WHO'S ROLE AND THE HEALTH RESPONSE TO VIOLENCE AGAINST WOMEN AND GIRLS IN EMERGENCIES - 9 May 2019, Brazzaville, Congo Collective action for ...

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WHO'S ROLE AND THE HEALTH RESPONSE TO VIOLENCE AGAINST WOMEN AND GIRLS IN EMERGENCIES - 9 May 2019, Brazzaville, Congo Collective action for ...
WHO’S ROLE AND THE HEALTH
RESPONSE TO VIOLENCE AGAINST
      WOMEN AND GIRLS
       IN EMERGENCIES
      9 May 2019, Brazzaville, Congo

    Collective action for better health outcomes
WHO'S ROLE AND THE HEALTH RESPONSE TO VIOLENCE AGAINST WOMEN AND GIRLS IN EMERGENCIES - 9 May 2019, Brazzaville, Congo Collective action for ...
PRESENTATION PURPOSE

• To present an overview of the GBV in
  emergencies project;
• To understand the essential elements of a
  health response to VAWG;
• To share information across contexts
  about the priorities for current health
  responses to VAWG and related
  challenges.

         Collective action for better health outcomes
WHO'S ROLE AND THE HEALTH RESPONSE TO VIOLENCE AGAINST WOMEN AND GIRLS IN EMERGENCIES - 9 May 2019, Brazzaville, Congo Collective action for ...
EXPECTED OUTCOME

Health Cluster coordinators are
equipped with information about
the components of a health
response to VAWG and what
global guidance and activities
exist to support their work in this
area.
        Collective action for better health outcomes
WHO'S ROLE AND THE HEALTH RESPONSE TO VIOLENCE AGAINST WOMEN AND GIRLS IN EMERGENCIES - 9 May 2019, Brazzaville, Congo Collective action for ...
PRESENTATION OUTLINE

•   GBV in Emergencies Project
•   Definitions
•   Scope and magnitude of the problem
•   The health consequences of VAWG
•   WHO’s mandate on VAWG
•   A multisectoral response and the role of the Health
    Cluster
•   Components of a health response to VAWG
•   WHO recommendations, policies, tools and guidelines
•   Draft regional framework and CO roadmaps
•   Institutionalization
             Collective action for better health outcomes
WHO'S ROLE AND THE HEALTH RESPONSE TO VIOLENCE AGAINST WOMEN AND GIRLS IN EMERGENCIES - 9 May 2019, Brazzaville, Congo Collective action for ...
GBV IN EMERGENCIES PROJECT

  Collective action for better health outcomes
WHO'S ROLE AND THE HEALTH RESPONSE TO VIOLENCE AGAINST WOMEN AND GIRLS IN EMERGENCIES - 9 May 2019, Brazzaville, Congo Collective action for ...
PROJECT BACKGROUND                                            16 May 2019

Goal
• Health sector has improved capacity to deliver services to GBV
  survivors and to enhance prevention.

Rationale
• As the United Nations lead agency for health and the IASC
  designated cluster lead agency for health in humanitarian settings,
  WHO is well placed to institutionalize the health sector response to
  GBV in crises, within a gender equality and human rights
  perspective.

Outcome
• Health sector/health care providers’ capacity to prevent and
  adequately respond to GBV is enhanced.
• Coordination between the health cluster and the GBV AoR is
  strengthened.
               Collective action for better health outcomes
WHO'S ROLE AND THE HEALTH RESPONSE TO VIOLENCE AGAINST WOMEN AND GIRLS IN EMERGENCIES - 9 May 2019, Brazzaville, Congo Collective action for ...
PROJECT BACKGROUND                                                                          16 May 2019

Activities
• GBV strengthened within health cluster responses
• In the following countries/sites: Afghanistan, Bangladesh
  (Cox’Bazar), DRC (Kasais), Iraq, Nigeria (Northeast), Whole of Syria

• Updated technical and normative guidelines and tools
• In particular the Clinical Management of Rape Survivors and Training
  materials on mental health, first line support and IPV
• Strengthened WHO participation in relevant interagency initiatives
                               Cluster Coordination      Health providers training
                               webinars and workshops                                                 • Technical support,
Timeline                                                                                                mentoring
                   April -            July -             October-                                     • Deployment of a
                                                                                     2019               GBV advisor to a
                    June            September            December
                                                                                                        new, acute
                                                                                                        emergency
                    Country           Supplies and technical     Monitoring                           • QAT research
                    missions          guidance development

               Collective action for better health outcomes
WHO'S ROLE AND THE HEALTH RESPONSE TO VIOLENCE AGAINST WOMEN AND GIRLS IN EMERGENCIES - 9 May 2019, Brazzaville, Congo Collective action for ...
PROJECT UPDATES                                       16 May 2019

                            Technical
     Scoping missions                            Trainings
                            Guidance
    • Iraq              • Updated Clinical   • Trainings and
    • Syria               Management of        workshops in all
                          Rape Manual          of the 6 target
    • Bangladesh                               countries
    • Nigeria           • Mental health
                          and GBV              between
    • DRC                                      October and
                          training
                          curriculum           December
                        • Self care
                          module

           Collective action for better health outcomes
WHO'S ROLE AND THE HEALTH RESPONSE TO VIOLENCE AGAINST WOMEN AND GIRLS IN EMERGENCIES - 9 May 2019, Brazzaville, Congo Collective action for ...
VAWG/GBV DEFINITIONS

      Collective action for better health outcomes
WHO'S ROLE AND THE HEALTH RESPONSE TO VIOLENCE AGAINST WOMEN AND GIRLS IN EMERGENCIES - 9 May 2019, Brazzaville, Congo Collective action for ...
GBV: DEFINITIONS
• Gender-based violence (GBV)
  is an umbrella term for any
  harmful act that is perpetrated
  against a person’s will and that
  is based on socially ascribed
  (i.e. gender) differences
  between males and females.
• GBV against women is a life-
  threatening global health and
  human rights issue.
• While men may experience
  GBV, in general women
  experience more sexual
  violence, more severe physical
  violence, and more control
  from male partners.
              Collective action for better health outcomes
IT’S ABOUT POWER AND CONTROL

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VAWG TAKES MANY FORMS
                                The most common:
                                Intimate Partner
                                Violence, i.e. experience
                                of one or more acts of
                                physical and/or sexual
                                violence
                                and/or emotional/
                                psychological abuse by a
                                current or former
                                partner
       Collective action for better health outcomes
16 May 2019

COMMON TYPES OF VAWG/GBV

  Sexual Violence by someone a woman knows or by a stranger.

  Intimate partner violence can include physical violence, sexual
  violence, emotional/psychological abuse, and controlling
  behaviors.

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✓ being physically forced to
                    have sexual intercourse
                    when you didn't want to
                  ✓ having sexual intercourse
                    because you were afraid
                    of what your partner
                    might do
                  ✓ being forced to do
                    something sexual that
                    you found humiliating or
                    degrading

Sexual Violence                  HEALTH
                                 EMERGENCIES
                                        programme
Involvement of a child in
sexual activity that he or
she does not fully
comprehend, is unable to
give informed consent to, or
for which the child is not
developmentally prepared
and cannot give consent, or
that violates the laws or
social taboos of society.

                     Child sexual abuse
                                HEALTH
                                EMERGENCIES
                                       programme
SESSION 1: DÉFINITIONS, MANDATS ET
INFORMATIONS CONTEXTUELLES

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SCOPE AND MAGNITUDE OF THE PROBLEM

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The prevalence of lifetime physical and/or sexual by intimate partner
            violence by WHO region (2013)

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7% of ♀ globally:
have experienced sexual violence by a non-partner
           Collective action for better health outcomes
Violence starts early in lives of women

Lifetime prevalence of intimate partner violence by age group among ever-
                      partnered
              Collective  action women   (WHO,
                                 for better     2013)
                                            health outcomes
GBV IN EMERGENCIES
• Conflict and displacement exacerbate pre-existing
  violence and present new forms of GBV.

• 1 in 5 women who are refugees or displaced
  experience sexual violence globally.
• Reported rates of IPV are more prevalent than non-
  partner sexual violence in emergency settings.
• Adolescent girls aged 10 - 19 are one of the most at-
  risk groups

            Collective action for better health outcomes
Analyse des données de l’Enqûete
Démographique et de Santé (EDS) de la
RDC pour évaluer les facteurs de risqué et
les facteurs de protection pour la VPI et le
rôle que joue le statut des femmes.

68.2% des répondentes avait vécu au
moins 1 des 3 types de VPI (physique,
sexuelle, émotionnelle).

Facteurs de risque - attitude d’acceptation
de la violence conjugale, utilisation de
l’alcool par le partenaire.

Facteurs de protection – unions
monogames.

Les résultats de cette étude démontre que
la VPI est fréquente et elle est justifiée
comme étant acceptable par beaucoup de
congolaises.

                               Collective action for better health outcomes
GBV IN EMERGENCIES
 • Conflict and displacement exacerbate pre-
   existing violence and present new forms of GBV.

 • 1 in 5 women who are refugees or displaced
   experience sexual violence globally.
 • Reported rates of IPV are more prevalent than
   non-partner sexual violence in emergency
   settings.
 • Adolescent girls aged 10 - 19 are one of the most
   at-risk groups

          Collective action for better health outcomes
HEALTH CONSEQUENCES OF VAWG

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HEALTH IMPACTS OF VIOLENCE

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PATHWAYS & HEALTH EFFECTS OF IPV

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HEALTH EFFECTS OF IPV

IPV   53% any contraception

IPV   52% condom use

IPV   10% child stunting

      Collective action for better health outcomes
INTER-GENERATIONAL & SOCIO-ECONOMIC
             CONSEQUENCES
Effects on     •   Higher rates of infant mortality
children of    •   Behavior problems
               •   Anxiety, depression, attempted suicide
women who
               •   Poor school performance
experience     •   Experiencing or perpetrating violence as adults
abuse          •   Physical injury or health complaints
               •   Lost productivity in adulthood

Effects on     • Inability to work
families       • Lost wages and productivity
               • Housing instability

Social and     • Costs of services incurred by victims and families (health, social, justice)
economic            ✓ 42% higher health care expenditure in the US
               • Lost workplace productivity and costs to employers
effects
                    ✓ 3.7% of GDP in Peru
               • Perpetuation of violence
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SMALL GROUP DISCUSSION (15 MINUTES)

  –What do you know about
   VAWG/GBV in the context of the
   emergency you are working in (ex.
   types, reported incidents, info from
   assessments re: risks) ?
  –To what extent are VAWG/GBV
   concerns and interventions
   integrated into the HPC/HNO/HRP?
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WHO’S MANDATE ON VAWG

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Violence against women on the development agenda

                                    5. GENDER EQUALITY
                                    SDG Target 5.2
                                    Eliminate all forms of violence against women and
                                    girls
                                    SDG Target 5.3
 No MDG                             Eliminate all harmful practices, such as child, early
                                    and forced marriage, and female genital mutilation
  targets
related to                          16. PEACE, JUSTICE
 violence                           SDG Target 16.1
                                    Significantly reduce all forms of violence and related
                                    death rates everywhere
                                    SDG Target 16.2
                                 End abuse, exploitation, trafficking and all forms of
             Collective action for betteragainst
                                 violence health   outcomes
                                                 children
VAW ON THE GLOBAL PUBLIC HEALTH AGENDA

69th World Health Assembly, May 2016
The Ministries of Health of the 193
Member States of WHO, endorsed the
Global Plan of Action on strengthening
the health system’s response to violence
against women and girls and against
children.

                  Collective action for better health outcomes
A call to action!

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A MULTISECTORAL RESPONSE TO GBV AND
THE ROLE OF THE HEALTH CLUSTER

      Collective action for better health outcomes
LA RÉPONSE MULTISECTORIELLE ET LE
RÔLE DU CLUSTER SANTÉ ET DES
PARTENAIRES DE LA SANTÉ

      Collective action for better health outcomes
INTRODUCTION A L’APPROCHE CLUSTER

• Les acteurs humanitaires sont variés et pluriels:
  – Le Système des Nations Unies (OCHA, UNHCR, UNICEF,
    OMS, UNFPA, FAO, PAM, PNUD, UNHABITAT);
  – Les ONG/I (Save The Children, Care International,
    MSF, ALIMA, ADRA, WAR CHILD, etc.);
  – Le CICR, Croissant Rouge, Conseil International des
    agences volontaires, Conseil américain de l’Action,
    Volontaire, etc.;
  – La BM, l’OIM; et
  – Au niveau des pays, il faut ajouter les acteurs
    nationaux (gouvernements, ONG/N, autres).

           Collective action for better health outcomes
INTRODUCTION A L’APPROCHE CLUSTER
• L’approche « CLUSTER » est l’un des quatre piliers de
  la réforme humanitaire intervenue en 2005
  (leadership, financement, partenariats et cluster) en
  vue de renforcer la réponse humanitaire face aux
  crises de plus en plus complexes, fréquentes et
  meurtrières.
• Le but de l’approche « Cluster » est de renforcer la
  préparation de tous les intervenants du secteur et
  leur capacités techniques à faire face aux
  urgences     humanitaires    en   garantissant     un
  leadership et une redevabilité prévisibles dans tous
  les secteurs de la réponse humanitaire.
           Collective action for better health outcomes
INTRODUCTION A L’APPROCHE CLUSTER

• L’IASC a désigné un leader mondial de chaque
  cluster. Celui-ci a la responsabilité d’assurer une
  réponse cohérente et efficace, mobiliser et
  inclure tous les acteurs du secteur dans le
  respect de leurs mandats et avantages
  comparatifs. Pour une meilleure coordination et
  efficacité de la réponse, un cluster peut être
  subdivisé en sous-clusters et ou en groupe de
  travail.
• Lead du Cluster Santé: OMS
           Collective action for better health outcomes
16 May 2019

CLUSTER SANTÉ

                                                   Santé

                                     Santé de la             Santé mentale et
                                    Reproduction                 soutien
                                        (SR)                   psychosocial

                                 Comme Lead, l’OMS a pour rôle
                                 de veiller à ce que les principaux
                                 partenaires humanitaires du secteurs
                                 respectent les priorités des différents
                                 programme respectives

        Collective action for better health outcomes
La réponse multisectorielle en matière
   de prévention et réponse aux VBG
                                         Réinsertion
                                      socioéconomique

        Education                                                 Communications
                                         Coordination
                                     Principes Directeurs
                                    Réseaux de Référence

   Psychosocial                                                            Santé

                              LA SURVIVANTE
       Familles                                                         Communauté
                                        Autorites locales
                                           Ministères
                                 Comités de Refugiés et Déplacés
                                      Organisations du SNU
Juridique/Judiciaire                                                        Sécurité
                       CollectiveONG nationales
                                  action        et internationales
                                         for better   health outcomes
                                   Leaders et groupes religieux
LES PARTENARIATS

• La communauté humanitaire reconnait
  qu’aucune agence humanitaire ne peut
  à elle seule couvrir tous les besoins
  humanitaires et que la collaboration n’est
  pas une option mais une nécessité.

• Parmi les partenaires humanitaires, il y a des
  agences et fonds du SNU, les ONG/I/N, les
  gouvernements, les privés, les fondations,
  les communautés, les survivants de VBG,
  etc.
          Collective action for better health outcomes
LES PARTENARIATS (SUITE)

• Les partenaires qui ont des interventions
  directes ou indirectes sur la santé doivent
  être impliqués dans la réponse holistique
  (multisectorielle).
• Les principes de partenariats sont l’égalité, la
  transparence,       la      redevabilité,     la
  complémentarité et l’orientation vers les
  résultats.
• Le cluster Santé doit veiller à la réduction de
  la surmortalité et de la surmorbidité face à
  une crise humanitaire et à la restauration de
  la dignité.
          Collective action for better health outcomes
16 May 2019

GBV AREA OF RESPONSIBILITY

                                                               Logement,
                                      Protection                             Action des
                                                    VBG         terres et
                                      de l’enfant                              mines
                                                                propriété

        Collective     action
               Gender-Based Violence Areafor
                                          of better health outcomes
                     Responsibility
CYCLE DE PROGRAMME HUMANITAIRE

    Collective action for better health outcomes
LE RÔLE DU CLUSTER SANTÉ ET DES
PARTENAIRES DE LA SANTÉ

Intégrer des actions
essentielles en matière de
VBG tout au long du cycle
de programme humanitaire

              Collective action for better health outcomes
LE RÔLE DU CLUSTER SANTÉ ET DES
PARTENAIRES DE LA SANTÉ – ÉVALUATION DES
BESOINS
                              ✓ Incorporer des questions
                                reliées aux VBG au sein des
                                évaluations sanitaires
                              ✓ Assurer que les VBG sont pris
                                en compte dans la Revue
                                des Besoins Humanitaires
                                (Humanitarian Needs
                                Overview)

                                Exemple: Combien de centres de santé
                                offrent des soins cliniques pour les
                                survivantes de viol et d’autres formes de
                                VBG?

                                Exemple : Existe-il des protocoles ou
                                procédures opérationnelles standards
                                pour la prestation de services de santé à
                                l’intention des survivantes?

       Collective action for better health outcomes
QUELLES INFORMATIONS SONT
    NÉCESSAIRES?
Message Clé: Considérez la violence basée                       Sources d’information
sur le genre comme un état de fait                              • Services de santé existants
Les actions sont pertinentes dès les premiers
stades d’une intervention humanitaire et                        • Statistiques sur l’accès aux services de
dans toutes les situations d’urgence, quelle                    santé
que soit la prévalence ou l’incidence connue                    • Enquêtes démographiques et de la
et vérifiée des différentes formes de VBG…
Dans les situations d’urgence, l’attente ou la                  santé
recherche de données démographiques sur                         • Informations sur les obstacles à l’accès
l’ampleur réelle de la question ne doit pas                     aux services par les femmes
être une priorité, compte tenu des problèmes
de sécurité et d’éthique que soulève la                         • Études spécialisées sur l’inégalité du
collecte de telles données. Dans ce contexte,                   genre et VBG
tous les membres du personnel humanitaire
ont le devoir de considérer les VBG comme                       • Informations sur les lois, politiques et
un état de fait et une menace pour les                          protocoles
populations touchées, de traiter cette
question comme un problème grave qui met
la vie des personnes en danger et                                             Suggestions:
d’appliquer les mesures sectorielles                                          ✓ Interroger les lead “VBG”. Se servir des
recommandées indépendamment de la
présence ou de l’absence de preuves                                           évaluations genre/VBG pour comprend
concrètes.                                                                    le contexte.
 ----- Directives pour l’intégration d’interventions ciblant la VBG de l’IASC
                                                                              ✓ Profiter de la calculatrice DMU pour
                                                                              faire une projection des intrants
                                  Collective action for betternécessaires.      health outcomes
LE RÔLE DU CLUSTER SANTÉ ET DES
PARTENAIRES DE LA SANTÉ – PLANIFICATION
STRATÉGIQUE
                             ✓ Comprendre l’impact des
                               différentes formes de VBG sur les
                               résultats de santé
                             ✓ S’assurer que l’apport des VBG aux
                               autres problématiques de santé soit
                               pris en compte dans le cadre des
                               objectifs sanitaires (ou du
                               Cluster/Secteur Santé) du Plan de
                               Réponse Humanitaire
                               (Humanitarian Response Plan)
                             ✓ Produire les 3W et 5W
                              Exemple : Inclure des services destines aux
                              survivantes dans la définition de “services qui
                              sauvent les vies” (“life-saving services”).
                              Exemple : Inclure de l’information sur la disponibilités
                              des services de santé VBG dans le résumé des
                              besoins.
                              Exemple : Inclure au moins 1 cible ou objectif dédié
                              aux VBG dans le plan de secteurde la santé, ex.
                              90% des centres de santé offre des soins cliniques
                              aux survivantes de VBG.

       Collective action for better health outcomes
LE RÔLE DU CLUSTER SANTÉ ET DES
PARTENAIRES DE LA SANTÉ – MISE EN ŒUVRE
ET MONITORING
                              ✓ Inclure les services VBG dans le
                                paquet de servies de santé
                                essentiels
                              ✓ Assurer la disponibilité des PPE,
                                traitements IST, contraception
                                d’urgence et le vaccine pour
                                l’hépatite B.
                              ✓ Inclure indicateurs pour mesurer les
                                résultats des interventions VBG.
                               Exemple : # de centres de santé avec un système de
                               référence fonctionnel.

                               Exemple : Assurer que le staff médical ont les
                               aptitudes en gestion clinque des survivantes de VBG.

                               Exemple : Inclure des espaces privées et
                               confidentielles dans le design de centres de santé.

                               Exemple : Mettre les survivantes en rapport avec
                               d’autres services nécessaires.

       Collective action for better health outcomes
LA COORDINATION INTER-SECTORIELLE
                                        CLUSTER SANTÉ             CLUSTER PROTECTION

                                        Santé mentale et
    Prestataires
                                            soutien                          VBG
    de services       Cluster Santé       psychosocial

              Coordination                Santé de la                   Protection de
                 inter-                 Reproduction RH                   l’enfance
               sectorielle

                                      ✓ Cartographie et analyse des lacunes dans les services
                                      ✓ Plaidoyer and sensibilisation sur les domaines
       Réponse intégrant                conjointes
        les VBG dans les              ✓ Développement de circuits de référencement et POS
            urgences
               Collective action for better health outcomes
SMALL GROUP DISCUSSION (15 MINUTES)

  –What actions do you currently
   prioritize to address VAWG/GBV
   within the Health Cluster/Sector?
  –What are challenges do you face in
   coordinating the health response to
   VAWG/GBV?

        Collective action for better health outcomes
LES COMPOSANTS D’UNE RÉPONSE
SANITAIRE EN MATIÈRE DE VIOLENCES
À L’ÉGARD DES FEMMES ET DES FILLES

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VIDEO: LA VIOLENCE À L’ÉGARD DES FEMMES :
INTERVENTION DANS LE SECTEUR DE LA SANTÉ

         Collective action for better health outcomes
Collective action for better health outcomes
LA SANTÉ: UN SERVICE INDISPENSABLE POUR
LES SURVIVANTES

                           Les prestataires de services de santé
                           et les systèmes de santé jouent un
                           rôle primordial en termes de fournir
                           un soutien aux femmes afin de
                           minimiser l'impact de la violence et
                           de prévenir que ça se produit.
Pourquoi les systèmes de santé?
• Il est plus probable que les femmes et les filles qui vivent des
  violences utilisent des services de santé.
• Les prestataires de services de santé sont souvent le premier
  point de contact professionnel pour les femmes.
• Il est probable que toute femme consulte des services de santé
  à un certain moment de sa vie.

             Collective action for better health outcomes
POURQUOI LES SYSTÈME DE SANTÉ?
• Les violences sont souvent responsables de blessures et de
  maladies physiques
• Les prestataires de santé peuvent offrir de meilleurs soins dans les
  conditions de violence en:
   – Identifiant les femmes victimes de violence avant l’aggravation
     de leur condition
   – Fournissant des soins appropriés
   – Réduisant les impacts négatifs sur la santé des VBG
   – Assistant les survivantes dans l’accès à la protection
   – Améliorant les services de santé sexuelle et
     reproductive/IST/VIH/SIDA
• Obligations en matière de droits de la personne de respecter les
  normes les plus élevées en matière de soins de santé.

              Collective action for better health outcomes
Le rôle du secteur
                                 de la santé
                               dans le cadre d’une
                               réponse holistique
                                (multisectorielle)

Collective action for better health outcomes
La réponse sanitaire en matière de VBG
   DISPENSER UN APPUI DE PREMIÈRE LIGNE EN CAS DE VIOLENCE EXERCÉE PAR UN PARTENAIRE INTIME ET D’AGRESSION
   SEXUELLE Écouter. S’informer des besoins et des préoccupations. Valider. Améliorer la sécurité. Soutenir.

        IDENTIFICATION ET SOINS DES VICTIMES DE VIOLENCE EXERCÉE PAR UN PARTENAIRE INTIME

           SOINS CLINIQUES POUR LES VICTIMES D’UNE AGRESSION SEXUELLE

            FORMATION DES PRESTATAIRES DE SOINS DE SANTÉ

           INTÉGRATION DES VIOLENCES COMMIS PAR UN PARTENAIRE INTIME ET VIOLENCES SEXUELLES

        LA DÉCLARATION OBLIGATOIRE N’EST PAS RECOMMANDEÉ

   COLLECTER DES DONNÉES AFIN DE GÉNÉRER UNE BASE D’EVIDENCE ET COORDONNER AVEC LES AUTRES
   SECTUERS

                                                                                      HEALTH    16 May 2019
                                                                                     EMERGENCIES
                                                                                            programme
SOUTIEN DE PREMIÈRE LIGNE

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GESTION CLINIQUE DU VIOL:
PRINCIPALES MISES À JOUR
• Preuves médico-légales
  ✓ Reconnaissance que la collecte de preuves judiciaires n’est
    souvent pas possible/disponible;
  ✓ Informations complètes en annexe mais ne constitue plus
    une étape;
  ✓ Accent sur l’importance d’une bonne documentation
• Traitement et suivi
  ✓ Traitement mis à jour selon les derniers protocoles
  ✓ Suivi à 2 semaines; 1mois, 3mois et 6mois
  ✓ Plus d’accent sur les références, soutien psychosocial et
    sécurité

             Collective action for better health outcomes
SANTÉ MENTALE ET ASSISTANCE
PSYCHOSOCIALE
                              •   Rôle du prestataire de santé
                              •   Information sur les réactions
                                  normales aux événements
                                  traumatiques
                              •   Soutien psychosocial de base
                              •   Évaluation des problèmes de
                                  santé mentale : dépression,
                                  suicide et automutilation,
                                  SPT, troubles somatiques

       Collective action for better health outcomes
WHO RECOMMENDATIONS, POLICIES,
TOOLS AND GUIDELINES

      Collective action for better health outcomes
IMPLEMENTATION TOOLS

"What"                                 "How”
         Collective action for better health outcomes
CLINICAL HANDBOOK FOR HEALTH PROVIDERS
 Objective
 • Tool/Job aid to strengthen the capacity
    of health-care providers.

 What does it do?
 • Provides operational guidance (the ‘how
   to’) based on WHO guidelines (the ‘what’)
 • It is an easy-to-use, helpful guide
   including practical tips and job aids
 • While it does not directly address young
   women (under 18) or men directly, many
   of the suggestions are applicable them.

                 Collective action for better health outcomes
CONTENTS OF THE CLINICAL HANDBOOK
                              Guiding principles for
    Introduction               providing women –
                                  centered care

                                  Awareness &
       Part 1                     Identification

       Part 2                   First-line support

                              Additional care after
       Part 3                    sexual assault

                               Additional care for
       Part 4                    mental health

     Collective action for better health outcomes
IPV & SV AGAINST
  WOMEN GUIDELINES

Objectives
• Guidance for clinicians on
  responding to IPV and SV
• Guidance to policy makers on
  training and models of health
  care provision
• Inform educators designing
  medical, nursing and public
  health curricula regarding
  training
              Collective action for better health outcomes
HEALTH MANAGER'S MANUAL
Objective
To strengthen health systems to
provide women-centred services
to survivors of violence.
What does it do?
• Provides operational guidance
  (the ‘how to’) for health
  managers & policy makers
• Easy-to-use guide with practical
  tips and job aids to plan,
  manage, monitor & evaluate
  services
            Collective action for better health outcomes
TOOLS AND GUIDELINES

       Collective action for better health outcomes
SMALL GROUP DISCUSSION (15 MINUTES)

• Which of the WHO guidelines, tools,
  and technical resources are already
  being used in your country?
• Which ones are the most relevant
  and useful to your emergency
  operation?
• What other GBV guidelines,
  information systems and/or processes
  are being    implemented
         Collective                          in your
                    action for better health outcomes
UPDATE ON WHO’S GBV IN EMERGENCIES
             PROJECT
      Collective action for better health outcomes
FINDINGS IN DRC AND NIGERIA                              16 May 2019

• GBV is under-reported due to fear and/or stigma;
• The level of access to health services by GBV survivors is low due to
  poor coverage and other barriers to access;
• The capacity of health staff to identify signs and symptoms of
  various forms of GBV and respond appropriately is limited;
• The infrastructure and/or set-up of health facilities is inadequate to
  provide quality care to GBV survivors;
• Medications, supplies and equipment to provide CMR (HIV PEP,
  ECP, dignity kits) are insufficient; and,
• Information, communication and referrals between health service
  providers and other GBV services (e.g., psychosocial, livelihoods,
  legal, etc.) is lacking.

               Collective action for better health outcomes
PROGRESS IN AFRO

Collective action for better health outcomes
1. GBV STRENGTHENED WITHIN HEALTH
   CLUSTER RESPONSES
Nigeria workshop on health           DRC workshop on GBV
cluster/sector response to           integration in the health
GBV                                  response
• Over 40 health managers            • A two-day workshop will be
  attended in Dec 2018 in              organized in Tshikapa (Kasai
                                       province) for participants from
  Maiduguri and in April 2019 in       the Health Clusters and/or
  Yola, representing members of        Reproductive Health Working
  the Health Sector and the            Groups from Mbuyi-Mayi,
  Reproductive Health Working          Kananga and Tshikapa.
  Group, State MoH planners,         • After the two-day workshop,
                                       these participants led a one-
  managers of government,              day workshops with Tshikapa-
  INGO and NGO medical                 based health partners to
  facilities and development           practice facilitating such a
  partners operating in                workshop, then replicated in
                                       Kananga and Mbuyi-Mayi.
  Northeastern Nigeria.
              Collective action for better health outcomes
2. STRENGTHENED CAPACITY OF HEALTH
   PROVIDERS ON GBV RESPONSE
Nigeria                              DRC
• WHO focused on mobile              • WHO will review and
  health teams to see how to           update national modules
  integrate GBV in non-facility        on GBV based on new WHO
  based, rapid responses that          guidance (updated CMR)
  access some of the most              and explore options for a
  hard-to-reach areas in the           ToT for a pool of master
  Northeast.                           trainers on clinical
• 91 health providers from             management of rape and
  WHO’s mobile health teams            IPV survivors.
  trained on First-Line Support
  in Dec 2018 (Borno State)
• 60 more trained in April 2019
  (Adamawa and Yobe
  States)

              Collective action for better health outcomes
HEALTH FACILITY READINESS EXERCISE –                          16 May 2019

MAIDUGURI, NIGERIA
• 18 managers of state-run health facilities in Maiduguri assessed the
  readiness of specific facilities to provide care to GBV survivors (e.g.
  availability of private space, protocols for care, trained staff, drugs
  and supplies for post-rape care, etc) using components of the
  Minimum Care Version of the GBV Quality Assurance (QA) Tool.
• None of the facilities met any of the 4 standards for GBV quality of
  care assessed through site visits.
• Findings shared with State Ministry of Health in order to develop
  plans to address these gaps.
• The approach taken over the two-day workshop gave participants
  hands-on experience to identify service delivery gaps and built
  ownership around ensuring that health facilities meet quality
  standards of care for women and girls subjected to intimate partner
  violence and/or sexual violence.

               Collective action for better health outcomes
SUB-REGIONAL MEETING ON WHO’S ROLE AND
THE HEALTH RESPONSE TO VIOLENCE AGAINST
 WOMEN AND GIRLS IN EMERGENCIES IN WEST
           AND CENTRAL AFRICA

   BAMAKO (MALI), APRIL 30 – MAY 2, 2019

       Collective action for better health outcomes
WHY ARE WE HERE?

• To bring countries together from the sub-
  region
• To talk about violence against women
  and girls in humanitarian situations
• To gain a common understanding
• To take action to provide quality health
  services to survivors

         Collective action for better health outcomes
DRAFT REGIONAL FRAMEWORK
AND COUNTRY ACTION PLANS/ROADMAPS

       Collective action for better health outcomes
PROPOSED CRITERIA TO JOIN PROJECT

MUSTS
WR has made a formal request
G2 or G3 emergency
Commitment to designate VAWG Focal Point and possibly fund a consultancy
Stable Health Cluster coordinator
Participated in Regional Meeting (Amman, Bamako)
NICE TO HAVES
PHSA completed or soon to be done
HeRams completed or soon to be done
GBV Guidelines have been rolled-out
Good collaboration with UNFPA and OCHA
GBVIMS and case management in place
MHPSS WG activated
SR WG functional

                      Collective action for better health outcomes
INSTITUTIONALIZATION

       Collective action for better health outcomes
SMALL GROUP DISCUSSIONS (15 MINUTES)

• What are the entry points for VAWG/GBV in your
  country?
• How can you integrate VAWG/GBV in your core
  functions? (leadership, operational support &
  capacity, technical excellence, programme
  delivery & partnerships)
• How can you integrate VAWG/GBV in the
  Humanitarian Programme Cycle?
• What resources do you need to bolster WHO’s
  role in responding to survivors?
          Collective action for better health outcomes
ERF: ENTRY POINTS TO EMBED GBV PREVENTION
& RESPONSE
•   Protection:
     – Protection must be at the heart of humanitarian action
     – In practice, for WHO and health partners, this means ensuring the
        availability of health services to prevent and alleviate human suffering,
        prioritizing the safety and dignity of patients and their families, meeting the
        health needs of diverse groups, and responding to the specific needs of
        survivors of sexual and gender-based violence and other forms of violence.
     – It also means advocating for the protection of populations, health workers
        and health facilities.
•   Gender, age and vulnerability sensitivity
     – Certain groups are more vulnerable to the health consequences of
       emergencies
     – Women and girls are at special risk, particularly in settings of conflict.
     – Ensuring that they have ready access to reproductive health services and
       are protected from gender-based violence are humanitarian response
       priorities.
     – The vulnerabilities and special needs of other groups, such as children,
       older people, the disabled, those living with HIV, and ethnic or religious
       minorities, must also beaction
                   Collective   addressed   in thehealth
                                      for better   designoutcomes
                                                          and implementation of
       emergency operations.
INTEGRATION IN ALL OUR CORE FUNCTIONS
                                        Leadership
                            Governance - Advocacy - Communication

 Programme delivery &                                                     Operational support
     partnerships                                1.1                          & capacity
                                       3.3
‐ Strategy, planning &                                     1.2             ‐ HR/roster management
  budgeting                                                                  and deployments
‐ Resource mobilization &       3.2        1 billion                       ‐ Learning, capacity
  grant management                     better protected          1.3         development & expert
‐ Partner engagement                     from health                         networks

‐ Allocations & work plan       3.1      emergencies                       ‐ Supplies, logistics & ICT
  management                                               2.1             ‐ Duty of care
‐ Monitoring & reporting                                                   ‐ Continuous business
                                        2.3                                  Improvement
‐ Lessons learning &                              2.2
  evaluation

                                      Technical excellence                   HEALTH
                             Analysis - Innovation - Policy - Knowledge     EMERGENCIES
                                                                                   programme
WHO’s Emergency Response
Framework (ERF)

                                      87

                           HEALTH
                           EMERGENCIES
                                  programme
16 May 2019

Institutionalizing GBV: Building Bridges

                      Global

                   Emergencies
                   Reproductive
                      Health
                   Mental Health

        Regional                   Country

                                             HEALTH
                                             EMERGENCIES
                                                    programme
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