4. In which ways is the initiative creative and innovative?
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The work of Khon Kaen Hospital’s OSCC started with an effort to change attitudes and increase the knowledge of relevant personnel, both within and outside the hospital. Training was provided to personnel who were directly involved, covering gender issues and the causes of violence against women and girls, unwanted pregnancy, support and care, empowerment, counseling and relevant laws. There are frequent meetings between personnel from different disciplines—including public health, police prosecutors, the Ministry of Social Development and Human Security, local administrators, relevant public and private agencies, schools and the media, to brainstorm methods of working together and monthly meetings to expand the networks within Khon Kaen and nearby provinces. Nowadays, in the 4 provinces there are 260 agencies working to protect women and girls and eliminate violence against them. Khon Kaen Hospital acts as the core agency for cooperation and is now supporting units at Roi Et Provincial Hospital, Mahasarakham Provincial Hospital and Kalasin Provincial Hospital. Khon Kaen Hospital is responsible for information technology support to monitor information about violated women and girls, while Roi Et Hospital is responsible for knowledge management. Mahasarakham Hospital manages the services for women and girls who experience violence in communities and schools. Kalasin Hospital is responsible for network service development. There is also cooperation with government agencies in four main Ministries—Ministry of Public Health, Ministry of Social Development and Human Security, Ministry of Education and Ministry of Justice.
The four main strategies of Khon Kaen Hospital’s OSCC are as follows:
Strategy 1 | Development of networks of support for women and girls who experience violence in medical services, law, social service, education, etc. The rights of women and girls, such as their rights to have protection, rights to be developed and rights to participate and be heard, are considered to be the most important factors in giving support.
Strategy 2 | Development of networks in schools and communities. There have been 38 activities relating to the establishment of monitoring systems, awareness building and establishment of prevention measures in the communities in the four provinces. Students and volunteers in the communities are trained to be able to take roles in rights protection. One of the results of this strategy is that women and girls are empowered and understand their own value.
Strategy 3 | Development of information systems for service provision to women and girls who experience violence and to facilitate the elimination of domestic violence. Khon Kaen Hospital has established a cooperative information center at the hospital. The center is managed and maintained by a team of academics, service providers and media personnel. The data is collected from both within and outside the hospital. The information gathered is compiled and presented in the form of guideline manuals, articles and news published both in print and online and broadcasted on radio and television. Khon Kaen Hospital has a website for OSCC which also publishes this information which has had 1.1 million hits and 4159 document downloads (http://mx.kkpho.go.th/oscc-rkks/oscc-rkks/). Furthermore, the center has also developed a computer application for data collection and analysis.
Strategy 4 | Development of knowledge management among networks. Each of the 260 organizations in the network for prevention of VAW have monthly meetings which have been held for the last 8 years. There are many examples of cooperation in qualitative research, multi-case studies, lesson-learned forums, knowledge management and published stories told by practitioners and service providers from the various disciplines. There are memorandums of understanding between 22 organizations in Khon Kaen province about the protection, prevention and elimination of violence against women, girls, disabled people and the elderly, domestic violence, unwanted pregnancy, child exploitation and human trafficking.
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5. Who implemented the initiative and what is the size of the population affected by this initiative?
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There are 260 organizations working together in the networks. Operations are carried out at 5 levels:
At community level, there are 1,249 volunteers, including community leaders and youth and women’s organizations. Young people are particularly important to the initiative because they can help their school mates who have problems. At sub-district level, there are 709 sub-district hospitals and 705 local administrative offices and police officials in the networks. At district level, there are 76 district hospitals and sheriffs and police captains in each district police station participating. At provincial level, there is cooperation from the Provincial Administrative Office, Khon Kaen Municipality Administration, prosecutors, police, the Provincial Office of Social Development and Human Security, the Provincial Office of Culture, private agencies, women entrepreneurs, mass media, lawyers, teachers, youth leaders, universities and colleges. At the national level, the network receives cooperation and support from the Office of Women’s Affairs and Family Development, the Ministry of Social Development and Human Security and the Friends of Women Foundation. The network has received support from international organizations, such as Plan International Thailand, the Ford Foundation and the British Embassy.
All organizations in the network take part in defining strategies for operations. Each organization has different roles and responsibilities. Community leaders monitor violence situations in communities, provide primary care and refer the women and girls for further support and care. The public health sector provides treatment, care and rehabilitation for women and girls and collects information for dissemination. The Provincial Office of Social Security and Human Development provides temporary shelters, such as emergency homes, and follow-up systems to improve the women’s life quality. The research committee of Khon Kaen University has an important role in carrying out research. Information is managed systematically by the “Roi Kaen Sara Sin Network”. Law experts provide legal counseling and law services. The monitoring and evaluation committee provides evaluation of activities in the projects.
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6. How was the strategy implemented and what resources were mobilized?
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The OSCC of Khon Kaen Hospital receives funding from both government and the private sector. Medical services provided by Khon Kaen Hospital need 1.2 million baht each year for management and maintenance. The hospital has sought and received further funding from the Thai Health Promotion Foundation for meetings of committees and working groups, training, counseling and capacity building e.g. in data collection and management, public forums, school and community leader training, guideline and manual publication, qualitative research, monitoring and evaluation.
The services of OSCC are mainly funded by the National Health Security Office. The OSCC also receives other funding from the Office of the Attorney General, the Faculty of Social Sciences and Humanities, Mahidol University (together with the Ford Foundation), local administrative offices, the Provincial Office of Social Development and Human Security (2010-2013), the Department of Health Service Support, the Ministry of Public Health, Sirinthorn Hospital (together with UNICEF), Khon Kean Province, 25 community hospitals, and Khon Kaen Municipality Administration.
The OSCC also receives funding from the private sector and international organizations. The Ford Foundation funded the research for the service system and a Visiting Personnel Program to Malaysia (1999-2004). Plan International funds OSCC’s unwanted pregnancy program. Other organizations who gave financial support to OSCC include the British Embassy, Osotspa Co., Ltd. (2013) and the Friends of Women Foundation, Thailand.
Furthermore, OSCC’s campaigns to eliminate VAW in Khon Kaen Province have been financially supported by 40 other organizations. As a result of this, a fund and a foundation were created to help girls and women who experience violence, in terms of their travel expenses and food provision during the referral process or when they return to their home towns and when they need to seek work.
Operative personnel in Khon Kaen Hospital’s OSCC include people from government and the private sector and civil society. Core personnel for each woman include 1 physician, 1 nurse, 1 social worker, who is the case manager, and 22 personnel from other disciplines (psychiatrists, psychologists, medical technicians, lawyers, etc.). The team work together to provide treatment, support and counseling and continuous follow-up of violated women and women who have unwanted pregnancies. The personnel in this team also develop the working system and expand the network, provide training on care for women and girls who experience violence or have unwanted pregnancies. The Hospital’s administrative committee also provides policy consultation and supervision. Other relevant participants include the committee and working groups from 78 districts in the 3 provinces, the research and knowledge management team of “Roi Kaen San Sin Network”, Child Protection Committee representatives, officers from the Ministry of Health, Ministry of Education, Ministry of Social Development and Human Security, youth leaders, local administrative officers, academic groups, community leaders, private organizations, lawyer groups, mass media, the Office of Provincial Culture, the OSCC community committee (composed of community leaders, volunteers and government representatives) and the OSCC school committee (teachers, students and parents).
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7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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1. Women and girls now receive prompt and sensitive treatment and are supported mentally and legally by the work of the multidisciplinary support team. Their physical and mental health is improved. They are empowered and can go back to live in their communities sooner.
2. Service providers’ attitudes have been changed. They provide their services with sensitivity, focusing on the needs of the girls and women without judging or imposing social values on them. The service system facilitates fast and systematic support for them while providing ample privacy and confidentiality. The feeling of safety encourages women and girls to seek services and complete the treatment and support process. Multiple exposures of victims to their violation experience through repeated questioning are minimized because the women’s stories are systematically recorded, filed and made available to authorized personnel involved in the case.
3. Through the service provided by Khon Kaen Hospital’s OSCC and the network system, we have established a standard and example of a model system for services for women and girls who experience violence or have unwanted pregnancies for Thailand as a whole.
4. Cooperation and integration of different sectors in government, medicine, public health (all sizes of hospitals in 4 provinces work together), education, social welfare, justice, local municipality, NGOs and communities has been achieved. The result of this is that the communities are aware of many forms of VAW. They come up with their own methods of preventing unwanted pregnancy in girls, human trafficking and violence against women and girls. Sub-district municipal offices develop core operation plans for the sub-district using money from district health funds.
5. Khon Kaen Hospital’s OSCC has also successfully developed a database of women and girls who are abused and violated. The database has since grown with our growing networks, presently covering data from 4 provinces. There are computer programs designed for violence data input which allow fast analysis of available assistance and support to women and girls. The database is accessible in provincial hospitals and district hospitals. The information from the database is also used in other One Stop Crisis Centers in other provinces. The database and data collection system developed by Khon Kaen Hospital’s One Stop Crisis Center has been used by the Ministry of Public Health as the model for similar systems all over the country.
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8. What were the most successful outputs and why was the initiative effective?
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Monitoring and evaluation is done by the multidisciplinary teams. The aspects monitored and evaluated include the knowledge and attitude of and the services provided by service providers, officers and other personnel operating in the networks of the OSCC. Also, policies and operations of all agencies involved in the support network of women’s and girls’ protection are evaluated. The four main areas which are closely monitored and evaluated are:
1. The Network of Support for Women and Girls Who Suffer from Violence Development Project
2. The One Stop Crisis Centers, Roi Kaen San Sin, in Schools and Communities Network Development Project
3. The Information System of Services for Women and Girls who Suffered from Violence and Elimination of Violence against Women and Girls Development Project
4. The Support for Women and Girls who Suffered from Violence Network’s Knowledge Management Project
Evaluation processes include both qualitative and quantitative assessments. Methods used in evaluation include questioning, observation, group dialogs and in-depth interviews. Evaluation is done across different levels of the operation, including hospitals, communities and database and information systems. Indicators are determined for evaluation of medical, social welfare, social service and legal service systems.
The work of Khon Kaen Hospital’s OSCC in particular is monitored and evaluated by a team of evaluators which includes hospital executives who are from multidisciplinary backgrounds. As for evaluation of the projects, the monitoring and evaluation teams comprise 10 representatives from various sectors and 9 academics from Khon Kaen University. Furthermore, there is an independent evaluation committee which monitors and evaluates the work of networks. They comprise representatives from 11 organizations, including the Child Protection Committee, the Public Health Working Group, education, social welfare and social work, youth leaders, local administrative offices, academia, community leaders, lawyers, mass media and provincial culture work.
Evaluation suggests that the networks have a systematic structure with a high level of integration of multidisciplinary knowledge and effective cooperation and that the work is geared towards a more proactive approach. Services are provided to victims of violence without redundancy and delay. People express their satisfaction with the services of the network.
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9. What were the main obstacles encountered and how were they overcome?
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The main obstacle to the work of OSCC is the patriarchal attitude in Thai society which criticizes and blames women and girls who suffer from violence or have unwanted pregnancies, that is women and girls are held responsible for the violence they fall victims to. The patriarchal perspectives are the result of a cultural construct which involves the interplay of social education on gender tradition and beliefs from multiple sources. Unfortunately, they present themselves in subtle ways in service providers, medical personnel and social workers who provide services for women and girls suffering from violence. For example, medical personnel are reluctant, if not unwilling, to provide abortion services to women. Women are viewed as irresponsible and are accused of improper sexual behavior. Often, women will be referred to other service providers. This causes both mental and financial distress for women. Furthermore, violence issues are not a priority in many hospitals. Consequently, they overlook the sensitivity required in dealing with women and girls who are victims to violence. The mental impact of abuse is often overlooked even though it is very important in care provision for victims. This leads to the denial of access to healthcare and legal support in cases of violence and unwanted pregnancy.
However, gradually we have seen improvement in the attitudes of personnel in the network. Presently, agencies from various sectors are willing to provide gender-sensitive services to women and girls who have unwanted pregnancy or are victims to violence and women and girls are now cared for physically and mentally. They are empowered and equipped with skills to continue a healthy life.
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