A microfinance intervention to improve health of rape survivors in the DRC

描述(由申请者提供)：美国在全球健康方面扮演着重要角色。它既是全球卫生领域最大的创新资助者，也是撒哈拉以南非洲护理和支持项目的最大捐赠者。由于对贫穷、社会孤立、慢性压力和创伤等社会决定因素的作用认识不足，以及获得保健服务的机会有限对健康差距的影响，这些努力的有效性和可持续性受到限制。这项研究的总体目标是为大规模实施经济方案建立科学基础，以改善性暴力和基于性别的暴力(SGBV)的女性幸存者的健康。在刚果民主共和国的过去十年里，强奸被用作战争武器，叛军和士兵使妇女和女孩遭受残忍的攻击、强奸、酷刑和肢解。强奸幸存者往往因感染、疾病、贫困、耻辱和社会孤立而进一步遭受创伤。这项研究的目的是测试一个创新的、由村庄领导的小额信贷计划在SGBV幸存者的健康、家庭经济稳定以及重新融入家庭和村庄方面的有效性。我们的初步证据表明，通过增加购买食品、住房和药品以及支付儿童学费的资金，由村庄领导的小额信贷方案改善了刚果妇女的健康和家庭经济稳定。幸存者还报告说，与性暴力和性暴力有关的长期压力、耻辱和创伤对健康的负面影响有所减少，因为他们再次成为富有成效的家庭和村庄成员。作为我们前期工作的结果，我们的小额信贷-学术研究合作提出了一项为期五年的实验试验，使用混合方法(定量和定性技术)。在这项试验中，刚果民主共和国南部瓦伦古地区Ngweshe酋长领地的10个村庄将被随机分为小额信贷干预组(n=5)或延迟控制组(n=5)。结果将在干预和对照村庄的个人和家庭两个层面进行衡量。我们估计每个干预和控制村将有50户参加，总共有500户。将在基线和基线评估后3、6、12和18个月收集对每个村庄成果的衡量。这项研究涉及国家少数民族健康和健康差距中心(NCMHD)制定和测试结构性干预措施以减少健康差距的优先事项。研究结果将为大规模实施结构性干预措施提供科学依据，目的是确定小额供资干预措施与改善性暴力和基于性别的暴力幸存者及其家人的健康、家庭经济安全和重新融入社会之间的因果关系。 公共卫生相关性：这项研究涉及国家少数民族健康和健康差距中心(NCMHD)制定和测试结构性干预措施以减少健康差距的优先事项。研究结果将为大规模实施结构性干预措施提供科学依据，目的是确定小额供资干预措施与改善性暴力和基于性别的暴力幸存者及其家人的健康、家庭经济安全和重新融入社会之间的因果关系。

DESCRIPTION (provided by applicant): 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 microfinance 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 microfinance intervention and improved health, household economic security, and reintegration for survivors of sexual and gender-based violence and their families.