- Conducting analyses, developing a committee of stakeholders for coordination, reforming laws and drafting policies and protocols are only the first steps in creating a comprehensive health sector approach to violence against women and girls. None of these will have any impact unless they are used to enhance response services across a network of providers and health facilities and to build prevention strategies. It is also necessary to engage managers and other high-level staff to address the issue and to secure organizational “buy-in” at a senior and strategic level within the health-care setting (WHO, 2010a).
- When deciding how to develop and implement services for survivors at the facility level, it is important to consider the theoretical models for programming that include:
- An ecological approach: understanding risks and protective factors at the individual, relationship, community and society levels.
- A multisectoral approach: linking health programming with other key sectors involved in prevention and response.
- A systems approach: ensuring that building capacity of health facilities to address violence against women and girls is system-wide, not just limited to specific training of key providers. A system-wide approach includes addressing the policies, protocols, infrastructure, supplies, staff capacity to deliver quality medical and psychosocial support, staff training and other professional development opportunities, case documentation and data systems, the functioning of referral networks, safety and danger assessments, among other items that are relevant to specific contexts and programmes. (See Heise, Ellsberg and Gottemoeller, 1999; Velzeboer et al., 2003; Bott et al., 2004.)
- An integrated approach: that seeks to improve health service delivery by incorporating violence programming into existing health programmes.
- Strategies for programme development should also consider issues such as:
- Human resource capacity, management and staff skills at any one facility
- Infrastructure, equipment and supplies at any one facility
- Service availability outside of the facility and coordination capacity of the relevant network
- Legislative or policy frameworks and funding
- It is important to keep in mind that some experiences show that if comprehensive care is not provided in one specific place, survivors may be deterred from accessing needed care, as travel time, costs and transport present a hardship, particularly for rural women (Claramunt, 2003).
- Other experiences, however, have shown that quality of services might be the most important factor for women in choosing where to go. (For more information, see quality of care in guiding principles.)
- Wherever services are provided, health facilities should follow basic steps outlined below in ensuring that their programming is well designed and delivered by competent and sensitive staff.
