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Healing invisible wounds and rebuilding livelihoods: Emerging lessons for combining livelihood and psychosocial support in fragile and conflict-affected settings

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Abstract

Populations living in fragile and conflict-affected settings (FCS) endure serious hardship, often including witnessing or having direct exposure to violence. These experiences adversely affect the mind, body, and spirit, and diminish the capacity of individuals and communities to take full advantage of economic empowerment opportunities. A small but growing number of programs have begun to combine psychosocial support with livelihood support in FCS, with some promising indication that this combination can enhance project outcomes. This paper assesses evidence to generate a ‘hypothesis of change’ that combining psychosocial with livelihood support can improve development outcomes in FCS. We reviewed evaluations of three categories of programs: (i) those that provide psychosocial support and assess impact on economic empowerment, (ii) those that provide livelihood support and assess impact on psychosocial well-being, and (iii) those that combine both types of support and assess impact on one or both outcomes.

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References

  1. World Health Organization. (2006) Interpersonal violence and alcohol. World Health Organization Report, http://www.who.int/violence_injury_prevention/violence/world_report/factsheets/pb_violencealcohol.pdf, accessed 16 April 2014.

  2. United Nations Office on Drugs and Crime. (2011). Global Report on Homicide. Geneva, Switzerland: United Nations Office on Drugs and Crime.

    Google Scholar 

  3. Willman, A., & Makisaka, M. (2011). Interpersonal Violence Prevention. Washington, D.C.: World Bank Group.

    Google Scholar 

  4. World Bank. (2015) Overview of fragility conflict and violence, http://www.worldbank.org/en/topic/fragilityconflictviolence/overview#2, accessed 10 September 2014.

  5. World Bank. (2015) Harmonized list of fragile situations, http://siteresources.worldbank.org/EXTLICUS/Resources/511777-1269623894864/FY15FragileSituationList.pdf, accessed 10 June 2015.

  6. OECD. (2015). States of Fragility 2015: Meeting Post-2015 Ambitions. Paris: OECD Publishing.

    Google Scholar 

  7. van Ommeren, M., Morris, J., & Saxena, S. (2008). Social and clinical interventions after conflict or other large disaster. American Journal of Preventive Medicine, 35(3), 284–286.

    Article  Google Scholar 

  8. Good, B., DelVecchio Good, M., Grayman, J., & Lakoma, M. (2006). Psychosocial Needs Assessment of Communities Affected by the Conflict in the Districts of Pidie, Bireuen and Aceh Utara. Jakarta, Indonesia: IOM.

    Google Scholar 

  9. Miller, K., & Rasmussen, A. (2010). Mental health and armed conflict: The importance of distinguishing between war exposure and other sources of adversity: A response to Neuner. Social Science and Medicine, 71(8), 1385–1389.

    Article  Google Scholar 

  10. Savoca, E., & Rosenheck, R. (2000). The civilian labor market experiences of Vietnam-era veterans: the influence of psychiatric disorders. J Mental Health Policy Econ, 3(4), 199–207.

    Article  Google Scholar 

  11. Anderson, K., & Mitchell, J. (1992). Effects of military experience on mental health problems and work behavior. Medical Care, 30(6), 554–563.

    Article  Google Scholar 

  12. Searing, E., Rios-Avila, F., & Lecy, J. (2013). The impact of psychological trauma on wages in post-conflict Bosnia and Herzegovina. Social Science and Medicine, 96, 165–173.

    Article  Google Scholar 

  13. Shemyakina, O. (2015). Exploring the impact of conflict exposure during formative years on labour market outcomes in Tajikistan. The Journal of Development Studies, 51(4), 422–446.

    Article  Google Scholar 

  14. Betancourt, T., McBain, R., Newnham, E., & Brennan, R. (2012). Trajectories of internalizing problems in war-affected Sierra Leonean youth: Examining conflict and post-conflict factors. Child Development, 84(2), 455–470.

    Article  Google Scholar 

  15. Butterworth, P., Leach, L., Strazdins, L., Olesen, S., Rodgers, B., & Broom, D. (2011). The psychosocial quality of work determines whether employment has benefits for mental health: Results from a longitudinal national household panel survey. Occupational and Environmental Medicine, 68(11), 806–812.

    Article  Google Scholar 

  16. van der Noordt, M., IJzelenberg, H., Droomers, M., & Proper, K. (2014). Health effects of employment: A systematic review of prospective studies. Occupational and Environmental Medicine, 71(10), 730–736.

    Article  Google Scholar 

  17. Bower, G., & Sivers, H. (1998). Cognitive impact of traumatic events. Development and Psychopathology, 10(4), 625–653.

    Article  Google Scholar 

  18. Koenen, K., Driver, K., Oscar-Berman, M., Wolfe, J., Folsom, S., & Huang, M. (2001). Measures of prefrontal system dysfunction in posttraumatic stress disorder. Brain and Cognition, 45(1), 64–78.

    Article  Google Scholar 

  19. Murnane, R., Willett, J., Braatz, M., & Duhaldeborde, Y. (2001). Do different dimensions of male high school students’ skills predict labor market success a decade later? Evidence from the NLSY. Economics of Education Review, 20(4), 311–320.

    Article  Google Scholar 

  20. Heckman, J., Stixrud, J., & Urzua, S. (2006). The effects of cognitive and non-cognitive abilities on labor market outcomes and social behavior. Journal of Labor Economics, 24(3), 411–482.

    Article  Google Scholar 

  21. McKay, S., Veale, A., Worthen, M., & Wessells, M. (2011). Building meaningful participation in reintegration among war-affected young mothers in Liberia, Sierra Leone and northern Uganda. Intervention, 9(2), 108–124.

    Article  Google Scholar 

  22. Janzen, J. (2016). The anthropology of violence: Context, consequences, conflict resolution, healing and peace-building in Central and Southern Africa. Journal of Public Health Policy. doi:10.1057/s41271-016-0008-1.

  23. Pouligny, B. (2010). Resilience, Trauma, and Violence: Background Paper to Society Dynamics of Fragility 2013. Washington, D.C.: World Bank Group.

    Google Scholar 

  24. Lund, C., De Silva, M., Plagerson, S., Cooper, S., Chisholm, D., & Das, J. (2011). Poverty and mental disorders: Breaking the cycle in low-income and middle-income countries. The Lancet, 378(9801), 1502–1514.

    Article  Google Scholar 

  25. Babcock, E. (2014). Using brain science to design new pathways out of poverty. Boston, MA: Crittenton Women’s Union.

    Google Scholar 

  26. Mollica, R., Brooks, R., Tor, S., Lopes-Cardozo, B., & Silove, D. (2013). The enduring mental health impact of mass violence: A community comparison study of Cambodian civilians living in Cambodia and Thailand. International Journal of Social Psychiatry, 60(1), 6–20.

    Article  Google Scholar 

  27. Brown, L., Rice, J., Boris, N., Thurman, T., Snider, L., Ntaganira, J., et al. (2007). Psychosocial benefits of a mentoring program for youth-headed households in Rwanda. Horizons Research Summary. Washington, DC: Population Council.

    Google Scholar 

  28. Thurman, T., Snider, L., Boris, N., Kalisa, E., Nkunda Mugarira, E., & Ntaganira, J. (2006). Psychosocial support and marginalization of youth-headed households in Rwanda. AIDS Care, 18(3), 220–229.

    Article  Google Scholar 

  29. Blattman, C., Fiala, N., & Martinez, S. (2013). Generating skilled self-employment in developing countries: Experimental evidence from Uganda. The Quarterly Journal of Economics, 129(2), 697–752.

    Article  Google Scholar 

  30. Blattman, C., Green, E., Annan, J., & Jamison, J. (2013). Building women’s economic and social empowerment through enterprise: An experimental assessment of the Women’s Income Generating Support (WINGS) Program in Uganda. Washington, DC: World Bank Group. Logica study series no. 1.

    Google Scholar 

  31. Glass, N., Perrin, N., Kohli, A., & Remy, M. (2014). Livestock/animal assets buffer the impact of conflict-related traumatic events on mental health symptoms for rural women. PLoS ONE, 9(11), e111708.

    Article  Google Scholar 

  32. Blattman, C., Jamison, J., and Sheridan, M. (2015) Reducing crime and violence: experimental evidence on adult non-cognitive investments in Liberia. Cambridge, MA: National Bureau of Economic Research. NBER Working Paper no. 21204.

  33. Blattman, C., & Annan, J. (2011). Reintegrating and Employing High Risk Youth in Liberia: Lessons from a Randomized Evaluation of a Landmine Action Agricultural Training Program for Ex-combatants. Evidence from Randomized Evaluations of Peacebuilding in Liberia: Policy Report. New Haven, CT: Innovations for Poverty Action.

    Google Scholar 

  34. World Bank. (2015). Can Skills Training Increase Employment for Young Women? The Case of Liberia. Washington, DC: World Bank Group.

    Google Scholar 

  35. Bannink-Mbazzi, F., & Lorschiedter, A. (2009). Psychosocial support to vulnerable youth in vocational schools in northern Uganda. Intervention, 7(2), 130–137.

    Article  Google Scholar 

  36. Leerlooijer, J., Bos, A., Ruiter, R., van Reeuwijk, M., Rijsdijk, L., & Nshakira, N. (2013). Qualitative evaluation of the Teenage Mothers Project in Uganda: A community-based empowerment intervention for unmarried teenage mothers. BMC Public Health, 13(1), 816.

    Article  Google Scholar 

  37. Weyermann, B. (2007). Linking economics and emotions: towards a more integrated understanding of empowerment in conflict areas. Intervention, 5(2), 83–96.

    Article  Google Scholar 

  38. Betancourt, T., McBain, R., Newnham, E., Akinsulure-Smith, A., Brennan, R., & Weisz, J. (2014). A behavioral intervention for war-affected youth in Sierra Leone: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53(12), 1288–1297.

    Article  Google Scholar 

  39. World Bank (2014) Proceedings of Conference on Invisible Wounds: A Practitioners’ Dialogue on Improving Development Outcomes Through Psychosocial Support, 6 May, Washington D.C.: World Bank Group.

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Correspondence to Samhita Kumar.

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Kumar, S., Willman, A. Healing invisible wounds and rebuilding livelihoods: Emerging lessons for combining livelihood and psychosocial support in fragile and conflict-affected settings. J Public Health Pol 37 (Suppl 1), 32–50 (2016). https://doi.org/10.1057/s41271-016-0009-0

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