Fast and Fair Vaccine Update August to October 2021

CARE's Fast and Fair initiative supports countries to equitably deliver COVID-19 vaccines through four pillars: Advocate, Facilitate, Protect and Mobilize.
CARE has identified 22* countries (and counting ) with strong capacity, partnerships, and readiness to scale.
By October 2021, CARE has supported vaccines in districts where 126 million people have delivered vaccines. We have also supported mass media messages promoting vaccines to 263 million people. Read More...


By August 9, 2021, Ethiopia had reported more than 284,000 COVID-19 cases and 4,426 deaths. Since COVID-19 was first reported in Ethiopia in March of 2021, the impacts of the pandemic, the measures taken to curb COVID-19, and additional political, economic, and environmental crises have severely impacted the population.
Women and girls bear different burdens in this crisis, and emergency responses often overlook the differences
in impacts and needs for women, girls, men, and boys in humanitarian responses. To that end, this research—
with funding from the EUTF (European Union Emergency Trust Fund) provides insight into the impact of COV1D-19 on women and girls in Ethiopia. This insight informs recommendations and guide EUTF partners and other relevant stakeholders in the areas of EUTF interventions. With this objective in mind, four woredas (administrative districts), one refugee camp, and one Industrial Park (IP) were considered as sample areas. These are Sekota Zuria and Gazgibla woredas in Wag Hemra zone of Amhara region; Moyale and Miyo woredas in Borena Zone of Oromia region, Asayita Refugee Camp in Afar region, and Bole-Lemi Industrial Park in Addis Ababa.
This research surveyed 372 women and girls in April 2021. The quantitative surveys covered adult women and girls over the age of 15. It also provides insights into the differences between refugees, Internally Displaced People (IDPs), refugees, and migrants. Qualitative from focus group discussions and key informant interviews also reflects opinions from men and boys. Read More...

Supporting flood Forecast-based Action and Learning (SUFAL) Project in the 2020 Monsoon Floods

Background: ‘Supporting flood Forecast-based Action and Learning’ (SUFAL) project was designed to contribute to reducing the adverse impacts of the increasing frequency of catastrophic flooding on the vulnerable and poor communities through Forecast-based Action (FbA). The project was funded by The Directorate-General for European Civil Protection and Humanitarian Aid Operations (ECHO) and was implemented through a consortium led by CARE Bangladesh, with Concern Worldwide, Islamic Relief and Regional Integrated Multi-Hazard Early Warning System for Africa and Asia (RIMES). The project was implemented in three northern districts of Bangladesh: Jamalpur, Gaibandha, and Kurigram. FbA contributed to disseminating Flood Early Warning messages with a lead time of 10 – 15 days with timely and accurate weather forecast information, while and it also helping to identify potential flooding areas.

Methodology: The primary purpose of the study was to “Evaluate the impact of early actions” applied through the SUFAL project on household and community beneficiaries in responding to the 2020 monsoon floods. Customized OECD-DAC criteria, Quasi-experimental design (Difference-in-Difference Method), Knowledge, Attitude and Practices (KAP) framework and Value for Money (VfM) framework were used as guiding methods and tools to design study instruments and evaluate the impact of early actions at every stakeholder level. The study covered a control group in non-project areas and three treatment groups in the project areas: Treatment group 1 (EWM support), Treatment group 2 (EWM + Evacuation + Shelter + WASH support), Treatment group 3 (EWM + Evacuation + Shelter + WASH + Cash-grant support). Treatment groups were categorized in three different groups to conduct cost-effectiveness analysis. The study areas were in the districts of Kurigram (Hatia, Begumganj, Buraburi, Shaheber Alga unions), Gaibandha (Bharatkhali, Saghata, Ghuridaha, Haldia unions) and Jamalpur (Kulkandi, Chinaduli, Noarpara, Shapdhor. The survey sample consisted of 224 control respondents (of which 153 were women) and 754 treatment respondents (of which 426 were women), among which Sample for treatment group 1, 2, and 3 were 293 (100 women), 292 (192 women) and 169 (134 women), respectively. A total of 118 of the 754 treatment households interviewed through the survey were women-headed households and 38 out of 224 control group households were women headed households. The team had conducted 7 FGDs with community members in the three implementation areas, and 27 KIIs with community volunteers, project staff, government officials, and other related NGOs.

Impact: It was found through the study that less people in treatment group experienced damages compared to control households, treatment households saved more resources in 2020 than control households, and the average monetary values of assets saved by treatment group in 2020 were higher compared to the control group households. Due to the drawn-out duration and intensity of the flood in 2020, respondents reported that they were not able to prevent more damages although they took more early actions. Besides, treatment areas were the most flood affected areas. The early messages had helped the community to prevent damage to their assets and livelihoods. The percentage of damage prevented in agricultural sector for the treatment group had increased to 28% since the flood of 2019. The damage prevented in fisheries had increased significantly by 18 percent in 2020 in compared to that of 2019. The death of family members from waterborne diseases had decreased (except female members) in comparison to the previous flood in 2019. It is quite evident that the early warning message had enabled the males to take early actions regarding relocation of the vulnerable
family members to higher grounds, relative’s houses, or to the shelters. The cash for work modality had also helped the community people to obtain a source of income by working for the embankment, roads, bamboo bridges, etc. Shelter renovations and upgradations reportedly encouraged the community people to evacuate faster. The average amount of loan taken by a treatment respondent and control respondent was found to have been Taka 20,194 and Taka 18,335 respectively. However, post flood loan burden was significantly less for the cash grant recipients (only 32% took loan after flood) as compared to other treatment groups (more than 50% took loan). The
cash grants are said to have helped the recipients address their basic needs during the flood and also helped them to some extent to repair their house and pay for livestock treatment after the flood. [70 pages] Read More...

Collective Impact for Nutrition (CI4N)

The objective of the Collective Impact for Nutrition (CI4N) initiative has been to improve the nutritional status of women aged 15 to 49 and children under 2, through a multisectoral approach and initiatives based on two strategic axes: (1) Alliances for learning and advocacy and (2) community nutrition. [34 pages] Read More...

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...

Learning to Listen: Regional Partnerships and Impacts

In 2017, CARE asked, “What will it take to scale our impact by 10 times more than we currently do? What about 100 times?” Part of the answer to that, with significant unrestricted investments from 2017-2020, were CARE’s Impact Growth Strategies. These aim to address the “missing middle” by supporting the skills, staff, and connections needed to bring our work together across regions and partners.
A recent review of these 4 regional platforms—Equal value, equal rights (EVER) in LAC; Women on the move (WoM) in West Africa; Her harvest, our future (HHOF) in Southern Africa; Made by Women in Asia Pacific—shows significant return on the investment. These returns merit continued investment in regional platforms that take creative approaches to partnership, local leadership, and the evolution of CARE’s operating models.
• Contributing to impact for 12 million people, with potential impact for 78 million more people impacted over the coming years.
• Paving the scaling pathways by demonstrating different models of partnership, design, evidence, impact, and fundraising. These experiences provide valuable experience and evidence of what works (and doesn’t) and how to continue our ambition of sustainable impact at scale.
• Demonstrating concrete tools and ability to center the voices of the people we serve, in new partnership models, feedback systems, power structures, and evidence. This includes crucial lessons on how to live out our strategic goal of being locally led and globally connected.
• Mobilizing resources by contributing to roughly $100 million in new restricted and flexible funding.

Final Report for the Final Evaluation of OFDA Response program

This report presents the final evaluation of the United States’ Agency for International Development (Office of Foreign Disaster Assistance ( Response Program implemented by CARE Turkey and its partners in Aleppo and Idleb governorates of Northwest Syria. The evaluation aimed to assess the program’s relevance, efficiency, effectiveness, impact, sustainability and coordination using the Organization for Economic Co operation and Development's Development Assistance Committee (OECD DAC) evaluation criteria and was carried out from July to October 2021.

“I am very satisfied with this assistance in terms of gravelling the road, providing the camp with water and upgrading the tents for the entire camp. All of those interventions were desperately needed. People are satisfied because the situation has improved within the camp.”
-Camp Manager
“I can say that this service is very important in all aspects because it is securing clean and safe water for the neighborhood (…). Everyone in the neighborhood is satisfied with the services.”
-FGD participant

Water for Food Security, Women’s Empowerment and Environmental Protection (SWEEP) Project

CARE, with the financial support from the Austrian Development Agency (ADA), has been implementing a three-year project titled "Water for Food Security, Women's Empowerment and Environmental Protection (SWEEP)" Project in East and West Belesa Woredas of Central Gondar Zone, Amhara Regional State. The SWEEP project was designed to address the socio-economic and environmental problems causing food insecurity, including inadequate access to water supply and environmental degradation, social barriers and gender inequality, limited livelihood opportunities and low productivity. Therefore, the final evaluation aims to evaluate the project's impact in terms of changes for the intended beneficiaries and provide evidence for future decisions demonstrating accountability to the project beneficiaries, stakeholders, and donors. [135 pages] Read More...

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