Post on 22-Feb-2016
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Tathmini GBV: Evaluating Comprehensive
Gender-Based Violence Program Scale-up in Tanzania
Susan SettergrenFutures Group
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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
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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
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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
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Study location: Mbeya RegionForm of GBV Mbeya All TanzaniaEver experienced gender-based physical violence since age 151 48.8% 38.7%
Ever experienced physical violence often in the past 12 months1 14.6% 9.4 %
Ever experienced sexual violence since age 151 14.6% 20.3%
Ever experience sexual or physical violence and told someone1 16.7% 10.1%
Ever experience sexual or physical violence and sought help1 36.8% 46.6%
Husband ever demonstrates controlling behaviors1 37.8% 35.1%
Experienced sexual violence prior to age 182 - 28% of females13% of males
First sexual experience was nonconsensual (among those who had their first sexual experience prior to age 18) 2
- 29% of females18% of males
HIV prevalance3 9.3% female9.2% male
6.6% female4.6% male
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.
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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
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Conceptual frameworkGBV program Expected outcomes
GBV services at health facilities
Linkages among programs and services
Community-based GBV sensitization and prevention programs
Decrease in experience and perpetration of GBV
Decrease in acceptance of GBV
Increase in availability and quality of GBV services at health facilities
Improved use of GBV services
Improved access to quality GBV services through multiple entry points
Increase in community knowledge of GBV
Increase in community actions to reduce GBV
Decrease in acceptance of harmful gender norms
Other GBV services
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Specific aims (1)
Did the GBV program lead to increased care for GBV survivors? – Primary outcome: Utilization of GBV services at health
facilitiesSecondary 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?
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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?
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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?
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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
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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
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Timeline
Study protocol development and planning
Feb ’12 Aug ‘12 Feb ’13 Aug ‘13 Feb ’14 Aug ’14 Feb ‘15
Analysis and dissemination
Baseline data collection Endline data collection
I n t e r v e n t i o n p e r i o d
MOHSW training curriculum development
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Asante sana!