An integrated health sector response to violence against women in Malaysia: lessons for supporting scale up
An integrated health sector response to violence against women in Malaysia: lessons for supporting scale up
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DOI：
10.1186/1471-2458-12-548
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发表时间：
2012-07-24
影响因子：
4.5
通讯作者：
Watts, Charlotte
中科院分区：
文献类型：
--
作者：
Colombini, Manuela;Mayhew, Susannah H.;Watts, Charlotte
背景：马来西亚一直处于发展和扩大一站式危机中心（OSCC）的最前沿，这是一种综合卫生部门模式，为遭受身体、情感和性虐待的妇女和儿童提供全面护理。本研究探讨了将 OSCC 模式扩大到马来西亚两个州期间所面临的优势和挑战，以便找出支持成功扩大规模的经验教训。方法：对 7 家医院机构的医疗保健提供者、政策制定者和关键信息提供者进行了深入访谈。医院记录和协议的文件分析对此进行了补充。使用 NVivo 7 对数据进行编码和分析。结果：OSCC 模型的实施因医院环境而异，实践受到组织系统和约束的影响。卫生服务提供者通常试图为受虐待的妇女提供护理，但由于缺乏培训、时间限制、分配的预算有限或缺乏外部支持服务的转诊系统，他们在其机构内得不到充分支持。这两个州的非专科医院都面临着缺乏专业人员和受虐妇女转诊选择有限的问题。尽管存在这些挑战，即使在资源更加有限的环境中，主动采取行动的工作人员也发现可以适应提供一定程度的 OSCC 服务，例如将妇女转介给当地非政府组织或社区支持团体，或培训护士提供基本咨询。结论：OSCC 的全国实施为遭受暴力的妇女提供了潜在的重要支持来源。我们的研究结果证实，只有拥有健全的卫生基础设施（即支持性卫生系统），卫生部门应对性别暴力的试点干预措施才能扩大规模。此外，在其他类似环境中成功复制 OSCC 模式要求该模式以及支持该模式的系统足够灵活，以允许服务模式适应不同类型的设施和护理水平以及可用资源，从而更好地支持致力于为受虐待妇女提供护理的提供者。
Background: Malaysia has been at the forefront of the development and scale up of One-Stop Crisis Centres (OSCC) - an integrated health sector model that provides comprehensive care to women and children experiencing physical, emotional and sexual abuse. This study explored the strengths and challenges faced during the scaling up of the OSCC model to two States in Malaysia in order to identify lessons for supporting successful scale-up.Methods: In-depth interviews were conducted with health care providers, policy makers and key informants in 7 hospital facilities. This was complemented by a document analysis of hospital records and protocols. Data were coded and analysed using NVivo 7.Results: The implementation of the OSCC model differed between hospital settings, with practise being influenced by organisational systems and constraints. Health providers generally tried to offer care to abused women, but they are not fully supported within their facility due to lack of training, time constraints, limited allocated budget, or lack of referral system to external support services. Non-specialised hospitals in both States struggled with a scarcity of specialised staff and limited referral options for abused women. Despite these challenges, even in more resource-constrained settings staff who took the initiative found it was possible to adapt to provide some level of OSCC services, such as referring women to local NGOs or community support groups, or training nurses to offer basic counselling.Conclusions: The national implementation of OSCC provides a potentially important source of support for women experiencing violence. Our findings confirm that pilot interventions for health sector responses to gender based violence can be scaled up only when there is a sound health infrastructure in place - in other words a supportive health system. Furthermore, the successful replication of the OSCC model in other similar settings requires that the model - and the system supporting it - needs to be flexible enough to allow adaptation of the service model to different types of facilities and levels of care, and to available resources and thus better support providers committed to delivering care to abused women.