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Adapting health sector approaches to different contexts and resource levels: from core services to comprehensive care

  • In addition to the overarching challenges presented above, developing a comprehensive model for health sector response is difficult in many settings where there is a shortage of health providers, facilities, equipment, and supplies, especially at the primary care level. Even in these settings, and without overloading community health volunteers and health workers who are addressing multiple issues, some basic interventions are still possible to enable the health sector to support women and girls affected by violence.

 

  • When developing policies and interventions to address violence against women and girls, the health sector should realistically consider resources and other challenges (such as those identified above), and develop a standard for minimum response that makes every effort to meet those challenges with the resources available.  As resources improve, countries should aim to provide an increasingly comprehensive package of care. 

 

  • In addition to the services that are provider within a particular facility, all facilities should know and link with other referral sources in their communities, and be able to provide referrals as necessary to survivors.

 

  • The following has been proposed as a model for considering what to prioritize according to resource availability in different settings around the world when responding to sexual violence.  However, it should be noted that the model described below should not encourage middle- and low-income countries to provide less than comprehensive services—the goal in all settings is to work towards the delivery of comprehensive care to survivors.

  

 

 

Services for Sexual Assault Survivors

 

Health Services Provided

Features of Service or Facility Management

Training

Core Services  for Sexual Assault                 (for all settings)

1.    Post-sexual assault pregnancy prevention and accessible, safe termination of pregnancy services [where legal]

2.    Treatment of sexually transmitted infections

3.    Treatment of genital or other injuries

4.    A report of the genital examination, where required, for legal purposes

5.    Basic information on treatments to victims/ survivors

1.    All facilities have clinical management guidelines and the country’s sexual assault policy

2.    All facilities have a fully enclosed room for providing care to victim/survivors in privacy

3.    Service providers have an understanding of the need to provide care in a manner that is confidential, sympathetic and non-judgmental and provides victim/survivors with information about their treatment, law on rape and how to access police and legal services.

4.    Services are provided at no cost to the victim/survivor 

1.    All institutions training doctors and nurses include a module on understanding of gender-based violence, including sexual violence, the clinical management guidelines and policy as part of their basic curriculum

Mid-level Services

for low to middle income countries

(in addition to the core):

1.    Prophylaxis against HIV infection where relevant for the country/[local] risk level

2.    A thorough examination of the victim/survivor, with  documentation of findings and  collection of specimens for DNA testing according to a standard policy and evidence kit

3.    Written or pictorial information to victims/survivors on treatment, rape and the law and accessing counselling and support

1.    Health service providers providing care for victim/survivors identified for most of the country

2.    Health facilities have policies that ensure care is provided sensitively, including having private waiting areas

3.    Health services are co-ordinated, managed and staff trained and supervised by an identified senior clinician

4.    Inter-sectoral collaboration is established at a facility level

5.    Forensic laboratories are available to support analysis of specimens collected

 

1.    Identified health service providers are given in-service training to update their clinical management and understanding of the needs of victim/survivors

 

Comprehensive Services

for middle and high income countries

(in addition to the core and mid-level):

1.    Comprehensive health services as outlined in the WHO’s Guidelines for medico-legal care for victims of sexual violence (2003).

 

1.    All services are provided by designated health service providers who are highly motivated, trained and continuously updated through on-going training

2.    All services are provided in facilities which are equipped to be conducive to sexual assault examinations

3.    People reporting sexual assault are transported to these facilities by the health service or the police (if they have been involved)

4.    All people are offered sexual assault care without having to report cases to the police

5.    Good inter-sectoral links with the preparation of victims for court testimony and advocates who are available to partner and support  victim/survivors after sexual assault

 

 

Source: Jewkes, R., 2006. Paper for Policy Guidance: Strengthening the Health sector Response to Sexual Violence (Unpublished).