As part of its Sector Wide Approach to Strengthening Health Programme (SWASTH) programme supported by the Department for International Development (DFID, UK) and the Bihar Technical Assistance Support Team (BTAST), GoB through WDC has been working since 2011 to strengthen the state response to VAWG. This response has been informed by global evidence and leading organisations working on VAWG issues. As part of its planning, BTAST conducted diagnostic and scoping studies to understand prevailing social norms related to gender-based violence and abuse.
SWASTH has followed the World Health Organization’s three-layered prevention of violence model. Under this, primary prevention is done through schools, Self-Help Groups and working with men and youth. At secondary level, routine antenatal screening, counselling and alcohol management are carried out. At the third level, service providers like judiciary, police, helplines and short-stay homes are sensitised.
Global evidence on VAWG shows that at the primary level, school-based communication can change knowledge, attitudes and reduce reported violence against the current partner. In South Africa, a micro-finance approach with training on Intimate Partner Violence IPV reduced the risk of physical and sexual violence by more than half during a period of two years. At the secondary level of violence protection, the protection orders sought from judiciary in the United States had brought significant reduction in threats of violence.
Similarly, regular identification of victims and support provided at the antenatal clinics lowered VAWG in United States. Non-directive counselling to encourage victim self-help lowered the incidence of physical abuse. According to a DFID paper published in 2008, proactive inquiry by health workers and advice to encourage self-help resulted in significant reduction in alcohol consumption by men, leading to the reduction in cases of VAWG.
In India, UNFPA programme (integrated into Government of India’s Reproductive and Child Health Phase II initiative) used the health facility as a significant catchment area for detecting and responding to domestic violence victims and survivors. In a first of its kind in India, hospital-based crisis centre Dilaasa was set up by Mumbai-based Centre for Enquiry into Health and Allied Themes (CEHAT) for women facing domestic violence. The crisis centre provides social and psychological support, referrals to shelters and legal aid and basic medical care. Initially, the centre started with one government hospital in Mumbai and was then extended to many hospitals. In 1984, the Tata Institute of Social Sciences (TISS) established a strategic alliance with Mumbai Police for creation of a special cell for women and children. The initiative resulted in increased reporting of cases on VAWG.
Drawing from all such global and local experiences, models and evidences, the gender interventions under SWASTH were conceptualised. Systems strengthening, intersectoral action, policy advocacy, community involvement, use of evidence and adaptive learning, addressing social norms and collaborative co-action have been the key principles of SWASTH’s gender interventions. For example, creation of stronger public systems, protection, legal, health and nutrition services that are gender-sensitive and responsive are critical for a violence-free environment. At the same time, responsive violence-redressal mechanisms like helplines, short-stay homes and special cells in the police station at the core of the government structure have been key to creating an enabling atmosphere for women and girls.