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Services for Sexual Violence Survivors in Kayanza and Muyinga Provinces, Burundi

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Services for Sexual Violence Survivors in Kayanza and Muyinga Provinces, Burundi Services for Sexual Violence Survivors in Kayanza and Muyinga Provinces, Burundi The RESPOND Project/Burundi October 2012 2012 EngenderHealth (The RESPOND Project) The RESPOND Project c/o EngenderHealth 440 Ninth Avenue New York, NY 10001 U.S.A. Telephone: 212-561-8000 Fax: 212-561-8067 e-mail: [email protected] www.respondproject.org This publication is made possible by the generous support of the American People through the U.S. Agency for International Development (USAID), under the terms of cooperative agreement GPO-A-000-08-00007-00. The contents are the responsibility of the RESPOND Project/EngenderHealth and do not necessarily reflect the views of USAID or the United States Government. This work is licensed under the Creative Commons Attribution-Noncommercial- Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/. Suggested citation: The RESPOND Project. 2012. Services for sexual violence survivors in Kayanza and Muyinga provinces, Burundi. New York: EngenderHealth. CONTENTS CONTENTS ................................................................................................................................................... iii ACKNOWLEDGMENTS ............................................................................................................................. v ACRONYMS AND ABBREVIATIONS ................................................................................................... vii EXECUTIVE SUMMARY .............................................................................................................................. ix INTRODUCTION ......................................................................................................................................... 1 METHODOLOGY ......................................................................................................................................... 3 FINDINGS ...................................................................................................................................................... 5 RECOMMENDATIONS ..............................................................................................................................15 REFERENCES ............................................................................................................................................... 21 APPENDIX A. Health Facility Manager Questionnaire ....................................................................... 23 APPENDIX B. Health Provider Questionnaire ..................................................................................... 33 APPENDIX C. Key Informant Interview Guide ................................................................................... 41 APPENDIX D. List of Key Informants .................................................................................................... 45 APPENDIX E. Focus Group Discussion Guide .................................................................................... 47 Services for Sexual Violence Survivors in Kayanza and Muyinga Provinces, Burundi iii ACKNOWLEDGMENTS This study was conducted with the generous financing of the Burundi Mission of the United States Agency for International Development (USAID). The study was led by Marie-Christine Ntagwirumugara, a consultant for The RESPOND Project/Burundi, and by Mahamadi Cissé, the project manager for RESPOND/Burkina Faso. The study was conducted through close collaboration among RESPOND, the Ministry of National Solidarity, Human Rights and Gender (MSNDPHG), the Ministry of Public Health and the Fight against AIDS (MSPLS), and administrative authorities in Kayanza and Muyinga provinces. Marie- Christine Ntagwirumugara served as the lead author and Ashley Jackson from RESPOND served as the lead technical editor. The report was also reviewed by Esther Braud, Maureen Clyde, Santiago Plata, Hannah Searing, Fabio Verani, and Jane Wickstrom from EngenderHealth/RESPOND. The report was copyedited by Michael Klitsch and was formatted by Elkin Konuk. Thanks are due to each of these collaborators. RESPOND also extends its gratitude to the health facility managers, health providers, Family Development Center teams, community members, and all others who participated in this study. Services for Sexual Violence Survivors in Kayanza and Muyinga Provinces, Burundi v ACRONYMS AND ABBREVIATIONS ABUBEF Burundian Association for Family Well-Being ADDF Association pour la Défense des Droits des Femmes AMAVES Association of the Compassionate for the Assistance of Those Affected by HIV/AIDS APRODH Association for the Protection of Human Rights and Detained Persons ARV antiretroviral (drug) BCC behavior change communication CDF Family Development Center COP Country Operational Plan FGD focus group discussion GBV gender-based violence ICRW International Center for Research on Women MAP Men As Partners® MSNDPHG Ministry of National Solidarity, Human Rights and Gender MSPLS Ministry of Public Health and the Fight against AIDS NGO nongovernmental organization PEP postexposure prophylaxis PEPFAR U.S. President’s Emergency Plan for AIDS Relief SEED Supply–Enabling Environment–Demand SOP standard operating procedure SRH sexual and reproductive health STI sexually transmitted infection SV sexual violence SWAA Society for Women and AIDS in Africa TMAP Technical Support to Map Gender-Based Violence Services in Tanzania UNICEF United Nations Children’s Fund USAID U.S. Agency for International Development Services for Sexual Violence Survivors in Kayanza and Muyinga Provinces, Burundi vii EXECUTIVE SUMMARY Addressing sexual violence (SV) is a priority of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) initiative in Burundi. With the support of PEPFAR and the partnership of the Ministry of National Solidarity, Human Rights and Gender (MSNDPHG) and the Ministry of Public Health and the Fight against AIDS (MSPLS), the RESPOND Project aims to improve efforts to prevent SV and to respond to SV survivors in two provinces—Kayanza and Muyinga—through the following results: 1. Strengthen the health sector response for SV survivors 2. Promote gender-equitable norms to prevent SV and to support survivors 3. Increase the capacity of communities and civil society to prevent SV Building upon the results of a national SV assessment led by RESPOND in August 2011, this study aimed to: Assess the health services available to SV survivors in the two provinces Identify other, nonmedical services available to SV survivors in the two provinces Explore the factors that allow SV to take place and prevent survivors from seeking help Develop recommendations for PEPFAR and the relevant ministries in Burundi Guide the strategy and activities of the RESPOND Project in Burundi Data were collected in a total of four townships in Kayanza and Muyinga. RESPOND audited 17 health centers and two hospitals, interviewing the 19 facility managers and an additional 30 providers. Key informant interviews were conducted with 24 administrative authorities, community leaders, and representatives of organizations that work in SV services. Focus group discussions (FGDs) were held with single-sex groups of 9–11 community members each. A total of 158 community members participated in 16 FGDs. Facility audits showed that health centers lack the trained staff and equipment necessary to respond to SV and that many providers hold attitudes that are unsupportive of SV survivors. Since they are unprepared to care for SV survivors, providers at health centers typically refer cases to hospitals after providing very few services, such as treating wounds and providing antibiotics for treatment of sexually transmitted infections (STIs). Given significant barriers to pursuing these referrals, it is likely that many survivors do not receive adequate medical care for SV, even after seeking it at health centers. Outside the health system, services for survivors are similarly limited. In both provinces, some legal and psychosocial services exist, although they are not well-known by communities. The study found no economic reintegration services or safe houses currently available to SV survivors in the two provinces. The Family Development Centers (CDFs), which are charged with coordinating SV services, have insufficient staff and funding to fulfill their mandate. While woman volunteers called “baremeshakiyago” (peer educators) and “imboneza” (community relays) raise community awareness about health and social issues, which in theory include SV, there appear to be no structures with which to engage men in SV prevention. Services for Sexual Violence Survivors in Kayanza and Muyinga Provinces, Burundi ix Factors that allow SV to happen and that prevent survivors from receiving help include power imbalances between men and women, the acceptability of marital rape, fears of retaliation by the perpetrator, taboos around discussing SV, the blaming of SV survivors, corruption in the court system, and cost and transportation barriers. Key recommendations include the following: Prepare health centers to offer survivors at least a minimum package of SV services, including counseling and referrals. Providers who work at first-line and referral facilities should be trained. It is very important for training to address attitudes around SV. Existing job aids for infection prevention and the care of SV survivors need to be adapted and disseminated to health facilities. Key commodities, supplies, and services,
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