Here in CARE International’s Evaluation e-Library we make all of CARE’s external evaluation reports available for public access in accordance with our Accountability Policy.

With these accumulated project evaluations CARE International hopes to share our collective knowledge not only internally but with a wider audience.

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Fast and Fair Vaccine Update August to October 2021

CARE's Fast and Fair initiative supports countries to equitably deliver COVID-19 vaccines through four pillars: Advocate, Facilitate, Protect and Mobilize.
CARE has identified 22* countries (and counting ) with strong capacity, partnerships, and readiness to scale.
By October 2021, CARE has supported vaccines in districts where 126 million people have delivered vaccines. We have also supported mass media messages promoting vaccines to 263 million people. Read More...

Our Best Shot: Frontline Health Workers and COVID-19 Vaccines

Fully realizing the social and economic benefits of halting COVID-19 requires investing in a fast and fair global rollout of COVID-19 vaccines. CARE estimates that for every $1 a country or donor government invests in vaccine doses, they need to invest $5.00 in delivering the vaccine.

Investments in frontline health workers are a critical component in this comprehensive vaccination cost. Of the $5.00 in delivery costs, $2.50 has to go to funding, training, equipping, and supporting health workers—especially women—who administer vaccines, run education campaigns, connect communities to health services, and build the trust required for patients to get vaccines. For these investments to work, they must pay, protect and respect women frontline health workers and their rights—a cost that is largely absent from recent WHO estimates on vaccine rollout costs. No current global conversations or guidance on vaccine costs includes the full cost of community health workers or long-term personnel costs.

Investing in a fast and fair global vaccine distribution will save twice as many lives as maximizing vaccine doses for the wealthiest countries in the world. Even better, investing in vaccine equality will speed up economic recoveries in every country in the world. For every $1 invested in vaccines in less wealthy countries, wealthy countries will see $4.80 of economic benefit because economies can fully re-open sooner. Failing to make this investment could cost wealthy economies $4.5 trillion in economic losses.

Current global debates are focused so narrowly on equitable access to for vaccine doses that they largely overlook the importance of delivering vaccines—and the key role women frontline health workers play in vaccine delivery. Of 58 global policy statements on vaccines, only 10 refer to the costs of delivery at all—and these are primarily technical advisories from the World Health Organization. No government donors are discussing the importance of vaccine delivery systems that are necessary to ending COVID-19. Only one statement—from Norway—refers to the importance of women health workers as part of the solution to ending COVID-19.

As new and dangerous strains of COVID-19 emerge in countries that are struggling to access the vaccine and control the pandemic, every day we wait for fair global vaccination allows for more contagious strains that spread around the world. The more chances the virus has to mutate in non-vaccinated populations, the higher the risk for everyone. Comprehensive global vaccine delivery plans that make sure the vaccine gets to people who need it—and that those people are ready to get the vaccine when it arrives—are the only way to end this threat. No one is safe until everyone is safe.
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A STUDY ON THE IMPACT OF COV1D-19 ON WOMEN AND GIRLS IN ETHIOPIA

By August 9, 2021, Ethiopia had reported more than 284,000 COVID-19 cases and 4,426 deaths. Since COVID-19 was first reported in Ethiopia in March of 2021, the impacts of the pandemic, the measures taken to curb COVID-19, and additional political, economic, and environmental crises have severely impacted the population.
Women and girls bear different burdens in this crisis, and emergency responses often overlook the differences
in impacts and needs for women, girls, men, and boys in humanitarian responses. To that end, this research—
with funding from the EUTF (European Union Emergency Trust Fund) provides insight into the impact of COV1D-19 on women and girls in Ethiopia. This insight informs recommendations and guide EUTF partners and other relevant stakeholders in the areas of EUTF interventions. With this objective in mind, four woredas (administrative districts), one refugee camp, and one Industrial Park (IP) were considered as sample areas. These are Sekota Zuria and Gazgibla woredas in Wag Hemra zone of Amhara region; Moyale and Miyo woredas in Borena Zone of Oromia region, Asayita Refugee Camp in Afar region, and Bole-Lemi Industrial Park in Addis Ababa.
This research surveyed 372 women and girls in April 2021. The quantitative surveys covered adult women and girls over the age of 15. It also provides insights into the differences between refugees, Internally Displaced People (IDPs), refugees, and migrants. Qualitative from focus group discussions and key informant interviews also reflects opinions from men and boys. Read More...

Gender Gaps in Vaccines November 2021

COVID-19 vaccinations are quickly becoming a story of inequality. Gender inequality is a critical part of this story. In 22 of 24 countries where CARE has data, women are less likely to be vaccinated and less likely to feel vaccines are safe.

There are massive local and global gaps in who can get vaccinated. Only 4.5% of people in low-income countries are vaccinated, and 79% of vaccinations have been in wealth countries. Tragically, wealth and geography are just two factors that skew access to vaccines. Another is gender. In many low and middle-income countries, women are less likely to get COVID-19 vaccines than men are. This compounds gender inequality women are already facing in health and decision-making Read More...

Supporting flood Forecast-based Action and Learning (SUFAL) Project in the 2020 Monsoon Floods

Background: ‘Supporting flood Forecast-based Action and Learning’ (SUFAL) project was designed to contribute to reducing the adverse impacts of the increasing frequency of catastrophic flooding on the vulnerable and poor communities through Forecast-based Action (FbA). The project was funded by The Directorate-General for European Civil Protection and Humanitarian Aid Operations (ECHO) and was implemented through a consortium led by CARE Bangladesh, with Concern Worldwide, Islamic Relief and Regional Integrated Multi-Hazard Early Warning System for Africa and Asia (RIMES). The project was implemented in three northern districts of Bangladesh: Jamalpur, Gaibandha, and Kurigram. FbA contributed to disseminating Flood Early Warning messages with a lead time of 10 – 15 days with timely and accurate weather forecast information, while and it also helping to identify potential flooding areas.

Methodology: The primary purpose of the study was to “Evaluate the impact of early actions” applied through the SUFAL project on household and community beneficiaries in responding to the 2020 monsoon floods. Customized OECD-DAC criteria, Quasi-experimental design (Difference-in-Difference Method), Knowledge, Attitude and Practices (KAP) framework and Value for Money (VfM) framework were used as guiding methods and tools to design study instruments and evaluate the impact of early actions at every stakeholder level. The study covered a control group in non-project areas and three treatment groups in the project areas: Treatment group 1 (EWM support), Treatment group 2 (EWM + Evacuation + Shelter + WASH support), Treatment group 3 (EWM + Evacuation + Shelter + WASH + Cash-grant support). Treatment groups were categorized in three different groups to conduct cost-effectiveness analysis. The study areas were in the districts of Kurigram (Hatia, Begumganj, Buraburi, Shaheber Alga unions), Gaibandha (Bharatkhali, Saghata, Ghuridaha, Haldia unions) and Jamalpur (Kulkandi, Chinaduli, Noarpara, Shapdhor. The survey sample consisted of 224 control respondents (of which 153 were women) and 754 treatment respondents (of which 426 were women), among which Sample for treatment group 1, 2, and 3 were 293 (100 women), 292 (192 women) and 169 (134 women), respectively. A total of 118 of the 754 treatment households interviewed through the survey were women-headed households and 38 out of 224 control group households were women headed households. The team had conducted 7 FGDs with community members in the three implementation areas, and 27 KIIs with community volunteers, project staff, government officials, and other related NGOs.

Impact: It was found through the study that less people in treatment group experienced damages compared to control households, treatment households saved more resources in 2020 than control households, and the average monetary values of assets saved by treatment group in 2020 were higher compared to the control group households. Due to the drawn-out duration and intensity of the flood in 2020, respondents reported that they were not able to prevent more damages although they took more early actions. Besides, treatment areas were the most flood affected areas. The early messages had helped the community to prevent damage to their assets and livelihoods. The percentage of damage prevented in agricultural sector for the treatment group had increased to 28% since the flood of 2019. The damage prevented in fisheries had increased significantly by 18 percent in 2020 in compared to that of 2019. The death of family members from waterborne diseases had decreased (except female members) in comparison to the previous flood in 2019. It is quite evident that the early warning message had enabled the males to take early actions regarding relocation of the vulnerable
family members to higher grounds, relative’s houses, or to the shelters. The cash for work modality had also helped the community people to obtain a source of income by working for the embankment, roads, bamboo bridges, etc. Shelter renovations and upgradations reportedly encouraged the community people to evacuate faster. The average amount of loan taken by a treatment respondent and control respondent was found to have been Taka 20,194 and Taka 18,335 respectively. However, post flood loan burden was significantly less for the cash grant recipients (only 32% took loan after flood) as compared to other treatment groups (more than 50% took loan). The
cash grants are said to have helped the recipients address their basic needs during the flood and also helped them to some extent to repair their house and pay for livestock treatment after the flood. [70 pages] Read More...

Collective Impact for Nutrition (CI4N)

The objective of the Collective Impact for Nutrition (CI4N) initiative has been to improve the nutritional status of women aged 15 to 49 and children under 2, through a multisectoral approach and initiatives based on two strategic axes: (1) Alliances for learning and advocacy and (2) community nutrition. [34 pages] Read More...

TAMANI (Tabora Maternal and Newborn Health Initiative) Impact Evaluation

According to the 2015-2016 DHS survey, Tabora region has the highest percentage population (45.8%) in the lowest wealth quintile in the country, which reflects high levels of structural inequality that have a direct bearing on reproductive, maternal, newborn, child, and adolescent health outcomes.(2) Polygamy is most prevalent in the Western zone with approximately one-third of marriages polygamous, contributing to high fertility rates. Tabora has a low contraceptive prevalence rate of 21.9%, and the Western Zone has the highest levels of teenage childbearing in Tanzania (38%). The latest DHS survey (2015-2016) indicated that 44.3% of women in Tabora deliver at home.

Given this context, the international aid organization CARE began reproductive health programming in Tabora in 2012 with the aim of improving maternal and reproductive health. This paper presents an impact evaluation of CARE’s second stage of reproductive, maternal and newborn health programming in Tabora, the Tabora Maternal and Newborn Health Initiative (TAMANI), which builds on the experience of CARE in the region and spans from 2017-2021. Read More...

Analyse Rapide Genre : Tremblement de terre du 14 août en Haïti

Haïti est enclin à des catastrophes naturelles de plusieurs sortes : cyclones, tempêtes tropicales, éboulements, inondations et tremblement de terre. En moins de douze ans, deux terribles tremblements de terre ont secoué le pays, entrainant des dommages énormes en vie humaine et en perte de toute sorte. Alors que le pays ne s’était pas encore remis des séquelles du premier séisme de magnitude 7.0 en 2010, un deuxième de magnitude 7.2 vient s’abattre le 14 août 2021 au sud du pays dont la plupart des sections communales affectées sont enclavées et difficiles d’accès. Selon le Gouvernement d’Haiti, on peut à date dénombrer 2 248 morts, 12 763 blessés et 329 personnes portées disparues.
Cette catastrophe vient augmenter le lot des préoccupations auxquelles est confrontée la société haïtienne en pleine crise politique, suite à la mort du président de la République en juillet 2021 et au cœur de toute sorte d’insécurité dont le kidnapping. Le pays continue à faire face à la COVID-19 qui a entrainé 588 morts sur un total de 21 124 cas, craignant jusqu’à présent des conséquences qui seraient dues aux éventuelles variantes. Ce désastre qui frappe sévèrement tous les secteurs d’activités de la vie nationale est également survenu en pleine saison cyclonique et à la veille de la rentrée scolaire. Il vient instaurer une situation humanitaire que les leçons tirées des crises antérieures permettront de mieux gérer.
C’est dans ce contexte particulièrement complexe qu’ONU Femmes et CARE, sous le leadership du Ministère à la Condition féminine et aux Droits des femmes (MCFDF) et en coordination avec la Direction Générale de la Protection Civile (DGPC), ont lancé l’Analyse Rapide Genre qui se veut une évaluation rapide de l’impact du tremblement de terre d’août 2021 sur les femmes, les hommes, les filles et les garçons, incluant les personnes en situation de vulnérabilité, afin d’éclairer la réponse humanitaire en cours en Haïti dans l’immédiat, ainsi que les efforts de redressement à moyen et à long terme. Cette étude est faite en partenariat avec l’Equipe spéciale genre de l’équipe humanitaire en Haiti et a obtenu le soutien financier, technique et logistique des partenaires suivantes : Fondation Toya, IDEJEN, UNFPA, OCHA, OMS/OPS, ONUSIDA, PAM, PNUD, et UNICEF.
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Who pays to deliver vaccines? An Analysis of World Bank Funding for COVID-19 Vaccination and Recovery

The World Bank is one key source of funding in the global push to vaccinate 70% of the world’s population against COVID-19. Many actors point to this as the funding that will cover any additional delivery needs for COVID-19 vaccines that national governments cannot meet. With $5.8 billion in funding already approved out of a $20 billion commitment, the World Bank funding is an important part of the picture, but the World Bank alone cannot cover the full gap in vaccine delivery needs.

Reviewing 60 funding agreements from the World Bank on COVID-19 vaccination and recovery shows the following insights.

• There is still a gap in delivery funding. The World Bank is currently funding $1.2 billion in vaccine delivery—10% of the total funding allocated for COVID-19 recovery. If that trend applies to the rest of the $20 billion commitment, World Bank funding will cover a between $2 and $4 billion—well below the $9 billion that ACT-A estimates as the lowest possible investment to vaccinate 70% of the world’s population. In contrast, $3.1 billion is going to purchase vaccines.
• Health workers remain underfunded. Only 15 of 60 agreements, just 25% detail provisions to pay health workers. Of those, 7 explicitly fund surge capacity, 3 provide for ongoing salaries, and 4 allow for hazard pay to health workers.
• Countries are taking on debt to rollout COVID-19 vaccinations. 86% of the funding in this analysis is in the form of loans. That gives countries debt that may weaken future pandemic preparedness rather than reinforcing health systems.
• All funders should adopt the World Bank’s commitments to investments in gender equality. 90% of the agreements in this analysis refer to gender inequality and many make corresponding investments—like requiring that 60% of vaccine leadership positions are women—to overcome these barriers. Earmarking exact funds going to advance gender equality would provide further transparency. Nevertheless, this consistent and concrete commitment is commendable, and all actors should strive to replicate it.
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Baseline Study on “Improving lives of Rohingya refugees and host community members in Bangladesh through sexual and reproductive healthcare integrated with gender-based violence prevention and response” Project

In response to the health and protection needs of the Rohingya refugees and the host communities in Cox ́s Bazar, CARE is implementing the project “Improving lives of Rohingya refugees and host community members in Bangladesh through sexual and reproductive healthcare integrated with gender-based violence prevention and response” with funding support by German Federal Foreign Office. This is a two year project targeting Rohingya refuges of camp 11, 12, 15 and 16 and vulnerable host communities of Jaliapalong union for GBV and SRH services.
To achieve improved sexual and reproductive health, GBV survivor support and protection from GBV of Rohingya Refugees in Cox ́s Bazar in Bangladesh, this project works across three outcomes. Firstly general and sexual and reproductive (SRH) health services will be provided through decetralised health centers which will rove around the target areas to provide services to people at their doorsteps. Improved Menstrual Hygiene management (MHM) is the second outcome of this project. There is an absence of space for washing and drying menstrual hyiene materials, leading women and girls to risk their health by drying their materials indoors. Through this project, therefore, two MHM spaces will be constructed next to CARE’s existing women and girls’ safe spaces (WGSS) in camps 12 and 16. The construction will be accompanied with training to ensure that the spaces are used appropriate. The third project outcome focuses on prevention of and response to gender-based violence. Services include psychosocial counselling, referral of GBV survivors, life-skills training, information and awareness-raising and recreational activities. These activities are complemented by community outreach activities, conducted through Rohingya volunteers, to ensure that the communities know about and can access the WGSS, and challenging harmful social norms associated with GBV. Community outreach will take place in camps 12 and 16 amongst refugee populations.
This report is 22 pages long. Read More...

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