Presented at the 2014 American Evaluation Association Conference.

1. Trafficking and Health: A
Compendium of M&E
Indicators
American Evaluation Association
October 18, 2014
Abby C. Cannon
Shelah S. Bloom

2. UN Protocol to Prevent, Suppress and Punish Trafficking in Persons,
Especially Women and Children (Palermo Protocol):
“The recruitment, transportation, transfer, harboring or receipt
of persons, by means of the threat or use of force or other
forms of coercion, of abduction, of fraud, of deception, of
the abuse of power or of a position of vulnerability or of the
giving or receiving of payments
or benefits to achieve the
consent of a person having
control over another person,
for the purpose of exploitation.”
Definition: Trafficking in Persons
Source: UN (2000). Protocol to Prevent Suppress and Punish Trafficking in Person, Especially Women
and Children, Supplementing the United Nations Convention Against Transnational Organized Crime.

3. Size of the problem
 Estimates range from 2.4 million¹ to 29.8²
million trafficking victims worldwide
BUT
 47,000 identified trafficking victims3
1. International Labour Organization. 2012. ILO Global estimate of forced labour: Results and methodology. Geneva.
Accessible at http://www.ilo.org/wcmsp5/groups/public/---ed_norm/---
declaration/documents/publication/wcms_182004.pdf
2. Walk Free Foundation. 2013. Global Slavery Index. http://www.globalslaveryindex.org/
3. US Department of State. 2013. Trafficking in Persons Report. Washington, DC. Accessible at:
http://www.state.gov/j/tip/rls/tiprpt/2013/index.htm

4. Trafficking in persons (TIP) & Health
 Dearth of research on health and trafficking
 Current research focuses on women and girls
that have been trafficked for sex
 Lacking research on:
 Other forms of trafficking (e.g. labor, child soldiers,
domestic servitude)
 Trafficking of men and boys

5.  Injuries from physical and sexual violence
 HIV exposure, poor reproductive health
outcomes
 Mental health symptoms (e.g. depression,
anxiety, suicidal ideation)
 Forced substance abuse or substance use as a
coping mechanism
 Headaches, fatigue, and weight loss
Health implications of TIP
Zimmerman C, Yun K, Shvab I, et al. The health risks and consequences of trafficking in women
and adolescents: findings from a European study. London, United Kingdom: London England
London School of Hygiene and Tropical Medicine; 2003.

6.  Limited measurement of policy or programming impact
 Limited availability of data
o Each sector provides a small and biased subset of
all cases
o Few indicators to monitor and evaluate TIP
o Lack of standardization of indicators
o Lack of consensus on key areas to measure at the
intersection of health, gender, and trafficking
Existing Gaps and Challenges

7. Collaborative Process
The consultation included leading experts in TIP
and health representing:
 USAID, US State Department, NIH
 UNICEF
 International Organization of Migration (IOM)
 International Labor Organization (ILO)
 NGOs: IRC, Free the Slaves, Geneva Global
 Leading consultants & top researchers

8. Consultation Objectives
 Day 1: Areas of measurement
 TIP and health overview in the international context
 Challenges in data collection & research
 Days 2-3: Indicators
 Attain consensus on the critical areas to TIP within
the context of gender and health
 Small group work on developing indicators
 Plenary group session to build consensus on all
indicators

9. Areas of Measurement
 Health sector response
 Post-trafficking Assistance and
Outreach Programs
 Health Status and Care Received
 Referrals
 Policy

10. Areas for further development
 Education
 Community awareness
 Migration and transnational border crossing
 Social welfare services
 Shame and stigma
 Special populations
 Refugee and humanitarian crises
 Sexual and gender minorities

11. Conceptual framework for TIP, health, and gender
Recruitment
• History of
abuse or
deprivation
• Socio-
environmental
influences
• Health
behaviors
Exploitation
• Deprived,
unsanitary
conditions
• Poor health
services access
• Poor working
and living
conditions
• Physical,
sexual, and
psychological
violence
• Restricted
movement
Integration
• Cultural
adaptation
• Shame, stigma
• Restricted
service access
• Retribution of
traffickers
Re-integration
• Social re-
adaptation
• Shame, stigma
• Restricted service
access
• Retribution of
traffickers
Travel & Transit
(if applicable)
• High risk transport
• Initiation violence
• Document
confiscation
Gender (in)equalities
Adapted from: Zimmerman C, Hossain M, Watts C. Human trafficking and health: A conceptual
model to inform policy, intervention and research. Soc Sci Med. 2011;73(2):327–335.

12. Indicators: Health Sector Response
1. Proportion of health care units that have personnel that have been
trained to identify and refer trafficked persons
2. Proportion of health care units that have personnel that have been
trained to provide trauma-informed care for trafficked persons.
3. Proportion of health units that have evidence of trafficking
awareness and response materials visibly available
4. Proportion of health units that have documented a protocol for
caring for trafficked people that includes informed consent and
stigma-free services.

13. Indicators: Post-trafficking assistance
program and outreach programs
5. Proportion of labor and occupational health inspectors who
are trained to identify and refer trafficked people within the
workplace.
6. Proportion of trafficking assistance programs that facilitate
medical and mental health care
7. Proportion of trafficking assistance programs that have and
use a comprehensive list of health providers
8. Proportion of trafficking assistance organizations that have
and use standardized medical and psychosocial needs
assessment tools

14. Indicators: Health Status and Care Received
9. Proportion of identified trafficked persons voluntarily receiving
medical and psychosocial care linked to needs identified in a needs
assessment.
10. Proportion of identified trafficked persons who received health
care voluntarily through informed consent.
11. Proportion of identified trafficked persons who received stigma-
free and non-discriminatory health services.
12. Proportion of identified trafficked persons with health
issues/conditions.

15. Referrals
13. Number of identified trafficked
persons referred to social welfare
services from the health sector.
14. Number of identified trafficked
persons referred to a health unit from
social welfare services.

16. Policy
INDICATOR 15: Existence of policies that support
and facilitate the health of trafficked persons.
Examples:
 Policy or legislation requiring that suspected and identified
trafficked people are entitled to state supported health care
that is non-discriminatory.
 Budget line (in government health budget or other
appropriate ministry budget) allocating funding for health
care services for trafficked people, foreign national or
citizen, in the country.
 Health services for trafficked people are available
voluntarily and available regardless of whether or not the
trafficked individuals participate in prosecution of their
trafficker.

17. Questions or comments?

18. MEASURE Evaluation is a MEASURE project funded by
the U.S. Agency for International Development and
implemented by the Carolina Population Center at the
University of North Carolina at Chapel Hill in partnership
with Futures Group International, ICF Macro, John Snow,
Inc., Management Sciences for Health, and Tulane
University. Views expressed in this presentation do not
necessarily reflect the views of USAID or the U.S.
Government. MEASURE Evaluation is the USAID Global
Health Bureau's primary vehicle for supporting
improvements in monitoring and evaluation in population,
health and nutrition worldwide.

19. www.measureevaluation.org