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.


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...

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.

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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.

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...

Post Distribution Monitoring/Evaluation finale du projet « COVID-19 : Prévention, protection et relèvement économique »

Les premiers cas de COVID-19 ont été enregistrés au Cameroun en début mars 2020. Au 18 avril 2020 le Cameroun est le 2e pays le plus touché en Afrique subsaharienne et le premier pays de la CEMAC avec 7860 cas confirmés au 08 juin 20201. Afin de limiter la propagation du virus COVID19, le gouvernement a mis en place des mesures de prévention strictes, dont la suspension des
vols commerciaux, la fermeture des frontières, la fermeture des écoles, la fermeture dès 18h des bars, restaurants et lieux de loisirs, l’interdiction de rassemblements de plus de 50 personnes, ou encore l’obligation du port du masque en public à partir du 13 avril 2020.
Pour apporter sa contribution à cet effort de solidarité, CARE International au Cameroun, a mis en œuvre le « Projet COVID-19 : Prévention, protection et relèvement économique » dans le District de santé de Biyem-Assi (Yaoundé) de juin à septembre 2020 en ciblant spécifiquement 150 femmes et filles IDPs et TS. Mis en œuvre en collaboration avec Horizons Femmes, ce projet a fait l’objet d’une évaluation finale interne afin de mesurer et apprécier les changements (éventuels) dus à l’intervention du projet sur les bénéficiaires par rapport à la période concernée.
En ce qui concerne la qualité de l’intervention, l’évaluation établit : (i) la pertinence du projet qui est aligné sur les besoins prioritaires des cibles, les objectifs de développement durable et les politiques nationales, y compris les stratégies de réponse face au COVID-19 ; (ii) une efficacité et une efficience satisfaisantes, les activités réalisées ayant permis d’atteindre les objectifs visés à des coûts et des délais raisonnables ; (iii) une pérennité envisagée, malgré la courte durée du projet, notamment par la continuité de certaines activités dans le cadre du projet CHAMP ; une prise en compte du genre acceptable, ce qui a permis d’adresser les besoins différenciés à chaque groupe ciblé par le projet.
Les recommandations formulées vont dans le sens de : (i) élargir l’intervention dans d’autres zones accueillant la même cible ; (ii) clarifier au lancement du projet les différents niveaux de diffusion de l’information ainsi que le type d’information à communiquer ; (iii) déployer le transfert monétaire inconditionnel dans davantage de projets du programme de redressement et relèvement post-crise ; (iv) accompagner les bénéficiaires ayant développé/redynamisé des AGR à la maturation de leurs activités ; (v) penser à une composante qui permettent aux IDPs qui le souhaitent de retourner vers leurs localités d’origine dans la mesure ou la situation sécuritaire évoluerait dans le sens de l’apaisement ; (vi) revoir la stratégie de sensibilisation sur la Hotline en insistant sur la signification du terme « Hotline » ou trouvant une appellation plus accrocheuse ; (vii) conserver la dynamique du code unique et l’implication des bénéficiaires dans les différentes étapes du projet pour une meilleure redevabilité. Read More...

STRENGTHENING WOMEN AND YOUTH AT RISK OF GENDER BASED VIOLENCE Challenges and opportunities for enhancing resilience, with a focus on urban contexts and adolescent girls

This learning brief documents challenges, capacities and opportunities of women and youth at risk of gender based violence (GBV), in particular in urban areas in Northern Uganda. It summarizes key findings from various studies of the Women and Youth Resilience Project (WAYREP), including two Rapid Gender Analyses, the baseline, knowledge model papers, and a qualitative assessment.
The learning brief informs WAYREP’s learning agenda which aims at:
 Gaining a better understanding of the livelihood and safety, security, and wellbeing challenges that marginalised and vulnerable communities face in urban poor and settlement settings with a focus on girls,
 Identifying and documenting effective and sustainable support strategies to alleviate challenges, namely poverty and gender-based violence (GBV), in the nexus, urban and COVID 19 context.
WAYREP’s overall objective is to “Strengthen the resilience of refugee and Ugandan women, girls and youth to live a life free from violence in Uganda”. WAYREP focuses on women and girls’ empowerment within the context of some of Uganda’s most pressing current challenges such as rapid urbanization, regular and high rates of displacement and migration across and within Uganda’s borders and a very young and largely unemployed population. In 2020, this fragile context was further exacerbated with the outbreak of the COVID-19 pandemic not only in terms of its health implications, but also in terms of its impact on livelihoods, safety and security. Read More...

AHP DFAT III-COVID-19: A Visit to OXFAM livelihood project in Teknaf

This joint monitoring visit was conducted in the Oxfam- MUKTI implemented project, part of the DFAT AHP III consortium. As per the agreed decision of the MEAL Working Group (MWG), the visit date was 27 February 2022. The activity was covered: 1) Homestead Gardening & Pit Composting, 2) Tailoring, 3) Goat Rearing, and 4) IGA of People with Disabilities. The visit location was Rasullabad, Dargapara, and Lichuaprang villages. A convenient sample was used in this visit, so generalizing is a limitation. Read More...

Strengthening the Economic Resilience of Female Garment Workers during COVID19 – Phase 2

This is the End of Project Evaluation Report for the Strengthening the Economic Resilience of Female Garment Workers during COVID19 – Phase 2 (SER) Project which was implemented in Phnom Penh, Kandal and Kampong Speu provinces. The Project commenced in July 2021 and concluded in February 2022. The goal of the project was to strengthen the economic resilience of female garment workers who are socially and economically marginalized in Cambodia to cope with the negative impacts of COVID-19. In order to conduct the evaluation, data was collected through a comprehensive literature review and fieldwork. The literature review was conducted reviewing reports and documents from the SER Project and also other relevant external publications. The evaluation interviewed 400 people and was conducted in January 2022.
• It should be noted that the project was not wholly a humanitarian type intervention project, which tend to have a short implementation period, rather the project had knowledge, capacity and resilience training elements which require a longer timeframe to implement. For this reason, as well as the delay to the start of the project and the impact of the COVID-19 pandemic, project staff were faced with a high workload within a challenging environment. Specifically, a longer time period would have given more time to prepare for project interventions such as the training, baseline and rapid situation assessment of the labour market. With more time the baseline and rapid situation assessment of the labour market could have been used to better tailor and inform the development of the training materials and curriculum.
• The focus on social protections in the project interventions was a relative new topic especially for factory workers, who are mostly only aware of the NSSF and the IDPoor. As highlighted as an unexpected result of the project, many project participants directing enquiries to local authorities about social protections. While local authorities are aware of social protections in general, they do not have detailed knowledge, especially since many social protections are administered at the national level and not at the village level. Therefore, more cooperation with local authorities should have been sought in order to prepare the local authorities for this situation.
• The delay in the signing the project’s administrative contract, caused the project to miss opportunities to use the findings of the baseline survey and the rapid situation assessment of the labour market to better inform the development of the project’s training activities.
• The evaluation found that while knowledge of GBV improved, the same was not the case for sexual harassment. Indeed, respondents who could not identify sexual harassment increased from 32% (114/356) at the baseline to 38% (139/362) at the endline. Project staff reported that this was not an unexpected finding as CARE’s previous sexual harassment projects had encountered similar such resistance to changing attitudes.

How Bangladesh Is Getting COVID-19 Vaccines to the Last Mile

Bangladesh has been one of the fastest countries receiving COVAX support to scale up vaccines, delivering more than 221 million vaccines by March 14, 2022. 54% of Bangladesh’s population is fully vaccinated, and another 22% have received at least one dose. Bangladesh is on track to meet its goal of 70% of the population fully vaccinated by September 2022.

Close coordination across multiple actors—from the Government of Bangladesh to INGOs like CARE to local health entrepreneurs—have been one of the keys to success. Working closely with the government-led National Vaccination and Deployment Plan and innovating when there have been gaps and challenges have helped achieve this success. These strategies continue to make sure that vaccines reach the people who need them most.

The Cost of Delivering COVID-19 Vaccines in Zambia

While Zambia aims to deliver COVID-19 vaccines to 70% of its people by June 30, 2022, the road to getting there is uncertain. The Zambian Ministry of Health reports that, as of February 21, 2022, 21.6% of people were fully
vaccinated. Vaccine doses available in the country are slowly rising, with 6.2 million doses arrived as of February 11, but less than half of those doses have made it into people’s arms. By February 23, only 2.77 million doses had gotten to people. By December 31, 2021, only 7.2% of people had gotten a vaccine, compared to a goal of 40%. Without significant investments in last mile delivery, especially for people at highest risk, Zambia risks missing its next COVID-19 vaccine targets.
CARE estimates that in Zambia, vaccine delivery costs a minimum of $17.18 per fully vaccinated person, or $7.30 per dose delivered. That is 7.2 times more than current global estimates. Even with its robust childhood vaccination system—93% of Zambian children got their first measles vaccine in 2019—Zambia has not been able to get enough COVID-19 vaccines to the last mile. Read More...

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