Gender-Based Violence Prevention and Response Project

Annual Progress Report Gender-based Violence Prevention and Response Project

Reporting Period from January—December, 2018

Submitted to: United Nations Population Fund Country Office for Nepal January, 2019

Table of Contents Chapter 1 ...... 4 Executive Summary...... 4 Chapter 2 ...... 6 Introduction ...... 6 Chapter 3 ...... 8 Outcomes achieved (expected outcomes achieved, changes in population, their behaviour, socio-cultural structure after implementation of activities) ...... 8 Outcome 1: Men and women in working districts increasingly prevent, report and address Gender-based Violence ...... 8 Outcome 2: Duty bearers respond effectively to gender-based violence in the working districts and increasingly at national level ...... 10 Chapter 4 ...... 12 Outputs Achieved and performance (with details of each activities performed under each outcomes with data tables/graphs and pictures of events) ...... 12 Outcome 1: Men and women in working districts increasingly prevent, report and address Gender-based Violence ...... 12 Output 1.1: Women Cooperatives (WC) have established functioning GBV watch groups and adolescent girls groups to address gender-based violence ...... 12 Output 1.2: Men and boys have acquired the capacity to engage in the prevention of and response to GBV ...... 13 Output 1.3. Civil Society Organisations, media and research organizations engaged in evidence based advocacy for an improved response to GBV by Government actors at district and national level...... 13 Outcome 2: Duty bearers respond effectively to gender-based violence in the working districts and increasingly at national level ...... 14 Output 2.1: Women and Children Development Offices, police, and legal service providers have been enabled to prevent GBV and respond to GBV ...... 14 Output 2.2: Women Service Centres (Safe Houses) have been established and are functional in the working districts, with links to capable referral safe houses in Kathmandu ...... 15 Output 2.3: Health facilities in the working districts have the capacity to provide adequate medical services and community based psychosocial case management for GBV survivors and their families ...... 15 Output 2.4: Ministry of Women, Children and Social Welfare and Ministry of Health are supported with evidence to develop policies and plans ...... 16 Chapter 5 ...... 17 5.1 Project Management and Financial Resources ...... 17 5.2 Percentage of budget spent vs. planned budget: ...... 18

Chapter 6 ...... 19 Lessons Learnt ...... 19 Annexes ...... 20 Annex-1 ...... 20 GBV Service Model and Cost-Sharing Matrix ...... 20 Annex-2 ...... 24 List of Municipalities selected for GBV Prevention and Response Activities ...... 24 Annex-3 ...... 25 A full overview of cases supported by the CPSWs ...... 25 Annex 4: ...... 25 DATA OF GBV CASES ...... 25 Annnex-5 : ...... 27 Human Interest Stories ...... 27 Annex-6 ...... 28 Photoes with title ( training, beneficiaries’ activities, monitoring), ...... 28

Chapter 1 Executive Summary

CMC-Nepal conducted mental health and psychosocial support activities in coordination and collaboration with the 10 local level governments of Udayapur (4), Sindhuli (3) and Okhaldhunga (3) to offer needful services to the survivors of GBV 2018. The program activities were focused on achieving the best results possible by means of training and back stopping supervision in capacity building, supervision and monitoring of the quality expected for the clinical management of the GBV cases through OCMCs in district hospital based in the project districts. Also the activities such as awareness, sensitization and advocacy helped the target population to come forward and set their views, ideas, opinions and thoughts to continue with the project activities at local level, in the long run. All 26 sessions of the Rupantaran course for Phase I were completed by mid-2018, and Phase II was completed in Siddhicharan Municipality (OKH), whereas in Dudhauli Rural Municipality (SDH) and Triyuga Municipality (UDP), the remaining sessions is on plan in the First Quarter of 2019. The girls have been more confident to solve their day-to-day problems related to reproductive health, GBV issues, become more expressive and bold enough to deal such issues. Girls in Sidhicharan and Dudhauli municipality could prevent child marriage issues (2), started promoting menstrual hygiene behaviour. Clinical supervision with PS Counsellors, Case Managers, Staff Nurse, based at the OCMCs, has been continued whole the yearlong which strengthened quality of mental health and psychosocial services (MHPSS) services to be offered to the survivors of GBV. Couples' Training Course was discontinued from the end of second quarter based on the recommendation made by the MTR. Documentation training to CPSW supported to produce data, report of GBV prevention and response work through the project. The obtained information from CPSWs supported to develop and move on with a new perspective that one needed to have equanimity to work on GBV issues and challenges. From the third quarter onward, the project activities has been implementing through local government (rural/ urban municipality).

Because of continuous interaction with elected leaders (Mayer/ chairperson, deputy Mayer/ chairperson, administration chief) to have contribution from (rural) municipalities. Nine (rural) municipalities contributed which ranged 30-50% budget for the salary of CPSWs and same for CPSWs coordinators in seven rural/municipalities in Sindhuli and Udayapur. It has increased involvement of the local governments to own the GBV program activities and incorporate them in their planning process. Eighty-five CPSWs in 10 rural/municipalities and seven CPSW Coordinators in 7 (rural) municipalities are selected with close cooperation of the (rural) municipalities, CMC-Nepal trained them following already tested and revised CPSW training manual, and mobilized to coordinate, identify, and refer GBV cases to hospital based OCMCs for a comprehensive management. Total number of GBV survivors to receive mental health and psychosocial support from three different OCMCs and GBV Clinic (Mission Hospital) based in Okhaldhunga, Sindhuli and Udayapur is 586 (499/F and 87/M). Case Managers, PS Counsellors and CPSWs and their coordinators are playing important role to manage GBV cases, starting from identification

to comprehensive management from OCMCs and CPSWs at community. The GBV Clinic in Community Hospital of Okhaldhunga is becoming more effective as shown by the increased number of GBV cases to receive services (see page 10 table). Regular field level backstopping supervision and distance coaching/ mentoring to case managers has increased confidence and competency to manage GBV cases at OCMC, GBV clinic and through outreach services. CPSWs involvement in prevention activities through interaction with community groups supported in early identification of GBV cases and referral to service places. Further CPSW are able to attend and provide emotional support and information of services available to survivors of GBV.

Chapter 2 Introduction

CMC-Nepal, primarily known as an professional organization in mental health and psychosocial field in Nepal. It has been implementing the psychosocial component of Gender-Based Violence Prevention and Response Project as per the partnership agreement and the approved work plan for 2018 between UNFPA and CMC-Nepal and is funded by Swiss Agency for Development Cooperation (SDC). The project has aimed to reduce the prevalence of GBV through an effective empowerment of women and men and through prevention and response interventions by more responsible and capable government agencies. The project activities of CMC-Nepal contributed in establishing effective response mechanism to the GBV survivors and partly in prevention of GBV as well through capacity building of multi-stakeholders involved in prevention and response. Also, that this project aimed at reaching out the ones unreached due to the issues of GBV in the communities the project is being implemented. CMC-Nepal has changed implementing strategy of the after MTR report in the changed political context of Nepal (federal system) with close interaction and cooperation of UNFPA and SDC as result partnership agreement has been developed with project implementing (rural) municipalities. District level staff of UNFPA, CMC-Nepal and other implementing partners of the project put large effort to encourage the local level authorities to the project activities into their (rural) municipalities.

CMC-Nepal involved to provide mental health and psychosocial support to GBV survivors in different 10 (rural) municipalities of the project districts; Okhaldhunga, Sindhuli, Udayapur. The activities implemented included training and capacity building of the service providers, backstopping supervision and distance coaching of the Case Managers (CMs), Psychosocial Counsellors (PSCs), Staff Nurses in OCMC, Safe House staff, CPSWs of women cooperatives till first two quarters and CPSWs of (rural) municipality in last quarter. Additionally couples were also trained in prevention of GBV in the first quarter which was removed from plan after the recommendation of MTR. In order to strengthen the holistic approach of intervention, CMC-Nepal focused on linkages of the services to be offered to the survivors of GBV. An orientation about project activities, its' importance at local level was provided to (rural) municipalities. It has supported (rural) municipalities to have their strong involvement in the program through cost contribution at the range of 30—50% (salary for CPSWs and CPSW Coordinators). This is a good beginning for the continuation of GBV program activities at local level and for the ownership by local government.

Besides, training, backstopping field level supervisions and distance mentoring service helped to service providers (Case Manager, PS Counsellor, CPSWs, and Safe House) helped to have a comprehensive thinking when it came to manage complex GBV cases at OCMCs. Mobilization of the CPSWs and CPSW Coordinators significantly supported to increase number of referrals at OCMCs compared to the months (mainly in the third quarter) when they were not placed in the respective project locations. The availability of specialist services (psychiatrist, clinical/ psychologists) at OCMC of district hospital and mission

hospital and other health facilities (in Udayapur and Okhaldhunga where another project of CMC-Nepal is implementing) in project covered area supported to access the services. GBV survivors having mental health problems are increasing attending the services. Community level stakeholders such as Girls Groups, Watch Groups, Women Cooperatives (during first and 2nd quarters) provided extensive support in prevention of GBV and referral of identified GBV cases to CPSWs. Working with(rural) municipalities provided opportunity to understand how to support them to understand about GBV issues and activities for prevention and response within local government system.

The key project activities of CMC-Nepal are: • Capacity building of psychosocial counsellors, community psychosocial workers (CPSWs) of women cooperatives and (rural) municipalities from last quarter , case managers of OCMC/districts hospital, safe house staff and Women Cooperative staff; • Finalization of the case management tools/guidelines which is in practice by three OCMCs and one GBV clinic, psychosocial counsellors and by all CPSWs; • Provide clinical supervision to the psychosocial counsellors, CPSWs, and case managers to enhance their confidence and skills in managing the GBV cases. • Provide counselling service to the GBV survivors at OCMCs and through outreach services; • Provide psychosocial counselling and psychiatrist services to complex GBV cases referred from project districts; • Documentation of lessons learnt and good practices; • Evidence based policy advocacy for institutionalization of the psychosocial services to GBV survivors and develop policy brief based on the comparative study of OCMC/district hospitals with or without psychosocial outreach workers; • Provide care for care givers training; • Mobilizing the funds for the community level activities i.e. roll out of the social and financial skill package, GEEGBVDCC meeting, quarterly meeting of WCs; • Provide training to couple in gender and GBV; • Orientation and advocacy with Municipality/Village Municipality for mainstreaming GBV prevention and response activities;

The main activities implemented in this reporting year under specific three outputs of outcome 1 and four outputs of outcome 2 were as follows:

Chapter 3 Outcomes1 achieved (expected outcomes achieved, changes in population, their behaviour, socio-cultural structure after implementation of activities) Outcome 1: Men and women in working districts increasingly prevent, report and address Gender-based Violence

CPSWs, watch group members, girls groups through women cooperatives and FCHVs, health workers, local leaders, trained couples contributed in identification of GBV cases and to increase awareness on prevention of GBV at community till end of second quarter and (rural) municipalities contributed to own CPSWs, their coordinators who actively engaged in GBV prevention and response to identified GBV survivors at community level and referral to OCMCs and other service providers (police, safe house etc.). Local government's has increased its' active involvement in project activities, monitoring of implemented activities, encouraged CPSWs to develop good coordination with ward elected members as they are placed at ward level. It is not easy to claim of outcome level results of the project activities implemented as the service of CPSWs placed at local level since November- December 2018 only. It has contributed to reactivate community level response mechanisms from local government institutions (at the ward level of municipalities) for GBV survivors which was remained dormant almost in August, September and October. Agreement with (rural) municipalities achieved in September-October that created collaboration with local government, completed selection of CPSWs and CPSW coordinators (during October-November) and completed CPSW training in November- December of 2018. CMC-Nepal’s support and effort mostly focused to institutionalize of GBV prevention and response mechanisms in to local government (rural) municipalities which was one of the important goal of the project for sustainability of services to GBV survivors. CPSWs and CPSWs' coordinators selected into (rural) municipalities have salaried status and become staff of municipality that provides good evidences of sustainability of response mechanism in GBV. Service providing team of OCMC (case managers, staff nurse) safe house and municipality (CPSWs and their coordinators) have shown confidence to work in GBV cases, to coordinate and referral of GBV cases into required service providing stake holders. Supervision workshops have further supported to CPSWs to enhance their understanding in GBV related issues-unequal power dynamics, meaning of gender discrimination/violence and its need to balance, understand issues, reducing tendency of being judgmental while attending the GBV cases, self-care issues of CPSW and coordination and referrals for further support. The CPSWs have started referring GBV survivors to OCMC and in coordination with respective Ward office and (rural) municipalities. CPSWs of (rural) municipalities) involved in creating awareness in GBV prevention and referral through community groups—girls groups, watch group, child clubs, mothers groups, women cooperatives, local police etc.

1An Outcome is the likely or achieved short term and/or medium-term effect of an intervention’s outputs against the logical framework or an equivalent Results Framework. The progress report must document changes at both population and organization/institution level (including behavioural changes).

Now the communities where the project is being implemented have been much more informed of the GBV issues and challenges, and become courageous to voice their views to the (rural) municipality representatives. CPSWs showed confidence to follow-up of GBV cases returned after services of referral institute (OCMC, safe house).The increased number of cases in the 4th quarter (141) at the OCMCs indicated the effectiveness of CPSWs, Case Managers, PS Counsellors, and psychosocial Supervisors' hard work to revive GBV prevention and response mechanisms. Based on activity report, Case Managers and PS Counsellors, CPSWs applied 60—70% of their knowledge to identify, support and refer cases to OCMC and other service providing agencies.

Case Managers have developed better skills in assessing overall situation of GBV survivors and case management competencies in coordination with various service providers through OCMC and out-reach services. Backstopping supervision has helped case managers and psychosocial counsellors to improve understanding on GBV which helped them realize how each one of them experienced GBV phenomena in many ways in their own communities, how that had impacted into their behaviour, mental and physical health etc. The supervision also helped them to realize the impact of patriarchal social norms, values, cultural practices, religious beliefs in women and how such practices contributed to perpetuate the incident of GBV. Clinical supervision workshop has encouraged and motivated to case managers and counsellors to work more creatively and constructively, and to make things more context appropriate.

The project activities contributed to link and strengthen the mental health and psychosocial services through existing structure of OCMCs. The Case Managers have maintained proper communication with the concerned service seekers, enhanced coordination with the health service providers at hospital and health facilities; provided psycho-education which focused on causes, symptoms, and intervention, and continued to follow with needy case and her family members. GBV cases being received services from OCMC have expressed good level of satisfaction (75—80%) based on the exit poll interview (EPI). CMC-Nepal's involvement in maintaining smooth and conducive relationship with the (rural) municipalities to strengthen partnership for smooth running of the GBV program activities was noteworthy. Formal and informal meetings, clarification of the issues emerged while working, sharing of experiences and intervention approaches with the (rural) municipality representatives made them feel the importance of GBV program activities in the long run. A total of 586 individual GBV survivors received services from OCMC in 2018 from three districts (Okhaldhunga, Sindhuli, Udayapur see Annex 1). Similarly, CPSWs provided basic community-based psychosocial support in coordination with Case Managers, PS Counsellors and CPSW Coordinators to 2146 (1695/F and 451/M) cases (see Annex 2).

Outcome 2: Duty bearers respond effectively to gender-based violence in the working districts and increasingly at national level

CMC-Nepal coordinated to make regular monitoring visits to observe Rupantaran course with the Social Development Sections of (rural) municipalities, based on the structured formats which focused on the quality of training, changes cultivated by the trainee participants, practicability of the contents, capacity of the trainees to share learning with others in the community etc. Elected as well as administrative members from (rural) municipalities observed Rupantaran course and one of the representatives stated, "this course should be continued with as many children as possible". Main agendas of the supervision were: marital conflicts; adjustment problems; substance abuse; cases of sexual violence, abuse, and harassment; suicidal ideas and threatens; coordination, communication to new referral channels.

Service providing team of OCMC (case managers, staff nurse) safe house and municipality (CPSWs and their coordinators) have shown confidence to work in GBV cases, to coordinate and referral of GBV cases into required service providing stake holders. Supervision workshops have further supported to CPSWs to enhance their understanding in GBV related issues-unequal power dynamics, meaning of gender discrimination/violence and its need to balance, understand issues, reducing tendency of being judgmental while attending the GBV cases, self-care issues of CPSW and coordination and referrals for further support. The CPSWs have started referring GBV survivors to OCMC and in coordination with respective Ward office and (rural) municipalities. CPSWs of (rural) municipalities) involved in creating awareness in GBV prevention and referral through community groups—girls groups, watch group, child clubs, mothers groups, women cooperatives, local police etc. CPSWs showed confidence to follow-up of GBV cases returned after services of referral institute (OCMC, safe house). The increased number of cases in the 4th quarter (141) at the OCMCs indicated the effectiveness of CPSWs, Case Managers, PS Counsellors, and Psychosocial Supervisors' hard work to revive GBV prevention and response mechanisms. Based on activity report Case Managers and PS Counsellors, CPSWs applied 60—70% of their knowledge to identify, support and refer cases to OCMC and other service providing agencies. Case Managers have developed better skills in assessing overall situation of GBV survivors and case management competencies in coordination with various service providers through OCMC and out-reach services. Backstopping supervision has helped case managers and psychosocial counsellors to improve understanding on GBV which helped them realize how each one of them experienced GBV phenomena in many ways in their own communities, how that had impacted into their behaviour, mental and physical health etc. The supervision also helped them to realize the impact of patriarchal social norms, values, cultural practices, religious beliefs in women and how such practices contributed to perpetuate the incident of GBV. Clinical supervision workshop has encouraged and motivated to case managers and counsellors to work more creatively and constructively, and to make things more context appropriate. Service providers at OCMC (case managers,

staff nurse, PS counsellors) and safe house staff demonstrated self-caring behaviour, maintain emotional stability and cope with work and daily stresses. Distance coaching sessions with Case Managers and PS Counsellors supported in addressing case management issues and challenges without any confusion. Cases served by psychiatrist and PS counsellor/ case managers have shown good progress in their emotional health status, regained their social and family level functioning. The mental health problem profile showed almost 70% of the cases seen by the psychiatrist were diagnosed with Anxiety and Depression and are managed accordingly with psychosocial counselling and medicines. CMC-Nepal in coordination with UNFPA conducted a 3-days' training which encouraged the frontline workers to influence the local level governments to think more creatively so as to make GBV prevention and response activity as an essential agenda in the planning process.

Chapter 4 Outputs Achieved and performance (with details of each activities performed under each outcomes with data tables/graphs and pictures of events)

Outcome 1: Men and women in working districts increasingly prevent, report and address Gender-based Violence Output 1.1: Women Cooperatives2 (WC) have established functioning GBV watch groups and adolescent girls groups to address gender-based violence

CMC-Nepal engaged in accomplishing the planned activities right from the beginning of the year 2018. All 26 sessions of the Rupantaran course was completed in Phase I, and as for Phase II, Siddhicharan municipality completed all 26 sessions, Triyuga 10 and Dudhauli completed 16 sessions. Ten days community-based psychosocial support training was conducted in each district. 85 CPSWs and 7 CPSW coordinators received knowledge and skills on community based psychosocial support mechanism in coordination with municipalities. Twelve events of backstopping supervision conducted, two in each district, with7 Case Managers, 3 PS Counsellors, and 4 Staff Nurses based at the OCMCs. The main objective of the supervision was to strengthen case management skills in GBV cases.

Table showing OCMC-based staff members: District Case Manager Staff Nurse PS Counsellor Total Okhaldhunga 3 1 1 5 Udayapur 2 1 1 4 Sindhuli 2 1 1 4 Total 7 3 3 9

360 adolescent girls from 18 different girl-groups received 264 sessions in Phase II. It was learned that the participants liked the course; it made them more expressive of the deeply rooted stigmas, they initiated coordination with the community groups. Of the total 586 GBV survivors at OCMCs, 251 from Okhaldhunga (188/F and 63/M); 75 Mission Hospital (71/F and 4/M); 135 Sindhuli (129/F and 6/M); and 125 from Udaypur (111/F and 14/M) received mental health and psychosocial counselling services. Individual cases received services from OCMC:

District Female Male Total Okhaldhunga 188 63 251 Sindhuli 129 6 135 Udayour 111 14 125 Mission 71 4 75

Hospital Total 499 87 586

2Women’s Cooperatives are community-based organizations set up by the Women and Children Offices. According to national guidelines, the WCs have to set up GBV watch groups in every ward and lead adolescent girls groups

The case managers, PS counsellors, safe house coordinators and OCMC based staff nurse perceived the Care for Care Givers training to be effective in dealing working and every day stresses. The pre-test average score indicated to be 79.4% and the post score was 87.2% which indicated that the training content and methodologies was effective. In the feedback report of the 18, 14 participants rated the training to have been excellent, whereas for 4, it was very good. The monitoring visit and the regular meetings/interactions with the local government helped to increase the number of girls participants in social and financial skills program, reduce stigma associated with adolescent health, raise awareness on child right, prevention of early marriage etc.

Output 1.2: Men and boys have acquired the capacity to engage in the prevention of and response to GBV

Eights groups of couples training was conducted with 246 participants (124/F and 122/M), which included the numbers of all project districts mainly during first quarter of reporting year.

Gender Okhaldhunga Sindhuli Udayapur Total Male 31 60 31 122 Female 33 60 31 124 Total 64 120 62 246

Four couple-groups were conducted in Sindhuli with 120 (60/F and 60/M) participants, 2 groups with 64 participants (31/F and 33/M) in Okhaldhunga and 2 groups in Udayapur with 62 participants (31/F and 31/M). Gender and GBV training contributed for better understanding of gender, patriarchal concept deeply rooted in the society and thinking, and role of men and women in gender socialisation. The trained couple showed improved understanding on the effect of unequal power relations between men and women (couples) in family and society and they were found motivated to show respectful behaviour and stop violence behaviour with spouse. However this activity has been stopped after recommendation of MTR since second quarter.

Output 1.3. Civil Society Organisations, media and research organizations engaged in evidence based advocacy for an improved response to GBV by Government actors at district and national level...

CMC-Nepal organized women's day in collaboration with the local stakeholders—police, (rural) municipalities, Women and Children's Office (previous WCO) etc. with the aim and objective of empowering women, and also having the men together to create awareness on prevention of GBV e.g. to stop child marriage and create awareness the legal aspects and consequences of early marriage etc. Rallies were held with the key notes on behalf of the Mayer of Okhaldhunga, previous WCO of OKH, and Chairperson of the Women's

Cooperatives. Mayor, Deputy Mayor, 20 CPSWs and 10 Women Cooperative members also attended the program with enthusiasm and motivation. There were 145 participants from different locations of Siddhicharan Municipality. The Mayor also put emphasis on the Rupantaran sessions conducted with girls groups. On the same day (March 8), there was another program to mark in Harkapur with 150 participants.

Also, that the International Girl Child Day was marked with different awareness raising and sensitizing activities in all three project (rural) municipalities of Okhaldhunga. Siddhicharan Municipality conducted an Speech Competition program among the school going children with a focus on the issues of gender discrimination, importance of educating the girls etc. Similarly, Molung Rural Municipality organized an interaction program among the stakeholders, and in Manebhangyang, a lawyer had session on the legal aspect of early child marriage, human and women's rights etc. The 16-days activism was also marked in Okhaldhunga with awareness campaigns and visited local schools of the respective (Rural) Municipalities and then conducted interaction sessions. The theme of the 16 Days of Activism in 2018 was: "End Gender-Based Violence in the World of Work".

Outcome 2: Duty bearers respond effectively to gender-based violence in the working districts and increasingly at national level Output 2.1: Women and Children Development Offices, police, and legal service providers have been enabled to prevent GBV and respond to GBV

GEEGBVDCC meetings were conducted on the regular basis through Women's Cooperatives at the beginning—until mid-2018. The GEEGBVDCC interacted on the issues and progress of the GBV program activities, and mainly the Rupantaran sessions that has gradually been helping bring changes in the behaviours of the adolescent girls. But it could not happen as before due to changed political context (federal structure); the policies were yet to be made to have the committee under legal provision. It is expected to be had in 2019.

Evaluation of the Rupantaran course took place with the structured forms and formats developed by Restless Development, an INGO that facilitates it. Frequent monitoring visits of the program activities supported in maintaining quality of the services offered and go ahead with the course accordingly. The girls who attended the course were encouraged to increase their outreaches to the community houses and invite the girls to receive training sessions, in both the Phases -- I and II of the Rupantaraan course, the WCs made visits, observed sessions, interacted with the participants. One event of quarterly review meeting was made in coordination UNFPA, with all 10 Women Cooperatives in May which mainly emphasized on the progress of previous year's decisions/commitments and further discussed on the reasons behind their failure to further implement. Community groups' involvement and interest to the GBV program activities greatly drew attention of the local governments and somehow made responsible to own the GBV program activities from 3rd quarter onward. Ten girls who received education support were happy to regularly attend sessions, encouraged other neighbouring girls to attend the sessions. Monitoring visits were by the (rural) municipality representatives in the last quarter of 2018 to observe the GBV prevention and response activities being implemented in the project districts. This

was important as it helped to realize the local level governments to take initiatives and start with the GBV program activities in their planning process. CMC-Nepal worked intensively to get the GVB prevention and response activities recognized by local level government and concerned stakeholders. In the later months of the year, it was felt of the communities being more courageous to seek support, make advocacies, generate ideas on the need of GBV activities, being more responsible, better coordination and understanding, linkages and capacity with the OCMCs, girls being more positive to invest their time and energy to spread the message that there should be equality and equanimity among boys and girls in any situation and context.

Output 2.2: Women Service Centres (Safe Houses) have been established and are functional in the working districts, with links to capable referral safe houses in Kathmandu

CMC-Nepal conducted a care for care givers training with the field level staffs that enhanced their understanding and confidence on the GBV case management and clinical skills. Case managers, PS counsellors, safe house coordinators and OCMC based staff nurse perceived the care for care givers training to be effective and helpful in their day-to-day activities to support the survivors of GBV. The pre-test average score indicated to be 79.4% and the post score was 87.2% which indicated that the training was a good support to the participants to increase their skills, knowledge and capacity to address the prevalent GBV issues in the project locations. The clinical supervisors offered regular supervision and mentoring to safe house in charge together with case managers and PS counsellors based at OCMCs, strengthened case management mechanism, developed coordination, cooperation and understanding with the hospital management system. Case managers and PS counsellors at OCMCs dealt with the cases such as stress, trauma, anxiety, depression, adjustment problems, marital conflicts, alcohol and substance, sexual difficulties etc., following bio-psychosocial model of intervention. Of the 165 hours of distance coaching, 40% of the time was spared with case managers and 60% with PS counsellors. This support enhanced clinical and psychosocial case management competency of the case managers and PS counsellors, based at OCMC/district hospitals to deal/intervene the cases having GBV problems. Further distance coaching supported PS counsellor in the coordination and interaction with (rural) municipalities.

Output 2.3: Health facilities in the working districts have the capacity to provide adequate medical services and community based psychosocial case management for GBV survivors and their families

CMC-Nepal worked to intensifying linkages, coordination, support mechanism, referral pathways, case identification, orientation and communication with the local level governments. Of the total 586 GBV survivors, 251 from Okhaldhunga (188/F and 63/M); 75 Mission Hospital (71/F and 4/M); 135 Sindhuli (129/F and 6/M); and 125 from

Udayapur (111/F and 14/M) received mental health and psychosocial support services. Individual cases received special mental health and psychosocial services from OCMCs. The survivors attended the clinic and received holistic services, were referred to the needy service centres. The GBV clinic in Okhaldhunga Community Hospital provided mental health and psychosocial support to the survivors to a significant number of GBV (71/F and 4/M) survivors in 2018. The clinic based staff members—a staff nurse and a case manager maintained coordination with the hospital system, referred cases to the locally available facilities. Output 2.4: Ministry of Women, Children and Social Welfare and Ministry of Health are supported with evidence to develop policies and plans

CMC-Nepal strongly involved in the organization first international mental health conference where research papers (poster, oral) presented in GBV issues, mental health issues and gaps in services, the declaration of two days conference owned by secretary of Ministry of Health and Population and Ministry of Women and Children in February 2018. In order to have an effective result with the activities implemented, CMC-Nepal conducted a training very useful for the Local Level Planning Process which helped the participants from UNFPA and its Partnership Agencies' staff members working for the GBV Prevention and Response Project in enhancing capacity on constitutional and legal framework and planning process and GESI & GBV to make them highly compatible for main-streaming their plans, programs and projects in effective and efficient manner to address their objectives set. There were 24 participants to receive the mentioned training which supported to be more careful on the gender in relation to legal issues, exploring possibilities with the local governments to go on with the GBV program activities right from the planning. The participants made commitments to approach the local government with some creative views and ides to continue with the GBV program activities.

Chapter 5 5.1 Project Management and Financial Resources CMC-Nepal has one full time project coordinator (male), 3 psychosocial counsellors (2 female and 1 male), one full time district project officer (male) one part-time technical director (male, 30%), one part time senior psychologist (female, 50%) and one full time finance officer (female). The team of psychosocial experts at CMC-Nepal is responsible for the capacity building of the Service providers at OCMC (case managers, staff nurse, PS counsellors), along with the CPSWs who have identified GBV survivors, provided psychosocial support and referred to OCMCs for the comprehensive services. CMC-Nepal is also in role of coordination and collaboration with the (rural) municipalities to further sensitize them to integrate GBV prevention and response activities in regular activities of (rural) municipalities.

Based on the signed Implementing Partner (IP) Agreement and Work Plan between UNFPA and CMC-Nepal, a further partnership agreement was signed between (Rural) Municipalities and CMC-Nepal on the third quarter of this year. CMC-Nepal provided technical support to hire and train Community Psychosocial Workers (CPSWs) and CPSW coordinators. (Rural) Municipalities hired 85 CPSWs (Janajati-36, Brahmin/Chhetri - 35, Dalit-9 and Madhesi-5) in Okhaldhunga, Sindhuli and Udayapur and 7 CPSW Coordinators (Brahmin/Chhetri -5 and Janajati-2) in Sindhuli and Udayapur districts on a cost sharing basis with UNFPA. The CPSWs and CPSW Coordinators were provided with ten-days training on Basic Psychosocial Support Skills and reporting and referral channels. Now, they have been working in their respective assigned Wards in close coordination with Ward Committees. CPSWs have been providing community-based psychosocial support in coordination with Case Managers, PS Counsellors and CPSW Coordinators and referring the GBV survivors to OCMCs for further psychosocial counselling and other services. And Likewise, there are six case managers (2 each in 3 OCMC district hospitals, all are female) and one staff nurse (female) and one case manager (female) in the GBV Clinic of Okhaldhunga Community Hospital, who is providing psychosocial counselling. CMC-Nepal has also signed a further partnership agreement with Okhaldhunga Community Hospital to execute the GBV prevention and response activities from the hospital and their outreach service. The staff composition in CMC-Nepal in this project indicates diverse representation in terms of gender, caste and ethnicity so there is no such diversity management issues. CMC-Nepal respects the diversity management and takes actions accordingly in recruitment and training.

CMC-Nepal disburses the funds to the (rural) municipalities and Okhaldhunga Community Hospital in advance basis based on the authorized quarterly funds received from UNFPA. The (rural) municipalities have been made responsible to settle the advance in each quarter, along with the certified invoices and other supporting documents. Orientation was provided from CMC-Nepal to the finance persons of the (rural) municipalities and CPSW coordinators on the financial aspects of the projects and required supporting documents to be collected.

The financial resources of the project were the funding received from UNFPA and contribution received in a range of 30-50% from 9 (rural) municipalities in cost sharing basis. The contribution received from the (rural) municipalities was directly used for the salary of CPSW and CPSWs coordinators.

5.2 Percentage of budget spent vs. planned budget: The total budget of the psychosocial component in GBV prevention and response project of the year 2018 is NPR 27,136,406 and the actual expenses of this year is NPR 23,823,925.68 (88% of total approved work plan budget). CMC-Nepal has received NPR 23,969,466.65 from UNFPA in year 2018 and the positive balance at the end of the year 2018 is NPR 145,540.97.

There is under spending in three outputs (output 1.1, output 2.2 and output 2.4) and the reasons on budget deviations (under spending) of the above output is described below.

Output 1.1 • Budget allocated for the second phase of Rupantaran course is only consumed 60%. There are 10 sessions in each girls group of Dhudhauli rural municipality and 16 sessions in Triyuga yet to be carried out. • The education support to the adolescent girls was only provided in Siddhartha municipality of Okhaldhunga. The process of selecting needy girls for education support was initiated in Triyuga Municipality, Udayapur and Dhudhauli rural municipality in Sindhuli however actual support will be provided in the first quarter of the year 2019. • The salary, travel and accommodation to CPSW and CPSW coordinator in Sindhuli is less consumed than the approved budget due to the delay in recruitment in two (rural) municipalities.

Output 2.2 • Backstopping supervision and mentoring on case management through conducting field level supervision was merged with the group supervision workshop to the CPSWs and there was less budget consumed in travel of the psychosocial experts of CMC-Nepal to conduct the field level supervision for the case managers.

Output 2.4 • The actual requirement of the budget for the consultant and fooding/accommodation was less than the planned so budget is less consumed in organizing Local level Planning Process

Chapter 6 Lessons Learnt

• It needs to have adequate time to develop linkages with the local governments as present cooperation has been established only since last quarter of reporting year. Still needs more discussion, sharing and communication for sustainability of the GBV program activities. • The partnership modality working with the (rural) municipalities’ has cultivated a sense of ownership to continue with GBV program activities and integrate GBV issues in their regular planning process. • CPSWs placed in (rural) municipalities felt they are being owned by municipalities and recognized their work in GBV area. CPSWs received request from elected representatives of ward to support the GBV cases they know and also started listening the concern of CPSWs when there is established cooperation with municipality team. • CPSWs have shown good motivation in attending GBV cases for emotional support and referral to OCMC and other service providers in the district. Regular distance coaching and field level backstopping support provided effective to enhance confidence to work in GBV issues. • Regular field level supervision and distance mentoring proved to be effective which could be observed in the skills and capacity demonstrated by Case Managers and PS Counsellors in managing GBV cases and feedback of the survivors received OCMC services. The GBV case management team learned the value of sharing and discussing about the management of cases for proper care and support. They learned to be patient, careful, confident, receptive, and observant while working with GBV cases. • It was realized that coordination, consultation, sharing and gathering of the project implementation partners would immensely help to achieve the objectives set. • Team work and proper communication with the concerned stakeholders strengthened GBV perspective and the level of understanding. • Constant advocacy with regard to GBV prevention and response mechanism needs to be conducted at all three layers of the governments for sustainability of the program activities in the long run.

Annexes Annex-1 GBV Service Model and Cost-Sharing Matrix

Who Rep hired Cost sharing details ortin Super Relatio CPSW CPSWs/ CPSW's g Supervi vision n s Name CPSW relatio CPSW # of chan sion mech betwee role/t of Coordin Reporting n with s task # of CPSW When Cost sharing amount % of cost sharing nel mecha anism n ask at District (Rural) ator (R) channel of Comm in CPSW Coordi hired of nism for CPSW (Rural Munici Municip CPSW unity comm nator CPS for CPSW and ) pality ality or (R) Mediat unity RM/ W CPSW Coord Ward Munic any Municip Project Total Project Total ors M Coor inator Commi ipality other ality dina ttee agency tor Coord inatio Case n, Identi Case Coordi ficatio Identi nation, n, ficatio Ward Case Basic n, Chairperson Identifi Coordi Emoti Emoti and cation, nation, onal onal Siddhic CPSW/Social Referra Referra Suppo Suppo haran Sep. Dev. Section l & l & rt & rt, Munici Municip 23, of the Reporti Reporti Reerr Repor pality 12 0 ality 2018 302,000 2,656,600 2,958,600 10.21 89.79 100 Municipality ng ng al ting OKH Coord inatio District Case n, Counse Identi Case llor/CM Coordi ficatio Identi C- nation, n, ficatio Ward Nepal's Case Basic n, Chairperson Technic Identifi Coordi Emoti Emoti and al cation, nation, onal onal Molung CPSW/Social Team Referra Referra Suppo Suppo Rural R. Dev. Section from l & l & rt & rt, Munici Municip Oct. 10, of the (Rural) Kathma Reporti Reporti Reerr Repor pality 8 0 ality 2018 360,000 794,000 1,154,000 31.20 68.80 100 Municipality ndu ng ng al ting

Coord inatio District Case n, Counse Identi Case llor/CM Coordi ficatio Identi C- nation, n, ficatio Ward Nepal's Case Basic n, Mane Chairperson Technic Identifi Coordi Emoti Emoti Bhanjy and al cation, nation, onal onal ang CPSW/Social Team Referra Referra Suppo Suppo Rural R. Dev. Section from l & l & rt & rt, Munici Municip Nov. 1, of the (Rural) Kathma Reporti Reporti Reerr Repor pality 9 0 ality 2018 - 1,079,400 1,079,400 0.00 100.00 100 Municipality ndu ng ng al ting Soci al CPSW Distric Dev Coordi t Coord elop naator/ Couns inatio men District ellor/ Case n, t Counse CMC- Identi Case Secti llor/CM Nepal Coordi ficatio Identi on C- 's nation, n, ficatio of Nepal's Techn Case Basic n, Mun Technic ical Identifi Coordi Emoti Emoti icipa al Team cation, nation, onal onal Kamala Ward lity Team from Referra Referra Suppo Suppo mai Nov. Chairperson and from Kath l & l & rt & rt, Munici Municip 18, and CPSW OC kathma mand Reporti Reporti Reerr Repor pality 7 1 ality 2018 500,000 2,451,584 2,951,584 16.94 83.06 100 Coordinator MC ndu u ng ng al ting Sindhul Soci i al Dev elop CPSW Distric men Coordi t Coord t naator/ Couns inatio Secti District ellor/ Case n, on Counse CMC- Identi Case of llor/CM Nepal Coordi ficatio Identi (Rur C- 's nation, n, ficatio al) Nepal's Techn Case Basic n, Mun Technic ical Identifi Coordi Emoti Emoti Dudha icipa al Team cation, nation, onal onal uli Ward lity Team from Referra Referra Suppo Suppo Rural R. Chairperson and from Kath l & l & rt & rt, Munici Municip Oct. 22, 1,185,00 and CPSW OC kathma mand Reporti Reporti Reerr Repor pality 14 1 ality 2018 0 1,969,100 3,154,100 37.57 62.43 100 Coordinator MC ndu u ng ng al ting

Soci al Dev elop Distric men t Coord t Couns inatio Secti CPSW ellor/ Case n, on Coordi CMC- Identi Case of naator/ Nepal Coordi ficatio Identi (Rur CMC- 's nation, n, ficatio al) Nepal's Techn Case Basic n, Mun Technic ical Identifi Coordi Emoti Emoti icipa al Team cation, nation, onal onal Sunkos Ward lity Team from Referra Referra Suppo Suppo hi Rural R. Chairperson and from Kath l & l & rt & rt, Munici Municip Oct.26, and CPSW OC kathma mand Reporti Reporti Reerr Repor pality 7 1 ality 2018 707,500 867,000 1,574,500 44.93 55.07 100 Coordinator MC ndu u ng ng al ting Soci al CPSW Distric Dev Coordi t Coord elop naator/ Couns inatio men District ellor/ Case n, t Counse CMC- Identi Case Secti llor/CM Nepal Coordi ficatio Identi on C- 's nation, n, ficatio of Nepal's Techn Case Basic n, Mun Technic ical Identifi Coordi Emoti Emoti icipa al Team cation, nation, onal onal Ward lity Team from Referra Referra Suppo Suppo Triyuga Chairperson and from Kath l & l & rt & rt, Munici Municip Oct. 1, and CPSW OC kathma mand Reporti Reporti Reerr Repor Udayap pality 7 1 ality 2018 660,461 2,480,039 3,140,500 21.03 78.97 100 Coordinator MC ndu u ng ng al ting ur Soci al CPSW Distric Dev Coordi t Coord elop naator/ Couns inatio men District ellor/ Case n, t Counse CMC- Identi Case Secti llor/CM Nepal Coordi ficatio Identi on C- 's nation, n, ficatio of Nepal's Techn Case Basic n, Mun Technic ical Identifi Coordi Emoti Emoti icipa al Team cation, nation, onal onal Ward lity Team from Referra Referra Suppo Suppo Katari Chairperson and from Kath l & l & rt & rt, Munici Municip Oct. 4, and CPSW OC kathma mand Reporti Reporti Reerr Repor pality 7 1 ality 2018 423,461 1,151,039 1,574,500 26.89 73.11 100 Coordinator MC ndu u ng ng al ting

Soci al CPSW Distric Dev Coordi t Coord elop naator/ Couns inatio men District ellor/ Case n, t Counse CMC- Identi Case Secti llor/CM Nepal Coordi ficatio Identi on C- 's nation, n, ficatio of Nepal's Techn Case Basic n, Mun Technic ical Identifi Coordi Emoti Emoti icipa al Team cation, nation, onal onal Ward lity Team from Referra Referra Suppo Suppo Belaka Chairperson and from Kath l & l & rt & rt, Munici Municip Oct. 1, and CPSW OC kathma mand Reporti Reporti Reerr Repor pality 7 1 ality 2018 528,461 1,046,039 1,574,500 33.56 66.44 100 Coordinator MC ndu u ng ng al ting Soci al CPSW Distric Dev Coordi t Coord elop naator/ Couns inatio men District ellor/ Case n, t Counse CMC- Identi Case Secti llor/CM Nepal Coordi ficatio Identi on C- 's nation, n, ficatio of Nepal's Techn Case Basic n, Mun Technic ical Identifi Coordi Emoti Emoti Chauda icipa al Team cation, nation, onal onal ndigad Ward lity Team from Referra Referra Suppo Suppo hi Chairperson and from Kath l & l & rt & rt, Munici Minicipa Oct. 1, and CPSW OC kathma mand Reporti Reporti Reerr Repor pality 7 1 lity 2018 528,461 1,046,039 1,574,500 33.56 66.44 100 Coordinator MC ndu u ng ng al ting

5,195,34 15,540,84 20,736,18 Total 85 7 4 0 4 25.05 74.95 100

Annex-2 List of Municipalities selected for GBV Prevention and Response Activities

Districts Municipalities Okhaldhunga 1. Siddhicharan Municipality 2. Molung Rural Municipality 3. Manebhanjyang Rural Municipality Udaypur 1. Triyuga Municipality 2. Belaka Municipality 3. Chaudandigadi Municipality 4. Katari Municipality Sindhuli 1. Kamalamai Municipality 2. Sinkoshi Rural Municipality 3. Dudhkoshi Rural Municipality

Annex-3 A full overview of cases supported by the CPSWs

CASES IDENTIFIED/SUPPORTED BY CPSWS (JAN. – DEC. 2018)

CASES IDENTIFIED/SUPPORTED FOLLOW-UP DISTRICT BENIFICIARIES BENIFICIARIES OKHALDHUNGA 137 135 SINDHULI 490 190 UDAYPUR 765 421 TOTAL 1392 746

Annex 4: DATA OF GBV CASES DATA JAN--DEC. 2018 OKHALDHUNGA SINDHULI UDAYPUR TOTAL Family 74 74 45 193 Counseling Individual 326 135 125 586 Services Psycho-education ퟏퟎퟒ ퟑퟕퟎ ퟏퟖퟐ 656 Brahmin 42 2 15 59 Chhetri 86 33 33 152 Janajati 113 65 37 215 Madhesi 1 1 1 3 Ethnicity Tharu 0 0 14 14 Dalit Pahadi 77 32 25 134 Dalit Madhesi 6 0 0 6 Others 1 2 0 3 Married 239 96 1 426 Unmarried 83 38 30 151 Marital Single 0 0 4 4 Status Divorced 4 1 0 5 Separated 0 0 10 10 Sexual Violence (Rape, Sexual 17 21 32 70 Type of Assault GBV Forced Marriage 2 3 0 5 Physical Abuse 78 52 26 156 Mental 204 33 60 297

Torture/Emotional Abuse Deprived From 12 10 0 22 Resources Dowry, Blame of 6 0 0 6 Witch Child 16 3 26 Marriage/Polygamy 7 Others (includes 0 4 4 mental Illness etc.) 0 CPSW 116 68 61 245 Self 25 29 20 74 WC 2 2 0 4 Referred Safe House 12 3 88 103 from Police 25 31 24 80 WCDO 3 0 0 3 Health Center 117 0 3 120 Others 26 2 9 37 Safe House 25 12 8 45 Police 39 33 21 93 CMC-Nepal 3 0 0 3 Health Center 51 0 24 75 Referred Legal Service 0 5 0 5 to Apeiron 2 6 5 13 Koshish 5 3 5 13 WCO 0 0 2 2 Others 0 0 2 2 Not Referred 201 29 24 254 Psychiatric Services 26 25 34 85 Follow-up cases 224 65 115 404

Annnex-5 : Human Interest Stories

A Case Supported by the Case Manager A woman of 20 married to a man of 40 years old. She was a second wife and had a 3 years old daughter. When her daughter was of one year old her husband decided to go for a foreign employment. He was nice to her and used to send money for one year at the beginning. After a year, her sister-in-law who was staying with her started behaving rudely. Sister-in-law informed to her husband that she spent money unnecessarily and spent time with other man. So, he stopped sending her money and started sending money to his sister. She than started having difficulties in managing finance and daily chores. Further husband started scolding and blaming that she might have an affair with other men and being honest to him. He returned back in two years and started abusing physically so she had to run away from home. She tried her best to save her married life when it was difficult she filed the case in police. Police referred the case to OCMC. When case manager saw her for the first time she was weak, pale, thin and sad. In the first session she expressed her wish to commit suicidal because she felt life is no worth of living. With adequate activity to build rapport with her, case manager started focusing to work on her feelings, provided time to vent her difficult emotions, supported to cope with suicidal ideas and low self-confidence. With few sessions of counselling (four time), client started feeling better, could win over on self-harming ideas rather decided she should fought for her right instead of escaping from trouble making husband. OCMC facilitated coordinating her with lawyer for legal remedies on her issues, she got legal divorce with the support of lawyer and got her property from husband. In this whole process OCMC made coordination between police and lawyer. She had come to OCMC for few more times after her divorce and she explained to case manager that she is relieved from threat and fear of her husband and now she is living peacefully. She is concerned about her daughter and she works and earns money which is sufficient for her and daughter. She wants to support and raise awareness about violence in her community and she wants to save many other's life who is suffering from gender based violence.

Annex-6 Photoes with title ( training, beneficiaries’ activities, monitoring),

[Local Level Planning Process Training]

Ms. Pratibha, the GBV project Coordinator from UNFPA, orienting on GBV issues during a ten- day training in Udaypur]Participants during the training]

[Care for care Giver's Training in Kathmandu]

[Ten days training in UDP]