More than twenty years’ experience working in war and crisis regions has led medica mondiale to develop a variety of operating methods and standards, which have proven helpful for providing support to survivors of sexualised wartime violence. In spite of this, we know that political, economic and socio-cultural dynamics frequently change the working conditions in our projects. As an organisation, we respond to this by continuous examination of our approach, monitoring its effects and further developing it.

medica mondiale has devised instruments and methods to allow for regular monitoring of the impact of our projects. We also commission external experts to conduct impact monitoring. In this way, we can respond to potential problems and learn from our mistakes. Paying due respect to the cultural specifics of project environments, we assess each regional context and draw up our evaluation system in close cooperation with local staff in partner organisations.

The challenge of everyday life realities: Impact monitoring in Liberia

Taking time off helps to stay healthy. Copyright:medica mondiale Liberia
Taking time off helps to stay healthy. Click to enlarge.

Since the beginning of our work in Liberia in 2006, medica mondiale has built a broad support network including expert counsellors in the provincial capitals and volunteer counsellors organised in solidarity groups on community level. They are the first contact for women affected by violence and have all been trained to apply the trauma-sensitive approach.

To assure quality, facilitate guidance and for continuous improvement, medica mondiale Liberia developed a two-tiered monitoring system of counselling services. It comprises of two main components: knowledge and self-care. It allows staff and volunteer counsellors to check their counselling ability and to determine whether their work complies with best practices and standards. At the same time, the system encourages counsellors to reflect on their work and to ensure self-care. After all, their own sound health is crucial for successful counselling, especially to offer the all-important feeling of protection and safety.

This constitutes the core of the trauma-sensitive approach. The monitoring of both components – knowledge and self-care – consists of four interdependent steps, one building upon the other. To ensure usefulness for all counsellors, tools and methods have been designed with a wide range of living and working conditions in mind. For example, the questionnaires contain pictures and symbols instead of text to ensure they are meaningful to women who cannot read and write.

Quality assurance for our counselling work

Attitude, ability, knowledge

Quality assurance for our counselling work. Copyright: medica mondiale
Quality assurance for our counselling work. Click to enlarge.

Initial short tests help to check if the fundamental approaches essential to trauma-sensitive counselling are known and the ability to apply them exists. Based on this self-reflection, monthly group meetings are held, during which the counsellors share and evaluate each other. Frequently, these meetings also serve to talk about specific cases and to find solutions together. In a third step and throughout long-term intervals, team leaders or external specialists provide group counselling sessions. Counsellors benefit by receiving feedback helping them to improve their work; the learned is then immediately tested in supervised role-play sessions. It is important to ensure that participants do not have the feeling they are being checked upon. Instead, sessions should be held in a spirit of assistance to further develop their valuable work. In a final step, the quality of the counselling and its impacts are monitored by an external evaluator.

Mindful organisational culture and self-care

The women involved in direct services in our projects have to cope with extremely painful experiences of their clients on a daily basis. This is all the more difficult as many of the counsellors are themselves survivors of sexualised violence. The sound health and well-being of these women as well as the existence of a mindful culture within their group or organisation are significant factors influencing the effects of trauma-sensitive counselling. The Mo­nitoring of "self-care" therefore provides staff with practical methods and various options encouraging rest and detachment from their work experience. The first step here involves physical relaxation exercises, followed up by regular group discussions and coaching sessions. These provide an opportunity to share their experiences with colleagues and experts, to learn how to deal with stress, while also receiving practical instructions on how to support each other.

Evaluation of changes in attitude and society

With the aim of monitoring the quality of trauma-sensitive counselling services, this two-tiered monitoring pyramid has proven very successful.

It is more difficult, however, to measure the impact related to "change in attitude" and "changes in society". Has the work of medica mondiale really contributed to impro­vements in self-confidence amongst the women in the project region? Do they know their rights and actively assert them? Have there been general changes in attitudes towards women or specific gender roles?

For the project region in Liberia, we can actually answer some of these questions. An external evaluation conducted by one of the institutional donors co-funding our project in 2012, revealed both a clear strengthening of the women and a positive change in attitude of men towards women. More often than not men stand up proactively for the rights of women in their community. The evaluation recognised that the mobilisation of women by medica mondiale led to positive results for the community as a whole, and did not just benefit the women.

In order to combat sexualised violence long term, medica mondiale engages govern­ment institutions, e.g. healthcare professionals, officers from the police and/or the justice sector. medica mondiale verifies on a regular basis, if cases of violence are being documented according to the given standards and if trainees apply what they learnt. In 2013, more than 98 per cent of the participants in one training group for healthcare professionals indicated that they were able to remember and implement their newly acquired knowledge in their daily work.