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Tammy L. MacLean, PhD Candidate London School of Hygiene & Tropical Medicine (U.K.)

Identifying Barriers to Treating Rape in Eastern DR Congo: Increasing support to local NGOs as a means to improve post-rape care. Tammy L. MacLean, PhD Candidate London School of Hygiene & Tropical Medicine (U.K.) Gender Violence & Health Centre . BACKGROUND.

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Tammy L. MacLean, PhD Candidate London School of Hygiene & Tropical Medicine (U.K.)

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  1. Identifying Barriers to Treating Rape in Eastern DR Congo:Increasing support to local NGOs as a means to improve post-rape care Tammy L. MacLean, PhD Candidate London School of Hygiene & Tropical Medicine (U.K.) Gender Violence & Health Centre

  2. BACKGROUND • SV has been a salient feature of the war in DR Congo. • SV can result in multiple negative health effects on RH and mental health, both short and long-term. • International community committed to universally available reproductive health services (ICPD, 1994). • Independent evaluation of RH services in East DR Congo indicated that treatment for rape was not available (RHRC Consortium, 2002). • WHO Guidelines (2004) established to treat rape survivors in conflict-affected regions.

  3. RESEARCH QUESTIONS • Are the WHO Guidelines fully implemented in North Kivu, DR Congo? • If not, what are the main barriers that prevent their full implementation?

  4. METHODS • Literature review identified 4 possible barriers (1) Insecurity; (2) Lack of trained health personnel; (3) Insufficient funding; and (4) Lack of data related to SV. B. Impact of 4 barriers were tested in North Kivu • Stakeholder analysis: 18 in-depth interviews with agencies providing or organizing health services. • Sampling: UNOCHA documents and snowballing. • Data collected in Goma City, March 2009. • Simultaneous translation during 10 interviews. • Thematic analysis of interview transcripts.

  5. STAKEHOLDERS SELECTED

  6. RESULTS (1): The WHO Guidelines are NOT fully implemented in North Kivu.

  7. RESULTS (2) All 4 barriers have prevented the delivery of health services for rape in North Kivu. However, international and local service providers were affected much differently.

  8. BARRIERS FOR WHOM?

  9. STUDY DESIGN LIMITATIONS • Time-specific findings (stakeholder analysis). • Unknown generalizability to other conflict-affected countries (single case study). • Stakeholder bias, unlikely to fully report own challenges. • No triangulation. • Identified main barriers associated with health service supply(not demand, e.g. rape related stigma). Sample Selection

  10. CONCLUSIONS • Local NGOs appeared better able to navigate insecurity to continue service provision, even where INGOs forced to pull out. Challenges long-held humanitarian approach (neutrality/independence). • Training of rape treatment is improving, but local NGOs lack direct access to (international) funds, preventing the payment and retention of health care personnel. NEXT STEP: Given that recent conflicts have demonstrated increasing security threats facing international organizations, future research should explore the possibility of shifting international resources from international to local NGOs. Overcoming the challenges local NGOs face in accessing funds could improve the capacity of local health personnel in North Kivu to treat rape.

  11. THANK YOU!

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