In a blog for World Mental Health Day, Julian Kosh looks at a pilot project to support survivors of abuse, trauma and cancer in Kenya and the Occupied Palestinian Territories. At its core is a ‘flexible funding’ approach that gives women’s rights organisations the freedom to test new approaches to mental health in the ways they think best
Women’s mental health has too often been a missing piece in the women’s empowerment agenda. The idea that we need to address anxiety, PTSD and depression as potential barriers to women’s community empowerment has been slow to gain traction in the aid sector.
Our new project, supported by players of People’s Postcode Lottery, is testing an innovative, community-led approach to address this gap in support. We have invested £150,000 in a pilot initiative in Kenya and the Occupied Palestinian Territory (OPT) to help survivors of abuse and mental trauma, as well as serious diseases such as cancer, who are often met with social stigma.
‘When we got this fund, it was the first time that we felt we were an independent organisation’Eman Shanan, Founder of Aid and Hope for Patient Cancer Care in Gaza
The goal is to strengthen community-led actions to address mental health issues experienced by women and girls affected by poverty – such as gender-based violence, discrimination and marginalisation. In Kenya, the work is led by our partners Badili Africa and Usikimye; in OPT, it is led by Aid and Hope Programme and the Wefaq Society for Women and Child Care.
Oxfam is not known for investing in mental or physical health interventions but in this pilot we saw the potential to draw on the resources and philosophy of our new Women’s Rights Fund (see below). Central to this, is the idea that women’s rights organisations are best placed to determine how to support their own communities and that funding should be provided flexibly to empower them to do this.
The importance of a gendered approach in mental health
The bulk of interventions on community-based mental health have traditionally emerged from the health sector and focus on finding ways to enhance and achieve universal access to mental healthcare. However, gender inequalities have not been prominently addressed in government policy and budgets. And, while there is widespread recognition that gender inequality negatively impacts women’s access to healthcare, few women’s rights organisations have been involved in creating a feminist or women-led approach to mental health which pays attention to the structural roots of collective trauma.
The context for women in Kenya and the OPT
Research we are doing in Kenya is showing that young adolescent girl students in Nairobi have been struggling with interruption of their studies and a lack of access to online education due to the COVID-19 pandemic. Student stipends were paused when colleges closed down and already impoverished families could not provide money for their children to learn, as family incomes were affected.
In Gaza, Palestine, the level of stress and insecurity among women and girls is related to factors including political violence, economic hardship, relationship problems and COVID-19.
Women in both places face the global problems brought by the pandemic, such as a shocking rise in domestic violence. Women also generally bore the brunt of lockdowns, with increases in unpaid care work responsibility and the stresses of losing jobs and finding new ways to earn an income. They also face discrimination in the workplace, particularly women suffering from chronic illnesses.
Learning by doing: how the pilot supports women
The short-term aim is to develop support at community level that can be run by lay people, with some support from health services. Cases which are chronic or need more expert medical support will be referred to hospitals. Meanwhile, women in the community will support their peers with less severe but more common cases of anxiety and depression.
The WROs will convene a group of women and adolescent girls to work together on understanding existing community-based mental healthcare approaches . They will develop concepts and language around women’s mental health tailored to the cultural context and which can be easily understood.
Initial activities will include:
- Training groups of community women volunteers as mental health supporters
- Group sessions with women and adolescent girls on stress management and well-being
- Family sessions on well-being and financial problem solving
One of the intended outcomes in both countries will be that the WROs develop a working model that integrates mental healthcare into their strategy and operations. Both the partners and Oxfam will continually share learning on the effectiveness and challenges of the project. Usually this will be via videoconference to encourage group discussion rather than a tick-box exercise of formal reporting, which can reinforce unequal power dynamics.
However, the scale of the challenge in contexts where it is hard to have open conversations on serious illness and mental health cannot be overestimated . As Eman Shanan, Founder of Aid and Hope for Patient Cancer Care in Gaza and herself a survivor of cancer, explains in this video: “Talking about [breast] cancer was a taboo. If you have a cancer, you should not tell anybody…”
She says the flexible funding has been crucial to freeing the organisation to take the path it wants to. “When we got this fund, it was the first time that we felt we were an independent organisation,” she says. “Nobody forced anything on our activities.”
In the long-term, the hope is for partner organisations to use some of the flexible funding to expand and develop the basic infrastructure to become independently operating within the next three to five years.
A new way of funding women’s rights organisations
At the heart of the project is the “flexible funding” approach, which is wholeheartedly supported by People’s Postcode Lottery. We want to fund projects that others might deem too risky, and favour shared learning over onerous reporting. The ethos is to innovate and share the risk together.
“Multi-year unrestricted funding allows organisations to address those needs they feel are most relevant and urgent,” says Dr Pamala Wiepking, Professor of Societal Significance of Charity Lotteries at Vrije Universiteit in the Netherlands.
Oxfam has been particularly focused on using flexible funding to support local women’s rights and feminist movements, particularly in the global south, who are chronically underfunded. Research by the Association of Women in Development (AWID) shows that WROs globally have an average income of just $20,000 a year. Approximately 48% have never received funding for core costs and 52% have never received multi-year support.
That’s why we launched Oxfam’s new Women’s Rights Fund, which supports WROs in this project and others around the globe with flexible, multi-year funding to invest in their own priorities. Decisions on how they spend the funding are made entirely by them. The fund was inspired by Oxfam’s longstanding work with WROs around the world, and by our 2019 research, A Leap of Faith.
In this pilot and others around the globe, we want to test and learn how to devolve more resources and power to grassroots organisations, challenge our own systems and become a better partner on the ground.
Thanks to Blandina Bobson and Sukaina Samhan for their help with this blog. We would like to thank the Postcode International Trust, which awards funds on behalf of People’s Postcode Lottery, for their support.