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RANO WASH Rural Access to New Opportunities in Water, Sanitation, And Hygiene Mid-Term Review Report

The $33 million USAID-funded Rural Access to New Opportunities in Water, Sanitation and Hygiene (RANO WASH) program seeks to increase equitable and sustainable access to WASH services to maximize impact on human health and nutrition and preserve the environment in 250 rural communes of Alaotra Mangoro, Amoron'i Mania, Atsinanana, Haute Matsiatra, Vakinankaratra, and Vatovavy Fitovinany regions of Madagascar. RANO WASH has three strategic objectives:
1) To support governance and monitoring at national, regional, and communal levels for sustainable WASH services;
2) To increase access to water and sanitation supply through supporting private sector capacity and public-private partnerships for sustainable water and sanitation supply across several regions in Madagascar; and
3) To increase good hygiene and sanitation behaviors by identifying and addressing multiple behavioral determinants.

The project was designed using the Sanitation and Water for All (SWA) Collaborative Behaviors and is guided by a system strengthening approach that establishes the building blocks for sustainable delivery of WASH services. This report presents findings from the midterm review, which evaluated the project's performance from 2018 to 2020 across five criteria, benchmarked progress and contribution towards WASH building blocks, and assessed the effectiveness of the consortium team. Read More...

WOMEN LEAD IN EMERGENCIES IN UGANDA

Women have a human right to participate in public life and decision-making, including in preparing for, responding to, and recovering from natural disasters, conflict, and other crises. Yet, women directly affected by crises are still excluded from most humanitarian responses and from public decision-making more broadly. Women’s participation in community responses and recovery saves lives and increases gender equality. Conversely, when women’s voices are not heard, women’s rights and needs are often not adequately met, and emergency response can reinforce inequalities that perpetuate vulnerability, insecurity, and poverty. Women Lead in Emergencies is a CARE global program that supports local women’s groups to take a lead in responding to the crises that affect them and their communities. It is the first practical toolkit for frontline CARE staff and partners with guidance on how to promote the participation and leadership of women in communities at the forefront of crisis within humanitarian programming. Read More...

Nepal COVID-19 Vaccine Costing Study

By December 6, 2021, 19.2 million doses of COVID-19 vaccines have been administered in Nepal, enough for 36% of the population to have gotten at least one dose of vaccine. After a rough road with unpredictable vaccine supply, the government has been able to procure several million vaccine doses. Now delivery at the last mile is the biggest hurdle they face. Nepal’s Minister of Health says, “We are not going have shortages of vaccines anymore, but our main concern and focus now is on getting these vaccines to all corners of the country, including the remote mountain areas.”

Based on national data, and in-depth studies in 2 health districts, CARE estimates that delivery costs from “tarmac to arm” for vaccines in Nepal are $8.35 (1,019 NPR) per dose of vaccine administered, or $18.38 (2,241 NPR) per person fully vaccinated.

This is nearly 5 times more expensive than current global estimate for delivery costs. These costs range from $11 per fully vaccinated person in easier to reach areas, to $33 per dose in remote, difficult to reach areas. Gaps in vaccine coverage are particularly acute for mountainous areas, people with low mobility, and communities far from health centers. Even the lowest-cost estimates for the easiest to reach areas are nearly 3 times higher than global average estimates.

70% of these costs are personnel needs to ensure vaccines reach people at the last mile. This points to a major need to improve investments in vaccine delivery, especially the health care workers who administer vaccines and ensure everyone gets vaccinated.
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Análisis Rápido de Género – ARG / Honduras, 2021. Desafíos para las mujeres y niñas ante una sostenida crisis sanitaria y ambiental.

El 2020, como resultado de los efectos de las crisis sanitaria y ambiental, se caracterizó por evidenciar y profundizar las deficiencias y limitaciones que
enfrenta Honduras en lo relacionado con: las brechas estructurales preexistentes y sus consecuencias en términos de seguridad y desigualdad, especialmente la profundización en la desigualdad de género; las carencias y debilidades de los sistemas de servicios esenciales a nivel sanitario y de protección social; las debilidades del sistema productivo - empresarial y la fragilidad de los procesos económicos del país; y las debilidades existentes en aspectos relacionadas con la infraestructura, las estrategias para la gestión de riesgos y la capacidad de respuesta ante fenómenos naturales.

Esto ha provocado un estancamiento o retroceso en aspectos relacionados con el acceso a medios de vida, a derechos económicos y sociales, y a derechos humanos fundamentales. Sin embargo, se debe subrayar que aunque ambas crisis afectaron directa o indirectamente a toda la población hondureña, su impacto es evidentemente desigual ya que resultó mayormente adverso para los grupos y la población más vulnerable, especialmente las mujeres y niñas. En consecuencia, han empeorado las condiciones y calidad de vida de la población subsistiendo en situación de pobreza o expuesta a alguna condición de riesgo ya sea física, psicológica, social, ambiental, económica o estructural. Esto preocupa en particular si adicionalmente se considera que Honduras está catalogado como uno de los países con mayor desigualdad en el área latinoamericana. El ARG buscó proporcionar recomendaciones prácticas para diseñar estrategias que permitan brindar una respuesta diferenciada a las principales necesidades y brechas humanitarias identificadas, y permitió identificar aquellos factores afectados por ambas crisis y que inciden negativamente en la protección a los derechos humanos fundamentales y en la calidad de vida de los grupos más vulnerables del país. Read More...

Análisis de Contexto Sobre Necesidades Humanitarias Bajo Escenario de Inseguridad Alimentaria Honduras, América Central.

Honduras es un país vulnerable a distintas amenazas naturales. Las tormentas se han hecho cada vez más frecuentes solo en la temporada de huracanes del Atlántico de 2020 fue la más activa de la historia y la quinta consecutiva en superar el promedio de actividad. Se registraron 30 tormentas tropicales con nombre, de las cuales 13 se convirtieron en huracanes, de estos 2 afectaron directamente Honduras (Eta e Iota en aproximadamente 10 días ambos meteoros azotaron el país, generando impactos adversos y evidenciando las condiciones de vulnerabilidad. En los últimos años se ha registrado un aumento significativo de afectación por fenómenos naturales, sociales, políticos, económicos que han puesto en evidencia las necesidades humanitarias de la población. Al respecto la Oficina de Coordinación Asuntos humanitarios (OCHA) de Naciones Unidas en abril 2020 estimaba que poco más de 2.7 millones de personas afectadas y de éstas al menos 1.3 millones de personas con necesidades humanitarias inmediatas, las principales afectaciones estaban asociadas con una pobreza endémica, unos desastres y choques climáticos recurrentes, y una violencia crónica endémica de difícil control.

La Unidad Técnica de Seguridad Alimentaria y Nutricional (UTSAN) estimó que de diciembre 2020 a marzo de 2021, por lo menos 2.9 millones de personas (31% de la población analizada) se encuentran en crisis alimentaria o peor, Fase 3 o superiora según la Clasificación Integrada en Fases de la Seguridad Alimentaria (CIF) y por tanto requieren acciones urgentes, esto asociado tanto efectos actuales por las tormentas y la pandemia como a la sequía prolongada en corredor seco y problemas estructurales como la pobreza y la desigualdad, entre otros. Ante ese escenario tan complejo de necesidades humanitarias se desarrolla un esfuerzo conjunto entre CARE, ASONOG, ADEPES, CASM, OCDIH para realizar en el periodo de mayo-junio del año en curso un proceso de análisis que contribuya a tener una actualización sobre las necesidades humanitarias en relación a inseguridad alimentaria en poblaciones en municipios y departamentos de influencia, así como la identificación de soluciones desde la perspectiva local frente a la problemática multidimensional que está propiciando un deterioro en la calidad de vida las poblaciones más vulnerables y de privación de derechos básicos. Read More...

CONEX Balkan Project Rapid Gender Analysis Report Western Balkan Region – Albania, Bosnia & Herzegovina, Kosovo, Montenegro, North Macedonia, and Serbia

CONEX is a regional project implemented in six Balkan countries designed to support the marginalized groups of people in the targeted communities that have suffered the most during the Covid-19 crisis, namely the elderly, unemployed women, minorities, refugees, internally displaced persons (IDPs) and persons with disabilities to transition from relief to recovery and onwards to development.
The Rapid Gender Analysis (RGA) has been conducted to provide essential information about gender issues and concerns that should be addressed and will not only be used to define concrete action points and possible adaptations of project design but also as a learning tool and advocacy platform with national NGO networks and local/national authorities. The RGA objectives are to:
 Assess the ways and the extent to which women and other vulnerable groups are affected by social and economic deprivation due to consequences of the COVID-19 crisis;
 Explore how the prevailing gender norms and roles relate to the project activities and objectives, in particular with regard to the access to information, ability to access services, employment and effects of gender based violence (GBV) and
 Increase the gender analysis and integration related capacities of project staff (gender-sensitization, RGA data collection training).
The RGA was conducted in the period May-October 2021 and consisted of three main segments facilitated by the CARE team: 1. Capacity building of partners on gender and how to conduct the RGA; 2. Coordination of data collection, analysis, and validation 3. RGA report writing.
In total, 28 implementing partners’ staff members from nine organizations in 21 locations in six target countries organized and facilitated 53 events (focus group discussions - FGDs and key informant interviews -KIIs) during which they directly talked to 195 persons (66% female), 21% ethnic minority (Roma and Ashkali), over 29% persons from rural areas and 11% persons with disabilities – PWD. Read More...

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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RESET II Project Promoting Resilient Livelihoods in Borana Final Report

Purpose: The purpose of this end line evaluation is to assess the achievements, constraints and lessons learnt and to produce sufficient evidence to show how the project performed against its overall objective. Overview of the project: Funded by the European Union (EU) through its European Union Trust Fund (EUTF) with a total budget of Є6,586,291, the Promoting Resilient Livelihoods in Borana RESET II Project was implemented by a consortium of CARE Ethiopia, Oromo Self Help Organization (OSHO) and Action against Hunger (AAH). The project focused in the geographic area of Arero, Miyo, Dire, Moyale, Dillo and Dhas districts in the Borena Zone within the Oromia region. The overall aim of enhancing the resilience of 100,000 PSNP beneficiaries, reducing irregular migration through improved access and coverage to provision of WASH, health and nutrition services, diversifying and increasing livelihood opportunities and incomes, improving Disaster Risk Reduction (DRR) capacity, enhancing research and knowledge management systems as well as reducing barriers to women empowerment, the project begun implementation October 2016 and end in December 2020. CARE’s Pastoralist Resilience Casual Model (PRCM) using proven CARE’S Village Saving and Loan Associations (VSLA), Climate Vulnerability and Capacity Assessment (CVCA), Social Analysis and Action (SAA), Participatory Scenario Planning (PSP) and AAH’s as well as Assisting Behavior change (ABC) methods and approaches were utilized throughout the project. Read More...

Impact Evaluation of the G-SAM Project in Ghana: Midline Report

USAID/Ghana’s Strengthening Accountability Mechanisms program (G-SAM) focuses on the district level of governance in Ghana, the Metropolitan, Municipal, or District Assemblies (MMDAs) democratically elected by residents. The following two activities are currently ongoing:
• Performance audits: The central government collects revenue and shares it with MMDA governments based on a revenue sharing formula. Prior to G-SAM, the Ghana Audit Service (GAS) conducted only a financial audit to ensure that this money was properly spent. Over the course of 2015 and with G-SAM funding, the GAS engaged in performance audits of 50 districts. In these audits the auditors went well beyond checking for receipts for purchases to assess the nature of project planning and contracting, the quality of service delivery outcomes and development
project outputs. This information has been used to develop citizen scorecards that were presented at district assemblies in April and May 2016; the scorecards are now being presented and discussed in public forums across the 50 districts.
• Civil society-led information campaign: Citizens struggle to hold their MMDA officials accountable, partially because they have very limited information about MMDA-level government budgets and activities. As such, a civil society-led effort under contract to CARE International and a coalition of Ghanaian CSOs has been conducting social audits on district capital projects and education and health service quality. This information will be used to develop citizen scorecards that will be presented and discussed in public forums over the course of the summer of 2016.
THE MIDLINE RESEARCH DESIGN
The G-SAM research design involves random assignment of 150 districts into one of three groups: a treatment group that has now received central government performance audits; a second treatment group that is now receiving civil-society led social audit; or a control group that will not receive either intervention. Given delays in the civil society organization (CSO)-led programming, this midline report only covers the 50 GAS performance audit districts and the 50 control districts. Moreover, while the baseline report provided data on citizen attitudes toward district governance and capital projects, the midline was carried out before any of the major citizen outreach efforts that will occur in both treatment arms in Summer 2016. The data collection only occurred among district administrators and politicians with the goal of determining if the GAS audits unto themselves, and without any significant citizen outreach, have had any effect on the planning, contracting and implementation of district capital projects.
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CARE Malawi COVID Vaccine Delivery Situation January 2022

“The vaccines are here but support for delivery is most needed, especially at the last mile.” – District Health Management Team member, Ntcheu
As of January 10, 2022, Malawi had delivered 1.84 million doses of vaccine out of the 3.12 million doses it has received so far.1 Many doses in country have rapidly approaching expiration dates, and if they do not get to people fast, they risk expiring on the shelves. To make sure the 1.26 million doses left go to the people who need them most, we must invest more in communication, engagement, and delivery. The $37M granted by the World Bank over the past year is sufficient for covering only 8% of Malawi’s total population. What is more, as the highly contagious Omicron variant spreads worldwide, it is even more critical that more people are vaccinated now. We cannot assume that the Government of Malawi and its current health system can do it alone.

The government and other health actors in Malawi are working tirelessly to vaccinate people, while facing multiple health crises. The health system is building on a base of committed (if overstretched) health workers, an openness to community feedback, and a long expertise of delivering The government is coordinating closely with many actors to reduce gender gaps, get vaccines to the last mile, and keep existing health services open. Nonetheless, the Ministry of Health is under-resourced, and operating in a global system where the vaccine supply that arrives may be close to expiring. For example, doses of the Astra-Zeneca vaccine had to be destroyed in the spring, after arriving in Malawi with only two and a half weeks left before their expiration date.

More investment is needed. To take just one example, the national government has been able to provide one van per district to support mobile vaccination sites, to get vaccines to the last mile. Mobile vaccinations are the most effective way to serve people who live far away from health centers and do not have access to easy forms of transportation. That means that in Ntcheu, one van is expected to serve a target population of 214,929 people living over 3,424 square kilometers. One van cannot serve those people fast enough to make sure vaccines get where they need to in time, especially when an inconsistent and unpredictable vaccine supply could have doses expiring at any time. Read More...

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