Interview: “Women’s organizations need to cooperate directly with local healthcare providers to ensure survivors are adequately supported”
Léa Dudouet is a project and network coordinator at the Women Against Violence Europe Network (WAVE). For more than two years, Ms. Dudouet has been responsible for managing WAVE’s ongoing projects and coordinating network-related activities. In this interview, Lea Dudouet highlights some of the key findings of the regional assessment “Cooperation between women’s NGOs and healthcare providers: A comparative study in the Western Balkans and Türkiye,” developed by WAVE with the support of the EU-funded programme on ending violence against women “Implementing Norms, Changing Minds,” with a view to spotlight promising practices of cooperation between women civil society organizations and healthcare professionals.
The regional assessment “Cooperation between women’s NGOs and healthcare providers: A comparative study in the Western Balkans and Türkiye” analyzed the quality of cooperation between women’s civil society organizations (CSOs) and healthcare providers within the context of multisectoral response to violence against women (VAW). What were some of the most important findings from the assessment?
One of the most important yet also saddening findings from the regional assessment is that cooperation between women’s CSOs and healthcare providers is insufficient in all Western Balkan countries. Notably, half the organizations included in the study reported that healthcare institutions do not refer women victims of violence to their organization. In addition to this, seven of the organizations did not have a signed protocol establishing collaboration with healthcare services, and their cooperation is based only on personal links with medical professionals or informal agreements. Another worrying finding is that although some countries have national healthcare protocols that include violence against women in the title, these only or primarily address domestic violence. Additionally, in North Macedonia and Türkiye, there is neither a general nor special protocol for healthcare providers when it comes to cases of VAW.
In terms of recommendations, the regional assessment highlights several areas where women’s organizations can concentrate their efforts in the future, including training for healthcare professionals, advocacy for the adoption of protocols, and use of national-level data on the access of victims to healthcare. To reach these goals, women’s organizations in the region would need the support of development partners as well as national governments.
Which are some of the promising practices of cooperation between women’s organizations and healthcare professionals?
One promising practice of cooperation comes from the women’s NGO Foundation United Women Banja Luka from Bosnia and Herzegovina, which runs a safe house for women victims of violence. Based on the Cooperation Agreement with the Health Centre Banja Luka, upon arrival to the safe house, a victim can receive free medical assistance in the local health centre. Fortunately, this support continued to be provided throughout the COVID-19 pandemic, despite capacity challenges.
Another promising practice highlighted in the research was the issuance of medical documents in cases where women experience violence. One organization in Albania noted that in addition to forensic doctors, some qualified and gender-sensitive family doctors also issue such certificates in cases of domestic violence, and the organization has managed to assist victims by using certificates in courts successfully as evidence. In an example shared by Serbian organization Fenomena, a survivor of sexualized violence had her injuries documented in a medical report at an emergency healthcare centre. The report was then successfully used at trial to convict the perpetrators.
The assessment also included guidelines for healthcare providers on how to respond when women patients disclose violence during a medical visit. How are these guidelines being disseminated?
In 2022, CSO partners organized a series of meetings and training workshops with local healthcare professionals to ensure they can effectively respond to disclosures of violence against women in their practices. In total, 192 healthcare centre staff and 78 local domestic violence coordinators were reached, as well as 35 ministry representatives and 32 health directorate representatives. During these meetings, healthcare providers received concrete instructions on how to identify cases of violence and what to do in such instances, including providing information on existing referral pathways to women’s specialist services in the area. A number of local healthcare centres in the region also placed posters in waiting rooms with information about local women’s specialist services that survivors can turn to for support.
Serbian NGO Fenomena expressed that the meetings organized brought about significant progress in working with healthcare professionals. Following the meetings organized with primary healthcare workers, the number of survivors who turned to women’s organizations in three nearby cities increased by 40 percent. All of them said that they got the contact information for the organization from their chosen doctor.
What are some of the gaps between existing practices and the standards set forth in the guidelines?
In some countries, such as Albania, healthcare workers are required by law to immediately report when they encounter a patient who has experienced domestic violence. Nevertheless, the number of such reports is still almost insignificant. Women’s organizations in the region have noted some reasons for the low level of referrals, including healthcare staff fearing possible retaliation from the perpetrator, being unaware of their legal obligation to refer, and lacking the time and human resources to adequately support survivors. In addition to this, medical certificates documenting injuries are not always provided free of charge to survivors (even when they should be), or healthcare providers sometimes refuse to issue such certificates. And finally, there is a lack of specialists, including psychologists and psychotherapists, with sufficient and adequate knowledge who can work with victims of domestic violence and other forms of violence against women.
Which institution-level practices can we learn from?
Women’s organizations need to have signed protocols or other structured forms of cooperation with respective healthcare institutions in their local communities to ensure that referral mechanisms, where they exist, can function properly and survivors can receive the support they need. For example, Albania is the only country in the region that has a general protocol on sexualized violence and a special protocol for healthcare providers. Albania can therefore be regarded as a good practice example in the area of establishing structures for multi-agency collaboration.
Two CSOs – Fenomena in Serbia and Foundation United Women Banja Luka in Bosnia and Herzegovina – are currently collaborating with local actors to strengthen and expand existing protocols that guide cooperation with women’s organizations and create higher standards for care for victims of VAW. It is therefore possible for women’s NGOs to cooperate directly with local healthcare practices to further ensure survivors are adequately supported, beyond national-level healthcare protocols.