Adaptation and implementation of the healthcare responding to violence and abuse intervention in Nepal, Sri Lanka, Brazil and occupied Palestinian territory: a comparative analysis and lessons learned
More details
Hide details
London School of Hygiene and Tropical Medicine, London, United Kingdom
University of Sao Paulo, Brazil
University of Peradeniya, Sri Lanka
Kathmandu University, Nepal
An-Najah National University, Occupied Palestinian Territory
University of Bristol, United Kingdom
World Health Organization, Switzerland
London School of Hygiene & Tropical Medicine, United Kingdom
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A980
Background: Health systems have a critical role in a multi-sectoral response to domestic violence against women, but the evidence is skewed to toward high-income countries, and lessons learned are not easily transferred to low-and-middle-income countries due to social, cultural and economic differences. The intervention strengthened the healthcare response to VAW through training for healthcare providers and managers and a care pathway for women experiencing domestic violence. The synthesis aimed to explore what factors promoted or inhibited the translation of HERA’s intended goals into a ‘real world’ set of activities. Methods: Data sources include: qualitative interviews with health care providers and managers and women who disclosed violence; clinic data on cases of domestic violence and referrals; and the Provider Intervention Measure which assessed changes in attitudes and behaviour. Thematic analysis was used to analyse qualitative data and descriptive statistics were used to analyse quantitative data. Results: The intervention increased disclosure of violence from a negligible baseline in clinical settings, but there was little acceptance of further referral for services among women. Although obstacles varied between countries, some Findings were ubiquitous: the impact of the Covid-19 pandemic; poor inter-sectoral coordination; lack of engagement with communities; and a disconnection between what the care pathway could offer and the diverse needs of women. There was inconsistent recording of violence, compounded by multiple documentation systems; uncertainty about role of health care vis-à-vis perpetrators of violence; and poor understanding of VAW as a priority policy issue across sectors. Conclusions: Fundamental research is needed to surface local understandings of how best to support women and children. Community engagement and community health workers have a critical role in building community trust in the health system response. Active leadership, management and institutional support is crucial to implementation.