Her perpetually moist eyes radiated intense sorrow. She is reserved. She does not say much before returning to her continuous quiet. Senayit, a young mother of three children, will never forget the day her daughter Hanna was raped.
At dusk, Senayit had asked Hanna, who was just 13 years old, to get milk for her younger sisters, but she had no luck! She returned with a blood-stained cloth and a broken heart.
Violence against women/girls and boys is a public health concern in Ethiopia. According to the 2019 Ethiopian Demographic and Health Survey (EDHS), 23 % of women aged 15-49 have experienced physical violence, and 10% have experienced sexual violence, of which 7% reported that they had experienced sexual violence in the past 12 months.
For Hanna, her mother, and millions of Ethiopians like them, getting help from the community, health facilities, and the legal system is quite formidable due to the stigma and discrimination attached to rape and further compounded by socio-economic and infrastructure problems.
Furthermore, thousands of people like Senayit and Hanna were predisposed to increased risk of gender-based violence (GBV) due to the COVID-19 pandemic, internal conflicts and clashes, and the subsequent displacements that have occurred in Ethiopia lately.
Though Ethiopia has made commendable progress (including adopting WHO’s health response to GBV survivor’s manual in 2016, currently under revision) to overcome these wide-ranging challenges and address GBV, considerable challenges remain.
Problems related to strengthening health response to GBV include suboptimal capacity of health workers, slow pace of scaling-up of comprehensive survivor-centered multi-sectoral and multi-dimensional approach to GBV, multiple emergencies and shocks, and lack of health-related indicators and guidance on workplace harassment, delays in revising the national strategic plan are, for instance, among the several challenges the country has faced.
To address these challenges, the Ethiopian Country Office of the World Health Organization (WHO-Ethiopia) pioneered the integration of health response to GBV in the essential emergency health services.
The WHO-Ethiopia Representative a.i., Dr. Nonhlanhla Dlamini, is earnestly driving WHO’s bold initiatives in supporting the development of national and regional guidelines on prevention and response to GBV, workplace harassment, including sexual exploitation and abuse (SEA) and the formulation of a training package to build the capacity of health workers across the health sector.
WHO also contributed to scaling up survivor-centred health responses to GBV in primary health care units and Mobile Health and Nutrition Teams, advocating for and defining outcome indicators (survivors of GBV who received health services and the number of health facilities providing health response to GBV survivors disaggregated by age, sex, and disability), and developing a GBV registry for collecting and monitoring service uptake.
Following the adoption of the guidelines on clinical management of GBV, WHO is supporting translation into local languages and has conducted related training and training of trainers (TOTs) on the prevention and response of workplace harassment, sexual exploitation, and abuse, focusing on health workers in conflict-affected areas.
The health referral system that extends from health extension programs to hospital-level clinical interventions is prioritized for scale-up. Health services for GBV survivors does not include out-of-pocket payment at the point of care at the one-stop centers, which WHO effectively advocated for.
Owing to these and the active guidelines and tools adopted from WHO in 2017, the coverage for health facility readiness for GBV has increased from 7.5% in 2020 for one-stop centers to 23% in 2022, and the health centers with a multi-disciplinary team approach from 3.5% in 2020 to 21% in 2022. Six-month report of 2022 showed that 2,834 female and 104 male GBV/SV survivors like Hanna and her mother had received services in 44 of 74 functioning one-stop centers.
WHO in its capacity to coordinate and as the lead key government partner in health, continues to develop policies and guidance on health response to GBV and be the key coordinator for the National Gender-in-Health Forum, which brings stakeholders and development partners to share experiences and knowledge to advance the program.
Vulnerable women/girls and children, like Hanna and her mother, are now included in the service provision package due to the rapid scale-up and mapping of GBV health services nationwide. Furthermore, survivors in conflict-affected areas are reached through mobile health and nutrition teams (MHNT) supported by WHO
N.B. The Survivors’ identities have been intentionally changed to preserve their privacy.
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