Are We Asking Too Much of the Health Sector? Exploring the Readiness of Brazilian Primary Healthcare to Respond to Domestic Violence Against Women.
Are We Asking Too Much of the Health Sector? Exploring the Readiness of Brazilian Primary Healthcare to Respond to Domestic Violence Against Women.
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DOI：
10.34172/ijhpm.2020.237
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发表时间：
2022-07-01
影响因子：
3.5
通讯作者：
Colombini M
中科院分区：
文献类型：
--
作者：
d'Oliveira AFPL;Pereira S;Bacchus LJ;Feder G;Schraiber LB;Aguiar JM;Bonin RG;Vieira Graglia CG;Colombini M
背景：人们日益认识到卫生部门在解决对妇女的家庭暴力方面的潜在作用。尽管巴西有一个关于暴力侵害妇女问题的全面政策框架，但在初级保健方面的执行工作一直缓慢而不完整，而且对执行工作面临的挑战知之甚少。本文旨在评估准备在巴西城市的两个初级保健诊所整合干预，以加强其家庭暴力的反应。 研究方法：我们对卫生管理人员和卫生服务提供者进行了20次半结构化访谈;对圣保罗和巴西的暴力侵害妇女和家庭暴力政策进行了文件分析;并进行了2次结构化设施观察。采用专题分析法对数据进行了分析。 结果如下：我们的准备评估结果显示，需要解决的现行政策和实践中的差距，特别是在治理和领导，卫生服务组织和卫生工作人员方面。家庭暴力在政治上得到的承认较少，与其他健康问题相比，家庭暴力被视为较低的优先事项。中央和市一级缺乏明确的指导，成为削弱提供者和管理者执行家庭暴力政策的一个关键因素。此外，对家庭暴力的应对措施失去了可见度，因为这些措施被一般性的暴力应对措施所冲淡。圣保罗初级保健系统的组织结构优先考虑咨询和家庭访问的数量作为主要业绩指标，这是使保健提供者有时间处理家庭暴力问题合法化的另一个困难。提供者报告的个人层面的挑战包括缺乏时间和如何应对的知识，以及对处理家庭暴力的恐惧。 结论：评估准备情况至关重要，因为它有助于评估已经到位的服务和基础设施，还有助于在实施前确定可能阻碍调整和整合干预措施的障碍，以加强对家庭暴力的应对。
Background: There is growing recognition of the health sector’s potential role in addressing domestic violence (DV) against women. Although Brazil has a comprehensive policy framework on violence against women (VAW), implementation has been slow and incomplete in primary healthcare (PHC), and little is known about the implementation challenges. This paper aims to assess the readiness of two PHC clinics in urban Brazil to integrate an intervention to strengthen their DV response. Methods: We conducted 20 semi-structured interviews with health managers and health providers; a document analysis of VAW and DV policies from São Paulo and Brazil; and 2 structured facility observations. Data were analysed using thematic analysis. Results: Findings from our readiness assessment revealed gaps in both current policy and practice needing to be addressed, particularly with regards to governance and leadership, health service organisation and health workforce. DV received less political recognition, being perceived as a lower priority compared to other health issues. Lack of clear guidance from the central and municipal levels emerged as a crucial factor that weakened DV policy implementation both by providers and managers. Furthermore, responses to DV lost visibility, as they were diluted within generic violence responses. The organizational structure of the PHC system in São Paulo, which prioritised the number of consultations and household visits as the main performance indicators, was an additional difficulty in legitimising healthcare providers’ time to address DV. Individual-level challenges reported by providers included lack of time and knowledge of how to respond, as well as fears of dealing with DV. Conclusion: Assessing readiness is critical because it helps to evaluate what services and infrastructure are already in place, also identifying obstacles that may hinder adaptation and integration of an intervention to strengthen the response to DV before implementation.
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