Sexual|Reproductive Health

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...

COVID-19 Vaccination Uptake: A study of Knowledge, Attitudes and Practices of Marginalized Communities in Iraq

CARE Iraq conducted a study to better understand community acceptance of COVID-19 vaccination and existing barriers to vaccine uptake. The objectives of the study were to create an understanding of people’s knowledge, attitudes and perceptions about COVID-19 and the vaccines, establish what reasons undermine the COVID-19 vaccination campaign and inform about the status of vaccine uptake among marginalized communities. The results of the study can inform policy makers and health actors to design awareness campaigns and address barriers to vaccine uptake to increase the vaccination rate.

CARE found that:
• Vaccine hesitancy is high.
• Women have less access to, knowledge of, and willingness to accept the COVID-19 vaccine then men.
• Barriers to access are still high, and higher for women than for men.
• Fear of side effects is the biggest obstacle.
• There is little trust in the vaccination process.
• Many people do not believe vaccines are important.
• People are not confident they have enough accurate information.

Key recommendations
• Social media can be a primary channel for vaccine messaging.
• It’s critical to counteract misinformation.
• Multiple sources of information are critical.
• Focus messaging for women and religious leaders.
• Develop different messages in different areas.
• Build on people’s willingness to be convinced with good information. 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...

Tabora Maternal & Newborn Health Initiative (TAMANI): Year 4 results

The Tabora Maternal and Newborn Health Initiative (TAMANI) is a five-year project led by CARE in partnership with the Government of Tanzania’s Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) and the Prime Minister’s Office for Regional and Local Government (PO-RALG). Implementing partners include the Society of Obstetricians and Gynecologists of Canada (SOGC), the Association of Gynecologists and Obstetricians of Tanzania (AGOTA), the Canadian Society for International Health (CSIH), McGill University’s Institute for Health & Social Policy, and Ifakara Health Institute (IHI). The project is financially supported by the Government of Canada and is closely aligned to Government of Tanzania (GoT) health polices, strategies and guidelines.
The Annual Report covers the period of April 1, 2020, to March 31, 2021.The report provides an analysis on operations to date against the Year Four Annual Work Plan. This report also highlights how the project
pivoted to respond to the COVID-19 global pandemic and includes reporting on COVID response programming as approved by GAC in March 2020. Read More...

COVID-19 Response in Tabora Tanzania (Bloomberg)

CARE Tanzania builds on its successful partnership with the Government of Tanzania’s Regional Health Management Team (RHMT) in Tabora Region. Leveraging funding from the Government of Canada as part of the Tabora
Maternal Newborn Health Initiative (TAMANI), CARE’s Bloomberg-funded COVID-19 activities builds on efforts to improve access of and quality of health services across health facilities and communities to challenge harmful gender norms.
In partnership with the Government of Tanzania, activities cover all 8 districts in Tabora Region. CARE provides technical support and training to Community Health Workers, who are supported by the government in their duties.With the onset of COVID-19, CARE Tanzania quickly implemented a digital survey to understand the impacts of COVID-19. The majority of female respondents reported increases in gender-based violence and harassment, with COVID-19 restricting women’s access to resources and decision-making. Read More...

The Final Evaluation of the Opportunities for Mother and Infants Development Project

The Opportunities for Mother and Infant Development (OMID) is a three year project (from 2018 to 2021), funded by The Glaxo Smith Kline (GSK). The current phase of the project has been implemented in the two districts (16th and 17th) in Kabul city. The main purpose of the project is to improve the health and reduce the mortality among mothers, newborns and children in the most vulnerable communities through community-based interventions facilitated and delivered by Community Health Workers (CHWs) and Community Midwives (CMWs).

Overall, the project has been effective in achieving the intended outcomes. Access and utilization of Maternal and Neonatal Child Health (MNCH) services have improved as demonstrated by achievement of the project’s key performance indicators across the continuum of care.

This included increases in the %:
- of women reporting ANC utilization
- of women who undertook the first ANC visit before by the 3rd trimester of their pregnancy
- of those who knew the date that the baby was expected to arrive
- of those women who had a plan where she would deliver the baby
- of those women who believed health facility is safer to deliver there

And decreases in the %:
- of those who didn’t go for ANC and believed it is not important
- of those who didn’t go for ANC and indicated the high cost of care as reason

The community systems strengthening undertaken by the project through establishment of community based health facilities and CHWs was effective in increasing health awareness and adoption of positive MNCH behaviors and practices. Read More...


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...

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...

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...

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