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Independent Formative Evaluation of Family Support Centres in Papua New Guinea

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Independent Formative Evaluation of Family Support Centres in Papua New Guinea Independent Formative Evaluation of Family Support Centres in Papua New Guinea FINAL 1 June 2016 Prepared for IOD PARC Australasia UNICEF Papua New Guinea Country Office Ground Floor, Suite 1 211 Blackshaws Rd Date Newport, Victoria 1 June 2016 Australia By Tel: +61 (3) 9391 1610 Kate Butcher www.iodparc.com.au Jo Kaybryn [email protected] Katherine Lepani Moale Vagikapi Lucy Walizopa Independent Formative Evaluation of Family Support Centres in Papua New Guinea Contents List of Tables ii List of Figures ii Acronyms iii Executive Summary 1 1. Introduction 4 1.1. Context and background 4 1.2. Object of the evaluation: Family Support Centres in PNG 6 1.3. Evaluation purpose, objectives and scope 12 1.4. Methodology 15 1.5. Key limitations 20 1.6. Data Protection and Ethical Considerations 21 2. Findings 22 2.1. Relevance 22 2.2. Effectiveness 26 2.3. Efficiency 37 2.4. Sustainability 42 2.5. Equity 45 3. Conclusions 48 4. Lessons Learned about Family Support Centres in PNG 53 5. Recommendations 55 For NDoH and key partners 55 For provincial FSC implementers 57 For Development partners 57 Annex 1: Terms of Reference 58 Annex 2: Evaluation Team Composition 67 Annex 3: Methodology 68 Annex 4: Stakeholder list 72 Annex 5: Evaluation Matrix 74 Annex 6: Evaluation Implementation Plan 78 Annex 7: Data Collection Tools 79 Annex 8: List of people met 86 Annex 9: Province data collection itineraries 93 Annex 10: Evidence matrix 94 Annex 11: Overview of FSC visited 96 Annex 12: Literature 106 References 107 i Independent Formative Evaluation of Family Support Centres in Papua New Guinea List of Tables Table 1: Summary of FSC activities as described in the PHA guidelines ............................................... 11 Table 2: Summary Profiles of Provincial FSC staff and clients .............................................................. 27 Table 3: Main presenting issues at FSC ..................................................................................................29 Table 4: Staff complements in FSCs ...................................................................................................... 30 List of Figures Figure 1: Timeline of FSC evolution in PNG ........................................................................................... 8 Figure 2: Map of PNG showing Family Support Centres visited ........................................................... 14 Figure 3: A model of the health sector response to GBV presented in the Lancet by Moreno et al....... 17 Figure 4: Theory of Change for the Evaluation of FSCs ......................................................................... 18 ii Independent Formative Evaluation of Family Support Centres in Papua New Guinea Acronyms ARB Autonomous Region of Bougainville CIMC Consultative Implementation and Monitoring Council CPD Country Programme Document DFAT Department for Foreign Affairs and Trade DfCD Department of Community Development DV Domestic Violence FGD Focus Group Discussion FHI Family Health International FSC Family Support Centre FSVAC Family and Sexual Violence Action Committee FSVU Family and Sexual Violence Units GBV Gender-based violence INGO International NGO IPV Intimate partner violence MCH Maternal and child health MSF Médecins Sans Frontières MTR Mid-Term Review NDoH National Department of Health NGO Non-governmental organisation OECD-DAC Organisation for Economic Co-operation and Development Assistance Committee OPP [Provincial] Office of the Public Prosecutor OSSC One Stop Service Centres PHA Provincial Health Authority PHAd Provincial Health Administration PLHIV People living with HIV PMTCT Prevention of mother to child transmission [of HIV] PNG Papua New Guinea RPNGC Royal Papua New Guinean Constabulary SOS Sexual Offences Squad STIs Sexually transmitted infections SV Sexual Violence TOC Theory of Change ToR Terms of Reference UNDAF United Nations Development Assistance Framework UNICEF United Nations Children’s Fund iii Independent Formative Evaluation of Family Support Centres in Papua New Guinea Executive Summary Overview of the evaluation object The first example of a Family Support Centre (FSC) in Papua New Guinea was established at Lae hospital in 20031 with support from Soroptimists International. By 2015, there were nominally fifteen FSCs in thirteen provinces across the country. UNICEF has provided support to nine of these FSCs and thus has commissioned this formative evaluation of the approach. Evaluation objectives and intended audience This formative evaluation aimed to generate findings and recommendations to improve the on-going implementation of FSCs in Papua New Guinea, and determine what worked and what did not work, analysing both the constraining and enabling factors. This evaluation is the first formal independent assessment of the Family Support Centres since their introduction in 2003. The unit of analysis was 14 FSCs from 2003 until the present. Nine of the FSCs are supported by UNICEF2 and five FSCs were established by other partners3. The objective of the evaluation was to determine the relevance, effectiveness, efficiency, sustainability and contribution to equity of the FSC approach. The primary users of the evaluation findings are the National Department of Health (NDoH) and Provincial Health Authorities/Administrations; Family Sexual Violence Action Committee (FSVAC); Department of Community Development, Youth & Religion (DfCDYR); and UNICEF as a key supporting partner. Secondary users include wider development partners (UN agencies, bilateral donors), faith based organizations, and civil society partners in PNG supporting the FSC approach. Evaluation methodology The methodology for this formative evaluation was based on qualitative, inductive, and participatory approaches. Mixed methods were used with qualitative research methods prioritised over quantitative methods. A draft theory of change was developed in consultation with stakeholders which provided a framework for the evaluation. The scope was to assess all FSCs based on available data since the inception of the approach in 2003, extensive literature review and visits to ten sites.4 Key findings and conclusions Relevance The FSC approach was found to be closely aligned with national priorities and there was a high level of political commitment, particularly at national level. At provincial and district levels, commitment was not always translated into tangible resources, or reflected in planning documents. Most sites visited had created an important 'hub' approach from which they were able to refer survivors and provide an essential role in facilitating access to health and justice services. However, the introduction of the concept of the ‘five essential services’ in 2007 has yet to be incorporated into the Guidelines for PHA/Hospital Management Establishing Hospital-Based Family Support Centres (2013).The hospital-based FSCs provided an effective service with an appropriate environment within which survivors could begin to recover. More could be done to ensure continued relevance of the service to 1 This FSC is now also referred to as the ‘Women and Children’s Support Centre’ 2 UNICEF was a key development partner in the initial stages of FSC implementation. The focus at that time was on physical infrastructure as the government did not have capacity to build FSCs and hardware had been deprioritised by many development partners. The Bradley Report recommended establishment of the FSVAC which would then develop a strategy on FSV and support the government to implement the FSC approach. 3 Recently launched Referral Guidelines (Nov 2015) cite 15 FSCs: Tari, Mendi, Buka, Goroka, Arawa, Madang, Vanimo, Alotau, PoM, Kerowagi, Maprik, Minj, Mt Hagen, Kundiawa, Lae. 4 These were: Mount Hagen, Alotau-Milne Bay, Kiriwina-Milne Bay, Kundiawa-Simbu, Minj-Jiwaka, Kerowagi-Simbu, Buka- ABG, Arawa-ABG, Port Moresby and Tari-Hela. The field trip took place between 14th November 2015 and 15th December. 1 Independent Formative Evaluation of Family Support Centres in Papua New Guinea users; only two FSCs visited systematically sought feedback from service users to improve the service, and only one attempted to establish a survivor support network. Effectiveness Lack of consistent and comparable data made it impossible to assess trends of service users. According to available data, there is a relatively small client load across the FSCs. Evidence from Tari shows that outreach activities promoting awareness of the service are successful in increasing uptake. The FSC staff in the Highlands were concerned that outreach may result in increased demand which would quickly outstrip supply. Although this concern was not evidenced, there were obvious gaps in staffing and expertise across the FSCs: for example, low capacity for FSCs to respond to children’s needs, too few safe houses available for temporary refuge, and only three sites met (or exceeded) the required staff profiles to ensure consistency of services. Two of the provincial Hospital FSCs provided the recommended five essential services, while the remaining eight FSCs visited facilitated access to them through referrals. All the provincial level sites had good relationships with relevant services indicating effective coordination. A much more inconsistent picture was found at district levels, where FSCs were variously understaffed and ill-equipped, and in some cases were defunct, never established, or buildings entirely co-opted for other uses. In some areas, the presence of an FSC had the perverse effect of
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