The health sector's response to gender-based violence in Tanzania: lessons from ilala district

Abstract

ABSTRACT Background: Gender-based violence (GBV) ranks among the most terrible and widely distributed of all human rights violations and is a public health burden. Tanzania's health sector has implemented policies to combat GBV, including the National Policy Guideline (2011) and the National Plan of Actions for the End-Violence Against Women and Children 2017/18 2021/22. Despite the presence of national policy guidelines for anti-GBV, the GBV rate remains high, and little is known about how well policy-level measures have been implemented by the health systems at the district level. This study aimed to explore responses at both facility and community levels. Objectives: To explore health sector’s achievements and challenges in responding to GBV in the Ilala District using the World Health Organization Health Systems Framework components. Materials and Methods: The study used a qualitative case-study approach, gathering data through document reviews, semi-structured interviews, focus group discussions, and observation. The study used purposive sampling to carefully choose and approach 51 participants suitable for the study. The study involved healthcare workers (HCWs), survivors of GBV at a one-stop center, community members, district/facility leaders, and police desk officers. Thematic analysis was used to analyse using the NVivo 14 trial. Results: The health sector at district level has responded to GBV through integrated services, para-social groups, exemptions, trained (HCWs), health information systems, and safety plans. However, the response still faces challenges including: limited community awareness, limited space, a shortage of forensic science-trained (HCWs), limited services and funds, and a fear of reporting among community members. Conclusion and Recommendations: The study highlights the health sector's response to GBV through integrated services, para-social groups, exemptions, and survivors' unification, but acknowledges challenges like limited community awareness, funding, and fear of reporting. Ilala district government should expand One GBV Stop Centers, raise community awareness, allocate percentages to Comprehensive Council Health Planning and Comprehensive Hospital Operational Plan funds for GBV initiatives, and train HCWs in forensic evidence. The Tanzania vi Police Medical Examination Form (PF.3) needs revision to facilitate private health facilities' completion, and the Ministry of Health should expedite the finalization process for universal health coverage