Erika Bonnevie and Jennifer Wagman, July 1, 2017
Violence against women (VAW) is one of the biggest issues women face
worldwide. The World Health Organization (WHO) estimates that 1 in 3 women have
experienced some sort of intimate partner violence, the most common form of VAW,
in their lives (WHO, 2016). Its effects are both immediate and long-term, and
include physical injury, unwanted pregnancy, increased risk of contracting
sexually transmitted infections, and mental health problems, among others (Black
et al., 2011; WHO, 2013). SASA! is a proven effective community mobilization
approach to reduce VAW and HIV risk and infection. It was designed by Raising
Voices, a non-governmental organization working to prevent violence against
women and children in Uganda.
SASA!, a Kiswahili word that means now, is based on the idea that now is the
time to take action to prevent violence against women and HIV. It is also an
acronym for the four phases of community mobilization that scale up the stages
of change and enable a community to move through a series of evolving activities
and experiences. Each phase uses specific strategies to engage community member
in a variety of ways. the goal of SASA! is to create social norm change by
engaging a critical mass of people from all walks of society. Instead of
focusing on traditional 'gender' issues, SASA! addresses understandings of power
and ways that power can be used both negatively and positively.
A pair-matched cluster randomized controlled trial conducted in Uganda's
capital Kampala found SASA! to be an effective approach for reducing VAW and HIV
risk behaviors and changing attitudes that support VAW (Ambramsky et.al, 2014;
Kyegombe, Abramsky, Devries & Watts, 2014). As a result, organizations in
more than 20 countries across the world have started implementing the SASA!
intervention as part of their ongoing work. This represents important progress
toward the global scale-up of VAW prevention. However, little is known about the
potential challenges of implementing a proven, evidence-based model like SASA!
in a 'real life' setting (i.e., where systematic oversight of each step of
implementation and rigorous research evaluation is unavailable). The Adaptations
Project aims to fill this gap.
The Adaptations Project
The Adaptations Project is a mixed methods study that seeks to learn from
four organizations using SASA! The project is being conducted by Raising Voices
and researchers from the University of California, San Diego's Center on Gender
Equity and Health. With funding from the UN Trust Fund to End Violence against
Women, we are using surveys and qualitative methods to examine how SASA! is
being adapted in four different contexts: rural Tanzania, a refugee camp in
Kenya, a Caribbean community in Haiti, and a humanitarian setting in Iraq. The
study aims to understand both the challenges and successes of adapting and
implementing SASA! to strengthen the evidence base of SASA!'s impact and provide
guidance on how to most effectively adapt the methodology to different
environments, maximize efficiency and cost-effectiveness, and offer guidance on
the organizational structures and processes necessary to implement and sustain
effective programs that reduce VAW.
Adapting SASA! in rural Tanzania: Lessons learned from my field visit
to Kigoma
In January 2017 I traveled to Kigoma, Tanzania to work with the
Women's Promotion Center (WPC), a local non-profit organization started in 2007
to promote women's dignity and equality, and respect for women's rights. Kigoma is a
rural fishing town located on Tanzania's northwestern side. It sits just sound
of the Burundi border and face the 
Democratic Republic of Congo across Lake
Tanganyika. Violence is an issue faced by many women in the area. The WPC
recently conducted a survey that showed 36% of women in Kigoma had experienced
partner violence in the previous year - although given the stigma placed around
disclosing violence, it is possible that the number is even higher (WPC,
2016).
WPC started implementing SASA! in 2014. After several years of working
intensively within the community, WPC recently began transitioning into the
Support phase. This will allow the organization to build on the connections they
have formed with the community and the awareness they have raised about
violence. Part of the SASA! program involves recruiting and training local
people to act as Community Activists, building skills, and allowing the
community to become part of the process of change. This emphasis on working with
the community and adaprting the program for the community is central to the
success of the SASA! program in Kigoma. During my time in Kigoma, I helped WPC
prepare for the Adaptations Project. This included training researchers, pilot
testing qualitative guides, and conducting interviews with WPC staff. My trip to
Kigoma showed me the importance of understanding the cultural nuances of a
location and recognizing that not all programs should adopt a one-size-fits-all
approach. To create a truly effective program that reduces VAW, is has been
crucial to adapt SASA! to fit the local circumstances in Kigoma. I hope my work
in Kigoma expands the evidence base for SASA!'s work, and shows others the
importance of understand and strengthening programs that have a real impact of
the lives of women worldwide.
Find out more information about SASA! and how to support and protect women in
your area and around the world!
References:
- Abramsky, T., Devries, K., Kiss, L., Nakuti, J., Kyegombe, N., Starmann, E., . .
. Watts, C. (2014). Findings from the SASA! Study: a cluster randomized
controlled trial to assess the impact of a community mobilization intervention
to prevent violence against women and reduce HIV risk in Kampala, Uganda. BMC
Medicine,12(1). doi:10.1186/s12916-014-0122-5
- Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick,
M.T., Chen, J., & Stevens, M.R. (2011). The National Intimate Partner and
Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National
Center for Injury Prevention and Control, Centers for Disease Control and
Prevention.
- Kyegombe, N., Abramsky, T., Devries, K., Watts, C. (2014) The impact of SASA!, a community mobilization intervention, on reported HIV-related risk behaviours and relationship dynamics in Kampala, Uganda. Journal of the International AIDS Society 17(1):19232. doi: 10.7448/IAS.17.1.19232
- Women’s Promotion Center (WPC). (2016) Internal Report. Kigoma, Tanzania: Women’s Promotion Center.
- World Health Organization (WHO). (2013). Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. Retrieved from http://apps.who.int/iris/bitstream/10665/85239/1/9789241564625_eng.pdf
- World Health Organization Media Centre. (2016). Violence against Women Fact Sheet. Retrieved from http://www.who.int/mediacentre/factsheets/fs/239/en/
