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!