In response to knowledge gaps about the scope and quality of gender-based violence (GBV) prevention and response services, the USAID/Ethiopia Transform: Primary Health Care project conducted a landscape analysis to comprehensively understand and strengthen the health system’s existing services. This landscape analysis was the first of its kind in Ethiopia and informed key actions that the project is currently implementing with the Ministry of Health to improve the quality of GBV prevention and response services within the Ethiopian health system. This poster presentation will share the regional case study methodology used to evaluate these services. The evaluation design combined qualitative and quantitative data collected from a targeted sample of facilities within primary health care networks to construct four in-depth, context-specific regional case studies and a final synthesis report of findings and recommendations. The presentation will also highlight the study’s appreciative and participatory approaches, utilization focus, and emphasis on ethical standards.
Statement of Relevance:
This poster presentation will visually highlight several evaluation best practices that the USAID Transform: Primary Health Care project applied to its landscape analysis of gender-based violence (GBV) prevention and response services in Ethiopia. We will share our regional, context-specific case study methodology, mixed-methods evaluation design, appreciative and participatory approaches, and utilization focus. This study was the first of its kind in Ethiopia and enlightened stakeholders on key knowledge gaps that inspired them to take action to improve GBV prevention and response services within the Ethiopian health system.
A case study approach ensured an in-depth, contextual understanding of GBV prevention and response services within a sample of primary health care networks in four project regions (Morra and Friedlander 1999). To construct a comprehensive picture of the availability and quality of services and identify successes and challenges, the project conducted key informant interviews with healthcare providers (at primary hospitals and health centers) and health extension workers (at health posts). This was complemented by the completion of observation checklists to assess the implementation of standard operating procedures (SOPs) at the health facilities where health care workers were interviewed. Emerging regional themes and findings were then synthesized to develop actionable conclusions and recommendations.
Appreciative inquiry (Preskill and Catsambas 2006) informed data collection and analysis, allowing a sensitive exploration of the complexities related to GBV discussions and experiences. Data collectors received comprehensive ethical training and guidance, and interview guides were carefully designed to capture both challenges and successes of existing services to strengthen and build upon what is working well within the health networks and referral systems.
The GBV landscape analysis also engaged key stakeholders throughout the various stages of the study, notably in the data consultation meeting where findings were validated and conclusions and recommendations were co-created by the individuals who would be responsible for acting upon them. This participatory approach allowed for inclusive evaluation that was in line with the views and needs of stakeholders (Institute for Development Studies 1998), resulting in a utilization focused study (Patton 1997) with concrete next steps. These actionable recommendations are being taken forward by the project and Federal Ministry of Health (FMOH) to improve GBV prevention and response mechanisms. Specific actions responding to landscape analysis findings have included the project engaging with the FMOH to support GBV strategic plan development; organizing multi-stakeholder SOP orientations; providing job aids inclusive of GBV care algorithms, SOPs, and clinical manuals; and integrating GBV prevention messaging into social and behavior change communication efforts.
USAID Transform: Primary Health Care Project. 2020. GBV Landscape Analysis Synthesis Report. Rockville, MD: EnCompass LLC.
Institute for Development Studies. 1998. “Participatory Monitoring & Evaluation: Learning from Change.” IDS Policy Briefing. Issue 12, November 1998.
Morra, Linda G and Amy C Friedlander. 1999. Case Study Evaluations. Operations Evaluation Department (OED): Washington, D.C. World Bank.
Patton, M.Q. 1997. Utilization-focused Evaluation: The New Century Text. Thousand Oaks, CA: Sage.
Preskill, Hallie S. and Tessie Tzavaras Catsambas. 2006. Reframing Evaluation through Appreciative Inquiry. SAGE Publications: Thousand Oaks, CA.