Colombini Manuela, Mayhew Susannah, Watts Charlotte
London School of Hygiene and Tropical Medicine, London, England.
Bull World Health Organ. 2008 Aug;86(8):635-42. doi: 10.2471/blt.07.045906.
There is growing recognition of the public-health burden of intimate partner violence (IPV) and the potential for the health sector to identify and support abused women. Drawing upon models of health-sector integration, this paper reviews current initiatives to integrate responses to IPV into the health sector in low- and middle-income settings. We present a broad framework for the opportunities for integration and associated service and referral needs, and then summarize current promising initiatives. The findings suggest that a few models of integration are being replicated in many settings. These often focus on service provision at a secondary or tertiary level through accident and emergency or women's health services, or at a primary level through reproductive or family-planning health services. Challenges to integration still exist at all levels, from individual service providers' attitudes and lack of knowledge about violence to managerial and health systems' challenges such as insufficient staff training, no clear policies on IPV, and lack of coordination among various actors and departments involved in planning integrated services. Furthermore, given the variety of locations where women may present and the range and potential severity of presenting health problems, there is an urgent need for coherent, effective referral within the health sector, and the need for strong local partnership to facilitate effective referral to external, non-health services.
亲密伴侣暴力（IPV）对公共卫生造成的负担以及卫生部门识别和支持受虐妇女的潜力日益受到认可。本文借鉴卫生部门整合模式，回顾了在低收入和中等收入环境中将应对IPV的措施纳入卫生部门的当前举措。我们提出了一个关于整合机会以及相关服务和转诊需求的广泛框架，然后总结了当前有前景的举措。研究结果表明，一些整合模式正在许多环境中得到复制。这些模式通常侧重于通过急诊或妇女健康服务在二级或三级层面提供服务，或通过生殖或计划生育健康服务在初级层面提供服务。从个体服务提供者对暴力的态度和缺乏相关知识，到管理和卫生系统面临的挑战，如工作人员培训不足、没有关于IPV的明确政策以及参与规划综合服务的各个行为体和部门之间缺乏协调，整合在各个层面仍然存在挑战。此外，鉴于妇女可能就诊的地点多种多样，以及所呈现的健康问题的范围和潜在严重性，卫生部门迫切需要连贯、有效的转诊，并且需要强大的地方伙伴关系来促进向外部非卫生服务的有效转诊。
