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USAID’s CNHA Health Facility Readiness and Functionality Assessment, 2024

The Community Nutrition and Health Activity (CNHA), funded by the United States Agency for International Development (USAID), is dedicated to enhancing the nutritional status of women and children within vulnerable 1000-day households in Bangladesh—those with pregnant and lactating women and/or children under two years. This assessment, conducted between March and June 2024, evaluated the readiness and functionality of 1,336 community clinics (CCs) and 354 Union Health and Family Welfare Centers (UH&FWCs) across 14 districts. It aimed to identify strengths and weaknesses in key operational areas, including governance and management, health workforce presence, service delivery, logistics, and information systems. The findings revealed a significant presence of community groups in CCs but highlighted operational gaps in regular meetings and management practices. While the availability of maternal and child health services was generally high, discrepancies existed in the provision of family planning methods and comprehensive nutritional services. The assessment serves as a foundational tool for CNHA to target interventions, enhance health systems, and improve overall community health outcomes by integrating these findings into local government improvement plans.

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Gender Equality & Women’s Empowerment Program III (GEWEP III) Midterm Study GLOBAL SYNTHESIS REPORT (PROMEESS III)

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.
Donor: NORAD 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...

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...

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...

USAID’s Community Nutrition and Health Activity (CNHA) Report – Consultation (Meetings with Stakeholders, Households & Community People to Understand Information Sources, Media Access and Habits of CNHA Primary Target Groups to Inform CNHA SBC Strategy)

The USAID Community Nutrition and Health Activity (CNHA) is a five-year project (2023-2028) aimed at improving the nutritional status of women and children within the first 1,000 days of life in vulnerable communities across Bangladesh. Implemented in collaboration with CARE-Bangladesh and partners, the project spans 50 Upazilas in 14 districts and focuses on enhancing service delivery at the community level through health facilities and a strong Social and Behavior Change (SBC) strategy. The project aims to increase the adoption of family planning, maternal and child nutrition, and other health-related practices among its target population of 4 million direct and 10 million indirect participants. To inform its SBC strategy, CNHA conducted stakeholder consultations in February 2024, gathering data from various groups, including pregnant and lactating mothers, adolescents, and community health service providers, through individual and group consultations.

The consultations revealed key findings on the sources and trustworthiness of health-related information, with community health workers like CHCPs and FWAs emerging as the most trusted sources. Although many pregnant and lactating mothers received information on nutrition and family planning, adolescents and mothers-in-law were less informed. Common barriers to accessing accurate information included limited literacy, restricted access to health facilities due to poor transportation, and traditional beliefs that discouraged the adoption of new practices. Despite the widespread use of mobile phones, especially smartphones, media access was limited, with most women relying on family and community gatherings for information. The consultations also highlighted the need for improved communication flow from health facilities to the community, particularly for nutritional information and family planning services. The consultations also highlighted the need for improved communication flow from health facilities to the community, particularly for nutritional information and family planning services, emphasizing the importance of targeted interventions to bridge gaps in knowledge and access within these vulnerable groups.

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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...

KEYSTONE PARTNER SURVEY 2023 CARE International

In 2023, CARE expressed its interest in conducting a Keystone Partnership Survey to understand how 304 local partners assessed their experience of working with CARE in an international development partnership. This report provides credible perceptual data from a partner perspective on how well CARE performs its role in the partnership.
Keystone’s partnership survey enables INGOs to benchmark their performance ratings against the experiences and perceptions of over 8,000 local partners of more than 90 INGOs (listed below in Table 1) that have taken the
survey.
Thematically, the survey explores the most important operational dimensions to international development partnerships – learning, monitoring & reporting, communications, financial support, and non-financial support.
CARE’s technical competence is further assessed through a series of questions about its sector-specific knowledge, leadership reputation, and value adding abilities. Overall relationship dynamics are captured through questions
about how well CARE learns and adapts, how CARE compares to other international partners, and the extent to which the local partner would recommend working with the CARE.
The report presents overall results for each survey question in a single graphic chart. For rating questions, Keystone employs Net Promoter Analysis (see Annex 6), allowing it to compare and benchmark CARE’s current responses against a benchmark drawn from Keystone’s global cohort of social change organizations.
Respondents indicated their region of work, budget size, type of organization, the type of work they do, and whether they were women-led. This enables us to analyse the data by these respondent characteristics without compromising anonymity. Where organizations of a particular characteristic (e.g., location or size of budget) vary from the average, we do not present it in a separate chart, but highlight these variations in the text accompanying
the charts. Read More...

Call to Action Field Implementation (CAFI) II

CAFI seeks to catalyze the Call to Action on Protection from Gender-Based Violence in Emergencies (CTA) on the ground. The project works with women-led organizations (WLOs) to drive change and foster Gender-Based Violence (GBV) prevention, risk mitigation, and response in humanitarian emergencies.

In 2013, governments, donors, and humanitarian organizations launched the CTA, to fundamentally transform how GBV prevention, risk mitigation, and response are addressed. The CTA aims to strengthen accountability in policies, systems, and mechanisms.
The partnership has grown to more than 100 members, but consolidating CTA implementation in the field is a key gap that needs to be addressed. As a result, CAFI was launched to advance the Call to Action 2021- 2025 Road Map on the ground.
What are the main objectives of CAFI?
● Catalyze increased representation and leadership of women and girls, specifically WLOs, in decision making structures and humanitarian assistance
● Amplify GBV expertise: scaling existing capacity of WLOs
● Address GBV root causes and coordinate effective response and risk mitigation
How does CAFI work?
CAFI aims at contributing to WLO strengthening through capacity-sharing approaches between partners. WLOs are engaged from the beginning, allowing them to co-create and adapt the project according to their needs and contexts and ensuring
accountability and women’s voice and leadership throughout the whole project cycle.

CAFI works through a consortium of 10 WLOs across Latin America and the Caribbean, West and Central Africa, the Middle East/North Africa, and Europe, who coordinate national networks of WLOs: Arab Women Organization (AWO) of Jordan, Baghdad Women Association (BWA) in Iraq, Center Women’s Perspectives (CWP) in Ukraine, Comité des Jeunes Filles Leaders (COJEFIL) in Niger, Dynamique des Femmes Juristes (DFJ) in the Democratic Republic of the Congo, Fundación
para el Desarrollo en Género y Familia (GENFAMI) in Colombia, Global Media Campaign (GMC) in Mali, Himaya Daeem Aataa (HDA) in Lebanon, and Tinta Violeta in Venezuela. In Iraq, Lebanon, and Venezuela, project activities are co-led by WEO, Sama for Development, and Uniandes, respectively. Read More...

Systems-Level Change in Niger: Women and Girls Are Better Off Today Than in 1991

Few development programs have a decades-long lifespan and impact. CARE’s Mata Masu Dubara model (MMD) has been rolled out since 1991, championing women's leadership and economic empowerment in Niger. Originally conceived as savings and credit groups, the model has evolved over the years to address women’s groups demands to have better access to public health services, improve nutrition, receive technical training and participate in civic and electoral processes, among others.

In 2023, CARE initiated a ground-breaking systems evaluation of MMD groups in Niger to explore the actual influence the groups have on women’s and girl’s voice, leadership, economic autonomy and climate justice, published in a May 2023 report. A complementary mixed-methods evaluation conducted from July to December 2023 explores the influence of MMD on women and girls’ maternal health, early and forced marriage, education and nutrition, in partnership with the Government of Niger.

Using CARE’s pathways of systems-level change, combined with qualitative and quantitative data, the study explored four dimensions of change for each one of the topics mentioned above: 1. Advocacy to influence policies and programs; 2. Changes in social norms; 3. Supporting social movements; 4. Strengthening systems and social responsibility. Today, CARE Niger serves 33,795 groups with 865,000 women and girl members. In Maradi, Zinder, Dosso and Tahoua 1,378 women and men answered a survey; 314 women and men participated in focus group discussions and individual interviews.

Are women and girls of Niger better off in 2023 than they were in 1991? Yes. While the review noted progress made towards more gender equity for girls’ education, access and use of sexual and reproductive health services and more attention paid to the welfare of pregnant and breastfeeding women, early and forced marriage still persists. Leveraging the power of MMD groups and other trusted community leaders (teachers, principals, MMD female leaders, religious leaders) to design interventions to curb early marriage would yield tremendous benefits. Indeed, early marriage robs girls of 9% of their future income.

Through MMD, women of Niger have found their voice, been elected to parliament in record numbers (over 30% in 2021), and participate in local decision making processes as town councilors and local representatives. Acting both at the program, local level and the national, influencing one, CARE, its partners and networks of MMD groups will continue to create a better, safer, more prosperous environment for Nigerien girls. (86 pages) Read More...

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