Standards for Health Service Delivery

In order to put all of these principles into action, it is critical that policy makers, health care administrators, and health care workers understand how these principles overlap, as well as how they actually relate to the provision of services for survivors. Some examples are provided below.

BASIC PRINCIPLE	SERVICE SPECIFIC STANDARDS
Right to privacy	Ensure privacy during any conversation between the survivor and provider or receptionist so that no one in the waiting room or in adjoining areas can overhear. In low resource settings where no such space exists, creative measures such as walking to another part of the facility with the client or to an outdoor patio might have to be taken. Systems and staff training to ensure privacy for adolescent clients so that—when deemed necessary--family members are not apprised of the reason for their visit.
Right to confidentiality	Do not share any information regarding a survivor without the survivor’s informed consent. All staff should be trained in maintaining confidentiality and services should have a policy related to this. Strict measures should be in place so that staff only discusses cases with other providers when strictly necessary, and in a manner that cannot be overheard. Institute secure measures for confidentiality of patient files.
Right to choose/ Autonomy	Seek informed consent for the examination and any tests. The principle of autonomy requires that survivors should be able to get health care without interacting with any other service before, or as a condition of, gaining health care. They should not have their name passed to any other agency, including a non-governmental organisation, social workers or researchers, unless they agree to such a referral. Autonomy is obviously reduced in settings where there is mandatory reporting and in situations where the victim/survivor is a child and needs protection from agencies, often from family members (excerpted from Jewkes, 2006). Informing the woman of legal mandates in order to help her engage in safety planning is also important.
Non-discrimination/ Equity	Ensure the same level of quality of care for all persons seeking assistance. Ensure that health programmes are age-specific and tailored to different sub-groups with wide access across a variety of settings, including considerations of geographic, cultural and linguistic diversity. Ensure that a range of support options are available that take into account the particular needs of women facing multiple discrimination (United Nations, 2006a).
Dignity/ Appropriateness	Ensure availability of female examiners where requested, and promote bodily integrity in examinations. Remind survivors that violence is not their fault and abuse should not be tolerated (Carreta, 2008). Ensure access to family planning, contraception, and where legal, safe abortion (WHO, 2008). Ensure confidentiality and comfort with private waiting areas, a private toilet and washing facilities, and a private examination room. (Jewkes, 2006).
Accessibility	Ensure services for survivors and prevention initiatives are free of cost (Schechtman, 2008; Claramunt and Cortes, 2003). Ensure location of services is accessible and/or provide transportation. Ensure linkages with the community, especially through community-based and non-governmental organizations. Identify appropriate means for reaching out the most marginalized members of the community about availability of services. (Jewkes, 2006). Ensure survivors have access to same-sex health care providers.
Safety	Ensure safety of the survivor as the paramount concern (Garcia-Moreno, 2002 b), as well as safety for the staff, and cultivate a working environment that does not minimize or deny potential safety risks (Council of Europe, 2008a). Conduct safety assessments and safety planning.
Non-malfeascence	Prioritize the well being of survivors and the delivery of services over data collection or any other secondary objectives.
Effectiveness/ Efficiency	Ensure that service providers are skilled, gender-sensitive, have ongoing training and conduct their work in accordance with clear guidelines, protocols and ethics codes (United Nations, 2006a). Ensure health policies and programmes are based on evidence. Monitor and evaluate service provision, seeking participation of service users. Ensure coordination among multisectoral actors. Sexual assault evidence collection kits, evidence chains and standard forms must be agreed by all sectors (Jewkes, 2006).

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