Gadappa Srinivas, Prabhu Priya, Deshpande Sonali, Gaikwad Nandkishor, Arora Sanjida, Rege Sangeeta, Meyer Sarah R, Garcia-Moreno Claudia, Amin Avni
Aurangabad Government Medical College and Hospital, Maharashtra, India.
Miraj Government Medical College and Hospital, Maharashtra, India.
Implement Res Pract. 2022 Jan 6;3:26334895211067988. doi: 10.1177/26334895211067988. eCollection 2022 Jan-Dec.
Violence against women [VAW] is an urgent public health issue and health care providers [HCPs] are in a unique position to respond to such violence within a multi-sectoral health system response. In 2013, the World Health Organization (WHO) published clinical and policy guidelines (henceforth - the Guidelines) for responding to intimate partner violence and sexual violence against women. In this practical implementation report, we describe the adaptation of the Guidelines to train HCPs to respond to violence against women in tertiary health facilities in Maharashtra, India.
We describe the strategies employed to adapt and implement the Guidelines, including participatory methods to identify and address HCPs' motivations and the barriers they face in providing care for women subjected to violence. The adaptation is built on querying health-systems level enablers and obstacles, as well as individual HCPs' perspectives on content and delivery of training and service delivery.
The training component of the intervention was delivered in a manner that included creating ownership among health managers who became champions for other health care providers; joint training across cadres to have clear roles, responsibilities and division of labour; and generating critical reflections about how gender power dynamics influence women's experience of violence and their health. The health systems strengthening activities included establishment of standard operating procedures [SOPs] for management of VAW and strengthening referrals to other services.
In this intervention, standard training delivery was enhanced through participatory, joint and reflexive methods to generate critical reflection about gender, power and its influence on health outcomes. Training was combined with health system readiness activities to create an enabling environment. The lessons learned from this case study can be utilized to scale-up response in other levels of health facilities and states in India, as well as other LMIC contexts.
Violence against women affects millions of women globally. Health care providers may be able to support women in various ways, and finding ways to train and support health care providers in low and middle-income countries to provide high-quality care to women affected by violence is an urgent need. The WHO developed Clinical and Policy Guidelines in 2013, which provide guidance on how to improve health systems response to violence against women. We developed and implemented a series of interventions, including training of health care providers and innovations in service delivery, to implement the WHO guidelines for responding to violence against women in 3 tertiary hospitals of Maharashtra, India. The nascent published literature on health systems approaches to addressing violence against women in low and middle-income countries focuses on the impact of these interventions. This practical implementation report focuses on the interventions themselves, describes the processes of developing and adapting the intervention, and thus provides important insights for donors, policy-makers and researchers.
针对妇女的暴力行为（VAW）是一个紧迫的公共卫生问题，医疗保健提供者（HCPs）在多部门卫生系统应对此类暴力行为方面具有独特地位。2013年，世界卫生组织（WHO）发布了应对亲密伴侣暴力和针对妇女的性暴力的临床和政策指南（以下简称《指南》）。在本实践实施报告中，我们描述了如何调整《指南》以培训医疗保健提供者，使其能够在印度马哈拉施特拉邦的三级卫生设施中应对针对妇女的暴力行为。
我们描述了为调整和实施《指南》所采用的策略，包括采用参与式方法来确定和解决医疗保健提供者的动机以及他们在为遭受暴力的妇女提供护理时所面临的障碍。这种调整基于对卫生系统层面的促进因素和障碍进行询问，以及对医疗保健提供者个人在培训内容、培训方式和服务提供方面的看法进行询问。
干预措施的培训部分以多种方式进行，包括在卫生管理人员中培养主人翁意识，使其成为其他医疗保健提供者的倡导者；跨干部联合培训以明确角色、职责和分工；以及促使大家深刻反思性别权力动态如何影响妇女的暴力经历及其健康状况。卫生系统强化活动包括制定针对妇女暴力行为管理的标准操作程序（SOPs）以及加强向其他服务机构的转诊。
在本次干预中，通过参与式、联合式和反思式方法加强了标准培训的实施，以促使大家对性别、权力及其对健康结果的影响进行深刻反思。培训与卫生系统准备活动相结合，营造了有利环境。从本案例研究中吸取的经验教训可用于扩大印度其他层面卫生设施和其他邦以及其他低收入和中等收入国家背景下的应对措施。
全球数以百万计女性遭受针对妇女的暴力行为影响。医疗保健提供者或许能够以多种方式支持女性，而找到方法培训并支持低收入和中等收入国家的医疗保健提供者，以便为受暴力影响的女性提供高质量护理是当务之急。世界卫生组织在2013年制定了临床和政策指南，为如何改善卫生系统应对针对妇女的暴力行为提供指导。我们制定并实施了一系列干预措施，包括培训医疗保健提供者以及服务提供方面的创新举措，以在印度马哈拉施特拉邦的3家三级医院实施世界卫生组织应对针对妇女暴力行为的指南。关于低收入和中等收入国家应对针对妇女暴力行为的卫生系统方法的新出现的文献侧重于这些干预措施的影响。本实践实施报告聚焦于干预措施本身，描述了开发和调整干预措施的过程，从而为捐助者、政策制定者和研究人员提供了重要见解。
