one stop centre

CONCEPT  NOTE  ON  THE  ESTABLISHMENT  OF  A  ‘ONE-STOP CENTER’    FOR    VICTIMS/SURVIVORS    OF    GENDER    BASED VIOLENCE AT THE SHELTER IN BAKOTEH

Introduction

In recent years, the international community has increasingly recognized Gender Based Violence (GBV) as a significant human rights, development and global health issue. Hitherto, the international community viewed GBV as a private matter to be dealt with among individuals and not a public matter that merited international or national response. This shift was driven, in part, by an increasingly effective and well organized grassroots movement of local, national, and international women’s Non-Governmental Organizations  (NGOs) that brought international attention to the plight of victims of gender-based violence and created a more public forum for discussion of the issue.

A  growing  body  of  research  confirms  that  GBV  has  significant  consequences, especially  for  girls  and  women’s  physical,  sexual  and  mental  health,  as  well implications for the health and wellbeing of families and communities. There are also  costs  to  societies.  Violence  against  women  drains  a  country’s  existing resources  and  handicaps  women’s  ability  to  contribute  to  social  and  economic
progress.  In  the  words  of  Kofi  Annan,  the  former  United  Nations  Secretary General, any society that fails to take measures to protect the safety and well-being  of  half  its   members “cannot  claim  to  be   making  real  progress.”1 Simultaneously, its broader social effects compromise the social development of children in the household, the unity of the family, the social fabric of affected communities, and the well-being of society as a whole. Victims/survivors  of  violence  against  women  therefore  need  timely  access  to health care and support services that respond to short-term injuries, protect them from further violations and address longer-term needs. Yet many do not get the help they need, because there are too few support services, because they do not have  access  to  services  or  do  not know about their  existence  or  because,  for whatever reason, they are reluctant to contact those services which are located at various places.

Rationale

The “Desk Review on GBV in The Gambia” report revealed that the health system does not have formal protocols or procedures for caring for survivors of gender-based violence. It is not clear how far health providers are trained on the proper procedures  for  responding  to  GBV,  ranging  from  the  provision  of  privacy  and confidentiality to the collection of forensic evidence, the conducting of safety plans,  and  the  referral  of  survivors  to  other  services  such  as  legal  aid  or counseling.   Interviews with few nurses during the desk review indicated that when a woman goes  to  a  hospital or  health    center  for  GBV-related  injuries,  health providers do little more than treat the physical effects of violence, usually only in the most extreme cases when survivors do attend health centers. Although there is no formal procedure for treating rape patients, the nurses who were interviewed stated that they usually examine rape victims for bruises, scrapes, and cuts and take a medical history and would also administer a vaginal swab (for rape survivors) According to various key informants, more than likely, patients do not report that their  injuries  resulted  from  violence  they  experienced  by  their  husbands  or partners. In most cases, women are ashamed and do not admit that they are being abused. Although some doctors may ask the woman about abuse if he/she suspects that violence is the cause of the injury, there is no protocol to screen women for GBV. Thus, more often than not, violence will go undetected. Nonetheless, it is important that doctors and nurses are aware of the tremendous strain GBV puts on survivors’ health and take every measure they know to address it. Unfortunately, this is not done in a systematic manner, and with limited recourse or services for victims, effects of this support are limited.
It is not clear if health providers at hospitals and health centers screen survivors of sexual violence for pregnancy, STIs, and/or HIV. The GFPA clinics, however, provide or offer Post-Exposure Prophylactics (PEP) or emergency contraception to rape  survivors.  It  is  further  not  clear  if  the  nurses  or  doctors  offer  safety planning, or if the health system has any formal, known mechanism for referring survivors of GBV to counseling, legal aid, shelter, or social services. Although it is not legally required, nurses and doctors would sometimes insist that they will not treat a GBV patient unless she/he has first reported the case to the Police and is accompanied by a Police officer to the hospital or health center. While the importance of reporting and prosecuting GBV cannot be undermined, survivors also should not be forced or pressured to report or press charges. If a health provider refuses to treat a woman who does not report the case to the Police or is accompanied by a police officer, the nurse or doctor is essentially forcing the patient to make at least an initial contact with police. Women’s fear of the justice system,  shame  of  being  abused  again,  and  limited  mobility  are  all  reasons  why woman do not report GBV cases to the Police. This unofficial requirement in health centres or hospitals that all GBV cases must be reported first to the Police may cause women to cover up the cause of their injury or even prevent women from seeking care. These uncoordinated responses to GBV cases  speak to the need for a systems approach—comprehensive reforms  that include  training for  everyone  who might have contact with survivors of GBV and reforms of policies and protocols.

Multi-sectoral Approach to Supporting Survivors of GBV: One-Stop Centres

One  of  the  best-known  good  practices  in  service  provision  involves  bringing together services in one location, often called the “One-stop centre.” This Centre will be  an interagency unit for victim/survivors of domestic or sexual violence. When a case is received, the victim/survivor will first be examined and treated by a doctor and also seen by a counselor, a social worker, within 24 hours in a separate examination room that protects privacy and confidentiality. If it appears that the victim will be in danger if she returns home, the doctor or nurse will refer her or him to the social worker who would arrange accommodation in a shelter or refuge. If the patient chooses not to seek shelter, she or he will be encouraged to return to see a social worker at the hospital at a later date. In any case, the victim would be encouraged to make a police report at the police unit based in the hospital. In a case involving severe injury or sexual violence such as rape, the police shall see the patient in the ward to record her statement and start investigations. The  ‘One-Stop Center’ would  ensure appropriate prevention of and  response to GBV-  a  multi-sectoral  approach  that  is  well  coordinated,  less  bureaucratic, sensitive and friendly. The underlying principle of such a multi-sectoral approach recognizes the rights and needs of survivors as preeminent, in terms of access to respectful and supportive services, guarantees of confidentiality and safety, and the ability to determine a course of action for addressing GBV incidents.

The advantage of the  ‘One Stop Center’ is the availability of all the necessary services ‘under one roof’- patients would not have to travel from one service point  or  provider  to  another.  It  helps  to  minimize  the  further  re-traumatisation  of victims who could be subject to multiple interviews. Patients’ confidence in the response systems would increase and reporting of cases may increase as a result. The  members  in  the  Centre  would  develop  formal  procedures  and  protocols. Accurate  and  comprehensive  data  and  other  documentation  that  are  crucial  in monitoring and enhancing accountability and devising effective responses would be available.

The  key  players  in  this  ‘One-Stop  Center’  would  be  the  Gambia  Police  Force, Ministry of  Health and  Social Welfare, Department of  Social Welfare,  Female Layers  Association  and  Women’s  Bureau.  These  players,  by virtue  of  their  key functions, have fundamental and crucial roles in ensuring survivors of Gender Based Violence have the requisite support they require. They are often the first to come into contact with a survivor of GBV and provide the initial support and guidance. (Others that are critical are the Ministry of Justice and other NGOs work with the  survivors  or  provide  them  support  services.).  The  Department  of  Social Welfare  would  provide  the  space  at  Bakoteh  Shelter  to  house  this  ‘One  Stop Center.’

Each of the players- social worker, police, lawyer and nurse or doctor- in the OneStop Center will be charged with basic responsibilities related to the prevention and response to GBV. The nurse or doctor, for example, should be able to actively screen survivors in a way that is respectful and supportive, interview in a friendly, professional manner (ensuring  same  sex  interviewers  for  survivors),  collect  forensic  evidence  when authorized by the survivor and provide testimony in cases where a survivor chooses to pursue legal action, be aware of and refer survivors to other support services.

The  social  worker  should  be  able  to  provide  supportive  and  psychological assistance, offer safe haven for victims who choose to leave an unsafe environment and facilitate support and referral.

The Police would interview the patient within the hospital and initiate investigation when necessary.
 
Conclusion

A large body of evidence documents the often severe and long lasting impact of GBV on human health including, but not limited to: (i) fatal outcomes; (ii) acute and chronic physical injuries and disabilities,  (iii) serious mental health problems and behavioral  deviations  increasing  the  risk  of  subsequent  victimization  and (iii) gynecological   disorders,   unwanted   pregnancies,   obstetric   complications   and HIV/AIDS . Furthermore, research conducted by NGOs and the Women’s Bureau have pointed to the prevalence of GBV in The Gambia. However, these cases are often not reported to the relevant authorities due to socio-cultural and traditional factors or barriers. Further the fear of violence and stigma reduces many victims’ willingness to use health or other services. The large majority turns to informal networks of friends and community members for help.

Establishing a ‘One-Stop Center’   at the Shelter in Bakoteh, and manned by trained and  selected  personnel  from  the  Gambia  Police  Force,  Department  of  Social Welfare and the nurses at the shelter with a   strong referral link to Serekunda General Hospital and Royal Victoria Teaching Hospital will therefore ensure early identification,  confidentiality,  monitoring and  respectful  treatment  of  survivors addressing physical, mental and reproductive health care needs, more long-term counseling, mental health care & rehabilitation and referral to social, economic and legal support. It would greatly improve survivor-provider Interaction which is the most feasible, affordable and efficient intervention within any care system aiming to address the survivors of GBV effectively.


2017  Welcome to network against gender based voilence