Regional/Global

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.

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Recipe for Response: What We Know About the Next Global Food Crisis, and How to Fight it

The genesis of the present hunger crisis goes back farther than February 2022 and is due to a combination of global and localized factors. Globally, climate change has compromised agricultural livelihoods and led to displacement, especially in regions like the Horn of Africa and Central America’s Dry Corridor, where famers struggle to produce yields that meet the needs of local markets. The global economic fallouts associated with COVID-19, and inadequate social safety nets, have led to record unemployment and growing poverty—especially for women and women-led households (UN Women 2021)—so that even where food is available, high prices put basic items out of reach for many. Armed conflict is also driving food insecurity, for example by making it difficult for farmers to cultivate their lands, or damaging or disrupting vital agricultural infrastructure—such as transportation, storage and distribution sites—and reducing access to markets and assistance.
Women and girls are disproportionately impacted by food insecurity and related shocks. Gender norms and roles mean that women are often responsible for their households’ food security, including shopping for and preparing food, yet they might also be the ones to eat “last and least” in their household. Women are also more likely to be excluded from decision-making when it comes
to addressing hunger in their communities (CARE 2020). These types of gendered imbalances hurt entire communities: in a 2021 assessment in Sudan, CARE found that 82% of people living in female-headed households reported recently skipping a meal, compared with 56% of people living in male-headed households. Read More...

CARE in the Pacific PARTNERSHIPS RESEARCH REPORT

Partnership is central to CARE International’s global vision where poverty has been overcome and all people live with dignity and security. CARE International’s partnerships in the Pacific are carried out through CARE Australia managed country offices in Papua New Guinea (PNG) and Vanuatu, and through the CARE in the Pacific team (which sits under CARE Australia) which manage partnerships in countries where CARE Australia does not have a country office. This currently includes Fiji, Kiribati, Samoa, Solomon Islands, Tonga, and Tuvalu. CARE Australia is in the process of developing its Pacific strategy. Central to this process is understanding its approaches to partnership and supporting local leadership with its partners in Fiji, Kiribati, Samoa, Solomon Islands, Tonga, and Tuvalu. CARE in the Pacific commissioned this Partnerships Research to document its partnership approach and reflect key contributions and gaps to advancing localisation for its partners in the Pacific. The research was conducted during September and November 2021 and involved CARE in the Pacific and 12 partners in Fiji, Kiribati, Samoa, Solomon Islands, Tonga, and Tuvalu.

What this research report does
⮚ Documents CARE in the Pacific’s partnership approach and the key features of the partnership that are supporting locally led outcomes
⮚ Employs a qualitative approach drawing on the voice of partners through feedback captured during interviews, and secondary documentation related to CARE’s partnership and localisation practice, and current sector discourse on localisation to demonstrate how CARE in the Pacific is supporting localisation, and approaches hindering locally led outcomes
⮚ Identifies actions and approaches for CARE in the Pacific for charting a more strategic course for partnership and localisation by building on existing positive practices and considering areas for improving partnership practice to better support localisation

Key findings
Partnership findings
⮚ CARE’s partnership can be characterised by long-term and short-term partnerships. The long-term partnership is guided by a high-level partnership agreement with sub-agreements developed for project or program specific engagement. Capacity strengthening is focused on supporting organisation-wide learning and growth. The short-term partnership usually begins with CARE either securing or identifying a funding opportunity. Based on consultation and shared objectives, agreement is sought to work together and co-design proposals/projects. A sub agreement guides the engagement. Capacity strengthening (informed by due diligence assessments) is largely focused on ensuring partners can meet CARE’s program quality, administrative and financial requirements, including donor compliance requirements.
⮚ Both long-term and short-term partnerships are contributing to positive change, in advancing CARE’s strategic objective of achieving greater impact through partnerships, and for partners, helping to achieve positive change at organisational and community levels. Having both short-term and long-term partnerships allow for flexibility in the partnership and as partnering is also influenced by the amount of funding CARE has available to support partners. A long-term partnering approach would better position CARE to achieve its broader partnership goals for transformed partnerships in the Pacific for reduced poverty and inequality. A key consideration is for CARE to articulate how it will support partners who want to transition to long-term partnerships, the strategy to engage long-term partnerships and with which organisations it will establish such partnerships.
⮚ CARE’s approach is grounded in supporting partners to achieve their mandate and objectives, working within partners priorities, and partners strengths. Partners perceive CARE is taking a partner led approach that is based on shared values and complementary vision, and a strong commitment to partnership. This approach together with the provision of quality technical support in gender, disaster, and humanitarian programming is helping establish CARE as a partner of choice. This is noted by partners as a core strength of CARE’s partnership approach and an area that CARE should continue to build on.
⮚ CARE has strong foundational policies, processes, and principles in place for partnership, but these are not being consistently applied outside of project implementation. CARE has strong processes and principles in place for partnering but these are not being fully maximised, with the focus more on assessing project delivery and results and not partnership outcomes. This approach to partnerships is potentially hindering achievement of more meaningful partnership outcomes, including more effective programming. There is a desire from partners to have more conversations and participate in processes that are focused on assessing the partnership.
⮚ CARE is directly investing in partnerships in several ways: recruitment of dedicated staff and consultants to the CARE in the Pacific team including a Partnerships Coordinator, Gender, and Inclusion Senior Advisor (Fiji), Program Quality Coordinator, Finance & Grants Coordinator and Project Coordinators. CARE is also demonstrating ongoing financial investment in partners by mobilising consecutive funding with the majority of its partners. It will be important for CARE to consider and plan for future resourcing that may be needed to support a long-term partnering approach, acknowledging that CARE largely operates on project specific funding which directly influences the parameters of support CARE is able to provide to partners as this support has to fit within project budgets. Read More...

She Told Us So (Again)

COVID-19’s impacts around the world are worse than they were in September 2020. Far from a return to “normal,” women and girls CARE works with around the world are saying that their situation continues to get worse as COVID-19 drags on amid other crises. Fati Musa in Nigeria says, “Women have suffered a lot during the pandemic, and we are not yet recovering from this hardship.” 55% of women were reporting gaps in their livelihoods as a priority in 2020. Now that number is 71%. For food insecurity, the number has jumped from 41% to 66%.
Since March of 2020, CARE—and more importantly, the women CARE works with—have been warning that COVID-19 would create special challenges for women and girls, above and beyond what men and boys would face. Tragically, these women were exactly right. What they predicted even before the WHO declared a pandemic has come true. In September 2020, CARE published She Told Us So, which showed women's and men's experiences in the pandemic so far. In March 2022, updated data shows that the cost of ignoring women continues to grow. For more than 22,000 people CARE has spoken to, COVID-19 is far from over. In fact, the COVID-19 situation has gotten worse, not just for women, but for men, too.
Ignoring the voices of women, girls, and other historically marginalized groups has worsened the situation for everyone—not just for women. Men are more than twice as likely to report challenges around livelihoods, food insecurity, and access to health care as they were in 2020, and are three times more likely to report mental health challenges—although they are still only two-thirds as likely as women to report mental health as a priority. As women burn through their coping strategies and reserves, men are also facing bigger impacts over time.

Women have stepped up to the challenge—especially when they get support from each other and opportunities to lead. They are sharing information, preventing COVID-19, and using their resources to support other members of their communities. 89% of women in savings groups in Yemen are putting some of their savings to help others. Women are stepping into leadership roles, "We are women leaders in emergency . . . we have the capacity to say: I have a voice and a vote, I am not going to stay stagnant . . . (participant, Colombia). In Niger, women are saying, “Now we women are not afraid to defend ourselves when a decision does not suit us. We will say it out loud because our rights are known and we know the ways and means to claim our rights.”

Those accomplishments are impressive, but they come at a cost. The constant struggle for their rights, and for even the most basic necessities, is taking its toll. Women are almost twice as likely to report mental health challenges as they were in 2020. As one woman in Iraq describes, “If any opportunity appeared, the man would be the favorite . . . This psychologically affected many women, as they turned to household work which included preparing food and cleaning only.”

To understand these challenges and create more equitable solutions, CARE invests in listening to women, men, and people from marginalized groups to understand the challenges they face, what they need, and the ways in which they lead through crisis. This report represents the voices of more than 22,000 people in 23 countries since September of 2020.
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Don’t Leave Them Behind: Global Food Policies Continue to Fail Women (December 2021)

811 million people in the world are going hungry, half a million of whom are on the brink of starvation. Clearly, current approaches are simply not enough to meet the scale of the crisis we are facing. If we continue to do what we have always done, we will continue to see the same problem: people going to bed hungry. We must find better solutions to prevent and end hunger—especially if we are going to meet the Sustainable Development Goal of Zero Hunger by 2030.

One of the first things we can do is consider who is going hungry. Using the term “people” hides part of the problem: gender inequality. Globally, women are 10% more likely to go hungry than men, and that gap is growing. In Somalia, for example, men are eating smaller meals; women are skipping meals altogether. We see this inequality play out at the international level, too—global solutions consistently ignore women, their rights, and the critical role women play in food systems.

Of 84 global policies and plans designed to address hunger released between September 2020 and December 2021, only 4% refer to women as leaders who should be part of the solution or provide funding to support them. 39% overlook women entirely. This is unacceptable. Ending hunger will take everyone’s talents, opinions, and work. It requires promoting equality, respecting rights, and truly listening to the people who are on the frontlines of the problem. Local food producers and leaders—especially women—must be a core part of the solution.
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Fast and Fair Vaccine Update August to October 2021

CARE's Fast and Fair initiative supports countries to equitably deliver COVID-19 vaccines through four pillars: Advocate, Facilitate, Protect and Mobilize.
CARE has identified 22* countries (and counting ) with strong capacity, partnerships, and readiness to scale.
As of October 2021: 126.2 million people have been vaccinated in areas where CARE is providing meaningful and significant promotion for vaccination rollout. We have also supported mass media messages promoting vaccines to 263 million people. Read More...

Gender Gaps in Vaccines November 2021

COVID-19 vaccinations are quickly becoming a story of inequality. Gender inequality is a critical part of this story. In 22 of 24 countries where CARE has data, women are less likely to be vaccinated and less likely to feel vaccines are safe.

There are massive local and global gaps in who can get vaccinated. Only 4.5% of people in low-income countries are vaccinated, and 79% of vaccinations have been in wealth countries. Tragically, wealth and geography are just two factors that skew access to vaccines. Another is gender. In many low and middle-income countries, women are less likely to get COVID-19 vaccines than men are. This compounds gender inequality women are already facing in health and decision-making Read More...

Who pays to deliver vaccines? An Analysis of World Bank Funding for COVID-19 Vaccination and Recovery

The World Bank is one key source of funding in the global push to vaccinate 70% of the world’s population against COVID-19. Many actors point to this as the funding that will cover any additional delivery needs for COVID-19 vaccines that national governments cannot meet. With $5.8 billion in funding already approved out of a $20 billion commitment, the World Bank funding is an important part of the picture, but the World Bank alone cannot cover the full gap in vaccine delivery needs.

Reviewing 60 funding agreements from the World Bank on COVID-19 vaccination and recovery shows the following insights.

• There is still a gap in delivery funding. The World Bank is currently funding $1.2 billion in vaccine delivery—10% of the total funding allocated for COVID-19 recovery. If that trend applies to the rest of the $20 billion commitment, World Bank funding will cover a between $2 and $4 billion—well below the $9 billion that ACT-A estimates as the lowest possible investment to vaccinate 70% of the world’s population. In contrast, $3.1 billion is going to purchase vaccines.
• Health workers remain underfunded. Only 15 of 60 agreements, just 25% detail provisions to pay health workers. Of those, 7 explicitly fund surge capacity, 3 provide for ongoing salaries, and 4 allow for hazard pay to health workers.
• Countries are taking on debt to rollout COVID-19 vaccinations. 86% of the funding in this analysis is in the form of loans. That gives countries debt that may weaken future pandemic preparedness rather than reinforcing health systems.
• All funders should adopt the World Bank’s commitments to investments in gender equality. 90% of the agreements in this analysis refer to gender inequality and many make corresponding investments—like requiring that 60% of vaccine leadership positions are women—to overcome these barriers. Earmarking exact funds going to advance gender equality would provide further transparency. Nevertheless, this consistent and concrete commitment is commendable, and all actors should strive to replicate it.
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Learning to Listen: Regional Partnerships and Impacts

In 2017, CARE asked, “What will it take to scale our impact by 10 times more than we currently do? What about 100 times?” Part of the answer to that, with significant unrestricted investments from 2017-2020, were CARE’s Impact Growth Strategies. These aim to address the “missing middle” by supporting the skills, staff, and connections needed to bring our work together across regions and partners.
A recent review of these 4 regional platforms—Equal value, equal rights (EVER) in LAC; Women on the move (WoM) in West Africa; Her harvest, our future (HHOF) in Southern Africa; Made by Women in Asia Pacific—shows significant return on the investment. These returns merit continued investment in regional platforms that take creative approaches to partnership, local leadership, and the evolution of CARE’s operating models.
• Contributing to impact for 12 million people, with potential impact for 78 million more people impacted over the coming years.
• Paving the scaling pathways by demonstrating different models of partnership, design, evidence, impact, and fundraising. These experiences provide valuable experience and evidence of what works (and doesn’t) and how to continue our ambition of sustainable impact at scale.
• Demonstrating concrete tools and ability to center the voices of the people we serve, in new partnership models, feedback systems, power structures, and evidence. This includes crucial lessons on how to live out our strategic goal of being locally led and globally connected.
• Mobilizing resources by contributing to roughly $100 million in new restricted and flexible funding.
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Gender Gaps in COVID 19 Vaccines

COVID-19 vaccinations are quickly becoming a story of inequality. Gender inequality is a critical part of this story. In 16 countries where CARE has data, women are less likely to be vaccinated, and less likely to feel vaccines are safe.
There are massive local and global gaps in who can get vaccinated Only 1 9 of people in low income countries are vaccinated, and 79 of vaccinations have been in wealth countries Tragically, wealth and geography are just two factors that skew access to vaccines Another is gender In many low and middle income countries, women are less likely to get COVID-19 vaccines than men are This compounds gender inequality women are already facing in health and decision making Read More...

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