3 . role of health systems in the response to gbv

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package

3. Role of health systems in the response to GBV

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Aim of the module• To understand why the health system

plays a crucial role in responding to GBV• To understand what this role entails, at the

levels of both, front line staff and management of health facilities

• To reflect on the barriers to effective health system responses to GBV and on ways to address these barriers

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Outlook• International obligations of States under

human rights law• Why do health care professionals play an

important role in addressing GBV? • Three levels to address:

Role of the health care staff Role of the health care facilities - management Role of policy makers and public administration

• Barriers to effective health care response to GBV and ways to address them

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International obligations of States to eliminate GBV

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States‘ international obligations to eliminate GBV – the “3 p‘s”

Also involves a duty to

improve the health

sector‘s response to

GBV.

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States international Obligations to eliminate GBV (2)

Key international human rights conventions and declarations:

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United Nations Convention on the Elimination of all Forms of Discrimination

against Women (CEDAW, 1979)

• Legally binding• Ratified by all states in the EECA region• Obliges states parties to end discrimination

against women in the political, economic, social, cultural, civil or any other field

• VAW/GBV is not explicitly mentioned, but:• CEDAW Committee General Recommendation

No. 19 on VAW (1992): GBV is a form of discrimination against women and therefore covered by CEDAW

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CEDAW General Recommendation 19 on VAW (1992)

Specifies the obligations of CEDAW states parties to respond to GBV, such as:•Ensure that laws against GBV give adequate protection to all women (penal sanctions, civil remedies, compensation)•Establish or support appropriate protective and support services (shelters, counselling, specially trained health workers, etc) •Implement gender-sensitive training of public officials and health care professionals•Undertake preventive measures to overcome harmful attitudes, customs and practices•Compile statistics and research (extent, causes and effects of GBV, effectiveness of interventions)

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CEDAW General Recommendation 24 on women and health (1992)

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Specifies the obligations of CEDAW states parties to address GBV in the context of health care, such as:•Enact and implement laws, policies, protocols and procedures to address GBV and to provide appropriate health services to survivors•Remove all barriers to women’s access to health services•Ensure women’s access to health services, in line with their right to dignity, autonomy, privacy, confidentiality, informed consent and choice•Implement gender-sensitive trainings for health professionals on identifying and response to GBV


OSCE Ministerial Council Decision No. 15/05

“Preventing and

combating VAW”

All countries in EECA are politically

bound

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Council of Europe Convention on preventing and combating violence against women and

domestic violence (Istanbul Convention, 2011)

• Legally binding, in force since 2014• EECA region (as of June 2014) – Ratified by Albania, Bosnia-Herzegovina,

Montenegro, Serbia and Turkey – Signed by Georgia, The Former Yugoslav Republic

of Macedonia, Ukraine

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H8


Istanbul Convention – examples of obligations (1)

Integrated policies and data collection: •Adopt and implement comprehensive and coordinated policies to prevent and combat all forms of GBV that

– place the rights of the survivor at the centre– effective cooperation among all relevant organizations

•Collect disaggregated relevant statistical data and support research on GBVPrevention: •Train professionals dealing with survivors of GBV on: gender equality, prevention and detection of violence, needs and rights of survivors, prevention of secondary victimization

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Istanbul Convention – examples of obligations (2)

Protection and support•Ensure access of survivors to adequate support services, health care, social services (with trained professionals)•Establish enough appropriate and easily accessible shelters and services for survivors of sexual violence•Establish state-wide 24/7 telephone helplines (free of charge and anonymous) •Ensure access of survivors to adequate and timely information on available support services and legal measures in a language they understand •Basic principles for service provision

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Agreed conclusions, 57th session of CSW (2013) on Eliminating and

Preventing Violence against Women and Girls

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• Better implementation of laws and policies: – Develop effective multi-sectoral policies – Allocate sufficient resources

• Tackle root causes and risk factors for GBV: discrimination, structural violence

• Provide accessible, comprehensive and multi-sectoral services– Police, judiciary, legal aid, health care, counseling

services – important role of women’s organizations – Training of medical professionals on GBV

• Research and comprehensive data collection


Select international guidelines on the health care response to GBV

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Why do health care professionals play an

important role in addressing GBV?

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Why do health care professionals play an important role in addressing GBV?

• GBV as a public health issue• Health care professionals are often the first point of

contact for survivors of GBV• Forensic medicine plays an important role in collecting

evidence to support the prosecution• Knowing about women’s situation helps in diagnosing

and treating health conditions• Responding to GBV helps to improve the overall quality

of health care Health care professionals are in a strategic

position to identify women who have experienced and/or are at risk of experiencing violence

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Levels to address the health care response to

GBV

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Levels to address the health care response to GBV

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Role of health care staff

• Understand GBV and provide information to patients on GBV and consequences to women‘s health

• Ask about GBV in case of clinical symptomes • Create a friendly and confidential environment • Collect patient‘s medical history• Undertake a medical examinination• Provide medical and psychological care• Document the health consequences• Refer to other service providers as needed• Assist patients to safety planning • Ensure follow-up care

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H10


Role of health facilities (1)

Provide the institutional framework to enable health care professionals to perfom their role. This includes: •Putting in place guidelines and protocols•Ensuring top-down support •Providing adequate infrastructure •Providing informative materials to patients and staff•Providing support to health care professionals•Networking with other organizations working on GBV•Implementing a system for monitoring & evaluation

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Role of health facilities (2)

Examples of recommended clinical policies and protocols for health facilities: •Sexual harassment policy•Policies and protocols about client privacy and confidentiality •Protocols for treating cases of VAW, including sexual abuse and rape•Protocols for handling situations of risk and crisis

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H10


Role of policy makers and public administration

• To provide a policy framework to guide the response of health facilities and health care professionals to GBV– Integration into wider GBV policies or action plans, e.g.

2011-2015 Strategic Action Plan to Combat Gender Based Violence, Armenia

– Adoption of special protocols or policies by Ministries of Health, e.g. Special Protocol for the Protection and Treatment of Women Victims of Violence, Republic of Serbia

• Effective implementation of policies requires:– Wide dissemination– Training of health care facilities and staff

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Barriers to medical care

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Barriers to medical care -examples

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3 . role of health systems in the response to gbv

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