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Tathmini GBV : Evaluating Comprehensive Gender-Based Violence Program Scale-up in Tanzania Susan Settergren Futures Group. Tathmini GBV. USAID Project SEARCH IQC, Task Order 9 External evaluation of the PEPFAR GBV Initiative Implemented by Futures Group in partnership with

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Tathmini gbv

Tathmini GBV: Evaluating Comprehensive Gender-Based Violence Program Scale-up in TanzaniaSusan SettergrenFutures Group


Tathmini gbv
Tathmini GBV

  • USAID Project SEARCH IQC, Task Order 9

  • External evaluation of the PEPFAR GBV Initiative

  • Implemented by Futures Group in partnership with

    • Muhimbili University of Health and Allied Sciences (MUHAS)

    • Pangaea Global AIDS Foundation

    • Population Council


Key features
Key features

  • Evaluation of the combined effects of a comprehensive program model that addresses GBV prevention and response services for GBV survivors

  • Focus on intimate partner violence and on sexual violence against adults and children

  • Rigorous study design that includes quantitative and qualitative measurement over time

  • Stakeholder engagement throughout the project

  • Translation of results for policy and program


Gbv program model
GBV program model

  • Facility-based services for GBV survivors

  • Facility-based GBV screening and referral in clinical settings

  • Clinic and community outreach

  • Community-based GBV prevention activities

  • Referrals to psychosocial support, legal services, and safe houses


Study location mbeya region
Study location: Mbeya Region

  • 1Tanzania 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, 2007-8.


Program implementation
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 Violence

  • Adaptation of SASA! community mobilization approach led by locally-based NGOs

  • Management and funding through the Walter Reed Program Tanzania


Conceptual framework
Conceptual framework

GBV program Expected outcomes

GBV services at health facilities

Improved use of GBV services

Increase in availability and quality of GBV services at health facilities

Improved access to quality GBV services through multiple entry points

Decrease in acceptance of GBV

Community-based GBV sensitization and prevention programs

Increase in community knowledge of GBV

Decrease in acceptance of harmful gender norms

Linkages among programs and services

Increase in community actions to reduce GBV

Decrease in experience and perpetration of GBV

Other GBV services


Specific aims 1
Specific aims (1)

  • Did the GBV program lead to increased care for GBV survivors?

    • Primary outcome: Utilization of GBV services at health facilities

      Secondary questions

  • Was 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?


Specific aims 2
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 questions

  • Was 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?


Hiv related outcomes
HIV-related outcomes

  • Did 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?


Study design
Study design

  • Pair-matched cluster randomized trial

    • 6 intervention clusters: immediate rollout of GBV interventions in the community and at the health facilities

    • 6 control clusters: rollout of GBV interventions delayed by 18 months

  • Cluster definition

    • One or more contiguous administrative wards surrounding a Health Center

  • Sufficient geographical distance between clusters to minimize cross-cluster contamination


Data collection
Data collection

  • Health facility register review of GBV service delivery and referrals (adults and children)

  • Household surveys of women, ages 15-49

  • Key informant interviews and focus group discussions with men, community leaders, other community representatives

  • Health facility register review of GBV screening and referrals

  • Health facility assessments

  • Key informant interviews with providers of GBV services

  • Exit interviews with health facility clients

  • Routine M&E conducted by program implementers


Timeline
Timeline

MOHSW training curriculum development

Feb ’12 Aug ‘12

Feb ’13 Aug ‘13

Feb ’14 Aug ’14 Feb ‘15

Study protocol development and planning

Analysis and dissemination

I n t e r v e n t i o n p e r i o d

Baseline data collection

Endline data collection


Asante sana
Asante sana!