Survivor Voices and Institutional Barriers: Assessing One-Stop Crisis Centers in Bangladesh through the Gender-Responsive Public Services Framework

Survivor Voices and Institutional Barriers: Assessing One-Stop Crisis Centers in Bangladesh through the Gender-Responsive Public Services Framework | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Survivor Voices and Institutional Barriers: Assessing One-Stop Crisis Centers in Bangladesh through the Gender-Responsive Public Services Framework Sayema Mubashshira, Sabkat Kamal, Rajib Ul Islam, Labina Taher, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7570606/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract One-Stop Crisis Centers (OCCs) are intended to deliver coordinated health, legal, and psychosocial support for survivors of gender-based violence. This qualitative study examines OCC operations in Bangladesh through the perspectives of survivors and service providers. Five key themes emerged: unequal awareness and access, institutional gaps and resource shortages, survivor experiences and service sensitivity, fragmented coordination, and insufficient feedback and oversight. These findings reveal a significant gap between policy objectives and actual experiences. Applying the Gender-Responsive Public Services framework, the study identifies persistent challenges, including limited access, reduced service quality due to institutional and social barriers, inadequate coordination, weak accountability, and minimal survivor involvement. Young, rural, and unmarried survivors encounter additional barriers, such as social stigma, lack of privacy, greater logistical challenges in reaching OCCs, and fear of negative community reactions. To ensure OCCs fully meet the needs of survivors, stakeholders must immediately increase resources, strengthen accountability, and prioritize survivor participation in ongoing reforms. One-Stop Crisis Center Gender-based violence Gender-responsive public services What this study adds This study might make three principal contributions to the literature. First, it identifies survivor-centered barriers and facilitators in accessing and receiving care at OCCs in Bangladesh, highlighting limited staffing, weak referral systems, and insufficient survivor-centered practices. Second, it documents system-wide implementation challenges, such as coordination shortfalls and resource gaps, that impede OCC effectiveness. Third, using an intersectional lens, the study reveals how factors like age, marital status, and rural–urban location shape survivors’ experiences with public services. By foregrounding both survivor and institutional perspectives, the study clarifies how OCCs can be improved to meet their intended goals. Introduction Gender-based violence (GBV) is a pervasive public health and human rights concern. It disproportionately affects women and girls. The World Health Organization estimates that nearly one in three women globally has experienced physical and/or sexual intimate partner violence or non-partner sexual violence in her lifetime (Katherine Rudzinski et al., 2025 ; World Health organization, 2024 , 2025 ). GBV does more than cause immediate physical harm. It leads to long-term health issues like psychological trauma, social isolation, and reduced access to education and work (Nguefack-Tsague et al., 2024 ). These outcomes are particularly severe in low- and middle-income countries (LMICs), where social stigma, weak legal enforcement, and limited service infrastructure restrict survivors’ access to help (O’Mullan et al., 2024 ; Sabri et al., 2023 ). Integrated service delivery models have been established internationally to address these challenges. One-Stop Crisis Centres (OCCs) provide coordinated health, legal, and psychosocial services for survivors, thereby minimizing secondary victimization (Olson et al., 2020 ). This approach reduces the necessity for survivors to interact with multiple institutions by centralizing support. Evidence indicates that OCCs enhance service accessibility and survivor satisfaction when adequately resourced and adapted to the local context (Evans et al., 2024 ). Sexual violence against women remains a serious issue in Bangladesh, leading to more discussions about women's rights. Study found the main reasons behind this violence, such as the patriarchal social system, forced marriage, cultural traditions, and obstacles to justice. (Banarjee, 2020 ). Since the early 2000s, OCCs established in public hospitals nationwide have played a vital role in providing integrated support and contributing to national efforts to address and reduce violence against women (Khandaker et al., 2025 ). However, research highlights ongoing barriers. These include staff shortages, limited awareness, and poor coordination. Such barriers undermine OCC effectiveness, especially in resource-constrained settings (Sikder et al., 2021 ). Despite strong policies, studies show that OCCs in Bangladesh have implementation problems. These include insufficient staffing, weak referral systems, and few survivor-centered practices (Newaz et al., 2023 ). This study applies the Gender-Responsive Public Services (GRPS) framework to assess OCCs as public service sites. Grounded in feminist political economy and human rights theory, GRPS emphasizes state accountability to ensure public services challenge gender inequality. The framework outlines five principles: availability, accessibility, acceptability, quality, and accountability. Services should be accessible to all women, regardless of class, geography, marital status, or ethnicity, and shaped by the needs and voices of those they serve. (ActionAid International's Framework, 2018 ; OECD, 2023 ). Understanding the perspectives of both survivors and staff is necessary to evaluate the effectiveness of OCCs in Bangladesh as support systems. This qualitative study addresses existing knowledge gaps regarding survivor interactions, institutional practices, and staff perceptions of service barriers. The findings aim to inform strategies for strengthening OCCs and to contribute to broader discussions on integrated GBV services in LMICs. Methods This study used a qualitative research design to evaluate OCC service delivery and user satisfaction in Dhaka and Cox’s Bazar. In-depth interviews (IDIs) with GBV survivors, service providers, and institutional stakeholders assessed how well OCCs meet survivors’ needs and the quality of services. IDIs explore participants' thoughts and motivations in depth and are especially valuable for sensitive topics. They also allow researchers to adapt questions and explore emerging themes during the conversation (Knott et al., 2022 ). Participants Data were collected from two OCCs located in Dhaka and Cox’s Bazar, representing urban and semi-urban service contexts, respectively. These sites were purposively selected due to their operational maturity and geographic contrast, enabling comparative insights into service delivery across socio-political landscapes. Participants were recruited using purposive and snowball sampling methods, ensuring a diversity of perspectives while prioritizing ethical sensitivity and trust-building. The final sample comprised 26 individuals: 22 GBV survivors and four OCC staff members (including case managers and counselors) involved in GBV response. Data collection tool An interview guide based on the GRPS framework was developed to evaluate how state institutions reflect and reproduce gendered power structures. It explored service delivery and user satisfaction for GBV survivors, as well as OCC client identification, institutional capacity, and coordination for service providers and stakeholders. The guide was thematically structured around the five GRPS pillars: availability, accessibility, acceptability, quality, and accountability, while allowing flexibility for participants to share their experiences. The guide was available in Bengali. Participation was voluntary (Supplementary file). Data collection IDIs were conducted in Bangla and lasted between 55 and 90 minutes. A pilot test with two participants was conducted to refine the interview language and minimize the risk of stigma or reinforcing negative stereotypes. Interviews began with rapport-building questions, followed by an overview of the study process. After obtaining consent, participants engaged in audio-recorded, semi-structured interviews. Safety protocols were implemented to protect both researchers and participants. Participants were informed of their right to skip questions, end the interview at any time, and access designated support contacts. The researcher employed active listening and verbal prompts to encourage participants to elaborate on their responses. All interviews were audio-recorded, and additional handwritten field notes were taken to capture nonverbal cues and contextual information. Data analysis The audio recordings of the IDIs were transcribed in Bengali first. The researcher read and re-listened to the transcripts to become acquainted with the data and translated the Bengali version of the transcript into English. The researcher followed the forward-back translation process (World Health Organisation, 2007 ). Another native speaker of Bangladesh translated four randomly selected sample transcripts from the English language to the Bengali version. The Bengali versions of the transcripts were then compared with the original Bengali recordings for accuracy and consistency. Minor changes were made to the wording, but no changes were made to the data's meaning. After coding, anonymized transcripts were uploaded to NVivo (version 2020 R1.7.1) for analysis. Participants' names were replaced with numeric codes to maintain anonymity. Researchers discussed and refined the major themes and their relationships. Findings are presented narratively with quotations. Thematic analysis followed Braun and Clarke’s six-step method, guided by the five GRPS pillars: availability, accessibility, acceptability, quality, and accountability (Braun & Clarke, 2006 ). Patterns and differences across participant narratives were explored. Data was analyzed using content analysis and triangulation to ensure consistency and cross-validation. Reflexivity was maintained throughout, with regular peer debriefing and reflexive journaling to enhance credibility. Researcher Positionality The researcher, with a public health background, maintained a reflexive journal during data collection and analysis. To address class and educational differences, strategies included rapport-building, open-ended questions, and a respectful interview environment to minimize power imbalances. Results The socio-demographic backgrounds and childhood experiences of 22 GBV survivors supported by OCCs in Dhaka and Cox’s Bazar highlight trends and reveal links between structural factors and lived experience. Half of the participants were aged 20–30, 40 percent were 10–20 years old, and 5 percent were under 10 or over 30 years old. Young women and adolescent girls were most affected by gender-based violence. Most participants had some formal education, but few completed higher secondary school, and only two attended university at the graduate level. Limited education both resulted from and contributed to disempowerment, especially when accessing support and legal systems. Half the participants were unmarried, 30 percent were married, and 20 percent were divorced. Several divorced participants left due to abuse and safety concerns. Seventy-five percent resided in Dhaka, with the remainder in Cox’s Bazar. All disclosed only their district, possibly due to stigma or fear. Sixty percent lived in nuclear families of one to five people, while 40 percent lived in extended families. The analysis identified five themes: unequal awareness and access, institutional gaps and resource constraints, survivor experiences and service sensitivity, fragmented multi-sectoral coordination, and lack of feedback and oversight mechanisms. Theme 1: Unequal awareness and access Participants consistently showed that survivors had limited awareness of OCCs. Most participants learned about these services only after a crisis, typically through referrals from police or medical staff. Reliance on intermediaries demonstrates how institutional gatekeeping limits survivors’ access to care. Survivors from rural and semi-urban areas faced additional barriers, such as long travel times and limited local information. These findings underscore the need for improved community outreach and reduced dependence on police referrals, which are not always accessible or safe for all survivors. “I had never heard of such a place before that day. No one in my village knew it existed. If the police officer hadn’t insisted, I would have gone back home, thinking there was no help for someone like me. People talk about hospitals and courts, but never about this center.” (Survivor, 9) “Unless the police bring them, many survivors don’t even reach us. The system unintentionally makes the police a gatekeeper. This discourages women who are already afraid of law enforcement.” (OCC staff, Dhaka) “It took me more than three hours to travel here, changing buses and walking long stretches. By the time I arrived, I was exhausted and frightened. Many women from my area wouldn’t even attempt the journey.” (Survivor, 7) Theme 2: Institutional gaps and resource constraints Participants reported significant shortages of trained personnel, especially during evenings, holidays, and emergencies. Both survivors and providers noted delays in service delivery and a lack of trauma-informed care. These staffing gaps undermine comprehensive and timely crisis support. As a result, survivors faced long wait times and inconsistent access to psychosocial counseling. These challenges contribute to the perception that OCCs are not adequately equipped to address urgent needs. “When I came, the counselor was not available. They told me to wait until the next day. I felt like my pain had to be put on hold. In that moment, I thought: if there is no one to listen now, then what is the meaning of a crisis center?” (Survivor, 5) “We don’t have enough staff to cover all shifts. If one person is absent, everything slows down. Survivors may have to wait hours just to give their statement or get medical care.” (OCC staff, Cox’s Bazar) “Some staff are kind, but others don’t know how to talk to survivors. Instead of comforting me, they kept repeating the same questions, like they didn’t understand that answering them was painful. It felt like I was being interrogated, not helped.” (Survivor, 2) Theme 3: Survivor experiences and service sensitivity Participants' accounts varied in this regard. Some described empathetic staff, while others reported judgment, invasive questioning, and secondary victimization. Privacy was often compromised in shared hospital spaces. These issues highlight the need for standardized trauma-sensitive training and reflect broader gender norms and victim-blaming attitudes that increase survivor distress. “Instead of asking how I was coping, they wanted to know what I wore, what time I left home, and who I spoke to. I felt blamed for the violence I suffered.” (Survivor, 2) “Confidentiality is almost difficult here. The space is small, people are always coming in and out, and survivors can’t trust that their stories will stay private.” (OCC staff, Dhaka) Theme 4: Fragmentation in multi-sectoral coordination Insufficient coordination among agencies supporting survivors was a significant barrier. Although OCCs are mandated to integrate medical, legal, and psychosocial services, staff reported fragmented systems, limited inter-agency communication, and reliance on manual follow-up. This lack of continuity often forced survivors to navigate multiple bureaucracies on their own, with no assurance that referrals to legal or social support were completed. Many survivors reported feeling abandoned after the initial crisis response, which reduced trust in the system. “After my first treatment, nobody contacted me. They said I could get legal help, but I never heard from anyone again. I had to find my own way, which was confusing and scary. It felt like the support ended as soon as I walked out of the room.” (Survivor, 20) “There is no shared system for tracking survivor cases. We don’t always know if she received legal help after medical care. We depend on manual follow-up, and sometimes we lose touch.” (OCC staff, Dhaka) Theme 5: Absence of feedback and oversight mechanisms Bangladesh has a comprehensive policy framework for addressing GBV, but implementation at the facility level is inconsistent. As a result, survivors rarely have opportunities to provide feedback, and staff report limited accountability mechanisms. To address these challenges, OCCs should include survivor perspectives in monitoring and evaluation processes to ensure programs are effective and not merely symbolic. “The government talks about protecting women, but when you come here, you see how little has changed. Promises are made on paper, but in reality, the rooms are crowded, staff are missing, and survivors are not even asked how the service worked for them.” (Survivor, 21) “Policies are strong, but the local implementation is weak. We lack mechanisms to evaluate the quality of services or gather feedback from survivors. Without monitoring, centers risk becoming symbolic rather than transformative.” (OCC staff, Cox’s Bazar) Discussion This study analysed the experiences of survivors and staff with OCCs in Bangladesh. The findings demonstrate a complex relationship between policy commitments, institutional realities, and survivor experiences. Although OCCs are intended to provide integrated, survivor-centered care for gender-based violence, systemic gaps constrain their practical effectiveness. Previous research on GBV services in South Asia also identifies uneven information dissemination, resulting in the underrepresentation of vulnerable populations among service users (Asseervatham et al., 2023 ; Muuo et al., 2020 ; Ogedegbe et al., 2025 ). Survivors’ limited awareness of OCC services constitutes a significant barrier to access. Most participants became aware of the centers only after referral by police or health facilities, which highlights the influence of institutional gatekeepers in determining access. This reliance disproportionately affects women from rural or low-income backgrounds, who often have fewer interactions with formal institutions. Expanding community-level awareness campaigns and establishing multiple entry points are crucial for addressing these disparities. Evidence from other LMICs indicates that training alone is inadequate; systemic reforms that prioritize survivor dignity and confidentiality are necessary (OECD, 2023 ; Sabri et al., 2023 ). Survivors reported experiences of blame and privacy violations, reflecting broader societal attitudes that stigmatize individuals affected by violence. Insufficient staff training and the absence of trauma-informed care remain significant obstacles within OCCs. The protection of survivor dignity and confidentiality is essential. In the absence of trauma-informed, culturally sensitive care and robust accountability, OCCs risk perpetuating the same harmful norms they are intended to address (Perrin et al., 2019 ; Raftery et al., 2022 ). Further complicating the picture, despite OCCs’ policy mandate to integrate health, legal, and psychosocial services, the lack of systematic referral and follow-up mechanisms undermines continuity of care (Olson et al., 2020 ). Our findings align with global literature that highlights the need for coordinated case management, particularly for survivors of violence who must navigate complex medical and legal processes simultaneously. Survivors often fell through gaps once the immediate crisis response ended. This reflects a broader challenge in LMICs' health systems where siloed services hinder cross-sectoral collaboration. The fragmented inter-agency coordination highlights the institutional siloing that plagues many public sector responses to complex social issues (Raftery et al., 2022 ; K. Rudzinski et al., 2025 ). Without legally binding protocols, cross-sectoral collaboration remains ad hoc and dependent on individual initiative rather than systemic design. Embedding survivor-tracking systems and inter-agency referral protocols would represent significant progress toward holistic care (Goicolea, 2023 ; Sharma et al., 2022 ). A key challenge in policy design and monitoring is policymakers' frequent failure to incorporate survivors’ perspectives. When survivor input is absent from service evaluation, initiatives often become symbolic rather than substantive (Raftery et al., 2022 ; Schaaf et al., 2020 ). Conclusion Persistent gaps exist between OCC policy objectives and their implementation. Despite the presence of national policies, unequal access, limited resources, stigma, and inadequate coordination continue to impede survivor-centered care. This gap reflects trends in other LMICs, where ambitious strategies are often undermined by resource constraints and limited participatory monitoring. Increasing survivor-centered accountability through routine feedback and participatory evaluation may help address these challenges. Addressing institutional and social inequalities and incorporating survivor perspectives into service delivery and policy evaluation are essential for strengthening OCC support for women affected by violence. Limitations This study provides important insights into the operations of OCCs in Bangladesh; however, several limitations must be acknowledged. The focus on two centers may not capture experiences from other regions, and certain groups, including transgender survivors and individuals with disabilities, may be underrepresented. The sensitive nature of the topics discussed may have resulted in underreporting, and translation processes could have led to some loss of nuance. Future research should incorporate anonymous feedback, exit interviews, and regular reviews by survivor-led groups to enhance transparency and responsiveness. Recommendations To strengthen workforce capacity and gender sensitivity, recruit and retain full-time legal and psychosocial professionals at OCCs. Provide all staff with ongoing, feminist-informed training on trauma, confidentiality, and stigma-free care. Ensure that training is practical and routinely monitored for effectiveness. To ensure cross-sectoral coordination, formalize inter-agency collaboration among police, health services, legal aid, and shelters through binding protocols and digital case tracking systems. These legal mandates should define roles, responsibilities, and standards for coordination to prevent service fragmentation. To secure sustainable public financing, allocate dedicated, gender-sensitive budgets for OCCs at both national and local levels. Integrate these allocations into annual government planning to protect survivor-centered care from donor dependency and short-term funding cycles. To enhance the impact of OCCs, public awareness campaigns should be implemented through multilingual, community-level initiatives targeting adolescents, ethnic minorities, and displaced populations. Declarations Ethics approval and consent to participate The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki . All participants were provided with detailed information about the study’s purpose, procedures, potential risks, and benefits. All responses were anonymous, ensuring data confidentiality. All participants provided their informed consent to participate in the study after being informed about the purpose of the study. The ethical aspects of this study were also reviewed and approved by the Biosafety, Biosecurity, and Ethical Review Board of Jahangirnagar University, Savar, Dhaka-1342, Bangladesh [Ref No: BBEC, JU/M 2022/ 21 (6)]. Consent for publication All authors Availability of data and material The data can be obtained from the corresponding author upon request. Competing interests None Funding This research received no specific grants from public, commercial, or non-profit funding agencies. Authors' contributions Sayema Mubashshira: Conceptualization; Methodology; Data collection; Writing: review & editing. Sabkat Kamal: Data curation; Writing: review & editing. 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Mapping the health systems response to violence against women: key learnings from five LMIC settings (2015-2020). BMC Womens Health , 21 (1), 360. https://doi.org/10.1186/s12905-021-01499-8 World Health Organisation. (2007). Process of translation and adaptation of instruments . http://www.who.int/substance_abuse/research_tools/translation/ World Health organization. (2024). Violence against women . https://www.who.int/news-room/fact-sheets/detail/violence-against-women World Health organization. (2025). Gender and health . https://www.who.int/health-topics/gender/strengthening-health-sector-response-to-gender-based-violence-in-humanitarian-emergencies#tab=tab_1 Additional Declarations No competing interests reported. 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adds","content":"\u003cp\u003eThis study might make three principal contributions to the literature.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFirst, it identifies survivor-centered barriers and facilitators in accessing and receiving care at OCCs in Bangladesh, highlighting limited staffing, weak referral systems, and insufficient survivor-centered practices.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSecond, it documents system-wide implementation challenges, such as coordination shortfalls and resource gaps, that impede OCC effectiveness.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThird, using an intersectional lens, the study reveals how factors like age, marital status, and rural–urban location shape survivors’ experiences with public services. By foregrounding both survivor and institutional perspectives, the study clarifies how OCCs can be improved to meet their intended goals.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eGender-based violence (GBV) is a pervasive public health and human rights concern. It disproportionately affects women and girls. The World Health Organization estimates that nearly one in three women globally has experienced physical and/or sexual intimate partner violence or non-partner sexual violence in her lifetime (Katherine Rudzinski et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; World Health organization, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2024\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). GBV does more than cause immediate physical harm. It leads to long-term health issues like psychological trauma, social isolation, and reduced access to education and work (Nguefack-Tsague et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). These outcomes are particularly severe in low- and middle-income countries (LMICs), where social stigma, weak legal enforcement, and limited service infrastructure restrict survivors’ access to help (O’Mullan et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Sabri et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIntegrated service delivery models have been established internationally to address these challenges. One-Stop Crisis Centres (OCCs) provide coordinated health, legal, and psychosocial services for survivors, thereby minimizing secondary victimization (Olson et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This approach reduces the necessity for survivors to interact with multiple institutions by centralizing support. Evidence indicates that OCCs enhance service accessibility and survivor satisfaction when adequately resourced and adapted to the local context (Evans et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSexual violence against women remains a serious issue in Bangladesh, leading to more discussions about women's rights. Study found the main reasons behind this violence, such as the patriarchal social system, forced marriage, cultural traditions, and obstacles to justice.\u003c/p\u003e\u003cp\u003e(Banarjee, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Since the early 2000s, OCCs established in public hospitals nationwide have played a vital role in providing integrated support and contributing to national efforts to address and reduce violence against women (Khandaker et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). However, research highlights ongoing barriers. These include staff shortages, limited awareness, and poor coordination. Such barriers undermine OCC effectiveness, especially in resource-constrained settings (Sikder et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Despite strong policies, studies show that OCCs in Bangladesh have implementation problems. These include insufficient staffing, weak referral systems, and few survivor-centered practices (Newaz et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study applies the Gender-Responsive Public Services (GRPS) framework to assess OCCs as public service sites. Grounded in feminist political economy and human rights theory, GRPS emphasizes state accountability to ensure public services challenge gender inequality. The framework outlines five principles: availability, accessibility, acceptability, quality, and accountability. Services should be accessible to all women, regardless of class, geography, marital status, or ethnicity, and shaped by the needs and voices of those they serve.\u003c/p\u003e\u003cp\u003e(ActionAid International's Framework, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; OECD, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Understanding the perspectives of both survivors and staff is necessary to evaluate the effectiveness of OCCs in Bangladesh as support systems. This qualitative study addresses existing knowledge gaps regarding survivor interactions, institutional practices, and staff perceptions of service barriers. The findings aim to inform strategies for strengthening OCCs and to contribute to broader discussions on integrated GBV services in LMICs.\u003c/p\u003e\n\n\n\n\n\n"},{"header":"Methods","content":"\u003cp\u003eThis study used a qualitative research design to evaluate OCC service delivery and user satisfaction in Dhaka and Cox’s Bazar. In-depth interviews (IDIs) with GBV survivors, service providers, and institutional stakeholders assessed how well OCCs meet survivors’ needs and the quality of services. IDIs explore participants' thoughts and motivations in depth and are especially valuable for sensitive topics. They also allow researchers to adapt questions and explore emerging themes during the conversation (Knott et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003ch3\u003eParticipants\u003c/h3\u003e\u003cp\u003eData were collected from two OCCs located in Dhaka and Cox’s Bazar, representing urban and semi-urban service contexts, respectively. These sites were purposively selected due to their operational maturity and geographic contrast, enabling comparative insights into service delivery across socio-political landscapes. Participants were recruited using purposive and snowball sampling methods, ensuring a diversity of perspectives while prioritizing ethical sensitivity and trust-building. The final sample comprised 26 individuals: 22 GBV survivors and four OCC staff members (including case managers and counselors) involved in GBV response.\u003c/p\u003e\u003ch2\u003eData collection tool\u003c/h2\u003e\u003cp\u003e An interview guide based on the GRPS framework was developed to evaluate how state institutions reflect and reproduce gendered power structures. It explored service delivery and user satisfaction for GBV survivors, as well as OCC client identification, institutional capacity, and coordination for service providers and stakeholders. The guide was thematically structured around the five GRPS pillars: availability, accessibility, acceptability, quality, and accountability, while allowing flexibility for participants to share their experiences. The guide was available in Bengali. Participation was voluntary (Supplementary file).\u003c/p\u003e\u003ch3\u003eData collection\u003c/h3\u003e\u003cp\u003eIDIs were conducted in Bangla and lasted between 55 and 90 minutes. A pilot test with two participants was conducted to refine the interview language and minimize the risk of stigma or reinforcing negative stereotypes. Interviews began with rapport-building questions, followed by an overview of the study process. After obtaining consent, participants engaged in audio-recorded, semi-structured interviews. Safety protocols were implemented to protect both researchers and participants. Participants were informed of their right to skip questions, end the interview at any time, and access designated support contacts. The researcher employed active listening and verbal prompts to encourage participants to elaborate on their responses. All interviews were audio-recorded, and additional handwritten field notes were taken to capture nonverbal cues and contextual information.\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe audio recordings of the IDIs were transcribed in Bengali first. The researcher read and re-listened to the transcripts to become acquainted with the data and translated the Bengali version of the transcript into English. The researcher followed the forward-back translation process (World Health Organisation, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Another native speaker of Bangladesh translated four randomly selected sample transcripts from the English language to the Bengali version. The Bengali versions of the transcripts were then compared with the original Bengali recordings for accuracy and consistency. Minor changes were made to the wording, but no changes were made to the data's meaning.\u003c/p\u003e\u003cp\u003eAfter coding, anonymized transcripts were uploaded to NVivo (version 2020 R1.7.1) for analysis. Participants' names were replaced with numeric codes to maintain anonymity. Researchers discussed and refined the major themes and their relationships. Findings are presented narratively with quotations. Thematic analysis followed Braun and Clarke’s six-step method, guided by the five GRPS pillars: availability, accessibility, acceptability, quality, and accountability (Braun \u0026amp; Clarke, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Patterns and differences across participant narratives were explored. Data was analyzed using content analysis and triangulation to ensure consistency and cross-validation. Reflexivity was maintained throughout, with regular peer debriefing and reflexive journaling to enhance credibility.\u003c/p\u003e\u003ch3\u003eResearcher Positionality\u003c/h3\u003e\u003cp\u003eThe researcher, with a public health background, maintained a reflexive journal during data collection and analysis. To address class and educational differences, strategies included rapport-building, open-ended questions, and a respectful interview environment to minimize power imbalances.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe socio-demographic backgrounds and childhood experiences of 22 GBV survivors supported by OCCs in Dhaka and Cox\u0026rsquo;s Bazar highlight trends and reveal links between structural factors and lived experience. Half of the participants were aged 20\u0026ndash;30, 40 percent were 10\u0026ndash;20 years old, and 5 percent were under 10 or over 30 years old. Young women and adolescent girls were most affected by gender-based violence. Most participants had some formal education, but few completed higher secondary school, and only two attended university at the graduate level. Limited education both resulted from and contributed to disempowerment, especially when accessing support and legal systems. Half the participants were unmarried, 30 percent were married, and 20 percent were divorced. Several divorced participants left due to abuse and safety concerns. Seventy-five percent resided in Dhaka, with the remainder in Cox\u0026rsquo;s Bazar. All disclosed only their district, possibly due to stigma or fear. Sixty percent lived in nuclear families of one to five people, while 40 percent lived in extended families. The analysis identified five themes: unequal awareness and access, institutional gaps and resource constraints, survivor experiences and service sensitivity, fragmented multi-sectoral coordination, and lack of feedback and oversight mechanisms.\u003c/p\u003e\u003cp\u003eTheme 1: Unequal awareness and access\u003c/p\u003e\u003cp\u003eParticipants consistently showed that survivors had limited awareness of OCCs. Most participants learned about these services only after a crisis, typically through referrals from police or medical staff. Reliance on intermediaries demonstrates how institutional gatekeeping limits survivors\u0026rsquo; access to care. Survivors from rural and semi-urban areas faced additional barriers, such as long travel times and limited local information. These findings underscore the need for improved community outreach and reduced dependence on police referrals, which are not always accessible or safe for all survivors.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I had never heard of such a place before that day. No one in my village knew it existed. If the police officer hadn\u0026rsquo;t insisted, I would have gone back home, thinking there was no help for someone like me. People talk about hospitals and courts, but never about this center.\u0026rdquo; (Survivor, 9)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Unless the police bring them, many survivors don\u0026rsquo;t even reach us. The system unintentionally makes the police a gatekeeper. This discourages women who are already afraid of law enforcement.\u0026rdquo; (OCC staff, Dhaka)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;It took me more than three hours to travel here, changing buses and walking long stretches. By the time I arrived, I was exhausted and frightened. Many women from my area wouldn\u0026rsquo;t even attempt the journey.\u0026rdquo; (Survivor, 7)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTheme 2: Institutional gaps and resource constraints\u003c/p\u003e\u003cp\u003eParticipants reported significant shortages of trained personnel, especially during evenings, holidays, and emergencies. Both survivors and providers noted delays in service delivery and a lack of trauma-informed care. These staffing gaps undermine comprehensive and timely crisis support. As a result, survivors faced long wait times and inconsistent access to psychosocial counseling. These challenges contribute to the perception that OCCs are not adequately equipped to address urgent needs.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;When I came, the counselor was not available. They told me to wait until the next day. I felt like my pain had to be put on hold. In that moment, I thought: if there is no one to listen now, then what is the meaning of a crisis center?\u0026rdquo; (Survivor, 5)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;We don\u0026rsquo;t have enough staff to cover all shifts. If one person is absent, everything slows down. Survivors may have to wait hours just to give their statement or get medical care.\u0026rdquo; (OCC staff, Cox\u0026rsquo;s Bazar)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Some staff are kind, but others don\u0026rsquo;t know how to talk to survivors. Instead of comforting me, they kept repeating the same questions, like they didn\u0026rsquo;t understand that answering them was painful. It felt like I was being interrogated, not helped.\u0026rdquo; (Survivor, 2)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTheme 3: Survivor experiences and service sensitivity\u003c/p\u003e\u003cp\u003eParticipants' accounts varied in this regard. Some described empathetic staff, while others reported judgment, invasive questioning, and secondary victimization. Privacy was often compromised in shared hospital spaces. These issues highlight the need for standardized trauma-sensitive training and reflect broader gender norms and victim-blaming attitudes that increase survivor distress.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Instead of asking how I was coping, they wanted to know what I wore, what time I left home, and who I spoke to. I felt blamed for the violence I suffered.\u0026rdquo; (Survivor, 2)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Confidentiality is almost difficult here. The space is small, people are always coming in and out, and survivors can\u0026rsquo;t trust that their stories will stay private.\u0026rdquo; (OCC staff, Dhaka)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTheme 4: Fragmentation in multi-sectoral coordination\u003c/p\u003e\u003cp\u003eInsufficient coordination among agencies supporting survivors was a significant barrier. Although OCCs are mandated to integrate medical, legal, and psychosocial services, staff reported fragmented systems, limited inter-agency communication, and reliance on manual follow-up. This lack of continuity often forced survivors to navigate multiple bureaucracies on their own, with no assurance that referrals to legal or social support were completed. Many survivors reported feeling abandoned after the initial crisis response, which reduced trust in the system.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;After my first treatment, nobody contacted me. They said I could get legal help, but I never heard from anyone again. I had to find my own way, which was confusing and scary. It felt like the support ended as soon as I walked out of the room.\u0026rdquo; (Survivor, 20)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;There is no shared system for tracking survivor cases. We don\u0026rsquo;t always know if she received legal help after medical care. We depend on manual follow-up, and sometimes we lose touch.\u0026rdquo; (OCC staff, Dhaka)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTheme 5: Absence of feedback and oversight mechanisms\u003c/p\u003e\u003cp\u003eBangladesh has a comprehensive policy framework for addressing GBV, but implementation at the facility level is inconsistent. As a result, survivors rarely have opportunities to provide feedback, and staff report limited accountability mechanisms. To address these challenges, OCCs should include survivor perspectives in monitoring and evaluation processes to ensure programs are effective and not merely symbolic.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The government talks about protecting women, but when you come here, you see how little has changed. Promises are made on paper, but in reality, the rooms are crowded, staff are missing, and survivors are not even asked how the service worked for them.\u0026rdquo; (Survivor, 21)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Policies are strong, but the local implementation is weak. We lack mechanisms to evaluate the quality of services or gather feedback from survivors. Without monitoring, centers risk becoming symbolic rather than transformative.\u0026rdquo; (OCC staff, Cox\u0026rsquo;s Bazar)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study analysed the experiences of survivors and staff with OCCs in Bangladesh. The findings demonstrate a complex relationship between policy commitments, institutional realities, and survivor experiences. Although OCCs are intended to provide integrated, survivor-centered care for gender-based violence, systemic gaps constrain their practical effectiveness. Previous research on GBV services in South Asia also identifies uneven information dissemination, resulting in the underrepresentation of vulnerable populations among service users (Asseervatham et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Muuo et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Ogedegbe et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Survivors\u0026rsquo; limited awareness of OCC services constitutes a significant barrier to access. Most participants became aware of the centers only after referral by police or health facilities, which highlights the influence of institutional gatekeepers in determining access. This reliance disproportionately affects women from rural or low-income backgrounds, who often have fewer interactions with formal institutions. Expanding community-level awareness campaigns and establishing multiple entry points are crucial for addressing these disparities.\u003c/p\u003e\u003cp\u003eEvidence from other LMICs indicates that training alone is inadequate; systemic reforms that prioritize survivor dignity and confidentiality are necessary (OECD, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Sabri et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSurvivors reported experiences of blame and privacy violations, reflecting broader societal attitudes that stigmatize individuals affected by violence. Insufficient staff training and the absence of trauma-informed care remain significant obstacles within OCCs. The protection of survivor dignity and confidentiality is essential. In the absence of trauma-informed, culturally sensitive care and robust accountability, OCCs risk perpetuating the same harmful norms they are intended to address (Perrin et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Raftery et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Further complicating the picture, despite OCCs\u0026rsquo; policy mandate to integrate health, legal, and psychosocial services, the lack of systematic referral and follow-up mechanisms undermines continuity of care (Olson et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Our findings align with global literature that highlights the need for coordinated case management, particularly for survivors of violence who must navigate complex medical and legal processes simultaneously. Survivors often fell through gaps once the immediate crisis response ended. This reflects a broader challenge in LMICs' health systems where siloed services hinder cross-sectoral collaboration.\u003c/p\u003e\u003cp\u003eThe fragmented inter-agency coordination highlights the institutional siloing that plagues many public sector responses to complex social issues (Raftery et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; K. Rudzinski et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Without legally binding protocols, cross-sectoral collaboration remains ad hoc and dependent on individual initiative rather than systemic design. Embedding survivor-tracking systems and inter-agency referral protocols would represent significant progress toward holistic care (Goicolea, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Sharma et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). A key challenge in policy design and monitoring is policymakers' frequent failure to incorporate survivors\u0026rsquo; perspectives. When survivor input is absent from service evaluation, initiatives often become symbolic rather than substantive (Raftery et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Schaaf et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePersistent gaps exist between OCC policy objectives and their implementation. Despite the presence of national policies, unequal access, limited resources, stigma, and inadequate coordination continue to impede survivor-centered care. This gap reflects trends in other LMICs, where ambitious strategies are often undermined by resource constraints and limited participatory monitoring. Increasing survivor-centered accountability through routine feedback and participatory evaluation may help address these challenges. Addressing institutional and social inequalities and incorporating survivor perspectives into service delivery and policy evaluation are essential for strengthening OCC support for women affected by violence.\u003c/p\u003e\n\u003cp\u003eLimitations\u003c/p\u003e\n\u003cp\u003eThis study provides important insights into the operations of OCCs in Bangladesh; however, several limitations must be acknowledged. The focus on two centers may not capture experiences from other regions, and certain groups, including transgender survivors and individuals with disabilities, may be underrepresented. The sensitive nature of the topics discussed may have resulted in underreporting, and translation processes could have led to some loss of nuance. Future research should incorporate anonymous feedback, exit interviews, and regular reviews by survivor-led groups to enhance transparency and responsiveness.\u003c/p\u003e\n\u003cp\u003eRecommendations\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eTo strengthen workforce capacity and gender sensitivity, recruit and retain full-time legal and psychosocial professionals at OCCs. Provide all staff with ongoing, feminist-informed training on trauma, confidentiality, and stigma-free care. Ensure that training is practical and routinely monitored for effectiveness.\u003c/li\u003e\n \u003cli\u003eTo ensure cross-sectoral coordination, formalize inter-agency collaboration among police, health services, legal aid, and shelters through binding protocols and digital case tracking systems. These legal mandates should define roles, responsibilities, and standards for coordination to prevent service fragmentation.\u003c/li\u003e\n \u003cli\u003eTo secure sustainable public financing, allocate dedicated, gender-sensitive budgets for OCCs at both national and local levels. Integrate these allocations into annual government planning to protect survivor-centered care from donor dependency and short-term funding cycles.\u003c/li\u003e\n \u003cli\u003eTo enhance the impact of OCCs, public awareness campaigns should be implemented through multilingual, community-level initiatives targeting adolescents, ethnic minorities, and displaced populations.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the ethical principles outlined in the \u003cem\u003eDeclaration of Helsinki\u003c/em\u003e. All participants were provided with detailed information about the study\u0026rsquo;s purpose, procedures, potential risks, and benefits. All responses were anonymous, ensuring data confidentiality. All participants provided their informed consent to participate in the study after being informed about the purpose of the study. \u0026nbsp; The ethical aspects of this study were also reviewed and approved by the Biosafety, Biosecurity, and Ethical Review Board of Jahangirnagar University, Savar, Dhaka-1342, Bangladesh [Ref No: BBEC, JU/M 2022/ 21 (6)].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eAll authors\u003c/p\u003e\n\u003cp\u003eAvailability of data and material\u003c/p\u003e\n\u003cp\u003eThe data can be obtained from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research received no specific grants from public, commercial, or non-profit funding agencies.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eSayema Mubashshira: Conceptualization; Methodology; Data collection; Writing: review \u0026amp; editing. Sabkat Kamal: Data curation; Writing: review \u0026amp; editing. Rajib Ul Islam: Data curation; Writing: review \u0026amp; editing. Labina Taher: Data curation; Writing: review \u0026amp; editing. Fariha Noshin: Data curation; Writing: review \u0026amp; editing. Mst Sabrina Moonajilin: Conceptualization; Methodology; Writing: original draft.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge all the participants, without whom the study would not have been possible.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eActionAid International\u0026apos;s Framework. (2018). \u003cem\u003eGender-responsive public services\u003c/em\u003e. https://actionaid.org/sites/default/files/grps_2018_online.pdf\u003c/li\u003e\n\u003cli\u003eAsseervatham, R. A., Eng, S., Eang, S., Tuot, S., \u0026amp; Yi, S. (2023). 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Promising practices for the monitoring and evaluation of gender-based violence risk mitigation interventions in humanitarian response: a multi-methods study. \u003cem\u003eConfl Health\u003c/em\u003e,\u003cem\u003e 16\u003c/em\u003e(1), 11. https://doi.org/10.1186/s13031-022-00442-4\u003c/li\u003e\n\u003cli\u003eSikder, S. S., Ghoshal, R., Bhate-Deosthali, P., Jaishwal, C., \u0026amp; Roy, N. (2021). Mapping the health systems response to violence against women: key learnings from five LMIC settings (2015-2020). \u003cem\u003eBMC Womens Health\u003c/em\u003e,\u003cem\u003e 21\u003c/em\u003e(1), 360. https://doi.org/10.1186/s12905-021-01499-8\u003c/li\u003e\n\u003cli\u003eWorld Health Organisation. (2007). \u003cem\u003eProcess of translation and adaptation of instruments\u003c/em\u003e. http://www.who.int/substance_abuse/research_tools/translation/\u003c/li\u003e\n\u003cli\u003eWorld Health organization. (2024). \u003cem\u003eViolence against women\u003c/em\u003e. https://www.who.int/news-room/fact-sheets/detail/violence-against-women\u003c/li\u003e\n\u003cli\u003eWorld Health organization. (2025). \u003cem\u003eGender and health\u003c/em\u003e. https://www.who.int/health-topics/gender/strengthening-health-sector-response-to-gender-based-violence-in-humanitarian-emergencies#tab=tab_1\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"One-Stop Crisis Center, Gender-based violence, Gender-responsive public services","lastPublishedDoi":"10.21203/rs.3.rs-7570606/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7570606/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eOne-Stop Crisis Centers (OCCs) are intended to deliver coordinated health, legal, and psychosocial support for survivors of gender-based violence. This qualitative study examines OCC operations in Bangladesh through the perspectives of survivors and service providers. Five key themes emerged: unequal awareness and access, institutional gaps and resource shortages, survivor experiences and service sensitivity, fragmented coordination, and insufficient feedback and oversight. These findings reveal a significant gap between policy objectives and actual experiences. Applying the Gender-Responsive Public Services framework, the study identifies persistent challenges, including limited access, reduced service quality due to institutional and social barriers, inadequate coordination, weak accountability, and minimal survivor involvement. Young, rural, and unmarried survivors encounter additional barriers, such as social stigma, lack of privacy, greater logistical challenges in reaching OCCs, and fear of negative community reactions. To ensure OCCs fully meet the needs of survivors, stakeholders must immediately increase resources, strengthen accountability, and prioritize survivor participation in ongoing reforms.\u003c/p\u003e","manuscriptTitle":"Survivor Voices and Institutional Barriers: Assessing One-Stop Crisis Centers in Bangladesh through the Gender-Responsive Public Services Framework","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-24 10:36:04","doi":"10.21203/rs.3.rs-7570606/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"865bae31-d1e2-4e10-9284-94d343e570d6","owner":[],"postedDate":"October 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-21T08:24:06+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-24 10:36:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7570606","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7570606","identity":"rs-7570606","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}