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Documenting medico-legal evidence in Kenya: Potential strategies for improvement

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Sexual violence (SV) remains a global public health problem and a violation of multiple human rights... It can negatively impact on the short- and long-term physical, social and mental health of survivors and is associated with many adverse health outcomes... One of the main gaps identified is a lack of understanding among health providers and police of the national documentation forms to be used in capturing survivor data... In response to this barrier, this study aimed to improve the documentation of medico-legal evidence in Kenya in order to facilitate improved health and legal outcomes for SV survivors... It comprised three main components: training of health providers, police officers and prosecutors; the introduction of a locally-assembled rape kit into the health facility; and the revision of the national clinical algorithm for guiding providers in the collection and documentation of medico-legal evidence at different service delivery points... The training of health providers (doctors, nurses, clinical officers, and laboratory technicians), police (officers station at the Gender Desk and Crime Unit), and prosecutors was conducted by a team of resource persons drawn from the Division of Reproductive Health, the laboratory of the Government Chemist, the Director of Public Prosecution's Office, and LVCT Health post-rape care program officers... The training therefore also aimed to equip police officers and health providers with knowledge of their role in providing post-rape care services, including their joint responsibility in enlightening the survivors about the importance of having the completed forms returned to the police before being forwarded to the prosecution office... To aid intervention site health providers in proper documentation of medico-legal evidence, the national clinical algorithm chart used for this purpose was revised... It is noteworthy that this seeming improvement in the completion of P3 forms in the intervention site describes the number of forms correctly filled, rather than the proportion of survivors whose forms were correctly filled... The unavailability of data on actual proportions is a limitation of this study, as such information would have provided a more accurate picture of the intervention's effect... Findings from this study suggest that multi-sectoral provider training sessions focused on existing national documents for use in the management of reported SV cases, or for the referral of survivors from one sector to the next, can potentially help improve the level of documentation of such cases by providers... This strategy is particularly important in settings where national documents have been developed and are used as medico-legal evidence in SV cases... Since the completion of this study, Kenya's national post-rape care form and the 2edition of the National Guidelines on Management of Sexual Violence in Kenya were officially revised, drawing on the study findings, and the multi-sectoral provider training approach described here has been adopted by Kenya's Sexual Offences Act Task force... Further funding was also obtained to explore and strengthen mechanisms for medico-legal evidence across sectors.

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Mentions: At baseline, the intervention and comparison sites started off on unequal footing, with 64% of SV survivor cases being documented on PRC forms in the comparison health facility site, versus no documentation at all on PRC forms in the intervention health facility site (Figure 2). Earlier provider trainings conducted about two years before the present study at the comparison health facility site explain this discrepancy. Although this earlier training was also offered at the intervention site, policy changes at this site severely limited the cadre of providers that could fill out PRC forms. This policy was abolished during the intervention period, when the health facility administration was sensitized on the revised national post-rape care guidelines, which allow the examining doctor, nurse, or clinical officer to perform this function.


Documenting medico-legal evidence in Kenya: Potential strategies for improvement
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4496633&req=5

Mentions: At baseline, the intervention and comparison sites started off on unequal footing, with 64% of SV survivor cases being documented on PRC forms in the comparison health facility site, versus no documentation at all on PRC forms in the intervention health facility site (Figure 2). Earlier provider trainings conducted about two years before the present study at the comparison health facility site explain this discrepancy. Although this earlier training was also offered at the intervention site, policy changes at this site severely limited the cadre of providers that could fill out PRC forms. This policy was abolished during the intervention period, when the health facility administration was sensitized on the revised national post-rape care guidelines, which allow the examining doctor, nurse, or clinical officer to perform this function.

View Article: PubMed Central - HTML

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sexual violence (SV) remains a global public health problem and a violation of multiple human rights... It can negatively impact on the short- and long-term physical, social and mental health of survivors and is associated with many adverse health outcomes... One of the main gaps identified is a lack of understanding among health providers and police of the national documentation forms to be used in capturing survivor data... In response to this barrier, this study aimed to improve the documentation of medico-legal evidence in Kenya in order to facilitate improved health and legal outcomes for SV survivors... It comprised three main components: training of health providers, police officers and prosecutors; the introduction of a locally-assembled rape kit into the health facility; and the revision of the national clinical algorithm for guiding providers in the collection and documentation of medico-legal evidence at different service delivery points... The training of health providers (doctors, nurses, clinical officers, and laboratory technicians), police (officers station at the Gender Desk and Crime Unit), and prosecutors was conducted by a team of resource persons drawn from the Division of Reproductive Health, the laboratory of the Government Chemist, the Director of Public Prosecution's Office, and LVCT Health post-rape care program officers... The training therefore also aimed to equip police officers and health providers with knowledge of their role in providing post-rape care services, including their joint responsibility in enlightening the survivors about the importance of having the completed forms returned to the police before being forwarded to the prosecution office... To aid intervention site health providers in proper documentation of medico-legal evidence, the national clinical algorithm chart used for this purpose was revised... It is noteworthy that this seeming improvement in the completion of P3 forms in the intervention site describes the number of forms correctly filled, rather than the proportion of survivors whose forms were correctly filled... The unavailability of data on actual proportions is a limitation of this study, as such information would have provided a more accurate picture of the intervention's effect... Findings from this study suggest that multi-sectoral provider training sessions focused on existing national documents for use in the management of reported SV cases, or for the referral of survivors from one sector to the next, can potentially help improve the level of documentation of such cases by providers... This strategy is particularly important in settings where national documents have been developed and are used as medico-legal evidence in SV cases... Since the completion of this study, Kenya's national post-rape care form and the 2edition of the National Guidelines on Management of Sexual Violence in Kenya were officially revised, drawing on the study findings, and the multi-sectoral provider training approach described here has been adopted by Kenya's Sexual Offences Act Task force... Further funding was also obtained to explore and strengthen mechanisms for medico-legal evidence across sectors.

No MeSH data available.