Trafficking and Health: A Compendium of M&E Indicators

Editor's Notes

• #3: Trafficking in persons is a complex, politically charged, and often-contentious human rights issue. A fundamental struggle faced by the counter-trafficking sphere is defining the phenomenon. This is the most commonly cited definition. The key elements of this definition and the definition the US State Department are forms of FORCE, FRAUD, or COERCION for exploitation of another person. Movement, transportation, or border crossings are not necessary for a person to be trafficked. A person can be trafficked in their own home. FYI for Shelah: in case you/someone in the audience wants to know the United States State Dept definition - the Trafficking Victims Protection Act (TVPA) definition: “sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age; or the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.”
• #4: Due to the varying definitions of trafficking and the difficult nature of counting people that have been trafficked, estimates of number of people trafficked world wide range. Few studies cite numbers as small as 500,000, but most estimates depict a much larger and pervasive issue with 29 million victims estimated. Despite the large estimations of how many people are trafficked, in 2012, there were only 47,000 victims identified, according to the US State Department. In order the fill this large gap between estimation and document victims, improved monitoring and evaluation is necessary, including methods and approaches used to reach this particularly hidden population.
• #5: It is well known that TIP is harmful; however, there is a dearth of research on the comprehensive health effects of trafficking, particularly around forms of trafficking other than sexual exploitation (e.g., labor trafficking, child soldiers, begging) and/or trafficking of men and boys. The majority of current research focuses on women and girls that have been trafficked for sex.
• #6: Initial research by Cathy Zimmerman and colleagues documented a wide range of health consequences of trafficking including: injuries from physical and sexual violence, poor reproductive health outcomes, mental health symptoms (including depression, anxiety, and suicidal ideation), forced substance use, substance use as a coping mechanism, headaches, fatigue, and weight loss . Mental health problems were shown to persist longer than most of the physical health problems. Research is severely lacking in other areas of exploitation including labor trafficking for agriculture, fishing, mining or trafficking for the trade of human organs, but what is known is that health risks of labor trafficking can include poor ventilation and sanitation, exposure to chemical or bacterial hazards, lack of protective equipment, repetitive motion strain, extreme temperatures, and extended work hours as well as sexual abuse. Individuals trafficked for organ removal also face various health consequences such as poor health outcomes following surgery, loss of productive work time, and lack of compensation for damages.
• #7: While trafficking has been gaining increasing international attention, there are serious gaps and little standardization in M&E of TIP as it relates to health. We already mentioned that the lack of standardized definition of TIP adds complexity to data collection and measurement. In addition, the general lack of systematic measurement of policy and programs has led to limited availability of data. Each sector provides a small and biased subset of all cases, e.g. criminal justice and survivor service agencies view TIP from their narrow perspective. Data is not comparable, and is usually not shared between sectors, governments, and NGOs. There is also a lack of consensus on areas to measure at the intersection of health, gender, and trafficking. In order to begin addressing these gaps, USAID requested a consultative meeting and collaborative process to develop a compendium of indicators for trafficking and health.
• #8: A meeting was held October 1-3, 2013 with international experts from trafficking and health. Representation included (read slide).
• #9: The first day of the consultation included brief presentations from several participants that included an overview of TIP definitions and policies in the international context; current research by participants or their agencies; and challenges in data collection and research of trafficking. The following day, areas of measurement were discussed and included: Policies and law, law enforcement, health sector and health service providers, non-health services (education, community awareness/involvement), referral mechanisms, and prevention. Later, during the iterative process of finalizing indicators, the purview of the compendium, and building upon existing research, the areas were refined. (and are on the next slide)
• #10: The finalized areas of measurement are: Health sector response Post-trafficking Assistance and Outreach Programs Health Status and Care Received Referrals Policy
• #11: Many indicators related to the areas listed here were proposed during the expert consultation; however, due to conflicting research or lack of an evidence base, they were included as areas for further development. Other indicators that were proposed were excluded because the relationship to health not strong enough in this compendium. Key point: The degree to which indicators needed to relate to health was one of the most significant challenges of the process. Because trafficking is harmful and has obvious negative health consequences, nearly every indicator related to trafficking could also be somehow connected to health. However, for the sake of this compendium, we narrowed the scope to indicators that were directly/overtly connected to health and/or the health sector’s response to trafficking. If you want to give examples of indicators that didn’t make the cut: Number of community awareness campaigns related to TIP (excluded because some participants argued that awareness campaigns have not been shown effective in decreasing trafficking AND this was not directly related to health.) Number of schools that include education about trafficking (excluded because not directly related to health, and should not necessarily be an indicator applied across the board. One participant pointed out that she did not necessarily want her 10 year old being warned about being trafficked at his urban European school. Side note: This also leads to the point that we avoided making generalizations about source and destination countries in this compendium. While some of these indicators will be applied in higher risk areas, we intentionally left that up for countries and organizations to decide for themselves.
• #12: Not sure if we want to include this slide or not?
• #13: Time allowing, you can go through some of the indicators from the compendium.
• #14: I think these are pretty self-explanatory, but let me know if you’d like more speaker notes 
• #15: As you see, the voluntary element of health care comes up again and again. Many of the experts in our working group insisted these words remain in the indicators to ensure that trafficked persons are always afforded choice in their health care. Trafficked individuals are often given treatment without consent, which continues to deprive them of choice, human rights, and self control. Most of these indicators are measured through a survey of trafficked persons or a record review at a post-trafficking assistance organization.
• #16: The initial referral indicators were refined to these two, as they are directly connected to the health sector and they are more measurable. Even still, not all health units will keep records that reflect all referrals given and received, but this leaves something to aspire to.
• #17: Additional examples of policies: Existence of a mechanism to ensure that the trafficked person retains their health records when being repatriated. National strategy or equivalent to link suspected and identified trafficked people with health and social services. You can delete some of the examples if you think the slide is too wordy.