ConnexUs Summary (AI-Generated)

This report presents the key results from an Impact Evaluation of a program that aimed to change norms around Gender-Based Violence in the Democratic Republic of Congo. The program, which utilized Community-Based Trauma Healing (CBTH) as a core approach, was implemented in 80 randomly selected villages, while the remaining 80 served as a control group. The evaluation collected primary data on Gender-Based Violence norms and behaviors across multiple waves in a large sample. It assessed the impact of selected aspects of the Tushinde Ujeuri program to reduce gender-based violence and improve community cohesion. The report finds that outcomes improved in the entire study area, across both intervention and control villages, over the study period, likely reflecting broader social trends and positive impacts from the holistic Tushinde program. When comparing villages assigned to CBTH programming and control, the report finds some promising changes, such as a 50% lower incidence of non-partner sexual violence in villages assigned to CBTH programming. However, when adjusting the analysis for multiple hypothesis testing, none of the reported results are significantly different from zero. Despite the lack of conclusive experimental evidence, the positive over-time changes observed in both intervention and control villages suggest promise for CBTH interventions to contribute to positive change in GBV-related outcomes, even in highly unstable environments.

• 35% of women globally report being victims of physical or sexual abuse during their lifetime
• One-third of women who have been in a relationship have experienced physical or sexual violence from a partner
• Globally, one out of every five women is expected to become a victim of rape or attempted rape during her lifetime
• The report presents key results from an Impact Evaluation of a program that aimed to change norms around Gender-Based Violence in the Democratic Republic of Congo
• The program utilized Community-Based Trauma Healing (CBTH) as a core approach
• The CBTH programming was implemented in 80 randomly selected villages, while the remaining 80 served as a control group
• The evaluation collected primary data on Gender-Based Violence norms and behaviors across multiple waves in a large sample
• Outcomes improved in the entire study area, across both intervention and control villages, over the study period
• When comparing villages assigned to CBTH programming and control, the report finds some promising changes such as a 50% lower incidence of non-partner sexual violence in villages assigned to CBTH programming
• When adjusting the analysis for multiple hypothesis testing, none of the reported results are significantly different from zero
• Despite the lack of conclusive experimental evidence, the positive over-time changes observed in both intervention and control villages suggest promise for CBTH interventions to contribute to positive change in GBV-related outcomes, even in highly unstable environments

EXECUTIVE SUMMARY

Gender Based Violence remains a persistent problem in many countries in the world. Thirty-five percent of women globally report being victims of physical or sexual abuse during their lifetime and one-third of women who have been in a relationship have experienced physical or sexual violence from a partner. Globally, one out of every five women is expected to become a victim of rape or attempted rape during her lifetime, and intimate partner violence (IPV) is the most common form of violence against women.

This report presents key results from an Impact Evaluation (IE) of a program that aimed to change norms around Gender Based Violence in the Democratic Republic of Congo. The evaluation collected primary data on Gender Based Violence norms and behaviors across multiple waves in a large sample and assesses the impact of selected aspects of the Tushinde Ujeuri program to reduce gender-based violence and improve community cohesion. The program was coordinated by IMA World Health and implemented by several partners including Panzi Foundation, Heal Africa, ABA Rule of Law Initiative and Search for Common Ground.

The IE employs a randomized controlled trial design to test the effectiveness of Community-Based Trauma Healing (CBTH) as a core approach to change norms and behavior around gender-based violence (GBV), and particularly intimate partner violence (IPV) as well as sexual violence (SV) more broadly. For the impact evaluation, 80 villages were randomly selected to receive the CBTH program from a list of 160 villages across 3 health zones in Eastern DRC. The remaining 80 villages served as a control group. We collected detailed baseline and follow-up data in all villages.

For the CBTH program in each community, Trauma Healing Champions (THCs) were recruited and trained to organize up to eight trauma healing sessions. Each session spanned across three days, meeting for about 2-3 hours each day for both men and women. The sessions focused on understanding the signs of trauma, thinking about healing and solutions, and understanding services and other forms of support that exist in the community or near the community.

The IE assesses impacts on perceived norms and individual attitudes and behaviors (self-reported and observed). In addition, the IE aims to assess whether and how these interventions affect the uptake of services provided to survivors of GBV through the Aire de Sante (health area) level service delivery of the Tushinde Ujeuri program. These services included the uptake of legal, medical, psychological, and socio-economic services. Within each Aire de Sante (40 in total), the CBTH programming was implemented in two randomly selected villages and two additional villages served as controls.

We find that outcomes improve in the entire study area, across both intervention and control villages, over the study period – likely reflecting broader social trends and positive impacts from the holistic Tushinde program. Between the two survey waves, we find a drop in IPV, non-Partner GBV, IPB and GBV perpetration as well as increases in many of our mental health indicators including depression, anxiety and PTSD. There is a 14-percentage point decrease of women reported having experienced IPV and a 9-percentage point decrease in non-partner GBV. These changes are impressive, as they occurred despite the global COVID-19 pandemic.

When comparing villages assigned to CBTH programming and control, we see some promising changes. Non-partner sexual violence was 50% lower in villages assigned to CBTH programming compared to those assigned to control villages (a drop in reported incidence from 5% to 2.6%). Self-efficacy and community resilience also improved in villages assigned to CBTH programming. While the differences are small, these findings show some promise, and indicate that CBTH has helped improve the outcomes it aimed to target—feelings of agency and ability to improve one’s own life and a greater sense of connectedness with, and trust in, one’s community as a whole.

However, these results should be seen as suggestive and not conclusive evidence that CBTH improved GBV related outcomes. When we adjust our analysis for multiple hypothesis testing (a statistical procedure to correct p-values), none of the reported results are significantly different from zero. Other mental health outcomes also moved in the right direction, but are not significantly different between villages assigned to CBTH programming and those assigned to control (even before correcting for multiple hypothesis tests).

One explanation for finding over-time changes in all villages but no experimental effect of CBTH is that spillover between treatment and control villages tampered the differences between CBTH and control villages. Indeed, nearly identical proportions of respondents across treatment and control villages expressed awareness of and exposure to CBTH programming in our survey. Combined with the positive overall progression in GBV outcomes between baseline and endline, this suggests that the program may have had an overall positive effect on both types of villages.

The COVID-19 pandemic occurred during project implementation – temporarily disrupting CBTH services and calling for adaptations to the programming model. While implementation was eventually able to resume, it is important to acknowledge that the pandemic represents a significant influence on villages participating in this IE. Around the world, there is significant evidence that the pandemic and its associated lockdown measures significantly impacted women’s social and economic inclusion, and physical security while simultaneously increasing the risk of multiple forms of violence. Within our own study, we presented findings that highlight how COVID-19 has had negative impacts on both individuals and villages. COVID-19 increased insecurity in nearly one in four villagers and disproportionately affected women. One in four respondents also said that they had quarantined at home as a result of the pandemic – women were four times more likely to report staying at home compared to men. Of those individuals who reported staying home, one in five experienced violence with the vast majority stating this violence had gotten worse since quarantine began. These adverse impacts of COVID-19 on mental health overall may have attenuated larger gains in mental health in treatment villages. IPV perpetration and victimization decreased over the course of the study period in all villages; however, this decrease was not higher in intervention villages compared to control villages.

Uptake of Tushinde services was quite high across all project sites, despite potential disruptions from COVID-19. However, 15% of endline respondents stated that they did not seek services when they otherwise would have because of concerns about the COVID-19. In addition, women had 80% greater odds of stopping to seek service compared to men.

The positive over-time changes we observe in the study villages, both intervention and control, are notable given it has been implemented in regions with ongoing conflict that were simultaneously affected by a global pandemic. Though we found no conclusive experimental evidence for the effectiveness of the CBTH programming, some of the positive over-time changes are likely due to the Tushinde program and CBTH programming. The over-time changes could, in theory, be caused by other environmental factors, but it is unlikely that any environmental factors would cause such large changes (e.g., a 14-percentage point decrease in intimate partner violence) during COVID-19. Those positive changes are also unlikely to result from respondents learning how to respond to the survey because not all outcomes improve. As such, there is promise for CBTH interventions to contribute to positive change in GBV-related outcomes, even in highly unstable environments.