Overview Integrate survivor support and assistance into reproductive health programmes
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Last edited: November 01, 2011

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In order to address some of the challenges of integrating survivor support programmes into the health care system, several models have been developed in countries around the world that provide specialized services for survivors.  These programmes may be housed in health facilities, or they may exist in the community.   Wherever they are situated, a defining feature of these programmes is that they specifically target the issue of violence against women and girls.

Lessons Learned:  A review undertaken in the United Kingdom notes that even where specialist services for sexual assault exist, there are usually parts of the country with much less well organised service provision (End Violence against Women and Equality and Human Rights Commission, 2007). This reflects the reality that most countries are still in a phase of progressive realisation of the right to access to high quality sexual assault health services according to national resources and legislative frameworks on the issue.

In middle and lower income countries, sexual assault centres with dedicated trained health care providers represent the gold standard in terms of care, but they are likely to only be a realistic model in settings of higher (or the highest) population concentration. Elsewhere, having trained providers in facilities identified as providing post-sexual assault care or a sexual assault examiner programme is likely to be more realistic in terms of cost. Even if sexual assault centres are the preferred model, a decision must be made about whether the service will be exclusively medical, nurse-led or a combination of both. Although forensic nurse- led services often provide a particularly satisfactory combination of high-level skills and victim/survivor-centred care, there is no reason why these should not also be features of medically-led services if medical examiners have also been appropriately trained and the services are provided by staff and led by managers with a shared ethos. In practice the decision about who should provide care is usually influenced by historical practices in service provision, scope of nursing practice and the acceptability of nurses as sources of expert testimony in courts (excerpted from Jewkes, R., 2006. “Paper for Policy Guidance: Strengthening the Health Sector Response to Sexual Violence”).

Example: In South Africa, in-depth research was undertaken by the Medical Research Council to determine how quality services for sexual assault could be delivered feasibly without compromising the needs of survivors.  See the power point presentation describing how research was used for policy development and implementation.