DELIVERING LASTING CHANGEMAY

FocusLike a Horror Movie

Eyewitness Accounts of Typhoon Haiyan

p2

POVInnovation Spotlight

Maternal and Child Health Goes Mobile

p8

NowDecades Later

The Spirit of the CARE Package® Lives On

p11

ActionStrategizing Success

Learning from CARE’s Water Work

p13

On the CoverA woman carries her CARE relief bag home on her head. On the island of Leyte in the Philippines, CARE distributed food parcels containing rice, canned meat and more to families whose homes were destroyed by powerful Typhoon Haiyan. Photo Credit: ©2013 Laura Sheahen/CARE

Senior Director Leadership Development and Volunteer Engagement KARA ANSOTEGUI

Managing Editor ALINA LABRADA

Editorial Committee TOLLI LOVE, ALICIA FRANCK, MARY KATE WILSON

Features Editorial Committee ALINA LABRADA, CAROL MEYER

Writers LAURA SHEAHEN, ELIZABETH BOWDEN-DAVID, ROGER BURKS

Photo Editor VALENDA CAMPBELL Design KAREN GOLD, PAUL LEWIS

CARE President and CEO Helene Gayle at a demonstration of foods used when weaning babies in a one-room health clinic in Vadiyaram village, India.

Photo credit: ©2008 Brendan Bannon/CARE

1

WELCOME

Dear Friends of CARE,

A warm welcome to the spring edition of IMPACT magazine! As we approach Mother’s Day we honor all of the women in our lives. Alongside the mothers who have given us life, there are women—of all ages and walks of life—who work tirelessly in the developing world to improve their communities and ensure that future generations enjoy basic human rights and opportunities for a better life. This year is particularly special for us. On Mother’s Day, we also celebrate the anniversary of the first CARE Package® delivered in 1946, to survivors of World War II. In honor of this milestone, this issue features two present-day CARE supporters who were at opposite ends of the CARE Package journey. Doug Johnson, a young boy in Mississippi, gathered items to send overseas to people he would never meet; and Hadwig Gofferje, a hungry girl in postwar Germany, rejoiced when her family received parcels of essential goods to help them. Their stories will inspire you and remind you of the legacy you are helping to continue.

Much like the boxes that aided Hadwig’s family decades ago in their time of need, the packages of rice, canned meat and sardines that CARE distributed in the Philippines last November helped families live through the immediate aftermath of Typhoon Haiyan. Our Focus article offers a personal look at the situation on the ground and the actions immediately taken after the disaster, first addressing emergency needs and then helping communities create alternative livelihoods and rebuild homes that will withstand future storms.

You will also read about CARE’s work in Bihar, India, where we are working with partners to implement an award-winning project to improve maternal and child health and survival. We are using a simple tool—the mobile phone—to help healthcare workers promote healthy, life-saving behaviors in one of the country’s poorest areas.

Lastly we share details of a report we commissioned to examine the sustainability of our water-related interventions around the world. The findings are helping us direct our current and future efforts with greater precision.

We are attacking poverty at its roots and creating lasting change. Thank you for taking the time to learn more about our work. I invite you to share your thoughts and ideas with me at www.impactmag.org. On behalf of the families and communities we serve, thank you for supporting CARE.

Sincerely,

Helene D. Gayle, MD, MPHPresident and CEO

We are attacking poverty at its roots and creating lasting change. Thank you for taking the time to learn more about our work.

2

FOCUS

A widow with no children left at home, 78-year-old Magdalena earned a living selling cookies and other items from a storefront in her house. When Typhoon Haiyan struck the country on November 8, 2013, the elderly woman—like millions of Filipinos caught in the Category-5 storm—fled to the safest place she could find—under her house.

Magdalena survived unhurt, as did many people on the island. Another island called Leyte—and in particular the eastern city of Tacloban—did not fare so well.

“It looked like a scene from a horror movie,” says Holly Solberg, CARE USA’s director of emergencies.

Like a Horror Movie: Eyewitness Accounts of Typhoon HaiyanBY LAURA SHEAHEN

“During the typhoon, I hid under the house, where my chickens normally live,” Judito Magdalena said, pointing to the dark, dusty area underneath her storm-damaged house on the island of Panay in the Philippines.

Solberg visited Tacloban in the weeks following the storm, after our initial CARE team began responding. The city was leveled by 150-mph winds1 and a massive wall of water that killed thousands of people and injured many more. “By the time I got there, there weren’t bodies around that you could see,” says Solberg. “What I did see was bad enough.” Tacloban was flattened, and countless other towns and villages on Leyte were destroyed. Roofs were sheared off and belongings swept away as people huddled in more strongly built houses or, like Magdalena, underneath something.

“I was just stunned that more people weren’t killed given the utter

destruction,” says Solberg. “I felt such heartache thinking about what people must have gone through.”

Typhoon Haiyan affected more than 16.1 million people, killing more than 6,200 and injuring more than 28,000.2 More than a million houses were damaged, with approximately half of those completely destroyed.3 Nearly 4.1 million people were displaced.4 Three islands in particular—Leyte, Panay and Samar—were badly hit. Even if the islands’ impoverished families had money, stores were destroyed and transporting supplies through the debris-strewn roads was almost impossible. People needed food and shelter immediately.

Photo Credit: ©2013 Peter Catons/CARE

3

Like a Horror Movie: Eyewitness Accounts of Typhoon Haiyan

In the past, CARE sent packages with items for survival; today the CARE Package represents not only immediate things like locally-procured food and shelter during an emergency, but also longer-term solutions like education and healthcare. “We still provide CARE packages, in a way,” Solberg said. “This is how CARE was born, and it’s still relevant.”

“But it’s gone beyond that. In addition to providing lifesaving support in the form of a food package, we’ve expanded and broadened our work so we’re not just helping people with immediate needs—we are helping them get on their feet. We’re with people throughout their recovery process, and we try to address underlying causes of why people are prone to risk in the first place” said Solberg.

HAIYAN’S IMPACT

In the village of Patag on the island of Leyte, a grandmother sits with her grandchildren and their food package they received from CARE and local partner ACCORD. Photo Credit: ©2013 Peter Caton/CARE

MASSIVE DESTRUCTION, MASSIVE RESPONSEEven before the storm hit, CARE mobilized its Philippines-based team, organized its local partners and deployed disaster relief specialists from across the globe. In the first days of the crisis, CARE teams slept in cars or on the floors of buildings whose roofs had been ripped away. “We saw destruction beyond imagination,” said Sandra Bulling, a communications officer for CARE International who arrived in the Philippines the day after the typhoon struck. It took hours for the first CARE team to go even a few miles over roads covered with branches, downed trees, toppled power lines and broken glass. “We had to stop all the time because our tires got punctured,” Bulling said.

There was no food available in rural areas and municipal authorities were running out. CARE quickly purchased metric tons of food, including rice, from other areas of the Philippines. Our first choice is always to buy food locally and regionally because this helps local merchants, empowers the economy, and is more efficient and sustainable than purchasing it elsewhere and shipping it in. Once the food was acquired, the challenge was how to deliver it to families in need. We arranged for the food to be delivered to Leyte by boat and then carefully trucked it over the debris-strewn roads.

Local CARE-trained partners mobilized dozens of volunteers to sort food items into family-sized packages at makeshift warehouses. In the spirit of the first CARE Package®, volunteers measured out portions from huge sacks of rice, adding other locally sourced items like cans of meat and sardines, to create thousands of CARE Packages. Many packages also contained beans, sugar, oil or biscuits.

Source: United Nations Office for the Coordination of Humanitarian Affairs. Situation Report 107. March 14, 2014.

MILLION AFFECTED

MORE THAN

MORE THAN

16.1 4,100,000DISPLACED

DEAD6,268

28,689 INJURED

1,061MISSING 550,928

HOUSES DESTROYED

589,404HOUSES DAMAGED

4

going to sleep hungry or fed. For others it meant they didn’t have to choose between buying food or buying nails to fix their roofs.

EMPOWERING SURVIVORS“The Filipino people help themselves and are very proactive in their own rebuilding,” Solberg said. “In the first few days after the storm, people used whatever they could salvage to put a roof over their heads. The sounds of hammering and sawing filled the villages.”

But some people didn’t have tools—or anything—to work with. “The roofs were flying off,” said Elcita Garjas, a mother of eight who lives in a slum area of the city of Ormoc. “Sometimes families couldn’t find missing parts of their homes. In many cases, people had no kind of shelter from the rain at all.”

CARE began distributing tarpaulins, flashlights, tools such as hammers, kitchen supplies including pots, and other items so that families could remain in their homes. “People used the tools to construct temporary shelters, to provide some element of cover,” says Philip Barritt, one of CARE’s shelter and reconstruction advisors. “It might leak slightly or be cold, but it gets them out of the worst of the weather.”

“Empowering people to repair their own homes is a much more accountable way to help. We’re giving them the means to do it with tools and training.”

PHILIP BARRITT

CARE SHELTER AND RECONSTRUCTION ADVISORA home lies in ruins in Ormoc City, Leyte Island in the Philippines after typhoon Haiyan ripped through the island. Photo Credit: ©2014 Peter Caton/CARE

SAMAR

LEYETE*PANAY**

48,045

109,02889,072

*In Leyte the actual number of beneficiaries has been considered; in Panay an average of 5 per household has been used.

** This is the total for round 1 (1,973 households), round 2 (5,565 households) and round 3 (7,940 households) distributions. The total also includes the number of households and individuals that received cash transfer for food purchases.

FOOD DISTRIBUTED TO

INDIVIDUALS

In the villages, residents patiently lined up in the heat—some carrying umbrellas to shield themselves from the sun—while CARE partner teams organized food distributions.

Tens of thousands of villagers received food in the first weeks after Typhoon Haiyan thanks to CARE and our partners. For most it meant the difference between

5

BUILDING BACK SAFERIn the months after Typhoon Haiyan CARE worked with families to build back safer housing, distributing not only tools, but also more secure metal roofing sheets. Perhaps most importantly we conducted training sessions on how to make homes stand up better to future typhoons, covering the four points in the box to the right.

During training sessions, CARE teams used posters in the local language to show people how to make repairs. Afterwards, roving teams of construction experts checked houses to ensure the repairs were done correctly.

“People want to make their houses stronger,” Barritt said. “They’re really willing to learn and go the extra mile. They want to protect their families in the future.”

In addition to shelter materials, tools and training, we provided families with small cash grants for timber and home repairs. “We have to trust people to buy what they need.

“Filipino families didn’t wait around hoping for someone to fix their houses. They got to work right away. They just needed a little help. It’s not what we do for them, it’s how we support them as they rebuild their homes and livelihoods.”

HOLLY SOLBERG

CARE USA’S DIRECTOR OF EMERGENCIES

CARE Philippines shelter officer Rochel Orit leads a build-back-safer training session for carpenters, roving teams and community members in Lanauan barangay, Pastrana municipality, Leyte, the Philippines. Photo Credit: ©2014 CARE

Nobody’s house is the same. Everyone’s house is built to suit their own needs,” Barritt explained. “Empowering people to repair their own homes is a much more accountable way to help. We’re giving them the means to do it with tools and training.”

There is much more to be done however.

4. ALIGN THE ROOFConstruct the roof with no

more than a 30-degree pitch to reduce the wind pressure that blows the roof sheeting off.

1. SECURE FOUNDATIONSEmbed timber or concrete posts at least 2 feet into the ground.

2. DIAGONAL BRACINGCreate diagonals that run from

the top of one post to the bottom of another to brace the house.

This creates triangles out of the frame, a very strong shape.

3. BUILD CONNECTIONSConnect the roof to the walls,

and the walls to the foundation, so they do not come apart. One way is to use metal strapping or

wire around the connections.

MAKING HOMES STRONGER

AND SAFER

6

REBUILDING LIVES AND LIVELIHOODSTyphoon Haiyan did not just destroy homes. It uprooted sturdy trees or split off fruit-bearing branches. It flattened crops. It swept away fish ponds and boats. As a result hundreds of thousands of families who relied on farming and fishing are unable to earn a living. In particular the damage to coconut harvests—a staple crop—was devastating. “Coconut trees can take 7 to 10 years to bear fruit again,” Solberg said. “What are they going to do? It’s a huge challenge.”

In the next phase of recovery, CARE will help farmers and fishermen get back to work through livelihood activities such as rice and vegetable farming, raising livestock and more. We are considering cash grants for things like rehabilitating and repairing boats to avoid the construction of unsafe boats.

CARE is working on livelihood interventions with local partners in Samar, Panay and Leyte. But Solberg worries that our immediate response funding could be exhausted soon and people will need longer-term recovery support. “The gaps are still huge. There’s been a lot of support for the immediate response, but to help people recover and regain their livelihoods, the funding needed is significant.”

WORKING IN PARTNERSHIPCARE’s success in responding swiftly to Typhoon Haiyan shows partnership in action. With core CARE staff on the ground when the typhoon hit, we were able to turn to our established partners and begin helping survivors immediately.

“We were really fortunate that we have partners who have years of experience in emergencies and development, who have been trained to respond to emergencies

when they happen. We weren’t starting from scratch,” Solberg said. The same partners had been implementing CARE programs before the typhoon. In Saint Bernard province on Leyte island, CARE-funded disaster preparedness programs run by partners helped families to evacuate before the storm hit.

Partner staff were physically closer to the typhoon zone than many Manila-based humanitarian organizations and were deployed quickly. They also knew the territory. “They’re from the area, they understand, they’re connected to the communities,” Solberg explained. “It positioned CARE well to be able to go in and support them.”

Local partner staff were also affected by the disaster, but kept working, like Minet, the head of CARE partner Leyte Center for Development. “She was this very busy woman with a huge smile,” recalls Solberg. “Her house was destroyed; her office was destroyed. We basically sat in what used to be the office. There were tarps.”

CARE Philippines shelter officer Rochel Orit takes measurements of the frame of a new home being constructed using CARE materials. Photo Credit: ©2014 Darcy Knoll/CARE

At a CARE food distribution camp, an organizer assists an old man to the registration area before he can receive a CARE food parcel after typhoon Haiyan hit the Philippines. Photo Credit: ©2014 Peter Caton/CARE

7

“She came out to look at the communities where we were working.” said Solberg. “Later, we drove her back home—it was then that she invited us to dinner! Such generosity—there’s the idea that ‘we’re victims ourselves, but there are people to help, and that gives us strength.’ I thought, ‘Wow, how amazing.’ Her can-do attitude and the leadership she displayed gave others strength, including me.”

Partner staff are quick to thank families on the ground. “It amazes me that people can get back on their feet, albeit with a little help from us, but mainly through their own capacity, their hard work,” said Athena Gepte, emergency response coordinator for another CARE partner, Assistance and Cooperation for Community Resilience and Development Inc. “You can do wonders with the community.”

CARE was able to reach thousands of people in the first weeks of the crisis because of the work we put into developing partner relationships and capacities over the years. “Partnership takes time.” Solberg said. “It’s not just financial support, it takes people time. That trust was there.”

MILES TO GOAs of early March—4 months after the typhoon struck—CARE had helped more than 265,057 people on the islands of Panay, Leyte and Samar. But with millions of people needing food, shelter and livelihoods, there’s much more to be done.

“We work hard to make sure that donations are put to good use so people have the means to move forward,” Solberg said. “It’s not a band-aid solution.”

Two boys in the typhoon-ravaged Green Valley village carry their CARE aid bags containing rice, sardines and canned meat on their heads. Photo Credit: ©2014 Peter Caton/CARE

Clothes hang among the devastation after typhoon Haiyan struck Ormoc City in the Philippines. The typhoon caught the Philippines by surprise by its size and strength, and is believed to be one of the strongest typhoons on record. Photo Credit: ©2014 Peter Caton/CARE

“The effect of the typhoon is lessened because of good-hearted people helping us recover.”

RUBY

TYPHOON SURVIVOR AND

RECIPIENT OF A CARE PACKAGE®

CARE and our partners find inspiration in Filipino families who managed to stay positive despite seeing their homes and farms wiped out. “When we were driving along the coast in Samar, there were about five little kids just smiling and waving, standing next to a Christmas tree by the side of their tent,” remembers Solberg. “There was a wooden sign that said ‘Help us and Merry Christmas.’ That struck me—that even in the midst of this, there was still hope. It’s not like they just gave up and life was over.”

CARE will continue our long-term recovery efforts in the Philippines, helping people regain their livelihoods. “The last thing people want is to be dependent on others for survival,” Solberg said. “CARE’s intention is to help people get back on their feet as soon as possible.”

LAURA SHEAHEN is former senior communications officer for CARE USA.

Endnotes

1 Fontain, Henry. (2013, November 18). Measuring the might of Haiyan. New York Times.

2 United Nations Office for the Coordination of Humanitarian Affairs. (2014, March 14). Situation Report 107 effects of Typhoon “Yolanda” (Haiyan). Retrieved March 24, 2014 from http://reliefweb.int/sites/reliefweb.int/files/resources/Update%20Yolanda%20Sitrep%20107.pdf

3 Ibid.

4 Ibid.

8

Innovation Spotlight: Maternal and Child Health Goes MobileBY ELIZABETH BOWDEN-DAVID

Mobile phones, once limited to developed nations, are now ubiquitous: the World Bank estimates that three-quarters of the earth’s population has access to a mobile device.1

POINT OF VIEW

Each year, mobile phones become less expensive and more powerful, and networks increase bandwidth and expand into rural areas—even into remote parts of the developing world like Bihar, India.

Most of Bihar’s 104 million residents live in poor rural communities where maternal- and infant-mortality rates remain high. In 2011 the maternal-mortality rate for Bihar stood at 305 per 100,000 live births; that’s 105 higher than India overall and higher than the Millennium Development Goal of 26.7.2

In this resource-poor place, CARE is using the mobile phone as a simple yet effective tool to promote better health among mothers and children.

Harnessing the power of mobile technology is a feature of CARE’s Integrated Family Health Initiative—a project to develop, test, and scale up innovative solutions to some of the most intractable barriers to maternal and child health in Bihar. The program focuses on the continuum of health and nutritional needs over approximately 1,000 days—that is, from the start of the mother’s pregnancy to the child’s second birthday. Guided by research that shows which behaviors and services have the greatest impact, the program specifically promotes skilled birth assistance, emergency obstetric care, immediate newborn

care, early and exclusive breastfeeding, age-appropriate complementary feeding, immunizations and the use of contraceptive methods.

Front-line health workers (FHWs) are at the heart of these efforts, including those whose job it is to visit pregnant women and new mothers in their homes.

As the most direct link that an impoverished family has to health services and advice, the front-line health worker plays a crucial role.

Photo Credit: ©2012 B. Ram Krishnan/CARE

9

Innovation Spotlight: Maternal and Child Health Goes Mobile

It is the FHW who can comfortably interact with a woman in her home, listen to concerns and offer guidance. Typically the FHW also has the opportunity to talk with key members of the household, such as the mother-in-law and husband, to encourage them to support the pregnancy and birth. For example, a family could plan for transportation to a medical facility for the birth, to save money for emergencies and ensure that the prospective mother gets adequate nutrition. However, despite this access, FHW’s have historically lacked the skills and support needed to be real catalysts for change.

Recognizing the untapped potential of these workers, CARE turned to mobile technology. At the outset of the program, CARE engaged FHWs to co-develop the mobile application software, ensuring a user-friendly and effective design. The resulting language, navigation logic and content elements reflect the close collaboration between the FHWs and the technology providers on the team. After careful testing the design was introduced in 2012.

The introduction of mobile technology has been transformative. FHWs can now register pregnant women, mothers and children on the spot; schedule and plan their home visits with ease; and keep track of services needed through the stages of pregnancy and beyond. With easy access to counseling protocols, these health workers improve the quality of health services on the spot. As one worker put it, “I don’t need to remember everything. It [the mobile] guides me on what to discuss.” Having tools and information at their fingertips has dramatically improved the confidence and decision-making abilities of these workers, enabling them to provide more robust care.

Interim results show that FHWs have significantly increased the number of women and children they serve. Between June 2012 and February 2014 in the four blocks of the Saharsa district, for example, 90 percent of pregnant women in the program area received visits from FHWs, compared to only 37 percent in the non-program area. Most importantly women and their families have begun adopting healthier behaviors and practices such as making sure the birth takes place in the presence of a skilled attendant, getting children immunized and introducing babies to solid food after 6 months.

In addition to benefitting pregnant women and babies, mobile communication also enables supervisors to offer more meaningful, real-time support to staff on the front lines. Data collection at local and regional levels is also more

Front-line health worker navigating health application on a mobile phone in Bihar. Photo Credit: ©2012 B. Ram Krishnan/CARE

efficient. The error-prone process of digitizing data used to begin in a block office almost 40 days after collection in the field. Now data is recorded digitally by the FHW in the villages with much greater accuracy. When properly collected and recorded, data can serve to guide decisions on the allocation of resources and help to steer the creation of maternal and child health policy.

A video explaining the value of family planning is especially popular among new mothers who often ask the health workers to share the video with their husbands and mothers-in-law.

10

Through this program and related efforts, CARE participates in Ananya, a coalition funded by the Bill & Melinda Gates Foundation to support the government of Bihar in accelerating progress toward ambitious health goals. Ananya has drawn global acclaim for its innovative model and recently won the prestigious mHealth Alliance Collaboration Award.3 The

award panel particularly noted the partnership’s highly scalable use of mobile technology to deliver health information and services to mothers and children living beyond the reach of formal health facilities.

Scaling up activities across Bihar has been CARE’s intention from the very beginning, along with ensuring the long-term sustainability

of gains. Specific elements of the program design—for example, using existing public health infrastructure and keeping costs within projected government budgets—helped to encourage wider implementation. In September 2013, encouraged by the interim results, the government of Bihar announced that it would invest $20 million to initiate programs statewide. The government committed to equip 100,000 FHWs with mobile-based applications, so that they could better support pregnant and breastfeeding mothers with basic healthcare services, nutrition education and family planning counseling. In a state with 2.7 million pregnancies each year, the projected impact of this undertaking is enormous.

When the Millennium Development Goals were established 14 years ago, few foresaw the potential for mobile phones to advance progress toward those goals. With the current success that CARE and our partners are experiencing in Bihar, there is reason to hope that mobile and related technologies can increasingly factor into the development community’s work to overcome poverty. CARE looks forward to ushering in the next generation of mobile health applications, especially those that will support the next generation of children and their mothers.

ELIZABETH BOWDEN-DAVID is a freelance writer for CARE USA.

Endnotes

1 The World Bank. (2012, July 17). Mobile phone access reaches three-quarters planet’s population. Retrieved March 25, 2014 from http:// www.worldbank.org/en/news/press-release/2012/07/17/mobile-phone-access-reaches-three-quarters-planets-population

2 The Millennium Development Goals are eight international development goals that were established following the Millennium Summit of the United Nations in 2000 following the adoption of the United Nations Millennium Declaration.

3 The mHealth Alliance is a coalition of organizations focused on using mobile technologies to advance health and well being in the developing world.

Baby Durga began to gain healthy weight after her mother Malti began working with a CARE trained front-line health worker equipped with a mobile phone. Photo Credit: ©2012 Jaspreet Mahal/CARE

Front-line health worker Manju counsels a mother and baby with her phone. Photo Credit: ©2012 B. Ram Krishnan/CARE

11

NOW

Decades Later: The Spirit of the CARE Package® Lives OnBY LAURA SHEAHEN

Sent by caring Americans, CARE Packages contained food and supplies. Decades later the spirit of the CARE Package lives on. Although we no longer ship boxes overseas, CARE programs help people obtain life-saving skills and tools. On this anniversary of the CARE Package, CARE staff sat down with two people on the sending and receiving end of the original packages.

It was 1945 and two children the same age, from different sides of the globe, witnessed the end of a war. In Brandenburg, Germany, 7-year-old Hadwig Gofferje and her family were struggling to survive after their town was nearly destroyed. In Cleveland, Mississippi, 7-year-old Douglas Johnson was making friends with German prisoners of war in a nearby camp.

Hadwig and Doug were too young to understand the complexities of war, but they could both understand suffering.

Hadwig and her family were hungry. Along with her mother and two sisters, they had fled their town near Poland for a church in a nearby village. “That’s where the food was,” she remembers. “We had rabbits that we ate—it was the only meat we’d get. It was a matter of survival.”

This year May 11 marks both Mother’s Day and the anniversary of the first CARE Package® shipment from the United States to Europe. Following World War II mothers throughout the war-torn continent—many of them widows—struggled to feed their families.

Photo Credit: ©1947 CARE

12

To help feed the family, Hadwig and her sister gathered leftover vegetables from a nearby garden. “After the farmers harvested, we’d pick up sugar beets they left behind. It was very hard and tedious. We’d boil it down to syrup because we didn’t have sugar.” For Hadwig’s family and thousands like them, everything was in short supply: food, clothing, even toothpaste.

Growing up in Cleveland, Mississippi, Doug had no idea what it was like to go without. But when his favorite teacher, Miss Maude Cain, urged her students to help people suffering in Europe, he wanted to help.

Hadwig. “We’d say [to our friends], ‘I got another CARE package!’”

Meanwhile Doug got to know Bavarian soldiers in a prisoner-of-war camp 15 miles from his home. “They were working in the cotton warehouse where my father was the supervisor. They liked my father,” he says. “They taught me how to count in German and say a few short sentences.” Doug still remembers some of the words he learned.

“When they went back to Germany, they wrote to us saying it wasn’t so good back there.”

For the small American boy, helping people in Europe was instinctive. “The war was a long way away, so the idea of enemies—it wasn’t something that really occurred to us [Americans],” said Doug.

Hadwig later made America her home. “I studied in the little village school. Eventually I moved to the USA and got a Fulbright scholarship,” she says. One of the first women to receive a Ph.D. from Massachusetts Institute of Technology, she has lived in the Boston area ever since.

With childhood memories that run deep, Doug and Hadwig still donate to CARE. “After World War II, we were barely surviving,” said Hadwig. “Now whenever anything happens, like a tsunami or the typhoon in the Philippines, I donate to CARE because I know first hand how miserable those people are.”

LAURA SHEAHEN is former senior communications officer for CARE USA.

“We packed the CARE boxes. We knew things were bad in Germany,” he says. “The boxes were small, and I said, ‘Could that small amount really do much?’ Miss Cain said that the people in Europe had so little, anything would help.”

Doug remembered, “So I went home and asked my parents for stuff to put in the box, like toothpaste, toothbrushes, soap.”

Thousands of miles away in a country Doug had never visited, Hadwig and her family were on the receiving end of similar boxes of essential supplies. “I got a pair of penny loafers. I treasured them,” said Hadwig. “The other kids were jealous. They were my only real shoes.” Families in Britain, France, Germany and many other European countries received boxes filled with food, clothing and basic toiletries.

The day when the packages arrived was special, remembers

CARE was founded in 1945 with the creation of the CARE Package®. Almost as soon as the first CARE Packages were off-loaded from ships in Le Havre, France, the CARE Package became an international icon. Today the CARE Package remains a powerful symbol of generosity and compassion, but instead of providing aid in cardboard boxes, CARE delivers lasting change. Photo Credit from Top: ©2012/CARE; ©1995/CARE; ©2009/

CARE; ©2013 Peter Caton/CARE.

13

Strategizing Success: Lessons from CARE’s Water TeamBY ROGER BURKS

CARE helped ease the burden for Fatuma and hundreds of her neighbors by harnessing a local spring and installing water pumps in her village. But that was just the beginning of a sustainable solution designed to provide water for years to come. CARE is also working with villagers and local authorities to ensure that the system is properly maintained and managed.

In close collaboration with the communities we serve, CARE has created committees that elect members, establish regulations and take ultimate responsibility for ensuring the maintenance for the water systems and reliable access for households. There is often a nominal user fee,

Fatuma used to spend at least 16 hours every week collecting water for her family. Many days the 50-year-old mother of four found herself carrying 55 pounds of water across eastern Ethiopia’s rocky, parched landscape—if the pond or stream had not dried up.

which goes into a fund to keep the systems working and water flowing.

This approach is also helping new leaders emerge. Today, instead of hauling water from far away, Fatuma has become a strong advocate for the community’s interests.

“I have initiated public discussions on how women suffer because of lack of water,” she said. “We’ve organized as a group and have gone to government offices so that people can hear our voices.”

Health. Community mobilization. Empowerment. So much comes from ensuring clean water.

CARE’s work to bring water to vulnerable communities spans more

than 50 years, beginning with a project in Mexico in 1957. A case study of that project was presented to President John F. Kennedy at the time he was considering starting the Peace Corps. Over 6 decades, CARE has used reports, case studies and other analyses to gauge the impact and document the challenges of our work in order to develop more innovative and sustainable solutions.

We are committed to the critical evaluation of our projects, not only to ascertain the results of our work, but more importantly, to discover how it makes a difference in the lives of the people we serve. We are also devoted to sharing that learning to improve

ACTIONPhoto Credit: ©2012 Josh Estey/CARE

14

the way organizations like CARE help empower communities to break the cycle of poverty. These are some of the reasons behind the recent Water+ Impact Report: Walking the Talk1.

WATER + IS MORE THAN H20For CARE, the term “water+” refers to an approach that encompasses not only improved water systems, but also sanitation and hygiene, productive uses of water such as irrigation, and ecologically sustainable water resource management, including watershed protection.

Water is integral to most of the work and the goals we pursue. To quote the report, “There is no food security without soil moisture management, no nutritional improvements without

safe water to drink and to cook food with, no stable ecosystems without vibrant watersheds, and no healthy schools without access to safe water for hygiene and sanitation facilities.”

CARE’s water+ programs are extensive—in 2013, our development projects in water served 3.3 million people and 1.2 million people benefitted from our emergency water interventions.

A TOOL FOR CHANGECARE and our partner organizations have made remarkable progress toward helping every individual access safe drinking water. Worldwide, between 1999 and 2010 more than 2 billion people gained access to improved sources. But despite these gains there are still 780 million people around the world

who lack such access and 2.5 billion people without adequate sanitation.

Despite the challenges of limited staff capacity and the difficulties surrounding the development of suitable evaluation tools and measures of success, CARE invests in monitoring, analyzing and reporting on our water programs. This kind of analysis leads to smarter strategies and more sustainable solutions.

The Water + Impact report synthesizes a total of 51 documents—including project evaluations, reports and case studies—collected from countries where CARE works in Africa, Asia, Latin America and the Caribbean, the Middle East, and Europe. Four staff members analyzed each document using a scoring system to provide insight on three key areas:

• Secure and sustainable access to water+ services

• Gender-sensitive water+ policies, institutions and social norms

• Gender-equitable control over water+ services

The scoring system combined these three areas in alignment with CARE’s theory of change for water programming. [See illustration Below]

Ultimately the impact is considerable: poor women and school-aged girls are able to improve

CARE’S WATER WORK AROUND THE WORLD

THE WATER+ THEORY OF CHANGE

Countries with CARE Water-Related Projects & Programs in 2012

Secure and Sustainable Access to Water+ Services

Gender-Sensitive Water+ Policies, Institutions and

Social Norms

Gender-Equitable Control Over

Water+ Services

Poor Women and School-Aged Girls Improve Their Lives

15

their lives. But the impact depends on more than just installation.

The report found that too often water projects falter within just a few years of implementation. Studies across sub-Saharan Africa estimate that approximately 36 percent of hand pumps in 21 countries are not working. This kind of systemic breakdown depletes resources, halts progress and discourages the communities that rely on these water sources.

and challenges in each of the three areas essential for lasting improvements in water, sanitation and health.

Secure and sustainable access to water+ services. CARE scored 6 out of 10.Evaluators commended the organization’s technical implementation, activities to change people’s behavior (such as hygiene practices) and installation of sanitary facilities. However there was substantial criticism regarding project sustainability. One particular shortfall was inadequate coordination with local government authorities to help monitor progress after CARE’s involvement ended. Another challenge was the lack of attention to replacement parts for local water systems and a shortage of qualified repair specialists. There was also a perceived missed opportunity to link water+ projects with similar interventions, including food security, livelihoods and health programs. These criticisms will inform better project design to enhance the permanence of positive change from CARE projects.

Gender-sensitive water+ policies, institutions and social norms. CARE scored 4 out of 10.Assessment for this domain depended on CARE’s ability to help influence policy and secure positive changes in local institutions in support of water+ and other developmental goals. Although there was plenty of evidence to support CARE’s success in working with community-based organizations, there was a lack of integration with local government to ensure sustainability. Even though this kind of coordination is not always immediately possible because of unstable political contexts and other difficult situations, CARE sometimes missed the opportunity to transform positive local change into larger scale impact through advocacy. In the future we must consistently find ways to scale small project successes into larger initiatives that positively change society and advance gender equity.

Gender-equitable control over water+ services. CARE scored 4 out of 10. This is one of the most difficult challenges in many of the communities

“If we are to end water poverty, global data pointing to the high rate of failure of water points require that we question our models for promoting sustainable water management. And that is exactly what the Water+ Impact report does.”

PETER LOCHERY

CARE USA WATER TEAM DIRECTOR.

QUESTIONS AND ANSWERSOne of the report’s principal findings regarding water-system sustainability is that strong governance is firmly linked to well-functioning water points. This means that community members have to learn not only how to fix a water pump but also know how to conduct regular committee meetings and report back to the community on the status of the system. There is also evidence that women’s participation in decision-making, water committees, elections and disseminating information helps ensure that water points are well-maintained and last longer.

More specifically, the report objectively examines CARE’s strengths

Newly arrived refugees from Somalia collect water at a water point that is having water delivered to it by a CARE water truck at Dagehaley camp, one of three camps that make up the Dadaab refugee camp in Dadaab, Noertheastern Kenya on the 9th July, 2011. Photo Credit: ©2011 Kate Holt/CARE

16

where we work. Simply put, control over water requires power, and power often has a gender aspect. As a result even shared management of improved water systems demands a significant shift in addressing women’s roles within traditional power structures. Many of CARE’s water+ programs included results that were extremely favorable to women and girls—for example, improved water sources within the village decreased the time needed to fetch water (sometimes by several hours per day) leading to more time for other kinds of work and socialization, including the ability to attend school. However, few water+ programs capitalized on this success by introducing opportunities for women and girls to take a more active role in their communities. By and large activities to address gender equity issues consisted of involvement in local water committees and, sometimes, savings and loan groups. CARE is cognizant of the need to better leverage water+ programs for more ambitious social change.

Although these scores may seem low, they are a reflection of CARE’s awareness of the multi-dimensionality of our water+ work, the ambitious nature of our theory of change and our dedication to self-improvement.

It also suggests that the water sector as a whole must do a better job of addressing lasting access to, and management of, water and related services.

WHAT WORKS One purpose of the Water+ Impact report was to develop these lessons in order to make them an operational part of our program strategy; however, the study also highlights a wide range of case studies and success stories.

One example is the Wells for Peace project in Niger. It operates in the Diffa region, an extremely harsh and arid zone with recurrent drought and severe living conditions. The area is home to at least 300,000 livestock herders who often compete for dwindling water resources, creating tension among the ethnic groups that share the region.

In this water+ project—framed by extreme weather and the potential for conflict—CARE focused on building relationships among different groups through dialogue and reaching agreements about where to locate wells and how to manage resources. We helped create and launch water committees

around 15 new, modern wells, ensuring equitable representation based on gender and different ethnic groups. And, to help ensure sustainability, CARE not only trained representatives on well maintenance but also put into place a system where nominal user fees help pay for the ongoing maintenance costs of the water system.

The Wells for Peace project is having significant success in one of Niger’s poorest areas and has extended its impact to other parts of the country: CARE is currently engaging government officials and experts at the regional level, including representatives from Niger’s Ministry of Water and Environment, who are using the project to inform their national strategy on natural-resource management and water issues.

KEYS FOR CHANGECARE’s Water+ Impact report, made possible by the Osprey Foundation, represents a welcome opportunity for self-reflection and understanding the nature of CARE’s impact throughout the thousands of communities where we work. Although sometimes critical, the report doesn’t diminish our programs, the generosity of our donors or the resolve of those we serve; rather, it identifies ways to improve strategy, streamline processes and develop innovations.

Last year CARE’s water+ programs had a positive impact on more than 4.5 million people. With lessons learned from this report—including investment and focus on better measurement, gender equity and governance—we will reach substantially more.

ROGER BURKS is a freelance writer for CARE USA.

Endnotes

1 http://www.care.org/sites/default/files/documents/CAREWaterImpactReportWebFINAL.pdf

Khadija Yussuf (in the foreground) and two other women carrying buckets of water on their heads from a watering hole, Tanzania. Photo Credit: ©2012 Josh Estey/CARE

Philanthropedia ranked CARE International fifth among 116 different nonprofits working in the field of water, sanitation and hygiene.

This demonstrates that, although our impact rankings show room for improvement, CARE’s work not only stacks up against, but surpasses, that of many of our peers.

17

CARE places special focus on working alongside girls and women to fight poverty. When explaining why we focus on girls and women to our supporters, we usually talk about CARE program participants whose personal stories exemplify the great impact girls and women can have on the lives of others. However, we recently learned of a donor who exemplified the same qualities we highlight in program participants.

Last year CARE’s Planned Giving team received a generous check from the estate of Maura Bean. In conversations with Bean’s niece, we learned she was a prominent agricultural scientist who successfully dedicated years of her life to improving the nutritional properties of staple grains. Bean held several patents, including U.S. Patent 3949093 A, April 1976, “Process for improving quality of protein-fortified baked goods”.

Long-time family friend and fellow agricultural scientist Leo Kissell recalls Bean as someone who cared not only for the people around her but, through her work in nutrition, for people she’d never met. Kissell

DONOR SPOTLIGHT

Maura Bean’s friend Leo Kissell served in the U.S. Army at the end of World War II. An amateur photographer, he befriended a family that ran a photography shop in the small German town where he was stationed. Leo wrote his parents asking them to send the family a CARE Package. He returned to the U.S. in April 1946 and continued sending CARE Packages to the family. He also became pen pals with the family’s daughter, Helga. In 1948 Helga came to the United States. Last August, Leo and Helga celebrated their 65th wedding anniversary. They live in Colorado.

Maura Beansays Bean spent a considerable amount of time in Bolivia in the early 1980s, working with Bolivian scientists on programs to improve the quality of local grains.

“We used to pick her up from the airport,” Kissell says. One time Bean shipped back a small amount of bread flour from Bolivia to test its nutritional properties in her lab. Kissell recalls with a smile how Bean was worried U.S. customs officials might mistake the flour for an illicit substance. “It would be hard to prove on the spot it was bread!” he laughs.

Bean was a great example of what CARE means when we say that, equipped with the proper resources, women have the power to lift whole families and entire communities out of poverty. She did it in life and, by naming CARE in her will, made certain she continued doing it even after she was gone.

To find out more about how you can leave CARE in your estate plans, contact senior director of planned giving, Trish Rooks, at 404-979-9528 or visit us online at www.care.org/pg.

IT ALL BEGAN WITH A CARE PACKAGE

Maura, far left, with sister-in-law Barbara Lyons, 1965.

CARE USA Headquarters

151 Ellis Street N.E.

Atlanta, GA 30303

We are eager for your feedback.

Please share your thoughts at

www.impactmag.org

or write to

CARE Impact Feedback

C/O Individual Giving

151 Ellis Street N.E.

Atlanta, GA 30303