Sexual and gender-based violence (SGBV) is widespread in the Democratic Republic of the Congo (DRC). Although the constitution and several international and African conventions ratified by the country guarantee gender equality and the right to sexual and reproductive health (SRH) for all, women and girls in conflict, post-conflict, and non-conflict areas of the DRC are exposed to SGBV by known and unknown perpetrators. Despite the high prevalence of SGBV, the gap in the availability of and access to quality services for survivors remains considerable. Several factors account for the service gap, including low institutional capacities on both the national and local levels to implement a complex and comprehensive SGBV prevention, mitigation, and response effort. Since April 2022, Médecins Sans Frontières (MSF) has been piloting the decentralization initiative in the Kamuandu health center (KHC) that aims to: 1) Improve access to SGBV care, including contraceptive and abortion care; and 2) Build staff capacity to provide holistic medical support to survivors at the health center level.

This report shares the findings of Phase 1 of a multi-phase developmental evaluation of the decentralization initiative carried out in Kasai central in July 2022. In line with the MSF Stockholm Evaluation Unit’s terms of reference, the Phase 1 evaluation aimed to evaluate the design and planning of the decentralization initiative for the KHC and its prospective implementation process. We employed a concurrent mixed-method approach that included a desk review, 17 semi-structured face-to-face and remote interviews with key MSF project team members (n=6), local stakeholders (n=5), and project beneficiaries (n=6), and observation of operations of the KHC. We addressed the primary evaluation questions through seven criteria: relevance, coherence, efficiency, effectiveness, impact, sustainability, and gender and human rights mainstreaming.

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