Table 1

Describing the impact of the PLGHA

Category of impact	Indicator of impact	Components	Method of verification/source of data
Financial and organisational	Organisational funding loss attributed to PLGHA	Discontinuation of previous USG global health assistance funded projects and the financial impact on: Prime recipients Sub-recipients Public sector, private sector, other NGOs receiving support from prime recipients or subrecipients	Comparison of pre-PLGHA and post-PLGHA operating budgets Interviews with financial managers of each entity
	Decreases in reproductive healthcare funding in a given country	Amount of funding for reproductive health in a given country pre-PLGHA and post-PLGHA, and comparison of activities funded under this rubric	Interviews with USAID mission staff and comparison of funding amounts Interviews with current FP grantees Interviews with past FP grantees
	Proportion of PLGHA funding loss recovered from other sources	New grants to non-certifying organisations explicitly intended to support activities previously supported by USG global health assistance	Interviews with non-certifying organisations Interviews with donors seeking to ‘replace’ funding and/or mitigate harm
	Funding required to meet the organisational burdens of understanding and complying with the policy	Additional time and money spent by complying organisations on legal counsel, management and other services to ensure compliance, and/or to mitigate harm Time and money spent by non-complying organisations to learn whether certain USG grants are going to be subject to PLGHA	Interviews with certifying organisations at country and headquarters levels Interviews with non-certifying organisations at country and HQ levels
	Number of funding opportunities missed because of PLGHA	Bids that non-certifying organisations declined to apply for that they otherwise would have	Interviews with organisations that funded USG global health assistance before PLGHA, or that report they were interested in receiving USG global health assistance
	Number of staff terminated due to PLGHA	Project-specific staff who lost their jobs following discontinuation of previously USG global health assistance funded projects	Interviews with non-certifying organisations
Health Services	Changed availability of SRH and non-SRH services	Number, type and scope of activities or interventions curtailed by PLGHA, and extent to which these are ‘replaced‘ by GGR-compliant activities Number of clinics closed due to PLGHA Number of mobile outreach efforts closed due to PLGHA and number of new efforts launched by replacement projects Changes in out-of-pocket costs for SHR services (both formal and informal fees)	Publicly available data on USG global health assistance grantees Interviews with USAID mission staff Interviews with certifying and non-certifying organisations Annual reports Interviews with clients Interviews with providers Review of MOH and clinic policies regarding costs
Health Services	Changes in number of clients served by USG global health assistance funded projects in SRH and in non-SRH	Number of clients previously served by curtailed services Number of clients served by replacement services	Service delivery statistics from certifying organisations Service delivery statistics from non-certifying organisations previously funded by USG global health assistance Health Management Information System data
National Public Health Coordination	Changes in SRH and other coordination mechanisms at national and subnational levels	Number of meetings Number of platforms/forums Content of discussion Stability in organisations actively participating in SRH and other coordination mechanisms	Meeting minutes Interviews with current and past meeting participants
Global level policy-making coordination	Changes in SRH and other coordination mechanisms at global and regional levels	Number of meetings Number of platforms/forums Content of discussion Stability in organisations actively participating in SRH and other coordination mechanisms	Meeting minutes Interviews with current and past meeting participants
Health impacts	Changes in population coverage of essential services Changes in health outcome indicators	Population coverage of HIV testing; prevention of vertical transmission; cervical cancer screening; modern FP; including method mix; safe abortion care; PAC; TB testing; emergency obstetric care; essential childhood vaccination; and other services as relevant Mortality attributable to unsafe abortion; proportion of pregnancies that are unwanted; incidence of childhood stunting and wasting; and other indicators as relevant	Representative household surveys Secondary analysis of existing surveys Measure of exposure to PLGHA
Impacts on other social and educational services	Changes in population coverage of essential services Changes in outcome indicators	Population coverage of education, clean water and other services as relevant Relevant outcome indicators	Representative household surveys Secondary analysis of existing surveys Measure of exposure to PLGHA

This table provides a framework for possible impact, not necessarily a roadmap for research. It is not a comprehensive list of possible indicators. These are cross-sectional, so attribution would be easier with at least two time points for many of the indicators (pre-PLGHA and post-PLGHA). Moreover, it may not be possible to collect accurate information for all of these indicators, including because the data do not exist, because of validity and bias challenges with interviewing, and because of concern about discussing abortion. Finally, even if the data are all available and accurate, attribution to the PLGHA will require careful triangulation.
FP, family planning; MOH, Ministry of Health; NGO, non-governmental organisation; PAC, postabortion care; PLGHA, Protecting Life in Global Health Assistance; SRH, sexual and reproductive health; TB, tuberculosis; USAID, US Agency for International Development; USG, US government.