Presentation on theme: "Tathmini GBV: Evaluating Comprehensive Gender-Based Violence Program Scale-up in Tanzania Susan Settergren Futures Group."— Presentation transcript:
1 Tathmini GBV: Evaluating Comprehensive Gender-Based Violence Program Scale-up in Tanzania Susan Settergren Futures Group
2 Tathmini GBV USAID Project SEARCH IQC, Task Order 9 External evaluation of the PEPFAR GBV InitiativeImplemented by Futures Group in partnership withMuhimbili University of Health and Allied Sciences (MUHAS)Pangaea Global AIDS FoundationPopulation Council
3 Key featuresEvaluation of the combined effects of a comprehensive program model that addresses GBV prevention and response services for GBV survivorsFocus on intimate partner violence and on sexual violence against adults and childrenRigorous study design that includes quantitative and qualitative measurement over timeStakeholder engagement throughout the projectTranslation of results for policy and program
4 GBV program model Facility-based services for GBV survivors Facility-based GBV screening and referral in clinical settingsClinic and community outreachCommunity-based GBV prevention activitiesReferrals to psychosocial support, legal services, and safe houses
5 Study location: Mbeya Region Form of GBVMbeyaAll TanzaniaEver experienced gender-based physical violence since age 15148.8%38.7%Ever experienced physical violence often in the past 12 months114.6%9.4 %Ever experienced sexual violence since age 15120.3%Ever experience sexual or physical violence and told someone116.7%10.1%Ever experience sexual or physical violence and sought help136.8%46.6%Husband ever demonstrates controlling behaviors137.8%35.1%Experienced sexual violence prior to age 182-28% of females13% of malesFirst sexual experience was nonconsensual (among those who had their first sexual experience prior to age 18) 229% of females18% of malesHIV prevalance39.3% female9.2% male6.6% female4.6% male1Tanzania DHS, 2010, which surveyed women ages 15–49.2 National Survey on Violence against Children, 2009, which surveyed girls and boys ages 18–24.3THMIS,
6 Program implementation Roll-out of services by the Regional Medical Office under the new MOHSW National Management Guidelines for Health Sector Prevention and Response to Gender-Based ViolenceAdaptation of SASA! community mobilization approach led by locally-based NGOsManagement and funding through the Walter Reed Program Tanzania
7 Conceptual framework GBV program Expected outcomes GBV services at health facilitiesImproved use of GBV servicesIncrease in availability and quality of GBV services at health facilitiesImproved access to quality GBV services through multiple entry pointsCommunity-based GBV sensitization and prevention programsDecrease in acceptance of GBVIncrease in community knowledge of GBVDecrease in acceptance of harmful gender normsLinkages among programs and servicesIncrease in community actions to reduce GBVOther GBV servicesDecrease in experience and perpetration of GBV
8 Specific aims (1)Did the GBV program lead to increased care for GBV survivors?Primary outcome: Utilization of GBV services at health facilitiesSecondary questionsWas the quality of GBV services at health facilities improved?Was GBV care more comprehensive – both within and across health facilities and through referrals to services outside health facilities?Did the source of referrals to health facilities change over time?Was there an increase in knowledge within communities about health services for GBV? About other GBV services?Did communities take action (and, if so, what actions) to facilitate survivor access to GBV services?What are key barriers in access to services? Did this change over time?
9 Specific aims (2) Did the GBV program lead to a decline in GBV? Primary outcome: Recent experience of GBV (specifically, IPV and SV among women ages 15-49)Secondary questionsWas there a decrease within communities in the acceptance of GBV?Was there an increase in community-led actions to stop GBV perpetration?Was there an increase in community-led actions to assist those at risk to prevent experience of GBV?Was there a shift in community norms toward greater gender equality?
10 HIV-related outcomesDid the GBV program contribute to increased utilization of HIV services including HIV counseling and testing, PMTCT, HIV care and treatment?Did the GBV program contribute to reduction in HIV risk behaviors and increase in protective behaviors?
11 Study design Pair-matched cluster randomized trial 6 intervention clusters: immediate rollout of GBV interventions in the community and at the health facilities6 control clusters: rollout of GBV interventions delayed by 18 monthsCluster definitionOne or more contiguous administrative wards surrounding a Health CenterSufficient geographical distance between clusters to minimize cross-cluster contamination
12 Data collectionHealth facility register review of GBV service delivery and referrals (adults and children)Household surveys of women, ages 15-49Key informant interviews and focus group discussions with men, community leaders, other community representativesHealth facility register review of GBV screening and referralsHealth facility assessmentsKey informant interviews with providers of GBV servicesExit interviews with health facility clientsRoutine M&E conducted by program implementers
13 Timeline MOHSW training curriculum development Feb ’12 Aug ‘12 Feb ’ Aug ’ Feb ‘15Study protocol development and planningAnalysis and disseminationI n t e r v e n t i o n p e r i o dBaseline data collectionEndline data collection