Strengthening Health System Responses to Gender-based Violence in EECA: A resource package 3. Role of health systems in the response to GBV 1

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package 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 2

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package 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 3

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package International obligations of States to eliminate GBV 4

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package States‘ international obligations to eliminate GBV – the “3 p‘s” Prevention of GBV Prosecution of perpetrators Protection of survivors Also involves a duty to improve the health sector‘s response to GBV. 5

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package States international Obligations to eliminate GBV (2) Key international human rights conventions and declarations: United Nations Convention on the Elimination of all Forms of Discrimination against Women (CEDAW, 1979) Programme of Action of the International Conference on Population and Development, Cairo (1994) Ministerial Council Decision No. 15/05 “Preventing and Combating Violence against Women” (2005) Council of Europe Convention on preventing and combating violence against women and domestic violence (Istanbul Convention, 2011) Agreed Conclusions of the 57th session of the Commission on the Status of Women (2013) 6

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package 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 7

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package 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) 8

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package CEDAW General Recommendation 24 on women and health (1992) 9 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

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package OSCE Ministerial Council Decision No. 15/05 “Preventing and combating VAW” All countries in EECA are politically bound 10 protection and support collect, analyze and disseminate comparable data strengthen the economic independence of women justice in armed conflict and emergencies

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package 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 11 H8

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package 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 GBV Prevention: Train professionals dealing with survivors of GBV on: gender equality, prevention and detection of violence, needs and rights of survivors, prevention of secondary victimization 12

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package 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 13

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Agreed conclusions, 57th session of CSW (2013) on Eliminating and Preventing Violence against Women and Girls 14 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

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Select international guidelines on the health care response to GBV WHO, Guidelines for medico-legal care for victims of sexual violence (2003) UNFPA, A Practical Approach to Gender-based Violence: A Programme Guide for Health Care Providers & Managers (2010) WHO, mhGAP Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings (2010) IPPF, Improving the health sector response to GBV: A resource manual for health care professionals in developing countries (2010) WHO, Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines (2013) 15

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Why do health care professionals play an important role in addressing GBV? 16

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package 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 17

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Levels to address the health care response to GBV 18

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Levels to address the health care response to GBV Health care staff Health facilities/ management Health administration and policy makers 19

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package 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 20 H10

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package 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 21

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package 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 22 H10

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package 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 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 23

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Barriers to medical care 24

Strengthening Health System Responses to Gender-based Violence in EECA: A resource package Barriers to medical care - examples Female patients Shame, guilt Fear of negative response, being blamed Fear of an escalation of violence Social isolation Lack of safe options for themselves and their children Lack of physical access, especially in remote areas Language and cultural barriers Health care providers Insufficient knowledge about domestic violence and competent handling of cases Lack of time Lack of institutional support, such as standardized protocols and institutionalized training Own attitudes and misconceptions about GBV 25 H12 H13