Khon Kaen Hospital One Stop Crisis Center
Khon Kaen Hospital

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Public awareness of the problem of violence against women (VAW) in Thailand began in late 1980’s when health providers and child protection services established a link between the causes of child abuse and the abuse of women in the family. Prior to 2007, most cases of VAW went unreported to the authorities because they did not respond effectively to complaints. A Thai NGO, ‘The Friends of Women Foundation’, reported that of 27,000 women who sought medical treatment for sexual harassment (20%) and domestic violence (80%) in 2011, only 1,300 of them reported the incidents to the authorities. The combination of underreporting of cases and poor data collection has limited the awareness of VAW in Thai society. A study of women’s health and violence published in 2003 revealed that 23 percent of women in Bangkok and 34 percent in one other province admitted to having been physically abused by their intimate partners, while 30 percent of women in Bangkok, and 29 percent in the provincial area had been sexually abused. The number of rape cases and indecent acts reported increased between 2003 and 2007. Statistics from the Ministry of Public Health showed that cases of violence against women who sought medical treatment were reported to the One-Stop Crisis Centers or OSCC in 2008-2011 were also increasing. The majority of offenders were either husbands or intimate partners. In 2009, the National Survey on Reproductive Health reported that married women aged 15-19 years suffered violence perpetrated by their husbands twice as often as women from older age groups. The majority of these women had only received a basic level of education. Some of them are migrant workers from neighbouring countries. Research has indicated that women who experience violence in Thailand suffer multiple consequences which lead to them having a poor quality of life, which in turn results in them feeling uncomfortable and frustrated. In Thai society women are expected to be loyal stay with their husbands even if they mistreat them. This can lead to repeated abuse. Divorced women have difficulty finding a new husband because of the social stigma which blames the woman for the failure of a marriage. Women are forced to have sex against their will and do not feel able to object. Husbands may refuse to wear condoms and force them to bring up their children alone while denying them a divorce. Women are either forcefully prevented from getting married or forced into marriage.

B. Strategic Approach

 2. What was the solution?
Khon Kaen Hospital was the first hospital in Thailand to develop a service center dedicated to providing support for women and girls who experience violence. The center is supported by gender experts and is known as the One Stop Service Crisis Center (OSCC). It is operated by an multidisciplinary team of medical personnel, nurses, social workers and other multidisciplinary networks outside the hospital. The center functions as a separate unit specially designed for women and girls who experience violence or have unwanted pregnancies. The objectives of the center are to: 1) educate personnel in order to change attitudes, 2) create networks and foster cooperation, 3) create practice guidelines to facilitate cooperation between members of the networks, 4) provide a learning space for those involved and 5) systematically manage information. The work of Khon Kaen Hospital’s OSCC includes multiple levels of cooperation. At the hospital level, the center has its own multidisciplinary team who act as case managers and seek support from networks in both the government and private sectors e.g. police, prosecutors, Ministry of Social Development and Human Security officials and public health personnel. The most important networks which help women access the service faster are the public health network and the community network. Community volunteers in sub-district and district hospitals provide primary care for women and girls, while provincial hospitals, like Khon Kaen Hospital, provide secondary care. University hospitals and specialist medical centers provide tertiary care. The networks operate in 76 districts of 4 provinces—Khon Kaen, Mahasarakhan, Kalasin and Roi Et. Khon Kaen Hospital serves as the core coordinator and supervisor for the other 3 provinces. The OSCC also provides training for public health volunteers in communities and schools so that they can care effectively for women and girls who experience violence and so that the volunteers can monitor violence against women and girls in their communities and schools. OSCC has pinpointed 4 issues for urgent attention: 1) violence against girls, women, disabled women and the elderly, 2) unwanted pregnancy, 3) prevention of violence in schools and 4) shared database development. In addition, the OSCC has sought to establish a cooperative working system, both in service provision and data synchronization, with a view to establishing networks and trainings for schools and communities to create proactive leaders in the prevention of VAW. The aim is to solve the problem of violence against women and girls by taking into account all perspectives. As a result of 14 years’ worth of work, the OSCC of Khon Kaen Hospital has become an example of best practice for other hospitals in Thailand.

 3. How did the initiative solve the problem and improve people’s lives?
1. Since the establishment of the OSCC, there has been gender sensitivity training for officers and medical personnel, as women and girls who experience violence need special care and case management which requires a multidisciplinary approach. 2. The hospital has also created a clinical practice guideline for women and girls who experience violence. The guideline addresses gender sensitivity and provides standards for easy access to services for women, such as confidentiality of patient record cards with access limited to those managing the cases and those working in shelters for women and girls. 3. A telephone hotline has been set up to provide easy access to the service. 4. A website has been established to help disseminate relevant information ( 5. The hospital also cooperates with other agencies including government, government enterprise, the private sector, women’s business groups and community leaders to help women and girls in the 4 provinces. The networks not only cooperate but also share resources and co-ordinate activities. 6. The Roi Kaen Sara Sin Information Center, covering four provinces (5 million people), was established to provide information about VAW and operation guidelines for each related field.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
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 ( 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.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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.
 6. How was the strategy implemented and what resources were mobilized?
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).

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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.

 8. What were the most successful outputs and why was the initiative effective?
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.

 9. What were the main obstacles encountered and how were they overcome?
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.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The establishment of the first One Stop Crisis Center in Thailand and the development of its services by integrating the work of all stake holders have helped many abused women and children, enabling them to have access to services, medication, physical and psychological support, and better quality of life. Across the four provinces, 3699 individuals have used the service in the last three years. Many women who have been treated violently have been able to start their life anew with more strength. By allowing all parts of the network to participate in solving problems and working together collaboratively, society as a whole has become more aware of the problem of VAW and has become more willing to participate in the process of monitoring, prevention, and problem solving at every level. Khon Kaen has made “Women Abuse Free” as an important indicator of quality of life of people in the province and included it in the policy called “Peaceful Khon Kean.” From its success at the provincial and regional level, the OSCC and its associated networks have become a model for the establishment and operation of OSCCs in other hospitals. In the year 1999, the Thai Cabinet ordered the Public Health Ministry to set up help centers for women and children who have been abused or treated with violence in every hospital in Thailand. Such centers were established in 20 pilot hospitals during the year 2001-2002. The target group has been extended to cover teenagers with unwanted pregnancy, beginning in 5 pilot hospitals in Thailand. Khon Kaen Hospital plays an important role in supporting other hospitals in the development of these services. Later, the concept was adopted by other agencies that are related to providing help for women and children treated with violence, such as the Ministry of Social Development and Human Security, the Royal Thai Police, the Office of the Attorney General, and Provincial offices of the Ministry of Labour. Officers from these ministries and offices have been sent to observe and study the work and exchange opinions and experiences with the members of the OSCC of Khon Kaen Hospital in order to adapt what they have learned to their own sectors. Today, Thailand has established 21,553 One Stop Crisis Centers or OSCCs in hospitals all over the country. A total of 31,755 women and children have been rescued and given assistance. Besides developing the services and supporting the dissemination of information and knowledge to other hospitals, Khon Kaen Hospital and the Khon Kaen Public Health Office have also created an information-recording internet program that connects to all related offices everywhere in Thailand. This was started in 2008 and has continued to the present. With regard to laws and policies, the experience at Khon Kaen Hospital provided the impetus and the necessary information to support the development of three new laws: (1) The Criminal Procedure Code of Thailand (2 ) The Child Protection Act BE 2003 (3) The Domestic Violence Victim Protection Act BE 2007. The support for these laws has given rise to many positive changes in Thai society. There is more awareness and acknowledgement of domestic violence and more concrete assistance is now given to the victims. The Office of the Permanent Secretary and the Cabinet has established policies and plans to free the country from violence against women and children, and in the year 2013 they became part of the national policy that enabled government sector and private sector to work together collaboratively in preventing and solving this problem.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
The One Stop Crisis Center of Khon Kaen Hospital was the first center in Thailand to provide protection and give assistance to abused children and women, as well as young women with unwanted pregnancies. It has operated from 1999 to the present. It does not only function as a model for the national service for providing assistance to women and children who are the victims of violence, but has also played an important role in making Thai society more aware of the problem. Fourteen years of working collaboratively with many different groups in various sectors of society has convinced us that to solve the problem of violence toward women and children, it is necessary to receive cooperation from many parties and the work needs to be done at different levels (eg. community, provincial, regional, and national level.) and in various dimensions (eg. medication service, assistance, transfer, public health, laws, social welfare, education, empowerment, database making, information providing for the establishment of policies, operation, etc.) Furthermore, Khon Kaen Hospital also decided that providing assistance to women and children who are victims of violence and those with unwanted pregnancy should be a priority, so that resources, personnel, and budget can be directly provided for the work, enabling the center to respond quickly to the problem. This also reduces redundancy of procedures and the chances that the victims are further abused by the process (For example, a violence victim being investigated and interviewed repeatedly by officers in different sections). This contributes to the continuity and sustainability of the project and has led to the setting up of many other One Stop Crisis Centers in other parts of the country. The hospital also provides necessary information to push forward this matter in terms of policy, so that prevention and suppression of violence toward women and children has been adopted as a national policy. Khon Kaen Hospital has become the learning center and source of information for many related organizations and institutes both in and outside of Thailand. Many have sent their representatives to observe and study the operation of the center here. In addition, the OSCC also gives importance to the collection and analysis of information, research, and the use of different kinds of media, such as books that talk about the experience of those who work for the center, as well as guidebooks and guidelines, which provide opportunities for people and organizations to learn and adapt the knowledge to their own workplace or transfer and disseminate it to others. Because of the effective operation of the OSCC in Khon Kaen Hospital, many public and private organizations have provided it with financial support. Some institutions such as “Path 2 Health” have granted a fund for the expanding of the network at the regional level, and in 2013 the Thai Health Promotion Foundation provided financial assistance for the center for 3 consecutive years for the project the offer help to teenagers with unwanted pregnancy.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
Providing assistance for women and children who have suffered violence is work that needs understanding, sensitivity and cooperation from many sectors and organizations. The subject of sexuality and violence toward women and children is sensitive and complicated, especially when it involves changing the attitudes and values that a person has been taught over many years. One of the lessons that the OSCC of Khon Kaen Hospital has learned is that many obstacles and challenges can still be found, even though we have integrated and placed the needs of the victims at the center of the endeavour. We still need to draw in more elements of society to cooperate with us, as well as to adjust their attitude and increase their sensitivity towards the problem. These include judges, attorneys, lawyers, police, social workers and public health offices and medical personnel, such as doctors, nurses, and psychologists. This is necessary in order to close the gaps that become obstacles to the work process and prevent more violence toward the victims, partiality, and social stigma. These institutions still need to develop their work proactively in cooperation with other organizations, such as schools and communities. There must be true equality and impartiality in individual level and organizational level. None should consider themselves as higher or more powerful institutions. There are also lessons learned from working with the network of schools and communities that protect women and children in their own areas. Most of them do not have a specific method of working and operate on a case-by-case basis. Although their past work has been successful up to a point, they still need a more specific format and more integration with the multi-occupational network. At the same time, the network of schools and communities is not the only one that needs to learn, understand, and develop a specific system for working, people in professions that are related to the problem of violence toward women and children need to study and develop their own body of knowledge as well. This knowledge must come from direct experience with the victims as well as training. It is important for them to understand sexual inequality in a patriarchal society like Thailand. The accumulated knowledge must be interpreted and synthesized into guidelines for good practice. The most important goal is not just giving help to the victims, because that is not the root of the problem. We need to understand the true cause of the problem in this society, which is the social values that see men as more important than women. That is why violence toward women and children is not a personal problem but a social one that involves everybody. This realization can lead to the ultimate solution for the problem.

Contact Information

Institution Name:   Khon Kaen Hospital
Institution Type:   Government Agency  
Contact Person:   Nadtaya Mills
Title:   Deputy Director, Khon Kaen Hospital  
Telephone/ Fax:   +6643336798/+6643337053
Institution's / Project's Website:  
Address:   56 Srijun Road, Tambon nai Muang, Amphur Muang
Postal Code:   40000
City:   Khon Kaen
State/Province:   Khon Kaen

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