20 February 2019

CARE International

2018

CARE International commits to developing approaches for addressing gender and social barriers to increased family planning use and validating tools to measure the impact of these approaches on health outcomes. CARE International also commits to reaching the most vulnerable and marginalized populations to reduce inequality, ensuring women and girls’ family planning and reproductive health needs are addressed in both development, emergency and post-conflict response activities. CARE’s commitment in 2012 to FP2020 in support of Every Woman Every Child has been rolled over until 2020 to help advance the Updated Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030). More information about this can be found here.

Commitment Progress

Over the past year, CARE has made significant progress toward its FP2020 commitment:

To address gender and social barriers…
CARE is scaling up the TESFA+ model, building on 7 years of experience in the area of social norms programming to reach adolescent girls in Ethiopia. The model is learning from the TESFA program and using evidence from an ex-post evaluation to iterate and scale in Ethiopia and other countries.

To strengthen local governance and social accountability…
CARE has made significant contributions to the evidence base for citizen-led social accountability for reproductive health, continuing to generate evidence on CARE’s Community Score Card and its contribution toward improved maternal and reproductive health outcomes in Malawi. Further results were published in 2018 and CARE is working to enhance CSC training and research methodology, as well as continuing to implement the CSC through various platforms such as schools and through supporting community and youth leadership.

In Bangladesh, CARE has demonstrated the effectiveness of a community-led accountability model, the Community Support System which the government is institutionalizing at the national level. A recent study jointly published by CARE and partners further strengthens the evidence around this model’s utility for the improvement of maternal and neonatal care in Bangladesh.

To reach the most vulnerable and marginalized populations,
CARE’s is supporting SRH services and programming in 19 crisis-affected countries and has generated robust evidence about the demand, feasibility and impact of rights-based FP/SRHR services in these settings.

The Bihar Technical Support Program has contributed to stunning achievements, including state-level impact in the areas of maternal and infant mortality (for example, Bihar’s maternal mortality ratio is now 165 per 100,000 live births in 2018 compared to 312 per 100,000 live births in 2005). Over the past year the program has supported a zero/low-parity family planning and gender-based violence program in the state, supporting the government in its effort to expand the basket of choice for family planning.

To build political will and mobilize action…
As co-chair of IAWG Advocacy and Accountability Working Group, CARE catalyzed powerful joint advocacy for the 2017 Family Planning Summit to get crisis-affected settings on the global family planning agenda for the first time, generating 21 new commitments and building a powerful cadre of donor champions.

CARE has also helped catalyze game-changing national policy reform in Bangladesh and Chad. In Bangladesh, we contributed to advocacy that unlocked access to FP for Rohingya refugees. CARE Chad is playing a lead role in convening spaces for advocacy to ensure implementation of policies that ensure comprehensive SRH services (in line with the Maputo protocol).

CARE has also catalyzed effective partnerships in FP by seconding a full-time Sr. Fellow to the global FP2020 Secretariat, to “power” FP2020’s new work in FP-in-crisis (after the 2017 FP Summit). The concrete outcomes generated by CARE’s foundational investment demonstrated the value-add of FP2020’s FP-crisis pillar, which is now funded. CARE also launched a partnership with the Center for Reproductive Rights, developing approaches to rights-based accountability in crisis-settings.

2017

Commitment Progress

CARE reaffirms the commitments we made at the London Summit 2012 and continues to deliver progress toward our commitment in support of 120 million women and girls worldwide. Since our last update in 2016, CARE has made progress on the following commitments:

CARE committed to develop approaches for addressing gender and social barriers to family planning use and validating tools to measure the impact of these approaches on health outcomes:

• Since 2016, CARE has further implemented and tested Social Analysis and Action© (SAA), one of CARE’s model for gender transformation. SAA is a community-led social change process through which individuals and communities explore and challenge social norms, beliefs and practices around gender and sexuality that shape their lives. CARE has used SAA with couples to improve communication and reproductive decision-making, with communities to build a more supportive environment for SRH, and with health providers to improve SRH service delivery to adolescents.

• In Ethiopia, CARE uses peer-based solidarity groups and community engagement strategies to improve family planning access. Combining these strategies with the SAA model into a unique SRH program, CARE achieved significant results, including an increase in participant’s use of family planning of 78%, up 27% from baseline.

• CARE is also reaching women in urban settings in the garment sector in Bangladesh and Cambodia. In Cambodia, CARE developed an innovative package of tools to support female garment workers in making informed, healthy, sexual choices and access reliable reproductive health services. Chat! Contraception consists of short, targeted activity-based sessions that provide key information on communication and consent, contraception, sexually transmitted diseases, and safe abortion; video dramas featuring characters in a fictional garment factory that engage workers’ emotions as they relate to the everyday challenges of characters; and an interactive mobile app that challenges workers to prove and improve their understanding of reproductive health topics. Chat! has had some notable results including increase of modern contraceptive use among sexually active women from 24% in 2014 to 48% in 2016, and complete confidence to discuss contraception with partners has doubled.

CARE also committed to strengthening local governance mechanisms and building capacity of women and communities:
• CARE has continued to expand spaces for meaningful participation of women and girls in shaping how reproductive health services are provided in their communities through the Community Score Card© (CSC). CARE’s Community Score Card© (CSC) brings together community members, health providers, and local government officials to identify obstacles to access and delivery of health services, to generate local solutions, and to work together to implement and monitor the effectiveness of these solutions in an ongoing process. We tested the effectiveness of this approach in improving family planning and other reproductive health outcomes through a cluster-randomized control trial (RCT) in Malawi. The results were significant, including 57% greater use of modern contraception (in treatment vs. control at endline) and 20% greater increase in health worker visits (in treatment vs control from baseline to endline). Our study is one of only a few RCTs that focuses specifically on the potential benefits of a social accountability approach, like the CSC, on improving access to, and use of, family planning services. To further build knowledge in this field, CARE reviewed its own experience with the CSC, and produced reports and evaluations to describe the outcomes, successes, and challenges of our 15-year experience (Gullo et al.,2016). The reviews suggest that the CSC prompts a wide range of outcomes and merits further attention as a strategy for improving accountability. Lessons for improvement include creating environments that facilitate health worker buy-in and participation, and further exploring opportunities for vertical movement of information to states and civil society actors.

• CARE is supporting the Government of Bihar to strengthen and increase coverage and quality of life-saving interventions for families, women, and children less than two years across the continuum of care. With funding from the Bill & Melinda Gates Foundation, CARE is testing and scaling several innovations in Bihar, India that are increasing quality of reproductive health services, strengthening the health workforce and expanding access to high quality reproductive, maternal and adolescent health services and information. One of the innovations includes a smartphone-based tool that is helping front line health workers reach, track and manage the communities they serve. Notable results from this innovation include:  Women who saw a health worker that used the app were 73% more likely to visit the doctor 3 times after they gave birth.  They were 14% more likely to do exclusive breastfeeding, and 32% more likely to use modern contraception. Women who worked with a health worker using the app were up to 81% more likely to get access to health information of all kinds—not just information on the mobile phone. Workers who used the phones were 23% more likely to visit women in the final trimester of pregnancy, and 20% more likely to visit them in the week following delivery.
These results were so compelling, that the government of India has just announced a $1.38 billion investment in health and nutrition over the next 3 years. That investment includes rolling out CARE’s ICT tool to an additional 1.4 million health workers in the 550 most vulnerable districts of India.

CARE also committed to reaching the most vulnerable and marginalized populations to reduce inequality and ensure women and girls’ SRH needs are addressed in development, emergency, and post-conflict response activities:
• CARE prioritizes sexual and reproductive health when we respond to emergencies and we work to ensure that family planning services are available to women in the most difficult, fragile and crisis-affected settings in the world. In Syria, CARE is working with partners to provide integrated emergency obstetric care, neonatal care, and contraceptive services into 10 primary health clinics in Aleppo and Idleb governorates. CARE also operates mobile clinics to deliver SRH and gender-based violence services, reaching an estimated population of 356,400 Syrians, including 87,501 women of reproductive age.

• CARE’s Supporting Access to Family Planning and Post Abortion Care project (SAFPAC) supports government and partners in Chad, Democratic Republic of Congo, Mali, Syria, Afghanistan, Bangladesh, Cambodia, Cameroon, Djibouti, Myanmar, Nepal, Niger, Nigeria, South Sudan, Uganda, Ivory Coast and the Philippines to deliver comprehensive and high-quality service in hard to reach areas. The SAFPAC model includes competency-based training, supportive supervision, effective supply chain management and procurement, and community engagement. Over the last five years of SAFPAC, results have demonstrated a steady and dramatic increase in new contraceptive users across the countries, with 66% of the new contraceptive users choosing long-acting reversible methods. CARE is also working to reach adolescents with SRH information and services in many of these countries.

Finally, CARE also committed to building political will and mobilizing action at all levels –local to national to global – to ensure implementation of policies and programs that address the needs of communities and are rights-based, effective, and culturally appropriate. Progress on this commitment include:
• In 2016 working with government of DRC to quantify the family planning funding gap in North Kivu, and supported the Ministries of Health and Planning to lobby provincial- level lawmakers and succeeded in securing a new budget line item to fill the gap and ensure adequate funding for family planning.
• Building U.S. support for family planning through ‘Learning Tours’ with members of the United States Congress, policy makers, journalists, and opinion leaders to demonstrate the impact of family planning programs around the world. Through Learning Tours, CARE is building a powerful cadre of champions who advocate for continued US government investment in international family planning programs.
• With funding from Family Planning 2020’s Rapid Response Mechanism, CARE was invited in 2016 by the Ministry of Health in Djibouti to help revise the national family planning policy and guidelines, with the goal of expanding the cadres of health workers authorized to provide a full range of contraceptive methods.
• In 2016, CARE played a leadership role in the revision of the Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings, successfully advocating for the repositioning of family planning as a priority intervention within the Minimum Initial Service Package for Reproductive Health in Crisis Situations (MISP).

2012—London Family Planning Summit

CARE International commits to putting reproductive rights, women’s empowerment and gender equality at the center of its sexual, reproductive and maternal health programming and policy work, by developing approaches for addressing gender and social barriers to increased family planning use and validating tools to measure the impact of these approaches on health outcomes. CARE will strengthen local governance mechanisms and the capacity of women and communities, particularly the most marginalized groups, to meaningfully participate in their own health, engage in local decision-making processes and to hold governments accountable to their commitments. CARE also commits to reaching the most vulnerable and marginalized populations to reduce inequality, ensuring women and girls’ family planning and reproductive health needs are addressed in both development, emergency and post-conflict response activities. Finally, CARE is committed to building political will and mobilizing action at all levels – local to national to global – to ensure continued funding and prioritization of SRMH, scale-up of successful approaches, accountability to commitments and implementation of policies and programs that are rights-based, effective, culturally appropriate and address the needs of communities.

2010

CARE commits $1.8 billion over the next 5 years to expand successful maternal, newborn and child health programs, with a focus on empowering girls and women to increase gender equity, linking health systems and communities in systems of mutual accountability, and using innovative approaches to reach the most vulnerable populations. By expanding its maternal health programs into at least 10 additional countries—a 50 percent increase—and by scaling-up programs in countries where it currently operates, CARE aims to aid more than 30 million women of reproductive age by the 2015 Millennium Development Goals deadline.

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