCH actively disregards the health, human rights, wellbeing, and childbirth experience of the woman. The addition of the indicator "Absolute change in total percentage of births delivered in a health facility" in the FY2018 APGs will further strengthen this reporting mechanism. Efforts to promote respectful maternity care could be strengthened, though the APGs do include changing attitudes of health care workers as an MCH strategy.
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 programs. The FAQs significantly hinder USAID's ability to support comprehensive maternal and child health programming.
2018_Acquisition and Assistance Strategy
As USAID’s first-ever Acquisition and Assistance (A&A) Strategy, this guidance document increases the accountability and transparency of USAID's procurement, partnering, and project management processes across the Agency. The goal of this Strategy is to streamline "approaches to design and procurement" and develop "new and innovative methods of collaboration" to advance USAID's Journey to Self-Reliance mandate. The Strategy is responsive to need and evidence-based because it cites the current make-up of USAID foreign assistance funding recipients and sets specific goals to diversify this partner base. Many of the strategies and shifts put forward in the report incorporate feedback received from smaller and/or local partners. The Strategy also demonstrates a commitment to human rights norms, specifically to the rights of self determination, by actively incorporating local partners in the design, procurement, and implementation of USAID's programming. Though the Strategy references the importance of "diverse" partners, it does not define who these partners are except for a specific mention of faith-based organizations. Women's rights and human rights groups should also be explicitly mentioned as underutilized partners because of their important role in advancing SRHR for all populations. This Strategy indicates a meaningful effort by USAID to ensure that local partners and recipient countries are included and supported throughout the Journey to Self-Reliance. However, this effort by USAID seems to be in direct conflict with the Trump Administration's strategy of decreasing appropriated funds as a means to motivate self reliance and haphazardly decrease U.S. involvement in foreign assistance. It is unclear in this strategy how USAID aims to reconcile this conflict.
D
D

Family Planning (FP)

 

USAID received a 66 (D) with transparency and 65 (D) without transparency for Family Planning. USAID was graded based on three family planning-related guidance and procedures that were issued in 2018. These documents varied in their grades, but none of them were gender transformative or explicitly based in human rights norms. As the agency that coordinates family planning funds through bilateral programs and partners with local civil society, USAID has the potential to implement truly evidence-based and human rights-based programming. These documents are evidence that USAID did not fully step into this role in 2018. The USAID budget grade reflects these conclusions, as a significant portion of the funds disbursed for family planning programming in FY 2019 was not responsive to unmet family planning need by country.

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_Acting on the Call Report
Acting on the Call is USAID's annual flagship report for reproductive, maternal, newborn, and child health services. The report cites country-level annual progress toward family planning targets and provides recommendations to advance family planning in each country context in a manner that is responsive to need. At the same time, the 2018 report, when compared to the 2017 version, includes more language regarding USAID's "Journey to Self-Reliance" framework for program countries. This language is consistent with the Trump administration's efforts to reduce U.S. funds for global health as a means to increase the incentive for countries to increase domestic funding. This method of achieving self reliance is neither evidence-based nor sustainable and, given this context, the addition of self reliance language in the report is concerning. Though Acting on the Call reports on both family planning and maternal and child health data, the report does not provide substantial detailed analysis of family planning programming. The evaluation of family planning efforts is not included within each country analysis. Additionally, the report does not mention gender norms or human rights principles as they apply to family planning.
2018_Maternal and Child Health Agency Priority Goals
The Agency Priority Goals (APGs) for Maternal and Child Health provide quarterly updates on family planning commodity delivery and an overview of family planning programs implemented by USAID. The goals are responsive to need and evidence-based in that they cite statistics regarding family planning that have informed the APGs. However, this report is lacking references to international human rights norms and does not include discussions surrounding gender norms in family planning programs. There is only one mention of family planning in each of the quarterly and annual indicators without any programmatic detail or guidance. These mentions of family planning are geared toward families and spacing of births, neither of which may apply to people who give birth outside of traditionally defined families or for people who seek contraceptives for purposes other than spacing births. The cited family planning indicator, "Absolute change in modern contraceptive prevalence rate," does not include any consideration for access to contraceptives for key populations, specifically, and does not account for the role of gender norms in shaping family planning and contraceptive access.
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 USAID's ability to implement comprehensive family planning and SRHR programs that are evidence-informed, responsive to need, consistent with internationally-recognized human rights principles and gender transformative.
2018_Acquisition and Assistance Strategy
As USAID’s first-ever Acquisition and Assistance (A&A) Strategy, this guidance document increases the accountability and transparency of USAID's procurement, partnering, and project management processes across the Agency. The goal of this Strategy is to streamline "approaches to design and procurement" and develop "new and innovative methods of collaboration" to advance USAID's Journey to Self-Reliance mandate. The Strategy is responsive to need and evidence-based because it cites the current make-up of USAID foreign assistance funding recipients and sets specific goals to diversify this partner base. Many of the strategies and shifts put forward in the report incorporate feedback received from smaller and/or local partners. The Strategy also demonstrates a commitment to human rights norms, specifically to the rights of self determination, by actively incorporating local partners in the design, procurement, and implementation of USAID's programming. Though the Strategy references the importance of "diverse" partners, it does not define who these partners are except for a specific mention of faith-based organizations. Women's rights and human rights groups should also be explicitly mentioned as underutilized partners because of their important role in advancing SRHR for all populations. This Strategy indicates a meaningful effort by USAID to ensure that local partners and recipient countries are included and supported throughout the Journey to Self-Reliance. However, this effort by USAID seems to be in direct conflict with the Trump Administration's strategy of decreasing appropriated funds as a means to motivate self reliance and haphazardly decrease U.S. involvement in foreign assistance. It is unclear in this strategy how USAID aims to reconcile this conflict.