One-stop centres (OSC)

• In recent years, the ‘one stop centre’ (OSC) model for attending to survivors of violence against women and girls has garnered attention in development settings as an exemplary approach to facilitating comprehensive and ethical care for survivors.  Not surprisingly, the humanitarian community’s interest in OSCs also appears to have accelerated as a method for scaling up quality services during post-conflict reconstruction and recovery. While there are many positive benefits for survivors, one-stop centres may not always be the most feasible method for providing such services, especially in low prevalence or low population density areas. 
• During the emergency phase of conflict, it is expected that a minimum initial service package (MISP) be available to survivors. Once the emergency has abated, programmers can begin to consider more comprehensive and sustainable approaches to coordinated care for survivors such as through the establishment of OSCs.
• To determine whether an OSC is the right option for improving survivor services in a particular conflict or post-conflict humanitarian setting, it is important to know what the term refers to (and thus what OSC programming entails), as well as what some of the other approaches are for responding to the needs of survivors. Any decisions regarding the appropriateness of different types of interventions will also be informed by local needs, financial and other resources, and human resource capacities.
• In general, coordinated care models (such as the OSC) seek to optimize a multi-sectoral approach and ensure consistency in the application of core guiding principles in all service delivery efforts.  Coordinated care can refer to survivor services that link sectoral responses within stand-alone programs (where health, psychosocial, police and legal assistance are available in one location), or that link sectoral responses through standardized referral pathways across programs (where health care providers, for example, provide a full array of response services within a health setting and then refer the survivor elsewhere for police and legal assistance).
• Although the OSC model has received a significant amount of attention from programmers and donors in various development and humanitarian settings, the term is often used differently across settings to describe different types of multi-disciplinary responses.  In order to provide some clarity around terminology as well as around different levels of services, the list below attempts to outline some of the coordinated care approaches (including OSCs) that have emerged globally in the last twenty to thirty years.

These summaries are taken from: Daly, K. and Bouhours, B. 2011. Appendix: Inventory of Responses to sexual violence, in “Conventional and Innovative Justice Responses to Sexual Violence.” Australia Institute of Family Studies.

• The term ‘one-stop’ as it is applied in many development contexts is often a misnomer if ‘one-stop’ is taken to mean a single setting where the full complement of multi-sectoral responses can be accessed by a survivor. Unlike the SART and SARC approaches where police and legal aid workers are a standard part of the on-site response team, many comprehensive care models in development and post-conflict contexts focus on medical care and referral, with some providing additional on-site psychosocial care and/or legal advice. In the absence of on-site police personnel, some OSCs may be creatively linked to police (i.e. next door to police precincts or have police officers on call through cell phones).

• Even though these models are often referred to as ‘one-stops’ they may more accurately reflect an integrated approach (for more information, see Commonwealth Secretariat, 2003). Integration refers to targeting various types of existing health providers (e.g. emergency rooms, clinics, sexual and reproductive health services, etc.) and determining how violence-related services can be incorporated to ensure that survivors presenting for care receive the necessary assistance related to their exposure to violence as quickly as possible.  Three basic models of integration include:

Adapted from Colombini, C., Mayhew, S. and Watts, C. 2008. “Health-sector Responses to Intimate Partner Violence in Low- and Middle-income Settings: A Review of Current Models, Challenges and Opportunities.” Bulletin of the World Health Organization 86 (8): 635-642.

• Integrated approaches to medical (and psychosocial) care and referral may be a more realistic alternative to initiating coordinated care in humanitarian settings than the resource-intensive SART/SARC-type approaches used in Western contexts that require a corps of specialized staff operating in a dedicated structure. 

• Integrated approaches can offer an improved standard of treatment but are not as expensive, and they do not rely as heavily on the capacities of the police and legal/justice systems in order to function effectively.  Services initiated within the health sector may also attract more survivors than forensic-based services (i.e. where medical examiners are linked to the police and/or situated in criminal justice offices), especially in settings where engaging the criminal justice sector is highly stigmatizing or presents security risks (such as when police investigations are undertaken without the consent the survivor and impunity for perpetrators is the norm; or where the security sector is responsible for the abuse).

• Still, these programs do require the commitment of administrators in order to be effective, as well as training and support for all staff working within the particular health setting, and the establishment of strong linkages with other sectors, especially the police.  In post-confict settings, where infrastructure is often even more limited than in development settings, programmers must anticipate the considerable outlay of resources that will be required to introduce integrated models of health care.

• When considering the most appropriate methods for coordinated care for survivors in a given setting, it is important to take into account the human, financial, and other resources that are available, and weigh them against strategies that allow for greatest access to safe and ethical services for survivors.  No matter how exemplary, a single one-stop center based in a metropolitan area is bound not to produce significant benefits across a population because the vast majority of survivors living outside the urban center will not be able to access that service.

• Programming experience in multiple settings suggests the following basicactions are critical to establishing and maintaining effective services for survivors:

1. Identify the service-delivery needs of the target population (establish the nature of violence and related help-seeking behavior and conduct a service mapping). 
2. Understand the obstacles to coordinated care (assess facilities and personnel within and across key sectors and calculate costs of existing and /or proposed programming).
3. Create institutional buy-in of key stakeholders (from national level policy-makers to institutional administrators and service providers).
4. Ensure supportive national and facility-level policy frameworks to enable integration and cross-sectoral linkages (with costing analysis and funding strategies included).
5. Ensure facility infrastructure can support integration and cross-sectoral linkages in a sustainable manner (i.e. proper space for services and transport to other services where necessary).
6. Define roles of service providers through inter-and intra-sectoral standard operating procedures.
7. Ensure on-going coordination within facilities and across sectors through active coordination networks.
8. Ensure on-going capacity development of service providers.
9. Build safe and ethical data collection and monitoring systems (adapted from Askew and Kim, unpublished).

• The integration of these models by local governments into their systems can be the most challenging part of this process even in stable environments. As such it is important to include programming strategies that will build sustainable capacity and infrastructure of key sectors at the national and local levels. Many settings seeking to scale up services have benefited from engaging with other countries/partners where lessons have already been generated about the challenges of implementing coordinated care approaches.