Sexual|Reproductive Health

South Sudan: The True Cost of COVID-19 Vaccines

By July 18, South Sudan was able to administer the 60,000 doses of COVID-19 vaccine they had in stock through a series of smart investments in delivery, training, and social mobilization coordinated with several different partners. As new doses are projected to arrive in country in August, South Sudan continues to reinforce gaps in the health systems to make COVID-19 vaccinations possible without disrupting existing health services.
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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...

A Qualitative study comparing the effects and outcomes of HIV-related interventions for Nepalese migrants – at source, transit and destination

The qualitative study, commissioned by Care Nepal, sought to explore the effects and outcomes of the EMPHASIS project, launched four years ago to reduce HIV and AIDS vulnerability among cross border migrants; and to influence national and regional policies relating to safe mobility through evidence generated regionally. The project, working along a continuum of source, transit, and destination areas, provides HIV prevention and treatment services to migrants and their families. Additionally, the project partners with local stakeholders to ensure safe passage of migrants on transit besides providing other support services. The study was, thus, designed to assess the influence of the project in addressing HIV vulnerabilities, and at the same to enquire into whether inter-country passage has been made safer for migrants. The study aimed to answer the following research questions: a) How has the EMPHASIS intervention impacted HIV vulnerabilities among Nepali migrants, b) What are the qualitative differences between HIV related attitudes and behaviors between migrants reached at destination and their spouses reached at source and those not reached either at source or destination, c) What are the qualitative differences between HIV
related attitudes and behaviors between spouses who have been reached by the project and those who have not been reached by the project, d)) What are the benefits and barriers of support services provided to migrants for safe mobility and empowerment. The study was conducted among 60 migrants and family members, and 5 key informants in four locations- two at the destination site of Delhi and two at the source site of Nepal. In depth interviews by trained researchers were conducted with the help of semi structured interview guides. [39 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...

Vulnerability to HIV & AIDS: A social Research on Cross Border Mobile Population from Bangladesh to India

There are a growing number of people migrating between Bangladesh, Nepal and India. Mobility has long been linked with heightened vulnerability to HIV & AIDS. While overall
HIV prevalence is low in Bangladesh and Nepal, there is a growing concern that vulnerable mobile populations are forming a bridge between high prevalence areas of India and low prevalence areas in Bangladesh and Nepal. Enhancing Mobile Populations’ Access to HIV & AIDS Services Information and Support (EMPHASIS) is a regional program being implemented by CARE Bangladesh, CARE India and CARE Nepal and led by CARE International UK (CIUK) to reduce AIDS related vulnerabilities among mobile populations crossing the borders of Bangladesh and Nepal into India. This 5-year (August 2009 – July 2014) program, is funded by the Big Lottery Fund (BIG) of United Kingdom.

Baseline Research on cross border migration was initiated to understand the drivers of mobility, access to services for migrants at source and destination, and to understand the risk and vulnerabilities associated with migration and HIV & AIDS. The study was conducted using quantitative methods and a separate qualitative study was conducted to enhance and complement the quantitative data. [57 Pages] Read More...

Somalia: Cash Transfers via Mobile Money for Maternal Child Health Services

This study is part of a larger multi-country study by CARE entitled “Cash and Voucher Assistance for Sexual Reproductive Health and Rights Outcomes: Learnings from Colombia, Ecuador, Lebanon and Somalia.”
CARE Somalia has used Cash and Voucher Assistance (CVA) in its programs for over ten years. This includes CVA for food security and livelihoods, nutrition, WASH, and education, as well as multipurpose cash transfers. Since 2018, with support from Office of Foreign Disaster Assistance (OFDA) (now the Bureau for Humanitarian Assistance (BHA)), CARE Somalia has been implementing a food security and Livelihoods, health, nutrition, protection and WASH program. With BHA support, CARE currently supports 19 MCH facilities across Somaliland and Puntland that target children and pregnant and lactating women (PLW). Read More...

Ecuador: Vouchers for Sexual Reproductive Health and Rights

This study is part of a larger multi-country study by CARE entitled “Cash and Voucher Assistance for Sexual Reproductive Health and Rights Outcomes: Learnings from Colombia, Ecuador, Lebanon and Somalia.” Ecuador is both a transit and destination country for refugees and migrants from Venezuela and elsewhere. As of July 2020, over 400,000 Venezuelans were living in Ecuador. Venezuelan refugees and migrants have considerable health, psychosocial, and economic needs. Within these groups, women, adolescents, and LGBTQI people face heightened risks of Gender-Based Violence (GBV), human trafficking, and sexual exploitation as well as challenges to earning an income while in Ecuador. Although the public health system in Ecuador is free to all regardless of migration status, not all health – and especially SRH services – are covered in the public system. Furthermore, safe access to available services without discrimination based on nationality, sexual orientation/gender identity, or age is a barrier to access and uptake of SRH services in Ecuador. Read More...

Colombia: Vouchers for Sexual Reproductive Health (SRH) Services

This study is part of a larger multi-country study by CARE entitled “Cash and Voucher Assistance for Sexual Reproductive Health and Rights Outcomes: Learnings from Colombia, Ecuador, Lebanon and Somalia.” As a result of Venezuela’s socioeconomic and political crisis, there have been massive migratory flows of people from Venezuela into Colombia.1 According to the Interagency Coordination Platform for Refugees and Migrants, as of May 2020 over 1.76 million Venezuelans had fled to Colombia with many continuing to walk to and across the Southern Border with Ecuador as caminantes.

CARE Colombia began direct operations in the country in 2019, focusing primarily on the needs of Venezuelan
refugees and migrants in Pamplona, Norte de Santander and, later, Bucaramanga, Santander. Cash and Voucher
Assistance then (CVA) are primary modalities for CARE Colombia, particularly for its SRHR and protection portfolio.
Working with populations on the move as was was the case in this program, together with high levels of unmet SRHR needs resulted in a unique operating environment for a voucher intervention supporting SRHR programming.
This case study focuses on the design of the programming only. Due to the timing of the review, no substantive data on the user experience of the vouchers or outcomes could be captured. Read More...

Lebanon: Cash Transfers for Sexual Reproductive Health and Rights (SRHR) within Protection

This study is part of a larger multi-country study by CARE entitled “Cash and Voucher Assistance for Sexual Reproductive Health and Rights Outcomes: Learnings from Colombia, Ecuador, Lebanon and Somalia.”
On August 4, 2020, an explosion in the port of Beirut left hundreds killed and thousands injured, damaged numerous neighborhoods – including hospitals and residential buildings – and left 300,000 people homeless. The economic, social, and psychological tolls of the blast were added to an already strained population suffering from an economic crisis and the impacts of COVID-19. The Lebanese Red Cross reported in a post-blast study2 that, of those surveyed, approximately 5% of respondents reported having family members who were pregnant or lactating and, of those households, 40% reported needing Maternal Child Health (MCH) services. A UNFPA report identified a decrease in SRH service availability due to facilities destroyed or damaged in the blast.
Prior to the blast, the Interagency Sexual and Gender-based Violence (SGBV) Task Force conducted an assessment with 562 women and girls across the country on the SGBV impact since the beginning of COVID-19. This assessment found that 51% of respondents felt less safe in their communities and only 30% reported accessing health services.4 Sixty-seven percent of respondents reported that the main barrier to accessing services was lack of money.5 Read More...

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