Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
9. Referrals to other service
providers
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Aim of this module
• To understand the importance of referral
systems in facilitating access of survivors of
GBV to multi-sectoral services
• To learn about the actors involved, the
requirements for effective referrals, and the
steps for developing and implementing
referral systems
• To learn about practical resources for health
care professionals and patients to facilitate
referrals
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Outlook
•
•
•
•
Definition of a referral system
Key actors involved in a referral system
Developing and implementing an effective
referral system - steps and recommendations
What health care professionals can do in the
absence of a referral system
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Definition of a referral system
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Defining referrals
Referrals are the processes of
• how a woman gets in touch with an individual
professional or institution about her case
• how professionals and institutions communicate
and work together to provide her with
comprehensive support
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Defining referral systems
A comprehensive
institutional framework
that connects various
Protection and
assistance of
entities with well-defined
survivors
and delineated mandates,
responsibilities and
powers into a network of
cooperation to ensure the
3 p’s:
Prosecution of
Prevention of
perpetrators
GBV
(UNFPA 2010)
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Importance of referral systems
• Survivors of GBV have multiple and complex
needs that require a comprehensive set of
services
• One single organization cannot provide all these
services
Coordinated multi-sectoral response is
necessary
A referral system = institutional framework
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Benefits of referral systems
Patient:
• Access to comprehensive and specialized care and
support, tailored to individual needs
Health care professional:
• First contact for survivors  important entry point
• Benefit from support and expertise from other partner
organizations  relief from work load
• Knowing that other needed services exist  increase
confidence to ask about GBV
• Able to adequately act upon the identification of a
survivor
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Levels of referral mechanisms
National
Regional
Community/municipal
 Example of setting up a local-level referral
mechanism in Kyrgyzstan
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Requirements of effective referrals
Health care professionals
Health
facilities/management
• Able to recognize GBV and
facilitate disclosure
• Able to assess the patient‘s
individual situation & needs
• Know about the existing
referral system and services
• Know about national laws
on GBV
• Obtain consent from patient
before sharing information
• Ensure ongoing capacity
building of staff (e.g. IRIS
intervention, UK)
• Multi-sectoral trainings: first
step to establishing
partnerships
• Put in place a coordinated
mechanism to monitor
services and improve
quality
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Capacity building improves referrals –
example: IRIS (UK)
• IRIS: Identification & Referral to Impove Safety
• 24 general practices in London and Bristol:
– training of health care professionals and admin staff
– establishment of simple referral pathway to specialist
DV service provider
– technical support to practice teams
• Evaluation: compared to 24 control practices
• Results: intervention practices showed
– 3 times higher identification rate
– 21 times more recorded referrals (compared to control
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practices)
Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Key actors involved in a referral
system
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Overview
Specialized
women’s
support services
General support
services
Police and
judiciary
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Standards for specialized women’s
services
• Run by independent women’s organizations
• Receive adequate financial support from the state
• Be specialized in two ways:
1.
2.
especially targeted at women survivors and their children
specialized on VAW as a gender specific form of
violence
• Apply a survivor-/women-centred, gender-sensitive &
human rights-based approach
• Be run and provided by women
• Be provided by professional staff trained on working with
survivors of GBV
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Types of providers of specialized
women’s services
•
•
•
•
Women‘s helplines
Women‘s shelters
Women‘s centres
Services specialized on supporting
survivors of sexual violence
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
General support services
• Funded and provided by state authorities
• Not designed for survivors of GBV –
benefit public at large
• Examples: health services, housing,
financial support, child welfare
• Complement, but not replace specialized
women’s services
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Police and judiciary
• Police, criminal justice system
– Investigation and prosecution of GBV,
determine criminal liability of defendant
– Police restraining orders (in some countries)
• Civil courts
– Divorce
– Child custody
– Protection orders (in some countries)
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Developing and implementing an
effective referral system - steps
and recommendations
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Step 1: Situation analysis and mapping
of services
• Obtain a comprehensive picture on the scope of
GBV, the legal framework on GBV and available
services – including gaps
• Identify entry points and potential referral
partners
• Look at national, regional, local levels
• Use a mix of sources and methodologies:
– official data and NGO reports
– desk research, qualitative interviews, focus group
discussions
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Step 2: Setting up a referral directory
• Organize information collected on service
providers in a referral directory
– Contact information
– Types of service provided, population served
– Criteria for eligibility/admission
• It’s a useful reference document for health care
providers when making referrals to other services
(also in the absence of a formal referral system)
• Management should
– provide copies to all staff (or at least one copy in a
convenient, accessible place)
– gather feedback from staff and ensure regular updates
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Step 3: Formalizing the partnership (1)
• How: Memorandum of Understanding (MoU),
inter-agency protocol
• Why: Provide an institutionalized basis for
effective coordination  sustainability
• What: Formalize cooperation
– Define roles and responsibilities of actors
involved
– Common principles for service provision
– Devise referral pathway (to whom to refer the
survivor, when, where, how)
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Step 3: Formalizing the partnership (2)
• Prerequisites:
– Develop work relationship based on trust
– Common understanding of GBV and vision of
how to respond, shared by all partners
– Willingness to share information on how
cases are handled on to accept feedback
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Components
of effective referral systems (3)
Joint vision
Joint strategy and
operational plan
Workable structure:
1) strategic group
2) operational arm +
thematic sub-groups
Adequate resources
(personal and
financial)
Standardized
protocols and
procedures
Coordinator playing
a facilitating role BUT participating
organizations make
the partnership work!
Government &
NGO
representation
Training of all
professionals involved
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Step 4: Providing staff with information
resources (1)
• Informing the patient of available services is
key to help her identify the most suitable
options
• Written information for patients need to be
discreet
• Examples:
– What: posters with tear-off slips, pamphlets,
brochures
– Where: examination rooms, women’s toilets
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Step 4: information resources (2)
• Examples (continued):
– Pocket–size lists of phone numbers
– Phone numbers in form of barcodes
(stickers, lip balms)
– Key rings with hidden information
– Key rings with personal alarms
Source: Standing Together against Domestic Violence (UK)
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
What health care professionals
can do in the absence of a formal
referral system
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Strengthening Health System Responses to Gender-based Violence in EECA: A resource package
Some ideas
• Use follow-up appointments to check on
patient’s well-being
• Consider establishing basic services in-house
– e.g. crisis intervention, support groups, overnight
accommodation in hospitals
– example: victim-support rooms (Tajikistan)
• Establish a referral directory and refer patient
to known service providers
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