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

描述（由申请人提供）：美国在全球卫生方面发挥着重要作用。它既是全球卫生创新的最大资助者，也是撒哈拉以南非洲护理和支持项目的最大捐助者。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，这些努力的有效性和可持续性受到限制。本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）的妇女幸存者的健康。过去十年，刚果民主共和国（DRC）将强奸作为一种战争武器，叛乱分子和士兵对妇女和女孩进行残酷的袭击、强奸、酷刑和肢解。强奸幸存者往往受到感染、疾病、贫穷、耻辱和社会孤立的进一步创伤。这项研究的目的是测试一项由村庄主导的创新型小额信贷方案对性暴力幸存者的健康、家庭经济稳定以及重返家庭和村庄的有效性。我们的初步证据表明，由村庄主导的小额信贷项目通过增加购买食品、住房和药品以及支付儿童学费的资金，改善了刚果妇女的健康和家庭经济稳定。幸存者还报告说，与性暴力相关的慢性压力、耻辱和创伤对健康的负面影响有所减少，因为她们再次成为有生产力的家庭和村庄成员。作为我们初步工作的结果，我们的小额信贷-学术研究合作提出了一项使用混合方法（定量和定性技术）的五年试验。在本试验中，刚果民主共和国南基伍省瓦龙古地区恩格威什部落的10个村庄将被随机分为小额信贷干预组（n=5）和延迟对照组（n=5）。将在干预村和对照村的个人和家庭层面衡量结果。我们估计每个干预和控制村将有50户家庭参与，总共500户家庭。将在基线和基线后3个月、6个月、12个月和18个月评估时收集每个村庄的成果测量数据。该研究解决了国家少数民族健康和健康差异中心（NCMHD）开发和测试结构性干预措施以减少健康差异的优先事项。研究结果将为大规模实施结构性干预措施的科学基础提供信息，目的是在小额供资干预措施与改善健康、家庭经济安全以及性暴力和基于性别的暴力幸存者及其家庭重新融入社会之间建立因果关系。

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.