Sexual|Reproductive Health

CARE Malawi COVID Vaccine Delivery Situation January 2022

“The vaccines are here but support for delivery is most needed, especially at the last mile.” – District Health Management Team member, Ntcheu
As of January 10, 2022, Malawi had delivered 1.84 million doses of vaccine out of the 3.12 million doses it has received so far.1 Many doses in country have rapidly approaching expiration dates, and if they do not get to people fast, they risk expiring on the shelves. To make sure the 1.26 million doses left go to the people who need them most, we must invest more in communication, engagement, and delivery. The $37M granted by the World Bank over the past year is sufficient for covering only 8% of Malawi’s total population. What is more, as the highly contagious Omicron variant spreads worldwide, it is even more critical that more people are vaccinated now. We cannot assume that the Government of Malawi and its current health system can do it alone.

The government and other health actors in Malawi are working tirelessly to vaccinate people, while facing multiple health crises. The health system is building on a base of committed (if overstretched) health workers, an openness to community feedback, and a long expertise of delivering The government is coordinating closely with many actors to reduce gender gaps, get vaccines to the last mile, and keep existing health services open. Nonetheless, the Ministry of Health is under-resourced, and operating in a global system where the vaccine supply that arrives may be close to expiring. For example, doses of the Astra-Zeneca vaccine had to be destroyed in the spring, after arriving in Malawi with only two and a half weeks left before their expiration date.

More investment is needed. To take just one example, the national government has been able to provide one van per district to support mobile vaccination sites, to get vaccines to the last mile. Mobile vaccinations are the most effective way to serve people who live far away from health centers and do not have access to easy forms of transportation. That means that in Ntcheu, one van is expected to serve a target population of 214,929 people living over 3,424 square kilometers. One van cannot serve those people fast enough to make sure vaccines get where they need to in time, especially when an inconsistent and unpredictable vaccine supply could have doses expiring at any time. Read More...

Nepal COVID-19 Vaccine Costing Study

By December 6, 2021, 19.2 million doses of COVID-19 vaccines have been administered in Nepal, enough for 36% of the population to have gotten at least one dose of vaccine. After a rough road with unpredictable vaccine supply, the government has been able to procure several million vaccine doses. Now delivery at the last mile is the biggest hurdle they face. Nepal’s Minister of Health says, “We are not going have shortages of vaccines anymore, but our main concern and focus now is on getting these vaccines to all corners of the country, including the remote mountain areas.”

Based on national data, and in-depth studies in 2 health districts, CARE estimates that delivery costs from “tarmac to arm” for vaccines in Nepal are $8.35 (1,019 NPR) per dose of vaccine administered, or $18.38 (2,241 NPR) per person fully vaccinated.

This is nearly 5 times more expensive than current global estimate for delivery costs. These costs range from $11 per fully vaccinated person in easier to reach areas, to $33 per dose in remote, difficult to reach areas. Gaps in vaccine coverage are particularly acute for mountainous areas, people with low mobility, and communities far from health centers. Even the lowest-cost estimates for the easiest to reach areas are nearly 3 times higher than global average estimates.

70% of these costs are personnel needs to ensure vaccines reach people at the last mile. This points to a major need to improve investments in vaccine delivery, especially the health care workers who administer vaccines and ensure everyone gets vaccinated.

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...

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.

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...

Rapport d’évaluation finale du projet : Préserver la Dignité et Réduire les Souffrances des personnes affectées par les effets des mouvements de population dans la commune de N’guigmi II

Le projet PREDIRES II a été mis en de Septembre 2019 à Août 2020. Il est axé sur les volets sécurité alimentaire, Violence basée sur le genre et la santé sexuelle reproductive. Le projet a touché 500 ménages vulnérables issus de 9 villages de la commune de N’guigmi. Les activités réalisées vont de la mise en place et formation des structures communautaires de protection et VBG, des pairs éducateurs sur IST/VIH/SIDA à l’appui alimentaire et une mise en place, formation et appui en cash pour AGR des groupements MMD.
Pour mieux évaluer la pertinence, l’efficacité, l’efficience et l’impact du projet, une évaluation finale a été faite, objet du présent rapport. L’évaluation a été conduite en interne et le plus simplement possible par le chef de projet. L’exercice a été guidé par 05 questions d’évaluation avec un certain nombre de sous-questions. Les méthodes de collectes ont été une revue documentaire du projet et une étude qualitative (enquête des connaissances, d’attitudes et des pratiques). Pour cette dernière, des entretiens de groupe ont été menés avec des hommes (jeunes et adultes) et femmes (jeunes et adultes). Les données ont été collectées par une équipe externes dans 3 villages d’intervention du projet. Le projet est à 63% du taux de consommation en Juillet 2020. [14 pages] Read More...

WADAANA (Prosperity) TDP returnee families in NWTD have access to improve WASH agriculture and food security. Tehsil Mir Ali & Miran shah North Waziristan Tribal District

Since 2008, the tribal districts of Khyber Pakhtunkhwa have experienced large population displacements causing instability and exacerbating vulnerabilities of the local communities. In order to improve resilience, critical humanitarian assistance provided to the returnee Temporarily Displaced Persons (TDP) in NWTD. The project was implemented by CARE international in Pakistan (CIP) with the funding from the Office of U.S. Foreign Disaster Assistance (OFDA) under the title “WADAANA” through its local partner, Peace and Development Organization (PADO).

CIP through its local partner rehabilitated (03) drinking water supply schemes, construction of 140 transitional latrines in the target communities, distribution of 250 hygiene kits to most vulnerable women beneficiaries, 200 awareness sessions and radio campaign for hygiene promotion coupled with PHAST (Participatory Hygiene and Sanitation Transformation) approach, rehabilitation of 5 irrigation channels to improve access to water of the farmers in the target area, provided 550 poultry package and 500 kitchen gardening kits to improve livelihood of the female in targeted communities.

Upon successful implementation, CIP conducted Post Distribution Monitoring (PDM) study in both Tehsils of Miran Shah & Mir Ali for poultry, kitchen gardening and hygiene kits. The study was conducted to get beneficiaries feedback about the utilization of poultry, kitchen gardening and hygiene kits distribution process, beneficiaries’ selection criteria, relevance, satisfaction with quality and quantity of Packages items, feedback and complaint response mechanism. A total of 66 recipients of Poultry Packages, Kitchen Gardening and hygiene kits were interviewed taking 5% as sample of the total distribution.

A Baseline Study and Social Norms Analysis using SNAP for the project BERHAN: Sexual and Reproductive Health and Rights Initiative in Amhara Region, Ethiopia

Background: BERHAN – Sexual and Reproductive Health and Rights initiative in Amhara region of Ethiopia seeks to support women and girls in Fogera and Estie woredas to safely exercise their sexual and reproductive health rights, leading to improved wellbeing (impact).

Objective: The purpose of this study was to understand the social norms that are associated with the practices of female genital cutting (FGC) and early marriage (EM), and to establish a baseline for all project indicators.

The quantitative survey was conducted on a randomly selected sample of 375 respondents comprising of men, women, girls, and boys (adults and adolescents). Quantitative data were collected using an interviewer administered structured questionnaire. Qualitative data were collected by masters and PhD degree holders, and quantitative data were collected by trained and experienced BSC level data collectors.

Results: The results revealed that FGC and EM were common practices in the community with a prevalence of 85.0% and 64.0% respectively. The community held the practices because of various reasons among which are cultural preservation and lack of knowledge. The community members were highly influenced by the sanctions that made them change their initial positions. Generally, women could not use contraceptive methods without permission from their partners or family members and this applies to all modern contraceptive methods.Only 3.7% of girls and women in the age group of 15-49 were able to use a modern contraceptive of their choice and, only 30.5% were able to decide on their own reproductive health care use. Read More...

Gender Gaps in COVID 19 Vaccines

COVID-19 vaccinations are quickly becoming a story of inequality. Gender inequality is a critical part of this story. In 16 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 1 9 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...

Regional project FAIR III “ For Active Inclusion & Rights of Roma Women in the Western Balkans III”

This intervention builds on extensive CARE’s expertise and experience in facilitating process related to women’s empowerment and gender equality across the globe and in the Balkan region. It also intends to scale up approaches and models that have proven successful over the last six years of the FAIR projects’ implementation (FAIR and FAIR II). The project seeks to empower Roma women and girls to be free and able to exercise their rights to live a healthy, dignified life free from violence, inequality and discrimination with support from their partners, families and communities in Bosnia and Herzegovina, Serbia and Montenegro. This will be accomplished through four output level results that need to be met for the longer-term changes to happen, they are inter-connected and mutually reinforcing since only in that way the outcome can be accomplished.

The first one (Output 1) refers to the enhanced capacities of Roma CSOs, youth and key community actors to practice and promote gender equitable, healthy and non-violent lifestyle with help of tested models and approaches. Under the second expected result (Output 2) Improved access to and provision of services for Roma, Egyptian (RE) women and girls (in particular on SRMH, GBV and Education) will be ensured through strengthening of the Roma CSOs and the existing participatory accountability community mechanisms. Output 3will enable three national-level Roma women networks to be active and contribute to the effective functioning of the regional Roma Women Balkans Network and its enhanced efforts towards Post 2020 EU Roma Integration Agenda. In the last expected result (Output 4), Roma women and girls, CSOs and Networks are part of the regional and global social movement initiatives promoting and advocating for gender equality and (minority) women’s rights. The project will directly target 26,150 people in total –aiming at 85% Roma and over 60% women and girls. Data collection under this project will be disaggregated by sex, age and ethnicity, whenever possible. Over20,000 people are expected to be reached in the three target countries through a series of promotional activities. Final Beneficiaries will include about 78,000 people in the 3 target countries based on the assumption that each target group person will reach out to at least 3 persons in his/her direct environment. [13 pages] Read More...

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