Module 5: Thematic Areas: Integrating gender-based violence interventions in health

Guidelines for Integrating Gender-based Violence Interventions in Humanitarian Action

MODULE 5 - Thematic Areas: Integrating Gender-Based Violence Interventions in HEALTH

Agenda Links between GBV and Humanitarian Programming Knowledge Basics for Implementing the Thematic Area

Guidance A Closer Look: Assessment; Resource Mobilization;

Implementation; Referrals; Coordination; Monitoring and Evaluation

Discussion of Implementation Strategy Developing an Action Plan

Outcomes HEALTH actors are informed about key relevant

elements of the Guidelines HEALTH actors are supported to develop an

action plan with indicators for integrating the Guidelines’ recommendations into their areas of operation

HEALTH actors identify accountability measures to track progress of GBV risk reduction mainstreaming and response

HEALTH


“Protection of all persons affected and at risk must inform humanitarian decision-

making and response…it must be central to our preparedness efforts, as part of

immediate and life-saving activities….”


Warm-up Activity: Mapping Risk acrosshealth

1) What types of GBV are prevalent in your settings?

2) What are the risks in this setting that contribute to GBV• Pre-existing - exists independent of, or prior to emergency or conflict

(culture, policy, etc.)• Emergency-related - specific to/resulting from the disaster or conflict• Humanitarian-related - caused directly or indirectly by humanitarian

environment

3) What can your cluster/sector do to prevent and mitigate GBV risks?• Pre-existing risk mitigation activity• Emergency-related risk mitigation activity • Humanitarian-related risk mitigation activity

Assessment, Analysis and Planning

What are our priority areas of inquiry for HEALTH?


A walk through HEALTH TAG: Assessment, Analysis & Planning

Key point:• Purpose is not for HEALTH actors to

undertake standalone GBV assessments, but rather to incorporate questions related to GBV risks into their ongoing HEALTH assessments


A walk through HEALTH TAG: Assessment (cont’d)

• Provides a list of recommended GBV-related questions to incorporate, as relevant, into HEALTH assessments and routine monitoring

• These questions do not cover the nature and scope of GBV, but basic issues related to HEALTH programming, policies and communications

• HEALTH specialists are NOT expected to undertake assessments about the extent of GBV


What does this mean for HEALTH? From page 42:h) What is the number, location, safety and accessibility of health facilities that provide clinical care—including mental health and psychosocial support—for survivors of rape and care/support for other forms of GBV

j) What is the range of health services provided to support the medical needs of GBV survivors (e.g. PEP to prevent HIV; emergency contraception)

g) What are health-care workers’ attitudes towards GBV survivors and the services provided


Activity: Conducting AssessmentsOption 1: Review and Discuss

Review the Areas of Inquiry in the GBV guidelines:

1) Which questions would you prioritize?

2) How will you collect this information?I. What surveys / assessment are already being used where you can

integrate questions II. When and where will the survey occur to ensure participation of at-risk

groups

3) Who would you need to work with to collect this information?I. What is the composition of the assessment team, men / women?II. What training will they require?III. How will they communicate about the assessment with the community?


Activity: Conducting AssessmentsOption 2: Review and Compare Review the Areas of Inquiry in the GBV guidelines against your current assessment tool.

1) Which GBV risks and considerations are already integrated in the assessment tool currently or previously used?

2) Which GBV risks or considerations would you prioritize for inclusion?

3) How will it be possible to integrate new questions which consider GBV risks?

I. With whom will you need to advocate to include these areas of inquiry?- Cluster coordinators, state actors, GBV specialists

II. With whom will you need to collaborate in order to safely and effectively integrate these areas of inquiry?- Cluster coordinators, state actors, GBV specialists


Activity: Conducting AssessmentsOption 3: Mapping information on GBV risks to mitigationPrioritize 3 areas of inquiry that apply to your context and carry out the below:

Area of Inquiry

Risk of Concern Potential for GBV Mitigation

1. Cultural and community perceptions, practices and norms

Access to health services is not possible for survivor due to discrimination from provider/ community

Psychological and emotional by provider, repeated experience of GBV by perpetrator, new assault/harassment by community

Identify and support existing community structures (midwives, women’s organizations, family members) to support survivors, ensure proper training of staff and acknowledge provider attitudes

2. Infrastructure

GBV related health services are not safe, confidential or supportive

Repeated GBV (intimate partner), new forms of GBV by other perpetrator, rape, harrassment

Ensure existing medical services and clinics have services for survivors integrated in their systems in a way that is non-stigmatizing


Quiz: Conducting Assessments HEALTH actors should:• Consult GBV specialists throughout the planning,

design, analysis and interpretation of an assessment• Not use local expertise• Strictly adhere to safe and ethical recommendations

for researching GBV• Share data that may be linked back to a group or an

individual, including GBV survivors• Seek out GBV survivors to speak to them specifically

about their experiences of GBV


Quiz: Conducting Assessments • Assume reported data on GBV/trends represent actual

prevalence/trends in the extent of GBV• Include GBV specialists on inter-agency and inter-sectoral

teams• Not include female assessors and translators when

conducting assessments• Conduct consultations in a secure setting where

individuals feel safe to provide information and participate in discussions and decision-making

• Provide training for assessment team members on ethical and safety issues


Discussion: • Is it always possible to include GBV in initial assessments?• How can one ensure inclusion of at-risk groups in

assessments?• Who needs to be involved? • Why is it the responsibility of HEALTH staff? Where does

this responsibility ends?• Who needs to be convinced?

ALWAYS INVOLVED WOMEN AND OTHER AT-RISK GROUPS IN THE DESIGN AND ASSESSMENT

OF HEALTH PROGRAMS

Resource Mobilization

What are HEALTH commitments to Resource Mobilization for GBV risk reduction?


A walk through the HEALTH TAG: Resource Mobilization

Key point:• Funding for HEALTH -related GBV prevention

and risk mitigation activities must be included in project proposals from the outset of emergency response



• In humanitarian settings, GBV resources tend to be linked to longer-term protection and stability initiatives

• Resources to address GBV in emergencies are often limited

• The Guidelines provide recommendations on incorporating GBV risk mitigation activities into project proposals

• Donors are encouraged to reference this section to ensure GBV issues are included in HEALTH proposals



GBV risk based on gender

analysis and safety audit

Proposed intervention

Risk vs. benefits

Adapted intervention

Impact?


What does this mean for HEALTH? GBV-related points to consider for inclusion in a proposal (Pg. 46):

1). Humanitarian Needs Overview/Situation Analysis: – Describe the vulnerabilities of women, girls and other at-risk groups;

2). Project Rationale/Justification: – Explain GBV-related risks related to HEALTH interventions in your

context;

3). Project Description: – Explain which activities may help in preventing or mitigating GBV– Describe mechanisms that facilitate reporting of GBV in safe and

ethical manner


What does this mean for HEALTH? How to measure GBV-related points to consider for inclusion in a proposal, cont’d:

Monitoring and Evaluation:

• M&E plan should track progress and adverse effects on GBV mainstreaming activities;

• M&E plan should include the participation of women, girls and other at-risk groups;

• Include outcome-level indicators to measure program impact on GBV-related risks;

• Disaggregate indicators by sex, age, disability and other vulnerability factors


THE IASC GENDER MARKER

Both Gender marker and GBV mainstreaming address issues of women and girls’ empowerment and gender equality and include men and boys as partners in prevention.

• = Tool that codes (0-2 scale) whether or not a humanitarian project is designed well enough to ensure that women/girls, men/boys will benefit equally from it or that it will advance gender equality in another way


What does this mean for HEALTH?

Some examples of GBV mainstreaming activities that can be included in GBV proposals:

• Facilities are safe and accessible to GBV survivors • Monitoring services in place to ensure commodities and

follow-up care are accessible (cost, location, provider training) • Supported environment by addressing the underlying causes

and contributing factors of GBV (health education, GBV prevention)


What does this mean for HEALTH?

Do you have other examples of mitigation strategies?


Activity: Resource Mobilization In Small Groups:

Review the assigned proposal in light with the resource mobilization checklist of the Guidelines and highlight:

– Good practices– Gaps– Proposed strategies to address these gaps.– Tools needed to better design proposals


Discussion:

• Is GBV-related activities in HEALTH programs always cost-effective? Why should it be considered?

• Do donors always support GBV-related activities in HEALTH programs? What can be some of these barriers?

GBV MAINSTREAMING ACTIVITIES ALWAYS CONTRIBUTE TO GOOD HEALTH

PROGRAMMING

Implementation

What are our commitments to include GBV prevention and mitigation within ongoing and new HEALTH activities?


Key takeaway:

If effectively designed, HEALTH programmes can mitigate risks of GBV:

Survivor medical services located within health facilities Participation of women and girls in HEALTH related

committees and decision making processesHealth access ensured for all affected persons

A walk through the HEALTH TAG: Implementation


A walk through the HEALTH TAG: Implementation• Provides guidance for putting GBV-related risk reduction

responsibilities into practice• Activities to improve the overall quality of GBV-related

prevention and mitigation strategies: Establish GBV-related responsibilities common to all actors

working within HEALTH Recommend strategies for HEALTH actors to reduce risks Maximize immediate protection of GBV survivors and persons

at risk and foster longer-term interventions to eliminate GBV• 3 main types of responsibilities: programming, policies,

and communications & information sharing


What does this mean for HEALTH?From page 47:• Maximize safety within and around health facilities

(adequate lighting; female guards at facilities; lockable sex-segregated latrines and washing facilities)

• Make opening times convenient for women, girls and other at-risk groups based on their household duties and school times.

• Ensure health facilities have and abide by standardized guidelines for the clinical care of survivors of sexual assault.


Activity- ImplementationOption 1: Review Mitigation Strategies

In small groups: 1. Review recommended mitigation strategies 2. Add any strategies missing 3. Prioritize 2-3 key strategies that should be prioritized 4. Highlight operational challenges

Rotate teams: troubleshoot challenges, provide recommendations

5. Create operational action plan: i. Key actionsii. Coordination amongst key actorsiii. Resources / support required


Activity- ImplementationOption 2: Mitigating GBV risk in Program Strategy

Review current programmatic strategy

In small groups:

1. Highlight GBV mitigation strategies currently integrated2. Review Guideline recommended mitigation strategies3. Prioritize 2-3 key strategies that should be prioritized 4. Create operational action plan:

i. Information needed ii. Key actionsiii. Coordination amongst key actorsiv. Resources / support required

Discussion: Prioritization and Selection Criteria

How to prioritize GBV risk reduction in HEALTH programs?

What types of investments are required? What vulnerability criteria would you use for

beneficiaries? What challenges are associated with these? How should sensitive information be managed to

protect affected populations, including survivors of GBV?

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DON’T SINGLE OUT GBV SURVIVORS OR VULNERABLE GROUPS

Coordination

What are our commitments to include GBV prevention and mitigation within ongoing and new HEALTH activities?


A walk through the HEALTH TAG: Coordination

Key takeaways:

• GBV prevention and risk reduction is most effective when done in coordination with both GBV specialists and other sectors

• Recommends specific actions for HEALTH actors to coordinate with others



• Supports humanitarian actors to define responsibilities and accountability mechanisms in GBV prevention and response efforts Establish responsibilities for humanitarian actors in the prevention

and mitigation of GBV Maximize immediate protection of GBV survivors and persons at risk

through multi-sectoral coordination on response to GBV incidents

• Coordination activities can move across the 3 main types of responsibilities: programming, policies, and communications & information sharing and may also include advocacy / efforts for: Assessment Resource Mobilization Monitoring and Evaluation



GBV Specialists can assist HEALTH actors to (Pg. 55):

1. Design and conduct HEALTH assessments that examine the risks of GBV, and strategize ways to mitigate these risks

2. Provide trainings for HEALTH staff on issues of gender, GBV and women’s/human rights

3. Develop standard operating procedures (SOPs) for HEALTH actors


What does this mean for HEALTH?Coordination with GBV Specialists, cont’d…

GBV Specialists can assist HEALTH actors to:

4. Identify where survivors can receive care, and provide HEALTH staff with skills and information to respond supportively to survivors

5. Provide training for the affected community on issues of gender, GBV and women’s/human rights as they relate to HEALTH rights

6. Review relevant statutory and customary laws and policies to strengthen GBV-related legal protections


What does this mean for HEALTH : Coordination with other sectors (p. 55)

HEALTH actors can work with (example):

• CCCM: Plan the location and ensure the accessibility of health facilities based on safety concerns and needs of survivors and those at risk of GBV

• LIVELIHOOD: Work with livelihoods programmers to provide cash-for-work to survivors and those at risk of GBV in health facilities and health outreach initiatives


What does this mean for HEALTH : Coordination for cross-cutting issues

Also coordinate with partners addressing:

gendermental health and psychosocial support

(MHPSS)HIVage environment


Activity: Coordination Option 1: Mechanisms to Support Program Implementation

Return to small groups from the implementation activity:

1. Reflect on the specific actions recommended

2. Who needs to be involved to execute this action – GBV specialists – Other clusters

3. What type of coordination is required – be specific

- Roles and responsibilities - Accountability mechanisms


Activity: Coordination Mapping • With what sectors would HEALTH benefit from stronger

coordination? i. What coordination mechanisms exist to support collaborationii. Key actions iii. Who is responsible, accountable, needs to be informediv. How will you monitor progress

• How could HEALTH and protection actors better coordinate/work together?

i. What coordination mechanisms exist to support collaborationii. Key actions iii. Who is responsible, accountable, needs to be informediv. How will you monitor progress


Suggested recommendations about referrals in the Guidelines • All humanitarian personnel who engage with affected

populations should have up to date written information about where to refer survivors for care and support.

• Ensure training on how to respectfully and supportively engage with survivors and provide risk reporting and/or referral information in an ethical, safe and confidential manner

• Any programmes that share information about reports of GBV must abide by safety and ethical standards (e.g. shared information does not reveal the identity of or pose a security risk to individual survivors, their families or the broader community)


Activity: Coordination Option 3: Coordination and Referrals w/ GBV specialistsIn small groups discuss:

• Map the current referral mechanism where your activities are ongoing

- What services are available- Which actors are involved

• What are your responsibilities within the referral mechanism?- Who do you immediately report an incident to?- Are there cases where you are unable to refer?

• What happens when there is no referral mechanism in place or when it is not functioning?

- What are your responsibilities in this situation?

Monitoring and Evaluation

What are priority indicators for GBV prevention and risk mitigation in HEALTH programming?


A walk through the HEALTH TAG: Monitoring & Evaluation

Key Point:• Indicators can be used to measure the

outcomes of activities undertaken across the programme cycle, with the ultimate aim of maintaining effective programmes and improving accountability



• Why? Limited evidence exists on effective integration of GBV programming in “other” sectors

• Indicators in the Guidelines aim to:– Track outputs resulting from interventions to affected

populations– Chart outcome of cluster activities– Measure progress toward objectives, considering

diversity of affected populations & their perspectives of the response


Monitoring & Evaluation: Indicators

• Why? Limited evidence exists on effective integration of GBV programming in “other” sectors

• Indicators in the Guidelines aim to:– Track outputs resulting from interventions to

affected populations– Chart outcome of cluster activities– Measure progress toward objectives, considering

diversity of affected populations & their perspectives of the response


A walk through the HEALTH TAG: Monitoring & Evaluation: Reporting

• Analyze existing data using a ‘GBV lens’ to improve GBV prevention and response

• Example: Existence of female security personnel in a specified location– What are the implications of the findings? – How may this affect GBV prevention and mitigation?

• Failing to meet a target can lead to response and resource mobilization

• Use data for action across the programme cycle


• # of health assessments that include GBV-related questions• # of health facilities with clinical staff who are trained on

CCSA and other forms of GBV • # of affected persons who report concerns about

experiencing GBV when asked about access to health centres

• of health facilities with CCSA with no fee for CCSA and other forms of GBV

• # of health sites with a standard referral pathway for GBV survivors

What does this mean for HEALTH (Pg. 57)?



Good to know:• Improvement or success is not

demonstrated by a decrease in reported GBV cases

• Targets and data sources can be modified to fit the context


Option 1: Prioritizing indicators and data collection methodology

1. Prioritize 1-2 indicators i. Select indicator from assessment, resource mobilization,

implementation or coordination based on current focus within response i. For example, if preparing for an assessment

2. Review the indicator reference sheet used for women’s participation

3. Fill out the blank indicator reference sheet for the indicator prioritized

i. Indicator descriptionii. Indicator acquisition iii. Data Quality issues iv. Data Analysis and Reporting/Dissemination

Activity: Monitoring & Evaluation


Option 2: Analyzing findings from gender or GBV evaluation

1. How are these findings relevant to your sector programming? i. Which sectoral activities may be contributing to GBV risks?ii. What cultural, community or policy variables may be contributing

to GBV risks?a. Representation of women, girls and at-risk groupsb. Traditional or cultural gender norms, power dynamicsc. Policies governing access to services, impunity

2. What activities could you adjust to prevent or mitigate GBV risks?i. Activities specific to prevention (focus on gender equality)ii. Activities specific to mitigation (focus on reducing exposure to risk)iii. Activities specific to response (focus on PFA, referral)

Activity: Monitoring & Evaluation

Monitoring and Evaluation

How do you know whether HEALTH programs contributed to reducing GBV risks?

- Did select HEALTH activities contribute to reducing GBV risks?

- What information lets you measure this? What are the challenges to monitoring GBV risks? Is it always possible to monitor that at-risk groups needs are

identified and responded to? Do HEALTH SOPs include direction for monitoring GBV risks

within HEALTH programming?

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Do not use number of reported cases as an indicator

of success.

Final Action Plan

1. In teams write down the priority actions to take forward

2. Refer to the prevention, mitigation and response activities of the day

3. Highlight key actors and responsibilities 4. Note attention to specific types of actions,

such as training, resources, staffing, access, etc.


Thank You.

For more information visit: www.gbvguidelines.org

http://www.gbvguidelines.org/

Module 5: Thematic Areas: Integrating gender-based violence interventions in health

Government & Nonprofit