Standards required in maintaining the chain of evidence in the context of post rape care services: Findings of a study conducted in Kenya

Sexual violence (SV) is a serious societal problem that creates significant challenges to local communities in their attempt to create an overall plan for meeting the medical, emotional, physical safety, and legal needs of SV survivors. It is important to understand the existing links between the health sector and police as a basis for addressing the complexities surrounding SV. Appropriate management of SV survivors requires a standardized clinical evaluation, an effective interface with law enforcement for the handling of forensic evidence, and coordination of the continuum of care. From the public health perspective, the issues to be addressed revolve around accessibility of medical services and consistency in quality of care. Public health concerns are also guided by the legal procedures to be observed in the collection of medico-legal evidence by health care providers from the survivor to be used in prosecution of the sexual offenders within the criminal justice system, hence the need for countries to develop standardized mechanisms through which appropriate support will be delivered to survivors of SV from a medical and legal dimension. This report presents the findings of an operations research study conducted in Nyanza and Eastern Province, Kenya, in 2007/8

Health sector inadequacies in attending to child survivors of sexual abuse in Kenya: An operations research

In 2015, LVCT Health (a Kenyan non‐governmental organisation) conducted an exploratory study to assess the quality and comprehensiveness of services provided to child survivors of sexual violence at two public health facilities in Kenya. Both quantitative and qualitative data collection methods were used, including a retrospective review of 164 child survivor medical records, a health facility staff inventory, in‐depth interviews with 31 healthcare providers and 19 exit interviews with 14 child survivors and their caregivers. Ethical approval was obtained from two independent ethics committees. Quantitative data were analysed using SPSS version 22, while qualitative data were analysed using NVivo 10 based on a thematic coding framework. The health facility staff inventory indicated that only two out of 581 providers had undergone previous training on the management of child survivors of sexual violence. Both health facilities lacked the appropriate equipment for the collection of forensic evidence from children and private rooms in which to conduct the clinical examination. Providers cited challenges in offering psychosocial support to children. Only 27 per cent of child survivors were documented to have received trauma counselling. There is a need for health facilities to enhance their human resource and infrastructural capacity to facilitate the delivery of comprehensive care to child survivors

The use of case advocates to manage child survivors of sexual violence in public health facilities in Kenya: A qualitative study exploring the perceptions of child survivors, care givers and health care providers

Background: The uptake of and retention in health services by child survivors of violence (CSV) is a growing challenge, especially in sub-Saharan Africa. While lay health workers have been used in several settings to improve access to health services, there is limited literature on the use of such workers to support services for CSV. Objective: To explore the acceptability of using trained lay health workers (case advocates) to provide basic information and escort CSV to various referral points within two public health facilities in Kenya. Participants: The following participants were enrolled after giving their consent: CSV 14–18 years of age presenting for services along with their caregivers during the study; caregivers above age 18; and healthcare providers (HCPs) providing services for sexual violence at the two study sites. Methods: In-depth interviews (14 with CSV and 27 with caregivers) and four focus group discussions (with 30 HCPs) were conducted. Data were transcribed in MSWord and analysed using a grounded theory analytical approach. Results: Caregivers and CSV reported that the case advocates were useful in fast-tracking access to services, easing CSV movement through health facilities and helping CSV communicate their issues. HCPs reported improved timeliness and completeness of services due to the involvement of the case advocates. Conclusion: The use of case advocates to support CSV is acceptable to children, caregivers and HCPs. Task-sharing between case advocates and HCPs has the potential to improve the uptake of the various services offered to CSV, especially in resource-limited settings