Improving the collection, documentation and utilization of ...
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Improving the collection, documentation and Improving the collection, documentation and utilization of medicoutilization of medico--legal evidence in Kenyalegal evidence in Kenya
Carol AjemaCarol Ajema, Wanjiru Mukoma, Wanjiru Mukoma
2828thth March 2013March 2013
44thth EAC Health & Scientific ConferenceEAC Health & Scientific ConferenceKigaliKigali
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• Ad hoc collection of evidence collection from survivors in Kenya :– Many health facilities lack equipment required to
undertake evidence collection
• Required documentation for survivors of SV reporting at health facilities and police:
– PRC form: health document for medico-legal documentation
– P3 form: Kenya police medical examination form
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Study Background
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• Duration:2010-Jan 2012• Sites: 2 districts• Target population: Police and health care
workers• How:
– Record review-baseline & end line
– Assembling rape kit;
– Training Police and health providers on use of
existing national protocols
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Chain of Evidence Study
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Study Collaborators
• Ministry of Health-
– Division of Reproductive Health
– Government Chemist
• Office of the Director of Public Prosecution
• Police Department
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Key Findings• 67%(n=501) of survivors were under 18years
– 331 survivors attended to at intervention site– 170 comparison site
• Survivors at the intervention site were three times more likely to have the Kenya police (P3) form filled in for them both at the health facility and police station
• PRC forms not filled in for all survivors– Incomplete forms- names, age, gender, examining health
provider information?• Only 17% of P3 forms at the facilities were signed 55
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Key Findings• There was an improvement in evidence collection
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Evidence collected
Baseline Data Endline Data
Intervention site
Comparison site
Intervention site
Comparison site
BloodUrine
External Swabs
HVS/AS
73 (72%)52 (51%)61 (60%)
-
8 (18%)8 (18%)1 (2%)
5 (11%)
206 (96%)154 (72%)19 (9%)
176 (82%)
38 (37%)38 (37%)3 (3%)
14 (42.4%)
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Findings• The rape kit was found useful
“The biggest problem in hospitals is that the supply of some of these things {commodities required to
retrieve evidence} is not sufficient. …… That’s why I find this {rape kit} so convenient. Because im able to collect evidence and attend to a survivor in a very
short time”Health provider
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• The introduction of the rape kit that resulted in:– Faster evidence collection and onward transmission
• Overall increase in use of and better completion of the medico-legal forms(PRC & P3)
• The rape kit reduced the number of reference documents required to complete the PRC form
• The rape kit can easily and effectively be used to improve evidence collection and documentation in poor resource settings - can be scaled up
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Conclusion
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Application of study findings Application of study findings
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National level advocacy• PRC form and PRC registers reviewed based on findings
• Ministry of Health – sourcing for rape kits within the GoK commodity supply
system- scale up– National guidelines reviewed
• Medical regulations for implementing the sexual offences Act requiring:
– Doctors, nurses and clinical officers to fill in the PRC forms– PRC form now recognised as legal document
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Application of study findings Application of study findings At the service delivery level• A multi-sectoral training approach adapted by the sexual
offences Act implementation taskforce
Documentation :– IECs developed adapted by the Ministry of Health
• a checklist on documentation of evidence collection• A brochure and poster on “sexual violence if it happens”• A poster on guidelines for documentation of medico-legal
examinationPRC register developed:
– Health providers to record at least THREE names of survivors 1010
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Moving forward..….
1313Building Partnerships, transforming lives
• Advocacy continues for– Acceptance of rape kit evidence as credible– Serialisation of the rape kit components
• Replication of the multi-sectoral training approach in scaling up Kenya’s response to sexual violence
• What services do we provide to survivors presenting after 72 hours? – No standards– Currently getting full PEP– No consistency of services
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Moving forward..….
1414Building Partnerships, transforming lives
• Future research:– paper trail of medico-legal evidence-esp. police
records– Case outcomes within the courts based on health
and police records
• Interventions required:– Role of community structures(traditional justice
system preferred by most) in evidence chain management
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PROJECT : the research-policy-practice interface
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COE 2COE 2––2010 2010 --20122012--Utilization of Utilization of documentation documentation
COE1: 2007 COE1: 2007 --2008 2008 Design, test model for Design, test model for a chain ofa chain of evidence evidence for PRCfor PRC
--Poor medicoPoor medico--legal linkages; legal linkages; no standards & chain of no standards & chain of evidenceevidence
Effectiveness of PRC kit for Effectiveness of PRC kit for improved justice outcomes improved justice outcomes unknownunknown
20011/12: 20011/12: -- Review of Review of algorithms; IEC, algorithms; IEC, Inclusion of rape kit Inclusion of rape kit into guidelines)into guidelines)
2008/9: 2008/9: -- Review of Review of guidelines (chapter on guidelines (chapter on forensic evidence)forensic evidence)--Review of PRC formReview of PRC form
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LVCT LVCT –– an indigenous Kenyan NGOan indigenous Kenyan NGO
• Quality Assured HIV testing and counselling (HTC) & links to Rx
• Vulnerable & at risk populations:• MSM/Prisons; Disability; Youth
;Sex workers; Survivors of SV• Evidence based policy reforms
• National standards; systems strengthening; scaling up
• South to south TA guidelines for HTC,QA,&PRCa
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Acknowledgements
1818Building Partnerships, transforming lives
• Population Council • Ministry of Health –Division of Reproductive
Health• The Government Chemist• The Police Department• Donors(SIDA,NORAD)• Study respondents
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Acronyms
1919Building Partnerships, transforming lives
• DRH Division of Reproductive Health• PRC Post Rape Care• LVCT Liverpool VCT, Care & Treatment