Strengthening health systems response to violence against women: protocol to test approaches to train health workers in India

Meyer, Stephen M.; Rege, Sangeeta; Avalaskar, Prachi; Deosthali, Padma; Garcia-Moreno, Claudı́a; Amin, Avni

doi:10.1186/s40814-020-00609-x

Cited by 6 publications

(6 citation statements)

References 36 publications

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“…The development of the initial framework occurred in two phases. First, a rapid review of studies on health system barriers and enablers to integrating IPV care [10,11,14,29,30] and on readiness and health systems strengthening [10,16,19,28,[30][31][32][33][34] was undertaken by MC (and SM) to identify capabilities for the framework. Following the review, the framework's key dimensions relating to health systems readiness and assessment were identified and described.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

Improving health system readiness to address violence against women and girls: a conceptual framework

Colombini

Mayhew

Garcia-Moreno

et al. 2022

BMC Health Serv Res

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Background There is an increasing focus on readiness of health systems to respond to survivors of violence against women (VAW), a global human rights violation damaging women’s health. Health system readiness focuses on how prepared healthcare systems and institutions, including providers and potential users, are to adopt changes brought about by the integration of VAW care into services. In VAW research, such assessment is often limited to individual provider readiness or facility-level factors that need to be strengthened, with less attention to health system dimensions. The paper presents a framework for health system readiness assessment to improve quality of care for intimate partner violence (IPV), which was tested in Brazil and Palestinian territories (oPT). Methods Data synthesis of primary data from 43 qualitative interviews with healthcare providers and health managers in Brazil and oPT to explore readiness in health systems. Results The application of the framework showed that it had significant added value in capturing system capabilities - beyond the availability of material and technical capacity - to encompass stakeholder values, confidence, motivation and connection with clients and communities. Our analysis highlighted two missing elements within the initial framework: client and community engagement and gender equality issues. Subsequently, the framework was finalised and organised around three levels of analysis: macro, meso and micro. The micro level highlighted the need to also consider how the system can sustainably involve and interact with clients (women) and communities to ensure and promote readiness for integrating (and participating in) change. Addressing cultural and gender norms around IPV and enhancing support and commitment from health managers was also shown to be necessary for a health system environment that enables the integration of IPV care. Conclusion The proposed framework helps identify a) system capabilities and pre-conditions for system readiness; b) system changes required for delivering quality care for IPV; and c) connections between and across system levels and capabilities.

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Section: Conceptual Frameworkmentioning

confidence: 99%

Improving health system readiness to address violence against women and girls: a conceptual framework

Colombini

Mayhew

Garcia-Moreno

et al. 2022

BMC Health Serv Res

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“…The methods for the research component of the study, involving a survey of providers' knowledge, attitudes and clinical practices prior to and following training, in-depth interviews and focus group discussions with providers, are described elsewhere (Meyer et al, 2020). In this report, we describe the development and adaptation of the implementation components.…”

Section: Describing the Interventionmentioning

confidence: 99%

Innovations in implementing a health systems response to violence against women in 3 tertiary hospitals of Maharashtra India: Improving provider capacity and facility readiness

Gadappa

Prabhu

Deshpande

et al. 2022

Implementation Research and Practice

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Background Violence against women [VAW] is an urgent public health issue and health care providers [HCPs] are in a unique position to respond to such violence within a multi-sectoral health system response. In 2013, the World Health Organization (WHO) published clinical and policy guidelines (henceforth – the Guidelines) for responding to intimate partner violence and sexual violence against women. In this practical implementation report, we describe the adaptation of the Guidelines to train HCPs to respond to violence against women in tertiary health facilities in Maharashtra, India. Methods We describe the strategies employed to adapt and implement the Guidelines, including participatory methods to identify and address HCPs’ motivations and the barriers they face in providing care for women subjected to violence. The adaptation is built on querying health-systems level enablers and obstacles, as well as individual HCPs’ perspectives on content and delivery of training and service delivery. Results The training component of the intervention was delivered in a manner that included creating ownership among health managers who became champions for other health care providers; joint training across cadres to have clear roles, responsibilities and division of labour; and generating critical reflections about how gender power dynamics influence women's experience of violence and their health. The health systems strengthening activities included establishment of standard operating procedures [SOPs] for management of VAW and strengthening referrals to other services. Conclusions In this intervention, standard training delivery was enhanced through participatory, joint and reflexive methods to generate critical reflection about gender, power and its influence on health outcomes. Training was combined with health system readiness activities to create an enabling environment. The lessons learned from this case study can be utilized to scale-up response in other levels of health facilities and states in India, as well as other LMIC contexts. Plain language summary Violence against women affects millions of women globally. Health care providers may be able to support women in various ways, and finding ways to train and support health care providers in low and middle-income countries to provide high-quality care to women affected by violence is an urgent need. The WHO developed Clinical and Policy Guidelines in 2013, which provide guidance on how to improve health systems response to violence against women. We developed and implemented a series of interventions, including training of health care providers and innovations in service delivery, to implement the WHO guidelines for responding to violence against women in 3 tertiary hospitals of Maharashtra, India. The nascent published literature on health systems approaches to addressing violence against women in low and middle-income countries focuses on the impact of these interventions. This practical implementation report focuses on the interventions themselves, describes the processes of developing and adapting the intervention, and thus provides important insights for donors, policy-makers and researchers.

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“…The intervention comprised not only the training of HCPs but also health service delivery/systems strengthening components, as per the recommendations in the WHO Guidelines (see Methods, sub-section intervention activities). The study protocol for the research and a description of the intervention are published elsewhere [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Healthcare Providers’ Perceptions and Experiences of Training to Respond to Violence against Women: Results from a Qualitative Study

Arora

Bhate-Deosthali

Rege

et al. 2023

IJERPH

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Healthcare providers (HCPs) can support women affected by violence, providing a safe way for women to disclose experiences of violence and mitigating violence against women (VAW) through the identification of cases in routine clinical practice. We conducted in-depth interviews and focus group discussions with HCPs in three tertiary facilities in Maharashtra, India, who had participated in training using the World Health Organization curriculum, adapted for the Indian context. n = 21 HCPs participated in in-depth interviews and n = 10 nurses participated in two focus group discussions. The respondents indicated that the training approach and content were acceptable and that the skills learned during the training were feasible to implement. A shift in perspective from viewing VAW as a private issue to understanding it as a health issue facilitated HCPs’ response. The training enabled HCPs to recognize barriers faced by women in disclosing violence and their role in supporting disclosure. HCPs reported barriers to providing care for survivors of violence, including a lack of human resources, the time during regular clinical practice, and a lack of strong referral networks. These data can be utilized to inform other efforts to train HCPs in facilities in this setting and provide evidence for ways to improve health systems’ responses to VAW in low-and middle-income country settings.

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Strengthening health systems response to violence against women: protocol to test approaches to train health workers in India

Cited by 6 publications

References 36 publications

Improving health system readiness to address violence against women and girls: a conceptual framework

Improving health system readiness to address violence against women and girls: a conceptual framework

Innovations in implementing a health systems response to violence against women in 3 tertiary hospitals of Maharashtra India: Improving provider capacity and facility readiness

Healthcare Providers’ Perceptions and Experiences of Training to Respond to Violence against Women: Results from a Qualitative Study

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