Book Review: A model health system approach to gender-based violence

Abstract

A model health system approach to gender-based violence VIOLENCE AGAINST WOMEN: The Health sector Responds. Velzeboer M, Ellsberg M, Areas CC, Garcia-Moreno C Pan American Health Organization, Washington 2003. Occasional Publication No. 12. 131 pp. THIS EXCELLENT REPORT complements and extends World Health Organisation efforts to emphasise the importance of health sector reform to combat gender-based violence, outlined in the 2002 WHO World Report on Violence and Health. In this case the Pan American Health Organization (PAHO) describes the process, experience and outcomes of model reform undertaken by a collaboration of government and non-government organisations in Central America to improve the health sector as part of an overall response to gender-based violence. For Australian readers interested in Australian health care reform, the value of this report lies both in the proposed model and processes used to drive the reform and the excellent resources section and bibliography. While the report cites the UN definition of violence against women (acts of gender-based violence resulting in harm to women) as the basis for its action, in fact the book addresses mainly responses to intimate partner violence. Section 1, The health sector responds to genderbased violence, profiles the evidence, rationale and processes of model development. The first chapter reviews the health outcomes of violence against women. The second describes findings of what is described as the 'Critical Path' studies in 10 countries. These summarise in-depth interviews with women and service providers in a range of government and non-government sectors about pathways for women and the services they access in order to leave a violent relationship behind. The analysis (unsurprisingly) identified, among other things, that the success of interventions depended on the availability, quality, and coordination of services and most of all on the commitment of providers. Chapter three then goes on to describe important factors (coalition building, legal reform, research dissemination, screening, surveillance and training strategies, etc.) utilised in the participating countries within the PAHO integrated model. This includes suggested strategies (eg, symposia, campaigns) to bring community, legal, education and health sectors together at national and regional levels. The authors argue for the overall incorporation of 'cross-cutting values' of gender equity, participation, and partnerships. Section 2, Lessons learnt from Central America, presents highlights from a participatory process evaluation in four of the countries. Chapter four reviews the legislative reform and other governmental policy changes and their limitations in these countries, which will be of limited interest to Australian readers. Chapter five is most useful, highlighting lessons from the PAHO evaluation of this integrated approach within the health system. The barriers to change are very familiar to Australian readers familiar with health system responses: unhelpful provider attitudes shaped by prevailing cultural norms; victimised women's mistrust of the health system, women's shame and embarrassment about disclosure; providers worried that screening would add another burden to their overstretched capacity; and some providers acknowledging that they have been the victims and abusers themselves. …