Abstract
BackgroundFor a comprehensive health sector response to intimate partner violence (IPV), interventions should target individual and health facility levels, along with the broader health systems level which includes issues of governance, financing, planning, service delivery, monitoring and evaluation, and demand generation. This study aims to map and explore the integration of IPV response in the Spanish national health system.MethodsInformation was collected on five key areas based on WHO recommendations: policy environment, protocols, training, monitoring and prevention. A systematic review of public documents was conducted to assess 39 indicators in each of Spain’s 17 regional health systems. In addition, we performed qualitative content analysis of 26 individual interviews with key informants responsible for coordinating the health sector response to IPV in Spain.ResultsIn 88% of the 17 autonomous regions, the laws concerning IPV included the health sector response, but the integration of IPV in regional health plans was just 41%. Despite the existence of a supportive national structure, responding to IPV still relies strongly on the will of health professionals. All seventeen regions had published comprehensive protocols to guide the health sector response to IPV, but participants recognized that responding to IPV was more complex than merely following the steps of a protocol. Published training plans existed in 43% of the regional health systems, but none had institutionalized IPV training in medical and nursing schools. Only 12% of regional health systems collected information on the quality of the IPV response, and there are many limitations to collecting information on IPV within health services, for example underreporting, fears about confidentiality, and underuse of data for monitoring purposes. Finally, preventive activities that were considered essential were not institutionalized anywhere.ConclusionsWithin the Spanish health system, differences exist in terms of achievements both between regions and between the areas assessed. Progress towards integration of IPV has been notable at the level of policy, less outstanding regarding health service delivery, and very limited in terms of preventive actions.
Highlights
For a comprehensive health sector response to intimate partner violence (IPV), interventions should target individual and health facility levels, along with the broader health systems level which includes issues of governance, financing, planning, service delivery, monitoring and evaluation, and demand generation
In Spain the primary responsibility for health system implementation lies at the regional level, in this study we explored the 17 regional health systems of the autonomous regions; the autonomous cities of Ceuta and Melilla, located in the North of Morocco were excluded since their health systems depend on a different structure (INGESA)
Research methodology This study aims to map and explore the integration of IPV response in the Spanish national health system
Summary
For a comprehensive health sector response to intimate partner violence (IPV), interventions should target individual and health facility levels, along with the broader health systems level which includes issues of governance, financing, planning, service delivery, monitoring and evaluation, and demand generation. The most recent global estimates of IPV has devastating effects on the health and wellbeing of women and children [1,3,5,6]. Especially primary health care, can be an IPV survivor’s first and only point of contact with public service professionals [7,8]. This contact can open doors for improved health and wellbeing; research shows that trained health providers improve IPV detection and referral to specialist violence agencies [9] - where intensive advocacy interventions can be provided [10]. A recent randomised controlled trial conducted in Australia showed that screening and brief counselling in primary care settings improved doctors’ follow up inquiry about women’s and children’s safety at 12 months, but did not improve other outcomes, such as quality of life, safety behaviour or anxiety [11]
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