Pathways of care for sexual violence survivors and the benefits and drawbacks of using community health workers to provide support health services to sexual violence survivors: A systematic review and case study in Kenya

Background: Research shows that sexual violence is widespread and has multiple adverse health consequences. Globally, majority of sexual violence survivors either do not access care or access care late. Many of those who access care are lost to treatment follow-up before they can fully realise the benefits of medical care. Evidence suggests that community health workers (CHWs) have the potential to improve healthcare for survivors. There is limited data however, on how to deliver these services effectively. Aim: To explore sexual violence survivors’ experience of seeking healthcare and experiences through the continuum of care in Kenya; and, to understand the benefits and drawbacks of using CHWs to provide support health services to sexual violence survivors. Methods: A mixed methods approach was used: 1) a systematic literature review of CHWs services for sexual violence to explore the existing models of services as well as the benefits and drawbacks; 2) records for 543 survivors were reviewed and key informant interviews conducted with healthcare providers in two referral hospitals. These hospital data were compared with national-level data on survivors from the Kenya Demographic and Health Survey 2014, and the Violence Against Children Survey 2010; 3) survivors were interviewed on their care pathways, current experience of services, perceived health service’s needs and experience of CHWs services; 4) CHWs, healthcare workers and other stakeholder’s with expertise in providing care for sexual violence were interviewed on their experiences and views on CHWs services for sexual violence. Results: There are multiple barriers to healthcare and missed treatment opportunities for survivors, both at the community and hospital level. Children, men, partnered or ever-partnered survivors and survivors experiencing violence from intimate partners are more likely to miss treatment. CHWs are already involved in sexual violence healthcare pathways carrying out awareness creation, identifying survivors, linking survivors to care and providing psychosocial support. However, training, better definition of roles and support from the healthcare system is needed. Conclusions: This thesis has identified specific barriers to services for sexual violence survivors and specific groups at risk of missing treatment. CHWs can form a part of interventions aimed to address the current barriers to treatment; however, more research is required to inform designing the models of services.