Evaluation of the Mambasa Project on Sexually Transmitted Infections / Victims of Sexual Violence 60 views0 applications

CONTEXT

The project to be evaluated has been implemented within Mambasa territory in the Ituri province of Democratic Republic of Congo (DRC). The area is particularly vulnerable to violence, with several armed groups present in its mining quarries and the RFO, including poachers, FARDC, Mai Mai, and rangers.

The main Mai Mai group operating in the gold quarries in Nia Nia health zone was dismantled by the FARDC after their chief was assassinated in 2018. However, members are still dispersed in small groups of armed criminals who are difficult to control (no political agenda, only economic interests etc.). The Mambasa-Beni axis remains precarious with banditry, hold-ups, kidnappings, and attacks, originating from population movements and intercommunal conflict because of its proximity to North Kivu (Beni Territory). The numerous gold quarries and their small and large-scale exploitation has attracted many opportunists including armed groups, and mining companies.

Frequent and often disproportionate recourse to violence against the civil population living near the quarries has important medical and psychological consequences for local people, who suffer sexual violence, physical trauma, and kidnappings. Sexual violence involving women and young people is generally tolerated by the community. Young girls are married off and rape cases are settled by the family; the notion of consent does not exist. The concept of witchcraft is pervasive and very young children are raped as a purifying rite to bring luck and prosperity, by men looking for gold. Young girls going to fetch water or wood in the forest are the first to fall prey to sexual violence, and they prefer not to speak out for fear of stigmatisation and feelings of guilt.

Health services in the region are characterised by a local health system with major structural problems at all levels: few healthcare providers, no continuous learning, very low income, numerous stockouts, lack of equipment and poor hygiene practices. Families with financial means prefer to seek care in the private sector.

DRC is still grappling with an Ebola epidemic in the northeast of the country, which has now killed more than 2,260 people (March 2020). With over 3,400 cases, this is the second-worst Ebola outbreak in history – following the 2014 West African epidemic. The epidemic has been unpredictable and challenging, especially Mambasa and Mandima health zones, and as such it is difficult to foresee the evolution of outbreaks in the area with certainty.

PROJECT DESCRIPTION

In response to this situation, in 2016 MSF Operational Centre Geneva’s (OCG) Desk 3[1] launched an intervention called STI/VSV Mambasa project. The main goal of the project was to contribute to reducing morbidity and mortality related to sexual violence, sexually transmitted infections (STIs) and epidemics (including Ebola), in the health zones of Mambasa, Mandima and Nia Nia, a region with a total population estimated to 294,305 people, and located in the Mambasa Territory of DRC’s Ituri Province. This was to be achieved by ensuring access to healthcare and case management for victims of sexual violence (VSV) and people with STIs, access to family planning, as well as support to the Ministry of Health (MoH) in epidemiological surveillance.

The intervention aimed to achieve the following results:

R1. VSVs receive quick and adequate access to medical and psychological treatment and free referrals when admission to hospital is required.

R2. Patients with STIs are treated free of charge according to the syndromic approach and HIV testing is offered to each patient.

R3. Family planning is accessible for everyone in the health facilities supported by MSF.

R4. Communities are informed about the package of care and can see benefits in changing behaviour in terms of prevention and consultation in supported facilities.

EVALUATION PURPOSE AND OBJECTIVES

With the forthcoming completion of the first project cycle (2016-2020), the implementation team would like to assess whether the project’s approach has been optimal for reducing morbidity and mortality related to sexual violence, STIs and epidemics in the targeted area. The purpose of the exercise is to take an informed decision on whether to continue the project with the next cycle in 2021 and assess if there are elements which are transferable to other interventions.

The primary audience of the evaluation is MSF OCG, the mission, operations department more broadly, and the medical department. Broader audiences include medical departments and operational cells working in DRC from other MSF operational centres, as well as the MSF Kinshasa coordination office. Efforts will be made to share the results with evaluation participants and the community in an appropriately tailored format.

The evaluation will focus on the following objectives:

1. Determine the differences between the expected and observed project results and examine the main reasons for these differences.
2. Examine how the project has adapted to changes in context.
3. Assess what degree of the intervention is essential to achieve the desired project outcomes.
4. Analyse the community perception of the services provided, as well as the perception of their engagement in the intervention.

In terms of scope, the evaluation will focus on three of nine project locations: Nia Nia, Biakato, and Mambasa. The reason for focusing the evaluation on these locations is the different contexts and the varying presence of other actors. As for the time period evaluated, the analysis will cover the whole first project cycle, i.e. from its launch in 2016 until 2020.

Further information is available here.