Gender Equality & Social Inclusion: Reporting on Sexual & Gender Based Violence

Learning Brief

Gender Equality & Social Inclusion: Reporting on Sexual & GenderBased Violence

January 2021

SHINE Supply (2018-2021) is a component of the Somalia Health & Nutrition (SHINE) programme, funded by UK aid from the UK government.

SHINE aims to reduce mother and child deaths in Somalia and Somaliland by improving health and nutrition services.

SHINE Supply is a component of the UK aid-funded Somalia Health & Nutrition (SHINE) programme. SHINE aims to reduce mother and child deaths in Somalia and Somaliland by improving health and nutrition services. SHINE Supply is being implemented in four regions, namely Galgadud and Banadir Regions in Somalia, and Awdal and Togdheer Regions in Somaliland. Gender Equality and Social Inclusion (GESI) is a cross-cutting component of all SHINE Supply activities.

The issue SHINE Supply has been tracking health facility reports on sexual and gender-based violence (SGBV) since 2019. From the monthly facility reports, we have observed sporadic reporting on this theme, with some health facilities exhibiting unusually high numbers compared to others. In December 2020, the SHINE Supply Team initiated a small operational study to better understand the differences in SGBV reporting across the programme.

Methodology for investigation The study covered 12 districts and 18 health facilities across the four SHINE Supply implementation areas. The 18 health facilities were purposefully sampled based on consistently high SGBV recording in monthly reports. With technical support from the Monitoring and Evaluation Lead, SHINE Supply’s Implementing Partners visited the selected facilities to verify reports against primary records for a six-month timeframe May-Oct 2020. They also conducted interviews with facility staff to interrogate the data. All findings (quantitative and qualitative) were captured in standardised data entry templates.

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Preliminary Findings •

Most facilities claimed they had never reported on SGBV - despite the fact that this was a criterion for selection in the study.

Nurse’s explanation of inconsistencies in SGBV reporting:

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Feedback from staff suggested that most SGBV data was being reported in error.

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When facility staff were asked if they reported every case of SGBV, 53% (9/18) said no and 47% (8/18) said yes.

“Rape cases are reported to this health centre because we are at the border. We also receive FGM cases to treat the complications, as well as domestic violence cases. There is a lot of domestic violence but we don’t have anywhere to report it”

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Many facilities suggested they did not report SGBV because they had not received accredited training and / or there were no appropriate forms / tools for reporting.

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Staff interviews pointed to widespread confusion about the definition of SGBV. Many referred to ambiguous definitions of ‘rape’ and several were under the impression that rape cannot occur within marriage.

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Many staff were unsure about whether female genital mutilation (FGM) data should be included in SGBV data.

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There was uncertainty about the role of the health facilities in reporting. Several staff expressed concerns about issues of privacy, maintaining confidentiality and personal safety.

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Many staff were unsure about the appropriate referral and / or reporting channels for SGBV. Some facilities shared data with specialist NGOs, rather than reporting through the health management information system (HMIS). Some facilities were concerned about duplicating the reporting of referral centres, such as hospital ‘Rape Units’.

Nurse’s explanation of low SGBV reporting: “Cases of SGBV are not reported because there are no SGBV services and dedicated staff to support them. Also, there is a need to create awareness on SGBV at the community level through Community Health Workers (CHWs) and Female Health Workers (FHWs) to help improve the services”

The SHINE Supply consortium is led by Mott MacDonald. The Essential Package of Health Services (EPHS) is implemented in four regions of Somalia and Somaliland by Action Against Hunger (Banadir), Mercy USA (Galgaduud) and Health Poverty Action (Awdal and Togdheer).

The Health Systems Strengthening component is supported by the International Procurement Agency (IPA), Charlie Goldsmith Associated (CGA), Mott Macdonald IHE and the Tropical Health and Education Trust (THET).

Next steps Based on these preliminary findings, the SHINE Supply team will aim to: •

Work with government and other key partners to develop a plan for improving formal training of health care workers and managers on SGBV case identification, management and reporting. We know from experience that this needs to form part of a multidisciplinary approach that includes: - Clarification of technical definitions, roles, responsibilities and referral and reporting pathways.

- Linkages to wider community engagement, community health worker and behaviour change initiatives.

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Review and assess the specific data quality control issues arising from this study.

We will use this to inform: - Staff training, guidance and data audit tools.

- Dialogue with government partners on strengthening routine HMIS reporting systems, guidelines and supportive supervision mechanisms.