Propuesta de uso Principal: Institucional.

At community level, there are Community Victim Support Units (300 of them) at police stations. One of the members of the Community Victim Support Unit core team are Health Surveillance Assistants. The Community Victims Support Unit generally undertakes prevention activities, mediation in case of violence and referral to health facility, police or traditional chief.

Interviews were carried out with Health Surveillance Assistants (HSAs) and members of Village Health Committees (VHCs) who work with communities to address specific health issues. In view of their role is important that they are linked to services addressing violence against women and that they are able to assist community members in negotiating linkages between the health sector, the police and NGOs working on violence, in particular.

However the VHC members described having difficulties in knowing where to refer cases of violence or how to proceed with such cases. Participants described a lack of a referral system between them and the hospital; that they do not share issues on GBV such as number of cases and how to handle them, though they meet to discuss other issues such as malaria and cholera prevention. They also said that they are not trained in prevention of violence and sometimes when they assist victims they are threatened by their partners (the perpetrators).

“Although sometimes we refer survivors of violence to the health facility, health care workers at the facility do not refer them back to us after discharging them from the hospital.” (VHC FGD, rural)

Another issue that arose was in relation to the role that community and religious leaders play in providing counselling, in particular to women experiencing violence. While a number of the interviewees mentioned that it was common for HSAs, VHC members, health workers and SWOs, to recommend that women access such leaders for advice, there is no protocol

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established for such referrals and it is not known whether religious or community leaders would in turn refer women and children to health or social services.

5.4 Summary

This chapter has presented an assessment of the legislative and policy environment and frameworks governing the health sector’s response to violence against women and children with qualitative research findings summarising a wide range of perspectives. Interviews were conducted with community members, with key informants, with health care workers and with a range of other stakeholders to elicit their perceptions of the various documents including of the multi-sectoral response to violence.

Section 5.1 involves the analysis of the legal framework. The analysis revealed that the Malawi government has shown intent to end violence in Malawi by ratifying different human rights instruments and stipulating specific issues in relation to protection of children and women and against violence in its various laws and policies governing the affairs of women and children. However, the major challenge now is that these instruments cannot be relied upon by women and children in national courts because, with the exception of some of the provisions in them, the instruments have not been domesticated. The other challenge is to ensure that the various conflicting aspects in law in Malawi are harmonised and translated into practice.

Section 5.2 presented an analysis of the relevant formal policies, guidelines, services delivery protocols and training curricula that have MoH recognition. There were a large number of policies, guidelines and training materials that touch on the health sectors response to violence. The most useful of these are the specific guidelines for sexual violence, guidelines for One Stop Centres and the family planning and couples counselling curricula. Pre-service training materials for family planning were found to be well thought through and detailed on GBV. However all available policies were limited in practice by poor dissemination, awareness and implementation with conflicts between documents, lack of funding prioritisation and lack of coordinated reporting being cited as key challenges.

Finally section 5.3 presented the perceptions of linkages between the health sector, government and non-government organisations and agencies and other service providers working on violence issues. There is evidence at national level that inter-sectoral linkages are being developed between the health sector and other key stakeholders but mechanisms for coordination, accountability and reporting need strengthening in order to effectively address

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violence. At the district level there was some evidence of functioning referral pathways in the districts where One Stop Centres are operational and awareness of the role of One Stop Centres and of linkages with police and NGOs. However, service users were very sceptical about the link between police and health services in general and about the response to violence in the majority of districts without OSCs in particular.

Having analysed the legal and policy framework and its perceived utility it is important to link this to a better understanding of perceptions and experiences of intimate partner violence from the perspectives of survivors, community members and service providers. This is critical in understanding not only how legislation, policy and strategy can be improved but also to understanding under what circumstance and why people access and implement the services in practice. Laws and policieswill never become living useful documents without a deeper understanding of intimacy and of violence in intimate relationships and how this plays out in the communities that the health sector is serving. Chapter 6 explores perceptions of IPV in Malawi.

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