Availability of clinical management of rape survivors
The percentage of health facilities that have standard protocols in use for clinical management of rape survivors, including the availability of trained staff, emergency contraception, ARVs for post-exposure prophylaxis (PEP), and presumptive STI treatment.
This indicator is calculated as:
(Number of health facilities offering clinical management of rape survivors/Total number of health hospitals) x 100
Verification that the components of clinical management of rape survivors are in place
Sexual violence toward women, men, young, and old has been reported from most humanitarian settings. In many conflicts, rape is used as a method of warfare to humiliate, dominate or disrupt social ties. In the aftermath of natural disasters, women and young people may be left unaccompanied – out in the open or in temporary shelters – at the same time that security lapses lead to increased lawlessness and chaos (UNFPA).
In order to prevent and manage possible health consequences, rape survivors must have access to clinical care, including supportive counseling, as soon as possible after the incident. Clinical management of survivors of rape includes the availability of trained staff and the following components:
- supportive communication
- history and examination
- forensic evidence collection as relevant
- compassionate and confidential treatment, including:
- emergency contraception
- treatment of STIs
- PEP to prevent HIV transmission
- care of wounds and prevention of tetanus
- prevention of hepatitis B
- referral for further services, e.g. health, psychological and social (IAWG on RH in Crisis, 2010).
Healthcare services should be able to provide such care at the onset of a humanitarian response.
Because this is essentially a composite indicator, it may be difficult to ascertain if a particular health facility provides clinical management for rape survivors with a “yes/no” response. For example, the facility may have a stockout of antibiotics on the day of assessment. Or perhaps a private consultation area has been established, but not all the service providers are fluent in the local language. The evaluator(s) will have to determine a system for identifying what does and does not constitute available clinical services for rape survivors in order to determine what proportion of health facilities are providing this service.
access, violence, sexually transmitted infection (STI), emergency
Inter-agency Working Group on Reproductive Health in Crises. 2010. Inter-agency Field Manual on Reproductive Health in Humanitarian Settings: 2010 Revision for Field Review.
UNFPA. Assisting in Emergencies: Addressing Sexual Violence in Humanitarian Settings. Available online at http://www.unfpa.org/emergencies/violence.htm.