Has the role of the health system against gender-based violence been exhausted?
One-stop crisis management centers are operating in 97 hospitals across the country to provide health care and legal assistance to victims of violence.
To make the campaign against gender-based violence effective, it needs to be permanently included in the organizational structure of the Ministry of Health and Population.
Any type of humiliating, painful or threatening behavior that occurs or may occur on the basis of gender is gender-based violence. The act of pressure, coercion or arbitrary deprivation of freedom also falls under gender-based violence.
Gender-based violence is deeply embedded in our society. It begins at the fetal stage. Abortion based on gender identity is the first stage of violence. Family and social discrimination during childhood and adolescence is the next stage.
After this, discrimination occurs at the reproductive age, sexual violence or discrimination is deprived of property and resources in old age.
A question that always arises in everyone's mind: Are only women victims of violence?
Answer: ‘No’.
Men and sexual and gender minorities are also victims, which is also confirmed by the data available in our regular health system. About 10 percent of those who seek services from one-stop crisis management centers due to gender-based violence are men. About 3-4 percent are sexual and gender minorities, while the rest are women. Even when analyzing this data, women are more likely to be affected.
Gender-based violence is an issue related to public health, human rights, and social justice. Domestic violence, sexual violence, child marriage, human trafficking, harmful traditional practices, and other forms of gender-based violence have long-term effects on women’s physical, mental, social, and sexual and reproductive health.
More than 60 percent of violence is perpetrated by acquaintances and acquaintances. Violence against women can occur in the public, private, and at any time in life.
There is a gender inequality gap in society. Different gender identities are also a major cause of discrimination. According to the Nepal Demographic Health Survey 2022, 23 percent of women aged 15 to 49 in Nepal have experienced physical violence.
The report states that 8 percent of women have experienced sexual violence in their lifetime. 27 percent have experienced physical, mental or sexual violence in their lifetime. 17 percent of women have experienced violence from their partners in the last 12 months. Of the women who have experienced sexual violence, 58 percent have neither told anyone about their pain nor sought any kind of help.
Similarly, the report shows that 14 percent do not seek help even if they tell someone, such as a friend or neighbor, about their pain. However, 28 percent of women seem to have sought help after violence. Since health institutions are the first contact and service center for victims of violence, the role of the health sector is not limited to treatment alone, but also includes psychosocial counseling, forensic evidence collection, safe referral, rehabilitation and multi-sectoral coordination, implemented by the Government of Nepal through the One-Stop Crisis Management Center (OCMC).
What is the One-Stop Crisis Management Center?
It is a multi-sectoral service system that provides free access to health care and other essential services to victims or affected persons through a single door. Through this, victims are provided with emergency health care, mental health and psychosocial counseling, forensic examination, legal aid, safe shelter, and effective referral services to the police, judicial bodies, and social rehabilitation services as needed.
The OCMC, which operates with the privacy, dignity, safety, and rights of the victim at the center, has been playing a significant role in making the health response to gender-based violence effective, accessible, and coordinated.
Is it necessary or not to provide the role of the health system against gender-based violence in the organizational structure of the Ministry of Health and Food Hygiene?
Currently, 97 hospitals across the country have one-stop crisis management centers, which is a significant achievement. This achievement needs further strengthening of its leadership, coordination, monitoring, and program management in the federal structure. This issue does not seem to have found a place in the newly approved structure of the Ministry.
It is necessary to make policy arrangements to effectively implement the right to health, gender equality, the right to a life free from violence guaranteed by the constitution, and the commitments made by Nepal at the international level.
The main foundations of which are presented below:-
- The health sector is the first and most important service point for victims of gender-based violence, which cannot be done by other sectors.
- A permanent structure is necessary to make services including the One-Stop Crisis Management Center sustainable and institutionalized.
- There is a need for clear leadership and coordination of this issue and the One-Stop Crisis Management Center service between the federal, provincial, and local levels.
- It is necessary to coordinate the role of the policy level to provide integrated management of health services related to gender-based violence, mental health, sexual and reproductive health, and forensic services, etc.
A health structure with clear responsibilities of the health sector is necessary for the implementation of national and international commitments, because since no single sector can cover the campaign against gender-based violence, it is called multi-sectoral.
Sarkar The response that the health sector has so far provided is only 28 percent of the access to the One-Stop Crisis Management Center, which is being provided by the health sector. This tells us that there is still work to be done.
To date, among the sectors that have presented some progress and achievements on behalf of Nepal in international forums on gender equality or gender-based violence, the One-Stop Crisis Management Center system and service is also a major achievement.
If this issue is not included in the structure of the health sector for a policy and coordinating role in the federal structure of such an important service, it will be a leadership crisis for this sector itself.
Health response to gender-based violence is an integral part of the health service system. Therefore, it is necessary to institutionalize it within the permanent organizational structure of the Ministry of Health and Food Hygiene, not as a project or temporary program, with clear responsibilities, sufficient human resources, a sustainable budget, and an effective monitoring system.
