Striving to Make a Difference: Health Care Worker Experiences With Intimate Partner Violence Clients in Tanzania

Background: Women’s responses to partner violence are influenced by a complex constellation of factors including: psychological attachment to the partner; context of the abuse; and structural factors, all of which shape available options for women outside of the relationship. Objective: To describe women’s responses to physical partner violence; and to understand the role of women’s economic resources on their responses. Methods: Cross-sectional data from Dar es Salaam and Mbeya, Tanzania. Multivariate logistic regression was used to explore the relationship between women’s economic resources and their responses to violence. Results: In both sites, among physically abused women, over one-half experienced severe violence; approximately two-thirds had disclosed the violence; and approximately 40% had sought help. Abused women were more likely to have sought help from health services, the police and religious leaders in Dar es Salaam, and from local leaders in Mbeya. Economic resources did not facilitate women’s ability to leave violent partners in Dar es Salaam. In Mbeya, women who jointly owned capital assets were less likely to have left. In both sites, women’s sole ownership of capital assets facilitated help-seeking. Conclusion: Although support services are being scaled-up in Tanzania, efforts are needed to increase the acceptability of accessing such services.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Physical partner violence, women’s economic status and help-seeking behaviour in Dar es Salaam and Mbeya, Tanzania

Vyas

Mbwambo

2017

“…On a systems level, HCW concerns include lack of time during consultations (16–18), lack of training for HCWs, both prequalification and in-service (17, 19), weak referral networks (16, 17, 19), lack of confidence in management support (20), insufficient flexibility, and policy constraints (10). On a policy level, political commitment translated into clear policies and protocols is necessary for successful IPV intervention (20, 21).…”

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confidence: 99%

Implementing intimate partner violence care in a rural sub-district of South Africa: a qualitative evaluation

Rees

Zweigenthal

Joyner

2014

BackgroundDespite a high burden of disease, in South Africa, intimate partner violence (IPV) is known to be poorly recognised and managed. To address this gap, an innovative intersectoral model for the delivery of comprehensive IPV care was piloted in a rural sub-district.ObjectiveTo evaluate the initiative from the perspectives of women using the service, service providers, and managers.DesignA qualitative evaluation was conducted. Service users were interviewed, focus groups were conducted amongst health care workers (HCW), and a focus group and interviews were conducted with the intersectoral implementation team to explore their experiences of the intervention. A thematic analysis approach was used, triangulating the various sources of data.ResultsDuring the pilot, 75 women received the intervention. Study participants described their experience as overwhelmingly positive, with some experiencing improvements in their home lives. Significant access barriers included unaffordable indirect costs, fear of loss of confidentiality, and fear of children being removed from the home. For HCW, barriers to inquiry about IPV included its normalisation in this community, poor understanding of the complexities of living with violence and frustration in managing a difficult emotional problem. Health system constraints affected continuity of care, privacy, and integration of the intervention into routine functioning, and the process of intersectoral action was hindered by the formation of alliances. Contextual factors, for example, high levels of alcohol misuse and socio-economic disempowerment, highlighted the need for a multifaceted approach to addressing IPV.ConclusionsThis evaluation draws attention to the need to take a systems approach and focus on contextual factors when implementing complex interventions. The results will be used to inform decisions about instituting appropriate IPV care in the rest of the province. In addition, there is a pressing need for clear policies and guidelines framing IPV as a health issue.

“…IPV was found to be a ‘hidden agenda’ because both HCWs and clients had difficulties to bring up the issue of violence. For the HCWs, this became a challenge even if they clearly indicated a desire to make a difference and identified the need for training and guidelines (28). …”

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confidence: 99%

Screening of women for intimate partner violence: a pilot intervention at an outpatient department in Tanzania

Laisser¹,

Nyström²,

Lindmark³

et al. 2011

Self Cite

Intimate partner violence (IPV) is a public health problem in Tanzania with limited health care interventions.ObjectivesTo study the feasibility of using an abuse screening tool for women attending an outpatient department, and describe how health care workers perceived its benefits and challenges.MethodsPrior to screening, 39 health care workers attended training on gender-based violence and the suggested screening procedures. Seven health care workers were arranged to implement screening in 3 weeks, during March–April 2010. For screening evaluation, health care workers were observed for their interaction with clients. Thereafter, focus group discussions (FGDs) were conducted with 21 health care workers among those who had participated in the training and screening. Five health care workers wrote narratives. Women's responses to screening questions were analyzed with descriptive statistics, whereas qualitative content analysis guided analysis of qualitative data.ResultsOf the 102 women screened, 78% had experienced emotional, physical, or sexual violence. Among them, 62% had experienced IPV, while 22% were subjected to violence by a relative, and 9.2% by a work mate. Two-thirds (64%) had been abused more than once; 14% several times. Almost one-quarter (23%) had experienced sexual violence. Six of the health care workers interacted well with clients but three had difficulties to follow counseling guidelines. FGDs and narratives generated three categories Just asking feels good implied a blessing of the tool; what next? indicated ethical dilemmas; and fear of becoming a 'women hospital’ only indicated a concern that abused men would be neglected.ConclusionsScreening for IPV is feasible. Overall, the health care workers perceived the tool to be advantageous. Training on gender-based violence and adjustment of the tool to suit local structures are important. Further studies are needed to explore the implications of including abuse against men and children in future screening.