Domain Score Overview

 

This is an average of the three domain scores below

HIV & AIDS

The U.S. Government received an 86 (B) with transparency and an 89 (B+) without transparency for HIV and AIDS across all actors in 2019. This grade reflected the continued commitment of the President’s Emergency Plan for AIDS Relief (PEPFAR) to implement programs that are evidence-based, responsive to need, and gender accommodating and Congress’s commitment to appropriating adequate funding for HIV and AIDS. Similar to past years, the implementation of the PLGHA policy by relevant actors harmed SRHR within this domain. Furthermore, HIV and AIDS continued to be omitted from key reporting documents across actors, including USAID’s annual Acting on the Call report. Low transparency of policy documents from USAID in this domain also contributed to the overall lower grade. In spite of these negative actions, however, the domain grade for HIV and AIDS-related funding and policies remained higher than the grades of the other domains across actors.

White House

The White House received an 84 (B) with transparency and an 87 (B+) without transparency for HIV and AIDS. The White House proposed adequate—but less than ideal—funding for the Global Fund and for the Department of State’s HIV and AIDS programs but zeroed out funding for USAID’s HIV and AIDS programs. This grade was harmed by the lack of inclusion of HIV and AIDS in a meaningful manner in the United States Strategy on Women, Peace, and Security and the Global Health Security Strategy. The transparency grade was low for HIV and AIDS due to the White House website no longer using filters or criteria to navigate the policies listed online. Similar to 2018, HIV and AIDS continued to be the White House’s highest scoring domain.

Congress

Congress received a 97 (A+) with transparency and a 97 (A+) without transparency due to Congress appropriating high levels of funding for the Global Fund and President’s Emergency Plan for AIDS Relief (PEPFAR) and high levels of transparency within policy and funding. This grade was further raised by the passage of the Global Health Innovation Act which instituted a Congressional reporting requirement regarding HIV and AIDS-related global health technologies by USAID.

Department of State

The Department of State received a 94 (A) with transparency and 98 (A+) without transparency for HIV and AIDS in 2019. The grade within this domain was raised by the Department of State and USAID Agency Priority Goals for HIV and AIDS, 2019 PEPFAR COP Guidance, and the updated version of the PEPFAR MER Indicator Reference Guide. Overall, these documents were based in evidence and responsive to need but did not include gender transformative language and were not grounded in international human rights norms. In particular, the PEPFAR COP Guidance included index testing guidance and targets that ignored evidence, international human rights norms, and input from civil society that advised against these targets. This grade was lowered by the implementation of the PLGHA policy through the 2019 PLGHA FAQs, which was responsive to need but not based in evidence or international human rights norms. In the budget evaluation, the Department of State largely disbursed HIV and AIDS funds in accordance with country-level HIV incidence.

US Agency for International Development

USAID received an 85 (B) with transparency and an 88 (B+) without transparency for the HIV and AIDS domain in 2019. USAID was graded based on a number of Agency-level guidance documents, Agency Priority Goals for HIV/AIDS, ADS Chapters, and two PLGHA FAQs. Though these documents were responsive to need, none of them included a gender transformative component and few were based on international human rights norms. The two PLGHA FAQs as well as the updated ADS Chapter 308 significantly reduced the Agency’s grade in this domain because they substantially hindered USAID’s ability to implement HIV and AIDS programming that promoted SRHR. USAID’s grade in this domain was again reduced due to the lack of HIV and AIDS-specific information in the 2019 Acting on the Call Report, which was noted in 2018 as well. Within this domain, USAID received a high budget score because USAID disbursed funds for HIV and AIDS programming according to country-level HIV incidence.

Department of Health and Human Services

HHS received a 60 (D-) with transparency and a 68 (D+) without transparency for HIV and AIDS in 2019. The four statements related to the U.S. government’s regressive stance on SRHR (including HIV and AIDS) shared by Alex Azar, the U.S. Secretary of Health and Human Services, significantly decreased the HHS’s grade in this domain. The amount of disbursed funds for HIV and AIDS programs through HHS was not publicly available which also contributed to the low transparency grade in this domain.

Department of Defense

The DoD received a 71 (C-) with transparency and an 81 (B-) without transparency due to the unavailability of budget information and low transparency in 2019. The DoD also did not release any policy or technical guidance related to HIV and AIDS in 2019.

 

This is an average of the three domain scores below

Maternal and Child Health (MCH)

The U.S. Government received a 68 (D+) with transparency and a 71 (C-) without transparency for Maternal and Child Health across all actors in 2019. This grade stemmed from a low budget request by the White House and gender-blind language across policy documents that reinforced the traditional gender binary with regard to maternal and child health programs. The U.S. government also omitted specific references to maternal and child health programming in the PLGHA policy documents and guidance, which indicates that the U.S. government did not consider the unique impact of the implementation of the PLGHA policy on maternal and child health programs. The grade was positively impacted by the continued issuance of USAID’s reports like Acting on the Call and USAID’s revision of ADS Chapter 212 that are based in evidence. Low transparency regarding USAID’s maternal and child health policies and maternal and child health funding by HHS also contributed to this grade.

White House

The White House received a 62 (D-) with transparency and a 65 (D) without transparency due to low funding proposed for Maternal and Child Health and for the defunding of UNICEF and UNIFEM (now UN Women) in 2019. This grade was further harmed by the exclusion of maternal and child health—and health more generally—in the United States Strategy on Women, Peace, and Security. The transparency grade was also low in this domain because the White House website no longer uses filters or criteria to navigate the policies listed online.

Congress

Congress received an 86 (B) with transparency and an 86 (B) without transparency because it appropriated adequate levels of funding for UNICEF and USAID’s maternal and child health programs but inadequate funding for UNIFEM (now UN Women). The Global Health Innovation Act neither hindered nor raised the grade within this domain. Congress scored high on transparency due to available policy and budget information.

Department of State

The Department of State received a 35 (F) with transparency and 40 (F) without transparency for Maternal and Child Health in 2019. This grade was lowered by the implementation of the PLGHA policy through the 2019 PLGHA FAQs, which was responsive to need but not based in evidence or international human rights norms. None of the documents graded in this domain included gender transformative language. The grade was raised by the PEPFAR COP Guidance and the PEPFAR MER Indicators, which both emphasized the importance of integrating maternal and child health and HIV and AIDS services, particularly for pregnant and breastfeeding women (PBFW) and prevention of mother-to-child transmission (PMTCT) activities. The transparency grade for policies was lowered by the State and USAID Annual Performance Report and FY 2020 Annual Performance Plan, as this document did not clarify the role of the Department of State in maternal and child health programming. In the budget evaluation, the Department of State disbursed maternal and child health funds in accordance with country level maternal mortality.

US Agency for International Development

USAID received a 75 (C) with transparency and a 78 (C+) without transparency for the Maternal and Child Health domain in 2019. USAID was graded based on a number of Agency-level guidance documents, Agency Priority Goals for Maternal and Child Health, Automated Directive System (ADS) Chapters, and two Protecting Life in Global Health Assistance (PLGHA) FAQ documents. While these documents varied in their grades and most were responsive to need, they were not gender transformative and few were based in internationally recognized human rights norms. ADS Chapter 212, however, provided a much-needed update to USAID’s breastfeeding practices and was one of the few documents based in international human rights norms and guidance. The Agency Priority Goals for Maternal and Child Health and annual Acting on the Call report both lacked any explicit discussion of respectful maternity care, depicting a backslide from previous years where respectful maternity care was included in both documents.

USAID’s budget grade in this domain suggested that the Agency’s maternal and child health programs were not responsive to need, as a significant portion of maternal and child health funds disbursed in FY 2019 was not programmed in countries with the highest maternal mortality. Following a consultation with USAID in 2020, we have made minor adjustments to the methodology for the budget calculation for USAID’s Maternal and Child Health domain to most accurately reflect the appropriation of these funds. This change is reflected in the 2019 grades.

Department of Health and Human Services

HHS received a 59 (F) with transparency and a 68 (D+) without transparency for Maternal and Child Health in 2019. The four statements related to the U.S. government’s regressive stance on SRHR (including maternal and child health) shared by Alex Azar, U.S. Secretary of Health and Human Services, significantly decreased the HHS’s grade in this domain. The amount of disbursed funds for maternal and child health programs through HHS was not publicly available, which also contributed to the low transparency grade in this domain.

Department of Defense

The DoD does not receive a grade within the Maternal and Child Health domain because they do not work in international maternal and child health.

 

This is an average of the three domain scores below

Family Planning (FP)

The U.S. Government received a 61 (D-) with transparency and a 64 (D) without transparency for Family Planning across all actors in 2019. This grade reflected the continued harm to SRHR by the implementation of the PLGHA policy and the harm to SRHR caused by omitting family planning from key global health documents concerning women and girls by various actors. Similar to 2018, this grade was also harmed by insufficient family planning funding, the defunding of the United Nations Population Fund (UNFPA) due to an unsubstantiated Kemp-Kasten amendment violation in FY 2019, low transparency of policies by USAID, and family planning spending by USAID that was not responsive to need.

White House

The White House received a 48 (F) with transparency and a 52 (F) without transparency because of the defunding of UNFPA (due to an unsubstantiated Kemp-Kasten amendment violation in FY 2019) and low funding proposed for USAID’s family planning program in the President’s proposed budget. These budgetary determinations significantly hindered the ability of U.S. global health assistance to support comprehensive family planning programs. This grade was further influenced by the lack of any acknowledgment of family planning programming needs from the United States Strategy on Women, Peace, and Security. The transparency grade was also low in this domain because the White House website no longer uses filters or criteria to navigate the policies listed online.

Congress

Congress received a 71 (C-) with transparency and a 71 (C-) without transparency due to inadequate funding appropriated for Family Planning and high levels of transparency within policy and funding. These budgetary determinations hindered the ability of U.S. global health assistance to support comprehensive family planning programs that promoted SRHR. The Global Health Innovation Act neither hindered nor raised the grade within this domain.

Department of State

The Department of State received a 55 (F) with transparency and 61 (D-) without transparency for Family Planning in 2019. This grade was lowered by the implementation of the PLGHA policy through the 2019 PLGHA FAQs and the omission of family planning in the PEPFAR Annual Report to Congress. The grade was raised by the 2019 PEPFAR COP Guidance and the PEPFAR MER Indicator Reference Guide, both of which emphasized the importance of family planning and HIV integration. The transparency grade for policies was lowered by the State and USAID Annual Performance Report and FY 2020 Annual Performance Plan, as this document did not clarify the role of the Department of State in global family planning programming. In the budget evaluation, the Department of State largely disbursed family planning funds in accordance with unmet contraceptive need at the country level. However, access to family planning and contraception was severely impacted by the Department of State once again defunding the United Nations Population Fund (UNFPA) due to an unsubstantiated Kemp-Kasten amendment violation in FY 2019.

US Agency for International Development

USAID received a 73 (C) with transparency and a 76 (C) without transparency for the Family Planning domain in 2019. USAID was graded based on a number of Agency-level guidance documents, Agency Priority Goals for Maternal and Child Health, Automated Directive System (ADS) Chapters, and two PLGHA FAQ documents. While these documents varied in their grades and most were responsive to need, they were not gender transformative and few were based in internationally recognized human rights norms. Many of these documents also lacked explicit mention of family planning programs, which further reinforced the siloed nature of USAID’s global health programming. This was particularly evident in the annual Acting on the Call report, which did not describe the extent to which—if at all—family planning and maternal and child health activities were integrated within USAID-funded programs.

Furthermore, USAID’s budget grade in this domain suggested that the Agency’s family planning programs were not responsive to need, as a significant portion of family planning funds disbursed in FY 2019 was not programmed in countries with the highest total fertility rate. Following a consultation with USAID in 2020, we have made minor adjustments to the methodology for the budget calculation for USAID’s Family Planning domain to most accurately reflect the appropriation of these funds. This change is reflected in the 2019 grades.

Department of Health and Human Services

HHS does not receive a grade within the Family Planning domain because they do not work in international family planning.

Department of Defense

The DoD does not receive a grade within the Family Planning domain because they do not work in international family planning.