HomeForeign Assistance Evaluations...Midline Evaluation of U.S.-Ghana Child Protection Compact Partnership

# 									Midline Evaluation of U.S.-Ghana Child Protection Compact Partnership							

Foreign Assistance Evaluations: Democracy, Human Rights, and Governance

Submitted by: DevTech Systems, Inc.

In Association with Khulisa Maangement Services

August 30, 2018

## 								Article Index							

        - Acronyms
        - Executive Summary
        - I. Background and Context
        - II. Evaluation Purpose, Scope and Questions
        - Evaluation Purpose and Audience
        - Evaluation Scope
        - Evaluation Questions
        - III. Evaluation Design and Methodology
        - Planning
        - Data Collection
        - Site Selection
        - Data Collection Methods and Sampling
        - Data Analysis
        - Limitations
        - Data Protection
        - IV. Findings
        - Definition of Child Trafficking for Forced Labor and Commercial Sexual Exploitation
        - EQ1: Progress Toward Achieving CPC Objectives
        - A. Protection – Services for Survivors of Child Trafficking
        - B. Prosecution – Child Trafficking Cases
        - C. Prevention – Awareness Efforts to Reduce Child Trafficking
        - D. Partnership – Structured Interagency Collaboration to Address Child Trafficking
        - EQ2: Challenges
        - EQ3: Training
        - V. Conclusions
        - Definition of TIP
        - Protection
        - Prosecution
        - Partnerships
        - Prevention
        - VI. Recommendations
        - Annex I: References
        - Annex II: Evaluation Statement of Work
        - Annex III: List of Interview and Focus Group Discussion Participants
        - Annex IV: KII Protocol
        - Annex V: FGD Protocol
        - Annex VI: Informed Consent Agreement
        - Annex VII: Data Collection and Analysis by Evaluation Question
        - Annex VIII: Feedback for the Endline Assessment

## Acronyms

AG                   Attorney General

AHTU               Anti-Human Trafficking Unit (part of GPS)

CCPC                Community Child Protection Committees

CPC                  Child Protection Compact Partnership (also referred to as the Partnership)

COR                 Contracting Officer’s Representative

CSEC                Commercial Sexual Exploitation of Children

DoS                  U.S. Department of State

DOVSSU          Domestic Violence and Victim Support Unit (part of GPS)

DSW                Department of Social Welfare (under MoGCSP)

ET                    Evaluation Team

FGD                 Focus Group Discussion

FTS                  Free the Slaves

GHS                 Ghanaian cedi

GI                    Group Interview

GIS                   Ghana Immigration Service

GoG                 Government of Ghana

GPS                  Ghana Police Service

HTF                  Human Trafficking Fund

HTS                  Human Trafficking Secretariat

INGH               International Needs Ghana

IOM                 International Organization for Migration

IP                     Implementing Partner

JUPOL              Judicial Police (part of GPS)

KI                     Key Informant

KII                    Key Informant Interview

MELR               Ministry of Employment and Labor Relations (Ghana)

MoGCSP          Ministry of Gender, Children and Social Protection (Ghana)

MoI                 Ministry of the Interior (Ghana)

MoJAGD          Ministry of Justice and Attorney General’s Department (Ghana)

NGO                Non-governmental organization

SOPs                Standard Operating Procedures

TIP                   Trafficking in Persons

TIP Office        Office to Monitor and Combat Trafficking in Persons (DoS)

TWG                Technical Working Group

USAID              U.S. Agency for International Development

USG                 Government of the United States

VOT                 Victim of Trafficking

## Executive Summary

Ghana is a source, transit, and destination country for men, women, and children subjected to forced labor and sex trafficking and has remained on the United States Government (USG) Tier 2 Watch List for three consecutive years (2015, 2016, and 2017). The five-year U.S.-Ghana Child Protection Compact (CPC) Partnership, signed in 2015, is the first program in which the Office to Monitor and Combat Trafficking in Persons (TIP Office) secured and leveraged negotiated commitments of a foreign government together with $5 million in targeted anti-trafficking foreign assistance aimed at addressing child trafficking.

The CPC focuses on eight objectives: 1) provision of comprehensive and trauma-informed services, including reintegration; 2) increasing successful investigations and prosecutions; 3) improving interagency cooperation; 4) increasing public awareness of child trafficking; 5) implementing standard operating procedures for identification and rescue of trafficked children; 6) standardizing referral protocols for timely interagency response; 7) implementing data collection mechanisms to monitor anti-trafficking outcomes; and 8) increasing options for livelihoods to support families of at-risk or trafficked children. To help accomplish these objectives, key partners International Organization for Migration (IOM) and Free the Slaves (FTS) work collaboratively with Ghana-based non-governmental organizations (NGOs).

This midline evaluation is designed to assess progress toward meeting the above objectives, examine challenges in meeting these objectives and provide a snapshot of training on child trafficking and ways in which training has been put to use. Data collected during this midline assessment has been assessed against baseline data collected during the start of the CPC and compares data from the CPC target regions (Greater Accra, Central and Volta) to the CPC comparison regions (Ashanti and Eastern). Two mixed teams of two evaluators each (one Ghanaian and one international; one male, one female) conducted a total of 70 key informant interviews (83 individuals) and three focus group discussions (42 individuals) in Ghana over a three-week period during February of 2018.

While the CPC is at the midway point, this midline evaluation comes at a relatively early stage in the implementation of key activities. Roll out and training on the Standard Operating Procedures (SOPs) began only five months prior to this evaluation. The new data collection process, while piloted with participating agencies, had not yet been implemented. The refurbishment of the Madina shelter for child trafficking victims was nearly complete but the shelter had not yet re-opened. Additionally, some CPC activities at the national level were delayed due to change in government actors after the elections at the end of 2016.  Nevertheless, measurable progress has been made to date. This report presents findings on the definition of child trafficking, and then organizes findings according to the four Ps – Protection, Prosecution, Prevention and Partnership.

**Definition:**As first reported in the baseline assessment,[1] confusion remains around whether movement is essential to establish a case of child trafficking with respondents in 77% of KIIs/GIs (n=53) indicating that movement is an essential element of human trafficking. Additionally, in 25% of KIIs/GIs, stakeholders believed that consent of a minor is a basis to dismiss the charge of trafficking in the case of the commercial sexual exploitation of the minor. The baseline also reported a lack of clarity between child labor and child trafficking. Such confusion around child labor versus child trafficking was not evident during this midline evaluation. While most respondents had a reasonable understanding of trafficking, the confusion about movement and consent could affect how police and prosecutors pursue trafficking cases.

**Protection:**National data demonstrates impressive increases in identification and rescue of child trafficking victims, increasing from seven in 2016 to 217 in 2017. However, CPC target regions do not appear to account for most of these increases; accounting for 33% of child victims identified in 2017.  Identification and rescue remain somewhat uneven, and not all agencies or districts, even within the target regions, are equally proactive.  Some respondents in law enforcement acknowledged that they waited for suspected cases to be reported and saw their role as reactive. Some police have been more pro-active, especially those working with IJM. One district officer noted increases in pro-active approaches in his district: “*Marine police are now patrolling the water; we are getting somewhere*” (target region, Ghana Police Service).

Measuring the quality and sufficiency of services for child victims of trafficking is to some extent contextual and subjective.  Nevertheless, respondents were asked to rank services based on their opinions and there was a fairly clear consensus that services were often under-resourced, not of consistently high quality, not sufficiently available in all locations, uneven in the array of services offered, and especially difficult to find for victims of sex trafficking. The Madina government shelter, refurbished under the CPC, is slated to open in 2018, and will add capacity for 40 children, including victims of sex trafficking.  As was similarly reported in the baseline assessment,[2] private shelters were better resourced than government shelters, and therefore able to offer more services and perceived higher quality services. In the absence of broad awareness and implementation of minimum standards for age-appropriate services for victims of trafficking, or monitoring systems to ensure implementation,[3] the scope and quality of services is not consistent across providers and remains dependent on resources.  Reintegration services are especially challenging, more so because push-factors of poverty and cultural norms are prevalent in some communities and community-based follow-up was said to be under-resourced.

In response to questions about trauma informed care, most respondents were able to recognize that victims of child trafficking had suffered trauma and that this might impact their wellbeing and behavior. Stakeholders offer emergency support (food, clothing, a place to sleep), try to calm the victim and offer parental advice. This compares with the baseline, which mentions “do no harm” approaches and using “basic social knowledge” in handling victims.[4] When asked what was meant by trauma informed care most described it as stabilizing the child in some way: for police, calming the child before interviewing them; for social workers, stabilizing them before providing other services or reuniting them with their families. Only one respondent, an NGO service provider, was able to fully describe trauma-informed approaches and how these had been implemented throughout the organization.

**Prosecution:**National data provided by the GoG shows progress during the period of the CPC in investigations, arrests, and to a lesser extent, prosecutions and convictions. Investigation of suspected child trafficking is seen as moving forward, with investigations in 2016 involving 7 child victims, accelerating to investigation involving 196 child victims reported in 2017.[5] Despite this, constraints to prosecution remain: prosecutors repeatedly cited shortcomings in evidence collection and preservation, while law enforcement and investigators mentioned resource constraints and obstacles in getting witness testimony. Interviewees also indicated undue influence from politicians and corruption from perpetrators as factors constraining prosecution of trafficking cases. The baseline assessment indicated that investigations had been pushed off on NGOs,[6] whereas this was not found to be the case during this midline assessment. Based on the number of prosecutions of all cases of trafficking, involving both adult and child victims, which climbed from 11 in 2016 to 29 in 2017, prosecutions are on the rise.  Convictions under the *Human Trafficking Act* of 2005, as amended, increased from zero to six convictions in 2017.[7] However, there were several instances where Attorney General (AG) prosecutors, after review of available evidence, reduced the charges to conform to that evidence, which was deemed insufficient to prove trafficking.

**Prevention:**Most respondents were aware of or had seen public awareness materials or campaigns, and many of these were reported to have some positive impact, significantly more so in target regions than in comparison regions. Respondents mentioned different messages and delivery channels, and some opinions diverged when it came to what worked best. The general consensus among respondents was that public awareness was most effective at the grassroots level, through community meetings and gatherings, referred to as *durbars*, and featuring community leaders, including faith leaders and chiefs.

Livelihoods schemes, including LEAP, are not viewed to be sufficient to prevent trafficking or to mitigate re-trafficking.  Virtually every interviewee who discussed livelihood schemes noted that there are few programs available and those which do exist are inadequate, not providing sufficient economic support to families at risk or to families of child trafficking victims to prevent trafficking or re-trafficking.

**Partnerships:**Creating a framework for collaboration is a key goal of the CPC and a structure with focal points is provided under the CPC Partnership. The HTMB, though not active during 2017, was reconstituted in early 2018.[8] The CPC Technical Working Group (TWG) is functional and active, though some reported that not all members are able to prioritize child trafficking to the same extent. The Human Trafficking Secretariat is considered informed and dedicated. Collaboration was reported throughout operations, including among GoG agencies and between the GoG and NGO actors.  Some cited that government should take the lead, and that a few non-State actors had overstepped their role, especially in undertaking rescues without engaging the police. Others displayed a strong reliance on NGOs. Overall, collaboration was routine and free of major challenges, but not typically governed by SOPs.

The Government of Ghana (GoG) financial contribution to the CPC partnership is difficult to track as the GoG is not able to fully disaggregate resources dedicated to combatting child trafficking. Significant funding has been allocated, but distribution was stalled until the Human Trafficking Management Board (HTMB) was reconstituted.

Under the CPC Partnership the MoGCSP is responsible for monitoring indicators to measure the success of CPC implementation and compiling data to facilitate a strategic response.[9]   Data flows are improving, as evidenced by the MoGCSP CPC Semiannual Report for January 2015 to December 2017 and as stated in interviews, and data is now being disaggregated for child trafficking and by CPC target regions.[10] Stakeholders have been trained on the use of a new database which will be rolled out in the CPC target regions pending approval by the GoG. According to national actors, several data collection challenges remain, including compilation of data from the districts up to the national level and lack of consistent electricity and connectivity which limits use of computers and leads to reliance on a paper-based system.  While many challenges remain, the above-mentioned CPC Semiannual Data Report as well as data submitted to DoS for the annual TIP Report clearly show more data being collected nationally and in the CPC target regions during 2017 than in prior years.[11]

**Challenges:**Respondents noted many challenges had been overcome, citing less confusion surrounding the definition of child labor versus child trafficking, advances in funding and resource allocation (including procurement of six vehicles from CPC funds), increased enthusiasm of the Ghana Police Service (GPS) and other stakeholders to address trafficking, better collaboration on rescues, accelerated awareness of child trafficking among CPC implementers and in communities, and better data reporting and flow.

Respondents also named several ongoing challenges. Resource and funding issues were at the top of the list of challenges, including resources for staffing, transportation and operations, and hospitality for community gatherings and TWG meetings. Several named the need for vehicles, boats, fuel, lodging and per diem to enable police to chase down suspects or enable social workers to follow-up on reintegrated victims. Funds for victim care were also said to be lacking, and several police and social workers said they used their own funds for emergency needs of victims. Shelters were said to be too few and under-resourced. This replicates the baseline finding, which also reported resource constraints.[12]****

A second continuing challenge was the lack of widespread buy-in on what constituted child trafficking and whether it should be illegal or prosecuted. Due to cultural norms around child labor, respondents felt that communities were not enthusiastic about pursuing trafficking, and outside of the most egregious cases, sometimes did not understand why it was illegal or even wrong. Some cases were reportedly handled through traditional methods of justice by community chiefs or leaders, rather than criminal cases in courts. Unemployment and endemic poverty were repeatedly cited as a challenge to preventing child trafficking.

**Training:**IOM has trained over 500 anti-trafficking stakeholders (GPS, DSW, MELR, MoJAGD, judges, and others) on the new SOPs for identification, screening and rescue of trafficked children, direct assistance, investigations and prosecution. At the time of this evaluation, the SOPs were newly-launched and their use not yet institutionalized; many stakeholders cited the use of other internal procedures and forms. More than half of respondents had not yet seen a case of child trafficking and thus had not had an opportunity to use the SOPs. This is likely to improve with more time and training (the SOPs were released in October 2017).

**Recommendations**
        - Through implementation of the next phase of CPC activities, consider additional emphasis on the following areas:           - Continue to promote understanding and application of Ghana’s definition of child trafficking.
          - Continue to support and monitor expansion and quality of protection services.
          - Expand efforts to develop and enhance service referrals for victims and their families.
          - Finalize and promote implementation of the CPC data collection methodology.
          - Emphasize and prioritize awareness-raising at the grassroots level.
          - Continue to advocate for LEAP eligibility for families with child victims of trafficking.
          - Continue to extend mandatory curriculum and training. 
        - Protection: Provide on-the-job training to Madina staff.
        - Prosecution:           - Encourage release of GoG funding to address resource constraints.
          - Examine feasibility of the task force model for collaboration on cases. 
        - Partnership:           - Invite more stakeholders to participate in select CPC TWG meetings.
          - Consider support to expand SOPs into the other regions, focusing first where authorities have identified cases. 

## I. Background and Context

### Human Trafficking in Ghana

Ghana is a source, transit, and destination country for men, women, and children subjected to forced labor and sex trafficking. Ghanaian children are particularly vulnerable to forced labor within the country in the fishing industry and in domestic servitude.  According to the U.S. Department of State’s (DoS) 2017 *Annual Trafficking in Persons**Report*, research has found that many of the children working on and around Lake Volta are subjected to forced labor and other harsh conditions and not allowed to attend school.[13] Another study found that children from nearly one-third of the households surveyed in the Volta and Central Regions had been subjected to trafficking.[14]

DoS has found that the Government of Ghana (GoG) does not fully meet the minimum standards for the elimination of trafficking, but that it has made significant efforts to do so. In the 2017 TIP Report, Ghana was placed on the Tier 2 Watch List for the third consecutive year. In 2018, Ghana was upgraded to Tier 2.[15]

### U.S.-Ghana Child Protection Compact Partnership

Seeking to assist the GoG in its efforts to address child trafficking, the five-year U.S.-Ghana Child Protection Compact (CPC) Partnership, signed in 2015, is the first such program in which the DoS Office to Monitor and Combat Trafficking in Persons (TIP Office) combined negotiated commitments of a foreign government with significant foreign assistance aimed at addressing child trafficking. The GoG participants in the Partnership include the Ministry of Gender, Children and Social Protection (MoGCSP), the Ministry of the Interior (MoI), the Ministry of Employment and Labor Relations (MELR) and the Ministry of Justice and the Attorney General’s Department (MoJAGD). The roles of each participating agency are defined in the Child Protection Compact (CPC) Partnership signed by the GoG and the U.S. Government (USG).

The GoG established a CPC Technical Working Group (TWG) to oversee the activities of the CPC. The TWG includes representatives from government and non-governmental organizations (NGOs). The government representatives on the TWG include the Ghana Police Service (GPS) and the Ghana Immigration Service (GIS) (both under the MoI), the MoJAGD public prosecutors, the Child Labor Unit (CLU) of MELR, and the Department of Social Welfare (DSW) and the Human Trafficking Secretariat, both under the MoGCSP. Non-governmental representatives include the International Organization for Migration (IOM), Free the Slaves (FTS) and International Needs Ghana (INGH); all three are actively involved in CPC implementation.

The TIP Office is providing foreign assistance totaling $5 million to two implementing partners (IPs), IOM and FTS, to support the GoG’s capacity to meet the eight CPC Partnership objectives.  To help the government accomplish the objectives, IOM and FTS also work collaboratively with Ghana-based NGOs. Implementation is conducted in three target regions – Central, Volta and Greater Accra.

## II. Evaluation Purpose, Scope and Questions

### Evaluation Purpose and Audience

This midline performance evaluation was commissioned by the TIP Office to evaluate the extent to which the CPC is achieving its eight objectives. It seeks to measure the effectiveness of all CPC components and thereby help to determine whether the goals, objectives, activities and performance indicators established at the outset need adjusting. This evaluation is also expected to identify key obstacles, so that mid-course corrections can be made and to address programmatic and contextual factors that have contributed to measurable change in commitment of government resources and political will for combating child trafficking. The TIP Office also seeks to understand the extent to which the CPC Partnership model has improved the GoG response to child trafficking and whether this model could be effectively employed in other countries.

Results from this evaluation are expected to be used to determine whether and how adjustment is needed to CPC activities, including those of IPs, at this critical, mid-term implementation period. In addition, this midline evaluation will enable the TIP Office to assess the effectiveness of this type of partnership in similar contexts, in order to design and implement future partnerships to be more effective. The evaluation will also be informative for other key stakeholders, including the GoG; DoS policy makers and program managers; members of Congress and congressional staff engaged in human trafficking related authorizations and appropriations; U.S. Embassy Accra; the DoS Africa Bureau; the United States Agency for International Development (USAID) and the Department of Labor staff working on child labor and child trafficking issues; IOM, FTS and the DoS Evaluation Community of Practice.

### Evaluation Scope

The midline evaluation covers the first two years of the CPC (10/1/15 – 12/31/17). This midline evaluation is the second phase of a multi-phased evaluation, to assess key factors in the government’s continuing response to child trafficking. Two baseline assessments were carried out for the CPC in 2016: the *Baseline Assessment of the Child Protection Compact Partnership*, conducted by Westat, and the Nordic Consulting Group Denmark A/S and JMK Consulting of Ghana report *Growing Up Free: Baseline Report* on the FTS program in Volta and Central Regions in Ghana.[16] This midline assessment will compare progress primarily to the Westat baseline assessment, and, where relevant, to the Nordic Consulting Group A/S baseline report.

### Evaluation Questions

This midline performance evaluation was designed to answer three main questions, the first of which is broken down into eight sub-parts:
        - To what extent have CPC-supported activities led to progress toward achieving the eight objectives of the Ghana CPC Partnership?           - Provision of comprehensive, gender-sensitive, trauma-informed care and case management services with appropriate community integration and follow up for an increased number of child trafficking victims.
          - An increased number of successful investigations and prosecutions of perpetrators of forced child labor and child sex trafficking.
          - Improved interagency coordination of anti-trafficking efforts.
          - Increased public awareness of the nature of child trafficking, its devastating impact on children, and the importance of prevention.
          - Establishment and implementation of procedures for pro-active identification and removal of children from trafficking situations, including children in forced child labor in the fishing industry.
          - Establishment and operation of a systematic referral mechanism with protocols for timely interagency response to suspected cases of child trafficking.
          - Implementation of mechanisms for data collection designed to monitor indicators of anti-trafficking program outcomes supported through this Partnership and which can be sustained to track key government interventions, such as the number of investigations, prosecutions, and convictions in child trafficking cases and the numbers of child trafficking victims identified and who receive services.
          - The increased use of livelihood options for families with children at risk of trafficking or removed from trafficking situations. 
        - What are the challenges in meeting these objectives? [What progress has been made in addressing challenges identified in the baseline study? What challenges have been overcome, and how? What challenges remain?]
        - What training have key actors received on child trafficking and how have they used the training?

## III. Evaluation Design and Methodology

The midline evaluation is designed to compare data collected at the mid-point of the CPC to data collected at baseline as well as to compare progress made in CPC target regions to comparison regions established at the outset of the CPC, though recognizing that progress in comparison regions may not be stagnant. In order to ensure consistency and maximize comparability of data, the evaluation team (ET) made every effort possible to utilize similar methodologies as the 2016 Westat baseline assessment, which collected baseline data for the three CPC target regions and the two comparison regions. To further strengthen the reliability and validity of this evaluation, the ET vetted the data collection instruments with TIP Office staff for their inputs and tested the KII protocol with the initial KIIs. The ET also peer reviewed the analyses of the data through internal discussions to agree on common themes emerging from the analyses. The evaluation followed three phases: planning, data collection and data analysis.

### Planning

During the planning phase, DevTech participated in a kick-off meeting as well as in two additional planning meetings with the TIP Office Contracting Officer Representative (COR) and others involved in development of the Ghana CPC Partnership and in oversight of the IPs to discuss the evaluation purpose and use, clarification of evaluation questions, challenges encountered during baseline data collection, logistical challenges and documents needed for the document review. During the planning phase, the evaluation team reviewed the evaluation scope of work as well as background documents as they became available, designed the data collection plan and a preliminary fieldwork schedule and drafted data collection protocols.

### Data Collection

#### Site Selection

The three target regions of the CPC are Greater Accra, Central and Volta. The two comparison regions are Ashanti and Eastern. In-person interviews and focus group discussions (FGDs) took place in February 2018; phone-based interviews took place in March 2018.[17] Site selection for the midline performance evaluation was based on the sites selected for the Westat baseline evaluation, which included the regional capitals as well as two districts per region, selected based on the prevalence of child trafficking and proximity to the regional capital.[18] Table 1, below, presents the sampling districts for each region.

#### Data Collection Methods and Sampling

There were three main methods of data collection for this study: (1) document review, (2) key informant interviews (KIIs) with experts and stakeholders, and (3) focus group discussions (FGD) with the CPC TWG as well as with two communities targeted for interventions. All data collection methods were implemented at the same time.

***Document Review:***The document review had several objectives:
        - Collect background information about the project to inform evaluation design;
        - Collect statistical information from secondary sources on estimated numbers of rescues, arrests, prosecutions, and convictions for child trafficking cases;
        - Verify the existence of Standard Operating Procedures (SOPs), referral mechanisms and other mechanisms developed through the Partnership;
        - Compile baseline information for comparison and analysis;
        - Develop a list of interventions supported by IOM and FTS that were intended to impact the achievement of the CPC objectives.

The initial document and literature review was conducted prior to data collection in Ghana. It was based primarily on the documents provided by the TIP Office, including the signed U.S.-Ghana Child Protection Compact Partnership, project Scopes of Work (SoWs), IOM and FTS quarterly reports, the Westat Baseline Assessment of the Child Protection Compact Partnership: Inception Report and Baseline Report and the Nordic Consulting Group Baseline report. The ongoing document review during the data collection included Ghanaian laws, SOPs developed through the CPC and statistics provided by the GoG to the U.S. Embassy in Accra and the TIP Office. The TIP Office requested that the ET not collect statistical data during fieldwork but rely instead on the above-referenced data provided by the GoG.[19] This differs from the Westat baseline, which asked each KI to provide data on cases in which they were involved.

***Key Informant Interviews:***Key informant interviews (KII) were our central data collection method for this evaluation. Twelve KIIs turned into group interviews (GIs) as more than one person from the office participated in the discussion. Findings from KIIs and GIs deepened the ET’s understanding of the implementation of CPC activities and provided opinions of different stakeholders regarding progress made toward achievement of CPC objectives and challenges in implementation.

In order to allow comparison with the baseline, KIIs/GIs were conducted in the same regions and districts as the baseline study. The initial list of key informants was based on the list of 67 government officials and 24 NGO representatives listed as key informants in the Westat baseline assessment. This included officials from each of the four participating CPC ministries: a minimum of one national-level official from each ministry, one regional-level official from each ministry in each of the five regions, and at least one district-level official per ministry (except for MoJAGD which does not have district level representation) in two districts of each of the five regions.  In case of turnover, the evaluation team generally interviewed the person currently in the position. Additionally, the ET sought to hold KIIs with those NGOs interviewed by the baseline assessment team who have a role in the CPC or are actively involved in related counter trafficking activities in the target or comparison regions.  A list of the types of individuals interviewed is included as Annex III, which also documents changes from the Westat baseline.[20]

**KII Protocol:** Interviews were guided by a protocol that included targeted inquiries to collect information to answer the evaluation questions (see Annex IV, KII protocol). The protocol used a semi-structured questionnaire format including both closed and open-ended questions. The KII protocol was designed to be tailored to each informant. Time would not allow for each respondent to answer all protocol questions; the ET had one hour with each key informant. Therefore, the protocol was designed with skip protocols, meaning that questions and sub-sections could be skipped if responses to prior questions made clear that they were not relevant to that informant. As a result, each question has a unique number of respondents who responded to it.  For sev

eral interviews, especially with CPC IPs at the national level, the interview protocol was not followed, but, where appropriate to the role of the respondent, the same line of questioning was included. For in-person interviews, each KI was also asked to define child trafficking. This question was asked in order to understand any confusion which might exist around child trafficking, child labor and other crimes, and to put KIs’ responses into context.

Not all informants could be interviewed in person. Some informants were not available during the fieldwork in their location. Additionally, and just as in the Westat baseline assessment, the ET could not go in person to each district due to time constraints. These KIs were interviewed by phone. The ET successfully conducted a total of 70 KIIs/GIs with 83 individual respondents.

In order to facilitate data collection, two two-person teams conducted interviews. Each team consisted of one international and one local team member.  The full team conducted the first several KIIs together to ensure that all team members would conduct interviews in the same manner and to test the protocol.  The ET revised the protocol during the first week of field work to ensure the questions solicited the information necessary to answer the evaluation questions.

***Focus Group Discussions:***The evaluation team conducted three FGDs. The first FGD was with 14 members of the CPC TWG. The ET had limited time with the TWG and focused the discussion on progress to date, government commitments and data collection.  While not planned in advance, the ET was able to organize two FGDs, involving 28 participants, with communities involved in FTS’s interventions, with the help of INGH. The ET met with community child protection committees (CCPC)[24] in both communities and additionally with some ‘learning group’ members developed by INGH in one community. A total of 42 individuals participated in FGDs (25 men, 17 women). See Annex V for the protocols used for all three FGDs.

### Data Analysis

Qualitative data collected during KIIs/GIs and FGDs was analyzed using Dedoose software. Quantifiable data from the interviews was analyzed using Excel. A table provided in Annex VII outlines major approaches to data collection and analysis for each evaluation question.

### Limitations

As with any evaluation, there are a number of limitations which can affect the reliability and validity of the findings. Below are some of the limitations and biases that may have affected data collection. The evaluation was designed to mitigate these biases by triangulating data across stakeholder groups and across data collection methods.

**Gender Bias:**Individuals have conscious and unconscious gender biases, including opinions about appropriate roles and behavior of males and females.  This can affect all aspects of an activity but may be especially important when it comes to sensitive issues such as human trafficking and sex trafficking in particular. Data analysis was conducted whenever possible to tease out gender differences. The full evaluation team and two-person sub-teams, all included both male and female members in order to mitigate gender bias in analysis and interpretation that team members themselves may bring to bear as well as to mitigate any bias that may result from how KIIs respond to interviewers of different genders.

**Recall Bias:**KIIs and FGDs rely on the memories of individuals.  Memories are imperfect and are influenced by many factors including what was deemed significant to the individual, what took their time and attention, and if there were other distractions in their life at the time of an activity or event. Recall bias was mitigated by aggregating responses from multiple informants.

**Response Bias:**Response bias comes into play when a person, consciously or unconsciously, provides a response influenced by a variety of factors. The individual may give a positive response in order to please the interviewer, influence the donor or present their organization or culture in a positive light. On the other hand, a person could give a negative response for the opposite reasons – to negatively portray a rival, for example. During group interviews, individuals may echo the opinions voiced by someone of higher rank.  The ET was accompanied during the first week of data collection by one TIP Office staff. The staff did not attend the FGD with the TWG in order not to bias their responses since most members of the TWG know her and her role. On one occasion, the ET asked the TIP Office staff to leave the room for the final portion of the interview to give the respondent a chance to speak anonymously.  In this interview and others, her presence did not appear to influence respondents’ willingness to make negative comments. In general, the ET utilized facilitation techniques to minimize response bias. As with recall bias, the analysis mitigated response bias by aggregating responses from multiple informants.

**Sampling and Selection Bias:**Because the midline evaluation is designed to mirror the Westat baseline study, the districts to be sampled and the individuals to be interviewed had been pre-determined, thus random sampling methods could not be utilized. Districts were selected based on recommendations by the MoGCSP and the TIP Office.[25] The Westat baseline assessment report does not indicate how individuals were selected. The selection of individuals and districts can influence the findings, for example if only the most active and engaged individuals are selected for interviews.  Additionally, given the constraints of budget and time, the evaluation team was not able to interview everyone involved in the CPC, had limited time with each individual and was not able to probe deeply with each person into every question.

**Poor or non-existent data collection and statistical information**: There is limited data available from the GoG on TIP cases, including victims identified, investigations, prosecutions or convictions. The ET received national data on human trafficking from the DoS.  The ET also received some data from the GoG, through the TIP Office, with data similar to the national data for the three CPC target regions, but for the calendar year 2017 only. Unfortunately, the ET did not receive this same data for the comparison regions.

**Other limitations:**Based on TIP Office guidance and time constraints, the methodology did not include interviews with trafficking victims or their guardians. Therefore, the analysis of evaluation questions related to assistance and services for victims does not include the opinions of child survivors or their families. While data triangulation may mitigate this limitation to some extent, the lack of survivor voices could not be fully mitigated within the planned methodology. As noted above, the ET was able to conduct FGDs with two communities in Ghana. At least two participants in one of the FGDs were parents of child victims of trafficking (VOTs) who received services through the CPC partnership. While the focus of the FGD was not on them or their children, their opinions on related matters are noted when applicable.

### Data Protection

Throughout data collection and reporting, the ET abided by the ethical principles of informed consent, respect, sensitivity, do no harm, non-discrimination and confidentiality. The ET obtained informed consent before each interview. The ET provided respondents with the written consent form and read aloud the sections describing the purpose of the study and voluntary participation in the interview. In FGDs in the communities, in order not to embarrass anyone who might be illiterate, the same procedure was followed but consent was taken verbally for each individual.[26]

Participation in this evaluation was not expected to present any risks or provide any direct benefits to respondents. Although the respondent population included only adults and was not expected to include any vulnerable groups,[27] the evaluation team nevertheless took steps to minimize any potential risk of participation by taking steps to protect respondents. First, interviews did not take place until respondents had given their informed consent as noted above. Additionally, all respondents were assigned an identification code.  Notes from interviews are marked only with the identification code, no names or other identifiers. The list of codes with identifying information about the respondents is kept separate from the interview notes. Only the ET members have access to the codes. Every effort was taken to ensure that information reported cannot be linked to the individuals from which it came.

## IV. Findings

Findings are presented below by evaluation question.   In addition to the evaluation questions, the ET was asked to assess respondents’ understanding of the definition of child trafficking.  This was done in order to ensure that confusion around definitions, which was found during the baseline assessment, would not impact on midline evaluation findings. Findings under the exploration of the definition of trafficking are presented first. Following this, findings for the first evaluation question – To what extent have CPC-supported activities led to progress toward achieving the eight objectives of the Ghana CPC project? – are presented. These findings have been re-ordered so that CPC objectives related to each of the four ‘Ps’ (protection, prosecution, prevention and partnership) are grouped together. While some objectives are relevant for more than one ‘P,’ they are grouped in the report as follows:

Protection:
        - EQ1.a: Provision of comprehensive, gender-sensitive, trauma-informed care and case management services with appropriate community integration and follow up for an increased number of child trafficking victims;
        - EQ1.e: Establishment and implementation of procedures for pro-active identification and removal of children from trafficking situations, including children in forced child labor in the fishing industry; and
        - EQ1.f: Establishment and operation of a systematic referral mechanism with protocols for timely interagency response to suspected cases of child trafficking.

Prosecution:
        - EQ1.b: An increased number of successful investigations and prosecutions of perpetrators of forced child labor and child sex trafficking.

Prevention:
        - EQ1.d: Increased public awareness of the nature of child trafficking, its devastating impact on children, and the importance of prevention; and
        - EQ1.h: The increased use of livelihood options for families with children at risk of trafficking or removed from trafficking situations.

Partnership:
        - EQ1.c: Improved interagency coordination of anti-trafficking efforts.
        - EQ1.g: Implementation of mechanisms for data collection designed to monitor indicators of anti-trafficking program outcomes supported through this Partnership and which can be sustained to track key government interventions, such as the number of investigations, prosecutions, and convictions in child trafficking cases and the numbers of child trafficking victims identified and who receive services.

Findings for evaluation questions 2 (challenges) and 3 (training) follow in order.

### Definition of Child Trafficking for Forced Labor and Commercial Sexual Exploitation

The CPC Partnership includes, in Addendum A, a definition of child trafficking.  The Republic of Ghana’s *Human Trafficking Act, 2005* (Act 694) and *Human Trafficking Prohibition (Protection and Reintegration of Trafficked Persons) Regulations, 2015***[28]** also define human trafficking and are consistent with, though not as descriptive as the definition in the CPC Partnership.

To clarify respondents’ understanding of the definition of child trafficking, at the outset of each in-person KII/GI, the team asked respondents to define child trafficking in their own words. The definition of child trafficking was asked of 66 respondents during 53 KIIs/GIs.[29] If the response was not clear, respondents were asked to provide an example of labor trafficking and/or sex trafficking and were probed to identify key elements in the example that matched the definition of child trafficking in their view.  Several responses required further probing to clarify the respondent’s definition of child labor trafficking versus other forms of labor abuses, and between child sex trafficking and other forms of sexual abuse or exploitation. During such probing, six respondents contradicted themselves or remained unclear, resulting in responses being classified as ‘unclear or vague.’

In only seven KIs/GIs (13%, n=53) did the definition fully conform with the CPC Partnership definition of child trafficking.  Respondents in target regions were slightly less likely to state a definition which fully conformed (11%, n=36) than those in comparison regions (18%, n=17).

Common among responses was the notion that movement was required in a case of trafficking (77% of KIIs/GIs, n=53).  Respondents in target regions were slightly more likely to state this than respondents in comparison regions (29 KIIs/GIs, n=36 (80%) and 12 KIIs/GIs, n=17 (71%), respectively). National and regional level respondents (7 KIIs/GIs, n=9 (78%) and 21 KIIs/GIs, n=27 (78%) respectively) were less likely than those at the district level (10 KIIs/GIs, n=12 (83%) to indicate that movement is required. There were also differences based on role or department, ranging from 60% (MoJAGD and IP/NGOs[30]) to 90% (MELR) and 92% (MoGCSP & DSW). See table 5, above.

Another common discrepancy between the CPC definition and the responses given related to child sex trafficking and whether the commercial sexual exploitation of a child (CSEC) was always considered trafficking. Probing on this question was not done consistently in the beginning of fieldwork. As a result, the numbers reported here may be lower than they would have been otherwise.

In 26 KIIs/GIs (19 target region, 7 comparison region), respondents indicated that there are circumstances under which a child under the age of 18 could be engaged in commercial sexual exploitation without it being trafficking. In six interviews respondents clearly indicated that if the child was doing this independently without a third party involved, including parents, then this was not human trafficking. In thirteen interviews (25%; 10 target, 3 comparison regions) respondents made the point that if the child was not forced or deceived they could ‘consent’ and then it was not human trafficking. “*Under 18 sex exploitation, is not TIP if done by consent”*(target region, GPS). One respondent made the case that if it was not by force and the child was not under 16, the age of sexual consent, then it was not human trafficking. In thirteen interviews respondents explicitly stated that CSEC of children under 18 would not be human trafficking if no movement was involved.[31] “*[We] have had cases in [location deleted] where a child is involved prostitution – children of 12 or 13. But it’s not trafficking because they have not been moved*” (target region, DSW). See table 6, below.

The Westat baseline assessment reported a lack of clarity between child labor and child trafficking which was not evident during this midline evaluation. The baseline assessment also found respondents’ definition of child sex trafficking was consistent with the law which was not evident in this evaluation. In both the baseline assessment and this midline assessment many respondents believed movement to be necessary in a trafficking case, *“a needed element for trafficking.”*[33] Though responses on the definition of child trafficking at midline were imperfect, most reasonably aligned with the Ghanaian legal definition of child trafficking and were therefore not likely to impact the validity of responses to evaluation questions. However, these differences may affect how individual cases are treated by authorities, in particular investigations and prosecutions.

### EQ1: Progress Toward Achieving CPC Objectives

#### A.  Protection – Services for Survivors of Child Trafficking

This section presents findings related to the extent that CPC-supported activities led to progress toward achieving the three objectives of the Ghana CPC project under the protection umbrella:
        - EQ1.a: Provision of comprehensive, gender-sensitive, trauma-informed care and case management services with appropriate community integration and follow up for an increased number of child trafficking victims;
        - EQ1.e: Establishment and implementation of procedures for pro-active identification and removal of children from trafficking situations, including children in forced child labor in the fishing industry; and
        - EQ1.f: Establishment and operation of a systematic referral mechanism with protocols for timely interagency response to suspected cases of child trafficking.

##### Provision of Services

One of the objectives of the CPC is to expand the availability and provision of comprehensive quality services for victims of all forms of child trafficking. To this end, the CPC aims to build government capacity to develop, provide, and fund services, provide training for government personnel related to survivor care and services, and enhance NGO services.[34] During its field work in Ghana, the ET conducted site visits at four shelters (3 active, 1 public and 2 private, serving a total of 115 children in residence (88 of whom were victims of trafficking) and 1 public shelter under renovation which had not yet re-opened. Based on TIP Office guidance and overall time constraints, the ET did not interview survivors or their families about service provision,[35] and the evaluation team did not directly observe services provided to survivors. Through 61 KIIs/GIs and 2 FGDs, the ET determined interviewees’ knowledge about the existence of services and their perceptions about the availability, accessibility and quality of services.

**Service Providers**

Twenty-eight respondents (19 in target regions, and 9 in comparison regions) stated that they or their agency directly served victims of child trafficking. This included a wide range of interventions and services that varied substantially between respondents from DSW (11), GPS (9, including 4 from Anti Human Trafficking Units (AHTUs) and one from judicial police (JUPOL), GIS (3), shelters (4), and non-shelter NGOs (1).

Eleven of 14 respondents from DSW – 7 in target regions, 4 in comparison regions – said that they provided services for victims of child trafficking, including providing hygiene supplies, helping with shelter placement, counseling, and assistance during reintegration. Shelter providers also mentioned DSW as a partner in placing survivors in shelter and facilitating reintegration, and one noted that DSW certifies shelters and then contracts for services with certified shelters.

Law enforcement and immigration officials also noted that they rely on DSW to place children in shelters. They also indicated that delays in placements result in they themselves providing food, clothing, mattresses, and incidentals for survivors immediately following identification and removal of victims from exploitative situations. They said they provided these basic needs using their personal resources, and based on goodwill, rather than as a function of their role or prescribed duty.*“[Police] do well with the little resources they have – they support [child VOTs] from their own pocket”*(target region, State Attorney). One police officer noted that female officers and the wives of male officers sometimes cared for survivors, even taking them home until they could be placed in a shelter or returned to parents. *“Our officers even give money from their own pocket, buy food, and shelter VOTs in their own homes”*(comparison region, GIS)*.*

**Shelter Services**

The TWG reported that they had completed a directory of shelters and placement locations in 2017. Respondents did not mention knowledge of this directory, though some noted that a directory would be useful. When asked if they were aware of any shelters that served victims of child trafficking, in 31 KIIs/GIs (n=61), (22 in target regions, 9 in comparison regions), respondents could name one or more places, including government shelters (two mentioned, a total of seven times), private shelters (five mentioned, a total of 22 times), and 10 other places, most of which were orphanages. Social workers were somewhat more likely to know of shelters than other respondents (40% of IP/NGOs, 50% MELR: 63% MoGCSP/DSW, 46% MOI/GPS/GIS and 50% MoJAGD). There was an overall perception of a lack of available shelters, especially at the regional and district level. Regional and district levels officials in both target and comparison regions, indicated a need for a shelter closer to them. After substantial delays, renovations at the Madina shelter in Accra are nearing completion and beds for 20 female and 20 male child victims of trafficking will be available.   This will help to ease the burden on existing shelters, but some shelter operators feared it could also mean sharing scarce funding with another provider.  As was similarly reported at baseline,[36] private shelters were better resourced than public shelters. The CPC Semiannual Data Report of MoGCSP showed that the public shelter received 8,000 GHS (about USD 1,700) a year for non-salary expenses, while one respondent noted that a private shelter spent several times that for a one-day event. Nonetheless, respondents from both public and private shelters reported resource constraints.

The ET visited four shelters (2 public, 2 private). During interviews with key staff, the ET asked about services provided to child trafficking victims.  These findings are presented below:[37]

**Eligibility criteria** for entering private shelters varied. Some accepted children through age 16, and young children were co-mingled with teenagers. One shelter strategically chose to limit entry to ages 7-17, citing that their specialized services were aimed at empowering youth, and under age seven required more labor-intensive oversight and higher staff/survivor ratios.  Only public shelters served survivors of both sex and labor trafficking, limiting shelter availability for victims of child sex trafficking. The public shelter in Accra also served street children who were co-mingled with child victims of trafficking. This was also the case at the time of the baseline assessment.[38] One IP/NGO explained that specialized skills were needed to effectively work with survivors of sex trafficking, and this was outside of their level of expertise, so they had made a strategic decision not to admit victims of sex trafficking for residential care.  The other noted that personnel were not trained to work with victims of sex trafficking and found that it was not easy for them, so they reintegrated the few they assisted quickly and no longer accept sex trafficking victims. This issue will likely be addressed with the opening of the Madina shelter.

**Duration of services** also varied. For public shelters, the stated goal was to reintegrate survivors, or place them in orphanages within a few months; private shelters took a longer view, with no specific exit deadline, trying to rehabilitate and build-out skills and readiness, catch survivors up to appropriate school grade-levels, and instill both yearning and agency for survivors to continue their education. In general, length of stays tended to be between three to nine months[39], determined on a case by case basis.

**Services provided also varied**. All four of the shelters visited provided basic necessities in-house, including accommodation, meals, clothing and shoes, and hygiene products.

All shelters provided some form of psychological screening and counseling; two offered expanded psychiatric services, including through partners (such as the Ghana Police Hospital).  While the Westat baseline assessment indicates that there was a scarcity of psychologists,[40] at midline respondents more often mentioned the prohibitive cost as an impediment to providing this service rather than a scarcity of professionals. Two shelters offered medical screening and access to services (through partners such as All Care). One planned to offer medical services. Only one shelter offered legal advice and advocacy services, though the extent of such services was not clear.  All shelters provided some kind of age-appropriate education, both in-house and through public schools; however, one shelter with generally shorter residencies did not enroll children in school. Only private shelters offered life skills and vocational training, but all offered some form of age-appropriate recreation, including crafts and outdoor activities. One of the private shelters operated a 24-hour hotline to provide advice and facilitate emergency intakes. Only private shelters participated in field rescues, one with police and one with or without police accompaniment. Only private shelters performed safety and risk assessments (on in-take and prior to reintegration).  Staff of public shelters rely on DSW staff who work in communities for such assessments. As discussed further below, some DSW respondents stated that they participated in rescue operations and/or performed safety and risk assessments.

**Reintegration Services**

All respondents who answered questions about reintegration considered reintegration strategies and services to be inadequate.  Some cited staffing constraints, but most cited transport and resource constraints as the main barrier to their work.  There are various agencies involved in reintegrating survivors back to their communities of origin and reuniting them with their parents or guardians.  Principally, police units transport children to their village and home, ideally after preparation with the family and community carried out by some combination of DSW and shelter providers. Only two (one private and one public) of the four shelters visited are involved in survivor reintegration or plan to be; one private shelter indicated that its role in reintegration is to make sure the child is ready, and DSW’s job is to ensure that the family and community are prepared.  One public shelter mentioned that they directly engage in reintegrating street children but not victims of trafficking. Five of 18 DSW staff who work in communities mentioned their role in assessing risks and preparing families before reintegration of survivors.  Three also mentioned their role in post-reintegration follow-up. Only one respondent from DSW acknowledged the role of NGO social workers in reintegration.  In only one interview did respondents specifically mention cases of re-trafficking, though three others mentioned that it was likely, and one mentioned a story he had heard about a voluntary return from a trafficking situation, facilitated by a concerned mother, but the father did not want the child, and returned the boy to the fishing trade within the week.

**Perceived Quality of Services**

During KIIs, respondents were asked how they would rank the quality of services offered by shelters or other service providers.  They were asked to rank such services using a defined scale (1=consistently low, 2=mostly low, 3=mixed, 4=mostly high, 5=consistently high). Out of 16 respondents who ranked government services, the average rank was 3.2 (mixed quality). Out of 22 respondents who ranked NGO or private services, the average rank was 4.3 (mostly high quality).  Similarly, at baseline, respondents ranked the public shelters slightly below adequate and the private shelters better than adequate[42]. When asked if available services were sufficient to meet survivors’ needs, 12 respondents ranked government services at an average of 3.1 (mixed), and 18 respondents ranked NGO and private services at an average of 3.7 (mixed). Overall, both the quality and sufficiency of services were perceived to be higher for NGO and private service providers, but the sufficiency of services for either was not perceived to be as high as respondents said was needed.

At least five respondents indicated that shelters in their area struggle to accept children because they can’t afford to support them; “*The NGOs are not well resourced. Even feeding is a problem. This is why they don’t want [the children] to stay there longer – [because] they can’t afford to feed them*” (comparison, AHTU). “*When you take a child there [to a private shelter] you have to pay for their upkeep*” (target region, GIS). The baseline assessment also found resource constraints to be an impediment for shelters.[43]

**Gender Issues**

When asked whether male and female victims of trafficking were treated differently, whether in shelter or not, 12 respondents from target regions (39%, n=31) and 7 from comparison regions (64%, n=11) said they were. Interviewees mostly referred to the fact that they had separate sleeping quarters.  Those few who perceived differences in treatment mentioned that females received a more sympathetic response, but also mostly acknowledged that sympathy was also common toward younger boys.  Actual services provided were said to be of a similar quality and nature for both boys and girls.

When asked whether victims of labor trafficking received different treatment from victims of sex trafficking, 13 respondents from target regions (48%, n=27) and 15 from comparison regions (71%, n=7) said there was a difference. Overall, a distinction was made several times by first responders and service providers that it was more challenging to work with victims of sex trafficking. Generally, the rationale was a pragmatic one, such as special needs of the victims and limited skill sets of the staff.  Two social workers and three shelter staff stated that victims of sex trafficking often experienced more severe trauma, and this required specialized psychological or psychiatric services.  However, two respondents stated that victims of sex trafficking would negatively influence the other children if they were in the same facility.

**Trauma-Informed Approaches**

The ET asked a series of questions aiming to determine levels of training and understanding of child-friendly and trauma-informed approaches for working with child survivors, and whether such training and understanding had been utilized to assist victims of child trafficking. While only one respondent (IP/NGO) was able to fully define trauma-informed approaches and describe how these had been systematically incorporated among all staff throughout the organization, most others gave less comprehensive responses but were able to describe something specific about how to work with traumatized children.  Respondents from both target and comparison regions respondents mentioned the following approaches: calming/stabilizing the victim, building trust, assuring safety, and providing lay counseling or professional psychological services as preliminary necessities in working with traumatized children. Many responses were not unlike the findings presented in the baseline assessment, which mentions ‘do no harm’ approaches and “basic social knowledge” in handling victims.[44] Law enforcement often spoke about the need to stabilize victims to improve cooperation, while NGOs and DSW viewed trauma-informed treatment as a way to improve behavior and/or promote healing.

While most interviewees had not yet worked with child victims of trafficking (see Table 25), they had other experience which could be brought to bear. DSW workers often mentioned experience with traumatized children related to child neglect and abuse or other traumatic conditions that they witness in their everyday work.  Respondents in other roles generally described qualities of human kindness and conscientious parenting that could be deployed in working with child victims of trafficking – for example, offering a meal or a place to nap, or giving advice. One police officer cited an incident where he bought clothing for a child who came in naked and in need of a bath.  There was no significant difference by agency or role or between comparison and target region actors.

In terms of training on trauma-informed approaches, 42% (n=53) stated that they had participated in some type of training, including 16 from target regions (48%, n=33), and six from comparison regions (30%, n=20).  In the target regions, this included four from the district level (MELR, GPS and 2 DSW), six from the regional level (DSW, State Prosecutor, ATHU, JUPOL, and two from a public shelter), three from the national level (ATHU, DSW, GIS), and three IP/NGOs.  In the comparison region, two respondents (GPS, DSW) at the district level received training, and four at the regional level (ATHU, State Prosecutor, and 2 from DSW). At the time of the baseline assessment, police were not receiving training on trauma informed approached.[45]

Many of the respondents were not sure who had conducted training. Some mentioned IOM, while others mentioned a variety of organizations (Save the Children, UNICEF, ILO, Ghana Labor Department, and others) and/or had participated in training before the start of the CPC.  All mentioned that training on trauma-informed approaches was typically a part of a broader training on human trafficking or on other topics, such as child-friendly policing.

According to IOM, over 500 government actors participated in training that included chapters from the SOPs, with sections covering child-friendly and victim-centered approaches, psychological support and mental health, PTSD and the impact of trauma on victims, and managing victims during the process of prosecution.

Virtually all respondents who reported they received training (22, n=53) said that it helped them understand how to cope with victims who experienced trauma. They gave examples that indicated that they have some understanding of the impact of trauma on children and youth. They mentioned symptoms of trauma in children that included depression, anger, acting out, mistrust, and inability or unwillingness to connect to others. Three in target regions noted that levels of trauma were typically more severe for victims of sex trafficking, and that they felt less confident in knowing how to work with such victims.  Only six, all from target regions, stated that they had utilized the training. The others had not been able to put the training to use, largely because they had not been involved in a case of child trafficking (see Table 25, below).

**Treatment of Survivors**

The ET asked questions to gauge perceptions about how victims are treated by other stakeholders and to rank their impressions on a 1-to-5 scale, about such treatment (1=consistently poor, 2=mostly poor, 3=mixed, 4=mostly well, and 5=consistently well).  Forty-five respondents offered a rank for some or all of the six categories of stakeholders (social workers, police, prosecutors and judges, immigration officers, communities, and parents). The average rank was notably the lowest for parents, at 2.7, with communities following closely behind at 2.9, both ranking just below “mixed.” All other stakeholders were ranked on average between 3 and 3.9, ranking just above “mixed.” Fluctuations in the rankings for parents and communities were also the most pronounced, ranging from consistently poor (1) to consistently well (5). The average rank was highest for immigration officials. There was no obvious correlation between the type of respondent and the ranking (i.e. respondents did not necessarily rank their own agency higher than others ranked them). Respondents in target regions gave higher rankings across all categories than respondents in comparison regions.

##### Identification and Rescue

As a part of the evaluation protocol, respondents were asked if they were involved in identification of potential victims and rescue (removal of a victim from an exploitative situation) during the period between October 2015 and December 2017.  If they affirmed that they were involved in either, a series of additional questions followed to probe into the details, methods and procedures utilized. Out of a total of 62 respondents, 18 said that they had been involved in identification and / or rescue of a trafficking victim, including 13 (30%, n=43) respondents in target regions and 5 (26%, n=19) in comparison regions.  Agencies involved were DSW (7), GPS (7), GIS (2), and IP/NGOs (2). The majority of respondents (71%, n=62) stated that they were not involved in rescues. This is partly due to the respective roles of respondents; however, many said they would take part in identification or rescue, but had not encountered a suspected case of child trafficking (see Table 25). Others, especially labor officers, said they lacked resources and transportation to make site visits needed to identify potential victims outside of locations close to their offices.  The baseline assessment also found resource issues to be a constraint to conducting rescues.[46] Vehicles provide through the CPC to AHTUs in target regions has partially addressed this issue at midline, though resources for fuel and other transportation expenses remain. The table below summarizes responses related to involvement in identification and rescue between October 2015 and December 2017.