Localization in Practice: Realities from Women’s Rights and Women-Led Organizations in Poland

During the invasion of eastern Ukraine in 2014, violence against women and girls, especially intimate partner violence and sexual violence, increased rapidly. Since February 2022, the situation has deteriorated to alarming new levels. Exacerbated and pervasive violence against Ukrainian women and girls is a consequence of war, with women and girls continuing to be abused, exploited, and raped in Ukraine and while they flee to other countries. An increasing number of survivors are coming forward, buttressed by additional reports from women’s rights activists, service providers, humanitarian organizations, and UN agencies. As conflict in Ukraine pushes millions of women to seek refuge abroad, those leaving remain highly vulnerable to risks like trafficking, or may face sexual exploitation and abuse when seeking access to accommodation, transportation, or financial resources.

Women’s organizations in Poland, particularly those providing services to survivors of violence and working on women’s rights, are reporting more and more requests for assistance from sexual violence survivors inside Ukraine. Polish civil society has demonstrated their commitment and fitness to respond to the growing humanitarian needs, but the international community must step up with financial and technical support to ensure that a sustainable, localized approach can continue. Read More...

Women at the last mile: How investments in gender equality have kept health systems running during COVID-19

Even before COVID-19, investments in health systems—and especially female health workers—were too low. In 2019 the world had a gap of 18 million health workers. Two years and fifteen million deaths later, we have at least 26 million fewer health workers than we need. , This leaves us severely underprepared for future pandemics and other major shocks to the health system, including conflict and climate change. We must invest in health systems that don’t just meet the needs of today, but that are also resilient in the face of future shocks.

Pandemic preparedness requires gender equality: equal recognition, support, and fair pay for ALL health workers. Globally, 70% of health workers are women, but half of their work is unpaid. We must do more to support these health workers. The glimmers of success in COVID-19 built on previous investments in women health workers, their skills, and equality in health systems. Pre-existing investments in equality helped systems respond to COVID-19. Increased investments will build better resilience for the crises that come next.

This report highlights case studies and lessons learned from 20 countries during COVID-19. The evidence shows that we must invest in gender equality in health systems to prepare for and respond to the next pandemic. Health worker training is not enough. Focusing only on health workers working within the formal health system is not enough. We need to work for equality.


Impact, Influence, and Innovation: Reflecting on 10 Years of the CARE-GSK Frontline Health Worker Initiative

In recognition of their critical role in health linkages and systems strengthening, CARE and GSK established a decade long strategic investment in frontline health workers (FHW) and community health workers (CHW) in 2011 called the Frontline Health Worker Initiative. Following 10 years of partnership and programming, this report explores the resulting impacts, influence, and innovation. It synthesizes reach and impact data from 13 programmes across the 9 countries included in the Frontline Health Worker Initiative between 2011 and 2021. The countries included in this initiative are Afghanistan, Bangladesh, Cambodia, Cameroon, Chad, Laos, Myanmar, Nepal, and Togo.
The data presented here is specific to the communities in which CARE delivered sexual and reproductive health, maternal and child health, nutrition, and sanitation programming with GSK’s support. The analysis is designed to identify the changes in overall health outcomes that occurred at a population level. While these findings do not necessarily imply causation, CARE’s efforts have likely reasonably contributed towards these changes within the specific communities.
The Frontline Health Worker initiative has achieved these results across multiple development and humanitarian contexts – including slow-onset and sudden shocks, conflict, and most recently the COVID-19 pandemic. Many of these results were only made possible through the long-term investment from GSK and scalable actions that were implemented across all nine countries. Critically, the Frontline Health Worker Initiative established platforms, networks and health service capacity-building that served as a catalyst for CARE to pivot towards the response to the COVID-19 pandemic quickly in the communities where these projects exist.
Learnings from this programme will serve to strengthen CARE’s private sector partnership models for future programmes to build resilience and achieve health impact in communities. Read More...

ON THE FRONTLINE: Lessons on health worker empowerment through the COVID-19 pandemic response

Around the world,frontline and community health workers serve to connecthealth services, commodities, and informationwiththose who need them. Equippedwith the relevant skills and community trust, theycanstrengthen health systems by bridginggeographic and financial accessibility gaps for rural, hard-to-reach, and vulnerable populations through last-mile health delivery. When integrated into national and local healthcare systems, community health workers can additionally help patients navigate complex systems of care and ensure care continuity across services. Historically during times of health crises, global governments and organizations have often relied on community health workforces as frontline responders to deliver life-saving care to disproportionate l y affected populations. The 2020 COVID-19 pandemic was no exception, with many countries mobilizing their existing community health worker programs or initiating new ones to assist with pandemic response . Leveraging lessons learned through its decades long support and implementation of frontline and community health worker initiatives across 60 countries, CARE developed guidelines for community-level pandemic response and disease prevention during this time. In June 2020, CARE partnered with Abbott to launch a one-year in-depth primary care response to the COVID-19 pandemic Read More...

Ukraine Rapid Gender Analysis (Primary Data) May 2022

"It is no longer very scary whether a rocket will arrive or not from the sea, but it is scary that we will die of starvation.”
The lives of people across Ukraine have been profoundly impacted by the humanitarian crisis brought on by the invasion on 24 February 2022. As of 29 April, 5.5 million refugees have already fled Ukraine,1 and the number of internally displaced people (IDPs) has reached 7.7 million. Of those who have fled the country, it is estimated that 90 per cent are women and children, while most men aged 18–60 are required to stay behind under martial law. Based on current data from the International Organization for Migration, 60 per cent of the adult internally displaced population are female, while 40 per cent are male. As the crisis quickly evolves, so do the needs and priorities of women and men across Ukraine.
This Rapid Gender Analysis (RGA), carried out by UN Women and CARE International, seeks to draw attention to the gender dynamics in the humanitarian crisis resulting from the war in Ukraine. The RGA also proposes recommendations for humanitarian leadership, actors and donors to ensure consideration of the gendered dimensions of risk, vulnerability and capabilities in response to this crisis.
The RGA is a progressive publication based on both primary and secondary data sources that compares pre-crisis data with up-to-date information as the situation evolves. This RGA builds upon the RGA Ukraine Brief (http://www.careevaluations.org/evaluation/rapid-gender-analysis-ukraine/) developed by CARE International during the first week of the war and on the UN Women and CARE RGA published 29 March6 based on an analysis of secondary data. For this report, the RGA team reviewed English, Ukrainian and Russian sources and interviewed 179
women and men from local communities across Ukraine, as well as representatives from civil society organizations (CSOs), UN agencies and government bodies. Particular effort was made to ensure that the voices of women and men in vulnerable situations and from different marginalized groups were included. Read More...

End line assessment of GSK supported Community Health workers (CHW) initiative in Sunamganj district, Bangladesh

In spite of improvement in maternal and child health, the Sylhet division continues to have the poorest indicators in Bangladesh. Higher mortality for both mother and child and poor utilization of healthcare services still exist in the Sylhet division. Sunamganj is one of the remotest areas in Bangladesh and belongs to the Sylhet division having the poorest maternal and child health status. Since December 2012, CARE Bangladesh together with GSK and other key stakeholders has been implementing a Community Health Workers (CHWs) Initiative, which aims to address the lack of skilled human resources in remote and underserved unions of Sunamganj district. The overall goal of the CHW initiative is to improve maternal and child health outcomes in underserved/remote and poor communities of Bangladesh by increasing their access to quality health care services. Through a unique model of Public-Private Partnership (PPP), the project developed 319 Private CSBAs who are providing maternal and child health services including primary treatment of Non-Communicable Diseases (NCDs) like diabetes and hypertension in the entire Sunamganj district. To do a robust measurement in terms of assessing maternal, neonatal and child health (MNCH) related knowledge and practices as well as documentation of learning of these innovative initiatives, icddr,b conducted a baseline study in 2012 and end-line assessment in 2018. Read More...

Improved WASH Services to the Myanmar Refugees Population in camps 15 (Jamtoli) and 16 (Potibonia), Ukhiya Upazila, Cox’s Bazar

Applying both quantitative and qualitative tools and approaches, the end-line assessment was conducted in February 2022. It covers 415 respondents' households from camps 15 and 16—data collection done with tablets in KoBo. The samples were drawn systematically. First, the sample size was determined following the most common statistical formula. The objectives of the study are as follows: 1) To know the present situation context on WASH; 2) To identify the targeted respondent's current Knowledge, Attitude and Practice (KAP).

The study findings reveal the following:
- The most commonly reported primary sources for drinking water were Piped water tap/Tap Stand, reported by 66% of households.
- In terms of water collection, male engagement has been increased. Overall, 86% of households reported women, followed by adult males (55%) and Children (6%). However, the male also helps them when they cook and cloth wash.
- Overall, only 2% of households reported a combined travel and waiting time of more than 30 Water containers.
- Females preferred to get 'Kolsi' (a pitcher) instead of Bucket or Jerrycan for carrying water. On the other hand, male and adolescent children preferred Jerrycan for carrying the water.
- 76% of respondents feel safe collecting enough water to meet their households' needs, such as drinking, cooking, laundry, bathing etc. However, women also reported that they feel unsafe because men go to water points to collect water.
- A significant proportion of households (88%) do not treat drinking water. Because they believe the drinking water source is safe—12% of households use the aqua tab to treat their water.
- The most-reported defecation (sanitation options) for household members five and above was communal latrines 86%, followed by shared latrines 14%, and single-household latrines 7%. Others places (2 %), bucket and open defecation was seldom reported 1%.
- The accessible latrine is one of the beauties of this project. This latrine is included: The railing on the way, The handle inside, The tap, The commode, The single-use.
- The community also thinks that these latrines will be equally helpful for elderlies.
- A significant 79% responded to the affirmative of privacy of latrine use. A significant number of
- 18% of the households' female members use the designated bathing facilities. However, this figure is low because of privacy concerns.
- All (100%) respondents mentioned that they cleaned every time they filled with fresh/clean water. While at the time of hurriedness, that type of cleaning activity has disrupted.
- 100% of households owned soap at the time of the interview. The study further explored other hand washing options/solutions households use when they do not have soap; because of CoVID-19, all respondents, even children, are aware of handwashing. They can recall the critical time of handwashing.
- Regarding the best way to receive health and hygiene messages, 45% stated Home visits by volunteers, and 2nd choice is by the local leaders. However, the study findings also revealed that only 7% of households said they do not know how to prevent diarrhea.
- 69% of females used reusable clothes, 16% used disposable pads. The reusable cloth is the most preferred for use during the menses.
- Most female respondents said they wash and reuse the MHM materials and dispose of way is Household/Trash bin, Throw in the open waste area/communal bins, In the latrine, Bury in the soil, and, Burn them
- Consideration of men, women and girls carrying water and provide water container that these particular groups prefer;
- The child-to-chid session needs to discuss the importance of Gender Marker because children remove the gender markers frequently, which causes a problem for the women;
- Need to keep attention to the elderly person in terms of WASH facilities along with Persons with Disabilities;
- Video documentaries for hygiene promotion may be more effective together; in this connection, CARE can collaborate with "shongjog" which is the open platform of CwC in Rohingya Camp. Read More...

Endline Report: An interim analysis of baseline and endline data for key indicators

TAMANI is a complex intervention for improving maternal and newborn health in Tabora, Tanzania. The overarching objective of this intervention is to address the challenges linked to (1) the decision to seek care, (2) the barriers to accessing care, and (3) the provision of the highest possible quality of care, collectively known as the “three delays”. Addressing these delays requires a complex set of changes in behaviors, attitudes, access to and use of resources, skills, and knowledge of clients and service providers. The intervention targeted the supply side by improving the quality of care at health facilities, and the demand side through programs to increase utilization of care through community engagement and addressing gender barriers to accessing care by women and their families. Read More...

My Forest, My Livelihood, My Family program (FUTURES) Baseline report

The FUTURES—My Forest, My Livelihood, My Family program (FUTURES) serves communities in the Yayu Coffee Forest Biosphere Reserve (YCFBR) located in Southwestern Ethiopia, in Oromia Regional State. The YCFBR encompasses the Hurumu, Yayo, Bilo Nopa, Alge-Sachi, and Doreni woredas of Illu-Abba Bora zone and Chora woreda of Buno Bedele zone and includes protected forest area as well as designated areas for economic activities like coffee and spice production, commercial forest plantations and eco-tourism, and areas where many traditional and modern agricultural practices take place.
Households in the area depend on a combination of small-scale agricultural and forest management systems dominated by traditional agronomic practices and characterized by a lack of crop diversity and low productivity. Deforestation, degradation, and increased loss of biodiversity are major concerns for sustainable agricultural and livelihood practice in the region. Social, gender, and cultural barriers have historically limited women’s and youth’s engagement in agricultural and economic sectors. High rates of early and forced marriage, and limited availability of reproductive health and family planning services, especially youth-friendly services, may further limit women and youth from participating meaningfully in agricultural practice and livelihood generation. Government services and local civil society organizations in the area operate at a limited capacity, and their offices are male-dominated and do not meaningfully incorporate a gendered approach to their work (Gebrehanna and Seyoum, 2020).
The three-year FUTURES project was launched in April 2021 to address many of the health, environment, and livelihood concerns of the YCFBR region. The project is implemented by CARE Ethiopia and its three local partners, Oromia Development Association (ODA), Environment and Coffee Forest Forum (ECFF), and Kulich Youth Reproductive Health and Development Organization (KYRHDO). The FUTURES project evaluation, funded by USAID, and led by Data for Impact (D4I), aims to understand the impact of the FUTURES project on key health, agricultural, and livelihood and conservation behavioral outcomes, and to contribute to knowledge about the implementation of cross-sectoral programs, including monitoring, evaluations, and learning (MEL) of such programs. Read More...

At the last mile: Lessons from Vaccine Distributions in DR Congo

The Democratic Republic of the Congo (DRC) has one of the lowest COVID-19 vaccination rates in the world, with just 0.87% of people in DRC having received even one dose. While the country has received 8.2 million doses of COVID-19 vaccine, it has managed to administer 528,000 of them—just under 11% of vaccines available. In April of 2021, DRC became one of the first countries to return 1.3 million COVID-19 doses to COVAX because they could not deliver them to people before the vaccines expired.

The challenges that risked more than a million doses expiring are still in play for most of the country. In both January and February 2022, 114,705 vaccines expired in country because there was not enough investment in systems and health workers to deliver vaccines. To reach 70% of the population—62.7 million people—DRC will need to drastically scale up and accelerate COVID-19 vaccination.

CARE is working with 4 vaccination sites—2 in Butembo and 2 in Goma—to support with community mobilization in partnership with local leaders, health center operations, and training. With joint action and communication plans developed with chiefs, religious leaders, and local authorities, and additional equipment to protect health workers, those sites had vaccinated 1,132 people. In those 4 sites, we have also conducted several rounds of research and problem-solving using community dialogues between health workers and clients using the Community Scorecard, as well as the Social Analysis and Action tools, which provides the insights for this case study. The team has also supported local vaccination teams with IT infrastructure, personnel costs, and creating locally adapted COVID-19 communications plans.

Version Francaise
La République démocratique du Congo (RDC) possède un des taux de vaccination les plus bas dans le monde avec la lutte contre COVID-19. Seulement 0,87% des personnes en RDC ont reçu même une seule dose du vaccin. Alors que le pays a reçu 8,2 millions de doses de vaccin contre la COVID-19, il n’a réussi qu’à en administrer 881,204, soit un peu moins de 11% des vaccins disponibles administrés. En avril 2021, la RDC est devenue l’un des premiers pays à restituer 1,3 million de doses de COVID-19 à COVAX parce qu’elle ne pouvait pas les administrer aux personnes avant l’expiration des vaccins.

Les défis qui risquaient d’expirer plus d’un million de doses sont toujours en jeu pour la majeure partie du pays. En janvier et février, 114,705 doses ont expiré dans le pays parce qu’il n’y avait pas assez d’investissements dans les systèmes et les agents de santé pour livrer des vaccins. Pour atteindre 70 % de la population, soit 62,7 millions de personnes, la RDC devra considérablement intensifier et accélérer la vaccination contre la COVID-19.

CARE travaille avec 4 sites de vaccination – 2 à Butembo et 2 à Goma – pour soutenir la mobilisation communautaire en partenariat avec les leaders et structures locaux, les opérations des centres de santé et la formation. Ces sites avaient vacciné 1 132 personnes. Dans ces 4 sites, nous avons également mené plusieurs séries de recherches et de résolution de problèmes à travers des dialogues communautaires entre les prestataires des services et les clients avec la Carte Communautaire et l’analyse et l’action sociale, à l’aide de la carte de pointage communautaire, qui fournit les informations nécessaires à cette étude de cas. On a aussi appuyé les missions de supervisions avec l’infrastructure pour la connexion internet, la motivation des prestataires, et l’élaboration des plans de communication adaptes aux contextes.

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