Improving The Availability & Use of SGBV Services in Kananga Project in Central Kasai, DRC

Phase 2 Evaluation report (in English and French)
MSF/Ghislain Massotte (2018)
“My story happened on a Tuesday last year. I remember it as if it was yesterday: a group of men came into the house, and the destroyed everything—our things, and us. First, they raped my little sister, then my sister-in-law, and me last. At the time, we didn’t speak out about it, or ask for help. It was only recently, one Sunday when I was at church, that I heard about care being provided for rape survivors . A female doctor had come to tell us about an organisation of doctors here in Kananga, that was treating rape survivors, even if the rape went back as far as last year. Once I’d heard this my husband also encouraged me to go to the hospital. He told me that it wasn’t my fault, and that I needed to get some treatment. That’s why I came here. When I came, the doctors all greeted me with a warm smile and I felt really welcome. They gave me vaccinations, like for tetanus, and they did some tests. They discovered that I had contracted syphilis. My husband also had to get care for this and he is on follow-up treatment. Since I began receiving care, it’s going really well. I feel at ease now. I eat and I walk as I should. There was a period, before, when I trembled and shook a lot. Even now, sometimes, when there’s a sudden movement, I shake in fear. But it’s getting better. Recently my sister-in-law also came to seek care, having seen the changes it was making in me. My younger sister, on the other hand, is in Lubumbashi. She went there after it all happened and she won’t be coming back.”

Sexual- and gender-based violence (SGBV) is a widespread phenomenon in the Democratic Republic of Congo (DRC). In 2017, Médecins Sans Frontières (MSF) launched the Kananga project to provide emergency medical assistance to people affected by the Kamwina Nsapu conflict in the Central Kasai. To adjust to the evolving context in 2020, MSF initiated the “decentralization initiative” which: aimed to 1) Improve access to SGBV care, including contraception and abortion care; and 2) Build staff capacity to provide holistic medical support to survivors at the health center level. From April 2022 to March 2023, MSF piloted the decentralization initiative at the Kamuandu Health Center (CSK) in the Tshikula Health Zone. Before the decentralization initiative, the CSK did not formally integrate post-sexual violence care.

In 2022, the Stockholm Evaluation Unit (SEU) commissioned a two-phase developmental evaluation of the decentralization initiative. Conducted from July to November 2022, Phase 1 assessed the design, planning, and prospective implementation of the decentralization initiative.

This Phase 2 evaluation, which is the focus of this report, was carried out in June 2023 and assessed the results of the implementation and handoff of the decentralization. We employed a concurrent mixed-methods approach combining desk review, secondary analysis of routine data from the CSK, case study methodology of the CSK, and 18 semi-structured interviews with providers (n=4), survivors (n=5), MSF staff (n=7), and external stakeholders (n=2). We analyzed the primary qualitative data for content and themes using inductive and deductive techniques and computed descriptive statistics to analyze secondary quantitative data. We addressed the primary evaluation questions through seven criteria: relevance, Coherence, efficiency, effectiveness, impact, sustainability, and gender and human rights mainstreaming.

Document Author(s)
Cady Nyombe Gbomosa, Manizha Ashna, Meg Braddock, and Angel M. Foster
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