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

A resource package

Challenges in building up a referral system

The process of developing a referral system needs time and patience. Visible results may take even a longer time to be appreciated.

  • Due to the lack of specific laws and national level operational protocols in some countries, organizations have to depend on personal contacts for referral. In this case goodwill attitude of the local government can become a key factor in overcoming administrative/bureaucratic barriers in the course of referral system building.
  • Coordination of work of referral system, follow up on cases, and ensuring monitoring and reporting can be complicated and time consuming.
  • The balance between follow up of survivors by different service providers and the need to maintain confidentiality can be difficult to maintain.
  • Competition among providers for leadership and visibility can be a threat to the effective work of a referral system.
  • Referral systems are highly dependent on the capacity and competency of a professional staff. Thus, there is always a strong need for on-going monitoring of standards and quality of services (internally and externally) and capacity building.
  • It can be hard to ensure that a strong focus on gender-based violence and women’s rights is maintained. There is always a risk that some members of referral system can reduce the issue of violence to the matter of physical well-being, family protection or even view it in the terms of family reconciliation.
  • Having to deal with gender-based violence places additional pressure on already over-worked health care providers. It may result in their resistance to engaging with VAW issues.
  • Data has not only to be collected, but also worked with. Sometimes extensive data is collected, but not adequately analyzed or used.
  • It can be challenging to overcome culturally specific barriers. For instance, social structure and ethnic identity of Muslim communities rest on principles of family and clan honor, formal relations between families and clans. Women are afraid that if their situation becomes public they will lose their privacy or hurt the family honor and reputation. Obligatory reporting can reduce the willingness of victims to seek help.
  • Security is always an issue. Some women that attend health clinics can be accompanied by perpetrators or family members, which raises issues of privacy and confidentiality. Staff members can be threatened by women’s perpetrators and families or even by the survivor herself because they do not want sensitive information documented for fear of damage to their respective reputations in the community.


Source: ANNA Center Moscow, Russia