Siti Hawa Ali

An integrated health sector response to violence against women in Malaysia: lessons for supporting scale up

BackgroundMalaysia has been at the forefront of the development and scale up of One-Stop Crisis Centres (OSCC) - an integrated health sector model that provides comprehensive care to women and children experiencing physical, emotional and sexual abuse. This study explored the strengths and challenges faced during the scaling up of the OSCC model to two States in Malaysia in order to identify lessons for supporting successful scale-up.MethodsIn-depth interviews were conducted with health care providers, policy makers and key informants in 7 hospital facilities. This was complemented by a document analysis of hospital records and protocols. Data were coded and analysed using NVivo 7.ResultsThe implementation of the OSCC model differed between hospital settings, with practise being influenced by organisational systems and constraints. Health providers generally tried to offer care to abused women, but they are not fully supported within their facility due to lack of training, time constraints, limited allocated budget, or lack of referral system to external support services. Non-specialised hospitals in both States struggled with a scarcity of specialised staff and limited referral options for abused women. Despite these challenges, even in more resource-constrained settings staff who took the initiative found it was possible to adapt to provide some level of OSCC services, such as referring women to local NGOs or community support groups, or training nurses to offer basic counselling.ConclusionsThe national implementation of OSCC provides a potentially important source of support for women experiencing violence. Our findings confirm that pilot interventions for health sector responses to gender based violence can be scaled up only when there is a sound health infrastructure in place – in other words a supportive health system. Furthermore, the successful replication of the OSCC model in other similar settings requires that the model – and the system supporting it – needs to be flexible enough to allow adaptation of the service model to different types of facilities and levels of care, and to available resources and thus better support providers committed to delivering care to abused women.

Health impact of intimate partner violence and implication on services in Malaysia

Materials and methods A cross-sectional study was conducted from May 2009 until May 2010 among women experiencing IPV who sought help from thirteen women non-governmental organizations in Malaysia. A total of 316 women were randomly selected and interviewed using a translated and validated WHO Multi-country Study on Women’s Health and Life Experiences questionnaire. Data was analyzed using PASW version 18. The disseminations of the results from this study were done through meetings and dialogues with health service care providers.

“I feel it is not enough…” Health providers’ perspectives on services for victims of intimate partner violence in Malaysia

BackgroundThis study explores the views and attitudes of health providers in Malaysia towards intimate partner violence (IPV) and abused women and considers whether and how their views affect the provision or quality of services. The impact of provider attitudes on the provision of services for women experiencing violence is particularly important to understand since there is a need to ensure that these women are not re-victimised by the health sector, but are treated sensitively.MethodsIn-depth interviews were conducted with 54 health care providers responsible for providing services to survivors of IPV and working in health care facilities in two Northern States in Malaysia. A thematic framework analysis method was employed to analyse the emerging themes. Interviews were coded and managed by using NVIVO (N7), a qualitative software package.ResultsWe found that when providers follow the traditional role of treating and solving IPV as “medical problem”, they tend to focus on the physical aspect of the injury, minimise the underlying cause of the problem and ignore emotional care for patients. Providers frequently felt under-trained and poorly supported in their role to help women beyond merely treating their physical injuries. What emerged from the findings is that time shortages may well impact on the ability of medical officers to identify cases of abuse, with some saying that time limitations made it more difficult to detect the real problem behind the injury. However, data from the interviews seem to suggest that time constraints may or may not end up resulting in limited care, depending on the individual interest of medical professionals on violence issues.ConclusionsPromoting empathetic health care provision is challenging. More awareness training and sensitisation could help, especially if courses focus on women’s needs and strengths and how health providers can validate these and contribute to a longer term process of change for victims of violence. Clear guidance on how to record history of abuse, ask questions sensitively and validate experiences is also important together with training on good communication skills such as listening and being empathetic.

One stop crisis centres: A policy analysis of the Malaysian response to intimate partner violence

BackgroundThis article aims to investigate the processes, actors and other influencing factors behind the development and the national scale-up of the One Stop Crisis Centre (OSCC) policy and the subsequent health model for violence-response.MethodsMethods used included policy analysis of legal, policy and regulatory framework documents, and in-depth interviews with key informants from governmental and non-governmental organisations in two States of Malaysia.ResultsThe findings show that womens NGOs and health professionals were instrumental in the formulation and scaling-up of the OSCC policy. However, the subsequent breakdown of the NGO-health coalition negatively impacted on the long-term implementation of the policy, which lacked financial resources and clear policy guidance from the Ministry of Health.ConclusionThe findings confirm that a clearly-defined partnership between NGOs and health staff can be very powerful for influencing the legal and policy environment in which health care services for intimate partner violence are developed. It is critical to gain high level support from the Ministry of Health in order to institutionalise the violence-response across the entire health care system. Without clear operational details and resources policy implementation cannot be fully ensured and taken to scale.

Validity and Reliability of the Malay Version of WHO Women’s Health and Life Experiences Questionnaire

The Women’s Health and Life Experiences questionnaire measures the prevalence, health implications, and risk factors for domestic violence. This cross-sectional study was conducted to determine the validity and reliability of the Malay version of World Health Organization (WHO) Women’s Health and Life Experiences Questionnaire. Construct validity and reliability assessment of the Malay version of the questionnaire was done on 20 specific items that measure four types of intimate partner violence (IPV) act; controlling behaviors (CB), emotional violence (EV), physical violence (PV), and sexual violence (SV), which were considered as the domains of interest. Face-to-face interviewing method was used for data collection. A total of 922 women completed the interviews. The results showed that exploratory factor analysis of four factors with eigenvalues above 1 accounted for 63.83% of the variance. Exploratory factor analysis revealed that all items loaded above 0.40 and the majority of items loaded on factors that were generally consistent with the proposed construct. The internal consistency reliability was good. The Cronbach’s α values ranged from 0.767 to 0.858 across domains. The Malay version of WHO Women’s Health and Life Experiences Questionnaire is a valid and reliable measure of women’s health and experiences of IPV in Malaysia.

Patterns of help-seeking among women experiencing intimate partner violence in Malaysia

Intimate partner violence (IPV) is not a new phenomenon and has consequences for womens well-being. Experiencing IPV is considered very stressful and the women who experience it struggle to survive emotional, physical and sexual violence. The purpose of this study is to identify the pattern of help-seeking by women who have experienced intimate partner violence and their level of satisfaction with the help they receive. Furthermore, this study has also explored the reasons that influence womens decisions on whether or not to seek help. A cross-sectional study was conducted between May 2009 and May 2010 among 316 women who experience IPV and seek help from womens non-governmental organizations (NGOs) in Malaysia. They were interviewed using the translated and validated WHO Multi-country Study on Womens Health and Life Experiences Questionnaire. In addition, the data was analysed using the IBM SPSS Statistics version 20 software. Chi-square tests were used to determine associations between severity of violence and help-seeking behavior. From the study, it is known that a majority of the abused women sought help from both formal and informal resources. The results suggest that more interventions are needed to help women recognise and deal with IPV as well as strengthen the support networks available for abused women.

Professional practice and innovation: The development and design of an electronic patient record using open source web-based technology

This paper describes the method used to develop the One Stop Crisis Centre (OSCC) Portal, an open-source web-based electronic patient record system (EPR) for the One Stop Crisis Center, Hospital Universiti Sains Malaysia (HUSM) in Kelantan, Malaysia. Features and functionalities of the system are presented to demonstrate the workflow. Use of the OSCC Portal improved data integration and data communication and contributed to improvements in care management. With implementation of the OSCC portal, improved coordination between disciplines and standardisation of data in HUSM were noticed. It is expected that this will in turn result in improved data confidentiality and data integrity. The collected data will also be useful for quality assessment and research. Other low-resource centers with limited computer hardware and access to open-source software could benefit from this endeavour.