Despite an influx of funding to prevent violence against women and children over the last decade, the field has reached a crisis point, according to a new coalition of researchers and programmers. Their claims are multiple: a narrow focus on “evidence-based” work is hindering innovation in the field, the need for rapid results is stifling longer-term change and the pressure to scale up too rapidly is destabilising some communities in the global south.
Now, a dozen NGOs, responsible for some of the most rigorously tested violence prevention and women’s empowerment programs across the global south, have come together in a coalition dedicated to critiquing and improving scaling practices.
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The Community for Understanding Scale Up (CUSP) has issued a policy brief with a set of recommendations for programmers, donors and policymakers, including recommendations on extending the length of funding cycles, maintaining fidelity to the core principles of interventions and thinking far beyond the limits of quantitative data and randomised controlled trials.
In the search for results, are big donors pushing the aid industry to breaking point? Or does a business-like search for efficiency mean better results for less money?
Speed over sustainability
Alice Welbourn, one of the founding members of CUSP, developed the Stepping Stones training program to combat intimate partner violence and HIV transmission in rural Uganda in 1992. The program is a structured series of participatory sessions around women’s rights, sexual and reproductive health and harmful expressions of power.
Stepping Stones is one of very few programs proven to reduce intimate partner violence, and one of even fewer to impact HIV rates and sexual health behaviours at the same time. Its holistic approach to community change — empowering communities to unpick harmful social norms that perpetuate gender inequality and HIV transmission — was explicitly designed to avoid the top-down approach of many public health campaigns.
Stepping Stones’ success has attracted international attention, but as donors have rushed to replicate it, Welbourn has grown critical of how her work has been used.
“We’re at a point where the drive to evidence is leading to derivative programming”
“Scaling up is causing massive problems for the field,” Welbourn said. While she is emphatically not against the expansion of projects to serve more communities, the nature of scaling demanded by donors, she claims, is much too fast and without regard to the sustainability of change.
Welbourn recounted one experience in Malawi, where the Coalition of Women Living With HIV and AIDS (COWLHA) used Stepping Stones as part of a gender-based violence prevention program with significant funding from the UN trust fund for women. The money was spent on comprehensively training staff and implementing the program in 144 communities across the country, she said. When the project was evaluated, there was a reduction in intimate partner violence for women, improvements in the mental health of women, an improvement in women’s ability to adhere to HIV medication and an increase in men getting tested and treated.
Then the funding cycle ended. All of COWLHA’s newly trained staff were made redundant, Welbourn added, and the research findings went unpublished: the program managers hadn’t signed the necessary paperwork for their research to be published in peer-reviewed journals. Learnings were lost and community members were left dejected when the program collapsed.
“We’re constantly charging in with the next project, the next initiative,” Welbourn said. “It’s so unethical the way in which communities are being pulled from pillar to post.”
Evidence versus innovation
Beyond short-termism, researchers say increasing expectations from donors that programs must be “evidence-based” are also causing problems for many small NGOs in the violence prevention sector.
Lori Heise, one of the world’s foremost violence prevention researchers, said in an interview for the Prevention Collaborative: “What has been framed as evidence has been quite narrow.” She argued that big donors prefer the hard numbers of quantitative analysis, at the expense of more nuanced qualitative understandings of not just how communities change, but why.
“It’s so unethical the way in which communities are being pulled from pillar to post”
That focus on hard evidence and numbers is limiting the kinds of program they decide to fund, she added. “We’re at a point where the drive to evidence is leading to derivative programming — everything is a variation on the same theme,” she said. Programs like Stepping Stones and the community mobilisation intervention SASA! have been replicated in scores of settings across the world, while funding for new approaches is thin on the ground. “It can stifle innovation,” she said.
Welbourn echoed Heise’s concerns, and argued that a narrow focus on evidence was also encouraging a “pick-and-mix approach” to existing programs. “It’s like taking a bit of Bach, a bit of the Beatles and something else and throwing it together,” she said.
Alex Butchart, coordinator of violence prevention at the WHO, stressed the importance of fidelity to original interventions: “Programs that are proven to be effective are so because of how they are designed at the point at which they were tested.” Mixing and matching different elements from different programs with good results will lead to a different — and potentially ineffective — program.
The problem, each researcher was keen to stress, is not the idea of scaling per se, but how quickly scaling is expected to happen and how it can lead to the recycling of the same ideas.
But examples of responsible, effective scaling abound. When Stepping Stones was adapted for use in the Gambia, researchers were keen to tailor the project to local norms and take time to understand how it might work in a new context. Rather than framing the project as a way to end HIV or violence against women, they spoke to rural communities about one of their key concerns: childbearing.
“Scaling up is causing massive problems for the field”
After extensive research, programmers opened a dialogue with communities around unprotected sex and the risks that sexually transmitted infections can pose to fertility. That framing tapped into local priorities, and community leaders — including imams and faith scholars — helped the program spread its message. Taking time to understand cultural context was vital to its success.
To rethink the field’s approach to scaling is no small undertaking. But the work of CUSP and others offers valuable in-roads. Lengthening funding cycles for scaling projects could allow more sensitive adaptations and give programmers more space to consider the sustainability of their impact. More research into the balance between adaptation to local context and fidelity to original programs will also be crucial to responsible scaling. — Edward Siddons
(Picture credit: Flickr/UN Photo)