Making health services a safe place for women: Uganda steps up to support women subjected to violence

November 2017

A women sits on a chair in a room, surrounded by people holding signs that say
A Training of the Trainers session on strengthening the health sector's response to violence against women in Uganda. Participants learn how to improve their referral plans by learning about the difficulties survivors face when being referred to various services.
WHO

Violence against women is a global public health problem. In Uganda, more than half of all women have experienced violence at least once in their life, most likely from an intimate partner, leaving them feeling unsafe in the place they should feel the safest – their home.

“Violence against women is everywhere in Uganda,” says Dr Olive Sentumbwe, National Professional Officer, WHO Uganda. “Women from all parts of society experience repeated abuse, which takes a toll on their physical and mental health.”

Violence often remains hidden, as survivors fear for their safety or are stigmatized. Very few women seek any help. Those that do seek professional help are likely to turn to their local health facilities since they can address their immediate physical or mental health needs, such as treatment for injuries or access to emergency contraception.

Women who have experienced violence are more likely to contract sexually-transmitted infections including HIV, suffer injuries, have an alcohol use disorder, experience depression, attempt suicide, or suffer other health consequences, so the health system is a key player in supporting survivors.

Working to eliminate a country-wide issue

To address the issue, the Ugandan Ministry of Gender, Labour, and Social Development, along with the ministries of health, justice and education, among others, have developed the National Action Plan on the Elimination of Gender-based Violence. The Action Plan focuses on implementing the country’s laws and policies on domestic violence and marital rape, providing health services for survivors, raising awareness and training police and health workers on how to respond.

In 2015, WHO worked with the Ministry of Health to update its national gender-based violence training manual. This manual is now used alongside WHO’s clinical and policy guidelines and its clinical handbook on responding to intimate partner violence and sexual violence in weeklong workshops to train health care providers, community leaders and workers in the judicial system on how to deliver services to survivors of violence.

To date more than 400 health workers have been trained across the country, helping to build a network of people committed to addressing violence against women.

One nurse who attended a training session in 2016 said, “The clinical handbook has empowered me with skills to identify that one is a victim to violence, and I am now able to examine, give proper treatment and refer whenever need arises.”

Health facilities in the country are equipped to provide a minimum initial package of care to survivors of rape, including emergency contraception, HIV post-exposure prophylaxis and mental health support – as recommended by WHO guidelines.

WHO has also developed an advocacy toolkit and launched a gender-based violence champions group in 2014 to sensitize policymakers and advocate for a stronger government response.

“There are now more incidents of violence disclosed to professional services throughout the country, which is a good sign that we are making progress,” says Dr Abdoulie Dodou Jack, Acting WHO Representative in Uganda. “We don’t know yet if behaviour is changing or whether incidence has dropped, but we do know that media coverage of the issue has increased, further raising community awareness.”

A global issue

Violence against women is not only a problem in Uganda; it’s a problem around the world. Globally approximately one woman in every three has experienced physical and/or sexual violence by an intimate partner or sexual violence by someone else at some point in their lives.

In 2016, the World Health Assembly endorsed a global plan of action to strengthen the role of the health system to address interpersonal violence in particular, against women and girls, and against children. One part of the plan encourages countries to enhance health service delivery and the capacity of health care providers to support survivors, as Uganda has done.

WHO just published a new manual, “Strengthening health systems to respond to women subjected to intimate partner violence or sexual violence,” which provides a “how-to” guide for health managers and policy-makers for planning, managing and monitoring services for women who have been subjected to violence.

“Health services have a crucial role in responding to violence against women,” says Dr Claudia Garcia-Moreno, who leads work at WHO on violence against women. “This guide is a practical tool for helping countries provide women subjected to violence with quality care and ensure their privacy, confidentiality and rights.”