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Table 1 Key summaries from health system response to VAW across five selected LMIC settings

From: Mapping the health systems response to violence against women: key learnings from five LMIC settings (2015–2020)

Bangladesh

Brazil

Bangladesh has OSCs at regional and district levels for responding to VAW. NGOs in Bangladesh have implemented screening checklists and referral flow-chart to facilitate identification of VAW and provision of services at sub-district health clinics. Collaboration between the Directorate General of Health, and the Ministry of Women and Children’s Affairs strengthen the government’s commitment to respond to VAW. Two significant challenges are proper infrastructure and ensuring privacy within the facility setting. A bulk of the financing for health system response is provided by international donors

In Brazil, much of the health system response to VAW is focused on sexual violence. While Brazil does not have OSCs, hospitals around the country provide response to sexual violence including medical services and psychosocial counseling. One of the most prominent laws, the Maria de Penha law, criminalizes domestic violence. Health care providers are mandated to report any incident of VAW, though many are untrained and have unsupportive attitudes towards VAW. Infrastructure challenges abound, compromising survivor identification and provision of survivor-centered care

Nepal

Rwanda

Nepal has OSCs in all districts, offering a full range of support services, with designated trained staff nurses. Service delivery at OSCs is protocolized. The Prime Minister’s Office monitors VAW data. Allocation of 15 percent of funds for awareness and response to VAW at community level underlines the government’s priorities. Assuring client privacy in health settings is a challenge. Provider training and evaluation takes place on an ongoing basis

Rwanda has policies for health systems response to VAW, and its OSC model exists across most districts. The government receives substantial financial support from foreign donors even as its own allocation is weak. Despite ranking high on global gender indices, societal attitudes indicate widespread normalization of VAW. Challenges in this setting include lacking infrastructure which compromise survivor privacy, weak intersectoral coordination, and poor monitoring and documentation of implementation

Sri Lanka

 

Sri Lanka provides OSC services in all districts. The cadre of Public Health Midwives focus on empowering survivors. There are laws on health system response to VAW; the government has demonstrated increasing responsibility for financing health sector response to VAW. A nodal person is designated within the health system who has the authority to work across ministries on strengthening the multisectoral VAW response. Gaps include lack of documentation of VAW cases and poor monitoring of implementation