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Responding to pervasive sexual violence on South Africa’s platinum belt
Médecins Sans Frontières (MSF) published a report 'Untreated violence: critical gaps in medical and clinical forensic care for survivors of sexual violence in South Africa' on Tuesday 28th November examining the critical gaps in medical and forensic care for survivors of sexual violence in South Africa.
Sexual violence may cause HIV and other sexually transmitted infections (STIs), unwanted pregnancy and mental health disorders. With prompt treatment by appropriately trained healthcare workers associated health consequences can be avoided or reduced. Providing survivors of sexual violence with access to comprehensive care is a medical imperative.
MSF has been working since 2015 to capacitate several designated public health facilities in the platinum belt as ‘Kgomotso Care Centres’, providing a comprehensive package of medical services (including clinical forensic services), as well as psychological and social services to survivors of sexual violence.
With the objective of verifying whether designated facilities have the capacity to provide comprehensive medical and clinical forensic care for survivors of sexual violence, Medicins Sans Frontieres conducted a nation-wide telephonic mapping of designated facilities in October 2017, providing an initial overview of what service provision gaps exist at designated facilities. The mapping, together with MSF experience working with the North West Department of Health in Bojanala District, informs recommendations on how to improve the provision of care in the future. Since 2015, MSF has supported the North West Department of Health (NWDoH) in providing comprehensive patient-centered services for survivors of sexual violence in Bojanala District.
The Department of Health (DoH) has designated 265 public healthcare facilities – mostly hospitals – across all provinces to provide medical and psychological care to survivors of sexual violence, as well as the option of clinical forensic services. Of these, 55 designated facilities are specialized, interdepartmental Thuthuzela Care Centers (TCC), based on hospital premises – so-called “one-stop-shops” for survivors of sexual violence, catering for their medical, mental health, social assistance, and legal needs. Other designated facilities – also hospital-based – extend access to essential medical and clinical forensic care to survivors of sexual violence who cannot easily access the TCCs. Designated health facilities should provide survivors of sexual violence with the care that addresses all possible health consequences.
Comprehensive medical and forensic care are currently not widely available to survivors of sexual violence in South Africa. Urgent interventions are required to ensure that access to services improves so that survivors of sexual violence can receive care to prevent or reduce the serious health consequences of rape, and pursue legal resolution if they wish to do so.
To close the gaps in healthcare provision for sexual violence survivors, MSF calls for the South African government to take urgent action on the following:
• Public health care services that address survivors’ medical, clinical forensic, mental health and social assistance needs should be more widely available throughout the country and extended to primary care settings. Robust referral networks between services should be established through interdepartmental cooperation.
• Train staff in the medical, psychological and social management of sexual violence. In the context of health facilities, task-shifting to professional nurses could ensure that quality clinical services are more widely accessible to survivors.
• Develop and make available clearer requirements as to what constitutes comprehensive care for survivors, in policy, National Directives and Instructions. Monitoring and evaluation of required services provided at designated facilities should be established to track the quality of service provision.
• The Department of Social Development, Department of Health, and other stakeholders must work together to improve community awareness and utilization of sexual violence services.
• National Department of Health, Department of Social Development and Department of Justice should undertake a more detailed assessment of service delivery gaps and develop an interdepartmental strategic plan to address issues identified by mid-2018.