Sexual|Reproductive Health
Examining Barriers to Family Planning Information, Products, and Services Among Ukrainian Refugees and Host Communities in Poland (English)
Cash and Voucher Assistance for Family Planning in Poland Assessment Report: This report examines barriers Ukrainian refugees and Polish host communities face in accessing family planning (FP) services. Refugees struggle with financial obstacles like transportation and private healthcare costs, compounded by Poland’s restrictive sexual and reproductive health (SRH) policies. The report highlights the potential of cash and voucher assistance (CVA) to improve access to FP services, with the need for contextual adaptation to Poland’s healthcare system.
Poland SRHR Stakeholder Workshop Learning Brief (August 2024): This brief shares insights from a workshop on sexual and reproductive health rights (SRHR) for Ukrainian refugees and Polish communities. It identified financial barriers, restrictive policies, and stigma as major challenges, and explored how CVA could improve SRH access by partnering with local stakeholders and adapting to Poland's restrictive policy environment. Read More...
Poland SRHR Stakeholder Workshop Learning Brief (August 2024): This brief shares insights from a workshop on sexual and reproductive health rights (SRHR) for Ukrainian refugees and Polish communities. It identified financial barriers, restrictive policies, and stigma as major challenges, and explored how CVA could improve SRH access by partnering with local stakeholders and adapting to Poland's restrictive policy environment. Read More...
Lafiyayyan Yara (Healthy Child) – Reducing Infections Disease Among Children Under Five (RIDCU) Bade LGA, Yobe State
The Lafiyayyan Yara (Healthy Child): Reducing Infectious Disease among Children under Five (RIDCU-5) project was a 27-month private donor funded project implemented from October 2021 through December 2023. The project strengthened health systems in Bade Local Government Area (LGA) of Yobe state by providing required equipment and medication for health facilities, increasing capacity of health personnel to use approved diagnostic methods, and engaging the community to improve uptake of health services.
The primary objective of the evaluation was to assess the project's performance and document its achievements, challenges, and best practices to guide future similar programming; and provide recommendations to CARE Nigeria and its partners to make informed decisions and enhance the effectiveness and efficiency of future initiatives.
Effectiveness
Evidence from the desk review showed that the project made remarkable progress towards reducing mortality in under-5 children through a community-based health systems strengthening approach that ensures that communities receive a core package of services. The major factors that influenced the effectiveness and achievement of the project results were the use of community structures (community health volunteers, model mothers, and community-based surveillance focal points), capacity building, the referral system and the Social Analysis and Action (SAA) approach through community dialogues, supportive supervision, routine monitoring visits and facility health promotion session. The SAA approach also helped to shift practices related to family planning, immunization and poor health seeking behavior, as evidenced from the qualitative findings.
Efficiency
In both the design and implementation of the project activities, CARE International RIDCU5 team ensured that the project was efficient. The project design allowed the RIDCU5 project to train and work with community members as volunteers and adequately build their capacity and work collaboratively with local partners and relevant stakeholders. The use of community structures and local partners made the project implementation cost effective and created the opportunity for sustainability.
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The project’s design engaged community volunteers1 to serve as model mothers, community-based surveillance focal points, feedback and accountability volunteers, and community health volunteers, has enabled the project to increase community mobilization through a cost-effective approach. Through the community referral system, and health promotion sessions, many women were reached through the activities of the community volunteers.
Impact
Findings showed that the objectives and activities of the CARE RIDCU5 project were relevant in addressing the humanitarian needs of Bade Local Government communities. The weekly dialogue session with model mothers helped to address social norms and practices that negatively impact maternal and child health and the strengthened detection and referral of infectious disease (acute respiratory illness, malaria, diarrhea, and measles) through community-based surveillance (CBS) that included door-to-door visits and referrals for care. Also, health promotion sessions and supportive supervision in the 22 health facilities of the implementation contributed to quality of services. The project was able to respond largely to the needs of the target groups, including Community Health Workers (licensed and volunteers); children under five and their caregivers; pregnant and postpartum women and adolescent girls through support to strengthen referral systems, community engagement approaches to improve health behaviors and accountability of the health system as well as capacity building and provision of supplies and equipment to improve health service delivery.
Sustainability
The involvement of community volunteers assisted in the community ownership of the project. At present, community volunteers and community leaders, who benefited from the training conducted by CARE International, are engaged in community mobilization and awareness creation among community members on various aspects of the project. Respondents reported that that through the knowledge gained from CARE international, they were able to strengthen their cooperation among each other. The project has also built the capacity of the local partners and community members in a sustainable way through supportive supervision and training for health care workers and volunteers to improve and enhance their capacity to diagnose and detect infectious diseases. Read More...
The primary objective of the evaluation was to assess the project's performance and document its achievements, challenges, and best practices to guide future similar programming; and provide recommendations to CARE Nigeria and its partners to make informed decisions and enhance the effectiveness and efficiency of future initiatives.
Effectiveness
Evidence from the desk review showed that the project made remarkable progress towards reducing mortality in under-5 children through a community-based health systems strengthening approach that ensures that communities receive a core package of services. The major factors that influenced the effectiveness and achievement of the project results were the use of community structures (community health volunteers, model mothers, and community-based surveillance focal points), capacity building, the referral system and the Social Analysis and Action (SAA) approach through community dialogues, supportive supervision, routine monitoring visits and facility health promotion session. The SAA approach also helped to shift practices related to family planning, immunization and poor health seeking behavior, as evidenced from the qualitative findings.
Efficiency
In both the design and implementation of the project activities, CARE International RIDCU5 team ensured that the project was efficient. The project design allowed the RIDCU5 project to train and work with community members as volunteers and adequately build their capacity and work collaboratively with local partners and relevant stakeholders. The use of community structures and local partners made the project implementation cost effective and created the opportunity for sustainability.
7
The project’s design engaged community volunteers1 to serve as model mothers, community-based surveillance focal points, feedback and accountability volunteers, and community health volunteers, has enabled the project to increase community mobilization through a cost-effective approach. Through the community referral system, and health promotion sessions, many women were reached through the activities of the community volunteers.
Impact
Findings showed that the objectives and activities of the CARE RIDCU5 project were relevant in addressing the humanitarian needs of Bade Local Government communities. The weekly dialogue session with model mothers helped to address social norms and practices that negatively impact maternal and child health and the strengthened detection and referral of infectious disease (acute respiratory illness, malaria, diarrhea, and measles) through community-based surveillance (CBS) that included door-to-door visits and referrals for care. Also, health promotion sessions and supportive supervision in the 22 health facilities of the implementation contributed to quality of services. The project was able to respond largely to the needs of the target groups, including Community Health Workers (licensed and volunteers); children under five and their caregivers; pregnant and postpartum women and adolescent girls through support to strengthen referral systems, community engagement approaches to improve health behaviors and accountability of the health system as well as capacity building and provision of supplies and equipment to improve health service delivery.
Sustainability
The involvement of community volunteers assisted in the community ownership of the project. At present, community volunteers and community leaders, who benefited from the training conducted by CARE International, are engaged in community mobilization and awareness creation among community members on various aspects of the project. Respondents reported that that through the knowledge gained from CARE international, they were able to strengthen their cooperation among each other. The project has also built the capacity of the local partners and community members in a sustainable way through supportive supervision and training for health care workers and volunteers to improve and enhance their capacity to diagnose and detect infectious diseases. Read More...
Línea de Base: Proyecto “Higiene, Agua y Saneamiento en La Habana y Pinar del Rio”(Spanish)
This Baseline Report provides an overview of the "Hygiene, Water, and Sanitation in Havana and Pinar del Rio" project, implemented by CARE Cuba in collaboration with local partners. The project focuses on improving access to safe water for two isolated rural communities (El Vallecito and Valle San Juan) that rely on contaminated local wells and inadequate water storage systems. It addresses water-related health risks and promotes menstrual health by introducing menstrual cups to women and menstruating individuals. The baseline data will serve as a reference for measuring project outcomes aimed at reaching 256 people and 250 women.
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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...
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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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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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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ELLA ALIMENTA AL MUNDO – PERÚ-Informe Final de Evaluación
CARE PERÚ, desde abril 2019 a diciembre 2022 implementa el proyecto “Ella Alimenta al Mundo”- EAM (SFtW - She Feeds the World - por sus siglas en inglés), programa lanzado en varios países por la Fundación PepsiCo a través de CARE USA. El propósito del proyecto ha sido reducir la desnutrición crónica y la anemia en niñas y niños menores de 5 años e incrementar los ingresos de 4,000 familias pobres que residen en 4 distritos priorizados, correspondiente a las provincias de Lima, Ica y Sullana con enfoque de género. El grupo objetivo son niñas y niños menores de 5 años y mujeres gestantes. Read More...
Private Sector Health Facility Assessment USAID Adolescent Reproductive Health (ARH)
USAID Adolescent Reproductive Health (ARH) is a youth co-led initiative to empower girls and boys,10-19 years old, including the most marginalized, to attain their reproductive rights. The project's primary goal is to support adolescents to reach their full potential and strengthen public systems and private entities to create an enabling environment for healthy reproductive health (RH) behaviors by ensuring the readiness of private health facilities to provide adolescent-responsive services.
OBJECTIVES
The study's main objective is to assess most private health facilities meeting USAID ARH specific criteria and identify gaps in providing high-quality services to adolescents. Read More...
OBJECTIVES
The study's main objective is to assess most private health facilities meeting USAID ARH specific criteria and identify gaps in providing high-quality services to adolescents. Read More...