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Health Education Research Advance Access published online on October 1, 2009
Health Education Research, doi:10.1093/her/cyp054
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© The Author 2009. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Process evaluation of the Intervention with Microfinance for AIDS and Gender Equity (IMAGE) in rural South Africa

James Hargreaves1,2,*, Abigail Hatcher1,2, Vicki Strange3, Godfrey Phetla2, Joanna Busza1, Julia Kim1,2, Charlotte Watts1, Linda Morison1, John Porter1, Paul Pronyk1,2 and Christopher Bonell1

1 Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
2 School of Public Health, University of the Witwatersrand, PO Box 2, Acornhoek 1360, South Africa
3 Social Science Research Unit, Institute of Education, 18 Woburn Square, London WC1H 0NR, UK

Correspondence to: * J. Hargreaves. E-mail: james.hargreaves{at}lshtm.ac.uk

The Intervention with Microfinance for AIDS and Gender Equity (IMAGE) combines microfinance, gender/HIV training and community mobilization (CM) in South Africa. A trial found reduced intimate partner violence among clients but less evidence for impact on sexual behaviour among clients’ households or communities. This process evaluation examined how feasible IMAGE was to deliver and how accessible and acceptable it was to intended beneficiaries during a trial and subsequent scale-up. Data came from attendance registers, financial records, observations, structured questionnaires (378) and focus group discussions and interviews (128) with clients and staff. Gender/HIV training and CM were managed initially by an academic unit (‘linked’ model) and later by the microfinance institution (MFI) (‘parallel’ model). Microfinance and gender/HIV training were feasible to deliver and accessible and acceptable to most clients. Though participation in CM was high for some clients, others experienced barriers to collective action, a finding which may help explain lack of intervention effects among household/community members. Delivery was feasible in the short term but both models were considered unsustainable in the longer term. A linked model involving a MFI and a non-academic partner agency may be more sustainable and is being tried. Feasible models for delivering microfinance and health promotion require further investigation.

Received on September 5, 2008; accepted on August 21, 2009


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