Evaluation and Implementation Science

Phuong Pham, Manasi Sharma, Kennedy Kihangi Bindu, Pacifique Zikomangane, Rachel C. Nethery, Eric Nilles, and Patrick Vinck. 2/16/2022. “Protective Behaviors Associated With Gender During the 2018-2020 Ebola Outbreak in Eastern Democratic Republic of the Congo.” JAMA Network Open. Read PublicationAbstract

Importance: In 2018 to 2020, the Democratic Republic of the Congo experienced the world’s second largest Ebola virus disease (EVD) outbreak, killing 2290 individuals; women were disproportionately infected (57% of all cases) despite no evidence of differential biological EVD risk. Understanding how gender norms may influence exposure to EVD, intensity, and prognosis as well as personal protective behaviors against the virus is important to disease risk reduction and control interventions.

Objective: To assess whether men and women differ in personal protective behaviors (vaccine acceptance, health-seeking behaviors, physical distancing) and the mediating role of EVD information and knowledge, perceived disease risk, and social relations.

Design, Setting, and Participants: This cross-sectional, multistage cluster survey study of 1395 randomly selected adults was conducted in the Ebola-affected regions of North Kivu from April 20, 2019, to May 10, 2019. Path analyses were conducted using structural equation modeling to examine associations among study variables. Statistical analysis was conducted from August 2019 to May 2020.

Main Outcomes and Measures: The main behavioral outcomes of interest were (1) vaccine acceptance, (2) formal health care seeking, and (3) self-protective behaviors. The primary factor of interest was self-reported gender identity. We also assessed sociodemographic factors.

Results: Among the study’s 1395 participants, 1286 (93%) had Nande ethnicity and 698 (50%) were women; the mean (SD) age was 34.5 (13.1) years. Compared with female participants, male participants reported significantly higher levels of education, wealth, and mobile phone access. There were associations found between gender and all EVD preventive behavioral outcomes, with evidence for mediation through EVD knowledge and belief in rumors. Men reported greater EVD knowledge accuracy compared with women (mean [SE] score for men: 12.06 [0.13] vs women: 11.08 [0.16]; P < .001), and greater knowledge accuracy was associated with increases in vaccine acceptance (β = 0.37; P < .001), formal care seeking (β = 0.39; P < .001), and self-protective behaviors (β = 0.35; P < .001). Lower belief in rumors was associated with greater vaccine acceptance (β = −0.30; P < .001), and greater EVD information awareness was associated with increased adoption of self-protective behaviors (β = 0.23; P < .001).

Conclusions and Relevance: This survey study found gender differences in adopting preventive protective behaviors against EVD. These findings suggest that it is critical to design gender-sensitive communication and vaccination strategies, while engaging women and their community as a whole in any response to infectious disease outbreaks. Research on the potential link between gender and sociodemographics factors associated with disease risk and outcomes is needed.

P.N. Pham, L. Fozouni, and al-Saiedi. 4/8/2021. “Association between distress and displacement settings: a cross-sectional survey among displaced Yazidis in northern Iraq.”  BMC Public Health, 21, 679. Publisher's VersionAbstract

Globally 70.8 million people have been forcibly displaced from their homes and are at disproportionally high risk for trauma. At the time of this study, there was an estimated 1.6 million internally displaced persons (IDP) in Iraq, more than two-thirds of whom reside in private, urban settings. This study aims to understand the impact of post-displacement accommodation on mental well-being of the Yazidi minority group displaced in Iraq.

Multi-stage stratified sampling was used to randomly select IDPs in camp and out of camp settlements in northern Iraq. Standardized questionnaires evaluated factors including exposure to violence and self-reported distress symptoms (measured by Impact of Event Scale-Revised). A multi-variate linear model assessed the relationship between settlement setting and distress symptoms.

One thousand two hundred fifty-six displaced Yazidi participants were included in the study: 63% in camps and 37% out of camps. After controlling for exposure to violence, social cohesion, unemployment, and access to basic services, IDPs in camps were predicted to have a 19% higher mean distress symptom score compared to those out of camps.

This study provides a framework to investigate post-displacement accommodation as a potential intervention to improve well-being for displaced populations. With a shift towards new models of emergency and long-term housing, it is important to understand the potential and limitations of more decentralized models, and identify effective methods to maintain access to basic services while improving living conditions for both displaced populations and their host communities.

Katrina Keegan

Katrina Keegan, MPH

Evaluation Researcher (Independent Contractor), Evaluation and Implementation Science

Katrina Keegan is the Evaluation Researcher (independent contractor) coordinating the external evaluation of UNHCR's Regional Response to Multiple...

Read more about Katrina Keegan, MPH
Phuong Pham, Patrick Vinck, and Eric Stover. 6/2007. Abducted: The Lord's Resistance Army and Forced Conscription in Northern Uganda.Abstract

Since the late 1980s, the Lord’s Resistance Army (LRA), a spiritualist rebel group with no clear political agenda, has abducted tens of thousands of children and adults to serve as porters and soldiers. In the early 1990s, children who escaped from the LRA or were captured by Ugandan soldiers were often paraded in the streets in the hope that someone would identify them. This treatment prompted a group of parents of abducted children to establish the Gulu Support the Children Organization (GUSCO), a reception center in Gulu, in 1994. In December 2005, the Berkeley-Tulane Initiative on Vulnerable Populations launched The Database Project to better document abduction and help improve the capacity of 8 reception centers in the northern districts of Gulu, Kitgum, Pader, Apac, and Lira to collect and analyze information about former LRA abductees.

Patrick Vinck and Phuong Pham. 1/2010. “Outreach Evaluation: The International Criminal Court in the Central African Republic.” The International Journal of Transitional Justice.Abstract

Public information and outreach have emerged as one of the fundamental activities of transitional justice mechanisms. Their objective is to raise public awareness, knowledge and participation among affected communities. Despite this increased focus, understanding of the role, impact and effectiveness of various outreach strategies remains limited, as is understanding of communities’ knowledge, perceptions and attitudes about transitional justice mechanisms, including their expectations. The study discussed in this article was designed to evaluate International Criminal Court (ICC) outreach programs in the Central African Republic.

Phuong Pham and Patrick Vinck. 8/2010. Building Peace, Seeking Justice: A Population-Based Survey on Attitudes About Accountability and Social Reconstruction in the Central African Republic.Abstract

Decades of Political Instability, state fragility, mismanagement, and a series of armed conflicts have led the Central African Republic (CAR) to a state of widespread violence and poverty. This study provides a better understanding of the scope and magnitude of violence in CAR and its consequences, as well as a snapshot of what the citizens of CAR believe is the best way to restore peace. It also examines the issue of justice and accountability for the serious crimes that were committed. This report provides a detailed analysis of results on a wide range of topics related to the population’s priorities and needs, exposure to violence, security, community cohesion and engagement, access to information, conflict resolution, reintegration of former combatants, transitional justice, and reparations for victims.

Jennifer Chan. 9/2010. Applied Technologies Module Evaluation.Abstract

In 2010, the Humanitarian Studies Course incorporated applied technologies into the coursework for the second consecutive year. The goal of this evaluation report is to reflect upon and determine the next steps for the Applied Technology Learning Module and to better understand its impact on participant learning during the 2010 Humanitarian Studies Course. This evaluation concludes that improvements in 1) didactics and preparation 2) integration of crowdsourcing and GIS technology 3) satellite communications and 4) volunteer capacity resulted in a successful educational experience for future humanitarian responders.

Phuong Pham, Patrick Vinck, Mychelle Balthazard, and Sokhom Hean. 6/2011. After the First Trial: A Population-Based Survey on Knowledge and Perception of Justice and the Extraordinary Chambers in the Courts of Cambodia.Abstract

On July 26, 2010, Kaing Guek Eav, alias Duch, was convicted of crimes against humanity and grave breaches of the 1949 Geneva Conventions for events that took place three decades earlier under the Khmer Rouge regime. Following this important milestone for the Extraordinary Chambers in the Courts of Cambodia (ECCC), the present study was implemented to (1) monitor public awareness and knowledge of the ECCC’s work, as well as of outreach and victim participation initiatives organized by the tribunal and local non-governmental organizations, (2) assess attitudes about justice and the desire for reparations for past crimes, and (3) recommend ways in which the ECCC, civil society, and the international community can continue to engage Cambodians in the work of the ECCC.

Phuong Pham, Patrick Vinck, Mychelle Balthazard, Judith Strasser, and Chariya Om. 11/2011. “Victim Participation and the Trial of Duch at the Extraordinary Chambers in the Courts of Cambodia .” Journal of Human Rights Practice, 3, 3, Pp. 264–287.Abstract

The trial of Kaing Guek Eav, alias Duch (Case 001), at the Extraordinary Chambers in the Courts of Cambodia (ECCC) was the first in the history of international criminal justice in which surviving victims of alleged crimes could participate directly in international criminal proceedings as civil parties. In this study, we interviewed all 75 civil parties residing in Cambodia, including those who had ultimately been denied civil party status at the conclusion of the trial in Case 001. The objective was to learn about their experiences in participating in the ECCC proceedings.

Phuong Pham and Patrick Vinck. 7/2014. Fragile Peace, Elusive Justice: Population-Based Survey on Perceptions and Attitudes about Security and Justice in Abidjan, Côte d’Ivoire. Read PublicationAbstract

This report presents the results of a mixed-methods study conducted in Abidjan, Côte d’Ivoire, to assess the population’s perceptions, knowledge, and attitudes about security and justice. The study included a survey of 1,000 randomly selected adult residents, to provide results that are representative of the population of the city of Abidjan. The specific objectives of this study were to:

  1. Assess the overall exposure to violence among the population in Abidjan.
  2. Document attitudes and opinions about transitional justice mechanisms.
  3. Examine how the population gathers information about the International Criminal Court (ICC), what factors influence Ivorians’ knowledge of the Court, and what correlation exists between information sources and perceptions.

Detailed results provided in the report outline the challenges of rebuilding peace and achieving justice after a decade of conflict, and just two years after a dramatic post-election crisis. The report reveals a population that has little or no trust in its government and in each other, concerned with its economic well-being, and somewhat divided about holding accountable the perpetrators of serious crimes during the postelection violence.

Patrick Vinck and Phuong Pham. 7/2014. Searching for Lasting Peace: Population-Based Survey on Perceptions and Attitudes about Peace, Security and Justice in Eastern Democratic Republic of the Congo .Abstract

This report presents the results of a mixed-methods study conducted in eastern Democratic Republic of the Congo (DRC) between November and December 2013, to assess the population’s perceptions, knowledge, and attitudes about peace, security and justice. The study included a survey of 5,166 randomly selected adult residents, to provide results that are representative of the adult population of territories and major urban areas in the provinces of North Kivu and South Kivu, and the district of Ituri.

Jr. Frederick M. Burkle, P. Gregg Greenough, and Gerald Martone. 1/2014. “The Changing Face of Humanitarian Crises .” Brown Journal of World Affairs, 20, 2, Pp. 19-36.Abstract

The scale and cadence of crises that demand international humanitarian response is increasing. The cumulative frequency and severity of climate change on large populations, rapid and unsustainable urbanization, decreasing biodiversity, and the impending realities of resource scarcities and the armed conflicts they might catalyze are only some of the challenges that loom ahead. It is ironic that while human civilization today possesses the most advanced technologies, global prosperity, and abundance, we face the greatest absolute number of people lacking access to clean water, food, shelter, and basic healthcare.

Adam Khalifa. 6/2014. “Cancer in refugees in Jordan and Syria between 2009 and 2012: challenges and the way forward in humanitarian emergencies.” The Lancet Oncology, 15, 7, Pp. E290-E297. Read PublicationAbstract

Treatment of non-communicable diseases such as cancer in refugees is neglected in low-income and middle-income countries, but is of increasing importance because the number of refugees is growing. The UNHCR, through exceptional care committees (ECCs), has developed standard operating procedures to address expensive medical treatment for refugees in host countries, to decide on eligibility and amount of payment. We present data from funding applications for cancer treatments for refugees in Jordan between 2010 and 2012, and in Syria between 2009 and 2011. Cancer in refugees causes a substantial burden on the health systems of the host countries. Recommendations to improve prevention and treatment include improvement of health systems through standard operating procedures and innovative financing schemes, balance of primary and emergency care with expensive referral care, development of electronic cancer registries, and securement of sustainable funding sources. Analysis of cancer care in low-income refugee settings, particularly in sub-Saharan Africa, is needed to inform future responses.

Patrick Vinck and Phuong Pham. 1/2016. Peacebuilding and Reconstruction Polls: Eastern Democratic Republic of the Congo, Poll Report #5 .Abstract
This poll is the fifth in a series of polls that will be conducted to provide reliable data and analysis on peace, security, justice and reconstruction in the Democratic Republic of the Congo. The project is a joint initiative of the Harvard Humanitarian Initiative (HHI) and the United Nations Development Programme (UNDP), in collaboration with MONUSCO Civil Affairs. HHI is responsible for the data collection, and independent analysis, and reporting of the results, in collaboration with partners at the Université Libre des Pays des Grands Lacs, Université Catholique de Bukavu, and Université de Bunia.