1. Monitoring and evaluation of IPV prevention programmes: lessons from the IMAGE and SASA! studies Charlotte Watts Ph.D. Department of Public Health and Policy London School of Hygiene and Tropical Medicine

2. Outline Gender, Violence & Health Centre, LSHTM Need for evidence on effective interventions Evaluation research by Gender Violence & Health Centre, LSHTM Lessons learned Challenges Conclusion

3. Gender, Violence & Health Centre Multi-disciplinary research team Charlotte Watts – social epidemiologist Cathy Zimmerman – behavioural scientist Julia Kim – clinician, social scientist Anna Foss - mathematician Loraine Bacchus – social scientist Seema Vyas - economist Tanya Abramsky - epidemiologist Mazeda Hossain – social epidemiologist Karen Devries - epidemiologist Ligia Kiss – social scientist Manuela Colombini – policy analyst Jo Nurse – clinician, policy analyst

4. Focus on identifying how to respond effectively What interventions are effective at preventing future violence against women? What puts some women at greater risk than others? What services are needed to help women recover from violence? What may be the health sectors role in addressing violence? Does economic development reduce womens vulnerability to violence or enable them to leave violent partnerships?

5. What works?: building an evidence base Strong evidence globally on scale and impacts of GBV Key policy question – what can we do? Limited evidence base from LMICs Prevention of violence Effective responses to violence Many promising interventions Prevention Youth programmes PROMUNDO / Program H – Brazil / India Men as Partners Stepping Stones – 40+ countries Soul City – educainment - strong messages about the unacceptability of violence Response Legal & counseling services Health services, including post-rape care Women only police stations

6. Many important and interconnected aspects of prevention Individual & relationship Experiences of childhood abuse, growing up in violent relationship Problematic alcohol use by male Status of women in household Community level Attitudes towards gender roles & acceptability of violence against women Status of women, levels of economic and social dependence on men Local responses to violence against women - Broader societal level Legal status of women Legislation on violence against women Ability to own property / access divorce

7. Broad scope of monitoring & evaluation Input Staff, materials, training Technical support Process Training of staff, community consultation Ongoing refinement of intervention Quality of activities conducted Outputs Activities conducted, materials distributed People participating in activities Numbers receiving services Outcomes / Impact Attitudes and beliefs, expectations in relationships Behaviours – in relationship, experience / perpetration of violence Actions – in response to violence

8. Important questions for evaluation Is the intervention feasible and acceptable? Did it have an impact? why / why not? are the result credible? Is it affordable / cost-effective? in comparison to alternatives to investment Is it replicable to other settings? where? are the results likely to be generalisable? Can it be scaled up?

9. IMAGE study, South Africa Provision of micro-finance plus participatory training on gender, violence & HIV to poor rural women Assess impact on recipients: economic and social empowerment past year risk of physical and/or sexual violence explore impact on HIV risk behaviours Project status Completed Showed 55% reduction past year IPV Significant impact on reported HIV risk behaviours among young recipients Ongoing research linked to scale-up

10. SASA! Study Uganda SASA! intervention Community mobiliization intervention to address womens vulnerability to HIV and violence Engages with men, women & local stakeholders Developed by Raising Voices, implemented by Centre for Domestic Violence Prevention SASA! study objectives Measure impact on attitudes, skills and behaviors in community Investigate processes and causal pathways Document economic costs of intervention Use study to identify key indicators for future monitoring. Project status Baseline data collection completed Intervention being implemented

11. IRC/MRI masculinities, intervention, Cote DIvoire IRC / MRI Intervention Aims to challenge and change masculinities that perpetrate violence Intervention developed by Mens Resources International Implemented by International Rescue Committee Evaluation objectives Measure impact on gender attitudes and behaviors – including perpetration of violence by men – among intervention participants and wider community Project status Baseline data collection ongoing

12. Evaluation study designs in South Africa, Uganda & Cote dIvoire Small cluster randomised controlled trials Intervention implemented in 4-6 villages given intervention. Comparable 4-6 villages given intervention at end of study Quantitative surveys at baseline and following implementation of intervention Complementary ongoing qualitative research Participants Project staff Community members Key stakeholders In South Africa and Uganda, economic costings of interventions

13. Integrating quantitative and qualitative research approaches Quantitative Routine monitoring of activities Mini-surveys Economic costing Large scale surveys Qualitative Participatory evaluation methods Timelines Most significant change Rositas story

14. Developing approaches to document insights from qualitative research Qualitative data provides rich insights Focus on trying to keep workable, linked to main questions In Uganda, testing methods to ensure that data collected can be easily summarized Fed quickly back into programming Knowledge 1 2 3 4 Negative Statements / Resistant to SASA! ideas Positive Statements / Accepting of SASA! ideas Participants tend to say that: - violence is only physical- violence may be physical, emotional, sexual, economic - violence against women does not have negative consequences - violence against women has negative consequences - women who experience violence are not at risk for HIV/AIDS - women who experience violence are at risk for HIV/AIDS Attitude 1 2 3 4 - some forms of violence against women are acceptable - violence against women is never acceptable - men should have power over women in relationships - women and men should balance power in a relationship - women and men should not share roles in their family and community - women and men should share roles in their families and community Skills 1 2 3 4 - men who use violence cannot change men who use violence should be publicly shamed - men who use violence can be supported to change - women who experience violence should be ignored- we should keep quiet if we know women experiencing violence - we should reach out to and support women experiencing violence - activists speaking out should be shunned - activists speaking out should be supported Behaviors 1 2 3 4 - they cannot balance power in their relationship - that they do balance power in their relationships - they must use / experience violence – it is unavoidable - they do not use / experience violence - they do not promote non- violence in the community - they promote non- violence in their community.