Providing protection services for survivors of sexual abuse in malawi
Download
1 / 28

Providing Protection Services for Survivors of Sexual Abuse in Malawi - PowerPoint PPT Presentation


  • 84 Views
  • Uploaded on

Providing Protection Services for Survivors of Sexual Abuse in Malawi. Dr Neil Kennedy - Assoc Prof Paediatrics, College of Medicine, University of Malawi Dr Yabwile Mulambia – Paediatric registrar, College of Medicine, University of Malawi Prof Geraldine MacDonald - QUB. MALAWI. Blantyre.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Providing Protection Services for Survivors of Sexual Abuse in Malawi' - kenyon


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Providing protection services for survivors of sexual abuse in malawi

Providing Protection Services for Survivors of Sexual Abuse in Malawi

Dr Neil Kennedy - Assoc Prof Paediatrics, College of Medicine, University of Malawi

Dr YabwileMulambia – Paediatric registrar, College of Medicine, University of Malawi

Prof Geraldine MacDonald - QUB


MALAWI in Malawi

Blantyre


Malawi
Malawi in Malawi

  • Population 15.9 million

  • 52% less than 18yrs

  • 1 million orphans

  • 11% HIV prevalence

  • Falling under-5 mortality


Child sexual abuse in malawi
Child Sexual abuse in Malawi in Malawi

  • School-based survey 2005

    • 1 in 4 children had forced or unwanted sex by 16

    • 88.4% knew perpetrator

  • MoH Welfare monitoring survey 2011

    • 5% of children 12-18 had been raped in the previous 12 months


Response to csa in malawi
Response to CSA in Malawi in Malawi

  • Advocacy 

  • Legal / policy framework 

    • CSA guidelines 2005

    • UNCRC

    • 2010 Act

  • Provision of services for survivors 


February 2009 disjointed service
February 2009 – disjointed service in Malawi

  • Police Station

  • Victim Support Unit

No psychological support



Hospital QECH

Social Services


February 2009 problems
February 2009 - problems in Malawi

  • Poor recognition and facilities for CSA at QECH

  • Poor communication with police

    • Were we seeing all the referrals?

    • Were police following up on reports?

    • Did police understand the reports? (particularly if no medical findings WHICH ARE OFTEN NORMAL)

  • Little or no contact with social services

    • Were children being protected from further abuse?

    • Did social services hear about abused children?

  • Lack of psychological victim support

  • Unknown prosecution rate

  • No coordinated service for victims


March 2009
March 2009 in Malawi

  • Meeting of key stakeholders from:

    • Police – Commissioner child protection

    • Justice – JusticeTwea (NJJF)

    • Social services – Director Social Welfare

    • Medicine

    • UNICEF

    • Partnership to Protect Children

  • Establishment Blantyre Child Protection Team

  • Commitment to build ‘One-Stop Centre’ at QECH



One stop centre
One-Stop Centre in Malawi


One stop centre services
One-Stop Centre Services in Malawi

  • Senior doctors trained in diagnosis of CSA and abuse

  • Services for women and children

  • 24 hours a day PEP / VCT / EC

  • Specialist child protection social worker

    • Ensure place of safety

    • Coordination with local CCPW and police

  • Police victim support

  • Volunteer led child trauma counselling



Evaluation of osc services to determine
Evaluation of OSC services to determine: in Malawi

  • The proportion of children attending that received services in accord with national guidelines.

  • The factors that encourage or discourage the use of the service by children and their families

  • The perceptions of quality of child protection services amongst service users and providers


Methods
Methods in Malawi

  • Investigator administered questionnaire in cohort of families of survivors 3 months after presentation

  • In-depth interviews with 25 of these families

  • IDI with 10 members of staff

  • August 2012-June 2013

  • Consented at presentation and re-consented at 3 months

  • Data collected in homes of survivors


228 Survivors of CSA in Malawi

All consented to follow up

59 lost to follow up

62 withdrew consent

107 participants re-consented at 3 months

25 In-depth interview

107 questionnaire


Moh guidelines
MOH guidelines in Malawi

  • Adequately handled case:

2005 Malawi National Guidelines

WHO guidelines



Factors encouraging service use why do they come
Factors encouraging service use – why do they come? in Malawi

  • Multiple overlapping responses

    • fear of contracting HIV / need for prophylaxis-19/25

    • Justice-3/25

    • counselling -2/25

    • Pregnancy- 1/25

    • were referred by the police-1/25

    • Verification of rape- 5/25

      “What we really wanted to find out was the HIV status of the child since there is AIDS…”


Perceptions of quality
Perceptions of quality in Malawi

73.8% (79/107) satisfied with the service

26.2% (28/107) were not satisfied with the service

  • 21- Police

    • 9 corruption-police

    • 3 negligence by the police

  • 4 -Justice

    • Sentence too short

  • 2 - health services

    • PEP not provided

    • Medical exam took too long

  • 1- counselling (required more sessions)


“She (Mercy) has been raped by her step-father since 2011. At first she told her aunt, her uncle, then neighbors, her teacher at school but none helped her…she also reported to the police …who gave a letter to give to her step-father for him to go to the police…”

  • “She was raped by 5 men of whom some were children of our neighbours. Its been five months since we first went to court. We were awaiting evidence given by the police. We went to court that morning and the police didn’t show up. The police officer present used our airtime to call him and he answered saying, “why did not you tell me all this time I would have prepared, I don’t have transport”. These men still keep threatening the girl”


Provider perceptions
Provider perceptions At first she told her aunt, her uncle, then neighbors, her teacher at school but none helped her…she also reported to the police …who gave a letter to give to her step-father for him to go to the police…”

  • Offered a good service, but that conviction rates (27%) should be higher.

  • Lack of transport funds hinders appropriate social welfare provision.

  • Many magistrates, investigators and prosecutors still lack the basic skills to deal appropriately with child survivors of sexual abuse.


Conclusions
Conclusions At first she told her aunt, her uncle, then neighbors, her teacher at school but none helped her…she also reported to the police …who gave a letter to give to her step-father for him to go to the police…”

  • The OSC model is an appropriate means to deliver high quality care to CSA survivors in urban Malawi

  • Fear of contracting HIV is driving disclosure


An opportunity exists to break the cycle of abuse
An opportunity exists to break the cycle of abuse At first she told her aunt, her uncle, then neighbors, her teacher at school but none helped her…she also reported to the police …who gave a letter to give to her step-father for him to go to the police…”

  • Shame

  • Fear

  • Stigma

  • No use

DON’T TELL TELL


  • Shame At first she told her aunt, her uncle, then neighbors, her teacher at school but none helped her…she also reported to the police …who gave a letter to give to her step-father for him to go to the police…”

  • Fear

  • Stigma

  • No use

  • Fear of HIV

  • Justice

DON’T TELL TELL


Conclusions1
Conclusions At first she told her aunt, her uncle, then neighbors, her teacher at school but none helped her…she also reported to the police …who gave a letter to give to her step-father for him to go to the police…”

  • Corruption amongst police is perceived to reduce prosecution rates.

  • Lack of transport reduces the effectiveness of the service.

  • Further training of prosecutors and magistrates to handle CSA cases is required


Next steps
Next steps At first she told her aunt, her uncle, then neighbors, her teacher at school but none helped her…she also reported to the police …who gave a letter to give to her step-father for him to go to the police…”

  • Complete the analysis – harm from OSC?

  • Highlight availability of PEP to encourage disclosure

  • Secure sustainable funding for transport / communication

  • Roll-out training to reflect community perceptions of services provided

  • Specific training for prosecutors / investigators and magistrates of CSA


Acknowledgments
Acknowledgments At first she told her aunt, her uncle, then neighbors, her teacher at school but none helped her…she also reported to the police …who gave a letter to give to her step-father for him to go to the police…”

  • UKaid

  • UNICEF

  • Association of Physicians

  • Members of the one-stop-centre team

  • Parents and children willing to share their story


ad