U.S. agencies implementing foreign assistance have individually and jointly developed strategies to guide their efforts. While State’s, USAID’s, and MCC’s strategies focus exclusively on foreign affairs or foreign assistance, DOD’s, HHS’s, and USDA’s strategies—as well as those of other agencies—address foreign assistance as part of larger portfolios of programs. State and USAID, which provide the majority of all foreign assistance, develop joint foreign assistance-related strategies. The State-USAID Joint Strategic Plan outlines top-level goals for State and USAID efforts, including the use of foreign assistance, to inform strategies developed by State and USAID bureaus, offices, and country teams. Six joint State-USAID regional strategies (e.g., the State Bureau of African Affairs–USAID Bureau for Africa Joint Regional Strategy) identify regional bureau priorities that are intended to align with the State-USAID Joint Strategic Plan and guide country-level planning for joint integrated country strategies. State, the lead U.S. foreign affairs agency, also develops strategies for its functional bureaus, which implement foreign assistance programs, and has participated in the development of a number of multisectoral and global strategies. State’s Office of U.S. Foreign Assistance Resources is responsible for coordinating foreign assistance programs, including providing strategic direction for both State and USAID. According to State documents, the Office of U.S. Foreign Assistance Resources strengthens the integration of foreign assistance with U.S. foreign policy priorities by guiding the development of coordinated strategic plans for each U.S. overseas mission at the country level (i.e., integrated country strategies), aiming for a holistic, whole-of-government approach. It provides tools and resources to assist bureaus, offices, and country teams in designing foreign assistance programs, projects, and processes that can help align with, and advance, broader strategic goals as well as monitoring and evaluation of progress and results. USAID, the lead U.S. foreign assistance agency, develops global, regional, and country strategies in the areas of health, democracy and human rights, water and sanitation, food security, education, poverty, and the environment, among others. MCC has developed one overall strategy document, related to its mission of reducing poverty through country-led economic growth. MCC also collaborates with stakeholders in and outside government to develop and implement foreign assistance programs. DOD performs security cooperation strategic planning, implementation, and oversight to achieve national defense strategy objectives. DOD also develops country-specific strategies for security cooperation and other assistance, including humanitarian assistance and efforts to build foreign partner security capacity. HHS has developed, or is a party to, a number of strategies related to global health, including strategies for specific diseases, such as HIV/AIDS, malaria, and Ebola, and for immunization and emergency preparedness. The Centers for Disease Control and Prevention (CDC), a component of HHS, develops its own strategies, which discuss CDC’s plans to combat infectious diseases worldwide. USDA has contributed to jointly issued strategies in food security related to two food aid programs that it administers—the Food for Progress program and the McGovern-Dole International Food for Education and Child Nutrition program. In addition, these agencies implement foreign assistance programs under the auspices of government-wide foreign assistance strategies developed by the National Security Council, the Executive Office of the President, and the Office of Management and Budget. These government-wide strategies include, for example, the National Security Strategy and the National Action Plan for Women, Peace, and Security. The geographic focus of these six agencies’ foreign assistance strategies ranges from country level to regional to global. For example, State, USAID, and DOD have developed integrated country strategies, country development cooperation strategies, and country cooperation plans, respectively, applicable to the countries where they implement foreign assistance. Similarly, State and USAID have six joint regional strategies and DOD has strategies focusing on its various geographic areas of command. In addition, various agencies, working both jointly and independently, have developed a wide variety of sectoral, multisectoral, agency-specific, and multi-agency strategies to guide global assistance efforts. Foreign assistance strategies are continuously developed and updated. Some strategies emerge after the launch of a specific initiative, such as the President’s Emergency Plan for AIDS Relief (PEPFAR), while others are updated as part of agencies’ strategic management processes. For example, State’s functional bureau strategies and its joint regional strategies with USAID are periodically updated as bureau-level components of State’s planning, budgeting, and performance management cycle. Planning at the agency level is reflected in the State- USAID Joint Strategic Plan, updated most recently in February 2018, with which bureau- and country-level strategies are expected to align. As we have previously reported, strategies that consider relationships among goals and objectives, interagency collaboration, and performance assessment can improve federal management. In particular, these considerations can help identify, eliminate, or better manage fragmentation, overlap, and duplication in the federal government. While many of the 52 foreign assistance strategies that we reviewed at least partially addressed the key elements we identified related to alignment of foreign assistance strategies, some did not address these elements. Regarding interagency coordination, 40 percent of the strategies generally identified roles and responsibilities for implementing the strategies, while 33 percent generally identified interagency coordination mechanisms; 23 percent and 38 percent, respectively, did not address these elements. Regarding strategic integration, 58 percent of the strategies we reviewed described linkages with U.S. foreign assistance strategies in the same sector and 54 percent generally described linkages with relevant higher- or lower-level U.S. foreign assistance strategies; 21 percent and 25 percent, respectively, did not identify such linkages. Regarding assessment of progress toward strategic goals, almost all of the strategies generally established desired results and a framework of goals and objectives and described activities to achieve results; however, 21 percent did not identify milestones or performance indicators and 21 percent did not outline plans for monitoring and evaluation. We also found that the six agencies implementing most U.S. foreign assistance do not have consistent guidance for strategy development that could help ensure their strategies address the key elements we identified. On the basis of our prior reporting about U.S. government strategic planning and interagency collaboration, we identified nine key elements that are important for helping to ensure that agencies’ foreign assistance strategies are well aligned in terms of implementation approach and desired results and that planning among multiple agencies is not fragmented. The nine elements we identified are associated with (1) interagency coordination, (2) strategic integration, and (3) assessment of progress toward strategic goals (see table 1). As we have previously reported, fragmentation in the U.S. government refers to circumstances in which multiple federal agencies are involved in serving the same broad area of national need and opportunities exist to improve service delivery. Implementing foreign aid involves the collaborative efforts of multiple U.S. agencies, each of which brings specific contributions and statutory authorities and has its own organizational structure, culture, and priorities. Our prior work has shown that foreign assistance strategies that consistently address (1) agencies’ roles and responsibilities and (2) interagency coordination mechanisms can help guide the implementation of various aspects of a strategy and the identification of agreed-on processes for effective collaboration to resolve conflicts and better manage fragmentation. Strategies that do not consistently address elements related to interagency coordination miss opportunities to ensure that agencies’ roles and responsibilities are clear and distinct and that coordination mechanisms are well defined. As figure 1 shows, of the 52 strategies we reviewed, 40 percent generally identified agencies’ roles and responsibilities and 23 percent did not address this element. In addition, while 33 percent generally identified interagency coordination mechanisms, 38 percent did not identify any such mechanisms. Agencies’ roles and responsibilities. Forty percent (21 of 52) of the strategies we reviewed generally defined agencies’ roles and responsibilities. For example, USAID’s Strategy on Democracy, Human Rights and Governance identified all agencies involved in its implementation and laid out the roles and responsibilities of each agency as well as USAID offices. Thirty-seven percent (19 of 52) of the strategies partially defined agencies’ roles and responsibilities, which suggests the potential for improvement in this area. For example, State-USAID joint regional strategies identified the partners and stakeholders and enumerated the activities that State and USAID or the embassy and missions would undertake. However, most of those strategies did not specify the individual agencies’ roles and responsibilities. Twenty-three percent (12 of 52) of the strategies contained no information about agencies’ lead, support, and partner roles. Interagency coordination mechanisms. Thirty-three percent (17 of 52) of the strategies we reviewed generally identified interagency coordination mechanisms. For example, USAID’s Multi-Sector Nutrition Strategy identified joint planning, funding, and programming mechanisms for coordination among development and humanitarian assistance agencies at country and regional levels in USAID and the U.S. government as a whole. Twenty-nine percent (15 of 52) of the strategies partially identified coordination mechanisms. For example, CDC’s Global Health Strategy and USAID’s Global Health Strategic Framework both described the agencies’ respective unique roles in global health but did not specifically discuss how the agencies would work together to achieve their goals. Thirty-eight percent (20 of 52) of the strategies did not discuss interagency coordination mechanisms. As our prior work has shown, agencies that establish strategies that align with partner agencies’ activities, processes, and resources are better positioned to accomplish common goals, objectives, and outcomes. Our prior work has also determined that collaboration among federal agencies working toward similar results can help ensure consistent goals and mutually reinforcing program efforts that effectively manage fragmentation. These agencies can use higher-level strategic plans as a tool to drive interagency collaboration to ensure complementarities in goals and objectives. To improve alignment of related strategies, each strategy should address (1) integration with relevant sectoral strategies and (2) integration with relevant higher- or lower-level strategies. Strategies that do not consistently address elements related to strategic integration do not clearly show whether objectives and activities align with existing strategic priorities at the government-wide, sectoral, regional, and country levels. As figure 2 shows, 58 percent of the strategies we reviewed generally described linkages with at least one relevant sectoral strategy, while 21 percent did not mention such linkages at all. In addition, 54 percent of the strategies generally described linkages with at least one higher- or lower-level foreign assistance strategy, while 25 percent did not describe any such linkages. Integration with relevant sectoral strategies. Fifty-eight percent (30 of 52) of the strategies we reviewed generally identified or described linkages with other, related U.S. government strategies. For example, State’s Strategy for Women’s Economic Empowerment discussed how its activities are designed to complement and reinforce those of the U.S. National Action Plan on Women, Peace and Security, the U.S. Strategy to Prevent and Respond to Gender-Based Violence Globally, and the U.S. Global Strategy to Empower Adolescent Girls. About 21 percent (11 of 52) of the strategies we reviewed partially addressed this element. For example, the strategy PEPFAR 3.0—Controlling the Epidemic: Delivering on the Promise of an AIDS-Free Generation explicitly referred to the PEPFAR Blueprint for Creating an AIDS-Free Generation and stated that targeting interventions for populations at greatest risk for HIV incidence is an important activity. However, the strategy did not discuss how its goals and objectives relate to the strategies of the various agencies implementing PEPFAR and did not refer to the other strategies pertaining to PEPFAR. The remaining 21 percent (11 of 52) of strategies did not mention any other relevant U.S. government strategies. (See app. II for additional analysis of strategies by sector.) Integration with relevant higher- or lower-level strategies. Fifty-four percent (28 of 52) of the strategies we reviewed generally described their relationship to relevant strategies at higher or lower levels of government. For example, the U.S. Global Strategy to Empower Adolescent Girls discussed its relationship to a policy framework that, according to the strategy, is embodied in three higher-level strategies establishing gender equality as an important element of U.S. foreign policy—the National Security Strategy, the U.S. Global Development Policy, and the Quadrennial Diplomacy and Development Review. About 21 percent (11 of 52) of the strategies we reviewed partially addressed this element— that is, they discussed their relationship with higher- or lower-level strategies in a limited way. For example, the U.S. Government Approach on Business and Human Rights discussed priorities outlined in the National Security Strategy, aligning activities of business with those priorities, and noted efforts by State’s Bureau of Democracy, Human Rights, and Labor to discuss human rights with businesses. However, the U.S. Government Approach on Business and Human Rights did not reference common goals or activities outlined in other relevant higher- level strategies, such as the U.S. Global Development Policy or the Quadrennial Diplomacy and Development Review. The remaining 25 percent (13 of 52) of strategies did not address their relationship with strategies at other levels of government. Our prior work has shown that effective strategies clearly identify goals and objectives and a means for assessing progress in achieving them and that alignment of strategies and other plans can improve the management of fragmentation. Therefore, our prior work has called for agencies to develop strategies that identify and describe (1) desired results, (2) activities to achieve results, (3) a hierarchy of goals and subordinate objectives, (4) milestones and indicators, and (5) plans for monitoring and evaluation. Strategies that do not consistently address elements related to assessing progress may limit agencies’ ability to specify and assess common goals and objectives and mutually reinforcing results. As figure 3 shows, most of the strategies we reviewed generally identified desired results, activities to achieve those results, and a hierarchy of goals and subordinate objectives. However, fewer strategies addressed how progress toward those goals and objectives would be assessed. In particular, 63 percent generally identified milestones and performance indicators, while 21 percent did not address this element. In addition, 42 percent of the strategies generally outlined plans for monitoring and evaluation, while 21 percent did not outline such plans. Desired results, activities to achieve results, and hierarchy of goals and objectives. Ninety-two percent (48 of 52) of the strategies we reviewed generally included a statement of desired results, and 90 percent (47 of 52) generally included a description of activities to achieve these results. For example, MCC’s Next: A Strategy for MCC’s Future stated the agency’s overall mission of reducing poverty through economic growth and listed priority actions for each goal, such as exploring new data sources for accurately identifying countries with high poverty rates. In addition, about 83 percent (43 of 52) of the strategies generally included a hierarchy of strategic goals and subordinate objectives. For example, CDC’s Global Health Strategy included a clear hierarchy of goals and subordinate objectives (see table 2). Six percent (3 of 52) of the strategies did not identify desired results, 2 percent (1 of 52) did not describe activities to achieve these results, and 10 percent (5 of 52) did not include a hierarchy of goals and objectives. Milestones and performance indicators. Sixty-three percent (33 of 52) of the strategies we reviewed generally included milestones or performance indicators. These strategies often incorporated milestones or indicators as discrete components of each goal or subordinate objective. For example, DOD’s Kenya Country Cooperation Plan tracked discrete tasks with specific time frames, using color-coding to designate stages of implementation. Fifteen percent (8 of 52) of the strategies partially addressed milestones or indicators. For example, the 2016 updated joint State-USAID Strategy to Prevent and Respond to Gender-Based Violence Globally included an annex listing indicators but did not link them to the strategic objectives and planned actions. Twenty- one percent (11 of 52) of the strategies did not include any milestones or performance indicators. Monitoring and evaluation plans. Forty-two percent (22 of 52) of the strategies we reviewed generally outlined monitoring and evaluation plans. These strategies typically outlined such plans in a specific goal or in a designated section or appendix. For example, USAID’s Kenya Country Development Strategy included a section on monitoring and evaluation planning. In this strategy, USAID committed to host donor coordination and other stakeholder forums to monitor progress and to establish a monitoring and evaluation “core team” to ensure that learning is incorporated in decision making. Thirty-seven percent (19 of 52) of the strategies partially addressed monitoring and evaluation planning. Some of these strategies emphasized the importance of monitoring and evaluation or made broad statements without outlining more specific plans. For example, the State-USAID Joint Strategy on Countering Violent Extremism noted that State and USAID will develop a results framework for measuring progress that will be accompanied by clear, well-developed, and well-resourced monitoring and evaluation plans. The strategy also noted that State and USAID will, to the extent possible, develop a common set of indicators to measure outputs and outcomes. However, the strategy provided no additional details. Twenty-one percent (11 of 52) of the strategies did not outline any monitoring and evaluation plans. The six agencies implementing most of U.S. foreign assistance do not have consistent guidance for strategy development that could help ensure their strategies address the key elements we identified. For example, State and USAID guidance for strategy development includes many of these elements but does not cover all strategies that these agencies are involved in developing. Additionally, guidance for State’s and USAID’s joint regional strategies, State’s functional bureau strategies, and USAID’s country development cooperation strategies does not apply to other State and USAID strategies, such as the joint State-USAID integrated country strategies. DOD has also established guidance for developing security assistance programs that addresses the key elements we identified. However, DOD’s guidance does not explicitly apply to the development of foreign assistance strategies. HHS, MCC, and USDA have not established any guidance on foreign assistance strategy development. Inconsistent guidance for developing foreign assistance strategies has contributed to variations in the strategies’ addressing the key elements we identified related to interagency coordination, strategic integration, and assessing progress toward strategic goals. Existing government-wide guidance requires agencies to address some of the key elements of assessment of progress toward strategic goals that we identified as being important for ensuring alignment of agencies’ foreign assistance strategies. In January 2018, the Office of Management and Budget issued new guidance for agencies that administer foreign assistance that includes some of the elements we used to assess the strategies we reviewed. For example, the guidance recommends that agencies ensure their programs have clear goals and objectives, align their programs with higher-level strategies or objectives, and plan for monitoring and evaluation while developing policies and strategies. In addition, the Government Performance and Results Act, as amended, requires agencies to submit strategic plans for program activities that include general goals and objectives for the major functions and operations of the agency, a description of how the goals are to be achieved, and a description and schedule of program evaluations. The act’s provisions were among the sources we used to develop the desirable characteristics from which we derived the key elements we identified. However, according to officials of State’s Office of U.S. Foreign Assistance Resources, there is no government-wide guidance that incorporates interagency coordination, strategic integration, and assessment of progress toward strategic goals into the interagency strategic planning process. In addition, the officials stated that there is no overarching review mechanism for strategies outside of the core strategic planning process for joint State-USAID strategies. According to State officials, State’s Office of U.S. Foreign Assistance Resources plays a significant role in promoting interagency coordination by convening roundtables and working groups. By collaborating with the five other agencies that implement most of U.S. foreign assistance to establish guidance for developing foreign assistance strategies, the office could help the agencies ensure that future strategies address the key elements we identified. Consistent guidance for strategy development could help the agencies align their strategies and better identify and manage fragmentation in foreign assistance planning. U.S. foreign assistance often involves multiple agencies or a whole-of- government approach. Alignment of related foreign assistance strategies can help agencies better identify and manage fragmentation. Moreover, consistently addressing the key elements we identified related to interagency coordination, strategic integration, and assessment of progress toward strategic goals can help ensure that strategies provide a clear and comprehensive picture of alignment. Several of the six largest providers of U.S. foreign assistance in the three sectors we reviewed have not issued consistent guidance for foreign assistance strategy development that incorporates these key elements. For example, some agencies have issued guidance that addresses many of the key elements we identified related to interagency coordination, strategic integration, and assessment of progress toward strategic goals, but this guidance does not apply to all of these agencies’ strategies. State’s Office of Foreign Assistance Resources leads interagency strategic planning for the implementation of foreign assistance. This office—which has responsibility for, and experience in, promoting coordination among agencies involved in foreign assistance—is uniquely placed to collaborate with other agencies implementing foreign assistance to establish guidance for developing foreign assistance strategies that addresses the key elements we identified. Such guidance would improve the agencies’ ability to align future strategies and to identify and manage fragmentation in foreign assistance planning. We are making the following recommendation to the Department of State: The Secretary of State should ensure that the Director of the Office of U.S. Foreign Assistance Resources leads an effort to establish, in collaboration with the five other agencies that implement most of U.S. foreign assistance, guidance for strategy development that addresses the key elements we identified related to interagency coordination, strategic integration, and assessment of progress toward strategic goals. (Recommendation 1) We provided a draft of this report to State, USAID, MCC, DOD, HHS, and USDA for review and comment. We received substantive comments from State, USAID, and MCC, which are reprinted in appendixes IV through VI, respectively. In addition, we received technical comments from HHS, which we incorporated as appropriate. State, USAID, MCC, USDA, and DOD did not provide technical comments about our draft report. In their substantive comments, State and MCC concurred with our recommendation. USAID’s comments expressed support for our goal of strengthening interagency coordination, strategic integration, and assessment of progress across the federal departments and agencies that implement U.S. foreign assistance. However, USAID suggested that we issue our recommendation to the National Security Council or address it jointly to State and USAID. We believe that our recommendation is appropriately addressed to State, given the responsibility of State’s Office of U.S. Foreign Assistance Resources for coordinating foreign assistance programs, including providing strategic direction for both State and USAID. We are sending copies of this report to the appropriate congressional committees and to the Secretaries of Agriculture, Defense, Health and Human Services, and State; the Chief Executive Officer of MCC; and the Administrator of the USAID. In addition, the report will be available at no charge on GAO’s website at http://www.gao.gov. If you or your staff have questions about this report, please contact me at (202) 512-3149 or gootnickd@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. GAO staff who made major contributions to this report are listed in appendix VII. This report examines the extent to which foreign assistance strategies address key elements that we identified related to alignment of agencies’ efforts—specifically, elements related to (1) interagency coordination, (2) strategic integration, and (3) assessment of progress toward strategic goals. We focused on the six agencies that administer the largest amounts of foreign assistance, according to fiscal year 2016 obligations data: the Departments of Agriculture (USDA), Defense (DOD), Health and Human Services (HHS), and State (State); the Millennium Challenge Corporation (MCC); and the U.S. Agency for International Development (USAID). We limited our review to foreign assistance strategies that were in effect during 2017. We further focused on strategies relating to health, security, and democracy assistance, which account for the majority of total foreign assistance obligations, according to fiscal year 2016 data. We excluded strategies for other assistance sectors, such as counternarcotics and other law enforcement activities that require interagency coordination with domestically focused agencies outside the scope of our review, such as the Departments of Homeland Security and Justice. To identify the strategies for this review, we asked the six agencies to update a list of 63 government-wide, agency, multi-agency, regional, sector-specific, and multisectoral strategies that they had provided for a related report that we published in June 2017. We also asked the agencies to provide country-level strategies for Afghanistan and Kenya, two of the largest recipients of U.S. security and development assistance, based on fiscal year 2016 obligations data. We obtained and initially reviewed 72 strategies, which included the 63 strategies we identified for the June 2017 report; 6 country-level strategies for Afghanistan and Kenya; and 3 updated strategies covering national security, the President’s Emergency Plan for AIDS Relief, and water and sanitation. We determined that 52 of these 72 strategies incorporated goals or activities related to health, security, or democracy assistance (see fig. 4). These 52 strategies, which had been issued by December 2017 and were current in that year, include 44 of those listed in our June 2017 report and 8 of those subsequently identified by the agencies. We reviewed the 52 strategies to determine the extent to which they addressed nine key elements we identified relating to the alignment of multiple strategies. We identified these nine elements by reviewing prior reports focused on foreign assistance in the security sector that assessed the quality of various U.S. government strategies; articulated practices for enhancing collaboration among federal agencies; or discussed fragmentation, overlap, and duplication among government programs. Those reports identified six desirable characteristics for government-wide strategies and practices for enhancing agency collaboration. For the purposes of this report, we selected three of these characteristics, related to interagency coordination, strategic integration, and assessment of progress toward strategic goals. We excluded three characteristics— purpose, scope, and methodology; detailed discussion of problems, risks, and threats; and description of future costs and resources needed— because we did not consider them to be directly related to alignment of strategies. The three characteristics we included comprised 15 elements, 9 of which we considered to be directly related to the alignment of health, security, and democracy assistance sector strategies across multiple agencies. We excluded 6 elements—for example, potential changes to structure and details on subordinate strategies and plans for implementation (e.g., enterprise architecture)—that we did not consider to be directly related to this topic. We reviewed the selected strategies using NVivo, a qualitative data analysis software package. For each strategy, two reviewers, including at least one with expertise in the area of foreign assistance addressed by each strategy, independently identified text related to each of the key elements we had identified. We used a standardized set of criteria in an assessment instrument to consistently judge whether each strategy sufficiently addressed these elements. This instrument contained evaluative questions intended to gauge the presence of each element— for example, “To what extent does the strategy address the agencies involved and their roles and responsibilities?”. Given the variety of strategies we reviewed and reviewers’ varying expectations for the detail and emphasis accorded the key elements we had identified, we rated the strategies using a three-part scale focused on the presence of these elements. We rated a strategy as generally addressing an element if the strategy provided sufficient detail to understand the element in that strategy; as partially addressing an element if the strategy mentioned it but lacked sufficient detail; and as not addressing an element if the strategy did not mention it. The two reviewers for each strategy independently documented their judgments on the extent to which the strategy addressed the key elements we had identified. Our initial coding shows that the reviewers agreed in about 78 percent (363 of 468) of these initial judgments. The reviewers reconciled their judgments, with resolution of differences split roughly evenly between accepting the higher and lower of the initial ratings. A supervisor reviewed each set of ratings for internal consistency. The supervisor related any identified issues, as appropriate, to the reviewers, who addressed them before the supervisor recorded the review as final. We examined these strategies and any appendixes included in the documents that the agencies submitted, because these strategic documents should broadly describe objectives and efforts—including interagency coordination, strategic integration, and assessment of progress toward strategic goals—needed to achieve them. We did not review agencies’ efforts to implement the strategies and did not assess the overall effectiveness of such efforts. Instead, we focused on the extent to which the strategies we reviewed provided a clear picture of the organization and management of U.S. foreign assistance efforts. To measure the extent of strategies’ integration with other relevant sectoral strategies and with higher- and lower-level strategies, we performed a word search for references to the other selected strategies in the same sector and to other strategies or sets of strategies (e.g., regional or country-level strategies) that we classified as either higher- or lower-level strategies. We searched for such references in each of the 14 strategies that we classified as covering the health sector, the 12 strategies that we classified as covering the security sector, and the 8 strategies that we classified as covering the democracy assistance sector. See appendix III for the results of this analysis. We also reviewed agency guidance related to foreign assistance strategies. We requested current versions of any relevant documentation from each of the six agencies. State provided us with agency guidance for developing its functional bureau strategies and joint State-USAID regional strategies as well as a related template. State also provided guidance documents related to its monitoring and evaluation policy and performance management. USAID provided strategic planning and implementation guidance for its country development and cooperation strategies. HHS, USDA, and MCC did not provide—and, according to agency officials, do not have—specific guidance related to what constitutes a foreign assistance strategy. DOD provided guidance for developing security assistance programs. We conducted this performance audit from May 2017 to July 2018 in accordance with generally accepted government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe that the evidence obtained provides a reasonable basis for our findings and conclusions based on our audit objectives. The following list shows the 52 foreign assistance strategies that we reviewed. 1. Quadrennial Diplomacy and Development Review: Enduring Leadership in a Dynamic World (2015) 2. U.S. Global Development Policy (Sept. 22, 2010) 3. State-USAID Joint Strategic Plan FY2014-2017 (Mar. 17, 2014) 4. State Department, Office of U.S. Foreign Assistance Resources (F), Functional Bureau Strategy (2016) 5. Millennium Challenge Corporation, NEXT: A Strategy for MCC’s Future (Feb. 24, 2016) 6. USAID Multi-Sectoral Nutrition Strategy 2014-2025 (May 2014) Regional strategies (not specific to any single sector) 7. State Bureau of East Asian and Pacific Affairs/USAID Bureau for Asia Joint Regional Strategy (approved May 24, 2016) 8. State Bureau of African Affairs/USAID Bureau for Africa Joint Regional Strategy (approved Apr. 5, 2016) 9. State Bureau of Near Eastern Affairs/USAID Bureau for Middle East Joint Regional Strategy, FY 2016-2018 10. State Bureau of European and Eurasian Affairs/USAID Bureau for Europe and Eurasia Joint Regional Strategy, FY 2015-2018 (approved April 2015) 11. State Bureau of Western Hemisphere Affairs/USAID Bureau for Latin America and the Caribbean Joint Regional Strategy, FY 2015-2018 12. State and USAID Joint Regional Strategy for South and Central Asia, and Afghanistan and Pakistan, FY 2015-2018 (June 2014) 13. PEPFAR: Strategy for Accelerating HIV/AIDS Epidemic Control 2017- 2020 (September 2017) 14. 2016-2020 CDC Strategic Framework for Global Immunization (May 2016) 15. “U.S. Government Strategy for Reducing Transmission of the Ebola Virus Disease in West Africa” (draft strategy, Sept. 30, 2015) 16. President’s Malaria Initiative Strategy 2015-2020 (April 2015) 17. President’s Emergency Plan for AIDS Relief (PEPFAR) Human Resources for Health Strategy PEPFAR 3.0 (February 2015) 18. CDC Division of Parasitic Diseases and Malaria Strategic Priorities 19. The Global Strategy of the U.S. Department of Health and Human Services (2015-2019) 20. State Department, Office of the U.S. Global AIDS Coordinator, 21. PEPFAR 3.0 Controlling the Epidemic: Delivering on the Promise of an AIDS-Free Generation (December 2014) 22. HHS Strategic Plan, 2014-2018 (updated March 10, 2014) 23. HHS Assistant Secretary for Preparedness and Response Strategic Plan (February 2014) 24. PEPFAR Blueprint: Creating an AIDS-Free Generation (November 2012) 25. USAID’s Global Health Strategic Framework: Better Health for 26. CDC Global Health Strategy 2012-2015 (June 29, 2012) 27. National Security Strategy of the United States of America (December 2017) 28. State Bureau of Political-Military Affairs, Office of Weapons Removal and Abatement, Conventional Weapons Destruction Strategic Plan, 2017-2019 29. Department of Defense Guidance for Security Cooperation (Aug. 29, 2016) 30. Department of State & USAID Joint Strategy on Countering Violent Extremism (May 2016) 31. State Department, Arms Control, Verification and Compliance, Functional Bureau Strategy (approved December 2015) 32. State Bureau of Political-Military Affairs, Office of Plans & Initiatives, Peace Operations Capacity Building Division, U.S. Global Peace Operations Initiative Strategy: Strengthening the Effectiveness of United Nations and Regional Peace Operations (October 2015) 33. National Security Strategy (February 2015) 34. State Department, Bureau of International Security and Nonproliferation, Functional Bureau Strategy, FY 2015-2018 (January 2015) 35. State Department, Bureau of Political-Military Affairs, Functional Bureau Strategy, FY 2015-2018 (January 2015) 36. State Department, Bureau of Counterterrorism, Functional Bureau Strategy, FY 2015-2017 (January 2015) 37. National Strategy for Counterterrorism (June 2011) 38. Security Sector Reform (February 2009) 39. State Department, The Secretary’s Office of Global Women’s Issues, Functional Bureau Strategy (approved Mar. 27, 2017) 40. United States Strategy to Prevent and Respond to Gender-based Violence Globally (June 2016) 41. United States National Action Plan on Women, Peace, and Security (June 2016) 42. U.S. Department of State Strategy for Women’s Economic Empowerment (June 2016) 43. United States Global Strategy to Empower Adolescent Girls (March 2016) 44. State Department, Bureau of Democracy, Human Rights, and Labor, Functional Bureau Strategy, FY 2015-2018 (approved 2014) 45. U.S. Government Approach on Business and Human Rights (2013) 46. USAID Strategy on Democracy, Human Rights and Governance (June 2013) Country strategies (for Afghanistan) 47. Department of Defense, Enhancing Security and Stability in Afghanistan. Report to Congress in Accordance With Section 1225 of the Carl Levin and Howard P. “Buck” McKeon National Defense Authorization Act for Fiscal Year 2015 (P.L. 113-291), as Amended (June 2017) 48. USAID Afghanistan Plan for Transition 2015-2018 (Jan. 6, 2016) 49. State/USAID Integrated Country Strategy: Afghanistan (February 2015) Country strategies (for Kenya) 50. State/USAID Integrated Country Strategy: Kenya (approved Feb. 1, 2017) 51. DOD/USAFRICOM: Kenya Country Cooperation Plan FY 2017-2021 (Nov. 8, 2016) 52. USAID Kenya Country Development Cooperation Strategy 2014-2018 (May 2014) Our analysis of strategies we reviewed in the health, security, and democracy assistance sectors found inconsistency in the extent to which the strategies addressed selected, or key, elements that we identified related to interagency coordination, strategic integration, and assessment of progress toward strategic goals. As figure 5 shows, about 30 percent (4 of 14) of the strategies in the health sector and about 17 percent (2 of 12) in the security sector generally identified interagency coordination mechanisms, while about 33 percent (4 of 12) in the security sector addressed agencies’ roles and responsibilities. In contrast, 75 percent (6 of 8) of the strategies in the democracy assistance sector generally addressed interagency coordination mechanisms and 63 percent (5 of 8) addressed agencies’ roles and responsibilities. As figure 6 shows, in the health sector, 50 percent (7 of 14) of the strategies generally addressed their relationship with at least one other strategy in the same sector and about 43 percent (6 of 14) generally addressed their relationship with at least one higher- or lower-level strategy. In the security sector, about 58 percent (7 of 12) of the strategies generally addressed their relationship with at least one other strategy in the same sector and their relationship with at least one higher- or lower-level strategy. In the democracy assistance sector, about 75 percent (6 of 8) of the strategies we reviewed generally addressed their relationship with at least one other strategy in the same sector, while about 63 percent (5 of 8) generally addressed their relationship with at least one higher- or lower-level strategy. Figures 7, 8, and 9 show the strategies in the health, security, and democracy assistance sectors, respectively, that refer to higher- and lower-level strategies as well as to other strategies in the same sector. As figure 10 shows, most strategies in the health, security, and democracy assistance sectors generally identified desired results, a hierarchy of goals and subordinate objectives, and activities to achieve results. However, strategies in all three sectors were less consistent in identifying milestones and performance indicators. Specifically, 57 percent (8 of 14) of health sector strategies, 50 percent (6 of 12) of security sector strategies, and 50 percent (4 of 8) of democracy assistance strategies generally addressed this element. In addition, while 71 percent (10 of 14) of strategies in the health sector outlined plans for monitoring and evaluation, 17 percent (2 of 12) of security sector strategies and 50 percent (4 of 8) of democracy assistance sector strategies generally addressed this element. In addition to the contact named above, James Michels (Assistant Director), Gergana Danailova-Trainor (Analyst-in-Charge), Timothy Young, Kay Halpern, Steven Putansu, Mona Sehgal, Drew Lindsey, Judith Williams, Leslie Holen, Ming Chen, Aniruddha Dasgupta, Mark Dowling, Giff Howland, Neil Doherty, and Reid Lowe made key contributions to this report.

Summary: More than 20 federal agencies spend billions of dollars on U.S. foreign assistance each year. Six agencies—the Departments of Agriculture, Defense, Health and Human Services, and State; the Millennium Challenge Corporation; and the U.S. Agency for International Development—implement most of this assistance, using multiple strategies. State is responsible for coordinating their efforts. Questions have been raised about potential inefficiencies in implementing multiple foreign assistance strategies. GAO was asked to review the alignment of U.S. foreign assistance strategies. This report examines the extent to which strategies include key elements GAO identified, related to interagency coordination, strategic integration, and assessment of progress, that help ensure alignment. These elements are based on GAO's prior work on strategic planning and interagency collaboration. GAO reviewed 52 strategies related to health, security, and democracy assistance that were current in 2017. These included government-wide, agency, multi-agency, and regional strategies as well as strategies for two countries. GAO also reviewed agency guidance and interviewed agency officials. Many foreign assistance strategies related to health, security, and democracy assistance that GAO reviewed at least partially addressed key elements GAO identified that help ensure the strategies are aligned. Prior work has found that consistently addressing these elements, related to interagency coordination, strategic integration, and assessment of progress, is important for, among other things, better managing fragmentation in strategic planning. However, some strategies did not address these elements (see figure). For example: Interagency coordination . Twenty-three percent of the strategies (12 of 52) did not address agencies' roles and responsibilities, and 38 percent (20 of 52) did not identify specific interagency coordination mechanisms. Strategic integration . Twenty-one percent of the strategies (11 of 52) did not address linkages with other related strategies, and 25 percent (13 of 52) did not address linkages with higher- or lower-level strategies. Assessment of progress toward strategic goals . Twenty-one percent of the strategies (11 of 52) did not include milestones and performance indicators, and 21 percent (11 of 52) did not outline plans for monitoring and evaluation. The six agencies implementing most U.S. foreign assistance do not have consistent guidance for strategy development that could help ensure their strategies address these key elements. Some agencies' guidance addresses many of the elements but does not apply to all of their foreign assistance strategies, while other agencies have no such guidance. The Department of State (State) plays a significant role in interagency coordination. By collaborating with other agencies to establish guidance that addresses the key elements GAO identified, State could help the agencies improve their ability to align future strategies and identify and manage fragmentation in foreign assistance planning. GAO recommends that State lead an effort to establish, in collaboration with the five other agencies, guidance for developing foreign assistance strategies that addresses the key elements GAO identified related to interagency coordination, strategic integration, and assessment of progress. State concurred with GAO's recommendation.