FINAL REPORT UGANDA NWO EWP-U Tilburg University new-1...10.1.1. Living in trauma from the past (first wave) .....137 10.1.2. The impact of violence and beliefs of spiritual possession

ResearchReport

Researchreport

TilburgUniversity

Cost-Benefit Analysis of Cash Transfer Programs and Post Trauma Services for Economic Empowerment of Women in Uganda (EWP-U)

ACost-BenefitAnalysis

ofCash-TransferProgramsandPost-TraumaServices

forEconomicEmpowermentofWomeninNorthUganda

ResearchReport(EWP-U)

Authors:

Prof.Dr.MirjamvanReisen(PrincipalInvestigator)

Dr.PrimroseNakazibwe(ResearchCoordinator)

Dr.MiaStokmans(MethodologyandAnalysis)

Dr.BerthaVallejo(ResearchCoordinatorandValorisation)

SelamKidane(Researcher)

2

Colofon

Tilburg,30April,2018

Authors:

Prof.Dr.MirjamvanReisen

Dr.PrimroseNakazibwe

Dr.MiaStokmans

Dr.BerthaVallejo

SelamKidane

Publishedby:

TilburgUniversity

Photo:Lira,Uganda.2017.MirjamvanReisen(copyrights)

Wehavemadeeveryefforttotruthfullyreportthefindingsoftheresearch.Ifthereisany

errororcommentonthecontentofthisreport,wearegratefulifyoubringthisimmediately

toourattention.

MirjamvanReisen,Email:[email protected]

3

TableofContents

LISTOFTABLES......................................................................................................................................10

LISTOFFIGURES....................................................................................................................................15

LISTOFACRONYMS...............................................................................................................................16

ACKNOWLEDGEMENTS.........................................................................................................................19

PURPOSEOFTHISREPORTANDORIGINOFCONTENT.........................................................................22

EXECUTIVESUMMARY:THECOST-BENEFITOFINCLUDINGTRAUMA-SUPPORTINSOCIAL

PROTECTIONPROGRAMS......................................................................................................................25

PARTI:CONTEXTANDBACKGROUND.................................................................................................34

INTRODUCTION............................................................................................................................35

HISTORYOFTHECONFLICTINNORTHANDEASTERNUGANDA..................................................37

Civilwar................................................................................................................................37

Abductions,killingsanddisplacement.................................................................................38

ExpansionofoperationalareasoftheLordResistanceArmy.............................................39

Women’sparticipationinthePeace,RecoveryandDevelopmentPlan..............................40

PARTII:RESEARCHQUESTIONSANDTHEORETICALFRAMEWORK....................................................43

RESEARCHQUESTIONSANDDESIGN............................................................................................44

Researchgap........................................................................................................................44

Operationalizationofsocialandeconomicresilience.........................................................46

4.2.1. Perceivedcapabilities:Assetsforrunningthehousehold...........................................46

4.2.2. Income.........................................................................................................................46

Socialinclusion.....................................................................................................................46

4.3.1. System:Feelingofsecurity..........................................................................................47

4.3.2. Empowerment:Achangeinagencyandbehavior......................................................47

4.3.3. Experiencinglessworry...............................................................................................47

Objectiveofthestudy..........................................................................................................47

4

Researchquestionandsub-questions.................................................................................48

Hypotheses..........................................................................................................................50

4.6.1. Unitofanalysis............................................................................................................52

4.6.2. Timelineofthestudy...................................................................................................52

Experimentaldesignandsamplingofrespondents.............................................................54

Researchdesign:Experimentinginreal-lifesituations........................................................55

Researchactivitiesanddetailedtime-line...........................................................................63

4.9.1. Focusgroupmeetingsandinterviewswithresourcepersonsonsocialprotectionand

trauma–2015..............................................................................................................................63

4.9.2. Firstdatacollection(Wave1)andinterviewsonaccessandparticipationtosocial

protection–2016.........................................................................................................................63

4.9.3. MeetingswithlocalcontactpersonsandradiostationsforSHLCPTS–2016.............64

4.9.4. Seconddatacollection(Wave2)InterviewsontraumaandSHLCPTS........................64

4.9.5. Publictestimonies.......................................................................................................64

4.9.6. Otherresearchactivities.............................................................................................64

4.9.7. Analysisofinterviewsandfocusgroups.....................................................................65

Quantitativedatapreparationandstatisticalapproach......................................................65

Definitionofterms...............................................................................................................67

4.11.1. Socialprotection.........................................................................................................67

4.11.2. Cashtransfers..............................................................................................................69

4.11.3. Trauma........................................................................................................................70

4.11.4. Collectivetraumaandhealing.....................................................................................71

Definitionofconceptsofeffect...........................................................................................72

4.12.1. Resilience....................................................................................................................72

4.12.2. Empowerment.............................................................................................................73

4.12.3. Impactofevents..........................................................................................................73

Definitionoftheoreticalconceptsexplainingchange..........................................................75

4.13.1. Livelihood....................................................................................................................75

5

4.13.2. Agency.........................................................................................................................76

4.13.3. Valuesandvalueentropy............................................................................................77

4.13.4. Policywindow.............................................................................................................78

DESCRIPTIONOFSTUDYPOPULATION.........................................................................................79

Descriptionofstudysites.....................................................................................................80

Kitgum..................................................................................................................................82

Lira.......................................................................................................................................83

Katakwi................................................................................................................................84

Amuria.................................................................................................................................85

PARTIII:SOCIALPROTECTIONINTERVENTIONS..................................................................................86

OVERVIEWOFSOCIALPROTECTIONINUGANDA.........................................................................87

PovertyinNorthernUganda................................................................................................87

SocialprotectionpolicyinUganda.......................................................................................87

SocialprotectionprogramsimplementedinUganda..........................................................90

SocialprotectionschemesinNorthernUganda..................................................................95

6.4.1. NationalAgriculturalAdvisoryServices(NAADS)........................................................96

6.4.2. NorthernUgandaSocialActionFund(NUSAF)............................................................96

6.4.3. TheUgandaSocialAssistanceGrantsforEmpowerment(SAGE)...............................97

6.4.4. RestockingProgram....................................................................................................97

6.4.5. CommunityDrivenDevelopment(CDD)program.......................................................98

6.4.6. YouthLivelihoodProgram...........................................................................................98

Localgovernmentsupporttowomen’sparticipationinsocialprotectionprograms..........99

PARTIV:TRAUMARELIEFINTERVENTIONS.......................................................................................100

TRAUMAINNORTHERNUGANDA..............................................................................................101

PrevalenceoftraumainNorthernUganda........................................................................101

TraumainterventionsinNorthernUganda........................................................................103

Traumasupportbylocalgovernment................................................................................104

Interventionsbywomen’sorganizations...........................................................................105

6

Needforanewintervention..............................................................................................109

DEVELOPMENTOFTHESHLCPTSPROGRAM..............................................................................110

Traumaandthehumanbrain............................................................................................110

EMDRasatraumahealingintervention............................................................................112

Multilevelhealingoftraumainpost-warcontexts............................................................115

Contextualizingandenlargingtheimpactoftraumasupportthroughradio....................116

DevelopmentoftheSHLCPTSprogram.............................................................................117

OutlineofthesixsessionsoftheSHLCPTSprogram..........................................................118

ContextualizingSHLCPTSandpreparationofradiodissemination(recordings)................121

ImplementationoftheSHLCPTSintervention...................................................................123

PARTV:QUALITATIVERESULTS:IMPACTOFSOCIALPROTECTION..................................................124

PARTICIPATIONINSOCIALPROTECTIONPROGRAMS................................................................125

NAADS/OperationWealthCreation...................................................................................125

NorthernUgandaSocialActionFundProject....................................................................127

RestockingProgram...........................................................................................................128

CommunityDrivenDevelopment......................................................................................131

YouthLivelihoodFunds......................................................................................................132

SocialAssistanceGrantsforEmpowerment......................................................................133

Conclusion..........................................................................................................................133

PARTVI:QUALITATIVERESULTS:IMPACTOFTRAUMARELIEFINTERVENTIONS.............................136

PARTICIPATIONINTRAUMARELIEFPROGRAMS........................................................................137

Interviewsofwomensufferingfrompost-traumaticstress..............................................137

10.1.1. Livingintraumafromthepast(firstwave)...............................................................137

10.1.2. Theimpactofviolenceandbeliefsofspiritualpossessiononhealthandpoverty...141

Livinginthepast(secondwave)........................................................................................144

10.2.1. Whentherebelscame..............................................................................................145

10.2.2. Therebelswillcomeback.........................................................................................150

RESULTSOFSHLCPTSPROGRAMREPORTEDBYPARTICIPANTS.................................................153

7

Outcomesofinterventionsessions....................................................................................153

11.1.1. Breathingexercises...................................................................................................153

11.1.2. Safeplaceandbilateralstimulation..........................................................................153

11.1.3. Subjectiveunitsofdistress(SUD)..............................................................................156

11.1.4. Useofskits................................................................................................................156

11.1.5. Whattheparticipantslearntfromtheskit...............................................................157

11.1.6. Communityevent......................................................................................................158

ImpactofSHLCPTSprogramonthefamily........................................................................159

ImpactofSHLCPTSprogramontheircommunities...........................................................163

Impactoftrainingonperceptionsofwomen’shealthandwellbeing..............................166

Therebelsarenotcomingback.........................................................................................168

PARTVII:CONSTRUCTIONANDANALYSISOFIES-RANDSERSCALES..............................................173

IMPACTOFEVENTSSCALE..........................................................................................................174

StatisticsofitemsinIES-Rsubscales..................................................................................174

CorrelationbetweenitemsintheIES-R.............................................................................178

ConclusionsaboutIES-R.....................................................................................................181

SOCIALANDECONOMICRESILIENCETOOL................................................................................182

StatisticsforitemsintheSERtool.....................................................................................182

13.1.1. Social.........................................................................................................................182

13.1.2. Capability...................................................................................................................183

13.1.3. Improvementofactualincome.................................................................................185

13.1.4. Women’sempowerment..........................................................................................186

13.1.5. Structural/system......................................................................................................188

13.1.6. Worry........................................................................................................................190

CorrelationbetweentheitemsintheSERscale................................................................191

InternalconsistencyoftheSER..........................................................................................203

Correlationsbetweenthesubscales..................................................................................205

PARTVIII:QUANTITATIVERESULTS...................................................................................................206

8

DESCRIPTIONOFRESPONDENTS................................................................................................207

Descriptionofparticipantsinfirstwaveanddistricts.......................................................207

Descriptionofrespondentssecondwaveanddistricts.....................................................209

LEVELSOFTRAUMA(WAVE1)....................................................................................................211

Levelsofself-reportedtrauma..........................................................................................211

Impactofcounselingtrauma’sonreductionoftrauma....................................................212

Conclusion..........................................................................................................................217

EFFECTOFSOCIALPROTECTIONONSOCIALANDECONOMICRESILIENCE(WAVE1)................218

Social..................................................................................................................................218

Capability...........................................................................................................................219

Income...............................................................................................................................221

Empowerment...................................................................................................................222

System................................................................................................................................223

Worry.................................................................................................................................225

Conclusion:Impactofprogramsoncapability,incomeandempowerment.....................226

EFFECTOFTHESHLCPTSPROGRAMONSOCIALANDECONOMICRESILIENCE(WAVE2)..........229

Social..................................................................................................................................229

Capability...........................................................................................................................232

Income...............................................................................................................................235

Empowerment...................................................................................................................238

System................................................................................................................................240

Worry.................................................................................................................................242

Conclusion:Impactoncapability,incomeandempowerment(wave2)...........................244

EFFECTOFSHLCPTSONREDUCTIONOFTRAUMA?(WAVE2)...................................................247

TotalmeanIES-R................................................................................................................247

Avoidance..........................................................................................................................249

Intrusion.............................................................................................................................250

Hyperarousal......................................................................................................................251

9

Conclusion..........................................................................................................................253

PARTIX:DISCUSSION.........................................................................................................................254

DISCUSSIONOFUNEXPECTEDFINDINGSANDVALIDITY............................................................255

APPENDIX1:OUTLINEOFSHLCPTSINTERVENTION............................................................................257

APPENDIX2:LITERATUREREVIEWONSOCIALPROTECTIONANDTRAUMA......................................258

APPENDIX3:SURVEYDESCRIPTIVES...................................................................................................269

APPENDIX4:IMPACTOFEVENTSSCALE-REVISED(IES-R)..................................................................272

APPENDIX5:SOCIALANDECONOMICRESILIENCESCALE(SER).........................................................274

REFERENCES........................................................................................................................................278

10

ListofTablesTable4-1.Summaryofresearchactivitiesbyphaseandtimepoint......................................53

Table6-1.SummaryofsocialprotectionprogramsinUganda...............................................91

Table8-1.OutlineforasixweekSHLCPTSprogramforvictimsoftraumaticstress.............119

Table10-1.SymptomsdescribedbythewomeninterviewedonTrauma(seesection4.9.2)

...............................................................................................................................................150

Table12-1.IES-R:Statisticsforitemspersubscale,firstwave(n=471)................................176

Table12-2.IES-R:Statisticsforitemspersubscale,secondwave(n=356)...........................177

Table12-3.IES-R:Characteristicsofthesubscales,firstandsecondwave..........................178

Table12-4.IES-R:Correlationofitemswithownscaleandotherscales,firstwave(n=471)

...............................................................................................................................................179

Table12-5.IES-R:Correlationofitemswithownscaleandotherscales,secondwave(n=356)

...............................................................................................................................................180

Table12-6.IES-R:Correlationbetweensubscales,firstandsecondwave...........................181

Table13-1.SER:StatisticsforitemsinSocialscale,firstandsecondwave..........................182

Table13-2.SER:StatisticsforitemsinCapabilityscale,firstandsecondwave....................183

Table13-3.SER:StatisticsforitemsinImprovementofActualIncomescale,firstandsecond

wave......................................................................................................................................185

Table13-4.SER:StatisticsforitemsinWomen’sEmpowermentscale,firstandsecondwave

...............................................................................................................................................187

Table13-5.SER:StatisticsforitemsinStructural/Systemscale,firstandsecondwave......188

Table13-6.SER:StatisticsforitemsinWorryscale,firstandsecondwave.........................190

Table13-7.SER:CorrelationofitemsonSocialandCapabilityscaleswithownscaleand

otherscales,firstwave..........................................................................................................192

Table13-8.CorrelationofitemsonIncomescalewithownscaleandotherscales,firstwave

...............................................................................................................................................193

Table13-9.SER:CorrelationsoftheitemsonWomen’sEmpowermentandSystemsscales

withownscaleandotherscales,firstwave..........................................................................194

Table13-10.SER:CorrelationofitemsonWorryscalewithownscaleandotherscales,first

wave......................................................................................................................................196

11

Table13-11.SER:CorrelationsofitemsfromSocialandCapabilityscaleswithownscaleand

otherscales,secondwave....................................................................................................198

Table13-12.SER:CorrelationofitemsfromIncomescalewithownscaleandotherscales,

secondwave..........................................................................................................................199

Table13-13.SER:CorrelationsofitemsfromWomen’sEmpowermentscalewithownscale

andotherscales,secondwave..............................................................................................201

Table13-14.SER:CorrelationsofitemsfromSystemscalewithownscaleandotherscales,

secondwave..........................................................................................................................202

Table13-15.SER:CorrelationofitemsfromWorryscalewithownscaleandotherscales,

secondwave..........................................................................................................................203

Table13-16.SER:Characteristicsofthesubscales,firstandsecondwave...........................204

Table13-17.SER:Correlationsbetweenthesubscales,firstandsecondwave....................205

Table14-1.Geographicareaoftherespondents..................................................................207

Table14-2.Geographicdistributionoftheprograms...........................................................207

Table14-3.Educationallevelofthedifferentgroups...........................................................208

Table14-4.Occupation/employmentofthedifferentgroups..............................................208

Table14-5.Geographicareaoftherespondents..................................................................209

Table14-6.Geographicdistributionoftheprograms...........................................................209

Table14-7.Educationallevelofthetreatmentgroups.........................................................210

Table14-8.Occupation/employmentofthetreatmentgroups...........................................210

Table15-1.IES-R:Totalmeanscoreforeachgroupofrespondents(cash/in-kindand/or

traumacounselling)...............................................................................................................211

Table15-2.IES-R:Numberofrespondentswithhightraumainthefirstwave....................212

Table15-3.IES-R:EffectofprogramsonthetotalmeanofIES-R.........................................212

Table15-4.EffectoftheprogramsonthetotalmeanofIES-Rwhencontrollingforage,

educationallevelandoccupation.........................................................................................213

Table15-5.IES-R:Avoidanceforeachgroupofrespondents(cash/in-kindand/ortrauma

counselling)...........................................................................................................................213

Table15-6.IES-R:EffectofprogramsontheAvoidancescale..............................................214

Table15-7.IES-R:EffectofprogramsontheAvoidancescalewhencontrollingforage,


12

Table15-8.Statisticsfortheintrusionsubscaleforeachgroupofrespondents(cash

transfer/in-kindand/ortraumacounselling)........................................................................215

Table15-9.IES-R:EffectofprogramsonIntrusionsubscale.................................................215

Table15-10.IES-R:EffectofprogramsontheIntrusionsubscalewhencontrollingforage,


Table15-11.IES-R:Hyperarousalforeachgroupofrespondents(cashtransfer/in-kind

and/ortraumacounselling)...................................................................................................216

Table15-12.IES-R:EffectofprogramsonHyperarousalsubscale........................................217

Table15-13.IES-R:EffectofprogramsontheHyperarousalscalewhencontrollingforage,


Table16-1.SER:ScoresontheSocialscaleforeachgroup(cashtransfer/in-kindand/or


Table16-2.SER:EffectofprogramsontheSocialscale........................................................218

Table16-3.SER:EffectofprogramsontheSocialscalewhentakingage,educationallevel

andoccupationintoaccount.................................................................................................219

Table16-4.SER:Capabilityscoresforeachgroupofrespondents(cash/in-kindand/or


Table16-5.SER:EffectoftheprogramsontheCapabilityscale...........................................220

Table16-6.SER:TheeffectofprogramsontheCapabilityscalewhentakingage,educational

levelandoccupationintoaccount........................................................................................220

Table16-7.SER:Incomescoresforeachgroupofrespondents(cashtransfer/in-kindand/or


Table16-8.SER:EffectofprogramsontheIncomescores...................................................221

Table16-9.SER:EffectofprogramsontheIncomescoreswhentakingage,educationallevel

andoccupationintoaccount.................................................................................................222

Table16-10.SER:Empowermentscoresforeachgroupofrespondents(cash/in-kindtransfer

and/ortraumacounselling)...................................................................................................222

Table16-11.SER:TheeffectofprogramsonEmpowerment...............................................223

Table16-12.SER:TheeffectofprogramsonEmpowermentwhentakingage,educational


Table16-13.SER:Systemscoresforeachgroupofrespondents(cash/in-kindtransferand/or


13

Table16-14.SER:TheeffectofprogramsontheSystemsubscale........................................224

Table16-15.SER:EffectofprogramsontheSystemsubscalewhentakingage,educational


Table16-16.SER:Worryscoresforeachgroupofrespondents(cashtransfer/in-kindand/or


Table16-17.SER:TheeffectofprogramsonWorry.............................................................226

Table16-18.SER:EffectofprogramsonWorrywhentakingage,educationalleveland

occupationintoaccount........................................................................................................226

Table17-1.SER:ScoresontheSocialscaleforeachgroupofrespondents(cashtransfer/in-

kind,traumacounselling,SHLCPTSprogram).......................................................................230

Table17-2.SER:EffectoftheprogramsontheSocialscale.................................................230

Table17-3.SER:EffectofprogramsontheSocialscalewhencontrollingforage,educational

levelandoccupation.............................................................................................................231

Table17-4.SER:ScoresontheCapabilityscaleforeachgroupofrespondents(social

protection:cashtransfer,traumacounselling,SHLCPTSprogram)......................................232

Table17-5.SER:EffectofprogramsonCapability................................................................233

Table17-6.SER:EffectoftheprogramsonCapacitywhencontrollingforageeducational


Table17-7.SER:ScoresontheIncomescaleforeachgroupofrespondents(cashtransfer/in-

kind,traumacounselling,SHLCPTSprogram).......................................................................235

Table17-8.SER:EffectoftheprogramsontheIncomescale...............................................237

Table17-9.SER:EffectofprogramsonIncomewhencontrollingforage,educationallevel

andoccupation......................................................................................................................237

Table17-10.ScoresontheEmpowermentscaleforeachgroupofrespondents(cash/in-kind

transfer,traumacounselling,SHLCPTSprogram).................................................................238

Table17-11.SER:EffectofprogramsonEmpowerment......................................................238

Table17-12.SER:EffectofprogramsonEmpowermentwhencontrollingforageeducational


Table17-13.SER:ScoresontheSystemscaleforeachgroupofrespondents(cash/in-kind


Table17-14.SER:EffectofprogramsonSystem..................................................................241

14

Table17-15.SER:EffectofprogramsonSystemwhencontrollingforage,educationallevel

andoccupation......................................................................................................................241

Table17-16.SER:ScoresontheWorryscaleforeachgroupofrespondents(cash/in-kind


Table17-17.SER:EffectofprogramsontheWorry..............................................................242

Table17-18.SER:EffectofsocialprotectiononWorrywhencontrollingforageeducational


Table18-1.IES-R:TotalmeanIER-Sscoreforeachgroupofrespondents(cash/in-kind


Table18-2.IESR:EffectofprogramsonthemeantotalIES-R.............................................248

Table18-3.IES-R:EffectofprogramsonthetotalmeanIES-Rwhencontrollingforage


Table18-4.IES-R:Avoidanceforeachgroupofrespondents(cashtransfer,trauma

counselling,SHLCPTSprogram).............................................................................................249

Table18-5.IES-R:EffectofprogramsonAvoidance.............................................................249

Table18-6.IES-R:EffectofprogramsonAvoidancewhencontrollingforageeducational


Table18-7.IES-R:Intrusionforeachgroupofrespondents(cash/in-kindtransfer,trauma

counselling,SHLCPTSprogram).............................................................................................250

Table18-8.IES-R:EffectofprogramsonIntrusion...............................................................251

Table18-9.IES-R:EffectofprogramsontheIntrusionwhencontrollingforage,educational


Table18-10.IES-R:Hyperarousalforeachgroupofrespondents(cash/in-kindtransfer,

traumacounselling,SHLCPTSprogram)................................................................................252

Table18-11.IES-R:EffectofprogramsonHyperarousal......................................................252

Table18-12.IES-R:EffectofprogramsonHyperarousalwhencontrollingforageeducational


Table0-1.Literaturereview:SocialProtectionandTraumainUganda................................259

15

ListofFiguresFigure3-1.MapofPeace,RecoveryandDevelopmentPlan(UgandaBureauofStatistics,

2015,printedinUNDP,2015).................................................................................................41

Figure4-1.Relationshipbetweenthevariablessocialprotection,traumaandSER...............41

Figure5-1.MapofUgandaanditsneighbors.........................................................................80

Figure5-2.PoliticalmapofUganda........................................................................................81

Figure5-3.EthnographicmapofUganda................................................................................82

Figure8-1.Impactofwaroncollectivetrauma....................................................................117

Figure16-1.MeanscoresonCapabilities,IncomeandEmpowerment................................227

Figure17-1.Interactioneffectbetweencash/in-kindandSHLCPTSprogramontheSocial

scale......................................................................................................................................231

Figure17-2.Interactionbetweencash/in-kindandtraumacounsellingontheCapabilityscale

...............................................................................................................................................234

Figure17-3.SER:Interactioneffectbetweencash/in-kindandtraumacounsellingonthe

Incomescale..........................................................................................................................236

Figure17-4.SER:InteractioneffectofcashandcounsellingontheEmpowermentscale...239

Figure17-5.MeanscoresonCapability,EmpowermentandIncomeforthosewhoreceived

theSHLCPTS-program...........................................................................................................244

Figure17-6.MeanscoresonCapability,EmpowermentandIncomeforthosewhodidnot

receivedtheSHLCPTS-program.............................................................................................245

16

ListofAcronyms

ALREP AgriculturalLivelihoodRecoveryProgramme

ANOVA AnalysisofVariance

APAI AcholiPsychosocialAssessmentInstrument

CAP CommunityActionProgram

CDD CommunityDrivenDevelopment

CIR CommunityInfrastructureRehabilitation

CPTSD-RI ChildPosttraumaticStressDisorderReactionIndex

DFID DepartmentforInternationalDevelopment

DSM Diagnosticandstatisticalmanualofmentaldisorders

EMDR EyeMovementDesensitizationReordering

EOC EqualOpportunitiesCommission

ESP ExpandingSocialProtection

EWP-U Empowerment of Women in Uganda

FAO Food and Agriculture Organization

FOBA ForceOboteBackGroup

HISP HouseholdIncomeSupportprogram

HAP HumanitarianAssistancePrograms

GZU GreatZimbabweUniversity

ICC InternationalCriminalCourt

IDP Internallydisplacedperson

IMF InternationalMonetaryFund

IEC ImpactofEventsScale

IES-R ImpactofEventsScale–Revised

Isis-WICCE Isis-Women’sInternationalCrossCulturalExchange

KALIP KaramojaLivelihoodImprovementProgramme

17

KIWEPI KitgumWomenPeaceInitiative

LRA LordResistanceArmy

MAAIF MinistryofAgricultureAnimalIndustryandFisheries

MFPED MinistryofFinance,PlanningandEconomicDevelopment

MGLSD MinistryofGender,LabourandSocialDevelopment

MUST MbararaUniversityofScienceandTechnology

NAADS NationalAgriculturalAdvisoryServices

NDPI FirstNationalDevelopmentPlan

NET NarrativeExposureTherapy

NRA TheNationalResistanceArmy

NRM NationalResistanceMovement

NUDEIL NorthernUgandaDevelopmentofEnhancedLocalGovernance,InfrastructureandLivelihoods

NUSAF NorthernUgandaSocialActionFund

NUREP NorthernUgandaRecoveryProgramme

OVC OrphansandVulnerableChildren

PCAF PeterC.AldermanFoundation

PEAP PovertyEradicationActionPlan

PGM ProductionandMarketingGrant

PRDP Peace,RecoveryandDevelopmentPlan

PRRO ProtractedReliefandRecoveryOperations

PTS Post-traumaticstress

PTSD PostTraumaticStressDisorder

PTSS PostTraumaticStressSyndrome

PWP PublicWorksProgram

RALNUC RestorationofAgriculturalLivelihoodsinNorthernUganda

SAGE SocialAssistanceGrantforEmpowerment

18

SCG SeniorCitizensGrant

SDIP SocialDevelopmentInvestmentPlan

SER SocialandEconomicResilience

SHLCPTS-program SelfHelpLowCostPostTraumaticStressProgram

SLF SustainableLivelihoodFramework

SUD Subjectiveunitsofdistress

TEWPA TesoWomenPeaceActivists

UN UnitedNations

UNPRAP UnitedNationsPeacebuildingandRecoveryProgramme

UNSCW UnitedNations61stCommissionontheStatusofWomen

UPDF UgandaPeople’sDefenseForce

UPE UniversalPrimaryEducation

USE UniversalSecondaryEducation

VFG VulnerableFamilyGrants

WFP WorldFoodProgram

WHO WorldHealthOrganization

WOPI-U WomenPeaceInitiative–Uganda

19

Acknowledgements

WearefirstofallgratefultoNWO-WOTROforawardingusthisresearch,whichgaveusthe

possibilitytoresearchaquestionofimportanceforthestakeholdersingovernmentand

serviceprovidingorganizations.

Weexpressoursincerethankstothewomen’sorganization,thewomen’sgroupsandallthe

womenwhoparticipatedinthisresearch.Ourspecialthanksgotothepartnerorganizations

KitgumWomenPeaceInitiative(KIWEPI),TesoWomenPeaceActivists(TEWPA)andWomen

PeaceInitiative–Uganda(WOPI-U)inNorthernUganda.

Wearegratefulforthesupportreceivedfromthedistrictchairpersonsanddistrictandsub

countyofficersinLira,Kitgum,KatakwiandAmuria,whoallowedustocarryoutthe

researchandforallthesupportreceivedintheprocess.Wearealsogratefulforallthosein

thedistrictswhohelpedinimplementingthetraumaservices.

OurthanksalsogototheGovernmentofUganda,specificallythePresident’sOffice,the

PrimeMinister’sOfficeandtheMinistryofGender,LabourandSocialDevelopmentand

ExpandingSocialProtectionSecretariatfortheirsupportincarryingoutthisresearchandfor

theirinterestintheresultsthroughouttheinvestigation.WespecificallythanktheHeadof

SocialProtection,Mr.KasaijaStephenandtheSeniorProgramOfficer,Ms.JaneNamuddu.

WethanktheMinistryofHealth,especially,Dr.Mugisha.

WewereespeciallyhonoredthatthePrimeMinisteracceptedaninvitationtoattendthe

disseminationoftheresultstoalltheparticipantsduringacommemorationheldinBorlonyo

onFebruary21st,2017ontheoccasionofthecommemorationofthemassacrebytheLord’s

ResistanceArmy(LRA)inLirain2004when300villagerswerekilled.Weverymuchthank

theMembersofParliamentandGovernment,especiallytheMinisterofStateforInternal

Affairs.

Weacknowledgegratefullythesupportreceivedfromlocalgovernments,especiallythe

districtchairpersonsofLira,Kitgum,KatakwiandAmuria;thedistrictdevelopmentofficers

ofLira,Kitgum,KatakwiandAmuria;theresidentdistrictofficersofKatakwiandLira;and

theleadersofthetechnicalandlocalcouncilsthree,twoandoneinallthesub-counties.

20

WearealsothankfultotheEqualOpportunitiesCommission(EOC),Ms.SylviaMuwebwa

Ntambi.TheEOCtookakeeninterestintheresultsandhostedseveralmeetingsallowingus

todisseminatetheresultsofthisstudy.

WeexpressourgratitudetoformerPresidentEllenJohnson-SirleafofLiberiaandformer

MinisterofGenderandSocialProtectionJuliaDuncan-Cassell,whoinvitedtheteamtothe

celebrationsoftheMarch8thInternationalWomen’sColloquiumcommemoratingthe

InternationalWomenDay,allowingtheprojecttopresenttheresultsoftheresearchtoan

internationalaudienceofpolicymakersandrelevantstakeholders.Wearealsogratefulfor

MinisterDuncan-Cassel’sparticipationinpresentingtheresultsattheUnitedNations61st

CommissionontheStatusofWomen(UNSCW)conferenceoonMarch13-24th,2017inNew

York,assemblinganinternationalaudienceofpolicymakersandimplementers.

WegratefullyacknowledgethecontributionofIsis-Wiccetoourprojectanditspartners,the

KitgumWomenPeaceInitiative(KIWEPI)-Kitgum,theWomenPeaceInitiative-Uganda

(WOPI-U)-LiraandtheTesoWomenPeaceActivists(TEWPA)-Soroti.Wealsothankthe

communityleadersandseniorcitizens,Ms.AmugeHellen–OrungoSubcounty,Ms.Rashida

Odongo–WOPI-U,Ms.AnnaAkura–AmidaSubcounty,Ms.GladysCangura–KIWEPI,Ms.

KongaiWinnie–UsukSubcounty,andMs.JaneEkume–TEWPA.

Wearegratefulforalltheotherpartnerswhotookakeeninterestintheresearchand

supportedthecommunicationaboutit,especiallytheradiostationsRadioTemboinKitgum,

VoiceofLangainLiraandKyogaVeritasRafioinSoroti.Theradiostationsallowedusto

createanenvironmentoftrustwiththecommunitiesforusasresearchersandwearereally

gratefulfortheirinterestandcommunicationsupport.

Wethankallthosewhoprovidedsupportduringtheresearchfromtheleadershipandstaff

ofTilburgUniversity,MbararaUniversityofScienceandTechnology(MUST)andMakerere

University.WeespeciallythankProf.Dr.PamelaK.Mbabazi(FormerDVCMUST),Viola

Nyakota,EdwardMusoke,AgnesAttalla,BrendaAmullo,AchenDorcusAchen,IreneKabale

(MUST),RuthOchieng,Prof.EugeneKinyanda,JulietWereandSuzanNkinzifromIsis-WICCE

andadvisersZecariasGerrima(AfricaMonitors)andJolandaAsmeredjo(Ph.D.candidateat

TilburgUniversity).SelanKidaneandZaminahMalolewereregisteredasPh.D.candidatesin

TilburgUniversitybasedonresearchcarriedoutfortheresearchpresentedhereandthey

21

havebothextensivelycontributedtotheresearchrespectivelyontraumaandonsocial

protectionpolicy

WeextendsincerethankstotheesteemedmembersoftheSteeringCommittee,Prof.Dr.

JosephineAhikireofMakerereUniversityandHellenKezie-NwohafromIsisWicce.

Finally,wewouldliketoacknowledgethecontributionsofadviserswhoassistedusduring

thisresearch,specificallyJaapKool,psychiatrist–withspecificknowledgeoftheresearch

areaandcontext.

Wesincerelyhopethatthisresearchwillcontributetobetterunderstandingofthe

relevanceofassistingtraumaservicesasacost-beneficialmeasuretoimprovethepositive

effectsofsocialprotectionprogram.

Prof.Dr.MirjamvanReisen(PrincipalInvestigator)

Dr.PrimroseNakazibwe(ResearchCoordinator)

Dr.MiaStokmans(Methodologyandanalysis)

Dr.BerthaVallejo(ResearchCoordinatorandValorization)

SelamKidane(Ph.D.Researcher)

ZaminahMalole(Ph.D.Researcher)

22

PurposeofthisReportandOriginofContentThisstudywascarriedoutfromJune2015toDecember2017undertheguidanceofthe

SteeringCommittee,composedofProf.Dr.MirjamvanReisen(TilburgUniversity),Prof.

Akihire(MakereUniversity),Dr.ViolaNyakota(MbararaUniversity)andHelenKezie-Nwoha,

Isis-WICCE.TheSteeringCommitteecompositionwasatributetotheimportanceattached

tothisresearchtotheexperiencesofpractitioner’sorganizationsandthedesirabilityofthe

practicalimplementationoftheknowledgefromthisresearchfortheirwork.

Thisresearchreportiscompiledtoprovideafirstoverviewoftheresearchresultsofthe

Cost-Benefit analysis of Cash Transfer Programmes and Post Trauma Services for Economic

Empowerment of Women in Uganda (EWP-U)program.

ThereportiscompiledundertheoverallresponsibilityofProf.Dr.MirjamvanReisen,Tilburg

University,astheprincipalinvestigatorofthestudy.Aninterdisciplinaryteam,with

backgroundinethnography,quantitativeresearch,socialscience,socialprotectionand

psychology,workedonthisresearch.

TheteamfromMbararaUniversityprovidedthedatainrelationtotheimplementationof

theresearch,studysites,samplingandcontextualdevelopmentsduringthestudy.

Dr.PrimroseNakazibwe,Mbarara,wasresponsiblefortheimplementationoftheresearch

onthegroundandledateamofseniorandjuniorresearchersandsupportstaffduringthis

time.Dr.PrimroseNakazibweistheauthoroftheSocial-EconomicResilienceScale(SER)

developedforthepurposeofthisresearch.TheSERappearedtobeaverysensitivescale

andwaslaterusedinsubsequentresearchcarriedoutinEthiopia.Shehascontributedto

thetheoreticalpositioningofthisresearch.Dr.PrimroseNakazibweisthe(co-)authorof

chapters4,5,6,7,8and9ofthisreport.

EdwardMusoke,MbararaUniversity,assistedinthedatapreparation.Prof.Dr.Pamela

Mbabazi,whowasdeputyVice-Chancellorduringthestartoftheprojectadvisedinitsearly

stages.

Dr.MiaStokmans,wasresponsiblefortheassessmentofthescales,thedesignand

statisticalanalysisandinterpretationofthefindingsofthereport.Shealsocontributedto

23

theoveralltheoreticalexplanatoryframeworkfortheresearch.Dr.MiaStokmansisthe(co-)

authorofthechapters4,12,13,14,15,16,17and18ofthisreport.

Dr.BerthaVallejo,TilburgUniversity,providedcoordinationsupportforthisresearchandwe

aregratefulforherdedicationtohelpbringthisworktocompletion.Sheandherteam

contributedtothedocumentationoftheresearchprocess,whichissetoutinthisreport,

andtotherelatedreportsonvalorizationandthedisseminationofresearchfindings,aswell

asfinancialreporting.

JuliaWere,Isis-WICCEcontributedsectionsontheworkofIsisWICCEtothisreport.

KristinaMelicherova,TilburgUniversity,isaPh.D.studentwhoassistedwithafewsections

ofthereport,specifically4.11.2and4.13.1.

SelamKidane,TilburgUniversity,isaPh.D.candidateregisteredatTilburgUniversityandis

responsibleforthesectionsinthisreportontrauma,collectivetraumaandthedesignofan

interventiontoaddresspost-traumaticstress(PTS)inpost-conflictlowresourceareas.The

interventioniscalledSelfHelpLowCostPostTraumaticStressprogram(SHLCPTS).Itis

inspiredbytheEyeMovementDesensitizationandReprocessing(EMDR)psycho-therapy.

MeasurementsofPTSwerecarriedoutwiththeImpactofEventsScale–Revisedversion

(IoS-R).Hercontributionstothisresearchwillbepartofthedissertationthatshewill

defendaspartofherPh.D.research.Sheisthe(co-)authorofchapter7,8,10and11.She

reservestherighttorepublishhercontributionsforacademicpurposesandforher

dissertationtodefendherPh.D.

ZaminahMalole,TilburgUniversity,isaPh.D.candidateregisteredatTilburgUniversityand

isresponsibleforthesectionsinthisreportonsocialprotectionpolicyinNorthernUganda.

Hercontributionstothisresearchwillbepartofthedissertationthatshewilldefendaspart

ofherPh.D.research.Sheisthe(co-)authorofchapters6and9.Shereservestherightto

republishhercontributionsforacademicpurposesandforherdissertationtodefendher

Ph.D.

Therearethreeanalysesthatarestillplannedforfurtheranalysisofthedata.Theseare:(i)a

systematiccodinglabelinganalysisofthe70interviewscarriedoutforthisresearch;(ii)a

24

moredetailedanalysisoftheconvergenceofvaluesreportedintheSERand(iii)astatistical

analysisofthelong-termeffectoftheSHLCPRS-programontheIoSandtheSER.

Thisreporthasbenefitedfrompeer-reviewbyProf.Dr.MunyaradziMawerefromGreat

ZimbabweUniversity(GZU)andhasreceivedalighteditingtouchbycopyeditorSusan

Sellars-Shrestha.Anymistakes,however,aretheresponsibilityoftheprincipalinvestigator

andyouarekindlyrequestedtobringanyerrorstoourattentionforfurtherconsideration.

Prof.Dr.MirjamvanReisen,principalinvestigator

TilburgUniversity

Email:[email protected]

April15,2018

25

ExecutiveSummary:TheCost-BenefitofIncludingTrauma-

SupportinSocialProtectionPrograms

Thisstudyinvestigatestheeffectofexistinggovernment-initiatedsocialprotectionprograms

(cashandin-kind)andtraumacounsellinginNorthernUgandaoneconomicdevelopmentin

NorthernUganda.Italsoexaminestheeffectofacounsellingprogramdevelopedforthis

study,theSelfHelpLowCostPostTraumaticStressprogram(SHLCPTS).Thestudywas

carriedoutusingapost-testonlydesign,whichencompassedtwotime-pointsof

measurement,referredtoasWaveIandWave2.Bothqualitative(focusgroupdiscussions

andinterviews)andquantitative(survey)datawerecollectedforthestudy.Theresearch

questionwasformulatedas:Doessupporttorelieftraumapositivelyaffecttherelationship

betweensocialprotectionandsocialeconomicresilience?

Whilstoriginallytheaimwastolookattheeffectofcash-transferprograms,thiswas

broadenedtoincludein-kindtransferprogramsinordertoallowforalargeenoughsample

ofrespondents.Themainvariablewasidentifiedastheexistenceofasocialprotection

supportprogram–i.e.,supportprovidedforthebenefitofincreasedsocial-economic

resilience.Thesocialprotectionprogramsincludedinthisresearchwereprovidedbythe

GovernmentofUganda,incollaborationwithlocalauthorities.

Thevariabletraumawashypothesizedasmediatingtheeffectofsocialprotectionprograms

onsocial-economicresilience,explainedbythedepressingeffectoftraumaonthe

processingofinformation.Thehypothesiswasformulatedwithspecificrelevanceforhighly

traumatizedpopulations.

ThisresearchwascarriedoutamongwomeninNorthernUganda,asstudieshaveindicated

thatthetraumaamongthesewomenisveryhighandthattheyhavelesscapabilitythan

mentoimprovetheirsituationduetodisempowerment,whichisheightenedbythetrauma

anditsgender-sensitivenature(gender-basedviolenceasasourceoftraumaishighly

prevalentinNorthernUganda).Inthisresearch,thehighly-validatedRevisedImpactof

EventsScale(IES-R)wasusedtomeasuretheprevalenceoftraumaandconfirmedthehigh

leveloftraumaamongthewomenstudied.Focusgroupsheldinfourdistrictsconfirmedthe

deeptraumaandsenseofabandonmentofthesewomen.Theyexpressedahighdegreeof

helplessnessanddisempowerment.Evenfortheresearchers,thewomen’sstorieswere

26

harrowingandcameacrossasveryaliveandpresentintheircurrentsituation,despitethe

longtimethathadpassedsincetheseeventshappened.Thementalprocessingofthe

traumaticeventswasnotcomplete–orhadnotevenbegun.Asaresult,theparticipants

reportedfeelingthatthefearinstilledinthembythetraumawasstillpresent.

Thestudywasparticularlyrelevantgiventhatlocalwomen’sgroupsparticipatedinthe

peaceprocessinNorthernUgandafollowinga20-yearcivilwarthatimpactedviolentlyon

thepopulation.ManygirlsandwomenwereabductedtoserveintheLordResistanceArmy

andwerevictimsofseveregender-basedviolenceandcrimes;thewaralsoproduced

internallydisplacedpeople(IDPs)whowerethevictimofviolenceintheIDPcampsorwhile

livinginunprotectedruralareas.Women’sgroupshadidentifieddealingwiththehighlevel

oftraumaasapriorityinthePeace,DevelopmentandRecoveryProgram,whichhasbeen

implementedsince2007.InarecentstudybytheUnitedNationsDevelopmentProgram

(UNDP),thefocusontraumahasdisappeared,despitetheextremelyhighprevalenceof

post-traumaticstress(PTS)amongwomeninNorthernUgandastilltoday.About85%ofthe

respondentsinthisstudyreportedexperiencinghighlevelsofPTS.Traumaamongelderly

womenwashigherthanamongyoungerwomen.Giventheextremelyhighnumberof

personswithPTS,andtheseverityofthelevelofPTS,itcanbeconcludedthatcollective

traumahasthepotentialtohinderprogramspromotinglivelihoodsinNorthernUganda.

ThisstudywascarriedoutinAmuria,Lira,KatakwiandKitguminNorthernUganda.Atotal

of475participantsweresurveyed.Inaddition,seventyinterviewsandsevenfocusgroup

interviewswereconducted.Thesocialprotectionprogramsincludedinthisstudyare:the

NationalAgriculturalAdvisoryServices(NAADS),NorthernUgandaSocialActionFund

(NUSAF),UgandaSocialAssistanceGrantsforEmpowerment(SAGE),Restockingprogram,

CommunityDrivenDevelopment(CDD)program,andYouthLivelihoodProgram.

Inthisstudy,theSocial-EconomicResilienceScale(SER)wasusedtomeasuretheeconomic

improvementoftheparticipants,definedintermsoflivelihood,assetoutbyChambersand

Conway(1992):

[A]livelihoodcomprisesthecapabilities,assets(stores,resources,claimsand

access) and activities required for a means of living: a livelihood is

sustainable which can cope with and recover from stress and shocks,

27

maintain or enhance its capabilities and assets, and provide sustainable

livelihoodopportunitiesforthenextgeneration;andwhichcontributesnet

benefitstootherlivelihoodsatthelocalandgloballevelsandintheshort

andlongterm.(ChambersandConway,1992,p.6)

Thisdefinitionisthebasisoftheformulationoftheobjectivesofsocialprotectionprograms.

TheSERwasdevelopedforthisresearchandcomprisesthefollowingsixconstructs,derived

fromthisdefinition:

1.Perceivedcapabilities:Assetsforrunningthehousehold.

- Financialcapabilities:Isthebudgetsufficientforfood,healthand

education?

- Competences:Havemyskillsandknowledgeincreased?

- Informationcapabilities:DoIhaveaccesstotheinformationIneed?

- Socialcapabilities:CanIhandlesocialissuesinthehousehold?

2.Income

- Improvementofincomeopportunities

- Self-determinationregardingincome

- Realizedimprovementof(household)income

- Realizedfinancialbuffer

3.Socialinclusion

- Attachmentwithcommunity

- Attachmentwithfamily

4.System:Feelingofsecurity

- Securityregardinglegalissues(rightsandaccesstolegalservices)

- Accessibilityofmedicalandfinancialservices

5.Empowerment:Achangeinagencyandbehavior

- Self-determination

- Self-worth

- Changeintransformativevalues

6.Experiencinglessworry

InordertomeasurethecostversusbenefitofprovidingreliefforPTSontheeffectofsocial

protectionforsocial-economicresilience(includingincome),anexperimentaldesignwasset

28

uptomeasurethedifferencesineffect.Thefirstwavecomprisedfourgroups:(i)

respondentswhoreceivedonlysocialprotection(cashandin-kind);(ii)respondentswho

receivedsocialprotection(cash/in-kind)andcounsellingtohelpaddressPTS;(iii)

respondentswhoreceivedbothsocialprotection(cash/in-kind)andcounselingand(iv)the

controlgroupofrespondentswhodidnotreceiveanysupport.

Theresultsofthefirstwaveshowthattraumahasanindependenteffectoncapability,

incomeandempowermentandthereisapositiverelationbetweensupportforreliefofPTS

andenhancedscopeoflivelihood.Thestudyexplicitlyfoundapositiverelationbetween

counselingprogramsandincome.Supportforrelieftraumawasfoundtohavean

independenteffectonincomeand,whilstthesocialprotectionprograms(cash/in-kind)also

showasignificantpositiveeffectonincomeandsocialeconomicresiliencemorebroadly,

theindependenteffectofsupportforreliefofPTSissignificantlyhigher.Moreover,the

combinationofsocialprotectionsupportandsupportforreliefofPTSprovidesthehighest

effectonincomeandonsocialeconomicresiliencemorebroadly.Thiseffectissignificant.

Theeffectofsupportforthereliefoftraumawasindependentandthehypothesisthat

supporttotraumahasamediatingeffectontheeffectofsocialprotectiononincomeand

socialeconomicresilienceshouldberejected.Thisstudyconcludesthatsupportforreliefof

traumahasitsowneffectonincomeandsocialeconomicresilience.

ThisstudyfoundthattheeffectofsupportforthereliefofPTSonincomeandsocial

economicresiliencewashigherthantheeffectofsocialprotectionprograms.Itcan,

therefore,befirmlyconcludedthatsupportingtraumareliefismorebeneficialthansocial

protectionprogramsintermsofimprovingincomeandsocial-economicresilience,even

thoughsocialprotectionprogramsdoalsoshowapositiveimpactonincomeandsocial-

economicresilience.

ThisconclusionjustifiedtheoriginalprioritizationbywomeninNorthernUganda,namely

thatreliefofPTSshouldbeurgentlyaddressedwithintherecoveryprogram.

Theoriginalresearchquestionofthisinvestigationappears,therefore,tobeextremely

relevant,asitinformsthefurtherquestion:whatwouldbeanoptimumcost-benefitpackage

forofferingrelieftoenhancesocial-economicbenefitsinNorthernUganda?

29

Inordertoconsiderthisquestion,anumberofissueswereconsideredbasedontheanalysis

ofthefirstwave.Theconclusionsdrawnwerethattheexistingcounselingsupportprograms

arelimitedintermsoftheirabilitytoreachalargenumberofwomen;theyarealsotime

intensiveandrequirethepresenceofasubstantialnumberofmentalhealthworkers,which

arenotavailableinreality.Theexistingprogramsrelyonexternalfundingandresources

and,asmuchofthesupportfortraumareliefhasbeenwithdrawn,manyofthewomenwho

participatedinthestudyhadneverreceivedanysuchsupport.

Anotherproblemidentifiedfromtheinterviewswasthatthemethodofcounselingrequired

extensivere-narrationofthetraumaticeventsandthatseverelytraumatizedwomencould

notbereachedthroughsuchmethodsduetoavoidance.

Takingallofthesefactorsintoaccount,asetofcriteriawasestablishedbytheresearch

teamtodesignaprogramtorelievePTS:

- Minimumcostformaximumbenefit

- Upscalable(notdependentontrainedhealthworkers)

- Contextualized(formaximumimpact)

- Availabilityofbackupservicesforreferralofpatientsifnecessary

TheprogramdesignedwascalledtheSelfHelpLowCostPostTraumaticStress(SHLCPTS)

program.ThisprogramreliedontheEyeMovementDesensitizationandReprocessing

(EMDR)self-helpmethod,whichwasspecificallydesignedtoaddressPTS.Alightversionof

theprogramwasputtogetherandcontextualizedwiththehelpoflocalradiostationsand

translatedintolocallanguagewithachoiceofwordingthatwouldappealtopeopleinthe

localcommunities.Recognizablelocalcommunityvoiceswereinvitedtoprovidethevoice

fortherecordings.Theresultwasaprogramofsixsessions,dividedintothreemainparts:(i)

educationabouttrauma;(ii)exercises(whattodoabouttrauma);(iii)bringingparticipants

backwithagencyintothefamiliesandcommunitieswheretheylive.

Theprogramwasimplementedasaninterventioninthefourdistrictsamongselected

groupswithapost-measurementin-groupdesign.Thefollowinggroupsweredistinguished:

(i)respondentswhoreceivedonlysocialprotection(cashandin-kind);(ii)respondentswho

receivedsocialprotection(cash/in-kind)andcounselling;(iii)respondentswhoreceived

bothsocialprotection(cash/in-kind)andcounseling;(iv)thecontrolgroupofrespondents

30

whodidnotreceiveanysupport;(v)respondentswhoreceivedsocialprotection(cashand

in-kind)andSHLCPTS;(vi)respondentswhoreceivedsocialprotection(cash/in-kind),

counsellingandSHLCPTS;(vii)respondentswhoreceivedsocialprotection(cash/in-kind)and

counselingandSHLCPTS;and(viii)therespondentswhoreceivedonlySHLCPTS.

TherespondentswereassignedtoSHLCPTSusingpurposivesamplingand,therefore,the

baselineofthetwogroupsisslightlydifferent.Comparednexttoeachother,thetwogroups

(withSHLCPTSandwithoutSHLCPTS)showpreciselythesameresults:

- CounselingandSHLCPTShaveahigherpositiveeffectonincomeandsocialeconomic

resiliencethansocialprotectionprograms(cash/in-kindsupport);

- SocialprotectionprogramsandcounselingandSHLCPTShaveanindependent

positiveeffectonincomeandsocial-economicresilience;

- CounselingandSHLCPTSdonothaveamediating,butdohaveadirecteffect,on

incomeandonsocialeconomicresilience.

TheSHLCPTSprogramhasaverylowbudgetdesignandhasprovedtobeupscalable,

includingthroughradioprograms.Infact,manyradiostationsincludedthesessionsintheir

programming.

Theconclusionofthisresearchisthattheinclusionofsupportfortraumareliefinsocial

protectionprogramsisdesirabletomaximizeimpactonincomeandsocialeconomic

resilience.Supportforrelieftraumashouldbeprioritizedoversocialprotectionprograms

givenitshighersignificanceinallthreemeasures(WaveIand2andwithSHLCPTS).Trauma

reliefhasitsownindependentandhighereffectonincomeandsocialeconomicresilience.

Intermsofcost-benefiteffectiveness,theprogramiscertainlyfeasiblegiventhecost-

effectivenatureoftheSHLCPTSprogramanditsupscalability.Inaddition,theparticipants

werefoundtobeextremelyhappywiththeprogramanditsresultsandtheyreported

extensivelyonthepositiveeffectsithadhadintheinterviewsthatwerecarriedoutandin

publictestimonies.Regardingthelocaldistrictauthorities,theprogramwaspositively

reviewedandinsomeinstancesimplemented(usingfundssourcedbythelocalauthorities).

Thisperceptionof,andeagernesstoimplement,theprogramtriangulatesthefindingsofthe

survey,inthattheprogramwaseffectiveinsupportingincreasedincomeandsocial

economicresilience.

31

Theinterviewsshowvariousinterestingelementsthatmayhelpexplainthesuccessofthe

program.First,theparticipantsreportedthattheprogramhadtriggeredasenseofcontrol

overtheirlives.Itwasobservedduringtheinterventionthatwomenwhohadpassedthe

firstphaseoftheintervention(thephaseofeducationontrauma)hadincreasedmotivation

tocarryonwiththesessions.Thisreportedsenseofcontrolwasfurtherenhancedbythe

exercises,whichstimulatedtheprocessingofthetraumaticevents.Althoughthe

researchersdonotbelievethattheprogramaloneissufficienttoenableparticipantsto

processtheirseveretraumaticevents,butwithintheisolatedenvironmentwithoutany

supportorservices,thesimpleexercisesprovidedgavetheparticipantsanabilitytostartto

controltheeffectsofthePTSandbeginprocessingit.Inthisway,theprogramisa‘game-

changer’:fromasituationofhopelessnessandlackofprospects,thewomenbegantolook

towardsthefuture.

Thethirdphaseoftheprogram,bringingthewomenbackintotheirfamiliesand

communities,alsohadamagnifyingimpact.Afewmonthslater,thewomenreportedthat

theywereassistingotherwomen,theirhusbandsandtheirfellowcommunitymembersto

managetheirPTSthroughtheeducationandexercisesthattheyhadbeengiven.Women

whohadparticipatedintheprogrambecamepositiveagentsofchangewithinthe

community,providingsupportforthereliefofPTS.

TheGovernmentofUgandaandtheleadersofLiradistrictgavegreattributetothe

participantsbyorganizingandattendingthecommemorationofthemassacreinBarlonyo,

recognizingthepainandsufferingthattookplaceinthepastandprovidingtheresources

withwhichtostrengthenthecommunitiestomoveforwardintothefuture.Thecounseling

programprovidedmentalhealingandawindowofchange–ithelpedthewomentosee

thatitwaspossibletowalkfromthepastintothefuture.Manyaskedtobeableto

participateintheSHLCPTSprogram,seeingtheempoweringeffectithadontheparticipants.

Empowermentwasfoundtobesystematicallyrelatedtotheincreaseinincome.This

underscoresthetheoreticalunderpinningofthisresearch,whichisthatnegativefeelings

depressthepositiveresultsofsocialprotectionprograms,limitingtheirabilitytoincrease

income.Theempoweringeffectofthesocialprotectionprogramsandthereliefprograms

forPTSexplaintheincreasedeffectonincomeandsocialeconomicresilience.Thisisalsothe

32

casewiththeincreaseincapabilities,animportantelementoflivelihood,andwhich

systematicallycorrelatedinthisresearchwiththeincreaseinincome.

Themainconclusionofthisinvestigationisthattheeffectofsupportforthereliefoftrauma

inseverelytraumatizedcommunitiesispositiveintermsofincreasedincomeandincreased

socialeconomicresilience(capabilityandempowerment).Theeffectwassignificantinthe

threeseparatemeasures.

Graph a: Effect of programs on income (wave 1)

1

1,5

2

2,5

3

3,5

4

4,5

5

capability

shlcpts & cash transfers/in-kind

shlcpts & counseling

shlcpts & cash transfers/in-kindand counselingonly shlcpts

The groups (that received different programs) do differ significantly on capability. Those who

received both cash transfer/in-kind as well as counseling score higher on capability

(significant interaction effect p< 0.05).

Graph b: Effect of programs on income (wave 2, with SHLCPTS)

1

1,5

2

2,5

3

3,5

4

4,5

5

income

shlcpts & cash transfers/in-kind shlcpts & counseling

shlcpts & cash transfers/in-kind and counselingonly shlcpts

33

Graph c: Effect of programs on income (wave 2, without SHLCPTS)

1

1,5

2

2,5

3

3,5

4

4,5

5

income

no shlcpts & cash transfers/in-kindno shlcpts & counseling

no shlcpts & cash transfers/in-kind and counselingno program

The groups (that received different programs) do differ significantly on income. This

difference can be attributed to counseling (p=0.10), SHLCPTS (p=0.10) and receiving both

cash transfer/in-kind and counseling (significant interaction effect, p<0.05). Those who

received counseling have higher expectations about income. Those who received SHLCPTS

have lower expectations about income (due to sampling bias). And those who received both

cash transfers/in-kind and counseling have higher expectations about income.

Itcantherefore,befirmlyconcludedthatsupporttotraumareliefingeneralandthe

SHLCPTSprograminparticularhashadasignificantpositiveeffectoneconomicresilience.It

isrecommendedthatitsworkableelementsarefurtherinvestigated,includinginother

locationsandcontexts.Basedonthisresearchitcanbeexpectedthattheintegrationofthe

SHLCPTS-programintoUganda’ssocialprotectionpolicywillreduceitscosts,while

increasingimpactoneconomicreturn.

34

PARTI:CONTEXTANDBACKGROUND

35

Introduction

InJune2015,TheDutchScienceorganizationprogram,NWO-WOTRO,awardedTilburg

Universityanditspartnersatwo-yearprojectentitled‘Cost-BenefitAnalysisofCashTransfer

ProgramsandPostTraumaServicesforEconomicEmpowermentofWomeninUganda

(EWP-U)’.TheconsortiumimplementingtheprogramconsistedofMbararaUniversityof

ScienceandTechnology,MakerereUniversityandIsis-WICCE.MbararaUniversity

coordinatedthestudyinUganda.MakerereUniversityprovidedexpertiseonthegender-

relatedaspectsofthetraumaofwomeninNorthernUganda.Theethicalapprovalwas

obtainedbyMbararaUniversity.Isis-WICCEprovidedtraumaservicesandassistedinthe

identificationofresearchsitesandcontactsandresourcepersonsforcarryingoutthe

research.

Thisresearchispartofaprograminvestigatingtheeconomicpotentialofsocialprotectionin

developingcountries.ThisparticularresearchwascarriedoutinNorthernUganda,aregion

inwhichtheGovernmentofUgandahastakenaparticularinterestinsupporting

rehabilitation.Theregionhassufferedfromyearsofconflictandthesocialprotection

programsoftheGovernmentofUgandaareparticularlytargetedtosupportthe

rehabilitationandreintegrationofformerabducteesoftheLord’sResistanceArmy(LRA).

Thisresearchlooksatthecost-benefitofintroducingtraumaservicesinthepreparationof

socialprotectionprogramsintheregion.Thepurposeistosolvetheproblemofmany

organizationsactiveinNorthernUgandaandinotherpost-conflictregions,whichhave

experienceddepresseduptakeofsocialprotectionprogramsduetoseveretraumaamong

thepopulation.Thisresearchaimstoidentifywhetherpost-traumaticstressmediatesthe

effectsofsocialprotectioneffortsonsocial-economicresilience.

Womenhavebeenparticularlyaffectedbytrauma,whichtheyexperiencedasabducteesof

theLRAandhavebeenimpactedonbysexualandgender-basedviolence.Thisstudyfocuses

onwomen,soastocarryouttheresearchamongthemostseverely-impactedpopulation

groupandtoinvestigateamoreorlesshomogeneousgroupofrespondentsintermsofthe

natureoftraumaexperienced.

TheNWO-WOTROprogramhasastrongemphasisonpolicyrelevanceandtheGovernment

ofUgandaandotherserviceprovidershavetakenakeeninterestinassistingwith

36

rehabilitationinNorthernUgandasincethedefeatoftheLRA.Thedisseminationanduptake

isreportedinaseparatevalorizationanddisseminationreport,whichdescribeall

internationalandlocalconferences,meetingsandpresentationswheretheresultsofthe

projectwerepresented.

Thisreportisthefirstcomprehensivewrite-upoftheresearch,howitwasimplementedand

itsresults.Therearetwosmallsetsofdatathatarestillbeinganalyzedandwhichwillbe

published:theanalysisofchangeinvalues(inspiredbytheBarrettmethod)andtheanalysis

ofthelong-termimpactoftheSelfHelpLowCostPostTraumaticStress(SHLCPTS)program

ontheImpactofEventsScale.Additionaldataonanextracontrolgroupwillalsobeusedto

publishthedatainacademicpublicfora.

TheatrocitiescommittedinNorthernUgandahaveleftseriousscarsandahighly

traumatizedandimpoverishedpopulation,asituationthatneedstobeaddressed,

preferablyinthemostcost-effectivewaytomaximizethepositiveresultsforthepeoplein

NorthernUganda,sothattheirhopeoflong-lastingpeaceanddevelopmentcanberealized.

37

HistoryoftheConflictinNorthandEasternUganda

UgandaisaformerBritishcolonysituatedinCentralAfricaandamemberoftheEastAfrican

Community.Thecountryhadapopulationof37.7millionin2017(UgandaBureauof

Statistics,2017).ThelargestethnicgroupsareBaganda(16.5%),Banyankole(9.6%),Basoga

(8.8%),Bakiga(7.1%),Iteso(7%),Langi(6.3%),Bagisu(4.9%),Acholi(4.4%),andLugbara

(3.3%),withothergroupsmakinguptheremainder(32.1%)(2014estimate)(Central

IntelligenceAgency(CIA),2018).TheNorthernUgandanprovincesarepopulatedbythe

Iteso,Langi,andAcholi,aswellasthesmallerethnicgroup,theKaramoja.

Civilwar

Forovertwodecades,sincethelate1980s,theLord'sResistanceArmy(LRA)wagedawar

againsttheUgandanPeople'sDemocraticArmyandthepeopleofNorthernUganda.The

extremebrutalityoftheconflictresultedinthetotaldestructionoftheregionandthe

displacementofover1.5millionpeople,turningNorthernUgandaintoahumanitarian

disasterzone.Tensofthousandsofadultsandchildrenwereabductedtoserveassoldiers,

porters,andsexualpartnersforthecommanders(Fazel,Bains,&Doll,2006).

ThecivilwarinNorthernUgandabeganin1986,whenUganda’scurrentpresident,President

Musevini,cametopower.TheNationalResistanceArmy(NRA),laterrenamedtheNational

ResistanceMovement(NRM),tookoverpowerandtheLRAdecidedtofightthenew

government(Apuuli,2006).TheLRAbeganasanevolutionof‘theHolySpiritMovement’led

byAliceLakwena.WhenAliceLakwenawasexiled,hernephewJosephKonytookoveras

leaderoftheLRA.Withthechangeofleadership,therebelgrouplostregionalsupport,

whichpromptedKonytoengageinactsofself-preservation,characterizedbystealing

suppliesandabductingchildrentofillhisranks.Therebelsstartedacampaignofterrorthat

includedchildabduction,mutilation,murderandgeneraldestruction.Theconflictwasat

initiallymainlyconcentratedinthedistrictsthatmakeuptheLangoandAcholiethnicsub-

regions(ibid.).

TheconflictinTesosub-regioncanalsobetracedtoaroundthesameperiodoftime,

followingtheescapesoldiersfromtheTitoOkelloLutwa(oneoftheformerpresidentsof

38

Uganda)regime,whichwasdefeatedbythegovernmentforcesoftheNRA.TheTesoregion

wasattackedbyotherrebelgroups,suchastheUgandaPeople’sDefenseForce(UPDF),the

ForceOboteBackGroup(FOBA),andtheHolySpiritMovement(HSM)ledbyAliceLakwena,

whichadvancedtoKampalafromNorthernUgandathroughtheTesosub-region(ibid.).

Abductions,killingsanddisplacement

TheLRAattacksconsistedof“abductions,killings,[the]burningandlootingofvillagesand

homes,andambushesonvehicles”,whichescalatedsharplyin2002(HumanRightsWatch

(HRW),2003a).Duetogovernmentdisplacementorders,800,000peopleweredisplaced,

comprising70%ofthepopulation(HRW,2003a).TheOperationIronFistlaunchedbythe

UPDFinSouthSudanfailedtoreducethenumberofadductionsofchildrenbytheLRA,

whichrosetoaconservativeestimateof20,000children(HRW,2003b).Theabductionof

childrenandyouthintoarmieshasbeenabrutalandcommonfeatureoftheconflictin

Uganda.TheUnitedNationssuggestedthatduringtheprolongedcivilwar,atotalof25,000

childrenwereforcedtoenlistassoldiers,withthegirlsforcedintosexualslavery(UNNews

Centre,2004).Thechildrenmetwithunspeakablebrutality:

TheLRAusesbrutaltacticstodemandobediencefromabductedchildren.

Childrenareforcedtobeatortrampletodeathotherabductedchildrenwho

attempttoescape,andarerepeatedlytoldtheywillbekillediftheytryto

runaway.Childrenwhofallbehindduringlongmarchesorresistordersare

also killed. Many others have been killed in battle or have died from

mistreatment,diseaseandhunger.(HRW,2003b,p.4)

Theabductionofwomenandgirlswasalsoaparticularlydevastatinganddefiningfeatureof

theconflict.Anestimated10,000girlsbecameforcedchildmothersasaresultofLRA

abductionbetween1988and2004.Another88,000girls,whowerenotabducted,became

child-mothersduetoconditionsintheinternallydisplacedperson(IDP)camps,oftenasa

resultofrape(Akeloetal.,2013).HumanRightsWatch(2003b)describedthesubjectionof

girl-childrentogenderbasedviolenceasfollows:

Girlsareusedasdomesticservantsforcommandersandtheirhouseholds.

Atagefourteenorfifteen,manyareforcedintosexualslaveryas“wives”of

39

LRAcommandersandsubjectedtorape,unwantedpregnancies,andtherisk

ofsexuallytransmitteddiseases,includingHIV/AIDS.(HRW,2003b,p.2)

Childrenwereafraidofabductions,butequallyluredintotheoperationsoftheUPDFas

childsoldiers(HRW,2003b).Vink,Phanc,andStover(2007;2009)reportedthatasaresult

ofLRAactivityinNorthernUganda,thousandsofcivilianswerekilledandmutilatedandan

estimated52,000to75,000peoplewereabductedandservedinthecapacityofsoldier,

porterorsexslave.

ExpansionofoperationalareasoftheLordResistanceArmy

AsaconsequenceofthemilitaryoperationsoftheUPDFinSouthernSudan,theLRAwas

abletoexpandtheareainwhichitoperatedfromGulu,PaderandKitgumdistrictstothe

districtsofLira,Apac,KatakwiandSoroti(Apuuli,2006).Civilianswerecrushedbetweenthe

UPDFandtheLRAandthenumberofIDPsroseto1.2millionpeople(HRW,2003a).TheIDPs

werevulnerabletoattacksbytheLRAandlivingindangeroussituations,exposedtounclean

waterandmalnourishedwithoutaccesstohealthservices(HRW,2003b).Insuchsituations,

illnessessuchasHIV/AIDScouldrapidlyspread.TheLRA’swidespreadviciousattacksand

abductionsleftTesodevastated.Thousandswerekilledorabducted,includingchildren,and

hundredsofthousandsofciviliansfledsouth.UnlikeintheAcholiandLangosub-regions,the

LRAmetsuchstrongresistanceinTesothattheywereoustedbyJanuary2004.

UnliketheLangoandAcholisub-regions,whichattributemuchoftheconflicttheyhadin

theirdistrictstotheLRA,inTesootherfactorscontributedtothesituation.Followingthe

defeatoftheLRA,theTesosub-regionwasaffectedbycattle-rustlinggroupsfromthe

neighboringKaramajongtribe.AftertheoverthrowofAmin'sregimeintheObotecoupof

1979,fleeingsoldierslefttheirarmoriesopeninKaramojaandtheKaramajongreplaced

theirspearswithguns,enablingthemtopursuetheirtraditionalpracticeofcattleraidingon

amoreextensiveanddevastatingscale.ThisparticularlyaffectedTeso,astheKaramajong

ravagedthearea,destroyinghomes,schoolsandclinics,stealingtheircattleandkillingmany

people.Themilitarization,duetotheUPDF’seffortstodefeattheLRA,exacerbatedtension

betweentheKaramajongandTesopeople(Bainomugisha,Okello,&Ngoya,2007).

About80,000peoplefromtheItesoethnicgrouphavenowbeenlivingincampsfor

protectionforupto25years.TheTesoandKaramajong,wholivedside-by-sidefor

40

centuries,havebeenlivinginconflictanduncertaintyleadingtoimpoverishment.The

proportionofKaramojapeoplelivinginpovertyofthehighestinUganda,with82%ofthe

populationofKaramojaand66%ofthepopulationofTesolivinginpoverty,accordingtothe

UgandanBureauofStatisticsin2006(citedin:Chapman&Kagaha,2009).

Women’sparticipationinthePeace,RecoveryandDevelopmentPlan

In2006,peacetalksstarted1.8millionIDPslivedincamps.(UnitedNations,2008).Formal

peacenegotiationsbeganin2005inJubaunderauspicesoftheUnitedNationsduringatime

ofrelative‘calm’,withthedraftingofaPeace,RecoveryandDevelopmentPlan(United

Nations,2008).

TheUgandaWomen’sCoalitionforPeace(UWPC)wasformedtorespondtothelackof

women’svoiceinthepeacenegotiations,establishedinlate2006.Thepurposeofthe

coalitionwastoensurethatwomen’sneeds,concernsandprioritieswereaddressedinthe

negotiationsandsubsequentrehabilitationefforts.TheorganizationIsis-Women’s

InternationalCrossCulturalExchange(Isis-WICCE)participatedinthecoalitionandcollected

informationonwomen’sprioritiesforpeacethroughitsexistingnetworksofrelationswith

womeninNorthernUganda(Nakubeera-Musoke,n.d.).

ThepeacenegotiationsresultedinthefirstPeace,RecoveryandDevelopmentPlan(PRDP)

forNorthernUgandaagreedin2007.ThePRDPaimedspecificallyatstabilizationof

NorthernUgandaandthepromotionofsocio-economicdevelopment.Itfollowedonthe

earliergovernmentprograms,withthedistinctionthatitwasfocusedonpeace-buildingand

onthereliefofthetraumainthecommunities.Thisreflectedtheprioritiesfromthe

communitiescommunicatedthroughtheengagementofUWPCinthepeaceprocess(United

Nations,2008).TheimplementationofthePRDPbeganin2009andcovers55districtsin

NorthernUganda.IthasbeensupportedbytheGovernmentofUgandaanddevelopment

partnersandresultedinthePRDP2and3.

41

Figure3-1.MapofPeace,RecoveryandDevelopmentPlan(UgandaBureauofStatistics,2015,

printedinUNDP,2015)

InacomprehensiveassessmentofthePRDP,UNDP(2015)analysistheprogramintermsof

itsimpactoneconomicresilience.Italsoincludesananalysisofitsimpactongender

equality.However,theUNDPassessmentdoesnotanalyzethewayinwhichtraumaaffects

thePRDPandtraumaasacomponentisnolongerprogrammedinthePRDP.Thisbegsthe

questionastowhethertheoriginalcallofwomenandwomen’sgroupsinNorthernUganda

hasbeensatisfied.

Women’sorganizationshavecontinuedtoraisetheconcernofPTSanditscontinued

prevalenceinNorthernUganda.Inanotherresearch,wecollectedthepracticalexperiences

ofwomen’sorganizationsengaginginrehabilitationeffortsinpeace-building,includingin

NorthernUganda.ThisresearchprojectwascarriedoutbyTilburgUniversityresultingina

publicationin2015,entitledWomen’sLeadershipinPeaceBuilding:ConflictCommunityand

Care(vanReisen,2015).Oneofthecontributionstothisbookspecificallyconsideredthe

prioritiesofwomenintherehabilitationprocessinNorthernUganda.Theanalysisaddressed

42

therelationshipbetweenprogramsfocusedonlivelihoodsinrelationtoaddressingtheneed

forhealingoftraumaintermsofenhancingtheroleofwomeninpeace-buildingefforts.The

authorofthischapter,apractitionerinNorthernUgandawrote:

Livelihoodorientedactivities […]arealsoan importantpart of thepeace

building package. These providewomen’s communitieswith assets, skills

and tools,whichcontribute to the improvementof their livingconditions.

SecularorganizationssuchasIsis-WICCE,havealsoplayedakeyroleinthe

importantareaoftraumahealingandinorganizinginternationalexchange

forlocallyrootedcommunityorganizations.(Ngeudjeu-Momekam,2015,p.

375)

Theconcernraisedinthisresearchwasthehighprevalenceoftraumaamongwomenand

theobservationofsuchtraumaleftunaddresseddepressingtheimpactoftherehabilitation

efforts.ThequestionappearedofrelevancenotonlytoNorthernUgandabutalsotoother

postconflictsituations,suchasforinstanceRwanda,SouthSudanandLiberia(VanReisen,

2015).

Hence,theresearchquestionidentifiedforthisresearchemergedfromthisquestionby

practitioners,thatinordertosustainthepeaceandstrengthenofeffortstowardsthe

rehabilitationofNorthernUganda,bothlivelihoodsandmentalhealthneededtobe

enhanced.Theresearchfocusesonthewayinwhichtraumaimpactsonlivelihoodprograms

and,morespecifically,onwhethereffortstosupportpost-traumaticstresspositively

improvetheeffectsofsocialprotectionprogramsaimedatimprovinglivelihoods.

Theaimofthisresearchistoidentifywhethertheclaimifwomen’sorganizationsworkingin

NorthernUgandaisright,whichisthattheimpactofsocialprotectionsupporttowomenin

NorthernUgandaisdepressedduetounaddressedPTSwhichwomenstillsufferfrom.

43

PartII:RESEARCHQUESTIONSANDTHEORETICAL

FRAMEWORK

44

ResearchQuestionsandDesign

Researchgap

Initiativesonsocialprotectionhaveshownthatevensmallamountsofmoneypaidreliably

andregularlycanmakeanenormouspositiveimpactonpeople’slives(MinistryofGender,

LaborandSocialDevelopment(MGLSD),2010).Accordingtothedescriptionofsocial

protection,ithasspecificobjectives,whicharerelatedtofoodsecurityandnutrition,decent

employment,andreducingoverallinequality,especiallygenderinequality(see,forexample,

FoodandAgricultureOrganization(FAO),2017).Theobjectivescanalsobeframedinterms

ofbettermanagingrisksandactiveparticipationinallspheresoflife(Holmes&Lwanga-

Ntale,2012).

Onthebasisofthedefinitionsofsocialprotection(foranoverview,seesection4.11.1),the

keyobjectiveofsocialprotectionisconstruedasenhancementofsocialandeconomic

resilienceorsustainablelivelihoods.

ThedefinitionoflivelihoodprovidedbyChambersandConway(1992):

“[A]livelihoodcomprisesthecapabilities,assets(stores,resources,claims

and access) and activities required for a means of living: a livelihood is

sustainable which can cope with and recover from stress and shocks,

maintain or enhance its capabilities and assets, and provide sustainable

livelihoodopportunitiesforthenextgeneration;andwhichcontributesnet

benefitstootherlivelihoodsatthelocalandgloballevelsandintheshort

andlongterm.”(ChambersandConway,1992,p.6)

Inthisresearch,thefocusisontheindividualleveloflivelihood(notthefamilyor

communitylevel).

FollowingfromChambersandConway(1992),theSustainableLivelihoodframework(DFID,

1999),emphasizesthatsustainablelivelihoodcomprisesoftheexpansionofchoice,

opportunitiesforself-determinationandtheflexibilitytoadaptovertime.Allofthese

characteristicsrefertoapositive,openmindset(requiringacontextthatenjoysaminimum

levelofpeace).Consequently,itcanbeassumedthat,atatheoreticallevel,the

45

improvementof(individual)livelihoodscanbeachievedbyachangeinmindsetorvalues—

fromreactingtoahazardordangertopro-activebehaviorthatisfuture-oriented.This

changeinmindsethasaneffectonhowpeopleperceiveopportunitiesandthreatsintheir

currentsituation,aswellastheirroutinewaysofevaluatingsituationsandresponding

accordingly(referredtoasagency).

Traumacanhinderthechangeinmindsetthatcanbeinitiatedbysocialprotection.Inastate

oftrauma,peopleareoverwhelmedbynegativeemotions.Thesenegativeemotionsaffect

thewaypeopleperceiveandevaluatethesocialprotectiontheyreceive.Accordingtothe

feelingsasinformationtheory(Schwarz,2010),peopleregardtheirfeelingsasasourceof

information.Oneusuallyassumesthatthefeelingsthatareexperiencedare‘about’

whateveristhefocusofone’sattention,unlessitisattributedtoaspecificincident

(Schwarz,2010).Peoplewhohavebeentraumatizedexperienceanintensivenegativemood.

Asmoodsarenottriggeredbyaspecificincident,thisnegativestatewillalsoimpactonhow

thesocialprotectionprogramisperceived.Consequently,thesocialprotectionisnot

regardedasanewstart(apositiveopportunity),butastemporallyrelieveofabadsituation.

Iftraumaisnothealed,peoplehavetroublechangingtheirmindset,despitethesocial

protectionthatisoffered.

Theobjectiveofsocialprotectionisthatpeoplefeelmoresecureandperceiveanexpansion

ofallkindsofassets.Moreover,theygainadifferentorientationtowardslife.Ata

theoreticallevel,thisdifferentmindsetcanbecapturedinachangeofvalues.Theterm

‘value’hasbeendefinedasanenduringprescriptiveorproscriptivebeliefthataspecificend

stateofexistenceorspecificmodeofconductispreferredtoanoppositeendstateormode

ofconductforlivingone’slife(Kahle,1983;Rokeach,1968;1973)(seealsosection4.11.1).

ValuesareunderstoodbyBarrett(2014)assharedperceivedvaluesofanindividualand

community.AccordingtoBarrettmisalignmentofvaluesinanorganizationalsystem

underminesitseffectiveness.Barrettidentifiesthatacultureandvaluestransformfunctions

bestiftherearequalityrelationships,andhearguesthattransformationbeginswiththe

conversations(aboutvalues)thathappenwithinthoserelationships.Anorganizational

systemcanbeacompany,acommunityorasociety.Whenthevaluesoftheorganizationor

community-systemaremorealigned,thenthemembersofthecommunity-systemwillbe

abletobringmoreeffortandpositiveenergytocontributetoit.

46

Thedistancebetweentheseperceivedvaluescanbemeasuredandthedistancebetween

valuesisanindicatorofthealignmentofsharedvalueswithinthesystem.Entropyisdefined

asthelevelofmisalignmentinperceivedvalues,whichunderminestheeffectivefunctioning

ofacommunityandisseenbyBarrett(ibid.)asacauseforthedysfunctionalityofan

organizationalsystem,whichhecalls‘entropy’.

Inlinewiththeobjectiveofsocialprotection,thevaluesofanindividualshouldbeless

orientedtoward(individual)survivalandmoretowardself-actualization(self-

determination),socialinclusionandhappiness.Thesamecountsforthevaluesthatthe

individualperceivesthecommunityhas.Consequently,thesesetsofvaluesshouldbemore

inaccordancewiththeobjectivesofsocialprotectionaftersocialprotectionprograms.

Operationalizationofsocialandeconomicresilience

Theeffectsofsocialprotectionshowitselfinsocialandeconomicresilience(seealsosection

4.11.1)andespeciallyinempowerment(seesection4.12.2).Inthisresearch,thesocialand

economicresiliencetoolwasdeveloped.ThistoolissuitableforthesituationinNorthern

Ugandaandconsistsofthefollowingcomponents:

4.2.1. Perceivedcapabilities:Assetsforrunningthehousehold.

- Financialcapabilities:Isthebudgetsufficientforfood,healthandeducation

- Competences:Havemyskillsandknowledgeincreased

- Informationcapabilities:DoIhaveaccesstotheinformationIneed

- Socialcapabilities:CanIhandlesocialissuesinthehousehold

4.2.2. Income

- Improvementofincomeopportunities

- Self-determinationregardingincome

- Realizedimprovementof(household)income

- Realizedfinancialbuffer

Socialinclusion

- Attachmentwithcommunity

- Attachmentwithfamily

47

4.3.1. System:Feelingofsecurity

- Securityregardinglegalissues(rightsandaccesstolegalservices)

- Accessibilityofmedicalandfinancialservices

4.3.2. Empowerment:Achangeinagencyandbehavior

- Self-determination

- Self-worth

- Changeintransformativevalues

4.3.3. Experiencinglessworry

Thisresearchwillexplorewhethersocialandeconomicresilienceincreasesduetothesocial

protectionimplementedinNorthernUgandabytheGovernmentofUganda.Inaddition,this

researchinvestigatesthemediatingeffectofsupportintraumareliefonthepositiveimpact

ofsocialprotectiononsocialandeconomicresilienceisalsoinvestigated.Therelationships

betweenthedifferenttheoreticalconceptsmentionedaresummarizedintheoretical

frameworkpresentedinFigure4.1.(Ajzen,1991;Barrett,2014;Chambers&Conway,1992;

DFID,1999.Kahle,1983;Kahle,1983;Rokeach,1968;1973.)

Objectiveofthestudy

ThepopulationinNorthernUgandahasbeenimpoverishedasaresultofthelongcivilwar,

whichlastedfrom1987to2006.TheGovernmentofUgandaismakingaconcertedeffortto

rehabilitatetheaffectedregions.Socialprotectionprograms(includingcashtransfers)have

beendevelopedtosupporttherehabilitationefforts.Thecivilwaralsocausedthe

populationtosufferfrompost-traumaticstress(PTS),asdiagnosedinvariouspsychiatric

studies(seechapters6&7).

Inastateoftrauma,peopleareoverwhelmedbyanegativemood.Thismoodaffectsthe

waytheyperceiveandevaluatetheopportunitiesavailable(includingsocialprotection

received)(Kahneman,2011;Schwarz,2012).Inatraumatizedstate,peoplewillnotregard

socialprotectionasanewstart(apositiveopportunity),buttheywillseeitasatemporary

relieveofabadsituation.Wecanthereforeassumethatiftraumaisnothealed,peoplecan

behinderedfromusingsocialprotectionprogramsasasteppingstonetosocial-economic

48

integration.Therefore,itisprobablethatPTScanhindertheeffectivenessofsocial

protectionprogramsforsocialandeconomicresilience(SER).

Thisstudyinvestigatestherelationshipbetween(1)socialprotectionprograms(cash-

transfersorin-kind)and(2)traumatreatment,and(3)theirimpactonsocio-economic

integrationinpost-conflictareas.Thestudysoughttodeterminetherelationshipbetween

socialprotectionprograms(cashtransfersorin-kind)andthesocial-economicdevelopment

ofindividualsinpost-conflictareas,aswellastheimpactoftraumatreatmentonthesocial-

economicdevelopmentofindividualsinpostconflictareasandtheeffectivenessof

radio/socialmediatedprogramsforthesupportofpost-traumaticstressinenhancingthe

effectofsocialprotectiononsocialeconomicresilience.

Themainobjectiveofthestudyistoestablishthe(mediating)effectofsupportfortherelief

traumaonsocialeconomicresiliencefromsocialprotectionsupport(seealsoFigure4.1).

Theaimistounderstandthebeneficialeffectsoftraumacounsellingontheeffectivenessof

socialprotectioninbuildingsocialeconomicresilience.Itisexpectedthatthestudywill

provideacost-benefitanalysisoftraumasupportasanadditionalcomponentofsocial

protection(whichfocusesonlyonsupportingrehabilitationthroughsupportintheformof

economictransfers,suchascashorin-kindcontributions).

Researchquestionandsub-questions

Theoverarchingresearchquestionis:

Doessupporttorelieftraumapositivelyaffecttherelationshipbetweensocial

protectionandsocialeconomicresilience?

Thesub-questionsare:

1. Whatistheprevalenceofpost-traumaticstressinthepopulationofNorthern

Uganda(districtsaffectedbythe20yearsofcivilwar)?

2. WhatsocialprotectionprogramshavebeeninitiatedbytheGovernmentof

UgandafortherehabilitationofpeopleinthedistrictsinNorthernUganda?

3. Whatistheeffectofsocialprotectiontransfersonsocialeconomicresilience?

4. Whatistheeffectoftraumasupportinterventionsonsocialeconomicresilience?

49

5. Whatisthecombinedeffectofsocialprotectionandtraumasupportonsocial

economicresilience?

6. WhatistheeffectoftheSelf-helpLow-costPostTraumaticStress(SHLCPTS)

programtosupporttraumainpost-conflictareas?

7. Whatistheimpactoftraumasupportprogramsontraumaandhowdo

traditionalmethodsofcounsellingcomparetotheSHLCPTSprogramintermsof

impactonloweringtheimpactofPTS?

8. WhatistheupscaleabilityoftheSHLCPTSprogram?

9. WhatisthechangeinValueTransformationasaresultofSocialProtectionand

TraumaServices?

10. Whatarethecostsofsocialprotectionprogramsandoftraumaprograms,and

whatisthemostcost-effectivesolutiontosupportrehabilitationinNorthern

Uganda?

11. Whatarethecost-benefitsforUgandaofincludingPost-traumastressrelief

programstosupportthepositiveeffectsofsocialprotectiononsocial-economic

resilience?

Figure4-1.Relationshipbetweenthevariablessocialprotection,traumaandSER

Intheframework(seeFigure4.1),itisassumedthatsupportfortraumareliefhasaneffect

onsocialandeconomicresilience.Supportfortraumareliefdecreasesthe(impactof)the

negativeemotionalstatecausedbytrauma.Asaconsequence,peopleadoptamorepositive

50

mindset,makingitpossibleforthemtoseetheopportunitiesofferedbythecurrent

situation(independentfromsocialprotection).Furthermore,traumareliefcanmakethem

viewsocialprotectionasanopportunitytoincreasetheirsocialandeconomicresilience.

Inotherwords,theframeworkassumesthatsupporttotraumareliefdecreasestrauma;this

hypothesisunderpinsthemainresearchquestion.Itispositedthatsocialprotectionsupport

enhancesthesocialeconomicresilienceofrecipients,butthattheeffectismediatedbythe

leveloftrauma,andthatsupportforthereliefofpost-traumaticstresswillimprovesocial

economicresilience.

Hypotheses

Thehypotheses,regardingtheresearchquestion,canbesummarizedasfollows:

Hypothesis1:Socialprotectionenhancessocialeconomicresilience

Hypothesis2:Supportfortraumareliefmediatesthepositiverelationshipbetween

socialprotectionandsocialeconomicresilience

Inaddition,thisresearchwilltestthefollowinghypotheses:

Hypothesis3:TheleveloftraumainNorthernUgandaremainshigh(thenormisset

accordingtoCreamer,Bell&Failla,2003,p.1494)

Hypothesis4:Theleveloftraumaisreducedbysupportontraumarelief

Inordertotestthesehypotheses,theresearchmadeuseoftwoscales:

Scale1:SocialEconomicResilienceScale(SER)–developedforthisresearch

Scale2:ImpactofEventsScale(IES-R)–ahighlyvalidatedscaleusedtomeasurethe

levelofstressexperiencedasaresultofpreviouslyexperiencedtrauma

InordertoexaminetheCost-BenefitofinclusionofRelief-servicestoPost-TraumaticStress

anupscaleableself-helpandlowcostpost-traumaticstress(SHLCPTS)programwas

developed.Thehypothesiswasthatthiscost-effectiveprogramwouldsignificantly

contributetothepositiveimpactofsocialprotectionprogramsonsocial-economic

resilience.Theresearchwilltestthefollowinghypotheses:

Hypothesis5:SHLCPTSenhancessocialandeconomicresilience.

51

Hypothesis6:SHLCPTShasapositivemediatingeffectontherelationbetweensocial

protectionandsocialandeconomicresilience.

Hypothesis7:SHLCPTShasapositiveeffectonreductionoftheleveloftrauma

Hypothesis8:AnupscalableformofPost-TraumaticStressreliefisacost-beneficial

solutionforrehabilitationofNorthernUganda.

Inordertotestthesehypotheses,theresearchmadeuseoftwoscales:

Scale1:SocialEconomicResilienceScale(SER)–developedforthisresearch

Scale2:ImpactofEventsScale(IES-R)–ahighlyvalidatedscaleusedtomeasurethe

levelofstressexperiencedasaresultofpreviouslyexperiencedtrauma

Theresearchfurtherexpectedvaluestochangeaspartoftheculturaltransformation

processinitiatedbythesupportprograms(bothcashtransfer/in-kindsocialprotection

programsandPost-TraumaticStressreliefservices):

Hypothesis8:Respondentswhoreceivedsocialsupport(comparedtothosewhodid

not)havevaluesthataremoreinlinewiththeobjectivesofsocialprotection.

Hypothesis9:Respondentswhoreceivedsocialsupport(comparedtothosewhodid

not)thinkthevaluesofthecommunityaremoreinlinewiththeobjectivesofsocial

protection.

Hypothesis10:Thevaluesofrespondentswhoreceivedsocialsupportaremorein

linewiththevaluesthatrespondentsattributetothecommunity(comparedtothose

whodidnot)

Inordertotestthesehypotheses,theresearchwilluseamethodology,whichwasinspired

byBarrett(2014),developedtomeasureValueTransformationandEntropyin

OrganizationalSystems(Stokmans,VanReisenandLanda,forthcoming).Themethodology

includesaqualitativeandquantitativeanalysis.Inordertotestthehypotheses9-10,itis

necessaryto:

• Definealistofvaluesthatreflecttheobjectivesofsocialprotection

• Developatooltocapturethevaluesoftheindividualandthosethathe/she

attributestothecommunity

52

• Developasimilarityindexthatcapturesthecorrespondencebetweenthevaluesof

anindividual(andvaluesattributedtothecommunity)andthevaluesthatreflectthe

objectivesofsocialprotection

Thisprocedurewasdevelopedandsuccessfullyappliedinanotherresearchprojectandwill

beusedtoanalyzethedataconcerningthevaluesinthisproject.Atpresent,alistofvalues

isbeingdevelopedthatcapturestheobjectivesofsocialprotectionbasedonthelistof

valuespresentedtorespondents.Theanalysisofhypotheses9-10hasnotbeencompleted

andwillbereportedinthefuture.

4.6.1. Unitofanalysis

Theunitofanalysisistheindividualrecipientofsocialprotectionsupportandofsupportto

helprelievetrauma.Theanalysisiscarriedoutatagrouplevelandacontrolgroupwas

included.Theinteractiveeffectoftheindividualchangeonthecollectivegroupchangewas

controlledthroughanadditionalcontrolgroup,whichhadnointeractionwiththeresearch

untilthefinalmeasure.Thecomparisonbetweenthecontrolgroupthatparticipatedinthe

researchandthecontrolgroupthatonlyparticipatedattheendwillrevealthepotential

measurementeffectsofthestudy.

4.6.2. Timelineofthestudy

Aliteraturereviewwasconductedinordertoscrutinizetheavailableliteratureonthe

relationshipbetweentrauma,socialprotectionandsocialeconomicresilience.Thefindings

areprovidedinannex2.

Theresearchinvestigatestheeffectofexistinggovernment-initiatedinterventionsforsocial

support(cashorin-kind)andtraumacounsellinginNorthernUganda,nexttotheeffectofa

counsellingprogramthatwasdevelopedbyoneoftheresearches.Thetimelineofthe

researchissummarizedinTable4.1.Theeffectofthesocialprotectionprogramsinitiatedby

thegovernmentcanbeexplorealongthelinesofapost-testonlydesign,which

encompassestwopointsofmeasurement(T1andT2).

Theprogramtoprovidesupporttopeoplewithpost-traumaticstresswasanintervention

designedspecificallyforthisresearchbasedonasetofcriteriathatemergedfromthe

analysisofdatafromthefirstroundofdatacollection(seesection4.9andchapter8).

53

Table4-1.Summaryofresearchactivitiesbyphaseandtimepoint

Timepoints

T0:June-July

2015

T0:August

2015–

December

2015

T1:March/

April2016

T2:

Implementation

September/

October2016

T3:January/

February2017

T4:Julyand

November

2017

T0 T0 T1 T2 T3 T4

Phase Phase1:

Selectionof

sites

accordingto

research

groups:

1.Cash

2.Counseling

3.Bothcash

and

counseling

4.Nosupport

Phase1:

Field

preparation

andscale

development

Phase2:

Measurement

of

SER

IES-R

Phase3:

1. SHLCPTS–

Program

2. No-SHLCPTS

Program

Phase4:

Measurement

of

SER

IES-R

Phase4:

Measurement

of

SER

IES-R

Research

activities

Survey

OpenEnded

Interviews

Observation

Trainingand

implementation

Survey

OpenEnded

Interviews

Observation

Survey

SER=SocialandEconomicResiliencetool;IES-R=ImpactofEventScale-Revised

Theeffectoftraumasupportwasmeasuredintwoways.First,inT1,theeffectofavailable

programsbythegovernmentorotherserviceproviderswasmeasured.T1alsoprovidedthe

pre-measurefortheexperimentwiththeSHLCPTSprogram.Secondly,asupportprogram

wasdesignedforthepurposeofthisresearchandofferedtoresearchparticipantsthrough

audiocommunicationarrangedwiththehelpoflocalradiostations(andvoices)(T2).The

impactofbothtraumasupportinterventionswasinvestigatedthroughapost-testonly

designinT3andT4).

54

Experimentaldesignandsamplingofrespondents

Thefirstphaseoftheprojectwasforpilotingtoolsandvisitingstudysitestoestablish

contactwithlocalwomengroupsandlocalleaders.Duringthisphase,theteamreachedout

tothefollowingdistricts:Soroti,Kaberamaido,Kitgum,Amuria,OyamandLuwero.

Therewasapurposiveassignmentofrespondentstothegroups,asareal-lifesituationwas

beinganalyzed.Thefollowinggroupsweredistinguished:

• cash(cashorin-kind,providedbytheGovernmentofUganda)

• counselling(providedbyNGO’sorDistrict)

• bothcashandcounselling(asabove)

• nosocialprotection(controlgroup-

Thesecondstudy(firstandsecondwave)hadapre-andpost-measure.Respondentswere

purposivelyassignedtothetraumasupportprogramdevelopedbytheresearchersin

collaborationwithlocalauthorities.Thefollowinggroupsweredistinguished:

• SHLCPTSandcash/in-kind

• SHLCPTSandcounselling

• SHLCPTSandbothcash/in-kindandcounselling

• SHLCPTSandnocash/in-kindnorcounselling

• Onlycash(cash/in-kind)

• Onlycounselling

• Bothcash/in-kindandcounselling

• Nosupport(controlgroup)

Asecondcontrolgroupwasaddedforpost-measurementonlyinordertomeasurethe

potentialimpactoftheresearchpresenceintheareasthatmayhaveaffectedthecontrol

group.Thesecondcontrolgroupparticipatedinthesurveyonlyonceandwasunrelatedto

otherlocationsincludedintheresearchanddidnotparticipateinanyprograms.

TheSelf-helpLow-costPostTraumaticStress(SHLCPTS)programwaspreparedforthe

research—anditisdescribedinChapter8.TheSHLCPTSwasprovidedthroughlocalradio

broadcasts(madeavailableduringtheresearchonlytotheparticipatinggroups).

55

Thelocalauthoritiesselectedcommunitieswheretheprogramcouldbeadministered.Those

communitieswereselectedbecausetheauthoritiesbelievedtheysuitedthepurposeofthe

studywell,duetohighleveloftraumaandlowsocialandeconomicresilience.This

somewhatdiminishesthecomparabilityoftheresultsbetweenthegroupsbutdoesnot

affectstheresultswithingroups.

Researchdesign:Experimentinginreal-lifesituations

Thisresearchprojectcanbecharacterizedasastudytoexploretheeffectivenessofan

existinginterventioninareal-lifesettinginruralNorthernUganda.A(quasi-)experimental

set-upwasused,asadvisedwhenthestudy’sobjectiveistounderstandthecausaleffectof

anintervention.Thedesignofthisstudyaimstoisolatetheinterventionfromother

extraneousvariablessothatalinkbetweeneffectscanbeestablishedbasedonthetheory

thatprovidesthehypothesesforacausalrelationship.Inapositivistapproach,allvariables

arecontrolledandconsequentlycausalconclusionsaredrawn.Althoughitisthemost

appropriatewayofdrawingcausalconclusions,acontrolledenvironmenthasthe

disadvantagethatitremovesfromtheexperimenttheknowledgeoftheeffectofthe

interventionwithinareal-lifesituation.Acontrolledenvironment,thus,runstheriskof

creatingartificialsituationsthatarenotalwaysrepresentativeofreal-lifesituations.

Carryingoutanexperimentinareal-lifesituationhastheimportantadvantagethatthe

interventioncanbestudiedinitsnaturalenvironment.Thefindingscan,therefore,inform

theresearchersaboutthewayinwhichtheinterventionrespondswithinareal-lifesetting,

whichisnotthecaseifthestudyisundertakeninanisolatedenvironment.Thisis

particularlyrelevantwhentheexperimentiscarriedoutintheenvironmentthathasa

particularinterestinthefindingsofthestudy,aswasthecasewiththisresearch.

Areal-lifeset-uprespondstoanincreasingdemandfortheresearchtobebeneficialto

society.Theproblemidentifiedbymanypolicymakers,whoareinterestedinevidence-based

decisionmaking,isthatresearchtendstobecarriedoutinasterileexperimentalset-up,

whichunderminesunderstandingofwhatmaybeexpectedofaninterventioninthereal-life

situationthatpolicymakersareconcernedwith.Itis,therefore,necessarytoconsiderthe

researchadvantagesandpossibilitiesofstudyinginterventionsinareal-lifecontext.

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Beforecarryingoutresearchonanintervention,criticalquestionsneedtobeasked,suchas:

Isitpossibletostudytheintervention?’Ifyes,isitpossibletoadheretoethicalstandardsto

ensurevalidityoftheresearchoutcome?Isthereanyadvantageinstudyingtheintervention

inquestion?Suchcriticalquestioningbeforeconductingresearchonaninterventionis

carriedoutisperemptoryasithelpsustoidentifyandunderstandthelimitationsofareal-

lifemethodology.

Toadvanceajustificationfortheimplementationofexperimentsinareal-lifeexperimental

setting,itshouldbeacknowledgedthatthiscreatesacomplexstudydesign.Thisisbecause

questionsonthesensitivityandsensibilities—questionsthatarecriticalinanyresearchthat

involveshumans—oftenarise.Thepurposeofthisnoteistoarticulatethebenefitsthatthe

studyinreal-lifesituationcangiveandtoproposethequalificationsthatneedtobe

consideredinthisapproach.

Usually,questionsregardingtheeffectivenessofinterventionsareapproachedbyobeying

therulessetforanexperimentaldesignasmuchaspossible(Shadish,Cook,&Campbell,

2001).Inordertobeabletomakecausalclaims(theinterventioncausedtheimprovement),

threeimportantrulesshouldbemet:

• Respondentscanberandomlyassignedtotreatmentandcontrolgroups

• Thetreatmentshouldbedesignedbyaresearcheronthebasisoftheory

• Thetreatmentshouldbeunderthecontroloftheresearcherandtherewithequalfor

eachindividualassignedtoaspecificgroup

Thequestionthatarisesinviewofthesethreerulesis:Canrespondentsbefullyassigned

randomlyinareal-lifesituation?Experiencedresearchersinresearchconcerninghuman

beingsareusuallyawarethatinreal-lifeinterventionstudies,theserulesoftencannotbe

followedinanarrowsense.Thisisonaccountoftheirbeingdissociativeandimpracticalin

manyreal-lifeinterventionstudies.

Thefirstrule,abouttherandomassignmentofindividuals,forexample,iscomplicated,as

participationinresearchwithhumans(asemphasizedbymanyethicalresearchcommittees

isalwaysonavoluntarybasis.Asunderlinedinresearchethicsaroundtheworld,persons

whoagreetoparticipateintheintervention,andintheresearchlinkedtotheintervention,

areabletochangetheirsituationanytimetheydeemnecessary.Infact,inreal-life

57

situations,researchparticipantsaregiventheopportunitytochangetheirsituationsothat

theyaremotivatedtoparticipateintheresearch.Otherwise,theywillchoosenotto,

therebymakingthewholeexercisefutile.Thus,itisunavoidabletohavesucharesearch

bias,ashighlightedinanyresearchwithhumans,andtheresearchmusttakepropernoteof

suchdynamics.

Inadditiontomotivationalissues,itisoftennotthecalloftheresearchertodecidewhogets

whatkindofintervention(ornoneatall).Asisthecaseinthisresearchproject,anexternal

organization,nottheresearcher,setthecriteriaandselectedtheindividualswhoreceived

cashand/orthosewhoreceivedtraumacounselling,ornosupportatall.Inreallife,social

interventionsarenotdistributedatrandomtothetargetpopulation;peopleshouldbe

informedabouttheintervention,peoplehavetoapply(motivationalissue),anda

commissionhastodecidewhocan,andisinfacteligible,toparticipate.Duetothesefacts,

treatmentgroupsandcontrolgroupswillprobablynotbesimilaronallrelevantvariables

exogenoustotheintervention.Thismakesresearchwithhumansevenmorecomplicated

andindeedchallenging.

Furthermore,auniqueassignmentofindividualstoaspecificgroupishardtorealizeinreal

lifesettings.Thisisbecause,byvirtueofthembeingzoonpolitikons(Aristotle)andsocialby

nature,peopletalkamongthemselves:theysharetheirconcerns.Moreover,theeffectofan

interventionontheparticipants(emotional,socialandeventheeconomicimprovementof

anindividual’ssituation)affectsotherpeopleinthesocialnetworkorthecommunityofthe

participant.Thisisbecauseman(andwoman)isneveranislanduntohimself/herself.We

areallpartofthewhole,whichmakesitevenmorecomplicatedtodealwithinterventions,

atleastinamannerthatwouldsatisfyall.Asinthecaseofthisresearch,thefactthat

participantscouldparticipateinthesocialprotectionprogram,affectedtheeconomyofthe

community,andthefactthatparticipantstalkedaboutthetraumacounselingintervention,

madethisintervention(partly)availabletootherpeople(andthewholecommunity)as

secondaryinterventioneffect.

Thesecondpointrelatestotherulethataninterventionshouldbebasedonatheory.While

thisruleshouldbemetascloselyaspossible,asimilarproblemastheonenotedabovealso

arisesthemomentyoutrytoapplytheorytoreal-lifesituations.Inreal-lifesituations,

interventionsareoftendesignedbyaspecificagenttoimplementaparticularpolicyand

58

researchersareaskedtoevaluatetheeffectivenessoftheseinterventions(asisthecasein

thisproject).Insuchcases,thetreatmentsdodifferbetweenandamonggroups.But,quite

often,thesedifferencesintreatmentarenotinspiredbytheorythatindicateswhyaspecific

interventionwillworkinoneparticularsituation,ornotinanother.Thesetreatmentsare

theresultoftheimplementationofpolicyandpartlybasedonagendasettingby

policymakersandthosewhoimplementtheagreedpolicy,whilethetreatmentmayprovide

apolicywindowforbringinginnewideasonthepolicyagendawith,importantly,an

unpredictableelementregardingwhenideasmaymoveontothepolicyagenda(Kingdon,

1995).Asaconsequence,theresearchobjectiveisnottotestcausalrelationsbetween

specificvariablesofatheory(theintentionofanexperimentwithinthepositivisticempirical

approach),buttoestablishtheeffectivenessofanintervention(whichconsistsofawhole

setofundefinedvariables)inareal-lifesituation.

Thethirdruleofanexperimentisthattheinterventionorthetreatmentisunderthecontrol

oftheresearcher,andthatthisisequalforeachindividualinaparticular(treatment)group.

Thisruleisparticularlyhardtorealizeinreal-lifeinterventions.Inreal-life,interventions

occurinasocialsituation,neverinavacuum.Participants,aswellasthosewhoexecutethe

intervention,workwithaninterventioninaspecificcontext.Theyhavetheirownideasof

howtheinterventionshouldbeappliedinasituation.Moreso,theyhavetheirown

expectationsofwhatwillwork(andnot),underwhatconditions,asisdictatedbytheir

context.Therefore,inthissocially-definedcontext,theparticipantsandthoseexecutingthe

intervention,willunavoidablyadjusttheinterventiontothephysical,social,andcultural

situationathand.Furthermore,multipleprojectsareoftenimplementedatthesametimein

thesamelocationbydifferentinitiators.Inthecaseofthisresearch,churchesalsooffer

socialsupportaswellascounselling,forexample.And,moregenerally,lifegoesonandmay

affectrespondentsindifferentways.So,aresearchershouldrealizethattheinterventionis

justoneoftheeventsthatishappeningtotherespondentsandthatthoseothereventscan

havedifferentimpactsondifferentrespondents.

Drawingontheanalysishere,governedbytherulesofcausalclaimsandinterventions,itcan

beconcludedthatitisoftenpracticallyimpossibletofollowthemethodologicalrulessetfor

atrueorevenaquasi-experimentaldesigntostudytheeffectivenessofasocialintervention

oraninterventiontakingplacewithinasocialreality.Dealingwithandresearchingpeople

59

remainsamammothchallengeforresearchersacrosstheboard,beitinthenatural

sciences,socialsciencesorhumanities.

Thisdoesnotmeanthattheeffectivenessofaninterventioncannotbestudied(Snow,et.

al.,2003).However,itdoesmeanthatoneshouldbethoroughandmeticulouswhen

carryingoutresearchonanintervention.Thiscanbeachievedbycommittingoneselfto

sensitivity(orresponsiveness)totheresearchsituationathandandapplyingdifferent

researchmethods(triangulation)inordertohavedatatoverifyandvalidatetheresultsof

thetestingoftheeffectoftheintervention.

Apossibilityistoelaborateanaturaldesign(Shadish,Cook&Campbell,2001)inwhichall

importantkeyvariablesmaynotbeknown.Inanaturaldesign,variablesmaybeidentified

basedonseveraldifferentscenariosoracombinationofthose.Variablesmaybeidentified

basedonthefollowingreasons:

(i) Developedhypothesesconcerningtheworkableelementsofthe

interventionthatisexpectedtocausetheeffect(basedontheory);

(ii) Understandingofthenatureofaparticularversionofthetreatmentasit

wasappliedinthenaturallifeenvironment;

(iii) Understandingoftheblendingofdifferenttreatmentsappliedinone

community;and

(iv) Understandingoftheextenttowhichtreatmentswillhaveaneffectatthe

collectivecommunityleveland,therefore,alsoaffectthecontrolgroup(in

thatcommunity).

Suchadesigndemandsspecificrequirementsofastudy,suchasbeingresponsivetowhatis

takingplaceintheenvironmentanddocumentingcarefullyallthecontextualspecificstaking

placebefore,during,andaftertheinterventionortreatmentisapplied.

Thesuggestiontoberesponsivetotheresearchsituationinitsreal-lifecontextis

counterintuitivetothetraditionalpositivisticempiricalresearch.Thisresearchtradition

prescribesthataresearchershouldbehaveasanobjective(outsider)observer,whodoes

notinterferewiththeresearchsituation.Thisargumentcanbecounteredbyconsideringthe

realitythattheresearcherisdoingthisresearchinasocialcontextwithhumanswhose

sensibilitiesorvaluesneedtobeseriouslyconsideredfromboththeperspectiveofresearch

60

ethicsandhumanrights.Thepoint,thus,isthattheresearchergathersspecificinformation,

whichnecessarilyandunavoidablymakeshim/herapartofthesocialrealityinwhichthe

interventiontakesplace(Burawoy,1998).

TheEWP-Uresearchprojectisconductedinareal-lifesetting,morespecificallyinarural

area,inwhichresearchersareaunique,extraordinaryphenomenon.Peoplehave

expectationsofwhatresearcherswillbedoingandhowtoapproachthem.Moreover,the

researcherhastoapproachandinteractwithlocalauthorities,participantsandnon-

participantoftheresearchaccordingtoproper(local)socialnorms.Thishas,asa

consequence,thattheresearcherrealizesthathe/sheisnotanobjective,outsiderobserver,

butanengagedresearcherwhoistryingtodiscoveranappropriatewaytoimprovethe

socialsituationathandforaparticulargroupofpeople.Accordingtoapositivisticlogic,such

anexpectationconcerningtheresearchitselfshouldnotexist.Butintherealityofthe

research,thesocialsituationispresentandcanneverbeavoidedatanygivenmoment.

Methodologically,itismoresoundtoacknowledgetheeffectsofthesocialembeddingofa

research,ratherthanartificiallydenytheexistenceofthesocialspecificinteractionofthe

real-lifeexperimentwithitsenvironment.

Byresearchingtheeffectofaninterventionforadefinedgroup(womeninNorthern

Uganda,inthecaseofthisproject),onehelpsthisparticulargroup(and,therefore,not

anothergroup),eventhoughthefindingsforthisresearchcanbeapplicablepartlyorwholly

insimilarcontextselsewhere.Thischoicecantriggerenvy.Intheresearchers’experience,

themeninthecommunity(spouses,fathers,andsons)wereaskingtobeincludedinthe

intervention.Suchareactionbyacommunityindicatesthatdoingresearchisnotan

objectiveactthatcanbelocatedoutsidethesocialsituationinwhichtheinterventiontakes

place.Itshowsthatresearchisanintegralpartofthesocialsituationinwhichthe

interventiontakesplace.Inthisstudy,thebroadercommunityandtheparticipantsofthe

differentresearchgroupswereallgivenaccesstotheSHLCPTSprogram.Localradio

broadcastontheprogramwassoughttoprovidebroaderbenefitfromtheinterventionto

thecommunityasawholeaftertheresearchwasendedsoasnottointerferewiththe

experimentalsetupofthestudy.

Inapositivistdesign,suchfactorswouldberemoved,butmakingtheoutcomeofthe

experimentirrelevanttoareal-lifesocialsituationisnotpractical,astheinterventionor

61

treatmentwouldalwaystakeplacewithinitssocialcontext.Itcan,therefore,bearguedthat

itismoreadvantageoustoimplementinterventionsortreatmentsthathaveaplaceinthe

socialcontextinquestion.Strategiestoimplementsuchinterventionscanbebetterstudied

byacknowledgingtheeffectofreallifeinacontext.Bylettinggoofthefixedideaofbeing

objective,oneopensthepathofbecomingmoreacquaintedandfamiliarwiththepeople,as

wellasthecommunityinwhichtheinterventiontakesplace.

Inordertostudyaninterventionortreatmentinanaturalsituation,theresearchersare

requiredtopayfullattentiontothespecificsofthesocialcontext.Thisisanimportantstep,

asresearchersareoftennotfamiliarwiththesocial,culturalandhistoricalsituationofthe

contextinwhichtheyaretocarryoutresearch.Alackofsharedexperiencesand

backgroundknowledgewouldthenhamperthevalidityoftheinformationgathered.Ifa

researcherisnotfamiliarandasksonlystandardizedquestions,andacceptsonlyrecorded

(standardized)answers,theprobabilitythatthequestion,aswellastheanswer,is

misunderstoodbytherespondentandtheresearcherishigh.Itis,therefore,imperativeto

understandthecontext,andtostudyhowthesocialcontextinteractswiththeexperiment.

Thislineofreasoningleadstotheconclusionthatanexperimentalmethodthatisusedto

researchaninterventionortreatmentinasocialsituationshouldbeenhancedbyscience

notionsemergingfromethnographicresearchtraditions.Thistypeofresearchdiffersfrom

positivisticresearch(amongotherthings)inthefollowingrespects:

• Theresearcherismoreengagedwithrespondentsandthecommunityin

ordertoovercomedifferencesinlanguageuse,normsandvaluesthatare

expressedin(social)expectationsandreactions(cognitive,emotionaland

behavioral),aswellasevaluations(whatisagood,appropriate,andbad

reaction)(symbolicinteractionistbase).

• Theresearcherissensitizedtothecontextoftheresearchsetting.Social

research,unlikenaturalscienceresearchcarriedoutinlaboratories,isalways

situatedinaspecificcontextthatcanbedescribedintermsofaphysical,

social,economic,cultural,andhistoricalentirety.

• Theresearchfocusesonsocialprocesses(whatpeoplearedoingandwhy

theyaredoingit;howtheinterventionishandledinthiscommunity),aswell

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astheoutcomesofsocialprocesses(theeffectoftheinterventiononspecific

variablesofinterest).

Thepositionofanethnographically-informedresearchmethodologyisthattheeffectofthe

socialinterventionortreatmentistheresultofsocialprocessesinaspecificcontext.The

processesemergingfromtheinterventionortreatmentwillthenbelocatedat,minimally,

threelevels:

1. Individuallevel(perceptions,feelings,opinions,andcompetences)

2. Socialinteractionofpeopleinvolvedintheintervention

3. Effectofthebehaviorofthepeopleinvolvedintheinterventiononthe

community

Thesesocialprocessestakeplacewithinaspecificcontext,whichspecifiesthephysical,

economic,social,culturalandhistoricalconditionsinwhichtheinterventiontakesplace.

Thisbroadercontextisnotnoise,aspositivistassume,butreality(Burawoy,1998).Itis,

therefore,essentialtoincluderealityintheresearch.

Whenaresearcherrealizesthattheresultsofacertaininterventionalwaysemanatefrom

socialprocessesinspecificsocialsituation,certainstandardrulesforexperimentaldesign

canbemodified.

Theruletopickrepresentativecasesisnolongerrelevant,asrepresentativecases,assuch

donotexistinareal-lifesituation,asallcontextsaredifferentandspecificand,therefore,

notrepresentative.Theurgetogeneralizetheresultstoawidercontext(otherpopulations,

othersocialcircumstances)needstobemodifiedbytheunderstandingoftheresearcherof

thespecificinteractionwiththesocialrealityinhis/herexperiment.Thisdoesnotmeanthat

itisnotpossibletoidentifyresultsatmoreaggregatelevels.Theresearcherispromptedto

searchformoreabstractinggeneraltendenciesacrossdifferentimplementationcontexts

andcansodevelopanabstracttheoryoftheworkingelementsoftheinterventionor

treatment.Thistheorycanthenbeusedasaguidelinetodevelop(andstudy)similar

interventionsortreatmentsinothercontextandtovalidateorrejectthetheory.

Inordertocometomoreabstractknowledge(theory)aboutwhyandhowanintervention

works,oneshouldstudytheprocessofimplementation,aswellasreactionstodifferent

63

versionsofaninterventionatdifferentmomentsintime(forexample,before,during,after,

half-a-yearlater,andsoon)indifferentsocialsettings(orcommunities).Bydescribingthe

context,thesocialprocesses,theinterventionortreatment,aswellastheeffectsofthe

interventionortreatment(onindividual,interpersonal,andcommunitylevel),the

researcherdevelopsanideaofhow(whatsocialprocesses)andwhy(whatkeyvariables

triggertheappropriatesocialprocesses)theseinterventionsworkingeneral(theory).This

theorywillthenindicatewhatversion(s)orwhichelementsofaninterventionortreatment

have(what)effectswithinthereal-lifeimplementationandinformstheresearcherofthe

practicalapplicabilityofanintervention,aswellastheexpectedimprovementintheeffect

ofvariables,inspecificsettings.

Researchactivitiesanddetailedtime-line

Forthisresearchseventyinterviewsandfocusgroupmeetingswerecarriedoutinthe

followingorder:

4.9.1. Focusgroupmeetingsandinterviewswithresourcepersonsonsocial

protectionandtrauma–2015

Focusgroupmeetings(n=7)wereheldduringthepreparatoryphasein:Kaberamaido(9July

2015)Amuria&Dokolo(9July2015),Kitgum,Katakwi(add9-11July2016),Soroti(10July

2015),Kitgum(10-11July2015),Amuru&Oyam-Gulu(12July2015)byresearchers

PrimroseNakazibwe,MirjamvanReisen,juniorresearchers(meetingsKampala8July2015).

Focusgroupscomprisedofwomenrespondentsfrom18–60yearsofage.Thenumberof

womenincludedinthegroupswasbetween15–25women.Atranslatorwasusedduring

themeetings.Themeetingswereopenconversationsonthesituationinthecommunity,the

needsofthewomen,theiraccesstosocialprotectionandcashtransferprogramsandtheir

well-being.Inaddition,openstructuredinterviewswereheldwithwomenleadersand

districtauthoritiesintheplacesvisited.ApreparatoryvisittookplacetoLuwero(November

19th,2015)buttheresearchersfoundthattrauma-reliefinLuwerowasnolongerapriority

forthecommunity.ItwasdecidednottoincludeLuwerointheresearch.

4.9.2. Firstdatacollection(Wave1)andinterviewsonaccessandparticipationto

socialprotection–2016

Survey-assistantsweretrainedandthefirstdatacollectionbysurvey(SERandEIS-R)was

implementedfromMarchtoMay2016andduringthistimeinterviews(n=20)weredoneby

64

ResearcherPrimroseNakazibweandjuniorresearchers(Lira,1st-6thMarch2016;Katakwi

andAmuria,7th-11thMarch2016;Kitgum,21stMarchto21stMay2016).Theformatwas

openinterviewsrelatedtoaspectsofaccessandparticipationprotectionprograms.

4.9.3. MeetingswithlocalcontactpersonsandradiostationsforSHLCPTS–2016

Meetingswereheldwithlocalcontactpersonsoftheresearchtofollowuponthefirst

roundofdatacollectioninfrom27April–5May2016).Thefollowingareaswerevisited:

Kampala:27–29April;KaabongandKitgum30April–2May;Soroti&Lira3May,Kampala

4May.

4.9.4. Seconddatacollection(Wave2)InterviewsontraumaandSHLCPTS

SecondroundofdatawerecollectedinJanuary2017)Individualinterviews(n=48)wereheld

duringdatacollectionbyresearcherPrimroseNakazibwe,MirjamvanReisenandSelam

Kidane(secondroundofdatacollection,24-27January2017,25JanuaryLira,26,January

Kitgum,27January,Gulu)(interviewsonimpactsofSHLCPTS).

4.9.5. Publictestimonies

- Publicindividualtestimonies(n=3)atdisseminationmeetingsinBarlonyo(21

February2016)andinKampala.

4.9.6. Otherresearchactivities

Otherresearchactivitiescomprisedofthefollowingsupportandpreparation:

- TrainingBarretMethod,byJolandaAsmeredjoinKampalaforTeam(05thto08th

January2016)

- Identificationandmeetingswithlocalradiostations(preparationofSHLCPTS)

PreparationandTrainingSHLCPTSinLirabySelamKidanecoordinatedbyPrimrose

Nakazibwe(Lira,18thto20thJuly2016)

- ImplementationofSHLCPTS,locationanddates:

o LiraDistrict

§ BarlonyoAgwengSubCounty-25thAugustto3rdOctober2016

§ OgurSubCounty-25thAugustto10thOctober2016.

o KatakwiDistrict

§ UsukSubCounty-7thSeptemberto17thOctober

§ NgariumSubCounty-8thSeptemberto18thOctober

65

o AmuriaDistrict

§ Orungo-7thSeptemberto23rdOctober2016

o Kitgum

§ AmidaSubCounty-27thAugustto24thOctober2016

§ TumangoParish-AkwangSubCounty-27thAugustto24thOctober

2016

Otherreportingactivities:

- BorlonyoCommemorationandradiodissemination(21February2017)

- LiberiaInternationalColloquium(March7-8,2017)(workshopandpresentationat

highlevelmeetingbyMirjamvanReisen,PrimroseNakazibwe)

- CSW(March12-152017)(workshopIsis-WICCE,PrimroseNakazibwe,Zamina

Malole)

4.9.7. Analysisofinterviewsandfocusgroups

Theinterviewtranscriptswerewrittenbytheintervieweesduringtheinterview.Thenotes

weredigitalizedinacoding/labelingoverviewbytheresearchers,accordingtopre-fixed

labels.Newlabelswereadded,wheretheyappearedrelevantandaddedtotheoverviews.

Therespondentswereanonymizedandtheinterviewinformationwasinsertedinoneexcel

file,withanencryptedpasswordprotectionandsavedontheTilburgUniversitysurfdrive.

Quantitativedatapreparationandstatisticalapproach

DatawerecollectedthroughsurveysSERandIES-R(seesections4.9.2)Thedatawere

collectedinthreerounds.Round1tookplaceinMarch-May2016,round2tookplacein

February2017).AthirdroundtookplaceinOctober/November2017.

Beforethedatawereanalyzed,theywereexaminedforout-of-rangenumbersandfor

respondentswithmorethan25%missinganswers.Inthefirstwave,472respondentstook

partintheinterviewandinthesecondwave357respondentstookpart.Duetoitemnon-

response(ofmorethan25%),onerespondentfromthefirstandonefromthesecondwave

wasremovedfromtheanalysis.Theotherrespondents(firstandsecondwave)answered

thequestionnairewithanitemnon-responseofislessthan10%onaverage.

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Duetothelargenumberofrespondents(wave1,n=472;wave2,n=357),itcanbeassumed

thatthedataoneachofthevariableshasanormaldistribution(centrallimittheorem;see,

forexample,Hays,1973).

SincethevalidityandreliabilityofthescalesusedwasnotyetestablishedforNorthern

Uganda,eachscale(anditscorrespondingsubscales)wereexaminedbymeansof:

• Anitem-analysis

• Areliabilityanalyses(internalconsistency)

• Ananalysistodeterminethediscriminantvalidityofthedifferentsubscalesofa

construct

Theresultsoftheseanalysesarereportedinchapter12and13.Appendix3includesthe

questionnaireusedatT1andT3.

Inordertoexaminethehypothesesregardingthemainresearchquestion,thedifferences

betweenthesocialprotectiongroupswereexaminedbymeansofanalysisofvariance.Two

differentanalyseswereperformed.

Ananalysisofvariance(ANOVA)wasconductedtoexploretheeffectsofthesocial

protectionmodes(cashandtraumasupport)onsocialandeconomicresilience.Thisanalysis

alsolooksfortheinteractioneffectbetweencashandtraumasupport,inotherwordsdoes

traumarelieftheeffectofcash?TheANOVAalsoexaminedwhetherthedifferences

betweenthesocialprotectiongroupsonsocialandeconomicresiliencestillholdifage(asa

covariate),educationallevel,andemploymentaretakenintoaccount.

Theseanalysesweredoneforthefirstandsecondwaveseparately,toexaminetheeffectof

traumasupportonthesocialandeconomicresiliencetool.

Inordertotesttheadditionalhypothesesregardingtrauma,theleveloftraumainthefirst

wavewasexaminedtoestablishthepercentageofpeoplewhoarehighlytraumatizedand

theeffectoftraumasupportontheleveloftraumareported(IES);socialandeconomic

resilience(SER)wasalsolookedat.

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Definitionofterms

4.11.1. Socialprotection

Socialprotectionhasemergedasakeypolicyframeworkforaddressingpovertyand

vulnerabilityinmanydevelopingcountries(Barrientos,2011).Socialprotectionisthefirst

actionofgoalone(endpovertyinallitsformseverywhere)oftheSustainableDevelopment

Goals(SDGs).TheFoodandAgricultureOrganization(FAO)seessocialprotectionascritical

forruraldevelopmentandithasadoptedaSocialProtectionFrameworktopromoterural

developmentforallinwhichitstates:

Threequartersofthechronicallyundernourishedandthoselivinginpoverty

reside in rural areas.Many of them are not covered by adequate social

protection,relypredominantlyonnaturalresourcesfortheirlivelihoods,and

areparticularly vulnerableandexposed tomultiple risks.Yet, theyplaya

critical role in ensuring global food security in the long term, and in

sustainably managing the natural resource base in the most fragile

ecosystems. Ensuring their access to social protection is not only a social

imperative, but it is critical to ensure their participation as partners in

developmentandeconomicgrowth.(2017,p.xii).

Socialprotectionschemeshaveproventoplayasignificantroleintacklingtheproblemof

povertyandvulnerability,andtheseschemeshavebeenviewedaspowerfultoolsfor

governments,policymakersanddonorstoaddresscertainproblems,suchasfuelandfood

crises,aggregateshocks,andothereconomiccrises(Waqas&Awan,2017).authorities.

Indevelopmentdiscourse,theconceptofsocialprotectionfirstemergedinthelate1980s

andintheearly1990sasacriticalresponsetothediscourseabout‘safetynets’(Devereux,&

Sabates-Wheeler,2004).Manyauthorscametousetheconcepttodrawattentiontothe

widernatureofpovertyanditsnatureasamulti-dimensionalproblem—hence,thediffering

definitionsofsocialprotection.Internationaldonoragencies,academicauthors,regional

politicalbodiesandspecificcountrieshavecomeupwithvariousdefinitionsoftheconcept

ofsocialprotectionasoutlinedbelow.

Conway,deHaan,&Norton(2000)definesocialprotectionas

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Public actions taken in response to levels of vulnerability, risk and

deprivationwhicharedeemedsociallyunacceptablewithinagivenpolityor

society.(p.2)

TheWorldBankstatesthat

Socialprotection isacollectionofmeasuresto improveorprotecthuman

capital, ranging from labor market interventions, publicly mandated

unemployment or old-age insurance to targeted income support. (2003,

online).

Itgoesontosaythat“Socialprotectioninterventionsassistindividuals,households,and

communitiestobettermanagetheincomerisksthatleavepeoplevulnerable”(ibid.).The

InternationalMonetaryFund’s(IMF)GovernmentFinanceStatisticsManualdefinessocial

protectionas“thesystematicinterventionintendedtorelievehouseholdsandindividualsof

theburdenofadefinedsetofsocialrisks”(IMF,2014,p.4),wheresocialrisksaredefinedas

“eventsorcircumstancesthatmayadverselyaffectthewelfareofhouseholdseitherby

imposingadditionaldemandsontheirresourcesorbyreducingtheirincome”(IMF,2014,p.

4).

TheAsianDevelopmentBankfocusesonsocialprotectionasapovertyreductionstrategy

and,thus,definestheconceptas“thesetofpoliciesandprogramsdesignedtoreduce

povertyandvulnerabilitybypromotingefficientlabormarkets,diminishingpeople’s

exposuretorisks,andenhancingtheircapacitytoprotectthemselvesagainsthazardsand

interruption/lossofincome”(AsianDevelopmentBank,2003,p.1).Withinthisconceptual

framework,socialprotectionconsistsoffivemajorelements:(i)labormarkets,(ii)social

insurance,(iii)socialassistance,(iv)microandarea-basedschemestoprotectcommunities

and(v)childprotection(ibid.).

ThedefinitionsoftheIMF,WorldBankandAsianDevelopmentBankfitwellinthe

perspectiveofawesterndevelopedsociety.Inadvanced,industrializedcountries,social

protectionconstitutesasetofintegratedinstitutionsandprograms,includingsocial

insurance,socialassistance,andemploymentprotectionandpromotion(Barrientos,&

Hulme,2009).Duetothemanyconstraintsindevelopingcountries,thereisagrowing

debateaboutthemeaningofsocialprotectionfromtheperspectiveofdevelopingcountries.

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BarrientosandHulme(2009)notesthatthereisagrowingconsensusaroundtheviewthat

socialprotectionconstitutesaneffectiveresponsetopovertyandvulnerabilityindeveloping

countries,andanessentialcomponentofeconomicandsocialdevelopmentstrategies.

Hence,therehasbeenanefforttounderstandsocialprotectionfromtheAfrican

perspective.Nevertheless,thereisnodistinctdefinitionoftheconceptthatcanbe

describedasAfrican(Holmes&Lwanga-Ntale,2012).AstudycommissionedbytheAfrican

Uniondefinessocialprotectionas“arangeofpublic(governmentfunded)measuresthat

givessupporttoallcitizensandhelpsindividuals,households,andcommunitiestobetter

managerisksandparticipateactivelyinallspheresoflife”(ibid).

IntheUgandancontext,theNationalSocialProtectionPolicydefinessocialprotectionsasa

systemthatiscomprisedoftwopillars,namely:socialsecurityandsocialcareandsupport

services(RepublicofUganda,2015;2016).Thesocialsecuritypillarherebyrefersto

protectiveandpreventiveinterventionstomitigatefactorsthatleadtoincomeshocksand

affectconsumption,whilethesocialcareandsupportservicesrefertoarangeofservices

thatprovidecare,support,protectionandempowermenttovulnerableindividualswhoare

unabletofullycareforthemselves.

Socialprotectionhasbeenclassifiedintofourmajorcategories:socialassistance,social

insurance,labormarketinterventionsandcommunitybasedsocialprotection.Forthe

purposesofthisstudy,morefocuswaspaidtosocialprotectionprograms,suchascash

transfersandin-kindtransfers(includinginputsandfooditems)fromboththegovernment

andNGOs.Cashtransfersincludebothconditionalandunconditionalgrantsfromthe

government,asenshrinedindifferentgovernmentprograms.In-kindtransfersincludedall

thefood,inputs(seedlings)andlivestockreceivedaspartoftheprogram.

4.11.2. Cashtransfers

Slater(2011),whileexplainingsocialprotection,recognizedthatcashtransfersforman

importantandgrowingpartofsocialprotectionprogramminginmanydevelopingcountries.

Similarly,BarrientosandHulmeobservedincreasedinterestforimplementationofprograms

ofcashtransferschemes,providedtothepoorestandvulnerableindividuals,inthecontext

asofpromotionofmorepermanentsocialprotectionprograms.(Barrientos&Hulme,2009)

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Cashtransferprogramscanbedefinedasinitiativewhichprovide‘noncontributorycash

grantstoselectedbeneficiariestosatisfyminimumconsumptionneeds’(Garcia&Moore,

2011,pp.32-33).Anon-contributoryaspectofcashtransferisinterpretedinaway‘that

beneficiariesdonotpayintoasystemthatlaterawardsthemthetransfers’(ibid,p.33).In

practice,cashtransfersmaybeconditionalorunconditional.Whileunconditionalcash

tranferisprovidedtoalleligibleindividuals,conditionalcashtransferisgrantedupon

fulfillmentofprescribedresponsibilitiesandconditions.Conditionsmayvaryfromone

programtoanother.Studywhichresearchedimpactofconditionalcashtranferson

maternalandnewbornhealthshowsthatbeneficiarieshavetocomplywithseveralhealth,

educationornutritionconditionsinordertobeeligible.(Glassman,Duran,&Koblinsky,

2013)Thereareongoingdebatesastotheusefulnessofconditionalitywithinthedomainof

cashtransfers.AccordingtoSchubertandSlaterconditionalprogrammesareoften

perceivedasmoreacceptablebypolicy-makersandtax-payers.(Schubert&Slater,2006,p.

573)

Inthecontextofthisstudy,unconditionalcashtransferprogramshavebeenanalyzed.In

particular,thegovernmentofUgandahasdevelopedtheSocialAssistanceGrantsfor

Empowerment(SAGE)throughwhichunconditionalcashtransfermechanismhasbeen

utilized.TheSeniorCitizensGrantsweregrantedtoindividuals,aged65orolder,without

constitutinganyfurtherconditions.Similarly,theVulnerableFamilyGrantsprovideddirect

incomesupportforvulnerablehouseholdswithlowlaborcapacityandahighdependency

ratio.

4.11.3. Trauma

Theindividualdistressandenduringpainandsuffering,includingpost-traumaticstress

disorder(PTS)andcomorbiddisorders,suchasdepression,causedbymasstraumaticevents

likewar,tortureandhumanrightsviolations,arewellevidenced(e.g.,Maresellaetal.,1996;

Turner,Bowie,Shapo,&Yule,2003).Howevermuchofthisdiscussionfocusesonindividual

distress,ignoringthecollectivenatureoftheaforementionedcalamities.Thisindividualized

focusontraumalimitsourabilitytoconceptualizetheproblemsandaddressthem

appropriately(Collieretal.,2003;Wessells&Monteiro,2001).

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While,undoubtedly,individualvictimsofatrocitiessuchastorturemightexperiencePTSD

andwouldclearlybenefitfromindividualinterventionandsupport,thistypeofintervention

doesnotaddressthestructuralcontextthatenabledsuchatrocitiestooccurinthefirst

place,nordoesitaddressresultantproblems,suchasmistrustandthelowsocialcohesion

thatoftenstemsfromthesocial,politicalandeconomiccontextsthatareincorporatedinto

thecollectiveconsciousness,makingthetraumaticeventsbecomeingrainedandinherentto

thecollectiveand,ifleftunattended,leadingtothemhappeningcyclically(Johnson,2006).

Inaddition,withoutabroadandcollectiveapproachtotraumaandhealing,practitioners

oftenfailtorespondtotherealityontheground,whenthemostoverwhelmingconcernfor

survivorsisnotpastmemories,assuch,butthestressofdailylivinginsituationswheretheir

socialsupportnetworkshavecollapsed.

4.11.4. Collectivetraumaandhealing

Theacknowledgementofthesimultaneouslyprivateandsocialnatureofpost-wartrauma,

incontextssuchasthecivilwarinUganda,allowsustogobeyondsymptomssuchasPTSD

toaddresscollectivetraumafocusingoncommunalmemoriesandgroupnarrativesthatcan

bepassedfromonegenerationtothenext.Heregrouptraumaisinterwovenintocollective

identity,tobecomethenewcontextwithinwhichhealing(includinghealingatthepersonal

level)oughttotakeplace.

Collectivetraumaistheimpactofanexperience,whichbecomesakeystoneinagroup’s

narrative,asetofbeliefsandidentity,bothforthecurrentgenerationandacross

generations.Collectivetraumainvolvesasocially-constructedprocesswithanimpactonthe

identityofthegroupanditsindividualmembers.Theimpactonthenarrativeandonthe

identityofthegroupcanbepresentevenwhenindividualmembersdonothave(orno

longerhave)signsofphysicalorpsychologicaldamage.Unlikeindividualtrauma,whichcan

beexperiencedbyasmallpercentageofpeople,withmostrecoveringwithinagivenperiod

oftime,collectivetraumadoesnotnecessarilyrefertosymptomsoftraumaticstress,butis

anoutcomethatincludestheresponsetothetraumaticevent,aswellasthewayitis

constructedintothebeliefs,decisions,behaviorsandnarrativesofthecollective(Shamai,

2015).Itisdefinedastheeffectfeltbymanyintheaftermathofatragedy(traumaticevent).

Itisablowtothebasictissueofsociallifeanddamagesthebondsattachingpeople

together,impairingtheprevailingsenseofcommunity(Erikson,1991).

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Communitiesimpactedbytraumawilloftenreactviolentlytowardsothers.Unresolved

traumaisamongthemostimportantrootcausesformodern-dayconflictsthattakeplace.

Theperpetrationandescalationofviolencecanbepartlyattributedtothisvery

phenomenon(Levine,1997).Indeed,researchhasshownthattheattitudestoreconciliation

andpeacebuildingwerenegativelyimpactedonbythehighprevalenceofunresolved

traumainUgandan(andRwandan)communities(Bayer,Klasen,&Adam,2007;Phametal.,

2009).

Collectivetraumaalsoleadstonewtraumaticevents,throughtheintergenerational

transmissionoftraumaandcopingstyle(Danieli,1998).Additionally,collectivetrauma

impairstheabilitytoreacttopatternsofthreatsandopportunity,causingpeopletobecome

trappedincyclesofvulnerability,leadingtosystemsofabuse.

Theadditionaladvantageofincludingthehealingofcollectivetraumaasaframework,in

post-conflictcommunities,suchasNorthernUganda,isthatitismorereadily

accommodativeofthetotaldevastationandsocietalcollapseexperiencedbymembersof

thecommunity,regardlessoftheirindividualtraumalevels.Suchimpactsaremorethanjust

theaggregationoftheindividualPTSD,butincludethesufferingassociatedwiththe

structuralviolenceandongoingissues,suchas:exclusion,deprivationandlackofaccessto

basicservices.

Definitionofconceptsofeffect

Inthissectionthedefinitionsofconceptsofeffectsaredefined.

4.12.1. Resilience

TheconceptofresilienceisderivedfromtheLatinwordresilire,whichmeanstoleapback,

torecoverfromandpositionelasticallyfollowingadisturbanceofsomekind.Itconstrues

resilienceasthebouncingbackofasystemfollowingashocktoitspre-existingstateorpath

(Martin&Sunley,2014).Thetermresiliencehasbeenusedbysociologiststoexplainthe

humanabilitytoreturntoitsnormalstateafterabsorbingsomestressoraftersurviving

somenegativechanges(Surjan,Sharma,&Shaw,2011,p.17–18)

Socialprotectionhasbeenviewedasanewstrategytoachieveresilienceforpeoplelivingin

poverty.FAO(2017)acknowledgesthefactthat“socialprotectionisnowbeingrecognized

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asinstrumentalinbothpovertyeradicationandruraltransformation,aswellasanintegral

componentofeffectivehumanitarianresponseandresiliencebuildingefforts”(p.2).

4.12.2. Empowerment

Page&Czuba(1999)definesempowermenta“aprocessthatfosterspower(thatis,the

capacitytoimplement)inpeople,foruseintheirownlives,theircommunities,andintheir

society,byactingonissuesthattheydefineasimportant"(p.10).Thus,women’s

empowermentisaprocessofgenderequalitywhichgiveswomenanopportunitytogain

morepowerandcontrolovertheirownlives(EuropeanParliament,2016).Inthecontextof

thisstudy,women’sempowermentistheprocessthroughwhichwomenareabletorecover

fromwaremotionallyandphysicallydisturbingsituationstobeabletoregainthemselves

outoftheseshockstoundertakeeconomicdecisionsaimedatimprovingtheirownlives.

4.12.3. Impactofevents

TheImpactofEventsScale(IES-R)hasbeenthemostwidelyusedself-reportmeasuresof

PTSD.TheScalewasdevelopedin1979beforetheDSM-III,asashortself-reportmeasurefor

assessingdegreeofsymptomaticresponsetoaspecifictraumaticexperience,takingplacein

theprevioussevendays(Horowitz,Wilner,&Alvarez,1979).Itsdevelopmentdrawsfrom

theunderstandingofresponsestotraumaticstressresponsestotherealmsofintrusionand

avoidanceastheprimarydomainofmeasurementofmeasurement.

Intheinitialreport(Horworthetal.,1979),datasupportedtheexistenceofhomogeneous

clustersofintrusionandavoidanceasmeasuredbyCronbachalpha(0.79forintrusionand

0.82foravoidance).Thecorrelationbetweensubscaleswassmall,allowingfor

independenceofthesubscales(18%ofthevariance).Andreliabilitywassatisfactorytoo

(coefficientsof0.87forintrusionand0.79foravoidance).

Zilberg,WeissandHorowitz(1982)conductedacomprehensivereplicationandcross-

validationofpsychometriccharacteristicsofthescaleanditsconceptualmodel.Theresult

revealedthatallitemswereendorsedfrequently(44%to89%ofthepooledsample),

suggestingthatcontentofexperiencefollowingtraumaticeventsasrepresentedintheIES

itempoolwassimilaracrosstypesofeventsanddifferentpopulations(e.g.,patientsand

non-patientpopulation).

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SundinandHorowitz(2002)presentedasummaryof18studiesonthecorrelationsbetween

avarietyofothermeasuresofsymptomsandintrusionandavoidance.Thecorrelationswith

generalsymptomswerelargerthantheaveragerelationshipofthetwosubscales.

HowevertheIESwasstillanincompleteassessmentofPTSD,withouttrackingtheresponses

tothedomainofhyperarousal,andsobeginningwithdatafromalongitudinalstudyof

responsesofemergencyservicepersonneltotraumaticeventsincludingamajor

earthquake,researchersdevelopedanewrevisedversionoftheScale(IES-R)byaddingaset

ofadditional7itemstotaphyperarousal(Weiss,Marmar,Metzler,&Ronfeldt,1995).These

additionalitemsthatwereinterspacedwiththeexistingitemsandthesplittingofone

doublebarreledquestionbroughttheIES-RparallelwithDSM-IVcriteria(Weiss&Marmar,

1997).Cruciallytherevisedversionwasdevelopedwithaviewtomaintainingcompatibility

withtheoriginal,theinstructionontheone-weektimeframewasmaintainedaswasthe

originalscoringscheme.Theinternalconsistencyofthethreesubscales,thepatternofitem-

totalcorrelations;test-reteststabilityandcommunalityoftheinterimcorrelationswereall

satisfactory(Weiss&Marmar,1997).Additionally,inresponsetotheexperienceoffrequent

answeringofquestionswiththeresponse‘sometimes’and‘often’respondentswereasked

toreportondegreeofdistressratherthanfrequencyofsymptoms,thismodifiedtheformat

ofresponse.Sub-scalescoringisnowthemeanofresponses(asopposedtototal)(Weiss,

2004).

DuetoitseffectivenessandsimplicitytheIES-Rhasbecomethetoolofchoiceformany

researchersworldwide.Ithasbeentranslatedtomanylanguagesincluding,Chinese(Wuand

Chan2003),French(Brunet,St.Hilaire,Jehel,&King,2003),German(Maercker&

Schuetzwohl,1998),Japanese(Asukaietal.,2002),Spanish(Baguenaetal.,2001)andItalian

(Giannantonio,2003),thereisaDutchversiontoo(Weiss,2004).ABosnianversionhasbeen

usedinastudy,comparingrefugeeandnon-refugeepopulations(Hunt&Gakenyi,2005).

VeroneseG.,PepeA.(2013)usedanadaptedshorterversionofIES,inArabic,normallyused

withchildren(CRIES)toaccuratelymeasurevicarioustraumaonprofessionalsocialworkers

andemergencyworkersoperatinginwarcontexts.

InadditiontoeffectivenessinidentifyinglevelsoftraumaIES-Rhasalsobeenusedto

measureeffectivenessofinterventions.ForexampleZangetal.(2013)usedtheChinese

versionofIES-R(alongwithseveralothermeasures)toassesstheefficacyofNarrative

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ExposureTherapy(NET)asashort-termtreatmentforPTSDforChineseearthquake

survivors.SimilarlyKimetal.(2005)UsedIES-Randotherscalestoinvestigatethe

effectivenessofmirtazapineduringthe24-weekcontinuationtreatmentinpatientswith

PTSDinKorea.

Howeverhavingdrawnattentiontothecomplexitiesofcomprehensivelyassessingtrauma

indifferentculturesandcontexts(e.g.,waranddisruption)VeroneseandPepecontendthat

whiletheresponsetotraumamaybeconsidereduniversal,thereislackofunivocalevidence

regardinghowbesttoassessandclassifythisresponse,especiallyinnon-Westerncontexts

(Giacamanetal.,2007),thisisduetothefactthat,thereisconsiderableevidenceindicating

thatculturaldifferencesgoverntheemotionalandbehavioralresponsetodistressinthe

aftermathoftraumaticexperiences(Rahman,Iqbal,Bunn,Lovel,&Harrington,2004).

Additionally,warandpoliticalviolenceaffectwell-being,notonlyatanindividuallevelbut

alsoatthecollectiveandcommunitylevel(Giacamanetal.,2007).Forinstance,inthecase

ofthePalestinianpopulation,humiliation,lackofdignity,andtheinabilitytooperatefreely

andsafelyoftenconstituteformsofwartrauma,hence,thereisaneedtoincludethese

dimensionsinanexhaustiveassessmentoftrauma(Giacamanetal.,2007;Veronese,2012).

InourcontextofwaraffectedNorthernUgandathismeans,measuringtraumasuchasIES-R,

shouldbesupplementedadditionalinstrumentsassessingvariousdomains.

Despitethechallengesmentionedaboveandothersassociatedwithaccuracyoflanguage

usageandthelimitedandspecifictimeframespecifiedinthetool,IES-Roffersthe

advantageofaneffective,shortandeasilyunderstoodmeasureofdistress,rangingfrom

normalstressresponsetoPTSDasexperiencedintheweekprecedingthetest.Specifically,

inthisresearchthescalewillnotbeusedtoprovidediagnosisbuttotrackchangeovertime

andtracethelevelsofsymptomsofPTSDandtogiveasnapshotofsymptomaticstatusat

thespecifictimesoftesting.

Definitionoftheoreticalconceptsexplainingchange

Thissectiondefinestheconceptsusedinthisresearchtoexplainprocessesofchange.

4.13.1. Livelihood

The first definition of livelihood is broadly accredited to Chambers andConway’sworking

definition(forexactcitationseesection4.1).Theirdefinitionwasacceptedandadaptedby

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theDepartmentforInternationalDevelopment(DFID),amongothers.TheDFIDrecognizedin

the set ofGuidance Sheets (DFID, 1999) that a livelihood is comprisedof the capabilities,

assetsandactivitiesrequiredforameansofliving.Alivelihoodissustainablewhenitcancope

withandrecoverfromstressandshocksandmaintainorenhanceitscapabilitiesandassets

bothnowandinthefuture,whilenotunderminingthenaturalresourcebase.(Chambers&

Conway,1992,p.6).Thisdefinitionacknowledgesthecomplexityofthelivelihoodconcept

and implies that securing livelihoods may entail e.g. access to water, land, health care,

education,orevenservicesprotectinglegalrights.(deSilva,2013,p.5)

Inordertoincreaseeffortstoreducepovertyandconductin-depthanalysisoflivelihood,the

DFID has built upon the working definition and introduced the Sustainable Livelihood

Framework (SLF) which has become one of the most widely applied frameworks within

development programs. The SLF introduces main factors affecting livelihoods and close

linkages between them. As the livelihood approach promotes people-centered picture, it

seekstounderstandthepeople’sstrengths(assets)thatthrougheffectiveutilizationcanlead

to positive livelihood outcomes. Therefore, the SLF also draws attention to the particular

assets,uponwhichlivelihoodsarebuilt,andcoreinfluencesandprocessesthatshapetheuse

oftheseassets.(DFID,1999)StemmingfromtheChambersandConway’sworkingdefinition,

assetsarerecognizedasresources,stores,claimsandaccesswhichpersonpossessandcan

use towards a livelihood. (Chambers & Conway, 1992, p. 25) The SLF distinguishes both

tangibleaswellasintangibleassetsandcategorizesthemintofivedistinctivegroups–human,

social,physical,naturalandsocialcapital.(DFID,1999)

Inemergenciesthatleadtopeoplebecomedestitute,itisoftenthecasethatlarge-scaleloss

of livelihood assets could be saved by providing timely assistance to save these assets.

Livelihoodsupportinemergencies,therefore,consistsofactionstakentoprotecttheassets

that are essential to people's livelihoods, and to support people's own priorities and

strategies.Itrelatestoanyactivitythataimstorestorepeople'sdignityandensureadequate

livingconditions(Caverzasio,2001).

4.13.2. Agency

Forpurposesofthisstudy,theconceptofagencyrefersto“theabilitytodefineone’sgoals

andactonthem,encompassingboth‘powerwithin’and‘powerwith’,thusemphasizingthe

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valueofindividualandcollectivedecision-making”(Jones&Shahrokh,2013,p.10).Agency

ismorethanobservableactions,althoughittendstobeoperationalizedasdecision-making,

butcanalsotakeanumberofforms(Kabeer,1999).Kabeer(1999,p.438)explainsthat

agencytakesmanyforms,including:“bargainingandnegotiation,deceptionand

manipulation,subversionandresistanceaswellasmoreintangible,cognitiveprocessesof

reflectionandanalysisanditcanbeexercisedbyindividualsaswellasbycollectives”(p.

438).Meyers(2002)addsthatagencyisaboutdefiningyourself,withoutnecessarily

focusingonone’sgoals.Shefocusesonthedebatethatagencyisaninnateskillthathelpsan

individualtoexerciseherownwillandthatwomencandiscoverthemselvesthroughtheir

‘agenticskills’.Thus,agencyisnotagivenvirtuethatsomeoneacquiresthroughexternal

intervention(Nakazibwe,2015).Meyersdefinesagencyintermsofskillsthatmaybe

improvedupon.Therefore,theunderstandingandapplicationofagencyinthisstudy

identifieswomenaschainactorswhopursueconsciousandunconsciousgoalstodetermine

theirlifethroughinterpretativeandnarrativeframeworksthathelpthemmakesenseof

theirworld.

4.13.3. Valuesandvalueentropy

Inthetheoreticalmodelthatguidesthisresearch,theconceptofvaluesreferstoan

enduringprescriptiveorproscriptiveabstractbeliefthataspecificendstateofexistence

(terminalvalue)orspecificmodeofconduct(instrumentalvalue)ispreferredtoanopposite

endstateormodeofconductforlivingone’slife(Kahle,1983;Rokeach,1968;1973).The

enduringstatedoesnotmeanthatvaluescannotchange,butthattheywillchangeonly

graduallyduetoaccumulatedexperiences.AccordingtoBarrett(2014,p.3)valuesare“a

shorthandmethodofdescribingwhatisimportanttousindividuallyorcollectivelyatany

givenmomentintime”.Theyare,therefore,universalinthattheytranscendcontext(and

time)(Barrett,2010,p.3).Valuesaremoreabstractanduniversalthanattitudes(opinions

aboutconsequencesofbehavior,seeforexampleAjzen,1991).Inthisresearch,socialand

economicresiliencecanberegardedasanattitude(withwhichtoapproachspecific

situations).Barrettemphasizesthatvalues-systemscanbemeasuredintermsoftheir

coherenceorincoherenceandtheirchangesovertime.

ValueEntropyisdefinedasthesituationofdysfunctionalitycharacterizedbyan

organizationalsysteminwhichperceivedvaluesamongdifferentlevelsofthesystemare

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incoherent(Barrett,2014).Culturaltransformationisaprocessthatenableshumanbehavior

tosupportprocessesofchangeintheorganizationalsystemthatischaracterizedbyhigh

entropy(ibid.).

4.13.4. Policywindow

Apolicywindow(Kingdon,1984)isaconceptthatencompassesamomentintime,which

hasastartingpointandanendpoint,duringwhichnewideascanenteranagenda;apolicy

windowusuallyopensunexpectedlyandprovidesforatimeinwhich(big)changecantake

place,asopposedtoincrementalchangeprocesses,whichonlyslowlybuildonwhatalready

exists.Policywindows,ontheotherhand,explainhowentirelynewideascanemergeand

drivechange.Thepolicywindowconceptualizesamomentinwhichchangecanoccur.

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DescriptionofStudyPopulation

ThisstudywasconductedamongtheNiloticethnicgroupsinUganda,whichoccupymuchof

theNorthernandEasterndistrictsinUganda.TheNiloticpeoplecommonlyuseaNilotic

language,whichdistinguishesthemfromotherethnicgroups,suchastheBantuinthe

South.TheNiloticlanguagespeakersprobablyenteredNorthernandEasternUgandaatthe

beginningofaboutC.E.1000.Thoughttobethefirstcattle-herdingpeopleinthearea,they

alsoreliedoncropcultivation,whichisthemaineconomicactivityandisstillcarriedoutto

date.ThelargestNiloticpopulationsinUgandaaretheItesoandKaramajongethnicgroups,

whospeakEasternNiloticlanguages,andtheAcholi,Langi,andAlur,whospeakWestern

Niloticlanguages.TheWesternNiloticlanguagegroupstogetheraccountforroughly15%of

thepopulation,orabout3.4millionpeople,withtheLangicontributing6%(1.4million),the

Acholi4%(900,000),andtheAlurabout2%(460,000).

TheAtesopeoplelivemainlyinTesosub-regiondistrictsofAmuria,Soroti,Kumi,Katakwi,

Ngora,Serere,Pallisa,BukedeaandKaberamaido,aswellasinthedistrictsofTororoand

Busia.Theynumberabout3.2million(9.6%ofUganda'spopulation).ThepeopleofTeso,

LangiandAcholitraditionallyliveinscatteredhomesteadsorvillages,astheycallthem,each

homesteadbeingsurroundedbytheirland,whichtheycultivateanduseforcattlegrazing.

Thispatternoflifewasseriouslydisruptedinthe1980sand1990s,becauseofthedangers

fromcattleraidersandthenrebels,whichforcedpeopletomoveclosetotradingcentersor

institutionssuchasschools,hospitalsandadministrativeheadquarters.

TraditionalTesosettlementsconsistofscatteredhomesteads,eachorganizedarounda

stockadeandseveralgranaries.Severalgroupsoflineagesformaclan.Clansareonlyloosely

organized,butclaneldersmaintainritualobservancesinhonoroftheirancestors.Menof

theclanconsulttheeldersaboutsocialcustoms,especiallymarriage.Muchofthe

agriculturalworkisperformedbywomen.Womenmayalsoownlandandgranaries,but

aftertheintroductionofcash-cropagriculture,mostlandwasclaimedbymenandpassedon

totheirsons(Photius,2004)TheItesoalsoshareresponsibilityamongthemselvesfor

resolvingdisputeswithintheirsettlementoramongtheirneighbors.

80

Descriptionofstudysites

ThestudywascarriedoutinAmuriaLira,Katakwi,andKitgum.AmuriaandKatakwidistricts,

arelocatedintheTesosub-region;LiradistrictislocatedintheLangosub-region;and

KitgumdistrictislocatedintheAcholisub-region.Allthesedistrictswereclassifiedbythe

GovernmentofUgandaasareasthatsufferedarmedrebellionand,thus,haveaspecific

developmentplan,calledthePeaceRecoveryandDevelopmentPlan(PRDP).

Uganda’sneighboringcountriesareRwanda,Kenya,theDemocraticRepublicoftheCongo

(DRC)andSouthSudan.Inrelationtotheresearchsite,themostimportantborderisthe

borderwithSouthSudan(previouslySudan),whichwasthemainoperationareaoftheLRA.

TheLRAmovedacrosstheborderwiththeDRC.TheKaramajoregionislocatedintheEast

andNorthernpartsofthecountry,borderingSouthSudanandKenya.

Figure5-1.MapofUgandaanditsneighbors

Source:https://www.dreamstime.com/uganda-political-map-capital-kampala-national-borders-

most-important-cities-rivers-lakes-illustration-english-labeling-image103226090

81

Figure5-2.PoliticalmapofUganda

Source:https://www.ezilon.com/maps/africa/uganda-maps.html

82

Figure5-3.EthnographicmapofUganda

Source:

https://reliefweb.int/sites/reliefweb.int/files/resources/25056AF8C870901EC1256F2D0047FCE8-

uganda_ethno.jpg

Kitgum

KitgumdistrictissituatedinNorthernUganda(RepublicofUganda,2012).Thedistrictis

borderedbyLamwodistrictinthenorth,theRepublicofSouthernSudaninthenortheast,

Kotidodistrictintheeast,Agagointhesoutheast,PaderdistrictinthesouthandGulu

districtinthenorthwest.Twosub-countieswereselectedfromthedistrictforthisstudy:

LabongAmidaandLabongAkwanga.Thedistrictcoversatotalareaof4,042square

kilometers.TheNationalPopulationCensusprojectedapopulationof259,840by2013,of

which126,910(49%)weremalesand132,930(51%)werefemales.Thedistricthasan

estimatedgrowthrateof4.1%,whichishigherthanthenationalfigureof3.6%.Accordingto

83

theDistrictDevelopmentPlan(2012),thedistricthasonecountyofChuaand9sub-

counties,1urbancounciland2townboards.Thesub-countieshave53parishesand605

villages,whiletheurbancouncilhas7parishesandwards.

ThemaineconomicactivitiesinKitgumdistrictareagricultureandanimalhusbandry.

However,themajorityofthepopulation(86%)dependsonsubsistenceagricultureforits

livelihood.Themajorcropsgrownaremaize,cassava,beans,millet,sweetpotatoes,ground

nutsandcotton.Themainlivestockkeptarecattle,goats,sheep,pigsandpoultry.The

districthasafewpeopleengagedinfishfarming,beekeepingandproducetrading.The

districtalsorecordsahighrateofadultilliteracy,withwomenbeingtheworstaffectedwith

only32%beingabletoreadandwrite.Thedistrictalsohasahighschooldropoutrateof

56%,whichisattributedtotheinsurgency.Theinsurgencycausedlossofproperty,livestock

andinfrastructureleadingtohouseholdfoodinsecurityandhighpovertylevels.Thestateof

UgandaPopulation2010reportedthatNorthernandEasternUgandahavesuffered

recurrentexposuretotransitoryfoodinsecurity(RepublicofUganda,2010).Astudy

conductedbyInvestinginPeace(2008)reportedthat79.9%ofthepopulationinKitgum

stoppedcultivationasaresultoftheinsurgency,while14.3%experiencedgrievousharm

andtheftoftheirlivestock(InvestinginPeace,2008,p.15).

ThegovernmentprogramsextendedtodifferentcategoriesofthepopulationinKitgum

districtincludetheProductionandMarketingGrant(PGM),CommunityDrivenDevelopment

(CDD),OperationWealthCreation(OWC)(formerlytheNationalAgriculturalAdvisory

Services,NAADS),FunctionalAdultLiteracy(FAL),SchoolsFacilitiesGrant,NorthernUganda

SocialActionFund(NUSAF),Peace,RecoveryandDevelopmentPlan(PRDP)andthe

AgriculturalLivelihoodRecoveryProgramme(ALREP).

Lira

LiradistrictispartofthegreaterLangosub-regionlocatedinNorthernUganda(Republicof

Uganda,2011).ThedistrictwasformedoutofLangodistrictin1974andismainlyoccupied

bytheLangoethnicgroup.LirabordersPaderandOtukedistrictsinthenortheast,Elebtong

districtintheeast,Dokolointhesouth,andApacinthewest.TheLangiarebelievedtohave

originatedfromAbyssiniainEthiopiaaround1800and1890andarepartoftheNilo-

Hamites,justliketheneighboringethnictribesofAtesoandKaramajong.Traditionally,

84

beforethecomingofthecolonialBritishgovernment,theLangiwereadministeredthrough

chieftainshipsorganizedaroundclans.Thedistrictcoversatotalareaof1,326square

kilometers.Thestudycovered2outofthe9sub-counties:AgwengandOgursub-counties.

ThemaineconomicactivityforpeopleinLiraisagriculturewith81%ofthepopulation

involvedinsubsistencefarming.Oftherestofthepopulation,3.1%areinvolvedinagro-

processingindustries,while15.9%areengagedincommercialandbankingactivities.The

peopleofLangotakeprideincattle,whichwasasignofwealthforalongtime,until

numbersdrasticallydeclinedduetoconstantcattlerustlingandtheftbyneighboringtribes

andthewarbytheLRA,whichlastednearly20years,from1987to2006.Astudyby

InvestinginPeace(2008)indicatedthat77.9%ofthepopulationofthedistrictstopped

cultivation,while11.6%losttheirlivestock,duetogrievousharmandtheft(InvestingPeace,

2008:15).Thedistrictisamongthenortherndistrictsthataresufferingaftermatheffectsof

thewar,withaveryhighpovertyrate—71%ofthepopulationlivebelowthepovertyline.

Katakwi

KatakwidistrictisinTesosub-regioninEasternUganda(RepublicofUganda,2014).The

districtliesatbetween1,036mand1,127mabovesealevel.Thedistrictpopulationof

Katakwi,accordingtothe2002census,was118,928,ofwhich57,401(48.3%)weremaleand

61,527(51.7%)werefemale(RepublicofUgandaCensus,2002).Thedistrictbordersthe

districtsofNapakinthenorth,Nakapiripiritintheeast,Amuriainthewestandnorthwest,

Sorotiinthesouthwest,andKumiandNgorainthesouth.Ithastwocounties,Toromaand

Usuk,andtensub-counties.Twosub-counties,UsukandNgarium,wereselectedforthis

study.

Thedistrictpopulationdrawsitslivelihoodfrompastoralismandcropproduction,withafew

peopleinvolvedinnon-farmactivitiesarisingfromincreasedurbanizationinthedistrict.The

districtexperiencedthecivilstrifeduetotheLRAinsurgencyandcattlerustlingraidsdueto

theirproximitytotheKaramajong.Thecivilwarkilledmanypeople,disintegratedmany

familiesanddestroyedalotofproperty,leavingthedistricteconomicallyimpoverished.

About64%ofthedistrictpopulationliveinpovertyduetotheeffectsofwar,continued

cattlerustlingandenvironmentalevents,suchasfloodinganddrought.Theweatherin

Katakwidistrictisunpredictable,withtoomuchrainattimes,causingflooding,andnot

85

enoughrainatothertimes,leadingtosomeprolongeddryspells—allofwhichhasledto

poorcropyields.

Amuria

AmuriadistrictisinTesosub-regionandlocated40kilometersnortheastofSorotitown.Itis

madeupoftwocounties,AmuriaandKapelebyong,with9sub-counties,47parishesand

388villages(JusticeandReconciliationProject,2012).Amuriadistrict,whichwascarvedout

ofKatwakidistrictin2005,issituatedinEasternUgandainTesosub-regionandbordersthe

districtsofKatakwiintheeast,Sorotiinthesouth,Keberamaidointhewest,Napaktointhe

northeast,andAlebtong,OtukeandAbimtointhenorth.Thedistrict’stotalareais

estimatedat2,613squarekilometers.Thedistricthasapopulationofapproximately

270,601people(RepublicofUgandaCensus,2002).Itwasoriginallycomprisedof10sub-

counties,ofwhichthisstudysampledonlytwo:OrungoandObalangasub-counties.

AmuriadistrictwasalsoaffectedbytheLRAinsurgenceinTesosub-region.Therebelsused

AmuriaasabasetoattacktherestoftheTesoregion,whichleftmanypeopleinthedistrict

displacedwithpropertydestroyed.Oneofthesub-countiesselectedfromthisdistrict,

Obalanga,experiencedamassmassacre,inwhichover365peoplewerekilledandburiedin

amassgrave.Thedistrictwasalsohometoover40,000IDPs(JusticeandReconciliation

Project,2012,p.6).

86

PARTIII:SOCIALPROTECTIONINTERVENTIONS

Addlogos(onlyfirstpage)

87

OverviewofSocialProtectioninUganda

PovertyinNorthernUganda

ThereareamplereasonsfortherehabilitationofNorthernUgandatohaveafocusonsocial

protectionthroughlivelihoodsprograms.Theshareofthepopulationlivingbelowthe

povertylinefellfrom55.7%in1992to19.7%in2012/13(UgandaHumanDevelopment

Report,2015;p21),butNorthernandEasternUgandastillrecordahighincidenceofpoverty

with34.7%(Acholi),17.6%(Lango)and40.5%(Teso)ofthepopulationlivinginconditionsof

poverty(UgandaNationalHouseholdSurvey,2017;p.85).Somanyfactorsareresponsible

forpovertyinUganda,including,amongothers,conflict,unfavorabledemographic

characteristics,andthechronicnatureofpoverty.TheStateofPopulationReport2010

pointedtoaneedforanoverallsocialprotectionframeworkwithprogramtoimprove

incomes,educationandhealthasawaytomitigatepoverty-relatedvulnerability(Republic

ofUganda,2015).NotwithstandingthefactthatUgandaendorsedtheMaputoDeclaration

in2003,committingitselftoadoptsoundpoliciesonagriculturalandruraldevelopment,and

toallocateatleast10%ofitsnationalbudgettothesectorby2009,EasternandNorthern

Ugandahavethehighestpercentageofpovertyinthecountry.

NorthernUgandawasgreatlyaffectedbytheLRAinsurgency.TheLRArevoltagainstthe

government,whichlastedforover20years,displacedpeopleanddestroyedproperty;many

peoplelosttheirlives,whilethosewhosurvivedremainseverelytraumatized(Ondoga,

2012;Okelloetal,2013).ThemajorityofthepopulationinNorthernUgandahasremained

impoverishedduetothepost-wareffects,exacerbatedbypovertyduetoincomeinsecurity,

lackofeducationorpooreducation,lackofaccesstogoodhealthservices,social

deprivation,andculturalpracticesthathavepreventedsomepeopleinthecommunities

fromaccessingwealthandlandduetotheirgender(Garber,2013).Thishasrenderedmany

householdsvulnerableandeconomicallyfragile.Women,olderpersons,personswith

disabilitiesandchildrenareparticularlyaffected.

SocialprotectionpolicyinUganda

AccordingtovariousstudiesconductedinUganda,SocialProtectionwouldgivevulnerable

personsanopportunitytoimproveandsustaintheirlivelihoodsandwelfare(MGLSD,2015).


88

Thiswouldenablepeopleandtheirdependentstomaintainareasonablelevelofincome

throughdecentworkandhaveaccesstoaffordablehealthcare,socialsecurityandsocial

careservices.InthecontextofUganda,socialprotectionreferstopublicandprivate

interventionsaimedataddressingrisksandthevulnerabilitiesthatexposecitizenstoincome

insecurityandsocialdeprivation,leadingindividualstoliveundignifiedlives(MGLSD,2015).

SocialprotectionisnotnewinUganda;thepoorandvulnerablehavealwaysbeencaredfor

bytheirfamiliesandcommunitysystems.However,unfortunatelyasUgandahasbecome

moremodernizedandmoreurban,traditionalsocialprotectionsystemshavebeenover-

stretched.Despitethereductioninpovertylevelsandsteadyeconomicgrowthexperienced

byUgandainrecentyears,nearly31%ofthepopulationstillliveinpovertyand26%ofall

thehouseholdsremaininchronicpoverty,characterizedbyvulnerablepeople(suchasolder

people,children,peoplewithdisabilities),withmanymorefallingintopovertyasaresultof

illness,unemployment,deathoffamilymembers,andtheeffectsofinternalconflictsand

insecurity,whichaffectsstandardsofliving(EqualOpportunitiesCommission(EOC),2016).

TheUgandaEmploymentPolicy2011,notesthatlessthan5%oftheeconomically-active

populationiscoveredbythemainpensionschemes—theNationalSocialSecurityFundand

thePublicServicePensionScheme.

Socialprotectionhasbeenwidelyrecognizedasakeyinstrumentforpovertyreductionand

improvedlivelihoodsamongvulnerablegroupsandpeople,notonlyinUganda,butthe

worldover(UNICEF,2015).Attheregionallevel,countriesacrossAfricahavedeveloped

formalsocialprotectionsystemsasoneofthecorecomponentsoftheirnational

developmentstrategies.Inlinewiththenationalobligationsandobjectivesoutlinedinthe

ConstitutionoftheRepublicofUganda,thegovernmenthastakenimportantstepsinthis

regard.In2006itsignedtheLivingstoneCalltoAction,whichsetsoutcommitmentstosocial

protection.ThegovernmentisalsoasignatorytotheAfricanUnionSocialPolicyFramework

(2008),whichrequiresmembercountriestorecognizethatsocialprotectionisastate

obligation(MGLSD,2011).In1987,UgandaratifiedtheInternationalCovenantonEconomic,

SocialandCulturalRightsand,in2002,itadoptedtheMadridPlanofActiononAgeing

(MIPAA,2002),whichcallsonsignatorynationstoensurethatsocialprotectionsystems

respondtotheneedsofolderpersons.UgandaisasignatorytotheUniversalDeclarationof

HumanRights(1948),whichrecognizessocialsecurityprovisions.


89

Acknowledgingthedevelopmentchallengesthecountrycurrentlyfaces,theGovernmentof

Uganda,throughitsSocialProtectionPolicy(2015),hasrecognizedtheimportanceof

reachingouttovulnerableandexcludedsectionsofthepopulation,therebyachieving

inclusive,sustainableandpro-poorequitabledevelopment.TheUgandaVision2040

identifiestheneedforthedevelopmentandimplementationofsocialprotectionsystemsto

respondtotheneedsofvulnerablegroups,suchastheelderly,orphanedchildren,andthe

disabled,amongothers.Thevisionfurtherrecognizesthedevelopmentofauniversalhealth

insurancesystemthroughpublic-privatepartnerships.

SocialprotectionwasfirstintegratedintoUganda’sPovertyEradicationActionPlan(PEAP)

andSocialDevelopmentInvestmentPlan(SDIP)in2004.Socialprotectionwasalsostrongly

reflectedinthefirstNationalDevelopmentPlan(NDPI),anditsimportancewasfurther

emphasizedinNDPIIandSDIP2(MGLSD,2011).Theimplementationsocialprotection

initiativesaresupportedbyawiderangeoflegislations,which,amongothers,include:The

PensionAct(1946),NationalSocialSecurityFundAct(1985),Children’sAct(2015),andEqual

OpportunitiesAct(2007).

Publicandprivateinstitutionshaveaddressedthetasksembeddedinsocialprotection

servicesinmanyways.Thevariousinterventionsrangefromnationalpolicies—originally

designedtoachievebroadergoals,butalsoencompassingsocialprotectionaspectsthrough

toad-hocsocialprotectionprograms.

ThesocialprotectionframeworkforUgandadefinesthesocialprotectionsystemas

comprisingtwopillars:SocialSecurityandSocialCareandSupport.SocialSecurity(thefirst

pillar)isapreventiveinterventiontomitigateincomeshocksandis,inturn,classifiedinto:

DirectIncomeSupport(cashtransfers)andSocialInsurance.DirectIncomeSupportprovides

regularandreliabletransfersofmoneytovulnerablepeople.Itisnon-contributory,which

meansthatthebeneficiariesdon’tcontributetoit.DirectIncomeSupportcoversthose

extremelyvulnerablepeopleandhouseholdswithoutanyformofincomesecurity.The

SocialCareandSupport(thesecondpillar)aimsatprovidingawiderangeofservicestothe

poorandvulnerable.


90

SocialprotectionprogramsimplementedinUganda

TheGovernmentofUgandahasimplementedvarioussocialprotectioninterventionsover

theyearssuchastheNationalSocialSecurityFund,NationalPensionsScheme,theNorthern

UgandaSocialActionFund(NUSAF),theOrphansandVulnerableChildren(OVC)program,

UniversalHealthServices,CashforWorkSchemesandtheParliamentaryPensionScheme.

However,withtheincreaseinurbanization,acuteunemploymentlevels,conflict,drought

andtheimpactofHIV/AIDS,thefabricofsocialsystemscontinuestowearthin(Republicof

Uganda,2015).Inaddition,theUniversalPrimaryEducation(UPE),UniversalSecondary

Education(USE)havebeenimplemented.

AtthecoreoftheUgandanSocialProtectionsystemistheDirectIncomeSupportprograms,

whichprovidesmall,butregular,transferstargetingindividualsandhouseholdstoprovide

themwithaminimumlevelofincomesecurity.TheseincludetheSocialAssistanceGrantfor

Empowerment(SAGE),underwhicharetheSeniorCitizenGrantsandVulnerableFamily

Grants(VFG),CommunityDrivenDevelopment(CDD)Programme,AgriculturalLivelihood

RecoveryProgramme(ALREP),KaramojaLivelihoodImprovementProgramme(KALIP)and

NorthernUgandaSocialActionFund(NUSAF).Thesocialprotectionprogramsare

implementedatthenationalandlocalgovernmentlevels.Thebeneficiariesusethecash

transfersreceivedastheywish(MGLSD,2016).AccordingtothereportbytheMinistryof

Gender,LaborandSocialDevelopment(MGLSD)onthefirstpilotofdirectcashtransfers

underSAGE,itwasindicatedthatthebenefitinghouseholdsandgroupsusedthecashon

accessinghealthservices,education,purchasingfoodandbasicnecessities,andinvestingin

smallbusinesses.

Forexample,theNUSAFprogramrequiredyoungadultsfromthesametownorvillageto

organizeintogroupsandsubmitaproposalforacashtransfertopayfor:(i)feesatalocal

technicalorvocationaltraininginstituteoftheirchoosing,and(ii)toolsandmaterialsfor

practicingthecraft.Likemanyparticipatorydevelopmentprograms,theobjectivewasnot

onlytoenrich,butalsotoempoweryoungadults.Onaverage,successfulgroupsreceiveda

lumpsumcashtransferofUSD7,108toajointlyheldbankaccount,whichbreaksdownto

roughlyUSD374pergroupmember,atmarketexchangerates.Theaveragegrouphad22

members,and80%ofgroupsrangedfrom13to31membersinsize,accordingtopre-

interventiongrouprosters.


91

Table6-1.SummaryofsocialprotectionprogramsinUganda

Nameofprogram Targetgroup/ Started Provider District(s) Categoryofprogram Focus

trauma

healing

Genderfocus

ExpandingSocial

Protection(ESP)

2010 GovernmentofUgandaundertheMGLSD,fundedbyDFID,IrishAIDandUNICEF

1. SocialAssistanceGrantsforEmpowerment(SAGE)–regular,unconditionalcashtransfer

SeniorCitizensGrant

(SCG)

Elderly(65years

andabove)

60yearsinthe

disadvantaged

Karamojaregion

July2010 Departmentfor

International

Development(DFID),

IrishAIDandUNICEF

andtheMinistryof

Gender,Laborand

SocialDevelopment

Apac,Kole,Amudat,

Moroto,Nakapiripirit,

Napak,Kiboga,

Kyankwanzi,

Kaberamaido,Katakwi,

Kyegegwa,Kyenjojo,

Nebbi,Zomboand

Yumbe

DirectIncome

Support

UGX50,000(USD20)

everytwomonths

None None

VulnerableFamilies

Grant(VFG)

Vulnerable

householdswithlow

laborcapacityanda

highdependency

ratio

Departmentfor

International

Development(DFID),

IrishAIDandUNICEF

andtheMinistryof

Apac,Kole,Amudat,

Moroto,Nakapiripirit,

Napak,Kiboga,

Kyankwanzi,

Kaberamaido,Katakwi,

Kyegegwa,Kyenjojo,

DirectIncome

Support(social

pension)

None None


92

Gender,Laborand

SocialDevelopment

Nebbi,Zomboand

Yumbe.

ExpandingSocial

ProtectionPhase2

Elderly 2015 MinistryofGender,

LabourandSocial

Development

NewdistrictsinFY

2015/16:FY2016/17,

FY2017/18:FY2018/19

DirectIncome

Support

UGX50,000(USD20)

everytwomonths

None None

2. PublicWorksProgram

NorthernUganda

SocialActionFund

(NUSAF)(Community

Development

Initiatives)

Community

mobilization

2002–

2008

Governmentof

Uganda

Widernorthcoveredby

PRDP

-Cashforwork

-Creationof

communityassets

-Provisionoffood

items

-Empowering

communities

None Genderisnota

criterionfor

participationin

theintervention

NorthernUganda

SocialActionFund

(NUSAF)

-HouseholdIncome

SupportProgram

(HISP)

Poorand

underemployed

youth,agedroughly

16to35inlocal

terms

2009–

2013

Governmentof

Uganda

Widernorthcoveredby

PRDP

-Cashforwork

-Creationof

communityassets

-Provisionoffood

items

None None


93

-PublicWorks

Program(PWP)

NorthernUganda

RecoveryProgramme

(NUREP)

2007–

2010

EuropeanUnion Acholi,LangoandTeso

andKaramojasub-

regionsin19districts

Cashforwork

KaramojaLivelihoods

Improvement

Programme(KALIP)

(replacedNUREP)

Extremely

vulnerable

individuals

(landlessorwithout

labor)

-Creationof

communityassets

-Provisionoffood

items

-Transferofcash

Agricultural

LivelihoodsRecovery

Programme(ALREP)

Extremely

vulnerable

individuals

(landlessorwithout

labor)

-Creationof

communityassets

-Provisionoffood

items

-Transferofcash

3. WorldFoodProgram(WFP)initiatives(programsconsideredassocialprotection)

ProtractedReliefand

RecoveryOperations

(PRRO)

Basedon

circumstances

2005to

date

WFP -Fooddistribution,

-Cashvouchersin

post-harvestseason


94

-Supplementaryand

therapeuticfeeding

KaramojaProductive

AssetsProgram(KPAP)

2011 WFP -Cashforwork

-Foodforwork

Restorationof

Agricultural

Livelihoodsin

NorthernUganda

(RALNUC)and

Development

AssistancetoRefugee

HostingAreas(DAR)

RALNUC–IDPs

returningtoown

land.

DAR–Increasing

agricultural

production

2005–

2008for

phase1

and2009–

2012for

phase2

DANIDA NorthernUganda

districts

Laborintensiveand

paymentisthrough

vouchersratherthan

cash,butinsome

areashasshiftedto

cash

Livelihoodsand

EconomicRecoveryin

NorthernAreas

(LEARN)

IDPs 2008 NorwegianEmbassy LRAaffectedareas Cashtransfers None None

YouthVentureCapital

Fund

Youth MinistryofGender,

LabourandSocial

Development

Wholecountry Cashandmaterial

transfer

None Yes

95

SocialprotectionschemesinNorthernUganda

TheGovernmentofUgandahasundertakenmanyprogramsfortheRestorationofpeace

anddevelopmentthroughthePeace,RecoveryandDevelopmentPlan(PRDP).In2007,The

PeaceRecoveryandDevelopmentPlan(PRDP)waslaunchedbytheGovernmentofUganda

butdidnotstartinfullscaleimplementation2009.Theoverallgoalofthisprogramwasto

stabilizeNorthernUgandaandlayafirmfoundationforrecoveryanddevelopmentthrough

specificallypromotingsocio-economicdevelopmentofthecommunities.Anumberof

nationalagencieswereexpectedtoaligntheirinterventionsframeworkstoPRDP(UN,

2009).MuchofthedevelopmentthatwasundertakenbythegovernmentofUgandawithits

partnerswasmainlyvisiblerecoveryanddevelopmentactivitieswithminimumfocuspaid

ontrauma/emotionalrecoveryforthevictimsofthemorethan20yearsofconflict(Internal

DisplacementMonitoringCentre(2012)

It’sinthislinethatgovernmentimplementedadditionalprogramssuchasNational

AgriculturalAdvisoryServices(NAADS)laterrenamedasOperationWealthCreation,

NorthernUgandaSocialActionFund(NUSAF),UgandaSocialAssistanceGrantsfor

Empowerment(SAGE),therestockingprogram,theCommunityDrivenDevelopment

program,andYouthLivelihoodProgram.Theseweresupplementedbyotherprogramsthat

werebeingimplementedbydevelopmentpartnerssuchas;USAID’sNorthernUganda

DevelopmentofEnhancedLocalGovernanceInfrastructureandLivelihoods(NUDEIL),the

EuropeanUnion’smillionAgriculturalLivelihoodRecoveryProject(ALREP),theUNlaunched

athree-yearPeacebuildingandRecoveryProgramme(UNPRAP).However,bythetimeof

thisstudy,manyoftheseprogramshadclosedandonlyjustofthemwerestillfunctional.

ThustheparticipantsinthisstudyidentifiedNationalAgriculturalAdvisoryServices(NAADS)

laterrenamedasOperationWealthCreation,NorthernUgandaSocialActionFund(NUSAF),

theUgandaSocialAssistanceGrantsforEmpowerment(SAGE),therestockingprogram,the

CommunityDrivenDevelopment(CDD)program,andYouthLivelihoodProgram.

Duringourstudy,thefollowingprogramswerestillfunctional;

• NationalAgriculturalAdvisoryServices(NAADS)

• NorthernUgandaSocialActionFund(NUSAF),

• TheUgandaSocialAssistanceGrantsforEmpowerment(SAGE),

96

• Restockingprogram,

• TheCommunityDrivenDevelopment(CDD)program,and

• YouthLivelihoodProgram.

6.4.1. NationalAgriculturalAdvisoryServices(NAADS)

NationalAgriculturalAdvisoryServices(NAADS)laterrenamedasOperationWealth

Creation:NAADS/OperationWealthcreationisanationalprogramthatbenefitsfarmers

from18yearsandabove.Bothmenandwomenbenefitfromthisprogramasindividualsor

asacommunitybasedorganizedgroup.Initially,theNAADSprogramwasdesignedtobuild

thecapacityoffarmerstoformandoperatefarmerassociations,demandadvisoryservices

andadoptimprovedagriculturaltechnologiesandpracticesthroughdemonstrationofthe

technologiesbymodelfarmersinthecommunity(Okoboietal.,2013).Membershiptothe

programdependsentirelyonthewillingnessofanindividualtobepartofthecommunity

basedgroupandreadytoworkasateamtocollectivelyaddressproblemswithintheir

communities.TheguidelinesforimplementationofNAADSprogramisbasedonguidelines

whichindicatethatparticipationoffarmersinNAADSissupposedtobethroughtheself-

selectionoffarmersthroughtheirfarmergroups(NAADS,2007).ThoroughtheNAADS

program,implementationoftheprograminvolvesthedisbursementoffundstodistrictand

subcountieswhereactivitiesareimplementedwhotransferthefundstothepeoplewho

aresupposedtobenefitfromtheprogramasfreeorsubsidizedinputs.Thusallthedistricts

thatwerepartofthisstudybenefitedfromthisprogram.Theprogramwasmeanttotarget

vulnerablepopulationsandwellasothercategoriesofpopulation.Thus,householdheaded

byafemale,youthoraPersonLivingwithDisability(PLWD)weresupposedtobetargeted.

Thebeneficiariesofthisprogramarecategorizedinthreeclustersandeachclusterbenefits

fromtheprogramaccordingtotheresourcesavailableandprioritiesforeachdistrict.For

example,thefarmersinTesoregion(Katakwi&Amuria,date)receivedfruitseedlingsto

boastproduction.

6.4.2. NorthernUgandaSocialActionFund(NUSAF)

TheNorthernUgandaSocialActionFund(NUSAF)combinesdifferenttypesofinterventions,

suchastemporaryemploymentschemesthroughpublicworks,householdasset-building

andcommunityinfrastructureprograms.Ithasbeeninplacesince2003andhas

implementedinthreephases(NUSAF1,NUSAF2andNUSAF2).Thefirstphasefocuson

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peaceandreconstruction,thesecondphaseonbasicserviceswhilethethirdphasefocused

onbuildingastrongerfocusonresiliencebuildinganddisasterriskfinancing.Bythetimeof

thisstudy,thegovernmentwasfinalizingtheimplementationofphasetwo.NUSAF2

providedsocialprotectiontothepeopleinthenorthernandeasternUgandathrough

temporaryemploymentschemeswiththeaimofprovidingcashsupportduringthelean

season.TheNUSAF2assettransferprogramprovidedhouseholdswithproductiveitems

suchasgoatsandseedlingstobekeptassavingsandprovidefoodsecurity.Theprogram

coveredallthedistrictsinNorthernandEasternUgandathatwereaffectedbythewar.The

localleadersidentifypeoplewhoaresupposedtobenefitfromthisprogram.Unlikeother

governmentprogramsthatsupportcommunitiesthroughbureaucraticprocedures,NUSAF

providesitsgrantsdirectlytocommunitiesalthoughtheresponsibilityformanagingthese

fundsisdecentralizedtocommunitylevelinstitutions.Therationaleofdirecttransferof

fundstocommunitiesistoenhancecommunityaction,enablecommunitiestoarticulate

andprioritizetheirneedsleadershipdevelopmentandresourcemobilization.

6.4.3. TheUgandaSocialAssistanceGrantsforEmpowerment(SAGE)

TheSeniorCitizensisthefirstsocialprotectionprogramtotargetaparticulargroupof

peopleundertheExpandingSocialProtectionProgrammethroughtheSocialAssistance

GrantsforEmpowerment(SAGE).TheSeniorCitizensGrantismeanttosupportolder

personsof65yearsandaboveand60forthemorevulnerableolderpersonsinKaramoja.

Theprogramhasnotbeenrolledoutinthewholecountrybutstillbeingimplementedin15

districtsin.Forthisstudyoutofthefourdistricts,itisonlyKatakwiDistrictthatwasamong

thedistrictsupportedbytheprogram.Eachoftheolderpersonsissupposedtoreceive

regular25,000UgandaShillings.Thismoneyismeanttoenablethemaccessbasicservices

andtostartincomegeneratingactivities.Apartfromage,selectionofthebeneficiariesis

basedonlevelofvulnerabilityamongtheoldineachsubcounty.Thus,oldwomen,persons

withdisabilityandthosesupportingabignumberdependentsaregivenpriority.

6.4.4. RestockingProgram

TheRestockingProgramcoversthegreaterNorthernUgandaespeciallyWestNile,Acholi,

LangoandTesosubregions,thusallthefourdistrictsincludedinthisstudywerepartofthis

program.BeforetheLRAinvasion,peopleintheseareashadlivestockkeepingasoneof

theirmajoreconomicactivityandasignofwealth.Whenthesesubregionswentthrough

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harmconflictforover20years,theyweresubjectedtolootingfromtherebelsandpeople

losttheirvaluableassetssuchaslivestock.Theareaswereaffectedbycattlewrestlingbythe

Karamojongs.BytheendofthewaranddisbarmentprocessinKaramoja,thecommunities

thatderivedtheirincomefromlivestockkeepingbecomevulnerabletopoverty.Asonethe

strategiestorehabilitatethepeopleintheseareas,PRDP2includedrestockingprograminits

2013/2014financialyear.TheprogramisadministeredbytheOfficeofthePrimeMinister

andtargetselderlyandpersonwithdisabilities,widows/widowers,PLWAs,Orphans,Ex-

combatants,formerabductees,femaleheadedhouseholds,childmothers,unskilledand

unemployedyouth.Thebeneficiariesareselectedbycommunityleaderstogetherwith

communityleaders.Thelocalgovernmentofficialsprocuretheanimalswhichtheydistribute

totheindividuals.Theseanimalsaregiventoindividualswithinhouseholdswhoare

supposedtoaccountforthem.

6.4.5. CommunityDrivenDevelopment(CDD)program

AllthelocalgovernmentsinUgandaareimplementingtheCommunityDrivenDevelopment

programsasawayofgivingcontrolofdecisionsandresourcestocommunitygroups.The

localcouncilsoperateatfivecouncilswiththeLocalCouncilfive(LC5)(hereinreferredtoas

District)beingthehighestlevelinthedistrict.However,LocalCouncilthree(LC3)(herein

referredtoastheSubCounty)implementthisprogramthroughapprovingcommunitybased

projects.TheLocalCounciltwo(LC2)(herereferredtoasaparish)supportthecommunities

inpreparingdevelopmentplanswhichtheysubmittoLC3forfunding.Individualsorganize

themselvesingroupsinwhichathirdmustbewomentoapplyforfundstoimplementtheir

project.ThisprogramreplacestheLocalGovernmentDevelopmentProgrammewhichwas

alsoformallyimplementedbytheMinistryofLocalGovernment.Thiscommunity

drivendevelopmentprogramisintenttobringpublicdecisionsclosertothepeople.

6.4.6. YouthLivelihoodProgram

ThisprogramwasinitiallymanagedbytheMinistryofFinance,PlanningandEconomic

Development(MFPED).ThisprogramwashandedovertoMinistryGender,Labourand

SocialduetothecentralroleplayedthisMinistryinregardtoyouthmattersinthecountry.

Theprogramtargetsindividualyouthaswellastheyouthorganizedingroups.Theprogram

givessoftloanstotheyouthwithnointerestrateandareexpectedtoreturnthemoneyso

thattheotheryouthsaccessthemoney.Theprogramfinancessmallscalebusinessventures

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whichhavebeeninplaceforabouttwotothreeyears.Thebeneficiariesofthisprogramare

selectedbytheSubCountylocalleaderswhothroughreviewingtheapplicationssentinby

thedifferentgroupsinasubcountychoosethesuccessfulindividualsandgroups.Thegroup

membersthenchooseeithertostartajointenterpriseorsharethemoneyforeachmember

todotheirownindividualproject.Thesubcountymayprocuretheitemsrequiredbythe

groupsanddistributeittothegroupsorallowtheyouthtomanagetheirfunds.

Localgovernmentsupporttowomen’sparticipationinsocialprotectionprograms

Thelocalgovernmentshavecomeupwithdifferentstrategiestohelpwomenparticipatein

thegovernmentsocialprotectionprograms.Thesestrategiesinclude;

• Due to limited funds received from the central government to support

district activities, local governments have patterned with civil society

organizationstomeetthegapsthatarecreatedwithlimitedfunds.InLira

district,thegovernmenthasputinplaceadomesticviolenceshadewhere

women who have been battered are kept as the local authorities

investigateandfindasolutiontotheproblem.

• Thedistrictshavealsoandsub-countyofficershavesupportedwomenonly

groupswiththeirownlocalfundswhichtheygeneratelocally.Theystarted

affirmativeactiongroupsforwomenaswayofpreparingthemtocompete

fornationalandregionalsocialprotectionprograms.

• Somedistrictshaveappointedfemalestaffinthevariousdistrictandsub-

countyofficestoallowgrassrootwomentointeracttheirleadersthrough

female staff.Oneof the local leaders in Liradistrictexplained thathe is

proudtohaveabout35%oftheirstaffbeingwomen(39/14/03/L)

However, one of the female local leaders from Orungo sub-county-Amuria District

(40/22/02/Or)indicatedthatsomeofthemaleleadersdon’tsupportwomentobenefitfrom

thesegovernmentprograms.Shenotedthatsomeoftheirmalecounterpartsinleadership

chargetheirstampswhenwomensubmittheirapplicationforsuchfundsyetinmostcases

theycannotafford.Thusmenbenefitmorethanwomenbecausetheycanaffordtopayfor

thestampbeforethefundsaregiven.

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PARTIV:TRAUMARELIEFINTERVENTIONS

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TraumainNorthernUganda

PrevalenceoftraumainNorthernUganda

Anepidemiologicalsurveycarriedout in2004,bytheMinistryofHealth inUganda, found

ratesofup to50% fordepression in themost conflict-affecteddistricts (suchasNorthern

Uganda), compared to 8% in districts not severely affected by war (Kinyanda, 2004).

Betancourtetal. (2009) carriedoutaqualitative study that lookedat localperceptionsof

psychosocialproblemsamongchildrenandadultsfromtheAcholiethnicgroup,whohadbeen

displacedbywar,inNorthernUganda.Thestudy,carriedoutusingpreviouslydevelopedrapid

ethnographicassessmentmethods,foundseverallocally-definedsyndromesthatcorrespond

todepression/dysthymia,anxietyandbehavioralproblems.

OtherstudieshavefoundhighratesofPTSD,depressionandanxietydisorders.Ovuga,Oyok,

&Moro,(2008)found,inastudyof58girlsand44boys,that87.3%hadexperiencedtenor

more war-related traumatic events, 55.9% suffered from PTSD and 88.2% suffered from

depression.However,thestudyalsoidentifiedthatsymptomsweren’trestrictedtoindividual

children,therewasawidercontextofmentalhealthproblemsintheirfamiliestoo.Nearly

halfofthechildren(42.2%)reportedapositivefamilyhistoryofseverementalillness;10.8%,

reportedafamilyhistoryofsuicide;22.5%,afamilyhistoryofattemptedsuicide;and45.1%,

afamilyhistoryofalcoholabuse.

Inacross-sectionalstudyof2,875individualsin8districtsinNorthernUganda,Pham,Vinck,

&Stover,(2009)foundthatoverhalf(56%)ofalltherespondentsandovertwo-thirdsofthose

whoexperiencedabductionmetthecriteriaforsymptomsofPTSDandfemaleparticipants

were more susceptible than males. Older men were more susceptible to depression.

Additionalsymptomsofmentalhealthdifficultieswereobservedinpeoplewith:alowscore

on a social relationship scale, high incidence of general traumatic event exposure, high

incidence of forced acts of violence, and problems reintegrating into communities after

abduction.

Robertsetal.(2008)conductedasurveyinIDPcampsusingsurveyinstrumentsdesignedto

measurephysicalandmental components,aswellasa traumascale (theHarvardTrauma

Questionnaire)and foundpoorphysicalandmentalhealth,with frequencyofexposure to

traumabeingaverystrongindicatorofpoorhealthandmentalhealthoutcomes.

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Muldoonetal.(2014)analyzedthementalhealthstatusandreintegrationofabductees,using

alocally-developedandvalidatedscalecalledtheAcholiPsychosocialAssessmentInstrument

(APAI),developedusingfreelistinginterviewswithyouth,localadultsandkeyinformantsto

identify and describe signs ofmental health syndromes affecting Acholi youth. The study

foundthatinthesampleof400youngwomensexworkers,atotalof129(32.2%)womenhad

beenabductedbytheLRA,ofthese(56.6%)hadself-reintegratedandtheresthadaccessed

atleastonereintegrationprogramrangingfromatraditionalcleansingceremony(67.9%),to

receivingamnesty(37.5%),orbeingregisteredandlodgedatareceptioncenter(28.6%),and

receivingare-insertionpackage(12.5%).Althoughthestudydidnot findabetweengroup

difference,indicatingthatthementalhealthstatusofabducteeswhoaccessedreintegration

programs were significantly different from those who self-reintegrated, the research

highlighted the complex relationships between exiting ‘bush life’ and reintegration into

‘normal’societyinNorthernUganda.

Allofthestudiesaboveareindicativeofhowthedevastationofwarhascausedwidespread

mentalhealthproblems,includingPTSD,onascalethataffectsnotonlyindividualsandtheir

families,butentirecommunities.

Studies,inotherpost-conflictcommunitieshavehighlightedtheneedtodevelopandprovide

mentalhealth intervention,not justtosupportandalleviatethepainof individuals,butto

enable healing and reconstruction of entire communities. In a national population based

mentalhealthsurveyinAfghanistan,Cardozoetal.(2004)foundthat62%ofparticipants(in

asampletotalof799adults)reportedhavingexperiencedat least4episodesoftraumatic

eventsinthe10yearsleadingto2002andtheseresultedintheprevalenceofextremelyhigh

levels of mental health problems, particularly depression, anxiety and PTSD, making the

provisionofmentalhealthcareanutmostpriorityforthereconstructioneffortinthecountry

asawhole.

Inadditiontobeinganimpedimenttodevelopment,PTSDhasalsobeenfoundtonegatively

impact on efforts for reconciliation.When people are traumatized, their systems remain

aroused,theybecomehypervigilant,butareunabletolocatethesocialthreat.Thiscauses

fearandreactivitytoescalateandleadstore-enactment insearchofanenemy.Unhealed

traumaticsocietaleventscan,therefore,leadtocyclesofviolence.

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Bayer,Klasen,&Adam(2007)conductedastudyof169formerchildsoldiersinUgandaand

Congo,whoreportedtobeingrecruitedviolentlyatayoungageandexposedtohighlevelsof

potentially traumatic events. The youngsterswho scored high on the Child Posttraumatic

StressDisorderReactionIndex(CPTSD-RI)showedsignificantlylessopennesstoreconciliation.

Amongthoseformerchildsoldiers,PTSDsymptomswereassociatedwith lessopennessto

reconciliationandmoreassociationwithrevenge.

InanassessmentoftheassociationoftraumalevelsandPTSDsymptomstoattitudestowards

reconciliationinpost-1994Rwanda,Pham,Weinstein,&Longman(2004)foundthatofthe

2,074participants,over2,000hadbeenexposedtotraumaticeventsand518(24.8%)metthe

criteriaforPTSD,asmeasuredbytheCivilianPTSDChecklist.ThoserespondentswithPTSD

werelesslikelytohavepositiveattitudestowardstheRwandannationaltrials,werelesslikely

to have a belief in community and less likely to have interdependencewith other ethnic

groups.

Inapaperpublishedin2004,Audergon,basedonherworkinCroatia,explainsthatpostwar

traumaismorethananindividualexperience,butratherwholecommunitiesaretraumatized

withimpactsthatcanevenchangethecourseofhistory.Tothisendthepaperurgesthata

morecomprehensiveunderstandingofpost-wartraumaisoneinwhichboththepersonal,

communal and political aspects are taken aboard. The paper explains how when whole

communitiessufferatrocity,traumastaysinthefabricofthefamily,communityandsociety

forgenerationsunlessitishealed.

TraumainterventionsinNorthernUganda

Until early 2007, community and international humanitarian organizations in Northern

Ugandaoperated12receptioncentersforLRAabducteeswhowereeithercapturedinbattle

ormanagedtofleetheircaptors(Pham,Weinstein,&Longman,2004).Uponarrival,former

abducteesweregivenamedicalexaminationand treated fordiseasesandotherailments.

Thosesuffering fromwarwoundsweresent tohospitalsandhealthcenters in theirhome

districtsandreferralsweremadetotheNationalReferralHospital,MulagoinKampala.Most

returneesstayedatthecentersfortwotosixweeksandparticipatedinarangeofactivities,

includingcounselling.HowevertheviolenceinLRA-affectedterritoriesaffectednotonlythe

abducted, who are forcibly taken by the group, but also other members of affected

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communities, who were not necessarily abducted, highlighting the need for a more

comprehensiveapproachtotraumahealingintheregion.Thementalhealthstatusofpeople

inNorthernUganda and the impact of themany years of torment have become not just

concernsofnationalmagnitude,butregularlyfeatureasissuesofconcernglobally.

Thepopulationsurveysconductedafterthecivilwarindicatedahighprevalenceofdepression

and post-traumatic stress symptoms (Nakimuli-Mpungu et al., 2013). Thus, before the

commencementoftheEWP-U,womeninthesedistrictswerestilltraumatizedbytheeffects

ofthewar,withlittleornosupporttohelpthemovercomethis.

Thisstudyinvestigateshowservicestoaddresspost-traumaticstressimpactedoneffortsof

socialprotection (cashand in-kind transfers)providedby theGovernmentofUganda.The

traumaserviceswereprovidedbylocalgovernmentorNon-GovernmentalOrganizationsin

Northern Uganda. In this study, these services are referred to as ‘counselling’. Specific

mentionismadetothecounsellingeffortsbyIsis-WICCEandsisterorganizationsastheeffect

ofthisservicewasspecificallyinvestigatedinthisresearch.

Traumasupportbylocalgovernment

The study findings indicate that many local governments lack health facilities to help

communitymemberswhoaretraumatized.Thereisnosingledistrictorsub-countythathad

anindependentvoteaccounttoaddresstraumainallthedistrictsvisited.Manyoftheselocal

governments indicatedthattheyhadtailoredtraumainterventionstotheirotheractivities

withvotestosupportreportedcases.Theofficeof thedistrictandsub-countycommunity

developmentwassingledouttoplayaroleasfarastraumainterventionisconcerned.The

officers fromthisofficepaidhomevisits topersonsreportedtobetraumatizedandthese

counselledormadereferraltohealthfacilitieswithinthedistrictorsub-county.

Thedistrictsandsub-countiesmentionedthattheyhavebeenabletolobbynon-government

organization that operate in their areas to take on trauma management during their

interventions in the community. In Agweng sub-county-Lira District, an organization TPO

which is supported by Plan Uganda, has been instrumental in supporting and counselling

traumatized people. Isis-WICCE has also been working with many community based

organizations to in conjunctionwithall the fourdistricts to trainand support traumatized

women.USAID,SEWICOandWorldEducationTrusthaveplayedagoodroleinLiraDistrict.

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The Government of Uganda, through the Ministry of Health, has been involved in the

treatmentofpeoplediagnosedwithmental-relatedhealthrisksthroughtheButabikaNational

ReferralHospital inKampala. Inordertoenhancethementalhealthservicedeliveryinthe

northern districts, the Ugandan government institutions (theMinistry of Health, Butabika

NationalReferralHospital,andtheMakerereUniversityDepartmentofPsychiatry)andthe

Peter C. Alderman Foundation (PCAF) initiated a public-private partnership in which four

districts(Arua,Kitgum,Gulu&Soroti)benefitedfromtheestablishmentoffourPCAFtrauma

clinics (Nakimuli-Mpungu et al., 2013). The clinics were based on group counselling

interventionforthoseexperiencingdepressionandpost-traumaticstresssymptoms.

Interventionsbywomen’sorganizations

Isis-Women’s International Cross Cultural Exchange (Isis-WICCE) set out to work with

communitiesaffectedbyarmedconflictin1993,workingwithwomen(andmen)inLuweero

(Central Uganda), Gulu, Kitgum, Lira, Pader, Soroti, Katakwi, Amuria, Kumi (North Eastern

Uganda)andKasese,BundibugyoinSouthWesternUganda.Oneofthekeyissuesthatstood

outwasthefactthatdespitegovernmentdesigningpostconflictreconstructionprograms,

theaspectoftraumamanagementandhealingforsurvivorswaslacking.

ThekeyapproachthatIsis-WICCEstartedwithwasbreakingtheisolationthatsurvivorsofthe

warwerelivingin,byorganizingwomenfriendlyspacesforsurvivorstosharethepainand

ordealsofthewar(suchasrape,sexualviolence,abductionandtorture)andhowtheywere

coping.Thisenabledthemtospeakout,cryandcounseleachother.Isis-WICCEalsoorganized

exchangevisitsforwomentointerfacewithfellowwomeninotherpostconflictdistrictswith

similarchallenges.Thisopenedtheirmindsthatthesufferingtheywereexperiencingwasthe

samedespite the ethnic divide, and theywere able to build friendships andnetworks for

peace.

Isis-WICCE further organized specialist-facilitated training for selectedwomen leaders and

healthworkers from the affected districts on traumamanagement. This enabled them to

understand and connect the pain they were experiencing as linked to the traumatic

experiencesofwar,andtogainskillsonidentifyingandmanagingtraumaattheindividual,

family and community levels. This process was comprehensive and time-consuming. On

returning to their communities, the trained women leaders started providing support to

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womenwhowerereturningfromcaptivityandthosewhohadbeenterriblyaffectedbywar.

They eventually formed community-based groups, including the Kitgum Women Peace

Initiative (KIWEPI) in Kitgum,Women Peace Initiative-Uganda (WOPI-U) in Lira, and Teso

WomenPeaceActivists (TEWPA) inKatakwiandAmuria. It shouldbeunderstood that the

women that Isis-WICCE trained were ordinary women, with not much formal training in

psychiatric treatment. So they took a non-medical approach to dealing with trauma and

workedthroughself-helpgroupstosupportwomensurvivorstoachievecollectivehealing.

These women’s groups made a few referral cases to Isis-WICCE, which organized some

medicalcampstorespondtobothphysicalhealing(sometimesinvolvingsurgeryclinics)and

psycho-socialsupport.

In Soroti and neighboring districts, TEWPA mobilized women into a movement of peace

animators and peace committees, and young boys and girls in school into peace clubs.

Workinginthissetup,womenwereprovidedbasictipsforcounsellingandmovedfromhouse

tohouseandorganizedhealingspacesforcounsellingandsupport(providingfoodtothose

whoneededandaccompanyingotherstoaccesshealthcare),enablingtraumatizedwomen

toregaintheirself-worth.

Ontheotherhand,KIWEPIopenedaspacethatreceivedformerlyabductedgirls together

withtheirbabiesbornoutofrape.Mostofthesegirlswerestigmatizedandrejectedbytheir

families.Throughcounsellingandattachingthesegirlstofosterhomes,hopewasrestored.

This, in addition to community sensitization toenable communities toacceptand combat

stigmahascontributedtothere-integrationofgirlsbackintothecommunity.

It shouldbenoted that KIWEPI, TEWPAandWOPI-U introduced a theatre component for

development as a means of counselling and also to provide entertainment to enable

community members to regain some happiness. The sessions were followed by a public

dialogueanddebateontheissuesdiscussed.Thishelpedthoseinpaintocomeforwardand

seeksupport.Otherwise,thesewomencounselledeachotherandsharedstoriesofwhathad

happenedtothemduringthewar.Theangerandvengeancefeltbythewomenwasdeep.

The leadersof theorganizationsstartedtoexplaintothevictimshowtheoffendersnever

intendedtoharmthem,butthecircumstancesofthewarforcedthem.Theimportanceof

forgiving was much emphasized as a component of healing. Thus, religious leaders were

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invited to take part in the counselling sessions so that the value of forgiveness could be

understood.

Thewomenwerealsotaughtbasicskillslikecookingandsowingtoempowerthemtostart

some income generating activities. Some of the women managed to reintegrate in the

communityandafewreturnedtotheirfamilies.TheorganizationssuchasKIWEPIalsoused

musictotalkaboutpeaceandtomakewomenfeelhappy.KIWEPIalsousedthecommunity

parliament, which is locally called a Baraza (an assembly where community members

assemble to talk about issues that affect them collectively), where they involved district

leaderstocomeandspeakaboutpeace.

Despite the counseling provided, women continued being confrontedwith the burden of

povertyintheirhomes.Therewasneedtoaddresslivelihoodconcernswithinthecounseling

model and this was introduced. The women survivors and formerly abducted girls were

equippedwithskillsintailoring,baking,farming,entrepreneurshipandprovidedwithstartup

kits.AndgroupsofwomenwhohadcontractedHIVwerefacingadoubleburdenofstigma

and were provided start up grants to improve their nutrition and engage in economic

activities. They bought heifers to enable them havemilk for improved nutrition and self-

esteem.

Isis-WICCE working with TEWPA, KIWEPI, andWOPI-U have been engaging leadership to

prioritizethepost-conflictneedsofwomen,especiallyinrelationtotraumahealing.Through

communityparliaments (Barazas)andmeetings,adialoguehasbeen initiatedwithdistrict

andnationalleadership,highlightingandremindingpowerholdersthatdevelopmentwithout

addressing traumahealing is retrogressive. Somegainshavebeenmade,e.g., theUganda

Peace, Recovery Development Plan 2 recognized and incorporated providing psychosocial

supportandcounsellingtotraumatizedcommunitymembersandabducteesasoneofthekey

components;theLiradistrictlocalgovernmentpassedabylawreducingdrinkinghoursand

bannedsometypesofliquorthattheyfeltwasescalatingtheproblem.

Thepsychosocialburdenremainshigh,withincreasingreportsofsuicide,alcoholism,gender

basedviolence,lossofhopeduetounemploymentamongyouthsandhighlevelsofpoverty

inthecommunity.Theseareallassociatedwithlowattentiontotraumahealing.Duringthe

pilot interviewswith the leaders and someof the victimsofwar (formally abducted child

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soldiersandcapturedwiveswhoescaped),itwasclearthatthesewomenhadindeedbeen

traumatizedbysomanyterribleincidentstheyhadenduredduringthewar.Thesewomen

sharedtheirstoriesrangingfromtorture,rape,forcefulkillingofclosefamilymembersand

friends,carryingheavyloadsandmanyawfulpersonalstories.Womenreportedbeingfearful

ofassociatingwithothercommunitymembers,asthewoundsoftheiractionsremindedfresh

intheheartsofthosepeoplewhohadlosttheirdearonesinwarandwhohaddecidedto

apportiontheblametosomeofthesewomen.Youngmotherscontinuedto lookafterthe

childrentheyproducedoutofrape,withoutanysupportfromtheirrelatives.Theirchildren

were not welcome in many of the families and communities, as they were regarded as

‘childrenoftheenemy’.

Despitethese interventions,thesewomenstill feelangerandgrief.Someofthemfeelthe

needforrevengeandwouldkilliftheygottheopportunity.Oneofthewomeninterviewed

explainedthat“themanwhorapedmeispassinghereeverydayandIwishedIhadagun,I

wouldshoothim”.Theyarestillveryupsetwiththeirowncommunities,whofailedtoprotect

them,butinsteadhauntedthem.Oneofthewomenleadersnotedthat“theirsocietywasstill

livinginyesterday”and,hence,didnotconsiderthemselvesyetinapost-conflictsituation.

Duringthepilotstudies,manymembersofthecommunitystillreportedcasesofsuicideand

evenkillings.TheyouthborninIDPcampshadmanyproblemsandhadnotreceivedmuch

counsellingtohelpthemovercomethetraumatheyexperiencedinthesecamps.

Despite the counseling provided, women continued being confrontedwith the burden of

povertyintheirhomes.Therewasneedtoaddresslivelihoodconcernswithinthecounseling

model and this was introduced. The women survivors and formerly abducted girls were

equippedwithskillsintailoring,baking,farming,entrepreneurshipandprovidedwithstartup

kits.AndgroupsofwomenwhohadcontractedHIVwerefacingadoubleburdenofstigma

and were provided start up grants to improve their nutrition and engage in economic

activities. They bought heifers to enable them havemilk for improved nutrition and self-

esteem.

Thepsychosocialburdenremainshigh,withincreasingreportsofsuicide,alcoholism,gender

basedviolence,lossofhopeduetounemploymentamongyouthsandhighlevelsofpoverty

inthecommunity.TheseareallassociatedbyIsis-WICCEtolowattentiontoprovidingtrauma

healing.

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Needforanewintervention

During the first round of data collection, a sample of 470 respondents were selected to

participateinthisstudy.Theseweregroupedunderfourcategories;thosewhohadreceived

cashtransfers,thosewhohadreceivedcounselling,thosewhohadreceivedbothcounselling

andcashtransfersandthosewhohadnotreceivednetherofthetwo.Thepreliminaryfindings

fromthefirstroundofdatacollectionindicatedthatalmostalltheparticipantsinthisstudy

reportedregardlessofwhethertheyhadreceivedcounsellingbeforeornotstilldepicteda

hightoveryhighdegreeoftrauma.

Thestoriessharedbytheparticipantsfromindividualinterviewsconfirmedthefindingsofthe

studyfromthefirstround.Thelocalleadersandindividualwomeninterviewedexpressedthat

therewascommonoccurrenceoftraumaticbehaviorsintheircommunities.Manypeoplein

theircommunitieswereknowntobehaveinwaysthatrequiredcounselling.However,many

communities lacked facilities where traumatized people would seek assistance. The local

leadersidentifiedthewartobethemaincauseoftraumaamongthecommunities,although

theyacknowledgedthattherearealsoneweventsthatcreatesimilarimpactsuchasdomestic

violence.Theparticipantsof thisstudythroughtheirownstatementsacknowledgedbeing

traumatizedfromtheeventsofthewarandthereafter.

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DevelopmentoftheSHLCPTSProgram

Thischapteroutlinestheprocessthatledtothedevelopmentofasix-weekSelf-HelpLow-

Cost Post-Traumatic Stress (SHLCPTS) Program that addresses both the individual and

collectivetraumacausedbythemanyyearsofatrocitiesinNorthernUganda.

When considering trauma healing in Northern Uganda, the veracity of universalized

psychological interventions, often developed in Western contexts and focusing solely on

individualtrauma,shouldbecarefullyconsidered.IntheUgandancontext,suchinterventions

shouldbeassessedwithanunderstandingofcollectiveculturesandtheimpactsofcollective

trauma.TheseaspectsshapethecontextofthetraumaticexperiencesinNorthernUganda,

aswellastheimpactsthathealingshouldaddress.

Simplyfocusingonindividualtraumadecontextualizesthecollectivesufferinginpost-conflict

communities.Thecontext forsuchcollectivesuffering,afterall, is thesocialandhistorical

fabric,andleavingthisoutofthehealingprocess,leadstofurtheratrocitiessuchashuman

rights violations (Lykes, 2001; Van Reisen&Munyaradzi, 2017), aswell as hampering the

recoveryofthosewhoarealreadysufferingfromPTSDandothermentalhealthproblems.On

theotherhand,thewiderfocus,locatingtraumainthecommunityaswellasinanyindividuals

whoaresufferingsymptomsof traumaticstresswillgiveopportunities forpractitioners to

focusonthecommunity-widepotentialtoeffecthealing(Bonano,2004;Kidane,2015).

Traumaandthehumanbrain

The development of the EMDR-based therapy intervention tool and its integration to

simultaneouslyaddresstheimpactsofthetraumaonindividualvictimsandcommunities,is

based on a comprehensive understanding of trauma and its physiological underpinning.

Traumaaffectsapersoninawaythatresultsinthereconfigurationofthenervoussystem.

Traumatizedpeoplebecomestuckandstopgrowinganddevelopingastheybecomeunable

to integrate their traumatic experiences into their ongoing life. Instead they continue to

organizetheirlivesasthoughthetraumaisstillgoingon.Energyisfocusedonsuppressingthe

inner chaos and attempting to maintain control over unbearable physiological reactions,

ratherthanspontaneousinvolvementintheirownlives(VanDerKolk,2014).

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Thehumanbrainisorganizedintothreesectionsandconnectedtothebodyinsuchaway

thatenablesautomatictriggeringofaphysicalescapeplanintheeventofemergency.This

systemisoperatedfromtheoldestpartofthebrain(theanimalbrain).However,theprocess

that triggers this reaction and enables the body to run, hide or freeze shuts down our

consciousmind (orhigherbrain). If theemergencymodesucceeds inavertingdanger, the

brain is then able to regain internal equilibrium and gradually begin to operate as usual.

However,ifforsomereasontheresponsetriggereddoesnotresultinsuccessfulescapeor

aversion,ifforexamplethepersonispreventedfromtakingeffectiveaction,thebrainwill

continuetofirestressreactions(andthechemicalsassociated),sendingsignalstothebodyto

escapeathreatthatmaynolongerexist.

Asthehumanbrain’smainfunctionisensuringsurvival,survivalisalwaysgivenprecedence.

Thesensoryinputthatentersthebrainisroutedviathethalamus(inthereptilianbrain)and

thentotheamygdala(inthelimbicbrain)(Cozolino,2002;vanderKolk,2014).Theneural

pathway from the thalamus to the amygdala is extremely fast. The amygdala filters

information coming in, if there is any threat or perceived threat, the hypothalamus is

immediately stimulated to respond by triggering the release hormones (cortisol and

adrenaline),whichprepare thebody todefend itself (Cozolino, 2002), andbyalerting the

systemtobecomehighlyarousedandready(Siegel,2001).Informationisalsorelayedtothe

hippocampalandcorticalcircuitsforfurtherevaluation(LeDoux,1996).Thefindingsofthe

hippocampusandcortexarethenrelayedbacktotheamygdala,thisprocessismuchslower

andproducesamoreconsideredresponse,oftenencouragingthesystemtocalmdown.

Indangersituations,higherbrainfunctionsareoverwhelmed(Siegel,2003)andthebrainis

focusedonimmediatesurvival(Cozolino,2002).Oxygenisdivertedawayfromthebrainto

thebodyandhormonesarereleasedactivatingthebodyforthe‘fight-flight-freezeresponse

(VanderKolk, 2014).Whenaperson is able to successfully avert a threat, employing the

strategydescribedabove,theyarelesslikelytobetraumatizedbytheexperience(Herman

1992).However,thisstructureofthebrainalsoresultsinlackofintegrationandmayresultin

thedissociationthatweseeinvictimsoftrauma(Cozolino,2002);iftheactiveresponsesare

unsuccessfulinavertingdanger,thenthepassiveresponses,suchasdissociation,ensue.“In

trauma, dissociation seems to be the favored means of enabling a person to endure

experiences thatcannormallybebeyondendurance” (Levine,1997:138). If the traumatic

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eventisrepeatedorbecomesongoing,thentheactivationisprolongedresultinginpotential

structuraldisintegrationofcomplextrauma,wherethetraumavictimcontinuestoactand

react,oftenre-victimizingthemselvesbybeingengagedinself-injuringbehaviors,suchasself-

harming. Insomeinstancesvictimsresorttoexternalizingthetraumabyvictimizingothers

(vanderKolk&McFarlane,1996).

Itisbelievedthisviciouscycleisformedbythecreationofneuralpathwaysorthewiringand

firingofneuronsinsuchawaythatthepersoncontinuestore-experiencethetraumaticevent

duetotheirinabilitytomodulatetheirarousedstate(Siegel,1999).Thisimpairmenttobrain

functioningalsoaffects thevital roleof thebrain inmediatingmemory,causing traumatic

experiencestobestoredpredominantlyas lessadaptable,contextfreeemotionalmemory

(Cozolino,2002).

Withoutintervention,atraumavictimcan,potentially,continuetolivetheirlivesasifthey

arestillindanger,weeks,months,yearsevendecadesafterthetraumaticexperience.Thisis

particularly the case for victims of events that were of ‘human design’ (APA, 2000), it is

believedthat theelementofbetrayalentailed in theseeventsmakestraumatizationmore

likely(vanderKolketal.,2007)andrecoverycomplicated(Salter,1995).

Understandingthisimpactoftraumaonprocessesinthebrainisessentialwhendeveloping

interventionsforsupportingvictimsofatrocitiesperpetratedbytheLRAthatweredesigned

to torment and terrorize entire communities. In a sense, trauma treatment is essentially

helpingvictimsovercome the imprintsof the traumaticexperiences,whichkeepbeing re-

activating resulting in the fight-flight-freeze responses to the slightest trigger. Given that

disintegrationofbrainfunctioninganddissociationareproblematicintheaftermathofwar

trauma,treatmentbasedoncreatingandembeddingassociationsandrestoringintegrationis

highly desirable. EyeMovementDesensitizationReordering (EMDR) is a therapy approach

thathasbeenhighlightedforeffectivelyintegratingoftraumaticmemoriesinPTSDsufferers.

EMDRasatraumahealingintervention

EMDR works by getting victims of traumatic stress to focus intensely on the emotions,

sensationsandmeaningoftheirtraumaticexperiencesfromasafesetting,whileengaging

theminabilateralstimulation.TheapproachwasfirstdevelopedbyFrancineShapiroin1988

andhassincebeenfoundtobeaneffectivetreatmentforPTSDacrossmanyfields(Chemtob

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et.al2000),includinginworkingwithrefugees(Moorenetal.2014).EMDRisapprovedas

top-levelevidencebasedtherapybytheWorldHealthOrganisation(WHO,2013).

EMDR’seffectivenessinhealingtraumaacrossmanycontextsandculturesmakesitanideal

choiceofanapproachtoaddresstraumaamongLRAvictimsinNorthernUganda.Indeedthis

isnotthefirsttimethattherapistshaveseenthepotentialofEMDRasanapproachfortrauma

treatmentintheUgandanmentalhealthsystem(Mastersetal.,2017).In2008,therewasan

initiative with the objective of developing a core group of Ugandan therapists skilled to

practiceEMDR,aswellastoteachthetechniquestoothers.

EncouragedbythesuccessofEMDRintreatingPTSacrossmanyculturesandcontexts,aswell

asthefactthatothertherapistsinUgandahadalreadyexploredthepotential,theobjective

of this current initiative became to develop sustainable community-based support using

EMDRtechniques.

Due to the impossibility of providing trained clinicians (even at basic levels) to provide

interventionandsupportattherateandinthelocations,itisrequired,itwasdecidedtomodel

theinterventionontheself-helpguidedevelopedbyFrancineShapiro.Themainobjectiveof

Shapiro’sself-helpguideisenablingpeopletounderstandwhytheyarethewaytheyareand

thenlearnwhattheycandoaboutpainandnegativereactions.Techniquesaredesignedto

enablepeople toattainwellbeingby takingcontroloverchoicesmadeonadailybasis. In

accordance,themodeldevelopedforworkinNorthernUgandahadtohavepsycho-education

aswellastechniquesforaddressingtraumaticmemoriesanddealingwithdistress.However,

becausethisformoftraumahealingisnewtothepotentialrecipientsandduetothefactthat

peoplewill still requirea levelof support to go through theprogram, itwasnecessary to

recruitsupportworkerstocoachpeople inthevarioustechniquesandencouragethemto

persist when difficulties arose. The role of support workers here will not be to provide

opportunitiestotalkthroughthetraumabuttodemonstratetechniquesandprovidesupport

if, for instance participants suffered demotivation following the activation of traumatic

memories,hence,thespecializationandtrainingrequiredisminimal.Inadditiontobeingcost

effectiveandsustainable, thisapproachalso leaves theagency in thecommunityenabling

peopletotrainandsupporteachotherusingthetechniquestheyhavemasteredfortheirown

use.

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PTSshattersitsvictims’senseoftrustofothersandparticularlyinrelationtotheeventsthat

made them frightened in theextremeorashamed. It is, therefore, alsovery important to

create a context in which those undergoing the intervention are not stigmatized, but

celebrated for their courage to face their experiences andovercome them.Asmentioned

above,ICTscansupportinterventionssuch.TheopportunitythatICTsprovidedinNorthern

Ugandawastousecommunityradiopersonalitiestodelivertheeducationandinformation

elementoftheinterventionandalsoprovidesupportandencouragementviamessages,on

podcastsandradiobroadcasts.Thesemessagesreinforcedandpromotedtheneedtoaddress

andovercometraumaandthecollectiveandindividualbenefitsthereof,encouraginghealing

bothattheindividualandcollectivelevels,enablingwholecommunitiestosupportthehealing

of themostvulnerablewhilebeingawareof thecommunitywide impactsandgenerating

therapeuticconversationsatawiderscale.

Inadditiontotheradiobroadcastsandpodcasts,theprogramalsoincludesopportunitiesfor

communitywidecelebrationsofthestepstowardshealingthatparticipantsoftheprogram

have taken and their contribution to collective healing. These events were supported by

community radio broadcasters and community elderswhowere invited to commend and

acknowledgethecourageousstepstakenbyvictimsofatrocitiestohealthemselvesandtheir

communities.Theseeventsareintendedtoaddressthecollectivetraumasufferedbywhole

communities, including children who were not yet born during atrocities, but have been

broughtupbytheadultswhoborethebrunt.

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Multilevelhealingoftraumainpost-warcontexts

Thisleadstotheconceptualizationoftraumahealingassupportingthemanyindividualswith

symptomsoftraumaticstress,whileatthesametimeaddressingcollectivetrauma,enabling

boththetraumatizedcommunityandtraumatizedindividualswithinittheopportunitytoheal

andmove on to post-traumatic growth. If collective trauma represents the disruption of

relationships atmany levels of the human system, recovery should also involve collective

processesofadaptationandthemobilizationofcapacitiesacrossalltheselevels(Saul2014).

Therefore,healingtraumasimultaneouslyattheindividualandcollectivelevelsiscrucialfor

post-conflictrecovery,andneglectingtraumahealinghasdetrimentalimpactsnotonlyonthe

wellbeingofindividuals,italsohamperspost-conflictreconstructionandpeacebuildingand

theimpactsofcollectivetraumawillaffectsubsequentgenerationsastraumaticmemories

and reactions are passed on through collective narratives, norms and societal structures,

extendingthecyclesofviolenceandvulnerability.

Havingjustifiedtheneedformultilevelhealinginpost-conflictcommunities,thechallengeof

providingsuchsupportbecomesevident.Thisisparticularlythecasegiventhedevastation

causedtothehumanandmaterialresourcesavailabletothecommunityandtheprioritization

ofotherneedsovertheneedsforpsychologicalhealing,beitindividualorcollective.Gelbach

andDavis(2007)statethat,althoughthetreatmentofpsychologicaldistressinindividualsand

familiesisgenerallybelievedtoexpeditecommunityrecovery,theprovisionofeffectiveand

affordablepsychotherapy isnotyetapriority inpost-disaster support.Although thereare

manyother reasons for this, including the timingof interventions,aswellas the typeand

effectivenessofsomeof theavailable techniques,a recurringconcern,particularly innon-

western cultures, is whether psychotherapy in itself is culturally biased and stigmatizing,

pathologizingnormalresponsestodangerandlabellingtraumasurvivorsasmentallyill(Miller

&Rasco,2004).

EMDRHumanitarianAssistancePrograms(HAP)assertthatclinicianstrainedinEMDR,have

overcomesomeofthesedifficultiestodevelopapost-disastertreatmentmethodthatfocuses

onsupportingthebrain’snaturalcapacitytoreprocessdisturbinginformationtoanadaptive

resolution(HAPvolunteers,2005).Inaddition,HAPfoundthattraininglocalclinicianshelps

tocircumventtheproblemscausedbydelayedinternationalresponsestotraumaticevents

andbuildssustainableresourcesincommunitiesplaguedbynaturaldisastersortheeffectsof

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violentconflict.ThepositiveoutcomesofHAPEMDRinterventionshavebeenpublished in

several peer-reviewed articles (e.g., Jarero et al., 1999; Adruiz et al., 2009; Fernandez,

Gallinari,&Lorenzetti,2004; Jareroetal.,2006;2010;Zaghrout-Hodalietal.,2008).More

details on the impact of trauma on the brain and how interventions like EMDR work is

providedbelow.Here,itwillsufficetosaythatEMDRtechniqueshavebeeneffectivelyused

andtraininglocalclinicianstodeliverthemhasbeeneffective.

However,inthecontextofpoorpost-disastercontexts,suchasUganda,eventhissuccessful

andrelativelycost-effectivetechniqueisnoteasytoimplementduetotheunavailabilityof

clinicians. This is particularly the case given the extent of the traumatization and the

deprivation of the region affected. If EMDR-based techniques are to be effectively

implementedtoaddressindividualandcollectivetraumainruralNorthernUgandathereis,a

needtofindarealisticandsustainablemediumtofacilitateaccessibility.

OneofthefeaturesofcommunitiesincurrentdayAfricaisthefastexpansionofICTs,thisis

botha challengeandanopportunity (VanReisen&Gerima,2016). Forourpurposes, it is

importanttodiscusstheopportunitiesforutilizingtechnologytofacilitatethecosteffective

andsustainableprovisionoftraumainterventioninresource-deprivedcommunitiessuchas

theonesinconsiderationhere.

Contextualizingandenlargingtheimpactoftraumasupportthroughradio

Adefiningcomponentofmasstrauma,suchasthetraumathattookplaceintheyearsofthe

civil war in Uganda, is the betrayal of social trust, which leaves victims devalued and

humiliated,underminingtheirsenseofcommunaltrustanddecency(Saul,2014).Restoring

socialtrustis,therefore,aforemosttaskofanyintervention.Infact,withoutrestoringtrust,

an interventionwill not have a chance ofmaking anymeaningful impact on recovery, as

recipientswillnotaccessorengagewithit.

The media plays an important role in building post-conflict recovery, as it can facilitate

collectivenarration,whichcanshapethemeaningascribedtotraumaticevents,aswellas

providingresourcesandsolutionstodifficultchallenges(SaulandLandau,2004).Withthisin

mind,theprojectundertookextensiveliaisonswithlocal,trustedmediapersonalities,using

podcastswithinformationforparticipants,aswellasadditionalcommunity-wideinformation

ontraumaandrecoveryforthewiderpublictopromotetrustandbuildconfidencebycreating

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platforms for the creation of common meaning and understanding, allowing community

memberstoopenuptoeachotherandexpresstheirneeds,viewsandattitudes.

Figure8-1.Impactofwaroncollectivetrauma

DevelopmentoftheSHLCPTSprogram

Basedon theconclusionsof theanalysisofwave1data (chapter15and16) theSHLCPTS

programwasdesignedbytheteam(ledbySelamKidane)todevelopatherapybasedonthe

followingcriteria:

• Basedonself-helpactivitiestomakeitsustainablewithinthelowresourcesettingofthe

communities;

• Foster to improve understanding of trauma and avoid re-narration so as to limit the

possibilityofre-traumatization;

• Ensure highly contextualized to create a level of trust and relevance for severely

traumatizedcommunities;

• Includeastrongcollectivecommunitybaseforthesupportprogram, includingsupport

fromcommunityleadershipandfamilies;

• Provide practical tools for Post-Traumatic Stress reduction based on scientific

understandingoftheeffectoftraumaprogramsinpost–warandconflictsettings;

• IntegratecontemporaryknowledgeofpsychiatrictreatmentofPost-TraumaticStress;

• Setprograminrealisticboundariesofalow-costsettingwithfewhealthworkers;

•Historyofseveretraumaticevents•Difficultiesincollectiveandindividualhealing

War

•MentalhealthproblemsincludingPTSD

•Hamperedeconomicdevelopment• Cyclesofviolenceandvulnerability(difficultieswithreconcilliationandpeacebuilding)

Individualandcollectivetrauma •Understandingtheimpactsof

traumaiinthebrain•Understandingtheimpactsoftraumainthecommunity

• Takingthecontextofresourcedeprivationintoaccount

•UnderstandingthepotentialrolethatICTscouldplay

EMDR-basedphasedtherapy

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• Set program up in a sustainable and upscalable manner that can be conducive to

disseminationbyavailablemedia,suchasradio.

OutlineofthesixsessionsoftheSHLCPTSprogram

Theabovediscussionoutlineshowthetraumainterventionwasdesignedtotakeintoaccount

theneurobiologyoftrauma,aswellastheimpactofcollectivetraumaonhealingandpost-

traumaticgrowth.Thereis,increasingly,recognitionthatworkingtoengageallareasofthe

brainisakeytoreintegratethepost-traumaticbody,mindandbrain,andintegrateemotions,

sensations,awarenessandthoughts.Thesearetheconnectionsthatareoftendisruptedby

complextrauma(Cozolino,2006;Ogden,2006;Siegel,2001).

AnumberofkeyinternationalbodiesandclinicianstreatingeithercomplexPTSDorPTSDina

surveyreport,endorsedaphasedapproach(Cloitreetal.,2012),whichwasreflectedinthe

developmentoftheSHLCPTS.

In accordance with guidance and good practice examples, a three-phase approach was

followedtoaddresstheextensiveimpactofcomplextraumainNorthernUganda.Thephases

oftreatmentareoutlinedintheTable8.1.

Giventheseverelimitationsofresourcesandtheriskoflosingclientmotivationendemicto

thecontext,theinterventionwasmuchshorterthantheaveragerecommendedundersuch

circumstances.Much of theworkwas, thus, directed towards education and coaching of

specific coping and processing skills and then a session was dedicated to psychosocial

rehabilitation.

TheSHLCPTSprogramwasdevelopedasaninterventionofferedinsixsessions,coveringthe

followingaspects:

Session1-2:psychosocialeducation,understandingtraumaandthebrain

Session3-4:learningactiveexercisestocontrolimpactoftrauma

Session5-6:preparingareorientationtowardsasupportivecommunity

Thesessionsaredetailedinthetablebelow.

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Table8-1.OutlineforasixweekSHLCPTSprogramforvictimsoftraumaticstress

Sessionnumber

Objectiveofsessionandactivities OnPodcast ThroughLivefacilitators

1. Introductionsessiontooutline:1.introductiontobreathingtechniques2.Whatistrauma?3.WhatisPTSDandwhatarethesymptoms?4. What is Complex Trauma and what are thesymptoms?5.Whatiscollectivetrauma?6.Whatdoestraumadotothebrain?7.WhatisEMDRwhatdoesitdoandhow?8.Safeplace

TheexplanationinaudiousingaccessiblelanguageandrelevantexamplesAnexplanationofasafecalmplaceandtheaudioofinstructionsforit

WelcomeandansweranyquestionsanddealwithlogisticsandpracticalitiesandcreateasafeplaceforpeopleBreathingtechniquesUsethecirclestoshowhowtraumaaffectindividuals,families,communityandsocietyUsethebrainmodeltoembedthedescriptionofhowtraumaaffectsthebrain.Usebusydeskanalogy.Supportwomen to remain focused on creating the safe calmplace and accessing it using their word. Practice that severaltimesandembedit.

2. This session is aimed at identifying the negativefeelings,wordsandreactionsthatpeoplewanttoaddress, remembering the touchstonememoriesthatanchorthosefeelingsandreactionsandmakeaplanforsupportwiththis

Exercises:1. SUDs2. TouchstoneMemories3. SafeCalmPlace

Welcomeandansweranyquestionsanddealwithlogisticsandpracticalitiesandcreatea safeplace forpeople checkingwithpeopleiftheyhavebeenusingtheirbreathingtechniqueGuidingandsupportingSUDsandtouchstonememoriesFinishingwithasafecalmplace

3. Introducingpeopletobilateralstimulation 1. Introduction to bilateralstimulationandrationale

2. Quick SUD and Touchstonerecap

3. Butterflyhug4. Safeplace

Welcomeandansweranyquestionsanddealwithlogisticsandpracticalitiesandcreatea safeplace forpeople checkingwithpeople if they have been using their breathing and safe calmplaceexercisesGuiding and supporting Suds and touchstone memories andbutterflyhugscheckingwithSUDsagainandrepeatingbutterflyhugs.Finishingwithasafecalmplace

4. Introducingpeopletobilateralstimulation 1. Introduction to bilateralstimulationandrationale

2. Quick SUD and Touchstonerecap

Welcomeandansweranyquestionsanddealwithlogisticsandpracticalitiesandcreatea safeplace forpeople checkingwithpeople if they have been using their breathing and safe calmplaceexercises

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3. Butterflyhug4. Safeplace

Guiding and supporting Suds and touchstone memories andbutterflyhugscheckingwithSUDsagainandrepeatingbutterflyhugs.Finishingwithasafecalmplace

5. Preparing for closure and thinking aboutsustainability of the techniques planningcommunityevent

1. Fourelementsexercise Welcomeandansweranyquestionsanddealwithlogisticsandpracticalitiesandcreatea safeplace forpeople checkingwithpeople if they have been using their breathing and safe calmplaceexercisesaswellasbilateralstimulation(butterflyhugs)Haveadiscussionontheimportanceofsustainabilityandaboutthefactthatthewomencanhavecontrolovertheiremotionandmemories using simple techniques especially when they areoverwhelmedorwhentheyfearbeingoverwhelmed.Planacommunityeventwhenthewomengettocelebratetheirachievementsinworkingthroughthesedifficultevents.Supportpeopletodothefourelementsandencouragethemtouseitregularly incombinationtoothertechniquesorontheirown

6.

Toholdacommunitycelebrationwherethewholecommunity comes to celebrate the women andtheirachievements

Radioannouncementoftheeventsandacknowledgement of the workundertaken by the women and theirsupportworkersandhowimportantthisis for the whole community (a lightexplanation of trauma and collectivetrauma)

Preparingsomethingthatthewomencantakewiththemasamementoand/oracertificateoftheworkthatwasundertaken.Helpingthewomenorganizeacommunityevent.Receiving T-shirts with messages on how participants havebecomeawareoftraumaandtreatments.

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ContextualizingSHLCPTSandpreparationofradiodissemination(recordings)

Atotalof27participantsfromthevariouscommunitiesandorganizationsinthesedistricts

wereinvitedtoattendapreparatorymeetingforthreedaysheldinLira(see4.9).Thesewere

radiopresentersandproducers,representativesofcommunitybasedorganizationsinthefour

districts,theprojectteammembersfromMbararaUniversityofScienceandTechnology,Local

governmentleaders,organizationsinthefourdistrictsworkingwithwomenrelatedissues,

andIsis-WICCEwhichorganizedthetrainingonbehalfoftheprojectteam.Theparticipants

wereintroducedtotheSHLCPTSprogrambySelamKidanefromTilburgUniversity

Ateamofjournalistsfromlocalcelebratedjournalistswasselectedfromeachregion(Lango,

Acholi and Teso) from leading local radio stations to participate in the training. After the

training,thejournalistsinvitedforthetrainingfromRadioTemboinKitgum,VoiceofTesoin

SorotiandVoiceofLangofromLirawereexpectedtotranslatethecontentofthetraining,

collectinterviewsfromlocalpeopleandintegratetheproductionoftrainingpackageinlocal

languages(Langi,AcholiandAteso).Theparticipantsinthetrainingprovidedavaluableinput

intheproductionofthetrainingscriptbyprovidingtranslationofkeywordssuchastrauma

whichwasdebatedandfinallyagreedtomean;AjijiinAcholi,AitapasunanaAdaminIteso

andNgatAwieOrucereinLangi.

Afterthetraining,thejournalistspreparedascriptwhichdetailedtheoutlineofthesessions

tobeused intrainingofthecommunitymembers.Adiscussionwasheldwitheachofthe

journalistsaboutthebreakdownofeachofthesixsessionstomakesurethatthecontentof

thetrainingandtheprogramoutlinewereclearlyunderstoodbeforetheywentontotranslate

thecontentofthetraining,collectinterviewsfromlocalpeopleandintegratetheproduction.

Adiscussionwasheldwiththejournalistsandothertraineesaboutfindinglexical,culturaland

situationalequivalencefortheEMDRbasedPTSDmanagementconceptsforlocallanguage

broadcast. Journalists who write and produce for small languages and communities in

developing societies face language challengeswhen trying to express complex or abstract

modern concepts. The relatively very short literary and printed history of such languages

makesitextremelydifficultforjournalisttofindequivalencetoexpresscomplexandabstract

scientificandtechnologicalconcepts.Theextensiveuseofimportedwordsandexpressions

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might usually leavemost of the audience in such communities confused about the exact

meaningoftheproduction.

IfasixsessionradiobroadcastaboutEMDRbasedPTSDmanagementtrainingistobeeffective

incommunicatingtheconceptsandideasitdesiresthecommunitytounderstandandbenefit

fromtheprogramsthecontentshouldbecommunicatedintheeasiestandyetmosteffective

and precise manner possible. Being able to find expressive and easy to adopt lexical

equivalents forwords like trauma, finding local proverbs, sayings, idioms, folk stories and

common traditional experiences means that the journalist can find locally digestible

expressionandstructuretocommunicatethemessageclearlywhilealsonotignoringtheneed

fortheprecisetransferofthecoreideas.Therecordingswerepreparedwithpopularradio

voicestoensurethatthepeopleinlocalcommunitiesfeltalocalrelevanceandownership.

Aftertherealizationoftherecordingthetrainersweretrainedtoimplementthetreatmentin

thecommunityandtheselectionprocessofparticipantswasexplained.Thetreatmentwas

explained to local health/mental health service providers, so that in case of any need for

followupofassistance,thiscouldbeprovided.

Theapproachwasintendedtoleaveasmuchoftheagency/resourcesandcontrolwiththe

formervictimsandtheircommunities,enablingthemtoregaincontroloveranaspectoftheir

life (i.e., theircontinuedhealing).Theemphasiswasonparticipantsbeingabletoenvision

themselvesinanempoweredstateabletouseEMDR-basedtechniquesasandwhenneeded

toinitiatehealingandmaintainit.

Photo1:ParticipantsoftheEMDRtrainingoftrainer’sworkshop

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ImplementationoftheSHLCPTSintervention

Sixsubcounties(Amida,Akwanga-Tumango,Usuk,Ngarium,Agwenge-Barlonnyo,Ogurand

Orungo)wereselectedtoparticipateinthetrainingleavingtheothersubcounties(Obalanga,

Agweng and Akwanga) as control groups for the subsequent rounds of data collection.

However,afterthethirdroundofdatacollection,theparticipantsfromtheremainingcontrol

groupwerealsoofferedtheintervention(aspartoftheethicalprocedure).

The SHLCPTS was conducted at sub county headquarters and other common community

gatherings.Thetreatment,whichlastedforaboutfivehours,startedwithparticipantstaking

arefreshmenttohelpthemrelaxasmanyofthemcamefromlongdistances.Thefirstsession

ofthetrainingsstartedwithanexplanationastowhytheteamhadreturnedtocommunities

aftertotheparticipantsthefirstroundofdatacollectionandtheexplainedthepurposeof

thevisit.Itwasindicatedthattheresearchprojecthadcarriedoutitsresearchandpromised

toreturntomakeafollowuponthefindingsofthestudy.Thetrainersmentionedthatthe

mainpurposeoftheteamvisitwastoofferasimpletreatmentwhichparticipantscoulduse

intheirdaytodaylifefortheirownbenefitandtothebenefitsoftheirfamilyandcommunity

membersatlarge.Membersofthecommunityintroducedthemselvesandeachofthemstood

up to mention their names and where they come from. The trainers also informed the

membersthattheywereselectedasonthebasisthattheyparticipatedinfirstroundofdata

collectionwhichwascarriedoutbyEWP-Uproject.

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PART V: QUALITATIVE RESULTS: IMPACT OF SOCIAL

PROTECTION

125

ParticipationinSocialProtectionProgramsThischapter reports theresultsof interviewsheldontheparticipationofwomen insocial

protectionprogramsinNorthernUganda.

ThegovernmentofUgandahasimplementedmanyprogramswhichhavebeenintroducedto

supportpeoplereturningfromthepostconflictLRAwar.Manyoftheseprogramsspecifically

targettheregionsaffectedwiththewarwhileothersarenationalprogramstargetingpeople

livinginpoverty.

NAADS/OperationWealthCreation

TheNationalAgriculturalAdvisoryServicesOrganizationisasemi-autonomouspublicagency

within theMinistry of Agriculture Animal Industry and Fisheries (MAAIF), responsible for

public agricultural advisory/extension services. This program is a national wide program

intendedtoimprovelivelihoodsofpeoplethroughsmallandmediumagriculturalenterprises.

NAADSobjectivesareasfollows:

• To promote food security, nutrition and household incomes through

increasedproductivityandmarketorientedfarming

• To empower all farmers to access and utilize contracted agricultural

advisoryservices

• To promote farmer groups to develop capacity to manage farming

enterprises.

• Tocreateoptionsforfinancinganddeliveryofagriculturaladviceforthe

differenttypesoffarmers.

• To catalyze the participation of the private sector to fund agricultural

advisoryservices.

TheNAADSprogramdoesnotspecificallytargetwomen.Theprogramalsoworkswithgroups

of farmers and only reaches out to individual farmers who are regarded as commercial

farmers.Thisprogramsupportsfarmerswithseedlingsandcashtransfers.Theroleoflocal

leadersistomobilizelocalleadersandassisttheminorganizingthemselvesingroups.They

are then given training in group dynamics, enterprise selection and help them with

registrationat sub-county level.NAADSsupports threecategoriesof farmerswho include;

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foodsecurityfarmers,marketorientedfarmersandcommercializedfarmers.Thecommercial

farmersarerequiredtocontribute10%oftheirenterprisebudgets.farmerssupportedinthis

wayaremainlymenwhogrowcropsatlargescale.Menalsoconstitutethemajorityofmarket

oriented farmers. This is because these two categories of famers require big size of land,

capitalandlaborwhichmanyruralfemalefarmersstilllackinUganda.

OneofthelocalleadersinterviewedinOgursub-countyhadthistosay:

…oursocietiesarestillverypatriarchalinnatureandmenstillcontrolmuch

oftheresourcesathome.Mendominatethegroupsthatcometosub-county

offices to look for opportunities and information on what is going on

comparedtowomen.Thisisbecausewomen’smovementisrestrictedand

many of the religious teaching keep women in subordinate positions.

(32/05/04/K)

AfemalerespondentfromUsuksub-countyadded:

…mostdecisionsmadebywomenaredisregardedasmenopenlycompete

withtheirwomen.Mendon’twantwomentooutcompetetheirdecisions

andwilldespiseamanwhosewife isknownforcompetingwithmenina

communitymeeting.Ahusbandfeelsembarrassedwhenhiswifeisinvolved

inanargumentinacommunitymeetingandwillgobacktorebukeher.So

manyofthedecisionsthatworkinthiscommunityarebroughtbymenwho

benefitsfromthem.(30/19/02/U)

WomendominatethefirstcategoryofNAADS-foodsecuritysupport,becausetheyconstitute

themajorityoffoodsecurityfarmers.Womenarechargedwiththeresponsibilityofproviding

food inhomesandthustaketheburdenofproducingfoodfortheirhousehold.Thusfood

productionbecomestheirfirstpriorityintheeventofsmallsizeofland.Unlikemen,women

onlytakeupcommercialfarmingafterensuringthattheirhouseholdsarefoodsecure.

OneofthefemalerespondentinNgariumnoted:

…howonearthcanyouthinkofplantingorangesandmangoeswhenyou

childrendon’thavefoodtoeat?Howdoyousacrificethelittlelandyouhave

togrowcropsyoucan’tputonaplatetoserveyourchildren?Whenthey

127

broughtusmangoesandorangestoplantatthesub-county,manywomen

didnotgopickthem.Theyhadnowheretoplantthemleavingmenasthe

onlybeneficiariesoftheprogram.(31/19/03/N)

NorthernUgandaSocialActionFundProject

TheNorthernUgandaSocialActionFundProject(NUSAF)isagovernmentfundedprogram

thatwasdesignedfornorthernUgandawiththeaimstoempowercommunitiesbyenhancing

theircapacitytosystematically identify,prioritize,andplanfortheirneedsand implement

sustainabledevelopmentinitiativesthatimprovesocio-economicservicesandopportunities.

ItisimplementedunderthePrimeMinister’sOffice.TheNorthernUgandaSocialActionFund

Project has been implemented in three phases. The development objective of the Third

NorthernUgandaSocialActionFundProjectforUgandaistoprovideeffectiveincomesupport

to and build the resilience of poor and vulnerable households in Northern Uganda. The

Northern Uganda Social Action Fund was implemented in three phases; Community

Infrastructure Rehabilitation (CIR), Household Income Support program (HISP) and Public

WorksProgram(PWP).Theprogramnolongerrecruitsnewmembersbutsupervisionisstill

ongoing.However,thisstudyfocusesontheexperiencesoftheNUSAF2whichwasbeing

phasedoutbythetimethisfieldworkwasbeingcarriedout.

TheHouseholdIncomeSupportprogram(HISP)targetsacommunityandexplaintothemthe

role of NUSAF 2. The community then identifies the beneficiaries and the assessment of

beneficiariesfollows.Thisproceduretargetsthemostvulnerablemembersofthecommunity.

ThesecondprocedureofHISPistobringpeopletogetheringroupsand30%oftheseshould

bewomenasmembersofthegroupbutalsoinleadershippositions.Justliketheexperiences

ofCDD,manyofwomenincludedinthesegroupsarepurposelyforwinningthegrantsthan

actualbeneficiaries.

Oneofthelocalleaderscommentedthat:

…menlookfortheirfemalerelativestoparticipateinthegroups.Theseare

selectedbecause theyhave control over themand they can’t dispute the

decisionstheymakeoncethemoneycomes.Aslocalleaders,wedon’thave

authority to decide the composition of the members of the community

128

groupsandsinceparticipationisbasedonwill,wecan’tforceotherwomen

toparticipate.(32/05/04/K)

RestockingProgram

AftertheendofthewarinNorthandEasternUganda,manypeopleintheseareashadlost

manyoftheirlivestocktothehandsoftherebelsandmanypeoplewhotookadvantageof

the war to robe them while people lived in internally displaced camps. The government

introducedtherestockingprogramwiththeaimofsupportingthepeoplewhoselivelihood

dependedon livestocktoresumetheirpractice.Theassessmentcriteriadoesnotconsider

womenasacategory,muchastheybenefitasmemberswhoqualifyinthesetcategoriesper

sub-county. Inmanysub-countiesvisited, local leaderstargetvulnerablepopulationasthe

beneficiariesoftherestockingprogramthatleavesoutmanyabledwomenfromparticipating

in thisprogram. Inmanyof thesecommunities, thevulnerablepopulation include;people

with disabilities, single parents, formally abducted people, widows, HIV/AIDS persons,

childrenwithdisabilityandtheelderly.Eachoftheselectedhouseholdgetsonecoworbull

dependingonthesupply.

InsomedistrictslikeKatakwi,thecriteriaforbenefitingfromtheprogrambenefitswomento

access thecows/bulls for therestockingprogram.Theprogramtargetsvulnerablepersons

andbecauseofgenderinequalitiesrootedinthesesocieties,womenconstitutethemajority

ofwomenwhoarevulnerableinmanydistricts.Forinstance,inNgariumsub-county,Katakwi

District,8outofthe12beneficiariesselectedinthefirstquarteroffinancialyear/2015/2016

werewidows.InOrungosub-county-AmuriaDistrict,outofthe42cowsreceivedinthesame

periodoftime,19womenweregiventowomen.

However,theleadersfromlocalauthoritieswhoimplementthisprogramdonotconsultthe

community in theprocessof selectionanddon’t seek theiropiniononwhat theywant to

receive.Manyofthecowsreceivedbythesevulnerablemembersofthecommunitieshad

diedor soldbecause thebeneficiaries couldnotmanage tomaintain them.Medication is

difficultbecausepeopleveterinaryservicesaregenerallyveryexpensiveandmanyvulnerable

peoplecannotaffordthem.

OneofthelocalleadersfromOgursub-countynotedthat:

129

…oneofthemistakemadebyleadersistoimplementgovernmentprogram

withoutconsultingthecommunitymembers.Theirneedsarenotconsidered.

Weare implementinggovernmentsprograms forwhich leaderswenever

participateintheirdesignandhencefollowwrittencriteria.(29/14/01/O)

Womeninvarioussub-countiesindicatedthelocalleadersdonotconsultthembeforegiving

them the cows. They indicated that if theywould seek their opinion, theywould suggest

somethingelsethatbenefitsthembetter.OneoffemalerespondentinNgariumsub-county

noted:

…weprefersheeptocowsbecausetheybringpeaceincommunitycompared

tocows.Thegovernmentsendsuscows,butthesebringmoretensionasthe

Karamajongsstillinvadeourcommunitiestostealourcows.Nosoonerthe

animalsaredeliveredthantheKaramajongsattackandstealthem.Sowe

prefersheep,becausetheattackersdon’thaveanyinterestinthem.Women

in female headed households cannot put up enough defense for their

animals and hence end up losing them tomale relativeswho sometimes

neverreturnthemtotheowners.(33/19/03/N)

AlocalLeaderinNgariumsubCountyexplainedthat:

…wedon’thaveenoughsecurityinthesub-countytoprotectalltheproperty.

Assub-county,wehaveonlythreepoliceofficersdeployedinthesub-county

policepost.Wecannotsufficientlyprotecttheanimalswegivetocommunity

membersandthuswhentheKaramajongscome,theytakeawayalmostall

theanimalsstocked.(34/30/03/N)

AnotherfemalerespondentfromUsuksaid:

…for us women we prefer sheep or goats for they have a higher

multiplicationeffectwhenreceivedasagroup.Asheepgivesbirthtwicea

yearwithapossibilityofhavingmorethanoneram,whichmakesiteasier

forwomentosharethemunlikeacowthatdeliversonecalfinalmosttwo

years.(35/20/03/U)

130

Thestudyfurtherrevealedthatwomenstillstrugglewithaccessandcontrolpowersinhomes

forthemtotheabletobenefitfromtherestockingprogram.Womendonothaveaccessto

landandarenotmeanttoownresourcesintheirhouseholds.Itemssuchascowsbringalot

ofconflictsinhomeswheretheyaregiven.

AfemalerespondentinNgariumsaid:

…womenprefersheeptocowsbecausetheyexercisemoreauthoritywith

themthancowsmoreespeciallyinhomeswherethehusbandsowncows.

Womenexercisemorepowersforsmallanimalsinhomescomparedtobig

onesinhomes.Owningasheepgivesawomananopportunitytomeether

personal needs as a husband may express less interest in the money

generatedfromitssell. Icansellasheepwithoutconsultingmyhusband,

buthowdoIsellacow??(36/19/03/N)

The focus group discussion with men from Obalanga sub-county-Amuria made similar

revelationaboutwomen’sownershipofitemsprocuredfromthegovernment.Theconfirmed

that women are not supposed to own any property accumulated in home unless their

husbandsconsent.

Oneofthemaleparticipantofthefocusgroupdiscussionmentionedthat:

Womenawomanreceivesacowfromthesub-county,itisdefinitelymine

andthewholefamilycanclaimit.Womenacquirepropertyfortheirfamilies

whointhiscaseincludesahusbandandchildren.(37/21/03/Ob)

Onemaleparticipant,however,disagreedstatingthat:

Itiseasyforawomantoownthetransfersreceivedinafamilybecausemany

men in their communities is likely to miss use it in case of polygamous

families.Inourcommunity,manymenfightforwomenpropertybecauseof

theirpolygamousnatureandunlesstheyclingontheirwivesproperty,they

willendupwithnothing.(38/21/03/Ob)

Thus, the restocking programwas noted to be one of the government program that has

instigated domestic violence in many communities where this program has been

131

implemented.Thegovernmentrequiresthatthecowsgivenmuststayforatleastfiveyears,

but inmany incidences, thesecowsare soldbefore the required time.Some local leaders

indicatedasamovetoensurethatbeneficiariesdonotselltheseanimalsafterreceivingthem,

theyhandoveranimalstowomeninhomeswhoarechargedwiththeresponsibilityoflooking

afterthem.Thus,thehusbandmustgetanapprovalfromthewifebeforesellingtheanimals.

Women who refuse to give their husband consent to sell are prone violence from their

spouses.Menpulloutofsupportingthewomentolookaftertheseanimalswhichleadsto

theirdeath.

CommunityDrivenDevelopment

TheCommunityDrivenDevelopment(CDD)programisimplementedasanationalprogram

throughtheofficeofdistrictandsub-countydevelopmentoffice.Theprogramrequiresthat

membersofthecommunityorganizethemselvesingroupsandwriteaprojecttobefunded

tothetuneoffundsavailable.Thisprogramliketherestockingprogramdoesnotspecifically

supportwomenasasinglecategory,butratherasapercentageofprojectteamoraquarter

basis. Hence their involvement is a part of assessment requirement for all the projects

supported.

Theideaofwomeninvolvementbeingarequirementforagrouptowinfundshasbroughta

disadvantageforwomentobenefitfromthisprogram.Womenareonlyincludedjusttomeet

thecriteriaandoncethefundscome,theyaregivennothingorverylittlefromthefundswhich

makes it difficult for them to improve on their lives.Women’s inability to read andwrite

meansthatmeninthesegroupstakeonthekeypositionsoftheteamwhichmarginalizes

women’sability toquestionandaccount for the funds received.Thismarginalizeswomen

furtherandtheyresenttheirparticipationintheprogramasthebenefitsdon’tcomethrough

toattracttheirfutureinvolvement.

Despitetheseshortcomings,thelocal leadersinthedistrictsvisitedindicatedthatwomen

prefertoparticipateinCDDprogramcomparedtootherprograms.Oneofthelocalleaders

fromOgursub-county-Lirasaid:

…womenprefertoparticipateinCDDprogrambecausemanyoftheprojects

fundedtargethouseholddevelopment.Womenputinextraefforttoensure

thattheirteamswinthesefundsbecausetheywillbeabletoimprovetheir

132

homes. Men tend to participate in the government programs that will

improvetheirincomesasindividuals,butCDDfocusesonthoseproblemsthe

communityidentifiestoimprovetheirhomes.(29/14/01/O)

The focus group discussion with men in Obalanga sub-county-Amuria complements the

submissionofthelocalleaderinOgursub-county,LiraDistrictthatmorewomenarelikelyto

benefitfromtheCDDbecauseitislocatedclosetowheretheyare.Themenagreedthatit

easierforwomentoattendmeetingthatorganizedclosetohomethanwhentheyaredistant

sayatthedistricts.ManyoftheCDDprojectsarevillagebased,sowomenarelikelytoattend

villagemeetingsthanmeetingsorganizedfarfromtheirhome.

The local government authorities have used community Driven Development program to

improvetoimplementothergovernmentprogramsthatbenefitwomenindirectly.Someof

thelocalgovernmentsrequirethatforateamtobenefitfromthesefunds,theyneedtohave

immunization cards for their children below 5 years, report cards for their primary going

children,possessionofsanitationitemssuchastoiletsandoneoftheirhouseholdmember

must have registered for functional adult education. These requirement pushes men to

becomemoreresponsivetothewomen’sneedsinhomeswhichimprovesthequalityoftheir

lifeandthatoftheirchildren.

YouthLivelihoodFunds

Theyouthlivelihoodprogramtargetsyouthbetween18yearsand35years.Thisprogram,just

asCDDandNUSAFdoesnotconsiderwomenasspecialcategorytobenefit.Youngwomen

and girls are still excluded from this programs by forces ofmale dominancy, cultural and

religiousfactors.Theboystakeadvantageofmarginalizationofgirlsbythenegativecultural

forcestodominatetheleadershipofthegroupsandthusonlyinvitegirlstomeettheselection

criteria.Thelocalleadersnotedthatthereisalotofmisuseoffundsandinthiscaseboysare

likelytotakethemoneyandthegirlslooseout.Acaseinoneofthesub-countieswasreported

wheretheboyswithdrewthemoneyanddisappearedleavingthegirlsbehindtoaccountfor

thefundstheyneverused.Justlikewomen,younggirlscan’tmovetothesub-countyoffices

tolookforinformationregardingtheavailabilityofopportunitiesfortheirowndevelopment.

133

SocialAssistanceGrantsforEmpowerment

The Social Assistance Grants for Empowerment (SAGE) is government of Uganda social

protectionprogramschemeundertheExpandingSocialProtectionProgramme.Thisscheme

wasinitiallypilotedtwotypesofdirectincomesupportgrants:theSeniorCitizensGrantsand

theVulnerableFamilyGrants.TheSeniorCitizensGranttargetedolderpersonsof65years

and above while the Vulnerable Family Grant on the other hand was paid to poor and

vulnerablehouseholdsthatlackedlaborcapacity.Bythetimewecarriedoutthisstudy,only

Katawkidistrictwasabeneficiaryofthisprogram.InNgariumsub-countywherethisstudy

wascarriedout,about300peoplewerebeneficiariesofthisprogramoftheseabout180were

women.Anindividualisentitledto25,000UGX.

Conclusion

Womenhavebeenabletoorganizethemselvesintogroupsdoingcashroundcirclesand

farminggroups.WomeninOgur,BarlonyoandObalangadecidedtostartsmallprojectsto

supplementboththeirhouseholdandtheircommunities.Oneofthegroupsvisitedsix

monthsafterthetrainingindicatedthattheywereneededtobegivenfunctionaladult

educationandtreessothattheyareablesustainablysupporttheircommunities.

ringmoretensionastheKaramajongsstillinvadeourcommunitiestosteal

ourcows.NosoonertheanimalsaredeliveredthantheKaramajongsattack

andstealthem.Soweprefersheep,becausetheattackersdon’thaveany

interest in them. Women in female headed households cannot put up

enoughdefense for their animals and hence end up losing them tomale

relativeswhosometimesneverreturnthemtotheowners.(33/19/03/N)

AlocalLeaderinNgariumsubCountyexplainedthat:

…wedon’thaveenoughsecurityinthesub-countytoprotectalltheproperty.

Assub-county,wehaveonlythreepoliceofficersdeployedinthesub-county

policepost.Wecannotsufficientlyprotecttheanimalswegivetocommunity

membersandthuswhentheKaramajongscome,theytakeawayalmostall

theanimalsstocked.(34/30/03/N)

AnotherfemalerespondentfromUsuksaid:

134

…for us women we prefer sheep or goats for they have a higher

multiplicationeffectwhenreceivedasagroup.Asheepgivesbirthtwicea

yearwithapossibilityofhavingmorethanoneram,whichmakesiteasier

forwomentosharethemunlikeacowthatdeliversonecalfinalmosttwo

years.(35/20/03/U)

Thestudyfurtherrevealedthatwomenstillstrugglewithaccessandcontrolpowersinhomes

forthemtotheabletobenefitfromtherestockingprogram.Womendonothaveaccessto

landandarenotmeanttoownresourcesintheirhouseholds.Itemssuchascowsbringalot

ofconflictsinhomeswheretheyaregiven.

AfemalerespondentinNgariumsaid:

…womenprefersheeptocowsbecausetheyexercisemoreauthoritywith

themthancowsmoreespeciallyinhomeswherethehusbandsowncows.

Womenexercisemorepowersforsmallanimalsinhomescomparedtobig

onesinhomes.Owningasheepgivesawomananopportunitytomeether

personal needs as a husband may express less interest in the money

generatedfromitssell. Icansellasheepwithoutconsultingmyhusband,

buthowdoIsellacow??(36/19/03/N)

The focus group discussion with men from Obalanga sub-county-Amuria made similar

revelationaboutwomen’sownershipofitemsprocuredfromthegovernment.Theconfirmed

that women are not supposed to own any property accumulated in home unless their

husbandsconsent.

Oneofthemaleparticipantofthefocusgroupdiscussionmentionedthat:

Womenawomanreceivesacowfromthesub-county,itisdefinitelymine

andthewholefamilycanclaimit.Womenacquirepropertyfortheirfamilies

whointhiscaseincludesahusbandandchildren.(37/21/03/Ob)

Onemaleparticipant,however,disagreedstatingthat:

Itiseasyforawomantoownthetransfersreceivedinafamilybecausemany

men in their communities is likely to miss use it in case of polygamous

135

families.Inourcommunity,manymenfightforwomenpropertybecauseof

theirpolygamousnatureandunlesstheyclingontheirwivesproperty,they

willendupwithnothing.(38/21/03/Ob)

Thus, the restocking programwas noted to be one of the government program that has

instigated domestic violence in many communities where this program has been

implemented.Thegovernmentrequiresthatthecowsgivenmuststayforatleastfiveyears,

but inmany incidences, thesecowsare soldbefore the required time.Some local leaders

indicatedasamovetoensurethatbeneficiariesdonotselltheseanimalsafterreceivingthem,

theyhandoveranimalstowomeninhomeswhoarechargedwiththeresponsibilityoflooking

afterthem.Thus,thehusbandmustgetanapprovalfromthewifebeforesellingtheanimals.

Women who refuse to give their husband consent to sell are prone violence from their

spouses.Menpulloutofsupportingthewomentolookaftertheseanimalswhichleadsto

theirdeath.

136

PARTVI:QUALITATIVERESULTS:IMPACTOFTRAUMARELIEF

INTERVENTIONS

137

ParticipationinTraumaReliefProgramsThisstudyinvestigateshowservicestoaddresspost-traumaticstressimpactedoneffortsof

socialprotection (cashand in-kind transfers)providedby theGovernmentofUganda.The

traumaserviceswereprovidedbylocalgovernmentorNon-GovernmentalOrganizationsin

Northern Uganda. In this study, these services are referred to as ‘counselling’. Specific

mentionismadetothecounsellingeffortsbyIsis-WICCEandsisterorganizationsastheeffect

ofthisservicewasspecificallyinvestigatedinthisresearch.

Interviewsofwomensufferingfrompost-traumaticstress

Thissectionpresentstheresultsofthequalitativedataontheprevalenceoftraumainthe

community,includingwomenwhohadparticipatedinthecounsellingsupportprogram(the

resultsofwhicharepresentedintheanalysisofthefirstwaveinchapter17and18).Inthis

chapterinterviewsarepresentedtoillustratetheexperienceoftraumainthecommunity.The

local leaders and individualwomen interviewed expressed that behaviors associatedwith

traumawerecommonoccurrenceintheircommunities.Manypeopleintheircommunities

wereknowntobehaveinwaysthatrequiredcounselling.However,manycommunitieslacked

facilitieswheretraumatizedpeoplewouldseekassistance.Thelocalleadersidentifiedthewar

tobethemaincauseoftraumaamongthecommunities,althoughtheyacknowledgedthat

therearealsoneweventsthatcreatesimilarimpactsuchasdomesticviolence.

Several women from all the districts through their own statements acknowledged being

traumatizedfromtheeventsofthewarandthereafter.Afewofwarrelatedtraumastories

aresharedhere.

10.1.1. Livingintraumafromthepast(firstwave)

The interviews revealed the problem that women suffering from post-traumatic stress

identifiedthatthetraumaofthepaststilldominatedtheircurrentlives.Theyexpressedho

theexperienceswerestillveryrealtodayintermsofthememoryandtheeffectsthishadon

them.Thetraumaofthepastwasthesourceofmentalandphysicalsufferinginthepresent.

Afemalerespondentaged35yearsfromAmidasub-countyrevealedthat:

…Iwasalmostbecomingamadwoman,IlostmymotherwhenIwasvery

youngshewasabductedwasrapedandthenkilledandeversinceeverything

138

hasbeendifficultforme.EverytimeIrememberherIgetaterribleheadache

andIfeellikekillingmyselftoo.IwishedIwasdead.(41/26/01/A)

Afemalerespondentaged45yearsinBarlonyonarratedthat:

…In2003wewereattacked,theywereactuallyinsidemyhouseandordered

meout.ItriedtoranawaybuttheycaughtmeandtookmetoOcholiland

andtheymademecarrytheirloot.OnthewayIspilledsomethingbecauseI

wasverytiredandtheybeatmeupsobadlyandcutmyear.LaterIgotthe

opportunitytoescapethemandcamebackhere.In2004therebelscame

backagainandthesoldiersalsomadethistheirbarracks.Thesoldierstold

ustostayindoorsandsotherebelsburntourhouses.Manypeopledied,I

onlyescapedbecauseIfellondeadbodiesandhidthere.Itisafterallthis

thatIdiscoveredIcontractedHIV.OvertheyearssincethenIdidn’tsleep

much, I haddreamsand very vividmemories (flashbacks), and if I slept I

nevercouldsleepindoors.Icouldseebloodeverywhere,thewellsandwhen

it got toomuch I used to run through the village sometimes screaming.

(42/25/01/B-Ag)

Picture1:Aparticipantsharingherstorywiththerestoftheparticipants

Anotherfemalerespondent50yearsfromOgurrelatedthat:

….Ihadthreeboys,Ilosttwoduringthewarandtheirfathertoo.Myone

remainingsonsustainedsomeinjuriesandsoIamresponsibleforlooking

afterthegrandchildrennow.Therebelscameandattackedpeople inthis

side and burnt our houses and only those who were able to ran away

survived,buteventhenwewerecaughtandIsustainedinjuriesasaresultI

wasrapedtoo,todatemybodyisweakalloverasaresult.WhenIdropped

139

theluggage,theyhadmecarrytheytoremystomachopen,Ihaveagreat

cutacrossmystomachasaresult.SometimesIheartrucksrunninginside

myhead,Icanhearthings,Ithinkaboutmyhusbandandsonsallthetime.

(43/25/01/O)

Afemalerespondentaged46fromOgurnarratedsaid:

….from 2001 to 2006, we lived a very hard life, in 2001 our home was

attackedwerunawayandhidinthebushes.Wewereveryscared,wecame

backlaterbutwewerestillscaredandhadtosleepinthebush.Onthe18th

ofNov2002,wewenttocampaftermymotherinlawwasshotandkilled

wewereinthatcrowdedanddirtycampuntil2006.Andtherethechildren

sawmanythingstheyshouldn’thaveseen.InDecember2006,wecameback

andIhonoredmypledgetogivemylifetoGoduponmyreturn.Iprayeda

lotandthathelpsme,butIstillhadbaddreamsanduptonowIworrythat

the rebels will come back for example last month they were talking

massacres and that made me think about all that bad time we had.

(44/25/01/O)

Afemalerespondent50yearsfromAmida-Kitgumstated:

…Actuallyourtroublesgobackto1979atleast,duringEdiAmintime,we

havebeenexperiencingproblemseversince.Wehavehadnoexperienceof

peace…notmuchduringpresidentMuseveniyears itwas insurgenceand

LRA.Allweknowiscattleraids,abductionsofchildren.Ourearswerecut

off, our peoplewere killed and thenwe had to go to the camp.We lost

everything. The camp inmanywayswasworse than the insurgence.Our

movementswererestrictedandsowewereconfined.Wehadmeagrefood

supply,therewasalotofillnesses,andchildrendidn’tgotoschool.TheHIV

epidemicalsotookholdthen,spreadingveryfastwithmoredevastation.In

2008wemoved fromthemaincamptoasatellitecampwhichwasabit

betterwehadabitoffreedomthere,threeyearslaterwemovedbackhome.

Westartedsettlingback,settingupourhomesandreturningbacktothe

camp until everything is ready. We tried setting up associations and

140

groupingourselvessowesupportedeachother.Iwasreallyhappytobeback

homeaftermanyyears,butitishardtomanageahomeandchildrenand

accessingyourownmeansaftermanyyears.Ialsohadalotofanxietyand

used tobeeasily frightened,hadnightmares.Often times I felt like Iwas

backinthewarandusedtogetreallyfrightened.(45/26/01/A)

In the interviews, local leaders mentioned that unmanaged trauma among women had

negativeimpactstotheirparticipationincommunitydevelopmentprogramsandtheirsocial

life.Womenwhowereregardedbythecommunityandlocalleadersassufferingfromsevere

traumahardlyparticipatedinanygovernmentprogramandevenwhentheydid,thetrauma

wasseenasaffectingthebenefitoftheprogramtothem.Womenwithtraumahadproblems

gettingmarried becausemanymen in the community consider them ‘mad’ andmentally

unstable which is seen as an obstacle to manage a home. Thus, many of the severely

traumatizedwomen are singlemothers. They experience sexual abusewhile the violators

don’twanttobeassociatedwiththem.Thewomenremainunmarried.Somewomenendup

withwhattheydescribeas‘anymanthatcomestheirway’,outofdisparatesituations.

TheconditionofPost-TraumaticStressidentifiedintheImpactofEventsScaleisconfirmed

withtheinterviews.Thewomenreportnightmares,mentalandphysicaldiscomfortresulting

from thememories, desire topush thememories away, anxiety and traumatic triggers of

stress.TheanalysisoftheinterviewsconfirmstheassessmentoftheImpactofEventsScale,

that the women population in the Northern Ugandan districts included in this study are

suffering fromhighdegreesofpost-traumatic stress.The interviewsdemonstrate that the

pastisverypresentinwomen’slivesandthatthepresenceofthetraumainthepresentis

experiencedasaverynegativeholdonthewomen’slives.Thetraumaiskeepingtraumatized

respondentsinanegativeemotionalstate,causinganegativeprocessingofinformation.The

traumatizedemotionalstateprovidedalivingofthetraumaandfearfromthepastsituation

inthepresent.

These interviews were undertaken after the counselling programs by non-governmental

organizationsandgovernmenthadbeencarriedout.Theinterviewsshowthattheneedsfor

mentalhealthsupportisstillverymuchneeded.

141

Theinterviewspointtothefollowingproblemsemergingfromtheinadequatetreatmentof

traumaintheregion:

• TheimpactofsupportofferedthroughSocialProtectionprogramsarenotmaximizeddue

tothedetrimentalimpactoftrauma;

• The narrative-based counseling techniquesmay cause a problem of re-traumatization

throughthere-narrationcomponentofthecounselingmethodsused;

• Traumatized participants seemed to lack understanding of trauma and they lacked

methods to help control the negative emotions of fear and anxietywhen traumawas

triggered;

The stories of collective experiences of trauma within highly traumatized communities

appearedtosuggestapotentiallyhighlevelofcollectivetraumawithinthecommunities.

10.1.2. Theimpactofviolenceandbeliefsofspiritualpossessiononhealthandpoverty

The end of war does not necessary mean the end of conflict. While women who had

experiencedthewarreturninghome,hopingtoresurrecttheirlivesfromtheeffectsofwar

andstartinganewlifefreefromtheeffectsofwar,newviolenceemergedintheirlives.Local

leaders reported new challenges emergingwhich had further traumatizing effects on the

women.Manyinterviewsillustratethis.Thestoriesoftworespondentsaresharedhereto

illustratethispoint.Thesenarrativesillustratehowageneralcontextofextremepovertyand

neglecthasimpactedonthepsychologicalstateofthewomen,includingfeelingsofloneliness,

depression and powerlessness, including a sense ofworthlessness based on their gender.

Experiencesoflossandlackofcontrolhaveexacerbatedtheseemotions.Theimpactofbelief

systemsofspiritualpossessionisalsoillustratedinthenarratives.

Afemalerespondentfrom,Orungosub-county–Amurianarratedthat:

…Myentirelifehasbeenfullofmisery,soulandpain.Ilostmymotherwhen

Iwastwoyearsoldandlifehasneverbeeneasy.Ihavelivedalifeofhard

work, torture and suffering. Everywhere I go I am not loved and people

believeImovewithbadluck.Igotmarriedatanearlyagethinkingthatthis

willsavemebutinsteadIfoundmoresufferingwithaveryabusivehusband

whousedtobeatmeeveryday.Whenthebeatinggotworse,Idecidedto

runawayandstaywithmybrotherwholivesinKenya.Eventheremy-sister-

142

in-lawwasnotveryreceptive.Onetimeherdressgotlostandsheaccused

meofstealingit.Everythingbadthathappenedinthathouse(mybrothers’)

I was accused. One day I decided to fast and pray but my-sister-in-law

accusedmeofrefusingtoeatbecauseshewastheonecooking.Idecidedto

returntoUgandathoughmybrotherwasnothappythatIleft.Ineededto

liveandfindsomepeacebutstill Ididnotfindthatpeace.Wherever Igo

peoplepointfingersatmethatIcamebackwitha‘Genie(ghosts)’andthat

whoeverassociateswithmewillhavebadluck.Evenatchurch,thepastor

told thecongregation that Iwaspossessedandthatnooneshouldmove

withmeuntilIreceivecleansing.Itwasveryworsewithmyneighbors,no

onecametomyhomeevenifsomethingfellinmycompoundnoonecomes

topickitsincetheydon’twanttocomeclosetome.EvenwhenIamwalking

peoplekeepadistance.Ifeelsolonely,neglectedandabandoned.Onetime

Ifeltlikecommittingsuicide.(46/27/01/Or)

AnotherfemalerespondentfromOrungosub-county–Amurianarratedthat:

….Iwasforcedtogetmarriedtoamanwhoneverprovidedanythingforthe

home(beitfood,clothingormedication).Igavebirthtomyfirstchildand

hadthesecondoneduringtheinsurgencyinTeso.Unfortunately,thesecond

childdieda fewdays laterand Ihad to throwherbody in thepit latrine

becauseIhadnowheretoburythischild.Wewerealwaysontherun.After

awhileIfellsick,wasdiagnosedwithtuberculosisandspentnearly5months

on treatment and in hospital bed-ridden. On return, my husband had

marriedaboutthreewomenandrumorhaditthatonehadbewitchedhim

thuscouldnotfunctionsexuallyanymore.BeingafaithfulwifeIwantedto

staywithmyhusbandsinceIalreadyhadachildwithhim.However,after

some years I felt I needed to have a normal marriage and have more

children.Irequestedtobeallowedtofindanothermanbutmyhusbandand

his familyrefused. I latermovedonandfoundanothermanandwehave

seven children.However, I havenot hadanypeaceat heart. Thepain of

losingmychildandnothavinggivenheraproperburialhasalwayshaunted

me and is a heavy load that I carry every day and wherever I go. Even

143

community members are always pointing a finger at me, laughing and

emphasizethatIamnotofficiallymarried.Iamalaughingstockandhave

lostmyworth.IfeelIshouldtakemylife.(47/22/09/Or)

Women explained that untreated trauma has had devastating effects when it comes to

HIV/AIDS control in the northern region of Uganda. One of the local leaders noted with

concernthat:

…it is very difficult to control the spread of HIV/AIDS with traumatized

populations.Peoplewhohavelostthewilltoliveadoptsexualbehaviorsthat

put everyone in the community in danger. Parents who are traumatized

don’tcaretoprotecttheirchildrenandthuswehavealotofearlypregnancy

in our area ofwhichmany of the children are also now contractedwith

HIV/AIDS. Adult people sexually interact without any form of protection

which leads to spread of the diseases in the community rampantly.

(48/14/01/Ag)

Anotherlocalleaderexplainedthat:

…peoplewhoare traumatizedhaveaverynegativemind.Theydon’t see

anythingpositivefromthisgovernmentandareveryquicktocriticizeany

faults. Theydon’t respond todevelopment callswithin their communities

andaftermissingoutontheseprograms,theycriticizethosewhohavebeen

keentotakethemup.Theyremainstagnantinthecommunitywhichfurther

marginalize them and keep them in poverty conditions. They don’t care

aboutwhatleadersdoorsay.(49/20/03/U)

Thesearejustsomeillustrationsofthemanystoriesnarratedbythewomenrespondentsto

theresearchers,oftenheart-breakingstories.Focusgroupmeetingsandindividual

interviewsgaveanextensiveaccountofthewayinwhichthecommunitybreak-down

resultedinseverecyclesofviolenceandserioushealthproblems,especiallyregarding

HIV/AIDS.

Theimportanceofthesenarrationsisinthattheseclarifythatthegeneralcontextofpoverty

andpowerlessness(includinggender-basedlackofpower)factorintothesituationof

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traumaandprovideacontextinwhichhealingiscomplicatedbythecontextualchallenges.

Thecyclesofviolenceemergingfrompovertyandbeliefsystemsmakehealinghardinsucha

context.Theviolenceamongseverelytraumatizedcommunitiesisresultinginanincreased

exposuretotheriskofcontractingseverehealthproblems,suchasHIV/AIDS.The

consequencesofthecyclesofviolence,aggravatedbybeliefsystemsareelementsofa

povertytrap,thatprovideadifficultconditionforSocialProtectionprogramstosucceed.

Livinginthepast(secondwave)

ThisisareportofinterviewsthatwereconductedaspartofafieldstudyinJanuary2017.The

interviews followed a series of trainings given to women in Northern Uganda who were

suffering from severe trauma followingmany years ofwar and conflict in the region. The

interviewscomprisedofbothin-depthindividualinterviewswith29womenandfocusgroup

discussionsinthefollowingsites:Barlonyo(twosites),Ogur,AmidaandUsuk.

ThisisareportofinterviewsthatwereconductedaspartofafieldstudyinJanuary2017.The

interviews followed a series of trainings given to women in Northern Uganda who were

suffering from severe trauma followingmany years ofwar and conflict in the region. The

interviewscomprisedofbothin-depthindividualinterviewswith29womenandfocusgroup

discussionsinthefollowingsites:Barlonyo(twosites),Ogur,AmidaandUsuk.

The transcripts of each individual interview and group discussionwas analyzed under the

followinglabels:

I. Whentherebelscame• The traumatic experiences faced by the women, their families and

communitiesasaresultofthemanyyearsofconflictintheregion• Thetypesoflossandsufferingexperiencedbythewomen

II. Therebelswillcomeback• Theimpactsofthetraumaticstresssufferedbythewomen,theirfamiliesand

communities after the rebels left or theyescaped from them, including themanyyearsofuncertaintyintheIDPcamps

• SymptomsoftraumaticstressdescribedduringtheinterviewIII. Therebelsarenotcomingback

• Theimpactofthetraumasupport(training)onindividualstresslevels• Examplesofhealingwithinthefamily• Theexamplesofwidercommunityhealing

InthesectionsbelowIoutlinethefindingsoftheinterviewsundereachoftheaboveheadings.

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10.2.1. Whentherebelscame

Irememberthefirsttimetherebelscame,therewerenocampsthensowehadtohidein

thebushesitwasveryscary.Thesecondtimetheycamewehadcampssoweranthere.I

waseighteenyearsoldandwasmarried.Ilostmymotherin-lawwhoisoneofthepeople

buriedinthesegroundshere.(07/24/01/B(aged29))

The women described a wide range of extremely traumatic events and a lot of loss and

devastationassociatedwithnotjusttheimmediateimpactoftheconflictbuttheextremely

stressfullifetheyareleadingasaresultofthedevastationanditsaftermath.

About half of the women described the war years and particular incidences, while the

remaindereitherjustmentioneditinpassingornotatall(perhapsPTSDinducesavoidanceof

traumaticmaterial).Themostdominantthemeofthesedescriptionsisloss.

Lossoflovedones,lossofhealthandwell-being,lossofahomeandlossoflivelihoods.There

wasn’tasingleparticipantwhodidn’treportlossandwasn’tsufferingfromthedevastative

consequenceofthatloss.

Thosewhowereyoungatthetimelosttheirparentsatanearlyageandhavelivedwithno

onetakingcareofthemandcontinuetofeelthelossandabandonment.Arespondent(28)

fromBarlonyosaid:

Ihavefourchildrenaged10,8,4andone;aftersomuchtroublewithmy

husbandIlefthimandcamebacktothisvillage.Ilostmyparentsand

havenoonetotakecareofmeorthechildren(03/24/01/B)

AnotheronefromUsukdescribedhermultiplelossasfollows:

In1986therebelsattackedouthometheybeatandkilledpeople,they

tiedmyfatherupandrapedmymother,andtookmeandmysiblings

withthem,theyalsotook3sacksofgrainanddestroyedeverythingwe

had.(22/27/01/U)

DuringthefocusgroupdiscussioninAmida,aman(age35)said:

IlostmymotherwhenIwasveryyoungshewasabductedwasrapedand

thenkilledandeversinceeverythinghasbeendifficultforme.Everytime

146

IrememberherIgetaterribleheadacheandIfeellikekillingmyselftoo.

IwishedIwasdead.(16/26/01/A)

Thereweremanywhospokeaboutthelossofchildren,siblings,andhusbands.Eachofthese

lossesrepresentsnotjustthelossofalovedonebutalsothelossofstatusinthecommunity

aswellasprotectionmakingthedamageimmense.

Arespondentreportsgettingfeverishandcollapsingeverytimesherememberedthedead.

…myhusbandtoldmenottothinkaboutthedeadandaboutdyingall

thetimeashebelievedthatifyouthinkaboutthedeadalot,theydraw

youtothemandthatwaswhyIwashavingthefeverandcollapsing,I

justcouldn’thelpbutthinkaboutallthat,allthetime.(16/26/01/A)

Awomen,aged50,describedthelossofherchildrenandtheimplicationsofthatasfollows:

Ihadthreeboys,Ilosttwoduringthewarandtheirfathertoo.Myone

remainingsonsustainedsomeinjuriesandsoIamresponsibleforlooking

afterthegrandchildrennow.(08/24/01/B)

An elderly mother (aged 61) from Barlonyo described the enormity of the death of her

husbandwhowasillandbedriddensincetheendofthewar.

Myhusbanddiedandleftme20children,biologicalandadoptedallare

maleexceptone.Myhusbandwasillandbedriddenforalongtimeand

thenhediedandIusedtoworryaboutthefactthatIhadnoonetohelp

meafterhisdeath.Iusedtoalsothinkalotaboutthewaryearsandall

thepain.(04/24/01/B)

Otherscontinuedtomournentiregenerationsoftheirfamily:

Iusedtoconstantlythinkaboutthedeathoftheeldersanditwassuch

anevilthoughtthatdisturbedme.Itcausedmepaininthechest.Iused

to fight people a lot when I have those thoughts and I used to cry

rememberingmymum,myfatherandmygrandparents(Ayoung18year

oldmother02/24/01/B)

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Theotherbiganddevastativelosswasthelossofaplace,ahomeandthestatusassociated

withahomeandpieceof landthatonecancultivate.Thiswasdescribedboth intermsof

havingtoranawayinthechaosandthenhavingtogointotheIDPcampsthatweredescribed

asevenmoreharsherduetotheconstantproblemsofsecurityaswellasbasicprovisions.

InOgur,aWomen(46)describedherlifebetween2001and2006asfollows

From 2001 to 2006we lived a very hard life, in 2001 our homewas

attackedwerunawayandhidinthebushes.Wewereveryscared,we

camebacklaterbutwewerestillscaredandhadtosleepinthebush.

Onthe18thofNov2002wewenttocampaftermymotherin-lawwas

shotandkilledwewereinthatcrowdedanddirtycampuntil2006.And

there the children saw many things they shouldn’t have seen.

(09/25/01/O)

SimilarlyinOgur,anotherwomen(21)said:

Evenatthecampmanypeopledied.Mybrotherswerecaughtandwere

takenwiththem[therebels].Iwaswithmyparentsbutthenmyfather

waskilledbytherebels.Alotofpeoplekilledanditisdifficultnottothink

aboutthat.(12/25/01/O)

InAmidaarespondent(50)putsherexperiencesinthecampinthecontextofalonghistory

oflossanddevastationgoingbacktothe1979.

Actuallyourtroublesgobackto1979atleast,duringEdiAmintime,we

havebeenexperiencingproblemseversince.Wehavehadnoexperience

ofpeace…notmuchduringMuseveniyearsitwasinsurgenceandLRA.

Allweknowiscattleraids,abductionsofchildren.Ourearswerecutoff,

our people were killed and then we had to go to the camp.We lost

everything.

Thecampinmanywayswasworsethantheinsurgence.Ourmovements

wererestrictedandsowewereconfined.Wehadmeagrefoodsupply,

therewasalotofillnesses,childrendidn’tgotoschool.TheHIVepidemic

alsotookholdthen,spreadingveryfastwithmoredevastation.In2008

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wemovedfromthemaincamptoasatellitecampwhichwasabitbetter

wehadabitoffreedomthere,threeyearslaterwemovedbackhome.

(14/26/01/A)

Lossoflivelihoodwasanothertypeoflossthatwasaconstantthemeacrossthesites.Thiswas

particularly devastative for thewomenwhowere forced to return home to their families

emptyhandedwhenthecattlethatweretheirdowrywereraidedandlooted.InUsukmany

familiessuffereddoubledevastationastheywerenotjustaffectedbytherebelsbutalsoby

theKaramojawarriornomadswhoraidedtheircattleandlootedthem,duringthechaosof

theconflict.

ArespondentinUsuktalkedaboutwhathappenedtoherataveryyoungage.

In 1980 the Karamoja cameand raided our house and they killedmy

father,Iwasstillalittlegirlbutwastakenbythemandwasraped,many

peoplewereraped.Onthewayweranawayfromthemandsomegood

peoplehelpedusand tookas to themissionandwegota lotofhelp

there.Thingswereabitbetterforawhile,Igrewupandgotmarriedbut

thentherebelscametheretoo…(21/27/01/U)

Similarly,anotherwomenfromUsuknarratedthedoubledevastationasfollows:

Karamojasandrebelsbothaffectedmylife.Karamojastookallourcattle

includingthosethatweremydowryandsomyhusbandsentmeback

homeandmyparentssentmebacktohim.Meandmy5childrenwere

in limbobutthenmyhusbanddiedandIwentbacktomyfamilywith

threechildren,buttheydidn’tacceptmeandrefusedtogivemeanyland.

(23/27/01/U)

Thelootingandmateriallossaffectsprospectsforthefuturetoo,belowishowarespondent

describedit.

WhentheKaramojasattacked,andtookallourcowstherewasnothing

leftformyschooling(andthatofmysiblings).Theytookcowsandnuts

andchickensandleftusnothingatallandtheyalsousedus,asservants

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and we had to do all they asked. School and studying became an

impossibilityandIwasdepressed.(25/27/01/U)

Inadditiontoallthelossessufferedalongsidetherestofthecommunity,therewerespecific

gender-basedatrocitiesthatmanyofthewomensuffered,namelyrapeandabductionsfor

domestic and sex slavery. During the abductionsmany sufferedmutilations and physical

injuriesaswell as contractingHIVandother sexually transmitteddiseasesandunwanted

pregnancies.

Awoman(45)fromBarlonyodescribedherpredicamentasfollows:

In 2003 we were attacked, they were actually inside my house and

orderedmeout.Itriedtoranawaybuttheycaughtmeandtookmeto

Ocholi land and they mademe carry their loot. On the way I spilled

somethingbecauseIwasverytiredandtheybeatmeupsobadlyandcut

myear.LaterIgottheopportunitytoescapethemandcamebackhere.

In2004therebelscamebackagainandthesoldiersalsomadethistheir

barracks.Thesoldierstoldustostayindoorsandsotherebelsburntour

houses.Manypeopledied,IonlyescapedbecauseIfellondeadbodies

andhidthere.ItisafterallthisthatIdiscoveredIcontractedHIV.Over

the years since then I didn’t sleepmuch, I had dreams and very vivid

memories(flashbacks),ifIsleptInevercouldsleepindoors.(09/24/01/B)

A respondent (50) also from Barlonyo had her stomach cut open as a punishment for

droppingthingsshewascarryingforthelootingrebels.

Therebelscameandattackedpeopleinthissideandburntourhouses

andonlythosewhowereabletoranawaysurvived,buteventhenwe

werecaughtandIsustainedinjuriesasaresult.Iwasrapedtoo,todate

mybodyisweakalloverasaresult.WhenIdroppedtheluggagethey

hadmecarrytheyslitmystomachopen, Ihaveagreatcutacrossmy

stomachasaresult.(08/24/01/B)

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10.2.2. Therebelswillcomeback

InDec2006wecamebackandIhonoredmypledgetogivemylifetoGod

uponmy return. I prayed a lot and that helpsme, but I still had bad

dreamsanduptonowIworrythattherebelswillcomebackforexample

lastmonththeyweretalking[about]massacresandthatmademethink

aboutallthatbadtimewehad(09b/25/01/O)

Evenmanyyearsaftertheeventsdescribedabovenearlyallthewomeninterviewed,were

sufferingfromarangeofsymptomsthatindicateposttraumaticstressdisorder(PTSD).The

tablebelowliststherangeofsymptomsdescribedbythewomen.

Thesesymptomsaffectedthewholefamilyincludingchildrenwhoweren’tbornorwereto0

youngtoactuallyremembertheeventsthemselves.

Thechildrenwereworriedtoo,theyusedtosaythattherebelsarestill

outthereandtheycancomeanytime.Onedaymygirldreamtthatthey

had actually come back and came into the house and she started

screaminginterror(10/25/01/O(aged44))

Table10-1.SymptomsdescribedbythewomeninterviewedonTrauma(seesection4.9.2)

PTSDSymptoms Description

Hyperarousal

Physicalreactions Whenanxious,myheartbeatsfast(12/25/01/O,21,fromOgur)

Reducedtolerancetonoise When I hear loud noise that sounds like gun shots I go into a panic

(11/25/01/O,48,fromOgur)

Panicattacks

depression

Ialsohadalotofanxietyandusedtobeeasilyfrightened,hadnightmares.

OftentimesIfeltlikeIwasbackinthewarandusedtogetreallyfrightened

(14/26/01/A,50,fromAmida)

Difficultyfallingorstaying

asleep

Ididn’tsleepmuch,Ihaddreamsandveryvividmemories(flashbacks),ifI

sleptInevercouldsleepindoors(09/24/01/B,45fromBarlonyo)

Difficultyconcentrating Iwasforgetful,mymemorysincetheproblemswehadherewasn’tsogood

(01/24/01/BfromBarlonyo)

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ButevenherewewereworriedIusedtoimaginethatonedaytherebels

wouldcomebackagainmaybefromBarlonyo.Thechildrenwereworried

sick too, theywantedtostudyanddogoodatschool,but theyweretoo

unsettled(11/25/01/O,48,fromOgur)

Beingeasilymovedtotears Icriedalot,Icriedallthetime(17/26/01/A,45,fromAmida)

Angeraggressivebehavior Iwasveryshorttemperedandquarreledalotwithpeople(17/26/01/A,45,

fromAmida)

Tensingofmuscles IwassoangryandIwouldfeelmymusclestense(21/27/01/U,fromUsuk)

AvoidanceandNumbing

Frequent periods of

withdrawal

Ihavealotofworriesandmanyproblemsthatmakemesad(03/24/01/B

28,fromBarlonyo)

SincelongagoIusedtoalwaysgetpreoccupiedwiththoughtsofthewar

and sometimes dream about being back there and dream about all the

peoplewhodiedthere(12/25/01/O,21,Ogur)

Inability to remember

important aspect of the

experience

Mymemoryisn’tgoodasItendtoforgetthingssincethewarandallmy

injuries(08/24/01/B,50,fromBarlonyo)

Re-experiencing

Flashbacks Icouldseebloodeverywhere,thewellsandwhenitgottoomuchIusedto

run through the village sometimes screaming (09/24/01/B, 45 from

Barlonyo)

WhenIdroppedtheluggagetheyhadmecarrytheyslitmystomachopen,

Ihaveagreatcutacrossmystomachasaresult.

SometimesIheartrucksrunninginsidemyhead,Icanhearthings,Ithink

aboutmyhusbandandsonsallthetime(08/24/01/B,50,fromBarlonyo)

andfelt likesomeonewascallingmynameevenwhentherewasnoone

(17/26/01/A,45,Amida)

152

EverytimeIamstressedIseethemutilatedbodyofmyfather(23/27/01/U,

22,fromUsuk)

Nightmares Iusedtoalsothinkalotaboutthewaryearsandallthepain.Runningfrom

placetoplacelosingalotofpeopleandalsolosingyourplaceandhome.I

used to get bad dreams and sometimes flashbacks it was frightening

(04/24/01/Bandelderlywomanof61fromBarlonyo)

Afterwecameback Iused tohavenightmaresaboutburninghomesand

beingchased.Iusedtogetworriedthattherebelsarecomingandfearalot

(10/25/01/O,44,fromOgur)

Feelings of intense distress

whenremindedoftrauma

Iusedtoconstantlythinkaboutthedeathoftheeldersanditwassuchan

evilthoughtthatdisturbedme(ayoungmotherof18years,fromBarlonyo

)

IusedtoalsoalwaysthinkabouthowIhavelosteveryoneandwasonlyleft

withmyhusbandandourchildren.Thatusedtoputmeintothisdeepmood

thatwouldstaywithmeallday.(04/24/01/B,35Barlonyo)

Othersymptoms

Feelingsuicidal Iwasalmostbecomingamadwoman, I lostmymotherwhen Iwasvery

young she was abducted was raped and then killed and ever since

everything has been difficult forme. Every time I remember her I get a

terrible headache and I feel like killing myself too. I wished I was dead

(16/26/01/A.35,Amida)

Mylifehadalotofstressandstresstookovermylife,Ioftenthoughtabout

killing myself but worried about how much worse it would be for the

childrenifIdidthat(24/27/01/U,fromUsuk)

Exhaustion wewerecaughtandIsustainedinjuriesasaresultIwasrapedtoo,todate

mybodyisweakalloverasaresult(08/24/01/B50,fromBarlonyo)

Physicalachesandpain Iusedtohavevividdreamsaboutthosetimesandusedtoalsogetavery

sharppaininmychest.(07/24/01/B,29fromBarlonyo)

Ihadaconstantheadache(17/26/01/A,45,fromAmida)

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ResultsofSHLCPTSProgramReportedbyParticipantsThis section presents the results of the SHLCPTS program. In this chapter interviews are

presentedtoillustratetheexperienceoftraumainthecommunityaftertheimplementation

oftheSHLCPTSprogram,reportedinrelationtothephasesofimplementationoftheprogram.

Outcomesofinterventionsessions

11.1.1. Breathingexercises

Trainersthenintroducedtheparticipantstothebreathingtechniquesandtookthem

throughtheexercise.Theparticipantsdidaboutfourroundsofbreathingexercisefollowed

byasmallbreakofaboutfiveminutesinbetween.Afterabout30minutes,theparticipants

wereaskedtorevealhowtheyfeltaftertheexercisetheygavesomeofthefollowing

comments;

• Icamewithbodyaches,butInowfeelmuchbetter

• Icamewithheadache,butIfeelrelivednow

• Icamefeelingemotionallybad,butnowIfeelmuchbetter

• Iwasfeelingaheatburn,butnowit’sgone

11.1.2. Safeplaceandbilateralstimulation

Thegroupslistenedtoarecordingonsafeplaceandbilateralstimulationandaftersharedas

below:

• They appreciated the butterfly hugs as the enable one feel comforted,lovedandknowthattheyarenotalone.

• Thebreath-inandoutexerciseasagoodmechanismforrelaxingandthecomfortablesittingwhichenablesbloodflow.

• Thesafeplaceshelpingonefeelsafeandforgetabouttheirproblems.

• Theimportanceofforgivenesswhichleavesthepersonrelievedandlightatheart.

154

Photo:Participantsexercisingasafecalmplace

Photo:Participant’sexercisingthebutterflyhug

Afterthetrainingincalmandbilateralstimulation,participantssharedtheirexperiences

duringinthenextsessionsandsomeofthesearecapturedbelow;

AfemalerespondentfromNgariumnarratedthat:

I had a problem in my family last week. My elder son had taken off with

someone’sdaughterandtheyoungsonhadalsomadesomegirlpregnant.As

if that wasn’t enough my daughter had gone to report the father at child

protection unit for failing to pay school fees.When I went home after the

traininglastweek,firstofallIwasconfusedanddidn’tknowhowtoproceed.

Earlythenextmorningthepeopleofthegirlthatmysonhadmadepregnant

camedemandingdowry.IwasdisturbedalotbutgoodenoughIhadattended

155

thetrainingsosherememberedapplicabilityofbreathingtechniqueandsafe

calmplace.Isatinsideherhousecontemplatingcommittingsuicidebutthen

sherememberedwhatshehadlearntduringthesessionsandwentinsideher

housetopracticethebreathingtechnique.IsleptandwhenIwokeupIknew

exactlywhat todo.The traininghadgivenmecourageandthus, Igathered

elderstohelpmeresolvetheconflict.Italkedtoherapparentin-lawsandseta

proper date formeeting themand finallywent to family protection unit on

behalf of her husband and promised she would take her daughter back to

school.Allinalltheexercisecalmedmedownandguidedmydecisionmaking.

(50/21/09/N)

AfemalerespondentfromBarlonnyostated:

At this beginning of this week, something happened that upset me so much. I was

on my way to well when I found one of the ladies with whom we have had some

misunderstandings. This woman abused me so much that I thought I should to

fight her. I decided not to fight her but she kept on provoking me. I decided to

ignore her and move up to the way to bring water to my home. But the anger in

me was boiling like food on fire. I decided to go back to the well to fetch more

water and on that day, I went back to the well until I even almost filled all the

cups at home. When I realized that I did not have any other place to pour the

water, I entered the house and locked myself in. I cried for such a long time that

my children got so concerned and started knocking the door terribly for me to

open. All along, it had not occurred to me that I could use the breathing

exercises to feel much better. When my children insisted on knocking the door,

I realized I needed to do something to cool down. Then it occurred to me that I

could actually do the exercises we were taught. So I did the breathing exercises

and after doing around four rounds of breathing exercises, I decided to also go

to my calm place and I felt much relaxed. I opened the door and all my children

were asking me what happened. I felt so relaxed that I did not want to go through

the stories again, so just continued with my day’s chores. I even did not find it

difficult later to sleep in the night as it has been all along after such incidents. I

am grateful to the training. (51/01/09/B-Ag)

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AnotherfemalerespondentfromBarlonnyoaddedthat:

I have been haunted by the memories of the massive killings that happened

in our village (Barlonnyo Village houses the massive grave where 121

people were killed at once and buried in a mass grave at the site where we

meet). I have been feeling very much sad and I would not stop thinking about

it. Sometimes when I would be moving around the village, I would get lost

in these thoughts and find myself stopping suddenly when am going

somewhere. But since I started the doing the exercises, I have overcome

these memories and all the bad feelings. I feel much happier now than

previously. (52/25/08/B-Ag)

11.1.3. Subjectiveunitsofdistress(SUD)

TheparticipantsweretheninvitedtoundertakeaSUDrankingeveryafteratrainingsession

withrankingstartingfrom1-10.Afterthefirstsession,therankingsweremadeasafollow-

upoftheprevioussession.

SpeakingaboutSUD,afemaleRespondentnarratedthat:

BeforethetrainingIwasforgetful,mymemorysincetheproblemswehad

herewasn’tsogood,butnowIamnotasforgetfulasIusedtobe.MySUD

duringthetrainingwas5-6atthestartandthenitcamedownto1-2,Ithink

Ihavestayedat1or2sincethentoo.Thebreathingexerciseshelpalot,I

havebeenbreathinginandoutandithelps.AlthoughIhavenottakenany

medicationforitthepaininmychestisnowgone.PeopleaskmewhyIsmile

alotandalsohowImanagedtochangemyselflikethis.TheynoticethatI

washandlookaftermyselfbetterthesedays.Ihavetaughtthebreathing

andkneetappingtomyfamilyandtheysayitworkstoo.(53/25/01/B-Ag)

11.1.4. Useofskits

Theillustrationsofthesessionswasdonewithuseofstoriesandskitsthatwereorganized

bythetrainersdependingonthesession.Theseskitshelpedthatpeopletoidentify

themselveswiththerealitiesaroundtheirdaytodaylifeandhowthisimpactedontheir

157

psychologicalbehaviors.OneoftheexamplesoftheskitusedinthetraininginArungoSub

Countyiscapturedherebelow;

Posterweresharedwithdifferentlabelssuchas:‘Family’;‘LocalCouncilleaders’;

‘Government’;‘Defiler’;‘Landgrabber’;‘CivilSociety’and‘clanleaders’.Theparticipants

werethenencouragedtoeachchoosethecategorytheywouldwishtobelongto.Theplay

rolledoutasbelow:

Thefamilywasforawidowedwomanwhostruggledtolookafterherthreechildren.One

dayadrunkardyouthdefiledheryoungestdaughter.ThefamilyrushedtotheLocalCouncil

leadersbutthecasekeptdraggingandwhentheyreachedouttotheclanleaderstheyjust

addedinjuryastheyremindedthewidowtoleavetheirson’slandwithherchildren.When

thelandgrabberscamehomethefamilystillreachedouttotheLocalCouncilleadersand

whentheywerenotfullyhelpedtheyreachedouttogovernment.Duringthatsameperiod,

acivilsocietyorganizationvisitedthecommunityeducatingthemonissuesofrightsand

traumahealing.Thefamilywasverygratefulforthisinformationandthehealingintroduced

tothem.Theywerealsoencouragedtocontinuouslyengagethedecisionandlawmakers.

11.1.5. Whattheparticipantslearntfromtheskit

1) Landgrabbingisnotverygoodasitdeprivesthewidowandherchildrenahomeandplaceforgardening.

2) Theabuseofwidow’srights.

3) Traumacausedtothewidowwithallthesuffering.

4) The torture andunfairnessof the in-lawswhowant to takeoverpropertyof theirdeceasedson.

5) Theslowreactionfromthelaw.

6) Theimportanceofengagingvariousstakeholders.

7) Thegroupwasadvisedonissuesofrightssuchaslandgrabbing;childprotection,andengagedtouselawtoaddresstheseissues.

8) Thewidowwasalsoencouragedtolearntoforgiveandforgettoliveapeaceful,fruitfulandtraumafreelife.

9) Neighborswereencouragedtobehelpfultosuchfamiliesastheyaregrieving,theyshouldtrytobeclosetothemtohelpthemovercometheirsoulandtraumas

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11.1.6. Communityevent

Participantsstillweregivenanopportunitytosharetheirexperienceswiththewhole

communitywhichwasalearningexperienceandachanceforthosewhodidn’tattendthe

sessionstoclearlyunderstandwhattheprojectwasallabout.Theseweredonein

collaborationwithcommunityleadersandfamiliesofthosewhohadbeentrained.A

certificateofparticipationwasissuedtotheparticipantsofthetrainingwhichtheyreceived

alongwiththeirfamilymembersandfriends.Thephotobelowshowsagroupofparticipants

fromUsukSubcounty-KatakwiDistrictduringtheircommunityeventsessions.

Photo:ParticipantsfromUsukabouttoentertaintheirguests

b)CommemorationofBarlonyoAttack

Barlonyomeaning"fieldofwealth"inLuo,isavillageinnorthernUgandanearLiratown.

Manyofitsresidentsareinternallydisplacedpeople(IDPs)frommanypartsofnorthern

Uganda.Theareaisoneoftheworsthitbythe20-yearofLRAinsurgency.ItisinLiraDistrict

about45-minutedrivefromLiratown.OnFebruary21,200Barlonyobecamethesiteofa

massacre.LRArebelsattackedfromdusktodawnkillingover300peopleaccordingtothe

localresidents(121people,accordingtotheofficialfigureonthememorialmarkstone).

Thismemorialsitewasthesiteofthisfieldstudyaswellasthesitewherethetrauma

supporttrainingwasprovidedtowomenfromthearea.

LiraDistrictLocalGovernmenttogetherwithDevelopmentPartnersworkingintheDistrict

organizedtheaboveannualeventonTuesday21stFebruary2017atBarlonyoWarmemorial

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site,AgwengSubCountyLiraDistrict.Thememorialprayerswasattendedbyanestimated

1500peopleincludingmen,womenandchildren.TheParticipantsweredrawnfromDistricts

ofLira,Alebtong,Katakwi,Amuria,SorotiandKitgumamongothers.Thethemeoftheyear

was“SocialProtectionandTraumaHealingforEmpowerment.”Theeventwaspresided

overbytheStateMinisterforInternalAffairsHon.ObigaKania.Duringthisevent,the

womenfromalltheregionsmettosharewitheachtheexperiencestheyhadderivedfrom

theinterventionaspartofthecelebration.WomencarriedmessagesofhopeontheirT-

Shirtsintheirlanguagesaspartofcommunitydisseminationofwhattheyhadlearnfrom

EMDRlightTreatment.Themessagesweretranslatedfromaphrase“Ihavelearnttoheal

myself,cometomeforhelp”.Fortheexample,theT-ShitsinAtesoread:“EsisiaNgo

Aisinapikinaomisiokaobiamamaajaiengarak”.

ImpactofSHLCPTSprogramonthefamily

Theinterviewscarriedoutaftertheinterventionshowedpositiveimpactonthelivesofpeopletraining,theirfamiliesandcommunityatlarge.

• Increasedself-esteemandsocialparticipation

• Decreaseindomesticviolenceandcommunityconflict

• Increasedabilitytoaddressconflicts

• Desiretocontinuetheself-helpexercisesandregularuse

• Trainingandcoachingofothermembersofthecommunity

• Requests from other members of the community and family members (includinghusbandsandmeningeneral)tobeincludedintheresearchaswell

Individualpersonalstoriesaresharedhereforillustration;

Ayoungmotherof18Yearsnarratedthat:

The deep breathing and eye movement exercises I remember the most.

BeforethetrainingIusedtoconstantlythinkaboutthedeathoftheelders

anditwassuchanevilthoughtthatdisturbedme.Itcausedmepaininthe

chest. Now when I start drifting to the thought about death I do my

breathingandeyemovementswithmyfingeraguideanditcalmsmedown.

BeforeIusedtofightpeoplealotwhenIhavethosethoughtsandIusedto

cryrememberingmymum,myfatherandmygrandparents.NowIfeelIam

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stronger thanbeforeand Idon’t fightwithothersor cryasmuchwhen I

remembertheelderswhodied.(54/25/01/B-Ag)

Ayoungermotherof21Yearsalsonarratedthat:

…SincelongagoIusedtoalwaysgetpreoccupiedwiththoughtsofthewar

and sometimes dream about being back there and dream about all the

peoplewhodiedthere.Ilostmanypeople.Evenatthecampmanypeople

died.Mybrotherswerecaughtandweretakenwiththem[therebels].Iwas

withmyparentsbutthenmyfatherwaskilledbytherebels.Alotofpeople

killedanditisdifficultnottothinkaboutthat.Thetraininghelped;theknee

taps, butterfly hugs and eye movement all helped. And the breathing

exercisestooarehelpful.WhenIgetanxiousandmyheartisbeatingfastI

dooneofthemandcalmmyselfdown.IamveryhappyandIdon’tcryas

muchIfeelfreeandIdon’tworryasmuchasIusedto.Nowthefeelingof

happinessand freedom is thereevenwhensomethingbadhappens I can

staycalmandfreeeventhen.Ilivewithmymotherinlawandsheseesthe

difference, I don’t quarrel with her much anymore. We have a better

relationshipnow.Myhusbandaswell,wehavestartedsharingeverything

witheachother.(55/25/01/B-Ag)

Anotherfemaleparticipantaddedthat:

…Ihavebeenhauntedbythememoriesofthemassivekillingsthathappened

inourvillage(BarlonyoVillagehousesthemassivegravewhere121people

werekilledatonceandburiedinamassgraveatthesitewherewemeet).I

have been feeling verymuch sadand Iwould not stop thinking about it.

SometimeswhenIwouldbemovingaroundthevillage,Iwouldgetlostin

these thoughts and find myself stopping suddenly when am going

somewhere. But since I started the doing the exercises, I have overcome

these memories and all the bad feelings. I feel much happier now than

previously.(56/15/09/B-Ag)

TheSHLCPTSprogramreceivedbythewomenwhoparticipatedinthisstudydidnotonly

haveanimpactontheirstateofmind,butratherthewholefamilyinsomecasesbenefited

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fromthechangesthatwerehappeningtotheirwives,sistersanddaughterinlaw.The

membersoftheirfamilieswereabletonoticethechangesinbehaviorsandreactionswhen

theywereupset.Afewwomenreportedtothattrainedtheirownchildrenandhusband

usingtheSHLCPTSexercises.Duringthefocusgroupdiscussionswomensharedtheirown

experienceswithintheirhomes.Thesewerealsosupplementedbythehusbandsandother

familymembersduringthesixsessionwhenthetraineesinvitedthemtoparticipateinthe

communityevent.Someoftheparticipantsinthisstudysharedtheirstoriesbelow.

AyoungermotherfromBarlonyo(whocamewithuncombedhairwithuncleanbabyduring

herfirstthreeweeks)hadthistosayduringthefirthweekofthetraining;

…WhenIcamefortrainingduringthefirstweek,Ididnotunderstandwhat

was taught. When I returned during the second week, I heard women

sharingthattheyhadseenchangesintheirbodiesbecauseofthebreathing

exercises.IhavebeenbattlingwithheadacheforaverylongtimeandIhad

triedall themedicines,butwithoutmuchhelp.This continuousheadache

could not allowme to combmy hair and even cutting it offwas equally

painful.Afterthesecondweek,whenIwenthome,Imadeitapointtotry

out thebreathingexercisesbymyself. I felt some reliefand repeated the

exercises when I was going to sleep. Since then, I can now sleep more

comfortablyastheheadachedisappeared.Icannowcombmyhairandalso

realized I learnt that keeping myself clean is important as my husband

commentedthatthetraininghaschangedmealot.LastFriday,twowomen

frommyknighthoodwhereinvolvedinthefightandIintervenedtostopthe

fight.TheyrespectedmeandIsatthemdowntotrainedthemthebreathing

exercisesandbythetime I left, they feltbetterandrequestedthat I take

themtothetraining.(57/25/08/B-Ag)

Oneofthefemaleparticipantnarratedthat:

…Iamsogratefultothepersonwhoinventedtheideaoftheseexercise.I

havebeenhavingfightswithmyhusbandforsometimeandeveryoneinmy

village knows that. But lastweek after the training, Iwent homeandas

usual, my husband started his fights. I was so annoyed that I started

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contemplatingifIcanattackhimandwefight,butIrememberedwhatwe

weretaught, Ientered intothehouse,didmyexercisesand Iwasableto

overcometheanger.IcameoutandpassedhimwhenIwasveryquietand

resumedmywork.ThatnightIdidthebreathingexercisesbeforeIwentto

sleepandIamsohappythatIwasabletosleep,whichhasnotbeenthecase

previously.Sincethen,wehavenothadafightwithmyhusband,becauseI

havelearnttomanagemytempers.Myhusbandcouldnotbelievethatwere

notfighting.Mymotherin-lawisveryhappythatfinallythereispeaceinmy

home.(58/01/09/0)

Anotherwomanalsomentionedthat:

…Iammarriedandliveclosetomymotherinlawshome.Mymotherinlaw

stayswithsomegrandchildrenwhobelongtomysisterinlawwhoismarried

somewhereelse.Shealsousedtoabusemefromtimetotimeandshekeeps

oncallingmeafailurewhomhissonhelpedtomarry.Afewweeksback,I

wenttomygardenonlytofindthatchildrenhaduprootedmycassavayet,I

hadalsosentthemcassavaathometocook.Iwassoannoyedanddecided

togoandspeaktomymotherinlawaboutit.Whenshesawmecoming,she

enteredherhouseandrefusedtocomeouttospeaktome.WhenIreturned

home,myhusbandhadalsocomehomeandItriedtoexplaintohimwhat

hadhappened.Heneveransweredanythingbackandalsorefusedtogothe

gardentoseethedamage.IwassoannoyedthatIwentintothehouseto

cry. I cried for some time, but later remembered the exercises. I did the

breathingexercisesandalsowent tomy safe clamplace.Afterawhile, I

cameoutofthehousefeelingmuchbetterandwasalsoabletoovercome

the anger. I went out and resumed my duties. My husband noticed the

changeandcalledmetoaskmewhyIwasnotoverreactingasIusuallydo

andIdidnotevenhavetheenergytoexplaintohimanymore.Ihavelearnt

tokeepquietandignorethechildrenandthemotherinlawbecauseofthe

exercisewhichhelpkeepcalmallthetime.Sincethen,bothmymotherin

lawandhusbandhavefoundoutthatIlearntthisangermanagementfrom

here,sotheyaskedmetotrainthem.(54/25/01/B-Ag)

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ImpactofSHLCPTSprogramontheircommunities

Thewomenwhoparticipatedappreciatedthetechniquestheylearntfromthistraining.The

womenexpressedthatknowledgeinapplicationofthetouchstonememoriesandsafecalm

placeastraumahealingtechniquepresentedthemwithskillsthattheywouldsharewiththe

restofthecommunitywiththosepeoplewhomtheywouldidentifywithtraumasymptoms.

Theyalsosaidtheywereusingthetraumahealingtechniquesathomeforthemselves,used

ittohelpotherfriendsandmembersoftheircommunities.Goingbacktothecommunities

aftersixmonthsaftertraining,thiswhatafewrandomlyselectedsampleofparticipantshad

tosay.

Arespondentexplained:

…Ilostmytwochildrentosicklecellsaftertheendofthewar.Theywere

everythingthatIhadinmylifeandeveryoneinthevillageknewhowmuch

I loved them.Whenmy last child, I was emotionally broken down and I

almostbecomemad.Ichangedcompletelyandadoptedacultureoffighting

withwhoeverannoyedorrebukedme.Anyonewhowoulddoanythingto

remindofmychildrenwouldfaceitroughwithme.Iwenttothemarketand

boughtanewtrouserwhichIusedtoputonwhenamgoingtofight[lifting

upandpicturesofherchildren]andeveryoneinthisvillageknowsthesetwo

items.Imovearoundthevillageputtingonthistrouserandeverybodyknew

whatIwasupto.Iwanttothatthepeoplewhobroughtthistrainingbecause

theyrescuedmylifefromfighting.IwanttotellthiscommunitythatIhave

decided to hang my photo to the wall in my sitting room, because the

traininghelpedmetoovercomethemanytearsIcriedforthem.Everyonein

this community is surprised thatweeks have passedwithout hearingmy

fights.Ihavesharedwithmanywomeninmyfamilythetechniquesofthe

trainingandmanyofthemarehappyaswell.Ihavealsocometotellthe

peopleinthiscommunitythatIwillneverappearinthecommunitywearing

thistrouser.[Thereisaloudapplausefromtherestoftheparticipantsinthe

training](58/01/09/O)

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DuringthecommunityeventinOgur,theCommunityDevelopmentOfficernotedthatthere

isalotofimprovementinthebehaviorsofthewomeninvolvedinthetrainingandhe

commentedaboutMatilda’stestimony;

…WewanttothankMbararaUniversityofScienceandTechnologyandtheir

partnersforbringingthistraininginOgur.Womeninthiscommunitywho

havebeentrainedhavechangedalot.IfyougetareportthatMatildahas

notfoughtinmorethanaweek,youaresurethatthistraininghasbeena

changingfactor.Werequestthatmorewomenaregivenanopportunityto

betrainedforasustainedpeaceinthecommunity.Irequestthatthosewho

havebeentrainedtryasmuchaspossibletotrainothersasthemessageon

yourT-shirtsreads.(29/14/01/0)

Oneofthefemaleparticipantwhowasateachernarrated:

…BeforethetrainingIwassoangryandIwouldfeelmymusclestenseupso

muchandbegintohurt.ButnowIamnotveryangryanymore.Itellmyself

allthetimethatIamactuallyabletohandlemydifficultiesifIstaycalm.I

don’tfirstgotofightandquarrelwithpeople,Icalmmyselfdownasmuch

asIcanandthengoandsortoutwhateverneedssortingout.Ihavetrained

myfellowteachersandtheywereamazedIknewthesetechniques.Wehave

also taught some of these techniques to the children at school and the

childreninmyfamilytoo.Mychildren’seatinghabitshaveimproved,now

theyeatbetterandarehealthier.(60/27/01/U)

Kot(notrealnames)(theoldestmembersofthegroup)hadthistosaytothecongregationatBarlonyodissemination:

…Duringthethirdmeetingoftraining,Iwenthome.Afterdoingthetouch

stonememoryIwasfeelingveryemotional.WhenIwhenIwenttosleep,I

had this dream,where two tortoiseswere chasing afterme. I have been

havingsuchthreateningdreamsforquiteanumberofyearssincethewar

endedandwecamebackhome.Iwassoscared,sowhenIwokeup,Iprayed,

butcouldnotfeelanydifference.Ihadneversharedmystorywiththerest

ofthewomeninthepasttwoweeks.Ididnotunderstandtheknowledgewe

165

werereceivinghadpowertohelpovercomesthesedreams. I thoughtthe

stories women were sharing were based on minor problems that had

experienced. I remembered theexerciseand the testimoniespeoplewere

givinganddecidedtogivethematry.However,Idecidedtogivemyselfa

chancetodotheexercisestofindoutiftheywouldhelpmetoo.WhenIdid

thebreathingexerciseandbutterflyhug,Istartedfeelingmuchbetterand

beforelong,Istarteddozing.Iwasabletosleepandsincethatday,Idothe

exercises before I go to sleep and since then I have not experienced any

scaringdreams.MyneighborstellthatIhaveputonweightandlookingvery

good.Theyhavesuggestedtofindformeahusbandtowedmeinchurch

[Laughsoutloud].NowIwanttogotoKampala,toseeitwithmyeyesand

afterthatgobacktoschool.Idon’twantanyoneinthiscommunitytoworry

aboutmeanymore.(61/25/08/O)

Duringthetraining,thetrainerscounselledwomenonsomeofthebasicsofhome

management.Theywouldencouragewomentotakeonmoreproductiveworktoimprove

ontheirincome.Womenwereencouragedtosparemoretimetotakecareofthemselves

andencouragedyoungmotherstoensurethattheydotheirbesttolookafterthechildren.

Thetrainerswouldputemphasisonthewomen’soutlookandexplainedhowthiswas

equallyimportantfortheirhealingprocess.Thetrainersemphasizedthatthecommunity

wouldbeabletorelatewiththeirrecoveryiftheyareabletonoticesomechangesintheir

lifeandalsothiswillhelpthemtoactaschangeagents.

DuringthedisseminationmeetinginBarlonyooneoftherespondentssharedthat;

…WhenIreturnedfromthebush,everyoneinthiscommunitythoughtthatI

was actually mad. The excommunicated me from many political and

economicprograms in thiscommunity. Ineverusedtocombmyhairand

sometimesIwouldnotwashorbotheratall.Iwentthroughadifficultlife

beingknowntobemadwhichtraumatizedmecompletely.Myexperienceis

not so different from the rest of the girls who were abducted, but my

scenario was quite different. Everywhere I passed, the children would

scream, “there she comes AK themadwoman. Butwhen the studywas

brought to my village, I was invited to participate in this because they

166

neededwomenwhowere known to be traumatized. Fortunately,my life

changeddrastically.Istartedwashingandcombingmyhair.Everyoneinthe

communityasksmewhathappenedandwhenItellthemaboutthesemagic

exercises.Ican’tbelievethatthatAK(referringtoherself)inmysimplelife

couldbecomesuchausefulpersontomycommunity.(62/21/02/B-Ag)

Impactoftrainingonperceptionsofwomen’shealthandwellbeing

Duringthetrainingandafterthetraining,manywomenexpressedthattheexerciseswould

resultinreliefonsomeofhealthchallengestheyhavebeenfacing.Theserangedfrom

simpledailyheadachestomorecomplexchronicpainproblemsthatwomenhadsuffered

fromforalongatime.

Afemalerespondentwhoexperiencedheadachesharedthatshehadstartedtolookafter

herselfandreportedthatshehadamuchgreatersenseofwell-being:

Iammarriedtoamanwhodrinksquitealotandhecomeshomelatealmost

everyday.IreachedapointtoleavethedooropensothatIdon’thaveto

wakeuptoopenforhim,butstillhebangsthedooruntilyoufeelyourheart

id dropping out. I have been nursing this anger for a long time and I

developedaheadachetothepointIcouldnotcombmyhair.SometimesI

wouldnotevenbother.Ihavebeensoannoyedwitheverythingthathappens

aroundme.WhenIcamehere,Ididnotevenbothertounderstandwhatwas

being taught in the first week. During the second week, the recordings

playedandtheexerciseswedidthatday,mademefeelbetter.SowhenI

wenthome,Itriedthemonmyownandrealizedtheywereindeedhelpful.I

havetriedthemseveraltimesandmylifehasgreatlychanged.Ihavebeen

abletocombmyhairafteralongtimeandIhavealsosmearedVaseline.I

nowevenbatheseveraltimesaday,sometimeseveninthemorningbefore

I go the garden. I have healed from all the memories that have been

hauntingme.(59/25/08/B-Ag)

Anotherrespondentexplainedthatthesupporthadpositiveimpactonrelievingpaininher

body:

167

Ihavebeenhavingabackacheandpainaroundmyneck forsometime.

Sometimeswhenthepainwouldgetworse, Iwouldevenfeel itswollen. I

havealsobeenveryemotionalandwouldgetveryupsetoververyminor

issues.Ihavebeentakingmedicationformybackacheforalongtime.But

inthepastthreeweekswhenIstarteddoingtheexercises,Ifeelmuchbetter

andnowIhaveevenstoppedtakinganymedicationforthesebodyaches.I

feelmuchhappierandmytempershavegreatlyimproved.(63/25/08/B-Ag)

Anotherrespondentaddedthatshehadamuch-increasedsenseofwell-beingafter

completingtheexercises:

…I have been having a heartburn for some time used to eat a lot of

magnesium.SinceIstarteddoingtheexercisesinthepasttwoweeks,Ihave

noticedthechangesinmybody,InolongerfeeltheheartburnandIhave

stoppedswallowingthemedicineevenwhenIeatfoodthatIthoughtwere

causing it. I wonderwhat kind ofmagic is in this therapy. Could it be a

spiritualinterventionandyoudon’texplainthattous!!Therecoveryismore

elseamiracletome.(64/25/08/B-Ag)

Anotherrespondentfurthernotedthatbodilydiscomfortandpainwasrelievedfollowing

theexercises:

Firstofall,IwilltellyouthatwhenIcamehere,IhadbackachewhenIcame

forthemeetinglasttime.WhenIcamehereandwedidtheexercises,Ifelt

muchbetterandbythetimewewenthome,thepainhadgreatlyrecued.

WhenIwenthome,Icontinuedwiththeexercisesandthepainwentaway

completely.Ihavealsobeengettingparalyzedwhensomethingannoysme.

I would feel some of my body parts have been taken away from me.

However,whenIstartedusingtheseexercisesinthepastthreeweeks,Ihave

notfeltthisinanypartofmybodyandIfeelhappyaboutthesechanges.I

havealsobeenveryupsetwith someofour local leaderswho tookus to

supporttheprogramofmalariacontrol.Forseveralmonthsnow,theyhave

neverpaidus.EverytimeIwouldneedtobuysomethingfromtheshopand

I don’t have thatmoney, Iwouldget veryannoyed.But sincewe started

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doingtheexercises,Ihavenotfeltthisangeragain.IamhappyandIwant

tothankyoufortheprogram.(65/25/08/B-Ag)

Thisparticipantalsoidentifiedamuchgreatersenseofself-awarenessinrelationtoher

rightsandhowshewastreated.

Therebelsarenotcomingback

Themainobjectiveoftheinterventionwastoenableparticipantstolearnstrategiestohelp

themovercomethetraumaticstressaffectingtheirday-to-dayfunctioning.Achievingthis,

hashadalotofpositiveeffectonindividualparticipants’physicalandpsychologicalwellbeing,

theirrelationshipwithintheirrespectivefamiliesaswellastheirfunctioningandrolewithin

thewidercommunity.Ithasenabledthemtolookforwardratherthanalwayslookbackin

fearoftherebelscomingback.ARespondentaged45,fromBalornyodescribedit:

Everyoneseesthedifferenceithasmadetoallofus.Weworktogether

andarehappierworkingtogether.BeforeIusedtothinkbackandfeel

thatrebelswouldcomebackbutnowwelookforwardtolife,weeven

have a dance group and have had the opportunity to go to different

villagestoperform.(09/24/01/B)

Asmentionedabovetherewasimprovementstobothphysicalandpsychologicalwellbeing

reportedasaresultoftheintervention.AwomenfromBarlonyosaid:

Thebreathingexerciseshelpalot,Ihavebeenbreathinginandoutand

ithelps.AlthoughIhavenottakenanymedicationforitthepaininmy

chestisnowgone.(01/24/01/B)

Severalwomenreportedhealthyweightgain,thisisacrucialindicatorparticularlyforthose

who are HIV positive as it indicates their physical health is in better shape following the

mentalhealthsupporttheyreceived.

Ishowedmychildrenandtheylikeit,theycanseeIamlessstressedand

haveputonweighttoo,becauseIamnottooworriedaboutthingslike

before.Iusedtotellthemaboutthetrainingevenduringthetrainingbut

nowtheycanseeitbothinthewayIamandhowIlooktoo.(09/25/01/O

(age46))

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Iammorepositiveaboutthingsnow,Ihaveasafeplaceunderatreeand

ifthingsgetreallybadItakemyselfthereandcalmmyselfdown.Iam

healthier andmyweight is also healthy I have gained a lot ofweight

(15/26/01/A(age26))

Therelieffromstressrelatedchestpainandtheattainmentofhealthyweightactuallyleda

womenfromUsuktoconcludethattheinterventionprobablysavedherlife.

Iwassothinatthetime,Iwouldsaymalnourished,Iwasinalotofpain

too,allthathaschanged,Ihavesinceputonweightandalsomychest

painisgone.Thetrainingprobablysavedmylife.(24/27/01/U)

InterestinglyseveralparticipantsusedtheSubjectiveUnitofDistress(SUD-a0-10scaleof

emotionaldisturbance)toreportbackonlevelsofanxietyandstress–atechniquethatwas

taughtduringthetraining.

DuringthetrainingmySUDwas10maybeevenmorenowIfeelitisone

and maybe two sometimes but not more. I am very grateful for the

trainingitsavedmefromalotofdifficultiesandpain.(07/24/01/B(aged

29)).

WhenweweretrainingatthestartmySUDwas10andmoreifIcoulddo

more,andthengraduallyitbecameeightandthenfiveandnowthere

aredayswhenIcansayitis1oreven0.(14/26/01/A(aged50))

DuringthetrainingmySUDbecame6firstandthen3(20/26/01/A(26))

Anotherrecurringthemewasthereductioninquarrellingandviolentoutbursts

Thetraininghelped;nowwhenIamathomeandthesefrighteningthings

happen I knowhow tohandle them.Evenwithother things likewhen

someonequarrels,Ibreathinandoutproperlybeforeresponding.When

IamagitatedIgotomysafecalmplaceandIfeelfreethere.

Onedaysomeonewasquarrellingand Igot reallyannoyed I justwalk

back in doors and got myself into my quiet calm place and did my

breathingthereandIfeltrelieved.(10/25/01/O(aged44))

170

Ilivewithmymotherin-lawandsheseesthedifference,Idon’tquarrel

withhermuchanymore.Wehaveabetterrelationshipnow.Myhusband

aswell,wehavestartedsharingeverythingwitheachother.

MyhusbandsawhowdifferentIam,Icansitcalmlyandtalkaboutthings

andwedon’tquarrelalotlikebefore,hesaysthistraininghasbeengood

forme(12/25/01/O(aged21))

Idon’tgetintomanyquarrelsaroundthevillageanymoreasIamable

tohandlethingsbetter.(15/26/01/A)

In many cases this led to a calmer family atmosphere and improved relationships with

children,husbandsandin-laws.

Asaresultofthistrainingmyfamilyiscalmerandisarolemodelforthe

wholecommunity.Beforeweusedtohavealotoftroubleandquarrels

andevenviolenceathome,nowwegetinvitedtocommunitygatherings

toshareourexperiencesandevenatchurch.Evenmyappearancehas

changed, I have put onweight andwashmore and look aftermyself

better.ThechildrenareproudofthisandIamhappy.(14/26/01/A(aged

50))

My husband even came and told the group leaders how things are a lot

betternowandhowthehouseisatpeacenow.Thechildrenarealothappier

too,evenifitmeantthatwhenIwasatthetrainingIwasawayfromthem

(16/26/01/A(35))

Ihavebeen livingwithmycurrenthusband formanyyearsbutwenever

married,butafterthetraininghesawhowIhadchangedandhowhappy

weallwereandwantedtomakethatpermanentandsohesuggestedwe

gotmarried ina church I agreedandwegotmarried. Everyone frommy

traininggroupcametosupportmeandwewerehappytohavethemaround.

Idon’tgetfrustrateda lot likebeforeandmydaughtersseethistoothey

havelearntthebreathingandsafecalmplace(15/26/01/A)

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The improvements inwellbeing and family relationships have also had a

positiveimpactonthewidercommunitywhohavenoticedthechangesand

have started toask tobe trained too,giving thewomenopportunities to

trainothers.

It[thetraining]makesmybrainthinkaboutotherthings,otherthanthewar

anddeathofmyfamily.TherestofthefamilyseethatIdon’tcryallthetime

andsodoourneighborsandeveryoneelsetoo.Weallfeellikewecannow

thinkaboutourselvesandnotjustaboutthewar.(08/24/01/B(50))

Participantsunderstand that theproblemsare sharedacross the community andwant to

haveaninputintothehealingofthewholecommunityanduseeveryopportunitytoshare

theirnewskillswiththeirneighbors.

Itellmyneighborsallaboutitandteachthemtheexercises,theyseehow

ithelpsuswithmanybadmemories.Mygrandfatherwaskilled inthe

warandalsowehadtorunawayalot.Itisnoteasy,beingshotatisallI

can remember clearly these were the things that made living very

difficult.(13/25/01/O(aged28))

PeopleaskmewhyIsmilealotandalsohowImanagedtochangemyself

likethis.TheynoticethatIwashandlookaftermyselfbetterthesedays.

Ihavetaughtthebreathingandkneetappingtomyfamilyandtheysay

itworkstoo.(01/24/01/B)

Thewomenaresopleasedwiththeimpactofthetrainingforthemselves,theirfamiliesand

communities,thattheyarenowlookingforwaystoexpanditsimpactandarealsodeveloping

waysforsustainingit.

wehavedevelopedlikeacooperativeandwepullmoneytogetherand

buythingsandthenwesellthat.Wediscussandagreeonwhatweinvest

inandthensell.(09/24/01/B(aged45))

Wehaveonlygotabout20womentrainedandwedoourbesttosupport

eachotherandotherstoobutmanypeopleaskusforhelpandwetrybut

it would have been good if there were more of us trained as the

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community is big and with many people that need this training.

(14/26/01/A(aged50))

MamaAnna(groupleader)isworkingonmakingthegrouppermanent

asthewomenseemtobegettingalotofsupportfromeachotherand

havealsobeensupportingothers(20/26/01/A(aged26))

173

PARTVII:CONSTRUCTIONANDANALYSISOFIES-RANDSER

SCALES

174

ImpactofEventsScaleInthisstudy,therevisedImpactofEventScalewasused.Thisscaleconsistsofthree

subscales:intrusion(8items),avoidance(8items)andhyperarousal(6items).Thescale

valuesoftheitemsrangesfrom0(notatall)to4(extremely)(0=notatall,1=alittlebit,2=

moderately,3=quiteabit,4-extremely).Foreachsubscale,ameaniscalculatedtogetan

indexofthescale.Thetotalscoreofthescaleiscalculatedbysummingthethreesubscales

(minimum0andmaximum12).

InordertoexploretheeffectofdifferentmodesofsocialsupportontheIES-R,thestatistical

propertiesofscaleitemsarefirstdescribed.Thescaleisanalyzedforthefirstandsecond

wave,separately,inordertoobtainsomeideaofitsreliability.Anitemanalysisisthen

conductedforeachofthesubscales,whichconsistsofinter-itemcorrelationsandthe

internalconsistencyofthescale(Cronbach’salpha).Thenthecorrelationsbetweenthe

itemsandthescalesareidentified;thecorrelationoftheitemwithitsownscale(withthe

itemremoved)andwiththeotherIES-Rscalesisexplored.Intheidealcaseanitemishigher

correlatedwithitsownscalethanwiththeotherscales.Finally,anycorrelationsbetween

thesubscalesarereported.Itisnotpossibletogivetest-retestreliabilitystatisticsduetothe

factthatthedifferentmodesofsocialsupporthavedifferentimpactsonthereported

trauma.

StatisticsofitemsinIES-Rsubscales

Table12-1givesthemean,standarddeviationandpercentageofmissingcasesoneachitem

fortheintrusion,avoidanceandhyperarousalscaleforthefirstwave.Table12-2givesthe

samestatisticsforthesecondwave.Bothtablesindicatethatthelevelofpost-traumatic

stressinthefirstandsecondwave,isratherhigh;allitemsonallsubscalescoreabovethe

level2whatindicatesmoderatestress.Furthermore,therespondentsscorehigheston

intrusionwithavalueofabove2.5forallitems.

Moreover,inthefirstwavethestandarddeviationforalloftheitemsisabove1,

whatissubstantialfora5-pointscale.Itindicatesthatthelevelofpost-traumaticstress

reportedvariesquitealotacrosstherespondents.Forthesecondwave,thestandard

175

deviationsseemtobesomewhatsmaller,althoughstillaround1.Thelastinteresting

statisticisthepercentageofmissingvalues.Inthefirstwave,formostitems,zero

respondentshaveamissingvalue.Ingeneral,respondentsmissedonly1or2itemsofthe

totalscale.Inthesecondwavethepercentageofmissingishigher.Butstillformostitems

onlyafewrespondentsdidnotanswerit,andrespondentsmostoftenmissedonly1itemof

thetotalscale.

176

Table12-1.IES-R:Statisticsforitemspersubscale,firstwave(n=471)

Subscale/item

(scalevalue:0(notatall)–4(extremely)

Average Standarddeviation

%Missing

Intrusion

Anyreminderbroughtbackfeelingsaboutit 2,92 1,20 0

Ihadtroublestayingasleep 2,68 1.24 0

Otherthingsmademethinkaboutit 2,76 1,17 0

IthoughtaboutitwhenIdidn'tmeanto 2,36 1,18 0

Picturesaboutitpoppedintomymind 2,71 1.21 2(0.8%)

Ifoundmyselfacting/feelinglikeIwasbackatthattime 2,43 1,22 2(0.8%)

Ihadwavesofstrongfeelingsaboutit 2,59 1,23 0

Ihaddreamsaboutit 2,67 1,26 0

Avoidance

IavoidedlettingmyselfbeupsetwhenIthoughtaboutitorwasremindedofit

2,37 1,23 2(0.8%)

Ifeltasifithadn'thappenedorwasn’treal 2,25 1,26 0

Istayedawayfromremindersofit 2,21 1,20 0

Itriednottothinkaboutit 2,18 1,23 0

IwasawarethatIhadalotoffeelingsaboutit 2,50 1,17 2(0.8%)

Myfeelingsaboutitwerenumb 2,04 1,16 0

Itriedtoremoveitfrommymemory 2,21 1,18 0

Itriednottotalkaboutit 2,28 1,19 0

Hyperarousal

Ifeltirritableandangry 2,78 1,24 2(0.8%)

Iwasjumpyandeasilystartled 2,30 1,22 0

Ihadtroublefallingasleep 2,64 1,27 2(0.8%)

Ihadtroubleconcentrating 2,45 1,19 2(0.8%)

Remindersofitcausedmetohavephysicalreactionssuchassweating,troublebreathing,nauseaorapoundingheart

2,66 1,33 2(0.8%)

Ifeltwatchfulandon-guard 2,33 1,17 0

177

Table12-2.IES-R:Statisticsforitemspersubscale,secondwave(n=356)

Subscale/item

(scalevalue:0(notatall)–4(extremely)

Average Standarddeviation

%missing

Intrusion

Anyreminderbroughtbackfeelingsaboutit 2,79 1,04 0

Ihadtroublestayingasleep 2,73 1.07 0

Otherthingsmademethinkaboutit 2,68 0,99 3(0,08%)

IthoughtaboutitwhenIdidn'tmeanto 2,34 1,13 1(0,03%)

Picturesaboutitpoppedintomymind 2,59 1.12 2(0,05%)

Ifoundmyselfacting/feelinglikeIwasbackatthattime 2,39 1,11 7(2,0%)

Ihadwavesofstrongfeelingsaboutit 2,60 1,03 4(1,1%)

Avoidance


2,72 0,81 1(0,3%)

Ifeltasifithadn'thappenedorwasn’treal 2,30 1,14 2(0,5%)

Istayedawayfromremindersofit 2,61 0,95 3(0,8%)

Itriednottothinkaboutit 2,54 0,97 2(0,5%)

IwasawarethatIhadalotoffeelingsaboutit 2,40 1,14 4(1,1%)

Myfeelingsaboutitwerenumb 2,13 1,10 3(0,8%)

Itriedtoremoveitfrommymemory 2,66 0,93 2(0,5%)

Itriednottotalkaboutit 2,42 1,08 1(0,3%)

Hyperarousal

Ifeltirritableandangry 2,66 1,11 3(0,8%)

Iwasjumpyandeasilystartled 2,35 1,11 5(1,4%)

Ihadtroublefallingasleep 2,68 1,09 2(0,5%)

Ihadtroubleconcentrating 2,63 1,08 3(0,8%)


2,74 1,18 6(1,7%)

Ifeltwatchfulandon-guard 2,96 1,25 3(0,5%)

178

CorrelationbetweenitemsintheIES-R

Regardingthefirstandsecondround,allitemsinaspecificscalecorrelatedquitewellwith

oneanother,astheCronbach’salpha(Table12-3)indicates,althoughtheCronbach’salpha

fortheavoidancescaleforthesecondwaveisonlymoderate(0.63).Forthefirstandsecond

wave,theaveragevalueofeachsubscaleisabout2.5,sorespondentsfeelmoderateto

quiteabitstress.Regardingthestandarddeviation,Table12-3indicatesthatthoseare

higherinthefirstwaveandinthesecondwave.Furthermore,itcanbeassumedthatthe

distributionofthescalesvaluesapproximatesanormaldistribution(skewnessandkurtosis

arebetween-1and1,exceptfortheskewnessofintrusioninthefirstandsecondwave,the

skewnessofhyperarousalinthesecondwaveandthekurtosisofintrusioninthesecond

wave.Allarealittlebithigherthan1).

Table12-3.IES-R:Characteristicsofthesubscales,firstandsecondwave

Wave Subscale Cronbach’salpha

#items Average

(range0–4)

SD Skewness Kurtosis Missing

Firstwave

(n=471)

Avoidance 0,916 8 2,26 0,96 -0,56 0,23 0

Intrusion 0,948 8 2,64 1,04 -1,07 0,58 0

Hyperarousal 0,952 6 2,53 1,11 -0,85 -0,24 0

Secondwave

(n=356)

Avoidance 0,628 8 2,47 0,52 -0,51 0,69 0

Intrusion 0,869 8 2,54 0,78 -1,18 1,12 0

Hyperarousal 0,867 6 2,50 0,87 -1,17 0,93 0

Inordertoexplorethedifferentsubscalesandtheirinter-correlationsmorethoroughlywe

willlookatthecorrelationoftheitemwithitsownscale(withtheitemremoved),andwith

theotherIES-Rscales(seeTable12-4forthefirstwaveandTable12-5forthesecondwave).

Regardingthefirstwave,Table12-4indicatesthatallitemscorrelatesufficientlywiththeir

ownscale(correcteditemtotalcorrelationsareallabove0.35).But,italsoindicatesthatall

itemshavearatherhighcorrelationwiththeotherscales(aboveabout0.5)andsomeitems

haveevenahighercorrelationwiththeotherIES-Rthanwiththeirownscale(theyare

markedyellow).Theseresultsindicatethat,inthefirstwave,thesubscalesareintertwined

andwillcorrelatedsubstantial.

179

Table12-4.IES-R:Correlationofitemswithownscaleandotherscales,firstwave(n=471)

Subscale/item Correcteditemtotalcorrelation

Correlationavoidance

Correlationhyperarousal

Intrusion

Anyreminderbroughtbackfeelingsaboutit 0,86 0,71 0,82

Ihadtroublestayingasleep 0,84 0,73 0,87

Otherthingsmademethinkaboutit 0,87 0,74 0,83

IthoughtaboutitwhenIdidn'tmeanto 0,68 0,75 0,65

Picturesaboutitpoppedintomymind 0,79 0,65 0,74

Ifoundmyselfacting/feelinglikeIwasbackatthattime 0,80 0,69 0,84

Ihadwavesofstrongfeelingsaboutit 0,87 0,72 0,91

Ihaddreamsaboutit 0,76 0,61 0,74

Avoidance Correcteditemtotalcorrelation

Correlationintrusion



0,74 0,62 0,57

Ifeltasifithadn'thappenedorwasn’treal 0,70 0,68 0,65

Istayedawayfromremindersofit 0,77 0,60 0,59

Itriednottothinkaboutit 0,75 0,52 0,50

IwasawarethatIhadalotoffeelingsaboutit 0,65 0,83 0,80

Myfeelingsaboutitwerenumb 0,65 0,65 0,63

Itriedtoremoveitfrommymemory 0,65 0,61 0,60

Itriednottotalkaboutit 0,75 0,69 0,70

Hyperarousal Correcteditemtotalcorrelation



Ifeltirritableandangry 0,87 0,70 0,88

Iwasjumpyandeasilystartled 0,74 0,74 0,75

Ihadtroublefallingasleep 0,89 0,71 0,88

Ihadtroubleconcentrating 0,88 0,74 0,84


0,88 0,69 0,84

Ifeltwatchfulandon-guard 0,86 0,73 0,84

180

Table12-5.IES-R:Correlationofitemswithownscaleandotherscales,secondwave(n=356)

Subscale/item Correcteditemtotalcorrelation



Intrusion

Anyreminderbroughtbackfeelingsaboutit 0,76 0,36 0,72

Ihadtroublestayingasleep 0,78 0,35 0,78

Otherthingsmademethinkaboutit 0,79 0,38 0,75

IthoughtaboutitwhenIdidn'tmeanto 0,13 0,46 0,06

Picturesaboutitpoppedintomymind 0,69 0,34 0,70

Ifoundmyselfacting/feelinglikeIwasbackatthattime 0,68 0,46 0,73

Ihadwavesofstrongfeelingsaboutit 0,71 0,33 0,75

Ihaddreamsaboutit 0,56 0,32 0,63

Avoidance Correcteditemtotalcorrelation



IavoidedlettingmyselfupsetwhenIthoughtaboutitorwasremindedofit

0,32 0,13 0,11

Ifeltasifithadn'thappenedorwasn’treal 0,34 0,40 0,27

Istayedawayfromremindersofit 0,28 0,04 0,07

Itriednottothinkaboutit 0,39 0,11 0,09

IwasawarethatIhadalotoffeelingsaboutit 0,39 0,69 0,62

Myfeelingsaboutitwerenumb 0,32 0,34 0,21

Itriedtoremoveitfrommymemory 0,33 0,21 0,19

Itriednottotalkaboutit 0,22 0,14 0,23

Hyperarousal Correcteditemtotalcorrelation



Ifeltirritableandangry 0,76 0,38 0,77

Iwasjumpyandeasilystartled 0,60 0,40 0,59

Ihadtroublefallingasleep 0,71 0,34 0,79

Ihadtroubleconcentrating 0,66 0,34 0,71


0,79 0,31 0,76

Ifeltwatchfulandon-guard 0,49 0,32 0,50

Forthesecondwave,similarresultswerefoundfortheavoidanceandhyperarousalscale.

However,oneitemoftheintrusionscale,‘IthoughtaboutitwhenIdidn'tmeanto’,didnot

181

correlatewellwithitsscale.Fortheavoidancescaleweseethatmostitemshavearather

lowcorrelationwithitsownscale.Ifwelookatthecorrelationofanitemswiththeother

scales,weseethatmostitemsoftheintrusionscale(except‘IthoughtaboutitwhenIdidn't

meanto’)haveratherhighcorrelation(aboveabout0,5)withthehyperarousalscale.For

thehyperarousalscaleweseethatallitemshaveratherhighcorrelationwiththeintrusion

scale.Fortheavoidancescaleweseethatmostitems(except‘IwasawarethatIhadalotof

feelingsaboutit’)arenotcorrelatedwiththeintrusionnorthehyperarousalscale.

Moreover,someitemshaveevenahighercorrelationwiththeotherIES-Rthanwiththeir

ownscale.Thissuggeststhatthescalesareintertwined.

Table12.6givesthecorrelationbetweenthescalesforthefirstandsecondwaveseparately.

Thistableshowsaratherhighinter-correlationbetweenthesubscalesinthefirstwave;all

correlationsareabout0.8orhigher.Inthesecondwavetheinter-correlationsare

substantiallylowerduetotheavoidancescale;thisscalecorrelatesabout0.5withintrusion

andhyperarousal.Intrusionandhyperarousalarestillhighlycorrelated,about0.90.

Table12-6.IES-R:Correlationbetweensubscales,firstandsecondwave

Wave Intrusion Hyperarousal

Firstwave Avoidance 0,815(n=471) 0,796(n=471)

Intrusion 0,936(n=471)

Secondwave Avoidance 0,520(n=356) 0,449(n=356)

Intrusion 0,887(n=356)

ConclusionsaboutIES-R

Onthebasisoftheseresults,itisconcludedthattheintrusionandhyperarousalarereliable

andhighlycorrelated.Theyareprobablymeasuringthesameunderlyingconstruct.

Regardingavoidancetheresultsaremixed.Inthefirstwavethescaleseemedinternal

consistent,butinthesecondwavetheinternalconsistencywasratherweak.Furthermore,

inthefirstwave,itcorrelatedhighwiththeotherscales,butinthesecondwavetheseinter-

correlationswereweak.Consequently,itisnotclearwhattheitemsoftheavoidancescale

aremeasuring.Oneshouldbecarefulininterpretingeffectsofthesocialsupporton

avoidance.

182

SocialandEconomicResilienceToolTheSocialandEconomicResilience(SER)toolconsistsofLikertscalesonsixscales:Social(5

items),Capability/HumanCapital(6items),ImprovementofActualIncome/Economic(13

items),Women’sEmpowerment(12items),Structural/System(2items),andWorry(10

items).

Thescalevaluesoftheitemsrangesfrom1(notatall)to5(extremely)(1=strongly

disagree,2=disagree,3=neutral,4=agree,5=stronglyagree).Moststatementsarestated

positively(highscoreindicateapositivemindset),however,forthesubscaleworryahigh

scoreindicatesmoreworry(anegativemindset).

TheSERscaleisanalyzedastheIES-R:theanalysesisdoneforthefirstandsecondwave

separately.Toexplorethereliabilityofthescale,anitem-analysisisconductedoneachof

thescales,whichconsistsofthestatisticsoftheitems,andtheinternalconsistencyofthe

scale(Cronbach’salpha).Thenthecorrelationsbetweentheitemsandthescalesare

examined.

StatisticsforitemsintheSERtool

Inthissection,thestatisticsofeachsubscaleoftheSER-toolwillbedescribed.

13.1.1. Social

Tables13-1givesthemean,standarddeviation,andnumberofcasesforwhomtheitemis

notapplicableandthenumberofmissingcasesontheitemsofSocialscaleforthefirstand

secondwave.

Table13-1.SER:StatisticsforitemsinSocialscale,firstandsecondwave

Social(firstwaven=471)

(1=stronglydisagree,5=stronglyagree)

Average Standard

Deviation

Not

applicable

Missing

IfeelItrustmycommunity 3.99 0.859 0 0

Ifeelattachedtomyfamily 4.159 0.756 0 0

Ifeelmycontactwiththeleadershipinmycommunityhas

improved

3.896 0.815 0 0

Ifeelmyrelationshipwiththerestofthecommunityhas

improved

3.898 0.743 0 1

183

Myparticipationinthegroupshasimproved 3.845 0.967 27 0

Social(secondwaven=356) Average Standard

deviation

Missing

IfeelItrustmycommunity 4.01 0.88 0

Ifeelattachedtomyfamily 4.32 0.73 0

Ifeelmycontactwiththeleadershipinmycommunityhas

improved

4.02 0.63 0

Ifeelmyrelationshipwiththerestofthecommunityhas

improved

3.99 0.72 0

Myparticipationinthegroupshasimproved Notincludedinthesecondwave

AllitemsoftheSocialscalescoreabovethescalemidpoint(3)andhavearathersmall

standarddeviation(smallerthan1).Furthermore,itseemsasifthescoresinthesecond

wavearesomewhathigherthaninthefirstwave.Thisindicatesthatmostrespondentsare

neutralorpositiveabouttheirintegrationinthecommunityandthattheyfeelthattheir

relationshipwiththeircommunityisimproving.Theitemnon-responseofthescaleisgood

(lessthan5%),sincealmostallrespondentsansweredeveryitemofthescaleifitwas

applicabletothem.No5isthat‘Ifeelmyrelationshipwiththerestofthecommunityhas

improved’wasmarkedasnotapplicableby27respondents.Thisitemwas,therefore,

removedforthesecondwave.

13.1.2. Capability


notapplicableandthenumberofmissingcasesontheitemsofCapabilityscaleforthefirst

andsecondwave.

Table13-2.SER:StatisticsforitemsinCapabilityscale,firstandsecondwave

Capability(firstwaven=471)


Average Standard

Deviation

Not

applicable

Missing

Ifeelmyabilitytopayformedicationhasimproved 2,45 1,18 0 1

Ifeelmycapacitytopayschoolfeeshasimprovedinthe

last6months

2,32 1,10 1 2

184

IfeelIcangetinformationaboutanythingIwant 2,85 1,10 0 0

IfeelIhaveskillstoenablemeimprovemylife 2,78 1,15 1 0

IfeelIhaveacquirednewproductiveskillstoimprove

mylife

2,76 1,13 2 1

Ifeelchangeintheamountofknowledgehold 2,85 1,08 1 0

Capability(secondwaven=356) average Standard

deviation

missing

Ifeelmyabilitytopayformedicationhasimproved 2,97 1,06 3

Ifeelmycapacitytopayschoolfeeshasimprovedinthe

last6months

2,67 1,13 1

IfeelIcangetinformationaboutanythingIwant 3,34 0,87 2

IfeelIhaveskillstoenablemeimprovemylife 3,45 0,87 2

IfeelIhaveacquirednewproductiveskillstoimprove

mylife

3,41 0,95 1

Ifeelchangeintheamountofknowledgehold 3,55 0,86 1

IfeelIamabletohandlemisunderstandingsinmy

household(new)

3,89 0,77 4

Myhusbandseeksmyopiniononmattersrelatedtoour

household(new)

2,80 1,46 25

Ihavebeenabletospacemychildren(new) 3,70 1,12 20

Inthefirstwave,theitemsaboutCapabilityallscorebelowthescalemidpointandhavea

ratherlargestandarddeviation.Inthesecondwave,thescoresseemssomewhathigherand

thestandarddeviationsomewhatlower.Thisindicatesthat,inthefirstwave,respondents

feeltheydonothavethecapabilitiestomanagelife,howeverlargedifferencesexist

betweenrespondentsbutthatmostrespondentsfeelthattheircapabilitieshaveimproved.

Inthefirstwave,theitemnon-responseofthisscaleisgood(lessthan5%),sincealmostall

respondentsansweredeveryitemoftheCapabilityscale.However,inthesecondwavethe

lasttwonewitems‘Myhusbandseeksmyopiniononmattersrelatedtoourhousehold’and

‘Ihavebeenabletospacemychildren’hadaratherhighnonresponse(>0,05%).

185

13.1.3. Improvementofactualincome


notapplicableandthenumberofmissingcasesoneachitemoftheImprovementofactual

incomescaleforthefirstandsecondwave.Inthefirstwave,theitemsregarding

improvementofactualincomeshowadefusepicture.Theitemsabouttheincomeposition

asitis,scoreabovethescalemidpoint,buttheitemsaboutthefutureorimprovementof

assetsscorebeneaththescalemidpoint.Consequently,theseitemswereremovedinthe

secondwave.

Table13-3.SER:StatisticsforitemsinImprovementofActualIncomescale,firstandsecondwave

Improvementofactualincome(firstwaven=471)


Average Standard

Deviation

Not

applicable

Missing

Iamabletosavemoney 3,23 1,20 1 1

Myincomewillcontinuetoimproveinthenext6

months

2,75 1,01 11 0

Iwillhaveemploymentinthenext6months 2,32 0,97 21 0

Iwillbeabletoownabusinessinthenext6months 2,66 1,06 8 0

Ihavemarketformyproduce 3,08 1,07 4 0

Iamabletomarketmyownproduce 3,17 1,10 4 2

Iamabletocontributetohouseholdincome 3,29 1,05 1 1

Mypersonalassetshaveimproved 2,65 1,02 0 0

Myaccesstohouseholdassetshasimproved 2,80 1,07 1 1

Iamabletosurviveinhardshiptimes 3,51 1,00 0 1

Iamabletomanagemyownincome 3,36 1,05 0 1

Iamabletomakedecisionsonincomeinyour

household

3,37 1,03 1 2

Iamabletoadoptnewproductiontechnologies 2,74 1,09 1 1

Iamabletosavemoney

3,23 1,20 1 1

186

Improvementofactualincome(secondwaven=356) average Standard

deviation

missing

Iamabletosavemoney 3,59 1,03 0

Myincomewillcontinuetoimproveinthenext6

months

Notincludedinthesecondwave

Iwillhaveemploymentinthenext6months

Iwillbeabletoownabusinessinthenext6months

Ihavemarketformyproduce 3,59 0,89 0

Iamabletomarketmyownproduce 3,74 0,93 1

Iamabletocontributetohouseholdincome 3,82 0,86 0

Mypersonalassetshaveimproved 3,16 0,90 0

Myaccesstohouseholdassetshasimproved 3,16 0,91 0

Iamabletosurviveinhardshiptimes 3,89 0,68 0

Iamabletomanagemyownincome 3,93 0,67 0

Iamabletomakedecisionsonincomeinyour

household

3,97 0,68 3

Iamabletoadoptnewproductiontechnologies Notincludedinthesecondwave

Iwillbeabletoownabusinessinthenext6

month?(new)

3,21 1,07 0

Iwillbeabletoimproveproduction(new) 3,43 0,94 6

Inthesecondwave,thescoresoftheimprovementofactualincomescaleseemssomewhat

higherandthestandarddeviationsomewhatlower.Theitemnon-responseofthescale(in

thefirstandsecondwave)isgood(lessthan5%),iftheitemsareregardedasapplicableto

therespondent.Notableisthat21respondentsregardedtheitem‘Iwillhaveemployment

inthenext6monthsasnotapplicabletothem.Thisisanotherreasonwhytheseitemswere

notincludedinthesecondwave.

13.1.4. Women’sempowerment


notapplicableandthenumberofmissingcasesontheitemsoftheWomen’sEmpowerment

scaleforthefirstandsecondwave.

187

Table13-4.SER:StatisticsforitemsinWomen’sEmpowermentscale,firstandsecondwave

Womenempowerment(firstwaven=471)


Average Standard

Deviation

Not

applicable

Missing

Iamabletotakeupnewinitiativesindependently 2,90 1,10 1 1

Iamabletomakedecisionsmoreindependently 2,91 1,10 2 0

Myhoursofhouseholdworkhavebeenabletoreduce 2,68 1,183 1 1

Haveyoubeenabletogainmoretimeforproductive

activities

2,71 1,17 0 1

Hasyourfreedomofmovementimproved 3,21 1,13 0 0

Ifeelimprovementinmyself-worth 3,31 0,99 1 0

feeltherehasbeenchangeinmyvalues 3,35 0,98 0 0

IfeelIaminchargeofmybody 3.42 1,06 2 0

IfeelIamabletomakedecisionsaboutcontraceptive

use

3,00 1,19 70 0

Myhouseholdrelationshaveimproved 3.29 1,01 28 0

TherehasbeenchangeinthewayIresolveconflictsin

myhousehold

3,43 0,93 32 0

Therehasbeenachangeinmyhusband'sattitude

towardsme

3,27 1,05 154 2

Womenempowerment(secondwaven=356) average Standard

deviation

missing

Iamabletotakeupnewinitiativesindependently 3,66 0,80 2

Iamabletomakedecisionsmoreindependently 3,75 0,77 2

Myhoursofhouseholdworkhavebeenabletoreduce 3,45 0,91 0

Haveyoubeenabletogainmoretimeforproductive

activities

3,61 0,87 1

Hasyourfreedomofmovementimproved 3,90 0,76 0

Ifeelimprovementinmyself-worth 3,99 0,77 1

188

feeltherehasbeenchangeinmyvalues 3,96 0,69 1

IfeelIaminchargeofmybody 4,21 0,75 1

IfeelIamabletomakedecisionsaboutcontraceptive

use


Myhouseholdrelationshaveimproved

TherehasbeenchangeinthewayIresolveconflictsin

myhousehold

Therehasbeenachangeinmyhusband'sattitude

towardsme

Regardingthefirstwaveofthewomenempowermentitems,allitemsscalescoreaboutthe

scalemidpointandhavearathersmallstandarddeviation(<1).Furthermore,theitemnon-

responseofthescaleisgood(lessthan5%)ittheitemsareapplicable.Notableisthat4

itemsareregardedasnotapplicablebyasubstantialproportionoftherespondent(>0,05%).

Quitealotoftheseitemsregardrelationshiptothefamily.Theratherhighnon-response

suggeststhattheseitemsarenotcomprehended,notapplicable,ortoooffensive

Theseitemswerenotincludedinthesecondwave.

Regardingthesecondwave,itseemsasifthescoresonwomenempowermentare

somewhatimprovingandtheirstandarddeviationseemstobesomewhatless.Theseresults

suggestthatmostrespondentshaveapositiveattitudetowardlife,andactinaccordance

withityetandthatthisattitudeimprovedinthesecondwave.

13.1.5. Structural/system

Table13-5givesthemean,standarddeviation,andnumberofcasesforwhomtheitemis

notapplicableandthenumberofmissingcasesontheitemsoftheStructural/Systemscale

forthefirstandsecondwave.

Table13-5.SER:StatisticsforitemsinStructural/Systemscale,firstandsecondwave

Structural/system(firstwaven=471)


Average Standard

Deviation

Not

applicable

Missing

IfeelIamabletoexercisemyrights 3.36 1.27 0 1

189

Iamabletoaccesslegalservicesmucheasier 2,84 1,24 0 0

Structural/system(secondwaven=356) Average Standard

deviation

Missing

IfeelIamabletoexercisemyrights 3.98 0,75 3

Iamabletoaccesslegalservicesmucheasier 3,42 0,86 3

Iamabletoseekandaccessmedicalservices?(new) 3,25 1,01 3

Iamabletoaccessfinancialservices?(new) 2,54 1,50 15

Inthefirstwave,thetwoitemsaboutstructural/systemsuggestthatrespondentshavea

globalpositiveattitudetowardthe(formal)community,butarelesssureaboutspecific

servicesandrights.Theitemnon-responseofthescaleisgood(lessthan5%).Inthesecond

wavethescoresonstructural/systemseemsomewhatimprovedandtheirstandard

deviationtobesomewhatless.

Inordertoimprovethisscale,twonewitemswereadded.Oneofthenewitemsabout

Structural/System(Iamabletoaccessfinancialservices)scoresbelowthescalemidpoint,

andthisitemhasalsoaratherlargestandarddeviation(1.50).Theitemnon-responseofthe

scaleisgood(lessthan5%).Theseresultssuggestthatrespondentshaveaglobalpositive

attitudetowardthe(formal)community,butarelesssureaboutfinancialservices.

Thelastscaleregardingworryindicatesthatallscoresareabovethescalemidpoint,and

mostitemshaveastandarddeviationofabout1.Theitem‘Iamworriedthatthe

governmentwillnotaddressmyneeds’hasastandarddeviationofabout1.7.Theseresults

suggestthatmostrespondentsworryallot.Theitemnon-responseofthescaleisgood(less

than5%),iftheitemsareregardedasapplicabletotherespondent.Notableisthat41

respondentsregardedtheitem‘IamworriedImaynotfindajob’asnotapplicabletothem.

Inthesecondwaveallmeanscoresarestillabovethescalemidpoint,andmostitemshavea

standarddeviationofjustabout1.Thissuggestthatlittleimprovementwasmade.Theitems

‘Iamworriedthatconflictmayhappenagaininmysociety’and‘Iamworriedofhostility

frommembersofmycommunity’havearatherhighstandarddeviation(1.44and1.22

respectively).Theseresultssuggestthatmostrespondentsworryallot.Theitemnon-

responseofthescaleisgood(lessthan5%)inthesecondwave.

190

13.1.6. Worry


notapplicableandthenumberofmissingcasesontheitemsoftheWorryscaleforthefirst

andsecondwave.

Table13-6.SER:StatisticsforitemsinWorryscale,firstandsecondwave

Worry(firstwaven=471) Average Standard

Deviation

Not

applicable

Missing

Iamworriedthatconflictmayhappenagaininmy

society

3,29 1,22 0 0

IamworriedthatIwillfailtoprovideformyfamily 3,51 0,97 3 1

IamworriedImaynotfindajob 3,55 1,11 41 0

Iamworriedofhostilityfrommembersofmy

community

3,00 1,08 0 0

IamworriedImaynotgetenoughmoney 3,68 0,91 0 0

Iamworriedthatmyleaderswillnotaddresstheneeds

ofmycommunity

3,59 1,06 0 1

Iamworriedthatclimatechangewillaffectfood

production

4,09 1,03 0 0

Iamworriedthatthegovernmentwillnotaddressmy

needs

3,73 1,69 0 0

Iamworriedmypsycho-socialstatuswillworsenifnot

treated

3,38 1,11 1 0

IfeelconfidentthatIcanovercomechallengesIhave

experiencedinthepast

3,54 1,02 0 0

Worry(secondwaven=356) Average Standard

deviation

Missing

Iamworriedthatconflictmayhappenagaininmy

society

3,03 1,44 0

IamworriedthatIwillfailtoprovideformyfamily 3,46 1,06 0

IamworriedImaynotfindajob 3,31 1,11 1

191

Iamworriedofhostilityfrommembersofmy

community

2,79 1,22 0

IamworriedImaynotgetenoughmoney 3,66 1,00 3

Iamworriedthatmyleaderswillnotaddresstheneeds

ofmycommunity

3,50 1,07 3

Iamworriedthatclimatechangewillaffectfood

production

4,35 0,94 3

Iamworriedthatthegovernmentwillnotaddressmy

needs

3,81 1,03 1

Iamworriedmypsycho-socialstatuswillworsenifnot

treated


IfeelconfidentthatIcanovercomechallengesIhave

experiencedinthepast

Table13-6indicatesthatallscoreareabovethescalemidpoint,andmostitemshavea

standarddeviationofabout1.Theitem‘Iamworriedthatthegovernmentwillnotaddress

myneeds’hasastandarddeviationofabout1.7.Theseresultssuggestthatmost

respondentsworryallot.Theitemnon-responseofthescaleisgood(lessthan5%),ifthe

itemsareregardedasapplicabletotherespondent.Notableisthat41respondentsregarded

theitem‘IamworriedImaynotfindajob’asnotapplicabletothem.

Inthesecondwaveallmeanscoresarestillabovethescalemidpoint,andmostitemshavea

standarddeviationofjustabout1.Thissuggestthatlittleimprovementwasmade.Theitems

‘Iamworriedthatconflictmayhappenagaininmysociety’and‘Iamworriedofhostility

frommembersofmycommunity’havearatherhighstandarddeviation(1,44and1,22

respectively).Theseresultssuggestthatmostrespondentsworryallot.Theitemnon-

responseofthescaleisgood(lessthan5%)inthesecondwave.

CorrelationbetweentheitemsintheSERscale

AstheSERscaleisrecentlydeveloped,thecorrelationofanitemwithitsownscalewillbe

exploredaswellasitcorrelationwithitemsoftheotherscales.Thiswillbedoneforthefirst

andsecondwaveseparately.Tables13-7to13-10givethecorrelationsforthefirstwave.

192

Table13-7.SER:CorrelationofitemsonSocialandCapabilityscaleswithownscaleandotherscales,firstwave

Correcteditem

totalcorrelation

Correlation

Capability Income Empowerment System Worry

Social

IfeelItrustmycommunity 0,477 0,146 0,183 0,183 0,067 -0,074

Ifeelattachedtomyfamily 0,421 0,114 0,062 0,070 -0,083 -0,057

Ifeelmycontactwiththe

leadershipinmycommunityhas

improved

0,535 0,292 0,288 0,223 0,192 -0,018

Ifeelmyrelationshipwiththerest

ofthecommunityhasimproved

0,581 0,244 0,347 0,266 0,111 0,049

Myparticipationinthegroupshas

improved

0,347 0,042 0,320 0,193 -0,068 0,175

Capability Correcteditem

totalcorrelation

Social Income Empowerment System Worry

Ifeelmyabilitytopayfor

medicationhasimproved

0,664 0,139 0,414 0,320 0,405 -0,220

Ifeelmycapacitytopayschoolfees

hasimprovedinthelast6months

0,672 0,116 0,383 0,309 0,437 -0,209

IfeelIcangetinformationabout

anythingIwant

0,714 0,259 0,516 0,479 0,510 -0,191

IfeelIhaveskillstoenableme

improvemylife

0,750 0,242 0,543 0,430 0,419 -0,107

IfeelIhaveacquirednew

productiveskillstoimprovemylife

0,733 0,226 0,523 0,435 0,360 -0,085

Ifeelchangeintheamountof

knowledgehold

0,769 0,303 0,592 0,514 0,479 -0,122

InspectionofTable13-7regardingtheSocialscaleindicatesthattheitem’myparticipation

inthegroupshasimproved’havealowcorrelationwiththeownscale(0.347),andeven

lowerwiththeotherscales(<0.32).Thisitemisincludedinthescaleforthefirstwave,

193

however,notaskedforinthesecondwave.RegardingtheCapabilityscale,Table13-8

indicatesthatallitemscorrelatesufficientwithitsownscaleandtoalesserextenttothe

otherscales.

Table13-8.CorrelationofitemsonIncomescalewithownscaleandotherscales,firstwave

Correcteditem

totalcorrelation

Correlation

Social Capability Empowermen

t

System Worry

Income

Iamabletosavemoney 0,551 0,293 0,378 0,328 0,170 0,006

Myincomewillcontinue

toimproveinthenext6

months

0,704 0,243 0,509 0,473 0,316 -0,087

Iwillhaveemployment

inthenext6months

0,491 0,197 0,424 0,323 0,122 -0,142

Iwillbeabletoowna

businessinthenext6

months

0,718 0,241 0,532 0,444 0,329 -0,126

Ihavemarketformy

produce

0,765 0,278 0,428 0,492 0,334 -0,026

Iamabletomarketmy

ownproduce

0,758 0,260 0,422 0,506 0,336 -0,004

Iamabletocontribute

tohouseholdincome

0,741 0,285 0,424 0,535 0,265 -0,006

Mypersonalassetshave

improved

0,652 0,233 0,522 0,487 0,367 -0,086

Myaccesstohousehold

assetshasimproved

0,624 0,243 0,497 0,469 0,292 -0,046

Iamabletosurvivein

hardshiptimes

0,542 0,267 0,246 0,364 0,039 0,091

Iamabletomanagemy

ownincome

0,697 0,133 0,317 0,582 0,289 0,066

194

Iamabletomake

decisionsonincomein

yourhousehold

0,651 0,232 0,325 0,597 0,333 0,062

Iamabletoadoptnew

productiontechnologies

0,490 0,177 0,544 0,536 0,458 -0,013

FortheIncomescale,Table13-8showsthatallitemscorrelatesufficientlywiththeirown

scale.Buttheitem‘Iamabletoadoptnewproductiontechnologies’correlateshigherwith

theCapabilityandEmpowermentscale.Inthefirstwave,allIncomeitemsareincludedin

theIncomescale.

Table13-9.SER:CorrelationsoftheitemsonWomen’sEmpowermentandSystemsscaleswithownscaleandotherscales,firstwave

Corrected

itemtotal

correlation

Correlation

Social Capability Income System Worry

Women’s

Empowerment

Iamabletotakeup

newinitiatives

independently

0,634 0,246 0,428 0,563 0,349 -0,052

Iamabletomake

decisionsmore

independently

0,636 0,193 0,373 0,509 0,334 0,003

Myhoursof

householdwork

havebeenableto

reduce

0,345 0,101 0,330 0,292 0,343 -0,045

Haveyoubeenable

togainmoretimefor

productiveactivities

0,709 0,143 0,511 0,517 0,550 0,005

Hasyourfreedomof

movementimproved

0,584 0,163 0,368 0,458 0,508 -0,026

Ifeelimprovement

inmyself-worth

0,689 0,152 0,242 0,471 0,365 0,072

195

Corrected

itemtotal

correlation

Correlation


feeltherehasbeen

changeinmyvalues

0,733 0,188 0,314 0,533 0,447 0,078

IfeelIamincharge

ofmybody

0,687 0,126 0,300 0,472 0,416 -0,003

IfeelIamableto

makedecisions

aboutcontraceptive

use

0,679 0,159 0,363 0,514 0,426 -0,021

Myhousehold

relationshave

improved

0,660 0,254 0,293 0,406 0,262 -0,021

Therehasbeen

changeinthewayI

resolveconflictsin

myhousehold

0,586 0,292 0,251 0,412 0,229 0,017

Therehasbeena

changeinmy

husband'sattitude

towardsme

0,493 0,380 0,321 0,375 0,186 -0,002

System Corrected

itemtotal

correlation

Social Capability Income Empowerment Worry

IfeelIamableto

exercisemyrights

0,712 0,029 0,425 0,340 0,534 -0,003

Iamabletoaccess

legalservicesmuch

easier

0,712 0,083 0,566 0,400 0,488 -0,108

Table13-9givesthecorrelationbetweentheitemsoftheWomen’sEmpowermentand

Systemsscales.Inspectionindicatesthat,inthefirstwave,allitemscorrelatesufficiently

withtheirownscale(correcteditemtotalcorrelationsareallabove0.35)andtoalesser

extentwiththeotherscales.

196

Table13-10.SER:CorrelationofitemsonWorryscalewithownscaleandotherscales,firstwave

Correcteditem

total

correlation

Correlation

Social Capacities Income Empowerment System

Worry

Iamworriedthatconflict

mayhappenagaininmy

society

0,431 0,083 -0,061 -0,031 -0,018 -0,127

IamworriedthatIwillfail

toprovideformyfamily

0,545 -0,043 -0,293 -0,167 -0,120 -0,152

IamworriedImaynot

findajob

0,475 -0,031 -0,283 -0,160 -0,097 -0,161

Iamworriedofhostility

frommembersofmy

community

0,380 -0,198 -0,026 -0,064 -0,010 0,137

IamworriedImaynotget

enoughmoney

0,583 0,133 -0,001 0,101 0,111 0,130

Iamworriedthatmy

leaderswillnotaddress

theneedsofmy

community

0,460 0,022 -0,074 0,046 0,003 -0,012

Iamworriedthatclimate

changewillaffectfood

production

0,391 0,107 -0,087 0,137 0,117 -0,027

Iamworriedthatthe

governmentwillnot

addressmyneeds

0,474 0,052 -0,147 -0,014 0,000 -0,069

Iamworriedmypsycho-

socialstatuswillworsenif

nottreated

0,264 0,010 0,227 0,234 0,231 0,392

IfeelconfidentthatIcan

overcomechallengesI

-0,011 0,263 0,292 0,290 0,203 0,100

197

Correcteditem

total

correlation

Correlation

Social Capacities Income Empowerment System

haveexperiencedinthe

past

Thecorrelationsforthelastscale,Worry,arepresentedinTable13-10.Thistablereveals

thatallitemsexcept‘Iamworriedmypsycho-socialstatuswillworsenifnottreated’and‘I

feelconfidentthatIcanovercomechallengesIhaveexperiencedinthepast’correlate

sufficientlywithitsownscaleandtoalessextenttotheotherscales.Theitem‘Iamworried

mypsycho-socialstatuswillworsenifnottreated’correlateshigherwiththesystemscale

thanwithitsownscale.Whiletheitem‘IfeelconfidentthatIcanovercomechallengesI

haveexperiencedinthepast’doesnotcorrelatesufficientlywiththeownscale,neitherthe

otherscales(<0.35).BothitemsareremovedfromtheWorryscaleintherestofthe

analyses.

Onthebasesoftheseinter-itemcorrelationsaswellastheextentspecificitemswerenot

applicable,someitemswerenotincludedinthesecondwave.InordertoimprovetheSER-

scale,somenewitemswereintroducedinthesecondwave.Thedifferencesbetweenfirst

andsecondwaveareindicatedinTable13-7to13-10.Next,wewillexplorethecorrelations

inthesecondwave,ofanitemwithitsownscaleasthecorrelationofanitemwiththeother

scales.

AsTable13-11indicatestheitemsoftheSocialscalearethesameforthefirstandsecond

wave.Asinthefirstwave,allitemsoftheSocialsubscalecorrelatesufficientlywithitsown

scaleandtoalesserextenttotheotherscales.

FortheCapabilityscale,threenewitemswereincludedinthesecondwave.Table13-11.

showsthatthenewitems‘IfeelIamabletohandlemisunderstandingsinmyhousehold’,

‘Myhusbandseeksmyopiniononmattersrelatedtoourhousehold’and‘Ihavebeenable

tospacemychildren’correlateinsufficientlywithitsownscale(<0.35).Theitem‘IfeelIam

abletohandlemisunderstandingsinmyhousehold’correlatessufficientlywiththesocial,

IncomeandEmpowermentscale.Theitem‘Ihavebeenabletospacemychildren’correlates

198

sufficientlywiththeIncomeandEmpowermentscale.Allthreeitemsareremovedfromthe

Capabilityscaleinthesecondwave.

RegardingtheIncomescalethreeitemsweredroppedandtwonewitemswereadded.In

thesecondwave,allitemsoftheincomescalecorrelatesufficientlywithitsownscale(see

Table13-12).Buttheitem‘Myaccesstohouseholdassetshasimproved’correlateshigher

withtheCapabilityscalethanitsownscale.Andboththeitems‘Iamabletosurvivein

hardshiptimes’,and‘Iamabletomakedecisionsonincomeinyourhousehold’correlate

higherwiththeEmpowermentscalethanitsownscale.Still,allincomeitemsareincludedin

theIncomescaleinthesecondwave.

Table13-11.SER:CorrelationsofitemsfromSocialandCapabilityscaleswithownscaleandotherscales,secondwave

Corrected

itemtotal

correlation

Correlation


Social

IfeelItrustmy

community

0,600 0,312 0,334 0,303 0,313 -0,148

Ifeelattachedtomy

family

0,447 0,289 0,296 0,186 0,247 -0,110

Ifeelmycontactwith

theleadershipinmy

communityhas

improved

0,563 0,320 0,469 0,412 0,340 -0,001

Ifeelmyrelationship

withtherestofthe

communityhas

improved

0,590 0,273 0,373 0,379 0,337 -0,071

Ifeelmyabilitytopay

formedicationhas

improved

0,510 0,181 0,407 0,211 0,060 -0,423

Ifeelmycapacityto

payschoolfeeshas

improvedinthelast6

months

0,509 0,145 0,415 0,170 0,074 -0,350

199

Corrected

itemtotal

correlation

Correlation


IfeelIcanget

informationabout

anythingIwant

0,618 0,308 0,429 0,293 0,137 -0,359

IfeelIhaveskillsto

enablemeimprove

mylife

0,641 0,417 0,576 0,351 0,310 -0,238

IfeelIhaveacquired

newproductiveskills

toimprovemylife

0,676 0,347 0,589 0,316 0,276 -0,228

Ifeelchangeinthe

amountofknowledge

hold

0,646 0,440 0,515 0,314 0,303 -0,229

IfeelIamableto

handle

misunderstandingsin

myhousehold(new)

0,335 0,350 0,421 0,375 0,318 -0,003

Myhusbandseeksmy

opiniononmatters

relatedtoour

household(new)

0,261 0,089 0,202 -0,038 -0,011 0,001

Ihavebeenableto

spacemychildren

(new)

0,215 0,213 0,347 0,231 0,139 -0,137

Table13-12.SER:CorrelationofitemsfromIncomescalewithownscaleandotherscales,secondwave

Correcteditem

total

correlation

Correlation


t

System Worry

Income

Iamabletosavemoney 0,561 0,342 0,415 0,388 0,253 -0,043

200

Correcteditem

total

correlation

Correlation


t

System Worry

Ihavemarketformy

produce

0,718 0,397 0,506 0,442 0,360 -0,084

Iamabletomarketmy

ownproduce

0,694 0,478 0,488 0,458 0,358 -0,124

Iamabletocontributeto

householdincome

0,702 0,407 0,451 0,545 0,247 -0,169

Mypersonalassetshave

improved

0,513 0,173 0,476 0,308 0,198 -0,295

Myaccesstohousehold

assetshasimproved

0,422 0,118 0,429 0,253 0,094 -0,248

Iamabletosurvivein

hardshiptimes

0,431 0,335 0,277 0,529 0,315 0,076

Iamabletomanagemy

ownincome

0,535 0,356 0,309 0,502 0,356 -0,031

Iamabletomake

decisionsonincomein

your

household

0,535 0,380 0,286 0,570 0,341 -0,079

Iwillbeabletoowna

businessinthenext6

month?(new)

0,628 0,263 0,516 0,267 0,197 -0,159

Iwillbeabletoimprove

production(new)

0,656 0,344 0,564 0,407 0,226 -2,78

201

Table13-13.SER:CorrelationsofitemsfromWomen’sEmpowermentscalewithownscaleandotherscales,secondwave

Correcteditem

totalcorrelation

Correlation


Women’sEmpowerment

Iamabletotakeupnew

initiativesindependently

0,474 0,269 0,314 0,440 0,367 -0,133

Iamabletomake

decisionsmore

independently

0,587 0,326 0,152 0,372 0,300 0,039

Myhoursofhousehold

workhavebeenableto

reduce

0,444 0,101 0,175 0,245 0,077 0,053

Haveyoubeenableto

gainmoretimefor

productiveactivities

0,545 0,227 0,365 0,495 0,195 -0,147

Hasyourfreedomof

movementimproved

0,516 0,306 0,195 0,355 0,312 -0,039

Ifeelimprovementinmy

self-worth

0,654 0,369 0,298 0,517 0,329 -0,109

feeltherehasbeen

changeinmyvalues

0,657 0,349 0,247 0,489 0,320 -0,053

IfeelIaminchargeofmy

body

0,511 0,370 0,169 0,395 0,329 -0,0,60

Table13-13givesthecorrelationofitemsfromtheWomen’sEmpowermentscaleforthe

secondwave.Forthisscale,fouritemsweredroppedinthesecondwave.Theremaining

itemscorrelatesufficientlywithownscale(correcteditemtotalcorrelationsareallabove

0.35)andtoalesserextentwiththeotherscales.

202

Table13-14.SER:CorrelationsofitemsfromSystemscalewithownscaleandotherscales,secondwave

Corrected

itemtotal

correlation

Correlation

Social Capability Income Empowermen

t

Worry

System

IfeelIamabletoexercise

myrights

0,156 0,438 0,151 0,343 0,458 0,024

Iamabletoaccesslegal

servicesmucheasier

0,392 0,256 0,254 0,304 0,239 -0,102

Iamabletoseekand

accessmedicalservices?

(new)

0,408 0,216 0,351 0,393 0,324 -0,274

Iamabletoaccess

financialservices?(new)

0,257 -0,055 0,221 0,191 0,104 -0,050

FortheSystemscaletwonewitemswereaddedinthesecondwave.Table13-14reveals

thatinthesecondwave,theitems‘IfeelIamabletoexercisemyrights’(olditem)and‘Iam

abletoaccessfinancialservices’(newitem)donotcorrelatesufficientlywithitsownscale.

Theitem‘IfeelIamabletoexercisemyrights’correlatessufficientlywiththesocial,income

andempowermentscale.Duetoconsistencywiththefirstwaveandtheheightofthe

correlationsbetweentheitems,theSystemscaleconsistsoftheolditems‘IfeelIamableto

exercisemyrights’and‘Iamabletoaccesslegalservicesmucheasier’,althoughthisscale

hasaratherweakreliability(seeTable13-16).

Thecorrelationsofthesecondwaveforthelastscale,Worry,arepresentedinTable13-15.

Forthesecondwave,twoitemsweredropped.Table13-15revealsthatallincludeditems

correlatesufficientlywithitsownscaleandtoalessextenttotheotherscales,exceptthe

item‘Iamworriedthatclimatechangewillaffectfoodproduction’whichcorrelates

insufficientlywithitsownscale.Duetoconsistencywiththefirstwave,allWorryitemsare

includedintheWorryscale.

203

Table13-15.SER:CorrelationofitemsfromWorryscalewithownscaleandotherscales,secondwave

Corrected

itemtotal

correlation

Correlation

Social Capability Income Empowerme

nt

System

Worry

Iamworriedthatconflictmay

happenagaininmysociety

0,414 -0,067 -0,247 -0,124 -0,087 -0,162

IamworriedthatIwillfailto

provideformyfamily

0,621 -0,101 -0,348 -0,240 -0,107 -0,064

IamworriedImaynotfinda

job

0,530 -0,088 -0,347 -0,214 -0,104 -0,111

Iamworriedofhostilityfrom

membersofmycommunity

0,461 -0,247 -0,214 -0,132 -0,043 -0,178

IamworriedImaynotget

enoughmoney

0,633 -0,014 -0,322 -0,136 -0,030 0,050

Iamworriedthatmyleaders

willnotaddresstheneedsof

mycommunity

0,628 -0,192 -0,315 -0,197 -0,154 0,008

Iamworriedthatclimate

changewillaffectfood

production

0,301 0,158 -0,093 0,088 0,205 0,216

Iamworriedthatthe

governmentwillnotaddress

myneeds

0,557 0,019 -0,209 -0,064 -0,042 0,096

InternalconsistencyoftheSER

Onthebasesoftheinteritemcorrelationsofthefirstwave,allitemsofaspecificscale,

exceptthelasttwoitemsoftheWorryscale(whichcorrelatedquitelow(<0.35)withthe

restofthescale(seeTable13-15)wereincludedinthescaleforthefirstwave.Cronbach’s

alpha(seeTable13-16)fortheSocialandWorryscalesindicatesthatthescalesareless

homogeneousthantheotherscales,althoughavalueofabove0.60–0.70isreached,which

isdeemedthelowerlimitofacceptability(Hairetal.,1998).

204

Forthesecondwave,thenewitemsoftheCapabilityscale,twoitemsofthesystem

scale,andoneitemoftheWorryscaledonotcorrelatedquitewellwiththeirownscale,as

theitemcorrelationsindicate(<0.35,seeTable13-11).Inordertobeconsistentwiththe

firstwave,itwasdecidedtoremovethethreenewitemsoftheCapabilityscale,toinclude

thetwoolditemsinthesystemscaleandtokeepall8itemsinWorryscale.Thisresultedin

theCronbach’salphaasreportedinthelowerpartofTable13-16.Thistableindicatesthat

thereliabilityofallscalesareappropriate(>0,70;Hairetal.,1998),exceptoftheSystem

scale.

Table13-16.SER:Characteristicsofthesubscales,firstandsecondwave

Wave Scale Cronbach’s

alpha

#

items

Average(range

1–5)

SD Skewness Kurtosis Missing

Firstwave Social 0,707 5 3,96 0,56 -0,17 -0,06 0

Capability 0,894 6 2,67 0,91 0,35 -0,25 0

Income 0,916 13 2,99 0,74 0,14 0,001 0

Empowerment 0,882 12 3,13 0,77 0,25 -0,26 0

System 0,832 2 3,10 1,16 -0,29 -0,60 0

Worry 0,764 8 3,55 0,66 -0,37 0,05 0

Second

wave

Social 0,748 4 4,08 0,56 -0,91 1,59 0

Capability 0,845 6 3,12 0,72 -0,35 -0,31 0

Income 0,874 11 3,59 0,59 -0,96 1,69 0

Empowerment 0,822 8 3,82 0,53 -0,55 2,21 0

System 0,585 2 3,70 0,68 -0,64 0,35 0

Worry 0,799 8 3,48 0,71 -0,42 0,13 0

Forthefirstandsecondwave,themeanscoresofthe(answered)itemsofasubscaleare

regardedasanindexofthatscale.Wheninspectingtheaveragescoresofeachsubscaleit

turnsoutthattherespondentsinthefirstwave,haveapositiveopiniontowardtheinformal

community(social),aneutralopiniontowardstheirincomeposition,empowerment,andthe

205

formalcommunity(system),anegativeopinionabouttheircapacities,andthattheyworrya

lot.Forthesecondwave,thescoresseemtoimproveforallsubscales.

Furthermore,Table13-16revealsthatallsubscalesarenormallydistributed(skewnessand

kurtosisarewithintherange-1–1)andseemtohaveasmallerstandarddeviationinthe

secondwavethaninthefirstwave.

Correlationsbetweenthesubscales

ThecorrelationsoftheitemswiththeotherscalesasreportedinTable13-11to13-15

suggestthatthesubscalesaresomewhatintertwined.Table13-17givesthecorrelations

betweenthescalesforthefirstandsecondwaveseparately.Itrevealsthat,forthefirstand

secondwave,theSocialandWorryscalesarenotcorrelatedwiththeotherscales(<0.5).

TheCapabilityscalecorrelateswiththeIncomescaleinthefirstandsecondwave,andwith

theWomen’sEmpowermentandSystemscaleinthefirstwave.Furthermore,the

EmpowermentscaleiscorrelatedwiththeIncomescaleinthefirstandsecondwave,and

withtheSystemscaleinthefirstscale.

Table13-17.SER:Correlationsbetweenthesubscales,firstandsecondwave

Social Capability Income Empowerment System

Wave

1st 2nd 1st 2nd 1st 2nd 1st 2nd 1st 2nd

Capability 0,264 0,393

Income 0,348 0,477 0,610 0,643

Women’sEmpower-

ment

0,272 0,415 0,509 0,352 0,660 0,605

System 0,060 0,405 0,535 0,245 0,400 0,383 0,553 0,406

Worry 0,025 -

0,117

-

0,191

-

0,409

-

0,032

-

0,204

-0,004 -

0,081

-

0,06

-

0,051

206

PARTVIII:QUANTITATIVERESULTS

207

DescriptionofRespondents

Descriptionofparticipantsinfirstwaveanddistricts

Intotal472respondentstookpartoftheinterview.Duetoitemnon-response(morethan

25%)onerespondentwasremovedfromtheanalysis.Otherrespondentsansweredthe

questionnairequitewell;Ingeneralitem-nonresponseislessthan10%.

Thedistrictsinwhichtherespondentsarelivingare(seealsoTable14.1):Lira(25.7%),

Katakwi(27.8%)Amuria(10.4%)andKitgum(36.1%).Thosedistrictsarelocateinthenorth

eastofUganda.

Table14-1.Geographicareaoftherespondents

District Numberofrespondents

Amuria 73

Lira 118

Katakwi 174

Kitgum 106

Thenexttableindicateshowthedifferentprogramsaredistributedacrossthedistricts.Chi-

squareanalysisrevealedthattheprogramsarenotdistributedequallyacrossthedistricts

(Ch1-square=116,11,df=9,p<0,05).

Table14-2.Geographicdistributionoftheprograms

District Programs

Cash/in-kindonly counselingonly Bothcashand

counseling

Noprogram

Amuria 3 5 37 4

Lira 28 5 50 32

Katakwi 30 48 12 41

Kitgum 25 50 38 57

Onaveragetheageoftherespondentsis42year(s.d.15.55).Ananalysisofvariance(one-

way)indicatesthatthegroupsdifferinage(F(3,459)=5.52,p<0.05).Posthocanalysis

revealedthatthecashonlygroupissignificantlyolder(47.99)thanthetraumaonlygroup

(40.60),thecashandtraumagroup(41.94)andthenoprogramgroup(39.86).

208

Table14.3indicatesthatmostrespondentsreceivedlessthatsecondaryeducation(almost

88%)andaChi-squaretestindicatethateducationallevelisnotequallydistributedacross

thegroups(Chi-square=20,08,df=9,p<0,05).

Table14.4indicatesthatmostrespondentsarefamers(almost84%)andaChi-squaretest

revealedthatoccupationisnotequallydistributedacrossthegroups(Chi-square=18.71,df

=9,p<0.05).

Table14-3.Educationallevelofthedifferentgroups

Kindofprogram Educationallevel

Neverbeento

school

AttendedPrimary

education

Attended

secondary

education

Tertiary

institution

Cash/in-kindonly 39 41 4 2

Traumacounseling

only

30 62 13 3

Bothcashtransferand

traumacounseling

35 75 20 6

Noprogram 52 72 9 1

Table14-4.Occupation/employmentofthedifferentgroups

Kindofprogram Employment/occupation

farming business Professionaljob none

Cash/in-kindonly 77 4 1 4

Traumacounseling

only

88 10 5 4

Bothcashtransferand

traumacounseling

109 14 9 5

Noprogram 119 4 1 10

Duetothedifferencesbetweenthegroups,wewillexploretheeffectsofage,educational

level,andoccupationnexttotheeffectsoftheprogramsinthechaptersthatreportofthe

effectsoftheprograms.

209

Descriptionofrespondentssecondwaveanddistricts

Intotal357respondentstookpartoftheinterviewinthesecondwave.Duetoitemnon-

response(morethan25%)onerespondentwasremovedfromtheanalysis.Other

respondentsansweredthequestionnairequitewell;Ingeneralitem-nonresponseisless

than10%.

Thedistrictsinwhichtherespondentsarelivingare(seealsoTable14.5):Amuria(18.0%),

Lira(29.8%),Katakwi(20.5%)andKitgum(31.7%).Thosedistrictsarelocatedinthenorth

eastofUganda.

Table14-5.Geographicareaoftherespondents

District Numberofrespondents

Amuria 46

Lira 104

Katakwi 121

Kitgum 113

Thenexttableshowshowthedifferentprograms(cash/in-kind,traumacounseling(not

SHLCPTS))aredistributedoverthedistricts.Chi-squareanalysisrevealedthatthetreatment

groupsarenotdistributedequallyacrossthedistricts(Ch1-square=43.461,df=9,p<0.05).

Table14-6.Geographicdistributionoftheprograms

district programs

Cashonly counselingonly Bothcashand

counseling

none

Amuria 2 16 36 10

Lira 25 30 32 19

Katakwi 13 30 18 12

Kitgum 22 17 36 38

Onaveragetheageoftherespondentsis42year(s.d.14.705).Ananalysisofvariance(one-

way)indicatesthatthegroupsdifferinage(F(3,352)=5.29,p<0.05).Posthocanalysis

revealedthatthebothcashandcounselinggroupissignificantlyolder(45.63)thantheno

210

program(firstwave)group(37.82;p<0.05),thetraumaonlygroup(40.50;p<0.10),butnot

thecashonlygroup(43.40).

Table14.7indicatesthatmostrespondentsreceivedlessthatsecondaryeducation(87%)

andaChi-squaretestindicatethateducationallevelisequallydistributedacrossthe

treatmentgroups(Chi-square=6.811,df=9,p>0.10).

Table14.8indicatesthatmostrespondentsarefamers(almost86.7%)andaChi-squaretest

revealedthatoccupationisequallydistributedacrossthetreatmentgroups(Chi-square=

12.46,df=9,p>0.10).

Table14-7.Educationallevelofthetreatmentgroups

Kindofprogram Educationallevel Neverbeento

schoolAttendedprimaryeducation

Attendedsecondaryeducation

Tertiaryinstitution

Cashtransferonly 25 33 4 0Traumacounselingonly

26 52 11 3

Bothcashtransferandtraumacounseling

43 59 15 4

None(nocashtransfernortraumacounseling

24 46 7 2

Table14-8.Occupation/employmentofthetreatmentgroups

Kindofprogram Employment/occupation Farming Business Professionaljob NoneCashtransferonly 57 2 0 3Traumacounselingonly

72 14 3 2

Bothcashtransferandtraumacounseling

105 10 3 3

None(nocashtransfernortraumacounseling

72 5 1 1

211

LevelsofTrauma(Wave1)Inthisresearch,traumawasoperationalizedwiththerevisedImpactofEventsScale(IES-R).

ThisscalereflectstheDSM-IVcriteriaforpost-traumaticstressdisorder.Regardingthefirst

wavewewillexplorethedifferencesinlevelsoftraumabetweenthegroupswhoreceived

sometypeofsupport(cash/in-kind:yes/no;counseling:yes/no)onthesubscalesoftheIES-

Randistotalscore.Isthepopulationtraumatizedtoalargeextent?Thisquestionisrelevant

asitisassumedinthetheoreticalmodelthathighlevelsoftraumaarehinderingthe

probabilitythatsocialprotectionincreaseslivelihood.

Levelsofself-reportedtrauma

Table15-1givesthestatisticsofthetotalmeanIES-Rscoreforeachgroupofrespondents.It

indicatesthatforallgroupstheaveragepost-traumaticstressisabout7(IES-R-total,sumof

thethreesubscales;minimum0maximum12,highermoretrauma).

Table15-1.IES-R:Totalmeanscoreforeachgroupofrespondents(cash/in-kindand/ortraumacounselling)

N Average SD Skewness Kurtosis

Cash/in-kindonly 86 7,58 2,57 -0,69 -0,18

Counselingonly 108 7,26 2,86 -0,88 0,45

Bothcash/in-kindandcounseling 137 7,30 3,29 -0,82 0,10

Noprogram 134 7,57 2,95 -1,40 1,40

Total 465

AccordingtoCreamer,Bell&Failla,(2003,p.1494)apersonexperienceshighlevelsof

trauma,ifthetotalmeanIES-Rishigherthan1.5.Table15-2indicateshowmany

respondentsinthefirstwavehadascorehigherthan1.5ontheIES-R.Itturnsoutthat

about84%oftherespondentsexperiencehighlevelsoftrauma.

212

Table15-2.IES-R:Numberofrespondentswithhightraumainthefirstwave

Low/moderatetrauma

(IES-R≤ ". $)(n=76)

Hightrauma(IES-R>1.5)

(n=388)

Cash/in-kind 13 73

Counseling 21 86

Cash/in-kindandcounseling 26 112

Noprogram 17 117

Missing 7

Impactofcounselingtrauma’sonreductionoftrauma

Inordertotestwhethercounselingprogramsreducetrauma,thedifferencesbetweenthe

groupsforthetotalmeanscoreoftheIES-Rwereexploredfirstandthenthedifferencesfor

thesubscales.

Table15.3revealsthatthegroupthatreceivedonlycounselingaswellasthegroupthat

receivedbothcashandtraumacounselinghavethelowestscoresonthetotalmeanIES-R.

WhentestingthedifferencesbetweenthegroupswithanANOVA(seeTable15-3),noneof

theprogramsturnedouttoaccountfordifferencesingroupmeans.

Table15-3.IES-R:EffectofprogramsonthetotalmeanofIES-R

Group(N=465) F-value p-value

Cash/in-kind F(1,460)=0,008 0,93

Counseling F(1,460)=1,093 0,296

Cash/in-kind*counseling F(1,460)=0,002 0,962

Thenewtquestioninvestigatediswhetherornotthesocio-economicbackgroundvariables

affectdifferencesbetweenthegroupsisexplored.Table15-4givestheresultswhentaking

age(asacovariate),educationallevelandemploymentintoaccount.

213

Table15-4.EffectoftheprogramsonthetotalmeanofIES-Rwhencontrollingforage,educationallevelandoccupation


Cash/in-kind F(1,450)=0,036 0,85

Counseling F(1,450)=0,397 0,53


Age F(1,450)=3,995 0,046

Educationallevel F(3,450)=4,19 0,006

Employment F(4,450)=2,51 0,058

TheresultsofTable15-4suggestthatpost-traumaticstressdisorderisnotrelatedtothe

kindofprogramreceived.However,thelevelofpost-traumaticstressisrelatedtoage(the

olderthehigherthescore,thehigherthepost-traumaticstress),educationallevel(thelower

theeducationallevelthehigherthescores,thehigherthepost-traumaticstress)andkindof

employment(womenwithabusinesshavehigherscoresthanthosewithout

occupation/employmentandreporthigherpost-traumaticstress).

Nextthedifferencesbetweenthegroupsforeachofthesubscalesisexploredseparately.

Table15-5givesthestatisticsfortheAvoidancescaleforeachgroupofrespondents.It

indicatesthatforallgroupstheaverageavoidanceisabout2(minimum0maximum4,

highermoretrauma)andthatthegroupwhoreceivednoprogramreportsthelowest

amountofavoidance.

Table15-5.IES-R:Avoidanceforeachgroupofrespondents(cash/in-kindand/ortraumacounselling)

Avoidance N Average SD Skewness Kurtosis

Cash/in-kindonly 86 2,31 0,83 -0,13 -0,22

Counselingonly 108 2,27 0,94 -0,55 0,20

Bothcash/in-kindand

counseling

137 2,27 1,08 -0,52 -0,15

Noprogram 134 2,20 0,93 -0,84 0,65

214

Total 465

WhentestingthedifferencesbetweenthetreatmentgroupswithanANOVA(seeTable15-

6),noneoftheprogramsturnedouttoaccountfordifferencesingroupmeans.

Table15-6.IES-R:EffectofprogramsontheAvoidancescale


Cash F(1,460)=0,376 0,540

Counseling F(1,460)=0,027 0,870

Cash*counseling F(1,460)=0,489 0,485

Whenthesocio-economicbackgroundvariables,age(asacovariate),educationalleveland

employmentaretakenintoaccountnexttothesocialprogrammodes,avoidanceisstillnot

affectedbysocialprotection(seealsoTable15-7).However,avoidanceisrelatedtoage(the


theeducationallevelthehigherthescores,thehigherthepost-traumaticstress)and

marginallytokindofemployment(howeverwhentestingthedifferencesbetweenthetypes

ofemploymentnosignificantdifferencesappeared).

Table15-7.IES-R:EffectofprogramsontheAvoidancescalewhencontrollingforage,educationallevelandoccupation


Cash F(1,450)=0,065 0,80

Counseling F(1,450)=0,167 0,68


Age F(1,450)=5,935 0,015


Employment F(3,450)=2,146 0,094

NextthedifferencesbetweentheinterventionsandtheIntrusionscaleareexplored.

215

Table15-8givesthestatisticsofIntrusionscaleforeachgroupofrespondents.Itindicates

thatforallgroupstheaverageIntrusionisabout2.6(minimum0maximum4,highermore

trauma).Table15-8suggeststhatthegroupsthatreceivedcounselingorcashand

counselingscoreloweronIntrusion.

Table15-8.Statisticsfortheintrusionsubscaleforeachgroupofrespondents(cashtransfer/in-kindand/ortraumacounselling)

Intrusion N Average SD Skewness Kurtosis

Cashonly 86 2,66 0,91 -0,78 -0,26

Counselingonly 108 2,60 0,99 -1,04 0,68

Bothcashandcounseling 137 2,56 1,15 -0,88 0,01

Noprogram 134 2,74 1,05 -1,45 1,48

Total 465

WhentestingthedifferenceswithanANOVA(seeTable15-9)nodifferencesbetweenthe

groupsaresignificant.

Table15-9.IES-R:EffectofprogramsonIntrusionsubscale


Cash F(1,460)=0,320 0,57

Counseling F(1,460)=1,592 0,208


Whenthesocio-economicbackgroundvariables,age(asacovariate),educationallevel,and

employmentaretakenintoaccountnexttoprograms,Intrusionisstillnotaffectedbythe

typeofprogramreceived(seealsoTable15-10).However,itismarginallyrelatedtoage(the


theeducationallevelthehigherthescores,thehigherthepost-traumaticstress)and

marginallytokindofemployment(havingabusinessgoeswiththemostintrusionreported).

216

Table15-10.IES-R:EffectofprogramsontheIntrusionsubscalewhencontrollingforage,educationallevelandoccupation


Cash/in-kind F(1,450)=0,694 0,405

Counseling F(1,450)=0,593 0,442


Age F(1,450)=3,355 0,068


Employment F(3,450)=2,439 0,064

ThelastsubscaletobeanalyzedisHyperarousal.Table15-11givestheHyperarousalscale

foreachgroupofrespondents.Table15-11suggeststhatthecounselingonlygroupaswell

asthecashandcounselinggroupexperiencestheleastamountofhyperarousal.

Table15-11.IES-R:Hyperarousalforeachgroupofrespondents(cashtransfer/in-kindand/ortraumacounselling)

Hyperarousal N Average SD Skewness Kurtosis

Cashonly 86 2,60 0,99 -0,64 -0,51

Counselingonly 108 2,39 1,09 -0,64 -0,51

Bothcashandcounseling 137 2,48 1,20 -0,73 -0,46

Noprogram 134 2,64 1,13 -1,19 0,38

Total 465

WhentestingthedifferenceswithanANOVA(seeTable15-12)counselingshoweda

marginallysignificanteffect(p<0.10).Posthocanalysesrevealedthatthecounselinggroup

scoredsomewhatlowercomparedtothenoprogramgroup(experiencedlesser

hyperarousal).

217

Table15-12.IES-R:EffectofprogramsonHyperarousalsubscale


Cash F(1,460)=0,054 0,816

Counseling F(1,460)=3,040 0,082


Whenthesocio-economicbackgroundvariables,age(asacovariate),educationallevel,and

employmentaretakenintoaccountnexttotheprogrammodes,hyperarousalisnot

affectedbytheprograms(seealsoTable15-13).However,itisrelatedtoeducationallevel

(thelowertheeducationallevelthehigherthescores,thehigherthepost-traumaticstress),

andmarginallyrelatedtoemployment(havingabusinessgoeswithmorehyperarousal

comparedtohavingnojob)butnotwithage.

Table15-13.IES-R:EffectofprogramsontheHyperarousalscalewhencontrollingforage,educationallevelandoccupation


Cash F(1,450)=0,002 0,961

Counseling F(1,450)=1,713 0,191


Age F(1,450)=2,231 0,136


Employment F(3,450)=2,567 0,054

Conclusion

Themainfindingsregardingtheleveloftraumacanbesummarizedasfollows:

• About85%oftherespondentsexperiencehighlevelsoftrauma.Consequently,itcan

beconcludedthatcollectivetraumacanhinderprogramspromotinglivelihoods.

• However,theanalysesrevealedthatthegroupsthatreceiveddifferenttypesof

support(ornone)didnotdifferinthetraumalevelsexperienced.

218

EffectofSocialProtectiononSocialandEconomicResilience

(Wave1)Inthisresearch,SocialandEconomicResiliencewasoperationalizedwiththeSER-tool,

whichconsistsofsixsubscales:Social,Capability/HumanCapital,ImprovementofActual

Income/Economic,Women’sEmpowerment,Structural/System,andWorry.Thischapter

exploreswhetherornottherearedifferencesbetweengroupsthatreceivedsometypeof

socialprotection(cash:yes/no;counseling:yes/no)onthesubscalesoftheSER-tool.

Social

Table16-1givesthestatisticsofthesocialscaleoftheSER.Itshowsthatthemeanscoreis

about4(onafive-pointscale).Furthermore,itsuggeststhatthemeanscoresareaboutthe

sameacrossthegroups.

Table16-1.SER:ScoresontheSocialscaleforeachgroup(cashtransfer/in-kindand/ortraumacounselling)

Social N Average SD Skewness Kurtosis

Cash/in-kindonly 86 3,96 0,533 -0,208 0,189

Counselingonly 107 3,95 0,544 -0,074 0,491

Bothcash/in-kindand

counseling

137 3,92 0,604 -0,291 0,156

Noprogram 134 3,93 0,566 -0,168 -0,817

total 464

WhentestingthedifferencesonthesocialsubscalewithanANOVA(seeTable16-2)no

differencesbetweenthegroupsaresignificant.

Table16-2.SER:EffectofprogramsontheSocialscale


Cash/in-kind F(1,460)=0,370 0,543

Counseling F(1,460)=1,488 0,223


219

Dothesocio-economicbackgroundvariables,inadditiontotheprograms,affecttheSocial

subscaleoftheSER.Table16-3givestheresultswhentakingage(asacovariate),

educationallevelandemploymentintoaccount.

Table16-3.SER:EffectofprogramsontheSocialscalewhentakingage,educationallevelandoccupationintoaccount


Cash/in-kind F(1,450)=0,162 0,687

Counseling F(1,450)=0,272 0,602


Age F(1,450)=0,161 0,688


Employment F(4,450)=3,389 0,018

TheresultsofTable16-3suggestthatthescoresontheSocialscalearenotrelatedtotype

ofprogramreceived,agenoreducationallevel.However,itisrelatedtokindofemployment

(womenwithabusiness,aprofessionaljoborfarminghavehigherscoresthanthose

withoutoccupation/employment).

Capability

Table16-4givesthestatisticsoftheCapabilitysubscaleoftheSER.Itshowsthatthemean

scoreisabout2.6(onafive-pointscale)whatindicatesmoderatelevelsofCapability.

Furthermore,itsuggestthatthegroupwhoreceivednoprogramscoreslowestonthe

capabilitysubscale.

Table16-4.SER:Capabilityscoresforeachgroupofrespondents(cash/in-kindand/ortraumacounselling)

Capability N Average SD Skewness Kurtosis

Cash/in-kindonly 86 2,668 0,821 0,566 0,071

Counselingonly 107 2,687 0,847 0,418 0,111

Bothcash/in-kindand

counseling

137 2,775 1,012 0,391 -0,505

220

Noprogram 134 2,552 0,898 0,138 -0,496

Total 464

WhentestingtheeffectoftheprogramswithanANOVA(seeTable16-5)nodifferences

betweenthegroupsaresignificant.

Table16-5.SER:EffectoftheprogramsontheCapabilityscale

N(464) F-value p-value

Cash/in-kind F(1,460)=1,29 0,256

Counseling F(1,460)=1,51 0,177



employmentaretakenintoaccountnexttotheprograms,capacityisstillnotaffectedbythe

programs(seealsoTable16-6).However,itisrelatedtoeducationallevel(thelowerthe

educationallevelthelowerthescores)andkindofemployment(womenwithabusinessora

professionaljob(butnotfarming)havehigherscoresthanthosewithout

occupation/employment),butnottoage.

Table16-6.SER:TheeffectofprogramsontheCapabilityscalewhentakingage,educationallevelandoccupationintoaccount


Cash/in-kind F(1,450)=1,165 0,281

Counseling F(1,450)=0,00 0,998


Age F(1,450)=0,406 0,525


Employment F(4,450)=3,916 0,009

221

Income

Table16-7givesthestatisticsoftheIncomescaleforeachofthegroups.Theaveragescore

isabout3(onafivepointscale)whichindicatesthatrespondentsperceivemoderateincome

opportunities.Moreover,itsuggeststhatthegroupswhoreceivednoprogramscoreslowest

onperceivedincomeopportunities.

Table16-7.SER:Incomescoresforeachgroupofrespondents(cashtransfer/in-kindand/ortraumacounselling)

Income N Average SD Skewness Kurtosis

Cash/in-kindonly 86 2,950 0,742 0,204 -0,266

Counselingonly 107 3,069 0,662 0,395 0,509

Bothcash/in-kindand

counseling

137 3,131 0,806 0,022 -0,048

Noprogram 134 2,827 0,708 -0,008 -0,228

Total 464

WhentestingtheeffectofprogramsontheperceivedIncomeopportunitieswithanANOVA

(seeTable16-8),counselingrevealsasignificant(positive)effect(cashonlyandthe

interactioneffectbetweencashandcounselinghadnosignificanteffect).

Table16-8.SER:EffectofprogramsontheIncomescores


Cash/in-kind F(1,460)=1,776 0,183

Counseling F(1,460)=9,248 0,002



employmentaretakenintoaccountnexttotheprograms,theperceivedIncome

opportunitiesarestill(positively)affectedbycounseling(seealsoTable16-9).Moreover,

educationallevelhasa(marginally)significanteffectontheincomescale(thehigherthe

educationallevelthehigherthescoreonincome),aswellasoccupation(thegroupwithno

222

jobhasalowerscoreonincomecomparedtofarming,businessandprofessionaljoband

farminghasalowerincomethatbusinessandprofessionaljob),butagehasnoeffect.

Table16-9.SER:EffectofprogramsontheIncomescoreswhentakingage,educationallevelandoccupationintoaccount


Cash/in-kind F(1,450)=1,386 0,240

Counseling F(1,450)=3,533 0,061


Age F(1,450)=0,071 0,790


Employment F(4,450)=7,031 0,000

Empowerment

Table16-10givesthestatisticsofEmpowermentscaleforeachofthegroups.Theaverage

scoreisabout3(onafive-pointscale)whichindicatesthatrespondentsperceivemoderate

levelsofempowerment.Moreover,itsuggeststhatthegroupwhoreceivednoprogram

scoreslowestonempowerment.

Table16-10.SER:Empowermentscoresforeachgroupofrespondents(cash/in-kindtransferand/ortraumacounselling)

Empowerment N Average SD Skewness Kurtosis

Cash/in-kindonly 86 3,134 0,799 0,465 -0,062

Counselingonly 107 3,111 0,675 0,154 0,225

Bothcash/in-kindand

counseling

137 3,291 0,802 0,215 -0,386

Noprogram 134 2,987 0,774 0,134 -0,580

Total 464

223

WhentestingtheeffectofprogramsonEmpowermentwithanANOVA(seeTable16-11),

cashandcounselingbothhaveapositivesignificanteffect(interactioneffectbetweencash

andcounselinghadnosignificanteffect).

Table16-11.SER:TheeffectofprogramsonEmpowerment


Cash/in-kind F(1,460)=5,708 0,017

Counseling F(1,460)=4,252 0,040



employmentaretakenintoaccountnexttotheprograms,Empowermentisstill(positively)

affectedbycash/in-kindandcounseling(buttheinteractioneffectisnotsignificant)(see

alsoTable16-12).Furthermore,weseethatagehasamarginallysignificanteffect(the

highertheagethemoreempowerment),butbotheducationallevelandemploymentdonot

haveasignificanteffectonEmpowerment.

Table16-12.SER:TheeffectofprogramsonEmpowermentwhentakingage,educationallevelandoccupationintoaccount

N(461) p-value

Cash/in-kind F(1,450)=3,591 0,059

Counseling F(1,450)=3,106 0,079


Age F(1,450)=3,368 0,067

Educationallevel F(3,450)=290 0,832

Employment F(4,450)=1,184 0,315

System

Table16-13givesthestatisticsoftheSystemscaleforeachgroups.Theaveragescoreis

about3(onafive-pointscale)whichindicatesthatrespondentsperceivemoderatelevelsof

224

security.Moreover,itsuggeststhatthegroupswhoreceivedonlytraumacounselingisleast

satisfiedwiththesystem.

Table16-13.SER:Systemscoresforeachgroupofrespondents(cash/in-kindtransferand/ortraumacounselling)

System N Average SD Skewness Kurtosis

Cash/in-kindonly 86 3,389 1,001 -0,462 0,225

Counselingonly 107 2,869 1,135 0,080 -0,759

Bothcash/in-kindandcounseling 137 3,095 1,254 -0,363 -0,726

Noprogram 134 3,086 1,125 -0,342 -0,479

Total 464

WhentestingtheeffectofprogramsontheSystemsubscalewithanANOVA(seeTable16-

14),cashandcounselingbothhavesignificanteffect(interactioneffectbetweencashand

counselinghadnosignificanteffect).Itturnsoutthatthosewhoreceivedcashscorehigher

onSystem,andthosewhoreceivedcounselingscoresloweronSystem.

Table16-14.SER:TheeffectofprogramsontheSystemsubscale


Cash/in-kind F(1,460)=3,796 0,052

Counseling F(1,460)=6,300 0,012



employmentaretakenintoaccountnexttotheprograms,Systemisstill(negatively)

affectedbycounselingbutnotbycash(northeinteractioneffectisnotsignificant)(seealso

Table16-15).Furthermore,weseethatagehasasignificanteffect(thehighertheagethe

higherthescoreonsystem).But,educationallevelandemploymentdonothavea

significanteffectonSystem.

225

Table16-15.SER:EffectofprogramsontheSystemsubscalewhentakingage,educationallevelandoccupationintoaccount


Cash/in-kind F(1,450)=2,272 0,132

Counseling F(1,450)=5,725 0,017


Age F(1,450)=10,346 0,001


Employment F(4,450)=1,439 0,231

Worry

Table16-16givesthestatisticsofWorryscaleforeachofthegroup.Itindicatesthat

counselinggroupscorelowestonWorry,whilethecashandcounselinggroupscoreshighest

onWorry.

Table16-16.SER:Worryscoresforeachgroupofrespondents(cashtransfer/in-kindand/ortraumacounselling)

System N Average SD Skewness Kurtosis

Cash/in-kindonly 86 3,543 0,542 -0,518 1,365

Counselingonly 107 3,365 0,704 -0,450 -0,260

Bothcash/in-kindand

counseling

137 3,685 0,695 -0,362 -0,001

Noprogram 134 3,584 0,616 -0,157 -0,734

Total 465

WhentestingtheeffectofprogramsonWorrywithanANOVA(seeTable16-17),receiving

cashhasa(positive)significanteffect(thosewhoreceivedcashworriedmore),receiving

counselingdoesnotdecreaseWorry(hasnosignificantmaineffect).However,the

interactioneffectbetweencashandcounselingisalsosignificantindicatingthatwhen

receivingbothcashandcounseling,Worryincreases.

226

Table16-17.SER:TheeffectofprogramsonWorry


Cash/in-kind F(1,460)=5,201 0,023

Counseling F(1,460)=0,385 0,535



employmentaretakenintoaccountnexttotheprograms,worryisstill(positively)affected

bycash,notaffectedbycounselingandtheinteractioneffectbetweencashandcounseling

isstillsignificantindicatingthatwhenreceivingbothcashandcounseling,Worryincreases.

Furthermore,age,educationallevel,noroccupationhaveasignificanteffectonWorry.

Table16-18.SER:EffectofprogramsonWorrywhentakingage,educationallevelandoccupationintoaccount

N(461) p-value

Cash/In-kind F(1,450)=4,938 0,027

Counseling F(1,450)=0,496 0,481


Age F(1,450)=0,280 0,597


Employment F(4,450)=0,623 0,601

Conclusion:Impactofprogramsoncapability,incomeandempowerment

ThefollowinggraphsillustratethepositiveeffectoftheprogramsonSocialEconomic

Resilience,particularlyasshowingincapability,incomeandempowerment.Thegraphs

showthatthesocialsupportprograms(indeedas‘cash’)haveasignificantpositiveimpact

onallthreeparameters.Thecounselingprogramhasahighersignificantpositiveimpacton

thethreeparametersandthecombinationofsocialprotection(indexedas‘cash’)and

counseling(traumasupport)hadthehighestsignificantpositiveeffectoncapability,income

andempowerment.

227

Figure16-1.MeanscoresonCapabilities,IncomeandEmpowerment(firstwave)

1

1,5

2

2,5

3

3,5

4

4,5

5

capability

cash transfers/in-kind

counseling

cash transfers/in-kind andcounseling no program

1

1,5

2

2,5

3

3,5

4

4,5

5

income


counseling


1

1,5

2

2,5

3

3,5

4

4,5

5

empowerment


counseling


228

Themainfindingsregardingtheeffectoftheprogramsthroughcash/in-kindtransferson

socialandeconomicresiliencecanbesummarizedasfollows:

Forreceivingcash/in-kindtheresultsindicatethat:

• Receivingcash/in-kindhasnoeffectonSocial,Capability,improvementofactual

Income

• Receivingcash/in-kindhasapositiveeffectonWomen’sEmpowermentandSystem

• Receivingcash/in-kindhasanegativeeffectonWorry(itincreasesworry)

Forreceivingcounseling,theresultsindicatethat:

• ReceivingcounselinghasnoeffectonSocial,CapabilityandWorry

• ReceivingcounselinghasapositiveeffectonimprovementofactualIncomeand

WomenEmpowerment

• ReceivingcounselinghasanegativeeffectonSystem

Furthermore,theinteractioneffectbetweencash/in-kindandcounselingissignificantfor

Worry:whenreceivingbothcashandcounseling,Worryincreases.

229

EffectoftheSHLCPTSProgramonSocialandEconomic

Resilience(Wave2)Inthischapter,thefocusisontheeffectoftheSHLCPTSprogramonSocialandEconomic

resilience.Inreadingthisreport,oneshouldrealizethatthetimebetweenfinishingthe

SHLCPTSprogramandthismeasurementwasonlyafewmonths.Consequently,the

reportedeffectivenessoftheSHLCPTSprograminincreasingsocialandeconomicresilience

maybeunderestimated.Furthermore,theprogramwasprobablynotassignedatrandomto

membersofacommunity,buttospecificcommunitiesthatcouldbenefitmostfromit.

Consequently,thoserespondentswhodidreceivetheSHLCPTSprogramprobablyscored

lowerintermsofsocialandeconomicresiliencecomparedtothosewhodidnotreceiveit,

whenstartingtheprogram.

Inthisresearch,socialandeconomicresiliencewasoperationalizedbymeansoftheSER-

toolthatconsistsofsixscales:Social,Capability/humancapital,improvementofactual

Income/economic,WomenEmpowerment,Structural/System,andWorry.Intheresearch,

theSHLCPTSprogramwasimplementedforthegroupsthatreceivedcash/in-kindonly,or

counselingonly,orbothcash/in-kindandcounseling,ornoprograminthefirstwave.This

resultsiseightdifferentgroupsofrespondents(seealsosection4.7).Thisdesignallowsusto

studythedirect(main)effectofSHLCPTSprogram,thelagged(main)effectofcash/in-kind

andthelagged(main)effectofcounseling(offeredbeforethefirstwave).Moreover,the

analysesallowustoinvestigatetheinteractionsbetweenthedifferenttypesprograms

(cash/in-kind,counseling,andSHLCPTSprogram).Inordertoexplorealltheseeffects,we

willgointothedifferencesbetweentheeightgroupsoneachofthesubscalesoftheSER-

toolsuccessively.

Social

Table17-1givesthestatisticsfortheSocialscoresforeachgroupofrespondents.Itshows

thatthesescoresrangefrom3.96to4.26(onafive-pointscale).Thegroupthatreceived

cashbutnoSHLCPTSprogramhasthelowestscore,whilethegroupsthatreceivedbothcash

andcounselingbutnoSHLCPTSprogramasthehighestscore.

230

Table17-1.SER:ScoresontheSocialscaleforeachgroupofrespondents(cashtransfer/in-kind,traumacounselling,SHLCPTSprogram)


Cash/in-kindonlyandSHLCPTS 25 3,96 0,70 -1,27 1,17

CounselingandSHLCPTS 56 3,99 0,54 -1,12 2,07

Cash/in-kind,counselingandSHLCPTS 85 3,99 0,63 -0,98 1,87

OnlySHLCPTS 21 4,00 0,54 -0,71 -0,42

Cash/in-kindonlyandnoSHLCPTS 37 4,14 0,47 -0,13 0,50

CounselingonlyandnoSHLCPTS 37 3,99 0,61 -0,62 0,83

Bothcash/in-kindandcounseling,noSHLCPTS 37 4,26 0,40 -0,18 1,95

Noprogram 58 4,15 0,52 -0,37 -0,25

Total 356

WhentestingthedifferencesonthesocialsubscalewithanANOVA(seeTable17-2),itturns

outthatSHLCPTSprogramhasamarginalnegativesignificanteffect.Furthermore,the

interactionbetweencashandSHLCPTSprogramisalsosignificant(receivingcashand

SHLCPTSprogramdecreasesthescoresontheSocialsubscale(seeFigure17.1).

Table17-2.SER:EffectoftheprogramsontheSocialscale


Cash/in-kind F(1,349)=0,031 0,861

Counseling F(1,349)=0,111 0,740

SHLCPTS F(1,349)=3,419 0,065


Cash*SHLCPTS F(1,349)=4,250 0,040

Counseling*SHLCPTS F(1,349)=0,600 0,439

231

Nextwhetherornotthesocio-economicbackgroundvariablesaffectthedifferences

betweenthegroupswillbeexplored.Table17-3givestheresultswhentakingage(asa

covariate),educationallevelandemploymentintoaccount.

Table17-3.SER:EffectofprogramsontheSocialscalewhencontrollingforage,educationallevelandoccupation


Cash/in-kind F(1,337)=0,009 0,924

Counseling F(1,337)=0,306 0,581

SHLCPTS F(1,337)=3,39 0,066


Cash*SHLCPTS F(1,337)=2,635 0,105

SHLCPTSprogram

Figure17-1.Interactioneffectbetweencash/in-kindandSHLCPTSprogramontheSocialscale

232


Age F(1,337)=0,028 0,867


Occupation F(3,337)=3,528 0,015

TheresultsofTable17-3suggestthatthescoresonthesocialscalearerelatedtoSHLCPTS

program(theprogramdecreasesscoresonthesocialsubscale).Nowtheinteraction

betweencashandtheSHLCPTSprogramismarginallysignificant(receivingcaseandthe

programdecreasesthescoresontheSocialsubscale).Moreover,thekindofemploymentis

alsorelatedtothesocialscore(womenwithabusiness,aprofessionaljoborfarminghave

higherscoresthanthosewithoutoccupation/employment).

Capability

Table17-4givesthestatisticsforCapabilityoftheSERforeachgrouprespectively.Itshows


cashbutnoSHLCPTSprogramhasthelowestscore,whilethegroupsthatreceivedbothcash


Table17-4.SER:ScoresontheCapabilityscaleforeachgroupofrespondents(socialprotection:cashtransfer,traumacounselling,SHLCPTSprogram)


Cash/in-kindonlyandSHLCPTS 25 3,10 0,79 -0,40 -1,31

CounselingandSHLCPTS 56 3,17 0,72 -0,17 -0,84


OnlySHLCPTS 21 3,25 0,66 -1,22 0,59

Cash/in-kindonlyandnoSHLCPTS 37 3,17 0,66 -0,10 -0,78


Bothcashandcounseling,NoSHLCPTS 37 3,39 0,74 -0,56 0,49

Noprogram 58 3,26 0,70 -0,06 -0,62

Total 356

233

WhentestingthedifferencesonthecapabilityscalewithanANOVA(seeTable17-5),itturns

outthatnoneofthemaineffectsaresignificant.Theinteractionbetweencash/in-kindand

traumacounselingissignificant(receivingcash/in-kindandtraumacounselingincreasesthe

scoresontheCapabilitysubscale;seeFigure17.2).

Table17-5.SER:EffectofprogramsonCapability


Cash/in-kind F(1,349)=0,259 0,611

Counseling F(1,349)=0,188 0,665

SHLCPTS F(1,349)=0,101 0,751


Cash/in-kind*SHLCPTS F(1,349)=0,557 0,456


234

Whenthesocioeconomicbackgroundvariables,age(asacovariate),educationalleveland

employmentaretakenintoaccountnexttothedifferentprograms,theANOVAanalysis

indicatesthatnoneofthemaineffectsaresignificant.Again,theinteractionbetween

cash/in-kindandcounselingrevealsasignificanteffect(receivingcashandtrauma

counselingincreasesthescoresontheCapabilityscale,andageismarginallyrelatedto

capacity(youngerwomenreporthigherCapability).

Table17-6.SER:EffectoftheprogramsonCapacitywhencontrollingforageeducationallevelandoccupation


Cash/in-kind F(1,337)=1,776 0,183

Counseling F(1,337)=0,061 0,805

Counselling

Figure17-2.Interactionbetweencash/in-kindandtraumacounsellingontheCapabilityscale

235

SHLCPTS F(1,337)=0,078 0,781



Counseling*SHLCPTS F(1,337)=0,0,25 0,874

Age F(1,337)=4,322 0,038


Occupation F(3,337)=1,844 0,139

Income

Table17-7givesthestatisticsforIncomeoftheSERforeachgrouprespectively.Itshows


cashandSHLCPTSprogramhasthelowestscore,whilethegroupsthatreceivedbothcash


Table17-7.SER:ScoresontheIncomescaleforeachgroupofrespondents(cashtransfer/in-kind,traumacounselling,SHLCPTSprogram)





OnlySHLCPTS 21 3,56 0,29 -1,18 2,25



Bothcashandcounseling,noSHLCPTS 37 3,71 0,57 -0,50 1,28

Noprogram 58 3,65 0,48 -0,39 0,20

Total 356

236

WhentestingthedifferencesontheincomesubscalewithanANOVA(seeTable17-8),it

turnsoutthatbothcounselingandSHLCPTSprogramhaveamarginallysignificantmain

effect(receivingcounselinggoeswithhigherscoresandreceivingSHLCPTSgoeswithlower

scoresontheIncomesubscale).Theinteractionbetweencashandcounselingisalso

significant(receivingcash/in-kindandtraumacounselingincreasesthescoresontheIncome

subscale;seeFigure17.3).

Counselling

Figure17-3.SER:Interactioneffectbetweencash/in-kindandtraumacounsellingontheIncomescale

237

Table17-8.SER:EffectoftheprogramsontheIncomescale


Cash/in-kind F(1,349)=0,084 0,772

Counseling F(1,349)=2,680 0,102

SHLCPTS F(1,349)=2,592 0,108


Cash*SHLCPTS F(1,349)=0,004 0,947



employmentaretakenintoaccountnexttotheprograms,theanalysisindicatesthat

counselinghasasignificanteffect(counselinggoeswithahigherscore).TheSHLCPTS

programhasamarginallysignificanteffectonIncome(butreceivingSHLCPTSprogramgoes

withalowerscore).Moreover,occupationhasasignificanteffect(beingunemployedgoes

withlowerscoresoftheIncomesubscale).

Table17-9.SER:EffectofprogramsonIncomewhencontrollingforage,educationallevelandoccupation


Cash/in-kind F(1,337)=0,207 0,650

Counseling F(1,337)=2,265 0,133

SHLCPTS F(1,337)=2,826 0,094




Age F(1,337)=1,734 0,189


Occupation F(3,337)=4,910 0,002

238

Empowerment

Table17-10-givesthestatisticsforEmpowermentoftheSERforeachgrouprespectively.It

showsthatthesescoresrangefrom3.54to3.92(onafive-pointscale).Thegroupthat

receivedcash/in-kindandSHLCPTSprogramhasthelowestscore,whilethegroupsthat

receivedbothcashandcounselingbutnoSHLCPTSprogramasthehighestscore.

Table17-10.ScoresontheEmpowermentscaleforeachgroupofrespondents(cash/in-kindtransfer,traumacounselling,SHLCPTSprogram)



CounselingandSHLCPTS 56 3,86 0,47 0,29 -0,23


OnlySHLCPTS 21 3,82 0,43 -0,456 1,343


CounselingonlyandnoSHLCPTS 37 3,83 0,56 -0,01 -0,05


Noprogram 58 3,83 0,47 0,19 0,74

Total 356

WhentestingthedifferencesontheEmpowermentsubscalewithanANOVA(seeTable17-

11),itturnsoutthatcounselinghasasignificantmaineffect(receivingtraumacounseling

goeswithhigherscoresontheEmpowermentsubscale).Furthermore,theinteraction

betweencash/in-kindandcounselingisalsosignificant(receivingnocash/in-kindandno

traumacounselingdecreasesthescoresontheEmpowermentsubscale,seeFigure17.4).

Table17-11.SER:EffectofprogramsonEmpowerment


Cash/in-kind F(1,349)=1,480 0,225

Counseling F(1,349)=5,453 0,020

239

SHLCPTS F(1,349)=0,878 0,350





employmentaretakenintoaccounttogetherwithtotheprograms,theanalysisindicates

thatcounselinghasasignificantmaineffect(receivingcounselinggoeswithhigherscoreson

theempowermentsubscale).Theinteractionbetweencash/in-kindandtraumacounselingis

stillmarginallysignificant(receivingnocash/in-kindandnocounselingdecreasesthescores

ontheEmpowermentsubscale.Moreover,neitherage,educationallevelnorkindof

occupationhaveasignificanteffectonEmpowerment.

Counseling

Figure17-4.SER:InteractioneffectofcashandcounsellingontheEmpowermentscale

240

Table17-12.SER:EffectofprogramsonEmpowermentwhencontrollingforageeducationallevelandoccupation


Cash/in-kind F(1,337)=1,397 0,238

Counseling F(1,337)=5,512 0,019

SHLCPTS F(1,337)=0,935 0,334




Age F(1,337)=0,838 0,361


Occupation F(3,337)=0,863 0,361

System

Table17-13givesthestatisticsforSystemoftheSERforeachgrouprespectively.Itshows


cashandSHLCPTSprogramhasthelowestscore,whilethegroupsthateitherreceived

counselingandSHLCPTSprogramorcounselingandnoSHLCPTSprogramhavethehighest

score.

Table17-13.SER:ScoresontheSystemscaleforeachgroupofrespondents(cash/in-kindtransfer,traumacounselling,SHLCPTSprogram)





OnlySHLCPTS 21 3,71 0,58 -0,54 -0,76


CounselingonlyandnoSHLCPTS 37 3,76 0,48 0,36 0,03

Bothcash/in-kindandcounseling,noSHLCPTS 37 3,74 0,73 -0,38 -0,12

241

Noprogram 58 3,61 0,73 -0,44 -0,31

Total 356

WhentestingthedifferencesontheSystemsubscalewithanANOVA(seeTable17-14),it

turnsoutthatnoneoftheprogramshasaneffectonthescoresoftheSystemsubscale.

Table17-14.SER:EffectofprogramsonSystem


Cash/in-kind F(1,349)=0,059 0,808

Counseling F(1,349)=2,435 0,120

SHLCPTS F(1,349)=0,080 0,778





employmentaretakenintoaccountnexttotheprograms,theanalysisindicatesthatstill

noneoftheprogramshasaneffectonSystem.Thesamecountsforthesocio-economic

backgroundvariables;educationallevel,noroccupationhaveaneffectonSystemscores.

Table17-15.SER:EffectofprogramsonSystemwhencontrollingforage,educationallevelandoccupation


Cash/in-kind F(1,337)=0,007 0,932

Counseling F(1,337)=2,212 0,138

SHLCPTS F(1,337)=0,171 0,680



Counseling*program F(1,337)=0,028 0,866

Age F(1,337)=0,397 0,529

242


occupation F(3,337)=0,390 0,760

Worry

Table17-16givesthestatisticsforWorryforeachgrouprespectively.Itshowsthatthese

scoresrangefrom3.27to3.75(onafive-pointscale).Thegroupthatreceivedbothcash/in-

kindandcounselingbutnoSHLCPTSprogramhasthelowestscore,whilethegroupthat

receivedcounselingandnoSHLCPTSprogramhasthehighestscore.

Table17-16.SER:ScoresontheWorryscaleforeachgroupofrespondents(cash/in-kindtransfer,traumacounselling,SHLCPTSprogram)





OnlySHLCPTS 21 3,71 0,39 -0,19 0,61

CashonlyandnoSHLCPTS 37 3,57 0,75 0,21 -0,54


Bothcashandcounseling,noSHLCPTS 37 3,27 0,80 -0,73 -0,18

Noprogram 58 3,46 0,69 -0,17 -0,02

Total 356

WhentestingthedifferencesonthesystemsubscalewithanANOVA(seeTable17-17),it

turnsoutthatnoneofprogramshasaneffectonWorry.

Table17-17.SER:EffectofprogramsontheWorry


Cash/in-kind F(1,349)=0,925 0,337

Counseling F(1,349)=0,706 0,401

SHLCPTS F(1,349)=0,019 0,891

243




Thequestionwhetherornotsocio-economicbackgroundvariablesage(asacovariate),

educationallevel,andemploymentinadditiontotheprogramsaffectWorryisexplored(see

alsoTable17-18).TheresultsindicatethatstillnoneoftheprogramshasaneffectonWorry.

OnlyagehasamarginallysignificanteffectontheWorrysubscale;theolderawomanthe

higherthescoreontheWorryscale(themoresheworries).

Table17-18.SER:EffectofsocialprotectiononWorrywhencontrollingforageeducationallevelandoccupation


Cash/in-kind F(1,337)=1,901 0,169

Counseling F(1,337)=0,714 0,399

SHLCPTS F(1,337)=0,003 0,960




Age F(1,337)=3,019 0,083


Occupation F(3,337)=0,491 0,689

244

Conclusion:Impactoncapability,incomeandempowerment(wave2)

Figure17-5.MeanscoresonCapability,EmpowermentandIncomeforthosewhoreceivedtheSHLCPTS-program

1

1,5

2

2,5

3

3,5

4

4,5

5

capability

shlcpts & cash transfers/in-kind

shlcpts & counseling

shlcpts & cash transfers/in-kindand counselingonly shlcpts

1

1,5

2

2,5

3

3,5

4

4,5

5

income



1

1,5

2

2,5

3

3,5

4

4,5

5

empowerment



245

Figure17-6.MeanscoresonCapability,EmpowermentandIncomeforthosewhodidnotreceivedtheSHLCPTS-program(wave2)

1

1,5

2

2,5

3

3,5

4

4,5

5

capability



1

1,5

2

2,5

3

3,5

4

4,5

5

income



1

1,5

2

2,5

3

3,5

4

4,5

5

empowerment



246

Themainfindingsregardingtheeffectivenessofprogramsinincreasingsocialandeconomic

resilienceare:

• Receivingcash/in-kindhasnoeffectonanyofthesubscalesofSER.

• ReceivingcounselinghasapositiveeffectoftheIncomeandEmpowermentscores.

• Receivingbothcash/in-kindandcounselingincreasestheCapabilityandIncome

scores,butlowersEmpowermentscores.

TheeffectofSHLCPTSarepreliminary,duetotheshorttimeperiodbetweenfinishingthe

programandthequestionnaire.Furthermore,oneshouldrealizethattheSHLCPTSprogram

wasnotassignedrandomlytoanindividual.Therewasaselectionofcommunitiesthatwere

expectedtobenefitmostoftheprogram.Consequently,atthestartoftheprogram,those

respondentswhodidreceivetheSHLCPTSprogramprobablyscoredloweronSocialand

EconomicResiliencecomparedtothose who did not receive it.

Theresultsoftheanalysesindicatethat:

• ReceivingSHLCPTSprogramgoeswithlowerscoresontheSocialandIncomescale.

• ThosewhoreceivedSHLCPTSprogramdonotdifferonCapability,Empowerment,

System,andWorry(althoughthismightbeexpectedbasedonthefactthatthose

whoreceivedSHLCPTSprogramweremostinneedfortraumasupport).

• ReceivingbothcashandSHLCPTSprogramgoeswithlowerscoresontheSocialscale.

Iftheseresultsareviewedfromtheperspectivethatthoserespondentswhodidreceivethe

SHLCPTSprogramprobablyscoredloweronSocialandEconomicResiliencecomparedto

thosewhodidnotreceiveit,theresultscanberegardedaspositive.ThebackloginSERis

reducedduetotheSHLCPTSprogram.Thisinterpretationisinlinewiththequalitative

resultsoftheSHLCPTSprogram.

247

EffectofSHLCPTSonReductionofTrauma?(Wave2)Inthischapter,thefocusisontheeffectoftheSHLCPTSprogramontrauma.Inreadingthis

report,oneshouldrealizethatthetimebetweenfinishingtheSHLCPTSprogramandthis

measurementwasonlyafewmonths.Consequently,thereportedeffectivenessofthe

SHLCPTSprograminreducingtraumamaybeunderestimated.Inthisresearchtraumawas

operationalizedwiththerevisedImpactofEventsScale(IES-R).Intheresearch,theSHLCPTS

programwasimplementedinthegroupsthatreceivedcashonly,orcounselingonly,orboth

cashandcounseling,ornoprogramatallinthefirstwave.Thisresultsin8differentgroups

ofrespondents(seealsosection4.1).Thisdesignallowsustostudythedirect(main)effect

ofSHLCPTSprogram,thelagged(main)effectofcashandthelagged(main)effectof

counseling.Moreover,theanalysesallowustoinvestigatetheinteractionsbetweenthe

differenttypesofprograms(cash/in-kind,counseling,andSHLCPTSprogram).Inorderto

explorealltheseeffects,wewillfirstanalyzethetotalmeansscoreoftheIES-Randthen

eachofthesubscalesseparately.

TotalmeanIES-R

Table18-1givesthestatisticsregardingthetotalmeanIES-Rforeachgroupofrespondents.

Itindicatesthatforallgroupstheaveragepost-traumaticstressisabout7(IES-R-total:sum

ofthethreesubscales;minimum0maximum12,highermoretrauma).Thisisquitesimilar

tothestresslevelreportedinthefirstwave.

Table18-1.IES-R:TotalmeanIER-Sscoreforeachgroupofrespondents(cash/in-kindtransfer,traumacounselling,SHLCPTSprogram)



counselingandSHLCPTS 56 7,81 1,66 -0,78 0,32


OnlySHLCPTS 21 7,95 1,41 -1,43 1,61




Noprogram 58 7,68 1,98 -1,24 1,49

Total 356

248

WhentestingthedifferencesbetweenthegroupswithanANOVA(seeTable18-2),receiving

cash/in-kindturnedouttomakeadifferenceingroupmeansinthesensethatwhen

receivingcashpost-traumaticstressdisorderhasdecreased.

Table18-2.IESR:EffectofprogramsonthemeantotalIES-R


Cash/in-kind F(1,349)=9,89 0,002

Counseling F(1,349)=1,43 0,233

SHLCPTS F(1,349)=1,69 0,194




Nextwhethersocio-economicbackgroundvariablesaffectdifferencesbetweenthegroupsis

explored.Table18-3givestheresultswhentakingage(asacovariate),educationalleveland

employmentintoaccount.

Table18-3.IES-R:EffectofprogramsonthetotalmeanIES-Rwhencontrollingforageeducationallevelandoccupation


Cash/in-kind F(1,337)=10,58 0,001

Counseling F(1,337)=1,74 0,188

SHLCPTS F(1,337)=1,20 0,274




Age F(1,337)=0,284 0,594


Occupation F(3,337)=0,949 0,417

TheresultsofTable18-3suggestthatpost-traumaticstressdisorderisrelatedtothe

programsprovided.Receivingcash/in-kindturnedouttomakeadifferenceingroupmeans

inthesensethatwhenreceivingcash/in-kindpost-traumaticstressdisorderhasdecreased.

Moreover,theanalysisindicatesthatage,educationallevelandoccupationarenotrelated

topost-traumaticstressdisorder.

249

Avoidance

Table18-4givesthestatisticsforavoidancescaleforeachgroupofrespondents.Itshows

thatforallgroupstheaverageavoidancerangesbetween2.3and2.6(minimum0maximum

4,highermoretrauma).ItsuggeststhatthegroupswhoreceivedcashonlyandSHLCPTS

programhasthelowestscores.

Table18-4.IES-R:Avoidanceforeachgroupofrespondents(cashtransfer,traumacounselling,SHLCPTSprogram)

N average SD skewness kurtosis


counselingandSHLCPTS 56 2,53 0,48 -0,44 0,45

Cash/in-kind,counselingandSHLCPTS 85 2,50 0,54 -0,11 -0,12

OnlySHLCPTS 21 2,64 0,39 0,21 -1,18



Bothcashandcounseling,noSHLCPTS 37 2,34 0,67 -1,02 0,77

Noprogram 58 2,53 0,22 -0,08 -0,09

total 356

WhentestingthedifferencesontheavoidancesubscalebetweenthegroupswithanANOVA

(seeTable18-5),receivingcash/in-kindturnedouttomakeadifferencesingroupmeansin

thesensethatreceivingcash/in-kindgoeswithlowerscoresontheavoidancescale.

Table18-5.IES-R:EffectofprogramsonAvoidance


Cash/in-kind F(1,349)=8,04 0,005

Counseling F(1,349)=0,22 0,639

SHLCPTS F(1,349)=0,97 0,325





employmentaretakenintoaccountnexttotheprograms,avoidanceisstill(negatively)

affectedbyreceivingcash(seealsoTable18-6).Moreover,theanalysisindicatesthatage,

educationallevel,andoccupationarenotrelatedtotheavoidancescores.

250

Table18-6.IES-R:EffectofprogramsonAvoidancewhencontrollingforageeducationallevelandoccupation


Cash/in-kind F(1,337)=7,73 0,006

Counseling F(1,337)=0,58 0,448

SHLCPTS F(1,337)=0,55 0,459



Counseling/in-kind*SHLCPTS F(1,337)=0,02 0,891

Age F(1,337)=0,08 0,784


Occupation F(3,337)=1,19 0,315

Intrusion

Table18-7givesthestatisticsoftheintrusionscoresforeachgroupofrespondents.Itshows

thattheaverageintrusionscoresforthegroupsrangefrom2.2to2.7(minimum0maximum

4,highermoretrauma).Thegroupcash/in-kindonlythatdidnotreceivedtheSHLCPTS

programhasthelowestscoreandthegroupsthatreceivedonlytheSHLCPTSprogramhas

thehighestscore.

Table18-7.IES-R:Intrusionforeachgroupofrespondents(cash/in-kindtransfer,traumacounselling,SHLCPTSprogram)

WhentestingthedifferencesintheintrusionscoresbetweenthegroupswithanANOVA

(seeTable18-8),receivingcash/in-kindturnedouttohaveasignificanteffect;thosewho

receivecashhavelowerscoresonintrusion.





OnlySHLCPTS 21 2,71 0,57 -1,65 2,91




Noprogram 58 2,64 0,89 -1,59 2,08

Total 356

251

Table18-8.IES-R:EffectofprogramsonIntrusion


Cash/in-kind F(1,349)=9,48 0,002

Counseling F(1,349)=0,60 0,439

SHLCPTS F(1,349)=2,31 0,129





employmentaretakenintoaccountnexttotheprograms,intrusionisstill(negatively)

affectedbyreceivingcash(seealsoTable18-9).Moreover,theanalysisindicatesthatage,

educationallevel,andoccupationarenotrelatedtotheintrusionscores.

Table18-9.IES-R:EffectofprogramsontheIntrusionwhencontrollingforage,educationallevelandoccupation


Cash/in-kind F(1,337)=10,56 0,001

Counseling F(1,337)=0,72 0,395

SHLCPTS F(1,337)=1,65 0,200




Age F(1,337)=0,79 0,375


Occupation F(3,337)=78 0,504

Hyperarousal

Table18-10givesthestatisticsofhyperarousalscaleforeachgroupofrespondents.Itshows

thattheaveragehyperarousalscoresforthegroupsrangefrom2.2to2.7(minimum0

maximum4,highermoretrauma).ThegroupreceivingcashonlyandnottheSHLCPTS

programhasthelowestscoreandthegroupsthatreceivedonlycounselinghasthehighest

score.

252

Table18-10.IES-R:Hyperarousalforeachgroupofrespondents(cash/in-kindtransfer,traumacounselling,SHLCPTSprogram)





OnlypSHLCPTS 21 2,60 0,66 -1,81 2,67

CashonlyandnoSHLCPTS 37 2,20 1,03 -0,46 -0,68


Bothcashandcounseling,NOSHLCPTS 37 2,34 0,87 -1,13 0,58

Noprogram 58 2,50 0,89 -1,47 2,11

Total 356

Whentestingthedifferencesonthehyperarousalsubscalebetweenthegroupswithan

ANOVA(seeTable18-11),receivingcashturnedoutmakeadifferencesingroup.Receiving

cashgoeswithlowerscoresonthehyperarousalscale.Counselingmadeamarginal

difference(p<0.10)too:thosewhoreceivedcounselingreportedhigherlevelsof

hyperarousal.

Table18-11.IES-R:EffectofprogramsonHyperarousal


Cash/in-kind F(1,349)=5,96 0,015

Counseling F(1,349)=2,71 0,101

SHLCPTS F(1,349)=0,82 0,366





employmentaretakenintoaccountnexttotheprograms,hyperarousalisstill(negatively)

affectedbyreceivingcashand(marginallysignificant)positivelybyreceivingcounseling(see

alsoTable18-12).Moreover,theanalysisindicatesthatage,educationalleveland

occupationarenotrelatedtoscoresonthehyperarousalscale.

253

Table18-12.IES-R:EffectofprogramsonHyperarousalwhencontrollingforageeducationallevelandoccupation


Cash/in-kind F(1,337)=6,57 0,011

Counseling F(1,337)=2,81 0,094

SHLCPTS F(1,337)=0,67 0,418




Age F(1,337)=0,29 0,589


Occupation F(3,337)=0,887 0,448

Conclusion

Themainfindingsregardingtheeffectivenessoftheprogramsinloweringtraumaare:

• Cash/in-kindcanreducetraumaattheoveralllevel(totalmeanIES-R)aswellasfor

eachofthesubscales.Thissuggeststhatcash/in-kindhasalaggedeffectontrauma.

• Counselingdidnotshowaneffectonthereportedtrauma.Thissuggestthat

counselingdoesnothavealaggedeffectontrauma

• TheSHLCPTSprogramhadnoeffectonthereportedtrauma.However,oneshould

realizethatthetimebetweenfinishingtheSHLCPTSprogramandthismeasurement

wasonlyafewmonthsmonth.

254

PARTIX:DISCUSSION

255

DiscussionofUnexpectedFindingsandValidity

Theconstructof‘system’(experiencingrights)didnotshowanindependentpositiveor

negativeeffectinthisstudyandtheexpectedeffectofthisconstructshouldbe

reconsidered.

Threeunexpectedeffectswerefoundinthisresearch.Thecorrelationwithsocialresilience

wasnegativewiththeSHLCPTS.Thisisexplainedbythedecreaseddependencyonthefamily

andthecommunityoftheparticipantsintheSHLCPTS.ThestrongeffectoftheSHLCPTSand

thepossibilitytonotrelyongroupprocessesforthecounselingcanexplainthisfinding.The

interviewsshowedthatwomenwereseenasmoresociallyactiveandcapable,sothe

findingsareinterpretedasdecreasednegativerelianceonsocialnetworks.Thiscouldbe

subjectforfurtherresearchinthefuture.

Thesecondunexpectedfindingwasthatworrycorrelatednegativelywithsocialeconomic

resilienceandincreaseofincomeinthegroupsthatreceivedsupportfortraumarelief.This

isexplainedbythefactthatwomenreportedintheinterviewstoworrylessaboutthepat

butmoreaboutthepresent.So,thenightmaresabouttraumaticeventswerereplacedbyin-

the-presentconcernsaboutpracticalaspectsoflife,workandincome.Thisfindingsexplains

exactlywhywomenexperienceincreasedsocialeconomicresilience–andmoreworry,

becausetheyhavemovedfromlivinginthepasttolivinginthepresent,withanenhanced

abilitytomanagethetraumaticevents.Theincreasedworryisasignthattheyhave

processedtraumaandareabletomakeamoreusefuldistinctionbetweenthepastandthe

present.

Thethirdunexpectedresultwasthatthegroupsthatreceiveddifferenttypesofsupport(or

none)didnotdifferinthetraumalevelsreportedthroughtheIES-R,althoughtheirlevelof

worrywas(negatively)increased.Thisfindingneedsfurtherinvestigation.Several

explanationscanbeoffered,particularlytheIES-Rbeinginsensitivetosmallchangeswith

shorttime-linesandpossiblyrequiringahigherdegreeofexperiencetoconduct.Athird

datacollectionwasimplementedtoinvestigatethepossibleimpactoftime(stilltobe

reported)andatriangulationofresultsofasimilarinvestigationcarriedoutinEthiopiamay

helprevealsomeofthereasonsofthisfinding.

256

Inordertoidentifywhethertheresultsofthisstudycanbereplicatedelsewhere,asecond

studywasundertakeninEthiopia.Thereportofthisresearchisforthcomingandconfirms

thefindingsofthisinvestigation.

257

Appendix1:OutlineofSHLCPTSIntervention

1. Introductiontotrauma

1.1 Whatistraumaandwhataretheriskfactorsthatincreasevulnerabilitytotraumatic

stress?

1.2 Whatistraumaticstressdisorderandwhatarethesymptoms?

1.3 Whatiscomplexpost-traumaticstressdisorderandwhatareitssymptoms?

1.4 Whatiscollectivetraumaandwhatareitsimpacts?

2. IntroductiontoPTSDandthebrainandEMDRtreatment

2.1 Whatdoestraumadotothebrain?

2.2 Howcanwehealthebrainfromtheeffectsoftrauma

3. Traumahealingtechniques

3.1 Breathingexercises

3.2 Asafecalmplace

3.3 Findingandrankingtouchstonememories

3.4 Bilateralstimulationsandthebutterflyhug

3.5 Fourelementsexercise(Earth-Air-Water-Fire)

4. PromotingCommunitywidehealing

4.1 Communitycelebrationevents(‘graduation’)

4.2 T-shirtswithtraumaandhealingmessagesasconversationstarters

258

Appendix2:LiteratureReviewonSocialProtectionandTrauma

Theliteraturereviewedforthisstudyusedanetworkapproachtoobtainliterature,which

wasusedasafirststagestep(Bernard,2006).Aspartofthisapproach,theresearchteam

approachedresearchersandpractitionerswhohavewrittenandthoseimplementingsocial

protectionandpsychosocialsupporttoobtainrecommendedreadings.Astartingpointfor

thesearchwastheMinistryofGenderandSocialProtectioninUganda.

Asystematicreview1wasusedbasedonthekey-words:socialprotection,psychosocial

support,trauma,cashtransfersandwomen’sempowerment.Asecondsearchwas

undertakentocapturetheliteraturespecificallyonNorthernUganda,thestudyareaforthe

research,andtoextendthetopicstolookforpotentialoverlapwithotherareasofresearch.

1Asystematicreviewisdefinedas“areviewinwhichthereisacomprehensivesearchforrelevantstudiesonaspecifictopic,andthoseidentifiedarethenappraisedandsynthesizedaccordingtoapre-determinedexplicitmethod”(Weed,2005,para.16).

259

Table0-1.Literaturereview:SocialProtectionandTraumainUganda

Author&year Social

protection

Cash

transfer

trauma/

PSTD

Gender/

women

Geographic

location

Mainfindings Researchgaps/futurestudygaps

Davidsonetal.

(2016)

No None Yes Yes Northern

Uganda

-Psychologicaltherapycan

reducedepression.

-Counsellingandmedicationis

valuedbyserviceusers.

Counsellingimproved

depression,andincreased

empowermentand

engagementinsocialactivities.

-Limitedliteratureontrauma

counsellinginSub-SaharanAfrica

-Theregapsinserviceprovision,

mentalhealthpolicyandlegislation

-Compensationhelptomeetsocial

needsandreducefeelingsofshame

andanger

Annanetal.

(2011)

Yes Yes Yes Yes Northern

Uganda

-Estimatestheimpactsofwar

onbothgenders

-Warleadstoinjuries,lost

educationandlost

opportunities.

Littleevidenceofsocialexclusionor

aggressioninaddressingeffectsof

war

260

Author&year Social

protection

Cash

transfer

trauma/

PSTD

Gender/

women

Geographic

location


-Ravagesofwarcouldleadto

psychologicaltraumaand

aggression.

Kirstenetal.

(2012)

Yes Yes No Yes Northeastern

Uganda

-Providingaccesstobasic

services,socialprotectionand

supporttolivelihoodsmatters

forthehumanwelfareof

peopleaffectedbyconflict.

-ThecurrentNational

DevelopmentPlanexplicitly

recognizestheneedto

integratebothNorthern

Ugandaintothemainstream

developmentofthecountry.

-Needforfurtherresearchand

assessmentoflivelihoodpromotion

andbasicservicesandsocial

protectionprovisioninNorthern

Uganda

-Dataexistsontheproblemsfacing

thegreaternorth,butlittleonwhat

workstobuildresilienthouseholds

andcommunities.

Alisonetal.

(2013)

Yes Yes No Yes Northern

Uganda

-Depressionandpost-traumatic

stressinpost-conflictsettingsis

publichealthconcern

worldwide.

Thereisneedtostandardizeandtest

theefficacyofthisinterventionusing

randomizedcontrolledtrial.

261

Author&year Social

protection

Cash

transfer

trauma/

PSTD

Gender/

women

Geographic

location


-Mentaldisordersbeforeand

afterconflictindicatethat

depressionmaybemore

relatedtothepersisting

conditionsofpovertyand

structuraladversitythanwar

relatedtrauma.

LoganShelby

(2016)

None None Yes None Northern

Uganda

Thereisaneedtofocuson

psychologicalneedsfirstand

thenoffereconomic

empowerment.

Traumadoesnotonlyaffect

individuals,butalsoentirefamilies.

MinistryOf

Gender,Labour

AndSocial

Development

(2015)

Yes None None None Pioneer

districtsfor

SAGE

InUgandathereisgrowing

numbersofpeopleinneedof

socialprotectionservices.

Gapidentifiedinthesocial

protectionpolicy—itdoesnotfocus

onthepsychologicalimprovementof

thebeneficiariesandeconomic

independence

Nakimuli-

Mpungu,E.

(2013)

No No Yes No Northern

Uganda

Groupcounsellingintervention

offeredinthetraumaclinicsis

feasibleandpotentially

-Futurestudiesshouldinclude

randomizedcontroltrialswithlarger

samplestoevaluatetheefficacyof

262

Author&year Social

protection

Cash

transfer

trauma/

PSTD

Gender/

women

Geographic

location


effectiveinalleviating

depressionandpost-traumatic

stresssymptoms.

locally-developedpsychosocial

interventionsforindividualsinpost-

conflictregions.

HarlacherT.

(2009)

No No Yes No Northern

Uganda

AlthoughresearchonPTSDis

biasedtowardstheexperience

ofwesterncountries,itisa

goodstartingpointfor

investigatingposttraumatic

stressreactionsamongthe

Acholi.

-Despiteexistinglocal

approachestohealing,the

applicationofWestern

approachestotraumatherapy

shouldnotbecategorically

excluded.

Thereisneedtoinvestigateand

supportexistinglocalcapacitiesfor

healing.

Babatunde

Omilola,

Yes None None None Africa -Africangovernmentsand

developmentpartnersactivities

focusontheformulation,

-Thereisgrowingemphasisonsocial

protectionasameansofalleviating

povertyandachievingthe

263

Author&year Social

protection

Cash

transfer

trauma/

PSTD

Gender/

women

Geographic

location


Sheshangai

Kaniki(2014)

adoptionandimplementation

ofsocialprotectionframeworks

especiallyforwomen,youth

andvulnerablegroups.

MillenniumDevelopmentGoals

(MDGs)inAfrica.

JoannaSanta

Barbara,(1997)

No No Yes No Children Whathashappenedtochildren

whowitnessedwarandthe

longandshort-term

psychologicaleffectsofwar,

whicharemanifestedasa

resultofthetraumatheywere

exposedto.

Thepsychologicaleffectofthe

eventsofthewarsontheparents

andguardiansofthesechildren.

GaithriA.

Fernando,

(2004)

None None Yes No Western

communities

Thestudyemphasizesthe

trainingofclinicalpsychologists

asaninterventionfor

traumatizedvictims.

Thestudyignorestherehabilitation

oftraumatizedvictimsintermsof

economicintervention.

KrishnaKumar

(1997)

Yes Yes Yes Yes Selected

countries

Internationalinterventions

havehelpedtraumatized

Asmuchasthemodelsthatareused

totreattraumatizedvictimsinother

partsoftheworldhaveworked,

264

Author&year Social

protection

Cash

transfer

trauma/

PSTD

Gender/

women

Geographic

location


including

Uganda

victimsincountrieswherethey

haveprovidedsupport.

chancesarehightheymaynotwork

incountrieslikeUgandagiventhe

natureoftheconflict.

TheWorldBank

(2011)

Yes No yes yes LatinAmerica,

Africa,South

eastAsia

Socialsafetynetsarechannels

throughwhichsocialprotection

canbedispensed.

-Thereisneedtoincludecash

transfersinsocialprotection.

-Thestudydidnotlookatsocial

protectiongivingeconomic

independencetothesocially

vulnerable.

Babajan,B.

(2013)

Yes yes yes No Mexico,

Nicaragua,

Malawi,

Honduras,

Braziland

Colombia

Socialprotectioncanbe

effective

Thestudydoesnotaddressissuesof

genderandeconomicindependence.

OvugaEand

LarroqueC,

(2012)

None None Yes,PTSD None Northern

Uganda

Itisnecessarytounderstand

thetypesofemotional

difficultieschildrenexperience,

aswellasthedegreetowhich

Theoutcomeofpost-traumaticstress

disorderinUgandaisunknown.

Howeverclinicalexperienceindicates

thatmostindividualswiththe

265

Author&year Social

protection

Cash

transfer

trauma/

PSTD

Gender/

women

Geographic

location


theyareaffected,inorderto

provideappropriatetreatment

interventionsandresources

thatmightpreventfurther

psychologicaldamage.

disorderrecoveraftertwotosix

sessionsofcounselling.

BernsteinE

(2009)


Uganda

Traumacanspreadand

negativelyaffectotheraspects

ofdailylifeinthecommunity.

Lookingatexistingprogramsthat

havesuccessfullymergedlocaland

westernapproachestohealing.

ESIDBriefingNo

22(2016)

Yes Yes None None Uganda Theprogressofthesocial

protectionagendainUganda

hasbeencloselyshapedbythe

extenttowhichtheglobalized

policycoalitioninsupportof

socialprotectionwasableto

alignthisagendawiththe

dominantandchanging

interestsandideaswithin

Uganda’srulingcoalition.

CertainkeyplayerswithinUganda’s

governmentdonotseesocial

protectionasanintegralpartofits

overalldevelopmentstrategy.

266

Author&year Social

protection

Cash

transfer

trauma/

PSTD

Gender/

women

Geographic

location


BainganaF&

Onyango

MangenP


Uganda

-Combiningmedical/clinical

activitieswithsocialactivities

leadstobetteroutcomesfor

patients.

-Formationandsupportofthe

patients’supportgroup,who

thenprovidepeer-to-peer

supporttothepatientsand

theircarers,provideincomesto

thepatientsandfamiliesof

thosewithmentaldisorders.

Itisimportanttodevelopguidelines

forthetrainingofvillagehealth

teams,includinghowtoformpatient

supportgroups,howtoprovide

supportforlivelihoodactivities,and

howsensitizationandmobilizationis

carriedout.

267

Author&year Social

protection

Cash

transfer

trauma/

PSTD

Gender/

women

Geographic

location


Christopher

Blattman,

NathanFiala&

Sebastian

Martinez(2013)

None Yes None Yes Uganda -Cashtransfersleadrecipients

tospendmoreontheirbasic

needs(suchasfood)andmay

allowrecipientstomake

investmentswithveryhigh

returns.

-Highreturnsoncash,even

amongpoor,unemployedand

relativelyuneducatedwomen

Importantquestionsforfuture

researchare:theextenttowhichthe

framinganddesignofthe

intervention(anunenforced;pre-

commitment’toinvestfunds)and

howthegroupnatureof

disbursementsinfluencesthesehigh

levelsofinvestment.

Mawere,M.,

Mubaya,T.R.,

vanReisen,M.,

&vanStam,G.

(2016)

None None None None Africa Heassertsthateveryperson

hasastrongdesiretorealizehis

orherfullpotential,toreacha

levelof‘self-actualization’.

Histhinkinghasdeeply

influencedtheparadigmofthe

developmentagenda,bothin

theoryandinpractice,andset

thefoundationformoral

AsGrahamandMessner(1998:196)

summarize,therearegenerallythree

majorcriticismsdirectedtoMaslow’s

TheoryofMotivation:(a)thereis

scantempiricaldatatosupportthe

theoreticalmodel,(b)thestudies

assumehumanbeingsaresimilarand

thatthetheoryuniversallyapplies,

and(c)applicationsorvalidationof

thetheorydonotconcern

themselveswithatheoryof

268

Author&year Social

protection

Cash

transfer

trauma/

PSTD

Gender/

women

Geographic

location


thinkingonindividual

entitlements.

motivation,butratherwiththeories

ofjobsatisfaction.

269

Appendix3:SurveyDescriptives

QuestionnaireforFemaleParticipants

QuestionnaireNo--------------IntervieweeName-----------------------------------------District----------

------------------SubCounty-----------------------------------

Date------------------------------------------------Category----------------------------------------------

Instructions

Explainthepurposeoftheinterviewandexplaintheparticipationisvoluntaryandreadand

havetheconsentformsigned/thumbprintbytherespondent

A.Biographicdataoftherespondent

1)Age_______________________________________________

2)LevelofEducation

a).Neverbeentoschoolb).AttendedPrimaryc).AttendedSecondaryd).Tertiary

institution

3)Occupation/Employment

a).Farming b).Business c).Professionaljob c).None

4.Othersourcesofhouseholdincome

a).Agriculture b).Poultry c).Marketvending d).Produce

trade e)Localbrewing f)None

5)Maritalstatus

a).Single b).Married c).Divorced d).Separated

e).Widow

6)Headshipoffamily

270

a).Femaleheaded b).Maleheaded c).Childheaded

7)Householdsize

a)Oneperson b)2-5people c)5-10People

d)Morethan10people

8.Haveyoureceivedanycashtransfersfromthegovernmentinthepastoneyear?

a)Yes b)No

9)Ifyes,whichtypeofcashtransfersdidyoureceive?

a)HardCash c)Cashvouchers

10)Didyoureceiveanyotherformoftransfersfromthegovernmentotherthancash?

a)Yes b)No

11)Ifyes,whatothertypeoftransferdidyoureceivefromthegovernment?

a)Foodtransfers b)Productionasset c)Livestock

d)Seedlings

12)Haveyoureceivedanyothertransfersfromothersourcesotherthanthegovernment?

a)Yes b)No

13.Ifyeswhatwasthesourceofthetransfer?

a)NGO b)Church/Mosque c)Neighbour/community

d)Familymembers

14)Whichtypeoftransfersdidyoureceivefromtheseothersources?

a)Cashtransfer b)Foodtransfers c)Cashvouchers d)

Productionasset e)Food

15)Doyouownland?

a)Yesb)No

16)Whatisyourmainsourceofinformation?

271

a)Radio b)Television c)Community

17)Whatisyourmainmeansoftransportation?

a)Car b)Motorcyclec)Bicycle d)Walking

18)Whichisyourmaingardeningtool?

a)Handhoe b)Sickle c)Nogarden d)Oxplough

19)Whatisyourmainsourceoflightingathome?

a)Electricity b)Solar c)Paraffinbiglamp

d)Smallcandles(Tadoba) e)Torch

20).Doyoubelongtoanycommunitygroup?

a)Yes b)No

21)Haveyoureceivedanycounselling?

a)Yes b)No

22.Whoprovidedthiscounselling?

a)Government b)NGO c)Friend

d)Church e)Radio

23.DidyouReceivetraumamanagementfromEWPproject a)Yes

b)No

272

Appendix4:ImpactofEventsScale-Revised(IES-R)INSTRUCTIONS: Below is a list of difficulties people sometimes have after stressful

life events. Please read each item, and then indicate how stressing each difficulty has

been for you DURING THE PAST SEVEN DAYS with respect

to…………………………………………………….. (event) that occurred

on…………………………(date). How much have you been distressed or bothered by

these difficulties?

Strongly

disagree

Disagree Neutral Agree Strongly

agree

1 Any reminder brought back feelings about it 1 2 3 4 5

2 I had trouble staying asleep 1 2 3 4 5

3 Other things kept making me think about it 1 2 3 4 5

4 I felt irritable and angry 1 2 3 4 5

5 I avoided letting myself get upset when I thought about it or was

reminded of it

1 2 3 4 5

6 I thought about it when I didn’t mean to. 1 2 3 4 5

7 I felt as if it hadn’t happened or wasn’t real 1 2 3 4 5

8 I stayed away from reminders of it 1 2 3 4 5

9 Pictures about it popped into my mind. 1 2 3 4 5

10 I was jumpy and easily startled 1 2 3 4 5

11 I tried not to think about it. 1 2 3 4 5

12 I was aware that I still had a lot of feelings about it 1 2 3 4 5

13 My feelings about it were kind of numb 1 2 3 4 5

14 I found myself acting/feeling like I was back at that time 1 2 3 4 5

15 I had trouble falling asleep 1 2 3 4 5

16 I had waves of strong feelings about it 1 2 3 4 5

17 I tried to remove it from my memory 1 2 3 4 5

18 I had trouble concentrating 1 2 3 4 5

19 Reminders of it caused me to have physical reactions such as

sweating, trouble breathing, nausea or a pounding heart

1 2 3 4 5

273

20 I had dreams about it 1 2 3 4 5

21 I felt watchful and on-guard 1 2 3 4 5

22 I tried not to talk about it 1 2 3 4 5

274

Appendix5:SocialandEconomicResilienceScale(SER) Strongly

disagree

Disagree Neutral Agree Strongly

agree

Part 1: Subjective/social

22 I feel I trust my community 1 2 3 4 5

23 I feel attached to my family 1 2 3 4 5

24 I feel my contact with the leadership in my community has

improved?

1 2 3 4 5

25 I feel my relationship with the rest of the community has

improved?

1 2 3 4 5

26 Part 2: Capability/ Human capital

27 I feel my capacity to pay for medication has improved 1 2 3 4 5

28 I feel my capacity to pay school fees improved in the last 6

months

1 2 3 4 5

29 I feel I can get information about anything I want 1 2 3 4 5

30 I feel I have skills to enable me improve my life 1 2 3 4 5

31 I feel I have acquired new productive skills to improve on my

life

1 2 3 4 5

32 I feel change in the amount of knowledge hold? 1 2 3 4 5

33 I feel I am able to handle misunderstandings in my household 1 2 3 4 5

34 My husband seeks my opinion on matters related to our

household

1 2 3 4 5

35 I have been able to space my children

Part 3: Improvement of actual income/ Economic

37 I am able to save money 1 2 3 4 5

38 I will be able to own a business in the next 6 month? 1 2 3 4 5

39 I will be able to improve production

40 I will be able to find market for my produce 1 2 3 4 5

41 I am able to market my own produce 1 2 3 4 5

42 I am able to contribute to household income 1 2 3 4 5

43 My personal assets have improved 1 2 3 4 5

275

44 My access to household assets has improved 1 2 3 4 5

45 I am able to survive in hardship times 1 2 3 4 5

46 I am able to manage my own income 1 2 3 4 5

47 I am able to make decisions on income in your household? 1 2 3 4 5

Part 4: Women empowerment

48 I am able to take up new initiatives independently 1 2 3 4 5

49 I am able make decisions more independently 1 2 3 4 5

50 My hours of household work been able to reduce? 1 2 3 4 5

51 Have you been able to gain more time for productive activities? 1 2 3 4 5

52 Has your freedom of movement improved? 1 2 3 4 5

53 I feel improvement in my self-worth? 1 2 3 4 5

54 I feel there has been a change in my values 1 2 3 4 5

55 I feel I am in charge of my own body? 1 2 3 4 5

Structural/System

56 I feel I am able to exercise my rights? 1 2 3 4 5

57 I am able to access legal services much easier? 1 2 3 4 5

58 I am able to seek and access medical services? 1 2 3 4 5

59 I am able to access financial services?

Worry

60 Iamworriedthatconflictmayhappenagaininmysociety 1 2 3 4 5

61 IamworriedthatIwillfailtoprovideformyfamily 1 2 3 4 5

62 IamworriedImaynotfindajob 1 2 3 4 5

63 Iamworriedofthehostilityfrommembersofmycommunity 1 2 3 4 5

64 IamworriedImaynotgetenoughmoney 1 2 3 4 5

65 Iamworriedthatmyleaderswillnotaddresstheneedsofmy

community

1 2 3 4 5

66 Iamworriedthatclimatechangewillaffectfoodproduction 1 2 3 4 5

67 Iamworriedthatthegovernmentwillnotaddressmypersonalneeds 1 2 3 4 5

276

Appendix 6: Value Scale (inspired by Barrett)

Instructions:

Read the values to the respondent and ask them to choose and rank their five

important values ranking from their Very important to Not Important and then List

the values that you think the local leader should have in your community

Read the Values List Personal

Values

List values

for leaders

(1) Not

important

(2) Slightly

Important

(3)

Moderately

Important

(4)

Important

(5) Very

Important

68 Family

69 Forgiving

70 Acknowledgement

71 Caring

72 Careful

73 Adaptability

74 Friendship

75 Respect

76 Self-discipline

77 Generosity

78 able to handle

insecurity

79 Dialogue

80 Perseverance

81 Resolving conflicts

82 sense of humour / fun

83 Decisive

84 Fair

85 Empathy

86 Wisdom

277

87 Patience

278

ReferencesAccorsi, S., Fabiani, M., Ferrarese, N., Iriso, R., Lukwiya, M., & Declich, S. (2003). The burden of traditional

practices, ebino and tea-tea, on child health in Northern Uganda. Social science & medicine, 57(11), 2183-

2191.

Adúriz, M. E., Bluthgen, C., & Knopfler, C. (2011). Helping child flood victims using group EMDR intervention

in Argentina: Treatment outcome and gender differences. International Perspectives in Psychology:

Research, Practice, Consultation, 1(S), 58.

Ajzen, I. (1991). The theory of planned behavior. Organizational behavior and human decision processes, 50(2),

179-211.

Akello, G. (2013). Experiences of forced mothers in northern Uganda: the legacy of war. Intervention, 11(2), 149-

156.

Akelo, V., Girde, S., Borkowf, C. B., Angira, F., Achola, K., Lando, R., ... & Lecher, S. L. (2013). Attitudes

toward family planning among HIV-positive pregnant women enrolled in a prevention of mother-to-child

transmission study in Kisumu, Kenya. PloS one, 8(8), e66593.

Amin, M. E. (2005). Social science research: Conception, methodology and analysis. Makerere University.

Amone-P’Olak, K. (2007). Coping with life in rebel captivity and the challenge of reintegrating formerly abducted

boys in Northern Uganda. Journal of Refugee Studies, 20(4), 641-661.

APA - American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: Fourth

edition - text revision (DSM-IV-TR). Washington DC: American Psychiatric Association.

Apuuli, K. P. (2006). The ICC arrest warrants for the Lord's Resistance Army leaders and peace prospects for

Northern Uganda. Journal of International Criminal Justice, 4(1), 179-187.

Aristotle (350 B.C./1946) Politics (trans. E. Barker). Oxford: Oxford University Press.

Asukai, N., Kato, H., Kawamura, N., Kim, Y., Yamamoto, K., Kishimoto, J., ... & Nishizono-Maher, A. (2002).

Reliability and validity of the Japanese-language version of the impact of event scale-revised (Ies-RJ):

four studies of different traumatic events. The Journal of nervous and mental disease, 190(3), 175-182.

Babajan, B. (2013, September). Social protection and its contribution to social inclusion. In Presented at the

UNDESA expert group meeting (Vol. 10, p. 11).

Baguena, M. J., Villaroya, E., Belena, A., Díaz, A., Roldán, C., & Reig, R. (2001). Psychometric properties of the

Spanish version of the Impact of Event Scale-Revised (IES-R). Analisis y Modificacion de

Conducta, 27(114), 581-604.

Baingana, F., & Mangen, P. O. (2011). Scaling up of mental health and trauma support among war affected

communities in northern Uganda: lessons learned. Intervention, 9(3), 291-303.

Bainomugisha, A., Okello, J., & Ngoya, J. B. (2007). The Tragedy of Natural Resources Dependent Pastoral

Communities A case of Teso-Karamoja Border Land Conflict.

Barber, S. L., & Gertler, P. J. (2008). Empowering women to obtain high quality care: evidence from an evaluation

of Mexico's conditional cash transfer programme. Health Policy and Planning, 24(1), 18-25.

Barrett, R. (2013). The values-driven organization: Unleashing human potential for performance and profit.

Routledge.

Barrientos, A., & Hulme, D. (2009). Social protection for the poor and poorest in developing countries: reflections

on a quiet revolution: commentary. Oxford Development Studies, 37(4), 439-456.

279

Bayer, C. P., Klasen, F., & Adam, H. (2007). Association of trauma and PTSD symptoms with openness to

reconciliation and feelings of revenge among former Ugandan and Congolese child

soldiers. Jama, 298(5), 555-559.

Bernstein, E. (2009). Social Suffering in Northern Uganda.

Betancourt, T. S., Speelman, L., Onyango, G., & Bolton, P. (2009). A qualitative study of mental health problems

among children displaced by war in northern Uganda. Transcultural psychiatry, 46(2), 238-256.

Blattman, C., Fiala, N., & Martinez, S. (2013). The economic and social returns to cash transfers: evidence from

a Ugandan aid program. Columbia University, Departments of Political Science and International &

Public Affairs.

Bonaño, J. M. C. (2004). Indicadores de desarrollo sostenible urbano: una aplicación para Andalucía/cJ. Marcos

Castro Bonaño. Instituto de Estadística de Andalucía.

Brunet, A., St-Hilaire, A., Jehel, L., & King, S. (2003). Validation of a French version of the impact of event scale-

revised. The Canadian Journal of Psychiatry, 48(1), 56-61.

Burawoy, M. (1998). The extended case method. Sociological theory, 16(1), 4-33.

Buskens, I., & van Reisen, M. (2016). Theorising agency in ICT4D: Epistemic sovereignty and Transformation-

in-Connection. Underdevelopment, Development and the Future of Africa, 394-432.

Cardozo, B. L., Bilukha, O. O., Crawford, C. A. G., Shaikh, I., Wolfe, M. I., Gerber, M. L., & Anderson, M.

(2004). Mental health, social functioning, and disability in postwar Afghanistan. Jama, 292(5), 575-584.

Caverzasio, S. G. (Ed.). (2001). Strengthening protection in war: A search for professional standards: Summary

of discussions among human rights and humanitarian organizations. International Committee of the Red

Cross, Central Tracing Agency and Protection Division.

Chambers, R., & Conway, G. R. (1992). Sustainable Rural Livelihoods: Practical Concepts for the 21st Century.

Brighton, UK: IDS Discussion Paper 296.

Chapman, C., & Kagaha, A. (2009). Resolving conflicts using traditional mechanisms in the Karamoja and Teso

regions of Uganda. Minority Rights Group briefing.

Chemtob, C. M., Tolin, D. F., van der Kolk, B. A., & Pitman, R. K. (2000). Eye movement desensitization and

reprocessing.

Christopherson, S., Martin, R., Sunley, P., & Tyler, P. (2014). Reindustrialising regions: rebuilding the

manufacturing economy?.

Cloitre, M., Courtois, C. A., Ford, J. D., Green, B. L., Alexander, P., Briere, J., & Van der Hart, O. (2012). The

ISTSS expert consensus treatment guidelines for complex PTSD in adults. Retrieved November, 5, 2012.

Cochran, W. G., & Carroll, S. P. (1953). A sampling investigation of the efficiency of weighting inversely as the

estimated variance. Biometrics, 9(4), 447-459.

Collier, P. (2003). Breaking the conflict trap: Civil war and development policy. World Bank Publications.

Conflict-Sensitive Approaches to Recovery and Growth Conflicts in Amuria District 2016-2020

Conway, T., De Haan, A., & Norton, A. (2000, March). Social protection: New directions of donor agencies. Paper

for the DFID-ODI Inter-Agency Seminar on Social Protection. Easthamstead Park.

Cook, T. D., Campbell, D. T., & Shadish, W. (2002). Experimental and quasi-experimental designs for

generalized causal inference. Boston: Houghton Mifflin.

280

Coustier, F., Jarero, G., Passerini, S., & Smyrl, W. H. (1999). Performance of copper-doped V2O5 xerogel in coin

cell assembly. Journal of power sources, 83(1-2), 9-14.

Cozolino, L. O. U. I. S. (2006). The social brain. Psychotherapy in Australia, 12(2), 12.

Creamer, M., Bell, R., & Failla, S. (2003). Psychometric properties of the impact of event scale—

revised. Behaviour research and therapy, 41(12), 1489-1496.

Crowley, M. (2013). Gender, the labor process and dignity at work. Social Forces, 91(4), 1209-1238.

Danieli, Y. (Ed.). (1998). International handbook of multigenerational legacies of trauma. Springer Science &

Business Media.

de Silva, T. (2013). Principles in international development: Sustainable livelihoods and human rights based

approaches. Washington, D.C.: U.S. Department of labor, Bureau of International Labor Affairs.

Devereux, S., & Sabates-Wheeler, R. (2004). Transformative social protection.

DFID (1999). DFID sustainable livelihoods guidance sheets. www.ennonline.net/dfidsustainableliving

DiCicco-Bloom, B., & Crabtree, B. F. (2006). The qualitative research interview. Medical education, 40(4), 314-

321.

Erikson, K. (1991). Notes on trauma and community. American Imago, 48(4), 455-472.

European Parliament. (2016) Women’s empowerment and its links to sustainable development. Brussels: Policy

department C: Citizen’s rights and Constitutional Affairs

Fazel, S., Bains, P., & Doll, H. (2006). Substance abuse and dependence in prisoners: a systematic

review. Addiction, 101(2), 181-191.

Fernandez, I., Gallinari, E., & Lorenzetti, A. (2004). A school-based EMDR intervention for children who

witnessed the Pirelli Building airplane crash in Milan, Italy. Journal of Brief Therapy, 2(2), 129-136.

Fernando, G. A. (2004). Working with survivors of war in non-western cultures: the role of the clinical

psychologist. Intervention, 2(2), 108-117.

Fullilove, M. (2013). Urban Alchemy: restoring joy in America’s sorted-out cities. New York: New Village Press

Gärber, B. (2013). Women’s Land Rights and Tenure Security in Uganda: Experiences from Mbale, Apac and

Ntungamo. Stichproben. Wiener Zeitschrift für kritische Afrikastu dien, 24, 1-32.

Garcia, M., & Moore, C. (2011). Cash dividend : the rise of cash transfer programs in Sub-Saharan Africa. World

Bank Publications. Retrieved from https://ebookcentral.proquest.com

Gelbach, R. A., & Davis, K. E. (2007). Disaster response: EMDR and family systems therapy under

communitywide stress. Handbook of EMDR and family therapy processes, 385-404.

Gelsdorf, K., Maxwell, D. G., & Mazurana, D. (2012). Livelihoods, basic services and social protection in

Northern Uganda and Karamoja. Secure Livelihoods Research Consortium; Overseas Development

Institute.

Giacaman, R., Abu-Rmeileh, N. M., Husseini, A., Saab, H., & Boyce, W. (2007). Humiliation: the invisible trauma

of war for Palestinian youth. Public health, 121(8), 563-571.

Giacaman, R., Mataria, A., Nguyen-Gillham, V., Safieh, R. A., Stefanini, A., & Chatterji, S. (2007). Quality of

life in the Palestinian context: An inquiry in war-like conditions. Health policy, 81(1), 68-84.

Giannantonio, M. (2003). Psicotraumatologia e psicologia dell’emergenza. Ecomind, Salerno.

Glassman, A., Duran, D., & Koblinsky, M. (2013). Impact of Conditional Cash Transfers on Maternal and

newborn Health. CGD Policy Paper 019. Washington DC: Center for Global Development.

281

Harlacher, T. (2009). Traditional ways of coping with consequences of traumatic stress in Acholiland (Doctoral

dissertation, Université de Fribourg).

Hays, W. L. (1973). Statistics for the social sciences (No. 04; HA29, H3 1973.).

Henrich, J., Ensminger, J., McElreath, R., Barr, A., Barrett, C., Bolyanatz, A., ... & Lesorogol, C. (2010). Markets,

religion, community size, and the evolution of fairness and punishment. science, 327(5972), 1480-1484.

Hickey, S., & Bukenya, B. (2016). The politics of promoting social cash transfers in Uganda.

Holmes, R., & Lwanga-Ntale, C. (2012). Social Protection in Africa: A Review of Social Protection Issues in

Research: Policy and Programming Trends and Key Governance Issues in Social Protection.

Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: a measure of subjective

stress. Psychosomatic medicine, 41(3), 209-218.

Howarth, R. J., & Sinding-Larsen, R. (1983). Multivariate analysis. In Handbook of exploration

geochemistry (Vol. 2, pp. 207-289). Elsevier Science BV.

Human Rights Watch. (2003). Stolen Children: Abducted and Abused: Renewed Conflict in Northern Uganda

Vol.15, No. 12 (A). New York, New York: HRW

Human Rights Watch. (2003). Stolen Children: Abduction and Recruitment in Northern Uganda Vol.15, No. 7

(A). New York, New York: HRW

Human Rights Watch. (2005). Uprooted and Forgotten Impunity and Human Rights Abuses in Northern Uganda

Vol.17, No. 12 (A). New York, New York: HRW

Hunt, N., & Gakenyi, M. (2005). Comparing refugees and nonrefugees: the Bosnian experience. Journal of anxiety

disorders, 19(6), 717-723.

Hunt, N., & Gakenyi, M. (2005). Comparing refugees and nonrefugees: the Bosnian experience. Journal of anxiety

disorders, 19(6), 717-723.

IMF. 2016. The IMF and Social Protection. Draft Issues Paper for an Evaluation by The Independent Evaluation

Office (IEO) - PDF. (February 19, 2016). Retrieved April 14, 2018, from

http://financedocbox.com/Retirement_Planning/73358302-The-imf-and-social-protection-draft-issues-

paper-for-an-evaluation-by-the-independent-evaluation-office-ieo.html

International Alert. (2008). Investing in Peace: Building a Peace Economy in Northern Uganda: (Vol. 1)

International Monetary Fund. (2003). Government finance statistics manual 2001.

Invasion of Teso Sub-Region through Obalanga Sub-County in 2003. Accessed April 8 2018 from

http://justiceandreconciliation.com/wp-content/uploads/2012/09/The-Day-the-Came_Obalanga-

Erratum-Sept-2012.pdf

Jarero, I., & Artigas, L. (2010). The EMDR integrative group treatment protocol: Application with adults during

ongoing geopolitical crisis. Journal of EMDR Practice and Research, 4(4), 148-155.

Jarero, I., Artigas, L., Mauer, M., López Cano, T., & Alcalá, N. (1999, November). Children’s post traumatic

stress after natural disasters: Integrative treatment protocol. In Poster presented at the annual meeting of

the International Society for Traumatic Stress Studies, Miami, FL.

Jones, N., & Shahrokh, T. (2013). Social protection pathways.

Justice and Reconciliation Project (JRP) (2012) The Day they Came: Recounting the LRA’s

Kabeer, N. (1999). Resources, agency, achievements: Reflections on the measurement of women's

empowerment. Development and change, 30(3), 435-464.

282

Kahle, L. R. (1983). Social values and social change: Adaptation to life in America. Praeger Publishers.

Kahle, L. R., Beatty, S. E., & Homer, P. (1986). Alternative measurement approaches to consumer values: the list

of values (LOV) and values and life style (VALS). Journal of consumer research, 13(3), 405-409.

Kahneman, D. (2011). Thinking, fast and slow. Penguin Books. London.

Kerlinger, F. N. (1973). Foundation of behavioral science. New York: Holt, Renehard and Winston.

Kidane, B., Coughlin, S., Vogt, K., & Malthaner, R. (2015). Preoperative chemotherapy for resectable thoracic

esophageal cancer. The Cochrane Library.

Kim, W., Pae, C. U., CHae, J. H., Jun, T. Y., & Bahk, W. M. (2005). The effectiveness of mirtazapine in the

treatment of post-traumatic stress disorder: A 24-week continuation therapy. Psychiatry and clinical

neurosciences, 59(6), 743-747.

Kingdon, J. W. (1995). The policy window, and joining the streams. Agendas, alternatives, and public policies,

172-189.

Kingdon, J. W., & Thurber, J. A. (1984). Agendas, alternatives, and public policies (Vol. 45, pp. 165-169). Boston:

Little, Brown.

Kinyanda, E., Hjelmeland, H., & Musisi, S. (2004). Deliberate self-harm as seen in Kampala, Uganda. Social

psychiatry and psychiatric epidemiology, 39(4), 318-325.

Kipkebut, D. J. (2010). Human Resource Management Practices and Organizational Commitment in Higher

Educational Institutions: A Kenyan Case. IUP Journal of Organizational Behavior, 9.

Klein, H. (1982) Children in the Holocaust: Mourning and bereavement. In: Anthony, E. James, & Koupernik,

Cyrille (Eds), The child in his family. New York: Taylor and Francis.

Knoops, G. J. (2014). An introduction to the law of international criminal tribunals: a comparative study. Martinus

Nijhoff Publishers.

Kumar, K. (Ed.). (1997). Rebuilding societies after civil war: Critical roles for international assistance. Boulder,

CO: Lynne Rienner.

LeDoux, J. (1998). Fear and the brain: where have we been, and where are we going?. Biological

psychiatry, 44(12), 1229-1238.

Levine, R. (1997). Financial development and economic growth: views and agenda. Journal of economic

literature, 35(2), 688-726.

Liebling, H., Davidson, L., Akello, G. F., & Ochola, G. (2016). The experiences of survivors and trauma

counselling service providers in northern Uganda: Implications for mental health policy and

legislation. International journal of law and psychiatry, 49, 84-92.

Lykes, M. B. (2001). Activist participatory research and the arts with rural Mayan women: Interculturality and

situated meaning making.

Maercker, A., & Schützwohl, M. (1998). Erfassung von psychischen Belastungsfolgen: Die Impact of Event

Skala-revidierte Version (IES-R). Diagnostica.

Marsella, A. J., Friedman, M. J., & Spain, E. H. (1996). Ethnocultural aspects of PTSD: An overview of issues

and research directions.

Masters, R., McConnell, E., & Juhasz, J. (2017). Learning EMDR in Uganda: An experiment in cross-cultural

collaboration. In M. Nickerson's (Ed.), Cultural Competence and Healing Culturally-Based Trauma with

EMDR Therapy: Innovative Strategies and Protocols (pp. 305-322). New York, NY: Springer Publishing

283

Mawere, M., Mubaya, T. R., van Reisen, M., & van Stam, G. (2016). Chapter Three Maslow’s Theory of Human

Motivation and its Deep Roots in Individualism: Interrogating Maslow’s Applicability in Africa. Theory,

Knowledge, Development and Politics: What Role for the Academy in the Sustainability of Africa?, 55.

McElroy, T., Muyinda, H., Atim, S., Spittal, P., & Backman, C. (2012). War, displacement and productive

occupations in northern Uganda. Journal of occupational science, 19(3), 198-212.

McFarlane, A. C., & Van Der Kolk, B. A. (1996). Trauma and its challenge to society.

Meyers, B. (2002). The contract negotiation stage of a school-based, cross-cultural organizational consultation: A

case study. Journal of Educational and Psychological Consultation, 13(3), 151-183.

Miller, K. E., & Rasco, L. M. (Eds.). (2004). The mental health of refugees: Ecological approaches to healing and

adaptation. Taylor & Francis.

Ministry Of Gender, Labour And Social Development (2015) The National Social Protection Policy

Mugenda, O. M. (1999). Research methods: Quantitative and qualitative approaches. African Centre for

Technology Studies.

Nabukeera-Musoke, H. (undated) Transitional justice and gender in Uganda: Making peace, failing women during

the peace negotiation process. Isis-WICCE.

Nachmias, C. F., & Nachmias, D. (1996). Research designs: cross-sectional and quasi-experimental

designs. Research methods in the social sciences, 125-151.

Nakazibwe, F. (2015). Lessons and Challenges of Social Work Practice: Reflections from Managing Complex

HIV/AIDS Cases in Uganda. Journal of Comparative Social Work, 3(1).

Nakimuli-Mpungu, E., Alderman, S., Kinyanda, E., Allden, K., Betancourt, T. S., Alderman, J. S., ... & Musisi,

S. (2013). Implementation and scale-up of psycho-trauma centers in a post-conflict area: a case study of

a private–public partnership in northern Uganda. PLoS medicine, 10(4), e1001427.

Nakimuli-Mpungu, E., Okello, J., Kinyanda, E., Alderman, S., Nakku, J., Alderman, J. S., ... & Musisi, S. (2013).

The impact of group counseling on depression, post-traumatic stress and function outcomes: A

prospective comparison study in the Peter C. Alderman trauma clinics in northern Uganda. Journal of

affective disorders, 151(1), 78-84.

Nkabala, H. N. (2014). Gender perspectives in the Lord's Resistance Army in relation to the Old Testament. Old

Testament Essays, 27(3), 930-944.

Ogden, C. M., & Pain, C. C.(2006) Trauma and the body: A sensorimotor approach to psychotherapy.

Ogula, P. A. (2005). Research methods. Nairobi: CUEA Publications.

Okello, J., Nakimuli-Mpungu, E., Musisi, S., Broekaert, E., & Derluyn, I. (2013). War-related trauma exposure

and multiple risk behaviors among school-going adolescents in Northern Uganda: the mediating role of

depression symptoms. Journal of affective disorders, 151(2), 715-721.

Okoboi, G., Kuteesa, A., & Barungi, M. (2013). The impact of the National Agricultural Advisory Services

Program on household production and welfare in Uganda.

Ondoga, M. (2012). The Lord's Resistance Army Wicked Problem. Army War Coll Carlisle Barracks PA Center

for Strategic Leadership.

Ovuga, E., Oyok, T. O., & Moro, E. B. (2008). Post traumatic stress disorder among former child soldiers attending

a rehabilitative service and primary school education in northern Uganda. African health sciences, 8(3),

136-141.

284

Page, N., & Czuba, C. E. (1999). Empowerment: What is it. Journal of extension, 37(5), 1-5.

Pham, P. N., Vinck, P., & Stover, E. (2009). Returning home: forced conscription, reintegration, and mental health

status of former abductees of the Lord's Resistance Army in northern Uganda. BMC psychiatry, 9(1), 23.

Pham, P. N., Weinstein, H. M., & Longman, T. (2004). Trauma and PTSD symptoms in Rwanda: implications for

attitudes toward justice and reconciliation. Jama, 292(5), 602-612.

Pham, P., & Vinck, P. (2007). When the war ends: a population-based survey on attitudes about peace, justice,

and social reconstruction in northern Uganda.

Pham, P., & Vinck, P. (2010). Transitioning to peace: A population-based survey on attitudes about social

reconstruction and justice in Northern Uganda.

Pham, P., Vinck, P., Balthazard, M., Hean, S., & Stover, E. (2009). So We Will Never Forget: A population-based

survey on attitudes about social reconstruction and the Extraordinary Chambers in the Courts of

Cambodia.

Photius, C. (2004). Nigeria land use, soils, and land tenure.

Rahman, A., Iqbal, Z., Bunn, J., Lovel, H., & Harrington, R. (2004). Impact of maternal depression on infant

nutritional status and illness: a cohort study. Archives of general psychiatry, 61(9), 946-952.

Republic of Uganda (2002) Uganda Population and Housing Census.

Republic of Uganda (2011) Lira District Local Government Five-Year Development Plan, Fy2010/11 to

2014/2015

Republic of Uganda (2011) Local Action Plan to Address Gender Based Violence and Other

Republic of Uganda (2012) Kitgum District Local Government Five- Year Development Plan, Fy2010/11 to

2014/2015, Volume 1: Policy Issues, Under Minute Number: 06/04/2012

Republic of Uganda (2014) Teso: Katakwi District Hazard, Risk and Vulnerability Profile.

Republic of Uganda (2016), Amuria District Local Government. Local Action Plan on Gender Based Violence

and Other Conflicts in Amuria, 2016-2020.

Roberts, B., Ocaka, K. F., Browne, J., Oyok, T., & Sondorp, E. (2008). Factors associated with post-traumatic

stress disorder and depression amongst internally displaced persons in northern Uganda. BMC

psychiatry, 8(1), 38.

Rokeach, M. (1968). Beliefs, attitudes and values: A theory of organization and change.

Rokeach, M. (1973). The nature of human values. Free press.

Saul, J. (2013). Collective trauma, collective healing: Promoting community resilience in the aftermath of disaster

(Vol. 48). Routledge.

Saul, J. (2013). Collective trauma, collective healing: Promoting community resilience in the aftermath of

disaster(Vol. 48). Routledge.

Saul, J. L. J., & Landau, J. (2004). Facilitating family and community resilience in response to major

disaster. Living beyond loss: Death in the family. 2nd ed. New York: WW Norton & Co, 285-309.

Schomerus, M., & Allen, T. (2006). A hard homecoming: lessons learned from the reception center process in

northern Uganda: an independent study.

Schwarz, N. (2011). Feelings-as-information theory. Handbook of theories of social psychology, 1, 289-308.

Shamai, M. (2015). Systemic interventions for collective and national trauma: Theory, practice, and evaluation.

Routledge.

285

Schubert, B., & Slater, R. (2006). Social Cash Transfers in Low-Income African Countries: Conditional or

Unconditional? Development Policy Review.

Slater, R. (2011). Cash transfers, social protection and poverty reduction. International Journal of Social

Welfare, 20(3), 250-259.

Snow, D. A., Morrill, C., & Anderson, L. (2003). Elaborating analytic ethnography Linking fieldwork and theory

Sources of analytic neglect, 44035960(22). Retrieved from www.sagepublications.com

Sundin, E. C., & Horowitz, M. J. (2002). Impact of Event Scale: psychometric properties. The British Journal of

Psychiatry, 180(3), 205-209.

Surjan, A., Sharma, A., & Shaw, R. (2011). Chapter 2 Understanding Urban Resilience. In Climate and disaster

resilience in cities (pp. 17-45). Emerald Group Publishing Limited.

Ter Heide, F., Mooren, T., Knipscheer, J. W., & Kleber, R. J. (2014). EMDR with traumatized refugees: From

experience-based to evidence-based practice. Journal of EMDR Practice and Research, 8(3), 147-156.

The World Bank (2011). Evidence and Lessons Learned from Impact Evaluations on Social Safety Nets

Tongco, M. D. C. (2007). Purposive sampling as a tool for informant selection. Ethnobotany Research and

applications, 5, 147-158.

Turner, S. W., Bowie, C., Dunn, G., Shapo, L., & Yule, W. (2003). Mental health of Kosovan Albanian refugees

in the UK. The British Journal of Psychiatry, 182(5), 444-448.

Uganda. (2018). CIA world factbook. Retrieved April 4,2018, from https://www.cia.gov/library/publications/the-

world-factbook/geos/ug.html

UN News Centre. (2004). UN relief official spotlights world’s largest neglected crisis in northern Uganda

http://www.un.org/apps/news/story.asp?NewsID=12297&Cr=uganda&Cr1#.UUYF4aVKq0s.

(Accessed on March 13 2013).

United Nations Development Program (2015) Uganda Human Development Report 2015. United Nations.

Retrieved from http://hdr.undp.org/sites/default/files/undpug2015_ugandahdr2015.pdf

United Nations. (2008). Is the PRDP politics as usual? Update on the implementation of Uganda’s peace, recovery

and development plan - Briefing note No. 2 - Uganda | ReliefWeb. (n.d.). Retrieved April 12, 2018, from

https://reliefweb.int/report/uganda/prdp-politics-usual-update-implementation-ugandas-peace-recovery-

and-development-plan

Van der Kolk, B. (2014). The body keeps the score. New York: Viking.

van Reisen, M. E. H. (Eds.). Women’s leadership in peace building: Conflict, Community and Care.

Van Reisen, M., & Mawere, M. (2017). Human trafficking and trauma in the digital era: the ongoing tragedy of

the trade in refugees from Eritrea. African Books Collective.

Veronese, G. (2013). Self-perceptions of well-being in professional helpers and volunteers operating in war

contexts. Journal of health Psychology, 18(7), 911-925.

Veronese, G., & Pepe, A. (2013). Psychometric properties of IES-R, short Arabic version in contexts of military

violence. Research on Social Work Practice, 23(6), 710-718.

Waqas, M., & Awan, M. S. (2017). Social Protection, Gender, and Poverty: Application of Social Protection

Index. Journal of Policy Practice, 16(4), 369-380.

Weiss, D. S. (2007). The impact of event scale: revised. In Cross-cultural assessment of psychological trauma

and PTSD (pp. 219-238). Springer, Boston, MA.

286

Weiss, D. S., Marmar, C. R., Metzler, T. J., & Ronfeldt, H. M. (1995). Predicting symptomatic distress in

emergency services personnel. Journal of Consulting and Clinical Psychology, 63(3), 361.

Wessells, M., & Monteiro, C. (2001). Psychosocial interventions and post-war reconstruction in Angola:

Interweaving Western and traditional approaches. Peace, conflict, and violence: Peace psychology for

the 21st century, 262-275.

World Health Organization, World Psychiatric Association, International Association for Child, Adolescent

Psychiatry, & Allied Professions. (2005). Atlas: child and adolescent mental health resources: global

concerns, implications for the future. World Health Organization.

Wu, K. K., & Chan, K. S. (2003). The development of the Chinese version of Impact of Event Scale–Revised

(CIES-R). Social Psychiatry and Psychiatric Epidemiology, 38(2), 94-98.

Zaghrout-Hodali, M., Alissa, F., & Dodgson, P. W. (2008). Building resilience and dismantling fear: EMDR group

protocol with children in an area of ongoing trauma. Journal of EMDR Practice and Research, 2(2), 106-

113.

Zang, Y., Hunt, N., & Cox, T. (2013). A randomised controlled pilot study: the effectiveness of narrative exposure

therapy with adult survivors of the Sichuan earthquake. BMC psychiatry, 13(1), 41.

Zilberg, N. J., Weiss, D. S., & Horowitz, M. J. (1982). Impact of Event Scale: a cross-validation study and some

empirical evidence supporting a conceptual model of stress response syndromes. Journal of consulting

and Clinical Psychology, 50(3), 407.

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