Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
Research Division, Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, USA.
Health Policy Plan. 2019 Mar 1;34(2):92-101. doi: 10.1093/heapol/czy106.
Several tools have been developed to collect information on health facility preparedness to provide sexual violence response services; however, little guidance exists on how this information can be used to better understand which functions a facility can perform. Our study therefore aims to propose a set of signal functions that provide a framework for monitoring the availability of clinical sexual violence services. To illustrate the potential insights that can be gained from using our proposed signal functions, we used the framework to analyse data from a health facility census conducted in Central Province, Zambia. We collected the geographic coordinates of health facilities and police stations to assess women's proximity to multi-sectoral sexual violence response services. We defined three key domains of clinical sexual violence response services, based on the timing of the visit to the health facility in relation to the most recent sexual assault: (1) core services, (2) immediate care, and (3) delayed and follow-up care. Combining information from all three domains, we estimate that just 3% of facilities were able to provide a comprehensive response to sexual violence, and only 16% could provide time-sensitive immediate care services such as HIV post-exposure prophylaxis and emergency contraception. Services were concentrated in hospitals, with few health centres and no health posts fulfilling the signal functions for any of the three domains. Only 23% of women lived within 15 km of comprehensive clinical sexual violence health services, and 38% lived within 15 km of immediate care. These findings point to a need to develop clear strategies for decentralizing sexual violence services to maximize coverage and ensure equity in access. Overall, our findings suggest that our proposed signal functions could be a simple and valuable approach for assessing the availability of clinical sexual violence response services, identifying areas for improvement and tracking improvements over time.
已经开发出了几种工具来收集有关卫生机构准备情况的信息，以提供性暴力应对服务；然而，对于如何利用这些信息来更好地了解一个机构可以履行哪些职能，几乎没有指导。因此，我们的研究旨在提出一套信号功能，为监测临床性暴力服务的可用性提供一个框架。为了说明使用我们提出的信号功能可以获得哪些潜在的见解，我们使用该框架分析了赞比亚中央省进行的一次卫生机构普查的数据。我们收集了卫生机构和警察局的地理坐标，以评估妇女获得多部门性暴力应对服务的便利程度。我们根据最近一次性侵犯时访问卫生机构的时间，定义了临床性暴力应对服务的三个关键领域：（1）核心服务，（2）即时护理，和（3）延迟和后续护理。综合所有三个领域的信息，我们估计只有 3%的机构能够全面应对性暴力，只有 16%的机构能够提供及时的即时护理服务，如 HIV 暴露后预防和紧急避孕。服务集中在医院，只有少数卫生中心和卫生所满足三个领域中的任何一个领域的信号功能。只有 23%的妇女居住在距离全面临床性暴力健康服务 15 公里以内的地方，38%的妇女居住在距离即时护理 15 公里以内的地方。这些发现表明需要制定明确的战略，将性暴力服务分散到地方，以最大限度地扩大覆盖范围，并确保获得服务的公平性。总的来说，我们的研究结果表明，我们提出的信号功能可能是评估临床性暴力应对服务可用性、确定需要改进的领域和跟踪随着时间的推移改进情况的一种简单而有价值的方法。
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