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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Rapid Gender Analysis TO SUPPORT THE GOVERNMENT OF SIERRA LEONE TO STRENGTHEN ITS HEALTH SYSTEM
This Rapid Gender Analysis (RGA) report presents findings from the gender and power analysis carried out in November and December 2023 in Falaba, Kambia, Bonthe, Tonkolili, Kenema, Karene, Kailahun, and Pujehun districts of Sierra Leone. The purpose of the RGA is to understand how gender and social norms, roles, relationships, and dynamics influence health outcomes and health-seeking behavior in Sierra Leone, especially for vulnerable populations. The report will inform the development of CARE’s future health programming and proposed interventions for health funding opportunities.
The document is structured into four primary chapters – Background, Methodology, Findings: Results and Analysis, and Recommendations—each containing sub-chapters. The background section outlines the study’s purpose, objectives, and underlying rationale. The methodology section describes the research design, applied approaches, data collection methods and participant information. The study’s key findings are categorized into distinct thematic areas aligned with CARE's Good Practices Framework for Gender Analysis and includes the following Core Areas of Inquiry:
• Household decision-making, division of labor and control of productive assets
• Control over one’s body
• Access to public spaces and services
• Claiming rights and meaningful participation in public decision-making
The RGA also applies the above domains related to health outcomes, behaviors, and health-seeking behavior, including gender dynamics within the Sierra Leone health system with recognition that unequal gender dynamics gaps impact health care providers and their ability to deliver quality services. Finally, the recommendations section outlines actions or interventions CARE should consider in future programming.
Key Findings:
* Men have more influence over decisions for the household than women—including the seeking of healthcare—and women lack control over key decisions related to sex, marriage, and children, including if and when to use contraception. Women’s mobility is limited by social norms which require male permission for movement.
• Contraceptive use is low. Despite around 70% of people knowing about contraceptives and where to get them, only 50% are currently using them. Many community members believe modern forms of family planning are haram or unhealthy, with anecdotal evidence suggesting there is perception that it promotes extramarital affairs.
• Front Line Health Workers (FLHW) face major barriers to effective service delivery: almost half of FLHWs interviewed are unpaid, effectively operating as volunteers, struggle with difficult living conditions and lack of supplies, and report inequitable treatment between male and female workers.
• There is a lack of evidence-based health information for pregnant women: only 27% of pregnant women in the study reported having received any information related to sexual and reproductive health or associated risks.
• Despite generally positive health-seeking behavior, both women and men are concerned by lack of availability of medicine. Read More...
The document is structured into four primary chapters – Background, Methodology, Findings: Results and Analysis, and Recommendations—each containing sub-chapters. The background section outlines the study’s purpose, objectives, and underlying rationale. The methodology section describes the research design, applied approaches, data collection methods and participant information. The study’s key findings are categorized into distinct thematic areas aligned with CARE's Good Practices Framework for Gender Analysis and includes the following Core Areas of Inquiry:
• Household decision-making, division of labor and control of productive assets
• Control over one’s body
• Access to public spaces and services
• Claiming rights and meaningful participation in public decision-making
The RGA also applies the above domains related to health outcomes, behaviors, and health-seeking behavior, including gender dynamics within the Sierra Leone health system with recognition that unequal gender dynamics gaps impact health care providers and their ability to deliver quality services. Finally, the recommendations section outlines actions or interventions CARE should consider in future programming.
Key Findings:
* Men have more influence over decisions for the household than women—including the seeking of healthcare—and women lack control over key decisions related to sex, marriage, and children, including if and when to use contraception. Women’s mobility is limited by social norms which require male permission for movement.
• Contraceptive use is low. Despite around 70% of people knowing about contraceptives and where to get them, only 50% are currently using them. Many community members believe modern forms of family planning are haram or unhealthy, with anecdotal evidence suggesting there is perception that it promotes extramarital affairs.
• Front Line Health Workers (FLHW) face major barriers to effective service delivery: almost half of FLHWs interviewed are unpaid, effectively operating as volunteers, struggle with difficult living conditions and lack of supplies, and report inequitable treatment between male and female workers.
• There is a lack of evidence-based health information for pregnant women: only 27% of pregnant women in the study reported having received any information related to sexual and reproductive health or associated risks.
• Despite generally positive health-seeking behavior, both women and men are concerned by lack of availability of medicine. Read More...
End Phase Evaluation: Epidemic Control and Reinforcement of Health Services (ECRHS) Phase II Project in Sierra Leone
The Epidemic Control and Reinforcement of Health System Services (ECRHS) project is funded under the German Financial Cooperation (BMZ) with Sierra Leone through KfW. Two phases have been successfully completed during the project implementation. The first phase of the project was launched in November 2015 and ended in 2018. The first phase was originally designed to respond to the Ebola outbreak. The second phase of the ECRHS project was considered an extended phase of the ECRHS I; and started in January 2019. Whereas the primary focus of ECRHSI was on public health emergency response, the aim of phase II of ECRHS is the sustainable establishment of an epidemiological control system, whilst also strengthening the performance of the health system with a focus on reproductive health / self-determined family planning. The purpose of this report therefore is to present findings of the final evaluation of the ECRHS II programme evaluation which was carried out with the general objective of ‘assessing the result and impact of the project goal and outcomes in targeted northern region of Sierra Leone’. Read More...
REPORT END PHASE EVALUATION (Epidemic Control and Reinforcement of Health Services (ECRHS) Phase 1 Programme in Sierra Leone) Ebola Emergency Response April
This report presents findings from the end phase evaluation of the Epidemic Control and Reinforcement of Health Services (ECRHS) Phase 1 Programme in Sierra Leone, which was implemented from November 2015 to December 2018. The aim of the Programme is to ‘Improve the health status of the population of Sierra Leone’. The Programme was originally designed to provide response to the Ebola outbreak in Sierra Leone, but also considered a longer-term view and worked towards putting in place preparations putting in place preparations for the transition of an extended health system strengthening (HSS) effort. Read More...
Gender Equality & Women’s Empowerment Program III (GEWEP) Midterm Study GLOBAL SYNTHESIS REPORT
Across six countries, this study examines the effect of a men’s and boys’ engagement intervention—aiming to change men’s and boys’ attitudes and behaviors around gender equality, women’s empowerment, and positive masculinities; including participants’ own masculine identity—and the state of civil society’s rights and protections, tracing improvement and erosion since 2020. Importantly, this is not an evaluation, rather this is a midterm study that comes alongside the Gender Equality & Women’s Empowerment Program III (GEWEP) implemented by CARE International. Instead of evaluating this program, this study focuses narrowly on the attitudinal and behavioral impact of this model intervention for engaging men and boys. GEWEP also sought to contribute to the civil society space, and thus we conclude this study with a discussion of the unique experiences of women’s rights and women-led organizations that did and did not partner with GEWEP teams.
To generate this global report, the Research Team both drew on the six country reports which accompany this study and engaged in entirely new analyses. Analysis for this global report pooled data from all six countries, while using analytical techniques to identify where any one country unduly influenced findings at the global level. To strike this balance between common tendencies across countries, and differences between countries, this study takes care to identify and report country-specific results alongside global findings. This is especially true where we identified countries as unique outliers.
For the section on men’s engagement, the Research Team leveraged an experimental design, advanced statistical methods, and multiple sources and types of data, including a multi-country survey with 3,226 respondents, to investigate the relationship between men’s engagement, including their level of engagement (“treatment saturation”), in program activities and associated changes in their attitudes and behaviors towards women and girls, gender equality, violence against women and girls, and masculinity. Across six countries—Afghanistan, Burundi, the Democratic Republic of the Congo (DRC), Mali, Niger, and Rwanda—the Research Team explores common factors that influence treatment effect, positively and negatively. Read More...
To generate this global report, the Research Team both drew on the six country reports which accompany this study and engaged in entirely new analyses. Analysis for this global report pooled data from all six countries, while using analytical techniques to identify where any one country unduly influenced findings at the global level. To strike this balance between common tendencies across countries, and differences between countries, this study takes care to identify and report country-specific results alongside global findings. This is especially true where we identified countries as unique outliers.
For the section on men’s engagement, the Research Team leveraged an experimental design, advanced statistical methods, and multiple sources and types of data, including a multi-country survey with 3,226 respondents, to investigate the relationship between men’s engagement, including their level of engagement (“treatment saturation”), in program activities and associated changes in their attitudes and behaviors towards women and girls, gender equality, violence against women and girls, and masculinity. Across six countries—Afghanistan, Burundi, the Democratic Republic of the Congo (DRC), Mali, Niger, and Rwanda—the Research Team explores common factors that influence treatment effect, positively and negatively. Read More...
Rafah Governorate: Deception, Destruction & Death in the “Safe” Zone Rapid Gender Analysis
The ongoing crisis in the Gaza Strip has been described as a “human rights crisis, a human-made humanitarian disaster”1 and a “war on woman.”2 Since October 7th there has been mass scale forced displacement of over a million Palestinians from Northern Gaza to Southern Governorates. The subsequent impacts of this, compounded with pre-existing gender inequalities and multidimensional vulnerabilities, have disproportionately impacted women and girls, as well as other vulnerable groups such as persons with disabilities, children, pregnant and lactating women, elderly populations, those living with chronic and mental health conditions.
Aim and methodology: The aim of this RGA was to hear from women and men currently in Rafah, with a focus on those providing essential services to communities and Internally Displaced People (IDPs) in the Governorate. The aim was to better understand the experiences of women, men, girls and boys at this moment, and to identify how CARE and the local and international humanitarian community, including U.N. Agencies, can best respond - understanding the formidable challenges and barriers to do so.
This RGA was conducted at a time where the population of Rafah were subject to continued and threatened bombardment from land, air and sea. As such it was intentionally designed to be light and small scale in terms of primary data collection; which took place between 7th April to 17th April 2024, and is complemented by secondary data review and analysis.
This RGA is being published in the days surrounding further escalation of violence in Rafah. The Gaza side of the Rafah border crossing with Egypt is blocked 6 and an evacuation order has been issued in the Eastern parts of Rafah; the designated “safe zone” in the Gaza strip. This reinforces the voices of the men and women who told us, with no uncertainty, that nowhere in Gaza is safe.
Key findings related to each area of inquiry and recommendations are summarised below, with more details to be found in the main report.
Key findings:
1. Shifting Gender Roles: Continuous displacement has led to some traditional gender roles adapting and expanding, as well as others being reinforced. Increased and unrealistic pressure has been placed on women to meet the needs and demands of dependents in a highly stressful environment, which has led to an increase in verbal and physical violence against women.
2. Coping Mechanisms: On the verge of starvation, nearly the entire population in Rafah has reported extreme and harmful coping strategies including but not limited to bartering with other essential items, begging, gathering wild foods, scavenging under rubble or in trash or seeking food outside their shelter.8 Reports indicate some women are fasting for several days in a row,9 and boys and girls are forced to work on the street selling or begging. Female heads of household, older women and women with disabilities face security and protection obstacles seeking access to food distributions.10
3. Sustaining through Community Networks of Solidarity: Community solidarity has emerged as a lifeline for survival, such as women supporting children’s education and men distributing food parcels or organising activities for children. Religion and prayer have played a key role in the coping strategies of men, women and children. For youth, social media (when accessible) played a role to maintain connections, articulate fears and share experiences with others. For children, where possible, play and educational outlets within shelters provide a brief respite from the reality of airstrikes.
4. Maternal & Reproductive Health: With an overwhelmed and overstretched health system, people with disabilities, chronic conditions and trauma are left without the most basic care. With estimates of 155,000 women in Gaza pregnant or lactating, and 5,500 expected to deliver in the next month,11 the lack of adequate maternal, sexual and reproductive health services leave mothers, newborns and their children exposed to severe and life-threatening health risks. If women survive pregnancy and childbirth, postpartum recovery, including ability to breastfeed, also present severe challenges.12
5. Mental Health and Psychosocial Support Services (MHPSS): Of extreme concern is the severe emotional, physical and psychological distress among the displaced population, especially among children and youth. As caregivers do their best to survive and manage their own mental health, the impact on children and youth is extensive and holds intergenerational impacts.
6. Education: With formal education effectively stopped since October 7th, children have lost out on a whole academic year of education. While there were reports of some initiatives such as ‘informal learning circles’ and remote learning, these are not easily accessible. Parents, caregivers and children are focused on daily survival; there is the increasing need for adolescents and young girls to support with chores or be confined to their tents due to safety issues; and, particularly for boys, the need to help earn money or seek supplies for the family. Read More...
Aim and methodology: The aim of this RGA was to hear from women and men currently in Rafah, with a focus on those providing essential services to communities and Internally Displaced People (IDPs) in the Governorate. The aim was to better understand the experiences of women, men, girls and boys at this moment, and to identify how CARE and the local and international humanitarian community, including U.N. Agencies, can best respond - understanding the formidable challenges and barriers to do so.
This RGA was conducted at a time where the population of Rafah were subject to continued and threatened bombardment from land, air and sea. As such it was intentionally designed to be light and small scale in terms of primary data collection; which took place between 7th April to 17th April 2024, and is complemented by secondary data review and analysis.
This RGA is being published in the days surrounding further escalation of violence in Rafah. The Gaza side of the Rafah border crossing with Egypt is blocked 6 and an evacuation order has been issued in the Eastern parts of Rafah; the designated “safe zone” in the Gaza strip. This reinforces the voices of the men and women who told us, with no uncertainty, that nowhere in Gaza is safe.
Key findings related to each area of inquiry and recommendations are summarised below, with more details to be found in the main report.
Key findings:
1. Shifting Gender Roles: Continuous displacement has led to some traditional gender roles adapting and expanding, as well as others being reinforced. Increased and unrealistic pressure has been placed on women to meet the needs and demands of dependents in a highly stressful environment, which has led to an increase in verbal and physical violence against women.
2. Coping Mechanisms: On the verge of starvation, nearly the entire population in Rafah has reported extreme and harmful coping strategies including but not limited to bartering with other essential items, begging, gathering wild foods, scavenging under rubble or in trash or seeking food outside their shelter.8 Reports indicate some women are fasting for several days in a row,9 and boys and girls are forced to work on the street selling or begging. Female heads of household, older women and women with disabilities face security and protection obstacles seeking access to food distributions.10
3. Sustaining through Community Networks of Solidarity: Community solidarity has emerged as a lifeline for survival, such as women supporting children’s education and men distributing food parcels or organising activities for children. Religion and prayer have played a key role in the coping strategies of men, women and children. For youth, social media (when accessible) played a role to maintain connections, articulate fears and share experiences with others. For children, where possible, play and educational outlets within shelters provide a brief respite from the reality of airstrikes.
4. Maternal & Reproductive Health: With an overwhelmed and overstretched health system, people with disabilities, chronic conditions and trauma are left without the most basic care. With estimates of 155,000 women in Gaza pregnant or lactating, and 5,500 expected to deliver in the next month,11 the lack of adequate maternal, sexual and reproductive health services leave mothers, newborns and their children exposed to severe and life-threatening health risks. If women survive pregnancy and childbirth, postpartum recovery, including ability to breastfeed, also present severe challenges.12
5. Mental Health and Psychosocial Support Services (MHPSS): Of extreme concern is the severe emotional, physical and psychological distress among the displaced population, especially among children and youth. As caregivers do their best to survive and manage their own mental health, the impact on children and youth is extensive and holds intergenerational impacts.
6. Education: With formal education effectively stopped since October 7th, children have lost out on a whole academic year of education. While there were reports of some initiatives such as ‘informal learning circles’ and remote learning, these are not easily accessible. Parents, caregivers and children are focused on daily survival; there is the increasing need for adolescents and young girls to support with chores or be confined to their tents due to safety issues; and, particularly for boys, the need to help earn money or seek supplies for the family. Read More...
Mastercard Impact Fund and CARE Global Partnership: Ignite Program Endline Results Report
From December 2019 through May 2023, the Ignite project, supported by the Mastercard Center for Inclusive Growth, was implemented by CARE in Vietnam, Pakistan and Peru where there are large segments of unserved micro and small enterprises ready for investment. The project was intended to increase financial security and resilience and grow the businesses of underserved micro-entrepreneurs, specifically those MSEs with between 2-10 employees, who have been in business for 2+ years. To achieve the above goal, the Ignite program envisioned a series of interventions to achieve intermediate outcomes, including improved ability to intentionally serve this segment from FSPs, business growth, financial sustainability, financial product performance, job creation and retention, financial resilience and enhanced digital literacy.
Impact level indicators include increase in household income and financial resilience. Both of the impact indicators have shown positive movements illustrating that the project has created a positive change. There are different degrees of change in different countries.
Percentage of strivers who reported an increase in household income showed impact across all three countries.
• Vietnam almost doubled the total number of households who increased income between baseline and endline (44% at baseline; 87% at endline), an increase of 43 percentage points.
• In Pakistan the number went up by 16 times (3% at baseline; 51% at endline).
• In Peru a total of 33% of the households reported an increase in their household income at the end of the project.
Percentage of strivers’ financial resilience also showed improvement.
• Vietnam recorded 43 percentage points improvement between baseline and endline (67% at baseline; 96% at endline).
• Peru showed 26 percentage points growth between baseline and endline (42% at baseline; 53% at endline).
•No comparable data for this indicator was found from Pakistan. Read More...
Impact level indicators include increase in household income and financial resilience. Both of the impact indicators have shown positive movements illustrating that the project has created a positive change. There are different degrees of change in different countries.
Percentage of strivers who reported an increase in household income showed impact across all three countries.
• Vietnam almost doubled the total number of households who increased income between baseline and endline (44% at baseline; 87% at endline), an increase of 43 percentage points.
• In Pakistan the number went up by 16 times (3% at baseline; 51% at endline).
• In Peru a total of 33% of the households reported an increase in their household income at the end of the project.
Percentage of strivers’ financial resilience also showed improvement.
• Vietnam recorded 43 percentage points improvement between baseline and endline (67% at baseline; 96% at endline).
• Peru showed 26 percentage points growth between baseline and endline (42% at baseline; 53% at endline).
•No comparable data for this indicator was found from Pakistan. Read More...
Pledge for Change Reporting 2024
Overall, CARE has made significant progress on Pledge 3, some good progress on Pledge 2 (though not all of this can be measured yet), and some progress on Pledge 1.
In relation to equitable partnerships, we have set interim targets for 2025 for the extent and diversity of partnerships, and seen some progress in these areas, but our 2023 Keystone partner survey highlights three main areas for improvement: funding adequacy and timing, promotion of partners in the media, and joint decision-making. CARE is working on connecting finance and program reporting systems to better report on financial transfers to local partners (and to set a meaningful target for this for future years). We are also analysing good practices from positive outlier countries in the partner survey, to identify specific actions and processes that can be spread more widely to improve partnership practices.
For authentic storytelling, we have been shifting behaviours and practices towards anti-racist and decolonized communications, based on our global Communications Commitments. We are setting up a working group to explore global media monitoring and automate some monitoring requirements. CARE will also launch our third biannual image audit and update our images and consent policy. We can demonstrate some progress in acknowledging partners and promoting local voices in annual reports and information/advocacy campaigns, but we are not yet able to measure this in relation to fundraising.
In terms of influencing wider change, we have consistently been ceding space to local and national women-led organizations (WLOs) to advocate for their priorities with policy makers. We have also seized advocacy opportunities at the multilateral level and in the US to enhance donor transparency and accountability. CARE will lead negotiations to develop an IASC-endorsed definition of Women and Girl-Led Organizations to boost the engagement, participation and decision-making by these organisations in humanitarian action. We will continue to leverage our positions of influence in various policy platforms to open up leadership spaces for WLOs, and support them in using these spaces. CARE will set up mechanisms to track how our media and communications team is creating opportunities for partners, especially WLOs, to feature their voices and policy priorities. Read More...
In relation to equitable partnerships, we have set interim targets for 2025 for the extent and diversity of partnerships, and seen some progress in these areas, but our 2023 Keystone partner survey highlights three main areas for improvement: funding adequacy and timing, promotion of partners in the media, and joint decision-making. CARE is working on connecting finance and program reporting systems to better report on financial transfers to local partners (and to set a meaningful target for this for future years). We are also analysing good practices from positive outlier countries in the partner survey, to identify specific actions and processes that can be spread more widely to improve partnership practices.
For authentic storytelling, we have been shifting behaviours and practices towards anti-racist and decolonized communications, based on our global Communications Commitments. We are setting up a working group to explore global media monitoring and automate some monitoring requirements. CARE will also launch our third biannual image audit and update our images and consent policy. We can demonstrate some progress in acknowledging partners and promoting local voices in annual reports and information/advocacy campaigns, but we are not yet able to measure this in relation to fundraising.
In terms of influencing wider change, we have consistently been ceding space to local and national women-led organizations (WLOs) to advocate for their priorities with policy makers. We have also seized advocacy opportunities at the multilateral level and in the US to enhance donor transparency and accountability. CARE will lead negotiations to develop an IASC-endorsed definition of Women and Girl-Led Organizations to boost the engagement, participation and decision-making by these organisations in humanitarian action. We will continue to leverage our positions of influence in various policy platforms to open up leadership spaces for WLOs, and support them in using these spaces. CARE will set up mechanisms to track how our media and communications team is creating opportunities for partners, especially WLOs, to feature their voices and policy priorities. Read More...
Youth Skills Development Impact Brief
Globally, an estimated 282 million young people (aged 15-24) are not employed, in education, or in training (defined as NEET),1 and young people are three times as likely as adults to be unemployed.2 Nearly 75% of the world’s 1.8 billion young people lack the skills needed for the labor market.3 Strong economies hinge upon youth having the skills to secure meaningful, well-paid work. CARE’s programs help young people succeed in jobs, entrepreneurship, and ongoing career learning. CARE provides comprehensive strategies that support and collaborate with national governments, employers, educators, parents, and youth to develop the workforce for today and tomorrow. We build our programs to connect
young people with mentors, training providers, and employers. We train youth in soft skills (such as critical thinking, time management, decision making, self-confidence, and others), financial literacy, and market-demanded technical vocational skills to meet the needs of the labor market.
CARE’s youth skills & workforce development programs primarily support Sustainable Development Goal 8 - Promote inclusive and sustainable economic growth. Since 2020, CARE’s programs have supported 22 million people in increasing their economic empowerment and participation in dignified work in 67 countries. Read More...
young people with mentors, training providers, and employers. We train youth in soft skills (such as critical thinking, time management, decision making, self-confidence, and others), financial literacy, and market-demanded technical vocational skills to meet the needs of the labor market.
CARE’s youth skills & workforce development programs primarily support Sustainable Development Goal 8 - Promote inclusive and sustainable economic growth. Since 2020, CARE’s programs have supported 22 million people in increasing their economic empowerment and participation in dignified work in 67 countries. Read More...
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