A Qualitative Evaluation of Medico-Legal Services in Gauteng, South Africa: Service Accessibility and Quality of Care to Rape Survivors

Abstract

Research findings and the recent prioritised focus on South African women\'s health and safety issues have highlighted the extent of the problem of rape in South Africa. At the same time it has brought into the foreground the critical role of the health sector in terms of its particular capacity and its unique position in delivering health and safety promotion interventions, preventing secondary victimisation of survivors of sexual assault and, importantly, in delivering accessible, quality services to survivors. It has been charged that victims of sexual violence in South Africa continue to face a health system that is limited, inaccessible, unco-ordinated and ineffective. Against this backdrop, a qualitative evaluation was undertaken to ascertain the current status of medico-legal services in the Province of Gauteng in South Africa against the Health Department\'s stated objectives and various other stakeholders\' views of how the service can and should function. The scope of the evaluation included an assessment of the structure and process of after-care services for adult rape survivors at 26 medico-legal centres in Gauteng. The evaluation framework included a focus on issues related to the availability, accessibility, quantity, effectiveness and acceptability of the services. Attention was granted to the views of various service agents involved in the care and management designed to evaluate the medico-legal clinics. This article presents the findings that emerged from the ‘accessibility\' component of the evaluation, and focuses on the impact thereof on the quality of care provided to rape survivors. Findings suggest that service accessibility of medico-legal clinics in Gauteng remains flawed in many respects. Although the medico-legal system is increasingly engaged in developing and improving service accessibility at district and regional levels, these reform efforts have not been consistently applied across the province, and furthermore continue to be hampered by a serious lack of human and financial resources. Recommendations to enhance service accessibility, and therefore quality of care, are proposed. It is anticipated that the evaluation will serve to inform the development of quality services based on the principles of best practice, as well as the development of standardised evaluation tools to assess the quality of care provided to rape survivors at medico-legal clinics. African Safety Promotion Vol.1(1) 2002: 24-36