Recommendations for innovative GBV service delivery: results of a study of mobile and remote programming in Myanmar, Burundi and Iraq

Gender-based violence (GBV), including intimate partner abuse, sexual violence and early marriage, typically increases during humanitarian emergencies, especially when crises result in displacement. Report of the Secretary-General on conflict-related sexual violence, 2017 (www.un.org/en/events/elimination-of-sexual-violence-in-conflict/pdf/1494280398.pdf). Often, people at greatest risk of GBV reside in areas that are difficult to access due to lack of infrastructure and services and security concerns. Given this, there is a need for innovative approaches that allow humanitarian actors to efficiently access and provide support to people at risk of GBV during emergencies.

In 2016, the International Rescue Committee (IRC), with the support of the US State Department, Bureau of Population, Refugees and Migration (PRM) and European Civil Protection and Humanitarian Aid Operations (ECHO), developed and piloted mobile and remote-based models of service delivery for GBV-affected populations in hard-to-access humanitarian settings. In 2017–18, independent researchers worked with IRC to assess the feasibility and acceptability of mobile and remote GBV services being piloted in Myanmar, Burundi and Iraq. This article outlines methods, key findings and recommendations from the study.

Mobile and remote programming

Mobile programming involves physical movement to sites where people are residing. It is typically used in responses to displacement in rural or urban non-camp settings, when people have difficulty accessing traditional (static) services. IRC’s Women’s Protection and Empowerment (WPE) teams provide a range of mobile programmes for women and girls, including GBV case management and group psychosocial (PSS) information sessions and associated activities, designed to increase psychosocial support, enhance life skills and provide confidential entry points for case management services.

With remote GBV service delivery, services are provided via a technology platform (i.e. a hotline, mobile application, chat or SMS) rather than in person. Remote methods are also used to provide supervision for staff and community focal points. Mobile and remote service delivery aims to address the access challenges typically faced by displaced people in emergency settings. However, these programmes can be difficult to implement and, in some cases, can introduce new challenges.

Methods

This cross-sectional mixed-methods study, together with ongoing monitoring data collected by IRC’s WPE teams in each pilot country, aimed to determine the feasibility and acceptability of mobile and remote models of GBV service delivery for women and girls. Individual interviews and focus group discussions were conducted in each country with adult women (aged 18-plus) and adolescent girls (15–17) who had recently participated in IRC’s mobile and remote programming. Interviewees were randomly selected from participants in PSS activities. A total of 151 beneficiary adults and 30 adolescents were interviewed across the three countries. IRC staff members and community focal points Community focal points are female community leaders trained to provide outreach and support psychosocial programming in safe spaces. They also assist WPE staff to better understand the cultural context and the needs of survivors, and of women and girls in general. who met the study criteria were invited to participate in either a focus group discussion or an individual in-depth interview, and asked to complete a written survey. A total of 45 staff members and 33 focal points took part across the three countries. Local non-IRC service providers, community leaders (women and men) and male community members (in Myanmar and Burundi) recruited from other IRC activities were also invited to participate in FGDs. In Iraq, FGDs also involved beneficiary community groups. A total of 150 community members and service providers participated across the three countries.

There are several limitations to the study. First, for logistical and security reasons the study was limited to mobile and remote services administered during protracted displacement, rather than short-term rapid response services. Second, although sampling was designed to enable random selection of beneficiaries from participant lists, logistical obstacles in some locations led to supplemental convenience sampling.

As a result, samples may be biased in some respects (e.g. regarding language, proximity to service sites and frequency of service use). Finally, non-service users were not sampled due to concerns from IRC regarding logistics and the ethical risks of identifying potential survivors who may have wished to remain anonymous. Because non-service users may offer important perspectives on impediments to accessing services, this gap should be considered when interpreting results.

Findings and recommendations

Detailed findings, discussion and recommendations are available in the full report. Key conclusions are summarised below. Information here is complemented by IRC’s Guidelines for mobile and remote gender-based violence service delivery developed in tandem with this study.

Programme satisfaction and access

Overall, beneficiaries were satisfied with the mobile and remote services they received and wanted more of them. People taking part in group activities across all settings reported general satisfaction with the warmth, relatability and trustworthiness of staff and the safety and privacy of case management, and frequently requested additional activities and expanded services.

Both staff and beneficiaries emphasised the role of psychosocial activities in reducing the stigma associated with seeking help and increasing confidentiality and safety for women and girls using GBV-focused services. Beneficiaries also valued the training and social support provided by group activities, such as dancing and income-generating initiatives.

Beneficiaries and staff also indicated that certain vulnerable groups, such as male and LGBTI-identified survivors of GBV, may not have been aware that services were available to them. Increased targeted outreach for such vulnerable groups is recommended, including messages appropriate to the cultural context.

Remote services such as hotlines can increase access, but context-specific barriers should be assessed and addressed. Staff, focal points and other stakeholders were generally enthusiastic about hotline services, and requests to increase hotline hours suggest that beneficiaries are interested in accessing services remotely. Staff and other stakeholders suggested that hotlines may be especially valuable for vulnerable groups facing particular stigma regarding help-seeking, such as men, boys and LGBTI people.  However, in some locations, access to phones and charging points is limited, and internet and phone services are poor. Some negative or mixed reactions to women and girls’ phone/internet use were identified during the study, implying a need for interventions to increase the acceptability of phone use among target populations.

Increasing opportunities for beneficiary participation in programme development and strengthening may improve service access and satisfaction. Given the short-term, transient and emergency nature of mobile and remote programming, there is often limited time to conduct a thorough assessment before programming begins. As a result, it is particularly important to ensure that mechanisms are in place to collect feedback from beneficiaries, focal points and community leaders so the mobile team can adjust to a community’s changing needs. In this study, respondents were eager to share ideas, and programme beneficiaries had a number of requests related to programming, scheduling and preferred activities.

It is also important that beneficiaries know how to access services, and understand the scope of the services available to them. The study highlighted a lack of consistency between staff and beneficiary understandings of services and access (e.g. some beneficiaries believed there were age caps and that they would be charged for services). Fees are typical in some services in host communities (such as government or private hospitals) and beneficiaries may associate these same barriers with mobile services in the same area. There were also unrealistic expectations about what mobile and remote programming could typically provide (e.g. longer-term vocational training).

Staff and community focal points

Community focal points are essential for facilitating access to services. Most beneficiaries who participated in the study identified focal points as their way into activities and services. However, focal points require extensive training on roles, responsibilities and appropriate behaviour that aligns with internationally recognised best practice and safety policies (e.g. to understand safety concerns associated with visiting survivors at their homes and to adopt feasible alternatives). Clear job descriptions are needed to define roles and clarify the boundaries associated with the provision of direct case management services. Regular supervision and ongoing dialogues should be conducted with focal points, with emphasis on identifying and addressing challenges they may face in adhering to safety and confidentiality protocols.

While in-person supervision is preferable, staff and focal points were positive about phone and web applications and hotlines to support remote supervision. Staff in all countries also requested additional support and self-care initiatives. Since mobile programming requires ongoing and intensive crisis intervention work, building strategies and resources for staff support into programming is critical. Approaches should be tailored to the context, but can draw on content available in the Interagency GBV case management guidelines.

Strengthening the referral network

Many respondents reported a need for additional referral options, especially for shelter, legal and economic services. While service mapping is important in any GBV response, mobile and remote programming require additional time and effort because services are provided in multiple sites. Additionally, unlike in camp settings, mobile sites frequently lack clear borders, leading to a lack of clarity about the catchment area and the target population for service delivery. Specifically, several stakeholders identified the need for more safe shelters. While this is not unique to mobile programming, it is particularly challenging due to the remoteness of the beneficiaries (particularly hotline callers).

Sustainability

The study found several successful instances where beneficiaries had self-organised (e.g. developing a village savings and loan association in Burundi). It is important to consider mechanisms for systematically shifting ownership of activities and spaces to community groups, including by helping community members to develop their own activities and use spaces as they wish.

Respondents stressed the importance of planning for sustainability by including local partners from the outset of programming. It is key to thoroughly assess the potential to work with civil society and community-based groups from the start, taking care not to undermine existing relationships or encourage competition for resources. If the plan is eventually to hand over to local organisations, ongoing capacity-building will be required, including both technical training and organisational development. Mobile teams should plan for the gradual handover of services, while continuing to provide in-person or remote supervision and technical support.

Areas for future research

Additional research is needed to assess the feasibility of economic initiatives for survivors with financial needs, with an emphasis on what might be feasible and beneficial within a mobile programming framework. Respondents indicated that economic barriers contribute to ongoing GBV risks, and many people in the study asked for expanded economic initiatives, including cash and livelihoods programming. Mobile programming contexts present considerable challenges here, and any such efforts should take into account guidance about the use of cash in GBV response, such as that available from the Women’s Refugee Commission. See https://www.womensrefugeecommission.org/issues/livelihoods/research-and-resources/1549-mainstreaming-gbv-considerations-in-cbis-and-utilizing-cash-in-gbv-response.

Future research should also include the perspectives of community members who are not using services. Focus group discussions could include specific vulnerable groups residing in the area but not using services. Discussions about ethics should frame such work, including adherence to established guidelines. Putting women’s safety first: ethical and safety recommendations for research on domestic violence against women (Geneva: Global Programme on Evidence for Health Policy, World Health Organization, 1999); M. Ellsberg and L. Heise, ‘Bearing witness: ethics in domestic violence research’, The Lancet, 359(9317), 2002.

We hope that these recommendations will be useful in strengthening programming for GBV survivors and women and girls in emergency and other humanitarian settings.

Leah E. James and Courtney Welton-Mitchell are Research Fellows at the Institute of Behavioral Science’s Natural Hazards Center, University of Colorado Boulder. Betsy Laird, Amy Neiman, and Meghan O’Connor work with the IRC’s Violence Prevention and Response Unit.