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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If you have an evaluation or study to share, please e-mail the document to ejanoch@care.org for posting.

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...

Rapid Assessment on COVID-19 Vaccine Uptake by Urban Marginalised Population in Bangladesh

As of 31 March 2021, there have been 127,877,462 confirmed cases of COVID-19 worldwide, including 2,796,561 deaths in 223 countries as reported by WHO. Bangladesh had 6,11,295 confirmed cases of COVID-19 and 9,406 confirmed deaths till the end of March 2021. In response to this situation, the administration of the first dose of the COVID-19 vaccine officially started on 7 February 2021 in the national hospitals and health complexes all over Bangladesh. Despite acute demand for the vaccine, a great deal of misinformation and misconception is also apparent among general people. With the ongoing vaccine administration, it is very important to understand community acceptance of COVID-19 vaccinations.
People’s knowledge, attitudes and perceptions towards COVID-19 are of utmost importance for Government and policymakers to address all barriers to vaccine uptake and ensuring that everyone has access to vaccine. With these contexts, this survey aims to identify the overall COVID-19 vaccination perceptions among the urban marginalized population in Bangladesh based on three main objectives:
 Understanding the knowledge and practice related to COVID-19 prevention
 Assessing the knowledge and perspective regarding COVID-19 vaccination
program
 To know the status of vaccine uptake among marginalized population
The urban marginalized population were purposively selected, as they are more likely to be unaccounted for or have the least access to the COVID-19 vaccine administration process. In this survey, researchers captured only the population that are direct service recipient of the Urban Health Programme (garment workers and people who inject drug) and other groups who are available around the catchment areas of the service centres of the facilities. Read More...

Better Gender Outcomes in Food Assistance through Complementary and Multi-Modal Programing

With an objective of contributing to the knowledge base of promising practice using a combination of modalities to deliver food security and gender outcomes, this study reviews Food for Peace (FFP), DFSA (Development Food Security Activity), EFSP (Emergency Food Security Program), and OFDA projects that explicitly or implicitly incorporated gender-focused programming [55 pages]. Read More...

CASH AND VOUCHER ASSISTANCE IN RESPONSE TO THE COVID-19 PANDEMIC

In April 2020, CARE received a five million dollar grant from MARS to implement a multi-country program, including Cote d’Ivoire, Ecuador, Ghana, Guatemala, Haiti, Honduras, India, Peru, Thailand, and Venezuela1, with the aim of reducing the negative impacts of COVID-19 on vulnerable populations, especially women and girls, using complementary and multimodal approaches. A key activity of this program was the provision of cash and voucher assistance (CVA) to vulnerable populations to meet their diverse basic needs. Program data indicated that CVA was implemented in Cote d’Ivoire, Ecuador, Ghana, Guatemala, Haiti, Honduras, and Thailand. Monitoring data from different countries showed that CVA was unconditional; with cash modality representing 95% of transfers. Key targets populations for CVA activities vary by country and include: vulnerable households (Cote d’Ivoire, and Haiti); migrants and refugees (Honduras, Ecuador, and Thailand); domestic workers (Guatemala and Ecuador); survivors of GBV and other forms of violence against women (Guatemala and Ecuador); and lesbian, gay, bisexual, transgender, intersex, and queer/questioning (LGBTQI+) individuals (Ecuador). Across all projects (or countries), participants reported numerous uses of CVA including purchase foods stuff, payment of health services, hygiene services, rental/housing, savings and livelihoods activities.
Given the nature and scale of this program as well as its organizational commitment to learning, CARE was keen to understand the extent to which the project supported and protected vulnerable populations against the loss or disruption of their livelihoods in a gender sensitive manner. The study seeks to provide open-source learnings for peer
companies and agencies on how CVA was utilized in this program with two major questions: (i) How gender sensitive was the process for CARE’s CVA? (ii) How gender sensitive was the intended outcome of CARE’s CVA?
This documentation report compiles lessons from across the projects implemented in the targeted countries and draws from the diversity of their experiences to provide some recommendations on more gender sensitive CVA in the future. Read More...

McGovern-Dole Food Fore Education Program HATUTAN – Midline Evaluation

The HATUTAN program (Hahán ne’ebé Atu fó Tulun ho Nutrisaun no Edukasaun or Food to Support Nutrition and Education) is a five-year initiative to build a partnership between schools and communities in order to improve literacy, learning, healthy, and nutrition for children and adults in Timor-Leste. The program works in partnership with the Government of Timor-Leste and development stakeholders to address two strategic objectives: improved literacy of school-aged children and increased use of health, nutrition, and dietary practices. The HATUTAN program is funded by the U.S. government through the Foreign Agricultural Service of the United States Department of Agriculture under the McGovern-Dole International Food for Education and Child Nutrition Program. The program is implemented by a consortium led by CARE International with Mercy Corps and WaterAid. The lead Timorese government partner is the Ministry of Education, Youth, and Sports, in collaboration with the Ministry of Health, Ministry of State Administration, and Ministry of Agriculture and Fisheries.

To achieve these objectives, the program supports, among a variety of activities, the Government of Timor-Leste’s school feeding program (SFP) to fully operate in all basic education and preschools throughout the school year. Key project activities include strengthening and supplementing the government-sponsored SFP and building school capacity through trainings for teachers and administrators and provision of resource materials. Additionally, the HATUTAN program seeks to support farmers to boost the production of local produce to increase yields and help create sustainable sources of nutritious food for local schools. In addition to activities related to literacy and SFPs, HATUTAN seeks to conduct trainings related to nutrition, health, and other topics, and to promote gender equality and the reduction of gender-based violence.

This report presents the midline evaluation of the HATUTAN program, which began in early 2019. It is important to note that restrictions due to the COVID-19 pandemic have had a substantial impact on program activities and target outputs and outcomes. In March 2020, HATUTAN field activities were halted, field offices were temporarily closed, and staff began to work from home due to a State of Emergency issued by the Government of Timor-Leste. This State of Emergency remains in effect to date, with varying levels of restriction on school activities, movement, and group gatherings. As a result, the HATUTAN program is behind schedule in terms of some major deliverables due to COVID-19. Additionally 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...

Vulnerability to HIV & AIDS: A social Research on Cross Border Mobile Population from Bangladesh to India

There are a growing number of people migrating between Bangladesh, Nepal and India. Mobility has long been linked with heightened vulnerability to HIV & AIDS. While overall
HIV prevalence is low in Bangladesh and Nepal, there is a growing concern that vulnerable mobile populations are forming a bridge between high prevalence areas of India and low prevalence areas in Bangladesh and Nepal. Enhancing Mobile Populations’ Access to HIV & AIDS Services Information and Support (EMPHASIS) is a regional program being implemented by CARE Bangladesh, CARE India and CARE Nepal and led by CARE International UK (CIUK) to reduce AIDS related vulnerabilities among mobile populations crossing the borders of Bangladesh and Nepal into India. This 5-year (August 2009 – July 2014) program, is funded by the Big Lottery Fund (BIG) of United Kingdom.

Baseline Research on cross border migration was initiated to understand the drivers of mobility, access to services for migrants at source and destination, and to understand the risk and vulnerabilities associated with migration and HIV & AIDS. The study was conducted using quantitative methods and a separate qualitative study was conducted to enhance and complement the quantitative data. [57 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...

Evaluation of Enhancing Mobile Populations’ Access to HIV and AIDS Services (EMPHASIS)

EMPHASIS is a 5 year project funded by Big Lottery Fund, UK, which was initiated in August 2009 and is due to conclude in July 2014. It has been implemented in Nepal, India and Bangladesh to address both HIV and AIDS vulnerability and safe mobility issues of cross border migrant populations. Its overall goal has been to contribute to reduction of vulnerability of mobile populations (particularly women) to HIV infection across selected cross border regions within India, Bangladesh and Nepal. There has however, appropriately, been an increased focus on safe mobility issues within the last two years of the project. The three main outcomes of the project focus on: 1) the development of an effective and integrated cross border model of HIV prevention, care, treatment and support to benefit mobile populations and their families and target groups at source, transit and destination locations who are vulnerable to acquiring and spreading HIV and AIDS, 2) building the capacity of partner organizations (including regional authorities, government agencies, border police, customs officials, research institutions, NGO, Community Based Organizations [CBO] and key stakeholders) to deliver improved and integrated services to mobile populations vulnerable to HIV, 3) Increasing recognition of the vulnerabilities of mobile populations and demonstration of ways to address them in source and destination communities that will inform policies and produce evidence based advocacy messages with which to lobby government stakeholders. The aim of this evaluation is to assess the project according to its three outcomes areas and to assess the effectiveness and relevance of different interventions. One week visits to India, Nepal and Bangladesh were conducted at the end of January/ early February 2014 by a team of three people, during which interviews and focus group discussion were conducted, and a Lickert Scale tool administered. These visits were then supplemented by some additional meetings in Bangladesh in April, following the production of the first draft report. An endline study was conducted in parallel to the evaluation, and its conclusions are also drawn upon in this report. [88 Pages] Read More...

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