Health Sector Inadequacies in Attending to Child Survivors of Sexual Abuse in Kenya: An Operations Research

Abstract

In 2015, LVCT Health (a Kenyan non-governmental organisation) conducted an exploratory study to assess the quality and comprehensiveness of services provided to child survivors of sexual violence at two public health facilities in Kenya. Both quantitative and qualitative data collection methods were used, including a retrospective review of 164 child survivor medical records, a health facility staff inventory, in-depth interviews with 31 healthcare providers and 19 exit interviews with 14 child survivors and their caregivers. Ethical approval was obtained from two independent ethics committees. Quantitative data were analysed using SPSS version 22, while qualitative data were analysed using NVivo 10 based on a thematic coding framework. The health facility staff inventory indicated that only two out of 581 providers had undergone previous training on the management of child survivors of sexual violence. Both health facilities lacked the appropriate equipment for the collection of forensic evidence from children and private rooms in which to conduct the clinical examination. Providers cited challenges in offering psychosocial support to children. Only 27 per cent of child survivors were documented to have received trauma counselling. There is a need for health facilities to enhance their human resource and infrastructural capacity to facilitate the delivery of comprehensive care to child survivors. KEY PRACTITIONER MESSAGES:• There is a need to develop child-specific guidelines for healthcare providers in order to ensure that child survivors of sexual violence receive good-quality services at the facility level. • Healthcare providers in public health facilities need competency-based training to enable them to acquire knowledge and skills to identify and respond to child survivors of sexual violence, collect evidence, communicate with the children and offer counselling support to child survivors effectively. • Services for child survivors should be centralised in health facilities to minimise the number of different contact points.

Assessing the care of doctors, nurses, and nursing technicians for people in situations of sexual violence in Brazil

“…The main difficulties pointed out by professionals in cases of sexual violence were lack of training, lack of communication with the specialized service network, and lack of knowledge on how to approach the patient. Studies carried out in Belgium, Ghana, and Kenya on the evaluation of care for people in situations of sexual violence in health services revealed the need for additional training for health professionals involved in the care of these patients, more specifically for the care of children [ 21 – 24 ]. It is recommended to draw up an annual training agenda with the aim of training and sensitizing professionals to identify and meet the specific needs of each case.…”

Safeguarding Children and Young People is Everyone's Responsibility

“…The fourth paper in this issue by Carolyne Ajema and colleagues () from Nairobi, Kenya, also draws on retrospective data from a review of the records of 164 child survivors of sexual abuse as part of an exploratory study assessing the range and quality of health services provided to these children. The study was undertaken in one rural and one urban public health facility in two counties in Kenya.…”

“…This study highlights one of the problems of relying on data from a retrospective review of medical records as data were missing from the records of child survivors of sexual abuse, yet it was not possible to determine whether missing data for prophylactic treatment related ‘to the lack of documentation despite services having been provided’ (Ajema et al ., , p. 483) or that the children had never actually received the services. Indeed, none of the child survivors who participated in the exit interviews had received the minimum package of care which should be available, including: injury management; prophylactic treatment (emergency contraceptives, HIV, PEP, STI drugs); counselling; evidence collection and analysis; documentation on the medico‐legal form; and referral to other non‐health‐related services.…”

“…Ajema et al . 's () research also reported a lack of facilities available for examinations with no private rooms in one of the hospitals, and difficulties in collecting forensic evidence because of the lack of essential equipment and basic lockable storage cupboards. The research highlights health system and service delivery gaps in the management of cases where children have been sexually abused.…”

“…The work presented by Ajema et al . () highlights the opportunities to develop

‘processes where children, communities and other stakeholders can contribute to both defining protection concerns and creating response mechanisms that are realistic, culturally appropriate and draw on the strengths and capacities which already exist within communities.’ ( Walker‐Simpson, , p. 260)

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