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Ensure protocols/guidelines are in place to support standardized implementation of national and sub-national policies

  • In general, protocols and guidelines establish what services should be provided, by whom, how, and the mechanism for monitoring them (Velzeboer, 2003). They standardize quality of care and provide clear procedures for staff to more confidently and effectively address violence against women and girls in accordance with their obligations.  Protocols are an important step in institutionalizing violence programmes and raising awareness among personnel (Velzeboer, 2003).
  • As for any specialty in medicine, protocols are needed to standardize survivor care based on evidence. Having norms and protocols in place also provides tools for monitoring quality of care (Ellsberg and Arcas, 2001).
  • Protocols and guidelines are generally created as reference tools for service providers to assist them in providing specific types of care to survivors.  They can be developed at the national, sub-national, and institutional levels.
  • It may be helpful to have a “Standards Committee”, which could be established by the national health ministry or health department, that is responsible for setting standards, developing standardized protocols and guidelines, and monitoring the extent and quality of training and protocol and guidelines implementation (Jewkes, 2006).
  • Sexual assault responses require additional standards with respect to bodily integrity and dignity, including in medical and forensic procedures, as well as specific mental health needs (Council of Europe, 2008a).  See examples in the table below.
  • Protocols must also address the needs of different demographic populations of survivors.   For example, statistics show in many countries a considerable percentage of rapes occur to children under the age of 14 (Kim et al., 2007a; Chang, 2004; Peterson, 2005). Adolescent girls may need different programmes than adult women or women who attend antenatal care.  Paediatric programmes often only address child abuse.  Disabled women and girls and older women may also need to know they can access specialized services (Beaulaurier, 2007). (See section on special considerations when working with specific populations for more information.)
  • Drafting health sector policies on violence is only the first step in a longer process.  The policies must be disseminated as widely as possible, through training to health workers, as well as through community education to the society at large.   Raising awareness of the health policies is an important way of promoting accountability of the health sector (Ellsberg and Arcas, 2001).  One useful method for professional dissemination is to create a process for accreditation, licensure and certification on violence against women and girls for health professionals.

 

 

FOCUS

EXAMPLES of NATIONAL GUIDELINES

Medical Management of Rape

Global: Guidelines for Medico-Legal Care for Victims of Sexual Violence (WHO, 2004).

 

Brazil:  Prevencao e Tratamento Dos Agravos Resultantes da Violencia Sexual Contra Mulheres E Adolescentes: Normas Técnicas (Ministry of Health, 2005).  

 

Chile:  Normas y Guia Clinica para la Atencion en Servicios de Urgencia de Personas Victimas de Violencia Sexual (Ministry of Health, 2004).

 

Colombia: Protocolo para el abordaje integral de la violencia sexual desde el Sector Salud (Convenio Secretaría Distrital de Salud, 2008)

 

Costa Rica: Protocolo de Atencion a Victimas de Violencia Sexual y/o Domestica en el Departamento de Ciencias Forenses  and Protocolo para la Atención de la Violencia Sexual y/o Doméstica en  el Departamento de Departamento de Medicina Legal (Ministerio Público de la República de Costa Rica, 2008)

 

Kenya: National Guidelines: Medical Management of Rape/Sexual Violence (Ministry of Health and Liverpool VCT, 2004).  

United States:  A National Protocol for Sexual Assault Medical Forensic Examinations (US Department of Justice, 2004).

 

Responding to Domestic Violence

Albania: The Albania Health Protocol on Domestic Violence (USAID, 2006).

 

Costa Rica: Protocolo de Atencion a Victimas Mayores o Menores de Edad de Delitos Relacionados con la Violencia Doméstica Cometidos por Personas Mayores de Edad (Ministerio Público de la República de Costa Rica, 2008) 

 

Guatemala: Protocolo de Atención a víctimas de Violencia Intrafamiliar (Ministerio de Salud Pública y Asistencia Social de Guatemala Programa Nacional de Salud Mental, 2008)

 

United Kingdom:  Responding to Domestic Violence:  A Handbook for Health Professionals (Department of Health, 2005). Available in English.

United States:  The National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings (Family Violence Prevention Fund, 2002, updated 2004).

Abortion

Global: "Safe Abortion: Technical and Policy Guidance for Health Systems" (WHO, 2003).

 

Global: La Atención del Aborto Centrada en la Mujer: Manual del Capacitador (Ipas, 2006)

Post-exposure Prophylaxis

Global: Post-exposure Prophylaxis to Prevent HIV Infection: Joint WHO/ILO Guidelines on Post-exposure Prophylaxis (PEP) to Prevent HIV Infection (WHO and ILO, 2007).  Available in English and French.

 

South Africa:  South Africa Treatment Guidelines for the use of AZT (Zidovudine) for the Prevention of HIV Transmission to Children who have been Sexually Abused

 

Screening

Global: Improving Screening of Women for Violence: Basic Guidelines for Healthcare Providers (Stevens, 2005)

 

Dominican Republic: Detección y Atención de la Violencia Basada en Género: Protocolo (Profamilia, 2006)

 

South Africa: Screening for Domestic Violence:  A Policy and Management Framework for the Health Sector (Martin and Jacobs, 2003)

 

During Pregnancy (Global): What Works: A Policy and Program Guide to the Evidence on Family Planning, Safe Motherhood, and STI/HIV/AIDS Interventions (Policy Project, 2003). See pages 160-161. 

Children and Adolescents

Australia:  Guidelines on the Management of Sexual Health Issues in Children and Young People (Department of Health and Families, Northern Territory Government, 2010)

Costa Rica: Protocolo de Atención legal a Víctimas de Delitos Sexuales y Violencia Doméstica Cometidos por Personas Menores de Edad (Ministerio Público de la República de Costa Rica, 2008)

South Africa:  The Integrated Case Management Guidelines: Child Abuse (for under 14) (Cape Metropolitan Council, Cape Town City Council, 2003)   

United States: Child Sexual Abuse: Intervention and Treatment Issues (Faller, 1993).

 

 See all of the tools available for the health sector.