DBV Surveillance SystemBelize Englebert Emmanuel MHM, Bsc. Ag. Director & National Surveillance Officer Epidemiology Unit Ministry of Health
Overview • National and local multisectorial system which started in 1999, • The MOH is the Institution or Ministry that ensures the implementation and provide the over sight of the surveillance system.
BACKGROUND • MOH, Belize, recognizes gender based violence as an important public health issue, which is PREVENTABLE, • Health sector is an important entry point for women and others affected by gender based violence, • The framework to address gender based violence is built on the conceptualization of health as a social product linked to the life conditions of men and women,
BACKGROUND • The system is based on the idea of detection, attention, prevention and promotion, • The objective is to draw the commitment of different sectors in the fight against domestic violence, • It is designed as a multi-sectoral response spearheaded by the Ministry of Health - MOH ,
BACKGROUND • Domestic Violence is included in the MOH Sexual and Reproductive Health Policy, • MOH/ MoHD in conjunction with key partners and stakeholders developed a National Action Plan for the Attention of Family Violence which is now Gender Based Violence and is part of the Sexual and Reproductive Health Plan, • Training: Sensitization for all sectors in Domestic Violence Counseling,
BACKGROUND • In 2003 the national response and surveillance system were evaluated by PAHO and CDC, • The system improved significantly since to collect information on homicides, detailed information on child abuse and rape out side of the home which was not included at the inception of the system.
GENDER BASED VIOLENCE SURVEILLANCE MODULE • The Gender Based Violence Surveillance is still a component of the National Health Information System (NHIS) and will be integrated into the new health Information System (BHIS), • The system uses a computerized menu-driven application which registers, stores, processes and produces information at the national and local levels, • The NHIS is an integrated decentralized information system which operates as a network with external locations coordinated by the Epidemiology Unit (central), • Six District Health Information Units (DHIU) coordinates the surveillance system at the local level,
GENDER BASED VIOLENCE SURVEILLANCE MODULE • The primary source of data collection is done using the data collection instrument (DV Forms) developed to capture relevant information of each episode, • The cases are reported and captured as the event occurs or reported (point of contact), • The form is filled out in triplicate, the original copy is given to the victim, the other is sent to MOH District Information Unit and the third copy is kept on the patients file in strict confidentiality,
GENDER BASED VIOLENCE SURVEILLANCE MODULE • District Health Information Unit compiles data and send information weekly via e-mail or CDs to the Central Unit in Belmopan, • DHIU also produces standardized reports at local levels.
Sectors; Participating, Collection/Production of Information • Health • Police • Women Department • NGOs • Family court
Information Users • Health • Police • Women´s Commission • NGOs • Media networks • Stakeholders
Statistical tables generated quarterly Victims • Cases by age, by sex, by district • Incidence rate by age, by sex, by district • Incidence rate by age group, by sex, by district, by country • Civil status by district • Percentage during pregnancy by age, by district • Ethnicity by district • Employed by district • Institution reporting by type of abuse, by age, by sex, by district Aggressor • Total by sex, by age, by district • Use of alcohol and drugs by type of violence • Schooling level by district • Employed by district • Ethnicity of aggressor by district
Statistical tables generated quarterly Incident • Incidence rate • Day of the week by district • Time of the day by district • Type of abuse, injury, age by district • Institution reporting type of abuse • Place of incident by district • Relation of aggressor to male client by district • Relation of aggressor to female client by district • Outcome for the client by district • Institution where the client was referred
Statistical tables generated quarterly Child abuse • Incidence and prevalence rate by sex, by district • Day of the week, by district • Time of the incident, by district • Type of abuse, injury, age by district • Institution reporting type of abuse • Place of incident by district • Relation of aggressor to male client by district • Relation of aggressor to female client by district • Outcome for the client by district • Institution where client was referred
Statistical tables generated quarterly Sexual abuse • Incidence and prevalence rate by sex, by district • Place of the incident • Day of the week when the incident occurred • Cases during pregnancy by district • Reporting institution by district • Relation of aggressor to male client by district • Relation of aggressor to female client by district • Outcome for the client by district • Institution where client was referred
Cases by Sex : Belize 2004- 2009 Source : The Epidemiology Unit, MOH Belize
Cumulative Cases reported by District of residence: Belize 2004-2009 Source : The Epidemiology Unit, MOH Belize
Cases by Type of Violence and Sex Belize 2004- 2009 N= 17109 Source : The Epidemiology Unit, MOH Belize
GENDERBASED VIOLENCE • Women have less control than their male partners over the use of protection, distribution of resources and access to health services, it’s more dangerous for them to refuse unsafe sex, • Women are the majority of rape victims, a direct risk factor for HIV, • Girls and boys who are victims of physical and/or sexual abuse during childhood are more likely to exhibit high-risk sexual behavior later in life, lowered self-esteem, and decreased ability to negotiate safer sex.
legal framework and institutional mechanisms that exist to deal with the problem • The Domestic Violence Surveillance Data Report, • Families and Children’s Act, • The Firearms Act addresses the manufacture, possession and trade of firearms, • Domestic Violence Act.
relevant interventions, Implemented programs and achievements • The Police Department has a family violence unit that addresses complaints of spousal abuse, • A shelter for battered women offers short-term housing, • The Belize Organization for Women and Development, an NGO, advises women on their rights and provides counseling.
relevant interventions, Implemented programs and achievements • Sixteen Days of Activism Against Gender based Violence observed during the month November each year • December HIV/AIDS days
relevant interventions, Implemented programs and achievements • The surveillance system on gender based violence involves all key partners that approach these cases, • In some areas we are still experiencing poor registration of cases, • The timeliness of report is still a challenge for the Ministry of Health; this situation has improved but needs to be strengthened at the local level, • This surveillance system is unique in the Caribbean and Central American regions and can contribute to the development of one similar in other countries.
Impact of the system • It strengthen alliances between surveillance systems of different sectors to facilitate referrals, follow-up, and sharing of results, • It contributed to the protection and improve care of victims of violence.
Way forward for Belize • Develop a standard integrated plan and protocol for the treatment of victims, • Develop an Integrated Gender-based Violence Surveillance System Protocol, • Develop Training Manual inclusive of protocol to be used as reference and training guideline for new staff, • Conduct training and retraining of administrators of the surveillance system , • Develop a generic template for Gender-based Violence analysis, • Prepare Gender-based Violence report for 2004-2009.