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Table 5 Overview of qualitative studies

From: Effectiveness of secondary and tertiary prevention for violence against women in low and low-middle income countries: a systematic review

Study Country and setting Methods Intervention Findings
Bernath and Gahongayire 2013 [24] Kigali, Rwanda
One stop centre in Kacyiru Police Hospital
Mixed-methods evaluation included:
- desk review of existing policies, laws, etc.
- collection of existing statistical data
- interviews with staff and stakeholders
- interviews with clients
ISANGE One Stop Centre (IOSC) is a programme designed to provide psychosocial, medical, police and legal services to survivors of abuse. It is housed inside a public hospital and offers free 24/7 service. The quality and availability of medical and forensic services are very high and strong links are present with police. However, weaknesses include:
- Difficulty following-up with survivors
- Inconsistent legal aid for survivors
- Requirement for survivors to report abuse to police to obtain services
- Limited data collection and monitoring
- Staff training is not systematically planned or monitored
Bhate-Deosthali, Sundari Ravindran, and Vindhya 2012 [44] Mumbai, India
Crisis centres at two public hospitals
Mixed-methods evaluation included:
- Review of project documents
- Interviews with program and hospital staff
- Analysis of case records
The Dilaasa Crisis Centres offer counselling (informed by a feminist perspective) to women who have experienced violence and are referred from the hospital or other health facility. They also provide referrals to partner organizations that provide legal assistance and temporary or permanent shelter. The centres’ locations in public hospitals make it possible to reach women from low-income or marginalized groups. Many survivors cited obtaining emotional support from the counselling and some reported improved psychological health. Survivors also stated that the centres helped them to register their complaints with the police. However, the centres faced an ongoing challenge while trying to change the attitudes of health professionals to recognize that domestic violence is an issue they should be concerned about, through ongoing training.
Doucet and Denov 2012 [43] Sierra Leone
Rural area in south
6 war-affected women and 4 social workers were purposively selected for open-ended interviews. Social workers provided psychosocial support to women following the war. The social workers focused on giving advice, as well as principles of solidarity and spirituality in their psychosocial support, rather than clinical diagnostics and psychology. War-affected women cited the social workers’ advice and support as playing an important role in their recovery. No women mentioned foreign professionals as making an impact on recovery, suggesting that local social work practices are valuable, despite being very different from those used in the Global North.
Human Rights Watch 2015 [26] Papua New Guinea 46 interviews were conducted: 27 with survivors of family violence and the remainder with local officials, activists, NGO workers, and other stakeholders. Interventions include:
- Family and Sexual Violence Units (FSVU) in 17 police stations to make police more accessible to victims of gender-based violence
- Family Support Centres in 15 hospitals to assist patients seeking care as a result of family violence
- Hotline that provides counselling, information, guidance, and referrals for care at local services
- Referral Pathway established by government officials in urban areas, designed to ensure that if a survivor accesses one service, they are linked to all other relevant ones
Many of these interventions are relatively new and are said to be effective at increasing support for survivors and access to services. However, barriers remain including:
- Lack of awareness about available services
- Limited access to services in rural areas
- Shortage of safe houses
- Service providers not putting the survivor’s best interests first (e.g., encouraging reconciliation)
- Lack of psychosocial counselling and case management services
- Weak law enforcement response. One expert stated that only 7 of the FSVU are functional.
- Limited court capacity and legal assistance for survivors
- Limited economic opportunities for survivors who leave their partners
Keesbury et al. 2012 [27] Kenya and Zambia
One-stop centres (OSC)
A comparative case study was conducted with purposively selected OSCs: 2 in Kenya and 3 in Zambia, representing a range of approaches to the OSC model. Mixed-methods were used, including:
- Facility inventory
- Record reviews
- Key informant interviews
One-stop centres (OSCs) provide integrated, multidisciplinary services for survivors of sexual and gender-based violence in a single physical location. Three major types of OSCs exist:
- Health facility-based and hospital-owned OSC, where OSC functions are integrated into routine health centre activities
- Health facility-based and NGO-owned OSC, where the NGO provides “wrap around” services at the health facility
- Stand alone NGO-owned OSC, which provides legal and psychosocial support onsite but refers elsewhere for medical care
The health facility-based and hospital-owned OSC model was found to be better set up to achieve a broader range of legal and health outcomes for survivors, and survivors felt that they were meeting their health needs. Challenges still remain with the OSC model:
- Poor integration of OSCs with the legal system
- Strengthening of the range of services provided by OSCs and/or linkages to outside services is needed
Kohli et al. 2013 [46] Democratic Republic of Congo
Two villages in Walungu Territory
In-depth interviews were conducted with 27 participants, including 13 survivors of sexual violence who were rejected by their families, 3 spouses of survivors, 1 community member, 5 mediators and 5 service providers Family mediation is a process of resolving family conflict between family members who have rejected a survivor of sexual violence and the survivor. Reintegrated survivors reported better relationships, improved opportunities for their children, and fewer mental health problems. However, challenges still exist, especially in cases where the survivor has a child from her rapist, or the survivor’s partner has remarried. Additional services such as economic support (e.g., children’s tuition, livelihood training, etc.) were cited as potential ways to improve reintegration.
GHD Pty Ltd. 2015 [25] Papua New Guinea In-depth interviews and/or focus group were conducted with staff, survivors, police officers, referral partners and other stakeholders. Limited quantitative data was also aggregated and analysed. The Family and Sexual Violence Units (FSVU) are police units that are tasked with responding to the needs of family and sexual violence survivors. They are present in 15 police stations and also provide referrals to other services for these survivors. The FSVUs have begun to change police response to FSV in PNG, however limitations still remain, including:
- Persistent culture of male dominance in police force
- Further training needed on how to provide supportive, non-judgemental services for survivors
- Improvements to procedures are needed, including timeliness of response, communicating their roles and processes to survivors and making arrest and prosecution protocols consistent across police stations
Manneschmidt and Griese 2009 [42] Afghanistan 109 women who were survivors of war-related violence participated in group evaluations (maximum of 13 participants per group), giving feedback on the intervention Basic Counselling Training (BCT) uses a group counselling process to provide women with psycho-education, relief from distressing symptoms, new social skills (e.g., problem-solving skills) and new support networks. Over half of participants mentioned that their social life had improved after the intervention, including their interactions with family members and their stress levels. Many participants also cited being happier or an improvement to their health.
Morel-Seytoux et al. 2010 [28] Zambia Mixed-methods evaluation included:
- Desk review of 36 USAID and CDC monitoring and reporting documents
- Key informant interviews with 240 beneficiaries, stakeholders, and ministry officials
- 24 site visits/observations
Coordinated Response Centres (CRCs) in 7 districts provide care and support for survivors to meet their medical, psychological and legal needs. The coordinated approach is an effective model and provides survivors with more comprehensive services. Coupling of these direct services with public awareness campaigns has improved the public’s knowledge of GBV and “broken the silence”
The Population Health and Development (PHD) Group Pvt. Ltd. 2012 [29] Nepal
Mobile camps in conflict-affected areas
Mixed-methods evaluation included:
- In-depth interviews and focus groups
- Analysis of secondary data and reviews
- Field visits
Mobile reproductive health camps were conducted for six days (plus four days follow-up) in 14 of the most conflict-affected areas of the country. Survivors of SGBV presenting to the camps were offered psychosocial counselling, legal and medical services, as well as shelter. The use of reproductive health camps to identify survivors was successful at minimizing stigma for survivors of sexual violence. 86% of survey respondents said the camp services were good and reasons cited included free drugs and services, no wait time, good provider behaviour and good counselling. The camps successfully reached marginalised populations with over 66% of clients coming from disadvantaged communities. However, challenges arose, including:
- Difficulty filing complaints with police because of politics, fear of family discord, etc.
- Challenges tracking survivors because the camps were conducted 5 years after the end of conflict
Wessel and Campbell 1997 [45] Managua, Nicaragua
Women’s centres in 3 poor neighbourhoods
Interviews with 21 survivors of domestic violence and 15 key informants involved in women’s centres or related projects. The Inter-Collective is a group of three women’s centres, or casas de la mujer, running programs for survivors of domestic violence, including self defence classes, self-help groups, legal information workshops, health care for survivors, as well as professional services from lawyers, psychologists and nurses. As a result of the intervention, survivors cited having new perceptions of women’s roles, increased emotional support and knowledge about their health and legal rights, decreased violence by their partners, and increased involvement in programs to help other survivors.