Strengthening Health System Responses to Gender-based Violence in Eastern Europe and Central Asia

A resource package

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Gender-based violence (GBV) against women and girls is one of the most widespread violations of human rights, with a significant impact on physical, psychological, sexual and reproductive health. Recent research shows that 25,4% of women in Europe and Central Asia have experienced physical or sexual violence by an intimate partner or sexual violence by a non-partner (WHO et al 2013).

The health sector is a critical entry point for identifying GBV, providing medical care to women and girls survivorsand referring them to other essential services, such as shelters, counselling centres or specialized medical care.Indeed, for many survivors of violence, a visit to a health professional is the first, and sometimes only, step enabling them to access support and care. Therefore, strengthening the capacity of health care professionals to identify and support women and girls survivors of violence is crucial to the prevention of and response to GBV.

Many countries in Eastern Europe and Central Asia (EECA) have made significant progress in acknowledging the problem of GBV and taking steps to prevent and respond to the issue. While governments and health facilities have adopted policies and programmes addressing the role of the health sector, for instance through developing health protocols and guidelines or designing and implementing training programmes for health professionals, GBV is still being addressed primarily as a law enforcement concern, rather than a public health issue. In many countries, there is need to further improve the policy framework for strengthening the health systems response and to translate this framework into an institutionalized response at the level of health facilities with appropriate referral pathways, supported by adequate knowledge and skills on the part of health care providers to identify and respond to GBV.

To address these shortcomings, UNFPA, the United Nations Populations Fund Regional Office for Eastern Europe and Central Asia (EECARO) and its Implementing Partner Women Against Violence Europe (WAVE) are working together to support capacity development of health professionals in the region in order to strengthen the response of health systems to GBV. The main result of this partnership which commenced in 2011 has been the development of a resource package that offers practical guidance for health care professionals, health facility management and policy makers available at www.health-genderviolence.org. In 2013 and 2014, the package underwent a complete revision to further improve its relevance in strengthening health system responses to GBV and to update it in line with recent international developments.

Aim of this publication

Overall, the UNFPA-WAVE resource package seeks to provide health care professionals in EECA with evidence and tools to promote laws, policies and programmes, with the overall aim of achieving a comprehensive multi-sectorial response to GBV, of which the health sector is an important part.  

More specifically, the package

  • offers in-depth background information to health care practitioners in order to better understand the nature and dynamics of GBV and the role of the health sector in the response to GBV;
  •  identifies practical steps and recommendations to design, implement, monitor and evaluate interventions to more effectively integrate the response to GBV into the health sector;
  • provides practical guidance for creating new, or strengthening existing, referral systems, highlighting the importance of multi-agency cooperation in the response to GBV;
  •  seeks to support efforts to strengthen the capacities of health professionals to understand GBV and its symptoms, to identify instances of GBV and to provide survivors with appropriate care and support.

In doing so, the resource package builds on international standards and guidelines, including, but not limited to, the 2013 WHO clinical and policy guidelines on health sector responses to violence against women. It also makes reference to existing good practice examples from East and Western Europe and Central Asia.

The resource package is supplemented by a compilation of country-specific resources from the region of Eastern Europe and Central Asia. Health care professionals and policy makers are encouraged to visit this collection of resources at the “Country Info” corner at www.health-genderviolence.org.It offers useful background information that may be used to further tailor the recommendations and guidelines provided in the present package to the needs of specific country contexts.

To whom does this resource package apply?

Geographic scope:The resource package applies to health care professionals in the region of Eastern Europe and Central Asia. The roll-out of the package will be supported by UNFPA EECARO in the following countries and terretories: Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kosovo (UNSCR 1244), Kyrgyz Republic, Republic of Moldova, Serbia, Tajikistan, the Former Yugoslav Republic of Macedonia, Turkey, Turkmenistan, Ukraine, andUzbekistan.

Level of health care provision:The resource package mainly addresses the level of non-specialized primary health care, which normally provides the first and most critical point of contact for women survivors of GBV seeking medical help. Additionally, the package may also provide relevant guidance for secondary health care settings, where women survivors may be referred to by primary health care providers.

Target group: The resource package primarily addresses health care staff providing direct services to survivors of GBV. This includes doctors, but also nurses and midwives, who, in the EECA region, are of particular importance in remote rural regions. Keeping in mind that transforming a sector’s response to GBV requires an institutionalized approach, the package also seeks to provide guidance to the management of health facilities (such as hospitals, health centres or doctors’ offices), as well as, where relevant, policy makers.

Thematic scope of the resource package

Forms of violence covered: While both women and men can become survivors of GBV, women and girls worldwide constitute the majority of those affected, as a result of prevailing unequal power relationships between women and men. Therefore, the resource package addresses the health sector responses to GBV, which is used interchangeably with violence against women, in line with United Nations (UN) standards. The guidance and training package provided in the present resource package mainly focus on violence committed by intimate partners, which is the form of GBV that affects women most. However, many of the provisions are also relevant to other forms of violence against women.

Structure of the resource package

Part I(Guidance for health facilities and health care professionals in strengthening health sector responses to gender-based violence) provides background information and practical guidelines to support policies and programmes in strengthening health system responses to GBV. It provides an overview of the causes, dynamics and consequences of GBV (chapter 1) and addresses the role of health care professionals in the response to GBV, with a focus on international human rights standards and key principles for service provision (chapter 2). Chapter 3 leads through the different steps of a health care provider’s intervention in a presumed case of GBV, starting from identification to the medical examination and provision of care, the documentation of GBV, risk assessment and safety planning up to referrals to other service providers. Chapter 4 addresses referral pathways for survivors of GBV, addressing issues such as the actors involved as well as necessary steps in setting up and implementing referral mechanisms. Part I concludes with an introduction to monitoring and evaluation (M&E) of health sector interventions to GBV, explaining key concepts and principles of M&E and proposing specific steps in setting up and implementing evaluations (chapter 5). 

Part II (Training package for health care professionals on strengthening health system responses to gender-based violence) offers a ready-made and user-friendly training curriculum to strengthen the knowledge and skills of health care professionals to understand GBV, to identify patients who have experienced GBV and to provide survivors with appropriate care, support and referrals. After a number of practical tips and recommendations for preparing trainings, it provides a training package consisting of ten modules, as follows:

  1.  Introduction and getting to know each other
  2.   Understanding GBV – definition, causes, dynamics and consequences
  3.  The role of health professionals in the response to GBV
  4.  International standards and principles for services
  5.  Identifying GBV
  6.  Undertaking a medical examination and providing medical care
  7.  Documenting GBV
  8.  Risk assessment and safety planning
  9.  Referrals to other service providers
  10. Evaluation of the training and closing

Each module provides the trainer with

  •  an outline of the training session, including key messages and content;
  • references to relevant chapters contained in part I of the package that trainers may consult as background information;
  • a PowerPoint presentation, group exercises and handouts.

Trainers may wish to apply the training package as included in the present publication, or adapt it in line with specific country needs and contexts.

The package seeks to make a contribution to the important work undertaken by health care professionals and policy makers in the EECA region to strengthen health system responses to GBV, be it in the process of developing or revising policies or protocols, implementing training programmes or setting up referral mechanisms. Any comments or requests should be directed to vanessa.depeyre@wave-network.org