Sexual|Reproductive Health
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...
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...
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...
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...
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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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.
Read More...
Tackling Vaccine Hesistancy and Expanding Vaccine Access in Tanzania with Community Health Workers in the Lead
Since September 2021, CARE Tanzania has worked as a partner to the Government of Tanzania to improve vaccine access across the country. CARE’s logistical support has helped the government to cover large, underserved geographical areas. To increase vaccine uptake, CARE staff has also engaged local Community Health Workers (CHWs) to address vaccination misconceptions and developed improved health communication and data management tools. An initial training took place in November 2021 and trained 217 CHWs in the Tabora region. With these new resources, these health workers on the front lines have put in place two new strategies. First, COVID-19 vaccination is now integrated with other basic health services at local facilities. CARE supported COVID-19 vaccine distribution in 268 health facilities in Tabora Region. These facilities distributed 20,287 COVID vaccines in areas supported by CARE. Second, the CHWs are now conducting targeted outreach informed by local concerns to address vaccine hesitancy in women and children. Now, not only are vaccinations being provided, CHWs have confirmed that women have increased their acceptance of vaccination shots. Read More...
Assessment on “Improving lives of Rohingya refugees and host community members in Bangladesh through sexual and reproductive healthcare integrated with gender-based violence prevention and response”
In response to the health and protection needs of the Rohingya refugees and the host communities in Cox´s Bazar, CARE is implementing the project “Improving lives of Rohingya refugees and host community members in Bangladesh through sexual and reproductive healthcare integrated with gender-based violence prevention and response” with funding support by German Federal Foreign Office. This is a two year project targeting Rohingya refuges of camp 11, 12, 15 and 16 and vulnerable host communities of Jaliapalong union for GBV and SRH services.
Indicator 1: %of targeted refugee and host community report an improved environment for women and girls following the implementation of SRH and GBV prevention measures
i. 93% respondents have good and very good understanding on available SRH service
ii. Proportion of women who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care. 17% of interviewed women can make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care.
iii. 32% of interviewed female from both host community and refugee community received both Anti-natal Care (ANC) and Post Natal Care (PNC).
So, we can say that, 47% (average of result of three proxy indicator) of targeted refugee and host community report an improved environment for women and girls following the implementation of SRH prevention measures.
iv. 49% of women and girls reporting feeling safe following the implementation of GBV prevention measures
v. 63% respondents (male 21`% and female 42%) go to community leaders for seeking help when they face any form of violence both in their home and also outside of their home
Here, “56% of targeted refugee and host community report an improved environment for women and girls following the implementation of GBV prevention”
Considering the average result of above GBV and SRH indicators, we can say that, 51.5% of targeted refugee and host community reported an improved environment for women and girls on SRH and GBV prevention measures at the baseline of the project.
Indicator 2: # of people (m/f) accessing services and information on SRH services and GBV prevention and response
Indicator 3: % of refugees and host population who report satisfaction with GBV and SRH assistance
i. 70% respondents from refugee and host community reported full satisfaction with GBV assistance
ii. 87% female and 65% male from refugee and host community reported full satisfaction with SRH assistance. (Among them 67% female from refugee and 20% female from host community, 45% male from refugee community and 20% male from host community)
Indicator 4: % of staff members with improved knowledge on SHR and GBV
Inicator 5: 45% of men and boys who report rejecting intimate partner violence and domestic violence
80% of staff members with improved knowledge on SHR and GBV
Indicator 5: # of women and adolescent girls having received MHM kit
i. Most of the respondents (85%) use reusable clothes
ii. 90% respondents wash and use the cloth again
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Indicator 1: %of targeted refugee and host community report an improved environment for women and girls following the implementation of SRH and GBV prevention measures
i. 93% respondents have good and very good understanding on available SRH service
ii. Proportion of women who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care. 17% of interviewed women can make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care.
iii. 32% of interviewed female from both host community and refugee community received both Anti-natal Care (ANC) and Post Natal Care (PNC).
So, we can say that, 47% (average of result of three proxy indicator) of targeted refugee and host community report an improved environment for women and girls following the implementation of SRH prevention measures.
iv. 49% of women and girls reporting feeling safe following the implementation of GBV prevention measures
v. 63% respondents (male 21`% and female 42%) go to community leaders for seeking help when they face any form of violence both in their home and also outside of their home
Here, “56% of targeted refugee and host community report an improved environment for women and girls following the implementation of GBV prevention”
Considering the average result of above GBV and SRH indicators, we can say that, 51.5% of targeted refugee and host community reported an improved environment for women and girls on SRH and GBV prevention measures at the baseline of the project.
Indicator 2: # of people (m/f) accessing services and information on SRH services and GBV prevention and response
Indicator 3: % of refugees and host population who report satisfaction with GBV and SRH assistance
i. 70% respondents from refugee and host community reported full satisfaction with GBV assistance
ii. 87% female and 65% male from refugee and host community reported full satisfaction with SRH assistance. (Among them 67% female from refugee and 20% female from host community, 45% male from refugee community and 20% male from host community)
Indicator 4: % of staff members with improved knowledge on SHR and GBV
Inicator 5: 45% of men and boys who report rejecting intimate partner violence and domestic violence
80% of staff members with improved knowledge on SHR and GBV
Indicator 5: # of women and adolescent girls having received MHM kit
i. Most of the respondents (85%) use reusable clothes
ii. 90% respondents wash and use the cloth again
Read More...
End of the Project Evaluation | Strengthening Approaches for Improved Maternal, Neonatal and Reproductive Health in Myanmar: Lashio Township, Northern Shan State, Myanmar
GSK and CARE Myanmar have been working together in the country since 2012 to provide better health services. The project was expanded from 45 villages to 60 villages in northern Shan State, based on successes and lessons learned in 2012-2015. The project goal is to contribute to the reduction of maternal and neonatal mortality through increased access to, and quality of, sexual and reproductive health, and maternal and child health services. Read More...
Gender Analysis Uganda – Rhino Refugee Settlement – Omugo Extension and Ariaze
Since the last decade, conflict in South Sudan (SS) and the Democratic Republic of the Congo (DRC) has led to an influx of refugees to Uganda. Across the West Nile region of Uganda, the refuge influx has increased the strain on a chronically overburdened health system and other services.
CARE is working in a consortium of partners1 led by MSI Reproductive Choices (MSI) on a multi-country programme across Uganda, Niger and Madagascar named the ASPIRE Project to identify, test and develop innovative, sustainable and scalable approaches with the aim of reaching some of the world’s most marginalised groups with comprehensive sexual and reproductive health and rights (SRHR).
To inform key programme design decisions, CARE conducted a gender analysis to understand the gendered dynamics around sexual and reproductive health, including barriers that women, girls, men and boys face with respect to accessing SRHR information, services and products, and present findings to the consortium.
This gender analysis provides information about the different needs, capacities and coping strategies of women, men, boys and girls in a crisis and how the crisis has impacted gender roles, relations and norms. The focus was on refugee women, men, boys and girls currently settled in Rhino Refugee Settlement in the West Nile Region of Uganda. Specifically, the study participants were from Omugo Extension Village 6 and Ariaze B. Read More...
CARE is working in a consortium of partners1 led by MSI Reproductive Choices (MSI) on a multi-country programme across Uganda, Niger and Madagascar named the ASPIRE Project to identify, test and develop innovative, sustainable and scalable approaches with the aim of reaching some of the world’s most marginalised groups with comprehensive sexual and reproductive health and rights (SRHR).
To inform key programme design decisions, CARE conducted a gender analysis to understand the gendered dynamics around sexual and reproductive health, including barriers that women, girls, men and boys face with respect to accessing SRHR information, services and products, and present findings to the consortium.
This gender analysis provides information about the different needs, capacities and coping strategies of women, men, boys and girls in a crisis and how the crisis has impacted gender roles, relations and norms. The focus was on refugee women, men, boys and girls currently settled in Rhino Refugee Settlement in the West Nile Region of Uganda. Specifically, the study participants were from Omugo Extension Village 6 and Ariaze B. Read More...
Gender analysis on sexual and reproductive health Niger – Maradi
L’objectif de cette analyse est de donner des recommandations pour la conception des activités du projet afin de garantir que l’intervention s’inscrive dans le «Do no harm» (Ne pas causer des préjudices), et prenne en compte les raisons et les influences les plus profondes sur les comportements et les choix des personnes.
Le consortium en charge du projet représente un partenariat pionnier qui testera des approches innovantes, durables et évolutives pour atteindre certains des groupes les plus marginalisés du monde avec des services complets relatifs à la santé et aux droits sexuels et reproductifs (SDSR). Face aux chocs permanents auxquels sont confrontés les groupes vulnérables dans les milieux fragiles et affectés par le changement climatique, cette approche globale du projet ASPIRE est fondée sur un cadre de résilience. Alors que le monde en développement est de plus en plus touché par le changement climatique et les crises humanitaires, le renforcement de la résilience devient une priorité essentielle si l’on veut permettre aux groupes vulnérables de s'adapter et de mener une vie saine et épanouie, dont l'accès à des services de santé sexuelle et reproductive (SSR) de qualité est une composante essentielle. Read More...
Le consortium en charge du projet représente un partenariat pionnier qui testera des approches innovantes, durables et évolutives pour atteindre certains des groupes les plus marginalisés du monde avec des services complets relatifs à la santé et aux droits sexuels et reproductifs (SDSR). Face aux chocs permanents auxquels sont confrontés les groupes vulnérables dans les milieux fragiles et affectés par le changement climatique, cette approche globale du projet ASPIRE est fondée sur un cadre de résilience. Alors que le monde en développement est de plus en plus touché par le changement climatique et les crises humanitaires, le renforcement de la résilience devient une priorité essentielle si l’on veut permettre aux groupes vulnérables de s'adapter et de mener une vie saine et épanouie, dont l'accès à des services de santé sexuelle et reproductive (SSR) de qualité est une composante essentielle. Read More...