Evaluation of impact of interventions at Survivors of Sexual Violence (SSV) Unit, Panzi Hospital in Bukavu

The overall purpose of this evaluation is to evaluate the fulfilment of the project in terms of delivering intended outputs, approaches taken, strengths and weaknesses, lessons learned, and to use evidence to make recommendations to improve the implementing organisation’s work in the future.

For several decades, eastern DRC has been marked by conflicts, resulting in a protracted humanitarian crisis. According to the Humanitarian Needs Overview (HNO) for DRC 2022, 27 million people are predicted to need humanitarian assistance in 2022. The illegal extraction and trade in minerals, timber and other natural resources as well as the land issues and unconstructive meddling of the neighbouring countries are factors contributing to the conflicts. Approximately 77% of the total population is experiencing extreme poverty, living on less than two USD per day. The health system suffers from considerable deficiencies, and a major part of all health care services is provided by the civil society, especially churches. Patients pay care out of pocket.

Young women and girls are particularly vulnerable and DRC is considered one of the least gender-equal countries globally. Underlying risk factors of SGBV include lack of security, lack of protection, lack of gender equality and lack of rule of law. Access to sexual and reproductive health (SRH) services, including contraceptives, is poor, which is yet another manifestation of structural discrimination of women and girls. SGBV is also a serious and widespread problem. There was a 73% increase of reported SGBV cases between Sept 2020 and 2021, for which 94% were women and girls. More than 600,000 are at risk of SGBV in 2022 (HNO DRC 2022). National statistics of the frequency of sexual violence, rape and gender-based violence in DRC are scarce, and due to gender inequalities, social stigma, impunity and the lack of awareness of human and civil rights, the unrecorded cases are deemed to be very high. The statistics of SGBV cases in South Kivu Province are generally based on the number of cases documented by the Panzi Hospital, but the number of untreated cases is still unknown.

In terms of access to sexual and reproductive health and rights (SRHR) and care, there is a low level of knowledge and understanding among the general population. This includes several SGBV issues: early and forced marriages; denial of access to resources and decisions for women; under-use and/or unavailability of SRH services sometimes linked to customs or the security situation; the practice of unsafe abortion; the rejection of survivors of sexual violence by the family/community as well as unwanted pregnancies of minors and adolescents resulting from unprotected sexual relations or rape.

SGBV committed by security forces, members of armed groups in the region, through domestic violence, as well as the lack of protection of survivors of sexual violence and their families, have been identified by the community as a major risk that prevents them from denouncing these SGBV incidents.

The humanitarian crisis in South Kivu Province is caused by several factors – including armed conflicts, land disputes, community tensions causing frequent population movements, floods, the effects of different disease outbreaks and the added impact of COVID-19. The security situation in South Kivu, which remained precarious in 2021, remains an obstacle to the prevention and response to widespread sexual violence in a context of impunity. The population’s lack of knowledge about SRHR, difficult access to services such as family planning, or psychosocial care, weak governance regarding protection and respect of fundamental human rights aggravates the vulnerability of Congolese women and girls. This undermines their emancipation and contributes to keeping them in a state of poverty.

In total, the SSV-project treated 8,327 patients between 2016 and 2021. Of these, 37% were 18-35 years old; less than 1% of these were men. Of the total number of patients treated during this period, 2.5% were men. Nearly 2% of the patients treated were younger than four years old.

PMU is the DG ECHO grant beneficiary of the project. PMU is a multi-sectoral faith-based actor providing development and humanitarian programmes since 1965. It is formally registered under the Swedish Pentecostal Church Movement and currently has programmes in 32 countries worldwide. In line with the Grand Bargain commitment, PMU promotes localisation and implements its projects through local partners. With vast experience working in complex, conflict-affected contexts, it has strong knowledge of synergies between humanitarian and development programming. PMU contributes with high-level assistance and expertise in humanitarian programming including project and budget management, application preparation, close monitoring and reporting of project activities and progress. PMU humanitarian projects globally include activities within the FSL, WASH, Health, Nutrition, Shelter/NFI and DRR sectors. It further ensures that its partners adhere to the humanitarian principles, Core Humanitarian Standards (CHS) and the IFRC Code of Conduct. PMU is a CHS Alliance member since 2019. The PMU head office is in Sweden and since 2015, the organization has a regional office in Bukavu, South Kivu with staff available to provide technical support and training on administration and finance to PMU partners. It also conducts regular compliance audits and monitors the organizational action plans developed together with its implementing partners (IP) in DRC. PMU is currently implementing projects in DRC with three partners, in addition to the IP of this proposed action. The IP of the intended action is Panzi Hospital. The owner of Panzi Hospital is the Pentecostal Church movement Communauté des Eglises de Pentecôte en Afrique Centrale (CEPAC), founded in 1921 as a result of the Swedish Pentecostal mission. PMU and CEPAC hence share the same roots. PMU started collaborating with CEPAC in DRC in the 1970s. Several development projects, especially within the areas of education, health, democracy, gender and livelihoods have been conducted by CEPAC in close collaboration with PMU with funding mainly sourced from SIDA and the Swedish foundation Radiohjälpen. Since the Panzi Hospital started, PMU has been supporting core activities and infrastructure as well as different development and humanitarian projects connected to the hospital through various grants (SIDA, DG ECHO, Radiohjälpen etc.).

Between 1999 and 2019, more than 98,000 patients have received support from the SSV project at Panzi Hospital. This includes more than 55,000 SSV and 42,000 patients suffering from severe gynaecological injury. During 2021, a total number of 1,259 SSV patients were admitted to Panzi Hospital. Panzi Foundation is a National NGO intricately connected to Panzi Hospital. PMU supports it and has a partnership agreement with them since 2014.

Since 2004, the SSV unit of the Panzi Hospital offers free and integrated holistic care (medical, psychosocial, legal and economic) to SSV patients and to women suffering from gynaecological injuries (fistulas and prolapse). The support to SSV patients must be holistic to help them restart their life again. Panzi Hospital and Panzi Foundation has thus developed a holistic model called

the “One Stop Centre” which includes four pillars: 1) medical treatment, 2) psychosocial support, 3) legal clinic and 4) socio-economic reintegration. PMU are highly committed to the vision of Panzi Hospital and the holistic care model through various projects and high-level advocacy. PMU are currently supporting three projects at the Panzi Hospital and the Foundation to ensure the holistic care of SSV and prevention of SGBV in South Kivu. The projects focus on medical and psychosocial care, socio-economic reintegration and gender equality and women rights – all targeting survivors of sexual violence.

STUDY TEAM

The consultant should understand institutions and intervention methodologies within the scope of the intervention to be evaluated, and experience in analysis of organizational systems and structures. Ideally, they need to be able to communicate in French and/or Swahili. A medical or health background would also be ideal, as would experience in SGBV work.

The logistic plan for the evaluation needs to include:

1. A plan for visiting the project location(s).
2. The names and functions of informants (e.g., from target groups, patients, government officials, external partner representatives, church members, staff, volunteers).
3. Accommodation and a travel plan for the consultant, including obtaining a DRC visa if the consultant is an expatriate.
4. Arrangement and booking of a time and place for individual interviews with key persons.
5. A budget that covers local transportation for the consultant and the informants, the cost of meals during workshops, as well as lodging for the consultant and, if necessary, for the informants.

TIME PLAN

Arrival of consultant: November 21, 2022

Departure of consultant: December 28, 2022

Draft report complete: December 5, 2022

Final report completed and presentation of findings: December 15, 2022

REPORTING

There should be an oral report of preliminary findings and draft recommendations to the local partner (SVS project team, Panzi Foundation) in connection to the consultant’s visit.

The report should be written in English or French and not exceed 20 pages, including an executive summary and recommendations. The report is shared with the local partner/implementing organisation (Panzi Hospital) and PMU.

Recommendations should have a rights-based perspective and consider sustainability in terms of strategy, performance and outcomes.

Proposed content of the evaluation report:

1. Introduction
2. Executive summary
3. Description of the scope of the project and evaluation methodology
4. Project achievements
5. Analysis of the sustainability of results
6. Lessons learned
7. Conclusion and recommendations 2022.