Decentralised community-based model for post-violence care

Key information
- Organisation: NACOSA
- Country: South Africa
- Region: Eastern and Southern Africa
- Stage of innovation: Stage 3: Pilot
- Start date: 2021
- End date: 2025
- Type of innovation: Services delivery innovation: new or different way of providing a service
- Funders: USAID
Summary of intervention
Historically, post-violence care (PVC) in South Africa has been provided at Thuthuzela Care Centres (TCCs) —one-stop service providers. Given the limited number of TCC facilities, many communities remain underserved; sexual violence cases go unreported and survivors do not access medical treatment.
To increase access to PVC, NACOSA takes critical services closer to communities. The programme is in 14 priority health districts across 7 provinces. A holistic package of services is provided in facilities through clinicians and psychosocial cadres, including social workers and social auxiliary workers. These trained First Responders ensure survivors access the minimum PVC package and support them to navigate the health system. They continue to provide long-term psychosocial support through case management. Gender-based violence (GBV) Ambassadors create awareness, including information, education and communication of GBV response services.
Clinical Mentors (professional Nurses), programme and M&E specialists provide technical assistance, including health systems strengthening, tools, standard operating procedures, capacity building and mentorship. Clinical trainings include forensic medicine, case management and GBV; WHO LIVES trains all clinical and non-clinical cadres who may receive disclosures.
Decentralisation has shown to be effective in reaching survivors that are unable to access TCCs, and GBV Ambassadors have increased reach. Timely access to services ensures critical interventions, such as post-exposure prophylaxis (PEP), STI treatment and emergency contraception can be administered, averting HIV, pregnancies, and the complications of untreated STIs; and more survivors can access clinical and psychosocial services. Injuries can be treated and referrals made to relevant services. The provision of emergency transport funds assists survivors to access follow-up care and treatment.
learnings
The biggest lesson learnt was that GBV Ambassadors must be supervised and assisted with developing targeted activity plans, for example, ensuring that all possible entry points for survivors are covered in the plans. It was also important to supervise the Ambassadors to ensure violence screening is not conducted in the community inappropriately. Training in WHO LIVES was essential for the Ambassadors to prepare them for violence disclosure.
next steps
NACOSA will continue to monitor this innovation in Ugu District, and will be rolling out similar interventions in other districts.
sustainability
This model can be replicated by including GBV awareness raising in community health workers’ activity plans, with data closely supervised and monitored by their supervisors and managers within the Department of Health. This will be especially appropriate as the Community Orientated Primary Care model is implemented as part of the NHI.
Tags
Adolescent girls and young womenGender and gender-based violenceHealth workersHIV preventionMental health and psychosocial supportPeer educatorsSexual and reproductive health and rights (SRHR)