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

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.

Intimate Partner Violence and Mental Health: Deepening Our Understanding of Associations, Pathways, and Prevention in Low- and Middle-Income Countries

“…For example, while a study from Northern Uganda found that gender equitable attitudes mitigated the relationship between IPV victimization and mental illness [ 29 ], analyses from Nigeria revealed that survivors of IPV who believed IPV was acceptable in some situations exhibited lower mental distress [ 26 ]. Third, this Special Issue offers actionable guidance for practitioners by evaluating promising intervention approaches [ 30 , 34 ], reviewing the evidence on what works to prevent IPV and subsequent psychological distress [ 35 , 36 ], and highlighting determinants for the successful implementation of integrated interventions that address IPV and mental health in tandem [ 37 ]. Importantly, all papers in this Special Issue advance the knowledge base on how to understand and address IPV and mental health in LMICs, ultimately strengthening our ability to make progress toward the SDGs.…”

Implementing and evaluating integrated care models for non-communicable diseases in fragile and humanitarian settings

“…In terms of implementation feasibility, a coordinated approach to service delivery, such as that required to organize and deliver integrated NCD care, is not new to humanitarian actors. For instance, there is experience in arranging multisectoral integrated service delivery for survivors of intimate partner violence ( Greene et al, 2021 ).…”

Co-creating Mental Health services that prevent a descent into Homelessness

“…Enhancing support networks and outreach services are critical to preventing a descent into homelessness or abject poverty . In such circumstances, as The Banyan's efforts reveal, the role of social work practitioners, alongside health professionals, is critical to a crisis intervention team (Greene et al, 2018;Reza Iravani & Majidi Parast, 2014). Social workers are in a unique position to provide both clinical services and coordinate interdepartmental liaison work, all embedded in a collaborative, justice and human rights framework.…”