Scaling-up GBC Interventions Using Organization Barrier Analysis_Cloninger_5.11.11

1. Scaling-up GBV Interventions Using Organization Barrier Analysis Jayme Cloninger11 May 2011

2. 70%1995: Beijing Platform for Action

3. 1/32010, Amnesty International

4. The Need – Research & Policy ChangeViolence against women is interwoven in all areas of poverty – food security, education, health, etc. High domestic abuse leads to higher child and maternal mortality rates (Population Council, 2008)Unwanted pregnancies, unsafe abortions, complications with high-risk pregnancies, lack of health care access, STI’s, psychological problems, child mortality rates Decision making power within the homeBoth research and policy need to conceptualize, investigate, and measure this multifarious character – If we can’t identify the problem, how can we address it?Need an improved streamlined set of indicators to measure and understand how GBV workWho are the implementers of the CSP? Why or why are they not measuring GBV?Silvia Chant, The International Handbook of Gender and Policy 2010

5. What is Gender-Based Violence (GBV)?Gender-based violence results in physical, sexual and psychological harm to both men and women and includes any form of violence or abuse that targets men or women on the basis of their sex, although women and girls are usually the primary victims. Unequal power relations between men and women

6. Maintains gender inequalities and/or reinforce traditional gender roles for both men and women.

7. Includes: battering, marital rape, sexual violence, dowry-related violence, female infanticide, honor crimes, early marriage, forced marriage, female genital cutting, sexual harassment in the workplace and educational institutions, commercial sexual exploitation, trafficking of girls and women, and violence perpetrated against domestic workers. - USAID, WID

8. Research QuestionTo whatdegreeare non-governmental organizations (NGOs) with child survival projects using gender-based violence (GBV) indicators, what are possible determinants of their usage, and what are the enablers and barriers to using GBV indicators?

9. Method: Organization Barrier AnalysisRapid assessment tool used to identify the most important behavioral determinants associated with a particular behavior to develop more effective behavior change communication messages and activities. Compares Doers and Non-Doers.

10. Developed in 1990 (by Tom Davis) and based on the Health Belief Model developed in the 1950s by the U.S. Public Health Service, and the Theory of Reasoned Action.

11. Seven Determinants, Independent Variables:Knowledge of GBV indicators Perceived severity and prevalence of GBV in project communities Perceived organizational and self-efficacy in measuring GBV and intervening in GBVAwareness of effective interventions against GBVPerceived effectiveness of current interventions against GBVPerceived social norms (of professional peers) concerning GBV measurement and interventions

12. SurveyHypothesisOverviewOrganizations that use gender-based violence indicators and thus intervene do so due to multiple factors including: Self efficacy

13. Perceived severity and prevalence of GBV

14. Knowledge of GBV

15. Capacity to measure and use indicators Subject: CORE Group member organization representativesTime Span: 15 October – 15 November Population: 58 NGOsRespondents: 31 replies (53% response rate)Questions: 23 total5 close-ended questions 12 scale questions 6 open-ended questions

16. FindingsDoer vs. Non-Doers:Doers: Only 15% of the respondents measure GBV in child survival projectsNon-Doers: 73% do not measure GBVUnsure: 12% were unsure Determinants found to be significant (p < 0.05) : Perceived severity and prevalence of GBV in project communities Organizational capacity Significant Enablers: Organizational leadership, knowledge and capacity buildingSignificant Barriers:Staff reluctance

17. Determinant: Perceived SeverityIn general, when GBV occurs in communities where your organization works with child survival projects, how serious a problem is it in relationship to other community problems?Statistically Significant: p=0.002* NGOs that measure GBV indicators are more likely to believe that GBV has serious consequences in the communities where they work

18. How often does GBV occur in the communities where your organization conducts (or has conducted) child survival projects?Statistically Significant: p=0.032NGOs that use GBV indicators are more likely to believe that GBV has serious consequences on child survival projectsDeterminant: Perceived Prevalence

19. To what degree do most STAFF who work with your child survival projects have the capacity (knowledge and skills) necessary to measure changes in GBV over the life of your child survival program (e.g., using a KPC survey)?Statistically Significant: p=0.03NGOs that use GBV indicators are more likely to believe that staff have the capacity to measure GBVDeterminant: Perceived Organizational and Self-Efficacy

20. What Would Make it Easier to Measure GBV?*p=0.001NGOs that use GBV indicators are more likely to believe that organizational leadership and understanding would make it easier to measure and intervene in GBV*

21. What Makes it Difficult to Measure GBV?*p=0.023NGOs that use GBV indicators are more likely to believe that staff attitudes makes it difficult to measuring GBV

22. Implications: ShortcomingsShortcomings12% were “unsure” of whether they measure GBVRespondents may have exaggerated on their scale answers for idealistic answers. Knowledge of field programs is not perfect

23. Implications: Future ActionResearch Needs:Research to compare different methods for changing NGOs representatives perceptions about gender-based violenceResearch with different groups (other than NGOs with child survival projects) on these same research questions.Research to compare different methods for informing NGOs about gender-based violencePolicy initiative ideas:Creation of standardized GBV prevalence indicators for CS projects. Finding case histories of organizations intervening successfully in GBV, identifying best indicators for GBV prevalence.Creation of communication materials on severity of GBV, [other significant findings].Creation of CORE/FSN WG to produce these materials, indicators, and trainings.Using Organizational Barrier Analysis as a tool for exploring why organizations do and do not adopt different interventions and practices (exploring other topics like family planning) certain indicators.

24. Your turn…What are the possible mechanisms through which men’s control over women leads to more maternal and child deaths in the areas where you work?What are the most important steps that CORE Group members and working groups should take individually or collectively to (a) increase GBV measurement and (b) increase GBV response in Child Survival projects? What would be the priority deliverables? What can your organization contribute?Knowing that lack of knowledge on GBV indicators and prevention/mitigation interventions were two barriers, what resources do you know of that are already available that organizations for GBV measurement and program design?

25. GBV Throughout a Woman’s LifeUNFPA, Gender Equalityhttp://www.unfpa.org/gender/violence.htm

26. GBV Indicators Proportion of CDP mothers/female caregivers who express accepting attitudes of women's empowerment. (Agree with at least 1 form of positive women's empowerment (a-c) and disagree with 1 negative form of male control (d-f))Self-efficacy is important for a woman to stand up for things that affect her well-being and that of her childrenProportion of CDP children, by gender and age, who say that it is okay for a man to beat his wife under certain circumstancesDomestic violence impacts maternal & child health among others

27. Suggested Resources USAID, Women in Development A Guide to Programming Gender-Based Violence Prevention and Response Activities http://www.usaid.gov/our_work/cross-cutting_programs/wid/pubs/USAID_GBV_Guide_Public.pdfCarolina Population Center Violence Against Women and Girls: A Compendium of Monitoring and Evaluation Indicatorshttp://www.cpc.unc.edu/measure/publications/pdf/ms-08-30.pdfM&E of Gender and Health Programs http://www.cpc.unc.edu/measure/training/materials/m-e-of-gender-and-health-programs.html

28. Bibliography Chant, Sylvia. The International Handbook of Gender and Poverty. Vol. 1. Nothampton: Edward Elgar Publishing, 2010.Grown, Caren; Rao Gupta, Geeta; Kes, Aslihan; UN Millennium Project, Task Force on Education and Gender Equality, “Taking Action: Achieving Gender Equality and Empowering Women” (2005). InterAction, “Tapping the Power of Equal Opportunity For Women and Men,” A Proven Strategy for Effective Foreign Assistance, September 2005. Population Reference Bureau (PRB), Interagency Gender Working Group (IGWG), and United States Agency for International Development (USAID), “The Crucial Role for Health Services in Responding to Gender-Based Violence,” a policy brief, no date. Population Reference Bureau (PRB), Interagency Gender Working Group (IGWG), and United States Agency for International Development (USAID), “Gender-Based Violence: Impediment to Reproductive Health,” a policy brief, no date. Population Council, “Sexual and Gender Based Violence in Africa: Literature Review,” February 2008. United Nations General Assembly, “Declaration on the Elimination of Violence against Women,” Resolution 48/104 of 20 December 1993. United Nations, UN Division for the Advancement of Women, UN Economic Commission for Europe, UN Statistical Division, “Indicators to measure violence against women,” (Report of the Expert Group Meeting, Geneva, Switzerland, 8 to 10 October 2007). World Health Organization, “Putting Women First: Ethical and Safety Recommendations for Research on Domestic Violence Against Women,” Geneva, Switzerland, 2001.

29. Interview (1/5)Interviewer: Jayme Cloninger, Public Policy Consultant, Food for the Hungry Interviewee: Todd Nitkin, Monitoring and Evaluation Specialist, Medical Teams International Background: Can you tell me a little bit about yourself and how you become a specialist in monitoring and evaluation? Todd originally was a foot and ankle surgeon eleven years in Maryland. Due to a severe car accident and serious injuries, he retired. Over time and through recovery, Todd realized he wanted to do something that would help people. He then entered the international public health masters program at John Hopkins. Todd was fascinated by how things worked and naturally gravitated towards methods and evaluation. What exactly do you do and how long have you been on staff at Medical Teams International? Todd is the senior advisor in methods and evaluation and the Washington, DC representative for MTI. He has served on staff for five years. What is your role in CORE Group and how long have you been on the Board of Directors? Todd originally heard about CORE group while in his graduate studies at Hopkins. He was interested in the advances the CORE Group was making in public health. CORE is the place to get the latest information on public health. What is the nature of CORE Group? A coalition? Nongovernmental organization? “CORE Group operates like an umbrella organization that looks out for the well being of all NGOs. It is a place where an NGO can go for a small membership fee and join a group that looks out for its own peers. CORE provides the latest knowledge on advocacy and program to design, and is always willing to ask new questions on ways to improve existing projects. CORE Group is working together to create new ways of doing things.”“In the Methods and Evaluation Working Group (M/E WG), where I am the chairman, we are constantly making new indicators, surveys, methodologies. When we have those, we test new methodologies, devise ways of spreading information on how to do these new methodologies.”

30. Interview (2/5) Are there currently any gender or protection/gender-based violence (GBV) working groups within the organization?“Social and behaviorial change I believe deals with GBV. The M/E WG would love to have GBV indicators available for people to use. My organization is very interested in expanding into providing GBV indicators. Before you contacted, we had already planned to move into that area.” “I personally and strongly believe that all NGOs would like to get into GBV. I don’t think that some NGOs have the capacity to do that yet. That’s where CORE Group comes in – we build NGOs capacity by showing them how to do things.”“CORE Group is constantly looking to better ourselves and move into areas that need more attention and GBV is one of those areas that we have discussed.” “Most or all NGOS would want to go into GBV. It’s not a question of whether or not some NGOs don’t want to. It is because a lot of NGOs don’t know how to.” “Often times I will get calls from NGOs who don’t have capacity to do survey work or measure indicators. These NGOs sometimes have a difficult time issuing the KPC surveys. GBV indicators are not widely known, because NGOs are not considering them. These NGOs are till trying to learn how to collect the indicators that are well known.”“If an organization is trying to adopt a new indicator they will go to the website or contact a working group for help. They will also go through the KPC survey and pick indicators from there. They follow this recipe, because they have no experience when working with new indicators. Until they get experience they won’t move into other areas.”“CORE Groups needs to get a good set of GBV indicators along with a new methodology to collect indicators and get it into the M/E WG website and then you will see that people and NGOs will start doing it.” Did you take the questionnaire on surveymonkey?Yes…

31. Interview (3/5)GBV in Child Survival Projects Have you ever measured any forms of GBV? If so, what indicators did you use?“No. Not yet. By chance this is the area we are moving into right now and we would like to start measuring GBV. It’s actually on my work plan right now.” How do you begin to come up with the indicator if you have never measured it before? Where do you start?“I personally have lots of experience with other indicators and have gone into new areas of study. First, you need to pick an area for the project and begin talking to people to see if there is a problem with GBV and if so, what forms. From this I would devise the indicators and then the questions. Essentially the step by step is to find out what issues of GBV there are, develop indicators and then the questions.” Does CORE Group provide information to members on GBV indicators?“If so, there is a minimal amount of information.” Does CORE Group provide information on how GBV impacts maternal and child health? “I believe GBV should be looked at in context of each project and the type of GBV will depend on the context of that specific field project, because it is what you have been granted to do. If you need to, organize parallel surveys at the same time.” How important is measuring GBV in child survival projects compared to other issues, such as malnutrition? “This is a very contextual question, because if you go into an area where there is high malnutrition and high mortality and some GBV, but not great. Then obviously, it is not as important as malnutrition. If you go into another area and you see there is GBV and causes problems with mother and child health, then it becomes a more important issue. It then becomes a more important than malnutrition.” Based on your perception, is GBV a hindrance to existing child survival projects? “Generally, in some areas, in some contexts, it is a hinderence. In other areas, it is not. If you go into IDP camps surrounded by military, GBV will usually be high there, and thus a hinderance to CS project.”

32. Interview (4/5) Would measuring GBV in child survival projects be helpful and informative in understanding how to reduce violence against women and maternal and child mortality rates?“The more knowledge you have of an area, the area in which you are working, the better your project will do. If you find out when you’re measure GBV that it’s not a problem, you won’t have to address it. But many times by measuring it you will find that it is a problem and you will need to address it in your project interventions or else your project interventions won’t be as effective. It’s very important to know the entire context of the situation of which you work. By measuring things often you find out things you did not understand to be a problem when you set out to do the needs assessment and decided to do the project in the area. May go into an area and not think it is an issue at all but when you start asking thorough questions you actually find out it is a problem” How does CORE Group tell NGOs to approach GBV?“There hasn’t been a lot of discussion with that yet. That’s why we need to move into that area. CORE Group needs to move into. NGOs are not considering GBV because they don’t know how to do it. That’s a great service that CORE group could be doing.” To what degree do indicators drive program design? “In my organization, they drive program design a great deal. We do a needs assessment. Pick areas of work. I do several types of survey (community, house to house, heath clinics, etc.) from all of that information. We look at exactly what the indicators are saving and adjust the project to be the most effect and give the people that we serve the most that we can.” Are there indicators on gender and GBV in any of the KPC modules? “The way it is done is we use DHS as national data to serve as a guideline for our proposal. We then do a needs assessment in a specific area to work in and find out what is going on. After the preliminary planning we then do the KPC, house hold survey and then design the project.”“There are very view gender and GBV question in the KPC survey. A view questions about inquire about who makes the decisions in the family regarding health issues, but not about GBV. The HIV module has a few. Remember, that’s for a specific population. We need to expand it to something that can be used in house hold surveys.”

33. Interview (5/5) What are the benefits of including gender/GBV indicators in the KPC modules? Any negative?“Putting GBV indicators in KPC modules will allows NGOs in their existing frameworks to measure GBV. A lot of these organizations don’t have the funding or capacity to do several different types of surveys, but if you can put it in the format to be asked in a KPC survey, they will do that. And, from that they will be able to determine for their projects what’s going on relative to GBV and be able to address that issue.”“No negatives as long as it is done well. Why it should be put in KPC, to make sure everything is given proper thought and done well and taught to people who are going to do the questions how to do things properly. One of the negatives could be that you upset people in communities you work if the questions are not asked properly. Particularly in the area where people have something to hide. In areas where there actually is GBV. I’m guessing, they would get the most upset. Things must be done properly.”“KPC is free” Donors request that they measure certain things?“Donors don’t know nearly as much as we do. Let’s say they are interested in doing a safe motherhood project. They guide you with what they are interested in but don’t guide you with what indicators to use. Often times you can go back to them and say we did the research and found that this is statistically significant and the actually problem is this (xyz). Most donors will be happy to fund that as well.” What about the NGOs that don’t have the capacity? No structural guidance on how to track it and measure it. When this is the case and outside of KPC survey and other surveys given to them, how do NGOs usually choose the indicators they want to use?“We have organizations like Save the Children and CARE with a large M/E staff of people and enormous resources. Based on past experience they know what to measure. Then there are other organizations who email the M/E WG and who are interested in new project area. They inquire about what indicators to use. Email ME to ask questions about areas and resources. Find indicators and questions based on resources.” Gap between academic literature and NGO work – knowledge. A lot of compiled research on GBV and gender in development suggest a policy change and need for indicators. It is obvious that there is survey work that says GBV is a problem and we see how it correlates with child survival projects, yet there is a disconnect with NGO action. Seems like academic communities has more knowledge, and the NGOs don’t despite the fact that they are the ones who do all the work. What’s the disconnect?“All NGO work begins with academic research. It takes time for findings of academic research to make it out to the real world. For example, HIV became well known and researched by academics who figured out what exactly could be done to limit the exposure of HIV. It takes a while to filter out the information to the NGOs and for the NGOs to learn how to incoprorate the findings into existing projects and how to add projects. There will be a time lapse. GBV research is very conclusive and we have learned that things need to be done about it. We need to get people access to proper indicators and proper guidance on how to perform interventions on GBV then NGOs will begin to do it. It’s just lagging behind the academic world a little bit, as it always has done.”

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