Table 2 Facilitators of survivor service provision

Individual-Level Facilitators

Supporting Quotes

Integrate religious/spiritual beliefs around mental illness and traditional healing practices (e.g., holy water) into professional care delivery

• “They go to holy water place, and these traditional healers. And they say, at least some of them actually benefit from these interventions. These days there are some initiative to integrate the two approaches. Working together with the holy water people and the traditional healers.”

Send text messages for patient tracking and retention in care; the trafficking population is highly mobile and difficult to retain in treatment, similar to the HIV population

• “Some kind of retention mechanism; retention in care, in mental health care. One thing I suspect will be common from my experience working in the HIV care setting is that starting people on a given treatment, whatever that treatment may be, is not very difficult. Keeping them in that care is difficult. Given the fact that victims of human trafficking may be highly mobile, we have to make sure we create a way whereby they get care in the place wherever they go. Some kind of mechanism to find them would be SMS, or some kind of mechanism to track them.”

Create opportunities for peer connections first, before offering professional services; shame and feeling alone can be barriers to help seeking and peers who have had shared experiences can help survivors be more receptive to services.

• “Peer support, just to give them the opportunity to openly speak about their problems and so on, that’s a first support. Then after that they need another support, sustainable support.”

• “Peer support is very important and one of the problems that potential migrants raise and even returnees raise. These abuses create a feeling of shame and they don’t clearly articulate what has happened to them. As a result, you know, potential migrants will not learn from them. “

• “The peer model, I’m sure it would work because these are young people and most of the people I see have nowhere to turn to and to talk to. They have nobody to talk to.”

Establish safe houses.

• “There has to be safe houses and there has to be rehabilitation center where they can get immediate health service and a follow up for business engagement or enterprise. Whatever they want to do. But the problem is that we don’t have such centers.”

Offer narrative therapy.

• “When you deal with this narrative exposure therapy, you give them the opportunity to write their narratives and they would have a written statement at the end of the therapy. It’s something that is dramatic and it gives you closure.”

System-Level Facilitators

Supporting Quotes

Ensure that interventions are a community effort; involve educators, academics, and policymakers in rehabilitation/reintegration efforts

• “The issue will not be left for only mental health professionals. The community should have to participate. The policymakers should have to be there. We who are teaching at university level should have to be there. The healthcare providers should have to be there. There should be an inter-collaboration.”

• “If we want to implement something else here unless it is aligned with the government policy and there is a favorable policy here, you can’t do anything else even though we came up with the huge amount of money.”

• “There should be a concerted effort. It should not be piecemeal. It should be concerted and sustainable.”

Strategize about most likely “entry points” into service systems; identify where are survivors most likely to interface with professionals and offer services there (e.g., airports, healthcare, community health workers)

• “When we were talking about entry points, are legal services really an ideal entry point? Going to the legal services may not be the first thing that comes to mind or, they don’t want to go public with that. It’s a kind of shame, so they just keep it there. The health services I would say could be you know, a first entry point.”

• “The area that you want to work from is the airport. The people that in that institution may expose human trafficking.”

• “If these health extension workers are getting adequate training about trafficking including sex trafficking, we can deliver enough information or we can distribute enough information about the awareness of trafficking for the wider community.”

Locate survivor services health, legal, economic, and social services at one center; use “one-stop shopping”

• “The one-stop shopping idea is something you have to very seriously consider. If there is a scheduled service delivery to victims of human trafficking, you can have the legal advisors come to the clinic or the healthcare providers go to the place where legal advice is provided. But you have to make that available at one stop so that one stop shopping can be entertained.”

Activate local community support structures; Ethiopia has a rich “social healing system,” described as including the following entities:

• Kebele: A small, localized administrative unit; a neighborhood or ward;

• Mahiber (mahibere): Amharic for ‘association;’ a cultural development association;

• Iquib (iqub,equb): A sustainable rotating funds association established by a small group of people in a community; and

• Idir: A burial society association established in small communities to raise money during emergencies, particularly after a death in a community.

• “There are these associations in every village. Everyone would be involved in idirs. It is voluntary, but usually everybody is involved. And the responsibility of these idirs is to take care of you in your time of need. These things, idirs, have been with us for, I don’t know, maybe for hundreds of years. These are very deep-rooted, very good resources to think about.”

• “The most resource that we have is the social ties that we have. It’s not like the western type, that is more individual. Nowadays due to globalization and due to fast urbanization, that type of thinking is coming but as a culture we have society norms that support each other, even though we are poor and even though we don’t have the money. We need to capitalize that. We need to use that as a good resource.”

• “The local government together with community-based association; there are lot of community based associations … .so people support each other during hard times. During weddings, funerals, and during economic bankruptcy or some problems, they support each other. There are self-help organizations at the community level. If these returnees are honest enough or they clearly express their needs to the local community, even though their parents are poor, destitute, some better off members of their community can support”

• “The social healing system … that is part of social medicine.”

• “One of the strengths we have, one of the cultural strengths we have is the social relationships, social interactions. Social support.”