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An integrated health sector response to violence against women in Malaysia: lessons for supporting scale up.

Colombini M, Mayhew SH, Ali SH, Shuib R, Watts C - BMC Public Health (2012)

Bottom Line: Despite these challenges, even in more resource-constrained settings staff who took the initiative found it was possible to adapt to provide some level of OSCC services, such as referring women to local NGOs or community support groups, or training nurses to offer basic counselling.Our findings confirm that pilot interventions for health sector responses to gender based violence can be scaled up only when there is a sound health infrastructure in place - in other words a supportive health system.Furthermore, the successful replication of the OSCC model in other similar settings requires that the model - and the system supporting it - needs to be flexible enough to allow adaptation of the service model to different types of facilities and levels of care, and to available resources and thus better support providers committed to delivering care to abused women.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK. manuela.colombini@lshtm.ac.uk

ABSTRACT

Background: Malaysia has been at the forefront of the development and scale up of One-Stop Crisis Centres (OSCC) - an integrated health sector model that provides comprehensive care to women and children experiencing physical, emotional and sexual abuse. This study explored the strengths and challenges faced during the scaling up of the OSCC model to two States in Malaysia in order to identify lessons for supporting successful scale-up.

Methods: In-depth interviews were conducted with health care providers, policy makers and key informants in 7 hospital facilities. This was complemented by a document analysis of hospital records and protocols. Data were coded and analysed using NVivo 7.

Results: The implementation of the OSCC model differed between hospital settings, with practise being influenced by organisational systems and constraints. Health providers generally tried to offer care to abused women, but they are not fully supported within their facility due to lack of training, time constraints, limited allocated budget, or lack of referral system to external support services. Non-specialised hospitals in both States struggled with a scarcity of specialised staff and limited referral options for abused women. Despite these challenges, even in more resource-constrained settings staff who took the initiative found it was possible to adapt to provide some level of OSCC services, such as referring women to local NGOs or community support groups, or training nurses to offer basic counselling.

Conclusions: The national implementation of OSCC provides a potentially important source of support for women experiencing violence. Our findings confirm that pilot interventions for health sector responses to gender based violence can be scaled up only when there is a sound health infrastructure in place - in other words a supportive health system. Furthermore, the successful replication of the OSCC model in other similar settings requires that the model - and the system supporting it - needs to be flexible enough to allow adaptation of the service model to different types of facilities and levels of care, and to available resources and thus better support providers committed to delivering care to abused women.

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Related in: MedlinePlus

Flowchart on the knock-on effects of different challenges across levels.
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Figure 1: Flowchart on the knock-on effects of different challenges across levels.

Mentions: The findings from our in-depth interviews show that the implementation of the OSCC model varies substantially and is influenced by a complexity of individual, systems/organisational and policy-level constraints. Our findings illustrate the plurality of factors affecting support for providers delivering front-line care in the scaled-up provision of IPV services in Malaysia, and the strong connections across individual, health care delivery and policy levels. Figure 1 shows a summary. The findings are structured around the three levels identified – policy, systems and provider – but highlight the interconnections at each stage.


An integrated health sector response to violence against women in Malaysia: lessons for supporting scale up.

Colombini M, Mayhew SH, Ali SH, Shuib R, Watts C - BMC Public Health (2012)

Flowchart on the knock-on effects of different challenges across levels.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3412746&req=5

Figure 1: Flowchart on the knock-on effects of different challenges across levels.
Mentions: The findings from our in-depth interviews show that the implementation of the OSCC model varies substantially and is influenced by a complexity of individual, systems/organisational and policy-level constraints. Our findings illustrate the plurality of factors affecting support for providers delivering front-line care in the scaled-up provision of IPV services in Malaysia, and the strong connections across individual, health care delivery and policy levels. Figure 1 shows a summary. The findings are structured around the three levels identified – policy, systems and provider – but highlight the interconnections at each stage.

Bottom Line: Despite these challenges, even in more resource-constrained settings staff who took the initiative found it was possible to adapt to provide some level of OSCC services, such as referring women to local NGOs or community support groups, or training nurses to offer basic counselling.Our findings confirm that pilot interventions for health sector responses to gender based violence can be scaled up only when there is a sound health infrastructure in place - in other words a supportive health system.Furthermore, the successful replication of the OSCC model in other similar settings requires that the model - and the system supporting it - needs to be flexible enough to allow adaptation of the service model to different types of facilities and levels of care, and to available resources and thus better support providers committed to delivering care to abused women.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK. manuela.colombini@lshtm.ac.uk

ABSTRACT

Background: Malaysia has been at the forefront of the development and scale up of One-Stop Crisis Centres (OSCC) - an integrated health sector model that provides comprehensive care to women and children experiencing physical, emotional and sexual abuse. This study explored the strengths and challenges faced during the scaling up of the OSCC model to two States in Malaysia in order to identify lessons for supporting successful scale-up.

Methods: In-depth interviews were conducted with health care providers, policy makers and key informants in 7 hospital facilities. This was complemented by a document analysis of hospital records and protocols. Data were coded and analysed using NVivo 7.

Results: The implementation of the OSCC model differed between hospital settings, with practise being influenced by organisational systems and constraints. Health providers generally tried to offer care to abused women, but they are not fully supported within their facility due to lack of training, time constraints, limited allocated budget, or lack of referral system to external support services. Non-specialised hospitals in both States struggled with a scarcity of specialised staff and limited referral options for abused women. Despite these challenges, even in more resource-constrained settings staff who took the initiative found it was possible to adapt to provide some level of OSCC services, such as referring women to local NGOs or community support groups, or training nurses to offer basic counselling.

Conclusions: The national implementation of OSCC provides a potentially important source of support for women experiencing violence. Our findings confirm that pilot interventions for health sector responses to gender based violence can be scaled up only when there is a sound health infrastructure in place - in other words a supportive health system. Furthermore, the successful replication of the OSCC model in other similar settings requires that the model - and the system supporting it - needs to be flexible enough to allow adaptation of the service model to different types of facilities and levels of care, and to available resources and thus better support providers committed to delivering care to abused women.

Show MeSH
Related in: MedlinePlus