Homa Bay County is located along the shores of Lake Victoria in western Kenya. It covers an area of 3,183.3Km2. The County has a population estimate of 1,244,597(641,163 females and 603,437 males) .
Between 2017 to 2020, Homa Bay County witnessed a rising steady trend of GBV cases, as follows: 2017 -72 cases; 2018-216 cases; 2019-323 cases; and 2020-390 cases. With the breaking of the COVID-19 pandemic in 2020, the numbers of GBV cases escalated.
County facilities had a challenge in offering comprehensive GBV services. Health facilities at level 2 offered services at 51%, level 3 at 30% and level 5 at 19%. These statistics prompted the County Health Department to think of an initiative to mitigate the effects of the rising GBV cases in the County.
The population most affected was and still is 1-15 years, mostly of female gender. GBV has been linked to the rising cases of HIV infections (51% among adolescents), teenage pregnancies (33% among adolescents), STI’S, unplanned general population pregnancies, physical impairments, school drop outs, domestic conflicts, and mental illness such as Post Traumatic Stress Disorder and depression.
Despite, the Department offering GBV services in a few select facilities, from the data available, it was realized that the community level involvement was wanting, incorporation of mental health interventions was minimal, health workers capacity to offer GBV services was inadequate, poor referral/follow-ups and uncoordinated sectoral (Children’s Department/Judiciary/Police/Rescue Center etc) linkages.
The above situation called for immediate action. After a series of consultations involving the Homa Bay County Health Department, the then County Woman Representative (current Homa Bay County Governor, H.E. Hon Gladys Wanga) and GVRC (Gender Violent Recovery Center at Nairobi Hospital) initiated the Homa Bay GBVRC (Hope Centre).
The idea of the Centre was prompted by a helpless case of a female minor, defiled at Shauri Yako estate, whose situation attracted the attention of major GBV stake holders including, H.E. Gladys Wanga (then County Woman Rep), Ministry of Health, State Department of Gender, State Department of Youth, the police and others. This case demonstrated the glaring gaps in the County’s ability and capacity to manage SGBV cases comprehensively.
Implementation of the practice
The County Government of Homa Bay had an existing space dedicated to helping GBV survivors. Through a partnership with Gender Violent Recovery Center at Nairobi Hospital the existing space was renovated and Hope Centre was established. The County hired and deployed specialized personnel relevant to GBV (psychologists), clinical management/psychosocial management, forensic management and first line support.
Further, the County conducted community sensitization on mental health via radio and offered treatment, psychotherapy and follow ups of general /GBV triggered mental health conditions at no cost. With the help of Community Health Volunteers (CHVs), the County identified survivors and created awareness.
The County integrated sexual and reproductive health friendly services like family planning services, STI management and HIV counselling.
Results of the practice
During the two-year period, there have been significant positive outcomes and outputs as stated below:
- Significant rise in GBV reported cases from an average of five patients monthly in 2020 to an average of 15 patients monthly in 2022.
- 30 youths trained in GBV/mental health
- 50 HCWs trained in GBV/Mental health services provision and practicing
- 80 CHVs trained in GBV/Mental health and practicing
- 20 GBV survivors linked to other GBV services providers
- 10 GBV perpetrators processed, and evidence submitted to court
- All GBV survivors receives psychosocial support and follow up
- All epilepsy cases receive expert services
- 10 medical students have received mentorship and training on GBV
- The number of general patients seeking mental health services and epilepsy services has increased significantly.
- Improved referrals of SGBV case from the community by the Community Health Volunteers.
- Self-referral from school pupils was also noted with one case reporting with her clothes safely stored in a bag for evidence collection.
- Referral from different departments of the hospital for GBV cases and mentally ill patients has also increased an indication that screening of survivors is done at different entry point is done effectively.
The County Government’s partnership with other stakeholders like police and organizations dealing with women reproductive health, creates a joint team effort and a sense of group responsibility to eliminate SGBV.
Creating of awareness via radio has sparked up new discussions on the subject hence ending the existing stigma associated with sexual violation and abuse.
The following were lessons learnt during the implementation of the project:
- Incorporation of mental health into GBV program improves quality of services and compliance of survivors to the treatment plans.
- Involvement of level 1 actors (CHVS) into the GBV activities increases community awareness, community case identification and general GBV services uptake.
- Creation of awareness through community outreaches and radio talks spread awareness faster on available services for SGBV survivors and mentally ill patients.
- Training of HCWs on GBV services i.e., first line support and trauma focused communication ensured that many patients opened up and thus increase in survivor /victim identification.
- Trauma focused communication increases the patient satisfaction as most GBV clients start adhering to follow-up clinics.
- Linkage with other service providers has enabled a quick flow of services. The police follow up cases and visit clients admitted in the wards before they get a discharge. This ensures several services related to SGBV are performed simultaneously.
- The Center will offer better outcomes if all services were accommodated under one roof. Survivors still seek laboratory services and pharmacy services outside the center.
- There is need for more human resources to facilitate the Centre’s operation on 24 hours’ basis.
- Partnership between state and non-state actors to increase resource mobilization and successful implementation of key projects is paramount.
- There is need for capacity building of staff from all departments to ensure that SGBV survivors are managed well without further trauma from healthcare workers. It increases their satisfaction and probability of coming back for clinic follow-ups.