other patients are really in need of medical attention : the quality of health services for rape survivors in South Africa

• Published in: Bulletin of the World Health Organization 2005-07, Vol.83 (7), p.495-502
• Main Authors: CHRISTOFIDES, Nicola J, JEWKES, Rachel K, WEBSTER, Naomi, PENN-KEKANA, Loveday, ABRAHAMS, Naeema, MARTIN, Lorna J
• Format: Article
• Language: English
• Subjects: Abortion; Acquired immune deficiency syndrome; Actitud del personal de salud; Adult; AIDS; Attitude of Health Personnel; Biological and medical sciences; Calidad de la atención de salud; Crime Victims; Cross-Sectional Studies; Disease prevention; Encuestas de atención de la salud; Estudios transversales; Evaluation; Female; Forensic medicine; Forensic Medicine - standards; General aspects; Health care; Health Care Surveys; Health Policy & Services; Health professionals; Health services; Hospitals; Hospitals, Public - standards; Human rights; Humans; Infections; Interviews; Interviews as Topic; Medical sciences; Medicina legal; Miscellaneous; Nurses; Nursing care; Physicians; Pregnancy; Professional attitudes; Professional-Patient Relations; Provinces; Public health; Public Health Administration - standards; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality; Quality of care; Quality of Health Care; Questionnaires; Rape; Rape victim services; Servicios de salud; Sex crimes; Sexually transmitted diseases; South Africa; STD; Sudáfrica; Surveys and Questionnaires; Survivors; Violación; Women's Health Services - standards; Womens health
• ISSN: 0042-9686; 1564-0604
• DOI: 10.1590/S0042-96862005000700009

To investigate in the South African public health sector where the best services for rape survivors were provided, who provided them, what the providers' attitudes were towards women who had been raped and whether there were problems in delivering care for rape survivors. A cross-sectional study of facilities was carried out. Two district hospitals, a regional hospital and a tertiary hospital (where available) were randomly sampled in each of the nine provinces in South Africa. At each hospital, senior staff identified two doctors and two nurses who regularly provided care for women who had been raped. These doctors and nurses were interviewed using a questionnaire with both open-ended and closed questions. We interviewed 124 providers in 31 hospitals. A checklist that indicated what facilities were available for rape survivors was also completed for each hospital. A total of 32.6% of health workers in hospitals did not consider rape to be a serious medical condition. The mean number of rape survivors seen in the previous six months at each hospital was 27.9 (range = 9.3-46.5). A total of 30.3% of providers had received training in caring for rape survivors. More than three-quarters of regional hospitals (76.9%) had a private exam room designated for use in caring for rape survivors. Multiple regression analysis of practitioner factors associated with better quality of clinical care found these to be a practitioner being older than 40 years (parameter estimate = 2.4; 95% confidence interval (CI) = 0.7-5), having cared for a higher number of rape survivors before (parameter estimate = 0.02; 95% CI = 0.001-0.03), working in a facility that had a clinical management protocol for caring for rape survivors (parameter estimate = 2; 95% CI = 0.12-3.94), having worked for less time in the facility (parameter estimate = -0.2; 95% CI = -0.3 to -0.04) and perceiving rape to be a serious medical problem (parameter estimate = 2.8; 95% CI = 1.9-3.8). There are many weaknesses in services for rape survivors in South Africa. Our findings suggest that care can be improved by disseminating clinical management guidelines and ensuring that care is provided by motivated providers who are designated to care for survivors.