More than twenty years after the adoption of the United Nations Declaration on the Elimination of Violence against Women, it is estimated that 35% of women worldwide have experienced physical and/or sexual intimate partner violence or sexual violence by a non-partner in their lifetime. The statistics for child violence do not look brighter. Although the health sector is often the point of entry to address these issues, health systems remain weak in preventing, identifying, and responding to interpersonal violence. At the 67th World Health Assembly (WHA), resolution WHA 67.15 on Strengthening the role of the health system in addressing violence, in particular against women and girls, and against children was adopted, requesting the Director-General to develop a draft global plan of action. After two years of consultations, the plan stands for adoption at the next WHA in May 2016, as the 138th Session of the Executive Board (EB) in January 2016 has recommended its endorsement.
The draft action plan is the result of extensive and inclusive consultations. A main challenge was constituted by the many culturally and religiously sensitive issues touched upon in the document. The discussions at the EB emphasised that two key factors allowed overcoming these obstacles: a strong reference to the importance of national contexts within the text, and a high level of commitment on the part of Member States. The list of co-sponsors of the EB resolution, including a wide range of countries from all regions, also testifies for the widespread engagement to tackle violence against women and children.
It is interesting to note that different WHO clusters, departments, and regions contributed to the consultation phase, thereby showing the capacity of WHO to work in a more integrated manner across the organisation. This effective internal coordination may have been facilitated by the technical character of the outcome document, which provides clear practical guidance, including a set of concrete actions for Member States, national and international partners, and the WHO Secretariat. The feeling among some observers of the EB discussions was in fact that WHO is delivering in technical areas, while progress on governance issues continues to prove more challenging.
The action plan aims at strengthening the health systems’ capacities to both prevent and respond to violence, while at the same time acknowledging the importance of integrating the health sector’s response within a broader multisectoral approach. Member States and observers have emphasised the centrality of health workforce training and community involvement as well as the importance of taking into account mental health, and improving data collection and analysis.
Although there was general agreement on the scope of the plan and its strong evidence base, some voices wished it to go even further. In particular, it was pointed out that emotional abuse, pornography, and the identification of vulnerable populations were missing in the document.
The action plan constitutes a great opportunity to boost action and initiatives at all levels to address interpersonal violence. This momentum needs to be sustained to make adoption at the next WHA and – subsequently – implementation a priority. Alignment with other international instruments, in particular with the specific targets integrated into the SDGs framework, will allow for a more systematic effort in this area.
The words of Dr Flavia Bustreo, Assistant Director-General for Family, Women's and Children's Health at WHO, capture the importance of the step achieved at the EB in January, and outline the action plan’s potential:
“The fact that the “world’s Ministers of Health” agreed it’s time to take action to strengthen the health system's response to violence - in particular against women, girls and children is a major step. Countries have recognized both the urgency of the issue and the pivotal role that the health sector plays in addressing it. Imagine if in all countries, healthcare professionals, often the first to witness the physical and psychological effects on victims, had the right training and tools to not only treat the physical symptoms of the violence, but also to identify the problem that lies behind the injuries, to listen emphatically, respond appropriately, and link to other sectors of society (police, social services, support networks…) who can then provide appropriate support to the victims and initiate the necessary proceedings. I am convinced that if we equip health practitioners everywhere with knowledge, skills and tools to prevent and respond to this violence, their actions can have a ripple effect which can turn the tide on this silent epidemic. This will only be achieved if backed by political commitment at the highest level to end violence in all its forms. This is indeed a key factor in those countries already making progress on the issue.”
Written by Flavia Bustreo, Assistant Director-General for Family, Women’s and Children’s Health, WHO