Special Evaluation/Report

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...

MAGNIFYING INEQUALITIES AND COMPOUNDING RISKS The Impact of COVID-19 on the Health and Protection of Women and Girls on the Move

More than one year into the coronavirus disease (COVID-19) pandemic—with some countries seemingly on their way out of the crisis while others enter new waves—evidence of its impact is growing. COVID-19 is increasing short-term humanitarian needs and negatively affecting longer-term outcomes for marginalized populations and people in vulnerable situations, significantly setting back hard-won development gains, magnifying inequalities, and compounding risks. Among those worst affected are the more than 80 million people worldwide—approximately half of whom are women and girls—who have been forcibly displaced by drivers such as persecution, conflict, generalized violence or human rights violations.1
The majority of forcibly displaced people live in resource-poor countries with weak public health and social protection systems, and economies that have been hard-hit by the pandemic.2 Yet, to date, there has only been limited research around the unique ways in which women and girls on the move are affected.3 This despite predictions of significant impacts on access to, and use of, basic health services—including for sexual and reproductive health (SRH)—and the overall protection environment, including increases in prevalence and risk of gender-based violence (GBV).
Placing gender at the center of its humanitarian and development responses, CARE undertook new research in Afghanistan, Ecuador, and Turkey between April and May 2021 to better understand how COVID-19 is impacting the health and protection of women and girls on the move. The three countries represent different types of forced displacement across multiple regions: internally displaced persons (IDPs) and refugee returnees in Afghanistan; more recent migrants and refugees due to the Venezuelan crisis in Ecuador; and longer-term Syrian refugees living under temporary international protection in Turkey. The primary data collected for this research included more than 1,000 surveys with women on the move and from host communities, to allow comparison; 31 focus group discussions (FGDs) with women and adolescent girls; and 45 key informant interviews (KIIs) with government actors, health and protection service providers, humanitarian organizations, and CARE staff. Read More...

Community Scorecard in Emergencies Learning Brief

To be effective and equitable towards global populations, humanitarian organizations must adhere to the core standards and principles on quality humanitarian response. Since the inception of ideas on the centrality of local participation in aid in the early 2000s and the more recent evolution of that concept into accountability towards affected populations, the humanitarian community has sought to turn this doctrine into reality.
Accountability in humanitarian response requires that organizations carry out their efforts in an ethically and legally responsible manner that is inclusive of the communities they are seeking to serve. Of UNICEF’s nine Core Humanitarian Standards (depicted here to the right), three specifically refer to mechanisms of accountability towards affected peoples: response is based on communication, participation and feedback; complaints are welcome and addressed; actors continuously learn and improve. In practice this could include centralizing the voices of affected peoples by engaging communities in needs and performance assessments and decision-making. Achieving this is often hindered by the constraints inherent to conflict settings such as lack of localization of assistance, communication between actors, and exploration of needs.
CARE’s Community Score Card
Seeking to actualize these principles of community participation and accountability into our programming, CARE developed the Community Score Card as part of a project aimed at developing innovative and sustainable models to improve health services. Working in crisis settings requires an understanding of the lived experiences of people, the power dynamics, and micro-politics that inform humanitarian response approaches. It also requires bridging the gap between civil society organizations, local and national governments, international non-governmental organizations, and impacted communities. Social accountability approaches do this by connecting citizens with those responsible for providing services. The Community Score Card (CSC) is a participatory social accountability mechanism for assessment, planning, monitoring and evaluation of services. Designed for ease of use and adaptation into any sector with a service delivery scenario, the CSC brings together users and providers of a particular service or program to jointly identify service utilization and provision challenges, mutually generate solutions, and work in partnership to implement and track the effectiveness of those solutions in an ongoing process of quality improvement. The CSC has five phases: (I) planning and preparation; (II) conducting the scorecard with the community; (III) conducting the scorecard with service providers; (IV) interface meeting where the all parties present their findings in the presence of duty-bearers and then jointly develop action plans; and (V) monitoring of the action plans and evaluation of overall process. 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...

Somalia: Cash Transfers via Mobile Money for Maternal Child Health Services

This study is part of a larger multi-country study by CARE entitled “Cash and Voucher Assistance for Sexual Reproductive Health and Rights Outcomes: Learnings from Colombia, Ecuador, Lebanon and Somalia.”
CARE Somalia has used Cash and Voucher Assistance (CVA) in its programs for over ten years. This includes CVA for food security and livelihoods, nutrition, WASH, and education, as well as multipurpose cash transfers. Since 2018, with support from Office of Foreign Disaster Assistance (OFDA) (now the Bureau for Humanitarian Assistance (BHA)), CARE Somalia has been implementing a food security and Livelihoods, health, nutrition, protection and WASH program. With BHA support, CARE currently supports 19 MCH facilities across Somaliland and Puntland that target children and pregnant and lactating women (PLW). Read More...

Ecuador: Vouchers for Sexual Reproductive Health and Rights

This study is part of a larger multi-country study by CARE entitled “Cash and Voucher Assistance for Sexual Reproductive Health and Rights Outcomes: Learnings from Colombia, Ecuador, Lebanon and Somalia.” Ecuador is both a transit and destination country for refugees and migrants from Venezuela and elsewhere. As of July 2020, over 400,000 Venezuelans were living in Ecuador. Venezuelan refugees and migrants have considerable health, psychosocial, and economic needs. Within these groups, women, adolescents, and LGBTQI people face heightened risks of Gender-Based Violence (GBV), human trafficking, and sexual exploitation as well as challenges to earning an income while in Ecuador. Although the public health system in Ecuador is free to all regardless of migration status, not all health – and especially SRH services – are covered in the public system. Furthermore, safe access to available services without discrimination based on nationality, sexual orientation/gender identity, or age is a barrier to access and uptake of SRH services in Ecuador. Read More...

Colombia: Vouchers for Sexual Reproductive Health (SRH) Services

This study is part of a larger multi-country study by CARE entitled “Cash and Voucher Assistance for Sexual Reproductive Health and Rights Outcomes: Learnings from Colombia, Ecuador, Lebanon and Somalia.” As a result of Venezuela’s socioeconomic and political crisis, there have been massive migratory flows of people from Venezuela into Colombia.1 According to the Interagency Coordination Platform for Refugees and Migrants, as of May 2020 over 1.76 million Venezuelans had fled to Colombia with many continuing to walk to and across the Southern Border with Ecuador as caminantes.

CARE Colombia began direct operations in the country in 2019, focusing primarily on the needs of Venezuelan
refugees and migrants in Pamplona, Norte de Santander and, later, Bucaramanga, Santander. Cash and Voucher
Assistance then (CVA) are primary modalities for CARE Colombia, particularly for its SRHR and protection portfolio.
Working with populations on the move as was was the case in this program, together with high levels of unmet SRHR needs resulted in a unique operating environment for a voucher intervention supporting SRHR programming.
This case study focuses on the design of the programming only. Due to the timing of the review, no substantive data on the user experience of the vouchers or outcomes could be captured. Read More...

CASH AND VOUCHER ASSISTANCE FOR SEXUAL REPRODUCTIVE HEALTH AND RIGHTS LEARNINGS FROM ECUADOR, COLOMBIA, LEBANON, AND SOMALIA

CARE is committed to ensuring that projects with cash and voucher assistance (CVA) are designed with and for women and girls, addressing recipients’ needs, challenges, and opportunities. CARE has invested in research on how to make CVA work for women and girls through gender-sensitive approaches to framing processes and outcomes of the modalities. As a widely accepted method of increasing access to services and improving autonomy, dignity, and resilience, programming with CVA has been integrated into numerous sectors to improve the lives of displaced communities, particularly the most underserved. To date, CARE’s CVA has primarily been used for food security and livelihood outcomes and multisectoral outcomes via multipurpose cash (MPC) transfers. Now, aligned with its strategic intent, CARE is investing in sectoral areas where CVA is less often used and that are of primary interest for women and girls, including gender-based violence (GBV) response and sexual and reproductive health and rights (SRHR).

Building on extensive experience with CVA and SRHR programming, CARE conducted a study to investigate how outcomes for the pilot initiatives using CVA for SRHR compare to global learnings, and to identify opportunities for strengthening and expanding pilots for long-term programming. The study reviewed programming in four contexts (Colombia, Ecuador, Lebanon, and Somalia). The initial study was undertaken by two consultants, one focused on Lebanon and Somalia and one focused on Colombia and Ecuador. Data collection included 25 remote key informant interviews (KIIs) with CARE staff at the global and country levels as well as staff from partner organizations, followed by After Action Reviews with each country team and a validation meeting. All activities were undertaken in either English or Spanish and transcripts were analyzed using data analysis software. Analysis was conducted both by country and across contexts to identify commonalities and thematic learning, mostly led by CARE technical advisors. Read More...

‘IF WE DON’ T WORK, WE DON’ T EAT’ Syrian Women Face Mounting Food Insecurity a Decade into the Conflict

Ten years ago, the lives of many Syrians changed profoundly as anti-government demonstrations escalated into violent conflict between forces allied to the Government of Syria and armed opposition groups. The resulting humanitarian crisis is one of the worst of our time – 6.7 million Syrians remain internally displaced; an estimated 13 million people are in need1 and 12.4 million live with food insecurity.

In recent months, the situation has deteriorated even further as the COVID-19 pandemic, mass displacements, natural
disaster, economic collapse and ongoing hostilities have combined to create a situation wherein households are
finding it increasingly difficult to meet their basic needs, including for food.

Average food prices in Syria increased by 236% in 2020 – and food prices are more than 29 times higher than the five year pre-crisis average, causing many families to resort to negative coping strategies. This includes eating fewer
or smaller meals to get by. Furthermore, due to the loss or reduced capacity of male heads of household to death, injury, disappearance or emigration in search of work, many Syrian women are now the sole or primary breadwinners for their families, bearing the full burden of providing for their families with limited livelihood opportunities. About 22% of Syrian households are now headed by women; this is up from only 4% prior to the conflict. Even in households where the male head of household is working in some capacity, dire economic circumstances have pushed women to find some source of income to help with household expenses. In both cases, women are thrust into the ‘provider’ role in a way that most had not previously experienced. Read More...

Our Best Shot: Frontline Health Workers and COVID-19 Vaccines

Fully realizing the social and economic benefits of halting COVID-19 requires investing in a fast and fair global rollout of COVID-19 vaccines. CARE estimates that for every $1 a country or donor government invests in vaccine doses, they need to invest $5.00 in delivering the vaccine.

Investments in frontline health workers are a critical component in this comprehensive vaccination cost. Of the $5.00 in delivery costs, $2.50 has to go to funding, training, equipping, and supporting health workers—especially women—who administer vaccines, run education campaigns, connect communities to health services, and build the trust required for patients to get vaccines. For these investments to work, they must pay, protect and respect women frontline health workers and their rights—a cost that is largely absent from recent WHO estimates on vaccine rollout costs. No current global conversations or guidance on vaccine costs includes the full cost of community health workers or long-term personnel costs.

Investing in a fast and fair global vaccine distribution will save twice as many lives as maximizing vaccine doses for the wealthiest countries in the world. Even better, investing in vaccine equality will speed up economic recoveries in every country in the world. For every $1 invested in vaccines in less wealthy countries, wealthy countries will see $4.80 of economic benefit because economies can fully re-open sooner. Failing to make this investment could cost wealthy economies $4.5 trillion in economic losses.

Current global debates are focused so narrowly on equitable access to for vaccine doses that they largely overlook the importance of delivering vaccines—and the key role women frontline health workers play in vaccine delivery. Of 58 global policy statements on vaccines, only 10 refer to the costs of delivery at all—and these are primarily technical advisories from the World Health Organization. No government donors are discussing the importance of vaccine delivery systems that are necessary to ending COVID-19. Only one statement—from Norway—refers to the importance of women health workers as part of the solution to ending COVID-19.

As new and dangerous strains of COVID-19 emerge in countries that are struggling to access the vaccine and control the pandemic, every day we wait for fair global vaccination allows for more contagious strains that spread around the world. The more chances the virus has to mutate in non-vaccinated populations, the higher the risk for everyone. Comprehensive global vaccine delivery plans that make sure the vaccine gets to people who need it—and that those people are ready to get the vaccine when it arrives—are the only way to end this threat. No one is safe until everyone is safe.
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