Multilevel Determinants of Integrated Service Delivery for Intimate Partner Violence and Mental Health in Humanitarian Settings.

M Claire Greene,Samuel Likindikoki,Ashley Nemiro,Clarisa Bencomo,Peter Ventevogel,Annie Bonz,Jessie K K Mbwambo,Wietse A Tol,Susan Rees,Terry M Mcgovern

doi:10.3390/ijerph182312484

Abstract

Inter-agency guidelines recommend that survivors of intimate partner violence in humanitarian settings receive multisectoral services consistent with a survivor-centered approach. Providing integrated services across sectors is challenging, and aspirations often fall short in practice. In this study, we explore factors that influence the implementation of a multisectoral, integrated intervention intended to reduce psychological distress and intimate partner violence in Nyarugusu Refugee Camp, Tanzania. We analyzed data from a desk review of donor, legal, and policy documents; a gender-based violence services mapping conducted through 15 interviews and 6 focus group discussions; and a qualitative process evaluation with 29 stakeholders involved in the implementation of the integrated psychosocial program. We identified the challenges of implementing a multisectoral, integrated intervention for refugee survivors of intimate partner violence at the structural, inter-institutional, intra-institutional, and in social and interpersonal levels. Key determinants of successful implementation included the legal context, financing, inter-agency coordination, engagement and ownership, and the ability to manage competing priorities. Implementing a multisectoral, integrated response for survivors of intimate partner violence is complex and influenced by interrelated factors from policy and financing to institutional and stakeholder engagement. Further investment in identifying strategies to overcome the existing challenges of implementing multisectoral approaches that align with global guidelines is needed to effectively address the burden of intimate partner violence in humanitarian settings.

Highlights

This article is an open access articleIntimate partner violence (IPV) is a significant threat to the health and wellbeing of women in humanitarian settings
We described determinants, challenges, and opportunities for successfully implementing integrated IPV and mental health services using a case example from a feasibility trial of the Nguvu intervention, a psychosocial and protection intervention developed in Nyarugusu Refugee Camp, Tanzania
Consistent with a social ecological analysis, we identified the determinants of successfully implementing multisectoral integrated IPV response services that were present within the structural context, the inter-institutional context, the intra-institutional context, and the immediate social and interpersonal context [50]

Summary

Introduction

This article is an open access article. Intimate partner violence (IPV) is a significant threat to the health and wellbeing of women in humanitarian settings. One-third of ever-partnered women globally are estimated to experience physical and/or sexual IPV during their lifetime [1,2]. Research suggests a greater burden of IPV in humanitarian settings where lifetime prevalence estimates reach up to 73% among women [3,4]. IPV is a leading risk factor for poor health distributed under the terms and conditions of the Creative Commons.

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