Health Services for Gender-Based Violence: Médecins Sans Frontières Experience Caring for Survivors in Urban Papua New Guinea

Abstract

BackgroundLevels of gender-based violence in Papua New Guinea (PNG) are high; health services for survivors are limited. Evidence from the few existing health services for survivors can inform improvements in care in this and similar settings.MethodsMédecins Sans Frontières supported health services for survivors in Lae, PNG from 2008–2013. Routine monitoring data from August 2010-April 2013 were used to describe patient and service characteristics.Results5,892 individuals received care over 6,860 presentations, the majority self-referred or referred by friends and family. Presentations were attributed to intimate partner violence(62%), non-partner sexual violence(15%), other forms of violence(3%), and past (but not current) violence(21%). 97% were female; an estimated 4.9% (95%CI:4.8–5.0%) of females resident in the catchment area presented to the programme during the 2.8years analysed. Of presentations for non-partner sexual violence, 79% knew their abuser and 50% were children <16 years. 92% of presentations reporting current violence received medical treatment for injuries. The majority of patients who received multiple counselling sessions reported improved functioning and decreased severity of psycho-social complaints.ConclusionsCommunity awareness of the availability of free, best-practice, accessible, confidential medical and counselling services for sexual and gender-based violence in Lae, PNG resulted in many survivors presenting for care. High levels of ongoing intimate partner violence and child sexual abuse by known abusers indicates that alongside comprehensive medical care, access to effective services in non-health sectors such as policing, protection and legal services are needed if survivors are to escape the cycle of violence.

The implementation and effectiveness of the one stop centre model for intimate partner and sexual violence in low- and middle-income countries: a systematic review of barriers and enablers

“…Thirteen evaluations from 14 countries found that communities were unaware of OSC services, (HC)10 15 18 22 28 30 36–38 42–44 47 50 which was linked to low utilisation 10 15 28 36 38 44 47. Awareness raising activities facilitated knowledge of the OSC in some settings,14 32 34 42 45 although in one study in South Africa, there was low awareness despite multiple community raising efforts 36…”

“…The most common barrier to OSCs, cited in 27 studies, was poor multisector collaboration (HC) 10–12 15–17 24 26–30 33 35–38 41 42 44–47 49–51. Fifteen studies reported weak partnerships with police sectors,10 16 26–28 30 33 37 41 42 46 47 49–51 eight with legal and justice services,10 16 28 30 38 47 49 51 six with shelters27 28 30 42 45 49 and five with NGOs 11 17 26 29 30. Several reports found that OSCs failed to share lessons learnt from implementation with stakeholders (LC) 10 15 27 28 38 44.…”

“…While multiple process evaluations of the OSC model have been performed, no studies have examined the effectiveness of the OSC model 18–51. Only one outcome evaluation has been published, which found that the OSC model led to short-term increased utilisation of primary health services 13.…”

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“…Gender violence affects women not only in adulthood, but also in childhood and adolescence. This violence is established by power relationships [32,33].…”

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“…Према истраживању, 63,6% лекара је у пракси имало случајеве насиља над женама, што представља охрабрујући податак будући да жртве пролазе неоткривене поред здравствених радника (од сто жена које су доживеле насиље, само пет је идентификовано) 16,17 ; слично је и у гвинејској студији 18 , код Финаца 19 је 90%. Проблем је у томе што се насиље не именује недвосмислено, већ у евиденцији налазимо дијагнозе по основу телесних повреда и стања која су у вези с претрпљеним насиљем.…”