The United States plays a significant role in global health. It is both the largest funder of innovation in global health and the largest donor to care and support programs in sub-Saharan Africa. The effectiveness and sustainability of these efforts are limited by gaps in knowledge of the role of social determinants, such as poverty, social isolation, chronic stress and trauma, and limited access to health care services has on disparities in health. The overall goal of the study is to build the science base for large-scale implementation of economic programs to improve the health of women survivors of sexual and gender based violence (SGBV). The last decade in the Democratic Republic of Congo (DRC) has seen the use of rape as a weapon of war, where rebels and soldiers subject women and girls to brutalizing attacks, rape, torture, and mutilation. Survivors of rape are often further traumatized by infections, disease, poverty, stigma and social isolation. The study objective is to test the effectiveness of an innovative, village-led microfinance program on SGBV survivor's health, household economic stability, and reintegration to family and village. Our preliminary evidence indicates that a village-led microfinance program improves Congolese women's health and household economic stability, through increased funds to purchase food, housing and medication and to pay school fees for children. Survivors also report a reduction in the negative health impacts of chronic stress, stigma and trauma associated with SGBV because they are once again productive family and village members. As a result of our preliminary work, our microfinance-academic research collaboration proposes a five-year experimental trial using mixed-methods (quantitative and qualitative techniques). In this trial, 10 villages in the Ngweshe Chiefdom in the Walungu Territory in South Kivu DRC will be randomized to either the microfinance intervention (n=5) or delayed control (n=5) group. Outcomes will be measured at the individual and household levels in both intervention and control villages. We estimate 50 household in each of the intervention and control villages will participate for a total of 500 households. Measurement of outcomes in each village will be collected at baseline and 3, 6, 12 and 18-months post-baseline assessment. The study addresses the National Center for Minority Health and Health Disparities (NCMHD) priorities to develop and test structural interventions to reduce health disparities. Research findings will inform the science base for large-scale implementation of structural interventions, with the aim to establish a causal relationship between a mcirofinance intervention and improved health, household economic security, and reintegration for survivors of sexual and gender-based violence and their families.

Public Health Relevance

The study addresses the National Center for Minority Health and Health Disparities (NCMHD) priorities to develop and test structural interventions to reduce health disparities. Research findings will inform the science base for large-scale implementation of structural interventions, with the aim to establish a causal relationship between a mcirofinance intervention and improved health, household economic security, and reintegration for survivors of sexual and gender-based violence and their families.

Agency
National Institute of Health (NIH)
Institute
National Institute on Minority Health and Health Disparities (NIMHD)
Type
Research Project (R01)
Project #
5R01MD006075-03
Application #
8392147
Study Section
Special Emphasis Panel (ZMD1-PA (08))
Program Officer
Dankwa-Mullan, Irene
Project Start
2010-12-24
Project End
2015-11-30
Budget Start
2012-12-01
Budget End
2013-11-30
Support Year
3
Fiscal Year
2013
Total Cost
$329,777
Indirect Cost
$76,221
Name
Johns Hopkins University
Department
Type
Schools of Nursing
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Kohli, Anjalee; Perrin, Nancy; Mpanano, Remy Mitima et al. (2015) Family and community driven response to intimate partner violence in post-conflict settings. Soc Sci Med 146:276-84
Kohli, Anjalee; Perrin, Nancy; Mpanano, Remy Mitima et al. (2015) Social interaction in the aftermath of conflict-related trauma experiences among women in Walungu Territory, Democratic Republic of Congo. Glob Public Health 10:55-70
Glass, Nancy; Perrin, Nancy A; Kohli, Anjalee et al. (2014) Livestock/animal assets buffer the impact of conflict-related traumatic events on mental health symptoms for rural women. PLoS One 9:e111708
Kohli, Anjalee; Perrin, Nancy A; Mpanano, Remy Mitima et al. (2014) Risk for family rejection and associated mental health outcomes among conflict-affected adult women living in rural eastern Democratic Republic of the Congo. Health Care Women Int 35:789-807
Glass, Nancy; Ramazani, Paul; Tosha, Mafille et al. (2012) A Congolese-US participatory action research partnership to rebuild the lives of rape survivors and their families in eastern Democratic Republic of Congo. Glob Public Health 7:184-95