Private providers seek to enhance gender-based violence services in Tanzania

Tanzanian health care providers want to offer services to the clients they see every day who are survivors of gender-based violence, yet the vast majority do not have access to the training, equipment, and support they need to help. To address this, SHOPS Plus coordinated with the government of Tanzania to engage private sector health providers in training and informal networking. This served to support provision of quality gender-based violence screening, care, and referral services. The trainings and networks offered private providers the opportunity to enhance their capacity to address a major contributing factor to poor health.

A SHOPS Plus assessment conducted in February 2021 illuminated the motivation providers have to offer gender-based violence services. It also illuminated the obstacles they face as private sector providers in a public sector system. To share assessment findings, facilitate dialogue, and explore next steps, SHOPS Plus hosted two meetings in July 2021 with representatives from the Tanzania Ministry of Health, Community Development, Gender, Elderly, and Children and Regional and Council Health Management Teams. Participants included the national gender-based violence coordinator, Gerald Kihwele, in addition to the Ministry gender-based violence trainers, social welfare officers, and private sector representatives.

The pilot’s key findings, shared and discussed in these meetings, included:

• Private providers and facilities are motivated to offer gender-based violence services. Participating providers showed commitment to attending the six-day training and applying what they learned in their daily practice, seeing it as a benefit to their clients.
• Training, supervision, and community education efforts bolster private sector gender-based violence service delivery. To effectively deliver gender-based violence services, private sector providers need training to develop clinical skills, supervision to ensure that they continue to provide quality services, and support for community education efforts so survivors know where they can obtain compassionate care.
• Private facilities face barriers to sustainably offering survivor-friendly services. In Tanzania, the gender-based violence response has been developed by and for the public sector. Health sector systems for referrals, cost-recovery, supplies, and data collection are geared for the public sector. The high attrition rates for health workers in Tanzania also create challenges in continuity of gender-based violence service provision.
• Reproductive coercion is common, and private providers do not typically have a protocol to address it. Reproductive coercion consists of behaviors that seek to control a woman’s or girl’s efforts to prevent pregnancy, seek safe abortion, or continue a pregnancy. Providers clearly understood the concept, and most could name specific examples of reproductive coercion among their clients. However, many mentioned that they faced barriers to providing appropriate care for women experiencing reproductive coercion.

The Tanzanian meeting participants highlighted how important the findings are for their continued work, particularly for their efforts to build support for increased resources dedicated to gender-based violence service integration in the private sector. Participants also expressed appreciation for the orientation on reproductive coercion. Gerald Kihwele pledged to advocate for the inclusion of reproductive coercion in upcoming policy and protocol changes.

SHOPS Plus released a brief capturing the pilot’s lessons for leveraging the private sector to expand access to gender-based violence care.