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

Abstract

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.

Barriers and Facilitators to Integrating Health Service Responses to Intimate Partner Violence in Low‐ and Middle‐Income Countries: A Comparative Health Systems and Service Analysis

“…; Jacobs and Jewkes ; Colombini et al. ; Joyner and Mash ; Rees, Zweigenthal, and Joyner ), three used quantitative methodology (Tiwari et al. ; Cripe et al.…”

“…). Six studies were conducted in Africa: five in South Africa (Jacobs and Jewkes ; Joyner and Mash and ; Matseke and Peltzer ; Rees, Zweigenthal, and Joyner ) and one in Kenya (Turan et al. ).…”

“…; Joyner and Mash and ; Matseke and Peltzer ; Turan et al. ; Rees, Zweigenthal, and Joyner ) and four studies discussed joint responses to both sexual violence by nonpartners and IPV (Guedes et al. ; Jacobs and Jewkes ; Naved et al.…”

“…); five studies examined primary health care (PHC) (Guedes et al. ; Jacobs and Jewkes ; Joyner and Mash and ; Rees, Zweigenthal, and Joyner ), of which three implemented the same comprehensive model of IPV care. Typically, entry points for violence tend to be concentrated in ANC because of the screening model used in these services, also widely implemented in high‐income countries.…”

How can we manage intimate partner violence better?

“…It became clear from work in the Witzenberg area, Cape Winelands, South Africa, that children are routinely removed in cases where domestic violence is reported, thereby further traumatising both mother and children. [4] Woollett and Hatcher [5] explore key intersections between mental health, IPV and HIV and recommend that HIV care is recognised as an optimal entry point for identifying patients who are living with mental disorders and/or IPV. They introduce the concept of 'continuous trauma' , which marks a vital evolution in our understanding of trauma beyond post-traumatic stress disorder, where the traumatic stress is no longer current or real.…”