“They have one clinician and she’s trying to do basically everything”: How Improved Data Management Can Strengthen Family Support Centres .

“We've only probably got about 16 Family Support Centres, and functioning, I would say a lot less,” said Dr Pamela, following a review of these critical health services spanning 11 provinces in Papua New Guinea.

Dr Pamela Kamya is an expert in health responses to gender-based violence and this review, led by UNFPA, is part of the EU-funded Spotlight Initiative’s in-depth analysis of services available to respond to, and appropriately refer, women and girls experiencing violence in Papua New Guinea.

Family Support Centres (FSCs) are one part of a referral pathway that connects survivors of violence to the health, legal, and psychological supports they need. The FSCs are critical to this process. Embedded in hospitals, they are often the first point of contact with a survivor they provide treatment for the acute physical and mental trauma of abuse. 

As Dr Pamela’s assessment found, many FSCs are struggling to reach the necessary standards of care.

“In the Family Support Centre, you would have clinicians and you would also have counsellors,” said Dr Pamela. “The challenge that we have in PNG is trying to find the balance between the two.”

“In some hospitals, we are more weighted to providing the clinical. We don't usually provide the psychosocial aspect of things. So, the mental health wellness of the victim is usually lacking in some. In others, we're providing more of the social worker component. So, it's seen more or less like a referral kind of clinic where people go and get psychosocial support, see a social worker and then get referred to other parts of the hospital to get the clinical care.”

This imbalance has detrimental effects on survivors of gender-based violence. For those Centres focused on psychosocial support, the delay in referring survivors to clinicians can be life-changing. “In 72 hours, they need to be provided with emergency contraceptives to prevent any pregnancy. They also need to be provided with HIV prevention. They also need to be provided with any with antibiotics to prevent any sexually transmitted infections. They also be provided tetanus injections if there's any objects that have been used during the rape or the sexual violence.”

To find out how well FSCs in the 11 target provinces were performing, Dr Pamela reviewed them against WHO global standards. This process, she says, poses some challenges.

“We were using a WHO tool, and it was a standard tool. In a lot of the aspects, if you're trying to compare a global standard to a country like Papua New Guinea, which is already struggling in various indicators within the health system already, there are challenges in trying to ask specific questions on the standard itself and getting a straight answer for it. Because there's always ‘We don't do this, but we do it this way’.”

However, Dr Pamela is quick to point out that the local approach is not necessarily a bad approach. “There’s then a challenge with explaining that, even though it doesn't follow the standard, this is what we can do in a context like PNG, given the resources that we have. They would utilize whatever resources they had to get this same outcome, even though they didn't follow the strict global standard.”

While staff of FSCs work hard to make the most of their resources, it is undeniable that they are in urgent need of support in order to fulfil their purpose. Under-resourcing is evidenced by a lack of staff, equipment, and time required to meet WHO standards. 

According to Dr Pamela, a shortage of medical professionals means some FSCs are left with one clinician. That one person is responsible for treatment – physical and psychosocial – of patients, along with referral and administration. The accuracy of data depends on how much time this individual has to enter patient information into a database, where it can be used to show how many people, of what age and gender, are being treated in the FSC.

Where data does exist, accuracy is not guaranteed. Dr Pamela explained that “Generally, even though the data is telling a story, the accuracy is quite questionable at this point in time without the proper training.”

“There are tools, there are forms that they use in the Family Support Centres that are sex disaggregated so they can collect how many women, how many men, how many children at different age levels, are accessing the service,” she said. “But in some of these facilities, they don't have data trained people that can sit there, take all this data, put it into a computer, sit down and analyze it, and give you monthly projections of how we're tracking because most of them are just maybe staffed with one clinician and she's trying to do basically everything.”

“They’ll fill out a raw form but it doesn’t necessarily go into a computer straight away,” she said. “Not everyone knows how to use a computer or Excel to enter this data, to analyze it. And some of them don't have computers.”

Dr Pamela also stressed the need for data privacy, ensuring patient data is deidentified and stored on a password protected computer to protect a survivor’s identity.

Accurate data informs staffing requirements, supply of medication and equipment, and trends in the type of injuries for which patients are presenting to the FSC. This information must be communicated to the Provincial Health Authority and training in effectively communicating this data is essential for decision making.  

“Because of the lack of training, you don't know how to emphasize some of these things that could trigger a decision to be made,” she said. “You know, decisions need to be informed, informed by information. And if you don't have that information readily available, you can't expect to someone to make a decision on something that they have very little data on.”

Despite the challenges, through her assessment there is one area in which Dr Pamela has collected strong data that has shown a clear and troubling trend.

“One of the major findings that has come up, that I'd probably want to stress, is the amount of children under the age of ten that are experiencing sexual violence,” she said. “Whether it's sexual penetration or touching or objects, equally boys and girls, these are under the age of ten.”

“They will grow up and they will grow up with all this trauma and we don't have, in Papua New Guinea, a trained children's counsellor specifically to deal with their mental health as a child growing up into an adult.”

Dr Pamela hopes that the assessment she has conducted demonstrates the importance of timely and accurate data in informing real action for these children.

“The work that I've done is as a preliminary assessment, to bring up some of this data that I hope that will inform better direction of the Spotlight Initiative, and maybe Government direction as well, to address the issue of gender-based violence and strengthenthe systems that we have in order to respond and to prevent.”

Returning to that difficult balancing act faced by resource-limited Family Support Centres and public health services, how would Dr Pamela approach the task of making these services fit for purpose?

“Mainly, I would probably focus on the prevention,” she said. “And again, I stress the importance of the data that's coming through, the importance of responding to the high, high rates of sexual violence to children and addressing the mental issues of that child.”

The first phase of the Spotlight Initiative will be ending in 2022. The UNFPA assessment will provide important insights on the current state of health responses to GBV and will inform strategies to strengthen data collection and management into the future.