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Develop policies, written protocols and strategies to support integration of services throughout facility

  • While each facility will want to draft its own policies and protocols for care according to the nature and scope of service, these polices and protocols should wherever possible be based on policies and protocols that exist at the national and sub-national levels, in order to ensure that health providers across a variety of agencies and institutions are working according the same general principles and guidelines that promote women’s safety, health and well-being.
  • When drafting policies and protocols, facilities should bear in mind several lessons learned about good practice:
  • Involve sensitized and trained staff in the development of policies and protocols in order to improve quality and effectiveness of services.
  • Distribute policies and protocols to all staff members, not just those providing direct services, and whenever useful, post summaries of policies and protocols (e.g. those on confidentiality) in the clinic to educate clients about standards and procedures for care.
  • Be sure to monitor the implementation and usefulness of policies over time through periodic staff feedback, review of client records, etc., in order to determine when and how policies and protocols may need to be revised  (Bott et al., 2004).
  • Every facility will need to determine the various policies and protocols that should be developed for that particular setting, but in general all facilities should address the following:

 

Type of Policy or Protocol

Why this type of policy or protocol is important and what it needs to contain

Examples

Sexual Harassment

Every health care organization should have a written policy that prohibits sexual harassment by staff members against other staff members and against clients. The policy should state what types of actions are prohibited and should include a clear definition of sexual harassment, the procedures for reporting a case of sexual harassment, and the consequences of violating the policy. Health care organizations cannot adequately address the issue of gender-based violence if they cannot ensure respect for the rights of their own staff members and clients. A sexual harassment policy that has a clear procedure for handling violations is therefore an essential part of this effort.

See the Office of the Special Advisor on Gender Issues and the Advancement of Women for examples of sexual harassment policies of UN agencies.   

 

See an overview of sexual harassment procedures and policies in medicine in the US.

 

Client privacy and confidentiality

Every health care organization should have written policies that explain how staff should protect client privacy and confidentiality. These policies should address issues such as where in the clinic and under what circumstances staff members are allowed to discuss information about clients with other staff or with clients themselves. The policies should address the circumstances under which providers are allowed to share information about clients with other people, including family members. The policy should also address the confidentiality of medical records and should explain whether or not providers are required to get parental consent for certain services, and whether or not adolescents can keep their personal and medical information confidential from their parents.

See Ensuring Privacy and Confidentiality in Reproductive Health Services: A Training Module and Guide for Service Providers (2003), PATH and Global Health Council.

 

Treating cases of violence against women, including sexual abuse and rape

Ideally, health care organizations should develop protocols for caring for women who experience gender-based violence, including rape. These protocols can help providers know how to respond to a woman’s disclosure of violence in a caring and supportive way, that preserves her human and legal rights. In cases of sexual violence, for example, the protocol should include guidelines about the provision of emergency contraception and testing for sexually transmitted infections. Such protocols may increase the chances that women will receive adequate treatment, especially when health care professionals have misconceptions about issues such as sexual abuse, emergency contraception and STIs/HIV.

 

See Minimal Elements of a Domestic Violence Protocol & Implementation of a Domestic Violence Protocol from the Family Violence Prevention Fund.

See the model protocol to guide medical and sexual assault history taking, forensic and general examination, and lab exams, which includes six forms from the Sexual Assault Nurse Examiner Programme in the United States.

 

See the Diagnostic and Treatment Guidelines from the American Medical Association for Domestic Violence.

Handling situations of risk and crisis

Health care organizations that want to strengthen their response to the issue of violence against women should develop protocols for caring for women who are in situations of crisis or high risk. This includes clients who appear to be at high risk of suicide, homicide, injury or extreme emotional distress. A protocol for situations of risk and crisis should include a discussion of how to identify risk factors, how to ensure that women get at least the basic assistance that they need, and who among the staff can provide emotional counseling and safety planning.

 

Model Protocol On Safety Planning for Domestic Violence Victims with Disabilities From the Washington State Coalition against Domestic Violence.

 

See the Employee Domestic Violence Policy and Procedure: Guidelines for Increasing Safety and Providing Support from the Family Violence Prevention Fund.

 

Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings from the Centers for Disease Control.

 

SASA! Health Care Provider Training Manual See the safety planning section on p. 33.

Adapted from Bott, S., Guedes, A., Guezmes, A. and Claramunt, C., 2004. Improving the Health Sector Response to Gender-Based Violence: A Resource Manual for Health Care Professionals. NY, NY: International Planned Parenthood Federation: Western Hemisphere Region, p.86. Available in English and Spanish.

 

 Example: Though there is a limited evidence-base to draw upon, one study in South Africa found that practitioners who offered better quality care (such as: HIV testing and counseling; sexually transmitted infection treatment; forensic testing; referrals for counseling; and abortion counseling) were more likely to perceive rape as a serious medical problem. These practitioners were also more likely to have previously worked in a clinic with rape treatment protocol, and generally had additional experience caring for rape survivors (Christofides et al., 2005 cited in Martin, 2007 and in Population