Percent of health units that have documented and adopted protocol for the clinical management of SGBV services
The percent of health facilities in the geographic region of study (e.g., country, region, community) that have a protocol in place for the clinical management of sexual and gender-based violence (SGBV) survivors that has been both documented and adopted. “Documented” means that staff should be able to show the protocol during an assessment. “Adopted” means that the health unit reports that they use it to guide practice. Adopted protocols should include the care for male survivors in addition to the usual protocols.
This indicator is calculated as:
(Number of health facilities reporting that they have both documented and adopted a protocol for the clinical management of SGBV survivors/ Total number of health facilities surveyed) x 100
Health units (at any level: primary, referral or tertiary care) must be able to show a documented protocol outlining the procedures to be used for identifying, providing care for and referring SGBV survivors who present to the unit. They should also be able to produce the protocols for care of male SGBV survivors, particularly if their current protocols exclude this. Health unit staff should be able to state where they can access the protocol when they need to refer to it (e.g., it is posted somewhere, or kept in a place readily accessible to staff). Units would be asked about the specific elements of clinical management, such as identification of affected women and girls, services to be provided, etc, as outlined in standard assessments such as IPPF, UNFPA, and SVRI. All health units that can answer the question affirmatively about policies and procedures and show a corresponding document are entered into the numerator.
If targeting and/or linking to inequity, classify outlets by location (poor/not poor).
A survey of health units. The survey would ideally be part of a specific study on readiness of health units, using a tool such as the IPPF assessment. The survey could be part of a more general study of health units and service provision. Either way, a probability sample of health units should be selected in order to assess the situation in the geographic area of interest.
Health service delivery programs are key in the prevention and response to SGBV. Every clinic visit made by a SGBV survivor presents an opportunity to address and ameliorate the effects of violence as well as help prevent future incidents. In order to take advantage of these opportunities, health facilities and providers need to be prepared to deliver appropriate services, including identification of survivors, necessary health services, counseling, and referrals to community-based resources such as legal aid, safe shelter and social services. This indicator measures whether or not a health unit has a standard protocol to guide the identification, service provision and referral mechanism for SGBV survivors. The protocol should describe the elements of care that should be provided, and the way in which it should take place. The protocol should be displayed or be otherwise accessible to health facility staff.
Ideally we would want to measure how the protocol is implemented, but this would involve a complex assessment. The IPPF, UNFPA and SVRI documents include examples of such an assessment of health unit readiness to deliver services to SGBV survivors, which includes questions pertaining to a protocol. This indicator should be considered as a single part of other indicators assessing how prepared health units are to deliver services.
health system strengthening (HSS), female genital cutting (FGC), quality, integration, violence
Male survivors of SGBV are typically excluded from the discussion – and subsequently standards of practice – on SGBV. It is important for evaluators to verify that health units have adopted protocols that include the care of this population as a step toward ensuring their needs are met.
Bloom S. “Violence Against Women and Girls: A Compendium of Monitoring and Evaluation Indicators.” USAID, IGWG, and MEASURE Evaluation, 2008.
International Planned Parenthood Federation. 2004. Improving the health sector response to gender-based violence: A resource manual for health care professionals in developing countries. IPPF/WHR Tools/02/September 2004. http://www.endvawnow.org/uploads/browser/files/Improving%20Health%20Sector%20Response%20to%20GBV:%20Resource%20Manual%20Dev%20Countries_English.pdf
Stevens, L. 2002. ‘A practical approach to gender-based violence: A programme guide for health care providers and managers’ developed by the UN Population Fund. Int. J of Gyn & Obstet. 78 (Suppl. 1): S111-S117.
Sexual Violence Research Initiative. 2008. Assessment Instruments Used to Study Healthcare-Based Interventions for Women Who Have Experienced Sexual Violence. Available at: http://www.svri.org/sites/default/files/attachments/2016-04-13/Assessment%20Instruments%20Used%20to%20Study%20Healthcare.pdf