Special Evaluation/Report

COVID-19: Impacts, Attitudes, and Safety Nets in Haiti (April 2021)

In April 2021, CARE conducted interviews with savings group members and leaders to understand their experiences of COVID-19, and how it was changing their lives. The survey included 364 women and 175 men, for a total of 539 respondents. This follows a survey done in June 2020 to understand what was happening at that time for members of savings groups. The surveys covered Artibonite and Grand Anse.

COVID-19 continues to have important impacts for women and men in savings groups. In general, men and women in these groups were reporting similar challenges across the sample. 86% of women and men are reporting impacts in their livelihoods, and 98% of people say that COVID-19 is affecting their ability to save. 64% say they can’t meet family needs and hunger has gone up. 90% of people are reporting that COVID-19 is impacting their social lives. More women than men report that Gender Based Violence has gone up. While women are more likely to have lost influence in the household than men (39% compared to 33%), men are more likely to report that they lost social status in the community (48% compared to 43%). Read More...

Community Scorecard for COVID-19 Vaccines in Malawi

The significant amount of misinformation surrounding COVID-19 has deteriorated trust in governments and health systems, leading the World Health Organization to claim it as an “infodemic.” As the massive vaccine roll-out efforts launch, systematic trust-building and social accountability approaches are vital to ensure that civil society can hold governments accountable for equitable and people-centered vaccine roll-out that reaches the last mile. CARE knows that epidemics, like COVID-19 and Ebola, start and end with communities, which is why we are working to build meaningful citizen engagement into national vaccine roll-out frameworks to increase trust, accountability, and information dissemination.
CARE’s Community Score Card
The Community Score Card (CSC) was developed by CARE Malawi in 2002 and has been effectively used in a wide range of settings and sectors to ensure that public services are accountable to the people and communities they serve. CSC has demonstrated impact on power-shifting and improving service quality and trust building within and between communities and government actors. When COVID-19 arrived in Malawi during March 2020, CARE adapted CSC for remote use. The remote CSC includes an SMS platform and WhatsApp groups through which groups of men, women, youth, community and religious leaders, and service providers could voice their concerns and hesitancies about the vaccine and other health services. The CSC helped to identify major concerns around the vaccine and aided stakeholders in creating locally-driven solutions to combat vaccine hesitancy and misinformation.
Building on these early experiences, from May to June 2021, CARE further implemented a pilot project designed to support efficient and equitable COVID-19 vaccine roll-out in three locations in Malawi: Kandeu and Chigodi health facility catchment populations in Ntcheu district and the New Hope Clinic health facility catchment population in Ngolowindo in Salima district. In all three locations, key stakeholders included groups of women, men, youth, community leaders (chiefs and religious), district health management teams, and health personnel (including health surveillance staff, health facility staff in-charge, and the health center management committee). CARE Malawi’s CSC team led the implementation of the pilot with support from CARE USA and digital support from Kwantu. Read More...

DIAGNÓSTICO SITUACIONAL SOBRE EL TRÁFICO Y LA TRATA DE PERSONAS EN EL CONTEXTO DE LA CRISIS HUMANITARIA EN LA ZONA TRANSFRONTERIZA DE PERÚ Y ECUADOR

En el año 2000 se aprobó el Protocolo para prevenir, reprimir y sancionar la trata de personas, especialmente mujeres y niños, que complementa la Convención de las Naciones Unidas contra la Delincuencia Organizada Transnacional que entró en vigor el 25 de diciembre de 2003. Desde esa fecha el desarrollo normativo de la trata de personas es permanente tanto en el Perú como en el Ecuador, países que comparten una amplia frontera común. Paralelamente se han creado nuevos servicios para la protección y asistencia a las víctimas, así como para la persecución y sanción del delito. En ese contexto, diversos fenómenos han ocurrido con particular intensidad, sobre todo en la zona fronteriza entre Perú y Ecuador. Dos en particular han marcado el desarrollo de la trata de personas en esa zona. La crisis humanitaria producto de la migración masiva de ciudadanos venezolanos y el contexto actual de emergencia sanitaria por el COVID-19, que obligó a ambos países a cerrar sus fronteras, abriéndose más de un circuito clandestino por el cual el flujo migratorio ha continuado discurriendo sin solución de continuidad a pesar del control militar implementado por el Perú desde el 26 de enero del 2021, lo que ha merecido un pronunciamiento conjunto de las Defensorías del Pueblo de Ecuador, Colombia y Perú exhortando a sus autoridades a tener como premisa la dignidad humana de las personas migrantes con necesidad de protección internacional, observar las normas universales y regionales de derechos humanos en este campo, así como evitar actos que promuevan el rechazo por parte de las comunidades de acogida. En ese contexto, las vulnerabilidades propias de las personas migrantes, así como de adolescentes y jóvenes de las regiones contiguas a la zona de frontera, se vieron potenciadas por la crisis económica generada a causa de la pandemia, así como por la pauperización de las condiciones del empleo marcadamente informal. Esas circunstancias que han agravado las necesidades de las personas han sido aprovechadas para la comisión de diversos delitos de explotación de seres humanos. Paralelamente la respuesta pública se ha visto impactada por la crisis sanitaria que ha reducido su capacidad para enfrentar el problema, además de las limitaciones que ya presentaba. En ese escenario, la sociedad civil y las organizaciones de cooperación han jugado un papel importante para paliar las necesidades. Por otra parte, el panorama de la trata de personas en la zona de frontera presenta varios desafíos que están descritos a lo largo del presente estudio y que sugieren un modelo de
gestión más eficiente para poder enfrentarla de manera eficaz, así como para atender el creciente número de personas vulnerables producto de la crisis humanitaria y de la realidad resultante como consecuencia de la emergencia sanitaria. El cierre de la frontera y su permeabilidad hacen evidente la necesidad de implementar una estrategia migratoria integralen cada país, así como en conjunto. Para la elaboración del presente informe se ha recogido información de fuentes documentales, así como de las instituciones públicas y privadas de ambos lados de la frontera, incluyendo a personas migrantes. Dicha información ha permitido describir las conductas, medios y finalidades del delito de trata; las características de los autores del delito de trata y tráfico de personas, las características de las víctimas; las principales rutas de la trata y tráfico de personas, así como las actividades en las que podría estar presente; los servicios de protección para víctimas; el estado de los mecanismos de sanción del delito de trata y tráfico de personas, así como la relación entre la migración, la trata y tráfico de personas. [46 Pages] Read More...

South Sudan: The True Cost of COVID-19 Vaccines

By July 18, South Sudan was able to administer the nearly all of the 60,000 doses of COVID-19 vaccine they had in stock through a series of smart investments in delivery, training, and social mobilization coordinated with several different partners. As new doses are projected to arrive in country in August, South Sudan continues to reinforce gaps in the health systems to make COVID-19 vaccinations possible without disrupting existing health services.

CARE’s estimated delivery costs from “tarmac to arm”1 for vaccines in these areas are $9.97 per dose of vaccine administered, or $22.22 per person fully vaccinated.

This is six times more expensive than current global estimate for delivery costs. For some actors providing vaccinations in South Sudan, the cost has been as high as $20 per dose administered when they include all costs. That’s because the health system in South Sudan is fragile, and it was already struggling to deliver even routine services. South Sudan is one of many health systems around the world that will need additional personnel, resources, and infrastructure to effectively deliver COVID-19 vaccines to at-risk populations, especially in hard-to-reach areas. The exact cost will continue to evolve as new vaccines arrive in country and the country vaccinates new groups of people. Read More...

GENDER AND COVID-19 VACCINES Listening to women-focused organizations in Asia and the Pacific

More than a year into the coronavirus pandemic, COVID-19 vaccines are being distributed across at least 176 countries, with over 1.7 billion doses administered worldwide. Combating the pandemic requires equitable distribution of safe and effective vaccines, however, women and girls are impacted by gaps both in the supply side and the demand side that hamper equitable distribution of the vaccine. Evidence reveals that 75 per cent of all vaccines have gone to just 10 countries, and only 0.3 per cent of doses have been administered in low-income countries. Very few of COVID-19 vaccines are going to those most vulnerable. The vaccine rollout in Asia and the Pacific has been relatively slow and staggered amid secondary waves of the virus. India, despite being the largest vaccine developer, has only vaccinated 3 per cent of the population and continues to battle a variant outbreak that, at its peak, was responsible for more than half of the world’s daily COVID-19 cases and set a record-breaking pace of about 400,000 cases per day.5However, the small Pacific nation of Nauru, reported a world record administering the first dose to 7,392 people, 108 per cent of the adult population within four weeks. Bhutan also set an example by vaccinating 93 per cent of its eligible population in less than two weeks. That success could be at risk, given the situation in India and the suspended export of vaccines. Read More...

CROSS-BORDER MIGRATION INTO INDIA AND DEVELOPMENT – Advocacy Paper

The migration discourse has not remained confined to focusing upon the mobility of people from low income countries to high income countries. There has been growing attention to migration from higher-income countries to lower-income countries. The current literature, however, is increasingly taking note of human movements within any of the two regions – the higher income countries and the lower income countries, also described as the global north and the global south respectively. Based on the level of development of the countries of origin and destination, the United Nations has therefore identified a typology of two inter-regional and two intra-regional streams of contemporary international migration: south-north and north-south, south-south and north-north (United Nations 2013). This typology also subsumes the category of a transit country in its roles of being an origin and a destination country at the same time. [26 Pages] Read More...

Women, Migration and Development: Investing in the future

On the 17th and 18th of July 2014, the International Conference on Women, Migration and Development: Investing In The Future was convened by CARE
International and hosted at the Overseas Development Institute in London. The objectives of the conference were to: 1) highlight the challenges faced by vulnerable migrant workers, especially women, 2) advocate, based on CARE and others’ experiences, for strategies, policy and practical responses which need to be taken to protect migrant workers’ well-being, particularly with respect to safe mobility and access to healthcare, 3) recognize women migrants’ contribution as economic actors and advocate for policies and planning processes that ensure their protection, 4) advocate for recognition of the role of migration as a key development enabler in the post-2015 development agenda. CARE and ODI presented the findings from their five year EMPHASIS (Enhancing Mobile Populations’ Access to HIV and AIDS Services, Information and Support) programme in South Asia. EMPHASIS, a project which started as a HIV and health intervention, was successful in surfacing and addressing other aspects such as safety and dignity of migrants, economic empowerment, financial inclusion and safe remittances, access to education for migrants’ children, and women’s empowerment. The conference was a response to the call at the May 2014 Stockholm Global Forum for Migration and Development both for civil society/government cooperation around regional systemic approaches to migration and for urgently needed programmatic data and evidence on migration. EMPHASIS is considered among very few projects globally which comprehensively cover the migration experience from source, through transit, to destination countries. The EMPHASIS Learning Series report, which provides a comprehensive overview of
the EMPHASIS programme, was launched during the conference. [5 Pages] Read More...

A Qualitative study comparing the effects and outcomes of HIV-related interventions for Nepalese migrants – at source, transit and destination

The qualitative study, commissioned by Care Nepal, sought to explore the effects and outcomes of the EMPHASIS project, launched four years ago to reduce HIV and AIDS vulnerability among cross border migrants; and to influence national and regional policies relating to safe mobility through evidence generated regionally. The project, working along a continuum of source, transit, and destination areas, provides HIV prevention and treatment services to migrants and their families. Additionally, the project partners with local stakeholders to ensure safe passage of migrants on transit besides providing other support services. The study was, thus, designed to assess the influence of the project in addressing HIV vulnerabilities, and at the same to enquire into whether inter-country passage has been made safer for migrants. The study aimed to answer the following research questions: a) How has the EMPHASIS intervention impacted HIV vulnerabilities among Nepali migrants, b) What are the qualitative differences between HIV related attitudes and behaviors between migrants reached at destination and their spouses reached at source and those not reached either at source or destination, c) What are the qualitative differences between HIV
related attitudes and behaviors between spouses who have been reached by the project and those who have not been reached by the project, d)) What are the benefits and barriers of support services provided to migrants for safe mobility and empowerment. The study was conducted among 60 migrants and family members, and 5 key informants in four locations- two at the destination site of Delhi and two at the source site of Nepal. In depth interviews by trained researchers were conducted with the help of semi structured interview guides. [39 Pages] Read More...

Bangladeshi Sailors Vulnerability to HIV and AIDs

Enhancing Mobile Populations’ Access to HIV and AIDS Services, Information, and Support (EMPHASIS) is a 5-year initiative funded by the UK’s Big Lottery Fund. The project has been implemented by CARE in three countries,
Bangladesh, India and Nepal. This study was initiated to generate evidence around the vulnerabilities faced by migrant populations traveling to India. Both qualitative and quantitative methods were used to explore the vulnerability of sailors and a standard BCC questionnaire was used to assess knowledge around HIV and AIDS. Qualitative methods were used to compliment quantitative findings to reveal other socio-economic dynamics that can contribute HIV and AIDS related vulnerabilities. Data collection was carried out in both Bangladesh and India. Both qualitative and quantitative data collection was done in Bangladesh,. As entry into the ports in India was restricted, only qualitative methods were used there. A total of 154 were interviewed with a quantitative questionnaire and 24 sailors participated in in-depth interviews. Focus group discussions (FGD) and Key Informant Interviews were conducted with selected community members such as doctors, Noujan Srameek Union members, and vendors. [46 Pages] Read More...

Journeys: Experiences of Nepalese and Bangladeshi cross border migrants living with HIV

Enhancing Mobile Population’s Access to HIV and AIDS Information (EMPHASIS), Services and Support is a 5-year project funded by Big Lottery Fund, UK. EMPHASIS is implemented in Nepal, India and Bangladesh to address AIDS related vulnerabilities of cross border populations who are moving between Bangladesh, India and Nepal EMPHASIS is an operations research project and one of the pioneer regional projects to address HIV and AIDS vulnerability among cross border populations. The project aims to address its goals through service provision,
capacity building of relevant partners/stakeholders, and advocacy through generating evidence. As part of generating evidence, EMPHASIS developed a research study to investigate the dynamics associated with accessing services for mobile groups who are already affected by HIV and AIDS. This study examines people and questions that were not covered by the EMPHASIS baseline survey that was previously conducted.

Three separate studies were conducted in Bangladesh, Nepal and India. Bangladesh and Nepal first initiated the study aiming to understand the dynamics of HIV infection among migrant populations and also to assess barriers to accessing services at source. In India the study was initiated later, to assess the barriers to accessing services at destination. The prime objective of the study was to present these barriers to services at the regional level among the regional stakeholders. Sharing the findings at South Asian Association for Regional Cooperation (SAARC) could be an important way to initiate dialogue between the governments of Nepal and India to formalize a cross border referral system. Country specific barriers to services will be provided as evidence to inform policy at the national level. [45 Pages] Read More...

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