HELPING SURVIVORS OF GENDER-BASED VIOLENCE IN IRINGA AND NJOMBE REGIONS OF TANZANIA ACHIEVE THEIR REPRODUCTIVE INTENTIONS MOTTA WITNESS, CLEMENT MATWANGA, MWALUKO KONGOLA, FEDDY MWANGA, GRACE MALLYA, RICHARD KILLIAN, AND CHLOE MANCHESTER RESPOND Tanzania Project (RTP)

SIGNIFICANCE/BACKGROUND RESULTS/KEY FINDINGS PROGRAM IMPLICATIONS/LESSONS

• In many societies, women are socialized to accept, tolerate, and even rationalize gender-based A sizable number of GBV and VAC cases are identified at health facilities and social welfare • Eighty-two percent of survivors (3,025) were women, while 18% were men (685). In response • Orientation of RHMTs, CHMTs and Middle Level Health Managers on 1 violence. According to the National Survey of Violence against Children , almost three in 10 offices. to this, the program reached more men with gender transformation and Couple Connect GBV and VAC, a two-day curriculum, is used to orient participants on the Tanzanian women and girls aged 13–24 reported having experienced at least one incident training though community volunteers (Figure 3). availability and importance of GBV/VAC screening and clinical services. of sexual violence before their 18th birthday, and 39% of women ages 15–49 have ever • From October 2013 to June 2015, 25,979 victims of all types of violence of all ages were The approach seeks to increase perception of GBV as a violation of • Since October 2012, RTP has trained 247 service providers and social welfare officers using experienced physical violence since age 15. served through RTP-supported sites, an increase from 9,112 during the first year of the project rights and has encouraged community leaders and community members (2012–2013). the MOHSW’s GBV curriculum. • There are strong linkages between GBV and sexual and reproductive health (SRH). Because to speak out against such crimes. This and other tools developed are • An additional 145 health authorities and managers received a two-day GBV/VAC orientation. victims of violence may not be able to negotiate use of condoms or other contraception, they • The majority of survivors (76%) received services. valuable assets in reversing societal norms that perpetuate violence. are particularly at risk of unintended pregnancies or sexually transmitted infections (STIs). • FP is integrated into the comprehensive package of services offered to each GBV client, • GBV services were integrated into other RCH services to reduce the Trainee follow-up, mentorship, and supportive supervision are conducted to ensure that services including providing their method of choice. number of visits needed. RTP supported training in comprehensive FP • The EngenderHealth-led RESPOND Tanzania Project (RTP) works in close collaboration with meet the national MOHSW standards. Tanzania’s Ministry of Health and Social Welfare (MOHSW) to contribute to curbing GBV and • From October 2013 to June 2015, 1,121 clients were discharged with an FP method, counseling to strengthen integration of FP into other services. Collection violence against children (VAC) and increasing the availability, quality, and utilization of GBV- including injectables, the pill, condoms, and (in the case of rape) emergency contraception. of forensic evidence in legal prosecution cases is still a challenge, as many Figure 2: Number of GBV/VAC-related referrals, by type, according to time period, Iringa and facilities lack essential equipment for collecting samples such as semen, in related health services. • From October 2013 to June 2015, 433 women received emergency contraception, 500 Njombe,1,200 July 2013–June 2015 cases of sexual violence. received postexposure prophylaxis, and 2,426 were tested for HIV (Figure 3). Some of the sexual assault survivors did not meet the medical eligibility criteria for emergency 1,000 • Multisectoral programming around GBV (which works with various sectors, PROGRAM INTERVENTION/ACTIVITY TESTED contraception or postexposure prophylaxis. such as law enforcement, policymakers, the health sector, women’s rights organizations, legal aid organizations, GBV response organizations, • RTP has been training service providers to screen GBV/VAC survivors by identifying key • The majority of cases observed were emotional violence (53%, N=13,917) and physical 800 and safe houses) has been shown to be a best practice in preventing indications of potential GBV and then providing clinical services, such as treatment for injuries, violence (39%, N=10,215); this is due to the awareness created in the community whereby and responding to GBV. This intervention could have benefited from a STI screening, and psychosocial assessment and counseling, including child-friendly services any form of violence is not tolerated, especially physical violence, and is now considered as a 600 stronger multisectoral approach. There are also insufficient social welfare and family planning (FP) counseling. Facilities are also linked to social, legal, and psychosocial violation of rights (Figure 1). Police officers and health service providers and not enough safe houses for GBV/ services. 400 Higher level facility VAC survivors. • Demand creation and community awareness are done by engaging Community Action Teams, Figure 1: Number of GBV/VAC survivors seen for various services, by type of service, according to • Referral linkages need to be strengthened to ensure that GBV/VAC who conduct community health talks and distribute GBV information pamphlets,and by time period, Iringa and Njombe, July 2013–June 2015 200 Legal aid survivors can get the social and medical services they need, including engaging service providers to conduct facility health talks. their FP method of choice. This involves partnering with local women’s 6,000 0 July–Sept. Oct.–Dec. Jan.–March April–June July–Sept. Oct.–Dec. Jan.–March April–June and legal community-based organizations, such as the National 2013 2013 2014 2014 2014 2014 2015 2015 METHODOLOGY 5,000 Organization for Legal Assistance, the Iringa Disabled Youth Development Cooperation, UMATI (the national IPPF affiliate), and Kiota Women’s • EngenderHealth has scaled up the total number of supported sites from 49 facilities in 2013 to 4,000 Figure 3: Number of clients receiving various services, by type of service, according to time Health and Development (Kiwohede). 121 facilities in 2015, including taking over sites in September 2013 that had been supported period, Iringa and Njombe, October 2013–June 2015 by another partner. Interventions were conducted in 10 districts in Iringa and Njombe 3,000 Neglect (VAC only) regions, in close collaboration with the national and local governments, and included partner 600 ACKNOWLEDGMENTS coordination annual meetings. 2,000 Sexual violence 500 RTP acknowledges the MOHSW collaborators at the zonal, regional, district, • EngenderHealth contributed to institutionalization of a GBV/VAC strategy through a number Emotional violence and facility levels, the generosity of the American People for their support of tools: a National GBV/VAC Training Curriculum for Health Care Providers and Social Welfare 1,000 400 through the U.S. Agency for International Development (USAID), GBV Officers developed by the MOHSW, in collaboration with Pathfinder International and the Physical violence 0 Emergency contraceptives implementing partners, and EngenderHealth colleagues. The contents of National GBV Technical Working Group (of which EngenderHealth is a member); a trainee 300 July–Sept. Oct.–Dec. Jan.–March April–June July–Sept. Oct.–Dec. Jan.–March April–June Postexposure prophylaxis this poster are the responsibility of EngenderHealth and do not necessarily follow-up tool; a nonclinical staff orientation tool for GBV/VAC; and a GBV/VAC orientation 2013 2013 2014 2014 2014 2014 2015 2015 reflect the views of USAID or of the U.S. government. package for local government leaders. 200 HIV testing • Community Health Management Teams (CHMTs) are supported to conduct quarterly supportive RTP supports service providers and social welfare officers to link clients to police, to higher 100 supervision visits to all districts, including routine data quality assessment. EngenderHealth • EngenderHealth, Inc., Plot #254, Mwai Kibaki Road/Kiko Avenue, PO Box level health facilities, or for legal aid. The greatest number of referrals were to the police, supported the MOHSW to develop such monitoring tools as a GBV client card, a client register, 78167, Dar es Salaam, Tanzania followed by referrals to higher health facilities and to legal aid. Some of the cases were 0 a tally sheet, and monthly summary forms. Service providers are trained on these tools, as well Oct.–Dec. Jan.–March April–June July–Sept. Oct.–Dec. Jan.–March April–June 2013 2014 2014 2014 2014 2015 2015 resolved at home and by local village leaders (Figure 2). 1 UNICEF Tanzania, U.S. Centers for Disease Control and Prevention (CDC), and Muhimbili University of Health and Allied as on the MOHSW’s District Health Information System. These tools were used to evaluate the Sciences. 2011. Violence against children in Tanzania: Findings from a national survey, 2009. Summary report on the prevalence project in terms of the number of clients reached and the quality of services. of sexual, physical and emotional violence, context of sexual violence, and health and behavioural consequences of violence experienced in childhood. Dar es Salaam.

www.engenderhealth.org INTERNATIONAL CONFERENCE ON FAMILY PLANNING • NOVEMBER 2015