Implementation Research to test approaches to rolling out WHO Guidelines and tools for the health sector response to violence against women

In 2013, the World Health Organisation (WHO) developed clinical and policy guidelines on ‘Responding to intimate partner violence and sexual violence against women,’ for low and middle income countries. India had expressed commitment to the Global Plan of Action agreed upon at the 67^th World Health Assembly to develop comprehensive mechanisms to respond to different forms of violence in 2014.

CEHAT has been involved advancing the health care sector’s response to violence against women. The purpose of this study is to implement these guidelines, generate evidence on feasibility of implementation, and also the possibility of developing a model health care response in tertiary medical setup. This project is in collaboration with the WHO, which has undertaken similar initiatives in Afghanistan, Pakistan and some parts of Africa. Subsequently these guidelines were also developed into a handbook for health care providers for responding to intimate partner violence (IPV) and sexual violence.

This will be a two-phase project. Phase 1 will include formative research to bring in perspectives from women users of publichealth services as well as providers perspective on offering services. The needs of healthcare providers and barriers faced by them in providing care for survivors of violence will also be assessed. Phase 2 involves implementation of a package of activities such as training, handholdingetc. based on the clinical handbook and the manual for health managers. It will also assess improvements on health care provider performance. The project duration is from March 2018 to February 2020. At the end of this study, a report on implementation of the project and learnings based on trainings will be released.

Collaboration has been established with the Directorate of Medical Education and Research (DMER). Two medical colleges in the state of Maharashtra (GMC Aurangabad and GMC Miraj) have been identified for the purpose of rolling out the guidelines. These colleges are already involved in the implementation of integrating Gender in Medical Education (GME) initiative of DMER and CEHAT.

A training of researchers was conducted where research principles, how to seek informed consent, how to conduct a FGD and In-depth interviews, discussion over handling practical issues which might come while conducting research etc. were discussed. This was attended by Dr. Sarah and Dr. Avni Amin from the WHO team, to provide guidance and a global perspective.

A two day stakeholder meeting was held on March 26-27, 2018 in Mumbai. The participants of this meeting are the potential implementers of this project in their respective government medical colleges. The meeting was aimed at making participants aware of violence against women as a public health issue and efforts taken by CEHAT and WHO towards addressing it. The meeting included several interactive exercises and discussions. The two medical colleges are going to implement this project in their colleges from June 2018, when they are expected to train all the faculty, resident doctors, nurses and support staff on clinical handbook and managers’ manual published by WHO and bringing it into the practices. In this meeting, participants developed a tentative plan for training of health care providers in their institution. Some brainstorming on documentation of violence cases and referrals was also carried out in this meeting.

The first half of the training of trainers programme was held on April 20-22, 2018 in Mumbai. It aimed at training the trainers – health care providers from three disciplines namely – casualty, medicine and gynaecology. Ms Aruna Burte, Advocate Manisha Tulpule were present as an external resource persons for this ToT. Training covered various concepts associated with gender, violence against women in different forms, its consequences, first line care to violence victims and medico-legal aspects of such cases. The latter half of the training is scheduled in July where remaining components of this project – documentation, system of referral, multi-sectoral involvement in this project will be discussed.

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Under WHO project, we have started organising refresher trainings for HCPs at Aurangabad and Miraj medical college. According to the study design, these trainings are being organized after 6 months of the initial trainings. A post- 6 months test has also been administered to participants to see the retention of knowledge, attitude and practices after the initial trainings. Every month two such trainings will take place one at each site and thus, a sample of 220 HCPs will be covered by month of May. Recently, first such training was organised at the Miraj Medical College in month of February. During this training, the sessions on covert signs of violence, LIVES, myths and facts related to sexual violence, and details of PWDVA act were carried out.

Photo Gallery 16-2-2019 Miraj

Photo Gallery 28-2-2019 Aurangabad

Photo Gallery 22-3-2019, Aurangabad

Photo Gallery 04-04-2019, GMC, Miraj

Photo Gallery 10-04-2019, GMC, Aurangabad

 

CEHAT Team:

Sangeeta Rege (Co-ordinator)

Sanjida Arora (Research Officer)

Prachi Avalaskar (Sr. Research Associate)

Rajeeta Chavan (Research Associate)

 

Supported By: World Health Organisation (WHO)