Right to Health


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...

End Phase Evaluation: Epidemic Control and Reinforcement of Health Services (ECRHS) Phase II Project in Sierra Leone

The Epidemic Control and Reinforcement of Health System Services (ECRHS) project is funded under the German Financial Cooperation (BMZ) with Sierra Leone through KfW. Two phases have been successfully completed during the project implementation. The first phase of the project was launched in November 2015 and ended in 2018. The first phase was originally designed to respond to the Ebola outbreak. The second phase of the ECRHS project was considered an extended phase of the ECRHS I; and started in January 2019. Whereas the primary focus of ECRHSI was on public health emergency response, the aim of phase II of ECRHS is the sustainable establishment of an epidemiological control system, whilst also strengthening the performance of the health system with a focus on reproductive health / self-determined family planning. The purpose of this report therefore is to present findings of the final evaluation of the ECRHS II programme evaluation which was carried out with the general objective of ‘assessing the result and impact of the project goal and outcomes in targeted northern region of Sierra Leone’. Read More...

REPORT END PHASE EVALUATION (Epidemic Control and Reinforcement of Health Services (ECRHS) Phase 1 Programme in Sierra Leone) Ebola Emergency Response April

This report presents findings from the end phase evaluation of the Epidemic Control and Reinforcement of Health Services (ECRHS) Phase 1 Programme in Sierra Leone, which was implemented from November 2015 to December 2018. The aim of the Programme is to ‘Improve the health status of the population of Sierra Leone’. The Programme was originally designed to provide response to the Ebola outbreak in Sierra Leone, but also considered a longer-term view and worked towards putting in place preparations putting in place preparations for the transition of an extended health system strengthening (HSS) effort. Read More...

The True Cost of COVID-19 Vaccination Campaigns in South Sudan

By November 2023, South Sudan had received 7,076,570 doses and administered 5,101,991 doses of COVID-19 vaccine through various vaccination strategies to curb the detrimental effects of COVID-19. The country has fully vaccinated 5,033,836 individuals across 80 counties of 10 states and 3 administrative areas .
CARE got funding from the United Nations Children's Fund (UNICEF) through Crown Agents (prime recipient of UNICEF). CARE International South Sudan conducted both static and intensified National COVID-19 Vaccination Campaign (NCVC)/Integrated COVID-19 Vaccination and Preventive Therapy (ICVOPT) in 9 counties from 3 states and 2 administrative areas out of 80 counties in South Sudan. CARE implemented the NCVC in Jonglei State (Twic East, Bor South & Duk counties), Western Bahr El Ghazal State (Jur River and Wau counties), Unity State (Rubkona and Mayom counties), Greater Pibor Administrative Area (Pibor County and Boma sub-county), and Ruweng Administrative Area (Pariang county).


El informe presenta los hallazgos del estudio de evaluación externa del Proyecto GROW: “Desarrollando capacidades para ofrecer tratamiento por el abuso de sustancias sensible al género 2014 – 2021”, que en adelante denominaremos Proyecto GROW. El informe contiene una síntesis de la información generada, procesada y analizada para responder a las preguntas que contiene cada uno de los siete objetivos específicos del estudio. Read More...

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