Innovation + Systems Strengthening in Bihar

Our Team-Based Goals and Incentives team from our Cohort 1 alums are part of a broader team dedicated to scaling innovation with the government of Bihar, India. In his annual letter, the Gates Foundation Director of the India Country Office highlight’s CARE’s work in Bihar, addressing the real-world challenges of making innovation effective in the midst of fragile and broken systems.  Way to go team!

The public health system in Bihar consists of hundreds of thousands of health workers, from doctors and auxiliary nurse midwives in primary health facilities to ASHA and Anganwadi workers who provide basic advice and care to women in communities. We began by helping the government test new techniques and technologies to improve the quality of these providers’ services in eight pilot districts. For example, to help frontline workers advise women about healthy practices like breastfeeding, we developed next-generation teaching aids based on digital technology. In facilities, we established a nurse-mentoring program that has, among other successes, doubled the number of nurses who wash their hands and wear gloves before and during procedures.

Though these interventions have led to successful outcomes, a careful review of the data revealed that by themselves they were unlikely to have enough impact on maternal, newborn, and child survival, which was the ultimate goal of the work. Therefore, the Government of Bihar, our foundation, and our grantee CARE India agreed to expand these investments in innovative methods and tools that solve specific problems to more districts and to augment them with investments in basic best practices that strengthen the underlying health system in general.

The partners are now working to bolster everything about Bihar’s health system, from budgeting and procurement to management practices and data collection. This two-pronged approach that layers technical solutions on top of a stronger health delivery platform promises to help Bihar meet its goals while generating lessons that will benefit other partners, especially other state governments interested in investing in the health and the human capital potential of their people.”

Read the full letter here

5 Minutes of Inspiration: How Married Girls in Ethiopia are Taking Charge of Their Lives

CARE Action Network took a moment to shout out Cohort 3 team TESFA and their work! Reposted here from

How Married Girls in Ethiopia are Taking Charge of Their Lives


“In the past I didn’t even want to be seen by other people, let alone talk to them. Nowadays, I am not scared of anyone. I speak up. I say what is on my mind.” – Mesobua Kassaw, 20, South Gondar, Amhara, Ethiopia

By April Houston

In the Amhara region of Ethiopia, as in other areas of the world with strong patriarchal traditions, women and girls are expected to be quiet and obedient to the men in their lives. Their own needs and desires are less valued than instructions handed down by religious leaders, government officials, their fathers, or husbands. It is not uncommon in these cultures for girls (and sometimes boys) to be married as teenagers. Once married, they often drop out of school and begin having children of their own, although adolescent pregnancy and childbirth comes with high risk of complications and death for these girls and their babies.

Fortunately, rates of early marriage in Ethiopia are on the decline, and the change is coming from members of the communities most impacted by these harmful traditions. CARE launched the TESFA program in the Amhara region in 2010 (“TESFA” stands for Towards Improved Economic/Sexual Reproductive Health Outcomes and means “hope” in Amharic) to unlock the power and secure the future of ever-married adolescent girls. We came back four years after the program ended to see what has changed for the original participants.

What was accomplished?

  • Physical, social, and economic wellbeing improved: Findings from the initial program evaluation conducted by the International Center for Research on Women identified gains in communication between girls and their husbands, decreased levels of gender-based violence, improved mental health, improved knowledge and use of sexual and reproductive health services (including family planning), and increased social capital and support.
  • Girls spread the word (without CARE’s help): A 2017 ex-post evaluation found that all the girls groups in two implementation districts (Farta and Lay Gayint) continued to meet, without any assistance from CARE.
  • Ending child marriage in Ethiopia with TESFA.Financial benefits led to increased independence and empowerment: Inspired by the financial education they received during TESFA, participants created their own income-generating activities, ranging from fattening cattle, poultry feeding, growing vegetables, and selling baked goods and coffee. The proportion of participants with their own savings grew by 23 percent (compared to 3 percent in comparison groups) from the beginning of the program to the end. As their financial situation improved and they were able to buy things for themselves, they also started having meaningful conversations with their husbands about spending (which most had never done before TESFA). One participant told us “spending without planning is now considered ‘old fashioned’.”
  • Girls are exercising their sexual and reproductive health rights: TESFA not only increased participants’ knowledge about sexual and reproductive health, but also the skills, confidence, and mobility necessary to gain access to health services. Girls reported that they feel comfortable discussing family planning with their husbands and decide jointly on how many children they will have and when, and whether to use contraception. The number of girls using a family planning method increased 15 percent over the life of the program.

How did we get there?

  • Start with savings groups: Although CARE had been using Village Savings and Loan Association (VSLA) groups to help marginalized women and communities save money and access loans, they had not been tried exclusively with adolescent girls or used to deliver health-related curriculum before TESFA. Many of the girls surveyed in the ex-post evaluation reported “saving money” as one of the top reasons for their participation in the program. (Learn more about CARE’s advocacy work on women’s economic empowerment)
  • Get community leaders on board: To complement the work of the girls’ groups and support their efforts to improve their lives and environment, CARE staff worked with community “gatekeepers” to identify and recruit individuals to participate in Social Analysis and Action (SAA) groups. SAA is a process by which participants explore and challenge social norms, beliefs, and practices around gender and sexuality. Adult members of these groups acted as liaisons between the program and the community and assisted the girls as allies – taking their needs and concerns to individuals with power to address them.
  • Train peers to be educators: Girls’ groups were facilitated and led by peer educators – girls from the community who received training on TESFA content, including sexual and reproductive health and economic empowerment/financial literacy.
  • Work for gender-transformative change: Four years after the conclusion of this phase of the TESFA program, community members have noticed sustained transformative change at the individual, family, and community levels. Acceptance of early marriage has decreased, leading to the interruption of 180 planned child marriages, and freedom of movement for girls has improved to a level they described as “ground-breaking” (aided by supportive government policies and better access to technology).
Ending child marriage in Ethiopia with TESFA.

Circles of Change on the Call Your Girlfriend Podcast

We’re thrilled to hear Cohort 2 Alum, Iman El-Mahdi, on the Call Your Girlfriend Podcast where she shared more about the Circles of Change model for preventing street harassment. Check it out here!  

“We step back from chaos in the U.S. and take a global view. Protests at the World Cup in Russia. The politics of globalization and migration on and off the pitch. In China, the government is cracking down on women organizing online. In Nepal, menstrual stigma risks the lives of women and girls. In slightly better news, women in Egypt are working to end gender-based violence, starting with the men who drive cabs and tuk-tuks.”

A new website for Dignified Work for Domestic Workers

Congrats to Cohort 1 Team, Dignified Work for Domestic Workers, on the launch of their new website and resource platform!

You can find a resources section which includes recent studies, videos, photographs, info graphs for you to download, share and disseminate as you please and our Blog: Currently most entries are in Spanish. Do expect some to be in English soon!

The program Equal Value, Equal Rights, is CARE’s impact multiplication strategy in Latin America, which seeks to advance the rights of millions of domestic workers in the region. For this, the program focuses on actions of political advocacy, articulation of national and global domestic workers’ organizations with international and regional organizations related to the subject, and in communication strategies of national/regional scope for employers’ sensitization and behavior change. CARE’s commitment to this population program is long-winded: we hope to positively impact the lives of 5 million domestic workers by the year 2020 and 10 million till 2030.

Equal Value, Equal Rights is a regional initiative that currently is being implemented in Colombia, Ecuador, Guatemala, Honduras and Mexico. However, CARE’s experience with domestic workers’ organizations already started on 2010 in Ecuador, Peru and Bolivia allowing our organization to systematize these experiences and learn together with domestic workers’ organizations at national and regional levels about what are the best strategies to continue advancing their rights.