Adaptive Capacity in Practice: Integrating Peace Responsiveness into Public Health Sector Governance, Management and Administration in Guinea-Bissau. Report

This insight report examines how Peace Responsive approaches were integrated into public health sector governance, management, and administration in Guinea-Bissau between 2023 and 2025, drawing on field experiences from a project implemented by Interpeace, Voz di Paz, WHO, UNICEF, and national institutions. It explores how health-for-peace programming can contribute to stability and cooperation in politically volatile, non-bellicose settings. The report identifies key relational and procedural dynamics shaping the health governance ecosystem, including patterns of mistrust, institutional friction, and the challenges of crisis-driven engagement between the state and health sector workers. Drawing on two flagship initiatives — the Health and Peace Resilience Barometer and the Equipa Mista (Joint Team) for Health Sector Governance — it proposes a complementary fifth pathway to WHO's Health for Peace framework: stabilising governance from within. Addressing instability in such contexts requires more than formal policy reform; it calls for sustained dialogue, adaptive programme design, and the strengthening of everyday cooperation among citizens, health workers, and institutions. By centring these relational foundations, this research offers practitioners and policymakers a model for advancing durable, peace-responsive health governance amid ongoing political uncertainty.

Seeding Peace Within: Lessons From Psychoeducation in Burundi

 When the guns fall silent, trauma begins. It lingers in bodies and minds, shaping daily interactions and the way communities relate to one another. In Burundi, decades of violence and instability have left behind invisible wounds that undermine trust, cooperation, and the collective ability to move forward. These unhealed scars not only harm individual well-being but also threaten the nation’s broader aspirations for peace, reconciliation, and development. Addressing trauma is therefore not a peripheral concern—it is a cornerstone of building a stable, inclusive, and resilient society.

The Synergies for Peace III programme (September 2022 – March 2025), coordinated by Interpeace and implemented in partnership with five Burundian civil society organisations—CENAP, BLTP, ICB, Jimbere/ASSEMAJI, and AJEBUDI-Yaga—was funded by the Swiss Agency for Development and Cooperation (SDC) from 2022-2023 and the Embassy of the Kingdom of the Netherlands (EKN) (2022-2025). Over its three years, the programme worked to advance reconciliation and promote more accountable and inclusive governance that responds to local and national priorities for peacebuilding. Its approach combined trauma healing, inclusive governance, and the empowerment of women and youth, while fostering collaboration between citizens and institutions.

Within this broader framework, the psychoeducation campaign had a specific and ambitious goal: to break the taboos surrounding trauma, normalize conversations about healing, and build momentum for both community-based psychosocial support and national-level policy advocacy. Between 2023 and 2025, the campaign reached more than 2.4 million people across the country through radio, theatre, storytelling, social media, and community events. It created spaces for individuals to reflect on their experiences, learn about trauma and resilience, and begin conversations about healing. Psychoeducation became both a mirror and a bridge: a mirror reflecting the hidden pain many carry, and a bridge linking individuals, communities, and decision-makers in a shared pursuit of recovery and reconciliation.

This report presents the lessons learned from the campaign. It highlights successes, challenges, and pathways for strengthening future psychoeducation interventions. Above all, it underscores that healing trauma is not only about reducing suffering—it is about restoring dignity, rebuilding relationships, and enabling communities to unlock their potential for peace and sustainable development.

From Fear to Forgiveness: How Sociotherapy Is Healing Wounds in Ngoma

In Ngoma District, East Province of Rwanda, stories once defined by pain and mistrust are being rewritten through courage, dialogue, and reconciliation. Two neighbours: Aloys Hakizimana, a genocide perpetrator, and Alphonsine Mugerintoki, a survivor, once lived in silent hostility, their lives divided by trauma and fear. Today, they share laughter, family milestones, and a renewed sense of peace.

A Life Haunted by Fear and Regret

After the 1994 Genocide against the Tutsi, Aloys fled to Tanzania to escape accountability for the crimes he had committed. When he returned to Rwanda, he avoided his home district of Ngoma and hid in Musanze, disguising himself as a 19-year-old to evade justice, though he was 33.

“I was afraid to meet those I wronged and my neighbours. I felt ashamed of the atrocities I committed,” he recalls. “To conceal my identity and age, I constantly wore shorts and shaved, hoping to appear much younger,” he said.

Even after he was eventually arrested and imprisoned, peace continued to elude him. “Even in prison, I could not sleep. I was constantly depressed and fearful, and sometimes I could hear the voices of those killed during the genocide.”

After confessing his crimes, the Gacaca court granted Aloys a reduced sentence of 11 years in prison.

After confessing his crimes, the Gacaca court granted Aloys a reduced sentence of 11 years in prison. After release, the burden of guilt grew heavier, until he joined an Adult Sociotherapy Group created in Ngoma.

A psychosocial support intervention, Sociotherapy is part of the Societal Healing Programme implemented by Interpeace, Prison Fellowship Rwanda, Haguruka, and Dignity in Detention with support from the Government of Sweden. It brings together genocide survivors, perpetrators, and their descendants to promote truth-telling, rebuild trust, and foster collective healing, reconciliation, and resilience.

“Whenever I was about to meet a genocide survivor, I would pretend to be on a phone call just to avoid them. I couldn’t bring myself to attend social gatherings for fear of facing them. I lived like that for years,” he admits.

When Healing Becomes Shared

For Aloys, the Sociotherapy group sessions became a turning point. At first, he sat quietly, listening more than speaking. But as others shared their pain and longing for honesty, the truth he had buried for years began to surface.

“The Sociotherapy came at the right time. I felt relieved after sharing my experience with everyone in the group. Today, I feel at ease with everyone in our community and no longer live in fear,” he says.

Through the process, Aloys discovered a new kind of strength: the strength to repair. He reached out to those he once feared, including Alphonsine, a woman who had lost everything and had attended Sociotherapy sessions alongside him.

Divided by unimaginable suffering, they found the courage to meet again; not as enemies, but as neighbours bound by a shared desire for peace.

“I was healed thanks to Sociotherapy. I was able to forgive Aloys. We now live well together,” says Alphonsine. “We invite each other to family events, such as weddings. He was even the first to contribute to the weddings of two of my children,” she adds.

For many survivors, one of the deepest wounds remains uncertainty over where their loved ones were buried. For Alphonsine, this burden was heavy. Years of anger and alienation took a toll.

“I was traumatised because people who committed genocide would gaslight me and call me crazy when I confronted them and asked them to at least tell me where they buried my loved ones,” she remembers. Her distrust led to heavy drinking, fights, and self-neglect.

The dialogues in the Sociotherapy sessions eventually yielded clues about bodies possibly dumped in a nearby lake. But details were scarce, making proper identification difficult. Recognising his responsibility, Aloys joined Alphonsine in encouraging perpetrators and neighbours to speak the truth. Their persistence led to the discovery of eleven bodies of genocide victims, finally laid to rest with dignity.

Their journey inspired others, like Monique, who was only 15 during the genocide. Among the eleven bodies found were her family members. Through Sociotherapy, she found the strength to forgive and advocate for truth. “If it wasn’t for Sociotherapy, we would not have found the bodies of our loved ones,” she reflects.

Rebuilding Trust and Resilience

Sociotherapy has reached 2,039 individuals through 140 community healing groups across five districts: Musanze, Nyabihu, Ngoma, Nyagatare, and Nyamagabe.

The programme has produced measurable positive changes: a 17.2% increase in intergroup trust, a 12.5% rise in social harmony, and a 9.5% improvement in readiness to forgive, resulting in a 34.5% increase in willingness to collaborate.

The journeys of Aloys and Alphonsine, as well as those of many participants in Sociotherapy, show that reconciliation is possible, even after the deepest wounds. Survivors who were once silenced now speak with dignity. Perpetrators who once hid in fear of revenge now take responsibility. Together, they are shaping a legacy of healing and truth for future generations.

Their stories serve as a quiet model of what reconciliation can look like when psychosocial healing meets courage and accountability. It is not just about individuals finding peace, but about entire communities rebuilding trust and resilience.

From the quiet hills of Ngoma, a message echoes nationwide: true reconciliation is not about forgetting, but about courage; the courage to face the past, speak the truth, and rebuild stronger together.

From Violence to Harmony: How Multifamily Healing Spaces Are Transforming Household Conflicts

The home of Antoine Ibyimana and Marie Mediatrice Uwimana in Nyamagabe District’s Kibumbwe Sector was once filled with fear and conflict. For years, domestic violence and alcohol abuse tore their family apart.

Today, that same household radiates peace, mutual respect, and renewed hope, thanks to Multifamily Healing Spaces (MFHS), an initiative helping families rebuild trust and harmony.

A Family in Crisis

A few years ago, Ibyimana’s life was dominated by alcohol. The high school teacher spent most of his time drinking and often returned home angry and violent. His wife and children would hide in their rooms, terrified of his temper.

“When I came home drunk, my children would run away. They saw me as a monster,” he recalls with regret.

Uwimana bore the full weight of the abuse. Even during her pregnancy, she endured both physical and emotional suffering. “I was deeply traumatised by his violence. On top of beating me, he would let us starve even though he earned a monthly salary. I struggled alone to find food for my children,” she recalls softly. “I was treated like a maid in my own home. Leaving crossed my mind many times, but I stayed for the sake of my children.”

Ibyimana’s controlling behaviour went beyond violence. He made every decision alone, sold family property without consultation, and kept his salary a secret. The lack of communication eroded trust and destabilised the family.

A Turning Point Through Dialogue

Everything changed when they joined a Multifamily Healing Space established in Kibibi Cell. These healing spaces bring families (parents and their children) together through guided dialogues to help them identify harmful behaviours, rebuild relationships, and strengthen parenting skills. For Ibyimana, it was a turning point.

“I realised how deeply my actions hurt my family,” he says. “I learned to communicate, to listen, and to make decisions together with my wife.”

MFHS is a group-based psychosocial intervention designed to help families confront historical trauma, improve communication, and resolve conflicts through healing dialogues. It also addresses intergenerational trauma through parent–child discussions and promotes positive parenting.

The intervention was introduced by Interpeace and its partners —Haguruka, Prison Fellowship Rwanda, and Dignity in Detention —as part of the Societal Healing Programme, funded by the Government of Sweden (2021–2025).

The State of Family Conflict

According to the 2024 Rwanda Governance Board (RGB) Citizen Scorecard Report, family conflict ranks as the top challenge to family cohesion and development (17.4%), followed by psychological abuse (13.9%).

The report identifies alcohol abuse (82.8%), poor communication (82.6%), and poor parenting (68.4%) as key drivers of family dysfunction.

A 2023 evaluation of MFHS found the intervention effective in resolving intrafamily conflicts, improving communication and problem-solving skills, and strengthening family cohesion and resilience. It combines locally developed methods with international best practices, tailored to the Rwandan context.

Healing the Family Bond

In the safe space of group discussions, Uwimana finally found her voice. Sharing her experiences with other families facing similar struggles gave her strength and perspective.

“The group helped me release years of pain. I felt supported for the first time,” she says.

Family-only sessions allowed Ibyimana and his wife to address their problems constructively. Both parents learned positive parenting techniques and conflict management skills, enabling them to improve communication and build stronger bonds with their children.

Their daughter, Jessica, who had fallen from the top of her class to thirtieth position due to anxiety and distraction from constant family conflict, regained top marks after the household calmed.

“I used to think being a father meant giving orders,” says Ibyimana. “Now I share meals with my children, help with homework, and guide them with love.”

Local leaders and neighbours have witnessed the remarkable change. A family that was once on the verge of divorce now serves as a model of harmony and mutual respect for others in the community -

“When they see how calm and caring my husband has become, some joke that I must have used witchcraft to change him,” Uwimana laughs. “But what changed him was dialogue, not magic.”

Across five districts —Musanze, Nyabihu, Ngoma, Nyagatare, and Nyamagabe —2,088 individuals have participated in MFHS. But the real impact is not measured by numbers alone.

Comparative data before and after the intervention show meaningful improvements: family communication and problem-solving capacities rose by 14.6%, indicating greater collaboration and effectiveness in addressing stressful situations.

Parenting practices also improved by 34.5% (increase in warm, nurturing, and inclusive parenting behaviours), and participatory parenting increased by 13.4%, showing greater inclusion of children’s views even during disagreements.

Building a Future Together

Beyond emotional healing, the dialogues taught families to manage resources responsibly. Families have learned to plan finances together, prioritising long-term goals over wasteful spending.

“Before, almost all my salary went to alcohol,” Ibyimana admits. “Now we’ve bought a piece of land and are saving to build our own house.”

Their story is one of resilience and renewal; a reminder that family peace is built through patience, empathy, and shared responsibility.

“I regret the years I wasted destroying my family,” reflects Ibyimana, “but I’m proud of the father and husband I’ve become.”

Across Rwanda, initiatives like Multifamily Healing Spaces continue to show that strengthening family resilience is foundational because resilient families build resilient communities.

From Survival to Leadership: Joseph’s Journey of Healing and Hope

In the steep hills of Nyabihu District, western Rwanda, a man once feared by his neighbours now leads efforts to foster peace and understanding in his community.

Joseph Nshimiyimana, a father and community leader, has experienced both the darkest and brightest sides of human existence — from a life defined by violence and isolation to one marked by healing and reconciliation.

Joseph was born into extreme poverty as one of twelve surviving children of his family. Hunger and neglect defined his early years. At just 12 years old, unable to bear life at home, he ran away and began to work as a shepherd.

His family, overwhelmed by hardship, believed he had died for years. As Joseph grew older, loneliness and lack of affection took a deep toll on his mental health, fuelling anger and aggression. Known in his village as a bully, he often terrorised neighbours and peers.

“He was extremely violent and dangerous. He would beat anyone, regardless of their age, for no reason,” recalls Willy Habiyaremye, a neighbour whom Joseph attacked several times. “He even set up a roadblock at the entrance to our village just to harass people. Everyone was afraid of him.”

Alcohol and narcotic drugs, especially cannabis, became part of Joseph’s daily life — a way to silence the pain he couldn’t express. Alone and mistrustful, he preferred the company of his hunting dogs to that of other people.

“I would smoke two pellets of cannabis at once to feel relaxed and find peace of mind,” Joseph recalls. “After smoking, I felt strong and powerful, like I had control over everyone. I didn’t want anyone near me — only my dogs. They made me feel like a king surrounded by his guards.”

Eventually, Joseph married, but the cycle of pain continued. His unresolved trauma turned into domestic violence.

“We lived in fear every day,” says his wife, Godelieve Ntegejo. “He would beat me and the children, and sometimes we fled to our in-laws’ house for safety. Even small things made him furious, like someone possessed.”

A Turning Point Through Healing

Joseph’s transformation unexpectedly began when he joined a Youth Sociotherapy group in Jomba Sector, Nyabihu District. Sociotherapy is part of a broader societal healing programme led by Interpeace in partnership with Prison Fellowship Rwanda, Haguruka, and Dignity in Detention — implemented from 2022 to 2025 with support from the Government of Sweden. Sociotherapy is a community-based psychosocial support approach that provides safe spaces for individuals to share, listen, and heal together.

Through open dialogue, self-reflection, mutual support, and guided reflection, Joseph began to confront his traumatic past.

“For the first time, I understood the pain I was carrying,” he says. “The sessions on care and safety made me realise how much I had passed my suffering on to others. From that moment, I decided to change.”

Gradually, Joseph stopped using drugs and alcohol. He reached out to those he had wronged, seeking forgiveness and making amends. His violent outbursts faded, replaced by empathy and accountability. By the end of the six-month Sociotherapy stages, Joseph had become a respected voice in his community — the same community that once feared him.

“When he came to ask for my forgiveness, I thought I was dreaming,” says a neighbour we found helping Joseph with farm work. “I couldn’t believe he had become humble and kind. I forgave him, and now we are close friends.”

Community members and leaders began to trust Joseph again, recognising his commitment to peace. His exemplary behaviour earned him three leadership roles within the village committee.

At home, his family life underwent a transformation. His wife and children — once living in fear — now speak of safety and hope. To mark this new chapter, Joseph chose to legalise his marriage and celebrate it in the local ADEPER church, reconciling with his faith.

“He listens now. He helps around the house. We talk and laugh. I feel loved and cared for,” Godelieve says with a smile.

Across 140 community healing groups in five districts, over 2,000 people have begun their healing journey as part of the Societal Healing Programme that has boosted resilience by 9%, emotional well-being by 24%, and self-management by nearly 30%.

Levels of trust and forgiveness among community members have also grown, paving the way for stronger social cohesion.

The Ripple Effect of Healing

Joseph’s transformation brought renewed harmony into his household and strengthened the couple’s livelihood. Together, they bought land to grow food, a cow to provide milk for their children, and manure to enrich their soil.

Once feared and despised, Joseph is now someone others — especially young people and couples in conflict — turn to for advice and encouragement. Drawing on his own story, he helps them reflect on their behaviour and accept responsibility for their actions.

So far, he has helped five couples in his neighbourhood resolve their disputes and rebuild trust.

“Joseph’s case proves that healing is possible when people are given safe spaces to talk, reflect and reconnect,” says a local leader.

Once a threat to social harmony, Joseph is now a source of hope, a living reminder that when individuals heal, entire communities can begin to thrive.

From Darkness to Light: How a Young Mother’s Healing Journey Inspires Hope

After years of rejection and despair, a young mother named Rosine from Musanze rebuilds her life through Resilience-Oriented Therapy, a community-based psychosocial approach transforming mental health care across Rwanda.

In the misty hills of Gataraga Sector, Musanze District, Rosine walks along a narrow path, holding her little daughter’s hand. To those who meet her today, she seems calm, confident, and full of quiet strength. But just a few months ago, Rosine’s world was shadowed by depression and despair.

As a teenager, she faced challenges that would overwhelm many adults: poverty, rejection, and the crushing loneliness of being a young mother abandoned by those she needed most – her own family and neighbours.

Rosine grew up in a humble home. Her education ended abruptly in fifth grade when her family could no longer afford school fees. Like many girls in similar circumstances, she was left to navigate life without the guidance or opportunities she once hoped for.

When she became pregnant, her already fragile situation collapsed. Her mother, shocked and angry, struggled to accept it. “It really hurt me. I thought about how I struggled to feed her, and she repaid me with an unplanned pregnancy. It felt like an abomination to me,” Rosine’s mother says.

“My mother rejected me. She would openly tell me to go back to the father of my child,” Rosine recalls. “I had to buy my own food and utensils. I was abandoned—helpless and hopeless.”

Her siblings distanced themselves, and her neighbours whispered behind her back. The father of her child, who had once promised marriage, disappeared shortly after the baby was born, cutting off all support — emotional and financial. The burden of depression and isolation became unbearable.

“I wanted to kill my child and myself because I couldn’t leave her alone in that suffering,” Rosine says quietly. “I had lost the taste for life because of the verbal abuse, harassment, bullying, and financial hardships.”

A Lifeline in the Darkness

Rosine’s turning point came when she was invited to join a Resilience-Oriented Therapy (ROT) group at her local health centre - Gataraga. Facilitated by trained psychologists, these sessions provide a safe and supportive environment for individuals experiencing trauma, depression, anxiety, or even suicidal thoughts to share their stories, support one another, and rebuild their confidence.

“Through ROT, I began to accept myself and my circumstances,” she says. “I learned to manage my emotions and respond calmly when insulted. Slowly, I started to believe that my life could change.”

Resilience-Oriented Therapy is a group-based psychosocial intervention introduced in 2023 by Interpeace, in collaboration with Rwanda’s Ministry of Health through the Rwanda Biomedical Centre (RBC). The initiative aims to decentralise mental health care by bringing therapeutic support to community health centres — making help accessible to those who might otherwise never seek it.

Grounded in Rwandan cultural values of solidarity and collective healing, ROT addresses a critical gap in one-on-one therapy, which remains limited and often stigmatised. Instead of focusing only on individual treatment, the sessions encourage participants to draw strength from shared experiences and to rebuild a sense of belonging.

“ROT helps people rediscover who they are,” explains one of the psychologists who facilitates the groups. “It teaches emotional regulation, identity rebuilding, and self-management—essential skills for mental resilience.”

The Broader Picture: Healing a Nation

More than three decades after the 1994 Genocide against the Tutsi, Rwanda continues to deal with its psychological aftermath. While remarkable progress has been made in national reconciliation and socio-economic recovery, the invisible wounds remain deep.

According to the Rwanda Biomedical Centre, one in five Rwandans has faced mental health challenges — a figure that emphasises the urgent need for accessible, community-based care. However, the number of professionals available remains low compared to the scale of demand.

Since its introduction, ROT has reached 621 individuals across five districts — Musanze, Nyabihu, Nyagatare, Ngoma, and Nyamagabe — through 52 healing groups in 32 health centres and seven hospitals. Each group is facilitated by a trained psychologist who guides participants through structured dialogues and exercises to process trauma, strengthen coping mechanisms, and envision positive futures.

Interpeace’s pre- and post-intervention data revealed striking results: cases of severe mental distress dropped from 38% to 19% among participants, marking significant progress toward recovery. Beyond the numbers, however, are hundreds of human stories — each a testament to resilience, empathy, and the possibility of change.

Rebuilding Bonds and Restoring Trust

Rosine’s personal transformation rippled outward. Her renewed confidence began to shift her relationship with her mother, who once rejected her out of shame and frustration.

“As a parent, it was hard to accept, especially because she didn’t tell me early,” her mother says. “I felt humiliated. But when I saw how she was struggling to recover, I began to regain my sense of being a parent and accepted it. I have found peace. Now I treat her equally and support her again.”

Their reconciliation mended more than a family bond; it restored faith within their community. Neighbours who had once gossiped now see Rosine as a symbol of courage and hope.

“Healing doesn’t end with one person,” says a psychologist who facilitates ROT sessions at the Gataraga Health Centre. “When one person heals, their whole family begins to heal—it’s like light spreading from one home to another.”

The psychologist explains that, whenever possible, families are involved in the healing process to prevent relapse due to a lack of family support.

A New Beginning

Today, Rosine, like other participants in ROT sessions, is determined to build a better life for her child. She works casual jobs to earn income and saves money, dreaming of opening a small shop and raising livestock. Each step she takes forward is an act of defiance against the despair that once consumed her.

“I have come out of darkness,” she says with a bright smile. “Now, I am in the light.”

Her story embodies what Resilience-Oriented Therapy stands for — restoring dignity, rebuilding identity, and turning pain into purpose.

Encouraged by the approach's success, Interpeace and the Rwanda Biomedical Centre are working together to scale Resilience-Oriented Therapy across all health centres and hospitals in the country. The goal is to make psychosocial support as routine and accessible as physical health services.

“By addressing mental well-being at the community level, we are not only healing individuals but strengthening Rwanda’s social fabric,” says Frank Kayitare, Interpeace Country Representative in Rwanda. “Every story like Rosine’s shows that resilience is not just a personal journey, it’s a collective transformation.”

Rosine’s journey from darkness to light is more than a personal triumph. It reflects a nation’s ongoing effort to prioritise mental health, rebuild trust, and foster compassion to achieve sustainable peace and development that the country aspires to.

As Rwanda continues its journey toward becoming a middle-income country by 2035, stories like Rosine’s remind us that progress is not measured only in infrastructure or the economy, but also in the emotional resilience of its people. Through initiatives like Resilience-Oriented Therapy, hope is being restored — one story, one family, one community at a time.