COVID-19 Vaccine Acceptance among People in Kailali, Nepal

COVID-19 has caused massive disruption and destruction worldwide, with millions of deaths since 2019. Vaccination plays a vital role in ending COVID-19. The objective of the study was to assess
the acceptance of the COVID-19 vaccine and its determinants among the general population aged 18 years and above. A total of 506 participants were interviewed in the study. A quantitative questionnaire covered socio-demographic characteristics of the respondent's knowledge related to the vaccine, misconceptions related to the vaccine, perceived reliable sources, and acceptability of the vaccine. The COVID-19 vaccine acceptance rate was 76% in the study area. The vaccine acceptance rate was slightly lower among female participants (74%) in comparison to their male counterparts (78%). The Bivariate analysis showed a significant association of acceptance of the COVID-19 vaccine with the municipality, caste/ethnicity, and family type. Similarly, in the multivariate analysis, religion, caste/ethnicity, and disability statuses were found to be significantly associated with vaccine acceptance. Concluding that the COVID-19 pandemic cannot be curbed if people do not accept the vaccine. The findings of the study showed that a considerable proportion of the respondents did not accept the vaccine due to fear of the side effects and doubt about vaccine efficacy. Therefore there is a need to increase advocacy and awareness of the COVID-19 vaccine to increase people's trust in it. Read More...

Strengthening Approaches for Maximizing Maternal and Newborn Health (SAMMAN)

The use of the family planning method enables people to achieve their desired number of children and helps to reduce unintended and high-risk pregnancies and unsafe abortions, which contributes to saving the lives of many women. The main objective of this study is to examine the post-intervention impact on the use of family planning methods among married women of reproductive age in Nepal. Read More...

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...

Climate Learning and Advocacy for Resilience (CLAR) Programme

Climate Learning and Advocacy for Resilience (CLAR) was a CARE Denmark global programme that during the years 2018-2021 provided technical support to CARE country programmes. The overall objective of CLAR was “Adaptive capacity and resilience of vulnerable communities to climate change impacts, risks and uncertainties has increased.” The programme had three interrelated specific objectives, focusing on (1) demonstrating good practice, innovation and impact in climate resilience, and generating new evidence and learning, (2) improving capacity and influence among CSOs and networks on global and national policies, plans and projects on climate change adaptation and finance, and (3) strengthening of climate knowledge brokering for multi-stakeholder, cross-discipline and South-South learning and coordination.
The intention with CLAR was to link practical approaches and outcomes in climate change adaptation work with influencing policy and planning processes, in particular national adaptation plans (NAPs) and finance. CLAR was to add value to CARE country programmes through the provision of technical support for integration of climate change adaptation implementation as well as cross-country learning and knowledge sharing. CLAR targeted both local, national, and global policy spaces to promote pro-poor, equitable and effective adaptation policies, and mechanisms. Through the Southern Voices on Adaptation (SVA) advocacy community of practice, CLAR supported the sharing of experiences and best practices in different contexts on how to influence adaptation policies and adaptation finance. Read More...


CARE Nepal and Handicap International implemented a community-based disaster risk reduction project called VISTAR-II in Kailali, Dadeldhura, Kanchanpur, and Dang districts under the DIPECHO-VIIII cycle. This project was for a period of 22 months from March 1, 2015, to December 31, 2016. The project aimed to strengthen the resilience of communities and institutions to natural disasters through building leadership and management capacities from the community level to the national level. After five years of the VISTAR-II intervention, a Post Project Sustainability Study was carried out in two randomly selected intervention districts, namely Kailali and Kanchanpur. out of the four districts. Read More...

Dignified and Violence-Free World of Work: A Study on Women Working in Informal Sectors in Nepal

A significant percentage (66.5%)1 of women in Nepal work in informal sectors and are vulnerable to all forms of violence and exploitation. The violence experienced by women in informal sectors ranges from physical, sexual, and verbal harassment to labor and economic exploitation by employers, co-workers and family members. Existing legal provisions such as Sexual Harassment (Elimination) at Workplace Act, 2015 do not have specific provisions for informal sectors whereas other mechanisms to address violence against women, in general, remain ineffective in implementation. In addition, socio-cultural norms and structures limit women’s access to justice-seeking mechanisms. Despite pervasive instances of violence and harassment experienced by women in informal sectors, there is a dearth of comprehensive documentation and evidence building on this issue. In this light, the paper examines the existing status, nature and experiences of violence faced by women working in diverse areas of the informal economy. It also critically analyses key gaps in existing legal provisions/policies and barriers to implementation from the perspective of informal sector workers.
The paper is based on the findings from 36 case studies of women working in 15 different informal sectors, Gendered Political Economy Analysis (GPEA) with community and policy stakeholders and desk review of relevant policies/legal provisions. The paper shows that women’s gendered social roles, lack of collectivisation and representation in decision-making bodies puts them in a weaker bargaining position to voice against instances of violence or to make it a priority agenda of advocacy for policymakers. Similarly, the findings of the paper indicate that lack of adequate and effective polices/provisions on safe working conditions and their implementation leads to invisiblisation of violence at the workplace, enabling powerholders to continue cycles of violence and exploitation without accountability. The paper contributes towards mainstreaming discourses around dignified work for women in the informal economy. It also serves as an evidence-based advocacy document to influence governments to ratify ILO Violence and Harassment Convention No. 190, which is a binding international treaty that protects all workers in formal and informal economy. 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.

Endline Evaluation of Udaan II: Catching the Missed Opportunity

Udaan II “Catching the Missed Opportunity” Project, funded by OPEC, is one of the most important initiatives for girls’ education and economic prosperity. As an instrument to women and girls’ empowerment through transforming harmful social norms, building life skills and advocating related policy reforms; the Project was operated for 3 years (November 2017 to October 2020). The project was focused on out of school girls (10 to 14 year old) from marginalized and socially excluded communities and have never been to school or dropped out in their primary education for delivering an accelerated learning approach. This project was implemented by Care Nepal in Krishannagar Rural Municipality, Kapilvastu Municipality and Maharajgunj Rural Municipality of Kapilbastu district in cooperation with its local partner Siddhartha Social Development Centre (SSDC).

The objective of the evaluation study was to measure both, the intended and unintended outcomes and impact of the project against the targeted results.

The evaluation study followed both the qualitative and quantitative methods for data collection. The focus group discussion, in-depth interview, and key informant interviews were the methods for field data collection. The data collected were analyzed and presented in tables, figures, and themes. [58 pages] Read More...

Endline Evaluation of Haushala Initiative of LEAD Program

Care Nepal has been implementing Haushala project which was designed to strengthen girls’ agency along with education outcomes, economic empowerment and adolescent sexual and reproductive health (ASRH) practices, hence helping to build sustainable change, including through creating a safer and more secure learning environment, facilitating social networks and gradually transforming traditional social norms with a negative impact on girls. The project also aimed to improve accountability and gender responsiveness of service providers for improved learning for girls.

During the evaluation both qualitative and quantitative data were collected using questionnaires, FGD and KII checklist for girls, parents, head teachers, cooperatives and school management committee. The data collection faced few limitations arising from COVID-19 which limited the logistical flexibility of the project along with created greater ethical consideration regarding health of the enumerators.

Girls reported that they perceived high parental support in their studies but this perception decreased with age. Parents and Girls both credit UALC and its program for aiding them and their children to attend formal schools. Parents were highly motivated by UALC and its stakeholders to help their daughter(s) to join formal education. However, it was also observed that the effort put by stakeholders such as schools and social mobilisers on influencing the parents who did not enroll their daughter(s) in formal school after UALC was not enough. But, as the transition was already very high and parents who did not send their daughter(s) for the first time were not that willing to re-enroll. Hence, the project can be deemed a success to certain point. [151 pages] Read More...

Evaluation of Enhancing Mobile Populations’ Access to HIV and AIDS Services (EMPHASIS)

EMPHASIS is a 5 year project funded by Big Lottery Fund, UK, which was initiated in August 2009 and is due to conclude in July 2014. It has been implemented in Nepal, India and Bangladesh to address both HIV and AIDS vulnerability and safe mobility issues of cross border migrant populations. Its overall goal has been to contribute to reduction of vulnerability of mobile populations (particularly women) to HIV infection across selected cross border regions within India, Bangladesh and Nepal. There has however, appropriately, been an increased focus on safe mobility issues within the last two years of the project. The three main outcomes of the project focus on: 1) the development of an effective and integrated cross border model of HIV prevention, care, treatment and support to benefit mobile populations and their families and target groups at source, transit and destination locations who are vulnerable to acquiring and spreading HIV and AIDS, 2) building the capacity of partner organizations (including regional authorities, government agencies, border police, customs officials, research institutions, NGO, Community Based Organizations [CBO] and key stakeholders) to deliver improved and integrated services to mobile populations vulnerable to HIV, 3) Increasing recognition of the vulnerabilities of mobile populations and demonstration of ways to address them in source and destination communities that will inform policies and produce evidence based advocacy messages with which to lobby government stakeholders. The aim of this evaluation is to assess the project according to its three outcomes areas and to assess the effectiveness and relevance of different interventions. One week visits to India, Nepal and Bangladesh were conducted at the end of January/ early February 2014 by a team of three people, during which interviews and focus group discussion were conducted, and a Lickert Scale tool administered. These visits were then supplemented by some additional meetings in Bangladesh in April, following the production of the first draft report. An endline study was conducted in parallel to the evaluation, and its conclusions are also drawn upon in this report. [88 Pages] Read More...

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