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.

Worker Wellbeing Project in Bangladesh, Indonesia and Vietnam Endline Evaluation

This endline evaluation was conducted to assess change and impact resulting from the Worker Wellbeing Project in Bangladesh, Indonesia and Vietnam. It was carried out independently by Rapid Asia to conduct an endline evaluation of the Worker Well-Being Project to provide a final report to the donor, capture details on impact and analyse lessons learned to be applied to future programming. The purpose of the Worker Wellbeing Project is to improve wellbeing for garment workers through access to dignified working conditions, legal and social protections and gender-equitable relationships. Findings from the evaluation will also be used to learn from and develop the Dignified Work portfolio and promote women's economic justice worldwide.

This evaluation sought to identify the extent to which the project achieved meaningful change in women workers’ lives both at home, community and in the workplace through the activities in each country by identifying outcomes from project activities and outputs to understand linkages between those outcomes and the projects outputs.

Key Findings
The EKATA engagement model
The EKATA model proved to be highly successful in greatly enacting change for women garment workers in the factories and at home. Women workers consistently highlighted the usefulness of the training had on their daily lives. Through the training, the women learnt how to reclaim those voices and negotiate at work for better conditions.
Engagement with men
Recognising the crucial role that men play in delivering gender-transformative impac by engaging them as stakeholders proved to be successful. Men were found to be receptive in recognising gender as a social construct, which then formed the basis for understanding the value of women and why domestic responsibilities should be shared and that sexual harassment of women is unacceptable.
Duty bearers’ responsiveness
Garment factory management staff believed they could see not only the benefit of the project but also an improvement in the conditions of the women workers, which they recognised as having a positive impact on their business. Employers appeared to welcome women garment workers raising their concerns, mainly due to the workers' improved communication skills.
Outcomes and their relation to activities
Beneficiaries of EKATA training found the sessions on financial management, gender equality, labour rights, leadership and communication the most valuable and impactful in their daily lives. It was found however, that such training alone would not be enough to deliver true impact. Evidence demonstrated that establishing committees from where women can launch collective demands was a significant trigger to exercising women’s rights.
Project sustainability
There is great potential for women recognising labour violations and unfair practices, gender inequality, and the capacity to take action without a considerable reliance on outside support. Sustainability is also underpinned by network activities, namely the linking of community worker association to local federations and trade unions and local service providers. Read More...

Supporting flood Forecast-based Action and Learning (SUFAL) Project in the 2020 Monsoon Floods

Background: ‘Supporting flood Forecast-based Action and Learning’ (SUFAL) project was designed to contribute to reducing the adverse impacts of the increasing frequency of catastrophic flooding on the vulnerable and poor communities through Forecast-based Action (FbA). The project was funded by The Directorate-General for European Civil Protection and Humanitarian Aid Operations (ECHO) and was implemented through a consortium led by CARE Bangladesh, with Concern Worldwide, Islamic Relief and Regional Integrated Multi-Hazard Early Warning System for Africa and Asia (RIMES). The project was implemented in three northern districts of Bangladesh: Jamalpur, Gaibandha, and Kurigram. FbA contributed to disseminating Flood Early Warning messages with a lead time of 10 – 15 days with timely and accurate weather forecast information, while and it also helping to identify potential flooding areas.

Methodology: The primary purpose of the study was to “Evaluate the impact of early actions” applied through the SUFAL project on household and community beneficiaries in responding to the 2020 monsoon floods. Customized OECD-DAC criteria, Quasi-experimental design (Difference-in-Difference Method), Knowledge, Attitude and Practices (KAP) framework and Value for Money (VfM) framework were used as guiding methods and tools to design study instruments and evaluate the impact of early actions at every stakeholder level. The study covered a control group in non-project areas and three treatment groups in the project areas: Treatment group 1 (EWM support), Treatment group 2 (EWM + Evacuation + Shelter + WASH support), Treatment group 3 (EWM + Evacuation + Shelter + WASH + Cash-grant support). Treatment groups were categorized in three different groups to conduct cost-effectiveness analysis. The study areas were in the districts of Kurigram (Hatia, Begumganj, Buraburi, Shaheber Alga unions), Gaibandha (Bharatkhali, Saghata, Ghuridaha, Haldia unions) and Jamalpur (Kulkandi, Chinaduli, Noarpara, Shapdhor. The survey sample consisted of 224 control respondents (of which 153 were women) and 754 treatment respondents (of which 426 were women), among which Sample for treatment group 1, 2, and 3 were 293 (100 women), 292 (192 women) and 169 (134 women), respectively. A total of 118 of the 754 treatment households interviewed through the survey were women-headed households and 38 out of 224 control group households were women headed households. The team had conducted 7 FGDs with community members in the three implementation areas, and 27 KIIs with community volunteers, project staff, government officials, and other related NGOs.

Impact: It was found through the study that less people in treatment group experienced damages compared to control households, treatment households saved more resources in 2020 than control households, and the average monetary values of assets saved by treatment group in 2020 were higher compared to the control group households. Due to the drawn-out duration and intensity of the flood in 2020, respondents reported that they were not able to prevent more damages although they took more early actions. Besides, treatment areas were the most flood affected areas. The early messages had helped the community to prevent damage to their assets and livelihoods. The percentage of damage prevented in agricultural sector for the treatment group had increased to 28% since the flood of 2019. The damage prevented in fisheries had increased significantly by 18 percent in 2020 in compared to that of 2019. The death of family members from waterborne diseases had decreased (except female members) in comparison to the previous flood in 2019. It is quite evident that the early warning message had enabled the males to take early actions regarding relocation of the vulnerable
family members to higher grounds, relative’s houses, or to the shelters. The cash for work modality had also helped the community people to obtain a source of income by working for the embankment, roads, bamboo bridges, etc. Shelter renovations and upgradations reportedly encouraged the community people to evacuate faster. The average amount of loan taken by a treatment respondent and control respondent was found to have been Taka 20,194 and Taka 18,335 respectively. However, post flood loan burden was significantly less for the cash grant recipients (only 32% took loan after flood) as compared to other treatment groups (more than 50% took loan). The
cash grants are said to have helped the recipients address their basic needs during the flood and also helped them to some extent to repair their house and pay for livestock treatment after the flood. [70 pages] Read More...

ASHAR Alo Project (Action for Supporting the Host Communities: Adaptation and Resilience)

ASHAR Alo (Action for Supporting the Host Communities: Adaptation and Resilience), meaning ‘Light of Hope’ in Bangla.
The project activities are focused on Jaliyapalong, Haldiapalang,Ratna Palong, PalongKhali union of Ukhiya Upzila and Dakshin Mithachari and Chakmarkul union of Ramu Upazila. CARE aims to strengthen host communities' resilience by enhancing community-based disaster risk reduction (DRR), upgrading infrastructure, and providing livelihoods opportunities across shelter, settlement, and WASH sectors. The project also responds to the urgent protection and gender-based violence needs in the host community. Activities are being undertaken in collaboration with government and community stakeholders and UN and NGO actors.
Cox’s Bazar is amongst the poorest districts of Bangladesh. In Ukhia, 33% of people live below the poverty line, and 17% below extreme poverty. This is linked to the region's poor land quality and high risk of natural disaster. Since the Myanmar refugee influx in the fall of 2017, over 902,984 refugees or 201,150 households (HH)s have settled in Ukhiya, and Teknaf.1 Despite limited resources, the local host community population welcomed the arriving refugees during the fall of 2017, sharing food, shelter, and supplies. However, the refugees’ extended presence has strained the community’s already scarce resources. Within the sub-region, Ukhia and Teknaf have been particularly affected, with 336,000 residents directly impacted by the refugee influx,2 leading to a deterioration of relations between these host community members and the refugees.
The region is highly prone to natural disasters; it experiences regular cyclones, floods, and landslides with triple global average precipitation3. Both individual homes and community shelters are weak and in disrepair. Over 40% of households do not meet Sphere standards; they are overcrowded, fragile and highly susceptible to damage and destruction by strong winds, rain, and flooding4. Land degradation, including the daily removal of over 700 metric tons of firewood from the area, has led to a loss of topsoil, coupled with the heightened risk of flash flooding, which has increased the potential destruction5. The accumulation of improperly disposed waste and poor pre-existing drainage systems aggravate these risks and increase the likelihood of damage to host communities6. Furthermore, community response plans and structures are ill-equipped to safeguard or offer substantive protection. [19 pages] Read More...

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...

Host Community Situation Analysis Impact of Rohingya Influx on Host Communities in Ukhia and Teknaf

Bangladesh became host to what is now the biggest refugee camp in the whole world. By November 2017 836,487 FDMN (Forcefully Displaced Myanmar Nationals) fled across the Myanmar-Bangladesh border to settle here mostly in two Upazilas:Ukhia and Teknaf of Cox's Bazar district. By January 2018, it became clear that this would be a prolonged crisis lasting years as the Myanmar government continued dithering about taking them back, and as also the FDMN expressed their unwillingness to go back fearing persecution. As a result of this huge and sudden influx, lives and livelihoods of the host communities have been affected in many ways. Therefore, this Situational Assessment aims to assess both the visible economic and the subtle social impacts of the recent influx on the host communities. Using Oxford’s integration conceptual framework, this assessment has been conducted to chalk out CARE Bangladesh’s future response to the refugee crisis by involving the host communities in the process and addressing their concerns so that the tension between the two communities is defused rather than intensified.
Presence of the refugees has brought about many social and economic changes creating massive pressure on the host communities. Economic activities in the two upazilas have gone through transitions, leading to the emergence of a new market system and reducing employment opportunities for the host communities.
On one hand prices of essentials have shot up almost twice as much, and on the other, due to an unpredictably large number of refugees entering the local labor market wages for day laborers have gone down. Though refugees are living in highly congested camps, they are getting aid materials as well as economic opportunity in the local market. On the contrary, the host communities are finding themselves pitted against the refugees as either their work have been taken away or their earnings significantly reduced. It is true that a few locally influential people owning large tracts of land and businesses are benefitting from the availability of cheap labor, but the poor and the ultra-poor from the host communities are bearing the brunt of these changes. Access to administrative, educational and healthcare needs has diminished. Reduced access and availability of CPR-resultant scarcity of timber, bamboo for shelter, food & cooking fuel created insecurity of accessing resources. Due to security risk of woman and girls mobility has goes down, women income earning opportunity getting reduced; all of this has evidently created tension between the host and the refugee communities and within host community households. If left unaddressed, this tension is likely to rise to the extent of creating potential threats of ethnic conflicts.
In response to these findings of the situational analysis possible types of interventions could be Gender specific livelihoods strengthening initiatives based on diversification of off/on farm activities, Transformative approach to build life free from GBV, Promoting youth leadership and Strengthening service delivery and demand side functions through Inclusive governance.

GENDER AND COVID-19 VACCINES Listening to women-focused organizations in Asia and the Pacific

More than a year into the coronavirus pandemic, COVID-19 vaccines are being distributed across at least 176 countries, with over 1.7 billion doses administered worldwide. Combating the pandemic requires equitable distribution of safe and effective vaccines, however, women and girls are impacted by gaps both in the supply side and the demand side that hamper equitable distribution of the vaccine. Evidence reveals that 75 per cent of all vaccines have gone to just 10 countries, and only 0.3 per cent of doses have been administered in low-income countries. Very few of COVID-19 vaccines are going to those most vulnerable. The vaccine rollout in Asia and the Pacific has been relatively slow and staggered amid secondary waves of the virus. India, despite being the largest vaccine developer, has only vaccinated 3 per cent of the population and continues to battle a variant outbreak that, at its peak, was responsible for more than half of the world’s daily COVID-19 cases and set a record-breaking pace of about 400,000 cases per day.5However, the small Pacific nation of Nauru, reported a world record administering the first dose to 7,392 people, 108 per cent of the adult population within four weeks. Bhutan also set an example by vaccinating 93 per cent of its eligible population in less than two weeks. That success could be at risk, given the situation in India and the suspended export of vaccines. 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...

Bangladeshi Sailors Vulnerability to HIV and AIDs

Enhancing Mobile Populations’ Access to HIV and AIDS Services, Information, and Support (EMPHASIS) is a 5-year initiative funded by the UK’s Big Lottery Fund. The project has been implemented by CARE in three countries,
Bangladesh, India and Nepal. This study was initiated to generate evidence around the vulnerabilities faced by migrant populations traveling to India. Both qualitative and quantitative methods were used to explore the vulnerability of sailors and a standard BCC questionnaire was used to assess knowledge around HIV and AIDS. Qualitative methods were used to compliment quantitative findings to reveal other socio-economic dynamics that can contribute HIV and AIDS related vulnerabilities. Data collection was carried out in both Bangladesh and India. Both qualitative and quantitative data collection was done in Bangladesh,. As entry into the ports in India was restricted, only qualitative methods were used there. A total of 154 were interviewed with a quantitative questionnaire and 24 sailors participated in in-depth interviews. Focus group discussions (FGD) and Key Informant Interviews were conducted with selected community members such as doctors, Noujan Srameek Union members, and vendors. [46 Pages] Read More...

Journeys: Experiences of Nepalese and Bangladeshi cross border migrants living with HIV

Enhancing Mobile Population’s Access to HIV and AIDS Information (EMPHASIS), Services and Support is a 5-year project funded by Big Lottery Fund, UK. EMPHASIS is implemented in Nepal, India and Bangladesh to address AIDS related vulnerabilities of cross border populations who are moving between Bangladesh, India and Nepal EMPHASIS is an operations research project and one of the pioneer regional projects to address HIV and AIDS vulnerability among cross border populations. The project aims to address its goals through service provision,
capacity building of relevant partners/stakeholders, and advocacy through generating evidence. As part of generating evidence, EMPHASIS developed a research study to investigate the dynamics associated with accessing services for mobile groups who are already affected by HIV and AIDS. This study examines people and questions that were not covered by the EMPHASIS baseline survey that was previously conducted.

Three separate studies were conducted in Bangladesh, Nepal and India. Bangladesh and Nepal first initiated the study aiming to understand the dynamics of HIV infection among migrant populations and also to assess barriers to accessing services at source. In India the study was initiated later, to assess the barriers to accessing services at destination. The prime objective of the study was to present these barriers to services at the regional level among the regional stakeholders. Sharing the findings at South Asian Association for Regional Cooperation (SAARC) could be an important way to initiate dialogue between the governments of Nepal and India to formalize a cross border referral system. Country specific barriers to services will be provided as evidence to inform policy at the national level. [45 Pages] Read More...

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