National Management Guidelines for the Health Sector ...

1 THE UNITED REPUBLIC OF TANZANIA. MINISTRY OF Health AND SOCIAL WELFARE. National Management Guidelines FOR THE Health Sector . RESPONSE TO AND prevention OF GENDER-BASED VIOLENCE (GBV). September 2011. TABLE OF CONTENTS. Foreword .. iv Acknowledgments .. v vi Glossary .. viii Section One: Introduction .. 1. Global and Regional Overview of Gender-Based Violence .. 1. Consequences of 2. Overview of Gender-Based Violence in Tanzania .. 2. GBV among Children and Adolescent in Tanzania .. 3. Tanzania Policy Environment for GBV.

2 4. Tanzania's Legal Environment for GBV .. 4. Government and Multi Sectorial Initiatives to Respond to GBV .. 5. National Health and Social Welfare Services Infrastructure .. 6. Section Two: Rationale and Objectives .. 8. Why Guidelines for Management of GBV .. 8. Users of these Guidelines .. 8. Objective of the GBV Management Guidelines .. 8. Section Three: Linkages of Health Facility with the Community Regarding GBV. Services .. 10. Health Providers Messages to Survivor and Community .. 10. Support Structures for the Ccommunity for a GBV Response.

3 11. Drop-in Center .. 12. Safe House .. 13. Section Four: Standards for Medical Management of GBV Survivors .. 14. Integrating GBV Services into Existing Health Services .. 14. Summary of Comprehensive GBV Medical Services Package .. 16. Minimum Standards of GBV Services by Level of Health Facility .. 17. Table of Comprehensive GBV Services and Standards .. 22. Section Five: Guiding Principles: Human Rights, Ethics, and Compassion .. 24. Guiding Principles .. 24. Procedures for Medical Care to a GBV Survivor .. 24. Rights of the Survivor.

4 25. Obligations of the Healthcare Provider .. 25. Criteria of Obtaining Informed Consent Regarding Children .. 26. Section Six: Medical Management of GBV (Over 18 Years old) .. 27. Introduction .. 27. Receiving the Survivor .. 27. History Taking .. 28. Physical Examination .. 30. Laboratory Investigations .. 31. Diagnosis .. 32. Treatment of GBV Survivors .. 32. Preventive Treatments .. 32. Psychosocial Care and Ssupport .. 34. Follow-Up Care, Treatment, and Referral .. 35. Documentation .. 35. Section Seven: Medical Management : Children and Adolescent 36.

5 Introduction .. 36. ii Receiving the Survivor .. 38. History Taking .. 38. Physical Examination .. 42. Laboratory Investigations .. 44. Diagnosis .. 45. Treatment .. 45. Psychosocial Care and Support .. 48. Follow up Care, Treatment, and Referral .. 50. Documentation .. 50. Section Eight: Linkages for GBV prevention and Services .. 52. Introduction .. 52. Linkage for Preventive Services .. 52. Linkage of GBV Services for Survivors .. 52. Integration and Coordination for GBV Services .. 53. Section Nine: Monitoring, Evaluation, and Quality Assurance.

6 54. Monitoring and Evaluation .. 54. Quality Assurance .. 54. Quality Assurance Procedures .. 55. Annex 1: Consent Form .. 57. Annex 2: Pictogram .. 58. Annex 3: GBV Medical Form .. 59. Annex 4: Police Form Three (PF3) .. 63. Annex 5: GBV Register .. 65. Annex 6: Laboratory Investigation for GBV .. 67. Annex 7: Mental Health Checklist .. 72. Annex 8: Adherence Counseling Guide .. 73. Annex 9: Psychosocial Support Guides .. 74. Annex 10: Summary of Preventive Treatments .. 77. Annex 11: GBV Indicators for the Health Sector .

7 79. Annex 12: Classification of GBV Injuries According to Outcome .. 80. iii FOREWORD. Gender-based violence (GBV) is a serious public Health concern and a human rights violation with negative consequences that impact people's lives, particularly those of women, girls, and boys in many countries, and Tanzania is not an exception. GBV also hinders the fight against the spread of HIV and improvements in sexual reproductive and child Health . This situation calls for a comprehensive Health Sector response. These National Management Guidelines are designed to support healthcare providers, in their efforts to prevent and respond to gender-based violence.

8 The development of the GBV Management Guidelines are guided by the Health Policy and key strategic documents in the Health Sector , namely, the Health Sector Strategic Plan III 9 HSSP III 2009 . 2015), Primary Health Services Development Program (MMAM 2007 2017), the Human Resource, for Health Strategic Plan (2008 2013), the National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child deaths in Tanzania One Plan (2008 2015), National Family Planning Costed Implementation Program (2010 2015), and the National Plan of Action for Orphans Vulnerable Children (OVC).

9 These Guidelines provide standards for the provision of high-quality and comprehensive medical services and procedures to GBV survivors, and encourage providers to identify and quickly mobilize the required resources, materials and essential medication for GBV, at Health facilities. The Guidelines build on the existing National Health Policy and provide a framework to guide comprehensive Management of GBV survivors, encompassing medical Management , referral for psychosocial care and support, with linkages to social and legal protection systems.

10 Hence, comprehensive Management of GBV survivors demands coordination within the Health Sector and close collaboration with other sectors and key stakeholders, as well as a comprehensive system for monitoring and evaluation of GBV interventions. The Management Guidelines are timely because this was the first time that gender-based violence was included in Tanzania Demographic and Health Survey (TDHS 2010). The findings of the TDHS. revealed a high prevalence of GBV. Although various prevention and response efforts related to GBV.