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BMC Womens Health. 2021 Oct 10;21(1):360. doi: 10.1186/s12905-021-01499-8.
Violence against women (VAW) is a global challenge, and the health sector is a key entry point for survivors to receive care. The World Health Organization adopted an earlier framework for health systems response to survivors. However, documentation on the programmatic rollout of health system response to violence against women is lacking in low and middle-income countries. This paper studies the programmatic roll out of the health systems response across select five low- and middle-income countries (LMIC) and identifies key learnings.
We selected five LMIC settings with recent or active programming on national-level health system response to VAW from 2015 to 2020. We synthesized publicly available data and program reports according to the components of the WHO Health Systems Framework. The countries selected are Bangladesh, Brazil, Nepal, Rwanda, and Sri Lanka.
One-stop centers were found to be the dominant model of care located in hospitals in four countries. Each setting has implemented in-service training as key to addressing provider knowledge, attitudes and practice; however, significant gaps remain in addressing frequent staff turnover, provision of training at scale, and documentation of the impact of training. The health system protocols for VAW address sexual violence but do not uniformly include clinical and health policy responses for emotional or economic violence. Providing privacy to survivors within health facilities was a universal challenge.
Significant efforts have been made to address provider attitudes towards provision of care and to protocolize delivery of care to survivors, primarily through one-stop centers. Further improvements can be made in data collection on training impact on provider attitudes and practices, in provider identification of VAW survivors, and in prioritization of VAW within health system budgeting, staffing, and political priorities. Primary health facilities need to provide first-line support for survivors to avoid delays in response to all forms of VAW as well as for secondary prevention.
针对妇女的暴力（VAW）是一个全球性挑战，卫生部门是幸存者获得护理的关键切入点。世界卫生组织（WHO）采用了一个较早的卫生系统应对幸存者的框架。然而，在中低收入国家，缺乏关于卫生系统应对暴力侵害妇女行为的方案实施情况的文件记录。本文研究了在五个选定的中低收入国家（LMIC）中卫生系统应对暴力侵害妇女行为的方案实施情况，并确定了关键的学习内容。
我们从 2015 年至 2020 年期间选择了五个在国家一级具有最近或正在开展的针对 VAW 的卫生系统应对方案的 LMIC 国家。我们根据世界卫生组织卫生系统框架的组成部分，综合了公开数据和方案报告。所选国家为孟加拉国、巴西、尼泊尔、卢旺达和斯里兰卡。
发现一站式中心是在四个国家的医院中提供护理的主要模式。每个国家都开展了在职培训，以解决服务提供者的知识、态度和实践问题；然而，在解决频繁的员工流动、大规模提供培训以及记录培训效果方面，仍存在重大差距。针对 VAW 的卫生系统方案解决了性暴力问题，但没有统一包括针对情感或经济暴力的临床和卫生政策应对措施。在卫生机构内为幸存者提供隐私是一个普遍的挑战。
在解决服务提供者提供护理的态度问题以及将护理方案纳入一站式中心方面，已经做出了重大努力。可以在培训对服务提供者态度和实践的影响方面的数据收集、服务提供者识别 VAW 幸存者以及在卫生系统预算编制、人员配备和政治优先事项中优先考虑 VAW 方面进一步改进。基层卫生机构需要为幸存者提供第一线支持，以避免延迟对所有形式的 VAW 作出反应，并进行二级预防。
