In South Africa, numerous local and provincial training programmes for post-rape care have been developed since 2003. In 2007, a review focusing on face-to-face meetings with all provincial Departments of Health countrywide found that trainings significantly varied in the content and length, which lasted from a few hours to 10 days10. Most of the training was
developed within or by Departments of Health, but a few provinces used external groups. Hence, training was fragmented and there was a bias towards the legal aspects of services and
10
67 when medical care was covered, training only focused on a specific component of care, such as PEP, but no training covered all aspects of medical care and legal requirements. Training was also provided by other government agencies such as the NPA and the Department of Social Development covering topics on sexual assault, domestic violence and victim empowerment. Table 3 provides an overview of the training content for six of the South African provinces depicting the amount of information covered under each goal, as defined by a national stakeholders’ meeting that occurred in May 2008.
In addition, training was often run by specific individuals and therefore depended on their interest and availability. These informal training programmes often lacked educational best practices in that learning objectives were not defined and the training was not based on a needs assessment. Only a few trainings incorporated manuals for trainees, whereas almost none had manuals or guides for trainers. Outcome measures were not specified and there was no formal evaluation of any of these programmes. Academic programmes were directed towards doctors or nurses with a unique programme piloted by the University of KZN that provided a single course for doctors, nurses and paramedics11. All academic programmes did not train on post-rape care
separately but covered all aspects of forensic medicine. Training on sexual assault and post-rape care for nurses was occurring in only a few provinces (e.g. Gauteng) and in some institutions after the initial efforts to train nurses as described in Chapter 1.
Based on published literature, no studies were found that specifically covered a training programme for post-rape care in the country. An intervention study, which was conducted in one hospital in Mpumalanga in 2003 incorporated five activities in the first phase of the study, of which one was the provision of training for health care and other service providers (54). This included the pharmacist, social workers, police, prosecutors, and district representatives from the Department of Health and Social Welfare. The intervention resulted in positive findings but as indicated, the training formed part of a larger intervention.
11Personal communication with Dr. Sagie Naidoo in 2007. Dr. Naidoo is the Clinical Manager (Medical): Clinical Forensic Medical Services of the eThekwini District in KZN.
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Table 3. Content of training in six provinces in South Africa based of five specified goals#
Gauteng KZN * Limpopo Northern
Cape
North West Free
State
Ensuring safety and avoiding revictimisation Context of rape & concerns of
victim/survivors
+ +
Prevalence, patterns & causes + +
Health consequences + +
Sensitivity, non-judgment & confidentiality
+
Needs of special groups ++ + + +
Law ++++++ +++++
+++++
++ + ++
Ethics, patients & sexual rights ++ +
Safety & preventing revictimisation +
Providing holistic care with proper treatment of injuries, and response to (risk of) unwanted pregnancy, HIV, STIs and psychological distress
Assess, record history & document ++ +
Non-genital injuries ++++ ++ + +++ Pregnancy + + + STIs + + + + + HIV + + + + Mental health ++ + + + Children ++++ ++ ++ ++
Providing information to survivors
Info on rape, law & legal processes +
Risks, testing, treatment, side effects, follow-up
+ HIV risk
Examination & related processes Psychological impact & coping Referral & further support
Collecting & documenting evidence and going to court
Examination +++++++ ++ ++ +++ ++
Crime kit & chain of evidence ++ ++ ++ +
Findings: J88 & interpretation +++ ++ + + + +
Courts +++++ ++ ++ +
Following up survivors and making referrals Follow-up visits
ART side effects 3 month HIV test
Vicarious trauma +
Monitoring care +
#
The number of + is a qualitative measure indicating the amount of content covered in the training. *
69 Some work has also been published on training for IPV and domestic violence. In the late 1990s, a study, which focused on attitudes and experiences of GBV in PHC nurses added a four- day training programme on the topic to a 12-month course that nurses were attending in rural Mpumalanga (68). All of the nurses, who participated in the study found the training to be valuable but there was no detailed evaluation of the training itself. Vezimfilho, a GBV programme that was piloted with nurses (63) trained HIV counsellors in a Johannesburg clinic over two days to screen women for IPV (64) but no screening was being conducted a year later. In an IPV service model intervention tested in the Western Cape, doctors and nurses were given a two-hour training on identification of IPV, attitudes and misconceptions surrounding IPV, and on how the intervention fitted into their work (58). The social worker providing the IPV service, as well as 19 other social workers received further training over four days on motivational interviewing, mental health assessment, use of the protocol, and on how to run life-skills and support groups as these were part of the intervention. As with the work in Johannesburg, a qualitative evaluation of the intervention showed poor uptake and adoption of the intervention by providers although survivors were supportive of the service (58).
In summary, with the exception of SANE programmes, international training programmes have been of varied lengths and have focused more on the clinical aspects of training (297, 302, 308, 332–334, 336, 345). Studies comprised of small focused groups and short courses. Very few studies had objective measures for evaluations of trainings, such as simulated cases or medical record reviews of a large sample. The majority of the studies reported some change in terms of knowledge, attitudes and practice, however, no study reported on an evaluation of a national training programme, in either high or LMIC.