health systems
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...
Support for Service Delivery Integration- Services (SSDI-Services) Endline
SSDI-Services was the flagship project for USAID/Malawi’s health office. The project was implemented from November 8, 2011 to March 7, 2017 under a cooperative agreement, valued at USD 89 million. Active project implementation occurred over a 4.5-year period from April 2012 to December 2016, with the preceding and following months focused on startup and closeout activities respectively.
SSDI-Services provided financial and technical assistance to the Malawian Ministry of Health (MoH) to deliver, refine, and scale up high-impact interventions contained in the Essential Health Package (EHP). The EHP includes globally proven and cost-effective interventions to address key causes of illness and death in Malawi. SSDI-Services implemented interventions under the following program areas: maternal, newborn, and child health (MNCH); family planning (FP); malaria; nutrition; HIV/AIDS; and sanitation and hygiene.
SSDI-Services was implemented by a consortium comprising Jhpiego as lead, CARE, Plan International, and Save the Children. The project focused on increasing access to, and strengthening the delivery of, EHP services both at the health facility and in the community. It leveraged the work of both SSDI-Communication and SSDI-Systems to improve health-seeking behavior and the quality of health services by addressing the informational needs of both service providers and their clients. It also addressed systems issues that may hinder the provision of high-quality Read More...
SSDI-Services provided financial and technical assistance to the Malawian Ministry of Health (MoH) to deliver, refine, and scale up high-impact interventions contained in the Essential Health Package (EHP). The EHP includes globally proven and cost-effective interventions to address key causes of illness and death in Malawi. SSDI-Services implemented interventions under the following program areas: maternal, newborn, and child health (MNCH); family planning (FP); malaria; nutrition; HIV/AIDS; and sanitation and hygiene.
SSDI-Services was implemented by a consortium comprising Jhpiego as lead, CARE, Plan International, and Save the Children. The project focused on increasing access to, and strengthening the delivery of, EHP services both at the health facility and in the community. It leveraged the work of both SSDI-Communication and SSDI-Systems to improve health-seeking behavior and the quality of health services by addressing the informational needs of both service providers and their clients. It also addressed systems issues that may hinder the provision of high-quality Read More...
Gender Analysis: Prevention and Response to Ebola Virus Disease in the Democratic Republic of Congo
The latest epidemic of Ebola Virus Disease (EVD) in the Democratic Republic of Congo (DRC) has rapidly evolved into the second largest outbreak in history. Deployed in an operational environment characterised by ongoing volatility, EVD prevention, treatment and containment efforts have faced multiple difficulties. Mistrust of EVD responders by local communities, coupled with targeted attacks on healthcare workers and facilities, have proved to be serious operational challenges. Despite a gressive efforts to stamp out the disease across three provinces, the virus has continued to spread and is responsible for the deaths of 3,303 people to date (as of 24th November 2019) with an overall fatality rate of 67%.
However, these casualty numbers hide the underlying characteristics of the EVD crisis. The reality is that the majority of fatalities consist of women (56%), and children (28%). Adult men constitute just 11% of EVD deaths. Yet fatalities alone do not fully demonstrate the differential ways in which men, women, boys and girls are exposed and experience the immediate risks and longer-term consequences of the disease. Socially prescribed cultural norms, attitudes and practices in relation to gender and age dictate how individual women, men, girls and boys are differentially impacted by the EVD crisis. It is therefore critical to better understand the socio-behavioural underpinnings to EVD aetiology. In light of the gendered dimensions of the EVD crisis, CARE International in DRC commissioned a Gender Analysis of the EVD crisis in North Kivu in order to provide information about the different needs, capacities and coping strategies of women, men, girls and boys during the EVD crisis. Read More...
However, these casualty numbers hide the underlying characteristics of the EVD crisis. The reality is that the majority of fatalities consist of women (56%), and children (28%). Adult men constitute just 11% of EVD deaths. Yet fatalities alone do not fully demonstrate the differential ways in which men, women, boys and girls are exposed and experience the immediate risks and longer-term consequences of the disease. Socially prescribed cultural norms, attitudes and practices in relation to gender and age dictate how individual women, men, girls and boys are differentially impacted by the EVD crisis. It is therefore critical to better understand the socio-behavioural underpinnings to EVD aetiology. In light of the gendered dimensions of the EVD crisis, CARE International in DRC commissioned a Gender Analysis of the EVD crisis in North Kivu in order to provide information about the different needs, capacities and coping strategies of women, men, girls and boys during the EVD crisis. Read More...
FINAL PERFORMANCE EVALUATION REPORT OF THE PROJECT “ZIKA RESPONSE IN ECUADOR AND PERU”
This document is the final report of the performance evaluation of the binational project Zika Response in Ecuador and Peru, implemented in Ecuador and Peru by CARE from 2016 to 2019. The main objectives of the project were to strengthen community, local and national capacities to respond to the outbreak of Zika virus and other vector-borne diseases, as well as to improve regional and national efforts to reduce Zika transmission rates.
The evaluation of the project in Ecuador was carried out in the intervention zones of 10 cantons of the provinces of El Oro, Manabí and Esmeraldas, between August and September 2019; in Peru, in 20 districts of 10 provinces of the departments of Tumbes, Piura, Lambayeque, and Cajamarca. After the elaboration of the work proposal and the methodological design of the evaluation, secondary information was collected and primary information was collected at field through interviews, focus groups and social mapping (in Ecuador), and a Likert scale survey (in Peru). The evaluation was framed in five blocks: General Aspects, Community Mobilization, Community-Based Surveillance, Social and Behavioral Change, and Inter-Institutional Planning and Coordination.
The main findings of the evaluation determine that the project achieved, for the most part, the objectives of the project, having as its main achievement the facilitation of inter-institutional coordination of the different actors in the territory. In Peru, the experience of community-based vector control, supported by technological and communications innovations, stands out. In both countries, the project successfully mobilized the community to carry out prevention strategies against Zika and increase knowledge of the risks of this type of disease, as well as useful individual and collective strategies for its prevention. Read More...
The evaluation of the project in Ecuador was carried out in the intervention zones of 10 cantons of the provinces of El Oro, Manabí and Esmeraldas, between August and September 2019; in Peru, in 20 districts of 10 provinces of the departments of Tumbes, Piura, Lambayeque, and Cajamarca. After the elaboration of the work proposal and the methodological design of the evaluation, secondary information was collected and primary information was collected at field through interviews, focus groups and social mapping (in Ecuador), and a Likert scale survey (in Peru). The evaluation was framed in five blocks: General Aspects, Community Mobilization, Community-Based Surveillance, Social and Behavioral Change, and Inter-Institutional Planning and Coordination.
The main findings of the evaluation determine that the project achieved, for the most part, the objectives of the project, having as its main achievement the facilitation of inter-institutional coordination of the different actors in the territory. In Peru, the experience of community-based vector control, supported by technological and communications innovations, stands out. In both countries, the project successfully mobilized the community to carry out prevention strategies against Zika and increase knowledge of the risks of this type of disease, as well as useful individual and collective strategies for its prevention. Read More...