Peer-reviewed article
Health Care Service Readiness and Quality of Care for Sexual Violence in Garissa, Kwale, Narok, and West Pokot Counties, Kenya: A Mixed-Methods Study.
Njogu J, Ndung'u L, Momanyi H, Nthumbi M, Wambua A et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study assessed the readiness and quality of health care services for sexual violence survivors in four Kenyan counties across 123 facilities. While most facilities offered general sexual violence care and stocked key medicines like antibiotics and emergency contraception, critical gaps were identified in HIV post-exposure prophylaxis availability, documentation systems, and provider training. Only 54% of facilities had staff trained in sexual violence care in the past year, and significant proportions of eligible survivors missed essential treatments including psychosocial assessment and preventive medications.
Key points
- 54% of facilities had a provider trained in sexual violence care in the past 12 months
- 85% of facilities routinely offered sexual violence care, but readiness to provide the minimum care package was low with steep differences across facility types
- Hepatitis B vaccine availability was very low (14%-25%), and HIV post-exposure prophylaxis was available in only 20% of dispensaries/clinics for children and 47% for adults
- Of 285 survivor charts reviewed, 32% missed psychosocial assessment, 22% missed HIV post-exposure prophylaxis despite eligibility, and 17% missed emergency contraception
- Only 59% of survivors sought health care within 3 days of sexual violence, and service gaps were driven by supply stock-outs, inadequate provider training, and poor documentation systems
Limitations
This is a cross-sectional assessment at one time point (July-September 2022) focused on facility readiness and documentation quality rather than health outcomes for survivors. The study cannot determine whether unmeasured community-based or traditional response systems serve survivors or establish causal links between specific gaps and survivor outcomes.
Abstract
Background The health care system is a critical entry point for sexual violence response including care and linkages to auxiliary services. However, detailed data on quality and readiness of facility-based sexual violence care in African settings is sparse, hindering measurement and improvements. Methods We report results from the first wave of longitudinal mixed-methods study conducted between July and September 2022 to assess readiness and quality of sexual violence services in 4 counties in Kenya supported by the Accelerate program. Health facility assessments were conducted within all (N=123) program-supported facilities in the 4 counties, including provider interviews; visual inspection and audit of essential infrastructure and commodities; and chart abstraction. We computed descriptive data summaries, and in-depth interviews from 40 purposively selected providers were analyzed thematically. Results Of 123 study facilities, 54% had a provider who received GBV in-service training in the past 12 months. Most facilities (85%) routinely offered GBV care. Of facilities offering GBV care, most stocked antibiotic for sexually transmitted infections (STIs) (71%), any emergency contraception pill (ECP) option (88%), and tetanus vaccine (93%), and most provided GBV counseling (90%). However, availability of hepatitis B vaccine was low across facility tiers (14%-25%). Dispensaries/clinics documented low availability of HIV post-exposure prophylaxis (PEP) for children and adults (20% and 47%, respectively), SGBV register (20%), and post-rape care forms (27%). Of 285 abstracted charts, most were in hospitals (62%) and for survivors under 18 years (69%). Just 59% of survivors presented promptly, within 3 days, for health care services. Of survivors who were eligible for care, a considerable proportion missed psychosocial assessment (32%), PEP for HIV (22%), ECP (17%), and treatment for bacterial STIs (15%). Qualitative data revealed service delivery gaps driven by disruptions in supplies and provider capacity gaps. Many providers indicated concerns in the chain of evidence due to gaps in documentation and logistical support for health care providers when providing legal testimony in courts. Conclusions Readiness to provide a minimum care package for sexual violence was low, with steep gradients across facility tiers. Delivery of timely and quality-assured sexual violence care requires addressing structural gaps driven by stock-out of supplies and inadequate providers' support including training. These corrective actions should be augmented by community-based interventions that link survivors to health care.