Health sector response to gender-based violence in community health care

: mixed method study of the public health midwife service in Sri Lanka

Abstract

Background: Public Health Midwives (PHMs) in Sri Lanka are expected to identify women
experiencing gender-based violence (GBV) in the community, provide support, and refer them
to Mithuru Piyasa (MP), hospital-based gender-based violence care centres. The Family
Health Bureau within the Ministry of Health has developed guidelines for health workers and
provides training for PHMs on GBV services. However, the referral rate from the community
health sector is alarmingly low, accounting for less than 10% of the total clients. Therefore,
further investigation is required to ensure the programme's effectiveness.
Objective: My research aimed to assess the reasons for low detection and referrals of GBV
survivors by PHMs in community health care settings in the current GBV programme and
develop a theory of change to enhance the existing GBV programme, with the objective of
increasing the identification and referral, and to develop recommendations for an improved
GBV programme.
Methods: An explanatory sequential mixed-method study was conducted. The study
involved an initial phase of quantitative data collection from 803 PHMs using a modified
Provider Intervention Measure questionnaire that was culturally adapted for the Sri Lankan
context. This was followed by semi-structured qualitative interviews with 12 PHMs who
completed the survey. The survey and interview data were Integrated and analysed.
Results: Although over three-quarters of PHMs attended GBV training in their lifetime, they
were trained using different methods and trainers. Moreover, many received training a long
time ago and could not recall any of the training content. Only a third were trained by the
Family Health Bureau. Most PHMs expressed their willingness and readiness to help GBV
victims, but only one-sixth had identified and referred GBV victims. The majority were not
aware of the existing GBV or the existence of MP GBV care centres.
Conclusion: These findings form the foundation of my recommendations to improve the GBV
services provided by PHMs: 1. Ensure that all PHMs receive comprehensive training on GBV,
including available support services, with regular refresher training. 2. Strengthen MP services
in all areas and establish coordination between PHMs and MP services. 3. Implement
monitoring and evaluation mechanisms for GBV services by PHMs at institutional and regional
levels. Utilise the data obtained to ensure ongoing programme improvement.

Date of Award	10 Dec 2024
Original language	English
Awarding Institution	University of Bristol
Supervisor	Gene S Feder (Supervisor), Natalia Lewis (Supervisor), Bacchus Loraine (Supervisor) & Thilini Rajapakse (Supervisor)