Strengthening Health System Responses to Gender-based Violence in Eastern Europe and Central Asia

A resource package

Programming for integration of GBV within Health System

5.6. Designing and implementing a monitoring and evaluation system

The monitoring and evaluation system – meaning the clarification of what should be monitored and evaluated, by whom, how and when – should be set up during the planning phase or at the latest in the beginning of implementation. A solid analysis of the problem and its context should be carried out as part of the strategy development and planning and can serve as a baseline for subsequent monitoring and evaluation.

5.5. Evaluation approaches

Many approaches to monitoring and evaluation are based on linear cause-effect models. Such models aim to logically connect a flow of inputs and activities to outputs and outcomes and to attribute change to an intervention. One of the most prominent linear models is the logical framework approach (described below). The strength of the logical framework approach is in making the underlying assumptions of one’s intervention transparent.

5.4. Monitoring and evaluation during the different phases of an intervention

5.4.1 The cycle of an intervention

Monitoring and evaluation have to be integrated into all phases of an intervention, from the planning to the implementation phase and beyond. Figure 12 illustrates these different phases, using the concept of the project cycle. This concept can also be applied to interventions other than projects, such as larger-scale interventions in health facilities, communities and at the policy level.

Figure 12: The five stages of the project cycle

5.3. Ethical considerations in evaluating interventions against gender-based violence

Collecting data on sensitive topics such as GBV often raises a number of ethical questions and safety concerns. This is especially the case when the survivor of violence is interviewed. The following concerns should always be taken into account when interviewing survivors: ensuring safety of respondents since they often live with their abuser; protecting confidentiality since breaching it could provoke an attack; making sure the interview process is non-discriminatory and does not cause distress.

5.2. Rationale and benefits of monitoring and evaluation

Monitoring and evaluation is essential to maintain or improve the quality of health system interventions against GBV and to understand whether these interventions have achieved the planned goals. Monitoring allows managers to track progress of projects, programmes or policies vis-a-vis the planned goals. Especially when new approaches are used, such as innovative early detection programmes, it is vital to closely monitor both intended and unintended results and to test and revise the assumptions on which the intervention is based.

5.1. Understanding monitoring and evaluation

Monitoring is the continuous assessmentof achievements during the implementation process.Evaluation is a periodic, comprehensive and systematic reviewof an intervention, its design, implementation and results.

Monitoring and evaluation have to be tailored for each intervention specifically. For example, monitoring and evaluation would look different for:

4.4. What health professionals can do in the absence of a formal referral mechanism

While the existence of a formal referral mechanism is an important prerequisite of effective referrals, it does not exist in all countries. In some countries, referral mechanisms might exist but the connected service providers might lack staff resources and/or infrastructure and therefore not be able to provide the full range or quality of services needed. This is what health professionals can do in the absence of a formal referral mechanism:

4.3. Steps for developing and implementing an effective referral system

4.3.1 Undertaking a situation analysis and mapping of existing services

At the outset, it is recommended to conduct a comprehensive situation analysis to assess the overall legal and institutional environment of a referral system. Also, developing a referral system does not necessarily mean establishing new services, but ratheridentifying existing services and agencies that will be included into the referral system. Therefore, it is important to obtain a comprehensive picture on services available and gaps, if any.

4.2. Key actors involved in the referral system

A referral system for GBV should involve a broad range of different stakeholders, including representatives from governmental and non-governmental organizations, including specialized women’s organizations. In countries with field presence of international organizations in the area of development or peace building/peacekeeping, relevant organizations should also be involved. Multi-sectoral initiatives work best at the local level, with agencies actually working together on a day-to-day basis (WAVE 2006).

3.4. Risk assessment and safety planning

The safety of patients who experienced GBV must be at the centre of any health sector intervention to GBV. In case of intimate partner violence, isolated occurrences of violence are rare; the danger of repeated offences is very high. In times of separation and divorce, the risk of violence even increases: The majority of murders, attempted murders and acts of serious violence are committed when a survivors attempt to leave violent partners. Ironically speaking, it may thus be safer for women to stay in a violent relationship than to end it (WAVE 2006).

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