evaluation of Medico-Legal Services in Gauteng: Implications
for the Development of Best Practices in the After-Care of Rape
Scope and Aims
scope of the evaluation project included an assessment of the
structure, process and outcome of after-care services for adult
rape survivors at 26 medico-legal centres in Gauteng. The evaluation
framework included a focus on issues related to the availability,
accessibility, quantity, effectiveness and acceptability of
the services. The current component of the evaluation
project granted attention to the views of various service agents
involved in the care and management of rape survivors.
aim of the evaluation was to ascertain the current status of
medico-legal services in Gauteng against the Health Department’s
stated objectives and various other stakeholders’ views of how
the service can and should function. It is anticipated that
the evaluation will serve to inform the development of quality
services based on the principles of best practice, as well as
the development of standardized evaluation tools to assess the
quality of care at medico-legal clinics.
A multi-method approach was
designed to evaluate the medico-legal clinics. In-depth focus
group discussions were conducted with service providers from
the different medico-legal centres, district and regional managers
and members of the South African Police Services (SAPS).
Individual interviews were conducted with the Director and Deputy-Director
of Medico-Legal Services for the Gauteng Provincial Health Department,
and with social workers/counsellors who provide counseling services
to rape survivors. Information related to structure and process
was also supplemented by the scrutiny of relevant documentation.
A detailed case review of selected medico-legal clinics (10
in total) was conducted. The guiding questions that were used
in conducting the analysis related to the key components of
the evaluation, as outlined above.
in line with the aim to develop a culture of learning and reflexivity
in the organisation, feedback of findings was provided to relevant
stakeholders, including the Directorate of Medico-Legal Services.
Feedback of findings at a consultative workshop with management
level stakeholders resulted in the formulation of priority action
steps to address current challenges facing the medico-legal
system. The findings of the evaluation have been, and
will be, disseminated through various mediums, including workshops,
meetings, conferences, seminars, the media and a report publicising
the findings to relevant stakeholders.
The findings of the current
evaluation suggest that the current system of service provision
at medico-legal clinics in Gauteng remains flawed in many respects.
Although the medico-legal system is increasingly engaged in
developing and improving service provision at district and regional
levels, these reform efforts have not been consistently applied
across the province. Consequently, minimum standards of care
are not being met, with problems of access; charges of insensitive
treatment of rape survivors; incompetent documentation of medico-legal
evidence; lack of human and financial resources; inadequate
training; disparities across clinics and weak inter-sectorial
collaboration being the leading concerns affecting the quality
of care provided to rape survivors. The identified challenges
to effective service delivery appear to predominate in historically
disadvantaged communities, with poor black women receiving the
most inadequate service. However, the evaluation also served
to highlight best practices currently being implemented at service
sites. These included the availability of protocols across
the province; environmental design and improved admission procedures
to afford greater privacy to rape survivors; an increased number
of referrals to social service agencies; the increased utilisation
of volunteers to assist in the functioning of medico-legal clinics
and the implementation of procedures to improve inter-sectorial
collaboration and co-ordination between service agents.
offer a range of recommended strategies for improving the functioning
of the medico-legal system and its related service components.
Of these, priority action steps to address the identified concerns
establishment of Violence Information, Training and Treatment
Centres (ViTICs) at district level across the province.
Their role and functions need to be made explicit. The
success of these centres implies political support, and increased
human and financial resources. The establishment of ViTICs
presents as an urgent requisite.
imperative to address concerns related to the issue of service
specialisation versus service generalisation so that an appropriate
balance is achieved between access to services and quality
acceleration of training, and increased human and financial
resources to support the implementation of ongoing training.
Since training has now been decentralised to the district
level, the required allocation of resources is to be the responsibility
of the districts.
input to the task team attending to the revision of the J88
form, as well as in-depth training to relevant service providers
in the use of the J88 form.
and protocols to ensure that crime kits are
accessible and collected timeously.
- Increased psychosocial
support services for rape survivors. This implies that
linkages with the Department of Welfare, NGOs, CBOs and other
relevant agencies be established and be strengthened.
provision of support to service providers to assist them in
dealing with their own traumatisation and stress.
- Initiating formal
interaction and strengthening the relationship with the Department
of Justice in order to facilitate the development of a standardised
protocol that would inform and ease the entry and involvement
of medical officers into the system.
collaboration with the SAPS.
- Closer collaboration with
the private sector.
adequately functioning communication system between management
and workers to ensure that all stakeholders are kept informed
of developments within the system. This will further serve
to clarify and address misperceptions, myths and anxieties
about service providers’ roles and functions (e.g., filling
of J88 form)