Care Uganda: ROCO KWO – Transforming Lives of Women Affected by Conflict Rose Amulen, Tilman Brück, Veronica Eragu, Pia Peeters and Aki Stavrou

Opportunity (WHY?)  Conceptually: Lack of evidence of which approaches to address psychological distress/trauma are effective for survivors of Sexual and Gender Based Violence (SGBV) and other conflict-affected populations.  Operationally: Care Uganda is starting a 15-year program of activities to help most vulnerable war affected women, including victims of SGBV in Northern Uganda.  This evaluation offers an opportunity to improve programming in Northern Uganda at the start of a long-term program and also to inform other programs in similar settings in other countries.

Project description  Care Uganda is starting a 15-year program  Aims to further development of vulnerable women in post-conflict Northern Uganda  Intervention will offer economic and psychosocial support through a variety of measures at the individual, household, group and community levels.

Strategies :  Promoting women’s empowerment Women’s vulnerability to rights denial and abuse- closely linked to the level of economic and social power –(H/h, community level) Promote a shift in the power relations that cause women to suffer low social status/ systematic injustice Addressing the psychosocial needs of the community over 20 years of conflict. Associated abuses, trauma, frustrations and vulnerability to- severe psychiatric symptoms, substance abuse, gynecological complaints, HIV/AIDS infection, low self-esteem, suicidal tendencies, stigmatization, dehumanizing consequences of war. Psychosocial support will be provided through community structures, referrals to other key service providers including health, justice and security Support envisaged to create social change, build self esteem, reduce PSS burden, strengthen coping mechanism.

Research questions Objectives of the impact evaluation  To generate evidence-based learning on impact of psychosocial assistance / counseling on functionality and well being (aspects include mental, social, physical and economic) for women survivors of war- related GBV / vulnerable women and their family members impacted by conflict.  What are the questions?  1. What type of psycho-social/counseling support works best? (individual, family counseling, group counseling, women support groups, combination)  2. How does psycho-social/counseling help vulnerable women?  3. Does psycho-social/counseling work better when combined with livelihood support?

Indicators  Indicators of well-being  subjective well-being (life satisfaction etc)  ‘objective’ measures of well-being (assets, food security, mental health indicators etc)  Indicators of functionality (behavior patterns)  measures of economic and social activities  Both at the individual and family/ household levels  for example the well-being of children

Identification strategy  Eligibility and selection rules  4 districts in Acholi sub-region in Northern Uganda  in there choose 16 vulnerable sub-counties  in there choose 80 vulnerable villages  in there choose 4800 vulnerable women  add another 4800 women in years 2 and 3 each  i.e. no random selection, no representativeness

Ethical considerations  Ethical considerations: 1. Evaluation will exclude the most traumatized women (in acute need of medical care &/or referral to specialized services). 2. No village or woman will be deferred treatment in the interests of the evaluation. 3. Program delivery mechanisms and content will not be altered in the interests of the evaluation. 4. Selection not randomised – treatment & control subjects chosen specifically because of traumatic experience.

Sampling considerations  Client (Treatment )Group:  No of villages &respondents within villages to be decided after timing, capacity & budgets resolved.  Selection of clients to be staggered over villages selected for Program Intervention in Years 1 & 2.  Control group – 5 options:  Additional Villages  Future Villages  Extra Participants  Alternative Mechanisms  Combination Approach

Rapid Vulnerability Survey (RVS)  A RVS will be administered to both treatment and control groups.  In control groups where program intervention is phased into future delivery or not available, low- risk trauma identification criteria will be used.  Identification criteria will be used to rank and match clients and control group women into possible generic sub-categories.  If severely or high-risk traumatised survivors identifies in RVS in control groups, they will be immediately offered counselling and support.

Control Group – Option A  Additional Villages (to Program Intervention Villages):  Chosen that are completely distinct & independent from those participating in the program.  Ideally not having any other like or otherwise development program being delivered during IE timeline.  Will be identified in a similar process as defined under eligibility – program villages.  Should have similar characteristics on average to the program villages (i.e. be similarly vulnerable) – RVS to fine-tune.  Conceptually, this is the most powerful approach.  Ethical considerations re: not providing services to vulnerable women.  Cost considerations.

Control Group – Option B  Future Program Intervention Villages:  Use phasing-in feature of the project to identify control groups.  Draw from villages scheduled for late 2 nd & 3 rd year wave of the program.  Will administer RVS for baseline - ask potentially high-risk traumatizing questions later on (just before the intervention) as these will be long-term recall issues.

Control Group – Option C  Extra Participants within Program Intervention Villages:  Increase sample of vulnerable women for the same villages.  Permits the marginal impact of expanding the project in each village to be determined.  2 variant approaches: 1.Ask group selection committee to extend the vulnerability group beyond the 60 most vulnerable women selected for treatment by a further 60 and who will comprise the control group. 2.Through RVS to be conducted to a random sample of non-client women (post client selection), calculate a vulnerability score to determine a sample of women who are similar to the client women selected by the participatory approach, to whom the RSV also administered.

Control Group – Option C (cont)  Ethical considerations of not providing full-treatment to control group. Basic treatment would be extended.  Cost implications of extending basic treatment in each sample village.  Disadvantage is that this approach will not capture the spillover effects of the program within a village (i.e. the evaluation will underestimate the effect of the intervention).

Control Group – Option D  Alternative Mechanisms (Differentiated Program Delivery to Program Intervention Villages):  The program could pre-determine which types of trauma counseling & livelihoods support (if any) will be made available to each of the villages.  Multiple combinations of different treatments, implementation processes and mechanisms could be tested.  Advantage is - this requires less surveying than any other approach.  Disadvantage is - will not be able to identify the basic effects of the program. (if different measures have positive but similar effects, then in a comparison of these measures one would hardly detect a significant difference.)  Does involve altering project design

Control Group – Option E  Combination Approach  Strong case for adopting some or all of these measures in combination.  Advantage:  each approach permits a different type of analysis.  Allow for differentiated learning on the program  Complementarity will enable a more complete picture overall.

Timeline  Finalize draft impact evaluation concept note (July 2010)  Workshop with CARE to finalize Impact Evaluation design (September 2010)  Initiate baseline survey (November 2010, tentatively)  Take it from there

Impact evaluation team  CARE staff (Care Uganda and Care Austria, Rose, program director, CARE director, M&E officer, program staff at the field level)  World Bank (DC based staff and Kampala based staff, Pia, Aki, Veronica)  DIME: Tilman and his team, field based coordinator

Thank you