Strengthening Health Systems Response to Intimate Partner Violence

SAJHA is conceptualised as a learning pilot intended to assess the sustainability and feasibility of scaling up of health systems’ response to women who report injuries caused by physical abuse from their intimate partners/spouses. While during the covid lockdown in 2020, when most of the social support services were closed or partially functioning, SAJHA continued to be completely functional and strategised pathways to spread its reach into the community.

Four out of 10 women face violence from their intimate partner in Bihar (NFHS, 2019-20). Many of them sustain physical injuries and need immediate medical aid. Identifying the need of the health facilities to reach out to women who disclose physical abuse and to provide them adequate support, SAJHA was designed in 2019 and implemented in Vaishali district in Bihar, across the health systems pyramid with the district hospital at the apex.

Our Activities

  • Strengthening the health facilities’ response to the cases of violence against women.
  • Improving the monitoring of case management within government health systems.
  • Improving awareness of frontline workers regarding service availability and approach towards violence against women.
  • Heightened vulnerability of women in their prime has been observed in Bihar. The husband was abuser in 60% of the cases, while the marital family was close at 50%.
  • Physical violence was the most common form of violence reported, and most survivors arrived at the health facility with physical injury. One-third of all survivors had sought informal support before coming to SAJHA, where most of them wanted support in initiating a legal response against the abuser/s.
  • Training was organised for the SAJHA team to develop their skills of doing tele counselling since most survivors would not be able to travel to the facility. SAJHA developed a protocol for health providers on responding to violence cases during the lockdown; this was shared with the Women’s Helpline, and also with the Office of the PS-Health, GOB. During the lockdown, SAJHA could provide support to 96 survivors.

Impact

  • Reached 632 survivors, and most of them were in the reproductive age group of 18-34 years and married.
  • Activated a multisectoral support network for survivors, involving the Women’s Helpline, Child Welfare Committee, District Legal Service Authority, Jeevika, and the Police.
  • Successfully documented attitude change among hospital staff in a short span of 18 months.
  • Ensured that all rape survivors reaching Vaishali District Hospital receive counselling and a copy of their medico legal form.
  • Institutionalised a monthly quality review meeting with stakeholders from all intervention facilities.
  • Provided psychosocial support including counselling in 96% of the cases and conducted safety assessment and planning for as many women in line with the World Health Organisation standard protocols.
  • Supported the government in adopting the Ministry of Health and Family Welfare mandated protocol for responding to the survivors of rape.

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