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Abstract:
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This report summarises the findings of a study investigating the health sector’s response to violence against women and children in Malawi. It was commissioned by the Ministry of Health, supported by UNICEF and conducted by the Liverpool School of Tropical Medicine. Rigorous methods were used for gathering the evidence base and the report includes:
a) A review of the literature from Malawi and the region on violence against women and children that draws out the key debates and highlights the importance of violence against women and children as a public health problem.
b) A review of the relevant Malawian legislation, policies and strategies that highlights progress as well as pointing out potential legislative and policy barriers to a comprehensive response. Our findings show that violence against women and children is recognised as a determinant of health. The mandate of the Ministry of Health in Malawi is a ‘duty of care’ to respond to violence against women and children through screening, direct provision of services, reporting and referral. The documents outline the importance of working collaboratively across sectors.
c) A summary of the findings from a qualitative study with health care workers and key informants. Primary data were collected in 2011 and analysed in early 2012. Our findings indicate that progress has been made in the health sector response through the establishment of One Stop Centres, through the provision of post-exposure prophylaxis following rape and through emerging curricula on violence issues that are embedded in training on family planning and on couples counselling. Overall however, findings revealed that the capacity of the health sector to deal comprehensively with violence is limited by staff shortage, lack of clarity of roles and a narrow focus of skills and knowledge. A wide range of cultural and institutional reasons were found to contribute to the under-reporting of violence, compounding the problem of capacity since violence remains invisible in the health sector. The findings reveal the importance of multi-sectoral collaboration to avoid parallel vertical programmes.
d) A brief case study on the number and typology of violence against women and children within Queen Elizabeth Hospital, Blantyre. Despite the stated perception of health care workers that they see many cases of violence related injury very few adults actively report violence and there is no reporting within the Health Management Information System. Facility observation revealed a lack of clear access point for adults and that staff lack time and clarity on what action to take in which circumstance. In contrast the uptake of services by children and adolescents in the One Stop Centre has shown an unmet need.
These four areas are synthesised to draw out key lessons of relevance to policymakers and are presented in a way that can inform policy and planning. Thus the report gives:
a) A review of the opportunities for mainstreaming of violence issues
b) A potential referral pathway for discussion by policymakers
c) An outline of a national strategic framework that provides a springboard for multi-sectoral action.
The report is accompanied by a document of useful resources that summarises the legislation in more detail and lists NGOs and other multi-sectoral stakeholders. |